Sources of personal income and HIV risk among sexually active women

Acceptability of a feasibility randomized clinical trial of a microenterprise intervention to reduce sexual risk behaviors and increase employment and HIV preventive practices (EMERGE) in young adults: a mixed methods assessment

BACKGROUND

Acceptability is a critical requisite in establishing feasibility when planning a larger effectiveness trial. This study assessed the acceptability of conducting a feasibility randomized clinical trial of a 20-week microenterprise intervention for economically-vulnerable African-American young adults, aged 18 to 24, in Baltimore, Maryland. Engaging MicroenterprisE for Resource Generation and Health Empowerment (EMERGE) aimed to reduce sexual risk behaviors and increase employment and uptake of HIV preventive behaviors.

METHODS

Thirty-eight participants were randomized to experimental (n = 19) or comparison group (n = 19). The experimental group received text messages on job openings plus educational sessions, mentoring, a start-up grant, and business and HIV prevention text messages. The comparison group received text messages on job openings only. Qualitative and quantitative post-intervention, in-person interviews were used in addition to process documentation of study methods.

RESULTS

Our results found that the study design and interventions showed promise for being acceptable to economically-vulnerable African-American young adults. The largely positive endorsement suggested that factors contributing to acceptability included perceived economic potential, sexual health education, convenience, incentives, and encouraging, personalized feedback to participants. Barriers to acceptability for some participants included low cell phone connectivity, perceived payment delays, small cohort size, and disappointment with one's randomization assignment to comparison group. Use of peer referral, network, or wait-list designs, in addition to online options may enhance acceptability in a future definitive trial. Expanding administrative and mentoring support may improve overall experience.

CONCLUSION

Microenterprise interventions are acceptable ways of providing young adults with important financial and sexual health content to address HIV risks associated with economic vulnerability.

TRIAL REGISTRATION

ClinicalTrials.gov. NCT03766165 . Registered 04 December 2018.

Microaggressions and Discrimination Relate to Barriers to Care Among Black Women Living with HIV

In the United States, black women living with HIV (BWLWH) represent the highest proportion of women living with HIV and dying from HIV-related illnesses when compared with women of other racial/ethnic groups. These disparities may be linked to social and structural factors faced by BWLWH, including race- and HIV-related discrimination, and gendered racial microaggressions (GRMs). GRMs are everyday insults that black women experience due to being both black and female (e.g., comments about their body). Commonly assessed barriers to HIV-related care (e.g., transportation, finance, community stigma) do not include personal experiences of race- and HIV-related discrimination and GRM. We present the cross-sectional associations between racial discrimination, HIV-related discrimination, GRM, and barriers to care. One hundred BWLWH in a large city in the Southeast United States completed baseline assessments as part of an intervention development study. At baseline assessments BWLWH completed measures on racial discrimination, HIV-related discrimination, GRM (frequency and appraisal), and barriers to care. Hierarchical multiple linear regressions controlling for age, education, and income indicated that higher race-related discrimination (β = 0.23, p < 0.05), higher HIV-related discrimination (β = 0.26, p < 0.01), and higher GRM (frequency: β = 0.31, p < 0.01; appraisal: β = 0.21, p < 0.05) significantly predicted higher total barriers to care. When all predictors were entered together GRMs contributed uniquely to total barriers to care and two subscales, while racial discrimination contributed uniquely toward one subscale. These findings further emphasize that for BWLWH interventions and policy efforts need to address racial discrimination, HIV-related discrimination, and GRM concurrently with other barriers to care, with special attention being given to daily GRM.

Associação entre estados afetivos negativos e comportamentos sexuais de risco

O presente trabalho teve como objetivo analisar, através da revisão da literatura, a associação entre estados afetivos negativos (e.g., depressão, ansiedade) e comportamentos sexuais de risco. Verificou-se que alguns estudos indicam uma associação entre problemas ao nível da saúde mental e/ou estados afetivos negativos e comportamentos sexuais de risco. Através da revisão da literatura concluiu-se que os estados afetivos negativos como a depressão, a ansiedade, e as experiências traumáticas se encontram associadas com comportamentos sexuais de risco e têm sido alvo de pouca atenção por parte da comunidade científica.    

Economic Context and HIV Vulnerability in Adolescents and Young Adults Living in Urban Slums in Kenya: A Qualitative Analysis Based on Scarcity Theory

Urban slum adolescents and young adults have disproportionately high rates of HIV compared to rural and non-slum urban youth. Yet, few studies have examined youth's perceptions of the economic drivers of HIV. Informed by traditional and behavioral economics, we applied a scarcity theoretical framework to qualitatively examine how poverty influences sexual risk behaviors among adolescents and young adults. Focus group discussions with one hundred twenty youth in Kenyan's urban slums were transcribed, coded, and analyzed using interpretive phenomenology. Results indicated that slum youth made many sexual decisions considered rational from a traditional economics perspective, such as acquiring more sex when resources were available, maximizing wealth through sex, being price-sensitive to costs of condoms or testing services, and taking more risks when protected from adverse sexual consequences. Youth's engagement in sexual risk behaviors was also motivated by scarcity phenomena explained by behavioral economics, such as compensating for sex lost during scarce periods (risk-seeking), valuing economic gains over HIV risks (tunneling, bandwidth tax), and transacting sex as an investment strategy (internal referencing). When scarcity was alleviated, young women additionally described reducing the number of sex partners to account for non-economic preferences (slack). Prevention strategies should address the traditional and behavioral economics of the HIV epidemic.

Demographic factors, mental health problems, and psychosocial resources influence women's AIDS risk

The aim of this study was to examine how depressive mood, posttraumatic stress disorder (PTSD) symptoms, self-efficacy, and social support are associated with HIV risk behaviors. Participants were sexually active women (N = 1488) recruited when attending gynecological consultations in primary care settings. Standardized questionnaires were administered to assess for depressive mood, abuse/assault-related PTSD, social support, self-efficacy, stress, and sexual risk behavior. The resulting association models showed that demographic factors, mental health problems, and resources are associated with sexual risk behavior. Detecting and treating mental health problems and interventions that bolster women's psychosocial resources are warranted.

The Role of Partner Support Among Women with Depressive Symptoms

Scarce research has explored how sex partners and their provision of social support impact depression among women. The purpose of this study is to examine the role of social support (overall and specific types of support) provided by a sex partner on depressive symptoms among a sample of women (n = 295). We assessed depression using the Centers for Epidemiological Studies Depression Scale and used a social network inventory to evaluate partner characteristics and types of support provided. Overall 76% (n = 225) of the sample experienced depressive symptoms in the past 90 days. Approximately one-third of the sample had a partner who provided emotional support (33.9%), financial support (36.6%), or socialization support (40.0%). About 41% of women said their partner offered no support while 16.3% had a partner who gave all three types of support. These findings demonstrate that partners and the level and types of support provided should not be discounted in mental health assessments.

Economic Resources and HIV Preventive Behaviors Among School-Enrolled Young Women in Rural South Africa (HPTN 068)

Individual economic resources may have greater influence on school-enrolled young women's sexual decision-making than household wealth measures. However, few studies have investigated the effects of personal income, employment, and other financial assets on young women's sexual behaviors. Using baseline data from the HIV Prevention Trials Network (HPTN) 068 study, we examined the association of ever having sex and adopting sexually-protective practices with individual-level economic resources among school-enrolled women, aged 13-20 years (n = 2533). Age-adjusted results showed that among all women employment was associated with ever having sex (OR 1.56, 95 % CI 1.28-1.90). Among sexually-experienced women, paid work was associated with changes in partner selection practices (OR 2.38, 95 % CI 1.58-3.58) and periodic sexual abstinence to avoid HIV (OR 1.71, 95 % CI 1.07-2.75). Having money to spend on oneself was associated with reducing the number of sexual partners (OR 1.94, 95 % CI 1.08-3.46), discussing HIV testing (OR 2.15, 95 % CI 1.13-4.06), and discussing condom use (OR 1.99, 95 % CI 1.04-3.80). Having a bank account was associated with condom use (OR 1.49, 95 % CI 1.01-2.19). Economic hardship was positively associated with ever having sex, but not with sexually-protective behaviors. Maximizing women's individual economic resources may complement future prevention initiatives.

Housing as a Social Determinant of Health: Exploring the Relationship between Rent Burden and Risk Behaviors for Single Room Occupancy Building Residents

A growing body of health determinants research recognizes that housing and health are intimately linked. This study explores the relationship between rent burden (the ratio of rent to income) and health risk behaviors among a sample of single room occupancy (SRO) building residents. Cross-sectional data were gathered from a sample of 162 residents living in privately owned, for-profit SROs in Chicago. Findings indicated that participants who had full rental subsidies and thus were designated in a no-rent-burden category were more likely to engage in risk behaviors including illicit drug use, having multiple sexual partners, and having sex without a condom, in comparison to participants with moderate or high-rent burdens. These findings suggest that interventions to increase housing stability and affordability and bolster reliable income sources (in addition to rental subsidies) may be key in reducing risk behaviors and improving health for vulnerably housed populations such as SRO residents.

Socioeconomic status and HIV vaccine preparedness studies in North America

Educational level, employment, and income are key components of socioeconomic status (SES). This article is a systematic review of SES variables in North American countries, and their relationship to willingness to participate (WTP) and retention in a hypothetical preventive phase 3 HIV vaccine trial and in actual HIV vaccine trials. Men who have sex with men (MSM) tended to have higher educational levels, be more employed, and had higher income levels than injection drug users (IDU) and women at heterosexual risk (WAHR). In large part, there was no relationship between educational level and WTP, as well as between educational level and retention. Similarly, there was no relationship between employment and WTP. In WAHR who were African-American, those employed were less likely than others to complete the study at 18 months. The exact occupations of participants analyzed have not been specified, and specification of these occupations may help determine whether enhanced retention (ER) strategies are required.