Social capital and HIV risks among acculturating Asian Indian men in New York City

Cognitive social capital as a health-enabling factor for STI testing among young men in Stockholm, Sweden: A cross-sectional population-based study

Objective

To assess whether different forms of cognitive social capital increased the relative probability of testing for sexually transmitted infections (STIs) among young men living in Stockholm, Sweden.

Methods

A population-based cross-sectional study was conducted in 2017 with men aged 20-29 years living in Stockholm County, Sweden (n = 523). The main outcome was STI testing patterns (never tested, tested only within a12-monthperiod, tested only beyond a12-monthperiod, repeatedly tested). The main exposure were two forms of cognitive social capital: social support (having received help, having someone to share inner feelings with) and institutionalized trust (in school, healthcare, media). Data were analyzed using weighted multivariable multinomial logistic regression to obtain adjusted weighted relative probability ratio (aRPR).

Results

After adjusting for confounding factors, receiving help (aRPR: 5.2, 95% CI: 1.7-16.2) and having someone to share inner feelings with (aRPR: 3.1, 95% CI: 1.2-7.7) increased the relative probabilities of young men testing for STIs, but only for those testing beyond a 12-month period. Trust in media increased the relative probability of STI testing for those testing only within a 12-month period (aRPR: 2.6, 95% CI: 1.1-6.1) and for those testing repeatedly (aRPR: 3.6, 95% CI: 1.5-8.8).

Conclusion

Young men in Stockholm County exhibit distinct STI testing patterns. Social support and trust in media were factors that increased the probability of being tested for STIs, with this effect varying according to the young men's STI testing pattern. Further studies are required to explore how trust in media might promote STI testing in this population.

Black Canadians' Exposure to Everyday Racism: Implications for Health System Access and Health Promotion among Urban Black Communities

This study explores the social determinants of Black Canadians' exposure to everyday racism, its relationship to health system access, and implications for health promotion. We used data from the A/C Study survey on HIV transmission and prevention among Black Canadians. We implemented the survey (N = 1360) in 2018-2019 in Toronto and Ottawa-two large cities that together account for 42% of Canada's Black population-among self-identified Black residents aged 15-64 years, who were born in sub-Sahara Africa or the Caribbean or had a parent who was born in those regions. Participants reported racist encounters in the preceding 12 months using the Everyday Discrimination Scale. We assessed the socio-demographic correlates of racist experiences and the impact of racism on health system access using multivariable generalised linear models. Sixty percent of participants reported experiencing racism in the preceding 12 months. Based on the adjusted odds ratios, participants were more likely to experience racism if they were older, employed, Canadian-born, had higher levels of education, self-identified as LGBTQ + and reported generally moderate access to basic needs and adequate housing; and less likely to experience racism if they lived in Ottawa, self-identified as female or reported higher levels of social capital. Visiting a healthcare provider or facility, and difficulty accessing healthcare were associated with racist experiences. Racist experiences diminished the likelihood of being tested for HIV. Racist experiences were widespread, especially among those with higher levels of social wellbeing or greater exposure to Canadian institutions. Study participants also associated racist experiences with the healthcare system.

Post-immigration Changes in Social Capital and Substance Use Among Recent Latino Immigrants in South Florida: Differences by Documentation Status

Changing social capital among recent Latino immigrants (RLIs) influences substance use post-immigration. This was a longitudinal study of 476 South/Central American RLIs examining social capital and substance use changes pre to post-immigration. Self-reported measures of social capital and substance use were compared between surveys administered within 1 year of immigration and 2 years post-immigration. Post-immigration, social capital, hazardous drinking and illicit drug use decreased. Women were less likely to engage in hazardous drinking [adjusted odds ratio (AOR) .32, p < .001], and less likely to use illicit drugs (AOR .67, p = .01). Documented individuals with higher levels of 'business' social capital had increased odds of illicit drug use (AOR 2.20, p < .05). Undocumented individuals with higher levels of 'friend and others' social capital had decreased risk for hazardous drinking and illicit drug use (AOR .55, p < .01; AOR .56, p < .05). Documentation status moderated the relationship between social capital and substance use. RLIs can be targeted for primary prevention of substance abuse.

Culture, but more than culture: an exploratory study of the HIV vulnerability of Indian immigrants in Canada

Explanations of immigrant health that ascribe to culture a fundamental causal role neglect the broader structural and contextual factors with which culture intersects. Based on a qualitative study of Indian immigrants' vulnerability to HIV in Canada, this paper presents a contextualised understanding of these individuals' understanding of, perceptions about, and responses to the HIV risk in their post-immigration lives. The study reveals that although culture - both traditional values and the norms of the diaspora community - appears to have constrained Indian immigrants' capacities to respond to the risk, this effect can be properly understood only by situating such constraint in the context of the settlement process that has shaped participants' living conditions, including their relationship with the diasporic community in Canada. We argue that HIV vulnerability should be conceptualised as a health inequality associated with broader systems of power relations (eg socio-economic marginalisation, gender inequality, discrimination, and racism). This more holistic conceptualisation of the intersection of culture, integration, and HIV vulnerability will facilitate exploration of HIV prevention strategies, through which interconnected inequalities of gender, race, and access to knowledge and resources can be challenged.

"It's Not What You Know but Who You Know": Role of Social Capital in Predicting Risky Injection Drug Use Behavior in a Sample of People who Inject Drugs in Baltimore City

BACKGROUND

Injection drug use is the third highest risk factor for HIV transmission. Injection drug users, marginalized population, continue to be at threat for several health problems, including HIV, Hepatitis B & C and drug overdose. The area of social capital and risk behaviors is understudied. The current study aims to prospectively assess the relationship between social capital and the risk behaviors associated with injection drug use.

METHODS

The sample of the present study is a subset of 130 drug users who reported injection drug use (IDU) at both baseline and first follow-up wave for assessing the relationship between social capital and needle sharing in the city of Baltimore, MD. Factor analysis, structural equation modeling and multivariate logistic regression were conducted to explore these relationships.

RESULTS

A single-factor model fit well with factor loadings ranging from .20 to .95. Social capital is shown to be significantly and inversely associated (p<.05) with 35% decreased odds of the risk of sharing needles with every unit increase in social capital (AOR: 0.65, 95% CI: 0.06, 0.84).

CONCLUSION

The result from this study can be used to inform and fill gaps in the field of harm reduction. The interplay between social support, social participation and norms of trust, reciprocity generated from the index's social network and its relationship with behavior of needle sharing demonstrates that these leverage points should be emphasized in future harm reduction interventions.

A Cross-Sectional Relationship Between Social Capital, Self-Compassion, and Perceived HIV Symptoms

CONTEXT

Individual resources of social capital and self-compassion are associated with health behaviors and perceived symptoms, suggesting that both are positive resources that can be modified to improve a person's symptom experience.

OBJECTIVES

The aim was to examine the relationship between self-compassion and social capital and its impact on current HIV symptom experience in adult people living with HIV (PLWH). We further explored the impact of age on this relationship.

METHODS

We conducted a cross-sectional analysis of 2182 PLWH at 20 sites in five countries. Social capital, self-compassion, and HIV symptom experience were evaluated using valid and reliable scales. To account for inflated significance associated with a large sample size, we took a random sample of 28% of subjects (n = 615) and conducted correlation analyses and zero-inflated Poisson regression, controlling for known medical and demographic variables impacting HIV symptom experience.

RESULTS

Controlling for age, sex at birth, year of HIV diagnosis, comorbid health conditions, employment, and income, our model significantly predicted HIV symptom experience (overall model z = 5.77, P < 0.001). Employment status and social capital were consistent, negative, and significant predictors of HIV symptom experience. Self-compassion did not significantly predict HIV symptom experience. For those reporting symptoms, an increase in age was significantly associated with an increase in symptoms.

CONCLUSION

Employment and social capital modestly predicted current HIV symptom experience. Social capital can be incorporated into symptom management interventions, possibly as a way to reframe a person's symptom appraisal. This may be increasingly important as PLWH age. The relationship between employment status and HIV symptom experience was significant and should be explored further.

The impact of acculturation and acculturative stress on alcohol use across Asian immigrant subgroups

Acculturation and acculturative stress are examined as predictors of alcohol use among Asian immigrants, using the 2004 National Latino and Asian Americans Survey (NLAAS). Separate regression analyses were conducted for Chinese (n = 600), Filipino (n = 508), and Vietnamese (n = 520) immigrants. Alcohol use varied for the three groups. English proficiency was associated with drinking for all groups. Family conflict was associated with drinking for Chinese immigrants. General acculturative stress and discrimination were associated with drinking for Vietnamese immigrants. Results underscore acculturation and acculturative stress as being contributors to alcohol consumption, and the importance of considering the heterogeneity of Asian immigrants in research on their alcohol use. The study's limitations are noted.

A pilot cohort study to assess the feasibility of HIV prevention science research among men who have sex with men in Dakar, Senegal

INTRODUCTION

Men who have sex with men (MSM) are disproportionately burdened by HIV in Senegal, across sub-Saharan Africa and throughout the world. This is driven in part by stigma, and limits health achievements and social capital among these populations. To date, there is a limited understanding of the feasibility of prospective HIV prevention studies among MSM in Senegal, including HIV incidence and cohort retention rates.

METHODS

One hundred and nineteen men who reported having anal sex with another man in the past 12 months were randomly selected from a sampling frame of 450 unique members of community groups serving MSM in Dakar. These men were enrolled in a 15-month pilot cohort study implemented by a community-based partner. The study included a structured survey instrument and biological testing for HIV, syphilis and hepatitis B virus at two time points.

RESULTS

Baseline HIV prevalence was 36.0% (43/114), with cumulative HIV prevalence at study end being 47.2% (51/108). The annualized incidence rate was 16% (8/40 at risk for seroconversion over 15 months of follow-up, 95% confidence interval 4.6-27.4%). Thirty-seven men were lost to follow up, including at least four deaths. Men who were able to confide in someone about health, emotional distress and sex were less likely to be HIV positive (OR 0.36, p < 0.05, 95% CI 0.13, 0.97).

CONCLUSIONS

High HIV prevalence and incidence, as well as mortality in this young population of Senegalese MSM indicate a public health emergency. Moreover, given the high burden of HIV and rate of incident HIV infections, this population appears to be appropriate for the evaluation of novel HIV prevention, treatment and care approaches. Using a study implemented by community-based organizations, there appears to be feasibility in implementing interventions addressing the multiple levels of HIV risk among MSM in this setting. However, low retention across arms of this pilot intervention, and in the cohort, will need to be addressed for larger-scale efficacy trials to be feasible.

Asian Indian views on diet and health in the United States: importance of understanding cultural and social factors to address disparities

This study describes Asian Indian immigrant perspectives surrounding dietary beliefs and practices to identify intervention targets for diabetes and heart disease prevention. Participants were asked about conceptualizations of relationships between culture, food, and health during 4 focus groups (n = 38). Findings reveal influences of beliefs from respondents' native India, preservation of cultural practices within the US social structure, conflicts with subsequent generations, and reinterpretation of health-related knowledge through a lens, hybridizing both "native" and "host" contexts. Galvanization of ethnically valued beliefs incorporating family and community structures is needed for multipronged approaches to reduce disproportionate burdens of disease among this understudied minority community.

HIV among immigrants living in high-income countries: a realist review of evidence to guide targeted approaches to behavioural HIV prevention

BACKGROUND

Immigrants from developing and middle-income countries are an emerging priority in HIV prevention in high-income countries. This may be explained in part by accelerating international migration and population mobility. However, it may also be due to the vulnerabilities of immigrants including social exclusion along with socioeconomic, cultural and language barriers to HIV prevention. Contemporary thinking on effective HIV prevention stresses the need for targeted approaches that adapt HIV prevention interventions according to the cultural context and population being addressed. This review of evidence sought to generate insights into targeted approaches in this emerging area of HIV prevention.

METHODS

We undertook a realist review to answer the research question: 'How are HIV prevention interventions in high-income countries adapted to suit immigrants' needs?' A key goal was to uncover underlying theories or mechanisms operating in behavioural HIV prevention interventions with immigrants, to uncover explanations as how and why they work (or not) for particular groups in particular contexts, and thus to refine the underlying theories. The realist review mapped seven initial mechanisms underlying culturally appropriate HIV prevention with immigrants. Evidence from intervention studies and qualitative studies found in systematic searches was then used to test and refine these seven mechanisms.

RESULTS

Thirty-four intervention studies and 40 qualitative studies contributed to the analysis and synthesis of evidence. The strongest evidence supported the role of 'consonance' mechanisms, indicating the pivotal need to incorporate cultural values into the intervention content. Moderate evidence was found to support the role of three other mechanisms - 'understanding', 'specificity' and 'embeddedness' - which indicated that using the language of immigrants, usually the 'mother tongue', targeting (in terms of ethnicity) and the use of settings were also critical elements in culturally appropriate HIV prevention. There was mixed evidence for the roles of 'authenticity' and 'framing' mechanisms and only partial evidence to support role of 'endorsement' mechanisms.

CONCLUSIONS

This realist review contributes to the explanatory framework of behavioural HIV prevention among immigrants living in high-income countries and, in particular, builds a greater understanding of the suite of mechanisms that underpin adaptations of interventions by the cultural context and population being targeted.

Social contexts of risk behaviors for HIV among male, unskilled, unregistered laborers in urban Vietnam

In Vietnam there has been relatively little success in controlling the HIV epidemic, in part because the subpopulations most exposed to the virus are often difficult to engage in prevention research and programs. In this qualitative study we explored social contexts shaping HIV risk behaviors among Vietnamese men involved in unskilled, unregistered, and low-income labor in urban settings. Based on self-disclosed behaviors, it is clear that these men were at high risk of sexually transmitted infection (STI). Evidence emerged from the interview data highlighting equivalent influences of individual psychological factors, social integration, social barriers, and accessibility regarding drug use and sexual risk behavior. Psychological influences such as tedium, distress, fatalism and revenge, and the strong effects of collective decision making and fear of social isolation appeared important for these men living on the economic and social margins of this rapidly urbanizing society. The study findings suggest directions for research and culturally appropriate HIV preventive education and services for these men.

A cross-sectional description of social capital in an international sample of persons living with HIV/AIDS (PLWH)

Background

Social capital refers to the resources linked to having a strong social network. This concept plays into health outcomes among People Living with HIV/AIDS because, globally, this is a highly marginalized population. Case studies show that modifying social capital can lead to improvements in HIV transmission and management; however, there remains a lack of description or definition of social capital in international settings. The purpose of our paper was to describe the degree of social capital in an international sample of adults living with HIV/AIDS.

Methods

We recruited PLWH at 16 sites from five countries including Canada, China, Namibia, Thailand, and the United States. Participants (n = 1,963) completed a cross-sectional survey and data were collected between August, 2009 and December, 2010. Data analyses included descriptive statistics, factor analysis, and correlational analysis.

Results

Participant's mean age was 45.2 years, most (69%) identified as male, African American/Black (39.9%), and unemployed (69.5%). Total mean social capital was 2.68 points, a higher than average total social capital score. Moderate correlations were observed between self-reported physical (r = 0.25) and psychological condition (r = 0.36), social support (r = 0.31), and total social capital. No relationships between mental health factors, including substance use, and social capital were detected.

Conclusions

This is the first report to describe levels of total social capital in an international sample of PLWH and to describe its relationship to self-reported health in this population.

HIV risk among MSM in Senegal: a qualitative rapid assessment of the impact of enforcing laws that criminalize same sex practices

Men who have sex with men (MSM) are at high risk for HIV in Senegal, with a prevalence of 21.5%. In December 2008, nine male HIV prevention workers were imprisoned for “acts against nature” prohibited by Senegalese law. This qualitative study assessed the impact of these arrests on HIV prevention efforts. A purposive sample of MSM in six regions of Senegal was recruited by network referral. 26 in-depth interviews (IDIs) and 6 focus group discussions (FGDs) were conducted in July–August 2009. 14 key informants were also interviewed. All participants reported pervasive fear and hiding among MSM as a result of the December 2008 arrests and publicity. Service providers suspended HIV prevention work with MSM out of fear for their own safety. Those who continued to provide services noticed a sharp decline in MSM participation. An effective response to the HIV epidemic in Senegal should include active work to decrease enforcement of this law.

Psychosexual and social-cognitive correlates of sexual risk behavior among male clients of female sex workers in Tijuana, Mexico

Male clients of female sex workers (FSWs) may act as a bridge to the general population contributing to the spread of HIV and other sexually transmitted infections (STIs) in the USA and Mexico. This study used cross-sectional data to identify psychosexual and social-cognitive factors associated with sexual risk behavior in a bi-national sample of 300 male clients of FSWs recruited in Tijuana, Mexico from June to October 2008. In a multiple regression analysis, the number of unprotected vaginal sex acts with FSWs was associated with higher sexual compulsivity scores, lower self-efficacy for condom use, greater use of illicit drugs, and more financial need. Behavioral interventions are urgently needed to assist clients of FSWs in reducing high-risk behaviors in an effort to prevent the spread of HIV/STIs in this high-risk population and their sexual partners.

GENDER, SEXUALITY, AND ETHNICITY AS FACTORS OF CLUB DRUG USE AMONG ASIAN AMERICANS

This article examines the relationship between substance use and gender, sexuality, ethnicity, and nativity among 250 Asian American youths involved in the dance club/rave scene. We find distinct patterns of drug use differing by country of origin and ethnicity. However, contrary to some literature we do not find significant differences corresponding to immigration status, or number of years in the U.S. The most significant differences between subgroups are related to gender and sexuality: male respondents consume more drugs, more frequently than female respondents, and non-heterosexual respondents consume more than heterosexual respondents, with differing patterns for men's and women's sexual subgroups. There were also significant gender and sexuality differences with respect to the contexts in which respondents consume drugs, with the most significant differences being between heterosexual and non-heterosexual men. As we discuss, these findings illustrate the need for further investigation of drug use patterns of gender and sexuality within Asian American communities.

Experiences of aging among immigrants from India to the United States: social work practice in a global context

The aging of immigrants is a critical component in the health dynamics of the nation's aging population. To date, few studies have addressed within-group diversity and linked contemporary contexts of global connectedness with the aging experiences of older immigrants. This study aims to conceptually understand the diversity in aging dynamics within a specific immigrant group: Indian immigrants in New York City. The impact of globalization and transnational connection on aging experiences on 2 within groups-Indians who came to the United States at age of 65 or older (LLIs) and those who came at an early age (ELIs) are analyzed. Implications for social work practice, research and policy are discussed.

Acculturating Indian immigrant men in New York City: applying the social capital construct to understand their experiences and health

This study qualitatively explored social capital available to individuals (N = 17) within a community-based purposive sample of adult male immigrants from India in New York City (NYC). Analysis of in-depth interview data identified possible pathways for social capital's influences upon acculturative stress. The study defined social capital in terms of the participants' social relationships among peers, in the workplace, and with their ethnic community. Their relationships were assessed in terms of support, trust, and reciprocity. Among the recent immigrants, hopelessness and frustration about future work prospects were associated with symptoms of depression and substance abuse. The participants identified wealth as a distinct marker of social class and they described social class as a combination of education and occupation. Social class largely determined the particular peer and community networks each participant joined. Participants relied upon ongoing connections with family in India, despite their geographic separation, to relieve acculturative stress. Social support from peers was the participants' most useful and immediate resource for alleviating acculturative stress. For participants of lower socioeconomic status, acculturative stress was compounded by social-relationship expectations and norms from India that persisted within NYCs immigrant community. Namely, lower-SES participants were more likely to experience frustration and setbacks when they sought out intimate social relationships with women.

Predictors of STDs among Asian and Pacific Islander young adults

CONTEXT

Limited information is available on factors associated with STDs among Asian and Pacific Islander young adults. Such information is vital to developing effective interventions to reduce STDs within this group.

METHODS

Data were derived from the National Longitudinal Study of Adolescent Health, Wave 3; the sample consisted of 605 female and 578 male Asian and Pacific Islander young adults. Logistic regression analysis was used to assess factors associated with ever having had an STD.

RESULTS

Thirteen percent of females and 4% of males had ever had an STD. Among those who had had an STD, 75% were female, 9% had ever been paid for sex, 31% had had sex before age 15 and 55% had had multiple sex partners in the previous 12 months. Being female (odds ratio, 4.1), being Indian (compared with being Filipino; 4.8), having ever been paid money for sex (4.7) and having had more than one sex partner in the past 12 months (2.5) were associated with increased odds of having had an STD diagnosis. The more respondents believed that STDs were responsive to treatment, the greater their odds of having had an STD (2.3); the more they believed that STDs had negative consequences for a relationship, the lower their odds of having had an STD (0.7).

CONCLUSIONS

Asian and Pacific Islander women and Indians are priority groups for both research and clinical attention; prevention efforts to reduce STDs should be tailored to these groups. Clinicians working with Asians and Pacific Islanders need to focus on clients' number of sexual partners and health-related beliefs.

Social capital and rates of gonorrhea and syphilis in the United States: Spatial regression analyses of state-level associations

We conducted spatial regression analysis to account for spatial clustering of sexually transmitted diseases (STDs) and to examine the state-level association between social capital (using Putnam's public use data set) and rates of gonorrhea and syphilis. We conducted the analysis for the 48 contiguous states of the United States for 1990, 1995, and 2000 and controlled for the effects of regional variation in STD rates, and for state variation in poverty, income inequality, racial composition, and percentage aged 15-34 years. We compared the results of the spatial regression analysis with those of ordinary least squares (OLS) regression. Controlling for all population-level variables, the percentage of variation explained by the OLS regression and by the spatial regression were similar (mid-90s for gonorrhea and low-70s for syphilis), the standardized parameter estimates were similar, and the spatial lag parameter was not statistically significant. Social capital was not associated with STD rates when state variation in racial composition was included in the regression analysis. In this analysis, states with a higher proportion of residents who were African-American had higher STD rates. When we did not control for racial composition, regression analysis showed that states with higher social capital had lower STD rates. We conjecture that sexual networks and sexual mixing drive the association between social capital and STD rates and highlight important measurement and research questions that need elucidation to understand fully the relationship between social capital and STDs.

Immigration and HIV/AIDS in the New York Metropolitan Area

Because the HIV pandemic undergoes continual change in its locations and affected populations, it is crucial to study HIV risk behaviors among mobile and immigrant groups within and across borders. The impact of cross-cultural migrations and the importance of studying that impact in terms of demographic characteristics as well as cultural and environmental factors has not received adequate attention in public health research. This collaborative analysis utilizes data from three studies of immigrant groups in New York to describe and compare these factors that provide the context for risk and prevention of HIVAIDS and other health challenges. Data discussed were obtained utilizing multi-method approaches to identify and describe HIV risks among both new and more established immigrant populations within the urban settings of North America, with NYC as a central focus. Demographic and epidemiological data situate the analysis within the larger contexts of US migration and the HIV/AIDS epidemic in NYC. The authors identify risk and protective factors embedded to varying degrees in immigrants' multiple cultures and sub-cultures. The three populations studied include: 1) new Hispanic immigrants from the Dominican Republic, Mexico and Central America; 2) West Indian (Caribbean) immigrants from Jamaica, Trinidad/Tobago and other anglophone Caribbean nations; and 3) South Asian immigrants from India (Indian Americans). The paper seeks differences and commonalities, focusing on the social, attitudinal and behavioral factors that contribute to increased HIV/AIDS vulnerability among these populations. The data presented also identify some of the attitudes and behaviors of individuals and groups, as well as other facilitators and obstacles to transmission for immigrants as they adapt to new environments. Topics addressed include factors affecting HIV/AIDS vulnerability of immigrant groups, goals and expectations, health and mental heath issues, gender role change, sexual risk, alcohol and other drug use, perception of HIV/AIDS risk and implications for prevention.