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Denison JA, Willis K, DeLong SM, Sievwright KM, Agwu AL, Arrington-Sanders R, Kaufman MR, Prabhu S, Williams AM, Fields EL, Alexander KA, Lee L, Yang C. Advancing Adolescent and Young Adult HIV Prevention and Care and Treatment Through Use of Multi-level Theories and Frameworks: A Scoping Review and Adapted HIV Ecological Framework. AIDS Behav 2024; 28:1694-1707. [PMID: 38351279 PMCID: PMC11069483 DOI: 10.1007/s10461-023-04255-1] [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: 12/12/2023] [Indexed: 05/05/2024]
Abstract
While multi-level theories and frameworks have become a cornerstone in broader efforts to address HIV inequities, little is known regarding their application in adolescent and young adult (AYA) HIV research. To address this gap, we conducted a scoping review to assess the use and application of multi-level theories and frameworks in AYA HIV prevention and care and treatment empirical research. We systematically searched five databases for articles published between 2010 and May 2020, screened abstracts, and reviewed eligible full-text articles for inclusion. Of the 5890 citations identified, 1706 underwent full-text review and 88 met the inclusion criteria: 70 focused on HIV prevention, with only 14 on care and treatment, 2 on both HIV prevention and care and treatment, and 2 on HIV-affected AYA. Most authors described the theory-based multi-level framework as informing their data analysis, with only 12 describing it as informing/guiding an intervention. More than seventy different multi-level theories were described, with 38% utilizing socio-ecological models or the eco-developmental theory. Findings were used to inform the adaptation of an AYA World Health Organization multi-level framework specifically to guide AYA HIV research.
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Affiliation(s)
- Julie A Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street. Room E5546, Baltimore, MD, 21205, USA.
| | - Kalai Willis
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephanie M DeLong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kirsty M Sievwright
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street. Room E5546, Baltimore, MD, 21205, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, US
| | - Allison L Agwu
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Michelle R Kaufman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sandeep Prabhu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street. Room E5546, Baltimore, MD, 21205, USA
| | - Ashlie M Williams
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street. Room E5546, Baltimore, MD, 21205, USA
| | - Errol L Fields
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Lana Lee
- Adult Clinical Branch, Office of HIV/AIDS, United States Agency for International Development, Washington, DC, USA
| | - Cui Yang
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Dake S, Bonful HA, Ganu V, Puplampu P, Asamoah A, Arthur HA, Mwintuu L, Asampong E, Kretchy IA, Anum A. Coping strategies among adolescents and young adults living with HIV/AIDS in Accra-Ghana. BMC Public Health 2023; 23:2350. [PMID: 38012649 PMCID: PMC10683146 DOI: 10.1186/s12889-023-17147-9] [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: 11/29/2022] [Accepted: 08/28/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Living with HIV/AIDS is remarkably stressful and has an adverse effect on one's physical and mental health. In Sub-Saharan Africa, the introduction of highly active anti-retroviral therapy has led to an increased number of children with perinatal acquired HIV who are living into adolescence and adulthood. Developing strategies to cope with HIV becomes imperative, especially among these adolescents. The study determined the factors that influence coping strategies among adolescents living with HIV. METHODS An analytic cross-sectional design was used. A total of 154 adolescents aged 10-19 years living with HIV were systematically sampled at the Fevers Unit of Korle Bu Teaching Hospital from June to December, 2021. The adolescent version of the KidCope tool was used to assess the choice of coping strategies. Stata 16 was used to determine associations between independent variables and the coping strategies identified. Only variables that were significant at p = 0.1 or less in the crude model were used to run the adjusted regression model. The level of significance was set at p = 0.05 with a 95% confidence interval. RESULTS The mean age of participants was 19.2 ± 0.45 years with 51.9% (80/154) of participants being males. A majority, 57.1% of the participants employed positive coping strategies with 87.0% (135/154) using cognitive restructuring strategy. In an adjusted linear regression model, participants coping strategies were significantly associated with their educational level (p = 0.04) and presence of both parents as caregivers (p = 0.02). CONCLUSION Participants largely adopted positive coping strategies in managing the disease. Factors that influenced the choice of coping strategies were higher levels of education and the presence of both parents as caregivers. The importance of a good social support structure and pursuing further education needs to be emphasized in counselling adolescents living with HIV as it promotes the choice of positive coping strategies.
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Affiliation(s)
- Selom Dake
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Harriet Affran Bonful
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana.
| | - Vincent Ganu
- Department of Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Peter Puplampu
- Department of Medicine, Korle Bu Teaching Hospital, Accra, Ghana
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
| | - Alexander Asamoah
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
- Public Health Division, Ghana Health Service, Accra, Ghana
| | - Hannah Ama Arthur
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Linus Mwintuu
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Emmanuel Asampong
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Irene A Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, Accra, Ghana
| | - Adote Anum
- Department of Psychology, University of Ghana, Accra, Ghana
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Folayan MO, Sam-Agudu NA, Harrison A. Exploring the why: risk factors for HIV and barriers to sexual and reproductive health service access among adolescents in Nigeria. BMC Health Serv Res 2022; 22:1198. [PMID: 36151543 PMCID: PMC9508705 DOI: 10.1186/s12913-022-08551-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Early sexual debut, low educational attainment, history of rape and transactional and intergenerational sex have been associated with HIV infection among Nigerian adolescents, especially females. We sought to understand the "why", and how to mitigate against these determinants and barriers to addressing adolescent sexual and reproductive health (SRH) and HIV prevention needs. METHODS This qualitative study generated data from 49 focus group discussions with male and female adolescents living with and without HIV, healthcare workers, members of civil society organizations working with young people, and parents of adolescents living with HIV. Participants were recruited from all six geopolitical zones in Nigeria. Data was analysed with ATLAS.ti software. Hermeneutic units were created, and codes developed from focus group transcripts. Network View Manager was used to create maps of codes, memos and quotations, and relevant quotes were retrieved from transcripts. RESULTS Four major themes were identified, relating to individual, parental, community and government roles in reducing the risk of HIV and unplanned pregnancy among adolescents in Nigeria. Individual factors influencing sexual risk behaviours of adolescents include peer pressure, poor risk perception for HIV, and misconceptions about the efficacy of contraceptives and condoms. Respondents entrusted State responsibilities such as facilitation of HIV-affected adolescents' access to education, rather, to individuals, parents and the community; and placed the blame for rape on rape survivors. Findings also highlighted the inadequacy of health systems to address adolescents' needs for treatment of sexually transmitted infections and to provide appropriate education on secondary HIV prevention for those living with HIV. CONCLUSION Rigorous studies are needed to understand dynamics between adolescents' risk behavior, HIV risk perception, parental roles in mitigating HIV risk in adolescents, and the role of communities and government in HIV prevention and treatment for adolescents in Nigeria.
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Affiliation(s)
- Morenike O Folayan
- Department of Child Dental Health Obafemi Awolowo University, 22005, Ile-Ife, Nigeria.
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology and Department of Pediatrics, University of Maryland School of Medicine, Baltimore, USA
- Department of Paediatrics and Child Health, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Abigail Harrison
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Brown University, Providence, USA
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Anderson KM, Tsuyuki K, Fernandez DeSoto A, Stockman JK. The Effect of Adverse Mental Health and Resilience on Perceived Stress by Sexual Violence History. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084796. [PMID: 35457663 PMCID: PMC9029884 DOI: 10.3390/ijerph19084796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/07/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022]
Abstract
Sexual violence, including nonconsensual sexual initiation and rape, remains pervasive, with impacts including adverse mental health and dysregulated stress response. Resilience is a promising interventional target. To advance the science, we examined the potential for resilience as an interventional tool by estimating associations between resilience, adverse mental health, and perceived stress among women by sexual violence history and partner perpetration. We analyzed 2018−2020 baseline survey data from 65 women enrolled in a prospective case-control study of sexual violence and HIV susceptibility in San Diego, CA. Multiple linear regressions were performed to examine associations, stratified by sexual violence history. About half of women experienced nonconsensual sexual initiation and/or rape; half of rapes were partner-perpetrated. Post-traumatic stress disorder (PTSD) was significantly associated with perceived stress among survivors (in regressions with depression and resilience, nonconsensual initiation: β = 6.514, p = 0.003, R2 = 0.616; rape: β = 5.075, p = 0.030, R2 = 0.611). Resilience was associated with lower perceived stress for all women; the effect appeared stronger among survivors of sexual violence (nonconsensual initiation: β = −0.599, p < 0.001 vs. β = −0.452, p = 0.019; rape: β = −0.624, p < 0.001 vs. β = −0.421, p = 0.027). Partner perpetration of rape was not associated with perceived stress. Our findings support leveraging resilience and addressing PTSD to reduce perceived stress among women with lifetime experiences of sexual violence.
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Affiliation(s)
- Katherine M. Anderson
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, San Diego, CA 92093, USA; (K.T.); (A.F.D.); (J.K.S.)
- Correspondence:
| | - Kiyomi Tsuyuki
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, San Diego, CA 92093, USA; (K.T.); (A.F.D.); (J.K.S.)
| | - Alexandra Fernandez DeSoto
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, San Diego, CA 92093, USA; (K.T.); (A.F.D.); (J.K.S.)
| | - Jamila K. Stockman
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, San Diego, CA 92093, USA; (K.T.); (A.F.D.); (J.K.S.)
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Folayan MO, El Tantawi M, Aly NM, Adeniyi AA, Oziegbe E, Arowolo O, Alade M, Mapayi B, Chukwumah NM, Oginni O, Sam-Agudu NA. Associations between a history of sexual abuse and dental anxiety, caries experience and oral hygiene status among adolescents in sub-urban South West Nigeria. BMC Oral Health 2021; 21:196. [PMID: 33874918 PMCID: PMC8054361 DOI: 10.1186/s12903-021-01562-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/12/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Sexual and oral health are important areas of focus for adolescent wellbeing. We assessed for the prevalence of sexual abuse among adolescents, oral health factors associated with this history, and investigated whether sexual abuse was a risk indicator for dental anxiety, caries experience and poor oral hygiene. METHODS This was a cross-sectional study conducted between December 2018 and January 2019 among adolescents 10-19 years old in Ile-Ife, Nigeria. Survey data collected included respondents' age, sex, and socioeconomic status, oral health risk factors (dental anxiety, frequency of tooth brushing intake of refined carbohydrates in-between-meals, flossing, dental visits, smoking, alcohol intake, use of psychoactive substances), caries experience, oral hygiene status, history of sexual abuse, and sexual risk behaviors (age of sexual debut, history of transactional sex, last sexual act with or without condom, multiple sex partners). Regression models were constructed to determine the association between outcome variables (dental anxiety, presence of caries experience and poor oral hygiene) and explanatory variables (oral health risk factors and history of sexual abuse). RESULTS The prevalence of sexual abuse in our cohort was 5.9%: 4.3% among males and 7.9% among females. A history of sexual abuse was associated with alcohol consumption (p = 0.009), cigarette smoking (p = 0.001), and a history of transactional sex (p = 0.01). High/severe dental anxiety was significantly associated with increased odds of a history of sexual abuse (AOR = 1.81; 95% CI 1.10, 2.98), but not with caries experience (AOR = 0.66; 95% CI 0.15, 2.97) nor poor oral hygiene (AOR = 1.68; 95% CI 0.95, 2.96). Dental anxiety was associated with increased odds of alcohol intake (AOR = 1.74; 95% CI 1.19, 2.56), twice daily tooth brushing (AOR = 1.48; 95% CI 1.01, 2.17) and daily consumption of refined carbohydrates in-between-meals (AOR = 2.01; 95% CI 1.60, 2.54). Caries experience was associated with increased odds of using psychoactive substances (AOR = 4.83; 95% CI 1.49, 15.62) and having low socioeconomic status (AOR = 0.40; 95% CI 0.18, 0.92). Poor oral hygiene was associated with increased odds of having middle socioeconomic status (AOR = 1.43; 95% CI 1.05, 1.93) and daily consumption of refined carbohydrates in-between-meals (AOR = 1.38; 95% CI 1.08, 1.78). CONCLUSION Adolescents who are highly dentally anxious need to be screened for a history of sexual abuse to facilitate access to professional care and support.
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Affiliation(s)
| | - Maha El Tantawi
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Nourhan M Aly
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | | | - Elizabeth Oziegbe
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olaniyi Arowolo
- Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Michael Alade
- Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Boladale Mapayi
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Nneka Maureen Chukwumah
- Department of Preventive Dentistry, School of Dentistry, University of Benin, Benin City, Nigeria
| | - Olakunle Oginni
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology and Department of Pediatrics, University of Maryland School of Medicine, Baltimore, USA
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6
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Folayan MO, Sam-Agudu NA, Adeniyi A, Oziegbe E, Chukwumah NM, Mapayi B. A proposed one-stop-shop approach for the delivery of integrated oral, mental, sexual and reproductive healthcare to adolescents in Nigeria. Pan Afr Med J 2020; 37:172. [PMID: 33447327 PMCID: PMC7778170 DOI: 10.11604/pamj.2020.37.172.22824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/24/2020] [Indexed: 11/25/2022] Open
Abstract
The interconnectedness of oral, mental, sexual, and reproductive health (OMSRH) in adolescents prompts exploration of novel approaches to facilitate comprehensive access of this population to the relevant health services. This paper proposes an integrated one-stop-shop approach to increasing adolescents' access to OMSRH care by leveraging on dental clinics as a template for integration, using a non-stigmatized platform to deliver stigmatized healthcare. Novel healthcare delivery models are needed to enhance adolescents' access to the comprehensive prevention and treatment services that they critically need. Effective, integrated health care for this population is lacking, especially across various health areas. This is a proposal for leveraging dental clinics for integrated OMSRH care, using facility-based services, to adolescents. Emphasis will be placed on reducing stigma as a barrier to service accessibility, acceptability, equitability and appropriateness. Empirical studies will be required to test the feasibility, validity and effectiveness of this proposed model.
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Affiliation(s)
| | - Nadia Adjoa Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria.,Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Abiola Adeniyi
- Faculty of Dentistry, Lagos State University College of Medicine, Lagos, Nigeria
| | - Elizabeth Oziegbe
- Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Nneka Maureen Chukwumah
- Department of Preventive Dentistry, College of Medical Sciences, University of Benin, Benin City, Edo, Nigeria
| | - Boladale Mapayi
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
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7
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Nwaozuru U, Iwelunmor J, Ong JJ, Salah S, Obiezu-Umeh C, Ezechi O, Tucker JD. Preferences for HIV testing services among young people in Nigeria. BMC Health Serv Res 2019; 19:1003. [PMID: 31881959 PMCID: PMC6935128 DOI: 10.1186/s12913-019-4847-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/17/2019] [Indexed: 11/17/2022] Open
Abstract
Background Despite high HIV incidence rates among young people in Nigeria, less than 24% of this population have ever tested for HIV. These low HIV testing rates suggest that current testing services may not align with their testing preferences. To address this gap, the objective of this study was to assess preferences for HIV testing options among young people in Nigeria. Methods We conducted a cross-sectional study using survey to assess preferences for HIV testing options among 113 youth aged 14–24 years residing in Nigeria. The survey included a series of hypothetical HIV testing options, comprised of six characteristics centered around HIV testing service (i.e. location of testing, test administrator, mode of pre-test, mode of post-test counseling, type of HIV test, and cost of HIV test). For each characteristic, participants were asked to select one of the options that they prefer or indicate none of the above. A descriptive analysis of the preferences made by participants was conducted, summarizing proportions of participants who selected different options for HIV testing. Results The mean age of study participants was 19.5 years old (SD = 2.7). Most youth (73, 64.6%) had at least a secondary school degree. There was pronounced heterogeneity in HIV testing preferences among young people. Although most youth preferred free HIV testing, 14 (16.7%) reported preferring paying a small amount compared to free testing. More youth preferred blood-based HIV self-testing 39(48.8%) compared to facility-based HIV testing and oral HIV self-testing. Conclusions Our finding suggest that young people have a range of HIV testing preferences in Nigeria. This suggests that a “one-size-fits-all” approach to delivering services to youth may be challenging in this context. HIV testing services can be optimized to reach young people if a variety options are provided to meet their unique preferences.
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Affiliation(s)
- Ucheoma Nwaozuru
- Saint Louis University College for Public Health and Social Justice, St. Louis, MO, USA.
| | - Juliet Iwelunmor
- Saint Louis University College for Public Health and Social Justice, St. Louis, MO, USA
| | - Jason J Ong
- Central Clinical School, Monash University, Clayton, Australia.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Sawsan Salah
- Saint Louis University College for Public Health and Social Justice, St. Louis, MO, USA
| | - Chisom Obiezu-Umeh
- Saint Louis University College for Public Health and Social Justice, St. Louis, MO, USA
| | - Oliver Ezechi
- The Nigerian Institute of Medical Research, Yaba, Nigeria
| | - Joseph D Tucker
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,London School of Hygiene and Tropical Medicine, London, UK
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Camargo CC, Cavassan NRV, Tasca KI, Meneguin S, Miot HA, Souza LR. Depression and Coping Are Associated with Failure of Adherence to Antiretroviral Therapy Among People Living with HIV/AIDS. AIDS Res Hum Retroviruses 2019; 35:1181-1188. [PMID: 31592722 DOI: 10.1089/aid.2019.0050] [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] [Indexed: 12/20/2022] Open
Abstract
Sustained adherence to antiretroviral therapy (ART) is critical in the prevention of drug resistance, disease progression, and death. We aimed to assess the level of ART adherence among 112 people living with HIV/AIDS (PLWHA) and to determine associated factors with that. The socioeconomic aspects were evaluated by medical records; the adherence, depression, and coping by specific questionnaires. Although most patients have undetectable viral load (79%) and CD4+ T count >500 cells/mm3 (65%), two-third (66%) of them exhibited a lower adherence, which was directly associated with some signs of depression (p = .006) presented by 65% of them. Some risk factors to presence of depression were female gender (p = .008) and low income (p = .013). In addition, most participants who reported tobacco (33%) and alcohol (29%) consumption had a low or intermediate adherence score. Among the coping strategies, self-control (p = .029), social support (p = .006), problem solving (p = .013), and positive reappraisal (p = .049) led to an improvement in adherence.
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Affiliation(s)
- Caio C. Camargo
- Department of Tropical Diseases, Botucatu Medical School (FMB), Univ Estadual Paulista (UNESP), Botucatu, Brazil
| | - Nayara R. V. Cavassan
- Department of Tropical Diseases, Botucatu Medical School (FMB), Univ Estadual Paulista (UNESP), Botucatu, Brazil
| | - Karen I. Tasca
- Department of Tropical Diseases, Botucatu Medical School (FMB), Univ Estadual Paulista (UNESP), Botucatu, Brazil
| | - Silmara Meneguin
- Department of Nursing, Botucatu Medical School (FMB), Univ Estadual Paulista (UNESP), Botucatu, Brazil
| | - Hélio A. Miot
- Department of Dermatology, Botucatu Medical School (FMB), Univ Estadual Paulista (UNESP), Botucatu, Brazil
| | - Lenice R. Souza
- Department of Tropical Diseases, Botucatu Medical School (FMB), Univ Estadual Paulista (UNESP), Botucatu, Brazil
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Nguyen KH, Padilla M, Villaveces A, Patel P, Atuchukwu V, Onotu D, Apondi R, Aluzimbi G, Chipimo P, Kancheya N, Kress H. Coerced and forced sexual initiation and its association with negative health outcomes among youth: Results from the Nigeria, Uganda, and Zambia Violence Against Children Surveys. CHILD ABUSE & NEGLECT 2019; 96:104074. [PMID: 31445403 PMCID: PMC6760991 DOI: 10.1016/j.chiabu.2019.104074] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 07/01/2019] [Accepted: 07/06/2019] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Coerced and forced sexual initiation (FSI) can have detrimental effects on children and youth. Understanding health outcomes that are associated with experiences of FSI is important for developing appropriate strategies for prevention and treatment of FSI and its consequences. METHODS The Violence Against Children Surveys were conducted in Nigeria, Uganda, and Zambia in 2014 and 2015. We examined the prevalence of FSI and its consequences (sexual high-risk behaviors, violence experiences, mental health outcomes, and sexually transmitted infections (STI)) associated with FSI among youth aged 13-24 years in three countries in sub-Saharan Africa. RESULTS Over one in ten youth aged 13-24 years who had ever had sex experienced FSI in Nigeria, Uganda, and Zambia. In multivariable logistic regression, FSI was significantly associated with infrequent condom use (OR = 1.4, 95%CI = 1.1-2.1), recent experiences of sexual violence (OR = 1.6, 95%CI: 1.1-2.3), physical violence (OR = 2.2, 95%CI: 1.6-3.0), and emotional violence (OR = 2.0, 95%CI: 1.3-2.9), moderate/serious mental distress (OR = 1.5, 95%CI: 1.1-2.0), hurting oneself (OR = 2.0, 95%CI: 1.3-3.1), and thoughts of suicide (OR = 1.5, 95%CI: 1.1-2.3), after controlling for demographic characteristics. FSI was not statistically associated with engaging in transactional sex, having multiple sex partners, or having a STI. CONCLUSION FSI is associated with infrequent condom use, recent experiences of violence and mental health outcomes among youth in sub-Saharan Africa, which may increase the risk for HIV and other consequences. Developing strategies for prevention is important for reducing the prevalence of FSI and its effects on children and youth.
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Affiliation(s)
- Kimberly H Nguyen
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Mabel Padilla
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrés Villaveces
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pragna Patel
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Victor Atuchukwu
- Nigeria Country Office, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Dennis Onotu
- Nigeria Country Office, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Rose Apondi
- Uganda Country Office, Center for Global Health, Centers for Disease Control and Prevention, Kampala, Uganda
| | - George Aluzimbi
- Uganda Country Office, Center for Global Health, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Peter Chipimo
- Zambia Country Office, Center for Global Health, Centers for Disease Control and Prevention, Lukasa, Zambia
| | - Nzali Kancheya
- Zambia Country Office, Center for Global Health, Centers for Disease Control and Prevention, Lukasa, Zambia
| | - Howard Kress
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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10
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Sexual practices, sexual behavior and HIV risk profile of key populations in Nigeria. BMC Public Health 2019; 19:1210. [PMID: 31477063 PMCID: PMC6721228 DOI: 10.1186/s12889-019-7553-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 08/26/2019] [Indexed: 11/29/2022] Open
Abstract
Background There is little evidence on the need for differentiated HIV prevention services for men who have sex with men (MSM), female sex workers (FSW) and people who inject drugs (PWID in Nigeria. The aim of the study was to determine and compare the HIV sexual risk profiles of FSW, MSM and PWID resident in Nigeria; and identify factors associated with condom use among the groups. This will help identify if differentiated HIV prevention services are needed for MSM, FSW and PWID in Nigeria. Methods This is a cross-sectional study. Data on sexual practices (anal, vaginal and oral sex), history of alcohol and psychoactive substance use, and high risk sexual behaviors for HIV infection (inconsistent use of condom) was collected from study FSW, MSM and PWID resident in Enugu, Nassarawa, Benue, and Akwa-Ibom States of Nigeria between April and June, 2015. Association between sexual practices, alcohol and psychoactive substance use, and HIV sexual risk behaviors; and differences in sexual risk behaviors of MSM, FSW and PWID were determined using Pearson chi-square for categorical variables, and t-test for continuous variables. Determinants of condom use in the last 30 days were identified using logistic regression analysis. Results The study population consisted of 188 (38.5%) FSW, 145 (29.7%) MSM and 155 (31.8%) PWID. MSM (AOR: 0.17; 95%CI: 0.05–0.67; p = 0.01) and PWID (AOR: 0.07; 95%CI: 0.02–0.21; p < 0.001) were significantly less likely than FSW to have used condom in the last 30 days. A lower proportion of FSW and PWID used condom during anal sex in the last 12 months when compared with MSM (p < 0.001 respectively). The proportion of MSM (23.5%) and FSW (23.4%) who had ever used psychoactive drugs was high. Of those who had ever used psychoactive drugs, 25.0% of FSW and 29.4% of MSM had injected drugs in the last 30 days of the survey. Also, 39.3% of PWID shared needles and syringes. The use of psychoactive substances (AOR: 5.01; 95%CI: 2.59–9.68; p < 0.001) and the ability to negotiate condom use (AOR: 2.04; 95%CI: 1.06–3.93; p = 0.03) were factors associated with condom use in the last 30 days of the survey. Conclusion HIV prevention programs designed for MSM, FSW and PWID need to address inconsistent condom use during sex by addressing condom negotation skills. This sexual risk behavior is common to the three groups. Electronic supplementary material The online version of this article (10.1186/s12889-019-7553-z) contains supplementary material, which is available to authorized users.
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Carlos S, López-del Burgo C, Ndarabu A, Osorio A, Rico-Campà A, Reina G, Burgueño E, de Irala J. Heterosexual oral and anal sex in Kinshasa (D.R.Congo): Data from OKAPI prospective cohort. PLoS One 2019; 14:e0210398. [PMID: 30650137 PMCID: PMC6334946 DOI: 10.1371/journal.pone.0210398] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 12/21/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Sexually transmitted infections can be spread through oral and anal heterosexual sex. There are few data on these practices in Sub-Saharan Africa. We analyzed the prevalence of heterosexual oral and anal sex among HIV Voluntary Counseling and Testing (VCT) attendees in Kinshasa and the associated sociodemographics, perceptions and behavioral factors. METHODS OKAPI (Observational Kinshasa AIDS Prevention Initiative) prospective cohort study. It evaluates the VCT impact on HIV-related knowledge and behaviors at 6 and 12-month follow-up. Since April 2016 until April 2018, 797 persons aged 15-59 years were HIV tested and replied to a baseline interview, including information about anal and oral sex. Descriptive, bi- and multivariate analyses were performed using baseline data. RESULTS Among 718 sexually active participants reporting heterosexual sex, 59% had had oral sex, 22% anal sex and 18% both practices. Among participants reporting "not" having had sex, 6% reported oral sex, 3% anal sex and 1% both. Oral sex was associated with a daily use of the Internet/mobile phone, perceiving low community HIV risk, reporting HIV-related behaviors (multiple partners, inconsistent condom use, anal, paid and forced sex) and having been pregnant. Being married-monogamous was inversely associated with oral sex. Anal sex was directly associated with having other risk sexual behaviors. CONCLUSIONS Oral and anal sex were common among people reporting heterosexual sex in Kinshasa. Perceiving a low community HIV risk and having other sexual risk behaviors are associated with these practices, which are commonly not considered as risky despite their strong association with HIV/STIs. They need to be considered when designing preventive strategies in Kinshasa.
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Affiliation(s)
- Silvia Carlos
- Preventive Medicine and Public Health Department, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality, University of Navarra, Pamplona, Spain
- * E-mail:
| | - Cristina López-del Burgo
- Preventive Medicine and Public Health Department, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality, University of Navarra, Pamplona, Spain
| | | | - Alfonso Osorio
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality, University of Navarra, Pamplona, Spain
- School of Education and Psychology, University of Navarra, Pamplona, Spain
| | - Anaïs Rico-Campà
- Preventive Medicine and Public Health Department, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Gabriel Reina
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Microbiology Service, Clínica Universidad de Navarra, Pamplona, Spain
| | - Eduardo Burgueño
- Monkole Hospital, Kinshasa, Democratic Republic of Congo
- School of Medicine, University of Mwene-Ditu, Mwene-Ditu, Democratic Republic of the Congo
| | - Jokin de Irala
- Preventive Medicine and Public Health Department, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality, University of Navarra, Pamplona, Spain
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Young CR, Kaida A, Kabakyenga J, Muyindike W, Musinguzi N, Martin JN, Hunt PW, Bangsberg DR, Haberer JE, Matthews LT. Prevalence and correlates of physical and sexual intimate partner violence among women living with HIV in Uganda. PLoS One 2018; 13:e0202992. [PMID: 30148854 PMCID: PMC6110509 DOI: 10.1371/journal.pone.0202992] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 08/12/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is a significant global health problem. Women who experience IPV have increased HIV incidence, reduced antiretroviral adherence, and a lower likelihood of viral load suppression. There is a lack of evidence regarding how to effectively identify and support women living with HIV (WLWH) experiencing IPV, including uncertainty whether universal or targeted screening is most appropriate for lower-resourced settings. We examined physical and sexual IPV prevalence and correlates among WLWH in Uganda to understand the burden of IPV and factors that could help identify women at risk. METHODS We utilized data from women receiving ART and enrolled in the Uganda AIDS Rural Treatment Outcomes (UARTO) cohort study between 2011 and 2015. Bloodwork and interviewer-administered questionnaires were completed every 4 months. IPV was assessed annually or with any new pregnancy. Multivariate models assessed independent socio-demographic and clinical factors correlated with IPV, at baseline and follow-up visits. RESULTS 455 WLWH were included. Median age was 36 years, 43% were married, and median follow-up was 2.8 years. At baseline 131 women (29%) reported any experience of past or current IPV. In the adjusted models, being married was associated with a higher risk of baseline IPV (ARR 2.33, 95% CI 1.13-4.81) and follow-up IPV (ARR 2.43, 95% CI 1.33-4.45). Older age (ARR 0.96, 95% CI 0.94-0.99) and higher household asset index score (ARR 0.81, 95% CI 0.68-0.96) were associated with lower risk of IPV during follow-up. CONCLUSION There was a high prevalence of physical and sexual IPV amongst WLWH, and many women experienced both types of violence. These findings suggest the need for clinic-based screening for IPV. If universal screening is not feasible, correlates of having experienced IPV can inform targeted approaches.
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Affiliation(s)
- Cynthia R. Young
- Division of Women’s Health, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Jerome Kabakyenga
- Maternal Newborn and Child Health Institute, Mbarara University of Science & Technology, Mbarara, Uganda
| | - Winnie Muyindike
- Department of Internal Medicine, Mbarara University of Science & Technology, Mbarara, Uganda
| | - Nicholas Musinguzi
- Global Health Collaborative, Mbarara University of Science & Technology, Mbarara, Uganda
| | - Jeffrey N. Martin
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, United States of America
| | - Peter W. Hunt
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - David R. Bangsberg
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, United States of America
| | - Jessica E. Haberer
- Center for Global Health, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Lynn T. Matthews
- Center for Global Health, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
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Folayan MO, Cáceres CF, Sam-Agudu NA, Odetoyinbo M, Stockman JK, Harrison A. Psychological Stressors and Coping Strategies Used by Adolescents Living with and Not Living with Hiv Infection in Nigeria. AIDS Behav 2017; 21:2736-2745. [PMID: 27605363 DOI: 10.1007/s10461-016-1534-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Little is known about stressful triggers and coping strategies of Nigerian adolescents and whether or not, and how, HIV infection modulates these sources of stress and coping. This study evaluated differences in stressors and coping strategies among Nigerian adolescents based on HIV status. We analysed the data of six hundred 10-19 year old adolescents recruited through a population-based survey from 12 States of Nigeria who self-reported their HIV status. Data on stressors and coping strategies were retrieved by self-report from participants, using a validated structured questionnaire. We compared results between adolescents with and without HIV with respect to identification of specific life events as stressors, and use of specific coping strategies to manage stress. Logistic regression analysis adjusted for age and sex. Adolescents living with HIV (ALHIV) had significantly increased odds of identifying 'having to visit the hospital regularly' (AOR: 5.85; 95 % CI: 2.11-16.20; P = 0.001), and 'having to take drugs regularly' (AOR: 9.70; 95 % CI: 4.13-22.81; P < 0.001) as stressors; and 'Seeking social support' (AOR: 3.14; 95 % CI: 1.99-4.93; p < 0.001) and 'using mental disengagement' (OR: 1.64; 95 % CI: 0.49-1.84; p = 0.001) as coping strategies. Adolescents not living with HIV had significantly increased odds of identifying 'argument with a friend or family member' as a stressor (AOR: 6.59; 95 % CI: 3.62-11.98; P < 0.001). Life events related to adolescents' HIV positive status were significant stressors for ALHIV. Providing targeted psychosocial support could help reduce the impact of such HIV status-related stressors on ALHIV.
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Affiliation(s)
- Morenike O Folayan
- Institute of Public Health and Department of Child Dental Health, Obafemi Awolowo University, 22005, Ile-Ife, Nigeria.
| | - Carlos F Cáceres
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nadia A Sam-Agudu
- Institute of Human Virology Nigeria, Abuja, Nigeria
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland Baltimore, Baltimore, USA
| | | | - Jamila K Stockman
- Division of Global Public Health, Department of Medicine, University of California, La Jolla, San Diego, CA, 92093, USA
| | - Abigail Harrison
- Population Studies and Training Center, and Department of Behavioral and Social Sciences, Public Health Program, Brown University, Providence, RI, 02912, USA
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