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Irie WC, Calabrese SK, Mayer KH, Geng EH, Blackstock O, Marcus JL. Social and structural factors associated with interest in HIV preexposure prophylaxis among Black women in the United States. AIDS Care 2024; 36:672-681. [PMID: 38176016 PMCID: PMC10994725 DOI: 10.1080/09540121.2023.2299338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
In a nationwide sample of cisgender Black women in the US, we assessed the associations between social and structural factors and interest in using HIV preexposure prophylaxis (PrEP). Among 315 respondents, 62.2% were interested in PrEP if it were provided for free. Positive social norms surrounding PrEP, including injunctive norms (perceived social acceptability of PrEP use) and descriptive norms (perceived commonality of PrEP use), were positively associated with interest in using PrEP. Concerns about HIV infection, recently visiting a health care provider, and comfort discussing PrEP with a provider were also positively associated with interest in using PrEP. Anticipating PrEP disapproval from others was negatively associated with interest in PrEP. Although PrEP can promote autonomy and personal discretion, Black women's PrEP-related decisions occur in a complex social environment. Black women may benefit from interventions to promote positive norms and attitudes surrounding PrEP at the community level and empower them in discussions with their providers about PrEP.
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Affiliation(s)
- Whitney C. Irie
- Boston College School of Social Work, Chestnut Hill, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Sarah K. Calabrese
- Department of Psychological and Brain Sciences, George Washington University, Washington, D.C., USA
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, D.C., USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
| | - Elvin H. Geng
- Division of Infectious Diseases, Washington University in St Louis, St. Louis, MO, USA
| | | | - Julia L. Marcus
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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2
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Sophus AI, Mitchell JW, Barroso J, Sales JM. Factors Associated with Planned Future Use of PrEP in the Next 3 Months and Likelihood to Use PrEP Among Black Cisgender HIV-negative Women in Texas. AIDS Behav 2024; 28:72-92. [PMID: 37768428 DOI: 10.1007/s10461-023-04188-9] [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] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
Identifying and then addressing barriers and leveraging facilitators is important to help increase pre-exposure prophylaxis (PrEP) use among Black women vulnerable to HIV acquisition. The present cross-sectional study examined what factors were associated with future plans to use PrEP, and general likelihood to use it among a convenience sample of 152 adult, Black cisgender women from three metropolitan areas in Texas. The final multivariable logistic regression model revealed that relationship status (aOR = 0.20, 95% CI: 0.05-0.73, p < 0.05), PrEP anticipated stigma (aOR = 0.29, 95% CI: 0.10-0.78, p < 0.05), perceived discrimination (aOR = 0.40, 95% CI: 0.21-0.78, p < 0.01) and interest in learning more about PrEP (aOR = 5.32, 95% CI: 2.60-10.9, p < 0.001) were associated with future plans to use PrEP. The final multivariable linear regression model with maximum likelihood estimation identified that perceived discrimination (β=-0.24, SE: -0.38 - -0.10, p < 0.01), perceived HIV risk (β = 0.33, SE: 0.18-0.49, p < 0.001), willingness to use PrEP with condoms (β = 1.26, SE: 0.94-1.60, p < 0.001), and comfort communicating about PrEP with a provider (β = 0.23, SE: 0.06-0.41, p < 0.01) were associated with general likelihood to use PrEP. Findings reveal key factors that warrant further attention and examination toward improving PrEP use within this population.
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Affiliation(s)
- Amber I Sophus
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, 11200 S.W. 8th Street, AHC5, Miami, FL, 33199, USA.
| | - Jason W Mitchell
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, 11200 S.W. 8th Street, AHC5, Miami, FL, 33199, USA
| | - Julie Barroso
- School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Jessica McDermott Sales
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Ichite A, Jean-Gilles M, Rosenberg R, Abbamonte J, Dévieux JG. Assessing the Preliminary Efficacy of a Nonrandomized, Clinic-Based HIV Risk Reduction Pilot Intervention for PrEP-Initiated, Alcohol- and Other Drug-Using Women of Color in Miami, FL. J Racial Ethn Health Disparities 2023; 10:3077-3094. [PMID: 36648620 PMCID: PMC10645637 DOI: 10.1007/s40615-022-01482-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 01/18/2023]
Abstract
In this paper, we assessed the preliminary efficacy and acceptability of a quasi-experimental, clinic-based sexual risk reduction pilot intervention for pre-exposure prophylaxis (PrEP)-initiated, alcohol- and other drug-using women of color and explored their self-reported barriers to, and facilitators of, PrEP use. Using a mixed methods design, analyses incorporated pre- and post-intervention study assessment data from 38 women and semi-structured process evaluations using a subsample of 25. The intervention administered over an 8-week period consisted of 4 one-on-one in person educational sessions, a process evaluation, and study assessments conducted at baseline and 3 and 6 months. Post intervention, statistically significant changes in sexual risk scores were not observed; however, we found significant decreases in alcohol use (Z = - 3.02, p = .003, η2 = .41). Process evaluation data revealed interpersonal relationships as a key motivator for PrEP initiation as well as a prominent barrier to PrEP use; these relationships rarely facilitated adherence. Overall, women found the intervention to be acceptable and reported a wide range of benefits of participation-most notably its therapeutic benefits. Findings from this study provide preliminary evidence of the potential for the Talking PrEP with Women of Color intervention to improve risky behaviors, knowledge, and attitudes related to sexual risk taking. Furthermore, findings suggest that interventions to increase PrEP uptake and adherence in at-risk women may benefit from supporting them in accurately estimating their risk for HIV and increasing their sense of social support.
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Affiliation(s)
- Amanda Ichite
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public, Health and Social Work, Florida International University, Miami, FL, 33199, USA.
| | - Michèle Jean-Gilles
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public, Health and Social Work, Florida International University, Miami, FL, 33199, USA
| | - Rhonda Rosenberg
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public, Health and Social Work, Florida International University, Miami, FL, 33199, USA
| | - John Abbamonte
- Department of Educational and Psychological Studies, Counseling Psychology Area, University of Miami, Coral Gables, FL, 33146, USA
| | - Jessy G Dévieux
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public, Health and Social Work, Florida International University, Miami, FL, 33199, USA
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Bond KT, Gunn A, Williams P, Leonard NR. Using an Intersectional Framework to Understand the Challenges of Adopting Pre-exposure Prophylaxis (PrEP) Among Young Adult Black Women. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:180-193. [PMID: 35401855 PMCID: PMC8992539 DOI: 10.1007/s13178-021-00533-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 06/14/2023]
Abstract
Introduction There is limited functional knowledge and utilization of pre-exposure prophylaxis (PrEP) among young adult Black cisgender women (YBW). Methods We conducted four focus groups with YBW using an intersectional framework to explore multiple levels of factors that impede YBW awareness, interest, and utilization of PrEP in conjunction with their sexual and reproductive healthcare needs. Results Influences at the cultural-environmental level included a lack of information and resources to access to PrEP and medical mistrust in the healthcare system. At the social normative level, influences included attitudes towards the long-term effects on sexual and reproductive health and self-efficacy to follow the PrEP regimen. At the proximal intrapersonal level, influences included anticipated HIV stigma from family and peers along with the fear of rejection from their main partners. Conclusions Translation of these results indicated that interventions to increase PrEP utilization and adherence among YBW will require multi-level strategies to address barriers to integrating HIV prevention into sexual and reproductive healthcare.
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Affiliation(s)
- Keosha T. Bond
- Department of Community Health and Social Medicine, CUNY School of Medicine, New York, New York, United States
| | - Alana Gunn
- Department of Criminology, Law, and Justice, University of Illinois At Chicago, Chicago, Illinois, United States
| | - Porche Williams
- CUNY Lehman College, Bronx, New York, New York, United States
| | - Noelle R. Leonard
- Silver School of Social Work, New York University, New York, New York, United States
- Center for Drug Use and HIV Research, NYU School of Global Public Health, New York, New York, United States
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Washio Y, Wright EN, Davis-Vogel A, Chittams J, Anagnostopulos C, Kilby LM, Teitelman AM. Prior Exposure to Intimate Partner Violence Associated With Less HIV Testing Among Young Women. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP2848-NP2867. [PMID: 29651922 PMCID: PMC6204109 DOI: 10.1177/0886260518768564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Low-income minority women are disproportionately represented among those living with HIV in the United States. They are also at risk for the SAVA (substance abuse, violence, and HIV/AIDS) syndemic issues. Women who have recently given birth are at high risk for substance use and intimate partner violence (IPV), and HIV testing is not routinely administered during the postpartum visit. We explored the relationship between substance use, IPV, and HIV testing among low-income young adult women attending Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a federally supported nutrition program. A survey assessed substance use, relationships in particular with violence exposure, and HIV testing behavior in the past 6 months among a convenience sample of 100 women aged 18 to 30. The survey was conducted at several WIC offices in an urban setting in the Mid-Atlantic region between June and December 2015. Physical violence was the only IPV variable significantly associated (p = .022) with not being tested for HIV in the past 6 months, remaining significant even after adjusting for demographic and other significant variables (adjusted odds ratio [AOR] = 0.02; 95% confidence interval [CI] = [0.00, 0.41]). Women exposed to physical IPV or psychological IPV in the past year were significantly more likely to have ever used an illicit drug (physical IPV: 34% vs. 59%, p = .052; psychological IPV: 22% vs. 53%. p = .002). These findings between physical IPV and HIV testing history highlight the need to further understand how the context of violence affects HIV testing behaviors. Providing convenient, safe, and accessible HIV testing sites in spaces like WIC may increase HIV testing rates overall and specifically among women experiencing IPV.
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Affiliation(s)
- Yukiko Washio
- Christiana Care Health Services, Newark, DE, USA
- University of Delaware, Newark, USA
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Chandler R, Hull S, Ross H, Guillaume D, Paul S, Dera N, Hernandez N. The pre-exposure prophylaxis (PrEP) consciousness of black college women and the perceived hesitancy of public health institutions to curtail HIV in black women. BMC Public Health 2020; 20:1172. [PMID: 32723313 PMCID: PMC7385954 DOI: 10.1186/s12889-020-09248-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 07/13/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Consistent use of Pre-Exposure Prophylaxis (PrEP), a biomedical intervention for HIV seronegative persons, has been shown to significantly decrease HIV acquisition. Black women are a viable population segment to consider for PrEP use as their HIV incidence is overwhelmingly higher than all other women groups. METHODS We developed and piloted a cultural- and age- appropriate PrEP education intervention to determine Black college women's: 1) perceptions of and receptivity to PrEP use; and 2) preferences for PrEP information delivery. RESULTS We recruited N = 43 Black college women. Most of our sample were sophomore and Juniors of whom identified as heterosexual (83%) and single (67%). Over 50% of young women had never been HIV tested and only 28% had been tested in the last 6 months; however, 100% of the women believed their HIV status was negative. Prior to participating in the study, most Black college women (67%) had not heard about PrEP and were unsure or apprehensive (72%) to initiate PrEP. The Black college women indicated that our educational intervention was extremely helpful (67%) for understanding and learning about PrEP. Post participating in our PrEP education module, regardless of delivery modality, participants reported being likely (62.55-70%) to initiate PrEP in the future. CONCLUSIONS Results indicate that Black college women would strongly consider PrEP when provided with basic knowledge, regardless of delivery modality. Participants also showed greater appreciation for in-person delivery and found it to be significantly more helpful and of greater quality for learning about PrEP; comprehension or perceived usefulness of PrEP-related content was relatively the same between groups. PrEP content delivery -- via in-person or online methods - is contingent on learning style and presentation. TRIAL REGISTRATION This study has been registered under the ISRCTN Registry as of July 6, 2020. The trial registration number is ISRCTN14792715 . This study was retrospectively registered.
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Affiliation(s)
- Rasheeta Chandler
- Nell Hodgson Woodruff School of Nursing (NHWSON), Emory University, 1520 Clifton Rd., NE, Atlanta, GA, 30322-4027, USA.
| | - Shawnika Hull
- George Washington University, Prevention and Community Health, 1918 F Street NW, Washington, D.C, 20052, USA
| | - Henry Ross
- University of Rochester, Center for Community Practice, 601 Elmwood Ave, Rochester, NY, 14627, USA
| | - Dominique Guillaume
- Nell Hodgson Woodruff School of Nursing (NHWSON), Emory University, 1520 Clifton Rd., NE, Atlanta, GA, 30322-4027, USA
| | - Sudeshna Paul
- Nell Hodgson Woodruff School of Nursing (NHWSON), Emory University, 1520 Clifton Rd., NE, Atlanta, GA, 30322-4027, USA
| | - Nikita Dera
- Morehouse School of Medicine, Community Health and Preventive Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA
| | - Natalie Hernandez
- Morehouse School of Medicine, Community Health and Preventive Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA
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Gursahaney PR, Cordes S, Ofotokun I, Wall KM, Jamieson DJ, Haddad LB. Factors associated with condom use among HIV-positive women living in Atlanta, Georgia. PLoS One 2019; 14:e0225406. [PMID: 31834885 PMCID: PMC6910822 DOI: 10.1371/journal.pone.0225406] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 11/04/2019] [Indexed: 11/19/2022] Open
Abstract
Objectives Consistent condom use is essential to reducing heterosexual transmission of HIV. African Americans are disproportionately affected by HIV in the United States despite comprising a small percentage of the population. Our objectives were to evaluate factors associated with self-reported condom use in a cohort of predominantly African American women receiving HIV care in Atlanta, Georgia. Methods A cross-sectional study of reproductive knowledge, attitudes, and practices among adult, sexually-active, HIV-positive women attending the Grady Infectious Disease Clinic in Atlanta, Georgia was conducted from July, 2013 to November, 2014 to evaluate factors associated with self-reported condom use. Primary outcomes included: condom use at last vaginal intercourse and consistent condom use with vaginal intercourse over the last six months. Descriptive, bivariable, and multivariable logistic regression analyses were performed. Results Of 187 women enrolled, 170 reported having vaginal intercourse in the last six months. Seventy-four percent used condoms at last vaginal intercourse, whereas 53% reported consistent condom use over the last six months. In adjusted analyses, factors associated with condom use at last intercourse included decreased frequency of sex, no history of drug use, and confidence to discuss condom use with sexual partners (p<0.05). Factors associated with consistent condom use in the past six months were older age, being single/dating, and confidence to discuss condom use with sexual partners. History of drug use, having HIV-positive partners, and unprotected anal intercourse were associated with inconsistent use (p<0.05). Conclusions Improved strategies are needed to educate women on the importance of safe sexual practices and condom negotiation. Healthcare providers should strive to have an open dialogue with patients about condom use, whether they engage in anal sex, and its risks.
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Affiliation(s)
- Priya R. Gursahaney
- University of Cincinnati College of Medicine, Department of Obstetrics and Gynecology, Cincinnati, Ohio, United States of America
- * E-mail:
| | - Sarah Cordes
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States of America
| | - Ighovwerha Ofotokun
- Emory University School of Medicine, Department of Medicine, Infectious Disease Division and Grady Health Care System, Atlanta, Georgia, United States of America
| | - Kristin M. Wall
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, Georgia, United States of America
| | - Denise J. Jamieson
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States of America
| | - Lisa B. Haddad
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States of America
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Bond KT, Ramos SR. Utilization of an Animated Electronic Health Video to Increase Knowledge of Post- and Pre-Exposure Prophylaxis for HIV Among African American Women: Nationwide Cross-Sectional Survey. JMIR Form Res 2019; 3:e9995. [PMID: 31144667 PMCID: PMC6658301 DOI: 10.2196/formative.9995] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/30/2018] [Accepted: 04/29/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Despite renewed focus on biomedical prevention strategies since the publication of several clinical trials highlighting the efficacy of pre-exposure prophylaxis (PrEP), knowledge of postexposure prophylaxis (PEP) and PrEP continues to remain scarce among women, especially among African American women who are disproportionally affected by HIV. In an effort to address this barrier and encourage uptake of PEP and PrEP, an electronic health (eHealth) video was created using an entertainment-education format. OBJECTIVE The study aimed to explore the feasibility, acceptability, and preference of an avatar-led, eHealth video, PEP and PrEP for Women, to increase awareness and knowledge of PEP and PrEP for HIV in a sample of African American women. METHODS A cross-sectional, Web-based study was conducted with 116 African American women aged 18 to 61 years to measure participants' perceived acceptability of the video on a 5-point scale: poor, fair, good, very good, and excellent. Backward stepwise regression was used to the find the outcome variable of a higher rating of the PEP and PrEP for Women video. Thematic analysis was conducted to explore the reasons for recommending the video to others after watching the eHealth video. RESULTS Overall, 89% of the participants rated the video as good or higher. A higher rating of the educational video was significantly predicted by: no current use of drugs/alcohol (beta=-.814; P=.004), not having unprotected sex in the last 3 months (beta=-.488; P=.03), higher income (beta=.149; P=.03), lower level of education (beta=-.267; P=.005), and lower exposure to sexual assault since the age of 18 years (beta=-.313; P=.004). After watching the eHealth video, reasons for recommending the video included the video being educational, entertaining, and suitable for women. CONCLUSIONS Utilization of an avatar-led eHealth video fostered education about PEP and PrEP among African American women who have experienced insufficient outreach for biomedical HIV strategies. This approach can be leveraged to increase awareness and usage among African American women.
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Affiliation(s)
- Keosha T Bond
- Department of Public Health, New York Medical College, Valhalla, NY, United States
| | - S Raquel Ramos
- Rory Meyers College of Nursing, New York University, New York, NY, United States
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Chapman Lambert C, Marrazzo J, Amico KR, Mugavero MJ, Elopre L. PrEParing Women to Prevent HIV: An Integrated Theoretical Framework to PrEP Black Women in the United States. J Assoc Nurses AIDS Care 2018; 29:835-848. [PMID: 29685648 PMCID: PMC7439521 DOI: 10.1016/j.jana.2018.03.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/29/2018] [Indexed: 11/16/2022]
Abstract
Preexposure prophylaxis (PrEP) with optimal adherence has demonstrated efficacy in reducing HIV incidence in women. Black women are disproportionately burdened by the HIV epidemic, accounting for more than half of all new HIV cases in women, thereby making PrEP an ideal prevention strategy for this group. However, to date, PrEP uptake by women in the United States has been slow. Further domestic research is needed to understand the multilevel factors related to PrEP awareness, uptake, and implementation in Black women. Our purpose was to review the current status of HIV prevention in Black women. We summarize clinical trials germane to federal approval of PrEP; discuss important PrEP studies focused on women, including non-oral options; and review multilevel barriers to PrEP uptake. Lastly, we discuss the use of an integrated theoretical framework to organize multilevel factors related to PrEP uptake by Black women in order to guide intervention development.
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10
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Clark M, Buchanan R, Kovensky R, Leve LD. Partner influences on young women's risky drug and sexual behavior. Reprod Health 2018; 15:156. [PMID: 30219076 PMCID: PMC6139176 DOI: 10.1186/s12978-018-0598-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 08/31/2018] [Indexed: 11/11/2022] Open
Abstract
Background Adolescent girls with a history of maltreatment are at heightened risk for health-risking behaviors, including unsafe sexual behaviors and drug use. However, few studies have examined the views of this population in regard to sexual partner choice, sexual behaviors, and decisions to use drugs with sexual partners. Methods We conducted 15 semistructured, open-ended qualitative interviews with young women ages 18–24 with a history of maltreatment and asked them to reflect on their experiences as adolescents. We used the constant comparison method to group the qualitative coded data into themes. Results Analysis of the interviews suggested that adolescent girls with maltreatment histories often report that they chose partners who are promotive of risky drug and sexual behavior. The interviews also provided insight into why this population is likely to use drugs with their partner and why they might be hesitant to talk about or practice safe sex with their partner. Conclusion The young women’s feedback highlighted five areas where adolescent girls with maltreatment histories could benefit: (a) provision of information about partner characteristics that are promotive of both risky behavior and those that are linked to healthy relationships, (b) provision of information about how one’s partner can influence one’s own drug use, (c) practice talking about safe sex with partners, (d) provision of information about safe sex practices and the risks associated with unsafe sex, and (e) provision of information about the risks associated with drug use and unsafe sexual behavior to adolescent boys.
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Affiliation(s)
- Miriam Clark
- Oregon Social Learning Center, 10 Shelton McMurphey Blvd, Eugene, OR, 97401, USA
| | - Rohanna Buchanan
- Oregon Social Learning Center, 10 Shelton McMurphey Blvd, Eugene, OR, 97401, USA.
| | - Rachel Kovensky
- Prevention Science Institute, 6217 University of Oregon, Eugene, OR, 97403, USA
| | - Leslie D Leve
- Prevention Science Institute, 6217 University of Oregon, Eugene, OR, 97403, USA
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11
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Aliyu G, El-Kamary SS, Abimiku A, Blattner W, Charurat M. Demography and the dual epidemics of tuberculosis and HIV: Analysis of cross-sectional data from Sub-Saharan Africa. PLoS One 2018; 13:e0191387. [PMID: 30192746 PMCID: PMC6128449 DOI: 10.1371/journal.pone.0191387] [Citation(s) in RCA: 11] [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: 11/15/2016] [Accepted: 12/27/2017] [Indexed: 02/07/2023] Open
Abstract
Background Convergence of tuberculosis (TB) and HIV epidemics is associated with higher morbidity and mortality risks and understanding their distribution across key demographic factors is essential for prevention and control. This analysis examines the prevalence of TB, HIV and TB-HIV coinfection across age and gender in patients with presumptive TB seeking care at the National TB and Leprosy Training Center in Nigeria. Methods Samples from 1603 presumptive pulmonary TB cases who provided informed consent were evaluated with a sequential testing algorithm that included a smear microscopy, cultures in liquid and broth media and then genotyping by Hain line probe assays. HIV was serially tested with two HIV rapid assays and retested with a third assay in non-conclusive samples. Results Twenty-three percent (375/1603) had confirmed pulmonary TB infection, 23.6% (378/1603) were positive for HIV infection and 26.9% (101/375) of the confirmed TB cases were HIV co-infected. Males had a higher prevalence of TB: 27.6% vs. 18.0%, p < .0001; and a lower prevalence of HIV: 19.0% vs. 29.6%, p < .0001. In the age range of 25–29 years, males were twice as likely to have TB (OR = 2.2; 95% confidence interval [CI]: 1.3–3.9, p = 0.0032) while females were five times more likely to have HIV (OR = 4.8; 95% CI: 2.6–8.9, p < .0001). Persons with TB-HIV coinfection were more likely to be young, female and less likely to be married. Conclusion Younger females with a high burden of HIV may be under-diagnosed and under-reported for TB in Nigeria. Community programs for intensified and early detection of TB and HIV targeting younger females are needed in this setting.
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Affiliation(s)
- Gambo Aliyu
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
- * E-mail: ,
| | - Samer S. El-Kamary
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Alash’le Abimiku
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - William Blattner
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Manhattan Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
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12
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Lima AC, Hilyard K, Davis TL, de Marrais K, Jeffries WL, Muilenburg JL. Protective behaviours among young African American women with non-monogamous sexual partners. CULTURE, HEALTH & SEXUALITY 2018; 20:442-457. [PMID: 28793851 DOI: 10.1080/13691058.2017.1356937] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In the USA, partner non-monogamy is reported to be more common among African American women than White women and may contribute to African American women's increased risk for HIV and other sexually transmitted infections (STIs). Few studies have explicitly and comprehensively described the protective behaviours that African American women employ with non-monogamous partners to reduce their HIV risk. We conducted interviews to examine protective behaviours among 11 African American women aged 18-24 years who perceived that a partner in the preceding 12 months had another sex partner. Participants described three types of partnerships with 29 non-monogamous men; these partnerships clustered into three categories. Narrative analysis revealed an overall paucity of protective behaviours with non-monogamous partners. Protective behaviours (i.e. communication and condom use) were informed by partnership type, rather than perceptions of non-monogamy. There were few instances in which partner non-monogamy motivated women to terminate sex partnerships. Rather, these decisions were often motivated by changes in other relationship dynamics. To address HIV/STI risk related to partner non-monogamy, HIV prevention strategies for young African American women should emphasise the importance of condom use in all non-marital partnership types. Interventions where testing is available may be effective for women who frequently test for HIV/STIs but do not use condoms.
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Affiliation(s)
- Ashley C Lima
- a Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention , Centers for Disease Control and Prevention , Atlanta , USA
| | - Karen Hilyard
- b Department of Health Promotion and Behavior , University of Georgia , Athens , USA
| | | | - Kathleen de Marrais
- d Department of Lifelong Education, Administration and Policy , University of Georgia , Athens , USA
| | - William L Jeffries
- a Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention , Centers for Disease Control and Prevention , Atlanta , USA
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13
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Bond KT, Frye V, Cupid M, Lucy D, Koblin BA. HIV-Related Communication and Safe Sex Practices among Heterosexual Black Men: A Qualitative Report. ACTA ACUST UNITED AC 2018; 4. [PMID: 30931351 DOI: 10.1353/bsr.2018.0001] [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: 11/11/2022]
Abstract
HIV prevention efforts have given limited attention to the influence of social norms on the process of communicating about safer sex practices among heterosexual Black men. To address this and inform the development of an HIV prevention behavioral intervention for heterosexual African American men, we conducted computerized, structured interviews with 61 men living in high HIV prevalence neighborhoods in New York City to participate in either one of the five focus group interviews and/or an in-depth qualitative interview. Participants had a mean age of 33 years, 25% held less than a high school education, 66% earned an annual income of $10,000 or less, and 86% had a history of incarceration Qualitative analysis was used to identify emergent themes within the domains of condom use communication, HIV status disclosure with sexual partners, and general HIV knowledge among peers. Thematic analyses revealed that communication was hindered by (1) low perception of risk of sex partners (2) relationship insecurities and (3) HIV stigma within the community and between sex partners. Most communication related to condom use was based on their perception of their sex partner's HIV risk and fear of contracting HIV and/or a partner's reaction to proposing or using condoms. Discussions related to HIV status elicited concerns of being labeled as HIV-positive or leading to unprotected sex. Communication among peers was rare due in part to the stigma of HIV in the Black community. Effective HIV interventions for heterosexual should include communication strategies that address the cultural norms that influence safe sex practices.
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Washio Y, Wright EN, Flores D, Davis A, Chittams J, Anagnostopulos C, Kilby LM, Teitelman AM. Perspectives on HIV Testing Among WIC-Enrolled Postpartum Women: Implications for Intervention Development. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2017; 29:457-474. [PMID: 29068716 PMCID: PMC6266864 DOI: 10.1521/aeap.2017.29.5.457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Low-income minority women are disproportionately represented among those living with HIV in the U.S and also at-risk for substance abuse and intimate partner violence-collectively called the SAVA syndemic-which may impede HIV testing uptake. Views about HIV testing were assessed among women (ages 18-29) enrolled in a federally funded nutrition program for women, infants, and children (WIC) in a large Mid-Atlantic city. A survey (n = 80) and three focus groups were conducted in WIC offices located in neighborhoods with high HIV prevalence. Among this primarily minority sample, most would be interested in getting an HIV test if offered at WIC. Benefits included knowing one's HIV status, convenience, and accessible location, while transportation and peer/partner encouragement were enabling factors. Barriers included privacy concerns and intimate partner violence. Findings will be used to design an intervention to promote HIV testing among women who attend WIC and that proactively addresses reported barriers.
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Affiliation(s)
- Yukiko Washio
- University of Delaware College of Health Sciences, Newark, Delaware
| | | | | | - Annet Davis
- University of Pennsylvania School of Medicine, Philadelphia
| | - Jesse Chittams
- University of Pennsylvania School of Nursing, Philadelphia
| | | | - Linda M Kilby
- Philadelphia Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), North Inc
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15
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Individual, Interpersonal, and Sociostructural Factors Influencing Partner Nonmonogamy Acceptance among Young African American Women. SEX ROLES 2017. [DOI: 10.1007/s11199-017-0811-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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16
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Hendrick CE, Canfield C. HIV Risk-Reduction Prevention Interventions Targeting African American Adolescent Women. ADOLESCENT RESEARCH REVIEW 2017; 2:131-149. [PMID: 28626791 PMCID: PMC5472099 DOI: 10.1007/s40894-016-0036-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 07/13/2016] [Indexed: 05/30/2023]
Abstract
African American young women are overwhelmingly disproportionately burdened by HIV/AIDS in the United States today. The purpose of the current systematic review was to identify the characteristics of efficacious HIV risk-reduction prevention interventions targeting African American adolescent women in order to inform future intervention development and expansion. We searched PubMed, PsychInfo, and ProQuest databases for journal articles and dissertations published between 2000 and 2015 reporting the impacts of HIV risk-reduction prevention interventions in the U.S. targeting African American adolescent women under age 25. Twenty articles assessing the efficacy of 12 interventions were eligible for inclusion. Selected interventions represented a total of 5,556 African American adolescent women and primarily drew from self-efficacy and self-empowerment-based theoretical frameworks. One intervention targeted girls under age 13; eight included participants ages 13-17; ten targeted adolescents aged 18-24 years; and five interventions included women over age 24 among their participants. Most interventions consisted of in-person knowledge and skills-based group or individual sessions led by trained African American female health professionals. Three were delivered via personal electronic devices. All programs intervened directly at the individual-level; some additionally targeted mothers, friends, or sexual partners. Overall, efficacious interventions among this population promote gender and ethnic pride, HIV risk-reduction self-efficacy, and skills building. They target multiple socio-ecological levels and tailor content to the specific age range, developmental period, and baseline behavioral characteristics of participants. However, demonstrated sustainability of program impacts to date are limited and should be addressed for program enhancements and expansions.
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Affiliation(s)
- C. Emily Hendrick
- Population Research Center, The University of Texas at Austin, 305
E. 23rd Street, Stop G1800, CLA 2.602, Austin, TX 78712-1699
| | - Caitlin Canfield
- Population Research Center, The University of Texas at Austin, 305
E. 23rd Street, Stop G1800, CLA 2.602, Austin, TX 78712-1699
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Bond KT, Gunn AJ. Perceived Advantages and Disadvantages of Using Pre-Exposure Prophylaxis (PrEP) among Sexually Active Black Women: An Exploratory Study. JOURNAL OF BLACK SEXUALITY AND RELATIONSHIPS 2016; 3:1-24. [PMID: 28725660 PMCID: PMC5512598 DOI: 10.1353/bsr.2016.0019] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Knowledge of pre-exposure prophylaxis (PrEP) continues to remain scarce among Black women who are disproportionally affected by HIV in the United States. A thematic analysis of open-ended questions from a sample of Black women (n=119) who completed a mix-methods, online, e-health study was conducted to examine the perceived advantages and disadvantages of using PrEP. Being a female controlled method, empowerment, option for women with risky sex partners, and serodiscordant couples were advantages described. Disadvantages of PrEP were identified as the complexity of the choice, encouragement of sex with risky partners, increased burden, promotion of unprotected sex, and newness of the drug.
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Affiliation(s)
- Keosha T Bond
- Center for Drug Use and HIV Research, NYU School of Nursing
| | - Alana J Gunn
- Department of Social Work, SUNY Binghamton University
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18
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Campos S, Benoit E, Dunlap E. Black Women with Multiple Sex Partners: The Role of Sexual Agency. JOURNAL OF BLACK SEXUALITY AND RELATIONSHIPS 2016; 3:53-74. [PMID: 28730162 PMCID: PMC5512887 DOI: 10.1353/bsr.2016.0028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Motivations of low-income substance using heterosexual Black women in New York City for having multiple sexual partners are explored in this paper. Analysis of in-depth interviews with 50 study participants demonstrates that their relationships consisted of those who had: (1) a main sex partner and a secondary sex partner; or (2) two or more "casual" partners. Individual-level motivations for extra relational sex fell into four dominant themes: sexual pleasure, partner infidelity, sex exchange and past main partners. Using a Black feminist framework, we describe how participants displayed considerable autonomy by actively forming and withdrawing from sexual relationships with men. However, women described low rates of condom use with main partners and inconsistent use of condoms with more casual sexual partners. This contradiction becomes an important area for sexual health interventions. Women who had sexual relations with only one current mate in the past two years were recruited as a monogamous comparison group.
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Affiliation(s)
| | - Ellen Benoit
- National Development and Research Institutes, Inc
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Gates ML, Staples-Horne M, Cartier J, Best C, Walker V, Schwartz D, Yoo W. Understanding Psychosocial and High-Risk Sexual Behaviors Among Detained Juveniles: A Descriptive Study Protocol. JMIR Res Protoc 2015; 4:e144. [PMID: 26733418 PMCID: PMC4712345 DOI: 10.2196/resprot.5153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 10/16/2015] [Accepted: 10/16/2015] [Indexed: 11/27/2022] Open
Abstract
Background African American women are disproportionately impacted by sexually transmitted infections (STIs), such as chlamydia and gonorrhea, which are known risk factors for human immunodeficiency virus (HIV) infection. STIs, particularly chlamydia and gonorrhea, are even more prevalent among young African American women with a juvenile detention history. The population with experiences with the criminal justice system has greater rates of STIs and is diagnosed more often with mental health issues, often related to sexual abuse or intimate partner violence, compared to peers who have not been detained by law enforcement. Psychosocial factors, especially those related to intimate relationships (ie, the imperativeness of being in a relationship and the power one has in their relationship), have emerged as important explanatory factors for acquiring STIs, including HIV, and a component of risk reduction interventions. Objective To investigate more comprehensively the relationship between psychosocial risk factors and STIs, including HIV, as it relates to reduction and prevention of these diseases. The long-term goal is to improve the effectiveness of evidence-based interventions with a major focus on intimate relationship dynamics. Methods This descriptive study surveys young women (ages 13-17) who have been detained (incarcerated) by a department of juvenile justice. In addition to being female and detained, eligibility criteria include being detained longer than 30 days and being free of cognitive impairments. This study will include young women from one juvenile detention center. The primary outcomes to be measured are STI knowledge, intimate relationship dynamics (ie, imperativeness and power), and high-risk sexual behaviors. High-risk sexual behaviors will be assessed using data extracted from health records. Results Preliminarily, we have received assent from 26 primarily young African American women. The majority of participants (81%) had inadequate knowledge about STIs, 52% perceived a lack of power in their relationship, 56% were fearful of negotiating condom use, and 60% were not comfortable refusing sex. Interestingly, a majority of participants (68%) did not perceive a relationship as imperative. Conclusions When enrollment and data collection are completed, it is expected that the primary outcome of intimate relationship dynamics (ie, imperativeness and power) will be associated with high-risk sexual behaviors and having an STI. Further, the findings are expected to provide guidance in developing a risk reduction intervention, for the population in which psychosocial factors related to intimate relationships will be central.
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Affiliation(s)
- Madison L Gates
- Institute of Public and Preventive Health, Department of Family Medicine, Medical College of Georgia, Georgia Regents University, Augusta, GA, United States.
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Teitelman AM, Calhoun J, Duncan R, Washio Y, McDougal R. Young women's views on testing for sexually transmitted infections and HIV as a risk reduction strategy in mutual and choice-restricted relationships. Appl Nurs Res 2015; 28:215-21. [PMID: 26112775 PMCID: PMC4509591 DOI: 10.1016/j.apnr.2015.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 12/01/2022]
Abstract
AIM The aim of this study was to identify relationship dynamics that influences the use of STI/HIV testing among young, urban African American women. BACKGROUND Increasing STI/HIV testing is a key prevention strategy, but more research is needed to identify barriers to testing for young women such as intimate partner violence (IPV). METHODS Thirty semi-structured interviews were conducted with African American women ages 18-24. Content analysis was used. RESULTS Women in choice-restricted relationships were unable to negotiate safer sex practices and testing was viewed as the best option. Women in relationships where the desire to use condoms was mutual used STI and HIV testing as a sign of trust building that preceded unprotected sex. CONCLUSIONS STI/HIV testing must be viewed as one strategy within a package of possible risk reduction. For those in choice-restricted relationships, clinicians should screen patients for partner abuse and provide additional support and referrals as clinically appropriate.
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Affiliation(s)
- Anne M Teitelman
- University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA.
| | - Julia Calhoun
- University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA.
| | - Rebecca Duncan
- University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA.
| | - Yukiko Washio
- Treatment Research Institute, Philadelphia, PA 19106, USA.
| | - Renee McDougal
- University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA.
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Harawa NT, Obregon NB, McCuller WJ. Partnerships between Black Women and Behaviorally Bisexual Men: Implications for HIV Risk and Prevention. SEXUALITY & CULTURE 2014; 18:570-891. [PMID: 25422580 PMCID: PMC4239658 DOI: 10.1007/s12119-014-9227-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Although an estimated 87% of new HIV infections in Black/African American women are attributed to sex with men, many women are unaware of their male partners' HIV risk factors. Research on women who are aware of a high-risk male partner may inform HIV prevention. We analyzed transcripts from semi-structured interviews with 20 Black women who reported sex with at least one man who had sex with men and women (MSMW) in the prior 5 years. We applied Choice and Sexual Network theories to the interpretation. The majority described their partnerships as committed and involving emotional or instrumental support. Substance abuse was a common component of the relationships and very few involved consistent condom use. Although nearly all respondents described it as alarming to learn of their partners' involvement with other men and several ended the relationships, many continued the relationships without protective changes in their sex behavior. These narratives indicate that although many leave, many other women remain in relationships after learning of a male partners' high-risk activity. Substance abuse, financial instability, and a desire to remain in intimate partnerships may discourage preventive actions in these women.
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Affiliation(s)
- Nina T Harawa
- Department of Research, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - Nora B Obregon
- Department of Research, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - William J McCuller
- Department of Research, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
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