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Kennedy CE, Yeh PT, Verster A, Luhmann N, Konath NM, de Mello MB, Baggaley R, Macdonald V. Counselling behavioural interventions for HIV, STI and viral hepatitis among key populations: a systematic review of effectiveness, values and preferences, and cost studies. J Int AIDS Soc 2023; 26:e26085. [PMID: 37221978 PMCID: PMC10206411 DOI: 10.1002/jia2.26085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 04/14/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION Key populations (sex workers, men who have sex with men, people who inject drugs, people in prisons and other closed settings, and trans and gender diverse individuals) are disproportionately affected by HIV, sexually transmitted infections (STIs) and viral hepatitis (VH). Counselling behavioural interventions are widely used, but their impact on HIV/STI/VH acquisition is unclear. METHODS To inform World Health Organization guidelines, we conducted a systematic review and meta-analysis of effectiveness, values and preferences, and cost studies about counselling behavioural interventions with key populations. We searched CINAHL, PsycINFO, PubMed and EMBASE for studies published between January 2010 and December 2022; screened abstracts; and extracted data in duplicate. The effectiveness review included randomized controlled trials (RCTs) with HIV/STI/VH incidence outcomes; secondary review outcomes of unprotected sex, needle/syringe sharing and mortality were captured if studies also included primary review outcomes. We assessed the risk of bias using the Cochrane Collaboration tool, generated pooled risk ratios through random effects meta-analysis and summarized findings in GRADE evidence profiles. Values and preferences and cost data were summarized descriptively. RESULTS We identified nine effectiveness, two values and preferences, and two cost articles. Meta-analysis of six RCTs showed no statistically significant effect of counselling behavioural interventions on HIV incidence (1280 participants; combined risk ratio [RR]: 0.70, 95% confidence interval [CI]: 0.41-1.20) or STI incidence (3783 participants; RR: 0.99; 95% CI: 0.74-1.31). One RCT with 139 participants showed possible effects on hepatitis C virus incidence. There was no effect on secondary review outcomes of unprotected (condomless) sex (seven RCTs; 1811 participants; RR: 0.82, 95% CI: 0.66-1.02) and needle/syringe sharing (two RCTs; 564 participants; RR 0.72; 95% CI: 0.32-1.63). There was moderate certainty in the lack of effect across outcomes. Two values and preferences studies found that participants liked specific counselling behavioural interventions. Two cost studies found reasonable intervention costs. DISCUSSION Evidence was limited and mostly on HIV, but showed no effect of counselling behavioural interventions on HIV/VH/STI incidence among key populations. CONCLUSIONS While there may be other benefits, the choice to provide counselling behavioural interventions for key populations should be made with an understanding of the potential limitations on incidence outcomes.
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Affiliation(s)
- Caitlin E. Kennedy
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Ping Teresa Yeh
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Annette Verster
- Department of Global HIVHepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Niklas Luhmann
- Department of Global HIVHepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | | | - Maeve Brito de Mello
- Department of Global HIVHepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Rachel Baggaley
- Department of Global HIVHepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Virginia Macdonald
- Department of Global HIVHepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
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Fu R, Hou J, Gu Y, Yu NX. Do Couple-Based Interventions Show Larger Effects in Promoting HIV Preventive Behaviors than Individualized Interventions in Couples? A Systematic Review and Meta-analysis of 11 Randomized Controlled Trials. AIDS Behav 2023; 27:314-334. [PMID: 35838860 DOI: 10.1007/s10461-022-03768-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 01/24/2023]
Abstract
This systematic review and meta-analysis aims to compare the effects of couple-based prevention interventions against individual-level interventions on HIV prevention in randomized controlled trials (RCTs), identify potential moderators, and assess study quality. Eleven RCTs were included, comprising 3933 couples in the intervention group and 7125 individuals in the individual control group, predominantly in heterosexual couples from the USA and Africa. Couple-based interventions had a more significant effect in promoting condom use and HIV testing. Education levels of high school or above, residence in low- and middle-income countries, and intervention design incorporating HIV counseling and testing were associated with higher odds of condom use. The quality assessment analysis identified methodological and theoretical heterogeneity factors. Evidence of couple-based HIV prevention RCTs among men who have sex with men, injecting drug users, sex workers, and transgender women warrant further investigation. Recommendations are made to improve the quality and replicability of future intervention studies.
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Affiliation(s)
- Rong Fu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, People's Republic of China
| | - Jianhua Hou
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, People's Republic of China
| | - Yuzhou Gu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, People's Republic of China
| | - Nancy Xiaonan Yu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, People's Republic of China.
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Li X, Sullivan P, Broz D, Handanagic S. Association Between Dual Partnership and Sexual and Injecting Behaviors Among Persons Who Inject Drugs in 23 US Cities, 2018. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2667-2678. [PMID: 35704143 DOI: 10.1007/s10508-022-02323-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 02/22/2022] [Accepted: 03/04/2022] [Indexed: 06/15/2023]
Abstract
Persons who inject drugs (PWID) engaging in receptive syringe sharing with their sex partner (dual partnership) may have different behavior patterns than people who have only sex or syringe sharing partnerships. PWID from 23 US cities were recruited for the National HIV Behavioral Surveillance in 2018 using respondent-driven sampling, interviewed, and tested for HIV. Log-linked Poisson regression was conducted to examine the associations between injecting and sexual behaviors and dual partnership. A total of 3435 PWID reported receptive syringe sharing and 42% engaged in dual partnership with their last sharing injecting partner. PWID who reported condomless vaginal or anal sex at last sex were more likely to engage in dual partnership (aPR = 1.85, 95% CI = 1.65-2.08). PWID who reported having two or more sex partners (aPR = 0.67, 95% CI = 0.62-0.72) or two or more sharing injecting partners (aPR = 0.54, 95% CI = 0.50-0.59) were less likely to engage in dual partnership. Findings suggest opportunities for tailored prevention intervention, including couple-based HIV testing, pre-exposure prophylaxis, and access to syringe services programs coupled with safer injection education to help reduce HIV risk.
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Affiliation(s)
- Xinyi Li
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS US8-4, Atlanta, GA, 30329, USA.
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA.
| | - Patrick Sullivan
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Dita Broz
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS US8-4, Atlanta, GA, 30329, USA
| | - Senad Handanagic
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS US8-4, Atlanta, GA, 30329, USA
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4
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Gollub EL, Beauvais S, Roye C. College-attending young men's sexual and reproductive health knowledge, attitudes and practices. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:706-716. [PMID: 32432978 DOI: 10.1080/07448481.2020.1762609] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 03/10/2020] [Accepted: 04/26/2020] [Indexed: 06/11/2023]
Abstract
ObjectiveMale involvement in contraceptive practice remains low. Family planning and pediatric health associations have recommended an emphasis on long-acting reversible contraceptives (LARC) in clinical counseling with adolescents and young adults, raising concerns about the resulting adverse impact on sexually transmitted infection (STI) rates. Participants: College-attending men responded to an internet based questionnaire (n=31) and a phone-based qualitative interview (n=25). Methods: Our survey solicited attitudes toward and knowledge of contraceptive methods and assessed communication practices with sexual partners regarding use of contraception and disease prevention. Results: Knowledge about female methods of contraception was low, with a comparatively high level of knowledge about Plan B. Parents and health care providers were cited as the most helpful sources of information. Conversations about protection with sexual partners were reported by most men, due mainly to fear of unplanned pregnancy, not STI. Conclusion: Addressing couple communication and dual protection among college-attending men needs greater emphasis.
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Affiliation(s)
- Erica L Gollub
- Health Science Program, Pace University College of Health Professions, Pleasantville, New York, USA
| | - Shirley Beauvais
- Lienhard School of Nursing, Pace University College of Health Professions, Pleasantville, New York, USA
| | - Carol Roye
- Lienhard School of Nursing, Pace University College of Health Professions, Pleasantville, New York, USA
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Zaneva M, Philpott A, Singh A, Larsson G, Gonsalves L. What is the added value of incorporating pleasure in sexual health interventions? A systematic review and meta-analysis. PLoS One 2022; 17:e0261034. [PMID: 35148319 PMCID: PMC8836333 DOI: 10.1371/journal.pone.0261034] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/21/2021] [Indexed: 01/14/2023] Open
Abstract
Despite billions of dollars invested into Sexual and Reproductive Health and Rights (SRHR) efforts, the effect of incorporating sexual pleasure, a key driver of why people have sex, in sexual health interventions is currently unclear. We carried out a systematic review and meta-analysis following PRISMA guidelines across 7 databases for relevant articles published between 1 January 2005-1 June, 2020. We included 33 unique interventions in our systematic review. Eight interventions reporting condom use outcomes were meta-analyzed together with a method random effects model. Quality appraisal was carried out through the Cochrane Collaborations' RoB2 tool. This study was pre-registered on Prospero (ID: CRD42020201822). We identified 33 unique interventions (18886 participants at baseline) that incorporate pleasure. All included interventions targeted HIV/STI risk reduction, none occurred in the context of pregnancy prevention or family planning. We find that the majority of interventions targeted populations that authors classified as high-risk. We were able to meta-analyze 8 studies (6634 participants at baseline) reporting condom use as an outcome and found an overall moderate, positive, and significant effect of Cohen's d = 0·37 (95% CI 0·20-0·54, p < 0·001; I2 = 48%; τ2 = 0·043, p = 0·06). Incorporating sexual pleasure within SRHR interventions can improve sexual health outcomes. Our meta-analysis provides evidence about the positive impact of pleasure-incorporating interventions on condom use which has direct implications for reductions in HIV and STIs. Qualitatively, we find evidence that pleasure can have positive effects across different informational and knowledge-based attitudes as well. Future work is needed to further elucidate the impacts of pleasure within SRHR and across different outcomes and populations. Taking all the available evidence into account, we recommend that agencies responsible for sexual and reproductive health consider incorporating sexual pleasure considerations within their programming.
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Affiliation(s)
| | | | | | | | - Lianne Gonsalves
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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6
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Expanding the continuum of substance use disorder treatment: Nonabstinence approaches. Clin Psychol Rev 2022; 91:102110. [PMID: 34864497 PMCID: PMC8815796 DOI: 10.1016/j.cpr.2021.102110] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 02/04/2023]
Abstract
Only a small minority of people with substance use disorders (SUDs) receive treatment. A focus on abstinence is pervasive in SUD treatment, defining success in both research and practice, and punitive measures are often imposed on those who do not abstain. Most adults with SUD do not seek treatment because they do not wish to stop using substances, though many also recognize a need for help. This narrative review considers the need for increased research attention on nonabstinence psychosocial treatment of SUD - especially drug use disorders - as a potential way to engage and retain more people in treatment, to engage people in treatment earlier, and to improve treatment effectiveness. We describe the development of nonabstinence approaches within the historical context of SUD treatment in the United States, review theoretical and empirical rationales for nonabstinence SUD treatment, and review existing models of nonabstinence psychosocial treatment for SUD among adults to identify gaps in the literature and directions for future research. Despite significant empirical support for nonabstinence alcohol interventions, there is a clear gap in research examining nonabstinence psychosocial treatment for drug use disorders. Future research must test the effectiveness of nonabstinence treatments for drug use and address barriers to implementation.
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Bond KT, Chandler R, Chapman-Lambert C, Jemmott LS, Lanier Y, Cao J, Nikpour J, Randolph SD. Applying a Nursing Perspective to Address the Challenges Experienced by Cisgender Women in the HIV Status Neutral Care Continuum: A Review of the Literature. J Assoc Nurses AIDS Care 2021; 32:283-305. [PMID: 33929979 PMCID: PMC10688540 DOI: 10.1097/jnc.0000000000000243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The field of HIV research has grown over the past 40 years, but there remains an urgent need to address challenges that cisgender women living in the United States experience in the HIV neutral status care continuum, particularly among women such as Black women, who continue to be disproportionately burdened by HIV due to multiple levels of systemic oppression. We used a social ecological framework to provide a detailed review of the risk factors that drive the women's HIV epidemic. By presenting examples of effective approaches, best clinical practices, and identifying existing research gaps in three major categories (behavioral, biomedical, and structural), we provide an overview of the current state of research on HIV prevention among women. To illustrate a nursing viewpoint and take into account the diverse life experiences of women, we provide guidance to strengthen current HIV prevention programs. Future research should examine combined approaches for HIV prevention, and policies should be tailored to ensure that women receive effective services that are evidence-based and which they perceive as important to their lives.
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Affiliation(s)
- Keosha T Bond
- Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Rasheeta Chandler, PhD, RN, FNP-BC, FAANP, FAAN, is an Assistant Professor, School of Nursing, Emory University, Atlanta, Georgia, USA. Crystal Chapman-Lambert, PhD, CRNP, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Loretta Sweet Jemmott, PhD, RN, is Vice President, Health and Health Equity, and Professor, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA. Yzette Lanier, PhD, is an Assistant Professor, School of Nursing, New York University, New York, New York, USA. Jiepin Cao, MS, RN, is a Graduate Student, School of Nursing, Duke University, Durham, North Carolina, USA. Jacqueline Nikpour, BSN, RN, is a Graduate Student, School of Nursing, Duke University, Durham, North Carolina, USA. Schenita D. Randolph, PhD, MPH, RN, CNE, is an Assistant Professor, School of Nursing, and Co-director, Community Engagement Core, Duke Center for Research to Advance Healthcare Equity (REACH Equity), Duke University, Durham, North Carolina, USA
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8
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Use of a Novel Couples' Verification Tool in a Male Partner Treatment Study of Women With Recurrent Bacterial Vaginosis. Sex Transm Dis 2021; 47:e58-e61. [PMID: 32590410 DOI: 10.1097/olq.0000000000001225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Verification of relationship status beyond self-report is an important aspect in sexually transmitted infection research, including partner treatment studies where primary sexual partners are targeted for enrollment. This exploratory study describes the use of a novel couples' verification tool in a male partner treatment study of women with recurrent bacterial vaginosis.
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Lookatch SJ, Wimberly AS, McKay JR. Effects of Social Support and 12-Step Involvement on Recovery among People in Continuing Care for Cocaine Dependence. Subst Use Misuse 2019; 54:2144-2155. [PMID: 31322037 PMCID: PMC6803054 DOI: 10.1080/10826084.2019.1638406] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Social networks that support recovery lead to enhanced treatment outcomes and sobriety regardless if this support stems from family, peer groups or 12-Step programs. Treatment process factors including readiness to change and commitment to abstinence also impact substance use. However, little is understood about the relationship between social support to treatment process factors during and after treatment for substance use disorders. Objectives: To identify the ways in which different social networks foster substance use change in a sample of individuals with cocaine dependence from intensive outpatient programs (IOPs). Methods: Data were drawn from two studies examining adults (N = 489) with cocaine dependence in IOPs for substance use disorders collected between 2004 and 2009. Assessment data were collected at 3- to 6-month intervals from baseline to 24-months and included the University of Rhode Island change assessment questionnaire, timeline followback, thoughts about abstinence, perceived social support - friend, and family versions and analyzed using GEE and mediational analyses. Results: Greater perceived friend social support was associated with greater readiness to change whereas greater perceived familial social support was associated with substance use goal; greater social support from both friends and family were associated with less substance use. Greater AA/NA participation was associated with substance use goal and readiness to change, and less substance use. Substance use goals partially mediated the impact of social support on later substance use. Conclusions/Importance: While peer and familial support are key to sustained recovery, their impact differentially affects treatment process variables. This information could be used to inform social support treatment interventions.
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Affiliation(s)
- Samantha J Lookatch
- Veterans Integrated Service Network 4, Mental Illness Research, Education and Clinical Center Michael J. Crescenz VA Medical Center , Philadelphia , PA , USA
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
| | - Alexandra S Wimberly
- UM School of Social Work, University of Maryland, Baltimore , Baltimore , MA , USA
| | - James R McKay
- Veterans Integrated Service Network 4, Mental Illness Research, Education and Clinical Center Michael J. Crescenz VA Medical Center , Philadelphia , PA , USA
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
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10
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El-Bassel N, Gilbert L, Goddard-Eckrich D, Chang M, Wu E, Goodwin S, Tibbetts R, Almonte-Weston M, Hunt T. Effectiveness of a Couple-Based HIV and Sexually Transmitted Infection Prevention Intervention for Men in Community Supervision Programs and Their Female Sexual Partners: A Randomized Clinical Trial. JAMA Netw Open 2019; 2:e191139. [PMID: 30924895 PMCID: PMC6450427 DOI: 10.1001/jamanetworkopen.2019.1139] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
IMPORTANCE In the United States, the prevalence rates of HIV and sexually transmitted infections (STIs) are higher among individuals in community supervision programs (CSPs) than in the general population. However, to date, no couple-based HIV or STI prevention interventions have been implemented for the large number of men in CSPs. OBJECTIVE To determine the effectiveness of a 5-session couple-based prevention intervention, compared with a 1-session counseling, testing, and referral (CTR) program, in reducing HIV and STIs as well as condomless intercourse among men in CSPs and their female sexual partners. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial was conducted from July 11, 2013 (first recruitment), through May 17, 2016 (last randomization). Participants were drug-involved men mandated to a CSP and their female sexual partners (n = 230 couples or 460 individuals). Participants were recruited from various CSP sites in New York, New York, and randomized into either the PACT (Protect and Connect) intervention condition or the HIV CTR control condition (n = 115 couples or 230 individuals in each arm). Analysis of behavioral outcomes used an intent-to-treat approach. Statistical analyses were conducted from November 1, 2017, through June 1, 2018. MAIN OUTCOMES AND MEASURES Self-reported data on sexual behaviors in the past 90 days were used to assess behavioral outcomes at all time points. Biomarkers were collected at baseline and 12 months, and behavioral outcomes were collected at baseline and 3, 6, and 12 months. RESULTS A total of 230 couples (460 individuals) were included. The mean (SD) age of participants was 35.0 (12.8) years, and most participants (341 [74.1%]) self-identified as black or African American race/ethnicity. Of the 18 new cases of STIs identified at the 12-month assessment, 10 came from the PACT arm and 8 from the HIV CTR control arm. Compared with the control participants, PACT participants had 33% fewer acts of condomless vaginal and/or anal intercourse with their main partner (incidence rate ratio [IRR], 0.67; 95% CI, 0.45-0.99; P = .04), 70% fewer acts with other partners (IRR, 0.30; 95% CI, 0.12-0.74; P = .009), and 40% fewer acts with all sexual partners (IRR, 0.60; 95% CI, 0.42-0.85; P = .005) over the entire follow-up period. In addition, PACT participants were less likely to report being under the influence of drugs or alcohol the last time they had vaginal and/or anal intercourse with their study partners (odds ratio, 0.55; 95% CI, 0.31-0.96; P = .04) and had 26% fewer sexual partners in the past 90 days (IRR, 0.74; 95% CI, 0.61-0.88; P = .001). At 12 months, HIV and STI incidence did not differ significantly between the 2 arms. CONCLUSIONS AND RELEVANCE The PACT intervention appeared to reduce risky sexual behaviors, such as condomless intercourse; this finding suggests that a couple-based HIV and STI prevention intervention program may curb the burgeoning HIV epidemic in CSPs. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01690494.
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Affiliation(s)
- Nabila El-Bassel
- Social Intervention Group, Columbia University School of Social Work, New York, New York
| | - Louisa Gilbert
- Social Intervention Group, Columbia University School of Social Work, New York, New York
| | - Dawn Goddard-Eckrich
- Social Intervention Group, Columbia University School of Social Work, New York, New York
| | - Mingway Chang
- Social Intervention Group, Columbia University School of Social Work, New York, New York
| | - Elwin Wu
- Social Intervention Group, Columbia University School of Social Work, New York, New York
| | - Sharun Goodwin
- New York City Department of Probation, New York, New York
| | | | | | - Timothy Hunt
- Social Intervention Group, Columbia University School of Social Work, New York, New York
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11
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Khan MR, Scheidell JD, Golin CE, Friedman SR, Adimora AA, Lejuez CW, Hu H, Quinn K, Wohl DA. Dissolution of Committed Partnerships during Incarceration and STI/HIV-Related Sexual Risk Behavior after Prison Release among African American Men. J Urban Health 2018; 95:479-487. [PMID: 30073599 PMCID: PMC6095753 DOI: 10.1007/s11524-018-0274-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Incarceration is strongly associated with post-release STI/HIV risk. One pathway linking incarceration and STI/HIV risk may be incarceration-related dissolution of protective network ties. Among African American men released from prison who were in committed partnerships with women at the time of incarceration (N = 207), we measured the association between committed partnership dissolution during incarceration and STI/HIV risk in the 4 weeks after release. Over one-quarter (28%) experienced incarceration-related partnership dissolution. In adjusted analyses, incarceration-related partnership dissolution was strongly associated with post-release binge drinking (adjusted odds ratio (AOR) 4.2, 95% confidence interval (CI); 1.4-15.5). Those who experienced incarceration-related partnership dissolution were much more likely to engage in multiple/concurrent partnerships or sex trade defined as buying or selling sex (64%) than those who returned to the partner (12%; AOR 20.1, 95% CI 3.4-175.6). Policies that promote maintenance of relationships during incarceration may be important for protecting health.
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Affiliation(s)
- Maria R Khan
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU School of Medicine, New York, NY, USA.
| | - Joy D Scheidell
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU School of Medicine, New York, NY, USA
| | - Carol E Golin
- Division of General Internal Medicine and Epidemiology, Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Behavior, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Samuel R Friedman
- National Development and Research Institutes, Inc., New York, NY, USA
| | - Adaora A Adimora
- Division of Infectious Disease, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carl W Lejuez
- Cofrin Logan Center for Addiction Research and Treatment, Department of Psychology, College of Liberal Arts & Sciences, University of Kansas, Lawrence, KS, USA
| | - Hui Hu
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA
| | - Kelly Quinn
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU School of Medicine, New York, NY, USA
| | - David A Wohl
- Division of Infectious Disease, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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12
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Shaver J, Freeland R, Goldenberg T, Stephenson R. Gay and Bisexual Men's Perceptions of HIV Risk in Various Relationships. Am J Mens Health 2018; 12:655-665. [PMID: 29355071 PMCID: PMC6131437 DOI: 10.1177/1557988317745759] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/25/2017] [Accepted: 11/02/2017] [Indexed: 11/24/2022] Open
Abstract
Men who have sex with men (MSM) bear a disproportionate burden of HIV incidence in the United States. Previous study of sexual decision-making and HIV risk among MSM has not accounted for relationship dynamics. Further research must examine this connection between relationship dynamics and sexual decision-making, especially regarding condomless anal intercourse. This study analyzes data gathered from gay and bisexual men regarding their sexual partners and sexual decision-making over a 10-week period through personal relationship diaries (PRDs) and a follow-up in-depth interview (IDI). Through coding and extraction of relationship dynamics, key patterns of participants' sexual decision-making processes were examined based on relationship type, which was categorized by commitment, formality, and sexual agreement. Participants' sexual relationships can be divided into five categories: (a) Uncommitted, one time, (b) Uncommitted, ongoing, (c) Transitioning or unknown commitment, (d) Committed, nonmonogamous, and (e) Committed, monogamous. These five categories correspond to patterns in sexual decision making and consequent sexual risk-taking behaviors. Each of these influence HIV risk within male-male sexual encounters in a particular manner, and understanding these is important for appropriately tailored HIV prevention interventions for MSM. Recommendations are included for interventions seeking to address HIV risk across a wide variety of MSM sexual relationships.
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Affiliation(s)
- John Shaver
- Center for Sexuality and Health
Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Ryan Freeland
- Center for Sexuality and Health
Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Tamar Goldenberg
- Center for Sexuality and Health
Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
- Health Behavior and Health Education,
University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Rob Stephenson
- Center for Sexuality and Health
Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
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Jarlais DCD, McKnight C, Feelemyer J, Arasteh K, Tross S, Campbell AN, Cooper HL, Perlman DC. Heterosexual male and female disparities in HIV infection at the end of an epidemic: HIV infection among persons who inject drugs in New York City, 2001-2005 and 2011-2015. Drug Alcohol Depend 2018; 185:391-397. [PMID: 29549851 PMCID: PMC6584620 DOI: 10.1016/j.drugalcdep.2017.12.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 12/03/2017] [Accepted: 12/03/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND We examined whether sex disparities (heterosexual male:female) in HIV infection continue to persist at the "end of the HIV epidemic" among persons who inject drugs (PWID) in New York City (NYC). An "end of the epidemic" was operationally defined as 1) prevalence of untreated HIV infection <5%, and 2) estimated HIV incidence <0.5/100 person-years. METHODS PWID were recruited from persons entering substance use treatment programs at Mount Sinai Beth Israel in 2001-2005 and 2011-2015. A structured interview was administered, and HIV and HSV-2 testing was conducted. Incidence was estimated using newly diagnosed cases of HIV. Disparity analyses compared prevalence of HIV, of untreated HIV, HIV risk behaviors, and estimated HIV incidence. RESULTS By 2011-2015, both heterosexual male and female PWID met the two criteria for an "end of the epidemic," and there were no significant differences in the prevalence of untreated HIV infection. A large sex difference remained in estimated HIV incidence. In 2013-2015, estimated HIV incidence was 2.8/10,000 PY for males and 7.1/10,000 PY for females. Females had greater risk for HIV on several factors. CONCLUSION While NYC has reached an "end of the epidemic" for both heterosexual male and female PWID, sex disparities persist, particularly differences in HIV incidence. Eliminating the sex disparities may require a greater focus on factors associated with sexual transmission.
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Affiliation(s)
- Don C. Des Jarlais
- Icahn School of Medicine at Mount Sinai, New York, NY, United States,Corresponding author at: The Baron Edmond de Rothschild Chemical Dependency Institute, Icahn School of Medicine at Mount Sinai, 39 Broadway 5th Floor Suite 530, New York, NY, 10006, United States., (D.C. Des Jarlais)
| | - Courtney McKnight
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Kamyar Arasteh
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Susan Tross
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, United States
| | - Aimee N.C. Campbell
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, United States
| | - Hannah L.F. Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
| | - David C. Perlman
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Gilbert L, Hunt T, Primbetova S, Terlikbayeva A, Chang M, Wu E, McCrimmon T, El-Bassel N. Reducing opioid overdose in Kazakhstan: A randomized controlled trial of a couple-based integrated HIV/HCV and overdose prevention intervention "Renaissance". THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 54:105-113. [PMID: 29414482 DOI: 10.1016/j.drugpo.2018.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/03/2018] [Accepted: 01/04/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate the efficacy of a couple-based integrated HIV/HCV and overdose prevention intervention on non-fatal and fatal overdose and overdose prevention behaviors among people who use heroin or other opioids in Almaty, Kazakhstan. METHODS We selected 479 participants who reported lifetime heroin or opioid use from a sample of 600 participants (300 couples) enrolled in a randomized controlled trial (RCT) conducted between May 2009 and February 2013. Participants were randomized to either (1) a 5-session couple-based HIV/HCV and overdose prevention intervention condition or (2) a 5-session Wellness Promotion and overdose prevention comparison condition. We used multilevel mixed-effects model with modified Poisson regression to estimate effects of the intervention as risk ratios (RR) and the corresponding 95% CIs. RESULTS About one-fifth (21.9%) of the sample reported that they had experienced an opioid overdose in the past 6 months at baseline. At the 12-month follow-up, both the intervention and comparison conditions reported significant reductions in non-fatal overdose and injection heroin/opioid use and significant increases in drug treatment attendance and naloxone use to prevent death from overdose. However, we found no differences between the study arms on any of these outcomes. There were three intervention condition participants (1.3%), compared to seven comparison condition participants (2.9%) who died from opioid overdose during the 12-month follow up period although this difference was not significant. DISCUSSION There were no significant conditions on any outcomes: both conditions showed promising effects of reducing non-fatal overdose and overdose risks. Integrating overdose prevention into a couple-based HIV/HCV intervention may be an efficient strategy to target the syndemic of opioid overdose, HIV and HCV in Kazakhstan.
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Affiliation(s)
- Louisa Gilbert
- Global Health Research Center of Central Asia, Almaty, Kazakhstan; Columbia University School of Social Work, New York City, United States; Global Health Research Center of Central Asia, United States.
| | - Timothy Hunt
- Global Health Research Center of Central Asia, Almaty, Kazakhstan; Columbia University School of Social Work, New York City, United States; Global Health Research Center of Central Asia, United States
| | - Sholpan Primbetova
- Global Health Research Center of Central Asia, Almaty, Kazakhstan; Columbia University School of Social Work, New York City, United States; Global Health Research Center of Central Asia, United States
| | - Assel Terlikbayeva
- Global Health Research Center of Central Asia, Almaty, Kazakhstan; Columbia University School of Social Work, New York City, United States; Global Health Research Center of Central Asia, United States
| | - Mingway Chang
- Global Health Research Center of Central Asia, Almaty, Kazakhstan; Columbia University School of Social Work, New York City, United States; Global Health Research Center of Central Asia, United States
| | - Elwin Wu
- Global Health Research Center of Central Asia, Almaty, Kazakhstan; Columbia University School of Social Work, New York City, United States; Global Health Research Center of Central Asia, United States
| | - Tara McCrimmon
- Global Health Research Center of Central Asia, Almaty, Kazakhstan; Columbia University School of Social Work, New York City, United States; Global Health Research Center of Central Asia, United States
| | - Nabila El-Bassel
- Global Health Research Center of Central Asia, Almaty, Kazakhstan; Columbia University School of Social Work, New York City, United States; Global Health Research Center of Central Asia, United States
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Zhong L, Zhang Q, Li X. Modeling the Intervention of HIV Transmission across Intertwined Key Populations. Sci Rep 2018; 8:2432. [PMID: 29402964 PMCID: PMC5799486 DOI: 10.1038/s41598-018-20864-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 01/26/2018] [Indexed: 11/23/2022] Open
Abstract
The HIV transmissions between multiple key populations make interventions difficult, particularly with multiple transmission behaviors. It remains unclear how significant the role of bridge individuals (who connect multiple communities) is in HIV transmission, and how to develop more effective intervention strategies targeting different transmission modes across key populations. In this research, we proposed a 2-layer social network framework to simulate the HIV transmissions across female sex workers (FSWs) and persons who inject drugs (PWID) through two behaviors: unprotected sex and needle-sharing. We proposed a set of intervention strategies based on the topological properties of individuals in the social network and estimated the efficacy of these strategies. Simulation studies demonstrated that bridge individuals played a significant role in HIV transmissions across the two networks. Prevention on such bridge individuals could help reduce both the scale and speed of HIV transmissions.
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Affiliation(s)
- Lu Zhong
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon, Hong Kong, SAR, China
| | - Qingpeng Zhang
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon, Hong Kong, SAR, China.
- Shenzhen Research Institute of City University of Hong Kong, Shenzhen, Guangdong, China.
| | - Xiaoming Li
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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16
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Gilchrist G, Swan D, Shaw A, Keding A, Towers S, Craine N, Munro A, Hughes E, Parrott S, Mdege N, Strang J, Taylor A, Watson J. Preventing blood-borne virus infection in people who inject drugs in the UK: systematic review, stakeholder interviews, psychosocial intervention development and feasibility randomised controlled trial. Health Technol Assess 2017; 21:1-312. [PMID: 29208190 PMCID: PMC5733383 DOI: 10.3310/hta21720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Opioid substitution therapy and needle exchanges have reduced blood-borne viruses (BBVs) among people who inject drugs (PWID). Some PWID continue to share injecting equipment. OBJECTIVES To develop an evidence-based psychosocial intervention to reduce BBV risk behaviours and increase transmission knowledge among PWID, and conduct a feasibility trial among PWID comparing the intervention with a control. DESIGN A pragmatic, two-armed randomised controlled, open feasibility trial. Service users were Steering Group members and co-developed the intervention. Peer educators co-delivered the intervention in London. SETTING NHS or third-sector drug treatment or needle exchanges in Glasgow, London, Wrexham and York, recruiting January and February 2016. PARTICIPANTS Current PWID, aged ≥ 18 years. INTERVENTIONS A remote, web-based computer randomisation system allocated participants to a three-session, manualised, psychosocial, gender-specific group intervention delivered by trained facilitators and BBV transmission information booklet plus treatment as usual (TAU) (intervention), or information booklet plus TAU (control). MAIN OUTCOME MEASURES Recruitment, retention and follow-up rates measured feasibility. Feedback questionnaires, focus groups with participants who attended at least one intervention session and facilitators assessed the intervention's acceptability. RESULTS A systematic review of what works to reduce BBV risk behaviours among PWID; in-depth interviews with PWID; and stakeholder and expert consultation informed the intervention. Sessions covered improving injecting technique and good vein care; planning for risky situations; and understanding BBV transmission. Fifty-six per cent (99/176) of eligible PWID were randomised: 52 to the intervention group and 47 to the control group. Only 24% (8/34) of male and 11% (2/18) of female participants attended all three intervention sessions. Overall, 50% (17/34) of men and 33% (6/18) of women randomised to the intervention group and 47% (14/30) of men and 53% (9/17) of women randomised to the control group were followed up 1 month post intervention. Variations were reported by location. The intervention was acceptable to both participants and facilitators. At 1 month post intervention, no increase in injecting in 'risky' sites (e.g. groin, neck) was reported by participants who attended at least one session. PWID who attended at least one session showed a trend towards greater reduction in injecting risk behaviours, a greater increase in withdrawal planning and were more confident about finding a vein. A mean cost of £58.17 per participant was calculated for those attending one session, £148.54 for those attending two sessions and £270.67 for those attending all three sessions, compared with £0.86 in the control group. Treatment costs across the centres vary as a result of the different levels of attendance, as total session costs are divided by attendees to obtain a cost per attendee. The economic analysis suggests that a cost-effectiveness study would be feasible given the response rates and completeness of data. However, we have identified aspects where the service use questionnaire could be abbreviated given the low numbers reported in several care domains. No adverse events were reported. CONCLUSIONS As only 19% of participants attended all three intervention sessions and 47% were followed up 1 month post intervention, a future definitive randomised controlled trial of the intervention is not feasible. Exposure to information on improving injecting techniques did not encourage riskier injecting practices or injecting frequency, and benefits were reported among attendees. The intervention has the potential to positively influence BBV prevention. Harm reduction services should ensure that the intervention content is routinely delivered to PWID to improve vein care and prevent BBVs. FUTURE WORK The intervention did not meet the complex needs of some PWID, more tailoring may be needed to reach PWID who are more frequent injectors, who are homeless and female. LIMITATIONS Intervention delivery proved more feasible in London than other locations. Non-attendance at the York trial site substantially influenced the results. TRIAL REGISTRATION Current Controlled Trials ISRCTN66453696 and PROSPERO 014:CRD42014012969. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 72. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gail Gilchrist
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Davina Swan
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - April Shaw
- School of Media, Culture and Society, University of the West of Scotland, Paisley, UK
| | - Ada Keding
- Department of Health Sciences, University of York, York, UK
| | - Sarah Towers
- Betsi Cadwaladr University Health Board, Bangor, UK
| | - Noel Craine
- Public Health Wales, Microbiology, Bangor, UK
| | - Alison Munro
- School of Media, Culture and Society, University of the West of Scotland, Paisley, UK
| | - Elizabeth Hughes
- Centre for Applied Research in Health, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Noreen Mdege
- Department of Health Sciences, University of York, York, UK
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Avril Taylor
- School of Media, Culture and Society, University of the West of Scotland, Paisley, UK
| | - Judith Watson
- Department of Health Sciences, University of York, York, UK
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Ibañez GE, Whitt E, Avent T, Martin SS, Varga LM, Cano MA, O’Connell DJ. 'Love and trust, you can be blinded': HIV risk within relationships among Latina women in Miami, Florida. ETHNICITY & HEALTH 2017; 22:510-527. [PMID: 27764959 PMCID: PMC6063356 DOI: 10.1080/13557858.2016.1244737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Latina women are disproportionately affected by HIV in the US, and account for 30% of all HIV infections in Miami-Dade County, Florida. The main risk for Latina women is heterosexual contact. Little is known about the relational and cultural factors that may impact women's HIV risk perception. This study aims to describe Latina women's perception of their HIV risk within a relational, cultural, and linguistic context. DESIGN Eight focus groups of Latina women (n = 28), four English speaking groups and four Spanish speaking groups, were conducted between December 2013 and May 2014. Women were recruited from a diversion program for criminal justice clients and by word of mouth. Eligibility criteria included the following: self-identify as Hispanic/Latino, 18-49 years of age, and self-identify as heterosexual. A two-level open coding analytic approach was conducted to identify themes across groups. RESULTS Most participants were foreign-born (61%) and represented the following countries: Cuba (47%), Honduras (17.5%), Mexico (12%), as well as Nicaragua, Puerto Rico, Colombia, and Venezuela (15%). Participant ages ranged between 18 and 49, with a mean age of 32 years. Relationship factors were important in perceiving HIV risk including male infidelity, women's trust in their male partners, relationship type, and getting caught up in the heat of the moment. For women in the English speaking groups, drug use and trading sex for drugs were also reasons cited for putting them at risk for HIV. English speaking women also reported that women should take more responsibility regarding condom use. CONCLUSION Findings emphasize the importance of taking relational and cultural context into account when developing HIV prevention programs for Latina women. Interventions targeting English speaking Latina women should focus on women being more proactive in their sexual health; interventions focused on Spanish speaking women might target their prevention messages to either men or couples.
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Affiliation(s)
- Gladys E. Ibañez
- Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Elaine Whitt
- Center for Drug and Health Studies, University of Delaware, Newark, DE, USA
| | - Tenesha Avent
- Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Steve S. Martin
- Center for Drug and Health Studies, University of Delaware, Newark, DE, USA
| | - Leah M. Varga
- Division of Research, Florida International University, Miami, FL, USA
| | - Miguel A. Cano
- Department of Epidemiology, Florida International University, Miami, FL, USA
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Khan MR, El-Bassel N, Golin CE, Scheidell JD, Adimora AA, Coatsworth AM, Hu H, Judon-Monk S, Medina KP, Wohl DA. The Committed Intimate Partnerships of Incarcerated African-American Men: Implications for Sexual HIV Transmission Risk and Prevention Opportunities. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:2173-2185. [PMID: 28332036 PMCID: PMC5911944 DOI: 10.1007/s10508-016-0916-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 11/10/2016] [Accepted: 12/03/2016] [Indexed: 06/06/2023]
Abstract
Incarceration is thought to influence HIV transmission by disrupting partnerships that provide support and protect against sex risk-taking. Current correctional facility-based family-strengthening programs focus on marital partnerships, a minority of inmates' partnerships. Research on the sex partnerships of incarcerated African-American men and the types of partnerships most likely to protect against HIV-related sex risk is limited. Improved understanding can inform expansion of correctional facility-based family-strengthening programs to a greater proportion of protective partnerships and HIV risk reduction programs to partnerships vulnerable to sex risk. Project DISRUPT is a cohort study of African-American men being released from prison in North Carolina who were in committed heterosexual partnerships at prison entry. Using baseline survey data (N = 189), we conducted latent class analysis (LCA) to identify subgroups of participants with distinct relationship profiles and measured associations between relationship characteristics and multiple partnerships of inmates and their partners in the six months before incarceration. LCA indicated a two-class solution, with relationships distinguished by satisfaction/stability (satisfied/stable class: 58.0%; dissatisfied/unstable class: 42.0%); each class had comparable relationship length and levels of marriage and cohabitation. Dissatisfied/unstable relationships were associated with multiple partnerships among participants (AOR 2.93, 95% CI 1.50, 5.72) and partners (AOR 4.95, 95% CI 1.68, 14.58). Satisfaction indicators-versus length, marriage, or cohabitation-were the strongest independent correlates of inmates' and partners' multiple partnerships. Pre-incarceration economic deprivation, mental disorder symptoms, substance use, and violence in relationships were associated with dissatisfaction/instability. Prison-based programs designed to maintain healthy partnerships, strengthen relationship skills, and reduce HIV risk-taking and violence in relationships are warranted and should be targeted to both marital and nonmarital partnerships. Programming also should address the poverty, mental illness, and substance use factors that threaten relationship satisfaction/stability and increase HIV risk.
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Affiliation(s)
- Maria R Khan
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY, 10016, USA.
| | - Nabila El-Bassel
- Social Intervention Group, Columbia University, New York, NY, USA
| | - Carol E Golin
- Division of General Internal Medicine and Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joy D Scheidell
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY, 10016, USA
| | - Adaora A Adimora
- Division of Infectious Disease, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ashley M Coatsworth
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, College of Medicine, Gainesville, FL, USA
| | - Hui Hu
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, College of Medicine, Gainesville, FL, USA
| | - Selena Judon-Monk
- Division of Infectious Disease, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Katie P Medina
- Division of Infectious Disease, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - David A Wohl
- Division of Infectious Disease, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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Gilchrist G, Swan D, Widyaratna K, Marquez-Arrico JE, Hughes E, Mdege ND, Martyn-St James M, Tirado-Munoz J. A Systematic Review and Meta-analysis of Psychosocial Interventions to Reduce Drug and Sexual Blood Borne Virus Risk Behaviours Among People Who Inject Drugs. AIDS Behav 2017; 21:1791-1811. [PMID: 28365913 PMCID: PMC5491643 DOI: 10.1007/s10461-017-1755-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Opiate substitution treatment and needle exchanges have reduced blood borne virus (BBV) transmission among people who inject drugs (PWID). Psychosocial interventions could further prevent BBV. A systematic review and meta-analysis examined whether psychosocial interventions (e.g. CBT, skills training) compared to control interventions reduced BBV risk behaviours among PWID. 32 and 24 randomized control trials (2000-May 2015 in MEDLINE, PsycINFO, CINAHL, Cochrane Collaboration and Clinical trials, with an update in MEDLINE to December 2016) were included in the review and meta-analysis respectively. Psychosocial interventions appear to reduce: sharing of needles/syringes compared to education/information (SMD −0.52; 95% CI −1.02 to −0.03; I2 = 10%; p = 0.04) or HIV testing/counselling (SMD −0.24; 95% CI −0.44 to −0.03; I2 = 0%; p = 0.02); sharing of other injecting paraphernalia (SMD −0.24; 95% CI −0.42 to −0.06; I2 = 0%; p < 0.01) and unprotected sex (SMD −0.44; 95% CI −0.86 to −0.01; I2 = 79%; p = 0.04) compared to interventions of a lesser time/intensity, however, moderate to high heterogeneity was reported. Such interventions could be included with other harm reduction approaches to prevent BBV transmission among PWID.
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Affiliation(s)
- Gail Gilchrist
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8BB, UK.
- Department of General Practice, University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Davina Swan
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8BB, UK
| | - Kideshini Widyaratna
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8BB, UK
| | - Julia Elena Marquez-Arrico
- Department of Psychiatry and Clinical Psychobiology, School of PsychologyUniversity of Barcelona, 08036, Barcelona, Spain
| | | | - Noreen Dadirai Mdege
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, YO24 2YD, UK
| | - Marrissa Martyn-St James
- School for Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Judit Tirado-Munoz
- Addiction Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Institute of Neuropsychiatry and Addictions, Parc de Salut Mar de Barcelona, 08003, Barcelona, Spain
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20
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Wimberly AS, Stern MR, Rosenbach SB, Thomas T, McKay JR. Challenges to Practicing HIV Sex-Risk Prevention Among People in Continuing Care for Cocaine Addiction. Subst Use Misuse 2017; 52:614-623. [PMID: 28026981 PMCID: PMC5584642 DOI: 10.1080/10826084.2016.1245746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Intimate partnerships are discouraged during early recovery, despite research that highlights their capacity to be resources for change. OBJECTIVE This study seeks to provide descriptions of intimate partnerships and how such partnerships challenge and/or support minimizing HIV sex-risk among participants in continuing care for cocaine addiction in order to inform substance use programming. METHODS Forty-two recorded continuing care counseling sessions of 33 people who discussed HIV sex-risk behavior were transcribed and analyzed using thematic analysis. This sample was derived from a larger randomized controlled trial that looked at the impact of a continuing care intervention for people with cocaine use problems. RESULTS Although participants expressed the desire for a primary intimate partnership, casual intimate partnerships that often involved HIV sex-risk behavior were more prevalent. Challenges to having a primary intimate partner included the belief that intimate partnerships do not support recovery, difficulty in developing friendships with women among heterosexual men, and the ubiquity of drug use and sex work in home environments with limited economic opportunity. Despite these challenges, some participants reported having primary intimate partners that supported their recovery through open communication. CONCLUSION Clinicians providing substance use interventions can consider encouraging components of intimate partnerships that support recovery. In addition, the strong environmental influence on individual HIV sex-risk behavior should be considered in delivering any substance use intervention.
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Affiliation(s)
- Alexandra S. Wimberly
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Max R. Stern
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarah B. Rosenbach
- Department of Applied Psychology, New York University, New York, New York, USA
| | - Tyrone Thomas
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James R. McKay
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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21
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Female Partner Acceptance as a Predictor of Men's Readiness to Undergo Voluntary Medical Male Circumcision in Zambia: The Spear and Shield Project. AIDS Behav 2016; 20:2503-2513. [PMID: 25931242 DOI: 10.1007/s10461-015-1079-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The World Health Organization has recommended the scale-up of voluntary medical male circumcision (VMMC) for HIV prevention in sub-Saharan Africa; however, men are often uninterested in undergoing VMMC. The Spear & Shield project enrolled 668 men and female partners from ten Zambian community health centers into parallel interventions promoting VMMC for HIV prevention or time-matched control conditions. A mediation model was utilized to examine the relationships between changes in women's acceptance of VMMC and men's readiness to undergo the procedure. Results demonstrated that, at 12 months post-intervention, a 5.9 % increase in the likelihood of undergoing VMMC among men in the experimental condition could be attributed to increased women's acceptance. From a public health perspective, involving women in VMMC promotion interventions such as the Spear & Shield project could significantly impact the demand for VMMC in Zambia.
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22
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Wechsberg WM, Zule WA, El-Bassel N, Doherty IA, Minnis AM, Novak SD, Myers B, Carney T. The male factor: Outcomes from a cluster randomized field experiment with a couples-based HIV prevention intervention in a South African township. Drug Alcohol Depend 2016; 161:307-15. [PMID: 26946991 PMCID: PMC5645020 DOI: 10.1016/j.drugalcdep.2016.02.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/10/2016] [Accepted: 02/10/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study examined the effects of the Couples Health CoOp intervention on heavy drinking, condom use, and HIV incidence. METHODS Thirty neighborhoods from one South African township were cluster randomized into three intervention arms: Couples Health CoOp (CHC), Women's Health CoOp/Men's Health CoOp (WHC/MHC), or a comparison arm. We recruited 290 men from informal drinking establishments who reported drinking alcohol regularly. We also recruited their main heterosexual sex partners. RESULTS At 6-month follow-up, men in the CHC arm were less likely to report heavy drinking (OR 0.47, 95% CI: 0.25, 0.90) and were more likely to report consistent condom use during the past month (OR 2.66, 95% CI: 1.23, 5.76) than men in the comparison arm. At baseline, 26% of women and 13% of men were HIV-infected; at 6-month follow-up, 16 females and 5 males had seroconverted. HIV incidence was significantly lower among women in the CHC arm (IRR 0.22, 95% CI: 0.04, 1.01) than in the WHC/MHC arm. CONCLUSIONS A couples-based intervention focusing on intersecting risks for HIV can improve biobehavioral outcomes, underscoring the importance of engaging couples together in HIV prevention.
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Affiliation(s)
- Wendee M Wechsberg
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, United States; University of North Carolina, Chapel Hill, NC, United States; Department of Psychology in the Public Interest, North Carolina State University, Raleigh, NC, United States; Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.
| | - William A Zule
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, United States
| | - Nabila El-Bassel
- Columbia University School of Social Work, New York, NY, United States
| | - Irene A Doherty
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, United States; University of North Carolina, Chapel Hill, NC, United States
| | - Alexandra M Minnis
- RTI International, 351 California Street, San Francisco, CA, United States
| | - Scott D Novak
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, United States
| | - Bronwyn Myers
- Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Tara Carney
- Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
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Wall KM, Canary L, Workowski K, Lockard A, Jones J, Sullivan P, Hills K, Fofana K, Stephenson R, Allen S. Acceptability of Couples' Voluntary HIV Testing Among HIV-infected Patients in Care and Their HIV-negative Partners in the United States. Open AIDS J 2016; 10:1-13. [PMID: 27014393 PMCID: PMC4780512 DOI: 10.2174/1874613601610010001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/19/2015] [Accepted: 12/23/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction: Couples’ voluntary HIV counseling and testing (CHTC) is an HIV risk reduction strategy not widely available in the US. Methods: We assessed willingness to participate in CHTC among US HIV-infected clinic patients via tablet-based survey and among HIV-negative persons with HIV-infected partners in care via mixed-method phone interviews. Results: Most of the N=64 HIV-infected partners surveyed were men (89%), on antiretroviral treatment (ART) (92%), and many self-identified homosexual (62%). We observed high levels of willingness to participate in CHTC (64%) among HIV-infected partners.
Reasons for not wanting to participate included perceived lack of need (26%), desire to self-disclose their status (26%), and fear of being asked sensitive questions with their partner present (17%). HIV-infected partners were interested in discussing ART (48%), other sexually transmitted infections (STIs) (44%), and relationship agreements like monogamy (31%) during CHTC sessions. All N=15 HIV-negative partners interviewed were men, most identified as homosexual (73%), and about half (54%) reported consistent condom use with HIV-infected partners. We observed high levels of willingness to participate in CHTC (87%) among HIV-negative partners, who were also interested in discussing ART (47%), other STIs (47%), mental health services (40%), and relationship agreements (33%). Most negative partners (93%) indicated that they believed their HIV-infected partner was virally suppressed, but in the event that they
were not, many (73%) were willing to take pre-exposure prophylaxis (PrEP). Conclusion: These results indicate that CHTC for serodiscordant couples is acceptable and should emphasize aspects most pertinent to these couples, such as discussion of ART/PrEP, STIs, and relationship agreements.
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Affiliation(s)
- Kristin M Wall
- Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, USA; Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, USA
| | - Lauren Canary
- Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, USA
| | | | - Annie Lockard
- Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia
| | - Jeb Jones
- Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, USA
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, USA
| | - Katherine Hills
- Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Centers for Disease Control and Prevention, Office of Public Health Preparedness and Response, Division of Emergency Operations, Atlanta, Georgia, USA
| | - Kadija Fofana
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Rob Stephenson
- Department of Health Behavior and Biological Sciences, School of Nursing, and the Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan, USA
| | - Susan Allen
- Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, USA
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24
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Bazzi AR, Syvertsen JL, Rolón ML, Martinez G, Rangel G, Vera A, Amaro H, Ulibarri MD, Hernandez DO, Strathdee SA. Social and Structural Challenges to Drug Cessation Among Couples in Northern Mexico: Implications for Drug Treatment in Underserved Communities. J Subst Abuse Treat 2016; 61:26-33. [PMID: 26470596 PMCID: PMC4695257 DOI: 10.1016/j.jsat.2015.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 08/03/2015] [Accepted: 08/28/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Available drug treatment modalities may inadequately address social and structural contexts surrounding recovery efforts. METHODS This mixed methods analysis drew on (1) surveys with female sex workers and their intimate male partners and (2) semi-structured interviews with a subsample of 41 couples (n=82 individuals, 123 total interviews) in Northern Mexico. Descriptive and content analyses examined drug cessation and treatment experiences. RESULTS Perceived need for drug treatment was high, yet only 35% had ever accessed services. Financial and institutional barriers (childcare needs, sex-segregated facilities) prevented partners from enrolling in residential programs together or simultaneously, leading to self-treatment attempts. Outpatient methadone was experienced more positively, yet financial constraints limited access and treatment duration. Relapse was common, particularly when one partner enrolled alone while the other continued using drugs. CONCLUSIONS Affordable, accessible, evidence-based drug treatment and recovery services that acknowledge social and structural contexts surrounding recovery are urgently needed for drug-involved couples.
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Affiliation(s)
- Angela R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th floor, Boston, MA 02118, USA.
| | - Jennifer L Syvertsen
- Department of Anthropology, The Ohio State University, 4046 Smith Laboratory, 174W. 18th Avenue, Columbus OH 43210, USA
| | - María Luisa Rolón
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA 92093-0507, USA; Facultad de Medicina, Universidad Xochicalco, Rampa Yumalinda 4850, Colonia Chapultepec Alamar C.P. 22540, Tijuana, Baja California, México
| | - Gustavo Martinez
- Federación Mexicana de Asociaciones Privadas, Plutarco Elías Calles No. 744 Norte, Col. Progresista, C.P. 32310, Ciudad Juárez, Chihuahua, México
| | - Gudelia Rangel
- Comisión de Salud Fronteriza México-Estados Unidos, Sección México, Paseo del Centenario #10851, Zona Río. C.P. 22010, Tijuana, Baja California, México; Secretaría de Salud, Homero 213, piso 19, Col. Chapultepec Morales, Delegación Miguel Hidalgo C.P. 11570, México, D.F
| | - Alicia Vera
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA 92093-0507, USA; Facultad de Medicina, Universidad Xochicalco, Rampa Yumalinda 4850, Colonia Chapultepec Alamar C.P. 22540, Tijuana, Baja California, México
| | - Hortensia Amaro
- School of Social Work and Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Montgomery Ross Fisher Building, Room 221 669W. 34th St., Los Angeles, CA 90089
| | - Monica D Ulibarri
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla CA 92093-0849, USA; California School of Professional Psychology, Alliant International University-San Diego, San Diego, CA
| | - Daniel O Hernandez
- School of Medicine, University of California, Davis, 4610 X Street, Sacramento, CA 95817, USA
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA 92093-0507, USA
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Janulis P. The micro-social risk environment for injection drug use: An event specific analysis of dyadic, situational, and network predictors of injection risk behavior. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 27:56-64. [PMID: 26530884 PMCID: PMC4715965 DOI: 10.1016/j.drugpo.2015.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 09/07/2015] [Accepted: 09/15/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study explores the risk environment for drug use by examining injection risk behavior during specific injection episodes. By leveraging multiple observations of injection episodes of participants, the study attempts to move beyond global assessment of environmental variables to simultaneously model within (i.e., event level) as well as between (i.e., individual level) predictors of injection risk. Furthermore, gender is also explored as a potential moderator of the relationship between the association of specific partner characteristics (e.g., having an injection partner who is also a sexual partner) and injection risk behavior. METHODS Data is used from the Sexual Acquisition of Transmission of HIV Cooperative Agreement Study (SATHCAP). Multilevel structural equation modeling is utilized to predict within and between variations in underlying injection risk behavior as measured using four indicators of injection risk. RESULTS Results indicated that a number of partner level characteristics (i.e., being emotionally close with the partner, sexual partnership, being a first time partner) and one social situational (i.e., the number of non-injectors present at the injection episode) characteristic predicted event level injection risk behavior. However, the impact of partner characteristics also appears to be moderated by gender of the participants. More specifically, sharing a sexual partnership with an injection partner was more strongly associated with injection risk among females as compared to males and females indicated higher levels of risk when injecting with other females while the partner's gender showed no significant association with risk for male injectors. CONCLUSION These results suggest that people who inject drug do report varying levels of risk during different injection episodes and this variation can be explained by partner and situational characteristics. Improved understanding of the social processes surrounding injection episodes is required to further refine harm reduction approaches.
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Affiliation(s)
- Patrick Janulis
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 North Michigan Avenue, Suite 2700, Chicago, IL 60611, United States.
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26
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Jones HE, Kirtadze I, Otiashvili D, Murphy K, O'Grady KE, Zule W, Krupitsky E, Wechsberg WM. Feasibility and initial efficacy of a culturally sensitive women-centered substance use intervention in Georgia: Sex risk outcomes. Subst Abuse Treat Prev Policy 2015; 10:47. [PMID: 26644132 PMCID: PMC4672492 DOI: 10.1186/s13011-015-0043-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper reports on the feasibility and initial efficacy of a culturally sensitive, comprehensive women-centered substance use intervention for women who inject drugs in Georgia in terms of the primary and secondary sex risk outcomes. The hypothesis under examination was that, relative to case management participants, participants in a culturally sensitive, comprehensive women-specific and -centered intervention would, on average, show significant decreases in past-30-day frequency of unprotected sex, unprotected sex at the last sexual encounter, and increases in condom use and safer sex actions. METHODS The study was a two-arm randomized trial, in which 173 potentially eligible women were screened, and those 128 women determined to be eligible were assigned at random to either Reinforcement-based Treatment plus Women's Co-Op (RBT + WC) or case management (CM). RBT + WC participants received 12 sessions of a structured intervention with the goal of reducing risky sex and substance use and improving physical and mental health. CM participants received 12 sessions of case management and informational brochures that focused on the same issues on which RBT + WC focused. Participants were assessed at baseline, post-treatment, and 3 months following treatment enrollment. RESULTS Analyses revealed case management having significantly overall higher Safer Sex action scores than RBT + WC, and a significant decrease over time for past 30-day number of unprotected sex acts. Unprotected sex at the last encounter and Condom Use action scores were nonsignificant. CONCLUSIONS Women who inject drugs in Georgia are engaging in risky sexual practices, and are in need of an intervention that addresses these risky behaviors. Reasons for the failure to find differences between a culturally sensitive, comprehensive women-centered intervention and case management tailored to the needs of women who inject drugs in Georgia may have been the result of inadequate power to detect an effect in a sample whose drug use was not as serious as warranted by the intervention. (ClinicalTrials.gov Identifier: NCT01331460 ).
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Affiliation(s)
- Hendrée E Jones
- UNC Horizons, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, 127 Kingston Drive, Chapel Hill, NC, 27514, USA.
- Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, School of Medicine, Johns Hopkins University, Baltimore, MD, 21224, USA.
| | - Irma Kirtadze
- Addiction Research Center, Alternative Georgia, Tbilisi, 0177, Georgia.
- Ilia State University, Business School, Tbilisi, 0162, Georgia.
| | - David Otiashvili
- Addiction Research Center, Alternative Georgia, Tbilisi, 0177, Georgia.
| | - Keryn Murphy
- UNC Horizons, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, 127 Kingston Drive, Chapel Hill, NC, 27514, USA.
| | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, College Park, MD, 20742, USA.
| | - William Zule
- Substance Abuse Treatment Evaluations and Interventions Research Program, RTI International, Research Triangle Park, ᅟ, NC, 27709, USA.
| | - Evgeny Krupitsky
- Department of Addictions, Bekhterev Research Psychoneurological Institute, St. Petersburg, 192019, Russia.
| | - Wendee M Wechsberg
- Substance Abuse Treatment Evaluations and Interventions Research Program, RTI International, Research Triangle Park, ᅟ, NC, 27709, USA.
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27
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Argento E, Shannon K, Nguyen P, Dobrer S, Chettiar J, Deering KN. The role of dyad-level factors in shaping sexual and drug-related HIV/STI risks among sex workers with intimate partners. Drug Alcohol Depend 2015; 157:166-73. [PMID: 26585612 PMCID: PMC4678956 DOI: 10.1016/j.drugalcdep.2015.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/30/2015] [Accepted: 10/22/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite high HIV burden among sex workers (SWs) globally, and relatively high prevalence of client condom use, research on potential HIV/STI risk pathways of intimate partnerships is limited. This study investigated partner/dyad-level factors associated with inconsistent condom use among SWs with intimate partners in Vancouver, Canada. METHODS Baseline data (2010-2013) were drawn from a community-based prospective cohort of women SWs. Multivariable generalized estimating equations logistic regression examined dyad-level factors associated with inconsistent condom use (<100% in last six months) with up to three male intimate partners per SW. Adjusted odds ratios and 95% confidence intervals were reported (AOR[95%CI]). RESULTS Overall, 369 SWs reported having at least one intimate partner, with 70.1% reporting inconsistent condom use. Median length of partnerships was 1.8 years, with longer duration linked to inconsistent condom use. In multivariable analysis, dyad factors significantly associated with increased odds of inconsistent condom use included: having a cohabiting (5.43[2.53-11.66]) or non-cohabiting intimate partner (2.15[1.11-4.19]) (versus casual partner), providing drugs (3.04[1.47-6.30]) or financial support to an intimate partner (2.46[1.05-5.74]), physical intimate partner violence (2.20[1.17-4.12]), and an intimate partner providing physical safety (2.08[1.11-3.91]); non-injection drug use was associated with a 68% reduced odds (0.32[0.17-0.60]). CONCLUSIONS Our study highlights the complex role of dyad-level factors in shaping sexual and drug-related HIV/STI risk pathways for SWs from intimate partners. Couple and gender-focused interventions efforts are needed to reduce HIV/STI risks to SWs through intimate partnerships. This research supports further calls for integrated violence and HIV prevention within broader sexual/reproductive health efforts for SWs.
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Affiliation(s)
- Elena Argento
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Kate Shannon
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3
| | - Paul Nguyen
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Sabina Dobrer
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Jill Chettiar
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3
| | - Kathleen N Deering
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3.
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Crepaz N, Tungol-Ashmon MV, Vosburgh HW, Baack BN, Mullins MM. Are couple-based interventions more effective than interventions delivered to individuals in promoting HIV protective behaviors? A meta-analysis. AIDS Care 2015; 27:1361-6. [PMID: 26608175 DOI: 10.1080/09540121.2015.1112353] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Despite several advantages to bringing couples together to learn how to protect themselves and new-born children from the risk of HIV infection, most interventions are designed for individuals or groups, not for dyads. This meta-analysis provides a direct test of whether couple-based interventions are more effective in promoting HIV protective behaviors than interventions delivered to individuals. We conducted systematic searches of five electronic databases and 60 journals. Eligible studies were controlled trials or prospective cohort designs; evaluated a couple-based intervention compared to an individual-level intervention; assessed at least one HIV prevention outcome (e.g., protective sex, drug use, HIV testing, medication adherence, and sexually transmitted infections [STI]); and were published between 1988 and 2014. Fifteen interventions, including 21,882 participants from China, Kenya, Rwanda, Tanzania, Trinidad, Zambia, and the USA, were evaluated. The results of random-effects models showed statistically significant intervention effects for protective sex (OR = 1.60, 95% CI = 1.21, 2.11), HIV testing (OR = 1.79, 95% CI = 1.31, 2.45), and Nevirapine uptake (OR = 1.51, 95% CI = 1.02, 2.24). The evidence demonstrates the usefulness of couple-based interventions in protecting individuals, partners, and new-born children from the risk of HIV transmission and infection.
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Affiliation(s)
- Nicole Crepaz
- a Division of HIV/AIDS Prevention , The U.S. Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Malu V Tungol-Ashmon
- a Division of HIV/AIDS Prevention , The U.S. Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - H Waverly Vosburgh
- a Division of HIV/AIDS Prevention , The U.S. Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Brittney N Baack
- a Division of HIV/AIDS Prevention , The U.S. Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Mary M Mullins
- a Division of HIV/AIDS Prevention , The U.S. Centers for Disease Control and Prevention , Atlanta , GA , USA
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29
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Abstract
Serodiscordant couples play an important role in maintaining the global HIV epidemic. This review summarizes biobehavioral and biomedical HIV prevention options for serodiscordant couples focusing on advances in 2013 and 2014, including World Health Organization guidelines and best evidence for couples counseling, couple-based interventions, and the use of antiviral agents for prevention. In the past few years, marked advances have been made in HIV prevention for serodiscordant couples and numerous ongoing studies are continuously expanding HIV prevention tools, especially in the area of pre-exposure prophylaxis. Uptake and adherence to antiviral therapy remains a key challenge. Additional research is needed to develop evidence-based interventions for couples, and especially for male-male couples. Randomized trials have demonstrated the prevention benefits of antiretroviral-based approaches among serodiscordant couples; however, residual transmission observed in recognized serodiscordant couples represents an important and resolvable challenge in HIV prevention.
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Affiliation(s)
- Kathryn E Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,
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30
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Teitelman AM, Calhoun J, Duncan R, Washio Y, McDougal R. Young women's views on testing for sexually transmitted infections and HIV as a risk reduction strategy in mutual and choice-restricted relationships. Appl Nurs Res 2015; 28:215-21. [PMID: 26112775 PMCID: PMC4509591 DOI: 10.1016/j.apnr.2015.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 12/01/2022]
Abstract
AIM The aim of this study was to identify relationship dynamics that influences the use of STI/HIV testing among young, urban African American women. BACKGROUND Increasing STI/HIV testing is a key prevention strategy, but more research is needed to identify barriers to testing for young women such as intimate partner violence (IPV). METHODS Thirty semi-structured interviews were conducted with African American women ages 18-24. Content analysis was used. RESULTS Women in choice-restricted relationships were unable to negotiate safer sex practices and testing was viewed as the best option. Women in relationships where the desire to use condoms was mutual used STI and HIV testing as a sign of trust building that preceded unprotected sex. CONCLUSIONS STI/HIV testing must be viewed as one strategy within a package of possible risk reduction. For those in choice-restricted relationships, clinicians should screen patients for partner abuse and provide additional support and referrals as clinically appropriate.
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Affiliation(s)
- Anne M Teitelman
- University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA.
| | - Julia Calhoun
- University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA.
| | - Rebecca Duncan
- University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA.
| | - Yukiko Washio
- Treatment Research Institute, Philadelphia, PA 19106, USA.
| | - Renee McDougal
- University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA.
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Jiwatram-Negrón T, El-Bassel N. Correlates of Sex Trading among Drug-Involved Women in Committed Intimate Relationships: A Risk Profile. Womens Health Issues 2015; 25:420-8. [PMID: 26092746 DOI: 10.1016/j.whi.2015.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 04/15/2015] [Accepted: 04/16/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite a slight decline in new human immunodeficiency virus (HIV) infections in New York, marked increases and concentrated epidemics continue among subsets of the population, including women engaged in sex trading. We examined the prevalence and correlates of sex trading among 346 low-income, HIV-negative women in HIV-concordant intimate relationships. METHODS Women and their long-term main partners were recruited to participate in an HIV prevention intervention. Baseline data were used in this article. FINDINGS Of the 346 women in the study, 28% reported sex trading during the prior 90 days. Multivariate analyses showed increased relative risk of sex trading by lifetime experience of severe intimate partner violence (IPV), drug, and alcohol use, and marginal significance for mental health hospitalization, partner drug dependency, and homelessness. CONCLUSIONS These findings suggest an urgent need for HIV prevention and intervention efforts targeted toward women in intimate relationships who trade sex for money or drugs, with an emphasis on IPV, mental health, history of incarceration, and substance abuse.
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Affiliation(s)
- Tina Jiwatram-Negrón
- Social Intervention Group (SIG), School of Social Work, Columbia University, New York City, New York.
| | - Nabila El-Bassel
- Social Intervention Group (SIG), School of Social Work, Columbia University, New York City, New York
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Importance of Women's Relative Socioeconomic Status within Sexual Relationships in Communication about Safer Sex and HIV/STI Prevention. J Urban Health 2015; 92:559-71. [PMID: 25665522 PMCID: PMC4456470 DOI: 10.1007/s11524-014-9935-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The socioeconomic status (SES) of women is increasingly considered an important factor for HIV/STI risk. The HIV/STI literature has largely focused on women's absolute levels of SES, and therefore, the importance of their SES relative to their male sexual partners remains understudied. This paper examines the association between women's relative SES and frequency of safer sex communication among heterosexual couples. A convenience sample of 342 couples (N = 684) recruited in New York City was asked about frequency of discussions with their partner about the need to use male condoms, about HIV prevention, and about STI prevention in the previous 90 days. Differences between partners in education, income, employment, housing, and incarceration history were combined using principal component analysis to form an index of women's relative SES. Negative binomial regression models assessed associations between woman's relative SES and communication frequency controlling for age, sex, race, ethnicity, education, and relationship type using a generalized estimating equation framework. On average, participants had 2.5, 4.2, and 4.8 discussions regarding the need to use male condoms, about HIV prevention, and about STI prevention, respectively. A one standard deviation increase in a woman's relative SES score was associated with increased frequency of discussions about male condom use (adjusted rate ratio [aRR], 1.15; 95% confidence interval [CI], 1.03-1.29), about HIV prevention (aRR, 1.25; CI, 1.14-1.37), and about STI prevention (aRR, 1.29; CI, 1.18-1.41). Women's relative SES may be an important factor for sexual communication, and further research on its role in HIV/STI risk may uncover avenues for intervention.
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Wechsberg WM, Deren S, Myers B, Kirtadze I, Zule WA, Howard B, El-Bassel N. Gender-Specific HIV Prevention Interventions for Women Who Use Alcohol and Other Drugs: The Evolution of the Science and Future Directions. J Acquir Immune Defic Syndr 2015; 69 Suppl 2:S128-39. [PMID: 25978479 PMCID: PMC4505613 DOI: 10.1097/qai.0000000000000627] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The use of alcohol and other drugs (AODs) is an important driver of gender disparities in HIV prevalence. Consequently, there is a need for women-specific HIV interventions that are conceptualized to address (1) women's risk behavior, their roles in sexual relationships, and gender power dynamics and (2) other issues commonly faced by women who use AODs, such as gender-based violence and victimization. This article presents the evolution of HIV prevention intervention research with women who use AODs. It looks at 3 generations of women-focused HIV research interventions, including first-generation projects that started in the 1990s, second-generation efforts where projects expanded in scope and included adaptions of evidence-based interventions for global relevance, and finally third-generation projects currently underway that combine biobehavioral methods and are being implemented in real-world settings. Because women who use AODs continue to report risk behaviors related to HIV, emphasis should be placed on training scientists to conduct gender-specific studies, increasing funding for new studies, and advocating to ensure that stigma-free services are available for these at-risk women.
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Affiliation(s)
- Wendee M. Wechsberg
- RTI International, Research Triangle Park, NC, USA
- University of North Carolina, Chapel Hill, NC, USA
- Department of Psychology in the Public Interest, North Carolina State University, Raleigh, NC, USA
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Sherry Deren
- Center for Drug Use and HIV Research, College of Nursing, New York University, New York, NY, USA
| | - Bronwyn Myers
- Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Irma Kirtadze
- Addiction Research Center, Alternative Georgia, Tbilisi, Georgia
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Minnis AM, Doherty IA, Kline TL, Zule WA, Myers B, Carney T, Wechsberg WM. Relationship power, communication, and violence among couples: results of a cluster-randomized HIV prevention study in a South African township. Int J Womens Health 2015; 7:517-25. [PMID: 25999767 PMCID: PMC4435250 DOI: 10.2147/ijwh.s77398] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Inequitable gender-based power in relationships and intimate partner violence contribute to persistently high rates of HIV infection among South African women. We examined the effects of two group-based HIV prevention interventions that engaged men and their female partners together in a couples intervention (Couples Health CoOp [CHC]) and a gender-separate intervention (Men’s Health CoOp/Women’s Health CoOp [MHC/WHC]) on women’s reports of power, communication, and conflict in relationships. Methods The cluster-randomized field experiment included heterosexual couples from a high-density South African township in which neighborhoods were randomized to one of the intervention arms or a control arm that received the WHC only. Participants completed in-person study visits at baseline and 6-month follow-up. We examined group differences using one-way analysis of variance and multivariable regression models. Results Of the 290 couples enrolled, 255 women remained in the same partnership over 6 months. Following the intervention, women in the CHC arm compared with those in the WHC arm were more likely to report an increase in relationship control (β=0.92, 95% confidence interval [CI]: 0.02, 1.83, P=0.045) and gender norms supporting female autonomy in relationships (β=0.99, 95% CI: 0.07, 1.91, P=0.035). Women in the MHC/WHC arm were more likely to report increases in relationship equity, relative to those in the CHC arm, and had a higher odds of reporting no victimization during the previous 3 months (MHC/WHC vs WHC: odds ratio =3.05, 95% CI: 1.55, 6.0, P=0.001; CHC vs MHC/WHC: odds ratio =0.38, 95% CI: 0.20, 0.74, P=0.004). Conclusion Male partner engagement in either the gender-separate or couples-based interventions led to modest improvements in gender power, adoption of more egalitarian gender norms, and reductions in relationship conflict for females. The aspects of relationship power that improved, however, varied between the couples and gender-separate conditions, highlighting the need for further attention to development of both gender-separate and couples interventions.
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Affiliation(s)
- Alexandra M Minnis
- RTI International, Research Triangle Park, NC, USA ; School of Public Health, University of California, Berkeley, CA, USA
| | - Irene A Doherty
- RTI International, Research Triangle Park, NC, USA ; University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, University of Cape Town, Cape Town, South Africa ; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Tara Carney
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, University of Cape Town, Cape Town, South Africa
| | - Wendee M Wechsberg
- RTI International, Research Triangle Park, NC, USA ; University of North Carolina, Chapel Hill, NC, USA ; North Carolina State University, Raleigh, NC, USA ; Duke University School of Medicine, Durham, NC, USA
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Wechsberg WM, El-Bassel N, Carney T, Browne FA, Myers B, Zule WA. Adapting an evidence-based HIV behavioral intervention for South African couples. Subst Abuse Treat Prev Policy 2015; 10:6. [PMID: 25888856 PMCID: PMC4344778 DOI: 10.1186/s13011-015-0005-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 02/16/2015] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND In South Africa, heterosexual couples are at risk for HIV infection and transmission through substance use, gender-based violence and traditional gender roles, and sex risk behaviors such as having multiple partners and unsafe sex. METHODS To address these interconnected HIV risks among heterosexual couples, we used the ADAPT framework to modify an existing, efficacious women's HIV prevention intervention (the Western Cape Women's Health CoOp) to include components of an evidence-based couple's intervention from the United States (Project Connect) and components from the Men as Partners program that has been used successfully in South Africa. We conducted focus groups with men, women and couples, and obtained feedback from a long-standing Community Collaborative Board (CCB) to guide the synthesis of elements of these three interventions into a new intervention. We then piloted the adapted intervention for feasibility and acceptability. RESULTS The new intervention is called the Couples' Health CoOp. This intervention targets men who use alcohol and other drugs and engage in unprotected sex, and their main female sex partners. The intervention addresses substance use, sex risk, HIV and other sexually transmitted infections, gender roles, gender-based violence, communication skills, and goal-setting activities to increase sexy (eroticize) safe-sex behaviors. The Couples' Health CoOp also includes "voices" from the focus group members to ground the intervention in the experiences of these at-risk couples. In addition, it utilizes a participant handbook that reiterates workshop content and includes homework assignments for couples to complete together to increase problem-solving skills within their relationship, and to improve their sexual relationship and help sustain HIV risk-reduction strategies. All of these adaptations were based on participants' suggestions made during formative work and pilot testing. CONCLUSIONS The Couples' Health CoOp is a couple-based HIV prevention intervention that targets alcohol and other drug use to reduce sexual risk, reduce gender-based violence and offer alternatives for conflict resolution, promote healthy relationships, and modify traditional gender roles in South Africa. TRIAL REGISTRATION NUMBER NCT01121692 .
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Affiliation(s)
- Wendee M Wechsberg
- Substance Abuse Treatment Evaluations and Interventions Research Program, RTI International, Research Triangle Park, NC, USA.
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
- Psychology in the Public Interest, North Carolina State University, Raleigh, NC, USA.
- Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA.
| | | | - Tara Carney
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, Cape Town, South Africa.
| | | | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, Cape Town, South Africa.
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - William A Zule
- Substance Abuse Treatment Evaluations and Interventions Research Program, RTI International, Research Triangle Park, NC, USA.
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Weaver TL, Gilbert L, El-Bassel N, Resnick HS, Noursi S. Identifying and intervening with substance-using women exposed to intimate partner violence: phenomenology, comorbidities, and integrated approaches within primary care and other agency settings. J Womens Health (Larchmt) 2015; 24:51-6. [PMID: 25554915 DOI: 10.1089/jwh.2014.4866] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Substance use and/or disorders (SUDs) have been identified as a significant correlate of intimate partner violence (IPV) exposure and present complex issues that intersect with the topography of IPV, attendant mental health, and physical co-morbidities and may pose barriers to primary care- and other agency-based screening and intervention efforts. Despite substantial research indicating significantly higher rates of all types and severity of IPV victimization among women with SUDs and bidirectional associations between partner or self-use of drugs or alcohol and IPV victimization, effective screening, brief interventions, coordinated systems of care, and treatment approaches to address these co-occurring problems remain very limited. We integrated select research examining the intersection of IPV victimization and SUDs and several comorbidities that have significant public health impact and provided recommendations for scaling up targeted interventions to redress these co-occurring problems among women in primary, emergency, and other care settings.
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Affiliation(s)
- Terri L Weaver
- 1 Department of Psychology, Saint Louis University , Saint Louis, Missouri
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Friedman SR, Perlman DC, Ompad DC. The Flawed Reliance on Randomized Controlled Trials in Studies of HIV Behavioral Prevention Interventions for People Who Inject Drugs and Other Populations. Subst Use Misuse 2015; 50. [PMID: 26222900 PMCID: PMC4568155 DOI: 10.3109/10826084.2015.1007677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This article discusses ways in which randomized controlled trials do not accurately measure the impact of HIV behavioral interventions. This is because: 1. Such trials measure the wrong outcomes. Behavior change may have little to do with changes in HIV incidence since behavior change in events between HIV-concordant people have no impact on incidence. Even more important, the comparison of HIV incidence rates between study arms of individual-level RCTs does not measure the true outcome of interest-whether or not the intervention reduces HIV transmission at the community level. This is because this comparison cannot measure the extent to which the intervention stops transmission by HIV-infected people in the study to those outside it. (And this is made even worse if HIV-infected are excluded from the evaluation of the intervention.) 2. There are potential harms implicit in most cognitively oriented behavioral interventions that are not measured in current practice and may not be measurable using RCTs. Intervention trials often reinforce norms and values of individual self-protection. They rarely if ever measure whether doing this reduces community trust, solidarity, cohesion, organization, or activism in ways that might facilitate HIV transmission. 3. Many interventions are not best conceived of as interventions with individuals but rather with networks, cultures of risks, or communities. As such, randomizing individuals leads to effective interventions that diffuse protection through a community; but these are evaluated as ineffective because the changes diffuse to the control arm, which leads to systematic and erroneous reductions in the evaluated effectiveness as RCTs measure it. The paper ends by discussing research designs that are superior to individual-level RCTs at measuring whether an intervention reduces or increases new HIV transmission.
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Affiliation(s)
- Samuel R Friedman
- a National Development and Research Institutes, Inc. , New York , USA
| | - David C Perlman
- a National Development and Research Institutes, Inc. , New York , USA
| | - Danielle C Ompad
- a National Development and Research Institutes, Inc. , New York , USA
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El-Bassel N, Gilbert L, Terlikbayeva A, Beyrer C, Wu E, Chang M, Hunt T, Ismayilova L, Shaw SA, Primbetova S, Rozental Y, Zhussupov B, Tukeyev M. Effects of a couple-based intervention to reduce risks for HIV, HCV, and STIs among drug-involved heterosexual couples in Kazakhstan: a randomized controlled trial. J Acquir Immune Defic Syndr 2014; 67:196-203. [PMID: 24991973 PMCID: PMC4162759 DOI: 10.1097/qai.0000000000000277] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Project Renaissance is a randomized controlled trial of an HIV/hepatitis C virus (HCV)/sexually transmitted infection (STI) prevention intervention conducted in Almaty, Kazakhstan. We hypothesized that couples assigned to the intervention of interest will have lower incidence of HIV, HCV, STIs, rates of unprotected sex, and unsafe injection over the 12-month follow-up period compared with those assigned to an attention control arm. DESIGN A total of 300 couples (600 participants) where one or both partners reported injecting drugs in the past 90 days were randomized to 1 of 2 arms: (1) a 5-session HIV/HCV/STI prevention intervention (risk reduction: RR) or (2) a 5-session Wellness Promotion (WP) intervention. RESULTS Over the 12-month follow-up period, assignment to RR compared with WP significantly lowered the incidence of HCV infection by 69% [incidence rate ratios (IRR) = 0.31, 95% (CI) confidence interval: 0.10 to 0.90, P = 0.031]. Although differences were not statistically significant, RR participants had a lower incidence of HIV infection by 51% (IRR = 0.49, 95% CI: 0.16 to 1.48, P = 0.204) and any STI by 37% (IRR = 0.63, 95% CI: 0.21 to 1.93, P = 0.418) than WP participants. RR participants reported significantly fewer numbers of unprotected vaginal sex acts with their study partners (IRR = 0.58, 95% CI: 0.36 to 0.93, P = 0.024) and more consistent condom use (odds ratios = 2.30, 95% CI: 1.33 to 4.00, P = 0.003) over the entire follow-up period compared with WP participants. CONCLUSIONS Project Renaissance demonstrated a significant effect for biological and behavioral endpoints. Findings draw attention to an HIV/HCV/STI prevention intervention strategy that can be scaled up for drug-involved couples in harm reduction programs, drug treatment, and criminal justice settings.
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Affiliation(s)
- Nabila El-Bassel
- Global Health Research Center of Central Asia, Columbia University, New York City, New York and Almaty, Kazakhstan
| | - Louisa Gilbert
- Global Health Research Center of Central Asia, Columbia University, New York City, New York and Almaty, Kazakhstan
| | - Assel Terlikbayeva
- Global Health Research Center of Central Asia, Columbia University, New York City, New York and Almaty, Kazakhstan
| | - Chris Beyrer
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Elwin Wu
- Global Health Research Center of Central Asia, Columbia University, New York City, New York and Almaty, Kazakhstan
| | - Mingway Chang
- Global Health Research Center of Central Asia, Columbia University, New York City, New York and Almaty, Kazakhstan
| | - Tim Hunt
- Global Health Research Center of Central Asia, Columbia University, New York City, New York and Almaty, Kazakhstan
| | - Leyla Ismayilova
- School of Social Service Administration, University of Chicago, Chicago, Illinois
| | - Stacey A. Shaw
- Global Health Research Center of Central Asia, Columbia University, New York City, New York and Almaty, Kazakhstan
| | - Sholpan Primbetova
- Global Health Research Center of Central Asia, Columbia University, New York City, New York and Almaty, Kazakhstan
| | - Yelena Rozental
- Global Health Research Center of Central Asia, Columbia University, New York City, New York and Almaty, Kazakhstan
| | - Baurzhan Zhussupov
- Global Health Research Center of Central Asia, Columbia University, New York City, New York and Almaty, Kazakhstan
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Jiwatram-Negrón T, El-Bassel N. Systematic review of couple-based HIV intervention and prevention studies: advantages, gaps, and future directions. AIDS Behav 2014; 18:1864-87. [PMID: 24980246 PMCID: PMC4507500 DOI: 10.1007/s10461-014-0827-7] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We conducted a systematic review of couple-based HIV biobehavioral (skills-building, VCT, and adherence) and biomedical (ART, circumcision) prevention and intervention studies designed to reduce sexual- and drug-risk behaviors and HIV transmission and acquisition. Of the 11,162 papers identified in the search, 93 peer-reviewed papers met the inclusion criteria and yielded a total of 33 studies conducted globally. Biobehavioral couple-based prevention and intervention studies have been efficacious in reducing sexual- and drug-risk behaviors, increasing access to HIV testing and care, and improving adherence. Biomedical couple-based studies were found to reduce HIV incidence among HIV-negative sex partners and viral load among HIV-positive partners. Despite much progress, couple-based HIV prevention and intervention studies remain limited; a number of methodological gaps exist and studies focusing on MSM, people who inject drugs, and sex workers are scarce.
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Affiliation(s)
- Tina Jiwatram-Negrón
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, Room 825, New York City, NY, 10027, USA,
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Palinkas LA, Robertson AM, Syvertsen JL, Hernandez DO, Ulibarri MD, Rangel MG, Martinex G, Strathdee SA. Client perspectives on design and implementation of a couples-based intervention to reduce sexual and drug risk behaviors among female sex workers and their noncommercial partners in Tijuana and Ciudad Juárez, México. AIDS Behav 2014; 18:583-94. [PMID: 24510364 DOI: 10.1007/s10461-014-0715-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This mixed-methods study examined the acceptability of a hypothetical couples-based HIV prevention program for female sex workers and their intimate (non-commercial) male partners in Mexico. Among 320 participants, 67 % preferred couples-based over individual programs, particularly among men. Reasons cited for preferring couples-based programs included convenience and health benefits for both partners. Participants reported that they would benefit from general health information and services, HIV counseling and testing, job training (particularly for men) and other services. However, qualitative interviews revealed that barriers relating to the environment (i.e., poor access to services), providers (i.e., lack of a therapeutic alliance), and intimate relationships (i.e., mistrust or instability) would need to be addressed before such a program could be successfully implemented. Despite women's concerns about privacy and men's preferences for gender-specific services, couples-based HIV prevention programs were largely acceptable to female sex workers and their intimate male partners.
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El-Bassel N, Shaw SA, Dasgupta A, Strathdee SA. People who inject drugs in intimate relationships: it takes two to combat HIV. Curr HIV/AIDS Rep 2014; 11:45-51. [PMID: 24477931 PMCID: PMC4096813 DOI: 10.1007/s11904-013-0192-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We reviewed papers published during the past 18 months (2012-2013) focusing on micro-social contexts of gender and power inequalities as drivers of HIV risks among people who inject drugs (PWID) in intimate heterosexual relationships. Although there has been a proliferation of social and behavioral research on the micro-social contexts of drug injection in heterosexual intimate relationships, there is still a gap in knowledge of these issues, particularly in low- and middle-income countries. Research has identified couple-based approaches for PWID in intimate relationships as an effective HIV prevention strategy to address micro-social contexts driving HIV risks. While HIV incidence has declined in many countries, prevalence remains at troubling levels among PWID and transmission from PWID to their sex partners is increasing in many parts of the world. HIV prevention among drug-using couples must address the importance of the relationship dyad and micro-social contexts.
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Affiliation(s)
- Nabila El-Bassel
- Global Health Research Center of Central Asia, Columbia University School of Social Work, New York, NY, USA,
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Amico KR. The key role of adherence for the effectiveness of antiretroviral-based prevention: state of the science and implications for the Asia-Pacific region. Sex Health 2014; 11:155-65. [PMID: 24331438 DOI: 10.1071/sh13104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 09/10/2013] [Indexed: 12/17/2022]
Abstract
Remarkable advances have been made in the last few years in biomedical strategies to prevent onward transmission of HIV (treatment as prevention (TasP)) and prevent infection among at-risk populations through pre-exposure prophylaxis (PrEP). Numerous issues remain heavily debated, primarily concerning the feasibility of leveraging resources for both widespread access to antiretroviral therapy (ART) for those living with HIV and access to effective prevention antiretrovirals (ARVs) among those at risk for infection. Even with consistent and wide-spread access to ARVs, the behavioural pathway from ARV access to successful rapid and durable suppression or reaching levels of PrEP adherence that confer high rates of protection is increasingly well recognised. For either 'biobehavioural' strategy to have maximal individual and community benefit, individuals accessing them must actually use them. In this review, the unique and overlapping factors influencing adherence to ART and PrEP are identified, with an emphasis on the behavioural, social and structural facilitators and barriers to TasP and PrEP success. The implications of the current research base and evidence generated specifically within the Asia-Pacific region are discussed.
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Dual HIV risk: receptive syringe sharing and unprotected sex among HIV-negative injection drug users in New York City. AIDS Behav 2013; 17:2501-9. [PMID: 23640654 DOI: 10.1007/s10461-013-0496-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
HIV-negative injection drug users (IDUs) who engage in both receptive syringe sharing and unprotected sex ("dual HIV risk") are at high risk of HIV infection. In a cross-sectional study conducted in New York City in 2009, active IDUs aged ≥18 years were recruited using respondent-driven sampling, interviewed, and tested for HIV. Participants who tested HIV-negative and did not self-report as positive were analyzed (N = 439). Adjusted odds ratios (aOR) and 95 % confidence intervals (95 % CI) were estimated using multinomial logistic regression. The sample was: 77.7 % male; 54.4 % Hispanic, 36.9 % white, and 8.7 % African-American/black. Dual risk was engaged in by 26.2 %, receptive syringe sharing only by 3.2 %, unprotected sex only by 49.4 %, and neither by 21.2 %. Variables independently associated with engaging in dual risk versus neither included Hispanic ethnicity (vs. white) (aOR = 2.0, 95 % CI = 1.0-4.0), married or cohabiting (aOR = 6.3, 95 % CI = 2.5-15.9), homelessness (aOR = 3.4, 95 % CI = 1.6-7.1), ≥2 sex partners (aOR = 8.7, 95 % CI = 4.4-17.3), ≥2 injecting partners (aOR = 2.9, 95 % CI = 1.5-5.8), and using only sterile syringe sources (protective) (aOR = 0.5, 95 % CI = 0.2-0.9). A majority of IDUs engaged in HIV risk behaviors, and a quarter in dual risk. Interventions among IDUs should simultaneously promote the consistent use of sterile syringes and of condoms.
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Jones D, Kashy D, Villar-Loubet O, Weiss S. Enhancing acceptability and use of sexual barrier products among HIV concordant and discordant couples. AIDS Behav 2013; 17:2185-93. [PMID: 23494224 DOI: 10.1007/s10461-013-0449-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Strategies to prevent HIV transmission may benefit from addressing both individual and dyadic factors. This study compared the impact of group and individual interventions on the acceptability of sexual barrier products among HIV sero-concordant and discordant couples, and evaluated the contribution of couple members' perceived product acceptability to their sexual barrier use. Participants (n = 216 couples) were multicultural couples in Miami, Florida. Longitudinal multilevel modeling and the actor-partner interdependence model were used for analyses. Product acceptability increased more among female group participants, and acceptability of male condoms increased more among sero-discordant couples in the group. Additionally, acceptability of products associated with prevention of STDS/HIV and pregnancy increased more among sero-concordant couples in the group condition. Both actor and partner product acceptability predicted use. Results support the use of group interventions targeting both partners in relationships in prevention programs designed to enhance sexual barrier use.
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Robertson AM, Syvertsen JL, Amaro H, Martinez G, Rangel MG, Patterson TL, Strathdee SA. Can't buy my love: a typology of female sex workers' commercial relationships in the Mexico-U.S. Border Region. JOURNAL OF SEX RESEARCH 2013; 51:711-20. [PMID: 23659340 PMCID: PMC3890374 DOI: 10.1080/00224499.2012.757283] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Female sex workers (FSWs) experience elevated risk for HIV and sexually transmitted infections (STIs) through unprotected sex with male clients, yet the complexity of these commercial relationships remains understudied. From 2010 to 2011, we explored FSWs' conceptualizations of various client types and related risk behavior patterns using semistructured interviews with 46 FSWs in Tijuana and Ciudad Juarez, Mexico, where FSWs' HIV/STI prevalence is increasing. Our grounded theory analysis identified four types of commercial relationships: nonregular clients, regular clients and friends, clients who "fell in love" with FSWs, and long-term financial providers who often originated from the United States. As commercial relationships developed, clients' social and emotional connections to FSWs increased, rendering condom negotiation and maintaining professional boundaries more difficult. Drug abuse and poverty also influenced behaviors, particularly in Ciudad Juárez, where lucrative U.S. clients were increasingly scarce. While struggling to cultivate dependable relationships in a setting marked by historical sex tourism from a wealthier country, some FSWs ceased negotiating condom use. We discuss the need for HIV/STI research and prevention interventions to recognize the complexity within FSWs' commercial relationships and how behaviors (e.g., condom use) evolve as relationships develop through processes that are influenced by local sociopolitical contexts and binational income inequality.
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Affiliation(s)
- Angela M Robertson
- a Division of Global Public Health, School of Medicine , University of California , San Diego
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The potential uses of preexposure prophylaxis for HIV prevention among people who inject drugs. Curr Opin HIV AIDS 2013; 7:563-8. [PMID: 23076122 DOI: 10.1097/coh.0b013e328358e49e] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE OF REVIEW Oral preexposure prophylaxis (PrEP) has shown HIV preventive efficacy for several key populations at risk for HIV infection including MSM and heterosexual men and women in HIV serodiscordant relationships. An efficacy trial of daily oral tenofovir among people who inject drugs (IDU) is underway in Thailand. RECENT FINDINGS Although efficacy data is pending, there is emerging biological and public health plausibility data suggesting the utility of PrEP as an effective component of combination HIV prevention for IDU. Drawing from studies characterizing adherence to antiretroviral therapy for IDU, there are a range of scientific and operational considerations for the potential use of PrEP for IDU. We review here the available literature on the potential use of PrEP for IDU, barriers to uptake and adherence, and potential implementation science questions, which could address, and potently increase, the effectiveness of this intervention. SUMMARY IDU remain the most underserved population in the HIV response worldwide, and have a marked gap in prevention services, making PrEP a potentially promising addition to the prevention toolkit for people who use drugs and, for those already living with HIV infection, for their spouses and other sexual partners.
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Syvertsen JL, Robertson AM, Palinkas LA, Rangel MG, Martinez G, Strathdee SA. 'Where sex ends and emotions begin': love and HIV risk among female sex workers and their intimate, non-commercial partners along the Mexico-US border. CULTURE, HEALTH & SEXUALITY 2013; 15:540-54. [PMID: 23473586 PMCID: PMC3674135 DOI: 10.1080/13691058.2013.773381] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study explores the affective dimensions of female sex workers' relationships with their intimate, non-commercial partners and assesses how emotions shape each partner's sexual and drug-related risk within their relationship. We draw on qualitative data from a study of HIV, sexually transmitted infections and high-risk behaviours among female sex workers and their non-commercial partners in Tijuana and Ciudad Juárez, Mexico, to illustrate that these couples share relationships based on love, trust, respect and emotional and material support. These relationships range in emotional intensity, which shapes partners' decisions not to use condoms with each other. Drugs were important in most couples' relationships. Among injectors, syringe sharing was common and represented both a sign of care and a pragmatic reaction to conditions of material scarcity. Our findings suggest that couple-based HIV interventions to address dual sexual and drug-related risks should be tailored to the emotional dynamics of sex workers' intimate relationships.
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Affiliation(s)
- Jennifer L. Syvertsen
- Division of Global Public Health, School of Medicine, University of California at San Diego, USA
| | - Angela M. Robertson
- Division of Global Public Health, School of Medicine, University of California at San Diego, USA
| | | | - M. Gudelia Rangel
- El Colegio de La Frontera Norte, Carretera Escénica Tijuana-Ensenada
| | - Gustavo Martinez
- Salud y Desarrollo Comunitario de Ciudad Juárez A.C. (SADEC) and Federación Mexicana de Asociaciones Privadas (FEMAP), Ave. Malecón Chihuahua, México
| | - Steffanie A. Strathdee
- Division of Global Public Health, School of Medicine, University of California at San Diego, USA
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Robertson AM, Syvertsen JL, Martinez G, Rangel MG, Palinkas LA, Stockman JK, Ulibarri MD, Strathdee SA. Acceptability of vaginal microbicides among female sex workers and their intimate male partners in two Mexico-US border cities: a mixed methods analysis. Glob Public Health 2013; 8:619-33. [PMID: 23398385 DOI: 10.1080/17441692.2012.762412] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Female sex workers (FSWs) may benefit from pre-exposure prophylaxis (PrEP) including microbicides for HIV prevention. Since adherence is a key factor in PrEP efficacy, we explored microbicide acceptability and potential barriers to use within FSWs' intimate relationships in Tijuana and Ciudad Juárez, Mexico, where HIV prevalence is increasing. FSWs and their verified intimate (non-commercial) male partners completed quantitative and qualitative interviews from 2010 to 2012. Our complementary mixed methods design followed an iterative process to assess microbicide acceptability, explore related relationship dynamics and identify factors associated with concern about male partners' anger regarding microbicide use. Among 185 couples (n=370 individuals), interest in microbicides was high. In qualitative interviews with 28 couples, most participants were enthusiastic about microbicides for sex work contexts but some explained that microbicides could imply mistrust/infidelity within their intimate relationships. In the overall sample, nearly one in six participants (16%) worried that male partners would become angry about microbicides, which was associated with higher self-esteem among FSWs and lower self-esteem and past year conflicts causing injury within relationships among men. HIV prevention interventions should consider intimate relationship dynamics posing potential barriers to PrEP acceptability and adherence, involve male partners and promote risk communication skills.
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Affiliation(s)
- Angela M Robertson
- Division of Global Public Health, Department of Medicine, University of California at San Diego, La Jolla, CA, USA
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Dual HIV risk and vulnerabilities among women who use or inject drugs: no single prevention strategy is the answer. Curr Opin HIV AIDS 2012; 7:326-31. [PMID: 22498480 DOI: 10.1097/coh.0b013e3283536ab2] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This article examines the dual HIV and sexually transmitted infection (STI) risk behaviors engaged in by women who use or inject drugs; the individual, social, and structural drivers of HIV and STI risk; prevention strategies; and the implications for multilevel, combined, sex-specific HIV prevention strategies. RECENT FINDINGS Women who use or inject drugs, especially female sex workers, are at dual risk for HIV, the hepatitic C virus (HCV), and other STIs. In countries with HIV prevalence higher than 20% among injecting drug users (IDUs), female IDUs have slightly higher HIV prevalence than male IDUs. Women who use or inject drugs face multilevel drivers that increase their vulnerabilities to HIV, HCV, and STIs. Despite advances in behavioral HIV prevention strategies for this population, most prevention studies have not sufficiently targeted dyadic, social, and structural levels. Few recent advances in biomedical HIV prevention have focused on women who use drugs and their unique needs. SUMMARY HIV prevention strategies and services need to address the unique and multilevel drivers that increase the vulnerabilities to HIV, HCV, and STIs among women who use drugs including those who engage in sex work. Scaling-up and improving access to multilevel and combined HIV prevention strategies for these women is central to combating the HIV epidemic.
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Syvertsen JL, Robertson AM, Abramovitz D, Rangel MG, Martinez G, Patterson TL, Ulibarri MD, Vera A, El-Bassel N, Strathdee SA. Study protocol for the recruitment of female sex workers and their non-commercial partners into couple-based HIV research. BMC Public Health 2012; 12:136. [PMID: 22348625 PMCID: PMC3359230 DOI: 10.1186/1471-2458-12-136] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 02/20/2012] [Indexed: 11/10/2022] Open
Abstract
Background Researchers are increasingly recognizing the importance of addressing sexual and drug-related HIV risk within the context of intimate relationships rather than solely focusing on individual behaviors. Practical and effective methods are needed to recruit, screen, and enroll the high risk and hard-to-reach couples who would most benefit from HIV interventions, such as drug-using female sex workers (FSWs) and their intimate, non-commercial partners. This paper outlines a bi-national, multidisciplinary effort to develop and implement a study protocol for research on the social context and epidemiology of HIV, sexually transmitted infections (STI), and high risk behaviors among FSWs and their non-commercial male partners in Tijuana and Ciudad Juarez, Mexico. We provide an overview of our study and specifically focus on the sampling, recruitment, screening, and successful enrollment of high risk couples into a public health study in this context. Methods/Design We used targeted and snowball sampling to recruit couples through the female partner first and administered a primary screener to check her initial eligibility. Willing and eligible females then invited their primary male partners for couple-based screening using a couple verification screening (CVS) instrument adapted from previous studies. The CVS rechecked eligibility and separately asked each partner the same questions about their relationship to "test" if the couple was legitimate. We adapted the original protocol to consider issues of gender and power within the local cultural and socioeconomic context and expanded the question pool to create multiple versions of the CVS that were randomly administered to potential couples to determine eligibility and facilitate study enrollment. Discussion The protocol successfully enrolled 214 high risk couples into a multi-site public health study. This work suggests the importance of collaborating to construct a study protocol, understanding the local population and context, and drawing on multiple sources of input to determine eligibility and verify the legitimacy of relationships. We provide a practical set of tools that other researchers should find helpful in the study of high risk couples in international settings, with particular relevance to studies of FSWs and their intimate partners.
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Affiliation(s)
- Jennifer L Syvertsen
- Department of Anthropology, University of South Florida, 4202 East FowlerAvenue, SOC 107, Tampa, FL 33620-7200, USA
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