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Comins CA, Baral S, Mcingana M, Shipp L, Phetlhu DR, Young K, Guddera V, Hausler H, Schwartz S. ART coverage and viral suppression among female sex workers living with HIV in eThekwini, South Africa: Baseline findings from the Siyaphambili study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002783. [PMID: 38776334 PMCID: PMC11111033 DOI: 10.1371/journal.pgph.0002783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/04/2024] [Indexed: 05/24/2024]
Abstract
In South Africa >60% of female sex workers (FSW) are living with HIV, the majority of whom are not virally suppressed. Identifying multi-level determinants of viral suppression is central to developing implementation strategies to promote retention in HIV care and viral suppression among FSW with unmet treatment needs. Adult cisgender FSW living with HIV for ≥6 months, conducting sex work as their primary source of income, and residing in Durban (South Africa) were enrolled into the Siyaphambili Study, a sequential multiple assignment randomized trial. Baseline viral load and CD4 were assessed, and an interviewer-administered survey was conducted, capturing socio-demographic, reproductive and sexual history and behaviors, vulnerabilities, substance use, mental health, and stigma. We assessed baseline determinants of viral suppression (<50 copies/mL) using bivariate and multivariable robust poisson regression, considering associations across the individual, network, environmental and macrostructural levels. From June 2018 -March 2020, 1,644 women were screened, with 1,391 eligible FSW living with HIV enrolled. The analyses were conducted among the 1,373 participants with baseline data. Overall, 65% (889/1,373) of participants were reported to be on antiretroviral therapy and 38% (520/1,373) were virally suppressed. In the multivariable model, FSW who experienced a lack of housing in the prior six months were less likely to be virally suppressed (aPR: 0.72, 95%CI 0.56-0.91), while older FSW (aPR: 1.46 95%CI: 1.16-1.83 for 30-39 years old vs. 18-29 years old; aPR: 2.15 95%CI: 1.64-2.80 for 40+ years vs. 18-29 years old) and FSW reporting hormonal or long-acting contraception use were more likely to be virally suppressed (aPR: 1.19 95% CI: 1.00-1.43). We found vulnerability to be high among FSW living with HIV in South Africa and identified individual and structural determinants associated with viral suppression. Taken together these results suggest optimizing HIV treatment outcomes necessitates supporting younger sex workers and addressing housing instability. Trial registration: NCT03500172.
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Affiliation(s)
- Carly A. Comins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Lily Shipp
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Deliwe Rene Phetlhu
- Department of Nursing, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | | | - Harry Hausler
- TB HIV Care, Cape Town, South Africa
- University of Pretoria, Pretoria, South Africa
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Kerrigan D, Barrington C, Donastorg Y, Perez M, Gomez H, Davis W, Beckham SW, Karver TS, Mantsios A, Galai N. Individual and Collective Forms of Stigma Resistance: Pathways Between HIV and Sex Work Stigma and Viral Suppression Among Female Sex Workers in the Dominican Republic. AIDS Behav 2024; 28:357-366. [PMID: 37725235 DOI: 10.1007/s10461-023-04169-y] [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: 09/08/2023] [Indexed: 09/21/2023]
Abstract
Intersecting forms of stigma including both HIV and sex work stigma have been known to impede HIV prevention and optimal treatment outcomes among FSW. Recent research has indicated that intersectional stigma can be resisted at the community and individual level. We assessed pathways between HIV stigma, sex work stigma, social cohesion and viral suppression among a cohort of 210 FSW living with HIV in the Dominican Republic. Through Poisson regression we explored the relationship between HIV outcomes and internalized, anticipated and enacted HIV and sex work stigma, and resisted sex work stigma. We employed structural equation modeling to explore the direct effect of various forms of stigma on HIV outcomes, and the mediating effects of multi-level stigma resistance including social cohesion at the community level and occupational dignity at the individual level. 76.2% of FSW were virally suppressed and 28.1% had stopped ART at least once in the last 6 months. ART interruption had a significant negative direct effect on viral suppression (OR = 0.26, p < 0.001, 95% CI: 0.13-0.51). Social cohesion had a significant positive direct effect on viral suppression (OR = 2.07, p = 0.046, 95% CI: 1.01-4.25). Anticipated HIV stigma had a significant negative effect on viral suppression (OR = 0.34, p = 0.055, 95% CI: 0.11-1.02). This effect was mediated by the interaction between cohesion and dignity which rendered the impact of HIV stigma on viral suppression not significant. Findings demonstrate that while HIV stigma has a negative impact on viral suppression among FSW, it can be resisted through individual and collective means. Results reinforce the importance of community-driven, multi-level interventions.
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Affiliation(s)
- Deanna Kerrigan
- George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Clare Barrington
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Yeycy Donastorg
- Instituto Dermatológico y Cirugía de Piel Dr. Huberto Bogaert Díaz, Santo Domingo, Dominican Republic
| | - Martha Perez
- Instituto Dermatológico y Cirugía de Piel Dr. Huberto Bogaert Díaz, Santo Domingo, Dominican Republic
| | - Hoisex Gomez
- Instituto Dermatológico y Cirugía de Piel Dr. Huberto Bogaert Díaz, Santo Domingo, Dominican Republic
| | - Wendy Davis
- George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - S Wilson Beckham
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Noya Galai
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Singh SK, Shri N. Sociodemographic correlates of discrimination against PLHIV in High HIV prevalence states of India, NFHS 2016-21. Sci Rep 2023; 13:15083. [PMID: 37699942 PMCID: PMC10497618 DOI: 10.1038/s41598-023-42162-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/06/2023] [Indexed: 09/14/2023] Open
Abstract
This study investigates the socio-demographic correlates of HIV discrimination among individuals aged 15-49 years. This study also aims to assess the change in discriminatory attitudes towards PLHIV in high HIV prevalence states from 2016 to 2021 using data from the national Demographic Health Survey (4th and 5th). To identify factors associated with discriminatory attitudes, a multivariable logistic regression analysis was performed. Further, predicted probabilities and average marginal effects were computed, and the difference in discriminatory attitudes across both rounds was examined using a non-linear Fairlie decomposition. Mass media exposure, improved wealth index, and comprehensive knowledge significantly reduced the discriminatory attitudes towards PLHIV. Fairlie decomposition indicated that comprehensive knowledge, knowledge of mother-to-child transmission, and mass media exposure was significant contributor to the differences observed in the discriminatory attitude towards PLHIV across survey rounds. This study emphasizes the importance of spreading accurate information about HIV transmission modes and reinforces existing programmes and policies aimed at reducing stigma and discrimination against PLHIV. These programmes' efficiency and effectiveness can be ensured by linking them with community-level programmes and activities organized by Self Help Groups (SHGs), which have resulted in a paradigm shift in empowering women in India.
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Affiliation(s)
- Shri Kant Singh
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Neha Shri
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India.
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Restar AJ, Quilantang MI, Wickersham J, Adia A, Guigayoma J, Bermudez AN, Galárraga O, Flores DD, Cu‐Uvin S, Nazareno J, Operario D, Sison O. Predictors of PrEP awareness, PrEP discussion and interest in long-acting injectable PrEP among Filipina transfeminine adults. J Int AIDS Soc 2023; 26:e26080. [PMID: 37306123 PMCID: PMC10258862 DOI: 10.1002/jia2.26080] [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: 10/17/2022] [Accepted: 03/08/2023] [Indexed: 06/13/2023] Open
Abstract
INTRODUCTION Transfeminine adults are impacted by the HIV epidemic in the Philippines, and newly approved modalities of pre-exposure prophylaxis (PrEP), including long-acting injectable (LAI-PrEP), could be beneficial for this group. To inform implementation, we analysed PrEP awareness, discussion and interest in taking LAI-PrEP among Filipina transfeminine adults. METHODS We utilized secondary data from the #ParaSaAtin survey that sampled Filipina transfeminine adults (n = 139) and conducted a series of multivariable logistic regressions with lasso selection to explore factors independently associated with PrEP outcomes, including awareness, discussion with trans friends and interest in LAI-PrEP. RESULTS Overall, 53% of Filipina transfeminine respondents were aware of PrEP, 39% had discussed PrEP with their trans friends and 73% were interested in LAI-PrEP. PrEP awareness was associated with being non-Catholic (p = 0.017), having previously been HIV tested (p = 0.023), discussing HIV services with a provider (p<0.001) and having high HIV knowledge (p = 0.021). Discussing PrEP with friends was associated with older age (p = 0.040), having experienced healthcare discrimination due to transgender identity (p = 0.044), having HIV tested (p = 0.001) and having discussed HIV services with a provider (p < 0.001). Very interested in LAI-PrEP was associated with living in Central Visayas (p = 0.045), having discussed HIV services with a provider (p = 0.001) and having discussed HIV services with a sexual partner (p = 0.008). CONCLUSIONS Implementing LAI-PrEP in the Philippines requires addressing systemic improvements across personal, interpersonal, social and structural levels in healthcare access, including efforts to create healthcare settings and environments with providers who are trained and competent in transgender health and can address the social and structural drivers of trans health inequities, including HIV and barriers to LAI-PrEP.
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Affiliation(s)
- Arjee Javellana Restar
- Department of EpidemiologyUniversity of Washington School of Public HealthSeattleWashingtonUSA
- Department of Behavioral and Social Sciences, Research Education Institute for Diverse Scholars (REIDS)Yale University School of Public HealthNew HavenConnecticutUSA
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Ma Irene Quilantang
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRhode IslandUSA
- Department of Behavioral SciencesUniversity of Philippines‐ManilaManilaPhilippines
| | - Jeffrey Wickersham
- Department of Behavioral and Social Sciences, Research Education Institute for Diverse Scholars (REIDS)Yale University School of Public HealthNew HavenConnecticutUSA
- Department of Internal MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - Alex Adia
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
- Division of Health Policy and ManagementUniversity of California – Berkeley School of Public HealthBerkeleyCaliforniaUSA
| | - John Guigayoma
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Amiel Nazer Bermudez
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
- Department of EpidemiologyBrown University School of Public HealthProvidenceRhode IslandUSA
- Department of Epidemiology and BiostatisticsUniversity of Philippines‐ManilaManilaPhilippines
| | - Omar Galárraga
- Department of Health Services, Policy, and PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Dalmacio Dennis Flores
- Department of Behavioral and Social Sciences, Research Education Institute for Diverse Scholars (REIDS)Yale University School of Public HealthNew HavenConnecticutUSA
- Department of Family and Community HealthUniversity of Pennsylvania School of NursingPhiladelphiaPennsylvaniaUSA
| | - Susan Cu‐Uvin
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Jennifer Nazareno
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Don Operario
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
- Department of Behavioral, Social, and Health Education SciencesEmory University Rollins School of Public HealthAtlantaGeorgiaUSA
| | - Olivia Sison
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
- Department of EpidemiologyBrown University School of Public HealthProvidenceRhode IslandUSA
- Institute of Clinical Epidemiology, National Institutes of HealthUniversity of Philippines‐ManilaManilaPhilippines
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Machingura F, Busza J, Jamali GM, Makamba M, Mushati P, Chiyaka T, Hargreaves J, Hensen B, Birdthistle I, Cowan FM. Facilitators and barriers to engaging with the DREAMS initiative among young women who sell sex aged 18-24 in Zimbabwe: a qualitative study. BMC Womens Health 2023; 23:257. [PMID: 37173783 PMCID: PMC10182710 DOI: 10.1186/s12905-023-02374-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/18/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Adolescent girls and young women (AGYW) are at high risk of contracting HIV and exchanging sex for financial or material support heightens their risk. In Zimbabwe, the DREAMS initiative integrated education and employment opportunities within HIV health promotion and clinical services for vulnerable young women, including those who sell sex. While most participants accessed health services, fewer than 10% participated in any social programmes. METHODS We conducted semi-structured qualitative interviews with 43 young women aged 18-24 to understand their experiences of engaging with the DREAMS programme. We purposively sampled participants for diversity in level of education, type and location of selling sex. We analysed the data by applying the Theoretical Domains Framework to explore facilitators and barriers to engaging with DREAMS. RESULTS Eligible women were motivated by hopes of escaping poverty, and their longer-term engagement was sustained through exposure to new social networks, including friendships with less vulnerable peers. Barriers included opportunity costs and expenses such as transport or equipment required for job placements. Participants also described pervasive stigma and discrimination related to their involvement in selling sex. Interviews highlighted the young women's struggles in a context of entrenched social and material deprivation and structural discrimination that hindered their ability to take up most of the social services offered. CONCLUSIONS This study demonstrates that while poverty was a key driver of participation in an integrated package of support, it also constrained the ability of highly vulnerable young women to benefit fully from the DREAMS initiative. Multi-layered HIV prevention approaches such as DREAMS that seek to alter complex and longstanding social and economic deprivation address many of the challenges faced by YWSS but will only succeed if the underlying drivers of HIV risk among YWSS are also addressed.
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Affiliation(s)
- Fortunate Machingura
- Centre for Sexual Health and HIV/AIDS Research, (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe.
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Joanna Busza
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, London, UK
| | - Gracious Madimutsa Jamali
- Centre for Sexual Health and HIV/AIDS Research, (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
| | - Memory Makamba
- Centre for Sexual Health and HIV/AIDS Research, (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
| | - Phillis Mushati
- Centre for Sexual Health and HIV/AIDS Research, (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
| | - Tarisai Chiyaka
- Centre for Sexual Health and HIV/AIDS Research, (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
| | - James Hargreaves
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, London, UK
| | - Bernadette Hensen
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Isolde Birdthistle
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Frances Mary Cowan
- Centre for Sexual Health and HIV/AIDS Research, (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Ransome Y, Hayashi K, Gamble-George JC, Dean LT, Villalonga-Olives E. Racial and ethnic differences in the association of social cohesion and social capital with HIV testing. SSM Popul Health 2023; 21:101327. [PMID: 36618543 PMCID: PMC9811247 DOI: 10.1016/j.ssmph.2022.101327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/24/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
HIV testing rates vary by race and ethnicity. Whether social capital indicators are related to HIV testing and whether these associations differ by race or ethnicity is unknown. Multivariable analysis was used to examine whether social capital (collective engagement and civic and social participation), including social cohesion (trust in neighbors, neighbors willing to help, feelings of belongingness) were associated with testing for HIV in the past 12 months. Participants were white, Black or African American, and Hispanic/Latino adults ages 18 to 44 (N = 2823) from the general population, in Philadelphia, PA who participated in the Southeastern Pennsylvania Household Health Surveys 2010 and 2012. Overall HIV testing in this sample was 42%, and was higher among women, and Black compared to white people. Mean social capital scores were significantly highest among whites. Greater trust in neighbors was associated with lower odds of testing for HIV (adjusted Odds Ratio[aOR]:0.61, 95% CI = 0.49-0.74), and this relationship varied by race/ethnicity, with stronger inverse associations among Hispanic/Latino (aOR = 0.43, p < 0.001) and white adults (aOR = 0.50, p < -0.001) than among Black adults (aOR = 0.75, p < 0.05). Greater neighborhood belongingness (aOR = 1.31, 95% CI = 1.11-1.54) and working together to improve the neighborhood (aOR = 1.33, 95%CI = 1.03-1.73) were associated with higher odds of testing for HIV. Different indicators of social capital were associated with higher as well as lower odds of testing for HIV. These patterns did not vary statistically by race or ethnicity. HIV testing prevention interventions will need to address social capital in design and implementation strategies.
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Affiliation(s)
- Yusuf Ransome
- Social and Behavioral Sciences, Yale University, School of Public Health, 60 College Street, LEPH 4th Floor, New Haven, CT, 06520, USA
- Corresponding author. Yale School of Public Health, 60 College Street, LEPH 4 th Floor, New Haven, CT, 06520, USA.
| | - Kamden Hayashi
- Department of Health Behavior, University of North Carolina, Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Joyonna C. Gamble-George
- Behavioral Science Training in Drug Abuse Research, New York University Rory Meyers College of Nursing, 380 2nd Avenue, Suite 306, NY, 10010, USA
- Center for Interdisciplinary Research on AIDS, Yale University, School of Public Health, 135 College Street, Suite 200, New Haven, CT, 06510, USA
| | - Lorraine T. Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6650, Baltimore, MD, 21205, USA
| | - Ester Villalonga-Olives
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA
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Busza J, Matambanadzo P, Phiri L, Meki B, Cowan FM. HIV prevention in individuals engaged in sex work. Curr Opin Infect Dis 2023; 36:1-8. [PMID: 36729746 DOI: 10.1097/qco.0000000000000891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW People who sell sex remain at disproportionate risk of acquiring HIV and should be prioritized for evidence-based HIV prevention programmes delivered at sufficient scale and intensity for effectiveness. Although new biomedical tools are becoming available, many basic lessons learned early in the HIV pandemic remain salient today and need renewed attention. RECENT FINDINGS New preexposure prophylaxis formulations, distribution systems, and delivery mechanisms are being successfully trialled and implemented, adding to well established prevention tools such as male and female condoms and lubricants. The importance of social support networks and community ownership of programmes has been consistently reaffirmed. Serious challenges remain in optimizing HIV prevention for sex workers, including providing services at the scale and intensity necessary for population level impact, addressing culturally sensitive issues of gender identity and sexual orientation, and protecting adolescents and young people who may sell sex. Pervasive social stigma, often reinforced by criminalization and police harassment, further constrain sex workers' access to available services and prevention tools. SUMMARY Meaningful community engagement and addressing the multiple social determinants of vulnerability at individual, community, and structural levels remain at the core of preventing HIV among people involved in selling sex.
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Affiliation(s)
- Joanna Busza
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Bee Meki
- Trans and Intersex Rising Zimbabwe, Zimbabwe
| | - Frances M Cowan
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe
- Department for International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Wilson EC, Turner CM, Dhakal M, Sharma S, Rai A, Lama R, Banik S, Arayasirikul S. Stigma as a barrier and sex work as a protective factor for HIV testing among trans women in Nepal. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001098. [PMID: 36963013 PMCID: PMC10022763 DOI: 10.1371/journal.pgph.0001098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 01/28/2023] [Indexed: 03/19/2023]
Abstract
Stigma towards trans women in Nepal creates individual and system-level risks for HIV. A critical protective factor is access to HIV prevention. Research is needed to determine the impact of stigma on HIV testing among trans women in Nepal. We conducted a secondary analysis of data collected using respondent driven sampling in 2019 on HIV risk among trans women in Nepal. Data analysis was restricted to trans women who were HIV negative at testing through the parent study. Descriptive statistics, tests for bivariable associations between HIV testing and stigma variables, and binomial Poisson regression were conducted to examine HIV testing outcomes. There were 173 participants who tested negative for HIV in our sample. The majority were under age 35 (59%) and most had a grade school education or less (64.7%). No trans women were homeless and most rented a room (70.5%) or owned their home (19.7%). The majority were currently sex workers (57.8%). Almost all HIV-negative trans women had ever been tested for HIV (90.8%), but only 53.5% in the last 3 months. The most frequently cited reason for not having been tested was thinking they were at low risk for HIV (40.9%) and being afraid of receiving a positive test result (22.7%). HIV and anti-trans stigma were high across most measures, including that almost all (94.2%) believed that most people in Nepal would discriminate against people with HIV. And most participants thought trans women were not accepted in Nepali Society (65.9%). Most participants also reported high social support (70.5%). Social cohesion among participants varied, with most experiencing medium (41.6%) or high (33.5%) social cohesion. Just over half had high social participation (55.5%). Participants who reported current sex work had lower prevalence of not testing for HIV in the last 3 months (prevalence ratio, PR = 0.54, 95% confidence interval, 95%CI = 0.32-0.92, p = 0.02). Every one-unit increase in social cohesion was associated with 1.05 times the prevalence of not testing for HIV in the last 3 months (95%CI = 1.01-1.09, p-value = 0.02). Trans women who did sex work were more likely to be HIV tested while those who were more socially connected to peers were less likely to have recently been tested for HIV. HIV stigma may result in fear of social rejection from peers if one tests positive. Interventions that focus on addressing stigma within trans women's social networks and strategies to mitigate HIV stigma in society may result in increased frequency of HIV testing among trans women in Nepal.
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Affiliation(s)
- Erin C. Wilson
- San Francisco Department of Public Health, Trans Research Unit for Equity (TRUE), Center for Public Health Research, San Francisco, California, United States of America
- * E-mail:
| | - Caitlin M. Turner
- San Francisco Department of Public Health, Trans Research Unit for Equity (TRUE), Center for Public Health Research, San Francisco, California, United States of America
| | | | | | - Anuj Rai
- Blue Diamond Society, Kathmandu, Nepal
| | | | - Swagata Banik
- Department of Public Health & Prevention Sciences, Baldwin Wallace University, Berea, Ohio, United States of America
| | - Sean Arayasirikul
- San Francisco Department of Public Health, Trans Research Unit for Equity (TRUE), Center for Public Health Research, San Francisco, California, United States of America
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Awareness, Willingness and Use of HIV Pre-Exposure Prophylaxis Among Female Sex Workers Living in Dar-es-Salaam, Tanzania. AIDS Behav 2023; 27:335-343. [PMID: 35838859 PMCID: PMC9852168 DOI: 10.1007/s10461-022-03769-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 01/24/2023]
Abstract
Tanzania is in the final stages to roll out pre-exposure prophylaxis (PrEP) to Female Sex Workers (FSWs) so as to reduce new infections. PrEP demonstration projects support programming through gaining first experiences.We analyzed data from a cohort of 700 HIV negative FSWs in Dar-es-Salaam to determine proportions of FSWs who were aware, willing and used PrEP. We compared proportions at cohort enrolment and after 12 months. Logistic regression was used to determine factors associated with PrEP use. PrEP awareness increased from 67% to 97% after 12 months. Willingness was high at both time points (98% versus 96%). Only 8% (57/700) had used PrEP. Being married/cohabiting or separated/divorced/widowed and having sex with a HIV infected partner were independently associated with PrEP use. The PrEP program should focus on scaling up access as willingness to use PrEP is high.
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Chen C, Baral S, Comins CA, Mcingana M, Wang L, Phetlhu DR, Mulumba N, Guddera V, Young K, Mishra S, Hausler H, Schwartz SR. HIV- and sex work-related stigmas and quality of life of female sex workers living with HIV in South Africa: a cross-sectional study. BMC Infect Dis 2022; 22:910. [PMID: 36474210 PMCID: PMC9724359 DOI: 10.1186/s12879-022-07892-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Environmental quality of life (QoL) assesses individually perceived factors such as physical safety and security, accessibility, quality of healthcare, and physical environment. These factors are particularly relevant in the context of sex work and HIV, where stigma has been identified as an important barrier across several prevention and treatment domains. This study aims to examine the association between different types of HIV- and sex work-related stigmas and environmental QoL among female sex workers (FSW) living with HIV in Durban, South Africa. METHODS We conducted cross-sectional analyses using baseline data from the Siyaphambili randomized controlled trial. FSW who reported sex work as their primary source of income and had been diagnosed with HIV for ≥ 6 months were enrolled from June 2018-March 2020, in eThekwini, South Africa. We evaluated the association between environmental QoL, dichotomizing the environmental domain score collected by the WHO Quality of Life HIV Brief (WHOQOL-HIV BREF) questionnaire at the median, and stigma using modified robust Poisson regression models. Five stigma subscales were assessed: sex work-related (anticipated, enacted, or internalized stigma) and HIV-related (anticipated or enacted stigma). RESULTS Among 1373 FSW, the median environmental QoL was 10.5 out of 20 [IQR: 9.0-12.5; range 4.0-19.0], while the median overall QoL was 3 out of 5 [IQR: 2-4; range 1-5]. One-third of FSW (n = 456) fell above the median environmental QoL score, while 67% were above the median overall QoL (n = 917). Reporting anticipated sex work stigma was associated with lower environmental QoL (adjusted prevalence ratio [aPR] 0.74 [95% CI 0.61, 0.90]), as was severe internalized sex work stigma (aPR: 0.64, 95% CI 0.48, 0.86). Reporting enacted HIV stigma versus none was similarly associated with lower environmental QoL (aPR: 0.65, 95% CI 0.49, 0.87). Enacted sex work stigma and anticipated HIV stigma were not statistically associated with environmental QoL. CONCLUSIONS This study highlights the need to consider the impact of multiple stigmas on FSW's non-HIV related clinical outcomes, including safety and physical well-being. Moreover, these results suggest that addressing underlying structural risks may support the impact of more proximal HIV prevention and treatment interventions. Trial registration NCT03500172 (April 17, 2018).
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Affiliation(s)
- Claire Chen
- grid.21107.350000 0001 2171 9311Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, W3503, Baltimore, MD 21205 USA
| | - Stefan Baral
- grid.21107.350000 0001 2171 9311Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, W3503, Baltimore, MD 21205 USA
| | - Carly A. Comins
- grid.21107.350000 0001 2171 9311Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, W3503, Baltimore, MD 21205 USA
| | - Mfezi Mcingana
- grid.438604.dTB HIV Care Association, Cape Town, South Africa
| | - Linwei Wang
- grid.415502.7MAP-Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON Canada
| | - Deliwe Rene Phetlhu
- grid.438604.dTB HIV Care Association, Cape Town, South Africa ,grid.8974.20000 0001 2156 8226University of Western Cape, Cape Town, South Africa
| | - Ntambue Mulumba
- grid.438604.dTB HIV Care Association, Cape Town, South Africa
| | - Vijay Guddera
- grid.438604.dTB HIV Care Association, Cape Town, South Africa
| | - Katherine Young
- grid.438604.dTB HIV Care Association, Cape Town, South Africa
| | - Sharmistha Mishra
- grid.415502.7MAP-Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Medicine, Division of Infectious Disease, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON Canada
| | - Harry Hausler
- grid.438604.dTB HIV Care Association, Cape Town, South Africa
| | - Sheree R. Schwartz
- grid.21107.350000 0001 2171 9311Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, W3503, Baltimore, MD 21205 USA
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Moore SJ, Wood-Palmer DK, Jones MD, Doraivelu K, Newman Jr A, Harper GW, Camacho-González A, del Río C, Sutton MY, Hussen SA. Feasibility and acceptability of B6: a social capital program for young Black gay, bisexual and other men who have sex with men living with HIV. HEALTH EDUCATION RESEARCH 2022; 37:405-419. [PMID: 36200434 PMCID: PMC9677235 DOI: 10.1093/her/cyac028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Young Black gay, bisexual and other men who have sex with men (YB-GBMSM) are disproportionately burdened by HIV and often exhibit suboptimal engagement in HIV care. With the goal of increasing engagement in HIV care, we designed a culturally specific, theory-based group-level program, Brothers Building Brothers by Breaking Barriers (B6), which aimed to strengthen resilience and social capital among YB-GBMSM living with HIV. We conducted a pilot trial to evaluate the program's acceptability and feasibility. Through clinic-based recruitment and community outreach events, we recruited and enrolled 71 YB-GBMSM into the study. Participants were randomized to either the B6 program or a control comparison program. Post-session evaluation surveys and in-depth qualitative interviews showed B6 to have high levels of acceptability and satisfaction. Specifically, participants described benefits to interacting in a group with other YB-GBMSM, and several described increased comfort with their own gay identities after participation. No adverse events or safety concerns were reported. However, there were challenges to feasibility, as reflected in recruitment and retention rates. The B6 program was highly acceptable among YB-GBMSM living with HIV; however, innovative program delivery methods and implementation strategies will be needed to improve recruitment and retention in future implementation of B6.
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Affiliation(s)
- Shamia J Moore
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Drew K Wood-Palmer
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Marxavian D Jones
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Kamini Doraivelu
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Antonio Newman Jr
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Gary W Harper
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Andrés Camacho-González
- Department of Pediatrics, Division of Infectious Diseases, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322, USA
| | - Carlos del Río
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
| | - Madeline Y Sutton
- Department of Obstetrics and Gynecology, Morehouse University School of Medicine, 720 Westview Drive, Atlanta, GA 30310, Georgia
| | - Sophia A Hussen
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
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12
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Hussen SA, Drumhiller K, Emerenini S, Moore SJ, Jones MD, Camacho-González A, Ransome Y, Elopre L, Del Río C, Harper GW. Understanding social capital among young black gay and bisexual men living with HIV: a qualitative exploration. CULTURE, HEALTH & SEXUALITY 2022; 24:1498-1513. [PMID: 34506268 DOI: 10.1080/13691058.2021.1974561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 08/26/2021] [Indexed: 06/13/2023]
Abstract
Social capital, defined as the sum of an individual's resource-containing, reciprocal and trustworthy social network connections, has been associated with improved engagement in care among people living with HIV globally. We conducted a qualitative interview study of social capital among 28 young Black gay, bisexual and other men who have sex with men ages 18-29 living with HIV in Atlanta, Georgia. We asked participants about bonding capital (relationships between individuals with similar demographic characteristics), bridging capital (relationships with individuals of different backgrounds), collective efficacy (involvement with community organisations) and satisfaction with their social networks. We found that participants described bonding capital from friends and family in depth, while more gaps were noted in bridging capital and collective efficacy. Bonding capital derived from families was especially critical to participants' satisfaction with their social capital. Findings suggest that interventions targeting young Black gay, bisexual and other men who have sex with men should build upon strong bonds with family and friends, and/or fill gaps in bridging capital and collective efficacy by connecting young men to mentors and organisations.
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Affiliation(s)
- Sophia A Hussen
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA, USA
| | | | - Sabina Emerenini
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Shamia J Moore
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Marxavian D Jones
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Andrés Camacho-González
- Department of Pediatrics, Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA, USA
| | - Yusuf Ransome
- Department of Social and Behavioral Sciences, School of Public Health, Yale University, New Haven, CT, USA
| | - Latesha Elopre
- Department of Medicine, Division of Infectious Diseases, University of Alabama, Birmingham, AL, USA
| | - Carlos Del Río
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA, USA
| | - Gary W Harper
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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13
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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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Restar AJ, Valente PK, Ogunbajon A, Masvawure TB, Sandfort T, Gichangi P, Lafort Y, Mantell JE. Solidarity, support and competition among communities of female and male sex workers in Mombasa, Kenya. CULTURE, HEALTH & SEXUALITY 2022; 24:627-641. [PMID: 33666535 PMCID: PMC8556737 DOI: 10.1080/13691058.2021.1876248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Female and male sex workers are at elevated risk for HIV infection, psychological distress and other adverse health outcomes. It is therefore important to understand how sex workers' social relationships with one another might inform psychosocial support services for this population. We conducted semi-structured interviews to examine the formation and nature of social networks of 25 female and 25 male sex workers recruited from bars and clubs in Mombasa, Kenya. Relationships between and among female and male participants were often formed based on a mutual understanding of the challenging nature of sex work. Both groups described their relationships in terms of friendship and brotherhood/sisterhood and highlighted the following benefits of sex worker social networks: economic benefits, access to information about HIV/STIs and protection, and support against violence from clients and law enforcement agents. Social networks were often threatened by competition for clients and hence could result in conflict. However, sex workers explained that their sense of solidarity and reliance on one another for health, protection and economic well-being helped minimise conflict. The social networks of sex workers could therefore be used to leverage or optimise access to HIV prevention and care.
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Affiliation(s)
- Arjee J. Restar
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
- Corresponding Author: Arjee Restar
| | - Pablo K. Valente
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, NY, USA
| | - Adedotun Ogunbajon
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Tsitsi Beatrice Masvawure
- Health Studies Program, Center for Interdisciplinary Studies, College of the Holy Cross, Worcester, MA, USA
| | - Theo Sandfort
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, NY, USA
| | - Peter Gichangi
- Technical University of Mombasa, Mombasa, Kenya
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
- Department of Anatomy, University of Nairobi, Nairobi, Kenya
| | - Yves Lafort
- KEMRI, Wellcome Trust Research Programme, Kilifi, Kenya
| | - Joanne E. Mantell
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, NY, USA
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15
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Eubanks A, Coulibaly B, Dembélé Keita B, Anoma C, Dah TTE, Mensah E, Maradan G, Bourrelly M, Mora M, Riegel L, Rojas Castro D, Yaya I, Spire B, Laurent C, Sagaon-Teyssier L. Rate and Predictors of Ineffective HIV Protection in African Men Who Have Sex with Men Taking Pre-Exposure Prophylaxis. AIDS Behav 2022; 26:3524-3537. [PMID: 35469111 DOI: 10.1007/s10461-022-03692-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Abstract
We investigated the rate and predictors of ineffective HIV protection in men who have sex with men (MSM) taking pre-exposure prophylaxis (PrEP) in a prospective cohort study from November 2017 to November 2020 in Mali, Côte d'Ivoire, Burkina Faso, and Togo. MSM had to be 18 years or older and at high risk of HIV infection to participate. They also received a comprehensive sexual health prevention package, including PrEP, in community-based clinics as part of the cohort study. Using socio-behavioral/clinical data, HIV protection during their most recent anal intercourse with a male partner was categorized as effective or ineffective (i.e., incorrect PrEP adherence and no condom use). Seventeen percent (500/2839) of intercourses were ineffectively protected for the 520 study participants. Predictors of ineffective HIV protection included being an event-driven user with financial difficulties, having a high alcohol misuse score, and not being a member of a community association. PrEP programs in West Africa must be tailored to socially vulnerable MSM who struggle to adopt PrEP.
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Affiliation(s)
- August Eubanks
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France.
| | | | | | | | - Ter Tiero Elias Dah
- Association African Solidarité, Ouagadougou, Burkina Faso
- Institut National de Santé Publique, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | | | - Gwenaëlle Maradan
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
- ORS PACA, Observatoire Régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Michel Bourrelly
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
- Coalition Plus, Community-Based Research Laboratory, Pantin, France
| | - Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
| | - Lucas Riegel
- Coalition Plus, Community-Based Research Laboratory, Pantin, France
| | - Daniela Rojas Castro
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
- Coalition Plus, Community-Based Research Laboratory, Pantin, France
| | - Issifou Yaya
- TransVIHMI, Univ Montpellier, INSERM, Montpellier, IRD, France
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
| | | | - Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
- ARCAD Santé PLUS, Bamako, Mali
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16
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Miller SS, Mantell JE, Parmley LE, Musuka G, Chingombe I, Mapingure M, Rogers JH, Wu Y, Hakim AJ, Mugurungi O, Samba C, Harris TG. Stigma, Social Cohesion, and HIV Risk Among Sexual and Gender Minorities in Two Cities in Zimbabwe. AIDS Behav 2022; 26:2994-3007. [PMID: 35304904 PMCID: PMC9372004 DOI: 10.1007/s10461-022-03622-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/24/2022]
Abstract
Though stigma is a recognized contributor to the disproportionate HIV burden among sexual and gender minorities (SGM) in sub-Saharan Africa, data describing this association among Zimbabwean SGM are limited. We examined relationships between SGM stigma and HIV and the potential for social cohesion to moderate the association among Zimbabwean men who have sex with men, transgender women, and genderqueer individuals. Consenting participants (n = 1511) recruited through respondent-driven sampling for a biobehavioral survey in Harare and Bulawayo completed structured interviews and received HIV testing. Reported SGM stigma was common (68.9% in Harare and 65.3% in Bulawayo) and associated with HIV infection in Harare (adjusted prevalence ratio [aPR] = 1.82, 95% confidence interval [CI] = 1.27–2.62) and Bulawayo (aPR = 1.51, 95% CI = 1.15–2.00) in relative risk regression. Social cohesion did not moderate these relationships. Findings demonstrate stigma’s association with HIV vulnerability among Zimbabwean SGM, highlighting the need for stigma-mitigation to reduce HIV transmission in this population.
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Affiliation(s)
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, USA
| | | | | | | | | | - John H Rogers
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Yingfeng Wu
- ICAP at Columbia University, New York, NY, USA
| | - Avi J Hakim
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Owen Mugurungi
- AIDS and TB Programme, Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Tiffany G Harris
- ICAP at Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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17
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Masunaga Y, Muela Ribera J, Jaiteh F, de Vries DH, Peeters Grietens K. Village health workers as health diplomats: negotiating health and study participation in a malaria elimination trial in The Gambia. BMC Health Serv Res 2022; 22:54. [PMID: 35016656 PMCID: PMC8753917 DOI: 10.1186/s12913-021-07431-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/16/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Although many success stories exist of Village Health Workers (VHWs) improving primary health care, critiques remain about the medicalisation of their roles in disease-specific interventions. VHWs are placed at the bottom of the health system hierarchy as cheap and low-skilled volunteers, irrespective of their highly valued social and political status within communities. In this paper, we shed light on the political role VHWs play and investigate how this shapes their social and medical roles, including their influence on community participation.
Method
The study was carried out within the context of a malaria elimination trial implemented in rural villages in the North Bank of The Gambia between 2016 and 2018. The trial aimed to reduce malaria prevalence by treating malaria index cases and their potentially asymptomatic compound members, in which VHWs took an active role advocating their community and the intervention, mobilising the population, and distributing antimalarial drugs. Mixed-methods research was used to collect and analyse data through qualitative interviews, group discussions, observations, and quantitative surveys.
Results and discussion
We explored the emic logic of participation in a malaria elimination trial and found that VHWs played a pivotal role in representing their community and negotiating with the Medical Research Council to bring benefits (e.g. biomedical care service) to the community. We highlight this representative role of VHWs as ‘health diplomats’, valued and appreciated by community members, and potentially increasing community participation in the trial. We argue that VHWs aspire to be politically present and be part of the key decision-makers in the community through their health diplomat role.
Conclusion
It is thus likely that in the context of rural Gambia, supporting VHWs beyond medical roles, in their social and political roles, would contribute to the improved performance of VHWs and to enhanced community participation in activities the community perceive as beneficial.
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18
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Restar A, Surace A, Adia A, Goedel W, Ogunbajo A, Jin H, Edeza A, Hernandez L, Cu-Uvin S, Operario D. Characterizing Awareness of Pre-Exposure Prophylaxis for HIV Prevention in Manila and Cebu, Philippines: Web-Based Survey of Filipino Cisgender Men Who Have Sex With Men. J Med Internet Res 2022; 24:e24126. [PMID: 34994705 PMCID: PMC8783281 DOI: 10.2196/24126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/14/2020] [Accepted: 09/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background The Philippines is experiencing an HIV crisis and is considering implementing pre-exposure prophylaxis (PrEP) as a national public health strategy for HIV prevention for cisgender men who have sex with men (cis-MSM). However, critical information on the awareness of PrEP among cis-MSM is needed to roll out this public health initiative. Objective This study aims to assess PrEP awareness and related correlates (ie, sociodemographic variables, social factors, and health care access and use) among Filipino cis-MSM. Methods We conducted a web-based survey with Filipino cis-MSM (n=179) residing in the cities of Manila and Cebu, Philippines. Multivariable analysis procedures were performed to examine the factors associated with PrEP awareness. Results Our sample demonstrated high awareness (134/179, 74.9%) and interest (159/179, 88.8%) in taking PrEP. The adjusted model showed that greater odds of PrEP awareness were associated with having a college education or higher versus a high school education or lower (adjusted odds ratio [aOR] 7.30, 95% CI 1.01-52.47), earning between PHP 10,000 (US $198.6) and PHP 20,000 (US $397.2) versus <PHP 10,000 (US $198.60; aOR 9.32, 95% CI 1.41-6.22), having had a prior HIV test (aOR 6.06, 95% CI 1.20-13.55), having high HIV knowledge (aOR 3.50, 95% CI 1.11-10.98), and having friends who discussed PrEP (aOR 11.17, 95% CI 2.73-14.5). Conclusions Our findings demonstrate that Filipino cis-MSM are aware of and interested in taking PrEP, but there is currently an unmet need for such biomedical HIV prevention technologies among this population. Incorporating PrEP education into routine HIV screening and leveraging cis-MSM social networks may be useful in optimizing potential PrEP implementation in the Philippines.
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Affiliation(s)
- Arjee Restar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.,Brown University Global Health Initiative, The Philippine Health Initiative for Research, Service, and Training, Providence, RI, United States.,amFAR, The Foundation of AIDS Research, Washington, DC, United States.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States.,Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | - Anthony Surace
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Alexander Adia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.,Brown University Global Health Initiative, The Philippine Health Initiative for Research, Service, and Training, Providence, RI, United States
| | - William Goedel
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Adedotun Ogunbajo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Harry Jin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Alberto Edeza
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Laufred Hernandez
- Department of Behavioral Sciences, University of Philippines in Manila, Manila, Philippines
| | - Susan Cu-Uvin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.,Brown University Global Health Initiative, The Philippine Health Initiative for Research, Service, and Training, Providence, RI, United States.,Providence-Boston Center for AIDS Research, Providence, RI, United States.,Department of Medicine, Miriam Hospital, Providence, RI, United States
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.,Brown University Global Health Initiative, The Philippine Health Initiative for Research, Service, and Training, Providence, RI, United States
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19
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Jorjoran Shushtari Z, Salimi Y, Hosseini SA, Sajjadi H, Snijders TAB. Determinants of safe sexual behavior of female sex workers in Tehran: the woman, her network, and the sexual partner. BMC Public Health 2021; 21:2219. [PMID: 34872543 PMCID: PMC8647307 DOI: 10.1186/s12889-021-12266-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the steady growth of sexual transmission of HIV, there is little evidence about safe sexual behavior of FSWs, and social network effects on this behavior, in Iran. Our aim in this study was to determine the effect of social network characteristics on condom use among FSWs, considering individual characteristics of the FSWs and of their sexual partners, characteristics of their relationship, and the FSW's personal network. METHODS A cross-sectional ego-centric network survey of 170 FSWs was carried out in Tehran between January and June 2017. A multilevel ordered logistic regression analysis was conducted to examine the effects of individual and relational characteristics simultaneously. RESULTS Condom use in sexual relationships of the FSWs on average was rather low. Important determinants of safe sexual behavior were found both at the level of the individual FSW and at the level of the sexual partner. The main determinants at the level of the individual FSW were FSWs' age and HIV knowledge. At the level of the sexual partner, age and education of sexual partners, as well as intimacy, duration of tie, frequency of contacts with a given partner, frequency of contact, perceived social support, and perceived safe sex norms were significantly associated with condom use. CONCLUSIONS The findings highlighted that considering only the individual characteristics of female sex workers is not sufficient for effectively promoting condom use. Factors at the network and dyadic level should also be considered, especially the role of sexual partners. Network-based interventions may be useful which modify social relationships to create a social environment that can facilitate changes in sexual behavior.
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Affiliation(s)
- Zahra Jorjoran Shushtari
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, P.O Box: 1985713834, Tehran, Iran
| | - Yahya Salimi
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyed Ali Hosseini
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, P.O Box: 1985713834, Tehran, Iran.
| | - Homeira Sajjadi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, P.O Box: 1985713834, Tehran, Iran
| | - Tom A B Snijders
- Department of Sociology, University of Groningen, 9712 TG, Groningen, Netherlands
- Nuffield College, University of Oxford, Oxford, OX1 1NF, UK
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20
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Goldenberg T, Kerrigan D, Gomez H, Perez M, Donastorg Y, Barrington C. Stigma, Social Cohesion, and Mental Health Among Transgender Women Sex Workers Living with HIV in the Dominican Republic. STIGMA AND HEALTH 2021; 6:467-475. [PMID: 36910276 PMCID: PMC9997213 DOI: 10.1037/sah0000337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Globally, transgender (trans) women experience pervasive stigma, which contributes to health inequities across multiple mental health outcomes. While trans stigma has been associated with increased mental health challenges, less is known about how stigma related to sex work and HIV affect mental health. Social cohesion may ameliorate the negative health consequences of stigma, but little is known about how social cohesion is associated with mental health among trans women. Using cross-sectional survey data collected in 2019 among 100 trans women sex workers living with HIV in Santo Domingo, Dominican Republic, we examined associations between stigma (related to HIV, sex work, and trans identity), social cohesion, and depression and anxiety symptoms. In unadjusted models, enacted and internalized sex work stigma were associated with greater odds of depression and anxiety symptoms and social cohesion was associated with less depression and anxiety. Resisted sex work stigma, which captured acceptance of self and work, was associated with lower odds of depression and trans stigma was associated with increased anxiety. In adjusted models, internalized sex work stigma was associated with increased depression (aOR=1.19, p=0.018) and anxiety symptoms (aOR=1.12, p=0.021), while social cohesion was associated with reduced depression (OR=0.81, p=0.002) and anxiety symptoms (aOR=0.086, p=0.023). Findings indicate the need for interventions to focus on reducing internalized sex work stigma and promoting social cohesion to improve mental health among trans women. Additional research is needed to determine how to best measure the intersections between HIV, sex work, and trans stigma and their impact on mental health.
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Affiliation(s)
- Tamar Goldenberg
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Hoisex Gomez
- HIV Vaccine Research Unit, Instituto Dermatológico y Cirugía de Piel Dr. Huberto Bogaert Díaz, Santo Domingo, Dominican Republic
| | - Martha Perez
- HIV Vaccine Research Unit, Instituto Dermatológico y Cirugía de Piel Dr. Huberto Bogaert Díaz, Santo Domingo, Dominican Republic
| | - Yeycy Donastorg
- HIV Vaccine Research Unit, Instituto Dermatológico y Cirugía de Piel Dr. Huberto Bogaert Díaz, Santo Domingo, Dominican Republic
| | - Clare Barrington
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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21
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Zarwell M, Walsh JL, Quinn KG, Kaniuka A, Patton A, Robinson WT, Cramer RJ. A psychometric assessment of a network social capital scale among sexual minority men and gender minority individuals. BMC Public Health 2021; 21:1918. [PMID: 34686175 PMCID: PMC8539846 DOI: 10.1186/s12889-021-11970-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social capital, the potential for individuals to access resources through group memberships, is linked to a constellation of health outcomes. We modified a previously evaluated Constructed Family Social Capital Scale for gay, bisexual and other men who have sex with men who belong to constructed families to create a new measure of social capital within sexual minority men and gender minority individuals' social networks. METHODS Participants were recruited from a Pride festival in Milwaukee, Wisconsin in 2018 to complete a cross-sectional survey. This analysis is restricted to 383 participants who identified as sexual minority men or gender minority individuals and completed nine items measuring social capital within their social networks. We conducted exploratory and confirmatory factor analyses to assess factor structure. Internal consistency was measured using Cronbach's alpha. RESULTS Reliability was high, indicating the scale's utility to assess Network Social Capital among sexual minority men and gender minority individuals. A single-factor solution with high factor loadings was found for the nine-item scale. CONCLUSIONS This study extended the psychometric properties of a preliminary social capital instrument modified from a prior study in a different population and context. The modified measure has implications for use among sexual minority men and gender minority individuals to measure social capital within social networks. Previous studies suggest that interventions to enhance social capital among sexual minority men and gender minority individuals may be beneficial for HIV prevention interventions. This tool may be relevant for the evaluation of social capital interventions within networks of sexual minority men and gender minority individuals.
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Affiliation(s)
- Meagan Zarwell
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA.
| | - Jennifer L Walsh
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Katherine G Quinn
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andréa Kaniuka
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Alexandra Patton
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - William T Robinson
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Robert J Cramer
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
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22
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Argento E, Strathdee SA, Shoveller JA, Braschel M, Shannon K. Correlates of Suicidality Among A Community-Based Cohort of Women Sex Workers: The Protective Effect of Social Cohesion. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:9709-9724. [PMID: 31431099 PMCID: PMC7608559 DOI: 10.1177/0886260519870167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Suicide is a critical public health concern globally. Sex workers experience a disproportionate burden of social and health inequities driven by forms of violence, stigma, and criminalization, yet empirical research on suicidality is limited. This study longitudinally investigated the burden and socio-structural correlates of recent suicidality among women sex workers in Vancouver, Canada. Data (2010-2017) were drawn from a community-based, prospective cohort of cis and trans women sex workers across Metro Vancouver. Women completed biannual interviewer-administered questionnaires, and correlates of suicidality in the last 6 months were analyzed using bivariate and multivariable logistic regression with generalized estimating equations (GEE). Of 867 women at baseline, 48% (n = 413) reported lifetime suicidality, 16% (n = 141) reported suicidality in the last 6 months, and 29% reported suicidality at some point during the study. In multivariable analysis, factors independently associated with suicidality included physical/sexual childhood abuse (adjusted odds ratio [AOR]: 2.99; 95% confidence interval [CI] = [1.75, 5.10]), mental health issues (depression/anxiety/posttraumatic stress disorder; AOR = 2.19; 95% CI = [1.63, 2.95]), intimate partner violence (AOR: 2.11; 95% CI = [1.60, 2.80]), physical/sexual client violence (AOR: 1.82; 95% CI = [1.33, 2.50]), and homelessness (AOR: 1.44; 95% CI = [1.10, 1.89]). Older age (AOR: 0.97; 95% CI = [0.95, 0.99]) and higher social cohesion (AOR: 0.88; 95% CI = [0.78, 0.99]) were significantly associated with reduced odds of suicidality. Findings reveal key socio-structural correlates of suicidality among sex workers including experiences of historical and interpersonal violence, trauma/mental health issues, and homelessness. Strengthening social cohesion may have a protective effect on suicidality. Trauma-informed community-led structural interventions tailored to sex workers are urgently needed alongside a legal framework that enables collectivization and connectedness.
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Affiliation(s)
- Elena Argento
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | | | - Jean A. Shoveller
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Kate Shannon
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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23
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Hill AO, Bavinton BR, Kaneko N, Lafferty L, Lyons A, Gilmour S, Armstrong G. Associations Between Social Capital and HIV Risk-Taking Behaviors Among Men Who Have Sex with Men in Japan. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3103-3113. [PMID: 34618277 DOI: 10.1007/s10508-021-02097-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 04/24/2021] [Accepted: 06/29/2021] [Indexed: 06/13/2023]
Abstract
Social capital has been positively associated with reduced HIV risk. However, few studies have investigated if associations vary between men who have sex with men (MSM) or heterosexual alters (possessors of actual resources embedded within social capital networks) and HIV risk-taking behaviors. In a cross-sectional survey of 1564 MSM in Greater Tokyo, we investigated whether social capital ascertained from MSM or heterosexual alters influenced HIV risk-taking behaviors (i.e., consistent condom use and lifetime HIV testing). Multiple logistic regression revealed that MSM with high levels of social capital from heterosexual networks were twice as likely to report consistent condom use with casual male partners, while MSM who reported high levels of social capital from MSM networks were over twice as likely to have tested for HIV yet were half as likely to use condoms consistently with regular male partners. Associations between MSM, social capital, and HIV testing indicate the potential for integrating social capital enhancement programs into current HIV interventions.
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Affiliation(s)
- Adam O Hill
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VC, 3086, Australia.
| | | | - Noriyo Kaneko
- School of Nursing, Nagoya City University, Nagoya, Japan
| | - Lise Lafferty
- Kirby Institute, University of New South Wales, Sydney, Australia
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VC, 3086, Australia
| | - Stuart Gilmour
- Graduate School of Public Health, St Luke's International University, Tokyo, Japan
| | - Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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24
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Bond V, Hoddinott G, Viljoen L, Ngwenya F, Simuyaba M, Chiti B, Ndubani R, Makola N, Donnell D, Schaap A, Floyd S, Hargreaves J, Shanaube K, Fidler S, Bock P, Ayles H, Hayes R, Simwinga M, Seeley J. How 'place' matters for addressing the HIV epidemic: evidence from the HPTN 071 (PopART) cluster-randomised controlled trial in Zambia and South Africa. Trials 2021; 22:251. [PMID: 33823907 PMCID: PMC8025534 DOI: 10.1186/s13063-021-05198-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 03/16/2021] [Indexed: 11/26/2022] Open
Abstract
Background In a cluster-randomised trial (CRT) of combination HIV prevention (HPTN 071 (PopART)) in 12 Zambian communities and nine South African communities, carried out from 2012 to 2018, the intervention arm A that offered HIV treatment irrespective of CD4 count did not have a significant impact on population level HIV incidence. Intervention arm B, where HIV incidence was reduced by 30%, followed national guidelines that mid trial (2016) changed from starting HIV treatment according to a CD4 threshold of 500 to universal treatment. Using social science data on the 21 communities, we consider how place (community context) might have influenced the primary outcome result. Methods A social science component documented longitudinally the context of trial communities. Data were collected through rapid qualitative assessment, interviews, group discussions and observations. There were a total of 1547 participants and 1127 observations. Using these data, literature and a series of qualitative analysis steps, we identified key community characteristics of relevance to HIV and triangulated these with HIV community level incidence. Results Two interdependent social factors were relevant to communities’ capability to manage HIV: stability/instability and responsiveness/resistance. Key components of stability were social cohesion; limited social change; a vibrant local economy; better health, education and recreational services; strong institutional presence; established middle-class residents; predictable mobility; and less poverty and crime. Key components of responsiveness were community leadership being open to change, stronger history of HIV initiatives, willingness to take up HIV services, less HIV-related stigma and a supported and enterprising youth population. There was a clear pattern of social factors across arms. Intervention arm A communities were notably more resistant and unstable. Intervention arm B communities were overall more responsive and stable. Conclusions In the specific case of the dissonant primary outcome results from the HPTN 071 (PopART) trial, the chance allocation of less stable, less responsive communities to arm A compared to arm B may explain some of the apparently smaller impact of the intervention in arm A. Stability and responsiveness appear to be two key social factors that may be relevant to secular trends in HIV incidence. We advocate for a systematic approach, using these factors as a framework, to community context in CRTs and monitoring HIV prevention efforts. Trial registration ClinicalTrials.gov NCT01900977. Registered on July 17, 2013. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05198-5.
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Affiliation(s)
- Virginia Bond
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SH, UK. .,Zambart, School of Public Health, University of Zambia, Ridgeway Campus, P.O. Box 50697, Lusaka, Zambia.
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa
| | - Lario Viljoen
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa
| | - Fredrick Ngwenya
- Zambart, School of Public Health, University of Zambia, Ridgeway Campus, P.O. Box 50697, Lusaka, Zambia
| | - Melvin Simuyaba
- Zambart, School of Public Health, University of Zambia, Ridgeway Campus, P.O. Box 50697, Lusaka, Zambia
| | - Bwalya Chiti
- Zambart, School of Public Health, University of Zambia, Ridgeway Campus, P.O. Box 50697, Lusaka, Zambia
| | - Rhoda Ndubani
- Zambart, School of Public Health, University of Zambia, Ridgeway Campus, P.O. Box 50697, Lusaka, Zambia
| | - Nozizwe Makola
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa
| | - Deborah Donnell
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA, 98109-1024, USA
| | - Ab Schaap
- Zambart, School of Public Health, University of Zambia, Ridgeway Campus, P.O. Box 50697, Lusaka, Zambia.,Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, LSHTM, Keppel Street, London, WC17HT, UK
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, LSHTM, Keppel Street, London, WC17HT, UK
| | - James Hargreaves
- Centre for Evaluation, Faculty of Public Health and Policy, LSHTM, Keppel Street, London, WC17HT, UK
| | - Kwame Shanaube
- Zambart, School of Public Health, University of Zambia, Ridgeway Campus, P.O. Box 50697, Lusaka, Zambia
| | - Sarah Fidler
- National Institute for Health Research Biomedical Research Centre, Imperial College, South Kensington, London, SW7 2BU, UK
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa
| | - Helen Ayles
- Zambart, School of Public Health, University of Zambia, Ridgeway Campus, P.O. Box 50697, Lusaka, Zambia.,Department of Clinical Research, Faculty of Infectious and Tropical Diseases, LSHTM, Keppel Street, London, WC17HT, UK
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, LSHTM, Keppel Street, London, WC17HT, UK
| | - Musonda Simwinga
- Zambart, School of Public Health, University of Zambia, Ridgeway Campus, P.O. Box 50697, Lusaka, Zambia
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SH, UK.,Africa Health Research Institute, Nelson R. Mandela Medical School, 719 Umbilo Rd, Durban, 4001, South Africa
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25
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Logie CH, Wang Y, Lalor P, Williams D, Levermore K. Pre and Post-exposure Prophylaxis Awareness and Acceptability Among Sex Workers in Jamaica: A Cross-Sectional Study. AIDS Behav 2021; 25:330-343. [PMID: 32666244 DOI: 10.1007/s10461-020-02972-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The HIV prevention cascade is understudied among sex workers in Jamaica, where sex work and same sex practices are criminalized. We implemented a cross-sectional survey with cisgender women, transgender women, and cisgender men sex workers in Jamaica. We conducted multivariable logistic regression analyses to identify factors associated with PrEP and PEP awareness and acceptability. Participants (n = 340) included cisgender men (n = 124), transgender women (n = 101), and cisgender women (n = 115). PEP awareness was low (33.2%), yet acceptability was high (70.8%). In multivariable analyses, recent sexual violence, recent client violence, and sex work social cohesion were associated with PEP awareness and acceptability. One-third (32.7%) reported PrEP awareness, with high acceptability (80.2%). Relationship status and recent physical violence were associated with PrEP awareness and acceptability. In multivariable analyses, gender identity was not associated with differences in PEP/PrEP awareness/acceptability. Findings highlight the need to increase PEP and PrEP awareness and access among sex workers in Jamaica.
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26
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Faini D, Munseri P, Bakari M, Sandström E, Faxelid E, Hanson C. "I did not plan to have a baby. This is the outcome of our work": a qualitative study exploring unintended pregnancy among female sex workers. BMC Womens Health 2020; 20:267. [PMID: 33261591 PMCID: PMC7709442 DOI: 10.1186/s12905-020-01137-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 11/25/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND High number of unintended pregnancies-often leading to induced abortions-are reported among female sex workers (FSWs), highlighting a major unmet need for contraception. To better understand barriers to contraceptive use, we explored FSW's pregnancy perceptions and experiences of unintended pregnancy. We hypothesized that sex work exacerbates barriers to contraceptive use and that FSW's pregnancy perceptions and experiences of unintended pregnancy influence future commitment to contraceptive use. METHODS We conducted in-depth interviews with 11 FSWs (January-June 2019) in Dar es Salaam, Tanzania. We purposively sampled FSWs with a positive pregnancy test from those participating in a HIV vaccine preparedness cohort. We used open ended questions to explore how FSWs make decisions when facing barriers to contraceptive use, dealing with unintended pregnancy and adhering to contraceptive use after experiencing unintended pregnancy. All interviews were conducted in Kiswahili, audio-recorded, transcribed and translated into English. Grounded theory approach was used to analyse transcripts. Open and selective coding was performed using Nvivo software. RESULTS FSWs reported that sex work impedes good contraceptive behaviour because sex workers felt unable to negotiate consistent condom use, avoided health services due to stigma, missed monthly contraceptive supplies because of inconvenient clinic operating hours or skipped contraceptive pills when intoxicated after taking alcohol. FSWs who perceived pregnancy to be a burden terminated the pregnancy because of fear of loss of income during pregnancy or child rearing expenses in case child support was not assured by their partners. FSWs who perceived pregnancy to be a blessing decided to keep the pregnancy because they desired motherhood and hoped that children would bring prosperity. Family planning counselling and availability of contraceptives during postpartum care influenced the initiation of contraception among FSWs. Financial hardships related to childrearing or painful abortion experiences influenced FSWs' commitment to good contraceptive practices. CONCLUSION Our results demonstrate that FSWs face barriers to initiating and adhering to contraceptive use because of sex work stigma, inability to negotiate condoms and failure to access medical services at their convenience. Our findings underscore the need to integrate contraceptive services with HIV programs serving FSWs in their areas of work.
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Affiliation(s)
- Diana Faini
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences (MUHAS), 9 United Nations Road, Dar es Salaam, Tanzania.
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Patricia Munseri
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Muhammad Bakari
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Eric Sandström
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
| | - Elisabeth Faxelid
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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27
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Jiang H, Liu J, Tan Z, Fu X, Xie Y, Lin K, Yan Y, Li Y, Yang Y. Prevalence of and factors associated with advanced HIV disease among newly diagnosed people living with HIV in Guangdong Province, China. J Int AIDS Soc 2020; 23:e25642. [PMID: 33225623 PMCID: PMC7680922 DOI: 10.1002/jia2.25642] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/15/2020] [Accepted: 10/29/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION A high proportion of people living with HIV (PLHIV) present for care with advanced HIV disease (AHD), which is detrimental to "90-90-90" targets to end AIDS by 2030. This study aimed to explore the prevalence of and factors related to AHD among newly diagnosed PLHIV in Guangdong Province, China. METHODS Newly diagnosed PLHIV were recruited from six cities in Guangdong Province from May 2018 to June 2019. AHD was defined as an initial CD4 count <200 cells/µL or an AIDS-defining event within one month of HIV diagnosis. Data from a questionnaire and the national HIV surveillance system were used to explore the potential factors related AHD. RESULTS A total of 400 of 997 newly diagnosed PLHIV were defined as having AHD with a proportion of 40.1%. After adjusting for statistically significant variables in univariate analysis, multivariable logistic regressions showed that individuals aged 30 to 39 years (adjusted odds ratio (aOR) = 1.77, 95% confidence interval (CI): 1.13 to 2.79) and ≥50 years (aOR = 1.98, 95% CI: 1.15 to 3.43) were at a higher risk of AHD than those aged 18 to 29 years. Participants diagnosed by voluntary counselling and testing (VCT) clinics were less likely to have AHD (aOR = 0.67, 95% CI: 0.48 to 0.94) than those diagnosed at medical facilities. Participants who had ever considered HIV testing (aOR = 0.66, 95% CI: 0.45 to 0.98) and who had high social support (aOR = 0.73, 95% CI: 0.55 to 0.97) were at a lower risk of AHD, whereas participants who had HIV-related symptoms within one year before diagnosis were at a higher risk of AHD (aOR = 2.09, 95% CI: 1.58 to 2.77). The most frequent reason for active HIV testing was "feeling sick" (42.4%, 255/601), and the main reason for never considering HIV testing was "never thinking of getting HIV" (74.0%, 542/732). CONCLUSIONS Low-risk perception and a lack of awareness of HIV-related symptoms resulted in a high proportion of AHD in Guangdong Province, especially among the elderly, those diagnosed at medical facilities and those with low social support. Strengthening AIDS education and training programmes to scale up HIV testing through provider-initiated testing and counselling in medical facilities and VCT could facilitate early HIV diagnosis.
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Affiliation(s)
- Hongbo Jiang
- Department of Epidemiology and BiostatisticsSchool of Public HealthGuangdong Pharmaceutical UniversityGuangzhouChina
| | - Jun Liu
- Department of HIV/AIDS Control and PreventionGuangdong Provincial Center for Disease Control and PreventionGuangzhouChina
| | - Zhimin Tan
- Department of Epidemiology and BiostatisticsSchool of Public HealthGuangdong Pharmaceutical UniversityGuangzhouChina
| | - Xiaobing Fu
- Department of HIV/AIDS Control and PreventionGuangdong Provincial Center for Disease Control and PreventionGuangzhouChina
| | - Yingqian Xie
- Department of HIV/AIDS Control and PreventionGuangdong Provincial Center for Disease Control and PreventionGuangzhouChina
| | - Kaihao Lin
- Department of Epidemiology and BiostatisticsSchool of Public HealthGuangdong Pharmaceutical UniversityGuangzhouChina
| | - Yao Yan
- Department of Epidemiology and BiostatisticsSchool of Public HealthGuangdong Pharmaceutical UniversityGuangzhouChina
| | - Yan Li
- Department of HIV/AIDS Control and PreventionGuangdong Provincial Center for Disease Control and PreventionGuangzhouChina
| | - Yi Yang
- Department of Epidemiology and BiostatisticsSchool of Public HealthGuangdong Pharmaceutical UniversityGuangzhouChina
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Tsang EYH. A Sisterhood of Hope: How China's Transgender Sex Workers Cope with Intimate Partner Violence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7959. [PMID: 33138225 PMCID: PMC7672577 DOI: 10.3390/ijerph17217959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/14/2020] [Indexed: 11/29/2022]
Abstract
Transgender sex workers (TSWs/TSW) face considerable challenges that affect their mental health and make their situations more vulnerable and precarious. TSWs often experience violence from clients, police, and others, but it is estimated that 50% of these acts of violence are at the hands of their intimate partners. The marginalization of TSWs is fueled by abuse through isolation and shaming which prevents them from seeking help through formal channels like police or counselling services. There is limited research on intimate partner violence (IPV) involving transgender sex workers (biologically male at birth who transition to women) and their partners who are typically heterosexual/bisexual men. In China, stigmatization, homophobia, heterosexism, and transphobia structurally disadvantage TSWs and this power structure tacitly supports violence and abuse against them. To survive, TSWs rely on informal networks with their 'sisters' for advice and emotional support which is more effective at combatting IPV than criminal justice or social policy efforts. Ethnographic data from in-depth interviews with 25 TSWs provide insight about IPV and how informal social support is a protective factor that helps them cope with routine acts of violence. The findings identify the importance of the 'sisterhood' and how it protects and helps TSWs manage their physical and mental health.
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Affiliation(s)
- Eileen Yuk-Ha Tsang
- Department of Social and Behavioral Sciences, City University of Hong Kong, Hong Kong, China
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29
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Zhao Y, Bromberg DJ, Khoshnood K, Sheng Y. Factors associated with regular HIV testing behavior of MSM in China: a cross-sectional survey informed by theory of triadic influence. Int J STD AIDS 2020; 31:1340-1351. [PMID: 33081648 DOI: 10.1177/0956462420953012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The prevalence of HIV infection among men who have sex with men (MSM) in China has increased in recent years. Regular HIV testing is a key prevention strategy for identifying HIV infections among MSM. Informed by the theory of triadic influence, we aimed to determine individual, social and environmental factors associated with regular HIV testing behavior. Regular HIV testing is defined as taking an HIV test every 3 to 6 months. Both an online survey and a face-to-face survey was administered to MSM in China. Logistic regression was used to examine associations with testing behavior. 500 MSM were surveyed, the prevalence of regular testing was 56.4%. In the final model, age of first sexual intercourse, self-efficacy, perceived risk, number of partners, orientation disclosure, knowledge of HIV testing, behavioral intention and HIV relevant behaviors (sexually transmitted infection testing history) were associated with regular HIV testing; social stream characteristics had stronger associations with regular testing than individual and environmental factors. Findings implicated that interventions aimed at improving the effective counseling service from healthcare providers and the medical environment and intrapersonal changes should be combined to encourage MSM to have their first HIV test and to keep coming back at regular intervals.
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Affiliation(s)
- Yafang Zhao
- School of Nursing, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Daniel J Bromberg
- Yale School of Public Health, Yale University. New Haven, CT, USA.,Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Kaveh Khoshnood
- Yale School of Public Health, Yale University. New Haven, CT, USA
| | - Yu Sheng
- School of Nursing, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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30
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Datta A, Pita A, Rao A, Sithole B, Mnisi Z, Baral S. Size estimation of key populations in the HIV epidemic in eSwatini using incomplete and misaligned capture-recapture data. Ann Appl Stat 2020. [DOI: 10.1214/20-aoas1327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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31
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Abstract
Concurrent sexual partnerships (i.e., relationships that overlap in time) contribute to higher HIV acquisition risk. Social capital, defined as resources and connections available to individuals is hypothesized to reduce sexual HIV risk behavior, including sexual concurrency. Additionally, we do not know whether any association between social capital and sexual concurrency is moderated by gender. Multivariable logistic regression tested the association between social capital and sexual concurrency and effect modification by gender. Among 1445 African Americans presenting for care at an urban STI clinic in Jackson, Mississippi, mean social capital was 2.85 (range 1-5), mean age was 25 (SD = 6), and 62% were women. Sexual concurrency in the current year was lower for women compared to men (45% vs. 55%, χ2(df = 1) = 11.07, p = .001). Higher social capital was associated with lower adjusted odds of sexual concurrency for women compared to men (adjusted Odds Ratio [aOR] = 0.62 (95% CI 0.39-0.97), p = 0.034), controlling for sociodemographic and psychosocial covariates. Interventions that add social capital components may be important for lowering sexual risk among African Americans in Mississippi.
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32
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Restar A, Ogunbajo A, Adia A, Nazareno J, Hernandez L, Sandfort T, Lurie M, Cu-Uvin S, Operario D. Using structural equation modelling to characterise multilevel socioecological predictors and mediators of condom use among transgender women and cisgender men who have sex with men in the Philippines. BMJ Glob Health 2020; 5:e002463. [PMID: 32699154 PMCID: PMC7380848 DOI: 10.1136/bmjgh-2020-002463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Risks for condomless sex among transgender women and cisgender men who have sex with men (trans-WSM and cis-MSM, respectively) in the Philippines, where HIV recently became a national public health crisis, are shaped and exacerbated by various risk factors across multiple levels. METHODS Between June 2018 and August 2019, we conducted a cross-sectional online study with 318 trans-WSM and cis-MSM respondents from Manila and Cebu cities. Structural equational modelling procedures were performed to determine direct, indirect and overall effects between condom use and latent variables across multiple socioecological levels: personal (ie, condom self-efficacy), social (ie, social capital), environmental (ie, barriers to condom and HIV services) and structural (ie, structural violence, antidiscrimination policies). RESULTS Adjusted for gender, age, location and income, our model showed that: (1) all latent variables at the structural and environmental levels were significantly positively associated with each other (all ps<0.05); (2) barriers to condom and HIV services were significantly negatively associated with social capital (p<0.001) as well as condom self-efficacy (p<0.001); and (3) there were significantly positive associations between social capital and condom self-efficacy (p<0.001), and between condom self-efficacy and condom use (p<0.001). Moreover, social capital and condom self-efficacy fully mediated and buffered the negative effects between environmental and structural barriers and condom use. CONCLUSION This is the first known study pointing to multiple relationships and pathways across multiple socioecological levels that can potentially be leveraged for future interventions aimed at improving condom use among Filipinx trans-WSM and cis-MSM. Such interventions should be multicomponent and build and/or strengthen social capital and condom self-efficacy, as well as intentionally target prominent structural and environmental barriers to condom use.
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Affiliation(s)
- Arjee Restar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Adedotun Ogunbajo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Alexander Adia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Jennifer Nazareno
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Laufred Hernandez
- Department of Behavioral Sciences, University of the Philippines Manila, Manila, Metro Manila, Philippines
| | - Theo Sandfort
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, New York, USA
| | - Mark Lurie
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Susan Cu-Uvin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, USA
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33
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Hakim AJ, Callahan T, Benech I, Patel M, Adler M, Modi S, Bateganya M, Parris KA, Bingham T. Addressing Vulnerable Population Needs in the Last Mile to the elimination of mother to child transmission of HIV: (Re)Claiming the HIV Response for Female Sex Workers and Their Children. BMC Public Health 2020; 20:1015. [PMID: 32590975 PMCID: PMC7320569 DOI: 10.1186/s12889-020-09114-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/15/2020] [Indexed: 11/10/2022] Open
Abstract
As countries strive to eliminate mother-to-child transmission of HIV, female sex workers (FSW) and their children still face barriers to accessing these essential services. Data on FSW uptake of HIV and reproductive health services before, during, and after pregnancy reveal inadequate service utilization. Stigma encountered by FSW in healthcare settings may contribute to low uptake of HIV testing, antiretroviral therapy (ART), and other prevention of mother-to-child HIV transmission (PMTCT) services. Coordination between community-based FSW and facility-based PMTCT programs can facilitate successful linkage of pregnant FSW to antenatal services to support PMTCT efforts. We offer a way forward to reach 90-90-90 targets for FSW and their families and eliminate mother-to-child transmission of HIV.
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Affiliation(s)
- Avi J Hakim
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA.
| | - Tegan Callahan
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Irene Benech
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Monita Patel
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Michelle Adler
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Surbhi Modi
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Moses Bateganya
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Kae Anne Parris
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Trista Bingham
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
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34
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Restar AJ, Adia A, Cu-Uvin S, Operario D. Characterizing PrEP Awareness and Interest Among Filipina Transgender Women. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:212-228. [PMID: 32749880 PMCID: PMC10442845 DOI: 10.1521/aeap.2020.32.3.212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Pre-exposure prophylaxis (PrEP) can efficaciously avert HIV acquisition for individuals at risk, including transgender individuals (trans) in the Philippines. We conducted multivariate logistic regression procedures in an online sample of Filipina trans women (n = 139) to examine associations of PrEP awareness. In this sample, 53% of Filipina trans women were unaware of PrEP, but almost all (93%) expressed interest in taking PrEP once learning about it. Greater odds of PrEP awareness was associated with discussion of HIV services with their health care providers, higher HIV knowledge, and discussion of PrEP among trans friends. Lower odds of PrEP awareness was associated with reporting being currently unemployed. The findings underscore a subset of trans women who might be early adopters of PrEP, and highlight PrEP inequities among trans women most marginalized, including those who are unemployed and have engaged in sex work.
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Affiliation(s)
- Arjee J Restar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island
- amfAR, The Foundation of AIDS Research, Washington, DC
| | - Alexander Adia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island
| | - Susan Cu-Uvin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island
- Providence-Boston Center for AIDS Research and Miriam Hospital, Department of Medicine, Providence, Rhode Island
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island
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35
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Readiness of female sex workers for HIV testing and its associated factors in Shire Endaselassie town, Tigray, Ethiopia: a cross-sectional study. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-019-01045-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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36
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Edi Putra IGN, Januraga PP. Social Capital and HIV Testing Uptake among Indirect Female Sex Workers in Bali, Indonesia. Trop Med Infect Dis 2020; 5:tropicalmed5020073. [PMID: 32392824 PMCID: PMC7345714 DOI: 10.3390/tropicalmed5020073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/23/2020] [Accepted: 05/06/2020] [Indexed: 01/20/2023] Open
Abstract
Indirect female sex workers (FSWs), a type of FSW working under the cover of entertainment enterprises (e.g., karaoke lounge, bar, etc.), remain as an important key population for HIV transmission, signaling the need of appropriate interventions targeting HIV-related behaviors. This study aimed to investigate the association between social capital and HIV testing uptake. A cross-sectional study was conducted among 200 indirect FSWs in Denpasar, Bali. The dependent variable was HIV testing uptake in the last six months preceding the survey. The main independent variables were social capital constructs: social cohesion (perceived peer support and trust) and social participation. Variables of socio-demographic characteristics were controlled in this study to adjust the influence of social capital. Binary logistic regression was performed. The prevalence of HIV testing in the last six months was 72.50%. The multivariate analysis showed that only peer support from the social capital constructs was associated with HIV testing uptake. Indirect FSWs who perceived a high level of support within FSWs networks were 2.98-times (95% CI = 1.43–6.24) more likely to report for HIV testing. Meanwhile, perceived trust and social participation did not show significant associations in relation to HIV testing uptake. As social cohesion (support) within FSWs’ relationships can play an important role in HIV testing uptake, existing HIV prevention programs should consider support enhancement to develop a sense of belonging and solidarity.
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Affiliation(s)
- I Gusti Ngurah Edi Putra
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Pande Putu Januraga
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar, Bali 80361, Indonesia
- Correspondence: ; Tel.: +6281246180389
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37
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Stockton MA, Pence BW, Mbote D, Oga EA, Kraemer J, Kimani J, Njuguna S, Maselko J, Nyblade L. Associations among experienced and internalized stigma, social support, and depression among male and female sex workers in Kenya. Int J Public Health 2020; 65:791-799. [PMID: 32347313 DOI: 10.1007/s00038-020-01370-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/29/2020] [Accepted: 04/06/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES This study (1) estimated the association between experienced sex work-related stigma and moderate-to-severe depressive symptoms (hereafter depression), (2) examined independent associations between internalized stigma, experienced stigma, and depression among sex workers, and (3) investigated the potential modifying role of social support. METHODS A cross-sectional survey was conducted among 729 male and female sex workers in Kenya. RESULTS The prevalence of depression was 33.9%, and nearly all participants reported at least one of the experienced and internalized stigma items. Increasing levels of experienced stigma was associated with an increased predicted prevalence of depression [aPD 0.15 (95% CI 0.11-0.18)]. Increasing internalized stigma was independently associated with higher experienced stigma and depression and appeared to account for 25.5% of the shared variance between experienced stigma and depression after adjustment for confounders. Social support from same-sex sex workers did not appear to modify the association between experienced stigma and depression. CONCLUSIONS Addressing the high levels of stigma that sex workers face and their mental health needs should be a public health and human rights imperative.
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Affiliation(s)
- Melissa A Stockton
- Epidemiology Department, Gillings School of Global Public Health, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA.
| | - Brian W Pence
- Epidemiology Department, Gillings School of Global Public Health, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - David Mbote
- Kuria Foundation for Social Enterprise, Nairobi, Kenya
| | - Emmanuel A Oga
- Center for Applied Public Health Research, RTI International, 6110 Executive Boulevard, Rockville, MD, 20852, USA
| | - John Kraemer
- Global Health Division, International Development Group, RTI International, Washington, DC, USA.,Department of Health Systems Administration, Georgetown University, Washington, DC, USA
| | - Joshua Kimani
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | | | - Joanna Maselko
- Epidemiology Department, Gillings School of Global Public Health, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Laura Nyblade
- Global Health Division, International Development Group, RTI International, Washington, DC, USA
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38
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Moazzami M, Ketende S, Lyons C, Rao A, Taruberekera N, Nkonyana J, Mothopeng T, Schwartz S, Baral S. Characterizing Multi-level Determinants of HIV Prevalence Among Female Sex Workers in Maseru and Maputsoe, Lesotho. AIDS Behav 2020; 24:714-723. [PMID: 31041624 PMCID: PMC6821589 DOI: 10.1007/s10461-019-02495-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Lesotho has a broadly generalized HIV epidemic with nearly one in three reproductive-aged women living with HIV. Given this context, there has been limited research on specific HIV risks. In response, this study aimed to characterize the burden of HIV and multi-level correlates of HIV infection amongst female sex workers (FSW) in Lesotho. Respondent driven sampling was used to recruit 744 FSW from February to September 2014 in Maseru and Maputsoe, Lesotho. Robust Poisson regression was used to model weighted prevalence ratios (PR) for HIV, leveraging a modified social ecological model. The HIV prevalence among participants was 71.9% (534/743), with a mean age of 26.8 (SD 7.2). Both individual and structural determinants involving stigma were significantly associated with HIV. Women with the highest enacted stigma score (≥ 5) had a 26% higher prevalence of HIV than individuals that did not experience any stigma (PR 1.26, 95% CI 1.01, 1.57). These data reinforce the extraordinarily high burden of HIV borne by FSW even in the context of the generalized HIV epidemic observed in Lesotho and across southern Africa. Moreover, stigma represents a structural determinant that is fundamental to an effective HIV response for FSW in Lesotho.
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Affiliation(s)
- Mitra Moazzami
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Sosthenes Ketende
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | | | | | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
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39
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Lyons CE, Schwartz SR, Murray SM, Shannon K, Diouf D, Mothopeng T, Kouanda S, Simplice A, Kouame A, Mnisi Z, Tamoufe U, Phaswana-Mafuya N, Cham B, Drame FM, Aliu Djaló M, Baral S. The role of sex work laws and stigmas in increasing HIV risks among sex workers. Nat Commun 2020; 11:773. [PMID: 32071298 PMCID: PMC7028952 DOI: 10.1038/s41467-020-14593-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 01/18/2020] [Indexed: 12/19/2022] Open
Abstract
Globally HIV incidence is slowing, however HIV epidemics among sex workers are stable or increasing in many settings. While laws governing sex work are considered structural determinants of HIV, individual-level data assessing this relationship are limited. In this study, individual-level data are used to assess the relationships of sex work laws and stigmas in increasing HIV risk among female sex workers, and examine the mechanisms by which stigma affects HIV across diverse legal contexts in countries across sub-Saharan Africa. Interviewer-administered socio-behavioral questionnaires and biological testing were conducted with 7259 female sex workers between 2011-2018 across 10 sub-Saharan African countries. These data suggest that increasingly punitive and non-protective laws are associated with prevalent HIV infection and that stigmas and sex work laws may synergistically increase HIV risks. Taken together, these data highlight the fundamental role of evidence-based and human-rights affirming policies towards sex work as part of an effective HIV response.
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Affiliation(s)
- Carrie E Lyons
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
| | - Sheree R Schwartz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins School of Public Health, Hampton House 624 N. Broadway 8th Floor, Baltimore, MD, 21205, USA
| | - Kate Shannon
- Centre for Gender & Sexual Health Equity, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada
| | - Daouda Diouf
- Enda Santé, Senegal, 56 Cité Comico VDN, B.P, 3370, Dakar, Senegal
| | | | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso, Institut Africain de Santé Publique, 12 BP 199, Ouagadougou, Burkina Faso
| | | | - Abo Kouame
- Ministère de la Sante et de l'Hygiène Publique, Abidjan, Côte d'Ivoire
| | - Zandile Mnisi
- Health Research Department, Strategic Information Division, Ministry of Health, Cooper Centre Office 106, Mbabane, Eswatini
| | - Ubald Tamoufe
- Metabiota. Avenue Mvog-Fouda Ada, Av 1.085, Carrefour Intendance BP, 15939, Yaoundé, Cameroon
| | - Nancy Phaswana-Mafuya
- DVC Research and Innovation Office, North-West University, Potchefstroom Campus, Private Bag X6001 Potchefstroom, 2520, Potchefstroom, South Africa
| | - Bai Cham
- Actionaid, Banjul The Gambia, MDI Road, Kanifing South PMB 450, Serrekunda PO Box 725, Banjul, The Gambia
| | - Fatou M Drame
- Enda Santé, Senegal, 56 Cité Comico VDN, B.P, 3370, Dakar, Senegal
- Gaston Berger University, Department of Geography, School of Social Sciences. BP: 234 - Saint-Louis, Nationale 2, route de Ngallèle, St. Louis, Senegal
| | - Mamadú Aliu Djaló
- Enda Santé, Guiné-Bissau. Bairro Santa Luzia, Rua s/n, CP 1041, Bissau, Guinea-Bissau
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
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40
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Otieno F, Ng'ety G, Okall D, Aketch C, Obondi E, Graham SM, Nyunya BO, Djomand G, Bailey RC, Mehta SD. Incident gonorrhoea and chlamydia among a prospective cohort of men who have sex with men in Kisumu, Kenya. Sex Transm Infect 2020; 96:521-527. [PMID: 31974213 DOI: 10.1136/sextrans-2019-054166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 12/30/2019] [Accepted: 01/12/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE STIs disproportionately affect men who have sex with men (MSM) in sub-Saharan Africa. We identified factors associated with incident Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among MSM in the Anza Mapema cohort study in Kisumu, Kenya. METHODS We enrolled 711 MSM who underwent HIV testing and counselling, medical history and examination, and collection of demographic and behavioural information. They also provided urine and rectal swab specimens for CT and NG testing by qualitative PCR at baseline and at months 6 and 12. Separate multivariable Cox regression models identified factors associated with first incident urethral or rectal infection. RESULTS Among the 619 men aged 18-54 years included in this analysis, there were 83 first incident urethral CT/NG infections (14.4 cases per 100 person-years (PY)) and 40 first incident rectal infections (6.84 cases per 100 PY), and an overall incidence of 18.0 cases per 100 PY (95% CI 14.8 to 21.8). Most urethral (84%) and rectal (81%) infections were asymptomatic. In the adjusted model, the risk of first incident urethral CT/NG decreased by 4% for each 1-year increase in age and was 41% lower for men who reported their partner used condom at last sexual encounter. Men who were HIV-positive had a 68% less risk of urogenital CT/NG compared with those who were negative. Men who reported being usually receptive or versatile as compared with usually insertive had an 81% increased risk of incident urogenital CT/NG. CONCLUSION Our study demonstrated a high incidence of urethral CT/NG infection, with somewhat lower incidence of rectal CT/NG infection, despite repeated testing and treatment, highlighting the need for preventive interventions to decrease the burden of CT/NG among Kenyan MSM. Most infections were asymptomatic, and routine aetiological screening for STIs is recommended.
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Affiliation(s)
| | | | - Duncan Okall
- Nyanza Reproductive Health Society, Kisumu, Kenya
| | | | - Eve Obondi
- Nyanza Reproductive Health Society, Kisumu, Kenya
| | - Susan Marie Graham
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Boaz O Nyunya
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Gaston Djomand
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robert C Bailey
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public health, Chicago, Illinois, USA
| | - Supriya D Mehta
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public health, Chicago, Illinois, USA
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Parmley LE, Comins CA, Young K, Mcingana M, Phetlhu DR, Guddera V, Mkhize H, Hausler H, Baral S, Schwartz S. Occupational barriers to accessing and adhering to antiretroviral therapy for female sex workers living with HIV in South Africa. Occup Environ Med 2020; 77:100-106. [PMID: 31911541 DOI: 10.1136/oemed-2019-105947] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 11/04/2019] [Accepted: 12/09/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES While female sex workers (FSW) are nearly 14 times more likely to be living with HIV than non-FSW, less than 40% of FSW living with HIV are on antiretroviral therapy (ART). We sought to understand how the work environment influences ART access and adherence for FSW in preparation for the Siyaphambili trial. METHODS FSW living with HIV (n=24) and key informants (n=15) were recruited to participate in semistructured in-depth interviews using maximum variation and snowball sampling, respectively. FSW were recruited on key variants including type of sex work venue, primary work time and history of ART use. Data were collected between September and November 2017 in Durban, South Africa. Interviews were audio-recorded, transcribed and translated. Data were then coded applying grounded theory in Atlas.ti. RESULTS FSW experienced occupational barriers to adherence including work-related migration, substance use and theft of ART on the job. Fear of wage loss due to HIV disclosure to clients and brothel managers prevented some FSW from accessing ART at their clinic and taking medications while working. FSW employed coping strategies to overcome barriers including sharing ART with colleagues, carrying small supplies of ART and visiting the clinic prior to appointments for ART refills. Further, some FSW received adherence support from colleagues who were also living with HIV. CONCLUSIONS Considering these occupational pressures on FSW and supporting positive coping strategies are important when designing and implementing HIV treatment programmes. Findings suggest strengthening social cohesion and supporting differentiated care efforts to improve HIV outcomes among FSW living with HIV.
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Affiliation(s)
- Lauren E Parmley
- ICAP, Columbia University, New York City, New York, USA .,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carly A Comins
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | - Vijay Guddera
- Key Populations Programme, TB HIV Care, Durban, South Africa
| | | | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Valente PK, Mimiaga MJ, Mayer KH, Safren SA, Biello KB. Social Capital Moderates the Relationship Between Stigma and Sexual Risk Among Male Sex Workers in the US Northeast. AIDS Behav 2020; 24:29-38. [PMID: 31587116 PMCID: PMC7276145 DOI: 10.1007/s10461-019-02692-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Stigma contributes to elevated HIV incidence among male sex workers (MSW). Social capital (i.e., resources accessed through one's social relationships) may act as a buffer between stigma and sexual risk behaviors and HIV acquisition. Using negative binomial regression, we examined the association between both sex work-related stigma and social capital with respect to number of condomless sex acts among 98 MSW living in the US Northeast. In models adjusted for sociodemographic characteristics, sex work-related stigma was associated with number of condomless sex acts with any non-paying partner (i.e., male and female) (aIRR = 1.25, p < 0.001) and male non-paying partners (aIRR = 1.27, p = 0.09) among individuals with low social capital, not among those with high social capital. Sex work-related stigma was not associated with number of condomless anal sex acts with male paying clients at any level of social capital. Future HIV prevention interventions should consider promoting social capital among MSW.
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Affiliation(s)
- Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Matthew J Mimiaga
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center for Health Equity Research, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Steve A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
- Center for Health Equity Research, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
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Moran A, Scheim A, Lyons C, Liestman B, Drame F, Ketende S, Diouf D, Ba I, Ezouatchi R, Bamba A, Kouame A, Baral S. Characterizing social cohesion and gender identity as risk determinants of HIV among cisgender men who have sex with men and transgender women in Côte d'Ivoire. Ann Epidemiol 2019; 42:25-32. [PMID: 31902624 DOI: 10.1016/j.annepidem.2019.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 11/18/2019] [Accepted: 11/28/2019] [Indexed: 01/30/2023]
Abstract
PURPOSE HIV prevalence has been previously estimated among cisgender men who have sex with men (MSM) in Côte d'Ivoire; however, limited data exist relating to the role of social cohesion and gender identity within this population. This study aims to examine these factors as risk determinants of HIV among MSM in Côte d'Ivoire. METHODS We conducted a cross-sectional study using respondent-driven sampling for recruitment with a structured sociobehavioral instrument and testing for HIV. After respondent-driven sampling adjustment, chi-squared tests and bivariate logistic regression and multivariate logistic regression analyses were performed to characterize social and identity-based risk determinants of biologically confirmed prevalent HIV infection. RESULTS HIV prevalence was 11.2% (n = 146/1301). Transgender woman identity was associated with higher odds of HIV compared with cisgender MSM (aOR = 3.4, 95% CI [2.0-5.8], P < .001). Having a combined social cohesion score of medium (aOR = 0.4, 95% CI [0.2-0.8], P < .01) or high (aOR = 0.2, 95% CI [0.1-0.3], P < .001) was associated with lower odds of HIV compared with a low score. CONCLUSION These data suggest that social cohesion is a determinant of prevalent HIV infection in Côte d'Ivoire among gay men, other cisgender MSM, and transgender women. The differences in HIV burden and social cohesion between transgender women and cisgender MSM highlight the need to better target the diversity of people traditionally included in the MSM umbrella to ensure comprehensive HIV prevention and treatment interventions.
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Affiliation(s)
- Alexander Moran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, MD.
| | - Ayden Scheim
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA
| | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, MD
| | - Benjamin Liestman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, MD
| | - Fatou Drame
- Department of Geography, Gaston Berger University, School of Social Sciences, Senegal; Enda Santé, Dakar, Senegal
| | - Sosthenes Ketende
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, MD
| | | | | | | | | | - Abo Kouame
- Programme National de Lutte Contre le SIDA, Ministere de la Lutte Contre Le SIDA, Abidjan, Republic of Côte d'Ivoire
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, MD
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MacPhail C, Khoza N, Treves-Kagan S, Selin A, Gómez-Olivé X, Peacock D, Rebombo D, Twine R, Maman S, Kahn K, DeLong SM, Hill LM, Lippman SA, Pettifor A. Process elements contributing to community mobilization for HIV risk reduction and gender equality in rural South Africa. PLoS One 2019; 14:e0225694. [PMID: 31790483 PMCID: PMC6886772 DOI: 10.1371/journal.pone.0225694] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 11/11/2019] [Indexed: 12/16/2022] Open
Abstract
Community mobilization has been recognized as a critical enabler for HIV prevention and is employed for challenging gender inequalities. We worked together with community partners to implement the ‘One Man Can’ intervention in rural Mpumalanga, South Africa to promote gender equality and HIV risk reduction. During the intervention, we conducted longitudinal qualitative interviews and focus group discussions with community mobilizers (n = 26), volunteer community action team members (n = 22) and community members (n = 52) to explore their experience of being part of the intervention and their experiences of change associated with the intervention. The objective of the study was to examine processes of change in community mobilization for gender equity and HIV prevention. Our analysis showed that over time, participants referred to three key elements of their engagement with the intervention: developing respect for others; inter-personal communication; and empathy. These elements were viewed as assisting them in adopting a ‘better life’ and associated with behaviour change in the intervention’s main focus areas of promoting gender equality and HIV risk reduction behaviours. We discuss how these concepts relate to the essential domains contained within our theoretical framework of community mobilization—specifically critical consciousness, shared concerns and social cohesion -, as demonstrated in this community. We interpret the focus on these key elements as significant indicators of communities engaging with the community mobilization process and initiating movement towards structural changes for HIV prevention.
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Affiliation(s)
- Catherine MacPhail
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
- Wits Reproductive Health & HIV Institute, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Nomhle Khoza
- Wits Reproductive Health & HIV Institute, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- STRIVE Research Programme Consortium, London School of Hygiene and Tropical Medicine, London, England, United Kingdom
| | - Sarah Treves-Kagan
- Center for AIDS Prevention Studies (CAPS), Department of Medicine, University of California, San Francisco, California, United States of America
| | - Amanda Selin
- Carolina Population Centre, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | | | | | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Suzanne Maman
- Department of Health Behaviour, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Stephanie M. DeLong
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Lauren M. Hill
- Department of Health Behaviour, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Sheri A. Lippman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Center for AIDS Prevention Studies (CAPS), Department of Medicine, University of California, San Francisco, California, United States of America
| | - Audrey Pettifor
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Carolina Population Centre, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
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Characterizing Sociostructural Associations With New HIV Diagnoses Among Female Sex Workers in Cameroon. J Acquir Immune Defic Syndr 2019; 80:e64-e73. [PMID: 30762674 DOI: 10.1097/qai.0000000000001920] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Female sex workers (FSW) are disproportionately affected by HIV in Cameroon, with an estimated 23.6% HIV prevalence. Given the unavailability of HIV incidence data, to better understand associations with acquiring HIV we assessed the prevalence and associations with new HIV diagnoses among FSW in Cameroon. METHODS In 2016, FSW were recruited through respondent-driven sampling from 5 cities for a biobehavioral survey. Participants self-reporting living with HIV or with an indeterminate test status were excluded from analysis. New diagnoses were defined as testing HIV-positive when participants self-reported HIV-negative or unknown status. A multivariable modified Poisson regression model was developed to assess determinants of new HIV diagnosis (referent group: HIV-negative) using key covariates; adjusted prevalence ratios (aPR) are reported if statistically significant (P < 0.05). RESULTS Overall 2255 FSW were recruited. Excluding participants who self-reported living with HIV (n = 297) and indeterminate test results (n = 7), 260/1951 (13.3%) FSW were newly diagnosed with HIV. Variables significantly associated with new HIV diagnosis were: no secondary/higher education [aPR: 1.56, 95% confidence interval (CI): 1.12 to 2.15], 5+ dependents compared with none (aPR: 2.11, 95% CI: 1.01 to 4.40), 5+ years involved in sex work compared with <1 year (aPR: 2.84, 95% CI: 1.26 to 6.42), history of incarceration (aPR: 2.13, 95% CI: 1.13 to 3.99), and low social capital (aPR: 1.53, 95% CI: 1.12 to 2.10). Higher monthly income (>250,000 FCFA vs. <50,000 FCFA) was associated with lower prevalence of new HIV diagnosis (aPR: 0.22, 95% CI: 0.05 to 0.86). CONCLUSIONS There are significant sociostructural factors that seem to potentiate risk of HIV infection and delay diagnosis among FSW in Cameroon. Initiatives to build social capital and integrate services such as pre-exposure prophylaxis and HIV self-testing into HIV programs may reduce new infections and decrease time to diagnosis and treatment.
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Mayer KH, Allan‐Blitz L. Similar, but different: drivers of the disproportionate HIV and sexually transmitted infection burden of key populations. J Int AIDS Soc 2019; 22 Suppl 6:e25344. [PMID: 31468653 PMCID: PMC6716057 DOI: 10.1002/jia2.25344] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 06/18/2019] [Indexed: 12/30/2022] Open
Affiliation(s)
- Kenneth H Mayer
- Beth Israel Deaconess Medical CenterHarvard Medical SchoolThe Fenway InstituteBostonMA
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47
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Karamouzian M, Shokoohi M, Kaplan RL, Noroozi A, Sharifi H, Baral SD, Mirzazadeh A. Characterizing the relationship between incarceration and structural risks among female sex workers in Iran: findings of a nationwide biobehavioral surveillance survey. Ann Epidemiol 2019; 35:29-34. [DOI: 10.1016/j.annepidem.2019.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 12/18/2022]
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Twahirwa Rwema JO, Lyons CE, Ketende S, Bowring AL, Rao A, Comins C, Diouf D, Drame FM, Liestman B, Coly K, Ndour C, Turpin G, Mboup S, Toure-Kane C, Castor D, Leye-Diouf N, Diop-Ndiaye H, Baral S. Characterizing the Influence of Structural Determinants of HIV Risk on Consistent Condom Use Among Female Sex Workers in Senegal. J Acquir Immune Defic Syndr 2019; 81:63-71. [PMID: 30865185 PMCID: PMC6536305 DOI: 10.1097/qai.0000000000001991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Female sex workers (FSWs) are disproportionately affected by HIV even in the most generalized HIV epidemics. Although structural HIV risks have been understood to affect condom negotiation among FSWs globally, there remain limited data on the relationship between structural determinants of HIV risk, including violence and socioeconomic status, and condom use among FSWs across sub-Saharan Africa. Here, we describe the prevalence of structural determinants and their associations with condom use among FSWs in Senegal. METHODS In 2015, 758 FSWs >18 years of age were recruited using respondent driven sampling in Senegal. Data on individual, community, network, and structural-level risks were collected through an interviewer-administered questionnaire. Poisson regression with robust variance estimation was used to model the associations of consistent condom use (CCU) and selected structural determinants. RESULTS The respondent driven sampling-adjusted prevalence of CCU in the last 10 sexual acts was 76.8% [95% confidence interval (CI): 70.8 to 82.8]. Structural determinants that were significantly associated with lower CCU were as follows: physical violence [adjusted prevalence ratio (aPR): 0.71; 95% CI: 0.52 to 0.98]; working primarily in a hotel or guest house (aPR: 0.85; 95% CI: 0.73 to 0.99); and difficultly accessing condoms (aPR: 0.72; 95% CI: 0.52 to 0.96). High income from sex work (aPR: 1.23; 95% CI: 1.04 to 1.46) was significantly associated with higher CCU. CONCLUSIONS Taken together, these data highlight the role of structural risk determinants on condom use among FSWs in Senegal. Moreover, these results highlight the need for structural interventions, including safe working spaces and violence mitigation programs, to support condom negotiation and access. Combined with condom distribution programs, structural interventions could ultimately increase condom use among FSWs in Senegal.
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Affiliation(s)
- Jean Olivier Twahirwa Rwema
- Department of Epidemiology, Key Populations Program,
Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD
| | - Carrie E. Lyons
- Department of Epidemiology, Key Populations Program,
Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD
| | - Sosthenes Ketende
- Department of Epidemiology, Key Populations Program,
Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD
| | - Anna L Bowring
- Department of Epidemiology, Key Populations Program,
Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD
| | - Amrita Rao
- Department of Epidemiology, Key Populations Program,
Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD
| | - Carly Comins
- Department of Epidemiology, Key Populations Program,
Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD
| | | | - Fatou M. Drame
- Enda Santé, Dakar, Senegal
- Universite Gaston Berger de St. Louis (UGB)
| | - Benjamin Liestman
- Department of Epidemiology, Key Populations Program,
Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD
| | - Karleen Coly
- Department of Epidemiology, Key Populations Program,
Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD
| | - Cheikh Ndour
- Division de la Lutte contre le Sida et les IST, Ministry
of Health, Dakar, Sénégal
| | - Gnilane Turpin
- Department of Epidemiology, Key Populations Program,
Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD
| | - Souleymane Mboup
- Institut de Recherche en Santé, de Surveillance
Epidémiologique et de Formations, Dakar, Sénégal
| | | | - Delivette Castor
- USAID, Office of HIV/AIDS, Bureau for Global Health,
Arlington, VA
| | - Nafissatou Leye-Diouf
- Institut de Recherche en Santé, de Surveillance
Epidémiologique et de Formations, Dakar, Sénégal
| | | | - Stefan Baral
- Department of Epidemiology, Key Populations Program,
Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD
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49
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Parmley L, Rao A, Young K, Kose Z, Phaswana-Mafuya N, Mcingana M, Lambert A, Hausler H, Baral S, Schwartz S. Female Sex Workers' Experiences Selling Sex during Pregnancy and Post-Delivery in South Africa. Stud Fam Plann 2019; 50:201-217. [PMID: 30997677 DOI: 10.1111/sifp.12090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nearly 75 percent of female sex workers (FSWs) in Port Elizabeth, South Africa are mothers, many of whom engage in sex work during pregnancy or after delivery. We conducted in-depth interviews with 22 postpartum and 8 pregnant FSWs in Port Elizabeth. Interview guides were used to probe women's experiences, challenges, and concerns about selling sex during pregnancy and post-delivery in a high-HIV-prevalence context. Interviews were transcribed, translated, and coded using thematic analysis. FSWs experienced and feared violence by clients during pregnancy, highlighting the need for safe work environments. Further, FSWs expressed concerns about HIV acquisition and vertical transmission during the perinatal period. Physical challenges related to pregnancy affected women's ability to work. Returning to work post-delivery presented barriers to initiating and practicing exclusive breastfeeding. As a result, many FSWs practiced mixed feeding. Interventions, tailored to respond to FSW's challenges and experiences, may offer improved health outcomes in this context.
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50
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Grosso AL, Ketende SC, Stahlman S, Ky-Zerbo O, Ouedraogo HG, Kouanda S, Samadoulougou C, Lougue M, Tchalla J, Anato S, Dometo S, Nadedjo FD, Pitche V, Baral SD. Development and reliability of metrics to characterize types and sources of stigma among men who have sex with men and female sex workers in Togo and Burkina Faso. BMC Infect Dis 2019; 19:208. [PMID: 30832604 PMCID: PMC6399877 DOI: 10.1186/s12879-019-3693-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/08/2019] [Indexed: 12/30/2022] Open
Abstract
Background Stigma is a multifaceted concept that potentiates Human Immunodeficiency Virus and sexually transmitted infection acquisition and transmission risks among key populations, including men who have sex with men (MSM) and female sex workers (FSW). Despite extensive stigma literature, limited research has characterized the types and sources of stigma reported by key populations in Sub-Saharan Africa. Methods This study leveraged data collected from 1356 MSM and 1383 FSW in Togo and Burkina Faso, recruited via respondent-driven sampling. Participants completed a survey instrument including stigma items developed through systematic reviews and synthesis of existing metrics. Using exploratory factor analysis with promax oblique rotation, 16 items were retained in a stigma metric for MSM and 20 in an FSW stigma metric. To assess the measures’ convergent validity, their correlations with expected variables were examined through bivariate logistic regression models. Results One factor, experienced stigma, included actions that were carried out by multiple types of perpetrators and included being arrested, verbally harassed, blackmailed, physically abused, tortured, or forced to have sex. Other factors were differentiated by source of stigma including healthcare workers, family and friends, or police. Specifically, stigma from healthcare workers loaded on two factors: experienced healthcare stigma included being denied care, not treated well, or gossiped about by healthcare workers and anticipated healthcare stigma included fear of or avoiding seeking healthcare. Stigma from family and friends included feeling excluded from family gatherings, gossiped about by family, or rejected by friends. Stigma from police included being refused police protection and items related to police confiscation of condoms. The Cronbach’s alpha ranged from 0.71–0.82. Median stigma scores, created for each participant by summing the number of affirmative responses to each stigma item, among MSM were highest in Ouagadougou and among FSW were highest in both Ouagadougou and Bobo-Dioulasso. Validation analyses demonstrated higher stigma was generally significantly associated with suicidal ideation, disclosure of involvement in sex work or same-sex practices, and involvement in organizations for MSM or FSW. Conclusions Taken together, these data suggest promising reliability and validity of metrics for measuring stigma affecting MSM and FSW in multiple urban centers across West Africa.
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Affiliation(s)
- Ashley L Grosso
- Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, 5th Floor, Baltimore, MD, USA. .,Research and Evaluation Unit, Public Health Solutions, 40 Worth Street, 5th Floor, New York, NY, USA.
| | - Sosthenes C Ketende
- Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, 5th Floor, Baltimore, MD, USA
| | - Shauna Stahlman
- Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, 5th Floor, Baltimore, MD, USA
| | - Odette Ky-Zerbo
- Programme d'Appui au Monde Associatif et Communautaire (PAMAC), 11 BP 1023, Avenue du Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Henri Gautier Ouedraogo
- Institut de Recherche en Sciences de la Santé (IRSS), 03 BP 7192, Ouagadougou, 03, Burkina Faso
| | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé (IRSS), 03 BP 7192, Ouagadougou, 03, Burkina Faso
| | - Cesaire Samadoulougou
- Institut de Recherche en Sciences de la Santé (IRSS), 03 BP 7192, Ouagadougou, 03, Burkina Faso
| | - Marcel Lougue
- Programme d'Appui au Monde Associatif et Communautaire (PAMAC), 11 BP 1023, Avenue du Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | | | | | | | | | - Vincent Pitche
- Conseil National de Lutte contre le SIDA et les IST, 01 BP 2237, Lomé, 01, Togo
| | - Stefan D Baral
- Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, 5th Floor, Baltimore, MD, USA
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