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Norr KF, Banda CK, Chang C, Krishna S, Kumbani LC, Liu L, McCreary LL, Patil CL. Condom use increased after a peer group intervention implemented by community volunteers in Malawi. BMC Public Health 2024; 24:1483. [PMID: 38831266 PMCID: PMC11145788 DOI: 10.1186/s12889-024-18991-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 05/29/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND HIV prevention remains a global priority, especially in sub-Saharan Africa. Our research team previously developed an evidence-based peer group program for HIV prevention called Mzake ndi Mzake (Friend to Friend). A community-engaged collaboration adapted the program for community ownership and implementation. Here we report whether this HIV prevention program, implemented by community volunteers, increased condom use among sexually active individuals in rural Malawi. METHODS Three communities sequentially rolled out the program. Effectiveness was evaluated using a stepped wedge design. Repeated surveys 11-13 months apart were conducted between 2016 and 2019. At Time 1, no community had offered the intervention. At Time 2, the first community had offered the intervention and two had not (control group). At Time 3, two communities had offered the intervention and one had not (control group). We used two condom use indicators; condom use frequency in the last 2 months (N = 771) and condom use at last sex (N = 880). The analytical sample included all sexually active persons answering that question at one or more time points. Mixed-effects cumulative logit and Generalized Estimating Equation (GEE) models were used to model the two condom indicators over time, controlling for demographic factors, UNAIDS HIV knowledge, safer sex self-efficacy and partner communication. RESULTS This peer group intervention implemented by trained community volunteers increased both condom use indicators at Times 2 and 3. In the final adjusted models with non-significant factors removed, condom use in the last two months increased for the intervention group vs. control group [Time 2: Adjusted Odds Ratio (AOR) = 1.59 (1.15, 2.21); Time 3: AOR 2.01 (1.23, 3.30)]. Similarly, condom use at last sex increased for the intervention group vs. control group [Time 2: AOR = 1.48 (1.08, 2.03); Time 3: AOR 1.81 (1.13, 2.90)]. Other significant predictors of greater condom use were also described. Although the intervention increased UNAIDS HIV knowledge, knowledge did not predict condom use. CONCLUSIONS In this community-engaged implementation study, an evidence-based peer group program for HIV prevention increased condom use when delivered by trained community volunteers. Community ownership and program delivery by trained volunteers offer an innovative and cost-effective strategy to address ongoing HIV prevention needs without overburdening healthcare systems in sub-Saharan Africa. TRIAL REGISTRATION Clinical Trials.gov NCT02765659 Registered May 6, 2016.
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Affiliation(s)
- Kathleen F Norr
- College of Nursing, University of Illinois Chicago, 845 S Damen Ave, Chicago, IL, 60612, USA.
| | - Chimwemwe K Banda
- Malawi Liverpool Wellcome Clinical Research Program, P.O Box 30096, Chichiri, Blantyre 3, Malawi
| | - Cecilia Chang
- School of Public Health, University of Illinois Chicago, 1603 W Taylor St, Chicago, IL, 60612, USA
| | - Shruthi Krishna
- School of Public Health, University of Illinois Chicago, 1603 W Taylor St, Chicago, IL, 60612, USA
| | - Lily C Kumbani
- Kamuzu University of Health Sciences, P/Bag 360, Chichiri, Blantyre 3, Malawi
| | - Li Liu
- School of Public Health, University of Illinois Chicago, 1603 W Taylor St, Chicago, IL, 60612, USA
| | - Linda L McCreary
- College of Nursing, University of Illinois Chicago, 845 S Damen Ave, Chicago, IL, 60612, USA
| | - Crystal L Patil
- School of Nursing, University of Michigan, 400 N. Ingalls St, Ann Arbor, MI, 48109, USA
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Kestelyn E, Van Nuil JI, Umulisa MM, Umutoni G, Uwingabire A, De Baetselier I, Uwineza M, Agaba S, Crucitti T, Delvaux T, van de Wijgert JHHM. High adherence to intermittent and continuous use of a contraceptive vaginal ring among women in a randomized controlled trial in Kigali, Rwanda. Front Glob Womens Health 2024; 5:1278981. [PMID: 38680542 PMCID: PMC11047128 DOI: 10.3389/fgwh.2024.1278981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 03/20/2024] [Indexed: 05/01/2024] Open
Abstract
Background The introduction of female-initiated drug-delivery methods, including vaginal rings, have proven to be a promising avenue to address sexually transmitted infections and unintended pregnancies, which disproportionally affects women and girls in sub-Saharan Africa. Efficient uptake of existing and new technologies such as vaginal rings requires in depth understanding of product adherence. This remains a major challenge as data on adherence to vaginal rings from African countries is limited. In this study, we explored adherence of contraceptive vaginal ring (NuvaRing®) use in Kigali, Rwanda using a mixed methods approach. Methods We collected quantitative and qualitative data at multiple time points from women participating in a clinical trial exploring the safety and acceptability of either intermittent or continuous use of the NuvaRing®. Various adherence categories were used including monthly and cumulative adherence measurement. The quantitative data were analysed using R and the qualitative data were analysed using a deductive, content-analytical approach based on categories related to the quantitative adherence measures. All data were compared and triangulated. Results Data from 120 enrolled participants showed that self-reported adherence was high at every study visit in both study groups. At first study visit 80% of the intermittent ring users and 79.7% of the continuous ring users reported perfect adherence (assessed as "the ring was never out"). Reporting of ring expulsions and removals were highest (28.3%) at the beginning of the trial. Self-reported perfect ring adherence increased during the study and reports of ring expulsions and removals declined as familiarity with this contraceptive method increased. The percentage of women with perfect cumulative adherence was non-significantly higher in the intermittent (61.7%) than in the continuous use group (54.3%). The low rate of discrepant adherence data after triangulation (6%) is in line with the perception of the participants as adherent throughout the study. Conclusions Self-reported adherence in both study groups was high with removals and expulsions being within the expected product range. Comprehensive adherence data triangulation allowed for a deeper understanding of context-driven behaviour that shaped adherence patterns and challenges. Our data categorisation and triangulation approach has shown potential for implementation in future vaginal ring studies aiming to better understand and measure adherence.
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Affiliation(s)
- Evelyne Kestelyn
- Rinda Ubuzima, Kigali, Rwanda
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Jennifer Ilo Van Nuil
- Rinda Ubuzima, Kigali, Rwanda
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | | | | | | | - Irith De Baetselier
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Tania Crucitti
- Experimental Bacteriology Unit, Institut Pasteur Madagascar, Antananarivo, Madagascar
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Janneke H. H. M. van de Wijgert
- Rinda Ubuzima, Kigali, Rwanda
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Rogers K, Ranganathan M, Kajula L, Lorraine Collins R, Livingston JA, Palermo T. The influence of gender-equitable attitudes on sexual behaviour among unmarried adolescents in rural Tanzania: a longitudinal study. Sex Reprod Health Matters 2023; 31:2260169. [PMID: 37850724 PMCID: PMC10586071 DOI: 10.1080/26410397.2023.2260169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
PLAIN LANGUAGE STATEMENT Gender norms that centre men and disadvantage women create gender inequality, which can lead to risky sexual behaviour. This study examined how both community and individual attitudes toward gender norms influenced risky sexual behaviour in adolescents, and whether that influence was different between males and females. We found that higher gender-equitable attitudes were linked to increased odds of HIV testing in the last 12 months, and decreased odds of engaging in a sexual relationship with a much older partner. Individual high gender-equitable attitudes among girls were also linked to higher odds of them using condoms and contraceptives. Gender-equitable attitudes did not seem to influence early sexual debut, engagement in transactional sex, having multiple sexual partners at the same time, or the number of sexual partners a participant had in the last 12 months. Based on these findings, programming designed to increase gender-equitable attitudes might be helpful in increasing HIV testing and condom and contraceptive use, but it needs to involve the entire community, not just individual boys and girls.
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Affiliation(s)
- Kate Rogers
- PhD Candidate, Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, SUNY, 330 Kimball Tower, Buffalo, NY14212, USA
| | - Meghna Ranganathan
- Assistant Professor, London School of Hygiene and Tropical Medicine, London, UK
| | - Lusajo Kajula
- Independent Consultant, UNICEF Office of Research-Innocenti, Dar es Salaam, Tanzania
| | - R. Lorraine Collins
- Associate Dean for Research, Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | | | - Tia Palermo
- Associate Professor, Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA
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Awan UA, Khattak AA, Ahmed N, Guo X, Akhtar S, Kamran S, Yongjing Z, Liu J, Khan S. An updated systemic review and meta-analysis on human papillomavirus in breast carcinogenesis. Front Oncol 2023; 13:1219161. [PMID: 37711194 PMCID: PMC10498127 DOI: 10.3389/fonc.2023.1219161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/17/2023] [Indexed: 09/16/2023] Open
Abstract
Background Breast Cancer (BC) stands out as the widely prevalent malignancy among all the types of cancer affecting women worldwide. There is significant evidence that the pathogenicity of BC may be altered by Human Papillomavirus (HPV) infection; however, conclusive data are not yet available. Methods By searching five databases, including EMBASE, IBECS, PubMed, Scopus, Science Direct, Google Scholar, and Web of Science, a thorough systematic analysis was conducted on the prevalence of HPV in BC patients from 1990 to June 30, 2022. After applying extensive eligibility criteria, we selected 74 publications for further analysis based on the prevalence of HPV infections in breast tissues. All of the data were analyzed using a random-effects meta-analysis, Cochran Q test and I2 statistic were used to calculate the heterogeneity of the prevalence among these studies using subgroup analysis. Variations in the HPV prevalence estimates in different subgroups were evaluated by subgroup meta-analysis. Results In total, 3156 studies were initially screened, resulting in 93 full-text studies reviewed, with 74 meeting inclusion criteria. Among a total of 7156 BC biopsies, the pool prevalence of HPV was 25.6% (95% CI= 0.24-0.33, τ2 = 0.0369 with significant heterogeneity between estimates (I 2 = 97% and p< 0.01). Consequently, 45 studies with available controls were further studied, and the prevalence of HPV in case-control studies was 26.2% with overall odds 5.55 (95% CI= 3.67-8.41, I 2 = 38%, τ2 = 1.4878, p< 0.01). Further subgroup analysis of HPV revealed HPV-16 had a maximum prevalence of 9.6% (95% CI= 3.06-11.86, I 2 = 0%, τ2 = 0.6111, p< 0.01). Among different geographical regions, Europe reported the maximum prevalence of HPV, i.e., 39.2% (95% CI=1.29-7.91, I 2 = 18%, τ2 = 1.2911, p< 0.01). Overall distribution showed HPV-18 was a frequent HPV subtype reported in Australia. Conclusion Current study provides a global estimate of HPV prevalence in BC patients and demonstrates a significant association between this virus and BC etiology. Nevertheless, we recommend further investigation into the underlying mechanism is essential to validate this hypothesis.
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Affiliation(s)
- Usman Ayub Awan
- Medical Research Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Medical Laboratory Technology, The University of Haripur, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - Aamer Ali Khattak
- Department of Medical Laboratory Technology, The University of Haripur, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - Noman Ahmed
- Department of Medical Laboratory Technology, The University of Haripur, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - Xingyi Guo
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, United States
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Sohail Akhtar
- Department of Mathematics and Statistics, The University of Haripur, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - Shehrish Kamran
- Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH&RC), Lahore, Pakistan
| | - Zhao Yongjing
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Jianbo Liu
- Henan Key Laboratory of Precision Diagnosis of Respiratory Infectious Diseases, Zhengzhou Key Laboratory of Precision Diagnosis of Respiratory Infectious Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Suliman Khan
- Medical Research Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Medical Laboratory Technology, The University of Haripur, Haripur, Khyber Pakhtunkhwa, Pakistan
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Norr KF, Banda CK, Chang C, Krishna S, Kumbani LC, Liu L, McCreary LL, Patil CL. Condom use increased after a peer group intervention implemented by community volunteers in Malawi. RESEARCH SQUARE 2023:rs.3.rs-3120974. [PMID: 37461672 PMCID: PMC10350185 DOI: 10.21203/rs.3.rs-3120974/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Background HIV prevention remains a global priority, especially in sub-Saharan Africa. Our research team previously developed an evidence-based peer group program for HIV prevention called Mzake ndi Mzake (Friend to Friend). A community-engaged collaboration adapted the program for community ownership and implementation. Here we report whether this HIV prevention program, implemented by community volunteers, increased condom use among sexually active individuals in rural Malawi. Methods Three communities sequentially rolled out the program. Effectiveness was evaluated using repeated surveys. At Time 1, no community had offered the intervention. At Time 2, the first community had offered the intervention and two had not (control group). At Time 3, two communities had offered the intervention and one had not (control group). We used two condom use indicators; condom use frequency in the last 2 months (N = 776) and condom use at last sex (N = 880). For each indicator, the sample included all sexually active persons answering that question at one or more time points. Regression analyses were used to model the two condom indicators over time, controlling for demographic factors, UNAIDS HIV knowledge, safer sex self-efficacy and partner communication. Results This peer group intervention implemented by trained community volunteers increased both condom use indicators at Times 2 and 3. In the final regression models. Other predictors of greater condom use for at least one condom use indicator included younger age group (13-19), male gender, not married/cohabiting, high involvement in religiously affiliated activities, higher safer sex self-efficacy, and greater partner communication. Although the intervention increased UNAIDS HIV knowledge, knowledge did not predict condom use. Conclusions This community engaged implementation study found that an evidence-based peer group program for HIV prevention increased condom use when delivered by trained community volunteers. Leveraging community strengths and human capital resources facilitated implementation of this effective HIV prevention program in rural Malawi. Community ownership and program delivery by trained local volunteers offers an innovative and cost-effective strategy to address ongoing HIV prevention needs without overburdening heathcare systems in sub. Trial registration Clinical Trials.gov NCT02765659 Registered May 6, 2016.
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Affiliation(s)
| | | | - Cecilia Chang
- School of Public Health, University of Illinois Chicago
| | | | | | - Li Liu
- School of Public Health, University of Illinois Chicago
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Quiroz-Mora CA, Valencia-Molina CP. [Effectiveness of structural interventions to promote condom use in adolescents and young people: Systematic Review]. Rev Salud Publica (Bogota) 2023; 22:453-462. [PMID: 36753246 DOI: 10.15446/rsap.v22n4.85800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/16/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Evaluate the effectiveness of structural or multicomponent interventions aimed at increasing the use of condoms in adolescents and young adults, identifying the strategies that form the interventions evaluated, and recognizing the theoretical models that support these interventions. METHODOLOGY Design: Systematic review of literature. Data source: MEDLINE databases were consulted via OVID, Embase, and CENTRAL in order to search for studies on interventions aimed at increasing the use of condoms in adolescents and young adults. Selection of studies: A total of 7 primary investigations were selected, in which the effect of a structured or multicomponent intervention to increase the use of condoms in adolescents and young adults was evaluated. The quality of the studies was evaluated using the Cochrane bias risk assessment. RESULTS Five investigations show changes in the percentages of condom use with values between 53% and 68%. The interventions targeted guided their actions more at individual level with strategies such as sexual health education, reproductive health counseling, knowledge about the condom, knowledge about STIs / HIV, than at organizational and environ-mental levels, which were aimed at the provision of condoms. The theoretical models proposed in the studies are focused on human behavior, individual behavior, and social learning. CONCLUSION Structural interventions that aim to increase the use of condoms in adolescents and young adults seem to show significant changes at individual level, but possible changes generated at both organization and environment levels are unknown.
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Affiliation(s)
- Carlos A Quiroz-Mora
- CQ: Fisioterapeuta. M. Sc. Epidemiología. M. Sc. Neurorehabilitación, Ph.D. (c) Salud, Grupo de Investigación en Promoción de la Salud (PROMESA). Universidad del Valle. Cali, Colombia.
| | - Claudia P Valencia-Molina
- CV: Enfermera. Ph. D. Salud Pública. Doctorado Interfacultades en Salud Pública, Universidad Nacional de Colombia. Directora Grupo de Investigación en Promoción de la Salud (PROMESA). Universidad del Valle. Cali, Colombia.
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Broderick K, Aristide C, Bullington BW, Mwanga-Amumpaire J, Downs JA, Sundararajan R. Stigma of infidelity associated with condom use explains low rates of condom uptake: qualitative data from Uganda and Tanzania. Reprod Health 2023; 20:12. [PMID: 36631809 PMCID: PMC9832812 DOI: 10.1186/s12978-023-01563-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 01/04/2023] [Indexed: 01/12/2023] Open
Abstract
Despite widespread messaging supporting male (external) condom use to prevent HIV in endemic settings, utilization of condoms is low across sub-Saharan Africa. A thorough understanding of barriers to condom use as a form of HIV prevention is necessary to reduce HIV transmission. Here, we present qualitative data from rural eastern Africa to explain low utilization of condoms among heterosexual adults. Focus groups and interviews were conducted in Tanzania and Uganda between 2016 and 2019. A content analysis approach was used to identify attitudes about condoms and factors related to use/non-use. We found that strategies such as abstinence and being faithful to one's partner are perceived as ideal but rarely achievable methods of HIV prevention. Condoms are used in the setting of "failure" to abstain or be faithful and are therefore stigmatized as markers of infidelity. As such, use within cohabiting and long-term relationships is low. Our data suggest that negative perceptions of condoms may stem from persistent effects of the formerly applied "ABC" HIV prevention approach, a public health messaging strategy that described A-abstinence, B-be faithful, and C-use a condom as tiered prevention tools. Condom uptake could increase if HIV prevention messaging acknowledges existing stigma and reframes condom use for proactive health prevention. These studies were approved by Weill Cornell Medicine (Protocols 1803019105 and 1604017171), Mbarara University of Science and Technology (Protocol 16/0117), Uganda National Council of Science and Technology (Protocol SS-4338), and the Tanzania National Institute for Medical Research (Protocol NIMR/HQ/R.8c/Vol.I/1330).
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Affiliation(s)
- Kathryn Broderick
- Weill Cornell Medical College, 525 East 68th Street, Room M130, New York, NY, 10065, USA
| | - Christine Aristide
- Weill Cornell Medical College, 525 East 68th Street, Room M130, New York, NY, 10065, USA
| | - Brooke W Bullington
- Weill Cornell Medical College, 525 East 68th Street, Room M130, New York, NY, 10065, USA
- Burlington Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | - Jennifer A Downs
- Weill Cornell Medical College, 525 East 68th Street, Room M130, New York, NY, 10065, USA
- Weill Cornell Medicine, Center for Global Health, New York, USA
- Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Radhika Sundararajan
- Weill Cornell Medical College, 525 East 68th Street, Room M130, New York, NY, 10065, USA.
- Weill Cornell Medicine, Center for Global Health, New York, USA.
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Shen Y, Zhang C, Valimaki MA, Qian H, Mohammadi L, Chi Y, Li X. Why do men who have sex with men practice condomless sex? A systematic review and meta-synthesis. BMC Infect Dis 2022; 22:850. [PMCID: PMC9661788 DOI: 10.1186/s12879-022-07843-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Despite a large amount of behavioral interventions to reduce human immunodeficiency virus (HIV)-related high-risk sexual behaviors, consistent condom use remains suboptimal among men who have sex with men (MSM). However, current databases are lack of synthesized evidence to explain why MSM practiced condomless sex.
Objective
Our study aims to conduct a systematic review and meta-synthesis of 39 eligible qualitative studies to explore the barriers to condom use among MSM.
Methods
A systematic review and meta-synthesis of qualitative studies (1994–2021). On March 4, 2021, a comprehensive search was conducted in 14 electronic databases. The study was conducted based on the Joanna Briggs Institute’s recommendations.
Results
Thematic analysis produced six synthesized themes, which were classified into three levels according to the Social-ecology Model. Individual level barriers to condom use included physical discomfort, lack of HIV/STI-related knowledge and substance use; interpersonal-level barrier was mainly the condom stigma, namely regarding using condom as symbols of distrust or HIV/sexually transmitted infections (STIs) prevention, or as violating traditional cognition of sex, or as an embarrassing topic; environmental/structural-level barriers included situational unavailability, unaffordability of condoms and power imbalance in the sexual relationship.
Conclusion
This meta-synthesis offered in-depth understanding of condom use barriers for MSM and could guide the development of multifactorial interventions according to the identified barriers, especially targeting to reduce condom stigma, which has not been focused and intervened previously.
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Fu TC, Rosenberg M, Golzarri-Arroyo L, Fortenberry JD, Herbenick D. Relationships between Penile-Vaginal Intercourse Frequency and Condom/Contraceptive Use from 2009 to 2018: Findings from the National Survey of Sexual Health and Behavior. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2022; 34:716-727. [PMID: 37008894 PMCID: PMC10062058 DOI: 10.1080/19317611.2022.2132340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/11/2022] [Accepted: 09/20/2022] [Indexed: 06/19/2023]
Abstract
Objectives To examine changes over time in event-level condom/contraceptive use and the association between past year penile-vaginal intercourse frequency and event-level condom/contraceptive use. Methods Data were from the 2009 and 2018 National Survey of Sexual Health and Behavior, an online probability survey of U.S. adolescents and adults. Results Use of condoms and highly effective hormonal contraceptives decreased while long-acting reversible contraceptive use increased from 2009 to 2018 among adults. Increased penile-vaginal intercourse frequency was associated with decreased use of most contraceptive methods but an increase in condom use for adolescents. Conclusions Sexual frequency should be considered when assessing condom/contraceptive use.
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Affiliation(s)
- Tsung-chieh Fu
- Center for Sexual Health Promotion, Indiana University, Bloomington, IN, USA
- Department of Applied Health Science, Indiana University, Bloomington, IN, USA
| | - Molly Rosenberg
- Department of Biostatistics and Epidemiology, Indiana University, Bloomington, IN, USA
| | | | - J. Dennis Fortenberry
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Debby Herbenick
- Center for Sexual Health Promotion, Indiana University, Bloomington, IN, USA
- Department of Applied Health Science, Indiana University, Bloomington, IN, USA
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Perception of Peer Condom Use Buffers the Associations Between HIV Knowledge, Self-efficacy, and Condom-Use Intention Among Adolescents: a Moderated Mediation Model. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 23:879-888. [PMID: 34962622 DOI: 10.1007/s11121-021-01324-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 10/19/2022]
Abstract
A better understanding of the complex relationships between HIV knowledge, self-efficacy, perception of peer condom use, and condom-use intention is needed for improving HIV prevention among adolescents. The study analyzed survey data collected from high school students (N = 1970) in the Bahamas. Mediation and moderated mediation modeling analyses were used for data analysis. Results showed that self-efficacy mediated the association between HIV knowledge and condom-use intention. Perception of peer condom use moderated the mediation model by modifying the HIV knowledge-self-efficacy and self-efficacy-condom-use intention associations among males, but not for females. Findings of the study suggest the significant impact of perception of peer condom use in competition with HIV knowledge and self-efficacy in promoting condom use. Effective intervention program may consider targeting the modification of adolescents' perception of peer condom use to promote condom use among adolescents.
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Nwaosu U, Raymond-Williams R, Meyrick J. Are psychosocial interventions effective at increasing condom use among Black men? A systematic review. Int J STD AIDS 2021; 32:1088-1105. [PMID: 34144658 PMCID: PMC8593286 DOI: 10.1177/09564624211024785] [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] [Indexed: 11/17/2022]
Abstract
Black men experience a disproportionate burden of sexually transmitted infections (STIs) in the United Kingdom (UK). STIs can seriously affect the health and well-being of affected individuals. With condoms effective at preventing STI transmission, this review aims to explore the evidence of effectiveness of psychosocial interventions at increasing condom use among Black men to inform UK-based interventions for this at-risk but unheard population. Nine databases were searched for qualifying studies. Two reviewers independently assessed the quality of studies. A narrative synthesis read across the heterogeneous studies for evidence of effectiveness. A total of 17 studies met the inclusion criteria. This review identified scientifically weak evidence of effectiveness in multifaceted psychosocial interventions to increase condom use among Black men, particularly men who have sex with women and men who have sex with men mainly from United States settings. The multifaceted nature of interventions provides obscure evidence on successful elements of interventions with positive effects. Despite the disproportionate STI burden among this group, no UK-based studies were identified. Future research should aim to better understand condom use behavioural experiences and motivators of condom use among UK Black men to inform ethnically culturally relevant and tailored interventions.
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Affiliation(s)
- Uzochi Nwaosu
- Health and Applied Sciences, University of the West of England, Bristol, UK
| | | | - Jane Meyrick
- Health and Applied Sciences, University of the West of England, Bristol, UK
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Lépine A, Treibich C, Ndour CT, Gueye K, Vickerman P. HIV infection risk and condom use among sex workers in Senegal: evidence from the list experiment method. Health Policy Plan 2020; 35:408-415. [PMID: 32040183 DOI: 10.1093/heapol/czz155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 11/13/2022] Open
Abstract
Social desirability bias, which is the tendency to under-report socially undesirable health behaviours, significantly distorts information on sensitive behaviours that is gained from self-reports. As a result, self-reported condom use among high-risk populations is thought to be systematically over-reported, and it is impossible to identify the determinants of condom use. The main objective of the article is to elicit unbiased information on condom use among female sex workers (FSWs) using the double list experiment method to analyse the role of HIV infection and exposure to HIV prevention methods in condom use. More specifically, the difference in levels of condom use between HIV-positive and HIV-negative FSWs is estimated. In addition, the role of FSWs' registration and participation in a pre-exposure prophylaxis (PrEP) demonstration project in condom use is considered. A list experiment was designed to elicit condom use information from 786 FSWs in Senegal who were surveyed in 2015 and 2017. Using the list experiment method, participants were randomly assigned to one of two groups (treatment or control) and were asked to report the number of statements they agreed with. Respondents assigned to the control group were presented with three non-sensitive items, whereas those allocated to the treatment group were presented with the same three statements plus the sensitive item (e.g. 'I used a condom during my last intercourse with a client'). Comparing the average number of sentences that were agreed with in both groups provides an estimation of the condom use rate in the treatment group and estimating such prevalence for several sub-groups allows the role of HIV infection risk in condom use to be identified. The percentage of FSWs using condoms in their last sexual intercourse with a client was 80% in 2015 and 78% in 2017, which was significantly lower than the 97% obtained in the face-to-face surveys in both waves. When estimating condom use among sub-groups with the list experiment method, we found that condom use among HIV-positive FSWs was only 34%, which was 47 percentage points lower than condom use among HIV-negative FSWs. We also found that registered FSWs are more likely to use condoms than clandestine FSWs. However, we did not find any difference in condom use between FSWs who were enrolled in the PrEP demonstration project and those who were not enrolled. Health policies should therefore aim to increase condom use among HIV-positive FSWs.
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Affiliation(s)
- Aurélia Lépine
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - Carole Treibich
- Univ. Grenoble Alpes, CNRS, INRAE, Grenoble INP, GAEL, 38000 Grenoble, France
| | - Cheikh Tidiane Ndour
- Division de Lutte contre le Sida et les IST/ nstitut d'hygiène Sociale, Avenue Blaise Diagne X Malick SY - BP 7381 Médina Dakar, Sénégal
| | - Khady Gueye
- Division de Lutte contre le Sida et les IST/ nstitut d'hygiène Sociale, Avenue Blaise Diagne X Malick SY - BP 7381 Médina Dakar, Sénégal
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Clifton BS8 2BN, UK
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Tompkins K, Brown J, Tozay S, Reeves E, Pewu K, Johnson H, Williams G, Conneh T, Diggs J, DeMarco J, King K, McMillian D, Merenbloom C, Fischer W, Wohl DA. The impact of semen testing for Ebola virus RNA on sexual behavior of male Ebola survivors in Liberia. PLoS Negl Trop Dis 2020; 14:e0008556. [PMID: 32925964 PMCID: PMC7515181 DOI: 10.1371/journal.pntd.0008556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 09/24/2020] [Accepted: 07/02/2020] [Indexed: 12/31/2022] Open
Abstract
Sexual transmission of Ebola virus (EBOV) is well established and has been implicated in multiple resurgences during the West African Ebola epidemic. Given the persistence of viral RNA in semen, guidelines from the World Health Organization (WHO) recommend abstinence or condom use for at least 1 year or until two semen PCR tests are negative. To better understand the impact of semen testing on sexual behavior, male EVD survivors were surveyed regarding their sexual behavior before and after semen testing. Of the 171 men who enrolled, 148 reported being sexually active following discharge from an ETU with 59% reporting episodes of condomless sex. At least one semen sample for testing was provided by 149 men and 13 of these men had EBOV RNA detected in their semen. When comparing sexual behaviors before and after semen testing, a positive semen test result had limited impact on behavior. Of those with seminal EBOV RNA detected, 61% reported no change in behavior pre- and post-semen testing with 46% engaging in condomless sex before and after testing and only 1 adopted safer sex behaviors following receipt of a positive result. Similarly, among men with undetectable EBOV in their semen, 66% reported no change in sexual behaviors with semen testing, with 55% forgoing condoms during sex. In only 11% was a negative semen result followed by abandoning condoms. There were no known sexual transmission events of Ebola virus in this cohort despite viral presence in semen during periods of condomless sex. This highlights the need to better understand the infectious potential of viral RNA persistence and determine what constitutes effective counseling for survivors and their partners. Ebola virus (EBOV) is established as a sexually transmitted infection, however there is limited information on the sexual behaviors of Ebola survivors. We surveyed a cohort of male Ebola survivors regarding sexual activity and condom use and offered semen testing to assess EBOV persistence in semen. We found that a large majority of men who were sexually active prior to contracting Ebola Virus Disease remained sexually active after their recovery with most reporting only intermittent condom use. Semen testing for the presence of Ebola virus had limited impact on sexual behaviors, with most continuing to report engaging in condomless sex whether EBOV was detected or not. This finding has implications for use of semen testing for outbreak control as well as counseling for Ebola survivors and their partners.
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Affiliation(s)
- Kathleen Tompkins
- The Institute of Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Jerry Brown
- The John F. Kennedy Hospital, Monrovia, Liberia
| | - Sam Tozay
- The University of North Carolina Liberia Project, Paynesville, Liberia
| | - Edwina Reeves
- The University of North Carolina Liberia Project, Paynesville, Liberia
| | - Korto Pewu
- The University of North Carolina Liberia Project, Paynesville, Liberia
| | - Harrietta Johnson
- The University of North Carolina Liberia Project, Paynesville, Liberia
| | - Gerald Williams
- The University of North Carolina Liberia Project, Paynesville, Liberia
| | - Tonia Conneh
- The University of North Carolina Liberia Project, Paynesville, Liberia
| | - Joseph Diggs
- The University of North Carolina Liberia Project, Paynesville, Liberia
| | - Jean DeMarco
- The Institute of Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Katherine King
- The Institute of Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Darrius McMillian
- The Institute of Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Carson Merenbloom
- The Institute of Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - William Fischer
- The Institute of Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Division of Pulmonary and Critical Care Medicine, The University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - David Alain Wohl
- The Institute of Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Analogbei T, Dear N, Reed D, Esber A, Akintunde A, Bahemana E, Adamu Y, Iroezindu M, Maganga L, Kiweewa F, Maswai J, Owuoth J, Ake JA, Polyak CS, Crowell TA, Falodun O, Song K, Milazzo M, Mankiewicz S, Schech S, Golway A, Mebrahtu T, Lee E, Bohince K, Hamm T, Parikh A, Hern J, Lombardi K, Imbach M, Eller L, Peel S, Malia J, Kroidl A, Kroidl I, Geldmacher C, Kafeero C, Nambuya A, Tegamanyi J, Birungi H, Mugagga O, Nassali G, Wangiri P, Nantabo M, Nambulondo P, Atwijuka B, Asiimwe A, Nabanoba C, Semwogerere M, Mwesigwa R, Jjuuko S, Namagembe R, Bagyendagye E, Tindikahwa A, Rwomushana I, Ssentongo F, Kibuuka H, Millard M, Kapkiai J, Wangare S, Mangesoi R, Chepkwony P, Bor L, Maera E, Kasembeli A, Rotich J, Kipkoech C, Chepkemoi W, Rono A, Kesi Z, Ngeno J, Langat E, Labosso K, Langat K, Kirui R, Rotich L, Mabwai M, Chelangat E, Agutu J, Tonui C, Changwony E, Bii M, Chumba E, Korir J, Sugut J, Gitonga D, Ngetich R, Kiprotich S, Rehema W, Ogari C, Ouma I, Adimo O, Ogai S, Okwaro C, Maranga E, Ochola J, Obambo K, Sing'oei V, Otieno L, Nyapiedho O, Sande N, Odemba E, Wanjiru F, Khamadi S, Chiweka E, Lwilla A, Mkondoo D, Somi N, Kiliba P, Mwaipopo M, Mwaisanga G, Muhumuza J, Mkingule N, Mwasulama O, Sanagare A, Kishimbo P, David G, Mbwayu F, Mwamwaja J, Likiliwike J, Muhumuza J, Mcharo R, Mkingule N, Mwasulama O, Mtafya B, Lueer C, Kisinda A, Mbena T, Mfumbulwa H, Mwandumbya L, Edwin P, Olomi W, Adamu Y, Akintunde A, Tiamiyu A, Afoke K, Mohammed S, Harrison N, Agbaim U, Adegbite O, Parker Z, Adelakun G, Oni F, Ndbuisi R, Elemere J, Azuakola N, Williams T, Ayogu M, Enas O, Enameguono O, Odo A, Ukaegbu I, Ugwuezumba O, Odeyemi S, Okeke N, Umeji L, Rose A, Daniel H, Nwando H, Nicholas E, Iyanda T, Okolo C, Mene V, Dogonyaro B, Olabulo O, Akinseli O, Onukun F, Knopp G. Predictors and Barriers to Condom Use in the African Cohort Study. AIDS Patient Care STDS 2020; 34:228-236. [PMID: 32396478 DOI: 10.1089/apc.2019.0302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Consistent condom use is an inexpensive and efficacious HIV prevention strategy. Understanding factors associated with condom use and barriers to use can inform strategies to increase condom uptake. The ongoing African Cohort Study prospectively enrolls adults at 12 clinical sites in Uganda, Kenya, Tanzania, and Nigeria. At enrollment, participants are asked about condom use at last sex with a regular partner. Robust Poisson regression models were used to evaluate predictors of self-reported condom use. Participants who reported not using condoms were asked to provide reasons. From January 2013 to September 2019, 2482 participants reported having at least one regular sexual partner in the preceding 6 months. Of those, 1577 (63.5%) reported using a condom at last sex. Condom use was more common among older participants, males, HIV-infected participants, and those with an HIV-infected partner. Married participants, those with a partner of unknown HIV status, and those reporting alcohol use were less likely to report condom use at last sex. Condom use at last sex also varied significantly by clinical site. Partner disapproval or refusal to use a condom was a consistent driver of disparities in condom use among participants who were HIV infected, female, and aged 18-24 years. Effective HIV prevention programs should integrate condom education with the tools necessary to negotiate condom use with regular partners.
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Affiliation(s)
- Tope Analogbei
- Health Implementation Program, Nigerian Ministry of Defense, Abuja, Nigeria
- US Army Medical Research Directorate—Africa, Abuja, Nigeria
| | - Nicole Dear
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Domonique Reed
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Allahna Esber
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Akindiran Akintunde
- US Army Medical Research Directorate—Africa, Abuja, Nigeria
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry Jackson Foundation MRI, Abuja, Nigeria
| | - Emmanuel Bahemana
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry Jackson Foundation MRI, Mbeya, Tanzania
| | - Yakubu Adamu
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry Jackson Foundation MRI, Abuja, Nigeria
- US Army Medical Research Directorate—Africa, Nairobi, Kenya
| | - Michael Iroezindu
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry Jackson Foundation MRI, Abuja, Nigeria
- US Army Medical Research Directorate—Africa, Nairobi, Kenya
| | - Lucas Maganga
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- National Institute of Medical Research—Mbeya Medical Research Centre, Mbeya, Tanzania
| | | | - Jonah Maswai
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Kenya Medical Research Institute, Nairobi, Kenya
- Henry Jackson Foundation MRI, Kericho, Kenya
| | - John Owuoth
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Kenya Medical Research Institute, Nairobi, Kenya
- Henry Jackson Foundation MRI, Kisumu, Kenya
| | - Julie A. Ake
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Christina S. Polyak
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Trevor A. Crowell
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
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Duflo E, Dupas P, Ginn T, Barasa GM, Baraza M, Pouliquen V, Sharma V. HIV prevention among youth: A randomized controlled trial of voluntary counseling and testing for HIV and male condom distribution in rural Kenya. PLoS One 2019; 14:e0219535. [PMID: 31361767 PMCID: PMC6667138 DOI: 10.1371/journal.pone.0219535] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/24/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Voluntary Counseling and Testing for HIV (VCT) and increasing access to male condoms are common strategies to respond to the HIV/AIDS pandemic. Using biological and behavioral outcomes, we compared programs to increase access to VCT, male condoms or both among youth in Western Kenya with the standard available HIV prevention services within this setting. DESIGN A four arm, unblinded randomized controlled trial. METHODS The sample includes 10,245 youth aged 17 to 24 randomly assigned to receive community-based VCT, 150 male condoms, both VCT and condoms, or neither program. All had access to standard HIV services available within their communities. Surveys and blood samples for HSV-2 testing were collected at baseline (2009-2010) and at follow up (2011-2013). VCT was offered to all participants at follow up. HSV-2 prevalence, the primary outcome, was assessed using weighted logistic regressions in an intention-to-treat analysis. RESULTS For the 7,565 respondents surveyed at follow up, (effective tracking rate = 91%), the weighted HSV-2 prevalence was similar across groups (control group = 10.8%, condoms only group = 9.1%, VCT only group = 10.2%, VCT and condoms group = 11.5%). None of the interventions significantly reduced HSV-2 prevalence; the adjusted odds ratios were 0.87 (95% CI: 0.61-1.25) for condoms only, 0.94 (95% CI: 0.64-1.38) for VCT only, and 1.12 (95% CI: 0.79-1.58) for both interventions. The VCT intervention significantly increased HIV testing (adj OR: 3.54, 95% CI: 2.32-5.41 for VCT only, and adj OR: 5.52, 95% CI: 3.90-7.81 for condoms and VCT group). There were no statistically significant effects on risk of HIV, or on other behavioral or knowledge outcomes including self-reported pregnancy rates. CONCLUSION This study suggests that systematic community-based VCT campaigns (in addition to VCT availability at local health clinics) and condom distribution are unlikely on their own to significantly reduce the prevalence of HSV-2 among youth.
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Affiliation(s)
- Esther Duflo
- Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | | | - Thomas Ginn
- Stanford University, Stanford, CA, United States of America
| | | | | | | | - Vandana Sharma
- Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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Mashaphu S, Wyatt GE, Zhang M, Mthiyane T, Liu H, Gomo E. Effectiveness of an HIV-risk reduction intervention to reduce HIV transmission among serodiscordant couples in Durban, South Africa. A randomized controlled trial. AIDS Care 2019; 32:537-545. [PMID: 31269801 DOI: 10.1080/09540121.2019.1634785] [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: 10/26/2022]
Abstract
Lack of condom use by married or cohabiting couples in populations with high rates of HIV infection has become a significant public health issue. This study investigated whether an HIV risk-reduction intervention (RRI) would increase condom use when delivered to serodiscordant couples as a unit. Of the 62 couples that were screened, 30 serodiscordant couples were enrolled in the study, and randomized 2:1 to an immediate intervention-waitlist control study. The 12-week intervention focused on communication, problem-solving, and negotiation skills. Participants were assessed at baseline, three and six months after the intervention. The main outcome measures were consistent condom use, HIV seroconversion and fidelity to the programme. The use of condoms increased for both the intervention and control groups after receiving a 12-week RRI. Group comparisons showed a significant difference at three months, with a significantly higher mean proportion of condom-protected sex acts (p = 0.0119) between the control and intervention groups, the later showing an increase in condom use. No seroconversion was detected, and the overall retention rate of participants was 83.33%. Counselling heterosexual couples as a unit prompted an increase in condom use, but sustained condom use remains a challenge.
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Affiliation(s)
- Sibongile Mashaphu
- School of Clinical Medicine, University of KwaZulu-Natal, College of Health Sciences, Durban, South Africa
| | - Gail E Wyatt
- Department of Psychiatry and Bio-Behavioural, Sciences University of California, Los Angeles, CA, USA
| | - Muyu Zhang
- Department of Psychiatry and Bio-Behavioural, Sciences University of California, Los Angeles, CA, USA
| | - Thuli Mthiyane
- South African Medical Research Council, Pretoria, South Africa
| | - Honghu Liu
- Department of Psychiatry and Bio-Behavioural, Sciences University of California, Los Angeles, CA, USA
| | - Exnevia Gomo
- School of Nursing and Public Health, University of KwaZulu-Natal, College of Health Sciences, Durban, South Africa
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Whiting W, Pharr JR, Buttner MP, Lough NL. Behavioral Interventions to Increase Condom Use Among College Students in the United States: A Systematic Review. HEALTH EDUCATION & BEHAVIOR 2019; 46:877-888. [PMID: 31165629 DOI: 10.1177/1090198119853008] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Traditional undergraduate college students in the United States are in the age range that experiences the highest rate of sexually transmitted infections (STIs) and are vulnerable to contracting STIs. Increasing condom use among college students is a prevention strategy to reduce the spread of STIs. Aim. The purpose of this systematic review of the literature was to identify behavioral interventions that increased condom use behaviors and/or intentions among college students. Method. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed in systematically searching, extracting, appraising, and synthesizing the evidence. A quality assessment was also conducted with the tool provided by the Effective Public Health Practice Project. Results. The initial search yielded 715 records. After critical appraisal, seven articles remained for review. Discussion. Four of the interventions were developed using the three constructs of the information, motivation, and behavioral skills model, and all four found significant increases in condom use or condom use intentions. Additionally, interventions that included modules to increase self-efficacy for condom use, taught participants where to get condoms and how to negotiate condom use with partners, or elicited positive associations (feels) toward condoms saw increased condom use or intention to use condoms.
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18
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Treibich C, Lépine A. Estimating misreporting in condom use and its determinants among sex workers: Evidence from the list randomisation method. HEALTH ECONOMICS 2019; 28:144-160. [PMID: 30324751 DOI: 10.1002/hec.3835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 08/30/2018] [Accepted: 09/15/2018] [Indexed: 06/08/2023]
Abstract
Social desirability bias, which is the tendency to underreport socially undesirable health behaviours, significantly distorts information on sensitive behaviours gained from self-reports. We applied the list randomisation method to indirectly elicit condom use among female sex workers and tested it among 651 female sex workers in Senegal, a country where sex workers face high social stigma and where the AIDS epidemic is mainly concentrated among this population. On the basis of our list randomisation, we found that the condom use rate in the last sexual intercourse with a client was 78%, which is significantly lower than the 97% obtained when asked directly in the survey. When estimating condom use among the subgroups, we found that female sex workers who are at a higher risk of infection are less likely to use condoms.
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Affiliation(s)
- Carole Treibich
- CNRS, INRA, Institute of Engineering Univ. Grenoble Alpes, University Grenoble Alpes, GAEL Grenoble, France
| | - Aurélia Lépine
- Department of Global Health and Development London, London School of Hygiene and Tropical Medicine, London, UK
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Crowell TA, Baral SD, Schwartz S, Nowak RG, Kokogho A, Adebajo S, Keshinro B, Makanjuola O, Michael NL, Robb ML, Charurat ME, Ake JA. Time to change the paradigm: limited condom and lubricant use among Nigerian men who have sex with men and transgender women despite availability and counseling. Ann Epidemiol 2018; 31:11-19.e3. [PMID: 30642695 DOI: 10.1016/j.annepidem.2018.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE This study characterized availability and uptake of condoms and condom-compatible lubricants (CCLs) at community-engaged condom education and distribution programs serving cisgender men who have sex with men and transgender women in Abuja and Lagos, Nigeria. METHODS Condoms and water-based CCLs were freely available to participants in the TRUST/RV368 cohort. Factors associated with their consistent use were assessed using Poisson regression with robust error variance to estimate relative risks (RRs) and 95% confidence intervals (CIs). RESULTS From March 2013-November 2017, 2090 cisgender men who have sex with men and transgender women enrolled with HIV prevalence 40.4% and incidence 12.8 cases per 100 person-years. Fifteen months after enrollment, the proportion who reported consistent condom and CCL use increased during receptive anal sex (21.7%-67.1%, P < .001) and insertive anal sex (25.4%-67.8%, P < .001). Multivariable analyses demonstrated independent impact of 15 months in care on uptake during both receptive (RR 2.62 [95% CI 2.29-3.00]) and insertive (RR 2.27 [95% CI 2.01-2.57]) sex. CONCLUSIONS Engagement in care improved condom and CCL uptake over time but inconsistent use remained common. Novel approaches to further increase uptake must be pursued alongside complementary strategies, such as sustained access to antiretroviral therapy for those living with HIV and provision of pre and postexposure prophylaxis for those at risk.
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Affiliation(s)
- Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD.
| | - Stefan D Baral
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sheree Schwartz
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Rebecca G Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore
| | - Afoke Kokogho
- HJF Medical Research International, Abuja, Nigeria; U.S. Army Medical Research Directorate - Africa/Nigeria, Abuja, Nigeria
| | | | - Babajide Keshinro
- HJF Medical Research International, Abuja, Nigeria; U.S. Army Medical Research Directorate - Africa/Nigeria, Abuja, Nigeria
| | | | - Nelson L Michael
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Merlin L Robb
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Manhattan E Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore
| | - Julie A Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD
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Saul J, Bachman G, Allen S, Toiv NF, Cooney C, Beamon T. The DREAMS core package of interventions: A comprehensive approach to preventing HIV among adolescent girls and young women. PLoS One 2018; 13:e0208167. [PMID: 30532210 PMCID: PMC6285267 DOI: 10.1371/journal.pone.0208167] [Citation(s) in RCA: 181] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
In sub-Saharan Africa, adolescent girls and young women (AGYW) are 5 to 14 times more likely to be infected with HIV than their male peers. Every day, more than 750 AGYW are infected with HIV. Many factors make girls and young women particularly vulnerable to HIV, including gender-based violence, exclusion from economic opportunities, and a lack of access to secondary school. The President's Emergency Plan for AIDS Relief (PEPFAR) is dedicating significant resources through the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) partnership to impact the lives of women and girls based on PEPFAR's mission to help countries achieve epidemic control of HIV/AIDS. The data show that new HIV infections must be reduced in AGYW, or the global community risks losing the extensive progress made towards reaching epidemic control. With support from PEPFAR and private sector partners-the Bill & Melinda Gates Foundation, Gilead Sciences, Girl Effect, Johnson & Johnson and ViiV Healthcare, DREAMS works together with partner governments to deliver a core package of interventions that combines evidence-based approaches that go beyond the health sector, addressing the structural drivers that directly and indirectly increase girls' HIV risk. Not only is DREAMS an effort to reduce new HIV infections, but it aims to reduce other critical vulnerabilities such as gender-based violence. When girls and young women thrive, the effects are felt throughout their families, communities and countries.
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Affiliation(s)
- Janet Saul
- Office of the U.S. Global AIDS Coordinator and Health Diplomacy, U.S. Department of State, Washington, DC, United States of America
| | - Gretchen Bachman
- Office of the U.S. Global AIDS Coordinator and Health Diplomacy, U.S. Department of State, Washington, DC, United States of America
| | - Shannon Allen
- Office of the U.S. Global AIDS Coordinator and Health Diplomacy, U.S. Department of State, Washington, DC, United States of America
| | - Nora F. Toiv
- Office of the U.S. Global AIDS Coordinator and Health Diplomacy, U.S. Department of State, Washington, DC, United States of America
| | - Caroline Cooney
- Office of the U.S. Global AIDS Coordinator and Health Diplomacy, U.S. Department of State, Washington, DC, United States of America
| | - Ta’Adhmeeka Beamon
- Office of the U.S. Global AIDS Coordinator and Health Diplomacy, U.S. Department of State, Washington, DC, United States of America
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Okafor UO, Crutzen R, Aduak Y, Adebajo S, Van den Borne HW. Behavioural interventions promoting condom use among female sex workers in sub-Saharan Africa: a systematic review. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2018; 16:257-268. [PMID: 28978291 DOI: 10.2989/16085906.2017.1358753] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objective of this review was to provide an overview of behavioural interventions promoting condom use amongst female sex workers (FSW) in sub-Saharan Africa. A search of four electronic bibliographic databases from 1990 to September 2016 was carried out. The search was limited to articles published in English. Studies which evaluated behavioural interventions to increase condom use among FSWs were selected and reviewed. Data were extracted on effectiveness, condom use, intervention content, and process outcomes. A total of 20 eligible articles describing 18 interventions in sub-Saharan Africa on HIV prevention with condom use as an outcome measure were identified. Most of the behavioural interventions incorporated a combination of approaches: health education by peers, health workers and project staff, and activities by brothel owners and brothel managers. Most studies showed effectiveness of these interventions on condom use with paying clients. Five studies measuring condom use with regular non-paying partners recorded less consistent condom use with these partners. This review illustrates the existence of sufficient evidence showing the effectiveness of behavioural interventions targeting correct and consistent condom use by FSWs.
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Affiliation(s)
- Uchenna O Okafor
- a Department of Health Promotion , Maastricht University , Maastricht , the Netherlands
| | - Rik Crutzen
- a Department of Health Promotion , Maastricht University , Maastricht , the Netherlands
| | - Yauri Aduak
- b Research Unit, Society for Family Health , Abuja , Nigeria
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Kennedy SB, Atwood K, Harris AO, Taylor CH, Shamblen S, Nagbe WM, Gobeh ME, Sosu F, Tegli JK, Morris CA. Preliminary Impacts of an HIV-Prevention Program Targeting Out-of-School Youth in Postconflict Liberia. Glob Pediatr Health 2018; 5:2333794X18754452. [PMID: 29399603 PMCID: PMC5788126 DOI: 10.1177/2333794x18754452] [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] [Received: 09/18/2017] [Accepted: 10/20/2017] [Indexed: 11/15/2022] Open
Abstract
Adolescents in Sub-Saharan Africa account for greater HIV/STI (human immuno defiency virus/sexually transmitted infection) burdens and difficult-to-reach populations. This study implemented a community-based HIV/STI program to reach at-risk youth aged 15 to 17 years in postconflict Liberia. Using a randomized controlled trial, community youths were assigned to an adapted version of an effective HIV/STI program, Making Proud Choices, or attention-matched comparison curriculum, General Health Program. Both programs were of similar doses, reach and coverage, and administered in classroom settings by trained health educators. The findings suggest that the adapted HIV/STI program had positive effects on knowledge, sexual refusal and condom use self-efficacy, condom negotiation self-efficacy, positive condom attitudes, parental communication about sex, and negative condom attitudes over time. Culturally adapted community-based, behavioral-driven programs can positively affect mediators of sexual behaviors in at-risk adolescents in postconflict settings. This is the first published report of an evidence-based HIV/STI program on sexual risk-taking behaviors of community youths in Liberia.
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Affiliation(s)
- Stephen B Kennedy
- UL-PIRE Africa Center, University of Liberia, Monrovia, Liberia.,Pacific Institute for Research & Evaluation, Louisville Center, Louisville, KY, USA
| | - Katherine Atwood
- Pacific Institute for Research & Evaluation, Louisville Center, Louisville, KY, USA
| | - Albert O Harris
- UL-PIRE Africa Center, University of Liberia, Monrovia, Liberia
| | - Curtis H Taylor
- UL-PIRE Africa Center, University of Liberia, Monrovia, Liberia
| | - Steve Shamblen
- Pacific Institute for Research & Evaluation, Louisville Center, Louisville, KY, USA
| | - Wede M Nagbe
- UL-PIRE Africa Center, University of Liberia, Monrovia, Liberia
| | - Mawen E Gobeh
- UL-PIRE Africa Center, University of Liberia, Monrovia, Liberia
| | - Fred Sosu
- UL-PIRE Africa Center, University of Liberia, Monrovia, Liberia
| | - Jemee K Tegli
- UL-PIRE Africa Center, University of Liberia, Monrovia, Liberia
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Parry C, Carney T, Petersen Williams P. Reducing substance use and risky sexual behaviour among drug users in Durban, South Africa: Assessing the impact of community-level risk-reduction interventions. SAHARA J 2017; 14:110-117. [PMID: 28969490 PMCID: PMC5639608 DOI: 10.1080/17290376.2017.1381640] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Alcohol and other drug (AOD) use is increasingly recognised as having a direct and indirect effect on the transmission of human immunodeficiency virus (HIV). However, there is evidence to suggest that drug- and sex-related HIV risk-reduction interventions targeted at drug users within drug treatment centres or via community outreach efforts can lead to positive health outcomes. This study aimed to test whether a community-level intervention aimed at AOD users has an impact on risky AOD use and sexual risk behaviour. In 2007, in collaboration with a local non-governmental organisation (NGO) in Durban, an initiative was begun to implement a number of harm reduction strategies for injection and non-injection drug users. The NGO recruited peer outreach workers who received intensive initial training, which was followed by six-monthly monitoring and evaluation of their performance. Participants had to be 16 years of age or older, and self-reported alcohol and/or drug users. Peer outreach workers completed a face-to-face baseline questionnaire with participants which recorded risk behaviours and a risk-reduction plan was developed with participants which consisted of reducing injection (if applicable) and non-injection drug use and sex-related risks. Other components of the intervention included distribution of condoms, risk-reduction counselling, expanded access to HIV Testing Services, HIV/sexually transmitted infection care and treatment, and referrals to substance abuse treatment and social services. At follow-up, the baseline questionnaire was completed again and participants were also asked the frequency of reducing identified risk behaviours. Baseline information was collected from 138 drug users recruited into the study through community-based outreach, and who were subsequently followed up between 2010 and 2012. No injection drug users were reached. The data presented here are for first contact (baseline) and the final follow-up contact with the participants. There were no decreases in drug use practices such as use of cannabis, heroin, cocaine and Ecstasy after the intervention with drug users; however, there was a significant reduction in alcohol use following the intervention. While there was a substantial increase in the proportion of participants using drugs daily as opposed to more often, the reduction in the frequency of drug use was not statistically significant. Following the intervention, drug users had significantly fewer sexual partners, but there were no significant differences following the intervention with regard to frequency of sex or use of condoms. Substance use in general and during sex was, however, decreased. While the findings were mixed, the study shows that it is possible to provide HIV risk-reduction services to a population of substance users who are less likely to receive services through community outreach, and provide risk-reduction information, condoms and condom demonstration and other services. More intensive interventions might be needed to have a substantial impact on substance use and substance use-related HIV risk behaviours.
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Affiliation(s)
- C.D.H. Parry
- PhD Psychology, is the Director of the Alcohol, Tobacco and Other Drug Research Unit at the South African Medical Research Council, Cape Town, South Africa
- Extraordinary Professor at the Department of Psychiatry, University of Stellenbosch, Tygerberg, South Africa
| | - T. Carney
- PhD Psychiatry & Mental Health, is a Senior Scientist at the Alcohol, Tobacco and Other Drug Research Unit, at the South African Medical Research Council, Cape Town, South Africa
- Honorary Lecturer at the Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - P. Petersen Williams
- PhD Public Health & Family Medicine, is a Senior Scientist at the Alcohol, Tobacco and Other Drug Research Unit, at the South African Medical Research Council, Cape Town, South Africa
- Honorary Research Associate at the Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Broel E, Huber LB, Warren-Findlow J, Racine E. The association between client type and condom use with steady and unsteady partners among persons seeking HIV testing and counseling services in Kenya. Afr Health Sci 2017; 17:979-990. [PMID: 29937868 PMCID: PMC5870265 DOI: 10.4314/ahs.v17i4.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Approximately 70% of global HIV infections are located in sub-Saharan Africa, and the prevalence of HIV infection in Kenya remains high. OBJECTIVES This study examined the association between client type (general population, commercial sex worker [CSW], or truck driver) and consistent condom use with steady and unsteady partners. METHODS Self-reported data included in the Kenyan Ministry of Health 2010-2011 National HIV Testing and Counseling Registry were used (n=11,567). Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained using logistic regression. RESULTS After adjustment, CSWs and truck drivers had decreased odds of consistent condom use with steady partners compared to the general population (OR=0.52; 95% CI: 0.41-0.67 and OR=0.29; 95% CI: 0.13-0.63; respectively). CSWs had 1.95 times the odds of consistent condom use (95% CI: 1.58-2.42) and truck drivers had 0.64 times the odds of consistent condom use with unsteady partners (95% CI: 0.45-0.91) compared to the general population. CONCLUSION Although CSWs consistently use condoms with their unsteady partners, truck drivers do not consistently use condoms with any partners. Future HIV prevention efforts should target CSWs and truck drivers to increase consistent condom use with all partners. Such efforts may decrease the prevalence of HIV in Kenya.
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Affiliation(s)
- Elizabeth Broel
- University of North Carolina at Charlotte, Department of Public Health Sciences
| | | | - Jan Warren-Findlow
- University of North Carolina at Charlotte, Department of Public Health Sciences
| | - Elizabeth Racine
- University of North Carolina at Charlotte, Department of Public Health Sciences
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Osuafor GN, Maputle S, Ayiga N, Mturi AJ. Condom use among married and cohabiting women and its implications for HIV infection in Mahikeng, South Africa. JOURNAL OF POPULATION RESEARCH 2017. [DOI: 10.1007/s12546-017-9195-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mirzaee M, Jahani Y, Sharifi H. Reasons for Inconsistent Condom Use Found as Answers to a Multiple Response Question: A National Survey of Iranian Adults, 2013. J Res Health Sci 2017. [PMCID: PMC7189953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: The use of condoms is important for preventing Sexually Transmitted Infections (STIs).
However, the prevalence of condom use is not satisfactory. The aim of this study was to assess the
reasons for inconsistent condom use in Iranian adults.
Study design: Cross-sectional study.
Methods: Data were gathered through multi-stage sampling. Participants were enrolled from 13
provinces in Iran aged between 19 and 29 years. They had ever-extramarital sex and did not use
condoms regularly in their sexual contacts, asked the reasons for inconsistent condom use.
Results: We had 3,246 adults, from which 635 (19.5%) had ever-extramarital sex. Among them, 495
(77.96%) did not use condoms with regularity. The reason frequently chosen for inconsistent condom
use was ‘that it is not accessible’ (49.3%). The differences between the categories of some variables,
according to the choice of reasons for inconsistent condom use, were significant (P<0.05): age,
gender, knowledge of HIV, attitude towards HIV, knowing infected HIV person and alcohol or
stimulant(s) used before sexual contact. According to multivariate multilevel logistic, the effect of
gender was significant on most of reasons for inconsistent condom use (P<0.05).
Conclusions: Most of the reasons that were selected for inconsistent condom use were inaccessibility
and not knowing that its use is essential. Hence, it is important to improve the knowledge of adults
regarding STI/HIV and extend the locations of condom distribution. We should try to promote the
culture of condom use as a routine.
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Affiliation(s)
- Moghaddameh Mirzaee
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
, Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Yunes Jahani
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
, Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
,Correspondence Yunes Jahani (PhD) Tel : +98 34 31325421
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
, Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
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Aluzimbi G, Lubwama G, Muyonga M, Hladik W. HIV Testing and Risk Perceptions: A Qualitative Analysis of Secondary School Students in Kampala, Uganda. J Public Health Afr 2017; 8:577. [PMID: 28878868 PMCID: PMC5575453 DOI: 10.4081/jphia.2017.577] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 02/07/2017] [Accepted: 05/31/2017] [Indexed: 11/23/2022] Open
Abstract
The purpose of this paper is to explore the perceptions of self-reported HIV testing and risk behavior among sexually active adolescents and youth in secondary schools in Kampala Uganda. This was a cross-sectional survey conducted between June and October 2010 among secondary school students in Kampala, Uganda. Forty eight (48) students across the 54 schools were purposively selected for the qualitative sub-study based on their responses to particular questions. We thematically analyzed 28 interviews for our qualitative study using Nvivo software. Drug and alcohol use coupled with peers pressure impaired students’ perceptions towards HIV risk and therefore increased their susceptibility to HIV risk behaviors. Of the 28 scripts analyzed, 82% (23/28) had ever had sexual partners, 79% (22/28) were currently sexually active, and 57% (16/28) had ever been tested for HIV. In conclusion, most adolescents interviewed did not perceive HIV testing to be important to HIV prevention and reported low perception of susceptibility to HIV infection. Development of an adolescent HIV prevention model is important in improving uptake of HIV services.
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Affiliation(s)
- George Aluzimbi
- Centers for Disease Control and Prevention, Division of Global HIV/AIDS and Tuberculosis, Kampala, Uganda
| | - George Lubwama
- Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
| | | | - Wolfgang Hladik
- Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda.,Centers for Disease Control and Prevention, Division of Global HIV/AIDS and Tuberculosis, Atlanta, GA, USA
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Woolf-King SE, Muyindike W, Hobbs MM, Kusasira A, Fatch R, Emenyonu N, Johnson MO, Hahn JA. Vaginal Prostate Specific Antigen (PSA) Is a Useful Biomarker of Semen Exposure Among HIV-Infected Ugandan Women. AIDS Behav 2017; 21:2141-2146. [PMID: 27224979 DOI: 10.1007/s10461-016-1433-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The practical feasibility of using prostate specific antigen (PSA) as a biomarker of semen exposure was examined among HIV-infected Ugandan women. Vaginal fluids were obtained with self-collected swabs and a qualitative rapid test (ABAcard®p30) was used to detect PSA. Trained laboratory technicians processed samples on-site and positive PSA tests were compared to self-reported unprotected vaginal sex (UVS) in the last 48 h. A total of 77 women submitted 126 samples for PSA testing at up to three study visits. Of these samples, 31 % (n = 39/126) were PSA positive, and 64 % (n = 25/39) of the positive PSA samples were accompanied by self-report of no UVS at the study visit the PSA was collected. There were no reported difficulties with specimen collection, storage, or processing. These findings provide preliminary data on high levels of misreported UVS among HIV-infected Ugandan women using practically feasible methods for PSA collection and processing.
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Affiliation(s)
- Sarah E Woolf-King
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA.
| | - Winnie Muyindike
- Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Marcia M Hobbs
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adrine Kusasira
- Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Robin Fatch
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Nneka Emenyonu
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Mallory O Johnson
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Judith A Hahn
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
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Zoboli F, Martinelli D, Di Stefano M, Fasano M, Prato R, Santantonio TA, Fiore JR. Correlation between knowledge on transmission and prevention of HIV/STI and proficiency in condom use among male migrants from Africa and Middle East evaluated by a Condom Use Skills score using a wooden penile model. BMC Res Notes 2017. [PMID: 28629409 PMCID: PMC5477424 DOI: 10.1186/s13104-017-2520-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Migrants in Italy are prevalently young adults, with a higher risk of sexual transmitted infections (STI) and HIV infection. Promoting consistent as well as correct use of condoms could reduce failure rate due to their improper use. The aim of our study was to evaluate Condom Use Skills among a migrant population recently landed in Italy, hosted in a government center for asylum seekers. METHODS The study sample was composed of 80 male migrants. Sanitary trained interviewers submitted a questionnaire to participants to investigate age, provenience, marital status, educational level and knowledge about transmission and prevention of HIV/STI. Then, we assessed participants' level of condom use skill with the Condom Use Skills (CUS) measure by using a wooden penile model. The interviewer filled in a checklist and assigned 1 point for correct demonstration of each behavior that may prevent condom failure during sex. RESULTS Participants' median age was 26 years and the sample was composed of 54 migrants from sub-Saharan Africa and 26 from Middle East. Most of them were married, with a lower middle level of education, up to 8 or 5 years. Half of the sample achieved the highest score in the questionnaire and our CUS showed a large number of people with middle high score classes. The Spearman's rho was 0.30, therefore answers to the questionnaire and CUS score appeared correlated (p < 0.05). In the multivariate model, to have a higher CUS score resulted to be associated to be older than 26 years (p < 0.05), with a higher level of education (p = 0.001), and a higher score in the questionnaire (p < 0.05). There were no significant differences in the level of CUS between single or married men and between African and Middle Asian migrants of the sample. CONCLUSIONS Our study shows that educational level influences the quality of knowledge and awareness about STI/AIDS and contribute to correct condom use. Since the half of participants had a low educational level and linguistic problems, the risk of missing campaigns messages or misunderstanding informative materials increases. Direct observation of condom-application on penile model may offer realistic assessment of application skills in these individuals.
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Affiliation(s)
- Fabio Zoboli
- Clinic of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, Viale Pinto 5, 71100, Foggia, Italy
| | - Domenico Martinelli
- Sector of Hygiene, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Mariantonietta Di Stefano
- Clinic of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, Viale Pinto 5, 71100, Foggia, Italy
| | - Massimo Fasano
- Clinic of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, Viale Pinto 5, 71100, Foggia, Italy
| | - Rosa Prato
- Sector of Hygiene, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Teresa Antonia Santantonio
- Clinic of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, Viale Pinto 5, 71100, Foggia, Italy
| | - Jose' Ramòn Fiore
- Clinic of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, Viale Pinto 5, 71100, Foggia, Italy.
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Krishnaratne S, Hensen B, Cordes J, Enstone J, Hargreaves JR. Interventions to strengthen the HIV prevention cascade: a systematic review of reviews. Lancet HIV 2017; 3:e307-17. [PMID: 27365205 DOI: 10.1016/s2352-3018(16)30038-8] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/22/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Much progress has been made in interventions to prevent HIV infection. However, development of evidence-informed prevention programmes that translate the efficacy of these strategies into population effect remain a challenge. In this systematic review, we map current evidence for HIV prevention against a new classification system, the HIV prevention cascade. METHODS We searched for systematic reviews on the effectiveness of HIV prevention interventions published in English from Jan 1, 1995, to July, 2015. From eligible reviews, we identified primary studies that assessed at least one of: HIV incidence, HIV prevalence, condom use, and uptake of HIV testing. We categorised interventions as those seeking to increase demand for HIV prevention, improve supply of HIV prevention methods, support adherence to prevention behaviours, or directly prevent HIV. For each specific intervention, we assigned a rating based on the number of randomised trials and the strength of evidence. FINDINGS From 88 eligible reviews, we identified 1964 primary studies, of which 292 were eligible for inclusion. Primary studies of direct prevention mechanisms showed strong evidence for the efficacy of pre-exposure prophylaxis (PrEP) and voluntary medical male circumcision. Evidence suggests that interventions to increase supply of prevention methods such as condoms or clean needles can be effective. Evidence arising from demand-side interventions and interventions to promote use of or adherence to prevention tools was less clear, with some strategies likely to be effective and others showing no effect. The quality of the evidence varied across categories. INTERPRETATION There is growing evidence to support a number of efficacious HIV prevention behaviours, products, and procedures. Translating this evidence into population impact will require interventions that strengthen demand for HIV prevention, supply of HIV prevention technologies, and use of and adherence to HIV prevention methods. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Shari Krishnaratne
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK; Centre for Evaluation, London School of Hygiene & Tropical Medicine, London, UK.
| | - Bernadette Hensen
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Jillian Cordes
- Department of Global Health, Emory University, Atlanta, GA, USA
| | - Joanne Enstone
- Public Health and Epidemiology, School of Medicine, Nottingham University, Nottingham, UK
| | - James R Hargreaves
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
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Awungafac G, Delvaux T, Vuylsteke B. Systematic review of sex work interventions in sub-Saharan Africa: examining combination prevention approaches. Trop Med Int Health 2017; 22:971-993. [PMID: 28449198 DOI: 10.1111/tmi.12890] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The incidence of HIV and sexually transmitted infections is disproportionately high among sex workers (SW). We aimed to update the evidence on the effectiveness of SW interventions in sub-Saharan Africa and to provide more insights into combination prevention. METHODS The Systematic review followed PRISMA guidelines in a search of PUBMED and POPLINE for peer-reviewed literature published between 1 January 2000 and 22 July 2016 (registration number on PROSPERO: CRD42016042529). We considered cohort interventions, randomised controlled trials and cross-sectional surveys of SW programmes. A framework was used in the description and mapping of intervention to desired outcomes. RESULTS Twenty-six papers(reporting on 25 studies) were included. A strategy that empowered peer educator leaders to steer community activities showed a twofold increase in coverage of behaviour change communication and utilisation of health facility among SW. Brief alcohol harm reduction effort demonstrated a significant effect on sexual violence and engagement in sex trading. A risk reduction counselling intervention among drug-injecting SW showed an effect on alcohol, substance use and engagement in sex work. No study on a promising intervention like PrEP among SWs was found. We observed that interventions that combined some structural components, biomedical and behavioural strategies tend to accumulate more desired outcomes. CONCLUSION The evidence base that can be considered in intervention designs to prevent HIV in SW in SSA is vast. The health sector should consider interventions to reduce binge alcohol intake and intravenous drug use among sex workers. Programmes should staunchly consider multicomponent approaches that explore community-based structural approaches.
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Affiliation(s)
- George Awungafac
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia.,Ministry of Health, Yaoundé, Cameroon
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Kim S, Chen Y, Ho EA, Liu S. Reversibly pH-responsive polyurethane membranes for on-demand intravaginal drug delivery. Acta Biomater 2017; 47:100-112. [PMID: 27717914 DOI: 10.1016/j.actbio.2016.10.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/23/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
Abstract
To provide better protection for women against sexually transmitted infections, on-demand intravaginal drug delivery was attempted by synthesizing reversibly pH-sensitive polyether-polyurethane copolymers using poly(ethylene glycol) (PEG) and 1,4-bis(2-hydroxyethyl)piperazine (HEP). Chemical structure and thermo-characteristics of the synthesized polyurethanes were confirmed by attenuated total reflectance-Fourier transform infrared spectroscopy (ATR-FTIR), 1H-nuclear magnetic resonance (1H-NMR), and melting point testing. Membranes were cast by solvent evaporation method using the prepared pH-sensitive polyurethanes. The impact of varying pH on membrane swelling and surface morphology was evaluated via swelling ratio change and scanning electron microscopy (SEM). The prepared pH-responsive membranes showed two times higher swelling ratio at pH 4 than pH 7 and pH-triggered switchable surface morphology change. The anionic anti-inflammatory drug diclofenac sodium (NaDF) was used as a model compound for release studies. The prepared pH-responsive polyurethane membranes allowed continuous NaDF release for 24h and around 20% release of total NaDF within 3h at pH 7 but little-to-no drug release at pH 4.5. NaDF permeation across the prepared membranes demonstrated a reversible pH-responsiveness. The pH-responsive polyurethane membranes did not show any noticeable negative impact on vaginal epithelial cell viability or induction of pro-inflammatory cytokine production compared to controls. Overall, the non-cytotoxic HEP-based pH-responsive polyurethane demonstrated its potential to be used in membrane-based implants such as intravaginal rings to achieve on-demand "on-and-off" intravaginal drug delivery. STATEMENT OF SIGNIFICANCE A reversible and sharp switch between "off" and "on" drug release is achieved for the first time through new pH-sensitive polyurethane membranes, which can serve as window membranes in reservoir-type intravaginal rings for on-demand drug delivery to prevent sexually transmitted infections (STIs). Close to zero drug release occurs at the normal vaginal pH (4.5) for minimal side effects. Drug release is only triggered by elevation of pH to 7 during heterosexual intercourse. The reversibly sharp and fast "on-and-off" switch arises from the creative incorporation of a pH-sensitive monomer in the soft segment of polyurethane. This polyurethane biomaterial holds great potential to better protect women who are generally at higher risk and are more vulnerable to STIs.
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Noroozi A, Mirzazadeh A, Farhoudian A, Hajebi A, Khankeh HR, Higgs P, Sharifi H, Armoon B, Noroozi M. Impact of HIV Status Notification on Risk Behaviors among Men Who Inject Drugs in Kermanshah, West of Iran. J Res Health Sci 2016; 16:116-121. [PMID: 27840338 PMCID: PMC7191024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/13/2016] [Accepted: 08/22/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND It is unclear whether knowing of current HIV status is associated with change in injecting behaviors among people who inject drugs (PWID) in Iran. The objective of the present study was to determine whether awareness of HIV positive status is associated with a reduction in injecting risk behaviors, after matching for socio-demographic characteristics. METHODS Five hundred male PWID were recruited in 2014 from two drop-in centers (DICs) in Kermanshah west of Iran. Trained interviewers collected data on socio-demographic characteristics, HIV testing and drug-related risk behaviors over the last month prior to interview using a structured questionnaire. Our primary exposure of interest was awareness of HIV status, used to group participants into three categories: positive, negative, unaware. We used coarsened exact matching to make the three groups statistically equivalent based on age, place of residence, education and income, and then compared them regarding the proportion of borrowing, lending and reuse of syringes. RESULTS Matched sample (n=320) had a mean age ± standard deviation (SD) of 33.5 ±7.6 yr. Overall, 25% (95% CI: 14%, 32%) of participants reported "borrowing a syringe" in the past month and 15% (95% CI: 7%, 22%) of them reported "lending a used syringe" to others in the past month. In comparison to PWID who were unaware of their HIV status, those knew they were HIV positive (OR 1.68, CI95%1.32-2.81) or negative (OR 1.54; 95% CI: 1.28, 2.71) were both more likely to report borrowing syringes in past month. CONCLUSIONS PWID WHO know they are positive for HIV are more likely to borrow another person's syringe, to report reuse of their own used syringes and less likely to report lending their syringes to others. Strategies to scale up HIV testing and counseling for PWID, which also increase awareness of HIV status, may decrease injecting related the risk behaviors.
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Affiliation(s)
- Alireza Noroozi
- a Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Mirzazadeh
- b Department of Epidemiology and Biostatics, University of California, San Francisco, CA, USA
,c HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Farhoudian
- d Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ahmad Hajebi
- e Addiction and High Risk Behavior Research Center, Tehran Institute of Psychiatry, Faculty of Behavioral Sciences and Mental Health, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Hamid Reza Khankeh
- f Research Center in Emergency and Disaster Health, University of Social Welfare and Rehabilitation, Tehran, Iran
,g Department of Clinical Sciences and Education, Karolinska Institute, Stockholm, Sweden
| | - Peter Higgs
- h Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Hamid Sharifi
- c HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Bahram Armoon
- i Student’s Research Committee, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Noroozi
- d Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
,Correspondence Mehdi Noroozi (PhD) Tel: +98 21 44856494
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Brown CA, Grosso AL, Adams D, Sithole B, Ketende S, Greene J, Maziya S, Mnisi Z, Mabuza X, Baral S. Characterizing the Individual, Social, and Structural Determinants of Condom Use Among Men Who Have Sex with Men in Swaziland. AIDS Res Hum Retroviruses 2016; 32:539-46. [PMID: 26651122 DOI: 10.1089/aid.2015.0240] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Within the broadly generalized HIV epidemic in Swaziland, men who have sex with men (MSM) have specific HIV acquisition and transmission risks. In the current era of expanding antiretroviral therapy-based prevention and treatment approaches, condom use remains a core component of mitigating these risks. A cross-sectional study characterizing the vulnerabilities for HIV among MSM in Swaziland was analyzed to describe factors associated with condom use at last sex with a male partner. Bivariate and multivariate logistic regression analyses were conducted to assess correlates of condom use at last sex with both casual and regular male partners. Disclosure of sexual practices to a healthcare provider and being able to count on other MSM to support condom use were significantly associated with condom use at last sex with a causal and a regular partner, respectively. Reporting difficulty insisting on condom use was inversely associated with condom use at last sex with both regular and casual partners. In addition, having faced legal discrimination was similarly inversely associated with condom use at last sex with a regular partner. Condom use among MSM in Swaziland may increase with improved partner communication, provider sensitization to encourage sexual disclosure, and the promotion of safer sex norms within MSM communities. These approaches, in combination with existing and emerging evidence of informed and human rights affirming prevention and HIV treatment approaches may reduce the incidence of HIV among MSM in Swaziland and all those in their sexual networks.
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Affiliation(s)
| | | | | | | | - Sosthenes Ketende
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | - Stefan Baral
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Zalta AK, Shankman SA. Conducting Psychopathology Prevention Research in the RDoC Era. ACTA ACUST UNITED AC 2016; 23:94-104. [PMID: 27065571 DOI: 10.1111/cpsp.12144] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The Research Domain Criteria (RDoC) initiative promoted by the National Institute of Mental Health emphasizes a dimensional approach to psychopathology that is agnostic to DSM diagnosis. The RDoC project offers exciting possibilities for advancing research aimed at preventing psychopathology. However, prevention has historically been defined using diagnostic status, requiring the field to redefine what constitutes prevention using an RDoC approach. This article outlines new criteria for prevention in the RDoC context and provides guidance for implementing these criteria. We also describe the role of prevention-mechanism trials that examine whether preventive interventions change proximal etiological mechanisms known to be associated with psychopathology. We hope that these modified criteria and recommendations will stimulate new possibilities for prevention research that will advance the field.
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Affiliation(s)
- Alyson K Zalta
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL; Department of Psychiatry, Rush University Medical Center, Chicago, IL
| | - Stewart A Shankman
- Department of Psychology, University of Illinois at Chicago, Chicago, IL
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Argento E, Shannon K, Nguyen P, Dobrer S, Chettiar J, Deering KN. The role of dyad-level factors in shaping sexual and drug-related HIV/STI risks among sex workers with intimate partners. Drug Alcohol Depend 2015; 157:166-73. [PMID: 26585612 PMCID: PMC4678956 DOI: 10.1016/j.drugalcdep.2015.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/30/2015] [Accepted: 10/22/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite high HIV burden among sex workers (SWs) globally, and relatively high prevalence of client condom use, research on potential HIV/STI risk pathways of intimate partnerships is limited. This study investigated partner/dyad-level factors associated with inconsistent condom use among SWs with intimate partners in Vancouver, Canada. METHODS Baseline data (2010-2013) were drawn from a community-based prospective cohort of women SWs. Multivariable generalized estimating equations logistic regression examined dyad-level factors associated with inconsistent condom use (<100% in last six months) with up to three male intimate partners per SW. Adjusted odds ratios and 95% confidence intervals were reported (AOR[95%CI]). RESULTS Overall, 369 SWs reported having at least one intimate partner, with 70.1% reporting inconsistent condom use. Median length of partnerships was 1.8 years, with longer duration linked to inconsistent condom use. In multivariable analysis, dyad factors significantly associated with increased odds of inconsistent condom use included: having a cohabiting (5.43[2.53-11.66]) or non-cohabiting intimate partner (2.15[1.11-4.19]) (versus casual partner), providing drugs (3.04[1.47-6.30]) or financial support to an intimate partner (2.46[1.05-5.74]), physical intimate partner violence (2.20[1.17-4.12]), and an intimate partner providing physical safety (2.08[1.11-3.91]); non-injection drug use was associated with a 68% reduced odds (0.32[0.17-0.60]). CONCLUSIONS Our study highlights the complex role of dyad-level factors in shaping sexual and drug-related HIV/STI risk pathways for SWs from intimate partners. Couple and gender-focused interventions efforts are needed to reduce HIV/STI risks to SWs through intimate partnerships. This research supports further calls for integrated violence and HIV prevention within broader sexual/reproductive health efforts for SWs.
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Affiliation(s)
- Elena Argento
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Kate Shannon
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3
| | - Paul Nguyen
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Sabina Dobrer
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Jill Chettiar
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3
| | - Kathleen N Deering
- Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Department of Medicine, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3.
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Nazari SSH, Noroozi M, Soori H, Noroozi A, Mehrabi Y, Hajebi A, Sharifi H, Higgs P, Mirzazadeh A. The effect of on-site and outreach-based needle and syringe programs in people who inject drugs in Kermanshah, Iran. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 27:127-31. [PMID: 26764125 DOI: 10.1016/j.drugpo.2015.10.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 10/16/2015] [Accepted: 10/29/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Needle and syringe programs (NSPs) are widely used to reduce harms associated with drug injecting. This study assessed the effect of facility-based (on-site services at drop-in centre) and outreach models of NSP on injection risk behaviours. METHODS Self-reported data from 455 people who injected drugs (PWID) during 2014 in Kermanshah, Iran, were examined to measure demographic characteristics and risk behaviors. Self-reported and program data were also assessed to identify their main source of injection equipment. Participants were divided into three sub-groups: facility-based NSP users, outreach NSP users and non-users (comparison group). Coarsened exact matching was used to make the three groups statistically equivalent based on age, place of residence, education and income, and groups were compared regarding the proportion of borrowing or lending of syringes/cookers, reusing syringes and recent HIV testing. RESULTS Overall, 76% of participants reported any NSP service use during the two months prior to interview. Only 23% (95%CI: 17-27) reported outreach NSP as their main source of syringes. Using facility-based NSP significantly decreased recent syringe borrowing (OR: 0.27, 95%CI: 0.10-0.70), recent syringe reuse (OR: 0.38, 95%CI: 0.23-0.68) and increased recent HIV testing (OR: 2.60, 95%CI: 1.48-4.56). Similar effects were observed among outreach NSP users; in addition, the outreach NSP model significantly reduced the chance of lending syringes (OR: 0.31, 95%CI: 0.15-0.60), compared to facility-based NSP (OR: 1.25, 95%CI: 0.74-2.17). CONCLUSION These findings suggest that the outreach NSP model is as effective as facility-based NSP in reducing injection risk behaviours and increasing the rate of HIV testing. Outreach NSP was even more effective than facility-based in reducing the lending of syringes to others. Scaling up outreach NSP is an effective intervention to further reduce transmission of HIV via needle sharing.
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Affiliation(s)
- Seyed Saeed Hashemi Nazari
- Safety Promotion and Injury Prevention Research Center, Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Noroozi
- Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamid Soori
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Noroozi
- School of Advanced Technologies in Medicine (SATM), Tehran University of Medical Sciences (TUMS), Tehran, Iran; Iranian National Center for Addiction Studies (INCAS), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Yadollah Mehrabi
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Hajebi
- Mental Health Research Center, Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Sharifi
- Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Peter Higgs
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Australia
| | - Ali Mirzazadeh
- Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Global Health Sciences, University of California, San Francisco, CA, USA.
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Mukandavire Z, Mitchell KM, Vickerman P. Comparing the impact of increasing condom use or HIV pre-exposure prophylaxis (PrEP) use among female sex workers. Epidemics 2015; 14:62-70. [PMID: 26972515 DOI: 10.1016/j.epidem.2015.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/21/2015] [Accepted: 10/25/2015] [Indexed: 02/03/2023] Open
Abstract
In many settings, interventions targeting female sex workers (FSWs) could significantly reduce the overall transmission of HIV. To understand the role HIV pre-exposure prophylaxis (PrEP) could play in controlling HIV transmission amongst FSWs, it is important to understand how its impact compares with scaling-up condom use-one of the proven HIV prevention strategies for FSWs. It is important to remember that condoms also have other benefits such as reducing the incidence of sexually transmitted infections and preventing pregnancy. A dynamic deterministic model of HIV transmission amongst FSWs, their clients and other male partners (termed 'pimps') was used to compare the protection provided by PrEP for HIV-negative FSWs with FSWs increasing their condom use with clients and/or pimps. For different HIV prevalence scenarios, levels of pimp interaction, and baseline condom use, we estimated the coverage of PrEP that gives the same reduction in endemic FSW HIV prevalence or HIV infections averted as different increases in condom use. To achieve the same impact on FSW HIV prevalence as increasing condom use by 1%, the coverage of PrEP has to increase by >2%. The relative impact of PrEP increases for scenarios where pimps contribute to HIV transmission, but not greatly, and decreases with higher baseline condom use. In terms of HIV infections averted over 10 years, the relative impact of PrEP compared to condoms was reduced, with a >3% increase in PrEP coverage achieving the same impact as a 1% increase in condom use. Condom promotion interventions should remain the mainstay HIV prevention strategy for FSWs, with PrEP only being implemented once condom interventions have been maximised or to fill prevention gaps where condoms cannot be used.
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Affiliation(s)
- Zindoga Mukandavire
- Social and Mathematical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK.
| | - Kate M Mitchell
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
| | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
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Cabezas MC, Fornasini M, Dardenne N, Barmettler D, Borja T, Albert A. A cross-sectional study to evaluate factors related to condom use with commercial sexual partners in workers from Ecuadorian companies. BMC Public Health 2015; 15:856. [PMID: 26337966 PMCID: PMC4558841 DOI: 10.1186/s12889-015-2184-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 08/25/2015] [Indexed: 11/21/2022] Open
Abstract
Background Unprotected intercourse with sex workers is one of the major risk factors for HIV infection. Consistent condom use is a prerequisite to lower the incidence of HIV. Methods We assessed the prevalence of condom use and its determinants among company workers engaged with commercial sexual partners in Ecuador. The study was based on a random sample of 115 companies and 1,732 workers stratified by province and working sector and utilized the “Behavioral Surveillance Surveys – Adult questionnaire” developed by Family Health International. Results Of the 1,561 sexually active workers, 311 (19.9 %) reported having intercourse with sex workers. Among them 25.9 % did not use a condom at the last sexual intercourse. As for condom use frequency over the last 12 months, 29/208 (13.9 %) reported never, 23 (11.1 %) sometimes, 24 (11.5 %) almost every time and 132 (63.5 %) every time. Factors adversely affecting condom use frequency over the last 12 months were female gender (OR = 4.56, 95 % CI: 1.45-14.4), older age (OR = 1.07, 95 % CI: 1.03-1.10), low educational level (OR = 4.69, 95 % CI: 1.95-11.3) and married workers living with spouse (OR = 7.66, 95 % CI: 3.08-19.1). By contrast, factors such as age at first sexual intercourse, job category, HIV transmission and prevention measure knowledge, single workers, previous exposure to HIV intervention programs and having a casual sexual partner were not affecting condom use frequency. When considering condom use during the last sexual intercourse or during the past 12 months with commercial sexual partners, results were similar. Conclusions Workers with low education, older age, female gender and those married living with their spouse should be targeted for specific educational interventions.
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Affiliation(s)
- María C Cabezas
- Public Health Department, University of Liège, Liège, Belgium. .,Medical School, Pontifical Catholic University, Quito, Ecuador.
| | - Marco Fornasini
- Translational Research Center, Universidad de las Américas (UDLA), Quito, Ecuador.
| | - Nadia Dardenne
- Public Health Department, University of Liège, Liège, Belgium.
| | | | - Teresa Borja
- Psychology School, Universidad San Francisco de Quito (USFQ), Cumbaya, Ecuador.
| | - Adelin Albert
- Public Health Department, University of Liège, Liège, Belgium.
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Rutakumwa R, Mbonye M, Kiwanuka T, Bagiire D, Seeley J. Why do men often not use condoms in their relationships with casual sexual partners in Uganda? CULTURE, HEALTH & SEXUALITY 2015; 17:1237-1250. [PMID: 26158527 DOI: 10.1080/13691058.2015.1053413] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
With a focus on Uganda, this paper examines men's condom use in sexual relationships with casual partners and what this might tell us about men's vulnerability to HIV-infection. We carried out repeat interviews with 31 men attending a clinic serving women at high risk for HIV infection and their partners in Kampala. We found that the experience of condom-less sex in the men's youth, itself the outcome of a restrictive home environment, was perceived as influencing later unsafe sexual behaviour. Peer pressure encouraged men to have multiple partners. Alcohol negatively affected condom use. Men often opted not to use a condom with women they thought looked healthy, particularly if they had had sex with the same woman before. Some men who were HIV-positive said they saw little point in using condoms since they were already infected. A concerted effort is required to reach men, like those in our study, to halt HIV and the transmission of other sexually transmitted infections.
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Affiliation(s)
| | - Martin Mbonye
- a MRC/UVRI Uganda Research Unit on AIDS , Entebbe , Uganda
| | | | - Daniel Bagiire
- a MRC/UVRI Uganda Research Unit on AIDS , Entebbe , Uganda
| | - Janet Seeley
- a MRC/UVRI Uganda Research Unit on AIDS , Entebbe , Uganda
- b London School of Hygiene and Tropical Medicine , London , UK
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Stern E, Pascoe L, Shand T, Richmond S. Lessons learned from engaging men in sexual and reproductive health as clients, partners and advocates of change in the Hoima district of Uganda. CULTURE, HEALTH & SEXUALITY 2015; 17 Suppl 2:S190-205. [PMID: 25953243 PMCID: PMC4706030 DOI: 10.1080/13691058.2015.1027878] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 03/07/2015] [Indexed: 05/24/2023]
Abstract
This study examined the impact of a three-year intervention project conducted in the Hoima district of Uganda, which sought to engage men in sexual and reproductive health as clients, equal partners and advocates of change. Structured surveys with 164 self-reported heterosexual men aged 18-54 years were used to assess knowledge and attitudes towards sexual and reproductive health. Data from these were analysed using Stata and SPSS. Additionally, five focus groups were conducted with the female partners and male beneficiaries of the project and with project peer educators. Four interviews were conducted with project staff and male beneficiaries. Data from these and the focus groups were analysed using a thematic approach. Following the intervention, a significantly greater number of men accessed, and supported their partners in accessing sexual health services services, had gained sexual and reproductive health awareness, reported sharing domestic duties and contraceptive decision-making, and displayed a decreased tolerance for domestic violence. It was more difficult to assess men's involvement and behaviours as advocates of change, which sheds light on the complexities of a gender transformative project and the importance of evaluating such projects from both men's and their partners' perspectives and at different levels of the male involvement model in sexual and reproductive health.
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Affiliation(s)
- Erin Stern
- Women's Health Research Unit, University of Cape Town, Cape Town, South Africa
| | | | - Tim Shand
- Sonke Gender Justice, Cape Town, South Africa
| | - Samantha Richmond
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
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Bazzi AR, Rangel G, Martinez G, Ulibarri MD, Syvertsen JL, Bazzi SA, Roesch S, Pines HA, Strathdee SA. Incidence and Predictors of HIV and Sexually Transmitted Infections Among Female Sex Workers and Their Intimate Male Partners in Northern Mexico: A Longitudinal, Multilevel Study. Am J Epidemiol 2015; 181:723-31. [PMID: 25769307 PMCID: PMC4408950 DOI: 10.1093/aje/kwu340] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 11/05/2014] [Indexed: 11/12/2022] Open
Abstract
Preventing human immunodeficiency virus (HIV) infection and other sexually transmitted infections (STIs) requires an understanding of sexual relationship factors beyond the individual level. We estimated HIV/STI incidence and identified time-varying predictors of STI acquisition in a prospective cohort study of female sex workers and their intimate (noncommercial) male partners in northern Mexico. From 2010 to 2013, couples underwent behavioral and biological assessments biannually for 24 months. Among 413 initially HIV-uninfected participants, 8 seroconverted during follow-up. Incidence of HIV (1.12 cases/100 person-years (PY)), chlamydia (9.47 cases/100 PY), active syphilis (4.01 cases/100 PY), and gonorrhea (1.78 cases/100 PY) was higher among women than among men (HIV: P = 0.069; all STIs combined: P < 0.001). In multivariable conditional logistic regression with individual fixed effects and correlated error terms within couples, risk of STI acquisition was significantly higher among women who had recently used cocaine, crack, or methamphetamine (adjusted odds ratio (OR) = 2.13, 95% confidence interval (CI): 1.07, 4.28). STI risk was lower among women who reported physically assaulting their male partners (adjusted OR = 0.44, 95% CI: 0.22, 0.86) and among men whose female partners had regular sex-work clients (adjusted OR = 0.38, 95% CI: 0.14, 1.03). Improving vulnerable couples' sexual health will require addressing the contexts in which drug use, interpersonal conflict, and economic vulnerability converge.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Steffanie A. Strathdee
- Correspondence to Dr. Steffanie A. Strathdee, Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0507 (e-mail: )
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West African female sex workers in Mali: reduction in HIV prevalence and differences in risk profiles of sex workers of differing nationalities of origin. J Acquir Immune Defic Syndr 2015; 68 Suppl 2:S221-31. [PMID: 25723988 DOI: 10.1097/qai.0000000000000444] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Female sex workers (FSW) in Mali are highly vulnerable to HIV. Their prevalence in 2009 was 9 times higher (24.2%) than that among pregnant women (2.7%). METHODS Four Integrated HIV/sexually transmitted infection (STI) Surveillance and Behavioral Surveys among FSW in Mali (2000, 2003, 2006, and 2009) tracked demographic characteristics, behavior, and HIV and STI prevalence. Logistic regression using generalized estimating equations to control for the cluster effect identified factors associated with HIV-positive serostatus adjusting for potential confounding. RESULTS Of 2430 FSW, 40.8% were Nigerian, 36.8% were Malian, and 22.4% were from other neighboring countries. Between 2003 and 2009, HIV prevalence dropped from 44.14% to 28.49% (P < 0.0001) among Malians, from 21.33% to 12.71% (P = 0.0082) among Nigerians, and from 43.42% to 33.67% (P = 0.0442) among "others." Between 2000 and 2009, condom availability increased (89.18%-99.3%; P < 0.0001) as did HIV testing (40%-75%; P < 0.0001). Consistent condom use with clients improved for Malians (72.3%-81.5%; P = 0.0092), but not among Nigerians (92.7%-90.94%; P = 0.8240) and "others" (88.9%-88.48%; P = 0.8452). Consistent condom use with boyfriends was low and improved only for Nigerians (9.8%-28.4%; P = 0.0003). Factors associated with HIV prevalence in the multivariate model were older age, study year (2003 and 2006), nationality, lack of education, mobility, STI symptoms, gonorrhea prevalence, and younger age at first sex. CONCLUSIONS This study documents progress in the fight against HIV among FSW in Mali. The different vulnerabilities to HIV found for different nationality FSW should be considered in programming and future research.
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Prevalence of HIV, sexually transmitted infections, and risk behaviours among female sex workers in Nairobi, Kenya: results of a respondent driven sampling study. AIDS Behav 2015; 19 Suppl 1:S46-58. [PMID: 25428282 DOI: 10.1007/s10461-014-0919-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We conducted a respondent driven sampling survey to estimate HIV prevalence and risk behavior among female sex workers (FSWs) in Nairobi, Kenya. Women aged 18 years and older who reported selling sex to a man at least once in the past 3 months were eligible to participate. Consenting FSWs completed a behavioral questionnaire and were tested for HIV and sexually transmitted infections (STIs). Adjusted population-based prevalence and 95 % confidence intervals (CI) were estimated using RDS analysis tool. Factors significantly associated with HIV infection were assessed using log-binomial regression analysis. A total of 596 eligible participants were included in the analysis. Overall HIV prevalence was 29.5 % (95 % CI 24.7-34.9). Median age was 30 years (IQR 25-38 years); median duration of sex work was 12 years (IQR 8-17 years). The most frequent client-seeking venues were bars (76.6 %) and roadsides (29.3 %). The median number of clients per week was seven (IQR 4-18 clients). HIV testing was high with 86.6 % reported ever been tested for HIV and, of these, 63.1 % testing within the past 12 months. Of all women, 59.7 % perceived themselves at 'great risk' for HIV infection. Of HIV-positive women, 51.0 % were aware of their infection. In multivariable analysis, increasing age, inconsistent condom use with paying clients, and use of a male condom as a method of contraception were independently associated with unrecognized HIV infection. Prevalence among STIs was low, ranging from 0.9 % for syphilis, 1.1 % for gonorrhea, and 3.1 % for Chlamydia. The data suggest high prevalence of HIV among FSWs in Nairobi. Targeted and routine HIV and STI combination prevention strategies need to be scaled up or established to meet the needs of this population.
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Wamai RG, Morris BJ, Bailey RC, Klausner JD, Boedicker MN. Male circumcision for protection against HIV infection in sub-Saharan Africa: the evidence in favour justifies the implementation now in progress. Glob Public Health 2015; 10:639-66. [PMID: 25613581 PMCID: PMC6352987 DOI: 10.1080/17441692.2014.989532] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article responds to a recent 'controversy study' in Global Public Health by de Camargo et al. directed at three randomised controlled trials (RCTs) of male circumcision (MC) for HIV prevention. These trials were conducted in three countries in sub-Saharan Africa (SSA) and published in 2005 and 2007. The RCTs confirmed observational data that had accumulated over the preceding two decades showing that MC reduces by 60% the risk of HIV infection in heterosexual men. Based on the RCT results, MC was adopted by global and national HIV policy-makers as an additional intervention for HIV prevention. Voluntary medical MC (VMMC) is now being implemented in 14 SSA countries. Thus referring to MC for HIV prevention as 'debate' and viewing MC through a lens of controversy seems mistaken. In their criticism, de Camargo et al. misrepresent and misinterpret current science supporting MC for HIV prevention, omit previous denunciations of arguments similar to theirs, and ignore evidence from ongoing scientific research. Here we point out the flaws in three areas de Camargo et al. find contentious. In doing so, we direct readers to growing evidence of MC as an efficacious, safe, acceptable, relatively low-cost one-off biomedical intervention for HIV prevention.
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Affiliation(s)
- Richard G. Wamai
- Department of African-American Studies, Northeastern University, Boston, Massachusetts, USA
| | - Brian J. Morris
- School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Robert C. Bailey
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jeffrey D. Klausner
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, California, USA
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High incidence is not high exposure: what proportion of prevention trial participants are exposed to HIV? PLoS One 2015; 10:e0115528. [PMID: 25569838 PMCID: PMC4287619 DOI: 10.1371/journal.pone.0115528] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 11/25/2014] [Indexed: 11/23/2022] Open
Abstract
Objective Randomized clinical trials of HIV prevention in high-risk populations of women often assume that all participants have similar exposure to HIV. However, a substantial fraction of women enrolled in the trial may have no or low exposure to HIV. Our objective was to estimate the proportion of women exposed to HIV throughout a hypothetical high-risk study population. Methods A stochastic individual-based model was developed to simulate the sexual behavior and the risk of HIV acquisition for a cohort of sexually active HIV-uninfected women in high HIV prevalence settings. Key behavior and epidemic assumptions in the model were based on published studies on HIV transmission in South Africa. The prevalence of exposure, defined as the proportion of women who have sex with HIV-infected partner, and HIV incidence were evaluated. Results Our model projects that in communities with HIV incidence rate of 1 per 100 person years, only 5-6% of women are exposed to HIV annually while in communities with an HIV incidence of 5 per 100 person years 20-25% of women are exposed to HIV. Approximately 70% of the new infections are acquired from partners with asymptomatic HIV. Conclusions Mathematical models suggest that a high proportion of women enrolled in HIV prevention trials may be unexposed to HIV even when incidence rates are high. The relationship between HIV exposure and other risk factors should be carefully analyzed when future clinical trials are planned.
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Fonner VA, Kennedy CE, O’Reilly KR, Sweat MD. Systematic assessment of condom use measurement in evaluation of HIV prevention interventions: need for standardization of measures. AIDS Behav 2014; 18:2374-86. [PMID: 24197972 DOI: 10.1007/s10461-013-0655-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
When evaluating HIV prevention interventions, condom use is a common outcome measure used to assess changes in HIV-related behaviors; however, no widely accepted standards exist for its measurement. Using systematic review data on HIV prevention interventions conducted in low- and middle-income countries, we examined trends in condom use measurement since 1990. We abstracted data from standardized forms on six dimensions of condom use: partner type, temporal period, measurement scale, consistency, controlling for abstinence, and type of sex. Of 215 studies reviewed, 109 studies (51 %) measured condom use as a primary outcome. Outcomes were stratified by partner type in 47 studies (43 %). Assessing condom use at last sex was the most common measurement. Consistency of condom use was assessed in 47 studies (43 %). Developing and utilizing standards for condom use measurement would increase comparability of findings across studies and benefit HIV prevention research. Recommendations include measuring condom use at last sex, frequency of condom use, and number of protected sex acts in studies evaluating the efficacy of behavioral interventions on sexual risk behavior.
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Dusabe J, Mchome Z, Nnko S, Changalucha J, Obasi A. "There are bugs in condoms": Tanzanian close-to-community providers' ability to offer effective adolescent reproductive health services. ACTA ACUST UNITED AC 2014; 41:e2. [PMID: 25432866 PMCID: PMC4283683 DOI: 10.1136/jfprhc-2014-100915] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives Young people in Tanzania are known to access reproductive health services from a range of close-to-community providers outside formal health settings such as drug stores, village AIDS committees, traditional healers and traditional birth attendants (TBAs). However, questions remain about the quality of services such agents provide. This study investigated their capacity to provide adolescent reproductive health (ARH) services and explored their readiness and ability to integrate with the mainstream health sector through community referral interventions. Methods Thirty-five focus group discussions exploring close-to-community provider experiences and attitudes to ARH service provision were carried out in two districts in Northern Tanzania. Discussions were conducted in Kiswahili, digitally recorded, verbatim-transcribed, translated and back-translated from Swahili to English. A thematic analysis was conducted using NVivo 9. Results The major close-to-community cadres providing reproductive health services were drug stores, traditional healers, TBAs and village health workers. They reported being the first port of call for adolescents seeking reproductive health services, but their knowledge of ARH needs was poor. They had negative attitudes to, and lacked the necessary resources for, the provision of such services for adolescents. Some were particularly unwilling to provide condom services and were prejudiced against adolescents using them. There was poor integration between the close-to-community providers and the formal health sector, further limiting their ability to provide adequate services. Conclusions Although close-to-community providers are considered a key resource in the community, most have limited capacity to provide ARH services. Without capacity-building investments such as training and cooperation with the mainstream health sector, their contribution to positive reproductive health outcomes is limited, or could indeed lead to adverse outcomes.
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Affiliation(s)
- John Dusabe
- Research Assistant, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Zaina Mchome
- Researcher, Tanzania National Institute for Medical Research, Mwanza, United Republic of Tanzania
| | - Soori Nnko
- Principal Research Scientist, Tanzania National Institute for Medical Research, Mwanza, United Republic of Tanzania
| | - John Changalucha
- Principal Research Scientist and NIMR Mwanza Director, Tanzania National Institute for Medical Research, Mwanza, United Republic of Tanzania
| | - Angela Obasi
- Senior Clinical Lecturer, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Fleming PJ, Mulawa M, Burke H, Shattuck D, Mndeme E, Attafuah J, Mbwambo J, Guest G. The role of relationship types on condom use among urban men with concurrent partners in Ghana and Tanzania. AIDS Care 2014; 27:466-72. [PMID: 25337930 DOI: 10.1080/09540121.2014.969675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Multiple concurrent partnerships are hypothesized to be important drivers of HIV transmission. Despite the demonstrated importance of relationship type (i.e., wife, girlfriend, casual partner, sex worker) on condom use, research on concurrency has not examined how different combinations of relationship types might affect condom use. We address this gap, using survey data from a sample of men from Ghana (GH: n = 807) and Tanzania (TZ: n = 800) who have at least three sexual partners in the past three months. We found that approximately two-thirds of men's reported relationships were classified as a girlfriend. Men were more likely to use a condom with a girlfriend if their other partner was a wife compared to if their other partner was a sex worker (GH: OR 3.10, 95% CI, 1.40, 6.86; TZ: OR 2.34, 95% CI 1.35, 4.06). These findings underscore the importance of considering relationship type when designing HIV prevention strategies in these settings.
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Vassall A, Chandrashekar S, Pickles M, Beattie TS, Shetty G, Bhattacharjee P, Boily MC, Vickerman P, Bradley J, Alary M, Moses S, Watts C. Community mobilisation and empowerment interventions as part of HIV prevention for female sex workers in Southern India: a cost-effectiveness analysis. PLoS One 2014; 9:e110562. [PMID: 25333501 PMCID: PMC4204894 DOI: 10.1371/journal.pone.0110562] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 09/19/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Most HIV prevention for female sex workers (FSWs) focuses on individual behaviour change involving peer educators, condom promotion and the provision of sexual health services. However, there is a growing recognition of the need to address broader societal, contextual and structural factors contributing to FSW risk behaviour. We assess the cost-effectiveness of adding community mobilisation (CM) and empowerment interventions (eg. community mobilisation, community involvement in programme management and services, violence reduction, and addressing legal policies and police practices), to core HIV prevention services delivered as part of Avahan in two districts (Bellary and Belgaum) of Karnataka state, Southern India. METHODS An ingredients approach was used to estimate economic costs in US$ 2011 from an HIV programme perspective of CM and empowerment interventions over a seven year period (2004-2011). Incremental impact, in terms of HIV infections averted, was estimated using a two-stage process. An 'exposure analysis' explored whether exposure to CM was associated with FSW's empowerment, risk behaviours and HIV/STI prevalence. Pathway analyses were then used to estimate the extent to which behaviour change may be attributable to CM and to inform a dynamic HIV transmission model. FINDINGS The incremental costs of CM and empowerment were US$ 307,711 in Belgaum and US$ 592,903 in Bellary over seven years (2004-2011). Over a 7-year period (2004-2011) the mean (standard deviation, sd.) number of HIV infections averted through CM and empowerment is estimated to be 1257 (308) in Belgaum and 2775 (1260) in Bellary. This translates in a mean (sd.) incremental cost per disability adjusted life year (DALY) averted of US$ 14.12 (3.68) in Belgaum and US$ 13.48 (6.80) for Bellary--well below the World Health Organisation recommended willingness to pay threshold for India. When savings from ART are taken into account, investments in CM and empowerment are cost saving. CONCLUSIONS Our findings suggest that CM and empowerment is, at worst, highly cost-effective and, at best, a cost-saving investment from an HIV programme perspective. CM and empowerment interventions should therefore be considered as core components of HIV prevention programmes for FSWs.
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Affiliation(s)
- Anna Vassall
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sudhashree Chandrashekar
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- St John's Research Institute, Bangalore, India
| | - Michael Pickles
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Imperial College, London, United Kingdom
| | - Tara S. Beattie
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Peter Vickerman
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Janet Bradley
- URESP, Centre de recherche du CHU de Québec, Québec, Canada
| | - Michel Alary
- URESP, Centre de recherche du CHU de Québec, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | | | | | - Charlotte Watts
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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