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Nearchou F, Flinn C, Mc Laughlin D, Niland R. Sexual health behaviours and partner notification practices related to sexually transmitted infections in young adults in Ireland. Ir J Med Sci 2024; 193:2079-2089. [PMID: 38517599 PMCID: PMC11294371 DOI: 10.1007/s11845-024-03668-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 03/13/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Sexually transmitted infections (STIs) impose burdens on individuals and communities, while their prevalence in young people has risen continually in recent years. Partner notification is an effective public health strategy which can limit STI transmission. AIMS This study aimed to explore young adults' sexual health behaviours, attitudes toward STI testing, and feelings toward visiting a sexual health clinic. It also aimed to investigate preferences for partner notification and the role of self-efficacy in people's intentions to notify a partner for STIs including the human immunodeficiency virus (HIV). METHODS A quantitative, cross-sectional design was applied. Participants were 400 adults aged 18-34 years (M = 23 years; SD = 4.27), recruited from the Republic of Ireland. RESULTS Over half of the participants reported never being tested for STIs. These young people placed less importance on undergoing regular STI testing and testing after unprotected sex than their counterparts who had been tested for STIs. Self-efficacy was significantly associated with intentions to notify partner(s) for STIs including HIV. CONCLUSIONS As STIs are becoming increasingly prevalent in young adults, it is important to gain a deeper understanding of the interventions used to break the transmission chain and how different beliefs and attitudes may affect them. Self-efficacy was a key component in PN intentions, suggesting that the belief in someone's ability or skillset to perform a sexual health behaviour is positively related to their intention to perform the behaviour.
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Affiliation(s)
- Finiki Nearchou
- School of Psychology, Newman Building, University College Dublin, Belfield Campus, Dublin 4, Dublin, Ireland.
| | - Clodagh Flinn
- School of Psychology, Newman Building, University College Dublin, Belfield Campus, Dublin 4, Dublin, Ireland
| | - Diarmuid Mc Laughlin
- School of Psychology, Newman Building, University College Dublin, Belfield Campus, Dublin 4, Dublin, Ireland
| | - Rachel Niland
- School of Psychology, Newman Building, University College Dublin, Belfield Campus, Dublin 4, Dublin, Ireland
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Xie Z, Duan Z. Balancing public health and privacy rights: a mixed-methods study on disclosure obligations of people living with HIV to their partners in China. Harm Reduct J 2024; 21:30. [PMID: 38311762 PMCID: PMC10840163 DOI: 10.1186/s12954-023-00920-9] [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] [Received: 11/09/2023] [Accepted: 12/24/2023] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND In 2021, a Chinese court, based on the newly enacted Civil Code, first revoked a marriage license due to the spouse's failure to disclose their HIV infection before the marriage. This landmark case ignited a fresh debate on whether people living with HIV (PLHIV) have a legal duty to inform their spouses and sexual partners. Advances in medicine have partially isolated HIV transmission from sexual contact, extending the legal basis for the obligation to disclose beyond disease prevention. This study investigates some possibly unforeseen challenges for PLHIV in China to fulfill this duty, and the outcomes of their decisions in light of the government's goal to promote health. METHODS This study aims to provide a detailed examination of the legal provisions and practices concerning partner notification among PLHIV in China. A mixed-methods research approach was employed between 2019 and 2020, combining questionnaire surveys, in-depth interviews, and participatory observations. A total of 433 valid responses were obtained through a questionnaire posted on a Chinese online platform for PLHIV. Following the collection and random coding of the questionnaire data, 40 individuals living with HIV were selected for in-depth interviews. Subsequently, a six-month field investigation was conducted in Guan ai jia yuan (Caring Home) in Jinhua City to further explore this issue. RESULTS A considerable proportion of PLHIV exhibit a high rate of disclosure to their spouses (nearly 80%). In the context of sexual partners, 56% of PLHIV stated that their sexual partners were aware of their HIV infection. Whether married PLHIV disclosing to their spouses or unmarried/divorced PLHIV disclosing to sexual partners, however, a substantial majority expressed apprehension about the potential disruption to their relationships that the disclosure might cause. The sole exception was observed among married PLHIV in extramarital relationships who demonstrated a slightly diminished level of concern in this context. Reasons for non-disclosure predominantly included undetectable viral load and the adoption of protective measures. DISCUSSION This study reveals that a prevailing "HIV stigma" hinders PLHIV from voluntarily fulfilling the disclosure duties bestowed by Article 38 of the Regulations on the Prevention and Control of HIV/AIDS, and the unclear legal provisions of the new Civil Code play a significant role in this regard. Addressing this issue necessitates not only increasing societal tolerance toward PLHIV and reducing instances of social exclusion but also shifting the legal basis of disclosure duties from disease prevention to rights and obligations within the legal relationships of the parties involved. When it comes to the recipients of disclosure, for instance, it is crucial to differentiate between spouses and sexual partners. As for PLHIV failing to fulfill their disclosure duties, apart from interventions involving indirect notifications, the addition of further legal responsibilities may not be advisable. Intentional transmission actions, on the other hand, should still be subject to severe penalties. CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
- Ziyi Xie
- Macao Polytechnic University, Faculty of Humanities and Social Science, Macao, China
| | - Zhizhuang Duan
- Zhejiang Normal University, Xingzhi College, Jinhua, China.
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Ihnatiuk AP, Shapoval AY, Kazanzhy AP, Kuzin IV, Riabokon SV, Shotorbani S, McDowell MR, Golden MR, Puttkammer NH. Distinctive model for HIV index testing (IT) in Eastern Europe: results of Ukraine's physician-led, integrated IT programme. BMJ Open 2023; 13:e070542. [PMID: 37730414 PMCID: PMC10514626 DOI: 10.1136/bmjopen-2022-070542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 08/30/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVES The effectiveness of HIV index testing (IT) in Eastern Europe has not been described. This study reports the performance of a scaled IT programme in Ukraine. DESIGN This observational study included clients enrolled in IT services in 2020, and used routinely collected data from programme registers and the national electronic health record system. SETTING The study covered 39 public-sector health facilities where IT services were integrated into medical visits for persons living with HIV (PLHIV) already enrolled in HIV care. PARTICIPANTS Participants included PLHIV with both recent (<6 months) and previously established (≥6 months) HIV diagnoses. INTERVENTION Ukraine's physician-led IT model involves a cascade of steps including voluntary informed consent, partner elicitation, selection of partner notification method and follow-up with clients to ensure partners are notified, tested for HIV and linked to HIV prevention and treatment services, as needed. PRIMARY AND SECONDARY OUTCOME MEASURES Outcomes included contact index, testing, index and HIV case-finding index disaggregated by index client (IC) subgroups, including people with current or past injection drug use (PWID) and men who have sex with men (MSM). RESULTS Of 14 525 ICs offered index testing, 51.9% accepted, of whom 98.3% named at least one sexual, injection or biological child partner. In total, 14.9% of ICs were PWID and 3.5% were MSM. Clients named 8448 unique partners (contact index=1.14). HIV case finding averaged 0.14 cases per client, and was highest among clients with recent HIV diagnosis (0.29) and among PWID (0.23), and lower among clients with established HIV diagnosis (0.07). More than 90% of all partners with new HIV diagnoses were linked to care. CONCLUSIONS There was a high case-finding index among ICs with recent HIV and high linkage to care for all partners, demonstrating the effectiveness of this integrated, physician-led model implemented in 39 health facilities in Ukraine.
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Affiliation(s)
- Alyona P Ihnatiuk
- International Training and Education Center for Health (I-TECH), Kyiv, Ukraine
| | - Anna Y Shapoval
- International Training and Education Center for Health (I-TECH), Kyiv, Ukraine
| | - Anna P Kazanzhy
- International Training and Education Center for Health (I-TECH), Kyiv, Ukraine
| | - Igor V Kuzin
- Public Health Center, Ministry of Health of Ukraine, Kiiv, Ukraine
| | | | - Solmaz Shotorbani
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Misti R McDowell
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Matthew R Golden
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, Washington, USA
- HIV/STD Control Program, Public Health, Seattle & King County, Seattle, Washington, USA
| | - Nancy H Puttkammer
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, Washington, USA
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Puttkammer N, Ihnatiuk A, Shapoval A, Kazanzhy A, Secor A, Shotorbani S, McDowell M, Golden M. Profile of partners who completed HIV testing and received a new HIV diagnosis in Ukraine's HIV index testing program: a retrospective cohort study to inform program improvement. BMC Infect Dis 2023; 23:291. [PMID: 37147618 PMCID: PMC10161989 DOI: 10.1186/s12879-023-08281-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 04/26/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Approximately one-third of people living with HIV in Ukraine are unaware of their HIV status. Index testing (IT) is an evidence-based HIV testing strategy that supports voluntary notification of partners with HIV risk, so they can receive HIV testing, prevention, and treatment services. METHODS Ukraine scaled up IT services in 2019. This observational study of Ukraine's IT program covered 39 health facilities located in 11 regions with high HIV burden. The study used routine program data from January-December 2020 to describe the profile of named partners and explore index client (IC) and partner factors associated with two outcomes: 1) completing testing; and 2) HIV case finding. Analysis used descriptive statistics and multilevel linear mixed regression models. RESULTS The study included 8,448 named partners, of whom 6,959 had unknown HIV status. Among them,72.2% completed HIV testing and 19.4% of those tested were newly diagnosed with HIV. Two-thirds of all new cases were among partners of ICs who were recently diagnosed and enrolled in care (< 6 months), while one third were among partners of established ICs. In adjusted analysis, partners of ICs with unsuppressed HIV viral load (VL) were less likely to complete HIV testing (adjusted odds ratio [aOR] = 0.11, p < 0.001), but more likely to receive a new HIV diagnosis (aOR = 1.92, p < 0.001). Partners of ICs who cited injection drug use or having a known HIV + partner as their own reason for testing were more likely to receive a new HIV diagnosis (aOR = 1.32, p = 0.04 and aOR = 1.71, p < 0.001 respectively). Involving providers in the partner notification process was associated with completed testing (aOR = 1.76, p = 0.001) and HIV case finding (aOR = 1.64, p < 0.01), compared with notification by ICs. CONCLUSION HIV case detection was highest among partners of recently diagnosed ICs, but IT participation among established ICs still yielded an important share of all newly-identified HIV cases. Areas for improvement in Ukraine's IT program include completing testing for partners of ICs with unsuppressed HIV VL, with history of injection drug use or discordant partnerships. Using intensified follow-up for the sub-groups at risk of incomplete testing may be practical. Greater use of provider-assisted notification could also accelerate HIV case finding.
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Affiliation(s)
- Nancy Puttkammer
- Department of Global Health, International Training and Education Center for Health (I-TECH), University of Washington, 325 Ninth Ave, Box # 359932, Seattle, WA, 98104, USA.
| | - Alyona Ihnatiuk
- International Training and Education Center for Health (I-TECH), 29 Obolonska St., Office 506, Kiev, 04071, Ukraine
| | - Anna Shapoval
- International Training and Education Center for Health (I-TECH), 29 Obolonska St., Office 506, Kiev, 04071, Ukraine
| | - Anna Kazanzhy
- International Training and Education Center for Health (I-TECH), 29 Obolonska St., Office 506, Kiev, 04071, Ukraine
| | - Andrew Secor
- Department of Global Health, University of Washington, 325 Ninth Ave, Box # 359932, Seattle, WA, 98104, USA
| | - Solmaz Shotorbani
- Department of Global Health, International Training and Education Center for Health (I-TECH), University of Washington, 325 Ninth Ave, Box # 359932, Seattle, WA, 98104, USA
| | - Misti McDowell
- Department of Global Health, International Training and Education Center for Health (I-TECH), University of Washington, 325 Ninth Ave, Box # 359932, Seattle, WA, 98104, USA
| | - Matthew Golden
- Department of Global Health, International Training and Education Center for Health (I-TECH), University of Washington, 325 Ninth Ave, Box # 359932, Seattle, WA, 98104, USA
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Golden MR, AugsJoost B, Bender M, Brady KA, Collins LS, Dombrowski JD, Ealey J, Garcia C, George D, Gilliard B, Harris T, Johnson C, Khosropour CM, Rumanes SF, Surita K, Tabidze I, Udeagu CCN, Walker-Baban C, Cramer NO. The Organization, Content, and Case-Finding Effectiveness of HIV Assisted Partner Services in High HIV Morbidity Areas of the United States. J Acquir Immune Defic Syndr 2022; 89:498-504. [PMID: 34974472 DOI: 10.1097/qai.0000000000002904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The contemporary effectiveness of assisted partner notification services (APS) in the United States is uncertain. SETTING State and local jurisdictions in the United States that reported ≥300 new HIV diagnoses in 2018 and were participating in the Ending the Epidemic Initiative. METHODS The study surveyed health departments to collect data on the content and organization of APS and aggregate data on APS outcomes for 2019. Analyses defined contact and case-finding indices (i.e., sex partners named and newly diagnosed per index case receiving APS) and estimated staff case-finding productivity. RESULTS Sixteen (84%) of 19 jurisdictions responded to the survey, providing APS outcome data for 14 areas (74%). Most health departments routinely integrated APS with linkage of cases and partners to HIV care (88%) and pre-exposure prophylaxis (88%). A total of 19,164 persons were newly diagnosed with HIV in the 14 areas. Staff initiated APS investigations on 14,203 cases (74%) and provided APS to 9937 cases (52%). Cases named 6799 partners (contact index = 0.68), of whom 1841 (27%) had previously diagnosed HIV, 2202 (32%) tested HIV negative, 541 (8% of named and 20% of tested partners) were newly diagnosed with HIV, and 2215 (33%) were not known to have tested. Across jurisdictions, the case-finding index was 0.054 (median = 0.05, range 0.015-0.12). Health departments employed 292 full-time equivalent staff to provide APS. These staff identified a median of 2.0 new HIV infections per staff per year. APS accounted for 2.8% of new diagnoses in 2019. CONCLUSIONS HIV case-finding resulting from APS in the United States is low.
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Affiliation(s)
- Matthew R Golden
- Center for AIDS and STD
- Division of Allergy and Infectious Diseases
- Department of Epidemiology, University of Washington
- Public Health-Seattle and King County, Seattle, WA
| | | | | | | | - Lyell S Collins
- Nevada Division of Public and Behavioral Health, Las Vegas, NV
| | - Julia D Dombrowski
- Center for AIDS and STD
- Division of Allergy and Infectious Diseases
- Department of Epidemiology, University of Washington
- Public Health-Seattle and King County, Seattle, WA
| | - Jamila Ealey
- Georgia Department of Public Health, Atlanta, GA
| | | | - Dan George
- Florida Department of Health, Tallahassee, FL
| | - Bernard Gilliard
- South Carolina Department of Health and Environmental Control, Columbia, SC
| | | | | | - Christine M Khosropour
- Center for AIDS and STD
- Department of Epidemiology, University of Washington
- Public Health-Seattle and King County, Seattle, WA
| | - Sophia F Rumanes
- County of Los Angeles, Department of Public Health Division of HIV and STD Programs, Los Angeles, CA
| | - Karen Surita
- HIV/STD Prevention and Care Unit, Texas Department of State Health Services, Austin, TX
| | | | - Chi-Chi N Udeagu
- Bureau of Hepatitis, HIV and STIs, Division of Disease Control, New York City Department of Health and Mental Hygiene, New York, NY
| | - Cherie Walker-Baban
- STD Control Program, Philadelphia Department of Public Health, Philadelphia, PA; and
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