Evaluating the effectiveness of personal resilience and enrichment programme (PREP) for HIV prevention among female sex workers: a randomised controlled trial

Beaten but not down! Exploring resilience among female sex workers (FSWs) in Nairobi, Kenya

BACKGROUND

In Kenya sex work is illegal and those engaged in the trade are stigmatized and marginalized. We explored how female sex workers in Nairobi, Kenya, utilize different resources to navigate the negative consequences of the work they do.

METHODS

Qualitative data were collected in October 2019 from 40 FSWs who were randomly sampled from 1003 women enrolled in the Maisha Fiti study, a 3-year longitudinal mixed-methods study exploring the relationship between HIV risk and violence and mental health. All interviews were audio-recorded, transcribed and translated. Data were thematically coded and analyzed using Nvivo 12.

RESULTS

Participants' age range was 18-45 years. Before entry into sex work, all but one had at least one child. Providing for the children was expressed as the main reason the women joined sex work. All the women grew up in adverse circumstances such as poor financial backgrounds and some reported sexual and physical abuse as children. They also continued to experience adversity in their adulthood including intimate partner violence as well as violence at the workplace. All the participants were noted to have utilised the resources they have to build resilience and cope with these adversities while remaining hopeful for the future. Motherhood was mentioned by most as the reason they have remained resilient. Coming together in groups and engaging with HIV prevention and treatment services were noted as important factors too in building resilience.

CONCLUSION

Despite the adverse experiences throughout the lives of FSWs, resilience was a key theme that emerged from this study. A holistic approach is needed in addressing the health needs of female sex workers. Encouraging FSWs to come together and advocating together for their needs is a key resource from which resilience and forbearance can grow. Upstream prevention through strengthening of education systems and supporting girls to stay in school and complete their secondary and/or tertiary education would help them gain training and skills, providing them with options for income generation during their adult lives.

Barriers and Facilitators to Promoting Resilience to HIV/AIDS: A Qualitative Study on the Lived Experiences of HIV-Positive, Racial and Ethnic Minority, Middle-Aged and Older Men Who Have Sex with Men from Ontario, Canada

Evidence-based research has highlighted the need for exploring factors that support the mental health of men who have sex with men living with HIV/AIDS (MSMLWH), and environmental influences that promote their resilience to HIV/AIDS. This exploratory study utilized a community-based participatory research approach to investigate barriers and facilitators to promoting resilience to HIV/AIDS, specifically among racial and ethnic minority, middle-aged and older MSMLWH, a population that continues to be significantly impacted by HIV/AIDS today. This collaborative, qualitative study recruited participants who identified as racial or ethnic minority MSMLWH, were aged 40 or older, and resided in Ontario, Canada. Participants (n = 24) discussed in their interviews barriers and facilitators to promoting resilience to HIV/AIDS, which they recognized from their lived experiences. Utilizing thematic analysis, themes related to barriers and facilitators to promoting resilience to HIV/AIDS were identified. Themes related to identified barriers included: (1) language proficiency, (2) racism, (3) pernicious norms in North American gay culture, and (4) HIV stigma. Themes related to identified facilitators included: (1) compartmentalization, (2) perseverance, and (3) community-based health and social services. This article discusses the implications of the study’s findings, particularly on how they may influence the development of future services for racial and ethnic minority, middle-aged and older MSMLWH.

Curing or causing? HIV/AIDS in health care system of Punjab, Pakistan

Background

Pakistan’s National AIDS Control Program has registered 44,000 HIV/AIDS patients to date, but the actual number of cases have been estimated to be as high as 150,000–170,000. The health care system has a very important role to play in this equation and must be reformed to improve the health care services in Pakistan, with regards to HIV/AIDS.

Methods

It was a qualitative research employing a phenomenological approach. The principal researcher visited nine public and private health care facilities and conducted 19 key informant interviews with people working for providing preventive and curative services, in addition to the observations made on the site.

Results

Pakistan’s health system has a limited capacity to address the HIV spread in the country, with its current resources. There is an obvious scarcity of resources at the preventive, diagnostic and curative level. However, menace can be curtailed through measures taken at the service delivery level by checking the unsafe needles practices, unclean surgical procedures and an unregulated and untrained private health workforce which are dangerous potentials routes of transmission of the virus to the general population. Healthcare establishments carry the chances of nosocomial infections including HIV/AIDS. Poverty, illiteracy and stigma associated with the disease is compounding the overall situation.

Conclusion

Improved accessibility to service delivery with a greater focus on prevention would be imperative to address the threat of HIV/AIDS in Pakistan. A health systems approach would help in identifying gaps at both strategic and operational levels, and concurrently find and implement solutions.

Strength-based interventions for HIV prevention and sexual risk reduction among girls and young women: A resilience-focused systematic review

Despite significant public health efforts, girls and young women still face gender-specific barriers to achieving optimal physical and mental health. Public health interventions have historically addressed the health needs of girls and young women using risk-focused, or deficit-based, approaches. Emerging research in public health and prevention provides an alternative approach, focusing instead on strengths and resilience. However, evidence remains limited regarding strength-based interventions to improve health outcomes for young women, including outcomes within the critically important areas of sexual and reproductive health. To address this gap in evidence, this review analyses the evidence base for intervention research using a strength-based resilience-focused approach to reduce HIV and sexual risk for girls and young women globally. A systematic search of published literature identified 35 articles, representing 25 unique interventions (N = 25). These interventions employed in-person, and other engaging methods, to deliver intervention content aimed at fostering resilience and changing sexual risk behaviours. Results also highlight gaps in measurement and study design, as well as variation in geographic setting and level of behaviour change. This review draws attention to the potential growth of strength-based intervention research, and offers future directions for developing and expanding research on resilience as an urgent global public health priority.

Evaluation and mechanism analysis of HIV prevention programme using resilience framework among female sex workers: A randomised controlled trial

BACKGROUND

Evidence shows traditional sexual harm reduction for female sex workers (FSW) based on health behaviour theories is effective but short-lived. This study aimed to evaluate and understand the effectiveness of a resilience-promoting programme in improving psychological health and, ultimately, safe sex practice.

METHODS

A randomised controlled trial was conducted at three Hong Kong-based non-governmental organisations. 127 sex workers were recruited and randomly assigned to the intervention or control groups. The former received a six-session resilience-promoting programme designed to improve self-esteem, self-efficacy and coping skills, whereas the latter had the usual care. Between-group differences in psychological outcomes and condom use were tested using the intention-to-treat, with ANOVA and chi-square tests, measured at baseline, post-intervention and 3-month follow-ups. Multiple mediation analysis was used to examine how the intervention worked through resilience factors.

RESULTS

Significant between-group improvements in adaptive coping (F 1,119 = 5.82, p < .05) and reduction in psychological distress (F 1,118 = 5.00, p < .05) were seen at post-intervention and 3-month follow-ups, with significant time × group interaction changes suggesting the changes occurred at different rates between the two groups. Condom use during the last transactions had increased in the intervention group and the rate of consistent condom use during transactions improved in the intervention group at follow-ups (χ 2 = 4.35, p < .05). Self-esteem and resilience significantly mediated the effect of intervention at reducing psychological distress.

CONCLUSIONS

These findings suggest that resilience improves the psychological health and general wellbeing of Chinese FSWs.

Analysis of resilience and sexual behavior in persons with HIV infection

The main objective of this study was to evaluate ex post facto resilience in persons with HIV infection and its relationship to socio-demographic and sexual behavior variables. Participants included 159 persons with HIV infection, of both sexes, aged between 19 and 55 years. Fifty-one percent of patients were infected through homosexual means. Sixty-seven percent were in the asymptomatic phase of infection. Assessment instruments used were the following: a questionnaire on socio-demographic data and sexual behavior and the Connor-Davidson Resilience Scale. The evaluation was individual, voluntary, and anonymous. The results showed that 49.05% of patients had average resilience, 27.68% had high resilience, and 23.37% had low resilience. They found that heterosexual patients infected with HIV, diagnosed between 1985 and 1990 (23 and 28 years of diagnosis) and those who had disclosed their HIV status to more than 30 people, had greater resilience than homosexual patients, diagnosed between 1996 and 2000 (13 and 17 years of diagnosis) and those who had disclosed their HIV status to 1–5 people. Finally, resilience was not a predictor of sexual risk factor. It is suggested that health interventions take into account the resilience and psychological variables that may be beneficial to improve coping with the disease.

Assessing health-related resiliency in HIV+ Latin women: Preliminary psychometric findings

BACKGROUND

HIV-associated vulnerabilities-especially those linked to psychological issues-and limited mental health-treatment resources have the potential to adversely affect the health statuses of individuals. The concept of resilience has been introduced in the literature to shift the emphasis from vulnerability to protective factors. Resilience, however, is an evolving construct and is measured in various ways, though rarely among underserved, minority populations. Herein, we present the preliminary psychometric properties of a sample of HIV-seropositive Puerto Rican women, measured using a newly developed health-related resilience scale.

METHODS AND DESIGN

The Resilience Scales for Children and Adolescents, an instrument with solid test construction properties, acted as a model in the development (in both English and Spanish) of the HRRS, providing the same dimensions and most of the same subscales. The present sample was nested within the Hispanic-Latino longitudinal cohort of women (HLLC), that is part of the NeuroAIDS Research Program at the University of Puerto Rico (UPR), Medical Sciences Campus (MSC). Forty-five consecutively recruited, HIV+ women from the HLLC completed a demographic survey, the HRRS, and the Beck Depression Inventory-I, Spanish version.

RESULTS

The results demonstrate excellent overall internal consistency for the total HRRS score (α = 0.95). Each of the dimensional scores also evidenced acceptable internal consistency (α ≥ 0.88). All the dimensional and subscale content validity indices were above the 0.42 cut-off. Analysis revealed a significant negative correlation between the HRRS total score and BDI-I-S (r(45) = -0.453, p < 0.003).

CONCLUSION

Albeit preliminary in nature, the present study provides support for the HRRS as a measure to assess resilience among individuals living with chronic medical conditions. Minority populations, especially non-English speaking ones, are understudied across the field of medicine, and when efforts are made to include these patient groups, measurement is rarely tailored to their unique cultural and linguistic experiences. The HRRS is a measure that addresses these notable voids in the medical literature.

Mental health of African asylum-seekers and refugees in Hong Kong: using the social determinants of health framework

Background

Hong Kong is non-signatory to the 1951 Refugee Convention and its 1967 Protocol, and has no systematic domestic policies committed to the rights of asylum-seekers and refugees (ASRs). This creates a tenuous setting for African ASRs there. This study explored how mapped social determinates of health has impacted the mental health and wellbeing of African ASR’s in Hong Kong.

Methods

A cross-sectional survey was carried out with 374 African ASRs. The survey comprised of: (a) socio-demographics; (b) health status; (c) health behaviours; and, (d) social experiences. Associations between social determinants of health and depression screen were explored and multivariable regression analysis was conducted.

Results

Majority of participants were 18–37 years old (79.7%), male (77.2%), single (66.4%) and educated (60.9% high school and above). Over a third (36.1%) screened positive for depression. Analyses revealed that living with family reduced the odds of a positive depression screen (OR = 0.25, 95%CI = 0.07–0.88). Those perceiving their health to be “Poor” were 5.78 times as likely to be screened for depression. Additionally, those with higher scores on the discrimination scale were more likely to have positive depression screen (OR = 1.17, 95%CI = 1.10–1.24).

Conclusion

A significant proportion of African ASRs in Hong Kong exhibits depressive symptoms. A complex interaction combining both social and perceptions of health and discrimination in the host society is likely exacerbated by their ASR status. The use of community support groups or even re-examination of the family reunification laws could improve the mental health and wellbeing of African ASRs in Hong Kong.

Violence against female sex workers in Cameroon: accounts of violence, harm reduction, and potential solutions

BACKGROUND

Female sex workers (FSWs) in Cameroon, and West Africa generally, suffer a disproportionate burden of HIV. Although violence against FSWs has been documented extensively in other parts of the world, data on violence from West African countries are lacking. The aim of this study was to qualitatively document violence and harm reduction strategies from the perspective of FSWs in Cameroon as well as to understand how experiences of violence may increase FSWs' HIV risk.

METHODS

FSWs from 7 major cities in Cameroon (Douala, Yaounde, Bamenda, Bertoua, Nagoundere, Kribi, and Bafoussam) were purposively recruited. Data from 31 in-depth interviews and 7 focus groups (n = 70; with some overlapping participants from in-depth interviews) conducted with these FSWs in 6 of these 7 cities (excluding Kribi) were analyzed using a grounded theory approach.

RESULTS

Transcripts revealed 3 primary themes related to violence: (1) sources and types of violence, including sexual, physical, and financial violence perpetrated by clients and police, (2) harm reduction strategies, including screening clients and safe work locations, receipt of payment before sexual act, and formation of an informal security network, and (3) recommendations on structural changes to reduce violence that emphasized sex work decriminalization and increased police accountability.

CONCLUSIONS

As in other parts of the world, violence against FSWs is pervasive in Cameroon. Interventions targeting violence and HIV must address the forms of violence cited locally by FSWs and can build on FSWs' existing strengths and harm reduction strategies. Structural changes are needed to ensure access to justice for this population.

Risk and Protective Factors Associated with Personal Mastery Among Sexual Minority African American Female Sex Workers

Research among sexual minorities has traditionally examined problems such as substance use, HIV risk, mental health problems, and victimization. Among sexual minority street-based female sex workers, these vulnerabilities can be magnified. Grounded in theories of resilience, this study examines risk and protective factors associated with a high level of personal mastery among a vulnerable population of women. Data are drawn from baseline interviews from street-based African American female sex workers enrolled in a randomized intervention trial in Miami, Florida. We compare sexual minority (N=197) and heterosexual (N=365) women on measures of risk and protective factors; among sexual minority women we present logistic regression analyses which reveal that severe mental distress and HIV transmission risk are associated with low levels of personal mastery, while protective factors of transportation access and social support are associated with high levels of personal mastery. These findings suggest that these protective factors may potentially facilitate the development of personal mastery and represent beneficial avenues for intervention efforts.