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Magarati M, Chambers RS, Yenokyan G, Rosenstock S, Walls M, Slimp A, Larzelere F, Lee A, Pinal L, Tingey L. Predictors of STD Screening From the Indigenist Stress-Coping Model Among Native Adults With Binge Substance Use. Front Public Health 2022; 10:829539. [PMID: 36033733 PMCID: PMC9411734 DOI: 10.3389/fpubh.2022.829539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 06/02/2022] [Indexed: 01/21/2023] Open
Abstract
Objective The American Indian/Alaska Native (AI/AN) population in the U.S. is thriving in spite of settler colonialist efforts of erasure. AI/AN people, however, continue to experience persistent health disparities including a disproportionate burden of substance use and sexually transmitted diseases/infections (STDs/STIs), as well as a disproportionate lack of public health STD screening services and STD prevention interventions grounded in AI/AN social contexts, experiences, and epistemologies. The present study explored how stressors and protective factors based on the Indigenist Stress Coping framework predict STD screening outcomes among Native adults. Methods We analyzed baseline self-report data from 254 Native adults ages 18-55 years with recent binge substance use who were enrolled in an evaluation of "EMPWR," a two-session STD risk reduction program in a rural, reservation-based community in the U.S. Southwest. Logistic regression models with robust variance were used to estimate odds ratios of lifetime STD testing for the theoretical stressors and cultural buffers. Results A little over half the sample were males (52.5%, n = 136), with a mean age of 33.6 years (SD = 8.8). The majority (76.7%, n = 195) reported having ever been screened for STD in their life. Discrimination score were significantly associated with lifetime STD testing: The higher discrimination was associated with lower odds of STD testing in the fully adjusted model (aOR = 0.40, 95%CI: 0.18, 0.92). The effects of AI/AN-specific cultural buffer such as participation in traditional practices on STD testing outcomes was in the expected positive direction, even though the association was not statistically significant. Household size was significantly associated with STD screening: The higher the number of people lived together in the house, the higher the odds of STD testing in the fully adjusted model (aOR = 1.19, 95%CI: 1.04, 1.38). Conclusion Our findings suggest that STD prevention programs should take into consideration AI/AN-specific historical traumatic stressors such as lifetime discrimination encounters and how these interact to drive or discourage sexual health services at local clinics. In addition, larger household size may be a protective factor functioning as a form of social support, and the extended family's role should be taken into consideration. Future research should consider improvement in measurements of AI/AN enculturation constructs.
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Affiliation(s)
- Maya Magarati
- Seven Directions, A Center for Indigenous Public Health, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States,*Correspondence: Maya Magarati
| | - Rachel Strom Chambers
- Department of International Health, Johns Hopkins Center for American Indian Health, Whiteriver, AZ, United States
| | - Gayane Yenokyan
- Johns Hopkins Biostatistics Center, Baltimore, MD, United States
| | - Summer Rosenstock
- Department of International Health, Johns Hopkins Center for American Indian Health, Whiteriver, AZ, United States
| | - Melissa Walls
- Department of International Health, John Hopkins Center for American Indian Health, Great Lakes Hub, Duluth, MN, United States
| | - Anna Slimp
- Department of International Health, Johns Hopkins Center for American Indian Health, Whiteriver, AZ, United States
| | - Francene Larzelere
- Department of International Health, Johns Hopkins Center for American Indian Health, Whiteriver, AZ, United States
| | - Angelita Lee
- Department of International Health, Johns Hopkins Center for American Indian Health, Whiteriver, AZ, United States
| | - Laura Pinal
- Department of International Health, Johns Hopkins Center for American Indian Health, Whiteriver, AZ, United States
| | - Lauren Tingey
- Department of International Health, Johns Hopkins Center for American Indian Health, Whiteriver, AZ, United States
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Leston J, Wenger H, Reilley B, Craig Rushing S, Rink E, Warren H, Howe J, Bloomquist P, Tah T, Jeffries I, Iralu J, Thorpe P, Apostolou A, Taylor MM. Creating a path forward: understanding the context of sexual health and sexually transmitted infections in American Indian/Alaska Native populations – a review. Sex Health 2022; 19:286-298. [PMID: 35760766 PMCID: PMC11081199 DOI: 10.1071/sh22040] [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: 03/04/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022]
Abstract
This review assessed sexual health and sexually transmitted infection (STI) burden among American Indian/Alaska Native (AI/AN) peoples within the context of current clinical and public health services. We conducted a review of published literature about sexual health and bacterial STIs among AI/AN populations in the United States using Medline (OVID), CINAHL (EbscoHost) and Scopus. Peer-reviewed journals published during 1 January 2005-2 December 2021 were included and supplemented by other publicly available literature. A total of 138 articles from reference lists met inclusion criteria, including 85 peer-review articles and 53 additional references. Results indicate a disproportionate burden of STIs is carried by AI/AN populations compared to non-Hispanic Whites. Risk for STIs in AI/AN people has origins in historical trauma and structural and social determinants of health. STI services are available for AI/AN populations, but many barriers to care exist. Community-based sexual health programming has been successful, but has thus far focused primarily on adolescents and young adults. A myriad of factors contributes to high rates of STIs among AI/AN populations. Longstanding disparities show a clear need to increase the availability of integrated, low-barrier STI prevention and treatment services. Implementation of multi-level (individual, physician, clinic, healthcare organisation, and/or community level), culturally relevant sexual health and STI interventions should be community-based and person-centred, acknowledge social determinants of health, and grounded in deep respect and understanding of AI/AN histories and cultures.
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Affiliation(s)
- Jessica Leston
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | | | - Brigg Reilley
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | | | | | - Hannah Warren
- Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Jean Howe
- Northern Navajo Medical Center, Indian Health Service, Shiprock, NM, USA
| | | | - Tina Tah
- Indian Health Service Headquarters, Rockville, MD, USA
| | - Itai Jeffries
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Jonathan Iralu
- Gallup Indian Medical Center, Indian Health Service, Gallup, NM, USA
| | - Phoebe Thorpe
- U.S. Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA, USA
| | | | - Melanie M. Taylor
- U.S. Centers for Disease Control and Prevention, Division of HIV Prevention, Atlanta, GA, USA
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Serier KN, Venner KL, Hernandez-Vallant A. The Condom Use Self-Efficacy Scale in Substance Use Disorder Treatment-Seeking American Indian Adults. Subst Use Misuse 2021; 56:2066-2073. [PMID: 34590538 DOI: 10.1080/10826084.2021.1963988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
American Indians (AIs) experience substance use disorder and sexual risk related inequities with elevated rates of sexually transmitted infections, unintended pregnancy, and fetal alcohol spectrum disorders. Substance misuse is associated with risky sexual behaviors including condomless sex. Objectives: The current study aimed to test the validity of the Condom Use Self-Efficacy Scale (CUSES) and the relationship between self-efficacy and condom use behaviors in AI individuals with substance use disorders (SUDs). Exploratory analyses also examined changes in condom use self-efficacy across SUD treatment. Methods: As part of a larger randomized controlled trial, AI individuals (N = 79) seeking SUD treatment completed baseline measures of condom use self-efficacy and sexual risk behaviors. Results: Confirmatory factor analysis (CFA) indicated that a 3-factor, 10-item version of the CUSES was a reliable and valid measure in this population. Condom use self-efficacy was associated with condom use behavior and increased during SUD treatment. Conclusions: Overall, it appears that the CUSES is a valid measure in AI individuals, is related to condom use behavior, and increases with SUD treatment. There is a need for future research to integrate these findings into AI cultural values. Addressing sexual risk behaviors in SUD treatment may be an important target and future research is needed to understand predictors of condom use self-efficacy and determine potential intervention targets to reduce sexual risk behaviors and related health inequities.
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Affiliation(s)
- Kelsey N Serier
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Kamilla L Venner
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA.,Center on Alcohol, Substance use, & Addiction, University of New Mexico, Albuquerque, New Mexico, USA
| | - Alexandra Hernandez-Vallant
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA.,Center on Alcohol, Substance use, & Addiction, University of New Mexico, Albuquerque, New Mexico, USA
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Kirkcaldy RD, Weston E, Segurado AC, Hughes G. Epidemiology of gonorrhoea: a global perspective. Sex Health 2020; 16:401-411. [PMID: 31505159 DOI: 10.1071/sh19061] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/19/2019] [Indexed: 12/14/2022]
Abstract
Although understanding the local epidemiology of gonorrhoea is critical for local efforts, understanding the multinational epidemiology may support development of national and international prevention and control policies and strategies. In this paper, current epidemiology of gonorrhoea is reviewed through an international lens and with a focus on selected populations. The World Health Organization (WHO) estimates that ~87 million new gonococcal infections occurred among people aged 15-49 years in 2016. Gonorrhoea rates are rising in many countries. Gay, bisexual and other men who have sex with men, racial or ethnic minorities, Indigenous populations and sex workers appear to bear disproportionate burdens of gonorrhoea. International travel can facilitate spread of gonorrhoea, including resistant strains, across international borders. Critical gaps in epidemiological knowledge are highlighted, including data on gonorrhoea among transgender persons and the burden of extragenital gonorrhoea. Even as further data are gathered, action - informed by currently available data - is needed now to confront this growing international threat.
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Affiliation(s)
- Robert D Kirkcaldy
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA; and Corresponding author.
| | - Emily Weston
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA
| | - Aluisio C Segurado
- Faculty of Medicine, University of São Paulo, Avenida Doutor Arnaldo, 455, 01246-903 São Paulo-SP, Brazil
| | - Gwenda Hughes
- Faculty of Medicine, University of São Paulo, Avenida Doutor Arnaldo, 455, 01246-903 São Paulo-SP, Brazil; and HIV & STI Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
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Lauren T, Catherine S, Rachel C, Hima P, Angelita L, Shauntel L, Laura M, Anna S, Anne R, Mariddie C, Charlotte G. Protecting our future generation: study protocol for a randomized controlled trial evaluating a sexual health self-care intervention with Native American youth and young adults. BMC Public Health 2019; 19:1614. [PMID: 31791323 PMCID: PMC6888928 DOI: 10.1186/s12889-019-7956-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 11/18/2019] [Indexed: 01/01/2023] Open
Abstract
Background Disparities in sexually transmitted infections (STI) are an urgent problem among Native American youth and young adults which are not fully explained by different sexual or related behaviors. These sexual health disparities are more likely attributed to social environments and structural determinants such as a shortage of sexual healthcare providers, lower socioeconomic status, and access barriers to STI screening and treatment, including geographic isolation and confidentiality concerns. Innovative, non-clinic based alternatives to promote STI screening and treatment are essential for alleviating these disparities. Self-care, or the care taken by individuals towards their own health and well-being may be such a strategy. This study will assess the efficacy of a self-care intervention, called Protecting Our Future Generation, for increasing uptake of STI screening and impacting sexual risk and protective behaviors among Native American youth and young adults living in a reservation-based community in the Southwestern United States. Methods The proposed study is a randomized controlled trial to test the efficacy of a self-care intervention compared to a control condition. Participants will be Native Americans ages 14–26 years old who have had vaginal or anal sex at least once in their lifetime. Participants will be randomized to the intervention which includes: 1) a sexual health self-assessment with embedded clinical prediction tool predicting STI positivity, and 2) personalized messaging with key steps to lower risk for STIs, or the control condition which includes: 1) a self-assessment about water, soda and sugar sweetened beverage consumption, and 2) personalized messaging to meet recommended daily intake. All participants will be offered a self-administered STI test. Participants will complete assessments at baseline, 3- and 6-months follow-up. The primary outcome measure is completion of STI screening. Discussion Protecting Our Future Generation is among the first self-care interventions uniquely focused on sexual health among a Native American population, who endure significant sexual health disparities and are under-represented in research. If efficacious, the intervention will be a model of sexual health self-care for Native American youth and young adults adaptable for use in healthcare and community-based settings. Trial registration Clinical Trials: http://clinicaltrials.gov; NCT03895320; Registered 03/28/2019.
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Affiliation(s)
- Tingey Lauren
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Bloomberg School of Public Health, 415 N. Washington St., Baltimore, MD, 21231, USA.
| | - Sutcliffe Catherine
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Bloomberg School of Public Health, 415 N. Washington St., Baltimore, MD, 21231, USA
| | - Chambers Rachel
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Bloomberg School of Public Health, 415 N. Washington St., Baltimore, MD, 21231, USA
| | - Patel Hima
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Bloomberg School of Public Health, 415 N. Washington St., Baltimore, MD, 21231, USA
| | - Lee Angelita
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Bloomberg School of Public Health, 308 Kuper St., Whiteriver, AZ, 85941, USA
| | - Lee Shauntel
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Bloomberg School of Public Health, 308 Kuper St., Whiteriver, AZ, 85941, USA
| | - Melgar Laura
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Bloomberg School of Public Health, 308 Kuper St., Whiteriver, AZ, 85941, USA
| | - Slimp Anna
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Bloomberg School of Public Health, 308 Kuper St., Whiteriver, AZ, 85941, USA
| | - Rompalo Anne
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Bloomberg School of Public Health, 415 N. Washington St., Baltimore, MD, 21231, USA
| | - Craig Mariddie
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Bloomberg School of Public Health, 308 Kuper St., Whiteriver, AZ, 85941, USA
| | - Gaydos Charlotte
- Johns Hopkins Center for the Development of Point Of Care Tests for Sexually Transmitted Diseases, Johns Hopkins University, Bloomberg School of Public Health, 855 N. Wolfe St., Baltimore, MD, 21205, USA
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Guy RJ, Ward J, Causer LM, Natoli L, Badman SG, Tangey A, Hengel B, Wand H, Whiley D, Tabrizi SN, Shephard M, Fairley CK, Donovan B, Anderson DA, Regan DG, Maher L, Kaldor JM. Molecular point-of-care testing for chlamydia and gonorrhoea in Indigenous Australians attending remote primary health services (TTANGO): a cluster-randomised, controlled, crossover trial. THE LANCET. INFECTIOUS DISEASES 2019; 18:1117-1126. [PMID: 30303108 DOI: 10.1016/s1473-3099(18)30429-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 06/13/2018] [Accepted: 07/03/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Timely diagnosis and treatment of sexually transmissible infections will prevent morbidity and onward transmission. We aimed to assess the efficacy of a point-of-care molecular test for Chlamydia trachomatis and Neisseria gonorrhoeae infections at the cluster level to improve infection management among Indigenous Australian communities with high prevalence of sexually transmissible infections. METHODS In this cluster-randomised crossover study, we recruited primary health services in Western Australia, Far North Queensland, and South Australia that provide care to Indigenous people in regional or remote locations. The services were eligible if they did 150 or more tests for C trachomatis or N gonorrhoeae infection per year among individuals aged 16-29 years, and if C trachomatis or N gonorrhoeae positivity was 10% or higher. Services were randomly assigned (1:1) by use of a random-number generator, stratified by geographical region, to either standard care conditions with routine laboratory-based sexually transmissible infection testing for 12 months followed by 12 months of intervention with molecular point-of-care testing, or the reverse sequence. The primary outcome was the proportion of people (aged 16-29 years) found to have C trachomatis or N gonorrhoeae who had a positive result at retesting 3 weeks to 3 months after treatment, and a secondary outcome was treatment within 7 days, both in those aged 16-29 years and at the cluster level. We did these analyses using data from all participants who had a positive result at testing, by point-of-care of laboratory testing (ie, the intention-to-treat population). The trial is registered with Australian and New Zealand Clinical Trials Registry (ACTRN12613000808741). FINDINGS Between June 1, 2013, and Feb 29, 2016, 12 health services were enrolled and randomly assigned to standard care followed by intervention (six) and the reverse sequence (six). After randomisation, one health service that was initially assigned to standard care was excluded because it no longer met the inclusion criteria. 455 individuals tested positive for C trachomatis or N gonorrhoeae infection in the intervention group, and 405 tested positive in the standard care group. In the intervention group, 12 (19%) of 63 individuals retested had a positive test result, compared with nine (13%) of 67 with positive retests in the standard care group (relative ratio [RR] 1·42, 95% CI 0·64-3·13; p=0·405), and 347 (76%) were treated within 7 days in the intervention group, compared with 191 (47%) in the standard care group (RR 1·66, 1·41-1·93; p<0·0001). INTERPRETATION Retesting rates were too low to draw conclusions on the effect of the intervention on repeat infections. Further research will be needed to determine whether point-of-care tests have an effect on reinfection rates, and the sustainability of using this technology. However, our findings show that time to treatment of C trachomatis or N gonorrhoeae infections in primary care clinics in remote areas in Australia with a high prevalence of sexually transmissible infections could be substantially reduced by the use of molecular point-of-care tests. FUNDING The National Health and Medical Research Council, Australia.
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Affiliation(s)
| | - James Ward
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | | | | | | | - Annie Tangey
- The Kirby Institute, UNSW Sydney, NSW, Australia; Ngaanyatjarra Health Service, Alice Springs, NT, Australia
| | - Belinda Hengel
- Apunipima Cape York Health Council, Westcourt, QLD, Australia
| | - Handan Wand
- The Kirby Institute, UNSW Sydney, NSW, Australia
| | - David Whiley
- Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
| | - Sepehr N Tabrizi
- Department of Microbiology, The Royal Women's Hospital and Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, VIC, Australia
| | - Mark Shephard
- International Centre for Point-of-Care Testing, Flinders University, Sturt Campus, Bedford Park, SA, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Carlton, VIC, Australia
| | - Basil Donovan
- The Kirby Institute, UNSW Sydney, NSW, Australia; Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia
| | | | | | - Lisa Maher
- The Kirby Institute, UNSW Sydney, NSW, Australia
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7
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Greene KM, Eitle D, Eitle TM. Developmental Assets and Risky Sexual Behaviors among American Indian Youth. THE JOURNAL OF EARLY ADOLESCENCE 2018; 38:50-73. [PMID: 29290640 PMCID: PMC5744875 DOI: 10.1177/0272431615596427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study examined the relationship between developmental assets during early and mid-adolescence and early adult sexual behaviors among American Indians using a subsample from the National Longitudinal Study of Adolescent Health (N = 465). Grounded in an assets framework, the authors explored the protective role of personal, family, school, and community assets as well as cumulative assets for sexual behaviors including early sexual debut, number of sexual partners, and frequency of condom use. The results indicated that certain assets during early and mid-adolescence, such as self-control, family support, and school attachment were protective for various risky sexual behaviors in early adulthood. Furthermore, cumulative assets emerged as an important predictor of sexual behaviors. These findings highlight the utility of applying a developmental asset framework to understand protective factors among American Indian youth.
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Affiliation(s)
- Kaylin M. Greene
- Please direct all correspondence to Kaylin Greene, Ph.D.; Department of Sociology and Anthropology; Montana State University; 2–128 Wilson Hall; Bozeman, MT 59717 ()
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Benzaken AS, Sabidó M, Brito I, Bermúdez XPD, Benzaken NS, Galbán E, Peeling RW, Mabey D. HIV and syphilis in the context of community vulnerability among indigenous people in the Brazilian Amazon. Int J Equity Health 2017; 16:92. [PMID: 28583173 PMCID: PMC5460420 DOI: 10.1186/s12939-017-0589-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 05/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Contextual factors shape the risk of acquiring human immunodeficiency virus (HIV) and syphilis. We estimated the prevalence of both infections among indigenous people in nine indigenous health districts of the Brazilian Amazon and examined the context of community vulnerability to acquiring these infections. METHODS We trained 509 health care workers to screen sexually active populations in the community for syphilis and HIV using rapid testing (RT). We then assessed the prevalence of HIV and syphilis using RT. A multivariable analysis was used to identify factors associated with syphilis infection (sociodemographic, condom use, intrusion, population mobility, and violence). RESULTS Of the 45,967 indigenous people tested, the mean age was 22.5 years (standard deviation: 9.2), and 56.5% were female. Overall, for HIV, the prevalence was 0.13% (57/43,221), and for syphilis, the prevalence was 1.82% (745/40,934). The prevalence in men, women, and pregnant women for HIV was 0.16%, 0.11%, and 0.07%, respectively, and for syphilis, it was 2.23%, 1.51%, and 1.52%, respectively. The district Vale do Javari had the highest prevalence of both infections (HIV: 3.38%, syphilis: 1.39%). This district also had the highest population mobility and intrusion and the lowest availability of prenatal services. Syphilis infection was independently associated with age (odds ratio [OR] 1.04, 95% confidence interval [CI]: 1.03-1.05), male sex (OR 1.32, 95% CI: 1.14-1.52), and mobility (moderate: OR: 7.46, 95% CI: 2.69-20.67; high: OR 7.09, 95% CI: 3.79-13.26). CONCLUSIONS The large-scale integration of RT in remote areas increased case detection among pregnant women, especially for syphilis, in districts with higher vulnerability. Mobility is an important risk factor, especially in districts with higher vulnerability. Contextually appropriate approaches that address this factor could contribute to the long-term success of HIV and syphilis control programs.
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Affiliation(s)
- Adele Schwartz Benzaken
- Department of STI, AIDS and Viral Hepatitis, Secretary for Health Surveillance, Ministry of Health Brazil, Brasília, DF, Brazil.,Tropical Medicine Foundation Doctor Heitor Vierira Dourado, Manaus, Brazil
| | - Meritxell Sabidó
- Department of STI, AIDS and Viral Hepatitis, Secretary for Health Surveillance, Ministry of Health Brazil, Brasília, DF, Brazil. .,Pan American Health Organization, Brasília, Brazil. .,TransLab. Department of Medical Sciences, Universitat de Girona, Catalonia, Spain. .,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Ivo Brito
- Department of STI, AIDS and Viral Hepatitis, Secretary for Health Surveillance, Ministry of Health Brazil, Brasília, DF, Brazil
| | - Ximena Pamela Díaz Bermúdez
- Pan American Health Organization, Brasília, Brazil.,Departamento de Saúde Coletiva, Universidade de Brasília, Brasília, Brazil
| | | | | | - Rosanna W Peeling
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - David Mabey
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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Gesink D, Whiskeyjack L, Suntjens T, Mihic A, McGilvery P. Abuse of power in relationships and sexual health. CHILD ABUSE & NEGLECT 2016; 58:12-23. [PMID: 27337692 DOI: 10.1016/j.chiabu.2016.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 06/06/2023]
Abstract
STI rates are high for First Nations in Canada and the United States. Our objective was to understand the context, issues, and beliefs around high STI rates from a nêhiyaw (Cree) perspective. Twenty-two in-depth interviews were conducted with 25 community participants between March 1, 2011 and May 15, 2011. Interviews were conducted by community researchers and grounded in the Cree values of relationship, sharing, personal agency and relational accountability. A diverse purposive snowball sample of community members were asked why they thought STI rates were high for the community. The remainder of the interview was unstructured, and supported by the interviewer through probes and sharing in a conversational style. Modified grounded theory was used to analyze the narratives and develop a theory. The main finding from the interviews was that abuse of power in relationships causes physical, mental, emotional and spiritual wounds that disrupt the medicine wheel. Wounded individuals seek medicine to stop suffering and find healing. Many numb suffering by accessing temporary medicines (sex, drugs and alcohol) or permanent medicines (suicide). These medicines increase the risk of STIs. Some seek healing by participating in ceremony and restoring relationships with self, others, Spirit/religion, traditional knowledge and traditional teachings. These medicines decrease the risk of STIs. Younger female participants explained how casual relationships are safer than committed monogamous relationships. Resolving abuse of power in relationships should lead to improvements in STI rates and sexual health.
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Affiliation(s)
- Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, 155 College St., 6th Floor, Toronto, Ontario M5T 3M7, Canada.
| | - Lana Whiskeyjack
- Blue Quills First Nations College, Box 279, St. Paul, Alberta T0A 3A0, Canada.
| | - Terri Suntjens
- Blue Quills First Nations College, Box 279, St. Paul, Alberta T0A 3A0, Canada.
| | - Alanna Mihic
- University of Toronto, 155 College St., Toronto, Ontario M5T 3M7, Canada.
| | - Priscilla McGilvery
- Saddle Lake Health Center, P.O. Box 160, Saddle Lake, Alberta T0A 3T0, Canada.
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Chambers R, Tingey L, Beach A, Barlow A, Rompalo A. Testing the efficacy of a brief sexual risk reduction intervention among high-risk American Indian adults: study protocol for a randomized controlled trial. BMC Public Health 2016; 16:366. [PMID: 27129956 PMCID: PMC4850664 DOI: 10.1186/s12889-016-3040-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/26/2016] [Indexed: 04/17/2023] Open
Abstract
Background American Indian adults are more likely to experience co-occurring mental health and substance use disorders than adults of other racial/ethnic groups and are disproportionately burdened by the most common sexually transmitted infections, namely chlamydia and gonorrhea. Several behavioral interventions are proven efficacious in lowering risk for sexually transmitted infection in various populations and, if adapted to address barriers experienced by American Indian adults who suffer from mental health and substance use problems, may be useful for dissemination in American Indian communities. The proposed study aims to examine the efficacy of an adapted evidence-based intervention to increase condom use and decrease sexual risk-taking and substance use among American Indian adults living in a reservation-based community in the Southwestern United States. Methods/Design The proposed study is a randomized controlled trial to test the efficacy of an adapted evidence-based intervention compared to a control condition. Participants will be American Indian adults ages 18–49 years old who had a recent episode of binge substance use and/or suicide ideation. Participants will be randomized to the intervention, a two-session risk-reduction counseling intervention or the control condition, optimized standard care. All participants will be offered a self-administered sexually transmitted infection test. Participants will complete assessments at baseline, 3 and 6 months follow-up. The primary outcome measure is condom use at last sex. Discussion This is one of the first randomized controlled trials to assess the efficacy of an adapted evidence-based intervention for reducing sexual risk behaviors among AI adults with substance use and mental health problems. If proven successful, there will be an efficacious program for reducing risk behaviors among high-risk adults that can be disseminated in American Indian communities as well as other rural and under-resourced health systems. Trial Registration Clinical Trials NCT02513225
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Affiliation(s)
- Rachel Chambers
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, 415 North Washington Street Suite 400, Baltimore, Maryland, 21224, USA.
| | - Lauren Tingey
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, 415 North Washington Street Suite 400, Baltimore, Maryland, 21224, USA
| | - Anna Beach
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, 415 North Washington Street Suite 400, Baltimore, Maryland, 21224, USA
| | - Allison Barlow
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, 415 North Washington Street Suite 400, Baltimore, Maryland, 21224, USA
| | - Anne Rompalo
- Johns Hopkins School of Medicine, Johns Hopkins University, 415 North Washington Street Suite 400, Baltimore, Maryland, 21224, USA
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Walker FJ, Llata E, Doshani M, Taylor MM, Bertolli J, Weinstock HS, Hall HI. HIV, Chlamydia, Gonorrhea, and Primary and Secondary Syphilis among American Indians and Alaska Natives Within Indian Health Service Areas in the United States, 2007-2010. J Community Health 2016; 40:484-92. [PMID: 25371109 DOI: 10.1007/s10900-014-9961-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
National rates from human immunodeficiency virus (HIV) and sexually transmitted disease (STD) surveillance may not effectively convey the impact of HIV and STDs on American Indian/Alaska Native (AI/AN) communities. Instead, we compared average annual diagnosis rates per 100,000 population of HIV, chlamydia (CT), gonorrhea (GC), and primary and secondary (P&S) syphilis, from 2007 to 2010, among AI/AN aged ≥ 13 years residing in 625 counties in the 12 Indian Health Service Areas, all AI/AN, and all races/ethnicities to address this gap. AI/AN comprised persons reported as AI/AN only, with or without Hispanic ethnicity. Out of 12 IHS Areas, 10 had higher case rates for CT, 3 for GC, and 4 for P&S syphilis compared to rates for all races/ethnicities. Eight Areas had higher HIV diagnosis rates than for all AI/AN, but HIV rates for all IHS Areas were lower than national rates for all races/ethnicities. Two IHS Areas ranking highest in rates of CT and GC and four Areas with highest P&S syphilis also had high HIV rates. STD and HIV rates among AI/AN were greater in certain IHS Areas than expected from observing national rates for AI/AN. Integrated surveillance of overlapping trends in STDs and HIV may be useful in guiding prevention efforts for AI/AN populations.
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Affiliation(s)
- Frances J Walker
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Tingey L, Strom R, Hastings R, Parker A, Barlow A, Rompalo A, Gaydos C. Self-administered sample collection for screening of sexually transmitted infection among reservation-based American Indian youth. Int J STD AIDS 2014; 26:661-6. [PMID: 25228666 DOI: 10.1177/0956462414552139] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 08/25/2014] [Indexed: 11/15/2022]
Abstract
American Indians suffer a disproportionate burden of sexually transmitted infection, particularly adolescents. Screening access barriers in rural and reservation-based communities necessitate alternatives to clinic-based options. Self-administered screening for three sexually transmitted infections was piloted among 32 American Indian adolescents aged 18 to 19. Participants self-collected in a private location; specimens were processed by trained, American Indian paraprofessionals and analysis was conducted by an outside laboratory. Participants testing positive were treated by a Public Health Nurse from the Indian Health Service. Results suggest high overall acceptability: 69% preferred a self-administered method over clinic-based screening, 75% would encourage their friends to use this method and 100% would use it again. A self-administered screening method has the ability to reach this and other high-risk populations that might not otherwise access screening, with added potential within the Indian Health Services system for uptake and dissemination in rural, reservation communities facing significant screening barriers.
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Affiliation(s)
- Lauren Tingey
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel Strom
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ranelda Hastings
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Anthony Parker
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Allison Barlow
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Anne Rompalo
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Charlotte Gaydos
- International Sexually Transmitted Diseases Research Laboratory, Johns Hopkins University, Baltimore, MD, USA
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Taylor MM, Reilley B, Yellowman M, Anderson L, de Ravello L, Tulloch S. Use of expedited partner therapy among chlamydia cases diagnosed at an urban Indian health centre, Arizona. Int J STD AIDS 2013; 24:371-4. [PMID: 23970704 DOI: 10.1177/0956462412472825] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chlamydia cases diagnosed in the women's clinic were more likely to receive expedited partner therapy (EPT) and to be re-tested as compared with urgent and emergent care settings. Fewer re-infections occurred among patients who received EPT. Disproportionate rates of chlamydia occur among American Indian (AI) populations. To describe use of EPT among chlamydia cases diagnosed at an urban Indian Health Service (IHS) facility in Arizona, health records were used to extract confirmed cases of chlamydia diagnosed between January 2009 and August 2011. Medical records of 492 patients diagnosed with chlamydia were reviewed. Among the 472 cases who received treatment, 246 (52%) received EPT. Receipt of EPT was significantly associated with being female (odds ratio (OR) 2.1, 1.03-4.4, P < 0.001) and receipt of care in the women's clinic (OR 9.9, 95% CI 6.0-16.2) or in a primary care clinic (OR 2.4, 95% CI 1.1-5.1). Compared with those receiving care in the women's clinic, the odds of receipt of EPT were significantly less in those attending the urgent/express care clinic (OR 0.1, 95% CI 0.06-0.2), and the emergency department (OR 0.1, 95% CI 0.05-0.2). Among treated patients who underwent re-testing (N = 323, 68% total treated) re-infection was less common among those that received EPT (13% versus 27%; OR 0.5, 95% CI 0.3-0.9). In this IHS facility, EPT was protective in preventing chlamydia re-infection. Opportunities to expand the use of EPT were identified in urgent and emergent care settings.
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Affiliation(s)
- M M Taylor
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA, USA.
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Guy R, Ward JS, Smith KS, Su JY, Huang RL, Tangey A, Skov S, Rumbold A, Silver B, Donovan B, Kaldor JM. The impact of sexually transmissible infection programs in remote Aboriginal communities in Australia: a systematic review. Sex Health 2012; 9:205-12. [DOI: 10.1071/sh11074] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 08/19/2011] [Indexed: 11/23/2022]
Abstract
Objective To systematically review evaluations of the impact of sexually transmissible infection (STI) programs delivered by primary health care services in remote Aboriginal communities. Methods: PubMed, Google Scholar, InfoNet, Cochrane Controlled Trials Register, Australian New Zealand Clinical Trial Registry, conference proceedings and bulletins were searched to April 2011 using variations of the terms ‘Aboriginal’, ‘programs’ and ‘STI’. The primary outcome of interest in the review was the change in bacterial STI infection prevalence in the target age group assessed through cross-sectional screening studies over a 5-year period or more. The characteristics of the primary health care service, STI programs and other clinical service outcomes were also described. Results: Twelve reports described four distinct STI programs in remote communities and their impact on STI prevalence. In the Anangu Pitjantjatjara Yankunytjatjara (APY) lands of northern South Australia, there was a reduction in the age-adjusted chlamydia and gonorrhoea prevalence by 58% and 67%, respectively (1996–2003). In the Tiwi Islands of Northern Territory (NT), chlamydia and gonorrhoea positivity decreased by 94% and 34%, respectively (2002–2005). In the Ngaanyatjarra Lands of Western Australia, crude chlamydia and gonorrhoea prevalence decreased by 36% and 48%, respectively (2001–2005), and in the central Australian region of NT, there was no sustained decline in crude prevalence (2001–2005). Conclusion: In three of the four programs, there was some evidence that clinical best practice and well coordinated sexual health programs can reduce STI prevalence in remote Aboriginal communities.
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Epidemiology of syphilis among Hispanic women and associations with congenital syphilis, Maricopa county, Arizona. Sex Transm Dis 2011; 38:598-602. [PMID: 21317685 DOI: 10.1097/olq.0b013e318210027d] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We investigated factors associated with high rates of congenital syphilis among Hispanic infants in Maricopa County, AZ. METHODS Using 2004-2008 syphilis case report data from the state and county health departments, we examined characteristics of pregnant and nonpregnant women with syphilis and their male partners. RESULTS During 2004-2008, 970 women were reported to have syphilis: 49% were Hispanic (of whom 49% were non-US citizens), 27% were white, 13% were black, and 8% were American Indian/Alaskan Native. Although 16% of Hispanic noncitizens reported drug use or high-risk sexual behaviors, 64% of these women had a male sex partner who reported drug use or anonymous sex. Hispanic women with syphilis were more likely to be pregnant (37%) than white (15%) or black women (13%) (P < 0.05), and were overrepresented among pregnant women with syphilis. Pregnant Hispanic noncitizens were treated later than pregnant Hispanic citizens (median 28 weeks gestation vs. 21 weeks, P = 0.01). CONCLUSIONS Innovative congenital syphilis prevention strategies that are relevant to Hispanic women are warranted. Strategies should address the reproductive health and prenatal care needs of Hispanic women, and may include interventions for their male partners.
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Neghina R, Neghina AM. Epidemiology of syphilis, gonorrhea and chlamydia in Romania, 1980-2009. J Infect 2011; 63:54-9. [PMID: 21641041 DOI: 10.1016/j.jinf.2011.04.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 04/10/2011] [Accepted: 04/21/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aims to analyze the epidemiology of syphilis, gonorrhea and genital chlamydial infections in Romania during 1980-2009 when radical changes occurred during transition from a communist regime to a democratic society. METHODS Surveillance data was retrieved from the National Center for Surveillance and Control of the Communicable Disease in Romania and the World Health Organization. RESULTS The mean annual incidences of syphilis, gonorrhea and genital chlamydia infections in Romania were 25.2 ± 15 cases per 100,000 inhabitants (1980-2009), 33.2 ± 26.6/100,000 (1980-2009) and 0.3 ± 0.4/100,000 (1994-2009), respectively. Although the infection rates for syphilis followed a significant ascending trend over the study period (p < 0.001), they declined dramatically since 2002 (p < 0.001). There was a significant decrease in gonorrhea-affected persons over the study period (p < 0.0001), while genital chlamydia infections registered a general ascending trend (p = 0.02) with insignificant decrease since 2006. CONCLUSIONS The declining trend of syphilis and gonorrhea infections in the general population especially during the last years is very encouraging but should not challenge the amount of resources dedicated to sexually transmitted infections. Consequently, compelling strategies and policies based mainly on education of the population should be put forth in order to advance efficient prevention.
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Affiliation(s)
- Raul Neghina
- Victor Babes University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania.
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Dean HD, Fenton KA. Addressing social determinants of health in the prevention and control of HIV/AIDS, viral hepatitis, sexually transmitted infections, and tuberculosis. Public Health Rep 2010; 125 Suppl 4:1-5. [PMID: 20629250 DOI: 10.1177/00333549101250s401] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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