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Bhattarai N, Bam K, Acharya K, Thapa R, Shrestha B. Factors associated with HIV testing and counselling services among women and men in Nepal: a cross-sectional study using data from a nationally representative survey. BMJ Open 2021; 11:e049415. [PMID: 34862281 PMCID: PMC8647541 DOI: 10.1136/bmjopen-2021-049415] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES This study is set up to explore the factors associated with Human Immunodeficiency Virus (HIV) testing among women and men in Nepal. STUDY DESIGN Nepal Demographic and Health Survey, 2016 adopts a cross-sectional design. SETTING Nepal. PARTICIPANTS Women and men of age 15-49 years. PRIMARY OUTCOME MEASURES Our primary outcome was ever tested for HIV. We used multivariable analysis at a 95% level of significance to measure the effect in outcome variables. RESULTS About one in 10 women (10.8%) and one in five men (20.5%) ever tested for HIV. Women who had media exposure at least once a week ((adjusted odds ratio (aOR)=2.8; 95% CI: 1.4 to 5.3) were more likely to get tested for HIV compared with those who had no media exposure at all. Similarly, those who had their recent delivery in the health facility (aOR=3.9; 95% CI: 2.4 to 6.3) were more likely to get tests for HIV compared with those delivered elsewhere. Likewise, among men, compared with adolescents (15-19 years), those from older age groups were more likely to get tested for HIV. Compared with no education, secondary (aOR=2.3; 95% CI: 1.4 to 3.6) and higher education (aOR=1.7; 95% CI: 1.0 to 2.8) had higher odds of getting tested for HIV. Similarly, wealth quintiles in richer and richest groups were more likely to get tested for HIV compared with the poorest quintile. Other characteristics like media exposure, paid sex and 2+ sexual partners were positively associated with being tested for HIV. CONCLUSIONS HIV testing is not widespread and more men than women are accessing HIV services. More than two-thirds of women who delivered at health facilities never tested for HIV. It is imperative to reach out to people engaging in risky sexual behaviour, people with lower educational attainment, and those in the lower wealth quintile for achieving 95-95-95 targets by 2030.
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Affiliation(s)
- Navaraj Bhattarai
- Nepal Public Health Research and Development Center, Kathmandu, Nepal
| | - Kiran Bam
- Public Health Professional, Kathmandhu, Nepal
| | | | - Rajshree Thapa
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
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Shri N, Muhammad T. Association of intimate partner violence and other risk factors with HIV infection among married women in India: evidence from National Family Health Survey 2015-16. BMC Public Health 2021; 21:2105. [PMID: 34789185 PMCID: PMC8597306 DOI: 10.1186/s12889-021-12100-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) infection remains an important public health concern in many countries. It is fuelled by gender inequality and disparity, which has resulted in a fundamental violation of women’s human rights. This study aims to find out the association of intimate partner violence (IPV) and other risk factors with the prevalence of HIV infection among married women in India. Methods This study is based on data from the India National Family Health Survey (2015–16). Bivariate analysis has been performed to estimate the prevalence of HIV. Logistic regression analysis is conducted to find out the association between IPV, factors such as having alcoholic husband and lifetime partner, and HIV infection among currently married women. Results Married women who had faced physical, sexual, and emotional violence from their husbands/partners were almost twice more likely to have tested HIV positive compared to married women who did not face violence [OR: 2.14, CI: 1.08–4.50]. The odds of testing for HIV positive was significantly higher among the married women experiencing IPV and having alcoholic husband [OR: 4.48, CI: 1.87–10.70] than those who did not experience IPV and had non-alcoholic husband. The use of condom did not show any significant association with HIV infection. Again, having more than one lifetime partner had a positive association with HIV infection compared to those with one partner [OR: 2.45, CI: 1.21–4.16]. Conclusions The study revealed that factors such as experiencing all types of IPV, having an alcoholic husband, increased number of lifetime partners, being sexually inactive, belonging to vulnerable social groups, and urban place of residence are important risk factors of HIV infection among married women in India. The results also suggest that gender-based violence and an alcoholic husband may represent a significant factor of HIV infection among married women and interventions should on focus such vulnerable populations.
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Affiliation(s)
| | - T Muhammad
- International Institute for Population Sciences, Mumbai, Maharashtra, India, 400088.
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Kashyap GC, Govind B, Srivastava S, R V, Bango M, Shaw S. A true face of Indian married couples: Effect of age and education on control over own sexuality and sexual violence. PLoS One 2021; 16:e0254005. [PMID: 34288932 PMCID: PMC8294513 DOI: 10.1371/journal.pone.0254005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/18/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Though there are several interventions evaluated over the past 25 years, significant knowledge gaps continue to exist regarding the effective prevention of sexual violence. This study explored the socio-economic and context-specific distinctive characteristics of husbands and wives on sexual autonomy and unwanted sexual experiences of currently married women in India. METHODOLOGY We have utilized the recent round of National Family Health Survey (NFHS-4, 2015-16) data for this exploration. The NFHS-4 survey had adopted a stratified two-stage sample design to reach out to the survey households. A total of 63,696 couples are included in the analysis comprising of women of 15-49 years age and men of 15-54 years age. Multivariate techniques have been applied to understand the adjusted effects of socio-economic and demographic variables on control over their sexuality and sexual violence. RESULTS Uneducated women married to uneducated men experienced more sexual violence and had less control over their sexuality than the other categories. The adjusted multivariate logistic model shows that educated husbands were significantly more likely to exercise control over their educated wives' sexuality (AOR = 0.88; CI:0.78-0.99). Women having older husbands were significantly less likely to be having no-control over own sexuality (AOR = 0.89; CI:0.83-0.95) and experienced sexual violence (AOR = 0.81; CI:0.70-0.95). Women having comparatively more-educated husbands were significantly less likely to experience sexual violence (AOR = 0.62; CI:0.47-0.81). Muslim women were significantly more likely to have no control overown sexuality. SC/ST women were significantly more likely to experience sexual violence (28%). CONCLUSIONS This study highlights the factors associated with control over one's sexuality and preponderance to sexual violence: age, education, spouse working status, wealth status, husband's alcohol consumption, women autonomy, decision-making, and freedom for mobility. This study suggests that empowering women with education, creating awareness regarding reproductive health, and addressing their socio-economic needs to help them achieve autonomy and derive decision-making power.
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Affiliation(s)
- Gyan Chandra Kashyap
- Institute of Health Management Research, Electronic City (Phase-I), Bengaluru, Karnataka, India
| | - Bal Govind
- Gokhale Institute of Politics and Economics, Deccan Gymkhana, Pune, Maharashtra, India
| | - Shobhit Srivastava
- International Institute for Population Sciences, Deonar, Mumbai, Maharashtra, India
| | - Veena R
- Healthcare Programs, International School of Business and Research, Infosys Drive, Bengaluru, Karnataka, India
| | - Madhumita Bango
- School of Health Systems Studies, Tata Institute of Social Sciences, Deonar, Mumbai, Maharashtra, India
| | - Subhojit Shaw
- International Institute for Population Sciences, Deonar, Mumbai, Maharashtra, India
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Raichur P, Salvi SP, Sangle S, Chavan A, Nimkar S, Gawande G, Rewari B, Mathad J, Mcintire K, Gupta A, Marbaniang I, Mave V. Trends and Sex Differences in Access to HIV Care with Scale Up of National HIV Treatment Guidelines in Pune, India. J Int Assoc Provid AIDS Care 2021; 19:2325958220931735. [PMID: 32573318 PMCID: PMC7313325 DOI: 10.1177/2325958220931735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Test and treat is the current global standard, yet sex differences persist in access to HIV care. We assessed the differences in presentation and antiretroviral therapy (ART) uptake by sex and ART-eligibility period among ART-naive adults registered at a public ART center in India. Four ART eligibility periods were defined by programmatically determined CD4 criteria (periods I-IV: CD4 <200, <350, ≤500 cells/μL, and any CD4) between January 2005 and December 2017. Of 23 957 participants, 12 510 were male. Men consistently presented with lower median CD4 count (period I-IV, P < .05) and higher median age (period I-III, P < .001) than women. From period I to IV, median age increased in women (P < .0001), ART initiation time decreased in both sexes (P < .001), and median CD4 remained <200 cells/µL in men. Advanced HIV disease and increasing age at presentation are persistent sex-specific trends which warrant innovative HIV testing strategies in both sexes.
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Affiliation(s)
- Priyanka Raichur
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - Sonali Pankaj Salvi
- Department of Medicine, BJ Government Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | - Shashikala Sangle
- Department of Medicine, BJ Government Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | - Amol Chavan
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - Smita Nimkar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - Gajanan Gawande
- Department of Medicine, BJ Government Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | - Bharat Rewari
- National AIDS Control Organisation, New Delhi, New Delhi, India
| | - Jyoti Mathad
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, NY, USA
| | - Katherine Mcintire
- Department of Medicine and Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - Amita Gupta
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India.,Department of Medicine and Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - Ivan Marbaniang
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India.,Department of Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India.,Department of Medicine and Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
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Aridoss S, Jaganathasamy N, Kumar A, Natesan M, Adhikary R, Arumugam E. Socio-demographic factors associated with HIV prevalence among pregnant women attending antenatal clinics in six Southern States of India: Evidences from the latest round of HIV sentinel surveillance. Indian J Public Health 2021; 64:S26-S31. [PMID: 32295953 DOI: 10.4103/ijph.ijph_60_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background HIV/AIDS is a global public health issue and its transmission in a defined geographic region is influenced by the interplay of sociodemographic and behavioral factors. Better understanding of sociodemographic characteristics of HIV-positive individuals is required to prevent the spread of HIV among the general population. Objectives The objective of the study was to find the association between HIV prevalence and sociodemographic characteristics of pregnant women aged 15-49 years attending the antenatal clinics (ANCs) in six Southern states of India. Methods The data from the latest round of HIV sentinel surveillance, a cross-sectional study, conducted during January-March 2017 among ANC attendees were considered for this analysis. Blood samples along with other relevant information were collected from 98,634 pregnant women from 248 sites across the states. The association between HIV prevalence and sociodemographic variables was examined using multivariable logistic regression. Results The highest HIV prevalence was reported in Karnataka (0.38%) and Andhra Pradesh (0.38%), followed by Telangana (0.33%), Odisha (0.28%), Tamil Nadu (0.27%), and Kerala (0.05%). In all states, the prevalence was highest among illiterate pregnant women exception being Kerala, wherein the prevalence was highest in pregnant women with schooling up to primary education. A significant association was found between HIV prevalence and spouse occupation in Karnataka and Odisha and spouse migration in Andhra Pradesh and Karnataka. Conclusions Need for improvising the interventions for the young, illiterates, having a migrant spouse, and spouse occupation as truckers/hotel staff is recommended to the stakeholders involved in HIV management of the six southern states of India.
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Affiliation(s)
| | | | - Arvind Kumar
- Associate Consultant, Strategic Information and Surveillance, National AIDS Control Organization, Ministry of Health Family Welfare, Government of India, New Delhi, India
| | | | - Rajatashuvra Adhikary
- National Professional Officer (HIV/AIDS), HIV Surveillance, WHO India Country Office, New Delhi, India
| | - Elangovan Arumugam
- Scientist G, Computing and Information Science, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
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Grose RG, Chen JS, Roof KA, Rachel S, Yount KM. Sexual and Reproductive Health Outcomes of Violence Against Women and Girls in Lower-Income Countries: A Review of Reviews. JOURNAL OF SEX RESEARCH 2021; 58:1-20. [PMID: 31902238 DOI: 10.1080/00224499.2019.1707466] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Gender-based violence (GBV) against women and girls is pervasive and has negative consequences for sexual and reproductive health (SRH). In this systematic review of reviews, we aimed to synthesize research about the SRH outcomes of GBV for adolescent girls and young women in low- and middle-income countries (LMICs). GBV exposures were child abuse, female genital mutilation/cutting, child marriage, intimate partner violence (IPV), and non-partner sexual violence. PsycINFO, PubMed, and Scopus searches were supplemented with expert consultations, reference-list searches, and targeted organizational website searches. Reviews had to contain samples of girls and young women ages 10-24, although inclusion criteria were expanded post-hoc to capture adolescent-adult combined samples. Twenty-seven reviews were quality-rated. Study-level data were extracted from the 10 highest quality reviews (62 unique studies, 100 samples). Reviews were mostly from Africa and Asia and published between 2011 and 2015. We found consistent associations between GBV and number of sexual partners, gynecological conditions (e.g., sexually transmitted infections [STIs]), unwanted/unplanned pregnancy, and abortion. Some types of IPV also were associated with greater use of contraception/STI prevention. Addressing GBV is essential to improve SRH for girls and women in LMICs.
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Affiliation(s)
- Rose Grace Grose
- Department of Community Health Education, Colorado School of Public Health, University of Northern Colorado
| | - Julia S Chen
- Hubert Department of Global Health, Rollins School of Public Health, Emory University
| | - Katherine A Roof
- Hubert Department of Global Health, Rollins School of Public Health, Emory University
| | - Sharon Rachel
- Kennedy-Satcher Center for Mental Health Equity, Satcher Health Leadership Institute, Morehouse School of Medicine
| | - Kathryn M Yount
- Asa Griggs Candler Chair of Global Health | Professor of Global Health and Sociology, Hubert Department of Global Health and Department of Sociology, Emory University
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Tsuyuki K, Donta B, Dasgupta A, Fleming PJ, Ghule M, Battala M, Nair S, Silverman J, Saggurti N, Raj A. Masculine Gender Ideologies, Intimate Partner Violence, and Alcohol Use Increase Risk for Genital Tract Infections Among Men. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:2316-2334. [PMID: 29294709 PMCID: PMC5756145 DOI: 10.1177/0886260517700619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Masculine gender ideologies are thought to underlie alcohol use, intimate partner violence (IPV) perpetration, and sexual risk of HIV and other sexually transmitted infections (STIs). We extend on studies in the Indian context by examining the roles of masculine gender ideologies, alcohol use, and IPV on three outcomes of HIV risk (condom use, genital tract infection [GTI] symptoms, and GTI diagnosis). We applied logistic regression models to cross-sectional data of men and their wives in rural Maharashtra, India (n = 1,080 couples). We found that men with less masculine gender ideologies demonstrated greater odds of condom use (i.e., lower odds no condom use, odds ratio [OR] = 0.96, 95% confidence interval [CI] = [0.93, 0.98]). IPV perpetration was associated with increased odds of reporting ≥1 GTI symptom (adjusted OR [AOR] = 1.56, 95% CI = [1.07, 2.26]) and decreased GTI diagnosis (AOR = 0.28, 95% CI = [0.08, 0.97]). Moderate alcohol consumption was associated with increased odds of reporting ≥1 GTI symptom (AOR = 1.51, 95% CI = [1.01, 2.25]). Our findings have direct implications for men's and women's health in rural India, including targeted GTI diagnosis and treatment, integrated violence prevention in STI clinics, and targeted intervention on masculine gender ideologies.
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Affiliation(s)
- Kiyomi Tsuyuki
- Division of Global Public Health, School of Medicine, University of California, San Diego (UCSD)
| | - Balaiah Donta
- National Institute for Research in Reproductive Health, Mumbai, India
| | - Anindita Dasgupta
- Division of Global Public Health, School of Medicine, University of California, San Diego (UCSD)
- Center for Gender Equity and Health, University of California, San Diego
| | - Paul J. Fleming
- Division of Global Public Health, School of Medicine, University of California, San Diego (UCSD)
| | - Mohan Ghule
- National Institute for Research in Reproductive Health, Mumbai, India
| | | | - Saritha Nair
- National Institute for Research in Reproductive Health, Mumbai, India
| | - Jay Silverman
- Division of Global Public Health, School of Medicine, University of California, San Diego (UCSD)
- Center for Gender Equity and Health, University of California, San Diego
- Department of Society, Human Development and Health, Harvard School of Public Health, Harvard University, Boston, MA, USA
| | | | - Anita Raj
- Division of Global Public Health, School of Medicine, University of California, San Diego (UCSD)
- Center for Gender Equity and Health, University of California, San Diego
- Clinical Addiction Research and Education, Section of General, Internal Medicine, Department of Medicine, Boston University, School of Medicine/Boston Medical Center, Boston, MA, USA
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Ranjan A, Kumar P, Ahmad S, Pandey S, Detel R. Pattern of sexual behavior among people in a rural area of Bihar: A qualitative study on wives of migrant workers. J Family Med Prim Care 2019; 8:1637-1641. [PMID: 31198729 PMCID: PMC6559064 DOI: 10.4103/jfmpc.jfmpc_180_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Population mobility and migration are important processes of human life. It affects broad range of sociocultural parameters. Mobility increases personal interaction and exposure to sexual partners from high-risk group. Although traditional Indian value prohibits premarital or extramarital sexual activities, but this aspect has not been explored in migrant workers. Methods: It was a qualitative study based on indepth interview of participants. The participants were wives of migrant workers. Indepth interviews were conducted by two female field interviewers recruited for the study. A total of 24 study subjects were recruited for the study. An indepth interview guide was prepared which mainly focused on sexual behavior, including premarital, marital, and extramarital, quality of marital relationship, gender roles, peer networks, substance abuse, work-related activities, etc., The transcripts were analyzed in NVIVO and themes were generated. Results: The premarital sex was more common in boys than girls. It is more common in the same age group and has increased in the recent years. Various reasons were cited in relation to premarital sex in rural areas like love affair, delayed marriage, watching bad movies, bad company, allurement for gifts money, etc., Some women had opinion that males belonging to affluent and powerful families had tendency to enjoy sex with other women within and outside village. The major themes which emerged from the study were the sexual activity, type of sexual partners, reasons for multiple sexual partner, and risky and nonrisky sexual activity. Conclusion: The findings of the study provided insights to design and conduct a larger and more representative quantitative study among the wives of migrant workers to understand the dynamic combination of biomedical, behavioral, and sociocultural factors that may influence transmission of infection within marriage.
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Affiliation(s)
- Alok Ranjan
- Department of Community and Family Medicine, AIIMS Patna, Phulwarisharif, Bihar, India
| | - Pragya Kumar
- Department of Community and Family Medicine, AIIMS Patna, Phulwarisharif, Bihar, India
| | - Shamshad Ahmad
- Department of Community and Family Medicine, AIIMS Patna, Phulwarisharif, Bihar, India
| | - Sanjay Pandey
- Department of Community and Family Medicine, AIIMS Patna, Phulwarisharif, Bihar, India
| | - Roger Detel
- Department of Epidemiology, Fielding School of Public Health, University of California, UCLA, USA
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Fehrenbacher AE, Chowdhury D, Jana S, Ray P, Dey B, Ghose T, Swendeman D. Consistent Condom Use by Married and Cohabiting Female Sex Workers in India: Investigating Relational Norms with Commercial Versus Intimate Partners. AIDS Behav 2018; 22:4034-4047. [PMID: 30006793 DOI: 10.1007/s10461-018-2219-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study examines determinants of consistent condom use (CCU) among married and cohabiting female sex workers (FSW) in India. Although CCU with clients is normative in the study area, most FSW do not consistently use condoms with intimate partners. Multiple logistic regression models indicated that condom use with intimate partners was associated with relationship status, cohabitation, HIV knowledge, STI symptoms, and being offered more money for sex without a condom by clients. Additionally, more days of sex work in the last week, serving as a peer educator, and participating in community mobilization activities were associated with higher odds of CCU across all partner types. Although improving economic security may increase CCU with clients, mobilization to reduce stigma and promote disclosure of sex work to non-cohabiting partners may be necessary to increase CCU overall.
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Affiliation(s)
- Anne E Fehrenbacher
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA
| | - Debasish Chowdhury
- Public Health Foundation of India (PHFI), Sector-44, Plot No-47, Gurgaon, 122003, India
| | - Smarajit Jana
- Sonagachi Research & Training Institute, Durbar Mahila Samanwaya Committee, 12/5 Nilmoni Mitra Street, Kolkata, West Bengal, India
| | - Protim Ray
- Sonagachi Research & Training Institute, Durbar Mahila Samanwaya Committee, 12/5 Nilmoni Mitra Street, Kolkata, West Bengal, India
| | - Bharati Dey
- Durbar Mahila Samanwaya Committee, 12/5 Nilmoni Mitra Street, Kolkata, West Bengal, India
| | - Toorjo Ghose
- School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Caster D17, Philadelphia, PA, 19104, USA
| | - Dallas Swendeman
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA.
- University of California Global Health Institute's Center of Expertise in Women's Health, Gender, and Empowerment, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA.
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10
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Devarayasamudram S, De Gagne JC, Kurudi NP, Kang HS. Effectiveness of a Structured Teaching Program on Knowledge and Attitudes Toward HIV among Young Women in India. J Community Health Nurs 2018; 35:49-56. [PMID: 29714504 DOI: 10.1080/07370016.2018.1446632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
India has the third highest number of persons living with HIV in the world. We evaluated the effectiveness of a structured teaching program on HIV-related knowledge and attitudes among 600 young women, aged 20-40 years, in India. This study employed a quasi-experimental pre-post design. Significant differences were found in the level of the participants' knowledge of (t = 78.89, p < .05) and attitudes toward (t = 64.14, p < .05) HIV after the intervention. Our findings suggest that the structured teaching program could be utilized in increasing young women's knowledge of, and improving their attitudes about, HIV.
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Affiliation(s)
| | | | | | - Hee Sun Kang
- d Red Cross College of Nursing , Chung-Ang University , Seoul , South Korea
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11
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Duggal M, Chakrapani V, Liberti L, Satyanarayna V, Varghese M, Singh P, Ranganathan M, Chandra P, Reynolds NR. Acceptability of Mobile Phone-Based Nurse-Delivered Counseling Intervention to Improve HIV Treatment Adherence and Self-Care Behaviors Among HIV-Positive Women in India. AIDS Patient Care STDS 2018; 32:349-359. [PMID: 30179531 DOI: 10.1089/apc.2017.0315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We assessed the acceptability of nurse-delivered mobile phone-based counseling to support adherence to antiretroviral treatment (ART) and self-care behaviors among HIV-positive women in India. We conducted open-ended, in-depth interviews with 27 HIV-positive women and 19 key informants at a government ART center in Karnataka, India. Data were analyzed with interpretive techniques. About half of the HIV-positive women owned a mobile phone and many had access to mobile phones of their family members. Most women perceived phone-based counseling as a personalized care approach to get information on demand. Also, women felt that they could discuss mental health issues and ask sensitive information that they would hesitate to discuss face-to-face. Findings indicate that, when compared with text messaging, mobile phone-based counseling could be a more acceptable way to engage with women on ART, especially those with limited literacy. Future studies should focus on testing mobile phone-based information/counseling and adherence interventions that take the local context into account.
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Affiliation(s)
- Mona Duggal
- Advance Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Indraprastha Institute of Information Technology, Delhi, India
| | - Venkatesan Chakrapani
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lauren Liberti
- School of Nursing, Yale University, New Haven, Connecticut
| | - Veena Satyanarayna
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Meiya Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | | | - Prabha Chandra
- Department of Psychiatry, Yale University, West Haven, Connecticut
| | - Nancy R. Reynolds
- School of Nursing, Yale University, New Haven, Connecticut
- School of Nursing, Johns Hopkins University, Baltimore, Maryland
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12
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Pouget ER. Social determinants of adult sex ratios and racial/ethnic disparities in transmission of HIV and other sexually transmitted infections in the USA. Philos Trans R Soc Lond B Biol Sci 2017; 372:20160323. [PMID: 28760764 PMCID: PMC5540863 DOI: 10.1098/rstb.2016.0323] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2017] [Indexed: 11/12/2022] Open
Abstract
In Black population centres in the USA, adult sex ratios (ASRs) are strongly female-biased primarily due to high male incarceration and early mortality rates. I explore the system of social determinants that shape these ASRs, and describe their apparent consequences. Evidence suggests that female-biased ASRs play a role, along with racial residential segregation, to increase mixing between core and peripheral members of sexual networks, facilitating transmission of human immunodeficiency virus and other sexually transmitted infections. Unique historical factors underlie Black male incarceration and mortality rates in the USA, making comparisons with other groups or other countries challenging.This article is part of the themed issue 'Adult sex ratios and reproductive decisions: a critical re-examination of sex differences in human and animal societies'.
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Affiliation(s)
- Enrique Rodriguez Pouget
- Center for Policing Equity at John Jay College of Criminal Justice, 524 West 59th Street, Room 6.63.14, New York, NY 10019, USA
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Nguyen AH, Giuliano AR, Mbah AK, Sanchez-Anguiano A. HIV/sexually transmitted infections and intimate partner violence: Results from the Togo 2013-2014 Demographic and Health Survey. Int J STD AIDS 2017; 28:1380-1388. [PMID: 28457202 DOI: 10.1177/0956462417705970] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Among clinic-based studies, intimate partner violence (IPV) has been shown to contribute to HIV/AIDS among young girls and women. Results from studies among the general population have been less consistent. This study evaluated the associations between HIV infection, any sexually transmitted infections (STIs), and IPV in a population-based sample of Togolese women. Data from the Togo 2013-2014 Demographic and Health Survey were utilized for these analyses. Women aged 15-49, who were currently married, had HIV test results, and answered the Domestic Violence Module were analyzed (n = 2386). Generalized linear mixed-models adjusting for sociodemographic variables, risk behaviors, and cluster effect were used to estimate HIV and STI risks with experience of IPV. HIV prevalence was 2.8%. Prevalence of IPV was 39% among HIV-positive women and 38% among HIV-negative women. Significant associations between IPV and HIV infection were not detected. Adjusted models found significant associations between experience of any IPV and having had STIs (OR 2.05, 95% CI 1.25-3.35). The high rates of violence in this setting warrant community-based interventions that address abuse and gender inequity. These interventions should also discuss the spectrum of STIs in relation to IPV.
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Affiliation(s)
- Anthony H Nguyen
- 1 Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Anna R Giuliano
- 2 Center for Infection Research on Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Alfred K Mbah
- 1 Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Aurora Sanchez-Anguiano
- 1 Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA
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Nyamathi AM, Ekstrand M, Yadav K, Ramakrishna P, Heylen E, Carpenter C, Wall S, Oleskowicz T, Arab L, Sinha S. Quality of Life Among Women Living With HIV in Rural India. J Assoc Nurses AIDS Care 2017; 28:575-586. [PMID: 28473182 DOI: 10.1016/j.jana.2017.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/15/2017] [Indexed: 01/20/2023]
Abstract
A cross-sectional examination was conducted on quality of life (QOL) among women living with HIV (WLWH) in rural Andhra Pradesh, India. Baseline data were collected from 400 WLWH and their children. QOL was measured with 10 items from the Quality of Life Enjoyment and Satisfaction Questionnaire. Findings revealed low QOL scores; on a scale from 0 to 3, the mean QOL score was 0.38 (SD = 0.30). Depression symptoms were reported by 25.5%, internalized stigma was high, and most reported little to no social support. Multivariable analysis revealed positive associations between QOL and CD4+ T cells (b = .0011, p = .021) and social support (b = .260, p < .0001), and a negative relationship between QOL and internalized stigma (b = -.232, p < .0001). Interventions focused on improving QOL for WLWH should incorporate strategies to improve social support and adherence to antiretroviral therapy, while mitigating internalized stigma.
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Ranjan A, Bhatnagar T, Babu GR, Detels R. Sexual Behavior, HIV Prevalence and Awareness Among Wives of Migrant Workers: Results from Cross-sectional Survey in Rural North India. Indian J Community Med 2017; 42:24-29. [PMID: 28331250 PMCID: PMC5348999 DOI: 10.4103/0970-0218.199794] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Migration has been linked to the spread of HIV epidemic from the urban areas of western India to the rural areas of north India. Objectives: This is the first population-based study among the wives of migrant workers of Muzaffarpur district in Bihar with objectives to describe their sexual behavior within marriage, estimate the prevalence of HIV, and to know their awareness regarding HIV/AIDS. Methods: A two-stage cluster survey was conducted by randomly selecting 25 eligible wives from each of the 34 selected villages. A total of 850 wives were interviewed and the blood samples were collected for HIV testing. To determine the factors associated with HIV/AIDS-awareness, we calculated adjusted odds ratios and 95% confidence intervals (CI) using multiple logistic regression analysis. Results: 34 (3%) of 850 wives reported condom use with their husband. HIV prevalence was 0.59% (95% CI: 0.19-1.37%) among the wives of migrant workers. Out of 850 wives, 132 (15.5%) had heard about HIV. Condoms use (OR = 3.21, 95% CI: 1.22-7.90) and premarital sex (OR=7.44, 95% CI: 1.6-33.67) were found significantly positively associated with HIV knowledge of wives. HIV awareness of the wives was significantly associated with age-group 15-24 years, literacy status, and possession of television and husbands’ literacy status. The knowledge about HIV among wives had significant positive impact on condoms use and premarital sex. HIV prevalence among the wives of migrant workers was higher than the prevalence among women in the general population. Education was found to be positively associated with awareness about HIV. Conclusions: Effective interventions are needed for increasing awareness of HIV among wives of migrant workers in Bihar.
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Affiliation(s)
- Alok Ranjan
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, India
| | - Tarun Bhatnagar
- ICMR School of Public Health, National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - Giridhara R Babu
- Public Health Foundation of India, IIPH-H, Bangalore campus, SIHFW premises, Bangalore, India
| | - Roger Detels
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
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Reynolds NR, Satyanarayana V, Duggal M, Varghese M, Liberti L, Singh P, Ranganathan M, Jeon S, Chandra PS. MAHILA: a protocol for evaluating a nurse-delivered mHealth intervention for women with HIV and psychosocial risk factors in India. BMC Health Serv Res 2016; 16:352. [PMID: 27491288 PMCID: PMC4973541 DOI: 10.1186/s12913-016-1605-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 07/29/2016] [Indexed: 01/12/2023] Open
Abstract
Background Women living with HIV are vulnerable to a variety of psychosocial barriers that limit access and adherence to treatment. There is little evidence supporting interventions for improving access and treatment adherence among vulnerable groups of women in low- and middle-income countries. The Mobile Phone-BasedApproach forHealthImprovement,Literacy andAdherence (MAHILA) trial is assessing the feasibility, acceptability and preliminary efficacy of a novel, theory-guided mobile health intervention delivered by nurses for enhancing self-care and treatment adherence among HIV-infected women in India. Methods/Design Women (n = 120) with HIV infection who screen positive for depressive symptoms and/or other psychosocial vulnerabilities are randomly assigned in equal numbers to one of two treatment arms: treatment as usual plus the mobile phone intervention (experimental group) or treatment as usual (control group). In addition to treatment as usual, the experimental group receives nurse-delivered self-care counselling via mobile phone at fixed intervals over 16 weeks. Outcome measures are collected at baseline and at 4, 12, 24 and 36 weeks post-baseline. Outcomes include antiretroviral treatment adherence, HIV-1 RNA, depressive symptoms, illness perceptions, internalized stigma and quality of life. Discussion The MAHILA trial will provide information about how a mobile health counselling intervention delivered by non specialist nurses may improve access to care and support the adherence and clinical outcomes of women with HIV infection living in low- and middle-income countries such as India. Trial registration NCT02319330 (First received: July 30, 2014; Last verified: January 2016)
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Affiliation(s)
- Nancy R Reynolds
- Division of Acute Care/Health Systems, School of Nursing, Yale University, 400 West Campus Drive, West Haven, CT, 06516, USA.
| | - Veena Satyanarayana
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, 560029, India
| | - Mona Duggal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Meiya Varghese
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru, 560029, India
| | - Lauren Liberti
- Division of Acute Care/Health Systems, School of Nursing, Yale University, 400 West Campus Drive, West Haven, CT, 06516, USA
| | - Pushpendra Singh
- Indraprastha Institute of Information Technology (IIIT-D), B-304, Academic Block, Okhla Phase III, New Delhi, 110020, India
| | - Mohini Ranganathan
- Department of Psychiatry, Yale University, School of Medicine, 300 George Street, New Haven, CT, 06511, USA
| | - Sangchoon Jeon
- Division of Acute Care/Health Systems, School of Nursing, Yale University, 400 West Campus Drive, West Haven, CT, 06516, USA
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru, 560029, India.
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17
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George MS, Lambert H. 'I am doing fine only because I have not told anyone': the necessity of concealment in the lives of people living with HIV in India. CULTURE, HEALTH & SEXUALITY 2015; 17:933-46. [PMID: 25706959 PMCID: PMC4772686 DOI: 10.1080/13691058.2015.1009947] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 01/16/2015] [Indexed: 06/04/2023]
Abstract
In HIV prevention and care programmes, disclosure of status by HIV-positive individuals is generally encouraged to contain the infection and provide adequate support to the person concerned. Lack of disclosure is generally framed as a barrier to preventive behaviours and accessing support. The assumption that disclosure is beneficial is also reflected in studies that aim to identify determinants of disclosure and recommend individual-level measures to promote disclosure. However, in contexts where HIV infection is stigmatised and there is fear of rejection and discrimination among those living with HIV, concealment of status becomes a way to try and regain as much as possible the life that was disrupted by the discovery of HIV infection. In this study of HIV-positive women and children in India, concealment was considered essential by individuals and families of those living with HIV to re-establish and maintain their normal lives in an environment where stigma and discrimination were prevalent. This paper describes why women and care givers of children felt the need to conceal HIV status, the various ways in which people tried to do so and the implications for treatment of people living with HIV. We found that while women were generally willing to disclose their status to their husband or partner, they were very keen to conceal their status from all others, including family members. Parents and carers with an HIV-positive child were not willing to disclose this status to the child or to others. Understanding the different rationales for concealment would help policy makers and programme managers to develop more appropriate care management strategies and train care providers to assist clients in accessing care and support without disrupting their lives.
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Affiliation(s)
| | - Helen Lambert
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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18
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Garner AL, Schembri G, Cullen T, Lee V. Should we screen heterosexuals for extra-genital chlamydial and gonococcal infections? Int J STD AIDS 2014; 26:462-6. [PMID: 25013220 DOI: 10.1177/0956462414543120] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 06/01/2014] [Indexed: 11/15/2022]
Abstract
Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) are two of the most prevalent bacterial sexually transmitted infections in the UK. Although the high burden of extra-genital infections with GC and CT in men who have sex with men has been well established, a significant number of extra-genital site infections with CT and GC could similarly be present in heterosexual women. For this reason we started to routinely offer extra-genital site testing for GC and CT in all patients attending our sexual health clinic who reported having had receptive anal sex and/or giving oral sex. This followed a review of current evidence by the clinical team and a change in local testing policy. This study not only confirmed a large reservoir of extra-genital infection amongst men who have sex with men, but also demonstrates that a comparable reservoir of extra-genital infection is present amongst heterosexual women. Our study adds to the mounting evidence that extra-genital site testing in heterosexual women should occur when oral or anal sexual activity is reported.
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Affiliation(s)
- Anna L Garner
- Manchester Centre for Sexual Health, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Gabriel Schembri
- Manchester Centre for Sexual Health, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Thomas Cullen
- Manchester Centre for Sexual Health, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Vincent Lee
- Manchester Centre for Sexual Health, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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Intimate partner violence and HIV infection among women: a systematic review and meta-analysis. J Int AIDS Soc 2014; 17:18845. [PMID: 24560342 PMCID: PMC3925800 DOI: 10.7448/ias.17.1.18845] [Citation(s) in RCA: 264] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 11/20/2013] [Accepted: 01/20/2014] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION To assess evidence of an association between intimate partner violence (IPV) and HIV infection among women. METHODS Medline/PubMed, Embase, Web of Science, EBSCO, Ovid, Cochrane HIV/AIDS Group's Specialized Register and Cochrane Central Register of Controlled Trials were searched up to 20 May 2013 to identify studies that examined the association between IPV and HIV infection in women. We included studies on women aged ≥15 years, in any form of sexually intimate relationship with a male partner. RESULTS Twenty-eight studies [(19 cross-sectional, 5 cohorts and 4 case-control studies) involving 331,468 individuals in 16 countries - the US (eight studies), South Africa (four studies), East Africa (10 studies), India (three studies), Brazil (one study) and multiple low-income countries (two studies)] were included. Results were pooled using RevMan 5.0. To moderate effect estimates, we analyzed all data using the random effects model, irrespective of heterogeneity level. Pooled results of cohort studies indicated that physical IPV [pooled RR (95% CI): 1.22 (1.01, 1.46)] and any type of IPV [pooled RR (95% CI): 1.28 (1.00, 1.64)] were significantly associated with HIV infection among women. Results of cross-sectional studies demonstrated significant associations of physical IPV with HIV infection among women [pooled OR (95% CI): 1.44 (1.10, 1.87)]. Similarly, results of cross-sectional studies indicated that combination of physical and sexual IPV [pooled OR (95% CI): 2.00 (1.24, 3.22) and any type of IPV [pooled OR (95% CI): 1.41 (1.16, 1.73)] were significantly associated with HIV infection among women. CONCLUSIONS Available evidence suggests a moderate statistically significant association between IPV and HIV infection among women. To further elucidate the strength of the association between IPV and HIV infection among women, there is a need for high-quality follow-up studies conducted in different geographical regions of the world, and among individuals of diverse racial/cultural backgrounds and varying levels of HIV risks.
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20
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Thapa S, Bista N, Timilsina S, Buntinx F, Mathei C. Social and behavioural risk factors for HIV infection among the wives of labour migrants in Nepal. Int J STD AIDS 2014; 25:793-9. [PMID: 24469967 DOI: 10.1177/0956462414521162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Summary Labour migration has increased the risk of HIV infection among the wives of labour migrants in Nepal. We conducted a matched case-control study to identify the social and behavioural factors for HIV infection among the wives of labour migrants in Nepal. We interviewed 112 wives of labour migrants diagnosed with HIV (cases) and 112 wives of labour migrants testing negative for HIV (controls) and used logistic regression analysis to assess independent factors associated with HIV infection. Literacy status was the only one woman-related social factor associated with HIV infection. Meanwhile literacy status, age when going abroad for the first time and country of migration were the husband-related social factors and alcohol consumption, living alone abroad and having an unpaid partner abroad were the husband-related behavioural factors associated with HIV infection in the wives. Given the husband-related social and behavioural factors are mostly determining the risk of HIV infection in the wives in our study, prevention efforts must incorporate behaviour change approaches targeting specifically to labour migrants and also to their wives.
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Affiliation(s)
- Subash Thapa
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Nirmala Bista
- Department of Public Health, Nobel College Pokhara University, Kathmandu, Nepal
| | - Suraj Timilsina
- Department of Microbiology, Nepal Medical College, Kathmandu, Nepal
| | - Frank Buntinx
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium Department of General Practice, University of Maastricht, Maastricht, Netherlands
| | - Catharina Mathei
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Kouyoumdjian FG, Findlay N, Schwandt M, Calzavara LM. A systematic review of the relationships between intimate partner violence and HIV/AIDS. PLoS One 2013; 8:e81044. [PMID: 24282566 PMCID: PMC3840028 DOI: 10.1371/journal.pone.0081044] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 10/17/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is a significant health problem that has been associated with HIV infection in numerous studies. We aimed to systematically review the literature on relationships between IPV and HIV in order to describe the prevalence of IPV in people with HIV, the prevalence of HIV in people experiencing IPV, the association between IPV and HIV, and evidence regarding mechanisms of risk and interventions. METHODS Data sources were 10 electronic databases and reference lists. Studies were included if they reported data on the relationship between IPV and HIV. All records were independently reviewed by two authors at the stages of title and abstract review and full text review. Any abstract considered eligible by either reviewer was reviewed in full, and any disagreement regarding eligibility of full texts or data extracted was resolved by discussion. RESULTS 101 articles were included. Experiencing IPV and HIV infection were associated in unadjusted analyses in most studies, as well as in adjusted analyses in many studies. The findings of qualitative and quantitative studies assessing potential mechanisms linking IPV and HIV were variable. Few interventions have been assessed, but two identified in this review were promising in terms of preventing IPV, though not HIV infection. CONCLUSIONS Experiencing IPV and HIV infection tend to be associated in unadjusted analyses, suggesting that IPV screening and linkage with relevant programs and services may be valuable. It is unclear whether there is a causal association between experiencing IPV and HIV infection. Research should focus on defining parameters of IPV which are relevant to HIV infection, including type of IPV and period of exposure and risk, on assessing potential mechanisms, and on developing and assessing interventions which build on the strengths of existing studies.
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Affiliation(s)
| | - Nicole Findlay
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michael Schwandt
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Liviana M. Calzavara
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Das A, Babu GR, Ghosh P, Mahapatra T, Malmgren R, Detels R. Epidemiologic correlates of willingness to be tested for HIV and prior testing among married men in India. Int J STD AIDS 2013; 24:957-68. [PMID: 23970619 DOI: 10.1177/0956462413488568] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There has been limited research in India on determinants of seeking HIV testing by Indian married couples. We analyzed data obtained from husbands of married couples participating in the National Family Health Survey 2005-06. Socio-demographic and behavioural predictors for willingness to be tested and self-reported prior testing were explored, using multivariate logistic regression. Factor scores were used to summarize knowledge variables related to HIV prevention and places of testing. Sixty-nine percent of the husbands were willing to be tested as part of National Family Health Survey 2005-06, and 7% reported some form of prior testing. Our results indicate that knowledge about HIV testing in hospitals and other health/welfare centres, knowledge about transmission of HIV, poor education, religion, economic status, occupation, early sexual debut, and use of contraceptives other than barrier methods were significant predictors for reported willingness to be tested. Knowledge about routes of transmission of HIV, younger age, educational level, religion other than Hindu or Muslim, economic status, occupation, history of blood transfusion, and condom use were significant correlates of previously being tested. Strategies to improve knowledge about HIV testing sites and HIV prevention may encourage married men to be tested and reduce the spread of infection from them to their wives.
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Affiliation(s)
- Aritra Das
- Department of Epidemiology, UCLA School of Public Health, Los Angeles, USA
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Ethical issues in obtaining collateral information on alcohol and drug use: experience from Asia and Africa. Curr Opin Psychiatry 2013; 26:330-4. [PMID: 23689550 DOI: 10.1097/yco.0b013e328361ebd7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW In many regions of the world, wives of alcohol and drug-using men are at an increased risk for HIV/AIDS because of their husbands' high-risk behaviours. These women also tend to be poor, illiterate and dependent on their husbands. Few interventions are designed exclusively for these women. Furthermore, these interventions have had to obtain permission from the husbands to recruit the wives. This article discusses the ethical concerns in obtaining husbands' permission to recruit their wives, with examples taken from India and other countries in Asia and Africa. RECENT FINDINGS Studies indicate that married women are recruited for interventions only with their husbands' consent. Researchers reported that this strategy was acceptable to the local culture, increased acceptance of the research by family and community and improved the participation rate of married women. However, this strategy conflicts with the ethical principles of individual autonomy and voluntariness. SUMMARY Designing research processes according to the local cultural norms is important. However, it is a researcher's ethical duty to ensure that every individual of the society, irrespective of sex, race or marital status, gets equal opportunities to make health-related decisions. This article suggests alternate strategies to directly approach and recruit monogamous wives of alcohol and drug-using men; further research is required to test the feasibility of suggested strategies.
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Cooperman NA, Shastri JS, Shastri A, Schoenbaum E. HIV prevalence, risk behavior, knowledge, and beliefs among women seeking care at a sexually transmitted infection clinic in Mumbai, India. Health Care Women Int 2013; 35:1133-47. [PMID: 23659311 DOI: 10.1080/07399332.2013.770004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Three hundred women presenting to a sexually transmitted infection (STI) clinic in Mumbai, India were surveyed and HIV tested. Thirty-nine percent were HIV infected; 80% were current sex workers, and HIV infection was not significantly associated with past-year sex work. Only 44% always used condoms with their noncommercial sex partners. Most believed that condom preparation is a male responsibility (58%); that condom use is a sign that partner trust is lacking (84%); and that if a woman asks her partner to use a condom, he will lose respect for her (65%). All women at STI clinics in India need HIV testing and culturally sensitive risk interventions.
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Affiliation(s)
- Nina A Cooperman
- a Division of Addiction Psychiatry , University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School , New Brunswick , New Jersey , USA
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Chibber KS, Krupp K, Padian N, Madhivanan P. Examining the determinants of sexual violence among young, married women in Southern India. JOURNAL OF INTERPERSONAL VIOLENCE 2012; 27:2465-2483. [PMID: 22279129 PMCID: PMC3617404 DOI: 10.1177/0886260511433512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The prevalence of sexual violence is increasingly being studied in India. Yet the determinants of sexual violence, irrespective of physical violence, remain largely unexplored. Here the authors identify the determinants of sexual violence, and additionally, explore how the presence of physical violence modifies these determinants. A cross-sectional analysis is conducted using baseline data from a longitudinal study involving young married women attending reproductive health clinics in Southern India. A multivariable logistic regression analysis is conducted to first identify determinants of sexual violence and then repeated after stratifying elements based on presence or absence of physical violence identified from participants' reports. 36% and 50% of the participants report experiencing sexual and physical violence, respectively. After adjusting for other covariates, women's partners' characteristics are found most significantly associated with their odds of experiencing sexual violence. These characteristics include husbands' primary education, employment as drivers, alcohol consumption, and having multiple sex partners. Women's contribution to household income also increases their odds of experiencing sexual violence by almost twofold; however, if they are solely responsible for "all" household income, the relationship is found to be protective. Physical violence modifies the determinants of sexual violence, and among women not experiencing physical violence, husbands' primary education and employment as drivers increase women's odds of experiencing sexual violence nearly threefold, and women who contribute "all" the household income (n = 62) do not experience sexual violence. These relationships are not significant among women experiencing physical violence. Study findings improve the understanding of the determinants of sexual violence. Future research is needed to examine the risk factors for different types of GBV independently and to tease apart the differences in risk factors depending on women's experiences. The significance of male partners' characteristics warrants in-depth research, and in order to promote gender-equitable norms, future interventions need to focus on male behaviors and men's day-to-day survival challenges, all of which likely influence conflicts in marital relationships.
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Affiliation(s)
- Karuna S Chibber
- University of California San Francisco, San Francisco, CA 94105, USA.
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