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Thomas D, Nalumansi A, Reichman M, Metitiri M, Nambi F, Kibuuka J, Nakabugo L, Kamusiime B, Kasiita V, Nalukwago GK, Muwonge TR, Simoni J, Montgomery ET, Mujugira A, Heffron R. Implementation of gender-based violence screening guidelines in public HIV treatment programs: A mixed methods evaluation in Uganda. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003185. [PMID: 38833452 PMCID: PMC11149855 DOI: 10.1371/journal.pgph.0003185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 04/12/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND HIV and gender-based violence (GBV) intersect to threaten population health. The Uganda Ministry of Health recommends routine GBV screening alongside HIV care but evidence detailing its implementation in HIV care settings is limited. We evaluated screening practices in public HIV clinics to generate evidence supporting GBV screening optimization. METHODS To evaluate GBV screening implementation in antiretroviral therapy (ART) clinics, we extracted client data from GBV registers at 12 public ART clinics in Uganda (January 2019-December 2021). We concurrently evaluated perceptions of GBV screening/referral practices by conducting in-depth qualitative interviews with providers (N = 30) and referral partners (N = 10). We contextualized quantitative findings with interview data which were analyzed using a thematic analysis approach. RESULTS During the evaluation period, >90% of providers in participating health facilities implemented GBV screening. Among 107,767 clients served in public ART clinics, providers identified 9,290 (8.6%) clients who experienced past-year physical, sexual and/or emotional GBV of whom 86% received counseling and 19% were referred to support services-most commonly to legal services. Key factors influencing GBV screening implementation included awareness of screening guidelines; client volume; and client's level of engagement in HIV care. Providers and referral partners identified important benefits to clients (e.g., pursuit of justice and removal from violent environments) when referrals were successful. Key factors influencing referrals included financial constraints that limited referral partners' ability to provide services at no cost to clients and socio-cultural norms that inhibited client willingness to pursue support services. CONCLUSIONS GBV screening implementation in ART clinics supports identification and referral of clients exposed to violence. The effectiveness of GBV screening may be limited by socio-cultural factors that inhibit client capacity to pursue referrals and fragmented and resource-constrained referral networks. Providers and referral partners identified allocating funds to support referrals and collaborative networking meetings as important opportunities for strengthening GBV referrals.
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Affiliation(s)
- Dorothy Thomas
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | | | - Mira Reichman
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Mine Metitiri
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Florence Nambi
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Joseph Kibuuka
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Brenda Kamusiime
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Vicent Kasiita
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | | | - Jane Simoni
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Psychology, University of Washington, Seattle, Washington, United States of America
| | - Elizabeth T. Montgomery
- Women’s Global Health Imperative, RTI International, Berkeley, California, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Andrew Mujugira
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Renee Heffron
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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Thorpe S, Orphé P, Pitcher G, McCleod K, Malone N, Stevens-Watkins D. Correlates of Transactional Sex Among Black Men and Women Who Misuse Opioids. HEALTH EDUCATION & BEHAVIOR 2024; 51:416-424. [PMID: 38281101 PMCID: PMC11200108 DOI: 10.1177/10901981231225440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
The rise in opioid misuse coincides with increased sexually transmitted infection (STI) and HIV incidence. Transactional sex is an under-researched phenomenon among Black Americans who misuse opioids, and may increase their risk of STI or HIV transmission. Given the disproportionate impact of the opioid epidemic on Black Americans and the risks associated with opioid misuse, the current study aims to investigate sociostructural factors, history of violence, and sexual risk factors associated with transactional sex among Black men and women. A sample of n = 375 Black adult Kentuckians reporting opioid misuse completed a survey including transactional sex, sociostructural, violence history, and sexual risk measures. Results of chi-squares and independent samples t-tests revealed that compared to men who did not report engaging in transactional sex, men who engaged in transactional sex were less educated, reported being sexually assaulted or having an unwanted sexual experience in their lifetime, and were more likely to use opioids or cocaine before or during sex in the last year. Women who engaged in transactional sex had a history of violence, more structural barriers, higher psychological distress, and engaged in more sexual risk behaviors compared to women who did not engage in transactional sex. Implications for future research and interventions with this population are discussed.
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Hatoum S, Mukamana D, Gishoma D, Kayiranga D, Pan W, Relf MV. Intimate Partner Violence Among Rwandan Women With HIV: A Cross-Sectional Study. J Assoc Nurses AIDS Care 2024; 35:222-233. [PMID: 38569185 PMCID: PMC11216853 DOI: 10.1097/jnc.0000000000000467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
ABSTRACT In Rwanda, women have higher incidence of HIV and intimate partner violence (IPV). This study aimed to estimate the prevalence of IPV among women living with HIV (WWH) in Rwanda and measure the difference in psychological outcomes, demographic data, and HIV-related outcomes using a cross-sectional, descriptive, observational design. A convenience sample of 162 Rwandan WWH were purposefully recruited to participate. The study collected demographic data and data about IPV, depression, HIV-related stigma, coping, self-esteem, and hope. The prevalence of any form of IPV in the sample was 27% with psychological IPV being the most prevalent. Demographic data had no statistical significance with the prevalence of IPV. WWH who experienced IPV had higher HIV stigma, lower coping self-efficacy, lower self-esteem, and less hope and worse HIV psychological outcomes. Further studies are needed to look into the correlation between the two and interventions addressing IPV prevention.
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Affiliation(s)
- Sandy Hatoum
- Sandy Hatoum, MSc-GH, BScN, is a Graduate of the Master of Science, Global Health program, Duke University, Durham, North Carolina, USA
- Donatilla Mukamana, PhD, RMHN, FAAN, is an Associate Professor, School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Remera Campus, Kigali, Rwanda
- Darius Gishoma, PhD, RMHN, is an Associate Professor, the School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Remera Campus, Kigali, Rwanda
- Dieudonne Kayiranga, MSN, RN, is an Assistant Lecturer and PhD in Nursing Student, School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Remera Campus, Kigali, Rwanda
- Wei Pan, PhD, is an Associate Professor, School of Nursing, Duke University, Durham, North Carolina, USA
- Michael Relf, PhD, RN, AACRN, ANEF, FAAN, is a Professor of Nursing and Global Health, Duke University, School of Nursing, Durham, North Carolina, USA
| | - Donatilla Mukamana
- Sandy Hatoum, MSc-GH, BScN, is a Graduate of the Master of Science, Global Health program, Duke University, Durham, North Carolina, USA
- Donatilla Mukamana, PhD, RMHN, FAAN, is an Associate Professor, School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Remera Campus, Kigali, Rwanda
- Darius Gishoma, PhD, RMHN, is an Associate Professor, the School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Remera Campus, Kigali, Rwanda
- Dieudonne Kayiranga, MSN, RN, is an Assistant Lecturer and PhD in Nursing Student, School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Remera Campus, Kigali, Rwanda
- Wei Pan, PhD, is an Associate Professor, School of Nursing, Duke University, Durham, North Carolina, USA
- Michael Relf, PhD, RN, AACRN, ANEF, FAAN, is a Professor of Nursing and Global Health, Duke University, School of Nursing, Durham, North Carolina, USA
| | - Darius Gishoma
- Sandy Hatoum, MSc-GH, BScN, is a Graduate of the Master of Science, Global Health program, Duke University, Durham, North Carolina, USA
- Donatilla Mukamana, PhD, RMHN, FAAN, is an Associate Professor, School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Remera Campus, Kigali, Rwanda
- Darius Gishoma, PhD, RMHN, is an Associate Professor, the School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Remera Campus, Kigali, Rwanda
- Dieudonne Kayiranga, MSN, RN, is an Assistant Lecturer and PhD in Nursing Student, School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Remera Campus, Kigali, Rwanda
- Wei Pan, PhD, is an Associate Professor, School of Nursing, Duke University, Durham, North Carolina, USA
- Michael Relf, PhD, RN, AACRN, ANEF, FAAN, is a Professor of Nursing and Global Health, Duke University, School of Nursing, Durham, North Carolina, USA
| | - Dieudonne Kayiranga
- Sandy Hatoum, MSc-GH, BScN, is a Graduate of the Master of Science, Global Health program, Duke University, Durham, North Carolina, USA
- Donatilla Mukamana, PhD, RMHN, FAAN, is an Associate Professor, School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Remera Campus, Kigali, Rwanda
- Darius Gishoma, PhD, RMHN, is an Associate Professor, the School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Remera Campus, Kigali, Rwanda
- Dieudonne Kayiranga, MSN, RN, is an Assistant Lecturer and PhD in Nursing Student, School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Remera Campus, Kigali, Rwanda
- Wei Pan, PhD, is an Associate Professor, School of Nursing, Duke University, Durham, North Carolina, USA
- Michael Relf, PhD, RN, AACRN, ANEF, FAAN, is a Professor of Nursing and Global Health, Duke University, School of Nursing, Durham, North Carolina, USA
| | - Wei Pan
- Sandy Hatoum, MSc-GH, BScN, is a Graduate of the Master of Science, Global Health program, Duke University, Durham, North Carolina, USA
- Donatilla Mukamana, PhD, RMHN, FAAN, is an Associate Professor, School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Remera Campus, Kigali, Rwanda
- Darius Gishoma, PhD, RMHN, is an Associate Professor, the School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Remera Campus, Kigali, Rwanda
- Dieudonne Kayiranga, MSN, RN, is an Assistant Lecturer and PhD in Nursing Student, School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Remera Campus, Kigali, Rwanda
- Wei Pan, PhD, is an Associate Professor, School of Nursing, Duke University, Durham, North Carolina, USA
- Michael Relf, PhD, RN, AACRN, ANEF, FAAN, is a Professor of Nursing and Global Health, Duke University, School of Nursing, Durham, North Carolina, USA
| | - Michael V Relf
- Sandy Hatoum, MSc-GH, BScN, is a Graduate of the Master of Science, Global Health program, Duke University, Durham, North Carolina, USA
- Donatilla Mukamana, PhD, RMHN, FAAN, is an Associate Professor, School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Remera Campus, Kigali, Rwanda
- Darius Gishoma, PhD, RMHN, is an Associate Professor, the School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Remera Campus, Kigali, Rwanda
- Dieudonne Kayiranga, MSN, RN, is an Assistant Lecturer and PhD in Nursing Student, School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Remera Campus, Kigali, Rwanda
- Wei Pan, PhD, is an Associate Professor, School of Nursing, Duke University, Durham, North Carolina, USA
- Michael Relf, PhD, RN, AACRN, ANEF, FAAN, is a Professor of Nursing and Global Health, Duke University, School of Nursing, Durham, North Carolina, USA
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Keddem S, Frye V, Davis A, Koblin BA, Tieu HV, Lipsky RK, Nandi V, Teitelman AM. The Moderating Effects of HIV Relevant Factors on the Relationship Between Intimate Partner Violence and Intention to Start HIV Pre-exposure Prophylaxis (PrEP) Among Cisgender Women. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1531-1539. [PMID: 38366311 DOI: 10.1007/s10508-024-02812-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 12/19/2023] [Accepted: 01/10/2024] [Indexed: 02/18/2024]
Abstract
Intimate partner violence (IPV) and HIV are serious and related public health problems that detrimentally impact women's health. Because women who experience IPV are more likely to acquire HIV, it is critical to promote HIV prevention strategies, such as HIV pre-exposure prophylaxis (PrEP), that increase autonomy. This study of cisgender women eligible for HIV PrEP took place between 2017 and 2019 in Philadelphia and New York City. This study aimed to examine the relationship between four types of IPV (control, psychological, physical, sexual) and intention to start PrEP among PrEP-eligible cisgender women and assess the extent to which HIV relevant factors moderated the association between IPV experience and intention to start PrEP. In this sample of PrEP-eligible women (n = 214), 68.7% indicated intention to start PrEP in the next 3 months. Ethnicity was strongly associated with intention to start PrEP, with Hispanic women having the highest odds of intending to start PrEP in the next 3 months. Having a controlling partner significantly predicted intention to start PrEP. Women with more than one sex partner and a controlling partner had higher odds of intending to start PrEP as compared with those who had one or no partners and had no IPV control. These findings point to a need for patient-centered interventions that address the need for safety and autonomy among cisgender, PrEP-eligible women.
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Affiliation(s)
- Shimrit Keddem
- Center for Health Equity Research & Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, 19104, USA.
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Victoria Frye
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, USA
| | - Annet Davis
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
| | - Rachele K Lipsky
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- School of Nursing, Duke University, Durham, NC, USA
| | - Vijay Nandi
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
| | - Anne M Teitelman
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Thomas Jefferson University College of Nursing, Philadelphia, PA, USA
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de Sousa Mascena Veras MA, Menezes NP, Mocello AR, Leddy AM, Saggese GSR, Bassichetto KC, Gilmore HJ, de Carvalho PGC, Maschião LF, Neilands TB, Sevelius J, Lippman SA. Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in Brazil. BMC Public Health 2024; 24:791. [PMID: 38481195 PMCID: PMC10938823 DOI: 10.1186/s12889-024-18224-3] [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: 10/07/2022] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Transgender women are disproportionately affected by both HIV and gender-based violence (GBV), defined as physical, sexual, or emotional violence perpetrated against an individual based on their gender identity/expression. While a growing body of evidence demonstrates that GBV leads to poor HIV care and treatment outcomes among cisgender women, less research has examined this association among transgender women. We assessed the impact of lifetime experiences of GBV on subsequent retention in HIV care and laboratory confirmed viral suppression among a sample of transgender women living with HIV (TWH) in Brazil. METHODS A pilot trial of a peer navigation intervention to improve HIV care and treatment among TWH was conducted in São Paulo, Brazil between 2018 and 2019. TWH were recruited and randomized into the intervention or control arm and participated in a baseline and 9-month follow-up survey and ongoing extraction of clinical visit, prescribing, and laboratory data. Generalized linear model regressions with a Poisson distribution estimated the relative risk (RR) for the association of lifetime physical and sexual violence reported at baseline with treatment outcomes (retention in HIV care and viral suppression) at follow-up, adjusting for baseline sociodemographic characteristics. RESULTS A total of 113 TWH participated in the study. At baseline, median age was 30 years, and the prevalence of lifetime physical and sexual violence was 62% and 45%, respectively. At follow-up, 58% (n = 66/113) were retained in care and 35% (n = 40/113) had evidence of viral suppression. In adjusted models, lifetime physical violence was non-significantly associated with a 10% reduction in retention in care (aRR: 0.90, 95% CI: 0.67, 1.22) and a 31% reduction in viral suppression (aRR: 0.69; 95% CI: 0.43, 1.11). Lifetime sexual violence was non-significantly associated with a 28% reduction in retention in HIV care (aRR: 0.72, 95% CI: 0.52, 1.00) and significantly associated with a 56% reduction in viral suppression (aRR: 0.44; 95% CI: 0.24, 0.79). CONCLUSION Our findings are among the first to demonstrate that lifetime experiences with physical and sexual violence are associated with poor HIV outcomes over time among transgender women. Interventions seeking to improve HIV treatment outcomes should assess and address experiences of GBV among this population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03525340.
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Affiliation(s)
| | - Neia Prata Menezes
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Adrienne Rain Mocello
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Anna M Leddy
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Gustavo Santa Roza Saggese
- Department of Collective Health, Santa Casa School of Medical Sciences, São Paulo, Brazil
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | | | - Hailey J Gilmore
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | | | - Luca Fasciolo Maschião
- Department of Collective Health, Santa Casa School of Medical Sciences, São Paulo, Brazil
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Jae Sevelius
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Sheri A Lippman
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
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Alsina E, Browne JL, Gielkens D, Noorman MAJ, de Wit JB. Interventions to Prevent Intimate Partner Violence: A Systematic Review and Meta-Analysis. Violence Against Women 2024; 30:953-980. [PMID: 37475456 PMCID: PMC10845820 DOI: 10.1177/10778012231183660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Intimate partner violence (IPV) remains a global health and human rights problem. This systematic review assesses the effects of preventive interventions on the occurrence of IPV experience or perpetration. Twenty-six studies published between January 1, 2008 and March 31, 2022 were included, contributing 91 effect sizes. Multilevel meta-analysis showed a protective pooled effect (risk ratio = 0.85, 95% CI [0.77, 0.99]). Interventions (also) including men were more effective than interventions for women only. No other moderators were found. Findings underscore that various IPV prevention interventions are now available that can improve the health and rights of women in diverse settings.
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Affiliation(s)
- Ema Alsina
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joyce L. Browne
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Desi Gielkens
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
| | - Maaike A. J. Noorman
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
| | - John B.F. de Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
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Willie TC, Phillips K, Shah A, Monger MPHM, Nunn A, Kershaw T, Chan PA, Baral SD, Mayer KH, Adimora AA, Mena LA, Stockman JK. Perspectives on HIV pre-exposure prophylaxis (PrEP) implementation in Mississippi among Black women and clinical staff: Recommendations for clinical trauma-informed programs. Prev Med Rep 2023; 36:102490. [PMID: 38116259 PMCID: PMC10728323 DOI: 10.1016/j.pmedr.2023.102490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 10/03/2023] [Accepted: 10/31/2023] [Indexed: 12/21/2023] Open
Abstract
Intimate partner violence (IPV) can constraint Black women's ability to prioritize and access Human Immunodeficiency Virus (HIV) pre-exposure prophylaxis (PrEP) services. Recent research has called for the development of trauma-informed PrEP implementation programs to improve the delivery of PrEP to Black cisgender women; however, many PrEP-prescribing settings do not reflect this recommendation. The current study sought to identify key components to develop a trauma-informed PrEP implementation program for Black cisgender women and clinical staff. We conducted focus groups with PrEP-eligible Black cisgender women (February-June 2019), and semi-structured interviews with clinical staff offering HIV prevention and treatment services (October-November 2020) in community healthcare clinics in Mississippi. Seven themes were identified as needed to facilitate integration of trauma-informed approaches into existing PrEP programs, including defining intimate partner violence (IPV), appropriate IPV screening and response, HIV prevention in abusive relationships, staff training needs, and creating supportive clinic environments. PrEP-eligible Black women and clinical staff generally agreed on how to best operationalize IPV screening and response, the importance of trauma-informed staff training, and the need for Black women-specific informational campaigns. However, Black women highlighted the need for providers to discuss HIV prevention in controlling relationships, and to respond to IPV disclosure. HIV pre-exposure prophylaxis has yet to achieve the potential impact observed in trials. Ultimately, realizing the HIV prevention potential of PrEP in the US necessitates centering the perspectives of Black cisgender women and staff to better integrate trauma-informed approaches.
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Affiliation(s)
- Tiara C Willie
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Karlye Phillips
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Aashna Shah
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - M P H Mauda Monger
- MLM Center for Health Education and Equity Consulting Services, 123-A Hwy 80 East #258 Clinton, MS 39056, USA
| | - Amy Nunn
- School of Public Health, Brown University, 121 S Main St, Providence, RI 02903, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA
| | - Philip A Chan
- Department of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
| | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, 615 N. Wolfe Street, Baltimore MD, 21205, USA
| | - Kenneth H Mayer
- Harvard Medical School and Harvard T H Chan School of Public Health, Harvard University, 25 Shattuck St, Boston, MA 02115, USA
| | - Adaora A Adimora
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, 170 Rosenau Hall, CB#7400, 135 Dauer Drive, Chapel Hill, NC 27599-7400, USA
| | - Leandro A Mena
- Department of Medicine, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
| | - Jamila K Stockman
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
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Kuchukhidze S, Panagiotoglou D, Boily MC, Diabaté S, Imai-Eaton JW, Stöckl H, Mbofana F, Wanyenze RK, Maheu-Giroux M. Characteristics of male perpetrators of intimate partner violence and implications for women's HIV status: A pooled analysis of cohabiting couples from 27 countries in Africa (2000-2020). PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002146. [PMID: 37672520 PMCID: PMC10482294 DOI: 10.1371/journal.pgph.0002146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/08/2023] [Indexed: 09/08/2023]
Abstract
Intimate partner violence (IPV) may increase women's HIV acquisition risk. Still, knowledge on pathways through which IPV exacerbates HIV burden is emerging. We examined the individual and partnership-level characteristics of male perpetrators of physical and/or sexual IPV and considered their implications for women's HIV status. We pooled individual-level data from nationally representative, cross-sectional surveys in 27 countries in Africa (2000-2020) with information on past-year physical and/or sexual IPV and HIV serology among cohabiting couples (≥15 years). Current partners of women experiencing past-year IPV were assumed to be IPV perpetrators. We used Poisson regression, based on Generalized Estimating Equations, to estimate prevalence ratios (PR) for male partner and partnership-level factors associated with perpetration of IPV, and men's HIV status. We used marginal standardization to estimate the adjusted risk differences (aRD) quantifying the incremental effect of IPV on women's risk of living with HIV, beyond the risk from their partners' HIV status. Models were adjusted for survey fixed effects and potential confounders. In the 48 surveys available from 27 countries (N = 111,659 couples), one-fifth of women reported that their partner had perpetrated IPV in the past year. Men who perpetrated IPV were more likely to be living with HIV (aPR = 1.09; 95%CI: 1.01-1.16). The aRD for living with HIV among women aged 15-24 whose partners were HIV seropositive and perpetrated past-year IPV was 30% (95%CI: 26%-35%), compared to women whose partners were HIV seronegative and did not perpetrate IPV. Compared to the same group, aRD among women whose partner was HIV seropositive without perpetrating IPV was 27% (95%CI: 23%-30%). Men who perpetrated IPV are more likely to be living with HIV. IPV is associated with a slight increase in young women's risk of living with HIV beyond the risk of having an HIV seropositive partner, which suggests the mutually reinforcing effects of HIV/IPV.
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Affiliation(s)
- Salome Kuchukhidze
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada
| | - Dimitra Panagiotoglou
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada
| | - Marie-Claude Boily
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Souleymane Diabaté
- Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Département de Médecine et Spécialités Médicales, Université Alassane Ouattara, Bouaké, Côte d’Ivoire
| | - Jeffrey W. Imai-Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- Center for Infectious Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry, and Epidemiology, Medical Faculty, LMU Munich, Munich, Germany
| | | | - Rhoda K. Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada
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9
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Kanagasabai U, Valleau C, Cain M, Chevalier MS, Hegle J, Patel P, Benevides R, Trika JB, Angumua C, Mpingulu M, Ferdinand K, Sida F, Galloway K, Kambona C, Oluoch P, Msungama W, Katengeza H, Correia D, Duffy M, Cossa RMV, Coomer R, Ayo A, Ukanwa C, Tuyishime E, Dladla S, Drummond J, Magesa D, Kitalile J, Apondi R, Okuku J, Chisenga T, Cham HJ. Understanding Gender-Based Violence Service Delivery in CDC-Supported Health Facilities: 15 Sub-Saharan African Countries, 2017-2021. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:39-51. [PMID: 37406144 DOI: 10.1521/aeap.2023.35.suppa.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Gender-based violence (GBV) is a complex issue deeply rooted in social structures, making its eradication challenging. GBV increases the risk of HIV transmission and is a barrier to HIV testing, care, and treatment. Quality clinical services for GBV, which includes the provision of HIV postexposure prophylaxis (PEP), vary, and service delivery data are lacking. We describe GBV clinical service delivery in 15 countries supported by the President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention. Through a descriptive statistical analysis of PEPFAR Monitoring, Evaluation, and Reporting (MER) data, we found a 252% increase in individuals receiving GBV clinical services, from 158,691 in 2017 to 558,251 in 2021. PEP completion was lowest (15%) among 15-19-year-olds. Understanding GBV service delivery is important for policy makers, program managers, and providers to guide interventions to improve the quality of service delivery and contribute to HIV epidemic control.
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Affiliation(s)
- Udhayashankar Kanagasabai
- Division of Global HIV and TB, Center for Global Health (CGH), U.S. Centers for Disease Control and Prevention (CDC), Atlanta Georgia
| | | | - Meagan Cain
- Division of Global HIV and TB, Center for Global Health (CGH), U.S. Centers for Disease Control and Prevention (CDC), Atlanta Georgia
| | - Michelle S Chevalier
- Division of Global HIV and TB, Center for Global Health (CGH), U.S. Centers for Disease Control and Prevention (CDC), Atlanta Georgia
| | - Jennifer Hegle
- Division of Global HIV and TB, Center for Global Health (CGH), U.S. Centers for Disease Control and Prevention (CDC), Atlanta Georgia
| | - Pragna Patel
- Division of Global HIV and TB, Center for Global Health (CGH), U.S. Centers for Disease Control and Prevention (CDC), Atlanta Georgia
| | - Regina Benevides
- Division of Global HIV and TB, Center for Global Health (CGH), U.S. Centers for Disease Control and Prevention (CDC), Atlanta Georgia
| | - Joseph B Trika
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Carrine Angumua
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Minlangu Mpingulu
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Kamanga Ferdinand
- The following authors are affiliated with their respective country's Ministry of Health: Kamanga Ferdinand (Democratic Republic of Congo), Hans Katengeza (Malawi), Raquel Maria Violeta Cossa (Mozambique), Chioma Ukanwa (Nigeria), and Tina Chisenga (Zambia)
| | - Fikirte Sida
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Katelyn Galloway
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Caroline Kambona
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Patricia Oluoch
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Wezi Msungama
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Hans Katengeza
- The following authors are affiliated with their respective country's Ministry of Health: Kamanga Ferdinand (Democratic Republic of Congo), Hans Katengeza (Malawi), Raquel Maria Violeta Cossa (Mozambique), Chioma Ukanwa (Nigeria), and Tina Chisenga (Zambia)
| | - Della Correia
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Meghan Duffy
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Raquel Maria Violeta Cossa
- The following authors are affiliated with their respective country's Ministry of Health: Kamanga Ferdinand (Democratic Republic of Congo), Hans Katengeza (Malawi), Raquel Maria Violeta Cossa (Mozambique), Chioma Ukanwa (Nigeria), and Tina Chisenga (Zambia)
| | - Rachel Coomer
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Adeola Ayo
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Chioma Ukanwa
- The following authors are affiliated with their respective country's Ministry of Health: Kamanga Ferdinand (Democratic Republic of Congo), Hans Katengeza (Malawi), Raquel Maria Violeta Cossa (Mozambique), Chioma Ukanwa (Nigeria), and Tina Chisenga (Zambia)
| | - Elysee Tuyishime
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Sibongile Dladla
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Jennifer Drummond
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Daniel Magesa
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Jane Kitalile
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Rose Apondi
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Jackson Okuku
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Joseph B. Trika (Cote d'Ivoire), Carrine Angumua (Cameroon), Minlangu Mpingulu (Democratic Republic of Congo), Fikirte Sida (Ethiopia), Katelyn Galloway (Eswatini), Caroline Kambona and Patricia Oluoch (Kenya), Wezi Msungama (Malawi), Della Correia, and Meghan Duffy (Mozambique), Rachel Coomer (Namibia), Adeola Ayo (Nigeria), Elysee Tuyishime (Rwanda), Sibongile Dladla, and Jennifer Drummond (South Africa), Daniel Magesa, and Jane Kitalile (Tanzania), Rose Apondi (Uganda), and Jackson Okuku (Zambia)
| | - Tina Chisenga
- The following authors are affiliated with their respective country's Ministry of Health: Kamanga Ferdinand (Democratic Republic of Congo), Hans Katengeza (Malawi), Raquel Maria Violeta Cossa (Mozambique), Chioma Ukanwa (Nigeria), and Tina Chisenga (Zambia)
| | - Haddi J Cham
- Division of Global HIV and TB, Center for Global Health (CGH), U.S. Centers for Disease Control and Prevention (CDC), Atlanta Georgia
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Beattie TS, Kabuti R, Beksinska A, Babu H, Kung’u M, Shah P, Nyariki E, Nyamweya C, Okumu M, Mahero A, Ngurukiri P, Jama Z, Irungu E, Adhiambo W, Muthoga P, Kaul R, Seeley J, Weiss HA, Kimani J. Violence across the Life Course and Implications for Intervention Design: Findings from the Maisha Fiti Study with Female Sex Workers in Nairobi, Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6046. [PMID: 37297650 PMCID: PMC10253020 DOI: 10.3390/ijerph20116046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
We examined violence experiences among Female Sex Workers (FSWs) in Nairobi, Kenya, and how these relate to HIV risk using a life course perspective. Baseline behavioural-biological surveys were conducted with 1003 FSWs June-December 2019. Multivariable logistic regression models were used to estimate the adjusted odds ratio (AOR) and 95% confidence intervals (CI) for associations of life course factors with reported experience of physical or sexual violence in the past 6 months. We found substantial overlap between violence in childhood, and recent intimate and non-intimate partner violence in adulthood, with 86.9% reporting one or more types of violence and 18.7% reporting all three. Recent physical or sexual violence (64.9%) was independently associated with life course factors, including a high WHO Adverse Childhood Experiences (ACE) score (AOR = 7.92; 95% CI:4.93-12.74) and forced sexual debut (AOR = 1.97; 95% CI:1.18-3.29), as well as having an intimate partner (AOR = 1.67; 95% CI:1.25-2.23), not having an additional income to sex work (AOR = 1.54; 95% CI:1.15-2.05), having four or more dependents (AOR = 1.52; 95% CI:0.98-2.34), recent hunger (AOR = 1.39; 95% CI:1.01-1.92), police arrest in the past 6 months (AOR = 2.40; 95% CI:1.71-3.39), condomless last sex (AOR = 1.46; 95% CI:1.02-2.09), and harmful alcohol use (AOR = 3.34; 95% CI:1.74-6.42). Interventions that focus on violence prevention during childhood and adolescence should help prevent future adverse trajectories, including violence experience and HIV acquisition.
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Affiliation(s)
- Tara S. Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Rhoda Kabuti
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Alicja Beksinska
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Hellen Babu
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Mary Kung’u
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | | | - Pooja Shah
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Emily Nyariki
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Chrispo Nyamweya
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Monica Okumu
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Anne Mahero
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Pauline Ngurukiri
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Zaina Jama
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Erastus Irungu
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Wendy Adhiambo
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Peter Muthoga
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Helen A. Weiss
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
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11
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O'Malley TL, Krier SE, Bainbridge M, Hawk ME, Egan JE, Burke JG. Women's perspectives on barriers to potential PrEP uptake for HIV prevention: HIV risk assessment, relationship dynamics and stigma. CULTURE, HEALTH & SEXUALITY 2023; 25:776-790. [PMID: 35839305 DOI: 10.1080/13691058.2022.2099016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 07/04/2022] [Indexed: 06/02/2023]
Abstract
HIV remains a significant health issue for women, and multiple overlapping factors shape women's HIV-related risk. Pre-exposure prophylaxis (PrEP) offers critical advantages over other existing options, yet it remains significantly underused among women in the USA where limited work has explored women's opinions on barriers to potential PrEP use. Using open-ended text responses from a sample of women seeking care at a US urban family planning health centre, this study aimed to understand perceptions of factors affecting potential PrEP use. Three themes concerning key factors impacting potential PrEP use emerged: HIV risk assessment, relationship dynamics, and anticipated stigma. Women's assessment of HIV risk suggests that identifying women in clinical settings as having low self-perceived risk may overlook the complexity of how women determine HIV-related risk and prevention needs. Women frequently referenced relationship dynamics when considering PrEP and discussed anticipated partner reactions about use contributing to non-use. Fear or worry of stigma were expressed as motivations to not use PrEP. Study results highlight the importance of public health and health care professionals normalising PrEP as a strategy in women's HIV prevention and sexual health decision-making. Woman-centred PrEP education, screening and communication strategies reflective of their unique HIV-related risk context are needed.
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Affiliation(s)
- Teagen L O'Malley
- Department of Infectious Diseases and Microbiology, School of Public Heath, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah E Krier
- Department of Infectious Diseases and Microbiology, School of Public Heath, University of Pittsburgh, Pittsburgh, PA, USA
| | - Maura Bainbridge
- Department of Infectious Diseases and Microbiology, School of Public Heath, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary E Hawk
- Department of Behavioral and Community Health Sciences, School of Public Heath, University of Pittsburgh, Pittsburgh, PA, USA
| | - James E Egan
- Department of Behavioral and Community Health Sciences, School of Public Heath, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica G Burke
- Department of Behavioral and Community Health Sciences, School of Public Heath, University of Pittsburgh, Pittsburgh, PA, USA
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12
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Swaich A, Richardson L, Cui Z, DeBeck K, Milloy MJ, Kerr T, Hayashi K. Experiences of violence during the COVID-19 pandemic among people who use drugs in a Canadian setting: a gender-based cross-sectional study. BMC Public Health 2023; 23:1020. [PMID: 37254109 PMCID: PMC10227817 DOI: 10.1186/s12889-023-15929-9] [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: 01/13/2023] [Accepted: 05/18/2023] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVES People who use drugs (PWUD) experience disproportionately high rates of violent victimization. Emerging research has demonstrated that the COVID-19 pandemic has exacerbated violence against some priority populations (e.g., women), however there is limited research examining the impact of the pandemic on the experiences of violence of PWUD. METHODS Using data collected between July and November 2020 from three prospective cohort studies of PWUD in Vancouver, Canada, we employed multivariable logistic regression stratified by gender to identify factors associated with recent experiences of violence, including the receipt of COVID-19 emergency income support. RESULTS In total, 77 (17.3%) of 446 men, and 54 (18.8%) of 288 women experienced violence in the previous six months. Further, 33% of men and 48% of women who experienced violence reported that their experience of violence was intensified since the COVID-19 pandemic began. In the multivariable analyses, sex work (Adjusted Odds Ratio [AOR] = 2.15, 95% confidence interval [CI]: 1.06-4.35) and moderate to severe anxiety or depression (AOR = 3.00, 95% CI: 1.37-6.57) were associated with experiencing violence among women. Among men, drug dealing (AOR = 1.93, 95%CI: 1.10-3.38), street-based income sources (AOR = 1.93, 95%CI: 1.10-3.38), homelessness (AOR = 2.54, 95%CI: 1.40-4.62), and regular employment (AOR = 2.97, 95% CI: 1.75-5.04) were associated with experiencing violence. CONCLUSION Our study results suggest economic conditions and gender were major factors associated with experiencing violence among our sample of PWUD during COVID-19. These findings highlight criminalization of drug use and widespread socioeconomic challenges as barriers to addressing violence among PWUD during periods of crisis.
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Affiliation(s)
- Anmol Swaich
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Lindsey Richardson
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Sociology, University of British Columbia, Vancouver, BC, Canada
| | - Zishan Cui
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- School of Public Policy, Simon Fraser University, Vancouver, BC, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
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13
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Bhushan NL, Shangase N, Kimaru LJ, Gomez-Olive FX, Kahn K, Pettifor AE. HIV Related Behaviors Among Male Partners of Adolescent Girls and Young Women in Rural South Africa. AIDS Behav 2023; 27:1469-1477. [PMID: 36318420 PMCID: PMC10485811 DOI: 10.1007/s10461-022-03882-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 05/16/2023]
Abstract
Improving men's engagement in HIV prevention is not only essential for reducing their own HIV risk but also the risk of transmitting HIV to their female partners. We conducted a cross-sectional survey using a population-based sample of men (age 18-30) who reported being a partner of an adolescent girls and young women (AGYW) in South Africa (N = 2827). We used logit-binomial regression models to examine associations among men's partnership characteristics, HIV risk perceptions, and HIV-related behaviors and examine differences by male partner age (younger men (18-24) vs. older men (25-30)) and age difference between partners (age-concordant (< 5 years) vs. age-disparate (≥ 5 years)). Most men reported inconsistent condom use (85%) and nearly half reported engaging in transactional sex (48%). Older men were just as likely as younger men, and men with age-disparate and age-concordant partners, to inconsistently use condoms, engage in transactional sex, and perpetrate intimate partner violence. Most men also reported a very high interest in pre-exposure prophylaxis (PrEP) (77%) and half reported having an HIV test in the past year (50%). There were no differences by male partner age or age difference between partners in PrEP interest but older men and men in age-discordant relationships were more likely than younger men and men in age-concordant relationships to have an HIV test in the past year. Male partners of AGYW in South Africa are engaging in HIV-related behaviors and need HIV prevention interventions to reduce risk for themselves and their female partners.
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Affiliation(s)
- Nivedita L Bhushan
- RTI International, 3040 Cornwallis Road, 27709, Research Triangle Park, NC, USA.
| | - Nosipho Shangase
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linda Jepkoech Kimaru
- University of Arizona, Tucson, AZ, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - F Xavier Gomez-Olive
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Audrey E Pettifor
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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14
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Ayamah P, Aheto JMK, Atuahene KS, Annang DA, Nartey DT, Amuasi SA, Abrefa‐Gyan T. Multiple indicators of violence against female sex workers and its associated factors in Ghana: Evidence from the 2015 integrated bio-behavioral surveillance survey cross-sectional study. Health Sci Rep 2023; 6:e1243. [PMID: 37152230 PMCID: PMC10158782 DOI: 10.1002/hsr2.1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/08/2023] [Accepted: 04/16/2023] [Indexed: 05/09/2023] Open
Abstract
Background and Aims Violence against female sex workers (FSWs) is a widespread phenomenon, especially in African nations like Ghana where sex work is outlawed primarily because of the pervasive worldview that sex work is a contravention of morality. Violence against FSWs deters them from accessing critical health services and heightens their risk of STIs including HIV infection. The study examined the prevalence and the associated factors of multiple indicators of violence against FSWs. Methods The study utilized a cross-sectional secondary data from the 2015 Integrated Bio-Behavioral Surveillance Survey conducted among FSWs and their nonpaying partners by Ghana AIDS Commission. We analysed data on a total of 4279 participants. Bivariate, and multivariable logistic regression analyses were utilized to identify factors associated with physical and sexual violence against FSWs. Data were analysed using Stata version 15. Results Of the 4279 FSWs, 433 (10%) and 1059 (25%) suffered physical and sexual violence, respectively. The predictors of physical violence are being a seater (adjusted odds ratio [aOR] = 0.53, 95% confidence interval [CI]: 0.36-0.74), aged ≥40 (aOR = 0.23, 95% CI: 0.08-0.64), nonuse of drugs (aOR = 0.56, 95% CI: 0.44-0.70), not using alcohol before sex (aOR = 0.69, 95% CI: 0.56-0.86) and petty business (aOR = 1.39, 95% CI: 1.05-1.82). Sexual violence was predicted by those aged 31-40 (aOR = 0.68, 95% CI: 0.49-0.94) and age ≥40 (aOR = 0.38, 95% CI: 0.22-0.66), currently married (aOR = 0.42, 95% CI: 0.27-0.67), having no living children (aOR = 0.69, 95% CI: 0.51-0.94), nonuse of drugs (aOR = 0.80, 95% CI: 0.68-0.94), and not using alcohol before sex (aOR = 0.74, 95% CI: 0.63-0.86). Region was associated with both physical and sexual violence. Both physical and sexual violence had negative consequences on consistency of condom use and condom failure among FSWs. Conclusion Physical and sexual violence against FSWs is pervasive, and a critical public health issue in Ghana. The identified associated factors could be considered as part of an overall strategy aimed at addressing the menace.
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Affiliation(s)
| | - Justice Moses K. Aheto
- Department of Biostatistics, School of Public Health, College of Health SciencesUniversity of GhanaAccraGhana
- WorldPop, School of Geography and Environmental ScienceUniversity of SouthamptonSouthamptonUK
- Epidemiology and Biostatistics, College of Public HealthUniversity of South FloridaTampaFloridaUSA
| | | | | | - David T. Nartey
- Research, Monitoring and EvaluationJSI Research and Training Institute Inc.BostonMassachusettsUSA
| | - Sue A. Amuasi
- Physician Assistantship and Public Health, School of Medicine and Health SciencesCentral UniversityAccraGhana
| | - Tina Abrefa‐Gyan
- Department of SociologyGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
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15
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Sileo KM, Sparks CS, Luttinen R. Spatial Analysis of the Alcohol, Intimate Partner Violence, and HIV Syndemic Among Women in South Africa. AIDS Behav 2023; 27:1339-1349. [PMID: 36197574 PMCID: PMC10038818 DOI: 10.1007/s10461-022-03870-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2022] [Indexed: 11/29/2022]
Abstract
The co-occurrence of and synergistic interactions between substance abuse, violence, and HIV, known as the "SAVA syndemic," is thought to be a driver of women's elevated risk for HIV in sub-Saharan Africa. This study uses data from the 2016 South African Demographic and Health Survey (DHS) and the 2016 South African Census to examine geospatial associations between alcohol use, intimate partner violence (IPV), unprotected sex, and HIV status among a population-based sample of 8528 South African women (age 15-49). Results support the geographic clustering of alcohol use, unprotected sex, and IPV, but not HIV, and geospatial clustering of HIV alone. This study highlights the need for geographically-tailored interventions to address syndemics through integrated interventions, such as those simultaneously focused on alcohol, IPV, and sexual risk reduction, and points to the need for more targeted research to link these factors to HIV from a place-based risk perspective.
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Affiliation(s)
- Katelyn M Sileo
- Department of Public Health, University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX, 78249-3209, USA.
| | - Corey S Sparks
- Department of Demography, University of Texas at San Antonio, San Antonio, TX, USA
| | - Rebecca Luttinen
- Department of Demography, University of Texas at San Antonio, San Antonio, TX, USA
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16
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Correa-Salazar C, Braverman-Bronstein A, Bilal U, Groves AK, Page KR, Amon JJ, Vera A, Ballesteros L, Martínez-Donate A. The impact of social violence on HIV risk for women in Colombia: A concurrent mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001571. [PMID: 36963089 PMCID: PMC10021609 DOI: 10.1371/journal.pgph.0001571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/01/2023] [Indexed: 02/26/2023]
Abstract
Gender, violence, and migration structurally impact health. The Venezuelan humanitarian crisis comprises the largest transnational migration in the history of the Americas. Colombia, a post-conflict country, is the primary recipient of Venezuelans. The Colombian context imposes high levels of violence on women across migration phases. There is little information on the relationship between violence and HIV risk in the region and how it impacts these groups. Evidence on how to approach the HIV response related to Venezuela's humanitarian crisis is lacking. Our study seeks to 1) understand how violence is associated with newly reported HIV/AIDS case rates for women in Colombian municipalities; and 2) describe how social violence impacts HIV risk, treatment, and prevention for Venezuelan migrant and refugee women undergoing transnational migration and resettlement in Colombia. We conducted a concurrent mixed-methods design. We used negative binomial models to explore associations between social violence proxied by Homicide Rates (HR) at the municipality level (n = 84). The also conducted 54 semi-structured interviews with Venezuelan migrant and refugee women and key informants in two Colombian cities to expand and describe contextual vulnerabilities to HIV risk, prevention and care related to violence. We found that newly reported HIV cases in women were 25% higher for every increase of 18 homicides per 100,000, after adjusting for covariates. Upon resettlement, participants cited armed actors' control, lack of government accountability, gender-based violence and stigmatization of HIV as sources of increased HIV risk for VMRW. These factors impose barriers to testing, treatment and care. Social violence in Colombian municipalities is associated with an increase in newly reported HIV/AIDS case rates in women. Violence hinders Venezuelan migrant and refugee women's access and engagement in available HIV prevention and treatment interventions.
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Affiliation(s)
- Catalina Correa-Salazar
- Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Ariela Braverman-Bronstein
- Epidemiology and Biostatistics Department, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Usama Bilal
- Epidemiology and Biostatistics Department, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Ali K. Groves
- Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Kathleen R. Page
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Joseph J. Amon
- Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Alejandra Vera
- Corporación Mujer Denuncia y Muévete NGO, Cúcuta, Colombia
| | | | - Ana Martínez-Donate
- Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, United States of America
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17
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Kuchukhidze S, Panagiotoglou D, Boily MC, Diabaté S, Eaton JW, Mbofana F, Sardinha L, Schrubbe L, Stöckl H, Wanyenze RK, Maheu-Giroux M. The effects of intimate partner violence on women's risk of HIV acquisition and engagement in the HIV treatment and care cascade: a pooled analysis of nationally representative surveys in sub-Saharan Africa. Lancet HIV 2023; 10:e107-e117. [PMID: 36463914 DOI: 10.1016/s2352-3018(22)00305-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/30/2022] [Accepted: 10/10/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Achieving the 95-95-95 targets for HIV diagnosis, treatment, and viral load suppression to end the HIV epidemic hinges on eliminating structural inequalities, including intimate partner violence (IPV). Sub-Saharan Africa has among the highest prevalence of IPV and HIV worldwide. We aimed to examine the effects of IPV on recent HIV infection and women's engagement in the HIV care cascade in sub-Saharan Africa. METHODS We did a retrospective pooled analysis of data from nationally representative, cross-sectional surveys with information on physical or sexual IPV (or both) and HIV testing, from Jan 1, 2000, to Dec 31, 2020. Relevant surveys were identified from data catalogues and previous large-scale reviews, and included the Demographic and Health Survey, the AIDS Indicator Survey, the Population-based HIV Impact Assessment, and the South Africa National HIV Prevalence, Incidence, Behavior and Communication Survey. Individual-level data on all female respondents who were ever-partnered (currently or formerly married or cohabiting) and aged 15 years or older were included. We used Poisson regression to estimate crude and adjusted prevalence ratios (PRs) for the association between past-year experience of physical or sexual IPV (or both), as the primary exposure, and recent HIV infection (measured with recency assays), as the primary outcome. We also assessed associations of past-year IPV with self-reported HIV testing (also in the past year), and antiretroviral therapy (ART) uptake and viral load suppression at the time of surveying. Models were adjusted for participant age, age at sexual debut (HIV recency analysis), urban or rural residency, partnership status, education, and survey-level fixed effects. FINDINGS 57 surveys with data on self-reported HIV testing and past-year physical or sexual IPV were available from 30 countries, encompassing 280 259 ever-partnered women aged 15-64 years. 59 456 (21·2%) women had experienced physical or sexual IPV in the past year. Six surveys had information on recent HIV infection and seven had data on ART uptake and viral load suppression. The crude PR for recent HIV infection among women who had experienced past-year physical or sexual IPV, versus those who had not, was 3·51 (95% CI 1·64-7·51; n=19 179). The adjusted PR was 3·22 (1·51-6·85). Past-year physical or sexual IPV had minimal effect on self-reported HIV testing in the past year in crude analysis (PR 0·97 [0·96-0·98]; n=274 506) and adjusted analysis (adjusted PR 0·99 [0·98-1·01]). Results were inconclusive for the association of ART uptake with past-year IPV among women living with HIV (crude PR 0·90 [0·85-0·96], adjusted PR 0·96 [0·90-1·02]; n=5629). Women living with HIV who had experienced physical or sexual IPV in the past year were less likely to achieve viral load suppression than those who had not experienced past-year IPV (crude PR 0·85 [0·79-0·91], adjusted PR 0·91 [0·84-0·98], n=5627). INTERPRETATION Past-year physical or sexual IPV was associated with recent HIV acquisition and less frequent viral load suppression. Preventing IPV is inherently imperative but eliminating IPV could contribute to ending the HIV epidemic. FUNDING Canadian Institutes of Health Research, the Canada Research Chairs Program, and Fonds de recherche du Québec-Santé. TRANSLATIONS For the French, Spanish and Portuguese translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Salome Kuchukhidze
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada
| | - Dimitra Panagiotoglou
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada
| | - Marie-Claude Boily
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Souleymane Diabaté
- Département de Médecine Sociale et Préventive, Université Laval, Québec City, QC, Canada; Centre de Recherche du CHU de Québec, Université Laval, Québec City, QC, Canada; Département de Médecine et Spécialités, Université Alassane Ouattara, Bouaké, Côte d'Ivoire
| | - Jeffrey W Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | | | | | - Leah Schrubbe
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada.
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Daniels J, De Vos L, Bezuidenhout D, Atujuna M, Celum C, Hosek S, Bekker LG, Medina-Marino A. "I know why I am taking this pill": Young women navigation of disclosure and support for PrEP uptake and adherence in Eastern Cape Province, South Africa. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000636. [PMID: 36962727 PMCID: PMC10021316 DOI: 10.1371/journal.pgph.0000636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 12/22/2022] [Indexed: 01/21/2023]
Abstract
There is limited understanding of the dynamic interplay between adolescent girl's and young women's (AGYW) disclosure and social support for using oral pre-exposure prophylaxis (PrEP) and adherence. Towards this, we conducted interviews with 42 AGYW enrolled in The Community PrEP Study who exhibited either high or low blood concentrations of tenofovir-diphosphate (TFV-DP) in dried blood spots. Guided by Theories of Practice, interviews and analysis focused on AGYW perspectives and experiences with PrEP disclosure, support and adherence. AGYW with high TFV-DP blood concentrations described larger social support networks and disclosure events. In contrast, those with low TFV-DP blood concentrations described disclosing to fewer people, resulting in limited social support. Participants discussed partner support, however, this support was not described as consequential to adherence, irrespective of TFV-DP levels. Those with high levels of TFV-DP in their blood described the ability to navigate social scrutiny and changes in social support, while those with low levels of TFV-DP in their blood were more likely to question their own continued use of PrEP. To facilitate AGYW's prevention-effective use of PrEP, expanded skill-building for disclosure and resiliency against changes to social support should be examined as part of PrEP services.
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Affiliation(s)
- Joseph Daniels
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, United States of America
| | - Lindsey De Vos
- Research Unit, Foundation for Professional Development, Buffalo City Metro, Eastern Cape Province, South Africa
| | - Dana Bezuidenhout
- Research Unit, Foundation for Professional Development, Buffalo City Metro, Eastern Cape Province, South Africa
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, United States of America
| | - Millicent Atujuna
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Connie Celum
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Sybil Hosek
- Departments of Psychiatry and Infectious Disease, Stroger Hospital of Cook County, Chicago, IL, United States of America
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Andrew Medina-Marino
- Research Unit, Foundation for Professional Development, Buffalo City Metro, Eastern Cape Province, South Africa
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
- Departments of Psychiatry and Infectious Disease, Stroger Hospital of Cook County, Chicago, IL, United States of America
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
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19
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Harris RM, Xavier Hall CD, Mills JC, Pence BW, Bgneris J, Wong FY. Beyond Viral Suppression-The Impact of Cumulative Violence on Health-Related Quality of Life Among a Cohort of Virally Suppressed Patients. J Acquir Immune Defic Syndr 2023; 92:59-66. [PMID: 36099083 PMCID: PMC11079852 DOI: 10.1097/qai.0000000000003099] [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: 12/28/2021] [Accepted: 09/06/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To elucidate how and in what ways cumulative violence affects health-related quality of life (HRQoL) among a clinical cohort of virally stable people living with HIV. DESIGN We used data from the University of North Carolina Center for AIDS Research HIV clinical cohort. Our analysis was limited to participants with an undetectable viral load (<200) and those who completed the Clinical, Sociodemographic, and Behavioral Survey between 2008 and 2017 ( n = 284). METHODS A path analysis was used to test our primary hypothesis that the effect of cumulative violence on HRQoL would be mediated through symptoms of post-traumatic stress disorder (PTSD), depressive symptoms, and HIV symptom distress. RESULTS The impact of cumulative violence on HRQoL was fully mediated by symptoms of PTSD, depressive symptoms, and HIV symptom distress. Greater exposure to violence was associated with higher odds of PTSD symptoms ( P <0.001), increased depressive symptoms ( P <0.001), and increased HIV symptom distress ( P < 0.01). HIV symptom distress displayed the largest association with HRQoL ( P < 0.001), followed by depressive symptoms ( P = 0.001) and PTSD symptoms ( P < 0.001). These factors explained approximately 51% of the variance in HRQoL ( R2 = 0.51, P < 0.001). CONCLUSIONS Our findings indicate that addressing physical and mental health symptoms rooted in violent victimization should be a point of focus in efforts to improve HRQoL among people living with HIV who are virally stable.
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Affiliation(s)
- Rachel M Harris
- Center for Population Sciences and Health Equity College of Social Work, Florida State University, FL
| | - Casey D Xavier Hall
- Institute for Sexual and Gender Minority Health and Wellbeing, Center for Population Sciences and Health Equity, Northwestern University, Florida State University, FL
| | - Jon C Mills
- College of Medicine, Center for Population Sciences and Health Equity, Florida State University, FL
| | - Brian W Pence
- Gillings School of Global Public Health, University of North Carolina, Chape Hill, NC
| | - Jessica Bgneris
- Center for Population Sciences and Health Equity, Graduate College of Social Work, Florida State University, University of Houston, TX; and
| | - Frankie Y Wong
- Center for Population Sciences and Health Equity, Florida State University, FL
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20
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HIV Disclosure Among Sexually Infected People Living with HIV and AIDS in China: Prevalence, Influencing Factors, and Negative Outcomes. AIDS Behav 2022; 27:2411-2429. [PMID: 36580165 DOI: 10.1007/s10461-022-03968-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 12/30/2022]
Abstract
HIV disclosure is crucial for HIV prevention and control, but may also lead to discrimination, insult, and even violence against people living with HIV and AIDS (PLWHAs). In this study, we examined HIV disclosure, its influencing factors, and its association with intimate partner violence (IPV) among 1153 PLWHAs through the sexual route in Jinan, Shandong Province, China. Our results showed that 76.4% (881/1153) PLWHAs had disclosed someone about their HIV infection, the HIV disclosure rates among family members, friends, spouses, and current fixed partners of PLWHAs were 43.5% (501/1153), 47.9% (552/1153), 56.8% (129/227), and 43.2% (336/777), respectively. HIV disclosure was affected by socio-demographics, disease characteristics, and psycho-social factors and varied among family members, close friends, spouses, and current fixed sexual partners. Age ≤ 33 years (aOR 1.79, 95% CI 1.27-2.53), heterosexual infection route (aOR 1.52, 95% CI 1.06-2.17), HIV diagnosis time > 36 months (aOR 1.84, 95% CI 1.30-2.59), with other chronic diseases (aOR 1.87, 95% CI 1.34-2.61), lower self-stigma (aOR 4.03-4.36, 95% CI 1.98-8.74), higher social support (aOR 1.71-1.73, 95% CI 1.03-2.83), no depression (aOR 1.54, 95% CI 1.12-2.11), and no suicidal ideation (aOR 1.79, 95% CI 1.28-2.50) were all independently associated with increased likelihood of HIV disclosure. HIV disclosure was associated with an increased risk of IPV among current fixed sexual partners (aOR 1.87, 95% CI 1.38-2.54) and spouses (aOR 2.54, 95% CI 1.41-4.56). Our findings suggest that the HIV disclosure rate of PLWHAs is still low and is affected by multiple factors. There is an urgent need to design targeted and comprehensive interventions to improve HIV disclosure. IPV prevention should also be incorporated into the intervention system of HIV disclosure to ensure adequate and continuous support for PLWHAs.
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21
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Triplett NS, Roberts ST, Hartmann M, Wagner D, Reddy KR, Mathebula F, Tolley EE, Baeten JM, Palanee-Phillips T, Montgomery ET. Examining Associations Between Mental Health, IPV Exposure, HIV Risk Behaviors, and PrEP Use in South African Women: An Analysis of Data from the Charisma Study. AIDS Behav 2022; 27:2030-2040. [PMID: 36459264 DOI: 10.1007/s10461-022-03936-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2022] [Indexed: 12/04/2022]
Abstract
Intimate partner violence (IPV) has been associated with poorer mental health outcomes and increased human immunodeficiency virus (HIV) risk behaviors. We examine the relations between IPV, mental health symptomology (defined as psychological distress and alcohol misuse), and engagement in HIV risk behaviors among a sample of South African women who participated in a randomized controlled trial of CHARISMA, an intervention to increase women's agency to use oral pre-exposure prophylaxis (PrEP) safely and consistently as well as mitigate relationship challenges. We also examined the impact of trial participation on women's mental health, as well as the impact of psychological distress on the effectiveness of the CHARISMA intervention. Mental health symptomology and IPV exposure were prevalent and associated with some HIV risk and protective behaviors. Trial participation reduced psychological distress. There was no evidence for mental health symptomology impacting the effectiveness of the CHARISMA intervention.
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Affiliation(s)
- Noah S Triplett
- Women's Global Health Imperative, RTI International, Berkeley, CA, USA.
- Department of Psychology, University of Washington, Seattle, WA, USA.
| | - Sarah T Roberts
- Women's Global Health Imperative, RTI International, Berkeley, CA, USA
| | - Miriam Hartmann
- Women's Global Health Imperative, RTI International, Berkeley, CA, USA
| | - Danielle Wagner
- Women's Global Health Imperative, RTI International, Berkeley, CA, USA
| | - Krishnaveni R Reddy
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Florence Mathebula
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Elizabeth E Tolley
- Behavioral, Epidemiological & Clinical Sciences Unit, FHI 360, Durham, NC, USA
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
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22
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Mutumba M, Bhattacharya S, Ssewamala FM. Assessing the social patterning and magnitude of inequalities in sexual violence among young women in Uganda: Findings from 2016 demographic and health survey. Glob Public Health 2022; 17:2826-2840. [PMID: 35167776 DOI: 10.1080/17441692.2022.2037149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Sexual violence (SV) is a significant global public health problem. To develop effectively targeted interventions to prevent SV and allocate resources equitably requires identifying the most vulnerable groups and the magnitude of these social inequities. However, these data are currently lacking. Using the Uganda Demographic and Health Survey, we examined SV among all young women and ever-married young women. We conducted univariate and bivariate analyses to characterise the prevalence and social patterning of SV, and then utilised the World Health Organization Health Equity Assessment Toolkit (HEAT) to assess the magnitude of social inequities in SV. At the national level, 5.5% among all young women and 20.5% of ever-married young women had experienced SV. For all young women, the largest inequities in SV were based on sub-national region of residence. Among the ever-married young women, we found profound education, wealth and place-based inequities in SV, which favoured young women with higher education, in wealthier households, and within central regions of Uganda. Our findings suggest a need for regionally targeted multi-sectoral interventions that take into consideration that multiple intersecting social dimensions such as education, poverty and the safe built environment, to address young women's risk for SV.
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Affiliation(s)
- Massy Mutumba
- Department of Health Behavior & Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | | | - Fred M Ssewamala
- Brown School of Social Work, University of Washington at St. Louis, St. Louis, MO, USA
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23
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Kim H, Martin E. Barriers to accessing pre-exposure prophylaxis among women experiencing intimate partner violence in the United States: a systematic literature review. AIDS Care 2022; 35:509-523. [PMID: 36102031 DOI: 10.1080/09540121.2022.2121959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Women experiencing intimate partner violence (IPV) are at increased risk of human immunodeficiency virus (HIV) infection but have limited uptake of pre-exposure prophylaxis (PrEP). We systematically reviewed the existing evidence for the association between IPV and PrEP use, and barriers to accessing PrEP among women with a history of IPV in the United States. A keyword search of PubMed, CINAHL, ScienceDirect, and Web of Science for relevant articles within the United States from 2012 to 2022 yielded 133 articles, of which 15 were ultimately included in the analysis. A qualitative synthesis of evidence suggests that the association between IPV and PrEP awareness, PrEP acceptability, PrEP use, and HIV risk perception was contingent on the mediating or moderating effects of women's relationship status, social network characteristics, and the timing and types of IPV. Controlling partners' reactions and a lack of independent decision-making in the abusive relationship were salient barriers. The methodological quality of qualitative studies was high; however, there were important risks of bias among quantitative and mixed-method studies. Additional studies are needed to understand barriers to PrEP use among women with IPV in more diverse settings and to provide rigorous evidence for developing targeted HIV prevention strategies for them.
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Affiliation(s)
- Heeun Kim
- Department of Public Administration and Policy, University at Albany, Albany, NY, USA
| | - Erika Martin
- Department of Public Administration and Policy, University at Albany, Albany, NY, USA.,Center for Collaborative HIV Research in Practice and Policy, University at Albany, Albany, NY, USA
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24
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Vavala G, Wang Q, Jimenez S, Ramos WE, Ocasio MA, Romero-Espinoza A, Flynn R, Bolan R, Fernandez MI, Doan P, Arnold EM, Swendeman D, Comulada WS, Klausner JD. Substance Use, Violence, and Sexual Risk Among Young Cis-Gender Women Placed at High-Risk for Human Immunodeficiency Virus Infection. AIDS Behav 2022; 26:3008-3015. [PMID: 35303189 PMCID: PMC10003641 DOI: 10.1007/s10461-022-03631-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 11/01/2022]
Abstract
The substance use, violence, and AIDS (SAVA) syndemic framework is used to study risk for HIV/AIDS. As a secondary analysis from a large HIV/AIDS prevention study, we categorized participants into having from zero to three SAVA conditions based on the presence or absence of self-reported substance use in the past 4 months, history of lifetime sexual abuse, and intimate partner violence. We used Poisson regression models to examine the association between the number of SAVA conditions and sexual risk behavior. Among all participants (n = 195, median age, 20), 37.9%, 19.5%, and 6.7% reported occurrence of one, two, and all three SAVA conditions, respectively. We found that more than one SAVA condition experienced by women was significantly associated with having more than one sex partner (adjusted prevalence ratio [aPR] = 1.88; 95% confidence interval [CI] = 1.28, 2.76) and with substance use before sex (aPR = 1.61 95% CI = 1.06, 2.45).
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Affiliation(s)
- Gabriella Vavala
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | - Qiao Wang
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Sergio Jimenez
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Wilson E Ramos
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Manuel A Ocasio
- Department of Pediatrics/ Section of Adolescent Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Adriana Romero-Espinoza
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Risa Flynn
- Los Angeles LGBT Center, Los Angeles, CA, USA
| | | | | | - Pearl Doan
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | | | - Dallas Swendeman
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - W Scott Comulada
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jeffrey D Klausner
- Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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25
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Villalba K, Jean-Gilles M, Rosenberg R, Cook RL, Ichite A, Martin P, Dévieux JG. Understanding the Impact of Intimate Partner Violence Type and Timing on Pre-exposure Prophylaxis Knowledge, Acceptability, Sexual Behavior, and Gender Roles Among Women of Color. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP12998-NP13017. [PMID: 33752483 DOI: 10.1177/08862605211001468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Knowledge and acceptability are key factors for pre-exposure prophylaxis (PrEP) use among women with a history of intimate partner violence (IPV) and research suggests that different types of IPV affect PrEP uptake differently. Few studies have examined whether the type (i.e., physical, sexual, and psychological) and timing (i.e., lifetime, past year) of IPV experiences are related to PrEP knowledge and acceptability, or whether gender roles and sexual risk behaviors affect PrEP use. We aimed to examine the associations between lifetime and past-year physical, sexual, and psychological IPV experiences on PrEP-related outcomes (i.e., knowledge, acceptability, sexual behavior if on PrEP) and the association between gender roles and PrEP-related outcomes. A total of 186 women of color at risk for HIV participated in this study, of whom 54% had ever experienced partner violence. Results showed that lifetime psychological (OR 3.0, 95% CI 1.1-9.4) and lifetime physical IPV (OR 5.5, 95% CI 1.2-18.9) were significantly associated with increased PrEP knowledge. lifetime psychological (OR 6.3, 95% CI 1.0-13.6) and lifetime physical IPV (OR 4.3, 95% CI 4.3-11.5) were significantly associated with increased sexual behavior if on PrEP. Past year physical IPV was significantly associated with interest in using PrEP (OR 1.9, 95% CI 1.7-4.3) and with sexual behavior if on PrEP (OR 4.0, 95% CI 1.1-13.1). Being subordinate to others was also significantly associated with interest in using PrEP (OR 1.5, 95% CI 1.2-2.4) Self-silencing was significantly associated with increased sexual behavior if on PrEP (OR 1.2, 95% CI 1.0-1.5). Gender norms and IPV type and timing can influence whether a person is interested in PrEP use. Both lifetime and past-year IPV experiences need to be examined in the context of gender norms when prescribing PrEP to encourage uptake and continuation among vulnerable women at risk for HIV.
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26
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Groves AK, Smith PD, Gebrekristos LT, Keene DE, Rosenberg A, Blankenship KM. Eviction, intimate partner violence and HIV: Expanding concepts and assessing the pathways through which sexual partnership dynamics impact health. Soc Sci Med 2022; 305:115030. [PMID: 35594760 PMCID: PMC9332133 DOI: 10.1016/j.socscimed.2022.115030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/02/2022] [Accepted: 05/06/2022] [Indexed: 11/16/2022]
Abstract
Over 2 million renters in the United States are legally evicted annually, and even more renters experience other landlord-related forced moves each year. While past research has documented an association between legal eviction and HIV risk, no studies have examined the relationship between forced moves and sexual partnership dynamics longitudinally, or the pathways through which forced moves impact such risk. Addressing this gap is imperative, particularly given inequities that place Black renters and women at disproportionate risk of eviction. This study leverages data from a longitudinal cohort study of 282 adults in New Haven to examine whether landlord-related forced moves reported at baseline (including, but not limited to, legal eviction) is associated with HIV sexual risk reported six months later. We use bootstrapped path analyses to examine intimate partner violence (IPV) victimization and perpetration as potential mediators. One-fifth of participants (21.2%) had experienced a landlord-related forced move at baseline. At follow up, nearly two-thirds (63.8%) reported at least one HIV sexual risk factor, one in seven (14.2%) reported IPV victimization, and one in ten (10.3%) reported IPV perpetration. Individuals who reported landlord-related forced moves were more likely to report IPV victimization (standardized β = 0.19, SE = 0.08, p = .02) and IPV perpetration (β = 0.25, SE = 0.09, p = .003). Both IPV victimization and perpetration mediated the association between landlord-related forced moves and HIV sexual risk (indirect victimization effect, β = 0.09, SE = 0.05, p = .06; indirect perpetration effect, β = 0.16, SE = 0.07, p = .02), though IPV victimization was only marginally significant. In conclusion, IPV is itself a negative consequence of forced moves that also contributes to other negative health effects, like HIV risk. Therefore, providers should offer violence screening and referral for clients who have recently faced a forced move. Simultaneously, policy-level solutions to prevent eviction and increase housing affordability are urgently needed to address the rising burden - and inequitable distribution - of evictions among low-income renters.
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Affiliation(s)
- Allison K Groves
- Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, 19104, 267 359 6274, USA.
| | - Patrick D Smith
- Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, 19104, 267 359 6274, USA.
| | - Luwam T Gebrekristos
- Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, 19104, 267 359 6274, USA.
| | - Danya E Keene
- Yale University School of Public Health, Department of Social and Behavioral Sciences, 60 College Street, New Haven, CT, 06510, USA.
| | - Alana Rosenberg
- Yale University School of Public Health, Department of Social and Behavioral Sciences, 60 College Street, New Haven, CT, 06510, USA.
| | - Kim M Blankenship
- American University, Department of Sociology, 4400 Massachusetts Avenue, Washington DC, 20016, USA.
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27
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Women's Economic Contribution, Relationship Status and Risky Sexual Behaviours: A Cross-Sectional Analysis from a Microfinance-Plus Programme in Rural South Africa. AIDS Behav 2022; 26:2349-2362. [PMID: 35064391 PMCID: PMC8782214 DOI: 10.1007/s10461-021-03566-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/17/2022]
Abstract
In sub-Saharan Africa, women bear a disproportionate burden of HIV/AIDS while also facing economic and gender inequalities. To explore the association of women’s economic contribution and relationship status with risky sexual behaviour, this study analysed cross-sectional data from 626 women aged 22 to 84 in rural South Africa. All women were enrolled in a microfinance plus gender training programme (Intervention with Microfinance for AIDS and Gender Equity (IMAGE)). We used univariable and multivariable logistic regression to explore the associations of relationship status and women’s household income contribution with inconsistent condom use, multiple sexual partners and transactional sex, respectively. We found that married, older women had the highest odds of inconsistent condom use, while those contributing all the household income had higher odds of multiple sexual partnerships, but lower odds of transactional sex compared to those with no contribution. Income contribution and relationship status have a nuanced relationship with sexual risk behaviours. Thus, economic strengthening interventions should target relevant vulnerable women while also addressing the broader social and economic drivers of risky sexual behaviour.
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28
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Leddy AM, Selin A, Lippman SA, Kimaru LJ, Twine R, Gómez-Olivé X, Kahn K, Pettifor A. Emotional Violence is Associated with Increased HIV Risk Behavior Among South African Adolescent Girls and Young Women in the HPTN 068 Cohort. AIDS Behav 2022; 26:1863-1870. [PMID: 34800183 PMCID: PMC9046300 DOI: 10.1007/s10461-021-03535-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2021] [Indexed: 11/05/2022]
Abstract
Limited research has explored how emotional intimate partner violence (IPV) shapes HIV risk behaviors. Using cross-sectional data from the HPTN 068 post-trial visit (N = 1942), we assessed the association between emotional IPV and its sub-domains (verbal abuse and threats) with condomless sex, transactional sex, and frequent alcohol use among young women in South Africa. In adjusted multivariable logistic regression models, any emotional IPV and verbal IPV were associated with increased odds of condomless sex (aOR: 1.47; 95% CI: 1.15, 1.87; and aOR: 1.48; 95% CI: 1.15, 1.89), transactional sex (aOR: 2.32; 95% CI: 1.74, 3.08; and aOR: 2.02; 95% CI: 1.51, 2.71) and alcohol use (aOR: 1.88; 95% CI: 1.39, 2.53; and aOR: 1.87; 95% CI: 1.37, 2.55). Threats were associated with transactional sex (aOR: 3.67; 95% CI: 2.62, 5.14). Future research should examine this relationship over-time and HIV prevention programs should consider and address emotional IPV.
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Affiliation(s)
- Anna M Leddy
- Department of Medicine, University of California, San Francisco, 550 16th St., 3rd floor, San Francisco, CA, 94158, USA.
| | - Amanda Selin
- Stanford University School of Medicine, Stanford, CA, USA
| | - Sheri A Lippman
- Department of Medicine, University of California, San Francisco, 550 16th St., 3rd floor, San Francisco, CA, 94158, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda J Kimaru
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Audrey Pettifor
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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29
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Makkan H, Maenetje P, Chetty-Makkan CM, Muchiri E, Latka MH, Edward VA, Price MA, Omosa-Manyonyi G, Lindan C. Attitudes Toward Gender-Based Violence Among Sexually Active Adult Men at High Risk for HIV in Rustenburg, South Africa. Am J Mens Health 2022; 16:15579883221106331. [PMID: 35748400 PMCID: PMC9234859 DOI: 10.1177/15579883221106331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Gender-based violence (GBV) toward women is widespread and has been associated with increased HIV risk. We investigated attitudes toward GBV among men living in Rustenburg, South Africa, who were enrolled in a longitudinal HIV incidence study. Participants were 18 to 49 years old, reported high risk sexual activity in the last 3 months, and were HIV-uninfected. Attitudes toward GBV were evaluated using responses to a five-item standardized questionnaire about men perpetrating physical violence on a female spouse; responses to each item were scaled from 1 (no agreement) to 4 (strong agreement) and summed. Total scores >10 were considered permissive toward GBV. Among the 535 men analyzed, nearly half (N = 229, 42.8%) had a GBV score >10. Being young (18-24 years) (adjusted odds ratio [aOR] = 1.53, 95% confidence interval [CI] [1.06, 2.22]), having less years of education (aOR = 1.61, 95% CI [1.11, 2.32]), and reporting no current sexual partner at baseline (aOR = 2.10, 95% CI [1.06, 4.14]) were independently associated with permissive attitudes toward GBV. The following behaviors reported in the last 3 months were also associated with high GBV scores: having a new female partner (aOR = 1.78, 95% CI [1.02, 3.10]), and having had an STI (aOR = 1.85, 95% CI [1.15, 2.99]). Consuming alcohol prior to sex in the last month (aOR = 1.59, 95% CI [1.09, 2.31]) was also associated with high GBV scores. A large proportion of South African HIV-uninfected men in this analysis reported permissive attitudes toward GBV. These attitudes were associated with HIV risk behavior. Integrating GBV and HIV prevention programs is essential.
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Affiliation(s)
- Heeran Makkan
- Rustenburg Research Centre, The Aurum Institute, Rustenburg, South Africa.,Department of Interdisciplinary Social Science, Public Health, Utrecht University, Utrecht, The Netherlands
| | - Pholo Maenetje
- Rustenburg Research Centre, The Aurum Institute, Rustenburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Candice M Chetty-Makkan
- Rustenburg Research Centre, The Aurum Institute, Rustenburg, South Africa.,Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Evans Muchiri
- Rustenburg Research Centre, The Aurum Institute, Rustenburg, South Africa
| | - Mary H Latka
- Rustenburg Research Centre, The Aurum Institute, Rustenburg, South Africa
| | - Vinodh A Edward
- Rustenburg Research Centre, The Aurum Institute, Rustenburg, South Africa.,Department of Interdisciplinary Social Science, Public Health, Utrecht University, Utrecht, The Netherlands.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA.,School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Matt A Price
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.,IAVI, New York, NY, USA
| | - Gloria Omosa-Manyonyi
- School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Christina Lindan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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30
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Bagwell-Gray ME, Ramaswamy M. Cervical Cancer Screening and Prevention among Survivors of Intimate Partner Violence. HEALTH & SOCIAL WORK 2022; 47:102-112. [PMID: 35311901 DOI: 10.1093/hsw/hlac009] [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: 09/29/2020] [Revised: 01/25/2021] [Accepted: 02/23/2021] [Indexed: 06/14/2023]
Abstract
Women who experience intimate partner violence are an underserved population at risk for cervical cancer, precipitated by their heightened risk for human papilloma virus (HPV) and underutilization of gynecological care. This pilot study describes the self-reported behaviors, levels of knowledge, and perceived self-efficacy with cervical cancer screening (i.e., Pap testing) and prevention (i.e., HPV vaccination) among survivors (N = 30) recruited from two domestic violence shelter organizations in the midwestern United States. Survey results indicate a need for increased knowledge and awareness about cervical cancer and prevention strategies among this population; only 23 percent (n = 7) participants reported an up-to-date Pap test and 17 percent (n = 5) participants reported HPV vaccination. Findings also indicate how theoretical constructs from the health belief model, together with feminist understandings of coercive control and empowerment, might explain survivors' proactive cervical health behaviors and offer insights for intervention.
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31
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Pashaei Z, Oskouie F, Moradi-Lakeh M, Jahanfar S, Haghani S. HIV serostatus disclosure to sexual partner: a survey among women in Tehran, Iran. Eur J Med Res 2022; 27:56. [PMID: 35395935 PMCID: PMC8994217 DOI: 10.1186/s40001-022-00663-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disclosure of HIV-positive status in women is associated with many factors. Consequently, status disclosure remains a challenge for Iranian women living with HIV. This study aimed to assess the prevalence, related factors, and reflections of HIV-positive status disclosure to a sexual partner(s) among Iranian women living with HIV. METHODS A cross-sectional study was conducted on 170 HIV-seropositive women. Participants were selected from patients registered in the largest HIV clinic and HIV-positive club of Iran. The "HIV disclosure" questionnaire had 38-items and all the interviews were administered by the researcher. Data were analyzed using SPSS version 21.0 software. We used a logistic regression method to calculate the crude odds ratio (COR) and the adjusted odds ratio (AOR) for self-disclosure as the independent predictor variable and the dependent variable, respectively. RESULTS One hundred and seventy HIV-positive women were enrolled. Most of them had disclosed their HIV status to at least one person (94.1%) and their sexual partners (86.5%). In the univariate analysis, being married (COR = 18.66, 95% CI 5.63-61.87), living with a sexual partner (COR = 4.72, 95% CI 1.92-11.62), being aware of sexual partners' HIV status (COR = 6.20, 95% CI 1.79-21.49), and gaining the support of sexual partner (COR = 9.08, 95% CI 3.48-23.64) were associated with higher odds of HIV status disclosure. In the multivariate analysis, being aware of sexual partners' HIV status, and gaining the support of sexual partners remained associated with HIV status disclosure. Most women reported a positive reflection from their sexual partners after disclosure, however, negative reflections from society were more common compared to sexual partners and family members. CONCLUSION This study shows high overall HIV disclosure proportions. It should be noted that a large number of women were infected by their sexual partners, especially by their spouses. The high rate of transmission in married people indicates an urgent need for more emphasis on appropriate prevention behaviors by infected partners.
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Affiliation(s)
- Zahra Pashaei
- Department of Community Health Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.,Iranian Research Center for HIV/AIDS (IRCHA), Iran Nursing Care, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Oskouie
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran. .,Department of Community Health Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shayesteh Jahanfar
- MPH Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, USA
| | - Shima Haghani
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
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32
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Decker MR, Lyons C, Guan K, Mosenge V, Fouda G, Levitt D, Abelson A, Nunez GT, Njindam IM, Kurani S, Baral S. A Systematic Review of Gender-Based Violence Prevention and Response Interventions for HIV Key Populations: Female Sex Workers, Men Who Have Sex With Men, and People Who Inject Drugs. TRAUMA, VIOLENCE & ABUSE 2022; 23:676-694. [PMID: 35144502 DOI: 10.1177/15248380211029405] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Gender-based violence (GBV) is that perpetrated based on sex, gender identity, or perceived adherence to socially defined gender norms. This human rights violation is disproportionately experienced by HIV key populations including female sex workers (FSW), people who inject drugs (PWID), and men who have sex with men (MSM). Consequently, addressing GBV is a global priority in HIV response. There is limited consensus about optimal interventions and little known about effectiveness. Our systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered in International Prospective Register of Systematic Reviews. Peer-reviewed and non-peer-reviewed literature were searched for articles that described a GBV prevention or response intervention specifically for key populations including FSW, PWID, and MSM. Results were organized by level(s) of implementation and pillars of a comprehensive GBV response: prevention, survivor support, and accountability/justice. Of 4,287 articles following removal of duplicates, 32 unique interventions (21 FSW, seven PWID, and nine MSM, not mutually exclusive) met inclusion criteria, representing 13 countries. Multisectoral interventions blended empowerment, advocacy, and crisis response with reductions in violence. Individual-level interventions included violence screening and response services. Violence-related safety promotion and risk reduction counseling within HIV risk reduction programming reduced violence. Quantitative evaluations were limited. Violence prevention and response interventions for FSW, PWID, and MSM span individual, community, and multisectoral levels with evidence of promising practices at each level. The strongest evidence supported addressing violence in the context of sexually transmitted infection/HIV risk reduction. As interventions continue to emerge, the rigor of accompanying evaluations must simultaneously advance to enable clarity on the health and safety impact of GBV prevention and response programming.
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Affiliation(s)
- Michele R Decker
- Department of Population, Family and Reproductive Health, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carrie Lyons
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathleen Guan
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vanessa Mosenge
- Continuum of Prevention, Care and Treatment of HIV/AIDS with Most at Risk Populations in Cameroon, CARE International, Yaoundé, Cameroon
| | - Ghislane Fouda
- Continuum of Prevention, Care and Treatment of HIV/AIDS with Most at Risk Populations in Cameroon, CARE International, Yaoundé, Cameroon
| | - Daniel Levitt
- Continuum of Prevention, Care and Treatment of HIV/AIDS with Most at Risk Populations in Cameroon, CARE USA, New York City, NY, USA
| | - Anna Abelson
- Department of Population, Family and Reproductive Health, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gnilane Turpin Nunez
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Iliassou Mfochive Njindam
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shaheen Kurani
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stefan Baral
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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The Long-Term Health and Human Capital Consequences of Adverse Childhood Experiences in the Birth to Thirty Cohort: Single, Cumulative, and Clustered Adversity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031799. [PMID: 35162821 PMCID: PMC8835353 DOI: 10.3390/ijerph19031799] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 02/01/2023]
Abstract
Human capital—that is the cumulative abilities, education, social skills, and mental and physical health one possesses—is increasingly recognized as key to the reduction of inequality in societies. Adverse childhood experiences have been linked to a range of human capital indicators, with the majority of research in high-income, western settings. This study aims to examine the link between adverse childhood experiences and adult human capital in a South African birth cohort and to test whether associations differ by measurement of adversity. Secondary analysis of data from the Birth to Thirty study was undertaken. Exposure data on adversity was collected prospectively throughout childhood and retrospectively at age 22. Human capital outcomes were collected at age 28. Adversity was measured as single adverse experiences, cumulative adversity, and clustered adversity. All three measurements of adversity were linked to poor human capital outcomes, with risk for poor human capital increasing with the accumulation of adversity. Adversity was clustered by quantity (low versus high) and type (household dysfunction versus abuse). Adversity in childhood was linked to a broad range of negative outcomes in young adulthood regardless of how it was measured. Nevertheless, issues of measurement are important to understand the risk mechanisms that underlie the association between adversity and poor human capital.
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Logie CH, Okumu M, Berry I, Loutet M, Hakiza R, Kibuuka Musoke D, Mwima S, Kiera UM, MacNamee C, Kyambadde P. Social contextual factors associated with lifetime HIV testing among the Tushirikiane urban refugee youth cohort in Kampala, Uganda: Cross-sectional findings. Int J STD AIDS 2022; 33:374-384. [PMID: 35125037 PMCID: PMC8958564 DOI: 10.1177/09564624211069236] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Urban refugee youth may live in social contexts characterized by structural drivers of HIV such as poverty and violence. Knowledge gaps remain regarding HIV testing practices among urban refugee youth, despite the increasing trend toward refugee settlement in urban contexts. This study examined social contextual factors associated with lifetime HIV testing among urban refugee youth in Kampala, Uganda. Methods We conducted a community-based study with a peer-recruited cohort of urban refugee youth aged 16–24 years living in Kampala’s informal settlements, and present baseline cross-sectional findings. We conducted descriptive statistics and logistic regression to examine socio-demographic (e.g., gender and age), material (e.g., income insecurity and education), relational (e.g., social support), and symbolic contexts (e.g., HIV-related stigma and intimate partner violence (IPV]) associated with lifetime HIV testing. Results Participants (n = 450) had a mean age of 20.4 years (standard deviation: 2.4 years), most lived in Uganda for 1–5 years (53.2%), and less than half reported lifetime HIV testing (43.4%). In multivariable analyses, odds of lifetime HIV testing were higher among youth with secondary school education or higher (adjusted odds ratio (aOR]: 2.30, 95% confidence interval (CI]: 1.27–4.17), currently employed (aOR: 1.79, 95% CI: 1.03–3.10), and reporting IPV (aOR: 3.61, 95% CI: 1.43–9.10). Having children was marginally associated with HIV testing (aOR: 2.17, 95% CI: 0.98–4.81, p = 0.052). Conclusions Findings demonstrate suboptimal HIV testing and the importance of tailored strategies to reach urban refugee youth who are unemployed and have limited formal education. There is a need to meaningfully engage urban refugee youth to create enabling environments for sexual health.
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Affiliation(s)
- Carmen H Logie
- Factor-Iwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- United Nations University Institute for Water, Environment & Health (UNU-INWEH), Hamilton, ON, Canada
| | - Moses Okumu
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Isha Berry
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Miranda Loutet
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Robert Hakiza
- Young African Refugees for Integral Development, Kampala, Uganda
| | | | - Simon Mwima
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- National AIDS Coordinating Program, Ugandan Ministry of Health, Kampala, Uganda
- Bukedi Prevention Institute, Kampala, Uganda
| | - Uwase Mimy Kiera
- Young African Refugees for Integral Development, Kampala, Uganda
- Bukedi Prevention Institute, Kampala, Uganda
| | - Clara MacNamee
- Factor-Iwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Peter Kyambadde
- National AIDS Coordinating Program, Ugandan Ministry of Health, Kampala, Uganda
- Most At Risk Population Initiative, Mulago Hospital, Kampala, Uganda
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Kaida A, Cameron B, Conway T, Cotnam J, Danforth J, de Pokomandy A, Gagnier B, Godoy S, Gormley R, Greene S, Habanyama M, Kazemi M, Logie CH, Loutfy M, MacGillivray J, Masching R, Money D, Nicholson V, Osborne Z, Pick N, Sanchez M, Tharao W, Watt S, Narasimhan M. Key recommendations for developing a national action plan to advance the sexual and reproductive health and rights of women living with HIV in Canada. WOMEN'S HEALTH 2022; 18:17455057221090829. [PMID: 35435062 PMCID: PMC9019372 DOI: 10.1177/17455057221090829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Action on the World Health Organization Consolidated guideline on sexual and reproductive health and rights of women living with HIV requires evidence-based, equity-oriented, and regionally specific strategies centred on priorities of women living with HIV. Through community–academic partnership, we identified recommendations for developing a national action plan focused on enabling environments that shape sexual and reproductive health and rights by, with, and for women living with HIV in Canada. Between 2017 and 2019, leading Canadian women’s HIV community, research, and clinical organizations partnered with the World Health Organization to convene a webinar series to describe the World Health Organization Consolidated guideline, define sexual and reproductive health and rights priorities in Canada, disseminate Canadian research and best practices in sexual and reproductive health and rights, and demonstrate the importance of community–academic partnerships and meaningful engagement of women living with HIV. Four webinar topics were pursued: (1) Trauma and Violence-Aware Care/Practice; (2) Supporting Safer HIV Disclosure; (3) Reproductive Health, Rights, and Justice; and (4) Resilience, Self-efficacy, and Peer Support. Subsequent in-person (2018) and online (2018–2021) consultation with > 130 key stakeholders further clarified priorities. Consultations yielded five cross-cutting key recommendations: 1. Meaningfully engage women living with HIV across research, policy, and practice aimed at advancing sexual and reproductive health and rights by, with, and for all women. 2. Centre Indigenous women’s priorities, voices, and perspectives. 3. Use language that is actively de-stigmatizing, inclusive, and reflective of women’s strengths and experiences. 4. Strengthen Knowledge Translation efforts to support access to and uptake of contemporary sexual and reproductive health and rights information for all stakeholders. 5. Catalyse reciprocal relationships between evidence and action such that action is guided by research evidence, and research is guided by what is needed for effective action. Topic-specific sexual and reproductive health and rights recommendations were also identified. Guided by community engagement, recommendations for a national action plan on sexual and reproductive health and rights encourage Canada to enact global leadership by creating enabling environments for the health and healthcare of women living with HIV. Implementation is being pursued through consultations with provincial and national government representatives and policy-makers.
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Affiliation(s)
- Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Women’s Health Research Institute (WHRI), Vancouver, BC, Canada
| | - Brittany Cameron
- PARN-Community Based HIV/STBBI Programs, Peterborough, ON, Canada
- International Community of Women Living with HV–North America (ICW-NA), Washington, DC, USA
| | - Tracey Conway
- Canadian Positive People Network (CPPN)/Réseau canadien de personnes séropositives (RCPS), Dunrobin, ON, Canada
| | - Jasmine Cotnam
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | | | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Brenda Gagnier
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Sandra Godoy
- Women’s Health in Women’s Hands Community Health Centre, Toronto, ON, Canada
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Saara Greene
- School of Social Work, McMaster University, Hamilton, ON, Canada
| | - Muluba Habanyama
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Mina Kazemi
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Mona Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jay MacGillivray
- Positive Pregnancy Program (P3), St. Michael’s Hospital, Toronto, ON, Canada
| | - Renee Masching
- Canadian Aboriginal AIDS Network (CAAN), Dartmouth, NS, Canada
| | - Deborah Money
- Women’s Health Research Institute (WHRI), Vancouver, BC, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital and Healthcare Centre, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Zoë Osborne
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Neora Pick
- Oak Tree Clinic, British Columbia Women’s Hospital and Healthcare Centre, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Margarite Sanchez
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- ViVA women, a network by and for women living with HIV, Vancouver, BC, Canada
| | - Wangari Tharao
- Women’s Health in Women’s Hands Community Health Centre, Toronto, ON, Canada
| | - Sarah Watt
- BC Centre for Disease Control (BCCDC), Vancouver, BC, Canada
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Patterson S, Nicholson V, Gormley R, Carter A, Logie CH, Closson K, Ding E, Trigg J, Li J, Hogg R, de Pokomandy A, Loutfy M, Kaida A. Impact of Canadian human immunodeficiency virus non-disclosure case law on experiences of violence from sexual partners among women living with human immunodeficiency virus in Canada: Implications for sexual rights. WOMEN'S HEALTH 2022; 18:17455065221075914. [PMID: 35168410 PMCID: PMC8855424 DOI: 10.1177/17455065221075914] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: People living with human immunodeficiency virus in Canada can face criminal
charges for human immunodeficiency virus non-disclosure before sex, unless a
condom is used and their viral load is <1500 copies/mL. We measured the
reported impact of human immunodeficiency virus non-disclosure case law on
violence from sexual partners among women living with human immunodeficiency
virus in Canada. Methods: We used cross-sectional survey data from wave 3 participant visits
(2017–2018) within Canadian HIV Women’s Sexual and Reproductive Health
Cohort Study; a longitudinal, community-based cohort of women living with
human immunodeficiency virus in British Columbia, Ontario and Quebec. Our
primary outcome was derived from response to the statement: ‘[HIV
non-disclosure case law has] increased my experiences of
verbal/physical/sexual violence from sexual partners’. Participants
responding ‘strongly agree/agree’ were deemed to have experienced increased
violence due to the law. Participants responding ‘not applicable’ (i.e.
those without sexual partners) were excluded. Multivariate logistic
regression identified factors independently associated with increased
violence from sexual partners due to human immunodeficiency virus
non-disclosure case law. Results: We included 619/937 wave 3 participants. Median age was 46 (interquartile
range: 39–53) and 86% had experienced verbal/physical/sexual violence in
adulthood. Due to concerns about human immunodeficiency virus non-disclosure
case law, 37% had chosen not to have sex with a new partner, and 20% had
disclosed their human immunodeficiency virus status to sexual partners
before a witness. A total of 21% self-reported that human immunodeficiency
virus non-disclosure case law had increased their experiences of
verbal/physical/sexual violence from sexual partners. In adjusted analyses,
women reporting non-White ethnicity (Indigenous; African/Caribbean/Black;
Other), unstable housing and high human immunodeficiency virus–related
stigma had significantly higher odds of reporting increased violence from
sexual partners due to human immunodeficiency virus non-disclosure case
law. Conclusion: Findings bolster concerns that human immunodeficiency virus criminalization
is a structural driver of intimate partner violence, compromising sexual
rights of women living with human immunodeficiency virus. Human
immunodeficiency virus non-disclosure case law intersects with other
oppressions to regulate women’s sexual lives.
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Affiliation(s)
- Sophie Patterson
- Faculty of Health Sciences, Simon
Fraser University, Burnaby, BC, Canada
- Faculty of Health and Medicine,
University of Lancaster, Lancaster, UK
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon
Fraser University, Burnaby, BC, Canada
- BC Centre for Excellence in HIV/AIDS,
Vancouver, BC, Canada
| | | | - Allison Carter
- Faculty of Health Sciences, Simon
Fraser University, Burnaby, BC, Canada
- Kirby Institute, University of New
South Wales, Sydney, NSW, Australia
- Australian Human Rights Institute,
University of New South Wales, Sydney, NSW, Australia
| | - Carmen H Logie
- Women’s College Research Institute,
Women’s College Hospital, Toronto, ON, Canada
- Factor-Inwentash Faculty of Social
Work, University of Toronto, Toronto, ON, Canada
| | - Kalysha Closson
- BC Centre for Excellence in HIV/AIDS,
Vancouver, BC, Canada
- School of Population and Public Health,
The University of British Columbia, Vancouver, BC, Canada
| | - Erin Ding
- BC Centre for Excellence in HIV/AIDS,
Vancouver, BC, Canada
| | - Jason Trigg
- BC Centre for Excellence in HIV/AIDS,
Vancouver, BC, Canada
| | - Jenny Li
- BC Centre for Excellence in HIV/AIDS,
Vancouver, BC, Canada
| | - Robert Hogg
- Faculty of Health Sciences, Simon
Fraser University, Burnaby, BC, Canada
- BC Centre for Excellence in HIV/AIDS,
Vancouver, BC, Canada
| | - Alexandra de Pokomandy
- McGill University Health Centre and
Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Mona Loutfy
- Women’s College Research Institute,
Women’s College Hospital, Toronto, ON, Canada
- Department of Medicine, University of
Toronto, Toronto, ON, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon
Fraser University, Burnaby, BC, Canada
- Women’s Health Research Institute
(WHRI), Vancouver, BC, Canada
- Angela Kaida, Faculty of Health Sciences,
Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
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2020 Syndemic: Convergence of COVID-19, Gender-Based Violence, and Racism Pandemics. J Racial Ethn Health Disparities 2022; 9:2077-2089. [PMID: 34648144 PMCID: PMC8515913 DOI: 10.1007/s40615-021-01146-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/27/2021] [Accepted: 09/03/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To conduct a rapid knowledge synthesis of literature on the social determinants of mental health of racialized women exposed to gender-based violence (GBV) during the COVID-19 pandemic. METHODS We adapted the Cochrane Rapid Reviews method and were guided by an equity lens in conducting rapid reviews on public health issues. Four electronic databases (Cochrane CENTRAL, Medline, ProQuest, and EBSCO), electronic news media, Google Scholar, and policy documents were searched for literature between January 2019 and October 2020 with no limitations for location. Fifty-five articles qualified for the review. RESULTS Health emergencies heighten gender inequalities in relation to income, employment, job security, and working conditions. Household stress and pandemic-related restrictions (social distancing, closure of services) increase women's vulnerability to violence. Systemic racism and discrimination intensify health disparities. CONCLUSION Racialized women are experiencing a 2020 Syndemic: a convergence of COVID-19, GBV, and racism pandemics, placing their wellbeing at a disproportionate risk. GBV is a public health issue and gender-responsive COVID-19 programming is essential. Anti-racist and equity-promoting policies to GBV service provision and disaggregated data collection are required.
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Saleem HT, Zhang L, Silberg C, Latkin C, Likindikoki S. Structural, everyday, and symbolic violence and the heightened vulnerability to HIV of women who use drugs in Tanzania. SSM - QUALITATIVE RESEARCH IN HEALTH 2021; 1. [PMID: 35174337 PMCID: PMC8846603 DOI: 10.1016/j.ssmqr.2021.100010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Women who use drugs shoulder a disproportionate burden of the HIV epidemic in Tanzania. The mechanisms through which violence contributes to their excessively high rates of HIV have not been explored. In this paper, we use concepts of everyday, symbolic, and structural violence to critically examine the relationship between violence and heightened HIV vulnerability of women who use drugs in Dar es Salaam, Tanzania. We conducted cross-sectional surveys with 200 women who use drugs and follow-up, in-depth interviews with 30 survey participants who identified as living with HIV between November 2018 and March 2019. We drew from grounded theory methods to analyze qualitative data and complemented qualitative findings with survey results. Structural violence perpetuated constraints on women's economic opportunities and reduced their agency in sexual encounters manifesting in their disproportionately high rates of HIV. Nearly all women in our study engaged in sex work to meet basic needs and to support their drug use. Their involvement in overlapping drug use and sex work scenes exposed them to physical and sexual violence. Despite the pervasiveness of structural and everyday violence, some women reenacted agency by adopting strategies to maintain control and safety, and to exercise harm reduction. A multi-pronged, structural harm reduction strategy is critical to reducing violence experienced by women who use drugs and their ability to protect themselves from HIV.
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Backe EL, Bosire E, Mendenhall E. "Drinking Too Much, Fighting Too Much": The Dual "Disasters" of Intimate Partner Violence and Alcohol Use in South Africa. Violence Against Women 2021; 28:2312-2333. [PMID: 34766522 DOI: 10.1177/10778012211034206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The intersecting issues of intimate partner violence (IPV) and alcohol abuse in South Africa are often characterized as "disasters." Ethnographic research among women in Soweto demonstrates the different manifestations of IPV, perceptions of abuse, and coping mechanisms to manage harmful domestic relationships. Findings suggest a consistent relationship between excessive drinking patterns and IPV-most significantly, physical and emotional abuse-while indicating that domestic violence measures should include questions about stress. The authors also argue against pathologizing the relationship between IPV and alcohol abuse, to instead center the structured, sedimented ways that violence within the home has become a "normalized" disaster.
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Affiliation(s)
- Emma L Backe
- Anthropology Department, 166722George Washington University, Washington, DC, USA
| | - Edna Bosire
- Center for Innovation in Global Health, 8368Georgetown University & College of Medicine, Johannesburg, South Africa.,Faculty of Health Sciences, University of Malawi and SAMRC Developmental Pathways for Health Research Unit, 37707University of the Witwatersrand, Johannesburg, South Africa
| | - Emily Mendenhall
- Edmund A. Walsh School of Foreign Service, Georgetown University and SAMRC Developmental Pathways for Health Research Unit, Johannesburg, South Africa.,Faculty of Health Sciences, 37707University of the Witwatersrand, Johannesburg, South Africa
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Gibbs A, Gumede D, Luthuli M, Xulu Z, Washington L, Sikweyiya Y, Adeagbo O, Shahmanesh M. Opportunities for technologically driven dialogical health communication for participatory interventions: Perspectives from male peer navigators in rural South Africa. Soc Sci Med 2021; 292:114539. [PMID: 34776288 PMCID: PMC8783050 DOI: 10.1016/j.socscimed.2021.114539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/15/2021] [Accepted: 11/04/2021] [Indexed: 01/30/2023]
Abstract
There is increasing interest in the potential to deliver participatory dialogical HIV and intimate partner violence (IPV) prevention interventions via digital platforms, though the majority of mHealth interventions have been didactic in approach. We undertook 10 in-depth interviews with male Peer Navigators (PNs) who had been extensively trained and working on a larger intervention promoting young people's sexual and reproductive rights, in rural KwaZulu-Natal. Interviews focused on their, and their peers', use of technology in their everyday lives. Data were transcribed and translated, and subjected to thematic analysis. PNs described structural barriers to the use of technology, including poor connectivity, high data costs, and erratic electricity. They primarily used Facebook and WhatsApp for communication and highlighted how reading messages asynchronously was important to overcome connectivity challenges. PNs shared how groups were primarily for information sharing, they also discussed ‘sensitive’ issues online. Privacy was a concern, especially for conversations, and there was recognition of how confidentiality could be breached. It was also felt that WhatsApp could potentially support greater openness in discussions. We reflect on the potential for online interventions to support dialogical health communication, highlighting how dialogical health communication may be enabled through information provision, the asynchronous communication enhancing the potential for reflection, and greater participation in discussion by those who are shyer. Despite this potential there remain important risks around privacy of discussions and how to implement these approaches online. Qualitative research with young men showed high levels of cellphone usage. Emphasizes the importance of sharing information and personal discussions online. Suggests potential opportunities for discussion and reflection via WhatsApp. Recognises limitations of WhatsApp communication for health communication.
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Affiliation(s)
- Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, South Africa; School of Nursing and Public Health, University of KwaZulu-Natal, South Africa.
| | - Dumsani Gumede
- African Health Research Institute (AHRI), Durban, South Africa
| | - Manono Luthuli
- African Health Research Institute (AHRI), Durban, South Africa
| | - Zakhele Xulu
- African Health Research Institute (AHRI), Durban, South Africa
| | | | - Yandisa Sikweyiya
- Gender and Health Research Unit, South African Medical Research Council, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Oluwafemi Adeagbo
- African Health Research Institute (AHRI), Durban, South Africa; Department of Health Promotion, Education and Behaviour, University of South Carolina, Columbia, USA; Department of Sociology, University of Johannesburg, South Africa
| | - Maryam Shahmanesh
- School of Nursing and Public Health, University of KwaZulu-Natal, South Africa; African Health Research Institute (AHRI), Durban, South Africa; Institute for Global Health, University College London, London, UK
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de Brito ES, Knauth DR, Brand ÉM, Calvo KDS, Vigo Á, Pilecco FB, Machado FV, de Teixeira MA, de Almeida FM, Hentges B, Silva DL, Teixeira LB. Factors Associated with HIV and Vulnerability Contexts for Women in Brazil. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3247-3256. [PMID: 33864176 DOI: 10.1007/s10508-021-01960-7] [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: 02/24/2019] [Revised: 01/31/2021] [Accepted: 02/13/2021] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to identify factors associated with HIV and vulnerability contexts for women in Porto Alegre, Brazil. The participants were 1326 women recruited by complex sampling design, divided into two groups: 640 women with HIV (WLH) and 686 women who did not have HIV (WNLH). Gross and weighted statistical analyses were performed. Logistic regression models were used to estimate the odds ratio (OR) for 12 variables. The main results demonstrated that WLH had lower income (p < .001) and poorer education (p = .038), and few used condoms during their first sexual intercourse (p < .001). The occurrence of HIV was higher among the black population (p < .001). Sex in exchange for money (p < .001) and sexually transmitted infections (p < .001) were more frequent among WLH than among WNLH. The age of sexual debut and age difference from the partner at first sexual intercourse (FSI) were not associated with the outcome. The high percentage of non-use of condoms during the FSI shows how vulnerable individuals are right at the beginning of their sexual lives. More effective prevention strategies can be developed by nurses in view of the contexts of vulnerability surrounding women.
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Affiliation(s)
- Emerson Silveira de Brito
- Department of Collective Health, School of Nursing, Federal University of Rio Grande do Sul, 90620-110, Porto Alegre, Brazil
| | - Daniela Riva Knauth
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Évelin Maria Brand
- Department of Collective Health, School of Nursing, Federal University of Rio Grande do Sul, 90620-110, Porto Alegre, Brazil
| | - Karen da Silva Calvo
- Department of Collective Health, School of Nursing, Federal University of Rio Grande do Sul, 90620-110, Porto Alegre, Brazil
- School of Nursing, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Álvaro Vigo
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Flávia Bulegon Pilecco
- Department of Preventive and Social Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Frederico Viana Machado
- Department of Collective Health, School of Nursing, Federal University of Rio Grande do Sul, 90620-110, Porto Alegre, Brazil
| | - Marsam Alves de Teixeira
- Department of Collective Health, School of Nursing, Federal University of Rio Grande do Sul, 90620-110, Porto Alegre, Brazil
| | - Franciele Moletta de Almeida
- Department of Collective Health, School of Nursing, Federal University of Rio Grande do Sul, 90620-110, Porto Alegre, Brazil
| | - Bruna Hentges
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Danielle Lodi Silva
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Luciana Barcellos Teixeira
- Department of Collective Health, School of Nursing, Federal University of Rio Grande do Sul, 90620-110, Porto Alegre, Brazil.
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
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Caplon A, Alexander KA, Kershaw T, Willie TC. Assessing Provider-, Clinic-, and Structural-Level Barriers and Recommendations to Pre-Exposure Prophylaxis (PrEP) Uptake: A Qualitative Investigation Among Women Experiencing Intimate Partner Violence, Intimate Partner Violence Service Providers, and Healthcare Providers. AIDS Behav 2021; 25:3425-3436. [PMID: 33974167 DOI: 10.1007/s10461-021-03297-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 11/30/2022]
Abstract
Intimate partner violence (IPV) relates to HIV susceptibility and acquisition. Existing research examined barriers to pre-exposure prophylaxis (PrEP) uptake among women but few studies assess uptake and delivery among IPV service providers, along with provider-, clinic-, and structural-level barriers. We conducted 34 semi-structured interviews with PrEP-eligible cisgender heterosexual women experiencing IPV, Reproductive Health providers, PrEP providers, and IPV service providers in Northeast US. Systems theory was used to examine barriers from individuals who either work closely with or are part of the population. The framework method was used to draw descriptive and explanatory conclusions. Findings suggest limited knowledge for Reproductive Health and IPV Service Providers. Providers often did not feel equipped to discussed PrEP in visits or focused efforts solely on safety. Expanding PrEP awareness is necessary and marketing should include women. Future research should investigate how providers can work collaboratively across sectors to ensure women receive comprehensive trauma-informed care.
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Affiliation(s)
- Amy Caplon
- Division of Cancer Control and Populations Sciences, National Cancer Institute, 9606 Medical Center Drive, Rockville, MD, 20850, USA.
| | - Kamila A Alexander
- Department of Community - Public Health Nursing, Johns Hopkins School of Nursing, Baltimore, MD, 21205, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Tiara C Willie
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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Willie TC, Alexander KA, Kershaw T, Campbell JC, Stockman JK. No Longer the Exception, but the Standard: Integrating Trauma-Informed Policy and Pre-exposure Prophylaxis Implementation for Women. Womens Health Issues 2021; 31:415-419. [PMID: 34175198 PMCID: PMC8448947 DOI: 10.1016/j.whi.2021.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Tiara C Willie
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | | | - Trace Kershaw
- Department of Social and Behavioral Sciences, New Haven, Connecticut
| | | | - Jamila K Stockman
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, California
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Zhu Y, Hou F, Chen C, Wei D, Peng L, You X, Gu J, Hao C, Hao Y, Li J. Moderating effect of self-efficacy on the association of intimate partner violence with risky sexual behaviors among men who have sex with men in China. BMC Infect Dis 2021; 21:895. [PMID: 34470607 PMCID: PMC8408951 DOI: 10.1186/s12879-021-06618-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/22/2021] [Indexed: 11/24/2022] Open
Abstract
Background In China, men who have sex with men (MSM) face a high risk of HIV infection. Intimate partner violence (IPV) is common in this population and leads to various adverse consequences, including risky sexual behaviors, substance abuse, and poor mental health, which pose huge challenges to HIV prevention and control. Methods An anonymous cross-sectional study was conducted to investigate the lifetime prevalence of IPV and prevalence of risky sexual behaviors during the previous 6 months in a convenience sample of 578 MSM from 15 cities covering seven geographical divisions in mainland China. The associations between IPV and risky sexual behaviors and the moderating effect of self-efficacy on these associations were explored through univariate and multivariate regression analyses. Results The prevalence rates of IPV perpetration and victimization were 32.5% and 32.7%, respectively. The proportions of participants who reported inconsistent condom use with regular or casual partners and multiple regular or casual sexual partners were 25.8%, 8.3%, 22.2%, and 37.4%, respectively. Multiple IPV experiences were positively associated with risky sexual behaviors; for example, any IPV victimization was positively associated with multiple regular partners, adjusted odds ratio (ORa) = 1.54, 95% CI [1.02,2.32], and multiple casual partners, ORa = 1.93, 95% CI [1.33, 2.80]. Any IPV perpetration was positively associated with inconsistent condom use with regular partners, ORa = 1.58, 95% CI [1.04, 2.40], and multiple casual partners, ORa = 2.11, 95% CI [1.45, 3.06]. Self-efficacy was identified as a significant moderator of the association between multiple casual sexual partnership and emotional IPV. Conclusions In conclusion, given the high prevalence of both IPV and risky sexual behaviors among Chinese MSM in this study, the inclusion of self-efficacy in interventions targeting IPV and risky sexual behaviors should be considered.
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Affiliation(s)
- Yang Zhu
- School of Public Health, Sun Yat-Sen University, North Campus, 74# Zhongshan 2nd Road, Guangzhou, 510000, China
| | - Fengsu Hou
- Department of Public Mental Health, Shenzhen Kangning Hospital, Shenzhen, China.,Sun Yat-Sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China
| | - Chun Chen
- Department of Mechanical and Automation Engineering, Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong, China
| | - Dannuo Wei
- School of Public Health, Sun Yat-Sen University, North Campus, 74# Zhongshan 2nd Road, Guangzhou, 510000, China
| | - Liping Peng
- School of Public Health, Sun Yat-Sen University, North Campus, 74# Zhongshan 2nd Road, Guangzhou, 510000, China
| | - Xinyi You
- School of Public Health, Sun Yat-Sen University, North Campus, 74# Zhongshan 2nd Road, Guangzhou, 510000, China
| | - Jing Gu
- School of Public Health, Sun Yat-Sen University, North Campus, 74# Zhongshan 2nd Road, Guangzhou, 510000, China.,Sun Yat-Sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China
| | - Chun Hao
- School of Public Health, Sun Yat-Sen University, North Campus, 74# Zhongshan 2nd Road, Guangzhou, 510000, China.,Sun Yat-Sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China
| | - Yuantao Hao
- School of Public Health, Sun Yat-Sen University, North Campus, 74# Zhongshan 2nd Road, Guangzhou, 510000, China
| | - Jinghua Li
- School of Public Health, Sun Yat-Sen University, North Campus, 74# Zhongshan 2nd Road, Guangzhou, 510000, China. .,Sun Yat-Sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China.
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Swann SA, Kaida A, Nicholson V, Brophy J, Campbell AR, Carter A, Elwood C, Gebremedhen T, Gormley R, King EM, Lee M, Lee V, Maan EJ, Magagula P, Nyman S, Pang D, Pick N, Povshedna T, Prior JC, Singer J, Tognazzini S, Murray MCM, Cote HCF. British Columbia CARMA-CHIWOS Collaboration (BCC3): protocol for a community-collaborative cohort study examining healthy ageing with and for women living with HIV. BMJ Open 2021; 11:e046558. [PMID: 34362800 PMCID: PMC8351488 DOI: 10.1136/bmjopen-2020-046558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Women living with HIV (WLWH) experience accelerated ageing and an increased risk of age-associated diseases earlier in life, compared with women without HIV. This is likely due to a combination of viral factors, gender differences, hormonal imbalance and psychosocial and structural conditions. This interdisciplinary cohort study aims to understand how biological, clinical and sociostructural determinants of health interact to modulate healthy ageing in WLWH. METHODS AND ANALYSIS The British Columbia Children and Women: AntiRetroviral therapy and Markers of Aging-Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CARMA-CHIWOS) Collaboration (BCC3) study will enrol WLWH (n=350) and sociodemographically matched HIV-negative women (n=350) living in British Columbia. A subset of BCC3 participants will be past participants of CARMA, n≥1000 women and children living with and without HIV, 2008-2018 and/or CHIWOS, n=1422 WLWH, 2013-2018. Over two study visits, we will collect biological specimens for virus serologies, hormones and biological markers as well as administer a survey capturing demographic and sociostructural-behavioural factors. Sociodemographics, comorbidities, number and type of chronic/latent viral infections and hormonal irregularities will be compared between the two groups. Their association with biological markers and psychostructural and sociostructural factors will be investigated through multivariable regression and structural equation modelling. Retrospective longitudinal analyses will be conducted on data from past CARMA/CHIWOS participants. As BCC3 aims to follow participants as they age, this protocol will focus on the first study visits. ETHICS AND DISSEMINATION This study has been approved by the University of British Columbia Children's and Women's Research Ethics Board (H19-00896). Results will be shared in peer-reviewed journals, conferences and at community events as well as at www.hivhearme.ca and @HIV_HEAR_me. WLWH are involved in study design, survey creation, participant recruitment, data collection and knowledge translation. A Community Advisory Board will advise the research team throughout the study.
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Affiliation(s)
- Shayda A Swann
- Experimental Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Angela Kaida
- British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Epidemiology and Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Jason Brophy
- Division of Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Amber R Campbell
- British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, British Columbia, Canada
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Allison Carter
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Faculty of Medicine, The Kirby Institute, Sydney, New South Wales, Australia
| | - Chelsea Elwood
- British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, British Columbia, Canada
- Obstetrics and Gynecology, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Tsion Gebremedhen
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Epidemiology and Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Elizabeth M King
- British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, British Columbia, Canada
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Melanie Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Vonnie Lee
- British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, British Columbia, Canada
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Evelyn J Maan
- British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, British Columbia, Canada
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Patience Magagula
- Afro-Caribbean Positive Network of BC, Vancouver, British Columbia, Canada
| | - Sheila Nyman
- Bear Rock Consulting, Lone Butte, British Columbia, Canada
| | - Davi Pang
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Neora Pick
- British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, British Columbia, Canada
- Division of Infectious Diseases, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Tetiana Povshedna
- Pathology and Laboratory Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Jerilynn C Prior
- British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, British Columbia, Canada
- Centre for Menstrual Cycle and Ovulatory Research, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shelly Tognazzini
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Melanie C M Murray
- British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, British Columbia, Canada
- Division of Infectious Diseases, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Helene C F Cote
- British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, British Columbia, Canada
- Pathology and Laboratory Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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Edwards KM, Changilwa P, Waterman E, Bikeri C, Mweru C, Khayanje N, Obel P. A Promising Approach to Preventing Gender-Based Violence and HIV Among Slum-Dwelling Youth in Nairobi, Kenya. Violence Against Women 2021; 28:1379-1397. [PMID: 34247565 DOI: 10.1177/10778012211014562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Gender-based violence (GBV) and HIV are interrelated public health problems affecting numerous global communities. To date, few prevention initiatives have demonstrated reductions in GBV and HIV, and thus there is an urgency to identify effective strategies to prevent these interconnected public health crises. The purpose of the current article is to describe a gender-enhanced life skills training curriculum (GE-LSTC) currently being developed in Nairobi, Kenya. We discuss previous research relevant to the GE-LSTC; the theoretical underpinnings of the GE-LSTC; the history and context of the GE-LSTC; preliminary implementation, feasibility, and acceptability data on the GE-LSTC; and plans for further refinement and rigorous evaluation of the GE-LSTC.
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Affiliation(s)
| | | | | | | | - Cecelia Mweru
- Life Skills for Behavior Change Center, Nairobi, Kenya
| | - Noel Khayanje
- Life Skills for Behavior Change Center, Nairobi, Kenya
| | - Patrick Obel
- Life Skills for Behavior Change Center, Nairobi, Kenya
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47
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Bagwell-Gray ME. Women's Experiences of Sexual Violence in Intimate Relationships: Applying a New Taxonomy. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP7813-NP7839. [PMID: 30791809 DOI: 10.1177/0886260519827667] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
How do women describe their experiences of sexual violence in their intimate relationships? In answering this question, the present article builds upon a newly developed taxonomy of intimate partner sexual violence (IPSV). Women with past or present intimate partner violence experience (N = 28) were recruited from a domestic violence program and the community at large. Data were collected with semistructured, in-person interviews, audio recorded, and transcribed. As defined by the taxonomy, 27 women (96%) experienced intimate partner sexual abuse; 19 (68%) experienced intimate partner sexual coercion; 14 (50%) experienced intimate partner sexual assault; and two (7%) experienced intimate partner-forced sexual activity. Intimate partner sexual abuse was central to women's experiences of IPSV. Common categories of sexual abuse were having sex outside of the relationship, controlling reproductive decisions, degrading with sexual criticism and insults, refusing communication, denying pleasure, and withholding sex. The types of IPSV did not typically occur in isolation; the taxonomy revealed a grouping pattern, with intimate partner sexual assault and intimate partner sexual coercion co-occurring with sexual abuse. Understanding the different types of IPSV as a comprehensive mechanism of sexual control is a meaningful way to conceptualize sexual violence in intimate relationships. The expanded taxonomy provides a useful therapeutic tool in helping women share and heal from these experiences.
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48
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Leis M, McDermott M, Koziarz A, Szadkowski L, Kariri A, Beattie TS, Kaul R, Kimani J. Intimate partner and client-perpetrated violence are associated with reduced HIV pre-exposure prophylaxis (PrEP) uptake, depression and generalized anxiety in a cross-sectional study of female sex workers from Nairobi, Kenya. J Int AIDS Soc 2021; 24 Suppl 2:e25711. [PMID: 34164924 PMCID: PMC8222843 DOI: 10.1002/jia2.25711] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION UNAIDS has identified female sex workers (FSW) as a key HIV at-risk population. FSW disproportionately experience gender-based violence, which compounds their risk of HIV acquisition and may contribute to adverse mental health outcomes. Pre-exposure prophylaxis (PrEP) is a powerful but underused HIV prevention tool for these women. This study explored the associations between intimate partner violence (IPV) and client-perpetrated violence against FSW, mental health outcomes and PrEP use. METHODS An anonymous questionnaire was administered to a convenience sample of 220 Nairobi FSW attending dedicated clinics from June to July 2019, where PrEP was available free of charge. A modified version of the WHO Violence Against Women Instrument assessed IPV and client-perpetrated violence, and the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) assessed depressive and anxiety symptoms respectively. Multivariable logistic regressions evaluated predictors of depression, generalized anxiety and PrEP use. RESULTS Of the total 220 women (median [IQR] age 32 [27-39]), 56.8% (125/220) reported depression (PHQ-9 ≥ 10) and 39.1% (86/220) reported anxiety (GAD-7 ≥ 10). Only 41.4% (91/220) reported optimal use of PrEP (taken correctly six to seven days/week) despite the cohort pursuing sex work for a median of 7 (4 to 12) years. Most women reported experiencing any violence in the past 12 months (90%, 198/220). Any recent IPV was frequent (78.7%, 129/164), particularly emotional IPV (66.5%, 109/164), as was any client-perpetrated violence in the past 12 months (80.9%, 178/220). Regression analyses found that violence was independently associated with depression (adjusted OR [aOR] 9.39, 95% CI 2.90 to 30.42, p = 0.0002) and generalized anxiety (aOR 3.47, 95% CI 1.10 to 10.88, p = 0.03), with the strongest associations between emotional IPV and both depression and anxiety. Recent client-perpetrated emotional violence (aOR 0.23, 95% CI 0.07 to 0.71, p = 0.01) was associated with decreased PrEP use, whereas client-perpetrated physical violence was associated with increased PrEP use (aOR 3.01, 95% CI 1.16 to 7.81, p = 0.02). CONCLUSIONS There was a high prevalence of recent violence by different perpetrators as well as depression and anxiety among FSW from Nairobi. PrEP use was relatively infrequent, and recent client-perpetrated emotional violence was associated with PrEP non-use. Interventions to reduce gender-based violence may independently enhance HIV prevention and reduce the mental health burden in this community.
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Affiliation(s)
- Maria Leis
- Department of MedicineUniversity of TorontoTorontoCanada
| | | | - Alex Koziarz
- Department of MedicineUniversity of TorontoTorontoCanada
| | - Leah Szadkowski
- Biostatistics Research UnitUniversity Health NetworkTorontoCanada
| | - Antony Kariri
- Department of Medical MicrobiologyUniversity of NairobiNairobiKenya
| | - Tara S Beattie
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonEngland
| | - Rupert Kaul
- Department of MedicineUniversity of TorontoTorontoCanada
| | - Joshua Kimani
- Department of Medical MicrobiologyUniversity of NairobiNairobiKenya
- Department of Medical MicrobiologyUniversity of ManitobaManitobaCanada
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49
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Leddy AM, Zakaras JM, Shieh J, Conroy AA, Ofotokun I, Tien PC, Weiser SD. Intersections of food insecurity, violence, poor mental health and substance use among US women living with and at risk for HIV: Evidence of a syndemic in need of attention. PLoS One 2021; 16:e0252338. [PMID: 34038490 PMCID: PMC8153505 DOI: 10.1371/journal.pone.0252338] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background Food insecurity and intimate partner violence (IPV) are associated with suboptimal HIV prevention and treatment outcomes, yet limited research has explored how food insecurity and IPV intersect to influence HIV-related behaviors. To fill this gap, we conducted a qualitative study with women living with or at risk for HIV in the United States. Methods We conducted 24 in-depth interviews with women enrolled in the San Francisco and Atlanta sites of the Women’s Interagency HIV study (WIHS). Participants were purposively sampled so half were living with HIV and all reported food insecurity and IPV in the past year. Semi-structured interviews explored experiences with food insecurity and IPV, how these experiences might be related and influence HIV risk and treatment behaviors. Analysis was guided by an inductive-deductive approach. Results A predominant theme centered on how food insecurity and IPV co-occur with poor mental health and substance use to influence HIV-related behaviors. Women described how intersecting experiences of food insecurity and IPV negatively affected their mental health, with many indicating using substances to “feel no pain”. Substance use, in turn, was described to perpetuate food insecurity, IPV, and poor mental health in a vicious cycle, ultimately facilitating HIV risk behaviors and preventing HIV treatment adherence. Conclusions Food insecurity, IPV, poor mental health and substance use intersect and negatively influence HIV prevention and treatment behaviors. Findings offer preliminary evidence of a syndemic that goes beyond the more widely studied “SAVA” (substance use, AIDS, and violence) syndemic, drawing attention to additional constructs of mental health and food insecurity. Quantitative research must further characterize the extent and size of this syndemic. Policies that address the social and structural drivers of this syndemic, including multi-level and trauma-informed approaches, should be implemented and evaluated to assess their impact on this syndemic and its negative health effects.
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Affiliation(s)
- Anna M Leddy
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
| | - Jennifer M Zakaras
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
| | - Jacqueline Shieh
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
| | - Amy A Conroy
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
| | - Ighovwerha Ofotokun
- School of Medicine, Emory University and Grady Healthcare System, Atlanta, GA, United States of America
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America.,Department of Veteran Affairs Medical Center, San Francisco, CA, United States of America
| | - Sheri D Weiser
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
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50
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Robbertz AS, Ishiekwene MN, Hucks OL, Armistead L. The impact of trauma on South African women with HIV: The role of anxiety and physical symptomology. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2021; 20:141-148. [PMID: 33985421 DOI: 10.2989/16085906.2021.1914692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Rates of trauma and HIV are high in South Africa, and those who experience more trauma have higher levels of psychological distress. This cross-sectional study examined trauma, physical, and mental health among black South African women living with HIV (WLH). We hypothesised that WLH would have higher rates of trauma than women not living with HIV (WNLH). We also hypothesised that there would be a relationship between trauma, anxiety, and physical symptoms, such that anxiety would mediate the relationship between trauma and physical symptoms for WLH. This study enrolled 242 women, 99 WLH. Women were individually interviewed, completing the Life Stressor Checklist (trauma history), the Physical Symptom Inventory, and the IPAT Anxiety Scale. WLH reported significantly more traumatic life events (M = 3.69, SD = 2.32) than WNLH (M = 3.06, SD = 2.42), t = -2.07, p = 0.04. Additionally, traumatic life events were positively associated with physical symptoms. Further, there was an indirect effect of trauma history on physical symptoms through anxiety, b = 0.97, 95% BC CI [0.29, 1.89], such that the direct effect of trauma on physical symptoms was no longer significant, b = 0.87, 95% BC CI [-0.83, 2.56] when anxiety was added to the model. This pattern of findings suggests that anxiety is a key mechanism through which trauma history is associated with more physical symptoms in WLH. Future research should focus on the effect of interventions alleviating the impact that trauma may have on the mental and physical health of WLH.
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Affiliation(s)
| | | | - Olivia L Hucks
- Psychology Department, Georgia State University, Atlanta, USA
| | - Lisa Armistead
- Psychology Department, Georgia State University, Atlanta, USA
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