1
|
Willingham ML, Teria RS, Dulana L, Badowski G, Cassel KD. Evaluating health status and risks among Native Hawaiian and Pacific Islander communities in Hawai'i: a respondent-driven sampling approach. Cancer Causes Control 2025:10.1007/s10552-024-01956-3. [PMID: 39775483 DOI: 10.1007/s10552-024-01956-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 12/21/2024] [Indexed: 01/11/2025]
Abstract
PURPOSE Respondent-driven sampling (RDS) is a sampling method that relies on social networks to recruit hard-to-reach populations, and reduces the bias from non-random selection. This study aimed to assess the efficacy of RDS in collecting health assessment data from underrepresented populations not captured by traditional sampling techniques. METHODS An RDS study was conducted in Hawai'i between 2017 and 2018 of Native Hawaiians, Chuukese, and Marshallese participants. 1006 cases consisting of 352 seeds and 654 recruits were analyzed in conjunction with data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), filtered to include Native Hawaiian/Other Pacific Islander participants (n = 1564). Missing network size data was imputed by RDSAnalyst and determined by the sample median network size. Weighted samples were compared for differences. RESULTS Chi-square testing revealed significant differences between the RDS and BRFSS weighted samples across sex, age, education, income, and colon/cervical cancer screening variables. Only BMI group and smoking status exhibited no significant differences. RDS methods recruited participants efficiently within one year. CONCLUSION The findings indicate that RDS offers an effective sampling methodology when trying to reach hidden populations and provides more insight into the social networks of underserved communities as the transfer/utilization of health information may be linked to social connectedness.
Collapse
Affiliation(s)
- Mark L Willingham
- University of Hawai'i Cancer Center, 701 Ilalo St, Honolulu, HI, 96813, USA.
| | - Rodney S Teria
- UOG Station, University of Guam, Mangilao, Guam, 96923, USA
| | - Louis Dulana
- UOG Station, University of Guam, Mangilao, Guam, 96923, USA
| | | | - Kevin D Cassel
- University of Hawai'i Cancer Center, 701 Ilalo St, Honolulu, HI, 96813, USA
| |
Collapse
|
2
|
Rudolph AE, Nance RM, Bobashev G, Brook D, Akhtar W, Cook R, Cooper HL, Friedmann PD, Frost SDW, Go VF, Jenkins WD, Korthuis PT, Miller WC, Pho MT, Ruderman SA, Seal DW, Stopka TJ, Westergaard RP, Young AM, Zule WA, Tsui JI, Crane HM, Whitney BM, Delaney JAC. Evaluation of respondent-driven sampling in seven studies of people who use drugs from rural populations: findings from the Rural Opioid Initiative. BMC Med Res Methodol 2024; 24:94. [PMID: 38654219 PMCID: PMC11036624 DOI: 10.1186/s12874-024-02206-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/21/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Accurate prevalence estimates of drug use and its harms are important to characterize burden and develop interventions to reduce negative health outcomes and disparities. Lack of a sampling frame for marginalized/stigmatized populations, including persons who use drugs (PWUD) in rural settings, makes this challenging. Respondent-driven sampling (RDS) is frequently used to recruit PWUD. However, the validity of RDS-generated population-level prevalence estimates relies on assumptions that should be evaluated. METHODS RDS was used to recruit PWUD across seven Rural Opioid Initiative studies between 2018-2020. To evaluate RDS assumptions, we computed recruitment homophily and design effects, generated convergence and bottleneck plots, and tested for recruitment and degree differences. We compared sample proportions with three RDS-adjusted estimators (two variations of RDS-I and RDS-II) for five variables of interest (past 30-day use of heroin, fentanyl, and methamphetamine; past 6-month homelessness; and being positive for hepatitis C virus (HCV) antibody) using linear regression with robust confidence intervals. We compared regression estimates for the associations between HCV positive antibody status and (a) heroin use, (b) fentanyl use, and (c) age using RDS-1 and RDS-II probability weights and no weights using logistic and modified Poisson regression and random-effects meta-analyses. RESULTS Among 2,842 PWUD, median age was 34 years and 43% were female. Most participants (54%) reported opioids as their drug of choice, however regional differences were present (e.g., methamphetamine range: 4-52%). Many recruitment chains were not long enough to achieve sample equilibrium. Recruitment homophily was present for some variables. Differences with respect to recruitment and degree varied across studies. Prevalence estimates varied only slightly with different RDS weighting approaches, most confidence intervals overlapped. Variations in measures of association varied little based on weighting approach. CONCLUSIONS RDS was a useful recruitment tool for PWUD in rural settings. However, several violations of key RDS assumptions were observed which slightly impacts estimation of proportion although not associations.
Collapse
Affiliation(s)
- Abby E Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, 1301 Cecil B Moore Avenue, Ritter Annex 905, Philadelphia, PA, USA
| | - Robin M Nance
- Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA
| | - Georgiy Bobashev
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Daniel Brook
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio, 43210, USA
| | - Wajiha Akhtar
- University of Wisconsin-Madison, Population Health Institute, 610 Walnut Street, 575 WARF, Madison, WI, 53726, USA
| | - Ryan Cook
- General Internal Medicine and Geriatrics, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, USA
| | - Hannah L Cooper
- Rollins School of Public Health, Emory University, Grace Crum Rollins Building, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
| | - Peter D Friedmann
- Baystate Medical Center-University of Massachusetts, Office of Research, UMass Chan Medical School - Baystate, 3601 Main Street, 3rd Floor, Springfield, MA, 01199, USA
| | - Simon D W Frost
- Microsoft Premonition, Microsoft Building 99, 14820 NE 36th St. Redmond, Seattle, WA, 98052, USA
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Vivian F Go
- University of North Carolina-Chapel Hill, 363 Rosenau Hall, CB# 7440, Chapel Hill, NC, 27599, USA
| | - Wiley D Jenkins
- Southern Illinois University, 201 E Madison Street, Springfield, IL, 62702, USA
| | - Philip T Korthuis
- Oregon Health & Science University, 3270 Southwest Pavilion Loop OHSU Physicians Pavilion, Suite 350, Portland, OR, 97239, USA
| | - William C Miller
- The Ohio State University, 302 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43210, USA
| | - Mai T Pho
- University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Stephanie A Ruderman
- Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA
| | - David W Seal
- Tulane University, 1440 Canal Street, Suite 2210, New Orleans, LA, 70112, USA
| | - Thomas J Stopka
- Tufts University School of Medicine, Public Health and Community Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
| | - Ryan P Westergaard
- University of Wisconsin-Madison, 1685 Highland Avenue, 5th Floor, Madison, WI, 53705-2281, USA
| | - April M Young
- University of Kentucky, 760 Press Avenue, Suite 280, Lexington, KY, 40536, USA
| | - William A Zule
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Judith I Tsui
- Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA
| | - Heidi M Crane
- Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA.
| | - Bridget M Whitney
- Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA
| | - Joseph A C Delaney
- Harborview Medical Center, University of Washington and University of Manitoba, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA
| |
Collapse
|
3
|
do Carmo Leal M, de Carvalho TDG, Santos YRP, de Queiroz RSB, Fonseca PAM, Szwarcwald CL, Riggirozzi P. Migration process of Venezuelan women to Brazil: living conditions and use of health services in Manaus and Boa Vista, 2018-2021. BMC Public Health 2024; 24:1051. [PMID: 38622585 PMCID: PMC11020171 DOI: 10.1186/s12889-024-18109-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 02/14/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The last decade saw the emergence of a new significant migration corridor due to the mass migration of Venezuelans to neighboring countries in South America. Since 2018, Brazil became the third host country of Venezuelan displaced populations. Little is known about how migratory processes affect needs, access to social programs, and public health services of migrant women. The goal of this study is to shed light on the socio-economic profile, living conditions, and use of health services of Venezuelan migrant women in two main reception cities in Brazil. METHODS A survey was conducted using respondent-driven sampling (RDS) in the cities of Boa Vista (Roraima), and Manaus (Amazonas). The study included 2012 Venezuelan migrant women aged between 15 and 49 years old who migrated from Venezuela to Brazil between 2018 and 2021. Relative prevalence was calculated, and the χ2 test was used to analyse the homogeneity of proportions. All analyses considered the complex sampling. RESULTS The main reasons for migrating relate to difficulties obtaining food (54%) and accessing health services (37.8%) in their country of origin. They were young and mixed race (65.7%) and had high school education (69.9%). In Manaus, 3.7% of the interviewees declared that they had no family income in the last month, while in Boa Vista, it was higher (66.2%) (p-value < 0.001). Almost one-third of them sought health care in the last 15 days, and 95% of them received care. The residents of Boa Vista arrived more recently and family income and access to paid work improved with time of residence in Brazil. CONCLUSIONS Given the increasing flow of Venezuelan migrants crossing to Brazil, a reception system was established for the provision of food, shelter, access to health services, and income transfer programs to migrants. This was the case despite high unemployment and poverty levels and income inequality, particularly in the city of Boa Vista. However, the majority had legal migrant status and had access to the public and universal healthcare system in Brazil (SUS). The use of the SUS was similar in both cities, acting as a buffer for the differences in opportunities offered.
Collapse
Affiliation(s)
- Maria do Carmo Leal
- National School of Public Health, Oswaldo Cruz Foundation, Leopoldo Bulhões Street, 1480, 8° floor, Bonsucesso, Rio de Janeiro, RJ, 21041-210, Brazil
| | - Thaiza Dutra Gomes de Carvalho
- National School of Public Health, Oswaldo Cruz Foundation, Leopoldo Bulhões Street, 1480, 8° floor, Bonsucesso, Rio de Janeiro, RJ, 21041-210, Brazil.
| | - Yammê Ramos Portella Santos
- National School of Public Health, Oswaldo Cruz Foundation, Leopoldo Bulhões Street, 1480, 8° floor, Bonsucesso, Rio de Janeiro, RJ, 21041-210, Brazil
| | - Rita Suely Bacuri de Queiroz
- Leônidas and Maria Deane Institute - Oswaldo Cruz Foundation - Fiocruz Amazônia, Street Terezina, 476 - Adrianópolis, Manaus, AM, 69057-070, Brazil
| | - Paula Andrea Morelli Fonseca
- Leônidas and Maria Deane Institute - Oswaldo Cruz Foundation - Fiocruz Amazônia, Street Terezina, 476 - Adrianópolis, Manaus, AM, 69057-070, Brazil
| | - Celia Landmann Szwarcwald
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Pía Riggirozzi
- Department of Politics and International Relations, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| |
Collapse
|
4
|
Szwarcwald CL. National health surveys: overview of sampling techniques and data collected using complex designs. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2023; 32:e2023431. [PMID: 38018648 PMCID: PMC10684127 DOI: 10.1590/s2237-96222023000300014.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/04/2023] [Indexed: 11/30/2023] Open
Abstract
This article aimed to present an overview of national health surveys, sampling techniques, and components of statistical analysis of data collected using complex sampling designs. Briefly, surveys aimed at assessing the nutritional status of Brazilians and maternal and child health care were described. Surveys aimed at investigating access to and use of health services and funding, those aimed at surveillance of chronic noncommunicable diseases and associated behaviors, and those focused on risk practices regarding sexually transmitted infections were also addressed. Health surveys through social networks, including online networks, deserved specific attention in the study. The conclusion is that the development of health surveys in Brazil, in different areas and using different sampling methodologies, has contributed enormously to the advancement of knowledge and to the formulation of public policies aimed at the health and well-being of the Brazilian population.
Collapse
Affiliation(s)
- Célia Landmann Szwarcwald
- Fundação Oswaldo Cruz, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
5
|
Braga LP, Szwarcwald CL, Damacena GN, de Souza-Júnior PRB, Dourado I, de Brito AM, Grangeiro A, Crosland Guimarães MD. Health vulnerabilities in female sex workers in Brazil, 2016. Medicine (Baltimore) 2022; 101:e30185. [PMID: 36107499 PMCID: PMC9439778 DOI: 10.1097/md.0000000000030185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/26/2022] Open
Abstract
Female sex workers (FSW) suffer stigma and discrimination that negatively impact their physical and mental health and affect access to health care services. This paper aims to describe selected health indicators among FSW in 12 Brazilian cities in 2016. Brazilian cross-sectional Biological Behavioral Surveillance Survey was conducted in 2016 among 4328 FSW recruited by respondent-driven sampling. The sample weighing was inversely proportional to participant's network sizes and the seeds were excluded from the analysis. Health indicators were estimated with 95% confidence interval and included indicators of health status, symptoms of depression, antenatal care, pap smear coverage, signs and symptoms of sexually transmitted infection, contraception and regular condom use, number of births and children alive per women, human immunodeficiency virus and syphilis testing, usual source of care, and perception of discrimination. Most participants self-rated their health as very good/good (65.8%) and 27.7% were positively screened for major depressive disorder episode on Patient Health Questionnaire-2. Antenatal coverage was 85.8% and 62.3% of FSW had access to pap smear exam in the past 3 years. A total of 67.0% of FSW were using some contraceptive method at the time of the study. Male condom was the most common method (37.1%), followed by oral pill (28.9%). A total of 22.5% FSW had never been tested for HIV and the main reasons were "not feeling at risk" (40.4%) and "being afraid or ashamed" (34.0%). The vast majority of FSW used Brazilian National Health System as their usual source of health care (90.2%). Approximately one-fifth of the participants felt discriminated against or were treated worse for being FSW (21.4%) and only 24.3% disclose their sex work status in health services. The vulnerability of FSW is expressed in all health indicators. Indicators of health status, antenatal care, pap smear coverage, and contraception were worse than in the Brazilian population, and point out to the importance of increase FSW's access to health care services. Also, stigma and discrimination emerged as an important barrier to FSW's health care in all dimensions and need to be struggled.
Collapse
Affiliation(s)
- Letícia Penna Braga
- Postgraduate Program in Epidemiology in Public Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Célia Landmann Szwarcwald
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Giseli Nogueira Damacena
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Paulo Roberto Borges de Souza-Júnior
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Inês Dourado
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Ana Maria de Brito
- Aggeu Magalhães Institute, Oswaldo Cruz Foundation IAM/Fiocruz, Recife, Pernambuco, Brazil
| | | | - Mark Drew Crosland Guimarães
- Department of Preventive and Social Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
6
|
de Almeida MM, da Silva LAV, Bastos FI, Guimarães MDC, Coutinho C, de Brito AM, Cavalcante S, Dourado I. Factors associated with symptoms of major depression disorder among transgender women in Northeast Brazil. PLoS One 2022; 17:e0267795. [PMID: 36048808 PMCID: PMC9436078 DOI: 10.1371/journal.pone.0267795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 04/17/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Transgender women (TGW) are one of the most vulnerable groups, including higher prevalence of HIV and mental health disorders, such as anxiety and depression than in the general population. Major Depression Disorder (MDD) is one of the most important mental health conditions due to an increasing trend in prevalence in the general population. This study aims at describing the prevalence of symptoms of MDD (SMDD) and associated factors among TGW in capitals of three States in Northeast Brazil. METHODS TGW n = (864) were selected from the cities of Salvador (n = 166), Recife (n = 350), and Fortaleza (n = 348) using Respondent Driven Sampling methodology. Symptoms of MDD were defined according to the Patient Health Questionnaire-9 scale. Multinomial logistic regression was used to compare those with mild/moderate or moderately severe/severe symptoms of depression with those with no depression, respectively, using complex sample design. Weighted Odds Ratio with 95% confidence interval were estimated. RESULTS 51.1% of the sample was classified as mild/moderate and 18.9% as moderately severe/severe SMDD. Mild/moderate SMDD was associated with a history of sexual violence (OR = 2.06, 95%CI: 1.15-3.68), history of physical violence (OR = 2.09, 95%CI: 1.20-3.67),) and poor self-rated quality of life (OR = 2.14, 95%CI: 1.31-3.49).). Moderately severe/severe SMDD was associated with history of sexual violence (OR = 3.02, 95%CI: 1.17-7.77), history of physical violence (OR = 4.34, 95% CI:1.88-6.96), poor self-rated quality of life (OR = 3.32, 95%CI:1.804-6.12), lack of current social support (OR = 2.53, 95%IC: 1.31-4.88) and lack of family support in childhood (OR = 2.17, 95%IC 1.16-4.05)). CONCLUSIONS Our findings strengthens the evidence of a higher prevalence of SMDD among TGW as compared to the general population. Public health policies and actions that target social determinants of risk and protection for MDD among TGW must be urgently implemented.
Collapse
Affiliation(s)
| | - Luís Augusto Vasconcelos da Silva
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Institute of Arts, Sciences and Humanities, Federal University of Bahia, Salvador, Brazil
| | | | - Mark Drew Crosland Guimarães
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Ana Maria de Brito
- Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Pernambuco, Brazil
| | - Socorro Cavalcante
- Health Department of the State of Ceará and Municipality of Fortaleza, Fortaleza, Brazil
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| |
Collapse
|
7
|
Silva RAD, Silva LAVD, Soares F, Dourado I. Uso de hormônios não prescritos na modificação corporal de travestis e mulheres transexuais de Salvador/Bahia, Brasil. CIENCIA & SAUDE COLETIVA 2022; 27:503-514. [DOI: 10.1590/1413-81232022272.44342020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/09/2020] [Indexed: 12/24/2022] Open
Abstract
Resumo O objetivo deste artigo é analisar o uso de hormônios não prescritos entre travestis e mulheres transexuais (TrMT) na cidade de Salvador, Bahia, Brasil. Trata-se de um estudo de corte transversal onde se utilizou a metodologia RDS (respondent driven sampling) para recrutar TrMT entre 2014 e 2016, em Salvador e sua Região Metropolitana. Foi realizada uma análise comparativa entre condições sociodemográficas, comportamentais e de afirmação de gênero com o uso de hormônios. Os dados ponderados pelo estimador RDS-II. Utilizou-se o programa Stata, versão 14, para análises estatísticas. Foram recrutadas 127 TrMT. Da amostra estudada, 69,1% das participantes fizeram uso de hormônios não prescritos, o que esteve associado ao uso de silicone líquido industrial e ao relato de satisfação corporal. As TrMT que estavam confortáveis com o pênis e que sentiam prazer com o mesmo apresentaram menor probabilidade de uso de hormônio. As participantes soropositivas para HIV reportaram maior proporção de uso de hormônio. O uso não prescrito de hormônios foi utilizado pela maioria das TrMT. É provável que esse uso esteja associado a uma melhor satisfação com a autoimagem e com o corpo entre as TrMT. Verificou-se o uso em elevadas quantidades desses medicamentos e de maneira exacerbada, provavelmente devido ao pouco acesso aos serviços de saúde pública.
Collapse
|
8
|
Decker MR, Meyer SR, Branchini Risko C, Abshir N, Mar AA, Robinson WC. Trafficking, Client and Police Violence, Sexual Risk and Mental Health Among Women in the Sex Industry at the Thai-Myanmar Border. Violence Against Women 2021; 28:2677-2699. [PMID: 34859727 DOI: 10.1177/10778012211060860] [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: 11/15/2022]
Abstract
This study describes sex trafficking and associations with violence and health among female migrants in the sex industry in Mae Sot, Thailand. The mixed-methods study included a qualitative interview phase (n = 10), followed by a cross-sectional survey phase (n = 128). Entry via trafficking (force, fraud, or coercion [FFC], or as minors) was prevalent (76.6%), primarily FFC (73.4%). FFC was associated with inconsistent condom use, inability to refuse clients, poor health, and anxiety. Past-year violence was normative including client sexual violence (66.4%), client coercion for condom nonuse (> 95%), and police extortion (56%). Working conditions enabled violence irrespective of mode of entry. Profound unmet needs exist for safety and access to justice irrespective of trafficking history.
Collapse
Affiliation(s)
- Michele R Decker
- Department of Population, Family & Reproductive Health, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Public Health and Human Rights, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarah R Meyer
- Program on Forced Migration and Health, Mailman School of Public Health, Columbia University, Baltimore, MD, USA
| | - Casey Branchini Risko
- Department of International Health, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - W Courtland Robinson
- Department of Population, Family & Reproductive Health, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of International Health, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
9
|
Leite BO, de Medeiros DS, Magno L, Bastos FI, Coutinho C, de Brito AM, Cavalcante MS, Dourado I. Association between gender-based discrimination and medical visits and HIV testing in a large sample of transgender women in northeast Brazil. Int J Equity Health 2021; 20:199. [PMID: 34488781 PMCID: PMC8422640 DOI: 10.1186/s12939-021-01541-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/24/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Gender-based discrimination remains a substantial barrier to health care access and HIV prevention among transgender women in Brazil. The aim of this study was to investigate the association between gender-based discrimination and medical visits, as well as with HIV testing among transgender women in the last 12 months in northeast Brazil. METHODS This is a cross-sectional study of 864 transgender women recruited using Respondent-Driven Sampling in three cities in northeastern Brazil in 2016. A socio-behavioral questionnaire was applied. Multivariate analyses were performed using logistic regression, with odds ratio and respective 95% confidence intervals estimation, to estimate the effect of gender-based discrimination on two outcomes: i) medical visits and ii) HIV testing in the last 12 months. RESULTS 547 transgender women (67·0%) had medical visits, and 385 (45·8%) underwent HIV testing in the last 12 months. In the multivariate analysis, gender-based discrimination was associated with a reduced likelihood of medical visits (OR: 0·29; 95%CI: 0·14-0·63) and HIV testing (OR: 0·41; 95%CI: 0·22-0·78) in the last 12 months. CONCLUSION Gender-based discrimination played an essential role in reducing the access of TGW to medical visits and HIV testing services. Furthermore, by confirming the association between gender-based discrimination and medical visits and HIV testing in the multivariate analysis, we have demonstrated how this predictive variable can affect by reducing access to health services. The findings point to the need for non-discriminatory policies based on the defense and promotion of human rights that may foster the access of transgender women to Brazilian health services.
Collapse
Affiliation(s)
- Beo Oliveira Leite
- Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Bahia, Brazil
- Collective Health Institute, Federal University of Bahia. Av. Basílio da Gama, s/nCampus Universitário do Canela, Salvador, Bahia 40110-040 Brazil
| | | | - Laio Magno
- Collective Health Institute, Federal University of Bahia. Av. Basílio da Gama, s/nCampus Universitário do Canela, Salvador, Bahia 40110-040 Brazil
- Life Sciences Department, Bahia State University, Campus1, Salvador, Bahia Brazil
| | | | | | | | | | - Inês Dourado
- Collective Health Institute, Federal University of Bahia. Av. Basílio da Gama, s/nCampus Universitário do Canela, Salvador, Bahia 40110-040 Brazil
| |
Collapse
|
10
|
Peitzmeier SM, Wirtz AL, Beyrer C, Peryshkina A, Sherman SG, Colantuoni E, Decker MR. Polyvictimization Among Russian Sex Workers: Intimate Partner, Police, and Pimp Violence Cluster With Client Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP8056-NP8081. [PMID: 30966847 PMCID: PMC9476162 DOI: 10.1177/0886260519839431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Female sex workers (FSW) are a key population in the HIV epidemic and face high levels of violence. While women globally are predominantly at risk of intimate partner violence (IPV), FSW are additionally vulnerable to violence from clients, police, and pimps associated with their occupation. FSW are therefore at risk of cumulative trauma from polyvictimization, or violence from multiple types of perpetrators. Polyvictimization is a driver of morbidity and mortality in numerous populations, but there has been little research on how multiple types of victimization are related to one another in FSW. A cross-sectional survey was conducted among 754 FSW from three cities in the Russian Federation. Surveys assessed lifetime experiences of client, police, intimate partner, and pimp violence. Multivariate log-binomial and Poisson regression were used to test associations between these types of violence. Forty-five percent experienced any type of violence, including 31.7% from clients, 16.0% from police, 15.7% from intimate partners, and 11.4% from pimps. One fifth (20.4%) experienced polyvictimization. Client violence was central to polyvictimization: Only 5.9% of polyvictimization occurs without client violence. When client violence was not present, police, pimp, or IPV co-occurred significantly less than would be expected under an assumption that these types of violence occur independently (p < .001). However, they co-occurred more than would be expected when client violence is present. After adjusting for other types of violence experienced and demographic factors, experiencing client violence was independently associated with police violence (adjusted relative risk [ARR] = 2.77, 95% confidence interval [CI] [1.67, 4.59]), IPV (ARR = 3.67, 95% CI [1.95, 6.89]), and pimp violence (ARR = 5.26, 95% CI [2.80, 9.86]). Client violence may drive exposure to other types of violence and enable polyvictimization in a way that other types of violence do not in this setting. Violence prevention interventions may achieve maximal effect in reducing multiple types of violence by focusing on client violence.
Collapse
Affiliation(s)
- Sarah M Peitzmeier
- University of Michigan, Ann Arbor, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea L Wirtz
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chris Beyrer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Susan G Sherman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Michele R Decker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
11
|
Sanhueza-Sanzana C, Kerr L, Kendall C. Mortality from AIDS and tuberculosis-HIV coinfection in the Chilean AIDS Cohort of 2000-2017. CAD SAUDE PUBLICA 2021; 37:e00212920. [PMID: 34190832 DOI: 10.1590/0102-311x00212920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/26/2020] [Indexed: 11/22/2022] Open
Abstract
This article aims to assess the sociodemographic and epidemiological factors associated with AIDS and tuberculosis-HIV coinfection mortality in the Chilean adult population between 2000 and 2017. This is a retrospective observational study, evaluating the incidence density of TB-HIV coinfection mortality in the population over 14 years of age. We used data from the Chilean AIDS Cohort database, 17,512 people enrolled in highly active antiretroviral therapy in the public health system in Chile. The Kaplan-Meier survival function and Cox regression were applied. Incidence density of 0.05 for 39,283 person-years for mortality with TB-HIV coinfection was recorded, with an increase in new cases in people living with AIDS among Aymara and Mapuche indigenous populations. Risk factors included CD4 < 500 cells/mm3 (HR = 3.2; 95%CI: 2.2-4.9), viral load at the start of treatment > 10,000 copies/uL (HR = 1.3; 95%CI: 1.2-1.6). Having high school or higher education (HR = 0.76; 95%CI: 0.6-0.9) is a protective factor for mortality for coinfection. Mortality was concentrated in TB-HIV coinfected people with increasing mortality among women and indigenous populations. The paper contributes to the growing recognition of the role of social determinants in disease outcomes, and the requirement to improve community-focused and community-based testing, sex education in schools, and structural interventions to reduce the adult mortality in Chilean population.
Collapse
Affiliation(s)
| | - Ligia Kerr
- Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brasil
| | - Carl Kendall
- Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brasil.,School of Public Health and Tropical Medicine, Tulane University, New Orleans, U.S.A
| |
Collapse
|
12
|
Associations of Sociodemographic Factors and Health Behaviors with the Emotional Well-Being of Adolescents during the COVID-19 Pandemic in Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116160. [PMID: 34200307 PMCID: PMC8201123 DOI: 10.3390/ijerph18116160] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 02/07/2023]
Abstract
This cross-sectional study utilizes data from a nationwide web-based survey aimed to identify the factors affecting the emotional well-being of Brazilian adolescents aged 12–17 during the period of school closures and confinement. Data collection took place from 27 June to 17 September 2020. We used the “virtual snowball” sampling method, and students from private and public schools were included. A total of 9470 adolescents were analyzed. A hierarchical logistic regression model was used to find the factors associated with reporting at least two of three self-reported problems—sadness, irritability, and sleep problems. The main proximal factor was loneliness (AdjOR = 8.12 p < 0.001). Problems related to school closures also played an important role. Regular intake of fruits and vegetables, as well as physical activity, demonstrated a positive influence on emotional well-being, while excessive screen time (AdjOR = 2.05, p < 0.001) and alcohol consumption negatively affected outcomes (AdjOR = 1.73, p < 0.001). As for distal variables, less affluent adolescents were the most affected, and males reported fewer emotional problems than females. Uncertainty regarding the disease in a context of socioeconomic vulnerability, together with rises in unhealthy behaviors and isolation from their immediate social circles, have negatively affected adolescents’ emotional status throughout the COVID-19 pandemic.
Collapse
|
13
|
Szwarcwald CL, Souza Júnior PRBD, Damacena GN, Malta DC, Barros MBDA, Romero DE, Almeida WDSD, Azevedo LO, Machado ÍE, Lima MG, Werneck AO, Silva DRPD, Gomes CS, Ferreira APDS, Gracie R, Pina MDFD. ConVid - Behavior Survey by the Internet during the COVID-19 pandemic in Brazil: conception and application methodology. CAD SAUDE PUBLICA 2021; 37:e00268320. [PMID: 33950078 DOI: 10.1590/0102-311x00268320] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/19/2020] [Indexed: 02/07/2023] Open
Abstract
The ConVid - Behavior Survey was conducted in Brazil from April 24 to May 24, 2020, aiming to investigate changes in lifestyles and health conditions during the COVID-19 pandemic. In this article, we present the conception and methodology of the research. We used a cross-sectional study using an Internet questionnaire, with questions validated in previous health surveys. The sampling method "virtual snowball" was used, as well as post-stratification procedures. The results related to chronic non-communicable diseases and pre-pandemic lifestyles were compared with estimates from the 2013 Brazilian National Health Survey and 2019 Surveillance of Risk and Protective Factors for Chronic Diseases by Telephone Survey. The total sample was 45,161 people. After data weighing, the sample distributions of demographic variables were similar to population variables. Only people with a low schooling level were underrepresented. The comparison with the previous results showed similarity in most estimates: recommended consumption of fruits and vegetables (22.1%), recommended physical activity (35.2%), tobacco smoking habit (12.3%), frequent and abusive alcohol consumption (6.7%), obesity (21.2%), self-reported prevalence of hypertension (18.6%), diabetes (7.1%), and heart disease (4.4%). The online survey made it possible to know the population's health conditions during the pandemic. The similarity of the indicators with those obtained in traditional research allowed the validation of the mean estimates. Studies are needed to investigate how the endogenous effects of virtual social networks can be considered when estimating variance.
Collapse
Affiliation(s)
- Celia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Giseli Nogueira Damacena
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | | | - Dalia Elena Romero
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Luiz Otávio Azevedo
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Ísis Eloah Machado
- Escola de Medicina, Universidade Federal de Ouro Preto, Ouro Preto, Brasil
| | | | | | | | - Crizian Saar Gomes
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - Arthur Pate de Souza Ferreira
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Renata Gracie
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Maria de Fátima de Pina
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| |
Collapse
|
14
|
Szwarcwald CL, Damacena GN, Barros MBDA, Malta DC, Souza Júnior PRBD, Azevedo LO, Machado ÍE, Lima MG, Romero D, Gomes CS, Werneck AO, Silva DRPD, Gracie R, Pina MDFD. Factors affecting Brazilians' self-rated health during the COVID-19 pandemic. CAD SAUDE PUBLICA 2021; 37:e00182720. [PMID: 33950075 DOI: 10.1590/0102-311x00182720] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 07/28/2020] [Indexed: 01/02/2023] Open
Abstract
This is a cross-sectional study investigating the factors affecting brazilians' self-rated health during the COVID-19 pandemic, based on data from the web-based behavior survey. Carried out from April 24 to May 24, 2020, the survey recruited participants by a chain sampling procedure. Its outcome was the worsening of self-rated health during the pandemic. Statistical analysis was based on a hierarchical model of determination. Logistic regression models were used to test the associations between sociodemographic characteristics, pre-existing health conditions, lifestyle indicators and intensity of social restraint measures, and biological and psychological issues during the pandemic. From the total sample of 45,161 participants, 29.4% reported worsening of health state during this period. After adjusting for hierarchical distal factors, the health problems mostly associated with worsening health state were: bad self-rated health (adjusted OR = 4.35, p < 0.001), health care seeking for mental health problem (adjusted OR = 3.95, p < 0.001), and for COVID-19 (adjusted OR = 3.60, p < 0.001). People who experienced sleep problems, worsening of back pain, depression and at least one flu symptom during the pandemic were twice as likely to report worsening of health status. Sedentary and eating behaviors and adherence to social distancing measures showed significant correlation with the outcome. There exists a relation between social, biological, and psychological factors, mediated by lifestyles and variables pertaining to confinement. Altogether, these factors have negatively affected self-rated health during the COVID-19 pandemic in Brazil.
Collapse
Affiliation(s)
- Celia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Giseli Nogueira Damacena
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | | | | | - Luiz Otávio Azevedo
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Ísis Eloah Machado
- Escola de Medicina, Universidade Federal de Ouro Preto, Ouro Preto, Brasil
| | | | - Dália Romero
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Crizian Saar Gomes
- Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | | | - Renata Gracie
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Maria de Fátima de Pina
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| |
Collapse
|
15
|
Romero DE, Muzy J, Damacena GN, Souza NAD, Almeida WDSD, Szwarcwald CL, Malta DC, Barros MBDA, Souza Júnior PRBD, Azevedo LO, Gracie R, Pina MDFD, Lima MG, Machado ÍE, Gomes CS, Werneck AO, Silva DRPD. Older adults in the context of the COVID-19 pandemic in Brazil: effects on health, income and work. CAD SAUDE PUBLICA 2021; 37:e00216620. [PMID: 33825801 DOI: 10.1590/0102-311x00216620] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/17/2020] [Indexed: 11/21/2022] Open
Abstract
The goal of this study is to characterize the population of older adults in Brazil during the COVID-19 pandemic with regard to health, socioeconomic conditions, gender inequality, adherence to social distancing and feelings of sadness or depression. It is a cross-sectional study carried out with Brazilian older adults who responded to an online health survey (N = 9,173), using a "virtual snowball" sampling method. Data were collected online via a self-administered questionnaire. Prevalence and confidence interval estimates were performed and verified for independence using Pearson's chi-square test. During the pandemic there was a fall in household income among almost half of older adults. Extreme social distancing was practiced by 30.9% (95%CI: 27.8; 34.1) and 12.2% (95%CI: 10.1; 14.7) did not adhere to it. Older adults who were not working before the pandemic adhered in greater numbers to extreme social distancing measures. Most of them presented comorbidities associated with a higher risk of developing the severe form of COVID-19. Feelings of loneliness, distress and sadness were frequent among older adults, especially women. The COVID-19 pandemic widened the inequality gap by affecting the most vulnerable older people. Strategies to mitigate loneliness and social distancing should consider social vulnerability and the marked difference between men and women in terms of household composition and socioeconomic and working conditions. The development of representative surveys of Brazilian older adults is recommended, investigating the impact of the pandemic on this population.
Collapse
Affiliation(s)
- Dalia Elena Romero
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Jéssica Muzy
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Giseli Nogueira Damacena
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Nathalia Andrade de Souza
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Celia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | | | | | - Luiz Otávio Azevedo
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Renata Gracie
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Maria de Fátima de Pina
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Ísis Eloah Machado
- Escola de Medicina, Universidade Federal de Ouro Preto, Ouro Preto, Brasil
| | - Crizian Saar Gomes
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | | |
Collapse
|
16
|
Magno L, Leal AF, Knauth D, Dourado I, Guimarães MDC, Santana EP, Jordão T, Rocha GM, Veras MA, Kendall C, Pontes AK, de Brito AM, Kerr L. Acceptability of HIV self-testing is low among men who have sex with men who have not tested for HIV: a study with respondent-driven sampling in Brazil. BMC Infect Dis 2020; 20:865. [PMID: 33213389 PMCID: PMC7678175 DOI: 10.1186/s12879-020-05589-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brazil has many people living with HIV (PLWH) who are unaware of their serostatus. The public health system has recently added HIV self-testing (HIVST) for key populations such as men who have sex with men (MSM). This study estimates HIVST acceptability among Brazilian MSM and explores factors associated with acceptability among MSM who have never tested for HIV or who had a previous negative result. METHODS Respondent-driven sampling (RDS) was used to recruit 4176 MSM in 12 Brazilian cities in 2016 to this biological and behavioral surveillance study. We excluded from this analysis all MSM who were aware of their positive HIV serostatus. Descriptive, bivariate and multivariate analyses were conducted. Overall proportions were weighted with Gile's estimator in RDS Analyst software and 95% confidence intervals were calculated. The analyses of HIVST acceptability were stratified by prior HIV testing (never or one or more times). RESULTS For this analysis, 3605 MSM were included. The acceptability of HIVST was 49.1%, lower among those who had never tested for HIV (42.7%) compared to those who had a previous HIV negative test (50.1%). In the subgroup of MSM who had never tested for HIV, those who reported discrimination or who had a medical appointment in the last 12 months reported higher HIVST acceptability. Among MSM who had a previous negative HIV test, only those reporting condomless receptive anal sex reported higher HIVST acceptability. In addition, we observed that high levels of knowledge of HIV/AIDS, taking part in lesbian, gay, bisexual, and transgender nongovernmental organizations (LGBT-NGO), or complete secondary or incomplete higher undergraduate education reported higher acceptability. CONCLUSIONS The acceptability of HIVST was low among MSM, especially among those who never tested for HIV. Given access to HIVST in Brazil, we point to the need for programs that enhance promotion of testing addressed to MSM.
Collapse
Affiliation(s)
- Laio Magno
- Department of Life Sciences, Bahia State University, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Bahia, Brazil.
- Institute of Collective Health, Federal University of Bahia, R. Basílio da Gama, s/n - Canela, Salvador, 45760-030, Bahia, Brazil.
| | - Andrea Fachel Leal
- Sociology Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Daniela Knauth
- Department of Social Medicine, Universidade Federal do Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia, R. Basílio da Gama, s/n - Canela, Salvador, 45760-030, Bahia, Brazil
| | | | - Elis Passos Santana
- Institute of Collective Health, Federal University of Bahia, R. Basílio da Gama, s/n - Canela, Salvador, 45760-030, Bahia, Brazil
| | - Tiago Jordão
- Department of Life Sciences, Bahia State University, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Bahia, Brazil
| | | | | | - Carl Kendall
- Tulane School of Public Health and Tropical Medicine, New Orleans, USA
- Department of Community Health, Federal University of Ceará, Fortaleza, Brazil
| | | | | | - Ligia Kerr
- Department of Community Health, Federal University of Ceará, Fortaleza, Brazil
| |
Collapse
|
17
|
Jennings Mayo-Wilson L, Mathai M, Yi G, Mak’anyengo MO, Davoust M, Massaquoi ML, Baral S, Ssewamala FM, Glass NE. Lessons learned from using respondent-driven sampling (RDS) to assess sexual risk behaviors among Kenyan young adults living in urban slum settlements: A process evaluation. PLoS One 2020; 15:e0231248. [PMID: 32275677 PMCID: PMC7147752 DOI: 10.1371/journal.pone.0231248] [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: 05/27/2019] [Accepted: 03/19/2020] [Indexed: 12/02/2022] Open
Abstract
Background Respondent-driven sampling (RDS) is a peer-referral sampling methodology used to estimate characteristics of underserved groups that cannot be randomly sampled. RDS has been implemented in several settings to identify hidden populations at risk for HIV, but few studies have reported the methodological lessons learned on RDS design and implementation for assessing sexual risk behaviors in marginalized youth. Methods We used RDS to recruit N = 350 young adults, aged 18 to 22, who were living in urban slum settlements in Nairobi, Kenya. A structured survey was used to assess sexual risk behaviors. Twenty seeds were selected and asked to recruit up to three eligible peers. We used small monetary incentives and a three-day recruitment coupon with sequential numbers linking recruiters to their recruits. Results Data collection was completed in 8 days with a maximum chain length of 6 waves. Each seed yielded 16 to 21 eligible recruits. Three (15%) seeds were unproductive and were replaced. RDS benefits were high identification rates (90% coupons returned per coupons given), high eligibility rates (100% eligible recruits per coupons returned), and high efficiency (~39 eligible recruits per day). 44% of the sample was female. Most recruits (74%) reported being “friends” for 7+ years with their recruiter. RDS overcame feasibility concerns of household-, clinic-, and school-based sampling methodologies in that underserved youth who were unemployed (68%), out of school (48%), ethnic minorities (26%), and having prior residential instability (≥2 moves in the past year) (20%) were successfully recruited, based on weighted analyses. Youth reporting HIV risk behaviors, including unprotected sex (38%), sex while high/drunk (35%), and sex exchange for pay (14%), were also enrolled. However, 28% were not sexually active within the last 6 months. Challenges included managing wait times during peaks and participant referral expectations. Community engagement, use of study-stamped coupons, broad inclusion criteria, incentives, and study sites within walking distances all contributed to the successful implementation of the sampling methodology. Conclusion RDS is an important tool in reaching a diverse sample of underserved and at-risk young adults for study participation. Implications for optimizing RDS for behavioral studies in this population are discussed.
Collapse
Affiliation(s)
- Larissa Jennings Mayo-Wilson
- Department of Applied Health Sciences, Indiana University School of Public Health, Bloomington, Indiana, United States of America
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Muthoni Mathai
- Department of Psychiatry, University of Nairobi, College of Health Sciences, Kenyatta National Hospital, Nairobi, Kenya
- Department of Mental Health, National Health and Development Organization (NAHEDO), Kenyatta National Hospital, Nairobi, Kenya
| | - Grace Yi
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Margaret O. Mak’anyengo
- Department of Psychiatry, University of Nairobi, College of Health Sciences, Kenyatta National Hospital, Nairobi, Kenya
- Department of Mental Health, National Health and Development Organization (NAHEDO), Kenyatta National Hospital, Nairobi, Kenya
| | - Melissa Davoust
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Massah L. Massaquoi
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Fred M. Ssewamala
- Washington University in St. Louis, The Brown School, Goldfarb, One Brookings, Drive, St. Louis, Missouri, United States of America
| | - Nancy E. Glass
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
| | - NAHEDO Study Group
- Department of Mental Health, National Health and Development Organization (NAHEDO), Kenyatta National Hospital, Nairobi, Kenya
| |
Collapse
|
18
|
Alecrim DJD, Ceccato MDGB, Dourado I, Kerr L, Brito AMD, Guimarães MDC. Factors associated with exchanging sex for money in men who have sex with men in Brazil. CIENCIA & SAUDE COLETIVA 2020; 25:1025-1039. [PMID: 32159671 DOI: 10.1590/1413-81232020253.18052018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/14/2018] [Indexed: 11/21/2022] Open
Abstract
This study aimed to analyze the association between sociodemographic, programmatic and contextual factors and the receipt of money in exchange for sex among men who have sex with men (MSM). This is a multicenter, cross-sectional study conducted in ten Brazilian cities between 2008 and 2009. Adult MSM recruited through the Respondent Driven Sampling (RDS) were interviewed. Weighted Odds Ratio (ORw) was obtained through logistic regression, retaining the variables associated with the event (p < 0.05) in the final model. Of the total sample, 33.3% reported receiving money in exchange for sex in the last 12 months before the interview. The variables that were independently associated with the event were age less than or equal to 25 years, lower education, lower social classes, previous history of syphilis, using sites or services to find sexual partners in the previous month, very high risk behavior, using illicit drugs in the previous six months, self-identifying as heterosexual or bisexual, having suffered physical violence due to sexual orientation and having suicidal thoughts always or most of the time. It was observed that MSM who received money in exchange for sex had greater socioeconomic, programmatic and contextual vulnerability, potentially increasing the risk of HIV infection than the other MSM in the sample.
Collapse
Affiliation(s)
- Denyr Jeferson Dutra Alecrim
- Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG). Av. Antonio Carlos 6627, Pampulha. 31270-010, Belo Horizonte, MG, Brasil.
| | - Maria das Graças Braga Ceccato
- Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG). Av. Antonio Carlos 6627, Pampulha. 31270-010, Belo Horizonte, MG, Brasil.
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador, BA, Brasil
| | - Ligia Kerr
- Universidade Federal do Ceará. Departamento de Saúde Comunitária. Fortaleza, CE, Brasil
| | | | | |
Collapse
|
19
|
Associations Between Violence and HIV Risk Behaviors Differ by Perpetrator Among Russian Sex Workers. AIDS Behav 2020; 24:812-822. [PMID: 31531737 DOI: 10.1007/s10461-019-02668-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Violence is associated with HIV and HIV risk behaviors among female sex workers (FSW). However, few studies assess multiple forms of violence and multiple HIV risk behaviors to build a comprehensive picture of how violence is implicated in HIV risk. Using respondent-driven sampling, 754 FSW were recruited in the Russian Federation. Surveys collected data on lifetime exposure to client, police, intimate partner, and pimp violence, as well as recent HIV risk behavior in the forms of injecting drug use (IDU), and inconsistent condom use with intimate partners and clients. Multivariable log-binomial and Poisson regression were used to assess associations between violence and HIV risk behavior outcomes. Lifetime client (31.7%), police (16.0%), intimate partner (15.7%), and pimp (11.4%) violence were prevalent. IDU (10.7%) and inconsistent condom use with intimate partners (45.1%) and clients (22.5%) were common. Intimate partner violence (IPV) and client violence were associated with IDU (ARRIPV 2.12, 95% CI 1.10, 4.10; ARRClient 2.75, 95% CI 1.19, 6.32), IPV and police violence were associated with inconsistent condom use with intimate partners (ARRIPV 1.10, 95% CI 1.01, 1.19; ARRPolice 1.11, 95% CI 1.01, 1.21), and IPV and police violence were associated with inconsistent condom use with clients (ARRIPV 1.49, 95% CI 1.02, 2.17; ARRPolice 1.65, 95% CI 1.19, 2.29). Each perpetrator-specific type of violence was associated with a unique set of HIV risk behaviors. Comprehensive violence prevention programming that addresses multiple perpetrators of violence against FSW, including clients, intimate partners and police, is critical for reducing sexual and drug-related HIV risk in FSW.
Collapse
|
20
|
Rocha GM, Guimarães MDC, de Brito AM, Dourado I, Veras MA, Magno L, Kendall C, Kerr LRFS. High Rates of Unprotected Receptive Anal Intercourse and Their Correlates Among Young and Older MSM in Brazil. AIDS Behav 2020; 24:938-950. [PMID: 30879210 DOI: 10.1007/s10461-019-02459-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The aim of this study was to estimate the prevalence and factors associated with unprotected receptive anal intercourse (URAI), stratified by age (18-24 or 25 + years old), in a sample of 4,129 MSM recruited by respondent driven sampling in 12 Brazilian cities in 2016. The prevalence of URAI was higher among younger MSM (41.9% vs 29.7%) (p < 0.01). Multivariate analysis indicated that perception of risk, sexual identity, self-rated health status, and having commercial sex were associated with URAI among younger MSM. History of sexual violence, sex with younger partners, having 6 + partners and unprotected sexual debut were associated with URAI among older MSM. Marital status, having stable partner, and reporting sex with men only were associated with URAI in both groups. Despite access to condoms and lubricants, preventive efforts may not be reaching MSM effectively. Age specific intervention approaches, including stigma, discrimination, and perception of risk must be considered.
Collapse
Affiliation(s)
- Gustavo Machado Rocha
- Federal University of São João del-Rei, Rua Sebastião Gonçalves Coelho, 400, CEP 35502-296, Divinópolis, MG, Brazil.
| | | | | | - Ines Dourado
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
| | - Maria Amélia Veras
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Laio Magno
- Department of Life Sciences, State University of Bahia, Salvador, Brazil
| | - Carl Kendall
- Center for Global Health Equity, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Department of Community Health, Federal University of Ceará, Fortaleza, Brazil
| | | |
Collapse
|
21
|
Robineau O, Gomes MFC, Kendall C, Kerr L, Périssé A, Boëlle PY. Model-based Respondent-driven sampling analysis for HIV prevalence in brazilian MSM. Sci Rep 2020; 10:2646. [PMID: 32060389 PMCID: PMC7021777 DOI: 10.1038/s41598-020-59567-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/17/2020] [Indexed: 11/09/2022] Open
Abstract
Respondent Driven Sampling study (RDS) is a population sampling method developed to study hard-to-reach populations. A sample is obtained by chain-referral recruitment in a network of contacts within the population of interest. Such self-selected samples are not representative of the target population and require weighing observations to reduce estimation bias. Recently, the Network Model-Assisted (NMA) method was described to compute the required weights. The NMA method relies on modeling the underlying contact network in the population where the RDS was conducted, in agreement with directly observable characteristics of the sample such as the number of contacts, but also with more difficult-to-measure characteristics such as homophily or differential characteristics according to the response variable. Here we investigated the use of the NMA method to estimate HIV prevalence from RDS data when information on homophily is limited. We show that an iterative procedure based on the NMA approach allows unbiased estimations even in the case of strong population homophily and differential activity and limits bias in case of preferential recruitment. We applied the methods to determine HIV prevalence in men having sex with men in Brazilian cities and confirmed a high prevalence of HIV in these populations from 3.8% to 22.1%.
Collapse
Affiliation(s)
- Olivier Robineau
- INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique, F75012, Paris, France. .,Service Universitaire des Maladies Infectieuses et du Voyageur, Tourcoing, France.
| | - Marcelo F C Gomes
- Fundação Oswaldo Cruz (Fiocruz), Programa de Computação Cientifica, Rio de Janeiro, Brazil
| | - Carl Kendall
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Ligia Kerr
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - André Périssé
- Fundação Oswaldo Cruz (Fiocruz), Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Departamento de Ciências Biológicas, Rio de Janeiro, RJ, Brazil
| | - Pierre-Yves Boëlle
- INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique, F75012, Paris, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Santé publique, F75012, Paris, France
| |
Collapse
|
22
|
Macleod CK, Bailey RL, Dejene M, Shafi O, Kebede B, Negussu N, Mpyet C, Olobio N, Alada J, Abdala M, Willis R, Hayes R, Solomon AW. Estimating the Intracluster Correlation Coefficient for the Clinical Sign "Trachomatous Inflammation-Follicular" in Population-Based Trachoma Prevalence Surveys: Results From a Meta-Regression Analysis of 261 Standardized Preintervention Surveys Carried Out in Ethiopia, Mozambique, and Nigeria. Am J Epidemiol 2020; 189:68-76. [PMID: 31509177 PMCID: PMC7119302 DOI: 10.1093/aje/kwz196] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 09/03/2019] [Indexed: 11/13/2022] Open
Abstract
Sample sizes in cluster surveys must be greater than those in surveys using simple random sampling in order to obtain similarly precise prevalence estimates, because results from subjects examined in the same cluster cannot be assumed to be independent. Therefore, a crucial aspect of cluster sampling is estimation of the intracluster correlation coefficient (ρ): the degree of relatedness of outcomes in a given cluster, defined as the proportion of total variance accounted for by between-cluster variation. In infectious disease epidemiology, this coefficient is related to transmission patterns and the natural history of infection; its value also depends on particulars of survey design. Estimation of ρ is often difficult due to the lack of comparable survey data with which to calculate summary estimates. Here we use a parametric bootstrap model to estimate ρ for the ocular clinical sign “trachomatous inflammation—follicular” (TF) among children aged 1–9 years within population-based trachoma prevalence surveys. We present results from a meta-regression analysis of data from 261 such surveys completed using standardized methods in Ethiopia, Mozambique, and Nigeria in 2012–2015. Consistent with the underlying theory, we found that ρ increased with increasing overall TF prevalence and smaller numbers of children examined per cluster. Estimates of ρ for TF were independently higher in Ethiopia than in the other countries.
Collapse
Affiliation(s)
- Colin K Macleod
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Robin L Bailey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Michael Dejene
- Michael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia
| | - Oumer Shafi
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | | | - Caleb Mpyet
- Department of Ophthalmology, Queen Mamohato Memorial Hospital, Maseru, Lesotho
- Sightsavers, Kaduna, Nigeria
- Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology, Groote Schuur Hospital, Cape Town, South Africa
| | - Nicholas Olobio
- National Trachoma Control Program, Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
| | - Joel Alada
- Department of Ophthalmology, Queen Mamohato Memorial Hospital, Maseru, Lesotho
| | - Mariamo Abdala
- Ophthalmology Department, Ministry of Health, Maputo, Mozambique
| | | | - Richard Hayes
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anthony W Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| |
Collapse
|
23
|
Szwarcwald CL, Souza Júnior PRBD, Malta DC, Barros MBDA, Magalhães MDAFM, Xavier DR, Saldanha RDF, Damacena GN, Azevedo LO, Lima MG, Romero D, Machado ÍE, Gomes CS, Werneck ADO, Silva DRPD, Gracie R, Pina MDFD. Adesão às medidas de restrição de contato físico e disseminação da COVID-19 no Brasil. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2020; 29:e2020432. [DOI: 10.1590/s1679-49742020000500018] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/06/2020] [Indexed: 12/24/2022] Open
Abstract
Resumo Objetivo: Analisar a adesão da população às medidas de restrição de contato físico e disseminação da COVID-19 no Brasil. Métodos: Inquérito de saúde, realizado pela internet, com amostragem em cadeia, no período de 24 de abril a 24 de maio de 2020. A intensidade da adesão à restrição de contato físico foi analisada segundo características sociodemográficas, utilizando-se modelos de regressão logística para investigar associações com ‘Nenhuma/pouca adesão’. Resultados: Dos 45.161 participantes, 74,2% (73,8-74,6%) relataram intensa adesão às medidas. O grupo que não aderiu às medidas foi composto homens (31,7%), com idade de 30 a 49 anos (36,4%), baixa escolaridade (33,0%), trabalhando durante a pandemia (81,3%), residentes nas regiões Norte (28,1%) e Centro-Oeste (28,5%) do país. Houve importante redução das taxas de crescimento diário, de 45,4 para 5,0%. Conclusão: Grande parte da população brasileira aderiu às medidas de restrição de contato físico, o que, possivelmente, contribuiu para reduzir a disseminação da COVID-19.
Collapse
|
24
|
Magalhães RDLB, Sousa LRM, Gir E, Galvão MTG, de Oliveira VMC, Reis RK. Factors associated to inconsistent condom use among sex workers. Rev Lat Am Enfermagem 2019; 27:e3226. [PMID: 31826167 PMCID: PMC6896796 DOI: 10.1590/1518-8345.2951.3226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 09/07/2019] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE to analyze the factors associated to the inconsistent condom use among sex workers. METHOD a transversal study, carried out in prostitution area, using the Respondent Drive Sampling. The sample was calculated based on the information by the Sex Workers Association: 600 female sex workers. The study selected seven women with different characteristics regarding color, age, and place of work, who were called seeds. After the participation, they received three coupons to recruit other participants in order to obtain a representative sample. The definition of inconsistent condom use was determined as occasional use or never using it. Univariate analyses and a multivariate logistic regression were performed. RESULTS 416 female sex workers participated in the study. The associated factors were having studied for less than eight years (Odds Ratio = 27.28), not having a permanent partner (Odds Ratio = 2.79), high alcohol use (Odds Ratio = 5.07), and being black (Odds Ratio = 2.21). CONCLUSION the factors associated to inconsistent condom use were: lower education levels, not having a permanent partner, high alcohol use, and being black.
Collapse
Affiliation(s)
| | - Laelson Rochelle Milanês Sousa
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/OMS Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Elucir Gir
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/OMS Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | | | - Vanessa Moura Carvalho de Oliveira
- Universidade Federal do Piauí, Departamento de Enfermagem, Teresina, PI, Brazil
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Renata Karina Reis
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/OMS Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| |
Collapse
|
25
|
Ferraz D, Couto MT, Zucchi EM, Calazans GJ, dos Santos LA, Mathias A, Grangeiro A. AIDS- and sexuality-related stigmas underlying the use of post-exposure prophylaxis for HIV in Brazil: findings from a multicentric study. Sex Reprod Health Matters 2019; 27:1650587. [PMID: 31533555 PMCID: PMC7888039 DOI: 10.1080/26410397.2019.1650587] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
AIDS-related stigma is a major hurdle to care and it hinders people from accessing HIV prevention methods, such as post-exposure prophylaxis. This study was designed to explore how AIDS-related stigma impacts the experience of using non-occupational post-exposure prophylaxis (nPEP) for HIV after sexual contact. Data were gathered in in-depth interviews with 59 people who voluntarily sought out nPEP in five public healthcare facilities in Brazil between 2015 and 2016. Data were analysed into three thematic categories: fear of being mistaken for a person living with HIV and AIDS (PLWHA); desire to hide particular features of one's sexual life; and experiences of stigmatising behaviour due to nPEP use. Based on the Health Stigma and Discrimination Framework, predominant manifestations of AIDS-related stigma in each category were analysed, as well as their intersections with gender- and sexuality-related stigmas. Results show that experiences of using nPEP are permeated by AIDS-related stigma, intersecting with sexuality- and gender-related stigmas. Stigma experiences are mainly perceived, anticipated and internalised; stigma practices include prejudice and stigmatising behaviours. Taking antiretrovirals (ARVs) led participants to the fear of being discriminated against as a PLWHA and having particular features of their sexual identities disclosed. Thus, hiding nPEP was strategic to protect from stigmatising behaviour. As ARV-based prevention technologies are scaled-up, interventions designed to tackle AIDS- and sexuality-related stigmas must be expanded in Brazil. Required interventions include public campaigns about nPEP, educational programmes in healthcare settings to offer adequate support to nPEP users and investments in stigma research and monitoring.
Collapse
Affiliation(s)
- Dulce Ferraz
- Public Health Analyst, Escola de Governo em Saúde, Fundação Oswaldo Cruz, Brasília, Brazil
- PhD Candidate, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Eliana Miura Zucchi
- Assistant Professor at Programa de Pós-Graduação em Saúde Coletiva, Universidade Católica de Santos, Santos, Brazil
| | | | | | - Augusto Mathias
- PhD Candidate, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Alexandre Grangeiro
- Researcher, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
26
|
Damacena GN, Szwarcwald CL, Souza Júnior PRBD, Ferreira Júnior ODC, Almeida WDSD, Pascom ARP, Pimenta MC. Application of the Respondent-Driven Sampling methodology in a biological and behavioral surveillance survey among female sex workers, Brazil, 2016. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 22Suppl 1:e190002. [PMID: 31576978 DOI: 10.1590/1980-549720190002.supl.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 07/03/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Respondent-Driven Sampling (RDS) has been used in surveys with key populations at risk of HIV infection, such as female sex workers (FSW). This article describes the application of the RDS method among FSW in 12 Brazilian cities, during a survey carried out in 2016. METHODOLOGY A biological and behavioral surveillance study carried out in 12 Brazilian cities, with a minimum sample of 350 FSW in each city. Tests were performed for HIV, syphilis, and hepatitis B and C infections. A social-behavioral questionnaire was also applied. RESULTS The sample was comprised of 4,328 FSW. For data analysis, the sample was weighted according to each participant's network size (due consideration to the implications of RDS complex design and to the effects of homophilia are recommended). DISCUSSION Although RDS methods for obtaining a statistical sample are based on strong statistical assumptions, allowing for an estimation of statistical parameters, with each new application the method has been rethought. In the analysis of whole-sample data, estimators were robust and compatible with those found in 2009. However, there were significant variations according to each city. CONCLUSION The achieved sample size was of great relevance for assessing progress and identifying problems regarding the prevention and treatment of Sexually Transmitted Infections. New RDS studies with more time and operational resources should be envisaged. This could further network development.
Collapse
Affiliation(s)
- Giseli Nogueira Damacena
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation - Rio de Janeiro (RJ), Brazil
| | - Célia Landmann Szwarcwald
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation - Rio de Janeiro (RJ), Brazil
| | | | | | - Wanessa da Silva de Almeida
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation - Rio de Janeiro (RJ), Brazil
| | - Ana Roberta Pati Pascom
- Department of Chronic Condition Diseases and Sexually Transmitted Infections, Ministry of Health - Brasília (DF), Brazil
| | - Maria Cristina Pimenta
- Department of Chronic Condition Diseases and Sexually Transmitted Infections, Ministry of Health - Brasília (DF), Brazil
| | | |
Collapse
|
27
|
Brito AMD, Szwarcwald CL, Damacena GN, Dourado IC. HIV testing coverage among female sex workers, Brazil, 2016. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 22Suppl 1:e190006. [PMID: 31576982 DOI: 10.1590/1980-549720190006.supl.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/12/2019] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Knowing the factors associated with periodic HIV testing among female sex workers (FSW) is essential to expand testing coverage and to broaden programs of treatment as prevention. METHODS We used data from 4,328 FSWs recruited by the respondent-driven sampling (RDS) method in 12 Brazilian cities in 2016. Data analysis considered the complex sampling design. The prevalence of HIV testing in the last year and periodic HIV test were estimated. Factors associated with regular HIV testing were identified through logistic regression models. RESULTS The testing coverage in the last year was 39.3%. Only 13.5% of FSW reported having performed a periodic HIV test in the last year. Among the factors associated with the higher probability of HIV testing in the last year were a better level of education, living with a partner, working indoors, consistent use of condoms, and regular use of public and private health services stood out. DISCUSSION Periodic HIV testing allows early diagnosis and immediate treatment of cases, reducing the chances of spreading the infection to the population. However, factors such as stigma and discrimination hinder the use of regular health services. CONCLUSION It is necessary to expand awareness campaigns, especially among FSWs with low educational level and greater vulnerability, in order to broaden the perception of risk and the importance of periodic testing, in addition to encouraging regular health care.
Collapse
Affiliation(s)
- Ana Maria de Brito
- Department of Collective Health, Aggeu Magalhães Institute, Oswaldo Cruz Foundation - Recife (PE), Brazil
| | - Célia Landmann Szwarcwald
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation - Rio de Janeiro (RJ), Brazil
| | - Giseli Nogueira Damacena
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation - Rio de Janeiro (RJ), Brazil
| | - Inês Costa Dourado
- Department of Collective Health, Federal University of Bahia - Salvador (BA), Brazil
| | | |
Collapse
|
28
|
da Costa LM, Raiol NC, Lisboa BLA, Frade PCR, Blandtt LDS, Silva-Oliveira GC, Machado LFA, Martins LC, Oliveira-Filho AB. Prevalence and Risk Factors for Human Immunodeficiency Virus Infection Among Female Sex Workers: Distinct Offers of Sexual Services in a Municipality of the Brazilian Amazon. AIDS Res Hum Retroviruses 2019; 35:826-832. [PMID: 31204860 DOI: 10.1089/aid.2019.0032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study determined the prevalence of human immunodeficiency virus (HIV) infection and its associated factors in female sex workers (FSWs) from the municipality of Bragança in the state of Pará, Brazil. A cross-sectional study using a respondent-driven sampling method was used to investigate 137 FSWs. They were interviewed using a questionnaire for the collection of data on their characteristics and risk behavior. Blood samples were collected for serological and molecular testing for HIV. Poisson regression models were used to estimate the reasons of prevalence (RP). The majority was single, young, poorly educated, had a low monthly income, and had worked in the sex trade for more than 7 years. Sexual services were offered either directly (easy identification of FSWs in street markets, town squares, street corners, bars, and gas stations) or indirectly/discretely (more complex identification of FSWs, offering services through a cryptic approach or an intermediary). Overall, 22 (16.06%) FSWs had anti-HIV-1/2 antibodies, and 21 (15.33%) also had complementary DNA-HIV. The use of illicit drugs [adjusted RP (aRP) = 3.13; 95% confidence interval (CI) = 1.27-8.41], unprotected sex (aRP = 4.09; 95% CI = 1.34-11.62), anal sex (aRP = 4.01; 95% CI = 1.37-10.15), the exemption of condoms for clients paying extra (aRP = 4.71; 95% CI = 1.52-10.89), more than 7 years working as a sex worker (aRP = 6.04; 95% CI = 1.20-16.33), low levels of education (aRP = 3.55; 95% CI = 1.15-11.02), and a lack of regular medical or gynecological examinations were all associated with HIV infection (aRP = 5.87; 95% CI = 1.26-15.71). The FSWs who offered their services indirectly suffered significantly less physical and sexual aggression, charged more for encounters, had a significantly higher monthly income, and were more likely to have undergone a medical or gynecological examination within the preceding 12 months. This study identified information relevant to the control and prevention of HIV in FSWs.
Collapse
Affiliation(s)
- Luana Mota da Costa
- Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança, Brazil
- Residência Multiprofissional em Saúde da Mulher e da Criança, Hospital Santo Antonio Maria Zaccaria, Bragança, Brazil
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, Brazil
| | - Nairis Costa Raiol
- Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança, Brazil
| | | | - Paula Cristina R. Frade
- Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança, Brazil
- Residência Multiprofissional em Saúde da Mulher e da Criança, Hospital Santo Antonio Maria Zaccaria, Bragança, Brazil
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, Brazil
| | - Lucinaldo da Silva Blandtt
- Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança, Brazil
- Residência Multiprofissional em Saúde da Mulher e da Criança, Hospital Santo Antonio Maria Zaccaria, Bragança, Brazil
| | | | | | - Luísa Caricio Martins
- Residência Multiprofissional em Saúde da Mulher e da Criança, Hospital Santo Antonio Maria Zaccaria, Bragança, Brazil
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, Brazil
| | - Aldemir B. Oliveira-Filho
- Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança, Brazil
- Residência Multiprofissional em Saúde da Mulher e da Criança, Hospital Santo Antonio Maria Zaccaria, Bragança, Brazil
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| |
Collapse
|
29
|
Abara WE, Trujillo L, Broz D, Finlayson T, Teshale E, Paz-Bailey G, Glick S, Al-Tayyib AA, Robinson WT, Masiello-Schuette S, Sey EK, Anderson BJ, Poe J, Braunstein S. Age-Related Differences in Past or Present Hepatitis C Virus Infection Among People Who Inject Drugs: National Human Immunodeficiency Virus Behavioral Surveillance, 8 US Cities, 2015. J Infect Dis 2019; 220:377-385. [PMID: 30915477 PMCID: PMC11111175 DOI: 10.1093/infdis/jiz142] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 03/26/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Historically, older people who inject drugs (PWID) have had the highest hepatitis C virus (HCV) burden; however, young PWID now account for recent increases. We assessed factors associated with past or present HCV infection (HCV antibody [anti-HCV] positive) among young (≤35 years) and older (>35 years) PWID. METHODS We calculated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) to examine sociodemographic and past 12-month injection behaviors associated with HCV infection. RESULTS Of 4094 PWID, 55.2% were anti-HCV positive. Among young PWID, anti-HCV prevalence was 42.1% and associated with ≤high school diploma/General Education Development diploma (GED) (aPR, 1.17 [95% CI, 1.03-1.33]), receptive syringe sharing (aPR, 1.37 [95% CI, 1.21-1.56]), sharing injection equipment (aPR, 1.16 [95% CI, 1.01-1.35]), arrest history (aPR, 1.14 [95% CI, 1.02-1.29]), and injecting speedball (aPR, 1.37 [95% CI, 1.16-1.61]). Among older PWID, anti-HCV prevalence was 62.2% and associated with ≤high school diploma/GED (aPR, 1.08 [95% CI, 1.02-1.15]), sharing injection equipment (aPR, 1.08 [95% CI, 1.02-1.15]), high injection frequency (aPR, 1.16 [95% CI, 1.01-1.34]), and injecting speedball (aPR, 1.09 [95% CI, 1.01-1.16]). CONCLUSIONS Anti-HCV prevalence is high among PWID and varies with age. Scaling up direct-acting antiviral treatment, syringe service programs, and medication-assisted therapy is critical to mitigating transmission risk and infection burden.
Collapse
Affiliation(s)
- Winston E Abara
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lindsay Trujillo
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dita Broz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Teresa Finlayson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eyasu Teshale
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sara Glick
- Division of Allergy and Infectious Diseases, School of Medicine, University of Washington, Seattle, Washington
| | - Alia A Al-Tayyib
- Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado
| | - William T Robinson
- STD/HIV Program, Louisiana Department of Health and LSU Health Sciences Center, School of Public Health, New Orleans, Louisiana
| | | | - Ekow K Sey
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Bridget J Anderson
- Bureau of HIV/AIDS Epidemiology, New York State Department of Health, Albany, New York
| | - Jonathon Poe
- TB/HIV/STD Branch, Texas Department of State Health Services, Austin, Texas
| | - Sarah Braunstein
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York
| |
Collapse
|
30
|
|
31
|
Meyer SR, Robinson WC, Branchini C, Abshir N, Mar AA, Decker MR. Gender Differences in Violence and Other Human Rights Abuses Among Migrant Workers on the Thailand–Myanmar Border. Violence Against Women 2018; 25:945-967. [DOI: 10.1177/1077801218805587] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe human rights violations against migrant workers at the Thailand–Myanmar border, and evaluate differences by gender and industry. This mixed methods study pairs key informant interviews ( n = 40) with a cross-sectional quantitative survey of migrant workers from Myanmar ( n = 589) recruited via respondent-driven sampling. Key informants described significant hazards during migration, including deception, theft, and physical and sexual abuse, the latter primarily for women. Quantitative results confirmed prevalent mistreatment and abuse, with significant gender differences, most notably women’s disproportionate burden of sexual abuse. Current evidence on the nature of experiences, and significant differences by gender, can position prevention and response programming.
Collapse
Affiliation(s)
| | | | - Casey Branchini
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | |
Collapse
|
32
|
Ferreira-Júnior ODC, Guimarães MDC, Damacena GN, de Almeida WDS, de Souza-Júnior PRB, Szwarcwald CL. Prevalence estimates of HIV, syphilis, hepatitis B and C among female sex workers (FSW) in Brazil, 2016. Medicine (Baltimore) 2018; 97:S3-S8. [PMID: 29912817 PMCID: PMC5991541 DOI: 10.1097/md.0000000000009218] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Female sex workers (FSW) bear a high burden of sexually transmitted infections (STI). In this paper, we estimate the prevalence of human immunodeficiency virus (HIV), HBV = hepatitis B virus (HBV), HCV = hepatitis C virus (HCV), syphilis and co-infections in the second Biological and Behavioral Surveillance Survey among FSW in Brazil. METHOD The survey was conducted in 12 Brazilian cities from July to November 2016. We used respondent-driven sampling (RDS) to recruit 350 FSW in each city. Rapid tests were used for screening HIV, syphilis, HCV, and HBV. Confirmatory tests were performed on all samples with reactive rapid test result. All testing algorithms and interpretations were done according to the recommendations of the Department of STI/AIDS and viral hepatitis, Ministry of Health. The STI diagnoses were given by: confirmed HIV infection by a positive result on Western blot; active syphilis infection, defined by a RPR titer equal or greater than 1/8; viremia period of HBV and HCV infections, characterized by a detectable (or quantifiable) viral load. Prevalence estimates and standard errors were calculated using statistical procedures suitable for data collected by RDS. RESULTS Excluding the seeds, 4245 FSW were enrolled. Prevalence estimates were: HIV 5.3% (95% CI: 4.4%-6.2%); active syphilis 8.5% (95% CI: 7.3%-9.7%); HBV 0.4% (95% CI: 0.2%-0.7%); and, HCV 0.9% (95% CI: 0.6%-1.3%). Among the 4154 FSW tested for the 4 infections, 13.3%; (95% CI 12.0%-14.8%) were diagnosed with at least one of the infections, of which 87.6% (95% CI: 83.3%-90.9%) had single infections. The prevalence of HIV/syphilis co-infection was 1.09% (95% CI: 0.7%- 1.6%) and of HIV/HCV or HBV infections was 0.4% (95% CI: 0.2%-0.7%). CONCLUSIONS Our results reveal the need to conduct more studies to estimate the prevalence of STI and co-infections among FSW in Brazil. Longitudinal trends in the prevalence estimates of HIV and other STI provide information to monitor changes in this high-risk population. Additionally, the study highlights the importance of measuring the hepatitis burden among FSW living with HIV, and the need of including FSW in all aspects of STI prevention, care, and treatment programs.
Collapse
Affiliation(s)
| | | | - Giseli Nogueira Damacena
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Wanessa da Silva de Almeida
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Paulo Roberto Borges de Souza-Júnior
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Célia Landmann Szwarcwald
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| |
Collapse
|
33
|
Szwarcwald CL, Damacena GN, de Souza-Júnior PRB, Guimarães MDC, de Almeida WDS, de Souza Ferreira AP, Ferreira-Júnior ODC, Dourado I. Factors associated with HIV infection among female sex workers in Brazil. Medicine (Baltimore) 2018; 97:S54-S61. [PMID: 29912814 PMCID: PMC5991538 DOI: 10.1097/md.0000000000009013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Female sex workers (FSWs) are one of the most-at-risk population groups for human immunodeficiency virus (HIV) infection. This paper aims at identifying the main predictors of HIV infection among FSW recruited in the 2nd Biological and Behavioral Surveillance Survey in 12 Brazilian cities in 2016. METHOD Data were collected on 4245 FSW recruited by respondent driven sampling (RDS). Weights were inversely proportional to participants' network sizes. To establish the correlates of HIV infection, we used logistic regression models taking into account the dependence of observations resultant from the recruitment chains. The analysis included socio-demographic sex work characteristics, sexual behavior, history of violence, alcohol and drug use, utilization of health services, and occurrence of other sexually transmitted infections (STIs). RESULTS HIV prevalence was estimated as 5.3% (4.4%-6.2%). The odds ratio (OR) of an HIV-positive recruiter choosing an HIV-positive participant was 3.9 times higher than that of an HIV-negative recruiter (P < .001). Regarding socio-demographic and sex work characteristics, low educational level, street as the main work venue, low price per sexual encounter, and longer exposure time as a sex worker were found to be associated with HIV infection, even after controlling for the homophily effect. The OR of being HIV infected among FSW who had been exposed to sexual violence at least once in a lifetime (OR = 1.5, P = .028) and the use of illicit drugs at least once a week were highly significant as well, particularly for frequent crack use (OR = 3.6, P < .001). Among the sexual behavior indicators, not using condoms in some circumstances were significantly associated with HIV infection (OR = 1.8, P = .016). Regarding the occurrence of other STI, the odds of being HIV infected was significantly higher among FSW with a reactive treponemal test for syphilis (OR = 4.6, P < .001). CONCLUSIONS The main factors associated with HIV infection identified in our study characterize a specific type of street-based sex work in Brazil and provided valuable information for developing interventions. However, there is a further need of addressing social and contextual factors, including illicit drug use, violence, exploitation, as well as stigma and discrimination, which can influence sexual behavior.
Collapse
Affiliation(s)
- Célia Landmann Szwarcwald
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro
| | - Giseli Nogueira Damacena
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro
| | - Paulo Roberto Borges de Souza-Júnior
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro
| | | | - Wanessa da Silva de Almeida
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro
| | - Arthur Pate de Souza Ferreira
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro
| | | | - Inês Dourado
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| |
Collapse
|
34
|
Szwarcwald CL, de Almeida WDS, Damacena GN, de Souza-Júnior PRB, Ferreira-Júnior ODC, Guimarães MDC. Changes in attitudes, risky practices, and HIV and syphilis prevalence among female sex workers in Brazil from 2009 to 2016. Medicine (Baltimore) 2018; 97:S46-S53. [PMID: 29893747 PMCID: PMC5991537 DOI: 10.1097/md.0000000000009227] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The present study aims at investigating the progress made toward controlling the human immunodeficiency virus (HIV)/AIDS epidemic among female sex workers (FSW) from 2009 to 2016. METHODS The baseline of respondent-driven sampling (RDS) study among FSW was carried out in 2009, in 10 Brazilian municipalities. In 2016, information on FSW were collected in 12 municipalities. The analyses took into account the dependence among observations, resulting from the recruitment chains, and the unequal probabilities of selection, resulting from the different network sizes. We analyzed changes in attitudes and risky behavior practices as well as variations in HIV and syphilis prevalence based on the comparison of 95% confidence intervals for each estimate. RESULTS Information on 2523 (2009) and 4245 (2016) FSW were analyzed. Commercial sex debut shifted to younger ages: while in 2009 the proportion of women who started sex work under 18 years old was 28.3%, in 2016 this percentage rose to 38.3%. The proportion of FSW affiliated to a nongovernmental organization (NGO) in defense of their rights (14.0%), in 2009, decreased to 7.8%, in 2016, as well as the proportion of FSW who received counseling on sexually transmitted infections (STI) in the past 6 months, from 47.5% to 24.4%. Relevant improvements were found for HIV testing in the last 12 months (from 20.3% to 39.3%). The proportions of those who were never tested for syphilis dropped from 57.9% to 48.5%. However, an opposite decreasing trend was found for the Pap smear examination in the last 12 months, decreasing from 43.6% to 31.5%. Regular condom use with clients significantly increased in the period. Regarding HIV prevalence, the 5% level was sustained and no significant differences were found, but syphilis prevalence was found to be more than 3 times higher in 2016 (8.5%) than in 2009 (2.4%). DISCUSSION Many are the challenges to be faced in attempting to reverse the upward trend of syphilis among FSW in Brazil. Despite the progress in condom distribution free of charge, it is necessary to increase awareness campaigns, emphasize the use, reaffirm STI counseling, and reiterate the need of regular syphilis screening in this key population group.
Collapse
Affiliation(s)
- Célia Landmann Szwarcwald
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation
| | - Wanessa da Silva de Almeida
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation
| | - Giseli Nogueira Damacena
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation
| | | | | | | | | |
Collapse
|
35
|
Vu L, Misra K. High Burden of HIV, Syphilis and HSV-2 and Factors Associated with HIV Infection Among Female Sex Workers in Tanzania: Implications for Early Treatment of HIV and Pre-exposure Prophylaxis (PrEP). AIDS Behav 2018; 22:1113-1121. [PMID: 29159593 DOI: 10.1007/s10461-017-1992-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This paper estimates population-based prevalence of HIV, syphilis, HSV-2 and factors influencing HIV infection using a national sample of 1914 female sex workers (FSWs) in 7 regions in Tanzania. Additionally, HIV incidence was estimated by comparing biological HIV results with self-reported HIV status. The average HIV prevalence among FSWs in all 7 regions was 28%, ranging from 14% in Tabora to 38% in Shinyanga. HIV incidence was found to be 13 per 100 person-years. Syphilis prevalence was 8% with significantly higher burden found in Iringa (11%), Mbeya (13%), and Shinyanga (12%). Nearly 60% of the study population was infected with HSV-2. The high HIV prevalence and incidence coupled with suboptimal condom use indicate an urgent need to roll out the "Treat-All" approach and provide antiretroviral therapy to FSWs living with HIV regardless of their CD4 count. In addition, antiretroviral-based prevention technologies such as oral pre-exposure prophylaxis and microbicides should be piloted and evaluated.
Collapse
|
36
|
Rocha GM, Kerr LRFS, Kendall C, Guimarães MDC. Risk behavior score: a practical approach for assessing risk among men who have sex with men in Brazil. Braz J Infect Dis 2018; 22:113-122. [PMID: 29551334 PMCID: PMC9428223 DOI: 10.1016/j.bjid.2018.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 01/01/2023] Open
Abstract
HIV/AIDS epidemic is not well controlled, and multiple sexual behavior factors help explain high rates of HIV infection among men who have sex with men (MSM). This article proposes to exam the use of a potential risk behavior score for HIV infection, based on the type and number of sexual partners, and condom use, and their associated factors in a sample of MSM in Brazil. A cross sectional RDS (Respondent Driven Sampling) study was performed among 3738 MSM aged 18+ years old from ten Brazilian cities. The risk behavior score was composed by the number of male partners and anal condom use in the last year with steady, casual, and commercial partners. Most participants were 25+ years old (58.1%), non-white (83.1%), and single (84.9%). Final weighted ordinal logistic model showed that age ≤ 25 years old (p = 0.037), homosexual or bisexual identity (p < 0.001), sexual initiation before 15-year-old (p < 0.001), having sex with men only in the last 12 months (p < 0.001), frequent alcohol and illicit drug use (p < 0.001), and use of local sites to meet sexual partners in the last month were independently associated with higher scores of risky behavior. Specific strategies should be developed aimed at the MSM population. Additionally, pre-exposed prophylaxis (Prep) should be considered for those at higher score as a strategy for reducing risk for HIV infection in this population.
Collapse
Affiliation(s)
- Gustavo Machado Rocha
- Universidade Federal de São João Del-Rei, Campus Centro Oeste Dona Lindu, Divinópolis, Minas Gerais, Brasil.
| | | | - Carl Kendall
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
| | - Mark Drew Crosland Guimarães
- Departamento de Medicina Preventiva e Social, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| |
Collapse
|
37
|
Magno L, Dourado I, da Silva LAV, Brignol S, Brito AMD, Guimarães MDC, Benzaken A, Pinho ADA, Kendall C, Kerr LRFS. Factors associated with self-reported discrimination against men who have sex with men in Brazil. Rev Saude Publica 2017; 51:102. [PMID: 29166436 PMCID: PMC5697921 DOI: 10.11606/s1518-8787.2017051000016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 10/24/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To estimate self-reported discrimination due to sexual orientation among men who have sex with men (MSM) in Brazil and to analyze associated factors. METHODS A cross-sectional study of 3,859 MSM recruited in 2008–2009 with respondent driven sampling. Data collection conducted in health centers in 10 Brazilian cities. A face-to-face questionnaire was used and rapid HIV and syphilis tests conducted. Aggregated data were weighted and adjusted odds ratio estimated to measure the association between selected factors and self-reported discrimination due to sexual orientation. RESULTS The sample was predominantly young, eight plus years of schooling, pardo (brown), single, low-income, and identified themselves as gay or homosexual. The prevalence of self-reported discrimination due to sexual orientation was 27.7% (95%CI 26.2–29.1). Discrimination was independently associated with: age < 30 years, more years of schooling, community involvement and support, history of sexual and physical violence, suicidal thoughts, and unprotected receptive anal intercourse. CONCLUSIONS The prevalence of self-reported discrimination among MSM in Brazil is high. These results challenge the assumptions that MSM-specific prevention and support programs are not required or that health professionals do not need special training to address MSM needs.
Collapse
Affiliation(s)
- Laio Magno
- Universidade do Estado da Bahia. Departamento de Ciências da Vida. Salvador, BA, Brasil.,Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil
| | - Inês Dourado
- Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil
| | - Luís Augusto V da Silva
- Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.,Universidade Federal da Bahia. Instituto de Humanidades, Artes & Ciências Professor Milton Santos. Salvador, BA, Brasil
| | - Sandra Brignol
- Universidade Federal Fluminense. Instituto de Saúde Coletiva. Niterói, RJ, Brasil
| | | | - Mark Drew Crosland Guimarães
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Medicina Preventiva e Social. Belo Horizonte, MG, Brasil
| | - Adele Benzaken
- Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de IST, Aids e Hepatites Virais. Brasília, DF, Brasil
| | - Adriana de A Pinho
- Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Carl Kendall
- Center for Global Health Equit. Tulane School of Public Health and Tropical Medicine. New Orleans, Louisiana, USA
| | | |
Collapse
|
38
|
Gomes RRDFM, Ceccato MDGB, Kerr LRFS, Guimarães MDC. [Factors associated with low knowledge on HIV/AIDS among men who have sex with men in Brazil]. CAD SAUDE PUBLICA 2017; 33:e00125515. [PMID: 29091176 DOI: 10.1590/0102-311x00125515] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/13/2016] [Indexed: 11/22/2022] Open
Abstract
This cross-sectional study analyzed social vulnerability, individual, and programmatic factors associated with low knowledge on HIV/AIDS among men who have sex with men (MSM). Respondent Driven Sampling (RDS) was used in 10 Brazilian cities. Knowledge scores on HIV/AIDS were estimated by Item Response Theory and categorized in three levels: high, medium, and low knowledge. Ordinal logistic regression was used for the analysis. Of the 3,746 MSM, 36.6%, 37.4%, and 26% showed high, medium, and low knowledge, respectively. The following were associated with low knowledge in the final model: schooling ≤ 8 years, non-white skin color, economic classes C and D-E, age < 25 years, having only one sex partner, and no previous HIV test. It is essential to improve knowledge on HIV/AIDS among young MSM with low socioeconomic status. Interventions focused on programmatic vulnerability factors can help reduce individual and social risk.
Collapse
|
39
|
Ferraz D, Paiva V. Sex, human rights and AIDS: an analysis of new technologies for HIV prevention in the Brazilian context. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 18 Suppl 1:89-103. [PMID: 26630300 DOI: 10.1590/1809-4503201500050007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 01/22/2015] [Indexed: 11/22/2022] Open
Abstract
Worldwide, HIV prevention is challenged to change because clinical trials show the protective effect of technologies such as circumcision, preexposure prophylaxis, and the suppression of viral load through antiretroviral treatment. In the face of demands for their implementation on population levels, the fear of stimulating risk compensation processes and of increasing riskier sexual practices has retarded their integration into prevention programs. In this article, following a narrative review of the literature on risk compensation using the PubMed database, we offer a critical reflection on the theme using a constructionist approach of social psychology integrated to the theoretical framework of vulnerability and human rights. The use of biomedical technologies for prevention does not consistently induce its users to the increase of riskier practices, and variations on the specificity of each method need to be carefully considered. Alternatives to the theories of sociocognitive studies, such as social constructionist approaches developed in the social sciences and humanities fields, indicate more comprehensive interpretations, valuing the notions of agency and rights. The critical analysis suggests priority actions to be taken in the implementation process: development of comprehensive programs, monitoring and fostering dialog on sexuality, and technical information. We highlight the need to implement a human rights-based approach and to prioritize dialog, stressing how complementary these technologies can be to meet different population needs. We conclude by stressing the need to prioritize sociopolitical changes to restore participation, dialog about sexuality, and emphasis on human rights such as core elements of the Brazilian AIDS policy.
Collapse
Affiliation(s)
- Dulce Ferraz
- Escola FIOCRUZ de Governo, Diretoria Regional de Brasília da Fundação Oswaldo Cruz, Brasília, DF, Brazil
| | - Vera Paiva
- Study Group for the Prevention of AIDS, Universidade de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
40
|
Dourado I, MacCarthy S, Reddy M, Calazans G, Gruskin S. Revisiting the use of condoms in Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 18 Suppl 1:63-88. [PMID: 26630299 DOI: 10.1590/1809-4503201500050006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 01/27/2015] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION It is known that a single prevention strategy is not enough to control multiple HIV epidemics around the world and in Brazil. However, it is not only necessary to recognize the importance of condoms as part of the policy of HIV/AIDS prevention but also discuss its limits. In this article, we aim to investigate the use of condoms in Brazil, draw critical reflections, and understand how they can once again be highlighted in Brazil's prevention strategy going forward. METHODS A narrative review of literature was conducted using keywords in PubMed. Reports from national surveys that guide the epidemiological and behavioral surveillance of the Brazilian Ministry of Health were also included. RESULTS A total of 40 articles and 3 reports were included in the review and 11 intervention studies to promote the condom use; the main findings were as follows: 1) Despite the increase in national studies on sexual behavior, little attention is given to the role of condom use; 2) There are few studies examining the factors associated with condom use among key populations such as men who have sex with men (MSM), female sex workers (FSW), drug users (DU), and transvestites and transexuals (TT), while substantial studies focus on adolescents and women; 3) Evidence suggests that a combination of interventions is more effective. DISCUSSION new prevention technologies must not lose sight of the critical importance of condoms, and efforts to reintroduce them should focus on the role of pleasure in addition to their potential to minimize the risk of HIV.
Collapse
Affiliation(s)
- Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Sarah MacCarthy
- Program on Global Health and Human Rights, University of Southern California, Los Angeles, CA, USA
| | - Manasa Reddy
- Program on Global Health and Human Rights, University of Southern California, Los Angeles, CA, USA
| | - Gabriela Calazans
- School of Medical Sciences, Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Sofia Gruskin
- Program on Global Health and Human Rights, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
41
|
Scheim AI, Bauer GR, Shokoohi M. Drug use among transgender people in Ontario, Canada: Disparities and associations with social exclusion. Addict Behav 2017; 72:151-158. [PMID: 28411424 DOI: 10.1016/j.addbeh.2017.03.022] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 03/16/2017] [Accepted: 03/29/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION We identified the prevalence and correlates of past-year illicit drug use among transgender people in Ontario, Canada, and disparities with the age-standardized non-transgender population. METHODS Data on transgender persons aged 16+ (n=406) were obtained from Trans PULSE, a respondent-driven sampling (RDS) survey (2009-2010). Overall and sex-specific estimates of past-year drug use (cocaine and amphetamines, based on data availability) in the reference population were obtained from Ontario residents aged 16+ (n=39, 980) in the Canadian Community Health Survey (2009-2010), and standardized to the overall and gender-specific transgender age distributions. For regression analyses with Trans PULSE data, past-year drug use included drug types associated with high risk of physical, psychological, and social harm to the user, and RDS-II weights were applied to frequencies and prevalence ratios (PR) derived from blockwise logistic regression models. RESULTS An estimated 12.3% (95% CI: 7.7, 17.0) of transgender Ontarians had used at least one of the specified drugs in the past year, with no significant difference by gender identity. Transgender Ontarians were more likely to use both cocaine (standardized prevalence difference; SPD=6.8%; 95% CI=1.6, 10.9) and amphetamines (SPD=SPD=1.3%, 95% CI=0.2, 3.1) as compared to the age-standardized non-transgender population. History of transphobic assault, homelessness or underhousing, and sex work were associated with greater drug use among transgender persons. CONCLUSIONS The prevalence of cocaine and amphetamine use among transgender people in Ontario, Canada was higher than in the age-standardized reference population. Social exclusion predicted within-group variation in drug use among transgender persons.
Collapse
Affiliation(s)
- Ayden I Scheim
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, K201 Kresge Building, London, ON N6A 5C1, Canada.
| | - Greta R Bauer
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, K201 Kresge Building, London, ON N6A 5C1, Canada
| | - Mostafa Shokoohi
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, K201 Kresge Building, London, ON N6A 5C1, Canada
| |
Collapse
|
42
|
Spiller MW, Gile KJ, Handcock MS, Mar CM, Wejnert C. Evaluating Variance Estimators for Respondent-Driven Sampling. JOURNAL OF SURVEY STATISTICS AND METHODOLOGY 2017; 2017:smx018. [PMID: 29376083 PMCID: PMC5784213 DOI: 10.1093/jssam/smx018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Michael W. Spiller
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-46, Atlanta, GA
| | - Krista J. Gile
- Department of Mathematics and Statistics, University of Massachusetts, Amherst. Lederle Graduate Research Tower, Box 34515, University of Massachusetts, Amherst, Amherst, MA 01003
| | - Mark S. Handcock
- Department of Statistics, University of California Los Angeles. University of California - Los Angeles Department of Statistics 8125 Mathematical Sciences Building Los Angeles, CA 90095
| | - Corinne M. Mar
- Center for Studies in Demography and Ecology, University of Washington. Raitt Hall 218C, Box 353412, Seattle, WA 98195
| | - Cyprian Wejnert
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-46, Atlanta, GA
| |
Collapse
|
43
|
Selvaraj V, Boopathi K, Paranjape R, Mehendale S. A single weighting approach to analyze respondent-driven sampling data. Indian J Med Res 2017; 144:447-459. [PMID: 28139544 PMCID: PMC5320851 DOI: 10.4103/0971-5916.198665] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and objectives: Respondent-driven sampling (RDS) is widely used to sample hidden populations and RDS data are analyzed using specially designed RDS analysis tool (RDSAT). RDSAT estimates parameters such as proportions. Analysis with RDSAT requires separate weight assignment for individual variables even in a single individual; hence, regression analysis is a problem. RDS-analyst is another advanced software that can perform three methods of estimates, namely, successive sampling method, RDS I and RDS II. All of these are in the process of refinement and need special skill to perform analysis. We propose a simple approach to analyze RDS data for comprehensive statistical analysis using any standard statistical software. Methods: We proposed an approach (RDS-MOD - respondent driven sampling-modified) that determines a single normalized weight (similar to RDS II of Volz-Heckathorn) for each participant. This approach converts the RDS data into clustered data to account the pre-existing relationship between recruits and the recruiters. Further, Taylor's linearization method was proposed for calculating confidence intervals for the estimates. Generalized estimating equation approach was used for regression analysis and parameter estimates of different software were compared. Results: The parameter estimates such as proportions obtained by our approach were matched with those from currently available special software for RDS data. Interpretation & conclusions: The proposed weight was comparable to different weights generated by RDSAT. The estimates were comparable to that by RDS II approach. RDS-MOD provided an efficient and easy-to-use method of estimation and regression accounting inter-individual recruits’ dependence.
Collapse
Affiliation(s)
- Vadivoo Selvaraj
- National Institute of Epidemiology, Indian Council of Medical Research, TNHB, Ayapakkam, Chennai, India
| | - Kangusamy Boopathi
- National Institute of Epidemiology, Indian Council of Medical Research, TNHB, Ayapakkam, Chennai, India
| | | | - Sanjay Mehendale
- National Institute of Epidemiology, Indian Council of Medical Research, TNHB, Ayapakkam, Chennai, India
| |
Collapse
|
44
|
Lima FSDS, Merchán-Hamann E, Urdaneta M, Damacena GN, Szwarcwald CL. Factors associated with violence against female sex workers in ten Brazilian cities. CAD SAUDE PUBLICA 2017; 33:e00157815. [PMID: 28380126 DOI: 10.1590/0102-311x00157815] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 05/02/2016] [Indexed: 08/19/2023] Open
Abstract
Few studies in Brazil have focused on violence against female sex workers, a theme that has attracted researchers' attention worldwide, especially due to possible associations with HIV. The current study aims to estimate the prevalence of violence against female sex workers according to type and perpetrator and to identify associated factors. A cross-sectional study was conducted with data on 2,523 female sex workers from ten Brazilian cities, and with the respondent-driven sampling (RDS). Prevalence of verbal violence was 59.5%, physical violence 38.1%, sexual violence 37.8%, intimate partner physical violence 25.2%, and violence by clients 11.7%. Factors associated with physical violence were age < 30 years (aOR = 2.27; 95%CI: 1.56-3.29), drug use (aOR = 2.02; 95%CI: 1.54-2.65), and price of trick ≤ BRL 29.00 or USD 9.00 (aOR = 1.51; 95%CI: 1.07-2.13). In conclusion, Brazilian female sex workers suffer a disproportional burden of violence. The identification of vulnerability factors is essential for interventions to safeguard human rights and control HIV.
Collapse
Affiliation(s)
| | | | - Margarita Urdaneta
- Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, Brasil
| | - Giseli Nogueira Damacena
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Célia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| |
Collapse
|
45
|
Grinsztejn B, Jalil EM, Monteiro L, Velasque L, Moreira RI, Garcia ACF, Castro CV, Krüger A, Luz PM, Liu AY, McFarland W, Buchbinder S, Veloso VG, Wilson EC. Unveiling of HIV dynamics among transgender women: a respondent-driven sampling study in Rio de Janeiro, Brazil. Lancet HIV 2017; 4:e169-e176. [PMID: 28188030 DOI: 10.1016/s2352-3018(17)30015-2] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/28/2016] [Accepted: 11/29/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND The burden of HIV in transgender women (transwomen) in Brazil remains unknown. We aimed to estimate HIV prevalence among transwomen in Rio de Janeiro and to identify predictors of newly diagnosed HIV infections. METHODS We recruited transwomen from Rio de Janeiro, Brazil, by respondent-driven sampling. Eligibility criteria were self-identification as transwomen, being 18 years of age or older, living in Rio de Janeiro or its metropolitan area, and having a valid peer recruitment coupon. We recruited 12 seed participants from social movements and formative focus groups who then used peer recruitment coupons to refer subsequent peers to the study. We categorised participants as HIV negative, known HIV infected, or newly diagnosed as HIV infected. We assessed predictors of newly diagnosed HIV infections by comparing newly diagnosed with HIV-negative participants. We derived population estimates with the Respondent-Driven Sampling II estimator. FINDINGS Between Aug 1, 2015, and Jan 29, 2016, we enrolled 345 eligible transwomen. 29·1% (95% CI 23·2-35·4) of participants had no previous HIV testing (adjusted from 60 participants), 31·2% (18·8-43·6) had HIV infections (adjusted from 141 participants), and 7·0% (0·0-15·9) were newly diagnosed as HIV infected (adjusted from 40 participants). We diagnosed syphilis in 28·9% (18·0-39·8) of participants, rectal chlamydia in 14·6% (5·4-23·8), and gonorrhoea in 13·5% (3·2-23·8). Newly diagnosed HIV infections were associated with black race (odds ratio 22·8 [95% CI 2·9-178·9]; p=0·003), travesti (34·1 [5·8-200·2]; p=0·0001) or transsexual woman (41·3 [6·3-271·2]; p=0·0001) gender identity, history of sex work (30·7 [3·5-267·3]; p=0·002), and history of sniffing cocaine (4·4 [1·4-14·1]; p=0·01). INTERPRETATION Our results suggest that transwomen bear the largest burden of HIV among any population at risk in Brazil. The high proportion of HIV diagnosis among young participants points to the need for tailored long-term health-care and prevention services to curb the HIV epidemic and improve the quality of life of transwomen in Brazil. FUNDING Brazilian Research Council, National Institute of Allergy and Infectious Diseases, Brazilian Sexually Transmitted Disease/AIDS, and Viral Hepatitis Department of the Brazilian Ministry of Health.
Collapse
Affiliation(s)
- Beatriz Grinsztejn
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
| | - Emilia M Jalil
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Laylla Monteiro
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Luciane Velasque
- Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ronaldo I Moreira
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ana Cristina F Garcia
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Cristiane V Castro
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Alícia Krüger
- Department of Surveillance, Prevention and Control of Sexually Transmitted Diseases, Aids and Viral Hepatitis, Brazilian Ministry of Health, Brazil
| | - Paula M Luz
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Albert Y Liu
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Willi McFarland
- Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Susan Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA; Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Valdilea G Veloso
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Erin C Wilson
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
| | | |
Collapse
|
46
|
Makarenko I, Ompad DC, Sazonova Y, Saliuk T, DeHovitz J, Gensburg L. Trends in Injection Risk Behaviors among People Who Inject Drugs and the Impact of Harm Reduction Programs in Ukraine, 2007-2013. J Urban Health 2017; 94:104-114. [PMID: 28097615 PMCID: PMC5359175 DOI: 10.1007/s11524-016-0119-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The study examined trends in injection risk behaviors among people who inject drugs (PWIDs) and assessed the impact of harm reduction programs in Ukraine during 2007-2013. We performed a secondary analysis of the data collected in serial cross-sectional bio-behavioral surveillance surveys administered with PWIDs in Ukraine in 2007, 2008, 2011, and 2013. Using data from 14 Ukrainian cities, we assessed short-term trends in injection risk behaviors with the Cochran-Armitage test for trend and multivariable logistic regression models, adjusted for age, sex, region, marital status, education level, occupation, age at injection drug use initiation, experience of overdose, and self-reported HIV status. The overall test for trend indicated a statistically significant decrease over time for sharing needle/syringe during the last injection (p < 0.0001), sharing needle/syringe at least once in the last 30 days (p < 0.0001), and using a common container for drug preparation (p < 0.0001). The prevalence of injecting drugs from pre-loaded syringes was high (61.0%) and did not change over the study period. After adjusting for all significant confounders and comparing to 2007, the prevalence of sharing needle/syringe during the last injection was unchanged in 2008 (OR = 1.06, 95% CI = 0.92, 1.21), and declined in 2011 (OR = 0.18, 95% CI = 0.15, 0.22) and 2013 (OR = 0.17, 95% CI = 0.14, 0.21). Sharing needles/syringes in the last 30 days significantly decreased when compared to that in 2007 (2008: OR = 0.81, 95% CI = 0.74, 0.89; 2011: OR = 0.43, 95% CI = 0.38, 0.47; and 2013: OR = 0.31, 95% CI = 0.27, 0.35). The prevalence of using common instruments for drug preparation also decreased compared to that in 2007 (2008: OR = 0.88, 95% CI = 0.85, 0.91; 2011: OR = 0.85, 95% CI = 0.85, 0.90; and 2013: OR = 0.74, 95% CI = 0.71, 0.76). The observed reduction in the prevalence of injection risk behavior over time is encouraging. Our findings suggest that prevention programs in Ukraine have positive impact and provide support for governmental expansion of these programs.
Collapse
Affiliation(s)
- Iuliia Makarenko
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Albany, NY, USA. .,New York State International Training and Research Program, State University of New York - Downstate, Brooklyn, NY, USA.
| | - D C Ompad
- College of Global Public Health, New York University, New York, NY, USA.,Center for Drug Use and HIV Research, Rory Meyer College of Nursing, New York University, New York, NY, USA.,Center for Health, Identity, Behavior, and Prevention Studies, New York University, New York, NY, USA
| | - Y Sazonova
- ICF "Alliance for Public Health", Kyiv, Ukraine
| | - T Saliuk
- ICF "Alliance for Public Health", Kyiv, Ukraine
| | - J DeHovitz
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Albany, NY, USA.,New York State International Training and Research Program, State University of New York - Downstate, Brooklyn, NY, USA
| | - L Gensburg
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Albany, NY, USA
| |
Collapse
|
47
|
Dourado I, Silva LAVD, Magno L, Lopes M, Cerqueira C, Prates A, Brignol S, MacCarthy S. [Building bridges: interdisciplinarity in practice. PopTrans Study: a study with transvestites and transsexual women in Salvador, Bahia State, Brazil]. CAD SAUDE PUBLICA 2016; 32:e00180415. [PMID: 27759798 DOI: 10.1590/0102-311x00181415] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 07/08/2016] [Indexed: 11/22/2022] Open
Abstract
Trans persons, including transvestites and transsexual women, show disproportionately high HIV/AIDS rates when compared to the rest of the population. However, few quantitative/qualitative studies have addressed trans persons in Brazil. Thus, a team of researchers from different fields is developing an interdisciplinary research project with the objective of shedding light on living conditions and ways of life among transvestites and transsexual women, while investigating determinant factors for HIV infection, syphilis, and hepatitis B and C. The article is intended to describe the experience with the implementation and development of an ethno-epidemiological study in Salvador, Bahia State, Brazil. Mapping the population began with a formative survey that was crucial for orienting the epidemiological survey. The production of ethno-epidemiological data posed a daily challenge for the researchers, triggering a series of reflections on the limits of our concepts and categories for translating the diversity of study participants' practices and experiences.
Collapse
Affiliation(s)
- Ines Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | - Luís Augusto V da Silva
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil.,Instituto de Humanidades, Artes e Ciências, Universidade Federal da Bahia, Salvador, Brasil
| | - Laio Magno
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil.,Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Brasil
| | - Maycon Lopes
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | - Caio Cerqueira
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | - Adriana Prates
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | - Sandra Brignol
- Instituto de Saúde Coletiva, Universidade Federal Fluminense, Niterói, Brasil
| | | |
Collapse
|
48
|
Scheim AI, Bauer GR, Shokoohi M. Heavy episodic drinking among transgender persons: Disparities and predictors. Drug Alcohol Depend 2016; 167:156-62. [PMID: 27542688 DOI: 10.1016/j.drugalcdep.2016.08.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 08/06/2016] [Accepted: 08/07/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Drawing on a survey of transgender people in Canada's most populous province, we estimate the frequency of heavy episodic drinking (HED), compare HED prevalence to the age-standardized background population, and examine associations with socio-demographics, gender transition, and social exclusion. METHODS 433 transgender persons aged 16+ completed a respondent-driven sampling survey in 2009-2010. Analyses were weighted using RDS II methods, including frequencies and prevalence ratios. Overall and sex-specific estimates of HED among Ontario residents in the 2009-2010 Canadian Community Health Survey (n=39,980) were standardized to the overall and gender-specific transgender age distributions. RESULTS Estimated prevalence of HED at least monthly among transgender Ontarians was 33.2% (95% CI: 26.3, 40.1), 1.5 times greater than expected based on the age-standardized Ontario population. Transmasculine (female-to-male spectrum) persons were more likely than transfeminine persons to report HED (42.2% versus 22.7%), an effect robust to covariate adjustment. Current sex work was associated with greater HED, but gender transition and social exclusion factors were not. CONCLUSION Gendered pathways to alcohol misuse, particularly among transmasculine persons, warrant further research and intervention development.
Collapse
Affiliation(s)
- Ayden I Scheim
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, K201 Kresge Building, ON N6A 5C1, London, Ontario, Canada.
| | - Greta R Bauer
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, K201 Kresge Building, ON N6A 5C1, London, Ontario, Canada.
| | - Mostafa Shokoohi
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, K201 Kresge Building, ON N6A 5C1, London, Ontario, Canada.
| |
Collapse
|
49
|
Johnston LG, Hakim AJ, Dittrich S, Burnett J, Kim E, White RG. A Systematic Review of Published Respondent-Driven Sampling Surveys Collecting Behavioral and Biologic Data. AIDS Behav 2016; 20:1754-76. [PMID: 26992395 PMCID: PMC6620785 DOI: 10.1007/s10461-016-1346-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Reporting key details of respondent-driven sampling (RDS) survey implementation and analysis is essential for assessing the quality of RDS surveys. RDS is both a recruitment and analytic method and, as such, it is important to adequately describe both aspects in publications. We extracted data from peer-reviewed literature published through September, 2013 that reported collected biological specimens using RDS. We identified 151 eligible peer-reviewed articles describing 222 surveys conducted in seven regions throughout the world. Most published surveys reported basic implementation information such as survey city, country, year, population sampled, interview method, and final sample size. However, many surveys did not report essential methodological and analytical information for assessing RDS survey quality, including number of recruitment sites, seeds at start and end, maximum number of waves, and whether data were adjusted for network size. Understanding the quality of data collection and analysis in RDS is useful for effectively planning public health service delivery and funding priorities.
Collapse
Affiliation(s)
- Lisa G Johnston
- University of California, San Francisco, Global Health Sciences, San Francisco, CA, USA.
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
| | - Avi J Hakim
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Samantha Dittrich
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Janet Burnett
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Evelyn Kim
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Richard G White
- CMMID and Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
50
|
Meyer SR, Decker MR, Tol WA, Abshir N, Mar AA, Robinson WC. Workplace and security stressors and mental health among migrant workers on the Thailand-Myanmar border. Soc Psychiatry Psychiatr Epidemiol 2016; 51:713-23. [PMID: 26661796 DOI: 10.1007/s00127-015-1162-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 11/29/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Migrant workers in low-resource settings may experience multiple types of workplace and security-related stressors. This study explores the relationship between these stressors and adverse mental health outcomes, through a study of migrant workers from Myanmar, working in agriculture, factory, and sex industries in and around Mae Sot, Thailand. METHODS Respondent-driven sampling was used to recruit a total sample of 589 male and female migrants. Trained data collectors administered a survey, which included measures of workplace and security-related stressors, and depression and anxiety symptoms. Multivariate regression models were conducted separately for depression and anxiety symptoms. RESULTS For male agricultural workers, security stressors (β = 1.9, p = .001) are associated with an increase in depression symptoms and coercive working conditions are associated with an increase in anxiety symptoms (β = .8, p = .000). For female agricultural workers, daily hassles and stressors were associated with both depression (β = 1.5, p = .000) and anxiety (β = .5, p = .027), and barriers to exit (β = 3.0, p = .005) and security stressors (β = .9, p = .010) were significantly associated with increased depression symptoms. In the factory subsample, sexual assault and abuse (depression: β = 2.7, p = .009; anxiety: β = 2.8, p = .002) and daily hassles and stressors (depression: β = .7, p = .007; anxiety: β = .7, p = .001) were both significantly associated with increased depression and anxiety symptoms for males. Other categories of stressors similarly showed different associations with mental health outcomes between occupational groups, and between male and female migrant workers. CONCLUSION The differing influences of stressors on mental health between the three occupational groups, and between males and females, indicate the need for targeted and tailored approaches to reduce specific stressors and improve services to address mental health needs. Prevention and response need to recognize the differences in working conditions, vulnerabilities, and needs between occupational groups, and between male and female migrant workers.
Collapse
Affiliation(s)
- Sarah R Meyer
- Program on Forced Migration and Health, Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins School of Public Health, Baltimore, MD, USA.,Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Wietse A Tol
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, USA.,Peter C Alderman Foundation, Kampala, Uganda
| | | | | | - W Courtland Robinson
- Department of Population, Family and Reproductive Health, Johns Hopkins School of Public Health, Baltimore, MD, USA.,Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| |
Collapse
|