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Mellini L, Poglia Mileti F, Tadorian M. Migrants facing intersectional vulnerability to HIV and AIDS in Switzerland: an exploratory study. CULTURE, HEALTH & SEXUALITY 2024:1-15. [PMID: 38415354 DOI: 10.1080/13691058.2024.2319335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
An emerging body of evidence suggests that a significant number of HIV-positive migrants to Europe acquire HIV after arriving in their host country. There is an urgent need to rethink HIV and AIDS prevention for migrant populations and to acknowledge the specific vulnerability to HIV and AIDS that migrants face. This article uses empirical data collected in a qualitative sociological study conducted in Switzerland. We provide evidence for the heuristic value of articulating an intersectional approach within a multilevel (biographical, interactional and contextual) framework to capture the complexity of the vulnerability to HIV and AIDS. We show that migrants' specific vulnerability to HIV and AIDS results from social vulnerabilities related to many social and cultural dimensions, including migration status, socioeconomic conditions, gender and sexual identity, sexual norms, the relational context in which sex occurs, power relations and sociocultural structures of the receiving country. The three case studies presented illustrate how HIV-related processes of intersectional vulnerability are embedded in sexism, cisgenderism, and racism, and how they are closely linked to social inequalities in health. Effective HIV and AIDS prevention for migrants must take greater account of these power relations and sociocultural structures.
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Affiliation(s)
- Laura Mellini
- Department of Social Sciences, University of Fribourg, Fribourg, Switzerland
| | | | - Marc Tadorian
- School of Social Work, University of Applied Sciences, Fribourg, Switzerland
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Scaramutti C, Hervera B, Rivera Y, Chueng TA, Forrest DW, Suarez E, Serota DP, Alkamli H, Ciraldo K, Bartholomew TS, Tookes HE. Improving access to HIV care among people who inject drugs through tele-harm reduction: a qualitative analysis of perceived discrimination and stigma. Harm Reduct J 2024; 21:50. [PMID: 38396017 PMCID: PMC10893685 DOI: 10.1186/s12954-024-00961-8] [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: 05/04/2023] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Tele-harm reduction (THR) is a telehealth-enhanced, peer-led, harm reduction intervention delivered within a trusted syringe services program (SSP) venue. The primary goal of THR is to facilitate linkage to care and rapid, enduring virologic suppression among people who inject drugs (PWID) with HIV. An SSP in Miami, Florida, developed THR to circumvent pervasive stigma within the traditional healthcare system. METHODS During intervention development, we conducted in-depth interviews with PWID with HIV (n = 25) to identify barriers and facilitators to care via THR. We employed a general inductive approach to transcripts guided by iterative readings of the raw data to derive the concepts, themes, and interpretations of the THR intervention. RESULTS Of the 25 PWID interviewed, 15 were in HIV care and adherent to medication; 4 were in HIV care but non-adherent; and 6 were not in care. Themes that emerged from the qualitative analysis included the trust and confidence PWID have with SSP clinicians as opposed to professionals within the traditional healthcare system. Several barriers to treatment were reported among PWID, including perceived and actual discrimination by friends and family, negative internalized behaviors, denial of HIV status, and fear of engaging in care. Facilitators to HIV care included empathy and respect by SSP staff, flexibility of telehealth location, and an overall destigmatizing approach. CONCLUSION PWID identified barriers and facilitators to receipt of HIV care through the THR intervention. Interviews helped inform THR intervention development, centered on PWID in the destigmatizing environment of an SSP.
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Affiliation(s)
- Carolina Scaramutti
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Belén Hervera
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yanexy Rivera
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Teresa A Chueng
- 2Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David W Forrest
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Edward Suarez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David P Serota
- 2Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hatoun Alkamli
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Katrina Ciraldo
- Department of Family and Community Medicine & Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tyler S Bartholomew
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hansel E Tookes
- 2Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Barr E, Popkin R, Roodzant E, Jaworski B, Temkin SM. Gender as a social and structural variable: research perspectives from the National Institutes of Health (NIH). Transl Behav Med 2024; 14:13-22. [PMID: 37074158 DOI: 10.1093/tbm/ibad014] [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: 04/20/2023] Open
Abstract
Gender is a social and structural variable that encompasses multiple domains, each of which influences health: gender identity and expression, gender roles and norms, gendered power relations, and gender equality and equity. As such, gender has far-reaching impacts on health. Additional research is needed to continue delineating and untangling the effects of gender from the effects of sex and other biological variables. The National Institutes of Health (NIH) vision for women's health is a world in which the influence of sex and/or gender are integrated into the health research enterprise. However, much of the NIH-supported research on gender and health has, to date, been limited to a small number of conditions (e.g., HIV, mental health, pregnancy) and locations (e.g., sub-Saharan Africa; India). Opportunities exist to support transdisciplinary knowledge transfer and interdisciplinary knowledge building by advancing health-related social science research that incorporates best practices from disciplines that have well-established methods, theories, and frameworks for examining the health impacts of gender and other social, cultural, and structural variables.
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Affiliation(s)
- Elizabeth Barr
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, USA
| | - Ronna Popkin
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Population Dynamics Branch, National Institutes of Health, Bethesda, MD, USA
| | - Erik Roodzant
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, USA
- Booz Allen Hamilton, McLean, VA, USA
| | - Beth Jaworski
- Office of Behavioral and Social Sciences Research, National Institutes of Health, USA
- Booz Allen Hamilton, McLean, VA, USA
| | - Sarah M Temkin
- Office of Research on Women's Health, National Institutes of Health, USA
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Huang AK, Nguyen M, German D, Alexander K, Charlton BM, Glick JL. Health Care Utilization and Care-seeking Behavior Among Vulnerabilized Sexual Minority Women: A Social-ecological Approach. J Health Care Poor Underserved 2024; 35:583-604. [PMID: 38828583 PMCID: PMC11250469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Sexual minority women (SMW) experience worse health than their heterosexual counterparts but have largely been omitted from health services research. To address this gap, we conducted 25 semi-structured, in-depth interviews with SMW. Transcripts were analyzed using thematic analysis, and findings were organized using a modified socioecological framework. Key themes at each socioecological level include (1) structural: stigma, sociocultural norms, health infrastructure; (2) organizational: stigma, patient-provider relationship, hours and location, linkage to care and co-location of services; (3) interpersonal: stigma and social support; (4) individual: internalized stigma, self-efficacy, socioeconomic status, health literacy, and intersecting identities. Stigma is the central theme affecting vulnerabilized SMW's experiences accessing care. Anti-stigma initiatives and factors that lead to personal resilience and can mitigate care access barriers were identified at each level. Interventions should focus on building inclusive policies/infrastructure and using SMW's unique social networks to empower and improve care access and health outcomes among vulnerabilized SMW.
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Porsch LM, Xu M, Veldhuis CB, Bochicchio LA, Zollweg SS, Hughes TL. Intimate Partner Violence Among Sexual Minority Women: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:3014-3036. [PMID: 36154756 PMCID: PMC10039964 DOI: 10.1177/15248380221122815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Intimate partner violence (IPV) is prevalent among sexual minority women (SMW). However, compared to IPV research with heterosexual women and other LGBTQ+ population groups, SMW are understudied. We conducted a scoping review to examine the current state of knowledge about IPV among SMW, and to identify gaps and directions for future research. A search of Medline, Embase, CINAHL, and PsycINFO databases returned 1,807 papers published between January 2000 and December 2021. After independent reviewers screened these papers for relevance, 99 were included in the final review. Papers were included if they used quantitative methods and reported IPV data on adult SMW separately from other groups. Findings confirmed high rates of IPV among SMW and highlighted groups with particular vulnerabilities, including non-monosexual women and SMW of color. Risk factors for IPV in this population include prior trauma and victimization, psychological and emotional concerns, substance use, and minority stressors. Outcomes include poor mental and physical health. Findings related to the effects of minority stressors on IPV and comparisons across sexual minority groups were inconsistent. Future research should focus on IPV perpetration; mechanisms underlying risk for IPV, including structural-level risk factors; and understanding differences among SMW subgroups.
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Affiliation(s)
| | - Mariah Xu
- Columbia University, New York, NY, USA
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Logie CH, Shannon K, Braschel M, Krüsi A, Norris C, Zhu H, Deering K. Brief Report: Social Factors Associated With Trajectories of HIV-Related Stigma and Everyday Discrimination Among Women Living With HIV in Vancouver, Canada: Longitudinal Cohort Findings. J Acquir Immune Defic Syndr 2023; 94:190-195. [PMID: 37850977 PMCID: PMC10730092 DOI: 10.1097/qai.0000000000003247] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/26/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION Women living with HIV (WLHIV) experience stigma rooted in social inequities. We examined associations between social factors (food insecurity, housing insecurity, violence, sexual minority identity, and substance use) and HIV-related stigma and Everyday Discrimination trajectories among WLHIV. METHODS This community-based open longitudinal cohort study with WLHIV living in and/or accessing HIV care in Metro Vancouver, Canada, plotted semiannual averages (2015-2019) of recent (past 6-month) HIV-related stigma and Everyday Discrimination. We examined distinct trajectories of HIV-related stigma and Everyday Discrimination using latent class growth analysis (LCGA) and baseline correlates of each trajectory using multinomial logistic regression. FINDINGS Among participants (HIV-related stigma sample: n = 197 participants with n = 985 observations; Everyday Discrimination sample: n = 203 participants with n = 1096 observations), LCGA identified 2 distinct HIV-related stigma and Everyday Discrimination trajectories: sustained low and consistently high. In multivariable analysis, concurrent food and housing insecurity (adjusted odds ratio [AOR]: 2.15, 95% confidence interval [CI] 1.12-4.12) and physical/sexual violence (AOR: 2.57, 95% CI: 1.22-5.42) were associated with higher odds of the consistently high (vs. sustained low) HIV-related stigma trajectory. Sexual minority identity (AOR: 2.84, 95% CI: 1.49-5.45), concurrent food and housing insecurity (AOR: 2.65, 95% CI: 1.38-5.08), and noninjection substance use (less than daily vs. none) (AOR: 2.04, 95% CI: 1.03-4.07) were associated with higher odds of the consistently high (vs. sustained low) Everyday Discrimination trajectory. CONCLUSIONS Social inequities were associated with consistently high HIV-related stigma and Everyday Discrimination among WLHIV. Multilevel strategies can address violence, economic insecurity, intersecting stigma, and discrimination to optimize health and rights among WLHIV.
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Affiliation(s)
- Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- United Nations University Institute for Water, Environment, and Health, Hamilton, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Candice Norris
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Haoxuan Zhu
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Kathleen Deering
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
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Hendrickson ZM, Tomko C, Galai N, Sisson LN, Glick JL, Sherman SG. A Longitudinal Analysis of Residential Mobility and Experience of Client Violence Among Women Who Exchange Sex in Baltimore. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:11017-11045. [PMID: 37395208 DOI: 10.1177/08862605231178492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Residential mobility remains an underexplored yet critical construct that may influence the risk of violence among women who exchange sex. This study examined the longitudinal relationship between residential mobility and experience of client-perpetrated physical or sexual violence among women who exchange sex in Baltimore, Maryland. Participants were at least at 18 years of age, were cisgender women, reported having engaged in transactional sex three or more times within the last 3 months, and were willing to be contacted for 6-, 12-, and 18-month follow-up visits. Analyses of responses from 370 women who exchange sex participating in at least one study visit were conducted. Unadjusted and adjusted Poisson regression models of the association over time between residential mobility and recent experience of physical or sexual violence were fit. Generalized estimating equations with an exchangeable correlation structure and robust variance estimation were used to account for clustering of participants' responses over time. Findings demonstrated that those who had lived in at least four places in the past 6 months had a 39% increased risk of client-perpetrated physical violence (aRR: 1.39; 95% CI: 1.07-1.80; p < .05) and a 63% increased risk of sexual violence (aRR: 1.63; 95% CI: 1.14-2.32; p < .01) compared to their less-mobile counterparts. These findings provide necessary evidence of correlations over time between residential mobility and experience of client-perpetrated violence among women who exchange sex. Strengthening our understanding of how residential mobility intersects with violence is critical for the development of public health interventions that are relevant to women's lives and needs. Future interventions should explore including residential mobility, a critical pillar of housing instability, with efforts to address client-perpetrated violence.
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Affiliation(s)
| | - Catherine Tomko
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Noya Galai
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- University of Haifa, Mt Carmel, Haifa, Israel
| | | | - Jennifer L Glick
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Susan G Sherman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Jenkins WD, Friedman SR, Hurt CB, Korthuis PT, Feinberg J, Del Toro-Mejias LM, Walters S, Seal DW, Fredericksen RJ, Westergaard R, Miller WC, Go VF, Schneider J, Giurcanu M. Variation in HIV Transmission Behaviors Among People Who Use Drugs in Rural US Communities. JAMA Netw Open 2023; 6:e2330225. [PMID: 37603331 PMCID: PMC10442709 DOI: 10.1001/jamanetworkopen.2023.30225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 07/16/2023] [Indexed: 08/22/2023] Open
Abstract
Importance People who use drugs (PWUD) continue to be at risk of HIV infection, but the frequency and distribution of transmission-associated behaviors within various rural communities is poorly understood. Objective To examine the association of characteristics of rural PWUD with HIV transmission behaviors. Design, Setting, and Participants In this cross-sectional study, surveys of PWUD in rural communities in 10 states (Illinois, Kentucky, New Hampshire, Massachusetts, North Carolina, Ohio, Oregon, Vermont, West Virginia, and Wisconsin) were collected January 2018 through March 2020 and analyzed August through December 2022. A chain-referral sampling strategy identified convenience sample seeds who referred others who used drugs. Rural PWUD who reported any past 30-day injection drug use or noninjection opioid use "to get high" were included. Exposures Individual characteristics, including age, race, gender identity, sexual orientation, partnership status, drug of choice, and location, were collected. Main Outcomes and Measures Past 30-day frequency of behaviors associated with HIV transmission, including drug injection, syringe sharing, opposite- and same-gender partners, transactional sex, and condomless sex, was assessed. Results Of 3048 rural PWUD (mean [SD] age, 36.1 [10.3] years; 225 American Indian [7.4%], 96 Black [3.2%], and 2576 White [84.5%] among 3045 with responses; and 1737 men [57.0%] among 3046 with responses), most participants were heterosexual (1771 individuals [86.8%] among 2040 with responses) and single (1974 individuals [68.6%] among 2879 with responses). Opioids and stimulants were reported as drug of choice by 1636 individuals (53.9%) and 1258 individuals (41.5%), respectively, among 3033 individuals with responses. Most participants reported recent injection (2587 of 3046 individuals [84.9%] with responses) and condomless sex (1406 of 1757 individuals [80.0%] with responses), among whom 904 of 1391 individuals (65.0%) with responses indicated that it occurred with people who inject drugs. Syringe sharing (1016 of 2433 individuals [41.8%] with responses) and transactional sex (230 of 1799 individuals [12.8%] with responses) were reported less frequently. All characteristics and behaviors, except the number of men partners reported by women, varied significantly across locations (eg, mean [SD] age ranged from 34.5 [10.0] years in Wisconsin to 39.7 [11.0] years in Illinois; P < .001). In multivariable modeling, younger age (adjusted odds ratio [aOR] for ages 15-33 vs ≥34 years, 1.36; 95% CI, 1.08-1.72) and being single (aOR, 1.37; 95% CI, 1.08-1.74) were associated with recent injection; younger age (aOR, 1.49; 95% CI, 1.20-1.85) and bisexual orientation (aOR vs heterosexual orientation, 2.27; 95% CI, 1.60-3.23) with syringe sharing; gender identity as a woman (aOR vs gender identity as a man, 1.46; 95% CI, 1.01-2.12), bisexual orientation (aOR vs heterosexual orientation, 2.59; 95% CI, 1.67-4.03), and being single (aOR, 1.71; 95% CI, 1.15-2.55) with transactional sex; and bisexual orientation (aOR vs heterosexual orientation, 1.60; 95% CI, 1.04-2.46) and stimulants as the drug of choice (aOR vs opioids, 1.45; 95 CI, 1.09-1.93) with condomless sex with someone who injects drugs. Conclusions and Relevance This study found that behaviors associated with HIV transmission were common and varied across communities. These findings suggest that interventions to reduce HIV risk among rural PWUD may need to be tailored to locally relevant factors.
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Affiliation(s)
- Wiley D. Jenkins
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield
| | - Samuel R. Friedman
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Christopher B. Hurt
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill
| | - P. Todd Korthuis
- Addiction Medicine Section, Oregon Health and Science University, Portland
| | | | | | - Suzan Walters
- School of Global Public Health, New York University, New York, New York
| | - David W. Seal
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | - Ryan Westergaard
- School of Medicine and Public Health, University of Wisconsin, Madison
| | - William C. Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus
| | - Vivian F. Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - John Schneider
- Biological Sciences Division, University of Chicago, Chicago, Illinois
| | - Mihai Giurcanu
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
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Goddard-Eckrich D, Gilbert L, Richer A, Chang M, Hunt T, Henderson A, Marotta P, Wu E, Johnson K, Moses H, Liu Y, El-Bassel N. Moderation Analysis of a couple-based HIV/STI Intervention Among Heterosexual Couples in the Criminal Legal System Experiencing Intimate Partner Violence: Results from a Randomized Controlled Trial. AIDS Behav 2023; 27:1653-1665. [PMID: 36322218 PMCID: PMC9629199 DOI: 10.1007/s10461-022-03897-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
Since the COVID-19 pandemic, intimate partner violence (IPV) rates have increased in the United States. Although accumulating research has documented the effectiveness of couple-based interventions in reducing HIV/STIs, it remains unclear whether they are effective and safe for couples experiencing IPV. We used moderation analysis from a randomized clinical trial to evaluate whether a couples-based HIV/STI intervention may have differential effectiveness in reducing HIV/STI risks among couples where one or both partners reported experiencing IPV compared to couples without such IPV among a sample of 230 men at risk for HIV/STIs who reported using drugs and were mandated to community supervision settings in New York City and their main female sexual partners. The findings of this study suggest that the effectiveness of this evidence-based couple HIV intervention in reducing condomless sex and other HIV/STI risks did not differ between couples with IPV compared to couples without IPV. Intimate partners who use drugs and are involved in the criminal legal system are disproportionately impacted by both HIV/STIs and IPV, underscoring the importance of couple-level interventions that may be scaled up to address the dyadic HIV risks and IPV together in community supervision settings.
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Affiliation(s)
- Dawn Goddard-Eckrich
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 801, New York, NY, 10027, USA.
| | - Louisa Gilbert
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 801, New York, NY, 10027, USA
| | - Ariel Richer
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 801, New York, NY, 10027, USA
| | - Mingway Chang
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 801, New York, NY, 10027, USA
| | - Timothy Hunt
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 801, New York, NY, 10027, USA
| | - Ambuir Henderson
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 801, New York, NY, 10027, USA
| | - Phillip Marotta
- Brown School, Washington University, 1 Brookings Dr, 63130, St Louis, MO, 63130, USA
| | - Elwin Wu
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 801, New York, NY, 10027, USA
| | - Karen Johnson
- University of Alabama, School of Social Work, Little Hall, 670 Judy Bonner Drive, Tuscaloosa, AL, 35401, USA
| | - Hermione Moses
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 801, New York, NY, 10027, USA
| | - Yifan Liu
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 801, New York, NY, 10027, USA
| | - Nabila El-Bassel
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 801, New York, NY, 10027, USA
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Rosen JG, Schneider KE, Allen ST, Morris M, Urquhart GJ, Rouhani S, Sherman SG. Selling sex in the context of substance use: social and structural drivers of transactional sex among men who use opioids in Maryland. Harm Reduct J 2022; 19:115. [PMID: 36242081 PMCID: PMC9569095 DOI: 10.1186/s12954-022-00697-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/03/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Transactional sex is an important driver of HIV risk among people who use drugs in the USA, but there is a dearth of research characterizing men's selling and trading of sex in the context of opioid use. To identify contextually specific factors associated with selling or trading sex in a US population of men who use drugs, we cross-sectionally examined social and structural correlates of transactional sex among men who use opioids (MWUO) in Anne Arundel County and Baltimore City, Maryland. METHODS Between July 2018 and March 2020, we used targeted sampling to recruit men reporting past-month opioid use from 22 street-level urban and suburban recruitment zones. MWUO completed a 30-min self-administered interview eliciting substance use histories, experiences with hunger and homelessness, criminal justice interactions, and transactional sex involvement. We identified correlates of recent (past 3 months) transactional sex using multivariable log-binomial regression with cluster-robust standard errors. RESULTS Among 422 MWUO (mean age 47.3 years, 73.4% non-Hispanic Black, 94.5% heterosexual), the prevalence of recent transactional sex was 10.7%. In multivariable analysis, younger age (adjusted prevalence ratio [aPR] 0.98, 95% confidence interval [95% CI] 0.97-0.99, p < 0.001), identifying as gay/bisexual (aPR = 5.30, 95% CI 3.81-7.37, p < 0.001), past-month food insecurity (aPR = 1.77, 95% CI 1.05-3.00, p = 0.032), and injection drug use in the past 3 months (aPR = 1.75, 95% CI 1.02-3.01, p = 0.043) emerged as statistically significant independent correlates of transactional sex. CONCLUSIONS Synergistic sources of social and structural marginalization-from sexuality to hunger, homelessness, and injection drug use-are associated with transactional sex in this predominantly Black, heterosexual-identifying sample of MWUO. Efforts to mitigate physical and psychological harms associated with transactional sex encounters should consider the racialized dimensions and socio-structural drivers of transactional sex among MWUO.
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Affiliation(s)
- Joseph G Rosen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E5031, Baltimore, MD, 21205, USA.
| | - Kristin E Schneider
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Sean T Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Miles Morris
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Glenna J Urquhart
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E5031, Baltimore, MD, 21205, USA
| | - Saba Rouhani
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
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Zeidan A, Salhi B, Backster A, Shelton E, Valente A, Safdar B, Wong A, Porta AD, Lee S, Schneberk T, Wilson J, Westgard B, Samuels-Kalow M. A Structural Competency Framework for Emergency Medicine Research: Results from a Scoping Review and Consensus Conference. West J Emerg Med 2022; 23:650-659. [PMID: 36205664 PMCID: PMC9541992 DOI: 10.5811/westjem.2022.6.56056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The application of structural competency and structural vulnerability to emergency medicine (EM) research has not been previously described despite EM researchers routinely engaging structurally vulnerable populations. The purpose of this study was to conduct a scoping review and consensus-building process to develop a structurally competent research approach and operational framework relevant to EM research. METHODS We conducted a scoping review focused on structural competency and structural vulnerability. Results of the review informed the development of a structural competency research framework that was presented throughout a multi-step consensus process culminating in the 2021 Society for Academic Emergency Medicine Consensus Conference. Feedback to the framework was incorporated throughout the conference. RESULTS The scoping review produced 291 articles with 123 articles relevant to EM research. All 123 articles underwent full-text review and data extraction following a standardized data extraction form. Most of the articles acknowledged or described structures that lead to inequities with a variety of methodological approaches used to operationalize structural competency and/or structural vulnerability. The framework developed aligned with components of the research process, drawing upon methodologies from studies included in the scoping review. CONCLUSION The framework developed provides a starting point for EM researchers seeking to understand, acknowledge, and incorporate structural competency into EM research. By incorporating components of the framework, researchers may enhance their ability to address social, historical, political, and economic forces that lead to health inequities, reframing drivers of inequities away from individual factors and focusing on structural factors.
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Affiliation(s)
- Amy Zeidan
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
| | - Brian Salhi
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
| | - Anika Backster
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
| | - Erica Shelton
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Alycia Valente
- University of Massachusetts, Department of Emergency Medicine, Worcester, Massachusetts
| | - Basmah Safdar
- Yale University, Department of Emergency Medicine, New Haven, Connecticut
| | - Ambrose Wong
- Yale University, Department of Emergency Medicine, New Haven, Connecticut
| | | | - Sangil Lee
- The University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, Iowa
| | - Todd Schneberk
- Los Angeles + University of Southern California, Department of Emergency Medicine, Los Angeles, California
| | - Jason Wilson
- Morsani College of Medicine, Division of Emergency Medicine, Department of Internal Medicine, Tampa, Florida
| | - Bjorn Westgard
- University of Minnesota Medical School, Department of Emergency Medicine, Minneapolis, Minnesota
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Social and structural determinants of health associated with police violence victimization: A latent class analysis of female sex workers who use drugs in Kazakhstan. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 106:103750. [PMID: 35667193 PMCID: PMC10024805 DOI: 10.1016/j.drugpo.2022.103750] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Punitive legal environments remain a challenge to HIV prevention efforts in Central Asia, and female sex workers who use drugs are vulnerable to police violence. Little is known about the heterogeneity of police violence against female sex workers who use drugs and factors associated with HIV risk in Central Asia, despite the growing HIV epidemic. METHODS We recruited a community-based sample of 255 female sex workers who use drugs in Almaty, Kazakhstan between February 2015 and May 2017. We used latent class analysis to differentiate women into distinct classes of police violence victimization, and multinomial logistic regression to identify individual-level health outcomes, HIV risk behaviors, and social and structural factors within the risk environment associated with class membership. RESULTS A three-class model emerged: Low Victimization (51%), Discrimination and Extortion (15%), and Poly-Victimization (34%). Relative to Low Victimization, factors associated with Poly-Victimization included being positive for HIV and/or sexually-transmitted infections (STI) (aOR: 1.78 (95% CI: 1.01, 3.14)), prior tuberculosis diagnosis (2.73 (1.15, 6.50)), injection drug use (IDU) (2.00 (1.12, 3.58)), greater number of unsafe IDU behaviors (1.21 (1.08, 1.35)), homelessness (1.92 (1.06, 3.48)), greater drug use (1.22 (1.07, 1.39)) and sex work stigma (1.23 (1.06, 1.43)), greater number of sex work clients (2.40 (1.33, 4.31)), working for a boss/pimp (2.74 (1.16, 6.50)), client violence (2.99 (1.65, 5.42)), economic incentives for condomless sex (2.77 (1.42, 5.41)), accessing needle/syringe exchange programs (3.47 (1.42, 8.50)), recent arrest (2.99 (1.36, 6.55)) and detention (2.93 (1.62, 5.30)), and negative police perceptions (8.28 (4.20, 16.3)). Compared to Low Violence, Discrimination and Extortion was associated with lower odds of experiencing intimate partner violence (aOR= 0.26 (0.12, 0.59)), but no other significant associations with the risk environment upon adjusting for socio-demographic characteristics. CONCLUSION Police violence against female sex workers who use drugs is pervasive in Kazakhstan. Patterns of police violence vary, with greater HIV susceptibility associated with a higher probability of experiencing multiple forms of police violence. Police sensitization workshops that integrate policing and harm reduction, and drug policy reforms that decriminalize drug use may help mitigate the HIV epidemic in Kazakhstan.
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Glick JL, Beckham SW, White RH, Nestadt DF, Logie CH, Galai N, Sherman SG. The Importance of Sexual Orientation in the Association Between Social Cohesion and Client Condom Coercion Among Women Who Exchange Sex in Baltimore, Maryland. AIDS Behav 2022; 26:2632-2642. [PMID: 35124757 PMCID: PMC10029811 DOI: 10.1007/s10461-022-03599-4] [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] [Accepted: 01/21/2022] [Indexed: 01/12/2023]
Abstract
Among women who exchange sex (WES), social cohesion is associated with multi-level HIV-risk reduction factors, and client condom coercion (CCC) is associated with increased HIV-risk. Sexual minority WES (SM-WES) face exacerbated HIV-risk, yet relevant research is scant. We examined the role of sexual orientation in the relationship between social cohesion and CCC among cisgender WES (n = 384) in Baltimore, Maryland using stratified logistic regression, controlling for potential confounders. Forty-five percent of WES experienced CCC. SM-WES reported significantly higher social cohesion than heterosexual WES. The relationship between social cohesion and CCC differed by sexual orientation. Among SM-WES, higher social cohesion was independently associated with decreased odds of experiencing CCC, controlling for food insecurity, crack use, police harassment, and method of finding clients. Among heterosexual WES, no significant association was found. Ongoing research and practice with WES should (1) collect sexual orientation data to allow for deeper understanding and tailored interventions, (2) leverage and nurture social cohesion and (3) tailor interventions to populations with attention to sexual orientation.
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Affiliation(s)
- Jennifer L Glick
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - S Wilson Beckham
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Rebecca Hamilton White
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Danielle Friedman Nestadt
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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14
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Beckham SW, Glick JL, Schneider KE, Allen ST, Shipp L, White RH, Park JN, Sherman SG. Latent Classes of Polysubstance Use and Associations with HIV Risk and Structural Vulnerabilities among Cisgender Women Who Engage in Street-Based Transactional Sex in Baltimore City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073783. [PMID: 35409469 PMCID: PMC8997521 DOI: 10.3390/ijerph19073783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/14/2022] [Accepted: 03/20/2022] [Indexed: 02/04/2023]
Abstract
We describe patterns of polysubstance use and associations with HIV risk-related behaviors among women engaged in street-based transactional sex, an understudied yet important population and area of research. This sample was restricted to cisgender women who reported drug use (n = 244) in the baseline of the longitudinal SAPPHIRE cohort study. Latent class analysis (LCA) was conducted using drug use measures (route of administration (injection/non-injection); type of drug (specific opioids, stimulants)) and selection based on fit statistics and qualitative interpretation of the classes. Polysubstance use was prevalent (89% ≥ 2), and 68% had injected drugs in the past 3 months. A three-class solution was selected: Class 1 ("heroin/cocaine use", 48.4% of sample), Class 2 ("poly-opioid use", 21.3%), and Class 3 ("poly-route, polysubstance use", 30.3%). Class 3 was significantly younger, and Class 2 was disproportionately non-White. Women reported high levels of housing (63%) and food (55%) insecurity, condomless sex with clients (40%), and client-perpetrated violence (35%), with no significant differences by class. Obtaining syringes from syringe services programs differed significantly by class, despite injection behaviors in all classes. Tailored HIV and overdose prevention programming that considers drug use patterns would strengthen their impact.
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Affiliation(s)
- Sam Wilson Beckham
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (J.L.G.); (S.T.A.); (R.H.W.); (J.N.P.); (S.G.S.)
- Correspondence:
| | - Jennifer L. Glick
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (J.L.G.); (S.T.A.); (R.H.W.); (J.N.P.); (S.G.S.)
| | - Kristin E. Schneider
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21201, USA;
| | - Sean T. Allen
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (J.L.G.); (S.T.A.); (R.H.W.); (J.N.P.); (S.G.S.)
| | - Lillian Shipp
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21201, USA;
| | - Rebecca Hamilton White
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (J.L.G.); (S.T.A.); (R.H.W.); (J.N.P.); (S.G.S.)
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (J.L.G.); (S.T.A.); (R.H.W.); (J.N.P.); (S.G.S.)
| | - Susan G. Sherman
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (J.L.G.); (S.T.A.); (R.H.W.); (J.N.P.); (S.G.S.)
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15
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El-Bassel N, Mukherjee TI, Stoicescu C, Starbird LE, Stockman JK, Frye V, Gilbert L. Intertwined epidemics: progress, gaps, and opportunities to address intimate partner violence and HIV among key populations of women. Lancet HIV 2022; 9:e202-e213. [PMID: 35151376 PMCID: PMC10009883 DOI: 10.1016/s2352-3018(21)00325-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 12/24/2022]
Abstract
The intersection of intimate partner violence and HIV is a public health problem, particularly among key populations of women, including female sex workers, women who use drugs, and transgender women, and adolescent girls and young women (aged 15-24 years). Intimate partner violence results in greater risk of HIV acquisition and creates barriers to HIV prevention, testing, treatment, and care for key populations of women. Socioecological models can be used to explain the unique multilevel mechanisms linking intimate partner violence and HIV. Few interventions, modelling studies, and economic evaluations that concurrently address both intimate partner violence and HIV exist, with no interventions tailored for transgender populations. Most combination interventions target individual-level risk factors, and rarely consider community or structural factors, or evaluate cost-efficacy. Addressing intimate partner violence is crucial to ending the HIV epidemic; this Review highlights the gaps and opportunities for future research to address the intertwined epidemics of intimate partner violence and HIV among key populations of women.
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Affiliation(s)
| | - Trena I Mukherjee
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Claudia Stoicescu
- School of Social Work, Columbia University, New York, NY, USA; Centre for Criminology, Oxford Law Faculty, University of Oxford, Oxford, UK; Centre for Evidence-Based Social Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Laura E Starbird
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Jamila K Stockman
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Victoria Frye
- School of Medicine, The City University of New York, New York, NY, USA
| | - Louisa Gilbert
- School of Social Work, Columbia University, New York, NY, USA
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Machat S, Lyons T, Braschel M, Shannon K, Goldenberg S. Internet solicitation linked to enhanced occupational health and safety outcomes among sex workers in Metro Vancouver, Canada 2010-2019. Occup Environ Med 2022; 79:373-379. [PMID: 35149596 DOI: 10.1136/oemed-2021-107429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 11/18/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Examine the independent association between online solicitation and sex workers' (SWs') occupational health and safety (OHS), particularly violence and work stress. METHODS Data were drawn from a cohort of women SWs (N=942, 2010-2019) in Vancouver, Canada. Analyses used descriptive statistics and bivariate and multivariable logistic and linear regression using generalised estimating equations (GEE); explanatory and confounder modelling approaches were used. RESULTS 33.9% (n=319) of participants solicited online and 14.1% (n=133) primarily solicited online in the last 6 months in at least one study visit. In multivariable GEE analysis, factors associated with primarily soliciting online included younger age (adjusted OR (AOR) 0.95 per year older, 95% CI 0.93 to 0.97), sexual minority status (AOR 2.57, 95% CI 1.61 to 4.10), gender minority status (AOR 3.09, 95% CI 1.80 to 5.28), higher education (AOR 2.13, 95% CI 1.34 to 3.40), higher sex work income (AOR 1.03 per $100 weekly, 95% CI 1.01 to 1.06), being an im/migrant to Canada (AOR 2.40, 95% CI 1.26 to 4.58) and primarily servicing in informal indoor workspaces (AOR 3.47, 95% CI 2.32 to 5.20). In separate GEE confounder models, primarily soliciting online significantly (1) reduced odds of physical/sexual workplace violence (AOR 0.64, 95% CI 0.39 to 1.06) and (2) reduced work stress (β coefficient -0.93, 95% CI -1.59 to -0.26). DISCUSSION/CONCLUSIONS Younger workers, gender/sexual minorities, im/migrants and those in informal indoor spaces had higher odds of soliciting online. Confounder models indicate access to online solicitation methods may support enhanced OHS. Decriminalisation of sex work-including advertising via online platforms-remains necessary to support SWs' OHS.
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Affiliation(s)
- Sylvia Machat
- AESHA, Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Tara Lyons
- AESHA, Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada.,Department of Criminology, Kwantlen Polytechnic University, Surrey, British Columbia, Canada
| | - Melissa Braschel
- AESHA, Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Kate Shannon
- AESHA, Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada.,Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shira Goldenberg
- AESHA, Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada .,School of Public Health, San Diego State University, San Diego, California, USA
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17
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Gaard G. Queering Environmental Justice Through an Intersectional Lens. Am J Public Health 2022; 112:57-58. [PMID: 34936399 PMCID: PMC8713599 DOI: 10.2105/ajph.2021.306489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Greta Gaard
- Greta Gaard is with the English and Women/Gender/Sexuality Studies Departments, University of Wisconsin, River Falls
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Ramos SR, Lardier DT, Opara I, Turpin RE, Boyd DT, Gutierrez JI, Williams CN, Nelson LE, Kershaw T. Intersectional Effects of Sexual Orientation Concealment, Internalized Homophobia, and Gender Expression on Sexual Identity and HIV Risk Among Sexual Minority Men of Color: A Path Analysis. J Assoc Nurses AIDS Care 2021; 32:495-511. [PMID: 34101701 PMCID: PMC8221709 DOI: 10.1097/jnc.0000000000000274] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT In the United States, 13 million people identify as sexual and gender minorities. The purposes of this article were to (a) examine the associations among sexual orientation concealment and internalized homophobia with HIV knowledge, health literacy, and transactional sex through sexual identity; and (b) assess whether gender expression moderates those relationships in sexual minority men of color. A multigroup mediation path model examined the association between sexual orientation concealment and internalized homophobia on HIV knowledge, health literacy, and transactional sex through sexual identity by gender expression. Results suggest that, among those with a masculine gender expression, as sexual concealment increased, health literacy decreased. The association between sexual orientation concealment and transactional sex varied by participant's gender expression as did the association between internalized homophobia and HIV knowledge. Multiple intersecting identities, when faced with anticipated discrimination and homophobia, can negatively affect health outcomes and increase HIV risk in sexual minority men of color.
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Affiliation(s)
- S. Raquel Ramos
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - David T. Lardier
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - Ijeoma Opara
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - Rodman E. Turpin
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - Donte T. Boyd
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - José I. Gutierrez
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - Chase Nicole Williams
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - LaRon E. Nelson
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - Trace Kershaw
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
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