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Schmeer KK, Echave PA, Nzitatira HN. Exposure to Armed Conflict and HIV Risk Among Rwandan Women. Demography 2023; 60:1181-1205. [PMID: 37489822 DOI: 10.1215/00703370-10890357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
This article focuses on the link between past exposure to violence and a critical public health issue in sub-Saharan Africa: HIV-positive status in women of reproductive age. Specifically, we use biosocial data from the Rwandan Demographic and Health Survey (2005‒2014) to assess how the timing and intensity of women's exposure to the war and genocide in Rwanda (1990‒1994) may be associated with their HIV status. We find significant differences in risk across age cohorts, with the late adolescence cohort (women born in 1970‒1974, who were aged 16‒20 at the start of the conflict) having the highest risk of being HIV positive 10‒20 years after the violence, even after controlling for current socioeconomic and demographic characteristics. Women who reported two or more sibling deaths, excluding those related to maternal mortality, during the conflict years also had higher odds of being HIV positive, net of cohort and control variables. Age at first sexual intercourse and number of lifetime sexual partners partially-but not fully-explain the associations between cohort and sibling deaths and HIV. These findings advance research related to armed conflict and population health and indicate that experiencing conflict during key stages of the life course and at higher intensity may affect women's long-term sexual health.
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Affiliation(s)
- Kammi K Schmeer
- Department of Sociology, The Ohio State University, Columbus, OH, USA
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Vasylyeva TI, Horyniak D, Bojorquez I, Pham MD. Left behind on the path to 90-90-90: understanding and responding to HIV among displaced people. J Int AIDS Soc 2022; 25:e26031. [PMID: 36352546 PMCID: PMC9646984 DOI: 10.1002/jia2.26031] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/20/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION In 2021, the number of people affected by displacement worldwide reached the highest on record, with an estimated 30.5 million refugees and 4.6 million asylum seekers seeking safety across international borders and further 53.2 million people displaced within their countries of origin. Most forcibly displaced persons come from or relocate to lower- and middle-income countries (LMICs) and many of those countries have large HIV epidemics. In this commentary, we describe some of the challenges at the intersection of HIV and displacement vulnerabilities that cannot be easily addressed in resource-limited environments. DISCUSSION HIV transmission and prevention and treatment efforts in the context of displacement are affected by myriad behavioural, social and structural factors across different stages of the displacement journey. For example, structural barriers faced by people experiencing displacement in relation to HIV prevention and care include funding constraints and legal framework deficiencies. Such barriers prevent all forced migrants, and particularly those whose sexual identities or practices are stigmatized against, access to prevention and care equal to local residents. Xenophobia, racism and other social factors, as well as individual risky behaviours facilitated by experiences of forced migration, also affect the progress towards 90-90-90 targets in displaced populations. Current evidence suggests increased HIV vulnerability in the period before displacement due to the effect of displacement drivers on medical supplies and infrastructure. During and after displacement, substantial barriers to HIV testing exist, though following resettlement in stable displacement context, HIV incidence and viral suppression are reported to be similar to those of local populations. CONCLUSIONS Experiences of often-marginalized displaced populations are diverse and depend on the context of displacement, countries of origin and resettlement, and the nature of the crises that forced these populations to move. To address current gaps in responses to HIV in displacement contexts, research in LMIC, particularly in less stable resettlement settings, needs to be scaled up. Furthermore, displaced populations need to be specifically addressed in national AIDS strategies and HIV surveillance systems. Finally, innovative technologies, such as point-of-care viral load and CD4 testing, need to be developed and introduced in settings facing displacement.
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Affiliation(s)
- Tetyana I. Vasylyeva
- Division of Infectious Diseases and Global Public HealthUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Danielle's Horyniak
- Public Health DisciplineBurnet InstituteMelbourneVictoriaAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Ietza Bojorquez
- Department of Population StudiesEl Colegio de la Frontera NorteTijuanaMexico
| | - Minh Duc Pham
- Public Health DisciplineBurnet InstituteMelbourneVictoriaAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
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Derksen J, Pavlova D, McClarty LM, Balakireva O, Herpai N, Lazarus L, Tennakoon A, Tarasova T, Lorway R, Pickles M, Mishra S, Shaw SY, Becker ML. Awareness and Utilization of HIV Testing and Prevention Services Among Female Sex Workers in Dnipro, Ukraine: Implications for Prevention Program Strengthening From the Dynamics Study. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:879191. [PMID: 36303675 PMCID: PMC9580627 DOI: 10.3389/frph.2022.879191] [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: 02/19/2022] [Accepted: 05/10/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Approximately 240,000 people live with HIV in Ukraine, concentrated among key populations, including sex workers. Non-governmental organizations (NGOs) play an important role in the funding and delivery of HIV testing and prevention services in Ukraine. These services are set within the context of national healthcare reforms as well as ongoing armed conflict. This study seeks to describe and understand the usage of HIV testing and prevention services among sex workers in the eastern Ukrainian city of Dnipro. Methods A cross-sectional bio-behavioral survey was administered in September 2017-March 2018 among 560 sex workers working in Dnipro. Descriptive analyses of survey data are presented alongside multivariable logistic regression models identifying factors associated with NGO awareness and HIV testing in the past 12 months; adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) are reported. Results Sixty-two percent of respondents were aware of NGOs offering HIV services. Sixty-eight percent had tested for HIV in the past 12 months, and 51% of those who reported the location of their most recent test were tested at an NGO. Those with 5–9 years in sex work had greater odds of being aware of NGOs (AOR = 5.5, 95%CI: 3.2–9.7) and testing for HIV (AOR = 3.4, 95%CI: 2.0–6.0) compared to those new to the profession. Contact with outreach workers was strongly associated with increased odds of testing (AOR = 13.0, 95%CI: 7.0–24.0). Sex workers in “offices” (brothel-like venues) reported higher odds of testing than all other workplaces, while those in entertainment venues (AOR = 0.3, 95%CI: 0.2–0.5) and public places (AOR = 0.2, 95%CI: 0.1–0.3) reported lower rates. Receiving prevention services, such as free condoms, was associated with increased testing (AOR = 16.9, 95%CI: 9.7–29.3). Discussion NGOs in Dnipro, Ukraine play an important role in HIV testing and prevention for women involved in sex work. However, focused efforts should be placed on supporting access to these services for women that are newer to sex work, and those working in entertainment venues or public places. Outreach workers appear to support access to HIV prevention information and supplies and facilitate linkages to HIV testing for sex workers.
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Affiliation(s)
- Joel Derksen
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Daria Pavlova
- Ukrainian Institute for Social Research After Olexander Yaremenko, Kyiv, Ukraine
| | - Leigh M. McClarty
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Olga Balakireva
- Ukrainian Institute for Social Research After Olexander Yaremenko, Kyiv, Ukraine
- Institute for Economics and Forecasting, Ukrainian National Academy of Sciences, Kyiv, Ukraine
| | - Nicole Herpai
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lisa Lazarus
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Aruni Tennakoon
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Tatiana Tarasova
- Ukrainian Institute for Social Research After Olexander Yaremenko, Kyiv, Ukraine
| | - Robert Lorway
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Michael Pickles
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Souradet Y. Shaw
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Marissa L. Becker
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- *Correspondence: Marissa L. Becker
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Daw MA, El-Bouzedi AH, Ahmed MO. The Impact of Armed Conflict on the Prevalence and Transmission Dynamics of HIV Infection in Libya. Front Public Health 2022; 10:779778. [PMID: 35433583 PMCID: PMC9009867 DOI: 10.3389/fpubh.2022.779778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
The interrelationships between HIV/AIDS and armed conflict are a complex phenomenon, and studies are rarely devoted to this area of research. Libya is the second-largest country in Africa that has been evoked with war since the NATO intervention in 2011. The country has also experienced one of the largest HIV outbreaks associated with the Bulgarian nurse's saga. The effect of the armed conflict on the dynamic spread of HIV is not yet well-known. The objectives of this study were to determine the impact of armed conflict on the epidemiological situation of HIV infection in Libya and to analyze the transmission dynamics of HIV strains during the conflict. We investigated the movement of people with HIV during the Libyan armed conflict, analyzed the HIV subtypes reported from 2011 to 2020, and followed up the infected cases all over the country. The patterns of HIV spread within the Libyan regions were traced, and the risk factors were determined during the conflict period. A total of 4,539 patients with HIV/AIDS were studied from the four regions during the Libyan conflict. Our data analysis indicated that Benghazi, the biggest city in the Eastern region, was the significant exporter of the virus to the rest of the country. The viral dissemination changes were observed within the country, particularly after 2015. A major virus flows from the Eastern region during the armed conflict associated with internally displaced people. This resulted in the dissemination of new HIV strains and accumulations of HIV cases in western and middle regions. Although, there were no significant changes in the national prevalence of HIV/AIDS. Our data highlight the factors that complicated the spread and dissemination of HIV during the armed conflict, which provide a better understanding of the interaction between them. This could be used to plan for effective preventive measures in tackling the spread of HIV in conflict and post-conflict settings.
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Affiliation(s)
- Mohamed Ali Daw
- Department of Medical Microbiology and Immunology, Faculty of Medicine, University of Tripoli, Tripoli, Libya
- *Correspondence: Mohamed Ali Daw
| | | | - Mohamed Omar Ahmed
- Department of Microbiology and Parasitology, Faculty of Veterinary Medicine, University of Tripoli, Tripoli, Libya
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Waller SG. Do Health Programs Contribute to Keeping the Peace? A Scientific Analysis. Mil Med 2021; 186:1227-1232. [PMID: 33742680 DOI: 10.1093/milmed/usab079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/28/2020] [Accepted: 03/19/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The role of health problems and programs to address problems in keeping the peace has not been scientifically analyzed. We sought to mitigate this gap in knowledge. METHODS We examined hundreds of conflicts in a robust international database (NAVCO 2.0) for the presence of health programs by conflict parties and were unable to demonstrate a significant statistical correlation between the presence of a health program and peace. Using this analysis and a comprehensive international database of health conditions (the Global Burden of Disease), we obtained Institutional Review Board approval and undertook a matched case-control analysis. We identified 14 countries with new-onset conflict as our cases and 52 similar countries without conflict during the same year as our controls. We calculated the association between conflict status and the prevalence of 254 different health conditions among the case and control nations. RESULTS None of the 254 health conditions had changes in prevalence that correlated with the conflict status of that nation. None of those common health conditions is therefore a predictive "leading indicator" of conflict in this study. CONCLUSIONS Without such an association or causal link, the role of health programs in peacekeeping and "stability operations" remains ambiguous. Negative findings do not mean that there is no connection between health programs and peace, and further study should be done. Our results have implications for the value of global health engagement missions.
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Affiliation(s)
- Stephen G Waller
- Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
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Manian S. Conflict and Risky Health Behavior: Evidence from Mexico's Drug War. JOURNAL OF DEVELOPMENT ECONOMICS 2021; 148:102562. [PMID: 33071432 PMCID: PMC7566850 DOI: 10.1016/j.jdeveco.2020.102562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Risky health behaviors contribute to a large share of disease in developing countries, yet few papers have studied the effect of conflict on these behaviors. The canonical health capital model predicts that conflict should increase risky health behaviors: as the likelihood of survival falls, incentives to invest in preventive measures also fall, increasing risk-taking. However, recent findings from various violent contexts, including the drug war in Mexico, suggest the behavioral response to conflict may reduce risk-taking. In this paper, I identify the effect of insecurity on sexual risk-taking using unique panel data on female sex workers in Ciudad Juarez, Mexico. I show that more intense conflict generates a large reduction in risky sex transactions. I rule out several alternate explanations, including compositional changes in sex markets and changes in drug use. The results suggest that the behavioral response to insecurity can mitigate the negative effects of conflict on health.
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Affiliation(s)
- Shanthi Manian
- P.O. Box 646210, Washington State University, Pullman, WA 99164-6210
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Lugova H, Samad N, Haque M. Sexual and Gender-Based Violence Among Refugees and Internally Displaced Persons in the Democratic Republic of the Congo: Post-Conflict Scenario. Risk Manag Healthc Policy 2020; 13:2937-2948. [PMID: 33328772 PMCID: PMC7734039 DOI: 10.2147/rmhp.s283698] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/23/2020] [Indexed: 12/26/2022] Open
Abstract
The ongoing humanitarian crisis in the Democratic Republic of the Congo has triggered sexual and gender-based violence, including rape, sexual slavery, trafficking, intimate partner violence, and sexual exploitation. Gender inequalities and abuse of power experienced by women and young girls at refugee settings further exacerbate their vulnerability to different forms of violence. This study aimed to offer an evidence-based approach to developing strategies in tackling the complex problem of sexual and gender-based violence among refugees and internally displaced persons in the Congo. We conducted a narrative review of all the relevant papers known to the authors to explore the origins of the problem, its implications on public health, and its impact on equity. The study revealed that sexual assault survivors face physical and psychological sufferings, excruciating emotions, and profound disruption of their social well-being since they are often stigmatized and ostracized by society. The analysis of current government policies revealed a lack of programs to address survivors' specific concerns and policy enforcement problems. This study suggested strategic objectives and policy implementation steps. The proposed strategies address women empowerment and gender stigma, provision of effective health services, and adequate response action.
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Affiliation(s)
- Halyna Lugova
- Unit of Community Medicine, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, Malaysia
| | - Nandeeta Samad
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, Malaysia
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Program implementation gaps and ethical issues in the prevention of HIV infection among infants, children, and adolescents in sub-Saharan Africa. Pediatr Res 2020; 87:406-413. [PMID: 31663519 DOI: 10.1038/s41390-019-0645-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/31/2019] [Accepted: 10/23/2019] [Indexed: 12/30/2022]
Abstract
Strategies for HIV prevention among infants, children, and adolescents have evolved significantly over the past 20 years. These include the global scale-up of simplified multidrug HIV regimens for pregnant women, leading to impressive reductions in new child HIV infections. However, significant gaps remain, especially in high HIV-burden sub-Saharan African countries. For example, many pregnant women living with HIV (WLHIV) are unable to access and sustain HIV testing and treatment partly due to low agency and harmful gender norms. Among pregnant WLHIV, adolescent girls face an additional layer of societal and health-system barriers in accessing care for themselves and their exposed infants. Legal and structural barriers limit access to HIV prevention-related sexual and reproductive health services among high-risk adolescents, including girls and young men who have sex with men. Key ethical issues underlying HIV prevention gaps for infants, children, and adolescents prevail. This narrative review explores these issues and highlights counter-measures for programming and policy, including gender empowerment, improving access to and appropriateness of critical health services, rights-based policy and legislation, closing research gaps, and considering the values and preferences of young people for HIV prevention and treatment services.
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Crellen T, Ssonko C, Piening T, Simaleko MM, Geiger K, Siddiqui MR. What drives mortality among HIV patients in a conflict setting? A prospective cohort study in the Central African Republic. Confl Health 2019; 13:52. [PMID: 31754370 PMCID: PMC6854658 DOI: 10.1186/s13031-019-0236-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/18/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Provision of antiretroviral therapy (ART) during conflict settings is rarely attempted and little is known about the expected patterns of mortality. The Central African Republic (CAR) continues to have a low coverage of ART despite an estimated 110,000 people living with HIV and 5000 AIDS-related deaths in 2018. We present results from a cohort in Zemio, Haut-Mboumou prefecture. This region had the highest prevalence of HIV nationally (14.8% in a 2010 survey), and was subject to repeated attacks by armed groups on civilians during the observed period. METHODS Conflict from armed groups can impact cohort mortality rates i) directly if HIV patients are victims of armed conflict, or ii) indirectly if population displacement or fear of movement reduces access to ART. Using monthly counts of civilian deaths, injuries and abductions, we estimated the impact of the conflict on patient mortality. We also determined patient-level risk factors for mortality and how the risk of mortality varies with time spent in the cohort. Model-fitting was performed in a Bayesian framework, using logistic regression with terms accounting for temporal autocorrelation. RESULTS Patients were recruited and observed in the HIV treatment program from October 2011 to May 2017. Overall 1631 patients were enrolled and 1628 were included in the analysis giving 48,430 person-months at risk and 145 deaths. The crude mortality rate after 12 months was 0.92 (95% CI 0.90, 0.93). Our model showed that patient mortality did not increase during periods of heightened conflict; the odds ratios (OR) 95% credible interval (CrI) for i) civilian fatalities and injuries, and ii) civilian abductions on patient mortality both spanned unity. The risk of mortality for individual patients was highest in the second month after entering the cohort, and declined seven-fold over the first 12 months. Male sex was associated with a higher mortality (odds ratio 1.70 [95% CrI 1.20, 2.33]) along with the severity of opportunistic infections (OIs) at baseline (OR 2.52; 95% CrI 2.01, 3.23 for stage 2 OIs compared with stage 1). CONCLUSIONS Our results show that chronic conflict did not appear to adversely affect rates of mortality in this cohort, and that mortality was driven predominantly by patient-specific risk factors. The risk of mortality and recovery of CD4 T-cell counts observed in this conflict setting are comparable to those in stable resource poor settings, suggesting that conflict should not be a barrier in access to ART.
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Affiliation(s)
- Thomas Crellen
- Médecins Sans Frontières Hollande, Avenue Barthelemy Boganda, PK4, Bangui, BP 1793 Central African Republic
- Mahidol-Oxford Tropical Medicine Research Unit, 420/6 Rajvithi Road, Tungphyathai, Bangkok, 10400 Thailand
| | - Charles Ssonko
- Médecins Sans Frontières, The Manson Unit, Chancery Exchange, 10 Furnival Street, London, EC4A 1AB UK
| | - Turid Piening
- Médecins Sans Frontières, Am Köllnischen Park 1, 10179 Berlin, Germany
| | - Marcel Mbeko Simaleko
- Ministre de la Santé Publique et de la Population, Bangui, BP 883 Central African Republic
| | - Karen Geiger
- Médecins Sans Frontières Hollande, Avenue Barthelemy Boganda, PK4, Bangui, BP 1793 Central African Republic
| | - M. Ruby Siddiqui
- Médecins Sans Frontières, The Manson Unit, Chancery Exchange, 10 Furnival Street, London, EC4A 1AB UK
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Becker M, Balakireva O, Pavlova D, Isac S, Cheuk E, Roberts E, Forget E, Ma H, Lazarus L, Sandstrom P, Blanchard J, Mishra S, Lorway R, Pickles M. Assessing the influence of conflict on the dynamics of sex work and the HIV and HCV epidemics in Ukraine: protocol for an observational, ethnographic, and mathematical modeling study. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2019; 19:16. [PMID: 31109323 PMCID: PMC6528269 DOI: 10.1186/s12914-019-0201-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 05/03/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Armed conflict erupted in eastern Ukraine in 2014 and still continues. This conflict has resulted in an intensification of poverty, displacement and migration, and has weakened the local health system. Ukraine has some of the highest rates of HIV and Hepatitis C (HCV) in Europe. Whether and how the current conflict, and its consequences, will lead to changes in the HIV and HCV epidemic in Ukraine is unclear. Our study aims to characterize how the armed conflict in eastern Ukraine and its consequences influence the pattern, practice, and experience of sex work and how this affects HIV and HCV rates among female sex workers (FSWs) and their clients. METHODS We are implementing a 5-year mixed methods study in Dnipro, eastern Ukraine. Serial mapping and size estimation of FSWs and clients will be conducted followed by bio-behavioral cross-sectional surveys among FSWs and their clients. The qualitative component of the study will include in-depth interviews with FSWs and other key stakeholders and participant diaries will be implemented with FSWs. We will also conduct an archival review over the course of the project. Finally, we will use these data to develop and structure a mathematical model with which to estimate the potential influence of changes due to conflict on the trajectory of HIV and HCV epidemics among FSW and clients. DISCUSSION The limited data that exists on the effect of conflict on disease transmission provides mixed results. Our study will provide rigorous, timely and context-specific data on HIV and HCV transmission in the setting of conflict. This information can be used to inform the design and delivery of HIV and HCV prevention and care services.
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Affiliation(s)
- Marissa Becker
- Centre for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada. .,Department of Community Health Sciences, University of Manitoba, S113 - 750 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0W3, Canada.
| | - Olga Balakireva
- Ukrainian Institute for Social Research after Oleksandr Yaremenko, 26 Panasa Myrnogo Str., Of. 211, Kyiv, 01011, Ukraine
| | - Daria Pavlova
- Ukrainian Institute for Social Research after Oleksandr Yaremenko, 26 Panasa Myrnogo Str., Of. 211, Kyiv, 01011, Ukraine
| | - Shajy Isac
- Centre for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada.,India Health Action Trust, E17, Ring Road, Defence Colony, New Delhi, 110021, India
| | - Eve Cheuk
- Centre for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | | | - Evelyn Forget
- Department of Community Health Sciences, University of Manitoba, S113 - 750 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0W3, Canada
| | - Huiting Ma
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Lisa Lazarus
- Centre for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Paul Sandstrom
- JC Wilt National HIV and Retrovirology Laboratory, 745 Logan Avenue, Winnipeg, R3E 3L5, Canada
| | - James Blanchard
- Centre for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Sharmistha Mishra
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Rob Lorway
- Centre for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Michael Pickles
- Centre for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
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Koegler E, Kennedy CE. A scoping review of the associations between mental health and factors related to HIV acquisition and disease progression in conflict-affected populations. Confl Health 2018; 12:20. [PMID: 29881448 PMCID: PMC5984364 DOI: 10.1186/s13031-018-0156-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 03/25/2018] [Indexed: 11/10/2022] Open
Abstract
The association between poor mental health and factors related to HIV acquisition and disease progression (also referred to as HIV-related factors) may be stronger among conflict-affected populations given elevated rates of mental health disorders. We conducted a scoping review of the literature to identify evidence-based associations between mental health (depression, anxiety, and post-traumatic stress disorder [PTSD]) and factors related to HIV acquisition and progression in conflict-affected populations. Five electronic databases were searched on October 10, 2014 and updated on March 7, 2017 to identify peer-reviewed publications presenting primary data from January 1, 1994 to March 7, 2017. Articles were included if: 1) depression, anxiety, and/or PTSD was assessed using a validated scale, 2) HIV or HIV-related factors were a primary focus, 3) quantitative associations between depression/anxiety/PTSD and HIV or HIV-related factors were assessed, and 4) the study population was conflict-affected and from a conflict-affected setting. Of 714 citations identified, 33 articles covering 110,818 participants were included. Most were from sub-Saharan Africa (n = 25), five were from the USA, and one each was from the Middle East, Europe, and Latin America. There were 23 cross-sectional, 3 time-series, and 7 cohort studies. The search identified that mental health has been quantitatively associated with the following categories of HIV-related factors in conflict-affected populations: markers of HIV risk, HIV-related health status, sexual risk behaviors, and HIV risk exposures (i.e. sexual violence). Further, findings suggest that symptoms of poor mental health are associated with sexual risk behaviors and HIV markers, while HIV risk exposures and health status are associated with symptoms of poor mental health. Results suggest a role for greater integration and referrals across HIV and mental health programs for conflict-affected populations.
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Affiliation(s)
- Erica Koegler
- 1Department of Health Sciences, University of Missouri, 512 Clark Hall, Columbia, MO 65211 USA.,2Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Room E5547 Baltimore, Baltimore, MD 21205 USA
| | - Caitlin E Kennedy
- 2Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Room E5547 Baltimore, Baltimore, MD 21205 USA
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Olakunde BO, Adeyinka DA, Wakdok SS, Oladele TT, Ozigbu CE. Quantification of the effect of terrorism on the HIV response in Nigeria. Lancet 2018; 391:1257-1258. [PMID: 29619953 DOI: 10.1016/s0140-6736(18)30700-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 01/22/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Babayemi O Olakunde
- National Agency for Control of AIDS (NACA), Central Business District 900211, Abuja, Nigeria.
| | - Daniel A Adeyinka
- National AIDS & STIs Control Programme, Federal Ministry of Health, Abuja, Nigeria; University of Saskatchewan, Saskatoon, SK, Canada
| | - Sabastine S Wakdok
- National Agency for Control of AIDS (NACA), Central Business District 900211, Abuja, Nigeria
| | - Tolulope T Oladele
- National Agency for Control of AIDS (NACA), Central Business District 900211, Abuja, Nigeria
| | - Chamberline E Ozigbu
- National AIDS & STIs Control Programme, Federal Ministry of Health, Abuja, Nigeria; University of South Carolina, Columbia, SC, USA
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Koegler E, Kennedy CE, Thompson CB, Winch PJ, Mpanano RM, Perrin NA, Glass N. Association between self-reported sexually transmitted infection treatment and mental health symptoms in conflict-affected eastern Democratic Republic of the Congo. Int J STD AIDS 2017; 29:212-220. [PMID: 28758569 DOI: 10.1177/0956462417722128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although poor mental health has been associated with sexual risk behavior, few studies have examined the association between mental health and sexually transmitted infections (STIs) in conflict-affected settings. With elevated symptoms of poor mental health in conflict-affected settings, it is important to consider if and how mental health may be a risk factor for STIs in these settings. We used cross-sectional logistic regression to examine the association between symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) with having been treated for an STI in rural South Kivu, Democratic Republic of the Congo. Among 753 adults, those with elevated self-reported symptoms of depression and anxiety (adjusted OR = 2.73, 95% CI 1.68, 4.44) and PTSD (adjusted OR = 1.89, 95% CI 1.17, 3.06) had higher odds of reporting ever being treated for an STI than those who were not symptomatic. Our findings suggest that future studies are needed to more rigorously examine the relationship between mental health and STIs.
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Affiliation(s)
- Erica Koegler
- 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,2 School of Health Professions, University of Missouri, Columbia, MO, USA
| | - Caitlin E Kennedy
- 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carol B Thompson
- 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Peter J Winch
- 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Nancy Glass
- 5 Johns Hopkins School of Nursing, Baltimore, MD, USA
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Mossoro-Kpinde CD, Gody JC, Mboumba Bouassa RS, Mbitikon O, Jenabian MA, Robin L, Matta M, Zeitouni K, Longo JDD, Costiniuk C, Grésenguet G, Touré Kane NC, Bélec L. High levels of virological failure with major genotypic resistance mutations in HIV-1-infected children after 5 years of care according to WHO-recommended 1st-line and 2nd-line antiretroviral regimens in the Central African Republic: A cross-sectional study. Medicine (Baltimore) 2017; 96:e6282. [PMID: 28272247 PMCID: PMC5348195 DOI: 10.1097/md.0000000000006282] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/09/2017] [Accepted: 02/13/2017] [Indexed: 11/26/2022] Open
Abstract
A large cohort of 220 HIV-1-infected children (median [range] age: 12 [4-17] years) was cared and followed up in the Central African Republic, including 198 in 1st-line and 22 in 2nd-line antiretroviral regimens. Patients were monitored clinically and biologically for HIV-1 RNA load and drug resistance mutations (DRMs) genotyping. A total of 87 (40%) study children were virological responders and 133 (60%) nonresponders. In children with detectable viral load, the majority (129; 97%) represented a virological failure. In children receiving 1st-line regimens in virological failure for whom genotypic resistance test was available, 45% displayed viruses harboring at least 1 DRM to NNRTI or NRTI, and 26% showed at least 1 major DRM to NNRTI or NRTI; more than half of children in 1st-line regimens were resistant to 1st-generation NNRTI and 24% of the children in 1st-line regimens had a major DRMs to PI. Virological failure and selection of DRMs were both associated with poor adherence. These observations demonstrate high rate of virological failure after 3 to 5 years of 1st-line or 2nd-line antiretroviral treatment, which is generally associated with DRMs and therapeutic failure. Overall, more than half (55%) of children receiving 1st-line antiretroviral treatment for a median of 3.4 years showed virological failure and antiretroviral-resistance and thus eligible to 2nd-line treatment. Furthermore, two-third (64%) of children under 2nd-line therapy were eligible to 3rd-line regimen. Taken together, these observations point the necessity to monitor antiretroviral-treated children by plasma HIV-1 RNA load to diagnose as early as possible the therapeutic failure and operate switch to a new therapeutic line.
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Affiliation(s)
| | - Jean-Chrysostome Gody
- Faculté des Sciences de la Santé, Université de Bangui
- Complexe Pédiatrique, Bangui, Central African Republic
| | - Ralph-Sydney Mboumba Bouassa
- Laboratoire de virologie, Hôpital Européen Georges Pompidou and Université Paris Descartes, Paris Sorbonne Cité, Paris, France
| | | | - Mohammad-Ali Jenabian
- Département des Sciences Biologiques et Centre de Recherche BioMed, Université du Québec à Montréal (UQAM), Montreal, QC, Canada
| | - Leman Robin
- Laboratoire de virologie, Hôpital Européen Georges Pompidou and Université Paris Descartes, Paris Sorbonne Cité, Paris, France
| | - Mathieu Matta
- Laboratoire de virologie, Hôpital Européen Georges Pompidou and Université Paris Descartes, Paris Sorbonne Cité, Paris, France
| | - Kamal Zeitouni
- Saint Georges Hospital University Medical Center, Université de Balamand, Beirut, Lebanon
| | - Jean De Dieu Longo
- Faculté des Sciences de la Santé, Université de Bangui
- Unité de Recherches et d’Intervention sur les Maladies Sexuellement Transmissibles et le SIDA, Département de Santé Publique, Faculté des Sciences de la Santé de Bangui, Central African Republic
| | - Cecilia Costiniuk
- Chronic Viral Illnesses Service, Division of Infectious Diseases and Research Institute of the McGill University Health Centre, Montréal
| | - Gérard Grésenguet
- Faculté des Sciences de la Santé, Université de Bangui
- Unité de Recherches et d’Intervention sur les Maladies Sexuellement Transmissibles et le SIDA, Département de Santé Publique, Faculté des Sciences de la Santé de Bangui, Central African Republic
| | - Ndèye Coumba Touré Kane
- Laboratoire de Bactériologie Virologie, Hôpital Aristide Le Dantec, Dakar and Université Cheikh Anta Diop de Dakar, Sénégal
| | - Laurent Bélec
- Laboratoire de virologie, Hôpital Européen Georges Pompidou and Université Paris Descartes, Paris Sorbonne Cité, Paris, France
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15
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O'Laughlin KN, Rabideau DJ, Kasozi J, Parker RA, Bustamante ND, Faustin ZM, Greenwald KE, Walensky RP, Bassett IV. Predictors of HIV infection: a prospective HIV screening study in a Ugandan refugee settlement. BMC Infect Dis 2016; 16:695. [PMID: 27881099 PMCID: PMC5120554 DOI: 10.1186/s12879-016-2021-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 11/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The instability faced by refugees may place them at increased risk of exposure to HIV infection. Nakivale Refugee Settlement in southwestern Uganda hosts 68,000 refugees from 11 countries, many with high HIV prevalence. We implemented an HIV screening program in Nakivale and examined factors associated with new HIV diagnosis. METHODS From March 2013-November 2014, we offered free HIV screening to all clients in the Nakivale Health Center while they waited for their outpatient clinic visit. Clients included refugees and Ugandan nationals accessing services in the settlement. Prior to receiving the HIV test result, participants were surveyed to obtain demographic information including gender, marital status, travel time to reach clinic, refugee status, and history of prior HIV testing. We compared variables for HIV-infected and non-infected clients using Pearson's chi-square test, and used multivariable binomial regression models to identify predictors of HIV infection. RESULTS During the HIV screening intervention period, 330 (4%) of 7766 individuals tested were identified as HIV-infected. Refugees were one quarter as likely as Ugandan nationals to be HIV-infected (aRR 0.27 [0.21, 0.34], p < 0.0001). Additionally, being female (aRR 1.43 [1.14, 1.80], p = 0.002) and traveling more than 1 h to the clinic (aRR 1.39 [1.11, 1.74], p = 0.003) increased the likelihood of being HIV-infected. Compared to individuals who were married or in a stable relationship, being divorced/separated/widowed increased the risk of being HIV-infected (aRR 2.41 [1.88, 3.08], p < 0.0001), while being single reduced the risk (aRR 0.60 [0.41, 0.86], p < 0.0001). Having been previously tested for HIV (aRR 0.59 [0.47, 0.74], p < 0.0001) also lowered the likelihood of being HIV-infected. CONCLUSIONS In an HIV screening program in a refugee settlement in Uganda, Ugandan nationals are at higher risk of having HIV than refugees. The high HIV prevalence among clients seeking outpatient care, including Ugandan nationals and refugees, warrants enhanced HIV screening services in Nakivale and in the surrounding region. Findings from this research may be relevant for other refugee settlements in Sub-Saharan Africa hosting populations with similar demographics, including the 9 other refugee settlements in Uganda.
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Affiliation(s)
- Kelli N O'Laughlin
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. .,Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, 02114-2698, USA. .,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. .,Harvard Humanitarian Initiative, Cambridge, MA, USA.
| | - Dustin J Rabideau
- MGH Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA.,Harvard University Center for AIDS Research (CFAR), Boston, MA, USA
| | - Julius Kasozi
- United Nations High Commissioner for Refugees, Representation in Uganda, PO Box 3813, Kampala, Uganda
| | - Robert A Parker
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, 02114-2698, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.,MGH Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA.,Harvard University Center for AIDS Research (CFAR), Boston, MA, USA.,Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Nirma D Bustamante
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Rochelle P Walensky
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, 02114-2698, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.,Harvard University Center for AIDS Research (CFAR), Boston, MA, USA.,Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA.,Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA.,Division of Infectious Disease, Brigham & Women's Hospital, Boston, MA, USA
| | - Ingrid V Bassett
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, 02114-2698, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.,Harvard University Center for AIDS Research (CFAR), Boston, MA, USA.,Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA.,Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA
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