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Warner M, Gibbs J, Blandford A. Shifting Norms and Value Conflicts: Exploring the Effects of HIV Status Disclosure Fields in Sex-Social Apps. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1575-1589. [PMID: 38302851 PMCID: PMC10954906 DOI: 10.1007/s10508-023-02801-5] [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: 02/03/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 02/03/2024]
Abstract
Sex-social applications used by men who have sex with men (MSM) often provide options to disclose HIV status to encourage more positive language and reduce stigma. Yet, little research has sought to understand how in-app disclosure fields impact on disclosure motivation. We interviewed MSM living with HIV and those who self-reported being HIV-negative ( N = 27 ) in the UK and applied a hierarchical model of motivation to interpret our data. We found conflicting motivations for disclosure and point to HIV status disclosure fields having shifted disclosure norms, limiting their perceived optionality. Moreover, the pairwise and location-aware nature of these apps fails to support narrative forms of disclosure, reducing motivation. We highlight an opportunity to support users in disclosing by linking apps more explicitly to the social narratives developed through public health campaigns. This could reduce the required effort to explain "the science" behind different treatment and prevention options and promote a more consistent narrative.
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Affiliation(s)
- Mark Warner
- Computer Science Department, University College London, 169 Euston Road, London, NW1 2AE, UK.
| | - Jo Gibbs
- Mortimer Market Centre, University College London, London, UK
| | - Ann Blandford
- Computer Science Department, University College London, London, UK
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Sineke T, Onoya D, Mokhele I, Cele R, Sharma S, Sigasa P, Dukashe M, Hansrod L, Inglis R, King R, Bor J. "I was scared dating… who would take me with my status?"-Living with HIV in the era of UTT and U = U: A qualitative study in Johannesburg, South Africa. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000829. [PMID: 37831644 PMCID: PMC10575521 DOI: 10.1371/journal.pgph.0000829] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/16/2023] [Indexed: 10/15/2023]
Abstract
South Africa rolled out Universal Test-and-Treat (UTT) in 2016, extending treatment eligibility to all persons living with HIV (PLHIV). We sought to understand how PLHIV in Johannesburg, South Africa, interpret and experience their HIV status, five years into the UTT era. In May 2021, we conducted in-depth interviews (IDI) (N = 27) with adult (≥18 years) PLHIV referred by HIV counsellors at three peri-urban primary healthcare clinics. We also conducted three focus group discussions (FGDs) (N = 27) with adult PLHIV recruited from clinics or from civil society organisations through snowball sampling. Follow-up interviews were conducted with 29 IDI and FGD participants. Participants were asked to reflect on their HIV diagnosis, what their HIV status meant to them and how, if at all, being HIV-positive affected their lives. Interviews and focus group discussions were audio-recorded, transcribed, translated to English, and analysed using a grounded theory approach. Participants perceived that HIV was common, that PLHIV could live a normal life with antiretroviral therapy (ART), and that ART was widely accessible. However, HIV elicited feelings of guilt and shame as a sexually transmitted disease. Participants used the language of "blame" in discussing HIV transmission, citing their own reckless behaviour or blaming their partner for infecting them. Participants feared transmitting HIV to others and felt responsible for avoiding transmission. To manage transmission anxiety, participants avoided sexual relationships, chose HIV-positive partners, and/or insisted on using condoms. Many participants feared-or had previously experienced-rejection by partners due to their HIV status and reported hiding their medication, avoiding disclosure, or avoiding relationships altogether. Most participants were not aware that undetectable HIV is untransmittable (U = U). Participants who were aware of U = U expressed less anxiety about transmitting HIV to others and greater confidence in having relationships. Despite perceiving HIV as a manageable chronic condition, PLHIV still faced transmission anxiety and fears of rejection by their partners. Disseminating information on U = U could reduce the psychosocial burdens of living with HIV, encourage open communication with partners, and remove barriers to HIV testing and treatment adherence.
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Affiliation(s)
- Tembeka Sineke
- Faculty of Health Sciences, Department of Internal Medicine, Health Economics and Epidemiology Research Office, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Dorina Onoya
- Faculty of Health Sciences, Department of Internal Medicine, Health Economics and Epidemiology Research Office, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Idah Mokhele
- Faculty of Health Sciences, Department of Internal Medicine, Health Economics and Epidemiology Research Office, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Refiloe Cele
- Faculty of Health Sciences, Department of Internal Medicine, Health Economics and Epidemiology Research Office, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Shubhi Sharma
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Patience Sigasa
- Faculty of Health Sciences, Department of Internal Medicine, Health Economics and Epidemiology Research Office, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | - Rachel King
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Jacob Bor
- Faculty of Health Sciences, Department of Internal Medicine, Health Economics and Epidemiology Research Office, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
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Gutin SA, Ruark A, Darbes LA, Neilands TB, Mkandawire J, Conroy AA. Supportive couple relationships buffer against the harms of HIV stigma on HIV treatment adherence. BMC Public Health 2023; 23:1878. [PMID: 37770885 PMCID: PMC10540419 DOI: 10.1186/s12889-023-16762-w] [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: 05/18/2023] [Accepted: 09/14/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION HIV stigma can impact couple relationships through stress or bring partners closer through shared experiences. Conversely, couple relationships may protect against the harms of stigma, including anticipated stigma on negative health outcomes. Yet few studies have assessed the potential link between HIV stigma, relationship dynamics, and antiretroviral therapy (ART) adherence. Using dyadic data from a cross-sectional study of Malawian couples living with HIV, we tested associations between anticipated stigma and: 1) relationship dynamics (e.g., trust, sexual satisfaction, communication) and partner support; and 2) self-reported ART adherence. METHODS Heterosexual couples (211 couples, 422 individuals) with at least one partner on ART were recruited from clinics in Zomba, Malawi. Partners completed separate surveys on anticipated stigma, relationship dynamics, and ART adherence. Linear mixed models evaluated associations between anticipated stigma and relationship dynamics, and whether associations varied by gender. Generalized estimating equation models tested for associations between anticipated stigma and high ART adherence (90-100% vs. < 90%) at the individual level, and whether they were moderated by relationship dynamics at the couple level. RESULTS Couples' relationship length averaged 12.5 years, 66.8% were HIV sero-concordant, and 95.6% reported high ART adherence. In multivariable models, sexual satisfaction (β = -0.22, 95%CI = -0.41;-0.03, p = 0.020) and partner social support (β = -0.02, 95%CI = -0.04;-0.01, p < 0.01) were negatively associated with anticipated stigma. Significant interaction effects showed that adherence is moderated in couples with higher partner support and sexual satisfaction such that adherence is lowest when anticipated stigma is high and social support is low, and that adherence is lowest when anticipated stigma is high and sexual satisfaction is low. CONCLUSIONS Increased anticipated stigma is most associated with lower ART non-adherence at lower levels of social support and sexual satisfaction. Conversely, supportive and fulfilling relationships may buffer the negative association between stigma and ART adherence. Couples' interventions that focus on improving communication and support systems within couples could reduce the negative impacts of anticipated stigma on couples living with HIV.
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Affiliation(s)
- Sarah A Gutin
- Department Of Community Health Systems, School of Nursing, University of California, San Francisco (UCSF), 2 Koret Way, San Francisco, CA, 94143, USA.
| | - Allison Ruark
- Wheaton College, 501 College Avenue, Wheaton, IL, USA
| | - Lynae A Darbes
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 North Ingalls Building, Ann Arbor, MI, USA
| | - Torsten B Neilands
- Division of Prevention Sciences, University of California, San Francisco (UCSF), 550 16Th. Street, #3311, San Francisco, CA, 94158, USA
| | - James Mkandawire
- Invest in Knowledge, Old Naisi Road, P.O. Box 506, Zomba, Malawi
| | - Amy A Conroy
- Division of Prevention Sciences, University of California, San Francisco (UCSF), 550 16Th. Street, #3311, San Francisco, CA, 94158, USA
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Mandlate F, Greene MC, Pereira LF, Sweetland AC, Kokonya D, Duarte CS, Cournos F, Oquendo MA, Wainberg ML, Sidat M, Sevene E, Mello MF. Lay HIV counselors' knowledge and attitudes toward depression: A mixed-methods cross-sectional study at primary healthcare centers in Mozambique. Front Public Health 2022; 10:919827. [PMID: 36249253 PMCID: PMC9554257 DOI: 10.3389/fpubh.2022.919827] [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] [Received: 04/14/2022] [Accepted: 08/31/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction Depression is the most common mental disorder among people living with HIV/AIDS and has a negative impact on HIV treatment outcomes. Training lay HIV counselors to identify and manage depression may contribute to improved patient access and adherence to treatment, and reduce stigma and discrimination among lay health workers toward both HIV and depression. The purpose of this study was to assess the current knowledge and attitudes of lay HIV counselors toward managing depression in primary care in Mozambique. Methods We conducted a mixed-methods cross-sectional study to assess depression-related knowledge and attitudes among lay HIV counselors in 13 primary healthcare facilities in Mozambique. We used the quantitative Depression Attitude Questionnaire (DAQ) scale, followed by open-ended questions to further explore three key DAQ domains: the nature of depression, treatment preferences, and professional attitudes or reactions. Results The sample included 107 participants (77.6% female, mean age: 32.3 years, sd = 7.4). Most (82.2%) had less than a high/technical school education. Findings suggested that some HIV counselors had knowledge of depression and described it as a cluster of psychological symptoms (e.g., deep sadness, anguish, apathy, isolation, and low self-esteem) sometimes leading to suicidal thoughts, or as a consequence of life stressors such as loss of a loved one, abuse, unemployment or physical illness, including being diagnosed with HIV infection. HIV counselors identified talking to trusted people about their problems, including family and/or counseling with a psychotherapist, as the best way for patients to deal with depression. While acknowledging challenges, counselors found working with patients with depression to be rewarding. Conclusion Lay health counselors identified HIV and psychosocial issues as key risk factors for depression. They believed that the treatment approach should focus on social support and psychotherapy.
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Affiliation(s)
- Flavio Mandlate
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - M. Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Luis F. Pereira
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Annika C. Sweetland
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Donald Kokonya
- School of Medicine, Masinde Muliro University of Science and Technology, Kakamega, Kenya
| | - Cristiane S. Duarte
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Francine Cournos
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Maria A. Oquendo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Milton L. Wainberg
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Mohsin Sidat
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Esperança Sevene
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Marcelo F. Mello
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
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Hareru HE, Kaso AW, Ashuro Z, Mareg M. Risky sexual practice and associated factors among people living with HIV/AIDS receiving antiretroviral therapy in Ethiopia: Systematic review and meta-analysis. PLoS One 2022; 17:e0266884. [PMID: 35421163 PMCID: PMC9009662 DOI: 10.1371/journal.pone.0266884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 03/29/2022] [Indexed: 11/18/2022] Open
Abstract
Background The risky sexual behavior of people living with HIV/AIDS (PLWHA) may impose a risk of transmitting the disease to their partners and increase Human Immunodeficiency Virus (HIV) co-infection. This systematic review and meta-analysis aimed to determine the pooled prevalence of risky sexual behavior and associated factors among PLWHA receiving [Antiretroviral Therapy (ART)] in Ethiopia. Methods To identify both published and unpublished research articles, systematic searches were performed in PubMed, HINARI, Medline, Science Direct, and Google Scholar databases. The review was carried out following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline. Cross-sectional studies reporting the prevalence of risky sexual practice and its associated factors among PLWHA receiving ART in Ethiopia were included. Two authors independently extracted all necessary data using a standardized data extraction format prepared in Microsoft Excel and exported to STATA version 14 statistical software for further analyses. The Cochrane Q test statistics and I2 test were used to assess the heterogeneity of the studies. Since the included studies exhibited considerable heterogeneity, the random-effects meta-analysis model was computed to estimate the pooled prevalence of risky sexual practice which was determined by dividing the total number of PLWHA with risky sexual practice practices by the total number of PLWHA on ART in the study and multiplied by 100. Furthermore, pooled odds ratio (OR) with 95% confidence interval (CI) was determined for the association between determinant factors and risky sexual practice. Result In this study, 2351 articles were identified from different databases, and fifteen articles were selected for final systematic review and meta-analysis. In Ethiopia, the pooled prevalence of risky sexual practices was 43.56% (95% confidence interval (CI):35.51, 51.62). Discussion about safe sex with sexual partner/s [AOR = 0.26, 95% CI: 0.08, 0.92] and having multiple sexual partners [AOR = 1.90, 95% CI: 0.53, 6.84] were factors significantly associated with risky sexual practice in Ethiopia. Conclusion A significant proportion of respondents engaged in risky sexual practices. Multiple sexual partners and a lack of discussion about safe sex are linked to a higher prevalence of the risky sexual practice in Ethiopia. It is critical to raise awareness about safe sexual practices during health education and counselling services and to encourage clients to freely discuss safer sex practices with their sexual partner/s at their antiretroviral therapy (ART) appointments as part of their follow-up care. Protocol registration The protocol for this systematic review and meta-analysis was registered at PROSPERO (record ID = CRD42021274600, 25 September 2021).
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Affiliation(s)
- Habtamu Endashaw Hareru
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
- * E-mail:
| | - Abdene Weya Kaso
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Zemachu Ashuro
- Department of Environmental Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Moges Mareg
- Department of Reproductive Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
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Owusu AY. Experiences of new diagnoses among HIV-positive persons: implications for public health. BMC Public Health 2022; 22:538. [PMID: 35303863 PMCID: PMC8932052 DOI: 10.1186/s12889-022-12809-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Ready acceptance of experiences of new diagnoses among HIV-positive persons is a known personal and public health safety-net. Its beneficial effects include prompt commencement and sustenance of HIV-positive treatment and care, better management of transmission risk, and disclosure of the HIV-positive status to significant others. Yet, no known study has explored this topic in Ghana; despite Ghana’s generalised HIV/AIDS infection rate. Existing studies have illuminated the effects of such reactions on affected significant others; not the infected. Methods This paper studied qualitatively the experiences of new diagnoses among 26 persons living with HIV/AIDS. Sample selection was random, from two hospitals in a district in Ghana heavily affected by HIV/AIDS. The paper applied the Hopelessness Theory of Depression. Results As expected, the vast majority of respondents experienced the new diagnoses of their HIV-positive infection with a myriad of negative psychosocial reactions, including thoughts of committing suicide. Yet, few of them received the news with resignation. For the vast majority of respondents, having comorbidities from AIDS prior to the diagnosis primarily shaped their initial reactions to their diagnosis. The respondents’ transitioning to self-acceptance of their HIV-positive status was mostly facilitated by receiving counselling from healthcare workers. Conclusions Although the new HIV-positive diagnosis was immobilising to most respondents, the trauma faded, paving the way for beneficial public health actions. The results imply the critical need for continuous education on HIV/AIDS by public health advocates, using mass media, particularly, TV. Healthcare workers in VCTs should empathise with persons who experience new diagnoses of their HIV-positive status. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12809-6.
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Affiliation(s)
- Adobea Yaa Owusu
- Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, P. O. Box LG 74, Legon, Ghana.
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Konkor I, Antabe R, Mkandawire P, McIntosh MD, Lawson ES, Husbands W, Wong J, Luginaah I. Knowledge of sexual partner's HIV serostatus and the practice of safer sex among heterosexual men of African descent in London, Ontario. ETHNICITY & HEALTH 2022; 27:375-387. [PMID: 32115995 DOI: 10.1080/13557858.2020.1734776] [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] [Received: 09/07/2019] [Accepted: 02/18/2020] [Indexed: 06/10/2023]
Abstract
Objective: Poor knowledge of sexual partners' HIV status is a major contributing factor in the heterosexual spread of HIV in Canada. This study examined knowledge of sexual partner's HIV serostatus and the practice of safer sex among self-identified heterosexual African, Caribbean and Black (ACB) men in London, Ontario.Design: A cross-sectional data was collected from 156 heterosexual ACB men in London. The negative log-log link function was fitted to estimate the relationship between knowledge of sexual partner's HIV status and condom use among ACB men.Results: Findings show that ACB men who know their sexual partner's HIV status are less likely to use condoms compared to men who do not know the serostatus of their sexual partner, controlling for other theoretically relevant covariates. In addition, the findings show that sexually active, single ACB men are less likely to use condoms. On the other hand, ACB men with higher education, employed and with income over 60 thousand dollars a year have a higher likelihood of using condoms.Conclusions: Heterosexual ACB men who used condoms even when they did not know their sexual partners' HIV status could be explained as a resilience-building strategy in response to their increasing HIV vulnerabilities. Heterosexual ACB men's use of condoms is further associated with socioeconomic factors including income, employment and education that need to be addressed for an improved safer sex.
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Affiliation(s)
- Irenius Konkor
- Department of Geography, Western University, London, Canada
| | - Roger Antabe
- Department of Geography, Western University, London, Canada
| | - Paul Mkandawire
- Institute of Interdisciplinary Studies, Carleton University, Ottawa, Canada
| | | | - Erica S Lawson
- Department of Women's Studies, Western University, London, Canada
| | | | - Josephine Wong
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada
| | - Isaac Luginaah
- Department of Geography, Western University, London, Canada
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Ruiz-Robledillo N, Clement-Carbonell V, Ferrer-Cascales R, Portilla-Tamarit I, Alcocer-Bruno C, Gabaldón-Bravo E. Cognitive Functioning and Its Relationship with Self-Stigma in Men with HIV Who Have Sex with Men: The Mediating Role of Health-Related Quality of Life. Psychol Res Behav Manag 2021; 14:2103-2114. [PMID: 34938135 PMCID: PMC8687686 DOI: 10.2147/prbm.s332494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/11/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction The human immunodeficiency virus (HIV) stills remains a serious public health problem. HIV acquisition has several negative health consequences, such as a cognitive deterioration or health-related quality of life (HRQoL) impairment. Although these negative consequences could be directly related to a significant increase in self-stigma in this population, few previous studies have analysed the possible associations between these variables. This is especially the case in specific groups of people living with HIV, such as men who have sex with men who could be at a greater risk of stigmatisation. The main aim of the present study was to evaluate the association between cognitive functioning, HRQoL and self-stigma in a group of men with HIV who have sex with men. Methods The present study was conducted in the Infectious Diseases Unit of the General University Hospital of Alicante (Spain). The final sample was composed of 70 participants who passed the inclusion and exclusion criteria. All were men with HIV who had sex with men and the sample’s mean age was 45 years. Each participant completed questionnaires on HRQoL and HIV self-stigma. Moreover, they completed an online cognitive assessment through the previously validated platform for cognitive evaluation CogniFit, Inc. Results The obtained results showed a significant association between memory functioning impairment, lower levels of HRQoL and higher HIV self-stigma scores. Hence, HRQoL, in the mental summary domain, was shown to be a significant mediator in the relationship between low memory performance and higher HIV self-stigma. Discussion Neurocognitive impairment could decrease HRQoL in men with HIV who have sex with men, and hence, reinforce the idea widespread in society that having HIV holds serious consequences. This fact, together with the reduced cognitive abilities to fight against their own self-stigma could represent plausible explanations of the obtained results. In this sense, intervention strategies, oriented towards reducing cognitive impairment, such as those based on cognitive training, and other psychological interventions to promote HRQoL could be effective approaches to prevent the negative effects of HIV self-stigma in this population.
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Affiliation(s)
- Nicolás Ruiz-Robledillo
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | | | - Rosario Ferrer-Cascales
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - Irene Portilla-Tamarit
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - Cristian Alcocer-Bruno
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - Eva Gabaldón-Bravo
- Department of Nursing, Faculty of Health Science, University of Alicante, Alicante, Spain
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Zaidi HA, Mathenjwa M, Mosery N, O'Neil K, Chitneni P, Psaros C, Khidir H, Safren SA, Bangsberg DR, Sayeed SA, Smit JA, Matthews LT. Overcoming Ethical Challenges to Engaging Men Who Have Sex with Women in HIV Research. AIDS Behav 2021; 25:4055-4060. [PMID: 33582889 PMCID: PMC10698834 DOI: 10.1007/s10461-021-03185-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 12/28/2022]
Abstract
Men who have sex with women are understudied in HIV research despite the extent to which they experience HIV-related mortality and contribute to the epidemic among women. During our experience of developing and piloting an HIV prevention intervention for men living with HIV in South Africa, and planning to have a child with an HIV-negative woman, ethical questions were posed regarding implementation of a male-centered intervention that did not require female partner participation. Two overarching ethical issues were the potential for (1) compromising women's reproductive and sexual autonomy and (2) increasing HIV-acquisition risks for the woman because the intervention efficacy was unknown. We describe here how these concerns were addressed to facilitate development of a male-centered HIV-prevention intervention. We hope this process manuscript will support researchers, clinicians, and reviewers to engage men who have sex with women in HIV prevention and care.
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Affiliation(s)
- Hussain A Zaidi
- Division of Infectious Disease, University of Alabama at Birmingham, 212 Zeigler Research Building, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
- Lang Center for Social and Civic Responsibility, Swarthmore College, Swarthmore, PA, USA
| | - Mxolisi Mathenjwa
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, University of the Witwatersrand, Durban, KwaZulu-Natal, South Africa
| | - Nzwakie Mosery
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, University of the Witwatersrand, Durban, KwaZulu-Natal, South Africa
| | - Kasey O'Neil
- Division of Infectious Disease, University of Alabama at Birmingham, 212 Zeigler Research Building, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Pooja Chitneni
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Steven A Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | | | - Sadath A Sayeed
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Boston Children's Hospital, Boston, MA, USA
| | - Jennifer A Smit
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, University of the Witwatersrand, Durban, KwaZulu-Natal, South Africa
| | - Lynn T Matthews
- Division of Infectious Disease, University of Alabama at Birmingham, 212 Zeigler Research Building, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
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Beshaw MA, Balcha SA, Lakew AM. Effect of Isoniazid Prophylaxis Therapy on the Prevention of Tuberculosis Incidence and Associated Factors Among HIV Infected Individuals in Northwest Ethiopia: Retrospective Cohort Study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:617-629. [PMID: 34135640 PMCID: PMC8197569 DOI: 10.2147/hiv.s301355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/19/2021] [Indexed: 11/25/2022]
Abstract
Background Treating latent tuberculosis (TB) infection with Isoniazid (INH) among human immune virus (HIV) infected patients reduces active TB occurrence and death by 62% and 26%, respectively. Even though other studies show aforementioned evidence, TB incidence and its associated factors among HIV-infected individuals who were on INH and never on INH is not well studied in northwest Ethiopia. Therefore, this study tried to assess the effect of INH prophylaxis in TB prevention and associated factors among HIV-infected individuals. Methods Data were extracted from charts of HIV-infected clients who completed INH (193) and were never on INH (198) after a simple random sampling selection was done among newly diagnosed patients on follow-up from 2008 to 2015. After data were collected, it was entered into Epi info version 7 and exported to SPSS version 22 for analysis. Cox regression model was fitted and the hazard ratio was reported. Results In this study, the overall TB incidence rate among HIV patients was 3.5/100 person-years (PY) [95% CI: 2.55, 4.82]. But it was 7.1/100 PY among patients who were never on INH and 0.35/100 PY among patients who completed INH. INH completed [adjusted hazard ratio (AHR) = 0.08, 95% CI: 0.02–0.37], on anti-retroviral therapy (ART) [AHR = 0.02, 95% CI: 0.01–0.04], baseline World Health Organization (WHO) stage I & II [AHR =0.22, 95% CI: 0.08–0.62] and baseline CD4 ≤ 350 [AHR=3.76, 95% CI: 1.39–10.18] were significantly associated with TB incidence. Conclusion Putting patients on INH for 6 months and ART were protective factors against TB. Therefore, health institutions are recommended to provide INH after ruling out active TB and contraindications for HIV-infected individuals.
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Affiliation(s)
- Mulat Addis Beshaw
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Shitaye Alemu Balcha
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayenew Molla Lakew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Fiorentino M, Nishimwe M, Protopopescu C, Iwuji C, Okesola N, Spire B, Orne-Gliemann J, McGrath N, Pillay D, Dabis F, Larmarange J, Boyer S. Early ART Initiation Improves HIV Status Disclosure and Social Support in People Living with HIV, Linked to Care Within a Universal Test and Treat Program in Rural South Africa (ANRS 12249 TasP Trial). AIDS Behav 2021; 25:1306-1322. [PMID: 33206263 DOI: 10.1007/s10461-020-03101-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 02/01/2023]
Abstract
We investigated the effect of early antiretroviral treatment (ART) initiation on HIV status disclosure and social support in a cluster-randomized, treatment-as-prevention (TasP) trial in rural South Africa. Individuals identified HIV-positive after home-based testing were referred to trial clinics where they were invited to initiate ART immediately irrespective of CD4 count (intervention arm) or following national guidelines (control arm). We used Poisson mixed effects models to assess the independent effects of (a) time since baseline clinical visit, (b) trial arm, and (c) ART initiation on HIV disclosure (n = 182) and social support (n = 152) among participants with a CD4 count > 500 cells/mm3 at baseline. Disclosure and social support significantly improved over follow-up in both arms. Disclosure was higher (incidence rate ratio [95% confidence interval]: 1.24 [1.04; 1.48]), and social support increased faster (1.22 [1.02; 1.46]) in the intervention arm than in the control arm. ART initiation improved both disclosure and social support (1.50 [1.28; 1.75] and 1.34 [1.12; 1.61], respectively), a stronger effect being seen in the intervention arm for social support (1.50 [1.12; 2.01]). Besides clinical benefits, early ART initiation may also improve psychosocial outcomes. This should further encourage countries to implement universal test-and-treat strategies.
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Affiliation(s)
- Marion Fiorentino
- Aix Marseille Univ, UMR912 - INSERM, IRD, SanteRCom, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, Faculté de Médecine, 27 bd Jean Moulin, 13005, Marseille, France.
- ORS PACA, Observatoire Régional de La Santé Provence-Alpes-Côte D'Azur, Marseille, France.
| | - Marie Nishimwe
- Aix Marseille Univ, UMR912 - INSERM, IRD, SanteRCom, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, Faculté de Médecine, 27 bd Jean Moulin, 13005, Marseille, France
- ORS PACA, Observatoire Régional de La Santé Provence-Alpes-Côte D'Azur, Marseille, France
| | - Camelia Protopopescu
- Aix Marseille Univ, UMR912 - INSERM, IRD, SanteRCom, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, Faculté de Médecine, 27 bd Jean Moulin, 13005, Marseille, France
- ORS PACA, Observatoire Régional de La Santé Provence-Alpes-Côte D'Azur, Marseille, France
| | - Collins Iwuji
- Africa Health Research Institute, Durban, South Africa
- Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, UK
| | | | - Bruno Spire
- Aix Marseille Univ, UMR912 - INSERM, IRD, SanteRCom, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, Faculté de Médecine, 27 bd Jean Moulin, 13005, Marseille, France
- ORS PACA, Observatoire Régional de La Santé Provence-Alpes-Côte D'Azur, Marseille, France
| | | | - Nuala McGrath
- Africa Health Research Institute, Durban, South Africa
- University of Southampton, Southampton, UK
| | - Deenan Pillay
- Africa Health Research Institute, Durban, South Africa
| | - François Dabis
- INSERM, UMR1219 Bordeaux Population Health Research Center, Université de Bordeaux, Bordeaux, France
| | | | - Sylvie Boyer
- Aix Marseille Univ, UMR912 - INSERM, IRD, SanteRCom, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, Faculté de Médecine, 27 bd Jean Moulin, 13005, Marseille, France
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12
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Abbamonte JM, Parrish MS, Lee TK, Ramlagan S, Sifunda S, Peltzer K, Weiss SM, Jones DL. Influence of Male Partners on HIV Disclosure Among South African Women in a Cluster Randomized PMTCT Intervention. AIDS Behav 2021; 25:604-614. [PMID: 32892297 PMCID: PMC10174224 DOI: 10.1007/s10461-020-03021-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Disclosure of HIV serostatus is beneficial for women, their partners, and their infants as it enables women to actively participate in preventative care (Hodgson et al. in PLoS ONE 9(11):e111421, 2014; Odiachi et al. in Reprod Health 15(1):36, 2018). Therefore, it is important that interventions addressing HIV prevention include elements that foster disclosure of HIV to partners. This study conducted in South Africa utilizes the "Protect Your Family" (PYF) behavioral intervention and compares Prevention of Mother to Child Transmission (PMTCT) among women participating in the program versus those in a control program. Within both groups, male partners were either present or not present for the intervention. The purpose of this study was to examine differential disclosure over time for individuals in the different conditions and partner involvement. A firth logistic regression revealed an interaction in the experimental condition with male partners participating (b = - 2.84, SE = 1.56, p = .012), in which female participants were less likely to disclose their HIV status over time. Findings from this study illustrate that additional efforts are needed to empower women to disclose their HIV status.
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Affiliation(s)
- John M Abbamonte
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Dominion Towers Suite 404, 1400 NW 10th Avenue, Miami, FL, 33136, USA
| | | | - Tae K Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Shandir Ramlagan
- HIV/AIDS/STIs and TB Research Programme, Human Sciences Research Council, Pretoria, South Africa
| | - Sibusiso Sifunda
- HIV/AIDS/STIs and TB Research Programme, Human Sciences Research Council, Pretoria, South Africa
| | - Karl Peltzer
- HIV/AIDS/STIs and TB Research Programme, Human Sciences Research Council, Pretoria, South Africa
- Department of Research Administration and Development, University of Limpopo, Polokwane, South Africa
- Department of Psychology, University of the Free State, Bloemfontain, South Africa
| | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Dominion Towers Suite 404, 1400 NW 10th Avenue, Miami, FL, 33136, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Dominion Towers Suite 404, 1400 NW 10th Avenue, Miami, FL, 33136, USA.
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13
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Onoya D, Hendrickson C, Sineke T, Maskew M, Long L, Bor J, Fox MP. Attrition in HIV care following HIV diagnosis: a comparison of the pre-UTT and UTT eras in South Africa. J Int AIDS Soc 2021; 24:e25652. [PMID: 33605061 PMCID: PMC7893145 DOI: 10.1002/jia2.25652] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/07/2020] [Accepted: 11/17/2020] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Policies for Universal Test & Treat (UTT) and same-day initiation (SDI) of antiretroviral therapy (ART) were instituted in South Africa in September 2016 and 2017 respectively. However, there is limited evidence on whether these changes have improved patient retention after HIV diagnosis. METHODS We enrolled three cohorts of newly diagnosed HIV-infected adults from two primary health clinics in Johannesburg from April to November 2015 (Pre-UTT, N = 144), May-September 2017 (UTT, N = 178) and October-December 2017 (SDI, N = 88). A baseline survey was administered immediately after HIV diagnosis after which follow-up using clinical records (paper charts, electronic health records and laboratory data) ensued for 12 months. The primary outcome was patient loss to follow-up (being >90 days late for the last scheduled appointment) at 12 months post-HIV diagnosis. We modelled attrition across HIV policy periods with Cox proportional hazard regression. RESULTS Overall, 410 of 580 screened HIV-positive patients were enrolled. Overall, attrition at 12 months was 30% lower in the UTT guideline period (38.2%) compared to pre-UTT (47.2%, aHR 0.7, 95% CI: 0.5 to 1.0). However, the total attrition was similar between the SDI (47.7%) and pre-UTT cohorts (aHR 1.0, 95% CI: 0.7 to 1.5). Older age at HIV diagnosis (aHR 0.5 for ≥40 vs. 25 to 29 years, 95% CI: 0.3 to 0.8) and being in a non-marital relationship (aHR 0.5 vs. being single, 95% CI: 0.3 to 0.8) protected against LTFU at 12 months, whereas LTFU rates increased with longer travel time to the diagnosing clinic (aHR 1.8 for ≥30 minutes vs. ≤15 minutes, 95% CI: 1.1 to 3.1). In analyses adjusted for the time-varying ART initiation status, compared to the pre-ART period of care, the hazard of on-ART LTFU was 90% higher among participants diagnosed under the SDI policy compared to pre-UTT (aHR 1.9, 95% CI: 1.1 to 2.9). CONCLUSIONS Overall, nearly two-fifths of HIV positive patients are likely to disengage from care by 12 months after HIV diagnosis under the new SDI policy. Furthermore, the increase in on-ART patient attrition after the introduction of the SDI policy is cause for concern. Further research is needed to determine the best way for rapidly initiating patients on ART and also reducing long-term attrition from care.
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Affiliation(s)
- Dorina Onoya
- Health Economics and Epidemiology Research OfficeDepartment of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Cheryl Hendrickson
- Health Economics and Epidemiology Research OfficeDepartment of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Tembeka Sineke
- Health Economics and Epidemiology Research OfficeDepartment of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Mhairi Maskew
- Health Economics and Epidemiology Research OfficeDepartment of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Lawrence Long
- Health Economics and Epidemiology Research OfficeDepartment of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Global HealthBoston University School of Public HealthBostonMAUSA
| | - Jacob Bor
- Health Economics and Epidemiology Research OfficeDepartment of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Global HealthBoston University School of Public HealthBostonMAUSA
| | - Matthew P. Fox
- Health Economics and Epidemiology Research OfficeDepartment of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Global HealthBoston University School of Public HealthBostonMAUSA
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
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14
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Viljoen L, Wademan D, Hoddinott G, Bond V, Seeley J, Bock P, Fidler S, Reynolds L. The act of telling: South African women's narratives of HIV status disclosure to intimate partners in the HPTN 071 (PopART) HIV prevention trial. WOMEN'S HEALTH (LONDON, ENGLAND) 2021; 17:1745506521998204. [PMID: 33645374 PMCID: PMC7924004 DOI: 10.1177/1745506521998204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 01/27/2021] [Accepted: 02/05/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Public health programming often frames HIV status disclosure as a means to negotiate condom- and abstinence-based prevention or to involve intimate partners in HIV care to garner treatment adherence support. HIV treatment can be used to ensure viral suppression and prevent onward transmission, which provides strong evidence to encourage disclosure. The ideological shift towards HIV treatment as prevention is expected to facilitate disclosure. PURPOSE There is a lack of research on how the scale-up of universal HIV testing and treatment influences disclosure practices in high burden settings. In this manuscript, we aim to address this gap. METHODS To this end, we conducted a two-phased narrative performative analysis of the disclosure scripts of 15 women living with HIV in three communities of Western Cape, South Africa where the HPTN 071 (PopART) HIV prevention trial implemented a universal HIV testing and treatment model as part of the intervention. The women were part of a larger cohort nested in the trial. We use Goffman's dramaturgical metaphor, which understands social interactions as 'performances' by 'actors' (people) guided by 'scripts' (anticipated dialogues/interactions), to explore how women living with HIV manage their status disclosure. CONCLUSION We describe how these women perform HIV status disclosure (or deliberate non-disclosure) to retain, reaffirm or redefine existing social scripts with partners. Their performances reveal priorities other than those imagined by public health programmes driving HIV disclosure (or non-disclosure): establishing trust, resenting betrayal and ensuring self-preservation while simultaneously (re)constructing self-identity. None of the women engaged with the concept of treatment as prevention in their disclosure narratives, either to facilitate disclosure or to 'justify' non-disclosure. HIV prevention, in general, and treatment adherence support were rarely mentioned as a reason for disclosure. To date, there has been a missed opportunity to ease and support disclosure in health programmes by tapping into existing social scripts, impeding potential patient and public health benefits of universal HIV testing and treatment.
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Affiliation(s)
- Lario Viljoen
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Department of Sociology and Social Anthropology, Stellenbosch University, Stellenbosch, South Africa
| | - Dillon Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Virginia Bond
- School of Public Health, Zambart, University of Zambia, Lusaka, Zambia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Sarah Fidler
- Imperial College NIHR BRC, Imperial College London, London, UK
| | - Lindsey Reynolds
- Department of Sociology and Social Anthropology, Stellenbosch University, Stellenbosch, South Africa
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15
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Diress GA, Ahmed M, Linger M. Factors associated with discriminatory attitudes towards people living with HIV among adult population in Ethiopia: analysis on Ethiopian demographic and health survey. SAHARA J 2020; 17:38-44. [PMID: 33357027 PMCID: PMC7759280 DOI: 10.1080/17290376.2020.1857300] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Extensive discriminatory attitudes in a population can affect people’s willingness to be tested for Human Immunodeficiency Virus (HIV), their initiation of antiretroviral therapy, social support as well as the quality of life of people infected with HIV. This study aimed to assess factors associated with discriminatory attitudes towards people living with HIV/AIDS (PLWHA). Secondary data analysis was conducted using data from the 2016 Ethiopia Demographic Health Survey. A total of 26,623 adult populations were included. Multivariable logistic regression analysis was conducted to identify factors associated with discriminatory attitudes. The proportion of participants having discriminatory attitudes towards PLWHA was 93.8% among men and 64.5% among women. This study revealed that rural residence, no formal education, lack of media access, not previously tested for HIV and lack of comprehensive HIV knowledge increase the odds of having discriminatory attitudes. In conclusion, there is a high-level discriminatory attitude towards PLWHA. Improvement in HIV-related knowledge and dealing with wrong perceptions and myths are extremely vital to reduce discriminatory attitudes towards HIV-infected people. Information, education and communication programmes need to intensify its educational campaigns to dispel these misconceptions.
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Affiliation(s)
- Gedefaw Alen Diress
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Mohammed Ahmed
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Melese Linger
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
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16
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Adiukwu F, Bytyçi DG, Hayek SE, Gonzalez-Diaz JM, Larnaout A, Grandinetti P, Nofal M, Pereira-Sanchez V, Ransing R, Shalbafan M, Soler-Vidal J, Syarif Z, Teixeira ALS, da Costa MP, Ramalho R, Orsolini L. Global Perspective and Ways to Combat Stigma Associated with COVID-19. Indian J Psychol Med 2020; 42:569-574. [PMID: 33354085 PMCID: PMC7735248 DOI: 10.1177/0253717620964932] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Frances Adiukwu
- Dept. Neuropsychiatry, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - Drita Gashi Bytyçi
- Mental Health Center Prizren, Hospital and University Clinical Service of Kosovo, Prizren, Kosovo
| | - Samer El Hayek
- Dept. Psychiatry, American University of Beirut, Riad El Solh, Beirut, Lebanon
| | - Jairo M Gonzalez-Diaz
- CERSAME, School of Medicine and Health Sciences, Universidad del Rosario - Clinica Neustra Senora de la Paz, Bogota, Colombia
| | - Amine Larnaout
- Razi Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Manouba, Tunis, Tunisia
| | - Paolo Grandinetti
- Addictions Service, Dept. Territorial Services, ASL Teramo, Teramo, Italy
| | - Marwa Nofal
- Helwan Mental Health Hospital, Helwan, Cairo, Egypt
| | - Victor Pereira-Sanchez
- Dept. Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York City, New York, USA
| | - Ramdas Ransing
- Dept. Psychiatry, BKL Walawalkar Rural Medical College, Ratnagiri, Maharashtra, India
| | - Mohammadreza Shalbafan
- Mental Health Research Center, Dept. of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Joan Soler-Vidal
- Fidmag Research Foundation, Hermanas Hospitalarias, Barcelona, Spain
- Hospital Benito Menni, Hermanas Hospitalarias, Sant Boi de Llobregat, Spain
| | - Zulvia Syarif
- Dept. Psychiatry, Tarakan General Hospital, Jakarta, Indonesia
| | - Andre Luiz Schuh Teixeira
- CERSAME, School of Medicine and Health Sciences, Universidad del Rosario - Clinica Neustra Senora de la Paz, Bogota, Colombia
| | - Mariana Pinto da Costa
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Portugal
- Hospital de Magalhães Lemos, Porto, Portugal
| | - Rodrigo Ramalho
- Hospital de Magalhães Lemos, Porto, Portugal
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Laura Orsolini
- Unit of Clinical Psychiatry, Dept. of Neurosciences/DIMSC School of Medicine, Polytechnic University Marche, Ancona, Italy
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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17
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HIV Status Disclosure and Sexual Transmission Risks Among People Who Are Living With HIV and Receiving Treatment for Non-HIV Sexually Transmitted Infections, Cape Town, South Africa. J Acquir Immune Defic Syndr 2020; 83:223-229. [PMID: 31913994 DOI: 10.1097/qai.0000000000002256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND HIV status disclosure to sex partners potentially reduces the risk of sexually transmitting HIV. However, there is limited information on the associations between HIV status disclosure in types of sexual partnerships and ensuing sexual practices. METHODS We examined HIV status disclosure to sex partners among 205 men and women living with HIV and receiving diagnostic and treatment services for a co-occurring sexually transmitted infection (STI) in Cape Town, South Africa. Participants completed partner-by-partner sexual behavior interviews and provided permission to extract recurrent STI clinic visits over the subsequent 12 months. RESULTS Three groups were formed on the basis of HIV status disclosure to sex partners: (1) 22% reported only HIV same-status partners, (2) 26% had HIV-negative or unknown HIV status (HIV different status) sex partners to whom they had disclosed their HIV status, and (3) 52% had at least one HIV different-status partner to whom they had not disclosed. There were no associations between HIV status disclosure and demographic characteristics, sexual practices, or recurrent STI clinic visits. Undisclosed HIV status to at least one HIV different-status sex partner was associated with greater alcohol use and less likelihood of receiving antiretroviral therapy; participants who were least likely to disclose their HIV status to partners drank more alcohol and were less likely to be taking antiretroviral therapy. CONCLUSIONS High prevalence of partner nondisclosure and lack of significant correlates to HIV status disclosure indicate a need for further research with an eye toward identifying disclosure processes and mechanisms that may ultimately lead to effective interventions.
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18
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Bogart LM, Matovu JKB, Wagner GJ, Green HD, Storholm ED, Klein DJ, Marsh T, MacCarthy S, Kambugu A. A Pilot Test of Game Changers, a Social Network Intervention to Empower People with HIV to be Prevention Advocates in Uganda. AIDS Behav 2020; 24:2490-2508. [PMID: 32030525 DOI: 10.1007/s10461-020-02806-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We conducted a pilot randomized controlled trial of Game Changers, a 6-session group intervention that empowers people with HIV to be HIV prevention advocates in their social networks. Ninety-nine people with HIV (51 intervention, 48 wait-list control) and 58 of their social network members (alters) completed baseline and 5- and 8-month post-baseline assessments. Results indicated high acceptability, demonstrated by participants' and facilitators' positive attitudes qualitatively and favorable ratings of intervention sessions quantitatively, and high feasibility (76% attended all intervention sessions). Intention-to-treat analyses indicated significantly increased HIV prevention advocacy among HIV-positive participants and alters [b (SE) = 0.4 (0.2), p = .017; b (SE) = 0.4 (0.2), p = .035]; reduced internalized HIV stigma [b (SE) = - 0.3 (0.1), p = .012], increased HIV-serostatus disclosure [b (SE) = 0.1 (0.1), p = .051], and increased social network density among HIV-positive participants [b (SE) = 0.1 (0.03), p = .004]; and marginally reduced condomless sex among alters [OR (95% CI) = 0.3 (0.1-1.2), p = .08]. Positioning people with HIV as central to prevention has the potential to reduce stigma and improve prevention outcomes throughout social networks.
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19
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Charles J, Exavery A, Barankena A, Kuhlik E, Mubyazi GM, Abdul R, Koler A, Kikoyo L, Jere E. Determinants of undisclosed HIV status to a community-based HIV program: findings from caregivers of orphans and vulnerable children in Tanzania. AIDS Res Ther 2020; 17:42. [PMID: 32678036 PMCID: PMC7364533 DOI: 10.1186/s12981-020-00299-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 07/07/2020] [Indexed: 12/01/2022] Open
Abstract
Background HIV status disclosure facilitates receipt of HIV prevention and treatment services. Although disclosure to sexual partners, family members or friends has been extensively studied, disclosure to community-based HIV programs is missing. This study assesses the magnitude of, and factors associated with undisclosed HIV status to a community-based HIV prevention program among caregivers of orphans and vulnerable children (OVC) in Tanzania. Methods Data are from the USAID-funded Kizazi Kipya project that seeks to increase uptake of HIV, health, and social services by OVC and their caregivers in Tanzania. Data on OVC caregivers who were enrolled in the project during January–March 2017 in 18 regions of Tanzania were analyzed. Caregivers included were those who had complete information on their HIV status disclosure, household socioeconomic status, and sociodemographic characteristics. HIV status was self-reported, with undisclosed status representing all those who knew their HIV status but did not disclose it. Multilevel mixed-effects logistic regression, with caregivers’ HIV status disclosure being the outcome variable was conducted. Results The analysis was based on 59,683 OVC caregivers (mean age = 50.4 years), 71.2% of whom were female. Of these, 37.2% did not disclose their HIV status to the USAID Kizazi Kipya program at the time of enrollment. Multivariate analysis showed that the likelihood of HIV status non-disclosure was significantly higher among: male caregivers (odds ratio (OR) = 1.22, 95% confidence interval (CI) 1.16–1.28); unmarried (OR = 1.12, 95% CI 1.03–1.23); widowed (OR = 1.12, 95% CI 1.07–1.18); those without health insurance (OR = 1.36, 95% CI 1.28–1.45); age 61 + years (OR = 1.72, 95% CI 1.59–1.88); those with physical or mental disability (OR = 1.14, 95% CI 1.04–1.25); and rural residents (OR = 1.58, 95% CI 1.34–1.86). HIV status non-disclosure was less likely with higher education (p < 0.001); and with better economic status (p < 0.001). Conclusion While improved education, economic strengthening support and expanding health insurance coverage appear to improve HIV status disclosure, greater attention may be required for men, unmarried, widowed, rural residents, and the elderly populations for their higher likelihood to conceal HIV status. This is a clear missed opportunity for timely care and treatment services for those that may be HIV positive. Further support is needed to support disclosure in this population.
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20
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Vreeman RC, Scanlon ML, Tu W, Slaven J, McAteer C, Aluoch J, Ayaya S, Nyandiko WM. Validation of an HIV/AIDS Stigma Measure for Children Living with HIV and Their Families. J Int Assoc Provid AIDS Care 2020; 18:2325958219880570. [PMID: 31581890 PMCID: PMC6900619 DOI: 10.1177/2325958219880570] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND There are few validated tools to measure stigma, particularly among children living with HIV and their families. METHODS This study was nested within a larger study that followed 240 child-caregiver dyads (children aged 10-15 years) at 8 clinics in western Kenya. The stigma instrument was administered to all child-caregiver dyads at 2 time points 6 months apart. The primary end point was to construct validity assessed by comparison to criterion constructs using generalized estimating equation models. RESULTS Mean age of child participants was 12.3 years and 52% were female. Generally, caregivers reported experiencing higher levels of HIV stigma compared to their children. Children (9%) and caregivers (14%) reported that HIV stigma made them feel stressed, anxious, and depressed. Child and caregiver stigma items showed high construct validity by emotional and behavioral outcomes. CONCLUSIONS The stigma instrument showed high validity when compared to emotional and behavioral outcomes.
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Affiliation(s)
- Rachel Christine Vreeman
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, NY, USA.,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Michael Lawrence Scanlon
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, NY, USA.,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts, Boston, MA, USA
| | - Wanzhu Tu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - James Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Carole McAteer
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Samuel Ayaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Winstone Mokaya Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
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21
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Hood KB, Hall CJ, Owens BD, Patev AJ, Belgrave FZ. HIV Testing Behaviors among Black Rural Women: The Moderating Role of Conspiracy Beliefs and Partner Status Disclosure. Ethn Dis 2020; 30:251-260. [PMID: 32346270 DOI: 10.18865/ed.30.2.251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective This study investigated whether HIV testing attitudes, HIV conspiracy beliefs, and reported sexual partner disclosure of HIV/STI status related to one-month self-report HIV testing outcomes following a brief intervention among Black women aged 18-25 years residing in rural Mississippi. Participants Black women (N=119; M age=19.90, SD=1.81) recruited in rural Mississippi completed an online assessment before a brief HIV prevention intervention and a one month follow-up assessment during January to November 2016. Main Outcome Measures Self-reported HIV testing 30-days following the intervention, partner HIV/STI status disclosure, beliefs in HIV conspiracy theory, and HIV testing attitudes in pre- and post-intervention assessments. Bivariate and multivariate analyses tested associations with HIV testing behaviors following the intervention. Results Moderated moderation was used to examine whether HIV conspiracy beliefs and partner disclosure status both moderated the relationship between pre-intervention attitudes toward HIV testing and HIV testing at 1-month follow-up. It was found that both HIV conspiracy beliefs and partner disclosure moderated the relationship between attitudes and HIV testing at one-month follow-up. When partner disclosure was low, women with more negative attitudes toward testing and higher conspiracy beliefs were less likely to get tested than those with negative attitudes and lower conspiracy beliefs; conspiracy beliefs did not relate to testing outcomes when testing attitudes were positive. Conclusion Findings suggest that interventions may benefit from accounting for conspiracy beliefs and the dyadic status disclosure when encouraging young rural women to test for HIV.
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Affiliation(s)
- Kristina B Hood
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Calvin J Hall
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Bianca D Owens
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Alison J Patev
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Faye Z Belgrave
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
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22
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Visser M, Hlungwani AJ. Maternal HIV status disclosure to young uninfected children: psychological variables of the mother. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2020; 19:48-56. [PMID: 32153231 DOI: 10.2989/16085906.2019.1681481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Mothers living with HIV are faced with the dilemma of when and how to disclose their HIV-positive status to their young uninfected children. In this study, a South African sample of mothers living with HIV, with young uninfected children (6-10 years) in the city of Tshwane was studied. In the sample of 406 mothers, 11.6% reported that they disclosed their HIV status to their young uninfected children. The research compared 47 mothers who disclosed (29 full disclosure and 18 partial disclosure) and a random sample of 50 mothers who did not disclose to their children, in terms of depression symptoms, parenting stress and coping strategies. The results showed that single and widowed mothers disclosed significantly more to their uninfected young children than mothers who had partners or were married. Mothers in the three disclosure groups did not differ in their experience of depression symptoms, parental distress and coping styles. Mothers who disclosed partially reported less parent-child dysfunctional interaction. Time since disclosure did not influence level of disclosure and was not significantly related to psychological outcome of mothers. Mothers who disclosed reported significantly more emotional and instrumental support as coping strategies than mothers who did not disclose. Mothers thus mostly disclose their status to their children to gain support and family closeness. Mothers who disclosed and had not disclosed did not differ in terms of psychological variables. Some mothers perceived partial disclosure as age-appropriate for young children. It is recommended that HIV-positive mothers receive psychosocial support services to equip them to disclose their health status in an age-appropriate way to their children, as it is documented that maternal disclosure benefits both mother and child.
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Affiliation(s)
- Maretha Visser
- Department of Psychology, University of Pretoria, South Africa
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23
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Kerr J, Harris L, Glass E, Golden T, Crawford T. "I Shall Live and Not Die": Using Monologues Based on the Experiences of Older African Americans Living With HIV to Address HIV-Related Stigma Among African Americans in Louisville, Kentucky. FAMILY & COMMUNITY HEALTH 2020; 43:257-263. [PMID: 32658028 DOI: 10.1097/fch.0000000000000268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Remediating racial/ethnic HIV inequities necessitates addressing HIV-related stigma. Arts- and media-based approaches demonstrate potential for effective knowledge translation and HIV-related stigma reduction. This study employs 5 monologues portraying lived experiences of older African Americans living with HIV to do this. Monologues were developed on the basis of qualitative research, actors performed them for live and online audiences, and surveys were distributed to gauge their potential for raising awareness about HIV-related stressors, reducing HIV-related stigma, and entertainment value. Monologues may also foster HIV testing. More scholarship should integrate arts-based knowledge translation with HIV education. Future efforts should focus on scaling this approach.
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Affiliation(s)
- Jelani Kerr
- Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences (Drs Kerr and Golden), Kent School of Social Work (Dr Harris), and Department of Comparative Humanities, School of Arts of Sciences (Ms Glass), University of Louisville, Louisville, Kentucky; and Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, Dayton, Ohio (Dr Crawford)
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24
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Nabunya P, Byansi W, Sensoy Bahar O, McKay M, Ssewamala FM, Damulira C. Factors Associated With HIV Disclosure and HIV-Related Stigma Among Adolescents Living With HIV in Southwestern Uganda. Front Psychiatry 2020; 11:772. [PMID: 32848940 PMCID: PMC7411995 DOI: 10.3389/fpsyt.2020.00772] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/21/2020] [Indexed: 11/13/2022] Open
Abstract
HIV-related stigma has been documented as one of the greatest obstacles to reducing HIV spread, engagement in HIV treatment, and poor mental health functioning among people living with HIV (PLWH). Although disclosure is important for people to receive social support, the fear of stigma and discrimination prevents PLWH from disclosing their status. For children and adolescents growing up with HIV -with no opportunity for normal transition through adolescence due to stigma, it is important to identify additional family and community support systems, to improve their acceptance and health outcomes, including mental health functioning. This study examined family communication and social support factors associated with HIV disclosure and HIV-related stigma among children and adolescents living with HIV in Uganda. Baseline data from an NICHD-funded Suubi+Adherence study (N=702) were analyzed. Adolescents (10-16 years) were eligible to participate if they were: 1) HIV positive and knew their HIV status, 2) prescribed antiretroviral therapy, 3) lived within a family, not an institution, and 4) enrolled in one of the 39 health centers in the study area. Multiple regression analyses were conducted to determine family communication (frequency and level of comfort communicating with caregiver), social support (perceived child-caregiver support and social support from classmates, close friends, teachers, and caregivers), associated with HIV disclosure, disclosure comfort, and HIV internalized and anticipated stigma. Results show that level of comfort communicating with a caregiver was significantly associated with how often children discussed their HIV status with other people (B = 0.02, 95% CI = 0.00, 0.03, p = 0.04), and level of HIV disclosure comfort (B = 0.08, 95% CI = 0.04, 0.13, p < 0.01). In addition, support from within the school environment, i.e., from teachers and classmates, was uniquely associated with both HIV disclosure and HIV-related stigma. Findings point to schools as potential for implementing HIV stigma-reduction programs. In addition, programming aimed at improving HIV care and treatment outcomes for adolescents living with HIV should consider incorporating both family communication strengthening and HIV-stigma reduction strategies in their efforts, in order to improve HIV health-related outcomes, including overall mental health functioning of HIV positive adolescents.
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Affiliation(s)
- Proscovia Nabunya
- Brown School, Washington University in St. Louis, St Louis, MO, United States.,International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - William Byansi
- Brown School, Washington University in St. Louis, St Louis, MO, United States.,International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St Louis, MO, United States.,International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Mary McKay
- Brown School, Washington University in St. Louis, St Louis, MO, United States
| | - Fred M Ssewamala
- Brown School, Washington University in St. Louis, St Louis, MO, United States.,International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Christopher Damulira
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, MO, United States
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25
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Matheu M, Sunil T, Castro-Peña A, Spears CE, Smith CJ, Flores JM, Taylor BS. Lack of virologic suppression is associated with lower HIV-related disclosure stigma in people living with HIV. AIDS Care 2019; 32:1001-1007. [PMID: 31658824 DOI: 10.1080/09540121.2019.1679705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Stigma remains a leading barrier to HIV care. To determine the influence of disclosure stigma (DS), fear of disclosing one's serostatus, on virologic suppression, a cross-sectional study was performed at the largest publicly-funded HIV clinic in South Texas. A survey was administered to participants who were: ≥18 years old, living with HIV, and receiving antiretroviral therapy. Surveys included demographics, adherence questionnaire, and a validated HIV-stigma scale with DS as the sum of 10 items ranked 0-3, with score of 30 indicating highest stigma. The primary outcome was lack of virologic suppression (LOVS): most recent HIV-1 RNA > 20 copies/ml. A bivariate analyses examined predictors of DS, dichotomized at the median. Depression score, perceived stress, and lack of friend/family support were associated with DS. Logistic regression models examined the relationship between DS, as a continuous variable, and LOVS. For 275 participants (69% Hispanic), median DS score was 18.5. DS was significantly inversely associated with LOVS (aOR 0.94 per 1 scale point; CI 0.89, 0.99) after adjustment for age, gender/sexual orientation, race/ethnicity, and drug use. The unanticipated inverse association between DS and LOVS highlights the complexity of this relationship. However, the balance of data in this cohort demonstrate an overall negative impact of DS.
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Affiliation(s)
- Michelle Matheu
- Department of Medicine, Division of Infectious Diseases, University of Texas Health, San Antonio, TX, USA
| | - Thankam Sunil
- The Institute for Health Disparities Research and The Department of Sociology, University of Texas, San Antonio, TX, USA
| | - Alexandra Castro-Peña
- Department of Medicine, Division of Infectious Diseases, University of Texas Health, San Antonio, TX, USA
| | | | | | | | - Barbara S Taylor
- Department of Medicine, Division of Infectious Diseases, University of Texas Health, San Antonio, TX, USA
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26
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Greene H, Jolly PE, Johnson T, Galarza R, Jaoko W, Padilla LA. Characteristics Associated with Disclosure Status to Sexual Partners among Kenyan Women. ACTA ACUST UNITED AC 2019; 5. [PMID: 32766452 PMCID: PMC7405985 DOI: 10.16966/2380-5536.166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Kenya has the fourth-largest HIV epidemic across the globe. Disclosure of HIV-positive status plays a critical role in the prevention of HIV transmission. Disclosure, specifically to sexual partners, has been shown to foster safer sexual behaviors in addition to emotional, social, or monetary support from partners. Objective: This study was conducted to identify factors associated with HIV-positive status disclosure to sexual partners compared to disclosure to other than sexual partners. Methods: A cross-sectional study was conducted from May to August 2012 among 497 HIV-positive women 19–49 years of age who had sex in the past six months. Participants were recruited from the Kenyatta National Hospital and Mbagathi Direct Hospital in Nairobi, Kenya. A questionnaire was administered to obtain data on HIV disclosure. Bivariate and multivariable logistic regression analyses were conducted to identify factors associated with disclosure of HIV-positive status to sexual partners. Results: Of the 497 women, 349 reported to whom they had disclosed their HIV status. Approximately 34% had disclosed their HIV-positive status to a sexual partner. Women who disclosed to their sexual partners were 11 times more likely to be married or in a common-law relationship and 4 times more likely for their sexual partner or spouse to be the heads of the households. Frequency of condom use, belief that HIV disclosure is important for HIV prevention and control, knowledge of partner’s HIV status, and number of sex partners were also significantly associated with disclosing to a sexual partner. Conclusion: This study found a low rate of disclosure of HIV-positive status by women to sexual partners and identified a number of factors associated with disclosure to sexual partners. These findings can be used in designing interventions that focus on individuals who have not disclosed their HIV-positive status to their sexual partners by demonstrating the importance of disclosure and safe sex practices.
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Affiliation(s)
- Haley Greene
- Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Alabama, USA
| | - Pauline E Jolly
- Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Alabama, USA
| | - Tierra Johnson
- Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Alabama, USA
| | - Ruby Galarza
- Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Alabama, USA
| | - Walter Jaoko
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Luz A Padilla
- Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Alabama, USA
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27
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Huang J, Lin D, Yu NX. Variations in Dyadic Adjustment Among Heterosexual HIV-Discordant Couples in Rural China: A Latent Profile Analysis. AIDS Patient Care STDS 2019; 33:323-335. [PMID: 31194573 DOI: 10.1089/apc.2019.0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The systemic framework of resilience and dyadic perspective of couple coping suggests that HIV-discordant couples may show heterogeneous profiles of dyadic adjustment, shaped by contextual risks and resources. This study aimed to identify heterogeneous profiles of dyadic adjustment and thus investigate the expression of resilience among 159 heterosexual HIV-discordant couples in rural China. We hypothesized that the couples could be grouped into distinct profiles: both members showing poor well-being, both members showing good well-being, and discrepant well-being across the two members. A latent profile analysis classified the couples into three subgroups based on well-being, which was measured using the World Health Organization Well-Being Index. As expected, one subgroup, labeled Maladapted Couples (n = 58, 36.5%), reported poor well-being in both people living with HIV/AIDS (PLWHA) and the seronegative spouse. The second subgroup, labeled Resilient Couples (n = 50, 31.4%), was characterized by relatively good well-being in both partners. In the third subgroup, labeled Maladapted PLWHA and Resilient Spouses (n = 51, 32.1%), the PLWHA showed poor well-being, while the seronegative spouses demonstrated good well-being. The identified subgroups were validated against external well-being measures, including depression and self-rated health measures. Exploratory analyses identified distinct patterns of contextual risks (including HIV stigma and financial difficulties) and resource factors (including individual resources and relational resources) across the subgroups. These findings underscore the heterogeneity of adjustment among heterosexual HIV-discordant couples in rural China and suggest the potential usefulness of services tailored to specific subgroups.
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Affiliation(s)
- Jiasheng Huang
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China
| | - Danhua Lin
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China
| | - Nancy Xiaonan Yu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China
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28
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Smith Fawzi MC, Siril H, Liu Y, McAdam K, Ainebyona D, McAdam E, Somba M, Oljemark K, Mleli N, Lienert J, Andrew I, Haberlen S, Simwinga A, Todd J, Makongwa S, Li N, Kaaya S. Agents of change among people living with HIV and their social networks: stepped-wedge randomised controlled trial of the NAMWEZA intervention in Dar es Salaam, Tanzania. BMJ Glob Health 2019; 4:e000946. [PMID: 31179027 PMCID: PMC6528754 DOI: 10.1136/bmjgh-2018-000946] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 02/06/2019] [Accepted: 02/08/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION NAMWEZA is a novel intervention that focuses on preventing HIV and promoting sexual and reproductive health and rights by addressing underlying factors related to vulnerability of acquiring HIV, such as depression, intimate partner violence (IPV) and stigma. The goal of the study was to evaluate the effect of the NAMWEZA intervention on risk behaviour as well as factors potentially contributing to this vulnerability for people living with HIV and their network members. METHODS A stepped-wedge randomised controlled trial was conducted from November 2010 to January 2014 among people living with HIV and their network members in Dar es Salaam, Tanzania. 458 people living with HIV were randomised within age/sex-specific strata to participate in the NAMWEZA intervention at three points in time. In addition, 602 members of their social networks completed the baseline interview. Intention-to-treat analysis was performed, including primary outcomes of uptake of HIV services, self-efficacy, self-esteem, HIV risk behaviour and IPV. RESULTS For people living with HIV, a number of outcomes improved with the NAMWEZA intervention, including higher self-efficacy and related factors, as well as lower levels of depression and stigma. IPV reduced by 40% among women. Although reductions in HIV risk behaviour were not observed, an increase in access to HIV treatment was reported for network members (72% vs 94%, p=0.002). CONCLUSION These results demonstrate the complexity of behavioural interventions in reducing the vulnerability of acquiring HIV, since it is possible to observe a broad range of different outcomes. This study indicates the importance of formally evaluating interventions so that policymakers can build on evidence-based approaches to advance the effectiveness of HIV prevention interventions. TRIAL REGISTRATION NUMBER NCT01693458.
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Affiliation(s)
- Mary C Smith Fawzi
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Hellen Siril
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Yuanyuan Liu
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Donald Ainebyona
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Magreat Somba
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Neema Mleli
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jeffrey Lienert
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Irene Andrew
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Jim Todd
- Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Samwel Makongwa
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nan Li
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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29
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Ayuttacorn A, Tangmunkongvorakul A, Musumari PM, Srithanaviboonchai K, Jirattikorn A, Aurpibul L. Disclosure of HIV status among Shan female migrant workers living with HIV in Northern Thailand: A qualitative study. PLoS One 2019; 14:e0216382. [PMID: 31048890 PMCID: PMC6497284 DOI: 10.1371/journal.pone.0216382] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/21/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Disclosure of HIV status is a critical gateway to HIV prevention. Despite many studies on this topic, there is a gap in knowledge regarding HIV status disclosure and risky sexual behavior in HIV-infected female migrant workers. The current study addressed this research gap, and focused on HIV-infected Shan female migrant workers in Northern Thailand. METHODS This study conducted in-depth interviews with 18 HIV-infected Shan female migrants (aged between 23-54 years old) and 29 healthcare workers in district hospitals in Chiang Mai. Content analysis was employed to identify particular themes related to HIV status disclosure, sexual risk behavior, and ART adherence. RESULTS We found that non-disclosure to husbands/partners was mostly related to fear of marital conflict and of losing social and financial support. Non-disclosure prevented Shan female migrant workers from negotiating condom use with their partners. Reasons for not disclosing to friends, family and other community members were mostly related to feared rejection and discrimination due to HIV-related stigma. Accounts of condomless sex in the context of HIV status disclosure suggest that gender norms and male dominance over women influenced decision-making for safe sex. Lastly, some female migrant workers perceived low risk of HIV transmission with good adherence to the ART. CONCLUSIONS This study highlighted the complex challenges of HIV status disclosure among HIV-positive Shan female migrant workers and the link between disclosure/non-disclosure and condom use. There is a pressing need to create realistic disclosure mechanisms that take into account the socio-cultural barriers to disclosure including marital conflicts, stigma, and gender norms. Messages to encourage condom use should be delivered carefully so that knowledge of the HIV transmission reduction qualities of good ART adherence does not serve as a barrier to condom use.
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Affiliation(s)
| | | | - Patou Masika Musumari
- Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Kyoto, Japan
- Japan Foundation for AIDS Prevention, Tokyo, Japan
| | - Kriengkrai Srithanaviboonchai
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Linda Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
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30
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The Effect of HIV Self-Testing Delivery Models on Female Sex Workers' Sexual Behaviors: A Randomized Controlled Trial in Urban Uganda. AIDS Behav 2019; 23:1225-1239. [PMID: 30652205 PMCID: PMC6510910 DOI: 10.1007/s10461-019-02393-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
HIV self-testing increases recent and frequent HIV testing among female sex workers (FSWs) in urban Uganda. Using results from a randomized controlled trial, we aim to establish the effect of HIV self-testing delivery models on FSWs’ sexual behaviors in this setting. Clusters of one peer educator and eight participants were 1:1:1 randomized to: (1) direct provision of an HIV self-test, (2) provision of a coupon for facility collection of an HIV self-test, or (3) referral to standard-of-care HIV testing services. Sexual behaviors were self-reported at 1 and 4 months. From October to November 2016, 960 participants were enrolled and randomized. At 4 months, there were no statistically significant differences in participants’ sexual behaviors, including inconsistent condom use, across study arms. We do not find any changes in sexual risk-taking among FSWs in response to the delivery of HIV self-tests. Routine policies for HIV self-testing are likely a behaviorally safe component of comprehensive HIV prevention strategies.
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31
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Kalomo EN. Associations between HIV-related stigma, self-esteem, social support, and depressive symptoms in Namibia. Aging Ment Health 2018; 22:1570-1576. [PMID: 29019412 DOI: 10.1080/13607863.2017.1387763] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The current study sought to investigate the association between HIV-related stigma, self-esteem, social support, and depression of people living with HIV and AIDS (PLWHA) in Namibia. METHOD Purposive sampling was used to recruit a total of 124 men and women living with HIV/AIDS in the Katima Mulilo region of northern Namibia. A cross-sectional survey was used to collect information on demographics, self-esteem, social support, HIV-related stigma, and depression. RESULTS Correlation analysis revealed that HIV-related stigma, self-esteem, and social support were all significantly correlated with depression. Further, Ordinary Least Squares (OLS) regression analysis indicated that HIV-related stigma was the largest risk factor and self-esteem was the largest protective factor with respect to depressive symptoms. DISCUSSION Findings indicated the necessity of appropriate assessment and intervention for psychosocial distress among PLWHA. Helping professionals should design evidence-based interventions that address individual and societal challenges that impact people living with HIV and AIDS.
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Affiliation(s)
- Eveline Ndii Kalomo
- a Fairmount College of Liberal Arts & Sciences, School of Social Work , Wichita State University , Wichita , KS , United States
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32
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Characterizing the Patterns of HIV Disclosure to Clients Among South African Female Sex Workers in Port Elizabeth. AIDS Behav 2018; 22:3924-3932. [PMID: 29968141 DOI: 10.1007/s10461-018-2199-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Female sex workers (FSW) in South Africa are disproportionately affected by HIV, yet little is known about their HIV-status disclosure with clients. Among 410 FSW participating in a cross-sectional study, 213 were HIV positive and aware of their status prior to enrollment. Among FSW aware of their HIV-status, 35% (74/213) reported disclosing their HIV-status to paying clients, whereas 75% (118/158) of those with regular, non-paying partners disclosed to them. In a multivariable analysis, disclosure to clients was associated with more years of education, disclosure to non-paying partners, and meeting clients at established sex work venues, whereas a history of sexual violence was associated with less disclosure. There was also evidence of mutual disclosure with clients, however disclosure was not associated with condom use with clients or being on antiretrovirals. Safer working environments may improve FSW HIV disclosure practices, however disclosure must also be linked with protective behaviors in this population.
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33
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Brittain K, Mellins CA, Remien RH, Phillips T, Zerbe A, Abrams EJ, Myer L. Patterns and Predictors of HIV-Status Disclosure Among Pregnant Women in South Africa: Dimensions of Disclosure and Influence of Social and Economic Circumstances. AIDS Behav 2018; 22:3933-3944. [PMID: 30155586 DOI: 10.1007/s10461-018-2263-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
HIV-status disclosure may improve psychosocial health and adherence to antiretroviral therapy (ART), but existing insights suffer from methodological limitations. We explored disclosure over time during pregnancy and postpartum among 1347 HIV-positive women in Cape Town. Among 995 women diagnosed HIV-positive before the pregnancy and entering antenatal care (median age 30 years), 95% had disclosed to ≥ 1 individual. In Mokken scale analysis, we observed two separate dimensions of disclosure: disclosure to a male partner, and disclosure to family/community members. Among 352 women diagnosed during the pregnancy and initiating ART (median age 27 years), 61% disclosed to a male partner and 71% to a family/community member by 12 months after diagnosis. Relationship status modified the impact of pregnancy intentions and poverty on disclosure to a male partner. These unique data provide important insights into dimensions of disclosure during pregnancy and postpartum, and suggest that women's social and economic circumstances are central determinants of disclosure.
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Affiliation(s)
- Kirsty Brittain
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Tamsin Phillips
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Allison Zerbe
- Mailman School of Public Health, ICAP, Columbia University, New York, NY, USA
| | - Elaine J Abrams
- Mailman School of Public Health, ICAP, Columbia University, New York, NY, USA
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Vitale A, Ryde J. Exploring Risk Factors Affecting the Mental Health of Refugee Women Living with HIV. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102326. [PMID: 30360458 PMCID: PMC6209869 DOI: 10.3390/ijerph15102326] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 12/21/2022]
Abstract
Little is known about how the intersection of being a forced migrant and living with HIV can contribute to the development or exacerbation of pre-existing mental conditions. This study is set in this context and it aims to explore specific risk factors affecting the mental health of refugee women living with HIV. A total of eight refugee women living with HIV took part in the study; they were individually interviewed, and their transcripts were thematically analyzed. The overall findings indicated that participants’ mental health was impaired by multiple stressors associated with their conditions, such as racial discrimination, HIV-related stigma, including from health professionals, loneliness, and resettlement adversities. These all represent threats to public health, as they discourage individuals from engaging with adequate health/mental health services. Despite their situation, participants had not received psychological interventions and their healthcare was reduced to managing the physical symptoms of HIV. Participants indicated their need to take part in group interventions that could promote their mental health and social recovery. These findings are relevant to raising awareness about the specific risk factors affecting refugee women living with HIV and to provide evidence for public health interventions based on this specific population’s need.
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Affiliation(s)
- Agata Vitale
- College of Liberal Arts (CoLA), Bath Spa University, Newton Park, Bath BA29BN, UK.
| | - Judy Ryde
- Trauma Foundation South West, Barrow Castle, Rush Hill, Bath BA22QR, UK.
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Fifield J, O'Sullivan L, Kelvin EA, Mantell JE, Exner T, Ramjee G, Blanchard K, Hoffman S. Social Support and Violence-prone Relationships as Predictors of Disclosure of HIV Status Among Newly Diagnosed HIV-positive South Africans. AIDS Behav 2018; 22:3287-3295. [PMID: 29744766 DOI: 10.1007/s10461-018-2136-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Despite the salience of social support and violence as potential outcomes of disclosure, how pre-existing social support and relationship violence among people living with HIV shapes and influences HIV status disclosure has received limited attention. Following the Disclosure Process Model, this study investigated pre-disclosure support and violence-prone relationships as predictors of disclosure using data from a prospective study of 459 newly diagnosed South African women and men. Most (88%) disclosed their status to at least one person by their 8-month interview. Level of social support was unrelated to disclosure to a partner. However, those with higher levels of support had higher odds of disclosing to family and to others. Women in violence-prone relationships were more likely to report disclosure to a partner than were those not in such relationships, counter to expectations. The findings suggest that the same mechanisms may not explain processes of disclosure across all relationship types.
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Affiliation(s)
- Jocelyn Fifield
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA.
- Ariadne Labs, Brigham and Women's Hospital and Harvard School of Public Health, Boston, MA, USA.
- , 401 Park Drive, Boston, MA, 02115, USA.
| | - Lucia O'Sullivan
- Department of Psychology, University of New Brunswick, Fredericton, NB, Canada
| | - Elizabeth A Kelvin
- Epidemiology & Biostatistics Program, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Theresa Exner
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Gita Ramjee
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | | | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Li H, Li X, Zhang L, Chow E. Effects of multiple types of stigma on the probability of HIV disclosure to sex partners: a systematic review. Sex Health 2018; 13:516-529. [PMID: 27491829 DOI: 10.1071/sh16089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 06/28/2016] [Indexed: 11/23/2022]
Abstract
Previous review studies explored factors related to the process of HIV disclosure. However, none of these review studies specifically focused on the effects of stigma on HIV disclosure to sex partners. A comprehensive systematic review of empirical studies on the effects of stigma on HIV disclosure to sex partners was conducted until December 2014. Twenty-seven articles published in English-language journals were selected, and study characteristics and findings were evaluated. Inconsistent findings in the assessment of impacts of stigma on HIV disclosure to sex partners were documented. Three underlying plausible reasons were identified, and these included: (1) different types of stigma may have different effects on HIV disclosure to sex partners; (2) studies used different measurement strategies; and (3) varied personal backgrounds and health factors that can mitigate, facilitate or moderate the effect of stigma on HIV disclosure to sex partners. Studies with precise definition measurements of specific types of stigma used them appropriately in a matching context to provide more consistent research results. This review identifies the need for further investigation into how the HIV disclosure process is shaped by particular types of stigma, types of sex partners and demographic characteristics of people living with HIV/AIDS.
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Affiliation(s)
- Haochu Li
- School of Public Health, Shandong University, 44 Wen Hua Xi Road, Jinan, Shandong Province 250012, China
| | - Xiaoming Li
- Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Lei Zhang
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, 100062, China
| | - Eric Chow
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic. 3004, Australia
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Papas RK, Gakinya BN, Mwaniki MM, Wu XK, Lee H, Martino S, Klein DA, Sidle JE, Loxley MP, Keter AK, Baliddawa JB, Maisto SA. Associations with Unprotected Sexual Behavior Among HIV-Infected Drinkers in Western Kenya. AIDS Behav 2018; 22:2840-2850. [PMID: 29767325 DOI: 10.1007/s10461-018-2150-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Approximately 71% of HIV-infected individuals live in sub-Saharan Africa. Alcohol use increases unprotected sex, which can lead to HIV transmission. Little research examines risky sex among HIV-infected individuals in East Africa who are not sex workers. The study purpose was to examine associations with unprotected sex in a high-risk sample of 507 HIV-infected sexually active drinkers in western Kenya. They were enrolled in a trial to reduce alcohol use. Past-month baseline alcohol use and sexual behavior were assessed using the Timeline Followback. A zero-inflated negative binomial model examined associations with occurrence and frequency of unprotected sex. Results showed heavy drinking days were significantly associated with unprotected sex occurrence across gender, and with unprotected sex frequency among women. Among women, transactional sex, alcohol-related sexual expectations, condom use self-efficacy, drinking-and-protected-sex days and age were associated with unprotected sex occurrence while alcohol-related sexual expectations, depressive symptoms and condom use self-efficacy were associated with unprotected sex frequency. Among men, alcohol-related sexual expectations, condom use self-efficacy, and age were associated with unprotected sex occurrence, while drinking-and-protected-sex days were associated with unprotected sex occurrence and frequency. Findings suggest robust relationships between heavy drinking and unprotected sex. Further research is needed elucidating the temporal relationships between drinking and unprotected sex in this population.
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Buhikire K, Voss J, Kigozi J, Nyakato P, Ankunda N, Kalebbo B, Musiitwa M, Muganzi A, Sewankambo NK, Nakanjako D. Reaching the First 90 in Uganda: Predictors of Success in Contacting and Testing the Named Sexual Partners of HIV+ Index Clients in Kiboga District. AIDS Behav 2018; 22:2458-2467. [PMID: 29754266 DOI: 10.1007/s10461-018-2137-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Assisted partner notification programs represent one strategy for targeted HIV testing and treatment of exposed individuals in high-risk populations. This study of a pilot Partner Services program in rural Uganda describes predictors of successful contact tracings and testing of partners of HIV+ individuals and possible barriers to contact. Partner contact tracing data was extracted from registers at seven Ministry of Health facilities between May and October 2016, to inform program implementation and scale up. A total of 464 HIV+ index clients named 660 sexual partners; 334/660 (51%) were contacted, 193/334 (58%) tested for HIV, and 61/193 (32%) tested HIV+. Current relationship status predicted contact [AOR = 0.23; (95% CI 0.15, 0.37), p < 0.0001] and testing [AOR = 0.19; (95% CI 0.09, 0.36), p < 0.0001]. Partner contact information type was associated with contact (p < 0.0001), and assisted disclosure with testing (p < 0.0001). Partner contact tracing is an effective means of identifying undiagnosed HIV infections.
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Hino S, Grodensky C, Rutstein SE, Golin C, Smith MK, Christmas L, Miller W, Phiri S, Massa C, Kamanga G, Pettifor A. HIV status disclosure during acute HIV infection in Malawi. PLoS One 2018; 13:e0201265. [PMID: 30048496 PMCID: PMC6062079 DOI: 10.1371/journal.pone.0201265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/13/2018] [Indexed: 01/05/2023] Open
Abstract
Diagnosis of acute HIV infection (AHI) presents an opportunity to prevent HIV transmission during a highly infectious period. Disclosure is important during AHI as a means to facilitate safer sex practices and notify partners, particularly as those with AHI may be better able to identify the source of their infection because of the recency of HIV acquisition. However, little is known about disclosure during AHI. We conducted 40 semi-structured interviews with Malawians diagnosed with AHI (24 men; 21 married). Most participants reported disclosing to a sexual partner within a month of diagnosis, and knew or had a strong suspicion about the source of their infection. Participants often assumed their source had knowingly infected them, contributing to anger and feeling that disclosure is futile if the source already knew their HIV status. Assisted partner notification, individual and couples counseling, and couples HIV testing may facilitate disclosure during AHI. CLINICAL TRIAL REGISTRATION NUMBER NCT01450189.
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Affiliation(s)
- Sayaka Hino
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
| | - Catherine Grodensky
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Sarah E. Rutstein
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
- Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| | - Carol Golin
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, United States of America
- * E-mail:
| | - M. Kumi Smith
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
| | - Lawrenson Christmas
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| | - William Miller
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
| | | | - Cecilia Massa
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Gift Kamanga
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Audrey Pettifor
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
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Mosisa G, Woldemichael K, Ayalew F. Risky sexual behavior and associated factors among antiretroviral therapy attendees in Nekemte Referral Hospital, Western Ethiopia: a cross-sectional study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2018; 10:125-131. [PMID: 30022860 PMCID: PMC6044365 DOI: 10.2147/hiv.s159670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background HIV/AIDS remains a major public health problem. Practice of risky sexual behaviors is the major effective driver of the HIV epidemic among HIV-positive individuals. This behavior exposes their partners to HIV, and for those that are already positive it exposes them to a risk of suprainfection by other strains. Objective The aim of this study was to assess the prevalence of risky sexual behavior and associated factors among people living with HIV attending antiretroviral therapy (ART) clinic at Nekemte Referral Hospital. Methods An institution-based based cross-sectional study was conducted at the ART clinic of Nekemte Referral Hospital from March to April 2016. A total of 337 people living with HIV on ART for at least 3 months were selected by consecutive sampling technique. Data were collected through face-to-face interview. Data were entered into Epi-data Version 3.1 and analyzed using SPSS version 20. Variables significant on bivariate logistic regression analysis at p<0.25 were considered as candidates for the multivariable logistic regression analysis, and statistical significance was set at p<0.05. Results Approximately one third (32.9%) of the study participants were engaged in risky sexual behavior in the past 3 months prior to the study. Having multiple sexual partners (adjusted odds ratio [AOR] =6.38, 95% CI: 1.65, 24.74), being with a positive sero-status partner (AOR =2.68, 95% CI: 1.31, 5.5), not disclosing sero-status (AOR =5.99, 95% CI: 1.36, 26.35), having a desire for a child (AOR =2.6, 95% CI: 1.5, 4.51), having experience of perceived stigma (AOR =2.63, 95% CI: 1.5, 4.62), and lack of education on importance of protecting self from strain (AOR =5.64, 95% CI: 3.19, 9.96) were significantly associated with risky sexual behavior. Conclusion and recommendation The prevalence of risky sexual behavior was high, and approximately one third of study participants were engaged in risky sexual behavior. Efforts to increase awareness through health education and counseling are highly recommended.
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Affiliation(s)
- Getu Mosisa
- Department of Nursing and Midwifery, College of Health Sciences, Wollega University, Nekemte, Ethiopia,
| | - Kifle Woldemichael
- Department of Epidemiology, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Fantahun Ayalew
- Department of Nursing and Midwifery, College of Health Sciences, Jimma University, Jimma, Ethiopia
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Kagee A, Bantjes J, Saal W, Sefatsa M. Utility of the Posttraumatic Stress Scale–Self-report version in screening for posttraumatic stress disorder among persons seeking HIV testing. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2018. [DOI: 10.1177/0081246318779191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The literature on the utility of self-report instruments in determining caseness for posttraumatic stress disorder in South Africa is sparse. We administered the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders–Research Version and the Posttraumatic Stress Scale–Self-report version to a sample of 500 South African community members seeking HIV testing. Of our original sample of 500, 306 (61.2%) reported an index event for posttraumatic stress disorder and 25 (5.0%) met the criteria for this diagnosis. The Posttraumatic Stress Scale–Self-report displayed internal consistency of .95 as measured by Cronbach’s alpha. Using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders as a gold standard, we conducted receiver operating curve analysis among the 306 participants who reported an index traumatic event to determine the extent to which the Posttraumatic Stress Scale–Self-report as a screening instrument successfully discriminated between participants who did and did not meet the diagnostic criteria for posttraumatic stress disorder. The Posttraumatic Stress Scale–Self-report yielded sensitivity of .76 and specificity of .78, with an area under the curve of .837. Positive and negative predictive values were .24 and .97, respectively. Our findings suggest that the Posttraumatic Stress Scale–Self-report may be effectively used to screen for posttraumatic stress disorder among community samples, including persons seeking HIV testing.
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Affiliation(s)
- Ashraf Kagee
- Department of Psychology, Stellenbosch University, South Africa
| | - Jason Bantjes
- Department of Psychology, Stellenbosch University, South Africa
| | - Wylene Saal
- Department of Psychology, Stellenbosch University, South Africa
| | - Mpho Sefatsa
- Department of Psychology, Stellenbosch University, South Africa
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Brief Report: Stigma and HIV Care Continuum Outcomes Among Ethiopian Adults Initiating ART. J Acquir Immune Defic Syndr 2018; 76:382-387. [PMID: 28834799 DOI: 10.1097/qai.0000000000001530] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Stigma harms the mental health of HIV-positive individuals and reduces adherence to antiretroviral therapy (ART), but less is known about stigma and other outcomes across the HIV care continuum. METHODS Among 1180 Ethiopian adults initiating ART at 6 urban HIV clinics, we examined the relationship of internalized, anticipated, and enacted stigma to HIV care-related outcomes ascertained by interview (repeat HIV-positive testing, provider vs. self-referred testing, missed clinic visit before ART initiation, eagerness to begin ART), and by abstraction of routinely collected clinical data (late ART initiation, 3-month gap in care following ART initiation). Logistic regression was used to assess the association of each type of stigma with each outcome, adjusting for potential confounders. RESULTS Scoring higher on each stigma domain was associated with 50%-90% higher odds of repeat HIV-positive testing. High internalized stigma was associated with higher odds of provider vs. self-referred test [adjusted odds ratio (aOR)high vs. low: 1.7; 95% confidence interval (CI): 1.3 to 2.2]. Higher anticipated stigma was associated with lower eagerness to begin ART (aORhigh vs. low: 0.55; 0.35-0.87; aORmedium vs. low: 0.45; 95% CI: 0.30 to 0.69). Any enacted stigma was associated with higher odds of a missed visit (aORany vs. none 1.8; 1.2-2.8). Stigma was not associated with late ART-initiation or with a subsequent gap in care. DISCUSSION AND CONCLUSIONS These findings provide further evidence of the importance of measuring and addressing stigma across the entire care continuum. Future work should test hypotheses about specific stigma domains and outcomes in prospective intervention or observational studies.
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Zeng C, Li L, Hong YA, Zhang H, Babbitt AW, Liu C, Li L, Qiao J, Guo Y, Cai W. A structural equation model of perceived and internalized stigma, depression, and suicidal status among people living with HIV/AIDS. BMC Public Health 2018; 18:138. [PMID: 29334959 PMCID: PMC5769512 DOI: 10.1186/s12889-018-5053-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 01/10/2018] [Indexed: 12/03/2022] Open
Abstract
Background Previous studies have shown positive association between HIV-related stigma and depression, suicidal ideation, and suicidal attempt among people living with HIV/AIDS (PLWH). But few studies have examined the mechanisms among HIV-related stigma, depression, and suicidal status (suicidal ideation and/or suicidal attempt) in PLWH. The current study examined the relationships among perceived and internalized stigma (PIS), depression, and suicidal status among PLWH in Guangzhou, China using structural equation modeling. Methods Cross-sectional study by convenience sampling was conducted and 411 PLWH were recruited from the Number Eight People’s Hospital from March to June, 2013 in Guangzhou, China. Participants were interviewed on their PIS, depressive symptoms, suicidal status, and socio-demographic characteristics. PLWH who had had suicidal ideation and suicidal attempts since HIV diagnosis were considered to be suicidal. Structural equation model was performed to examine the direct and indirect associations of PIS and suicidal status. Indicators to evaluate goodness of fit of the structural equation model included Chi-square Statistic, Comparative Fit Index (CFI), Root Mean Square Error of Approximation (RMSEA), Standardized Root Mean Square Residual (SRMR), and Weighted Root Mean Square Residual (WRMR). Results More than one-third (38.4%) of the PLWH had depressive symptoms and 32.4% reported suicidal ideation and/or attempt since HIV diagnosis. The global model showed good model fit (Chi-square value = 34.42, CFI = 0.98, RMSEA = 0.03, WRMR = 0.73). Structural equation model revealed that direct pathway of PIS on suicidal status was significant (standardized pathway coefficient = 0.21), and indirect pathway of PIS on suicidal status via depression was also significant (standardized pathway coefficient = 0.24). There was a partial mediating effect of depression in the association between PIS and suicidal status. Conclusions Our findings suggest that PIS is associated with increased depression and the likelihood of suicidal status. Depression is in turn positively associated with suicidal status and plays a mediating role between PIS and suicidal status. Therefore, to reduce suicidal ideation and attempt in PLWH, targeted interventions to reduce PIS and improve mental health status of PLWH are warranted.
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Affiliation(s)
- Chengbo Zeng
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, #74 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Linghua Li
- Department of Infectious Disease, Guangzhou Number Eight People's Hospital, #627 Dongfeng Road, Guangzhou, 510080, China
| | - Yan Alicia Hong
- Department of Health Promotion and Community Health Sciences, School of Public Health, Health Science Center, Texas A&M University, College Station, TX, 77843, USA
| | - Hanxi Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, #74 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Andrew Walker Babbitt
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, #74 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Cong Liu
- Department of Infectious Disease, Guangzhou Number Eight People's Hospital, #627 Dongfeng Road, Guangzhou, 510080, China
| | - Lixia Li
- Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Pharmaceutical University, #283 Jianghai Street, Guangzhou, 510220, China
| | - Jiaying Qiao
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, #74 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Yan Guo
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, #74 Zhongshan 2nd Road, Guangzhou, 510080, China. .,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China. .,Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, China.
| | - Weiping Cai
- Department of Infectious Disease, Guangzhou Number Eight People's Hospital, #627 Dongfeng Road, Guangzhou, 510080, China.
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Pintye J, Drake AL, Kinuthia J, Unger JA, Matemo D, Heffron RA, Barnabas RV, Kohler P, McClelland RS, John-Stewart G. A Risk Assessment Tool for Identifying Pregnant and Postpartum Women Who May Benefit From Preexposure Prophylaxis. Clin Infect Dis 2017; 64:751-758. [PMID: 28034882 DOI: 10.1093/cid/ciw850] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 12/12/2016] [Indexed: 01/05/2023] Open
Abstract
Background A human immunodeficiency virus (HIV) risk assessment tool for pregnant women could identify women who would most benefit from preexposure prophylaxis (PrEP) while minimizing unnecessary PrEP exposure. Methods Data from a prospective study of incident HIV among pregnant/postpartum women in Kenya were randomly divided into derivation (n = 654) and validation (n = 650) cohorts. A risk score was derived using multivariate Cox proportional hazards models and standard clinical prediction rules. Ability of the tool to predict maternal HIV acquisition was assessed using the area under the curve (AUC) and Brier score. Results The final risk score included the following predictors: having a male partner with unknown HIV status, number of lifetime sexual partners, syphilis, bacterial vaginosis (BV), and vaginal candidiasis. In the derivation cohort, AUC was 0.84 (95% confidence interval [CI], .72-.95) and each point increment in score was associated with a 52% (hazard ratio [HR], 1.52 [95% CI, 1.32-1.76]; P < .001) increase in HIV risk; the Brier score was 0.11. In the validation cohort, the score had similar AUC, Brier score, and estimated HRs. A simplified score that excluded BV and candidiasis yielded an AUC of 0.76 (95% CI, .67-.85); HIV incidence was higher among women with risk scores >6 than with scores ≤6 (7.3 vs 1.1 per 100 person-years, respectively; P < .001). Women with simplified scores >6 accounted for 16% of the population but 56% of HIV acquisitions. Conclusions A combination of indicators routinely assessed in antenatal clinics was predictive of HIV risk and could be used to prioritize pregnant women for PrEP.
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Affiliation(s)
- Jillian Pintye
- Department of Global Health, University of Washington, Seattle, USA.,Family and Child Nursing, University of Washington, Seattle, USA
| | - Alison L Drake
- Department of Global Health, University of Washington, Seattle, USA
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Jennifer A Unger
- Departments of Global Health and Obstetrics and Gynecology, University of Washington, Box 359909, Seattle, WA, USA
| | - Daniel Matemo
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Renee A Heffron
- Department of Global Health, University of Washington, Seattle, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Ruanne V Barnabas
- Department of Global Health, University of Washington, Seattle, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Pamela Kohler
- Department of Global Health, University of Washington, Seattle, USA.,Psychosocial and Community Health, University of Washington, Seattle, USA
| | - R Scott McClelland
- Department of Global Health, University of Washington, Seattle, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA.,University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Kenya
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, USA
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45
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Kagee A, Bantjes J, Saal W. Prevalence of Traumatic Events and Symptoms of PTSD Among South Africans Receiving an HIV Test. AIDS Behav 2017; 21:3219-3227. [PMID: 28224321 DOI: 10.1007/s10461-017-1730-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We studied posttraumatic stress disorder (PTSD) among a community sample of 500 persons seeking an HIV test. The majority of participants (62.2%) indicated that they had experienced at least one index event that qualified for PTSD, even though a small proportion (5%) actually met the diagnostic criteria for the disorder. Of those who reported an index event, 25 (8.04%) met the diagnostic criteria for PTSD while 286 (91.96%) did not. On average about one-third of participants who did not meet the criteria for PTSD endorsed PTSD symptoms whereas more than three quarters of those who met the full criteria did so. No demographic factors were associated with PTSD caseness, except number of traumatic events. These results are discussed in the context of the need to address traumatic events and PTSD among persons who undergo HIV testing.
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Borges REA, Silva MDFDS, Melo LPD. “Mas não tive coragem de contar”: a revelação da condição sorológica na experiência amorosa de pessoas que vivem com HIV. SAUDE E SOCIEDADE 2017. [DOI: 10.1590/s0104-12902017170311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Estudo socioantropológico de abordagem qualitativa que aborda os relacionamentos amorosos de pessoas que vivem com HIV/aids (PVHA) no atual contexto de cronicidade da infecção e de restrição discursiva sobre a epidemia. A partir de narrativas breves em forma de comentários às postagens sobre experiências amorosas de PVHA publicadas em um blog pessoal, este artigo objetiva compreender os significados atribuídos às estratégias para revelação da condição sorológica e as formas de enfrentamento das reações dos parceiros amorosos diante dessa atitude. Da análise temática do material empírico emergiram duas categorias: “mas não tive coragem de contar” - o desvelar da condição sorológica; e “e do nada sumiu” - as (re)ações do outro da relação. As narrativas evidenciaram as experiências na convivência com o segredo em torno de suas condições sorológicas e os sentimentos envolvidos em sua revelação, diante da possibilidade de um relacionamento amoroso. Nesse sentido, o segredo se expressou pela inexistência da “coragem de contar” ao(à) parceiro(a). Além disso, destaca-se o significado atribuído às reações do outro perante o conhecimento da condição sorológica, apontado, principalmente, como uma “porta” que se abre e permite (ou não) a experiência amorosa.
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Wanyama JN, Nabaggala MS, Wandera B, Kiragga AN, Castelnuovo B, Mambule IK, Nakajubi J, Kambugu AD, Paton NI, Wanyenze RK, Colebunders R, Easterbrook P. Significant rates of risky sexual behaviours among HIV-infected patients failing first-line ART: A sub-study of the Europe-Africa Research Network for the Evaluation of Second-line Therapy trial. Int J STD AIDS 2017; 29:287-297. [PMID: 28814161 DOI: 10.1177/0956462417724707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There are limited data on the prevalence of risky sexual behaviours in individuals failing first-line antiretroviral therapy (ART) and changes in sexual behaviour after switch to second-line ART. We undertook a sexual behaviour sub-study of Ugandan adults enrolled in the Europe-Africa Research Network for the Evaluation of Second-line Therapy trial. A standardized questionnaire was used to collect sexual behaviour data and, in particular, risky sexual behaviours (defined as additional sexual partners to main sexual partner, inconsistent use of condoms, non-disclosure to sexual partners, and exchange of money for sex). Of the 79 participants enrolled in the sub-study, 62% were female, median age (IQR) was 37 (32-42) years, median CD4 cell count (IQR) was 79 (50-153) cells/µl, and median HIV viral load log was 4.9 copies/ml (IQR: 4.5-5.3) at enrolment. The majority were in long-term stable relationships; 69.6% had a main sexual partner and 87.3% of these had been sexually active in the preceding six months. At enrolment, around 20% reported other sexual partners, but this was higher among men than women (36% versus 6.7 %, p < 0.001). In 50% there was inconsistent condom use with their main sexual partner and a similar proportion with other sexual partners, both at baseline and follow-up. Forty-three per cent of participants had not disclosed their HIV status to their main sexual partner (73% with other sexual partners) at enrolment, which was similar in men and women. Overall, there was no significant change in these sexual behaviours over the 96 weeks following switch to second-line ART, but rate of non-disclosure of HIV status declined significantly (43.6% versus 19.6%, p <0.05). Among persons failing first-line ART, risky sexual behaviours were prevalent, which has implications for potential onward transmission of drug-resistant virus. There is need to intensify sexual risk reduction counselling and promotion of partner testing and disclosure, especially at diagnosis of treatment failure and following switch to second- or third-line ART.
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Affiliation(s)
- Jane N Wanyama
- 1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Maria S Nabaggala
- 1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Bonnie Wandera
- 1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Agnes N Kiragga
- 1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Barbara Castelnuovo
- 1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ivan K Mambule
- 2 Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Josephine Nakajubi
- 1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Andrew D Kambugu
- 1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Nicholas I Paton
- 3 Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Rhoda K Wanyenze
- 4 School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert Colebunders
- 5 Institute of Tropical Medicine, Antwerp, Belgium.,6 Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Philippa Easterbrook
- 1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
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Kagee A, Saal W, De Villiers L, Sefatsa M, Bantjes J. The Prevalence of Common Mental Disorders Among South Africans Seeking HIV Testing. AIDS Behav 2017; 21:1511-1517. [PMID: 27188430 PMCID: PMC5114161 DOI: 10.1007/s10461-016-1428-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We administered the Structured Clinical Interview for the DSM to 485 persons seeking HIV testing at five community testing centres in South Africa to determine the prevalence of common mental disorders among this population. The prevalence estimates for the various disorders were as follows: major depressive disorder: 14.2 % (95 % CI [11.1, 17.3]); generalised anxiety disorder 5.0 % (95 % CI [3.07, 6.93]); posttraumatic stress disorder 4.9 % (95 % CI [2.98, 6.82]); and alcohol use disorder 19.8 % (95 % CI [16.26, 23.34]). Our findings imply the need to research the integration of screening and referral trajectories in the context of voluntary HIV counselling and testing.
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Affiliation(s)
- Ashraf Kagee
- Stellenbosch University, Stellenbosch, South Africa.
| | - Wylene Saal
- Stellenbosch University, Stellenbosch, South Africa
| | | | - Mpho Sefatsa
- Stellenbosch University, Stellenbosch, South Africa
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Donald KAM, Fernandez A, Claborn K, Kuo C, Koen N, Zar H, Stein DJ. The developmental effects of HIV and alcohol: a comparison of gestational outcomes among babies from South African communities with high prevalence of HIV and alcohol use. AIDS Res Ther 2017; 14:28. [PMID: 28482927 PMCID: PMC5422965 DOI: 10.1186/s12981-017-0153-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 04/26/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND There is growing evidence of the negative impact of alcohol on morbidity and mortality of individuals living with HIV but limited evidence of in utero effects of HIV and alcohol on exposure on infants. METHODS We conducted a population-based birth cohort study (N = 667 mother-infant dyads) in South Africa to investigate whether maternal alcohol use and HIV affected gestational outcomes. Descriptive data analysis was conducted for all variables using frequency distributions, measures of central tendency, and estimates of variance. Hierarchical multiple regression was conducted to determine whether maternal alcohol use, maternal HIV status and other risk factors (socioeconomic status, smoking, depression) predicted infant outcomes. RESULTS Our results showed severity of recent alcohol use and lifetime alcohol use predicted low birth weight. Similarly lifetime alcohol use predicted shorter infant length, smaller head length, smaller head circumference, and early gestational age. However, HIV status was not a significant predictor of gestational outcomes. CONCLUSIONS The unexpected finding that maternal HIV status did not predict any of the gestational outcomes may be due to high rates of ART usage among HIV-infected mothers. The potentially negative effects of HIV on gestational outcomes may have been attenuated by improved maternal health due to high coverage of antiretroviral treatment in South Africa. Interventions are needed to reduce alcohol consumption among pregnant mothers and to support healthy growth and psychosocial development of infants.
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Affiliation(s)
- Kirsten A. M. Donald
- Department of Paediatrics and Child Health, Institute of Child Health Building, Red Cross War Memorial Children’s Hospital, 5th Floor, Klipfontein Road, Rondebosch, Cape Town, 7700 South Africa
| | - Anne Fernandez
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI USA
| | - Kasey Claborn
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI USA
- Department of Medicine, Rhode Island Hospital, Providence, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, USA
| | - Caroline Kuo
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI USA
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Nastassja Koen
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Heather Zar
- Department of Paediatrics and Child Health, Institute of Child Health Building, Red Cross War Memorial Children’s Hospital, 5th Floor, Klipfontein Road, Rondebosch, Cape Town, 7700 South Africa
- South African Medical Research Council Unit on Child & Adolescent Health, Cape Town, South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
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Ncube B, Ansong J, Daniels K, Campbell-Stennett D, Jolly PE. Sexual risk behavior among HIV-positive persons in Jamaica. Afr Health Sci 2017; 17:32-38. [PMID: 29026375 DOI: 10.4314/ahs.v17i1.6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND HIV/AIDS remains a global public health challenge, especially in sub-Saharan Africa and the Caribbean. Sexual risk behaviors among HIV-positive persons place their partners at risk for HIV transmission and other sexually transmitted infections. Stopping transmission acts among HIV-positive people is crucial in reversing HIV incidence. OBJECTIVE This study aimed to assess the prevalence and predictors of sexual risk behaviors among HIV-positive individuals in clinical care in Northwestern Jamaica. METHODS A cross-sectional survey of 118 (33 males and 85 females) HIV-positive individuals was used to assess demographic and health characteristics, HIV/AIDS knowledge, attitudes, and beliefs and sexual risk behaviors. RESULTS About 12% of the study population stated that they had unprotected anal or vaginal sex without disclosing their HIV status. Participants who agreed that condoms reduce the risk of HIV transmission were 13.1 times more likely to use condoms during their last sexual encounters(95% CI: 2.1-79.0) than those who disagreed. About 75% of participants reported using a condom every time they had sexual intercourse in the past year, while 25% used condoms irregularly. Participants who had unprotected anal or vaginal sex without disclosing their status were less likely to have used condoms during the last sexual encounter (OR=0.1; 95% CI: 0.02-0.5). CONCLUSION The prevalence of unsafe sex remains high among sexually active people living with HIV/AIDS in Jamaica. Study participants who engaged in unprotected sex without disclosing their HIV-positive status potentially place their partners at risk for HIV transmission and other sexually transmitted infections. The study findings highlight the need to promote safe sexual behaviors and a positive social environment for people living with HIV/AIDS in Jamaica.
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Affiliation(s)
- Butho Ncube
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jessica Ansong
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kewanna Daniels
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Pauline E Jolly
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
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