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Mutie C, Otieno B, Mwangi E, Kithuci K, Mutisya A, Gachohi J, Mbuthia G. Global burden of HIV among long-distance truck drivers: a systematic review and meta-analysis. BMJ Open 2024; 14:e085058. [PMID: 39097316 PMCID: PMC11298726 DOI: 10.1136/bmjopen-2024-085058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 07/19/2024] [Indexed: 08/05/2024] Open
Abstract
OBJECTIVES The purpose of this study was to systematically summarise the empirical evidence on the prevalence of HIV among long-distance truck drivers (LDTDs) from all parts of the world. DESIGN A systematic review and meta-analysis were conducted. DATA SOURCES We searched PubMed, ProQuest Central, PubMed Central, Cumulated Index to Nursing and Allied Health Literature and Global Index Medicus to identify relevant information published from 1989 to 16 May 2023. ELIGIBILITY CRITERIA Peer-reviewed publications of English language reporting on the prevalence of HIV among LDTDs were included. Non-empirical studies like literature reviews were excluded. DATA EXTRACTION AND SYNTHESIS Using a standardised data abstraction form, we extracted information on study characteristics and HIV prevalence levels. Crude prevalence estimates per 100 participants were computed and later transformed using logit transformation to have them follow a normal distribution. A meta-analysis of prevalences using the random effects model was performed. The I2 statistic was used to quantify the degree of heterogeneity across studies. A subgroup analysis using meta-regression was performed to investigate factors that could explain variability across studies. The Joanna Briggs Institute tools and Newcastle-Ottawa Scale were used to assess the quality of the included studies. To assess the certainty of evidence, the Grading of Recommendations Assessment, Development, and Evaluation approach was used. RESULTS Of the 1787 articles identified, 42 were included. Most of the included studies were conducted in sub-Saharan Africa (45.23%, n=19) and Asia and the Pacific (35.71%, n=15). The pooled prevalence of HIV was 3.86%, 95% CI (2.22% to 6.64%). The burden of HIV was highest in sub-Saharan Africa at 14.34%, 95% CI (9.94% to 20.26%), followed by Asia and the Pacific at 2.12%, 95 CI (0.94% to 4.7%) and lastly Western, Central Europe and North America at 0.17%, 95% CI (0.03% to 0.82%). The overall heterogeneity score was (I2=98.2%, p<0.001). CONCLUSION The global burden of HIV among LDTDs is 3.86%, six times higher than that of the general population globally. Compared with other regions, the burden of HIV is highest in sub-Saharan Africa at 14.34%, where it is estimated to be 3% in the general population. Thus, LDTDs endure a disproportionately high burden of HIV compared with other populations. Consequently, more LDTD-centred HIV research and surveillance is needed at national and regional levels to institute tailored preventive policies and interventions. PROSPERO REGISTRATION NUMBER CRD42023429390.
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Affiliation(s)
- Cyrus Mutie
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | | | - Elijah Mwangi
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Kawira Kithuci
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Albanus Mutisya
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - John Gachohi
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Grace Mbuthia
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
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Ssenyonjo J, Mistler C, Adler T, Shrestha R, Kyambadde P, Copenhaver M. Examining HIV Knowledge and Sexually Risky Behaviors among Female Sex Workers in Kampala, Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:163. [PMID: 38397654 PMCID: PMC10888220 DOI: 10.3390/ijerph21020163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024]
Abstract
HIV incidence remains alarmingly high among female sex workers (FSWs) in Uganda, necessitating targeted interventions. This study aimed to identify individual and provider-level barriers and facilitators to primary HIV prevention among FSWs in an urban setting. Focus groups involving FSWs and healthcare providers (HCPs) were conducted to inform the development of tailored prevention interventions. Results revealed that all participants had mobile phones, recent sexual activity, and a history of HIV testing, with high rates of sexually transmitted infections and varying HIV test results. FSWs displayed a well-informed awareness of HIV transmission risks, emphasizing the threat for those not testing positive. They unanimously recognized the crucial role of HIV testing in informing, mitigating risks, promoting ART use, and endorsing consistent condom usage. Despite heightened awareness, HCPs noted potential underestimation of vulnerability. Various challenges, including inadequate condom usage, substance abuse, and client dynamics, underscored the complexity of safeguarding against HIV transmission among FSWs. Widespread alcohol and drug use, including marijuana, kuber, and khat, served as coping mechanisms and social facilitators. Some FSWs successfully reduced alcohol intake, highlighting challenges in addressing substance use. FSWs preferred group discussions in health education programs, emphasizing peer interactions and the effectiveness of visual aids in HIV prevention education. This study provides comprehensive insights to guide the development of targeted interventions addressing the multi-faceted challenges FSWs face in HIV prevention.
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Affiliation(s)
- Jude Ssenyonjo
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Colleen Mistler
- Division of Prevention and Community Research, Department of Psychiatry, School of Medicine, Yale University, New Haven, CT 06520, USA
| | - Tanya Adler
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Peter Kyambadde
- Most At-Risk Populations Initiative-MARPI, Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Michael Copenhaver
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
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Rael CT, Sandfort TGM, Gichangi P, Lafort Y, Mantell JE. Condom Use Among Male Sex Workers With Their Male Clients in Mombasa, Kenya: Results of a Sub-analysis of a Pilot, Multilevel, Structural, HIV Risk-Reduction Intervention. J Assoc Nurses AIDS Care 2023; 34:248-258. [PMID: 37129476 PMCID: PMC10754228 DOI: 10.1097/jnc.0000000000000401] [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] [Indexed: 05/03/2023]
Abstract
ABSTRACT Despite the advent of preexposure prophylaxis, consistent condom use continues to be recommended because preexposure prophylaxis does not prevent sexually transmitted infections. This is important for high-risk populations (e.g., male sex workers; MSW) in low-resource, high-HIV/sexually transmitted infection prevalence settings, such as the Mombasa region in Kenya. This study aimed to examine the relationship between MSW's condom use, and their knowledge, beliefs, and attitudes about condoms. MSW (N = 158) completed surveys on their sexual behaviors/practices/attitudes. We used multiple regressions to identify associations between condom use, HIV knowledge/attitudes, and self-efficacy. Three quarters of participants reported always using condoms in the past week, and 64.3% reported always using condoms in the past month with male clients. Mean scores for knowledge and attitudes/self-efficacy toward condoms/safer sex were positively associated with condom use. Interventions to build self-efficacy, such as condom negotiation, and/or bringing up condom use with clients may be useful for Kenyan MSW.
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Affiliation(s)
- Christine Tagliaferri Rael
- Christine Tagliaferri Rael, PhD, University of Colorado College of Nursing, Aurora, Colorado, USA, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Theo G. M. Sandfort, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Peter Gichangi, BSc, MBCHB, MMED(O/G), PhD, MPH, DVC, ARE, Department of Environmental and Health Sciences, School of Applied and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
- Yves Lafort, MD, MS, PhD, Ghent University, Ghent, Belgium
- Joanne E. Mantell, MS, MSPH, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Theo G M Sandfort
- Christine Tagliaferri Rael, PhD, University of Colorado College of Nursing, Aurora, Colorado, USA, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Theo G. M. Sandfort, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Peter Gichangi, BSc, MBCHB, MMED(O/G), PhD, MPH, DVC, ARE, Department of Environmental and Health Sciences, School of Applied and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
- Yves Lafort, MD, MS, PhD, Ghent University, Ghent, Belgium
- Joanne E. Mantell, MS, MSPH, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Peter Gichangi
- Christine Tagliaferri Rael, PhD, University of Colorado College of Nursing, Aurora, Colorado, USA, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Theo G. M. Sandfort, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Peter Gichangi, BSc, MBCHB, MMED(O/G), PhD, MPH, DVC, ARE, Department of Environmental and Health Sciences, School of Applied and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
- Yves Lafort, MD, MS, PhD, Ghent University, Ghent, Belgium
- Joanne E. Mantell, MS, MSPH, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Yves Lafort
- Christine Tagliaferri Rael, PhD, University of Colorado College of Nursing, Aurora, Colorado, USA, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Theo G. M. Sandfort, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Peter Gichangi, BSc, MBCHB, MMED(O/G), PhD, MPH, DVC, ARE, Department of Environmental and Health Sciences, School of Applied and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
- Yves Lafort, MD, MS, PhD, Ghent University, Ghent, Belgium
- Joanne E. Mantell, MS, MSPH, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Joanne E Mantell
- Christine Tagliaferri Rael, PhD, University of Colorado College of Nursing, Aurora, Colorado, USA, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Theo G. M. Sandfort, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Peter Gichangi, BSc, MBCHB, MMED(O/G), PhD, MPH, DVC, ARE, Department of Environmental and Health Sciences, School of Applied and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
- Yves Lafort, MD, MS, PhD, Ghent University, Ghent, Belgium
- Joanne E. Mantell, MS, MSPH, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
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Nabayinda J, Kizito S, Witte S, Nabunnya P, Kiyingi J, Namuwonge F, Nsubuga E, Bahar OS, Mayo-Wilson LJ, Yang LS, Nattabi J, Magorokosho N, Ssewamala FM. Factors Associated with Consistent Condom Use Among Women Engaged in Sex Work: Lessons From the Kyaterekera Study in Southwestern Uganda. AIDS Behav 2023; 27:969-977. [PMID: 36112259 PMCID: PMC9974574 DOI: 10.1007/s10461-022-03833-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 11/01/2022]
Abstract
We examined the factors associated with consistent condom use among women engaged in sex work in the Southern parts of Uganda. We used baseline data from a longitudinal study involving WESW from 19 hotspots in Southern Uganda. We conducted hierarchical models to determine the individual, economic, behavioral, and health-related factors associated with consistent condom use. We found that, alcohol use (b=-0.48, 95% CI=-0.77, -0.19), accepting money for condomless sex (b=-0.33, 95% CI=-0.38, -0.28), multiple customers (b=-0.01, 95% CI=-0.01, -0.005), being married (b = 0.50, 95% CI = 0.01, 0.99), owning more assets (b = 0.08, 95% CI = 0.05, 0.13), having another income earner in the household (b = 0.55, 95% CI = 0.27, 0.83), condom use self-efficacy (b = 0.11, 95% CI = 0.03, 0.19), condom use communication (b = 0.06, 95% CI = 0.001, 0.12), and being knowledgeable about HIV/STIs transmission (b = 0.08, 95% CI = 0.01, 0.15) were associated with consistent condom use. Additionally, 29% of the women were consistent condom users. Hence, there is need to implement interventions that promote consistent condom use among WESW.
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Affiliation(s)
- Josephine Nabayinda
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Samuel Kizito
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Susan Witte
- Columbia University School of Social Work, 1255 Amsterdam Avenue, 10027, New York, NY, USA
| | - Proscovia Nabunnya
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Joshua Kiyingi
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Masaka Office, Kampala, Uganda
| | - Edward Nsubuga
- International Center for Child Health and Development (ICHAD), Masaka Office, Kampala, Uganda
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Larissa Jennings Mayo-Wilson
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Rosenau Hall CB7400, 27599, Chapel Hill, NC, USA
| | - Lyla Sunyoung Yang
- Columbia University School of Social Work, 1255 Amsterdam Avenue, 10027, New York, NY, USA
| | - Jennifer Nattabi
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Natasja Magorokosho
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Fred M Ssewamala
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA.
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Sensoy Bahar O, Nabunya P, Nabayinda J, Witte S, Kiyingi J, Nsubuga E, Schriger S, Nattabi J, Mayo-Wilson LJ, Nakigudde J, Tozan Y, Ssewamala FM. "I decided in my heart I have to complete the sessions": A qualitative study on the acceptability of an evidence-based HIV risk reduction intervention among women engaged in sex work in Uganda. PLoS One 2023; 18:e0280138. [PMID: 36634037 PMCID: PMC9836279 DOI: 10.1371/journal.pone.0280138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The HIV burden remains a critical public health concern and women engaged in sex work [WESW] are at significantly higher risk compared to the general adult population. Similar to other sub-Saharan African countries, Uganda reports high rates of HIV prevalence among WESW. Yet, they have not been targeted by theory-informed HIV prevention intervention approaches. METHODS We conducted semi-structured in-depth interviews with 20 WESW upon intervention completion to explore their experiences with an evidence-based HIV risk reduction intervention that was implemented as part of a combination intervention tested in a clinical trial in Uganda (2018-2023. Specifically, we explored their initial motivations and concerns for participating in the intervention, barriers and facilitators to attendance, and their feedback on specific intervention characteristics. RESULTS The main expectations revolved around access to health-related information, including information on STIs, HIV, and PrEP as well as on how one can protect themselves while engaging in sex work. Initial concerns were around potential breach of confidentiality and fear of arrest. The main facilitators for session attendance were the motivation to learn health-related information, the attitude of facilitators, and the incentives received for participation, whereas main challenges were related to family commitments and work schedules. WESW appreciated the group format of the intervention and found the location and times of the intervention delivery acceptable. DISCUSSION AND CONCLUSIONS Overall, our findings suggest that the HIV risk reduction intervention was appropriate and acceptable to WESW. Yet, WESW experience unique concerns and barriers that need to be accounted for when designing interventions targeting this population, especially in resource-limited settings where sex work is illegal and highly stigmatized. CLINICAL TRIAL REGISTRATION NCT03583541.
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Affiliation(s)
- Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Josephine Nabayinda
- Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Susan Witte
- Columbia University School of Social Work, New York City, NY, United States of America
| | - Joshua Kiyingi
- Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Edward Nsubuga
- International Center for Child Health and Development Field Office, Masaka, Uganda
| | - Simone Schriger
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Jennifer Nattabi
- Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Larissa Jennings Mayo-Wilson
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
| | - Janet Nakigudde
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Yesim Tozan
- School of Global Public Health, New York University, New York City, NY, United States of America
| | - Fred M. Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
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Mataboge P, Nzenze S, Mthimkhulu N, Mazibuko M, Kutywayo A, Butler V, Naidoo N, Mullick S. Planning for decentralized, simplified prEP: Learnings from potential end users in Ga-Rankuwa, gauteng, South Africa. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 4:1081049. [PMID: 36699142 PMCID: PMC9868940 DOI: 10.3389/frph.2022.1081049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/16/2022] [Indexed: 01/12/2023] Open
Abstract
Background In South Africa, youth experience challenges with oral Pre-Exposure Prophylaxis (PrEP) access and uptake. Taking services out of healthcare settings has the potential to increase reach and overcome these challenges. This paper presents young and older people's preferences for decentralized, simplified PrEP service delivery and new long-acting HIV prevention methods, in Ga-Rankuwa, South Africa. Methods Between May and August 2021, both PrEP user and non-user adolescent girls and young women (AGYW), pregnant AGYW, female sex workers, adolescent boys and young men (ABYM), and men who have sex with men (MSM) were recruited to participate in focus group discussions (FDGs) in Ga-Rankuwa, Gauteng. Twenty-two FGDs were conducted. Participants were asked about PrEP uptake, potential acceptability of long-acting HIV prevention products, provision of integrated, simplified, and decentralized services, and digital tools to facilitate access to PrEP and other SRH services. A qualitative approach using inductive thematic analysis was carried out to explore emerging themes on decentralized, simplified delivery and the acceptability of long-acting methods. Results Of the 109 participants included in the study approximately 45% (n = 50) were female, the median age was 23 years ± 5.3. A third (n = 37) were current or previous PrEP users, of which, 59.5% (n = 22) collected PrEP refills from the clinic. Decentralized, simplified service delivery was appealing; health facilities, pharmacies and institutions of learning were preferred as service points for PrEP and SRH services, and recreational spaces preferred for dissemination of health information and engagement. ABYM were more open to having recreational spaces as service points. Long-acting Cabotegravir was preferred over the Dapivirine Vaginal Ring due to concerns around perceived side-effects, efficacy, and comfort. Conclusion Providing long-acting PrEP methods through decentralized, simplified service delivery was appealing to this population. They provided practical locations for decentralized service provision to potentially increase their engagement with and uptake of HIV prevention and SRH services.
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Betunga B, Atuhaire P, Nakasiita C, Kanyamuneza C, Namiiro P, Tugume J, Hairat M, Sarki AM, Mugabi B, Lilian B, Mugisha R, Kumakech E, Asiimwe JB. Factors influencing the use of multiple HIV prevention services among transport workers in a city in southwestern Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001350. [PMID: 36962980 PMCID: PMC10021771 DOI: 10.1371/journal.pgph.0001350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/08/2023] [Indexed: 03/06/2023]
Abstract
The use of multiple HIV prevention services has been found to decrease the risk of acquiring HIV when tailored to individuals at risk of HIV exposure, including transport workers. Therefore, we assessed the uptake of multiple HIV prevention services (≥2) and associated factors among transport workers in a city in Southwestern Uganda. This cross-sectional study comprised motorcycle taxi riders, motor vehicle and truck drivers, aged 18 to 55 years who were selected and responded to an interviewer-administered questionnaire, between November 2021 and February 2022. Data was analyzed using descriptive statistical and modified Poisson regression analyses. Out of 420 participants, 97.6% were male, with a median age of 28 years and the majority were aged <34 years (84.6%). Overall, less than half (45.3%) of the participants had used multiple (≥2) HIV prevention services within a one-year period. Many participants had used condoms (32.2%) followed by voluntary HIV counseling and testing (27.1%), and safe male circumcision (17.3%). Most participants who tested for HIV had ever used condoms (16.2%), followed by those who received safe male circumcision and had ever used condoms (15%), and those who tested for HIV and had started on antiretroviral therapy (ART) (9.1%). In the adjusted model, factors that were significantly associated with the use of multiple HIV prevention services included religion (aPR = 1.25, 95% CI = 1.05-1.49), the number of concurrent sex partners (aPR = 1.33, 95% CI = 1.10-1.61), prior HIV testing and awareness of HIV serostatus (aPR = 0.55, 95% CI = 0.43-0.70), awareness of HIV prevention services (aPR = 2.49, 95% CI = 1.16-5.38), and financial payment to access HIV services (aPR = 2.27, 95% CI = 1.47-3.49). In conclusion, the uptake of multiple HIV prevention services among transport workers remains suboptimal. Additionally, individual behavioral factors influence the use of multiple HIV services compared with other factors. Therefore, differentiated strategies are needed to increase the utilization of HIV prevention services among transport workers.
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Affiliation(s)
- Benjamin Betunga
- Faculty of Nursing and Health Sciences, Bishop Stuart University, Mbarara, Uganda
| | - Phionah Atuhaire
- Faculty of Nursing and Health Sciences, Bishop Stuart University, Mbarara, Uganda
| | - Catherine Nakasiita
- Faculty of Nursing and Health Sciences, Bishop Stuart University, Mbarara, Uganda
| | - Christa Kanyamuneza
- Faculty of Nursing and Health Sciences, Bishop Stuart University, Mbarara, Uganda
| | - Proscovia Namiiro
- Faculty of Nursing and Health Sciences, Bishop Stuart University, Mbarara, Uganda
| | - Joseph Tugume
- Faculty of Nursing and Health Sciences, Bishop Stuart University, Mbarara, Uganda
| | - Matovu Hairat
- Faculty of Nursing and Health Sciences, Bishop Stuart University, Mbarara, Uganda
| | - Ahmed M Sarki
- Aga Khan University, Uganda Campus, Kampala, Uganda
- Family and Youth Health Initiative (FAYOHI), Dutse, Jigawa State, Nigeria
| | | | - Birungi Lilian
- College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Richard Mugisha
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edward Kumakech
- Faculty of Nursing and Midwifery Lira University, Lira, Uganda
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Mantell JE, Khalifa A, Christian SN, Romo ML, Mwai E, George G, Strauss M, Govender K, Kelvin EA. Preferences, beliefs, and attitudes about oral fluid and blood-based HIV self-testing among truck drivers in Kenya choosing not to test for HIV. Front Public Health 2022; 10:911932. [PMID: 36438254 PMCID: PMC9682285 DOI: 10.3389/fpubh.2022.911932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 10/03/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Clinical trials in sub-Saharan Africa support that HIV self-testing (HIVST) can increase testing rates in difficult-to-reach populations. However, trials mostly evaluate oral fluid HIVST only. We describe preferences for oral fluid vs. blood-based HIVST to elucidate prior trial results and inform testing programs. Methods Participants were recruited from a HIVST randomized controlled trial in Nakuru County, Kenya, which aimed to test the effect of choice between oral HIVST and facility-based testing compared to standard-of-care on HIV testing among truck drivers. We conducted in-depth interviews (IDIs) with purposively sampled trial participants who declined HIV testing at baseline or who were offered access to oral fluid HIVST and chose not to pick up the kit during follow-up. IDIs were conducted with all consenting participants. We first describe IDI participants compared to the other study participants, assessing the statistical significance of differences in characteristics between the two samples and then describe preferences, beliefs, and attitudes about HIVST biospecimen type expressed in the IDIs. Results The final sample consisted of 16 men who refused HIV testing at baseline and 8 men who did not test during follow-up. All IDI participants had tested prior to study participation; mean number of years since last HIV test was 1.55, vs. 0.98 among non-IDI participants (p = 0.093). Of the 14 participants who answered the question about preferred type of HIVST, nine preferred blood-based HIVST, and five, oral HIVST. Preference varied by study arm with four of five participants who answered this question in the Choice arm and five of nine in the SOC arm preferring blood-based HIVST. Six key themes characterized truckers' views about test type: (1) Rapidity of return of test results. (2) Pain and fear associated with finger prick. (3) Ease of use. (4) Trust in test results; (5) fear of infection by contamination; and (6) Concerns about HIVST kit storage and disposal. Conclusion We found no general pattern in the themes for preference for oral or blood-based HIVST, but if blood-based HIVST had been offered, some participants in the Choice arm might have chosen to self-test. Offering choices for HIVST could increase testing uptake.
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Affiliation(s)
- Joanne E. Mantell
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States,*Correspondence: Joanne E. Mantell
| | - Aleya Khalifa
- ICAP at Columbia University, New York, NY, United States,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Stephanie N. Christian
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, PA, United States
| | - Matthew L. Romo
- Department of Epidemiology and Biostatistics and Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Eva Mwai
- The North Star Alliance, Nairobi, Kenya
| | - Gavin George
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa,Division of Social Medicine and Global Health, Lund University, Lund, Sweden
| | - Michael Strauss
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Kaymarlin Govender
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Elizabeth A. Kelvin
- Department of Epidemiology and Biostatistics and Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
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Telemedicine Experience for PrEP Care among PrEP-Eligible Women and Their Primary Care Providers during the First Year of the COVID-19 Pandemic in the United States. Trop Med Infect Dis 2022; 7:tropicalmed7100280. [PMID: 36288021 PMCID: PMC9611465 DOI: 10.3390/tropicalmed7100280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/23/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022] Open
Abstract
(1) Background: During the two-year-long siege from the COVID-19 pandemic, a significant proportion of doctor visits transitioned from in-person to virtual. Scare evidence is available to assess the quality of patient-provider communication via the platform of telemedicine, especially for PrEP care within primary care settings. (2) Methods: Participants included 18 primary care providers and 29 PrEP-eligible women. Through content analysis and thematic analysis, facilitators and barriers embedded at different levels of telemedicine were identified and assessed. (3) Results: Women and providers reported pros and cons regarding their telemedicine experiences during the initial wave of COVID-19. Both groups of participants agreed that telemedicine visits were more convenient, efficient, and comfortable than in-person visits. However, without face-to-face interactions, some women felt less empathy, caring, and connected with their providers during virtual visits. Health providers expressed concerns with telemedicine, including patients’ privacy, lack of intimacy between patients and providers, and delayed lab work. (4) Conclusions: Our data indicate multi-level factors may affect telemedicine experience among PrEP-eligible women and health providers. Participants expressed concerns that may further entrench these long-existing health disparities in healthcare. Proactive efforts from policymakers, health professionals, researchers, and stakeholders are urgently required to tackle identified barriers and to pave the way for the new infrastructure that ensures health equity in society.
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10
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Sensoy Bahar O, Nabunya P, Nabayinda J, Witte SS, Kiyingi J, Mayo-Wilson LJ, Filippone P, Yang LS, Nakigudde J, Tozan Y, Ssewamala FM. "I expected little, although I learned a lot": perceived benefits of participating in HIV risk reduction sessions among women engaged in sex work in Uganda. BMC Womens Health 2022; 22:162. [PMID: 35562821 PMCID: PMC9100307 DOI: 10.1186/s12905-022-01759-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 05/06/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The global HIV burden remains a public health concern. Women engaged in sex work (WESW) are at higher risk of acquiring HIV compared to the general adult population. Uganda reports high rates of HIV prevalence among WESW. While WESW in Uganda have long been the subject of surveillance studies, they have not been targeted by theory-informed HIV prevention intervention approaches. In this study, we explored the perceived benefits of an evidence-based HIV risk reduction intervention that was implemented as part of a combination intervention tested in a clinical trial in Uganda. METHODS As part of a larger randomized clinical trial, we conducted semi-structured in-depth interviews with 20 WESW selected using a stratified purposive sampling. All interviews were conducted in Luganda, language spoken in the study area, and audio-recorded. They were transcribed verbatim and translated to English. Thematic analysis was used to analyze the data. RESULTS WESW's narratives focused on: (1) condom use; (2) alcohol/drug consumption; (3) PrEP use; (4) "handling" customers; and (5) "massaging" customers. WESW agreed that male condom was one of the important learning points for them and planned to continue using them while female condoms were received with mixed reactions. Many women appreciated receiving information about the risks of consuming alcohol and drugs, and discussed how they reduced/ eliminated their consumption. PrEP information was appreciated though identified by fewer WESW. Handling a client was discussed as a helpful strategy for safer sex through improved ability to convince customers to use condoms or avoiding sex. Massaging was also beneficial to avoid penetrative sex, but similar to female condom, massaging also yielded mixed perceptions. CONCLUSION WESW found the intervention beneficial and described ways in which it improved their ability to engage in safer sex and stay healthy. The fact that WESW identified other strategies beyond condom use as helpful underlines the importance of adopting a comprehensive approach to behavioral interventions targeting HIV prevention even when combined with other interventions. Additionally, WESW's narratives suggest that incorporating the tenets of social cognitive theory and harm reduction approaches in HIV prevention among this population can result in risk behavior change.
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Affiliation(s)
- Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA.
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Josephine Nabayinda
- International Center for Child Health and Development Field Office, Masaka, Uganda
| | - Susan S Witte
- Columbia University School of Social Work, New York City, NY, USA
| | - Joshua Kiyingi
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Prema Filippone
- Columbia University School of Social Work, New York City, NY, USA
| | | | - Janet Nakigudde
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Yesim Tozan
- School of Global Public Health, New York University, New York City, NY, USA
| | - Fred M Ssewamala
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, USA
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11
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Sood I, Chinnakaran A, Majumdar A, Sabherwal S. Assessment of COVID-19-related awareness, knowledge, prevention practices and challenges faced by truck drivers in major transport cities of India: a cross-sectional survey. BMJ Open 2022; 12:e052543. [PMID: 35228278 PMCID: PMC8886092 DOI: 10.1136/bmjopen-2021-052543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess COVID-19-related awareness and knowledge among truck drivers across India and report prevention practices followed, and challenges faced, by them during the COVID-19 lockdown. DESIGN Cross-sectional study. SETTING Delhi, Kanpur, Kolkata and Bangalore from July to September 2020. PARTICIPANTS Data were collected in Hindi using a structured questionnaire via telephonic interviews. Minimum 200 drivers were included from each location. OUTCOME MEASURES Sociodemographic profile, awareness regarding COVID-19, knowledge regarding infection sources, disease spread and vulnerable populations, prevention practices followed and challenges faced. Information sources were also assessed. RESULTS Fisher's exact test and Analysis of variance (ANOVA) test were used to check for significant differences across proportions. P value less than 0.05 was considered significant. Overall, 1246 drivers were included, with 72% response rate. Of 1246 drivers, 65% were 30-50 years of age. A majority correctly answered knowledge questions regarding communicability (95%) and fatality (66%). Fifty per cent drivers were aware of treatability of the disease, while only 43% and 24% correctly reported all signs and symptoms and routes of transmission, respectively. No driver was aware of all high-risk populations. Overall Knowledge Score is significantly associated with region. Mobile phones were the primary source of information across all regions. Over two-third drivers follow all prevention practices regularly, which differed significantly across regions. Following standard prevention practices was positively correlated with higher knowledge scores and was significantly correlated with mask use. Worry about the disease was common. Less than 40% drivers received full payment for work during this period, while 25% drivers were unable to return home due to the pandemic. Seven per cent and 26% drivers had either limited or no access to food and health services, respectively. CONCLUSIONS Awareness activities and employer provisioned social security/health insurance might safeguard this vulnerable population till the pandemic fully abates as well as in similar situations in the future.
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Affiliation(s)
- Ishaana Sood
- Department of Community Ophthalmology and Public Health Research, Dr Shroff's Charity Eye Hospital Delhi, New Delhi, Delhi, India
| | - Anand Chinnakaran
- Department of Community Outreach and Public Health Research, Dr Shroff's Charity Eye Hospital Delhi, New Delhi, Delhi, India
| | - Atanu Majumdar
- Bio-statistician, Dr Shroff's Charity Eye Hospital Delhi, New Delhi, Delhi, India
| | - Shalinder Sabherwal
- Department of Community Ophthalmology and Public Health Research, Dr Shroff's Charity Eye Hospital Delhi, New Delhi, Delhi, India
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Onovo A, Kalaiwo A, Agweye A, Emmanuel G, Keiser O. Diagnosis and case finding according to key partner risk populations of people living with HIV in Nigeria: A retrospective analysis of community-led index partner testing services. EClinicalMedicine 2022; 43:101265. [PMID: 35028548 PMCID: PMC8741428 DOI: 10.1016/j.eclinm.2021.101265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/11/2021] [Accepted: 12/20/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The HIV epidemic in Nigeria is concentrated in Key Populations (KP), people who inject drugs (PWID), men who have sex with men (MSM), female sex workers (FSW), and partners of people living with HIV. Due to stigma and discrimination, these groups have low access to HIV testing services (HTS) and linkage to treatment is challenging. To address this gap, index partner testing, targeting sexual contacts and injecting partners of KP index clients, was introduced in 2017. METHODS The study was a retrospective analysis of community-led HIV index partner testing-involving review of secondary data from partner notification services registers. Between October 1, 2018, and September 30, 2019, HIV testing as part of index partner testing services was offered at nightclubs, hotels, and community-based ART clinics in the states of Akwa Ibom, Cross River, and Lagos. Index testing was assisted by peer navigators. We used provider and passive Partner Notification (PN) methods. In-person and social network methods were used to recruit partners of KP. We described the implementation of index partner testing services as part of the national KP program, analyzed PN delivery models, and calculated HIV seropositivity among persons who underwent Index Partner Testing. One-Way ANOVA and Tukey-HSD test were performed to determine whether the differences in mean HIV seropositivity between partners are statistically significant. FINDINGS PN was predominantly done through provider referral 5,159 (68.3%) and passive/client referral 2,278 (30.1%). A total of 3,119 index partners; 1,322 FSW (42.4%), 1,255 MSM (40.2%) and 542 PWID (17.4%) identified 8,989 sexual and injecting partners (index partner ratio 1:2.9). Among the partners, 7,556 (84.1%) were first-time testers, and 79.4% (5,999) of male partners tested. Of the 3,753 (49.7%) partners who tested HIV-positive, 3,492 (93.0%) were enrolled in HIV care. HIV seropositivity rate was 65.5% (1,021/1,557) among females and 45.5% (2,732/5,999) among males and was disproportionately higher among PWID injecting partners 99.1% (581/586), PWID sexual partners 98.9% (433/438) and MSM sexual partners 95.6% (605/633) in Cross river compared with 71.4% (575/805) in FSW sexual partners. INTERPRETATIONS Including index partner testing as part of a community-led HTS can help improve HIV case-finding approach for KP, particularly for reaching first-time testers, male KP, and persons not yet diagnosed with HIV. Scale-up of index partner testing within community-led HTS is essential for achieving the United Nations 95-95-95 goals. FUNDING This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
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Affiliation(s)
- Amobi Onovo
- Office of HIV/AIDS and TB, US Agency for International Development, Nigeria
- Institute of Global Health, University of Geneva, Switzerland
| | - Abiye Kalaiwo
- Office of HIV/AIDS and TB, US Agency for International Development, Nigeria
| | - Angela Agweye
- Office of HIV/AIDS and TB, US Agency for International Development, Nigeria
| | | | - Olivia Keiser
- Institute of Global Health, University of Geneva, Switzerland
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13
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Pundhir A, Shukla A, Goel AD, Pundhir P, Gupta MK, Parashar P, Varshney AM. Exploring unsafe sexual practices among truck drivers at Meerut District, India: a cross-sectional study. Afr Health Sci 2021; 21:547-556. [PMID: 34795707 PMCID: PMC8568232 DOI: 10.4314/ahs.v21i2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Despite implementation of HIV prevention programmes for truck drivers in India, unsafe sex behavior among truck drivers has been documented. Objective The objective of this study was to assess knowledge about HIV Transmission and modes of prevention, pattern of condom use with high risk partners and explore the practice of unsafe sex and its risk factors among truck drivers. Methods This exploratory cross-sectional study design was conducted on a recruited convenient sample of 100 truck drivers above 18 years from March to May 2015. Binary logistic regression was used to compute unadjusted odds ratio [95% Confidence Interval] for establishing association of risk factors with unsafe sex. Results Overall, only 7% had complete knowledge about HIV/AIDS transmission and prevention. 54% of truck drivers have sex with a high risk partner (commercial sexual worker or men having sex with men) and thirty-eight percent reported unsafe sexual practices due to inconsistent condom use with them. The various risk factors found significantly associated with unsafe sex were mean age of first intercourse (OR= 0.92, 95% CI: 0.75 – 0.97), access to pornography (OR = 4.4, 95% CI: 1.8 – 10.7) and conuming psychoactive substance before sex (OR = 4.06, 95% CI: 1.09 – 15.02). Conclusion Socio-demographic, occupational factors, pornography access and consuming psychoactive substances seems to influence the sexual behaviour of truckers.
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Affiliation(s)
- Ashish Pundhir
- Department of Community Medicine Rama Medical College, Kanpur ,Uttar Pradesh India - 209217
| | - Arvind Shukla
- Department of Community Medicine and Family Medicine All India Institute of Medical Sciences-Raipur Raipur, Chattisgarh
| | - Akhil Dhanesh Goel
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences Jodhpur, Rajasthan, India
| | - Pooja Pundhir
- Department of Internal Medicine Memorial Hermann Hospital Houston, Texas, USA
| | - Manoj Kumar Gupta
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences Jodhpur, Rajasthan, India
| | - Pawan Parashar
- Department of Community Medicine Subharti Medical College Meerut, Uttar Pradesh, India
| | - Amit Mohan Varshney
- Department of Community Medicine Maharani Laxmibai Medical College Jhansi, Uttar Pradesh
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14
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Atuhaire L, Adetokunboh O, Shumba C, Nyasulu PS. Effect of community-based interventions targeting female sex workers along the HIV care cascade in sub-Saharan Africa: a systematic review and meta-analysis. Syst Rev 2021; 10:137. [PMID: 33952347 PMCID: PMC8101125 DOI: 10.1186/s13643-021-01688-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/26/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Female sex workers are extremely vulnerable and highly susceptible to being infected with human immunodeficiency virus. As a result, community-based targeted interventions have been recommended as one of the models of care to improve access to HIV services and continued engagement in care. We conducted a systematic review to (1) assess the effect of FSW-targeted community interventions on the improvement of HIV services access along the treatment cascade and (2) describe community-based interventions that positively affect continuation in HIV care across the HIV treatment cascade for FSWs in sub-Saharan Africa. METHODS We defined the 5 steps that make up the HIV care cascade and categorized them as outcomes, namely, HIV testing and diagnosis, linkage to care, receipt of ART, and achievement of viral suppression. We conducted a systematic search of randomized controlled trials, cohort, and cross-sectional studies done in sub-Saharan African countries and published from 2004 to 2020. The period was selected based on the time span within which ART was scaled up through widespread roll-out of comprehensive HIV programs in sub-Saharan Africa. We reviewed studies with data on the implementation of community interventions for any of the HIV care cascade stage. The data were analyzed using random effects meta-analysis where possible, and for the rest of the studies, data were synthesized using summary statistics. RESULTS The significant impact of the community interventions was observed on HIV testing, HIV diagnosis, and ART use. However, for HIV testing and ART use, the improvement was not sustained for the entire period of implementation. There were minimal interventions that had impact on HIV diagnosis, with only one community service delivery model showing significance. Generally, the interventions that had reasonable impact are those that implemented targeted and comprehensive package of HIV services provided at one location, and with unique strategies specific to each cascade stage. CONCLUSIONS The evidence brought forward from this review shows that the effect of community-based interventions varies across the different stages of HIV care cascade. A broad package of interventions including a combination of behavioral, biomedical, and structural, designed with specific strategies, unique to each cascade stage appears to be more effective, although information on long-term treatment outcomes and the extent to which FSWs remain engaged in care is sparse. There is need to conduct a further research to deepen the assessment of the effectiveness of community-based interventions on HIV care cascade for FSWs. This will enhance identification of evidence-based optimal interventions that will guide effective allocation of scarce resources for strategies that would have a significant impact on HIV service delivery. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020157623.
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Affiliation(s)
- Lydia Atuhaire
- Division of Epidemiology & Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Olatunji Adetokunboh
- Division of Epidemiology & Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa.,Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Constance Shumba
- School of Nursing and Midwifery, Aga Khan University, Nairobi, Kenya.,Department of Population Health, Aga Khan University, Nairobi, Kenya
| | - Peter S Nyasulu
- Division of Epidemiology & Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. .,School of Public Health, Faculty of Medicine and Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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15
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Atuhaire L, Adetokunboh O, Shumba C, Nyasulu PS. Effect of female sex work-targeted community-based interventions along the HIV treatment cascade in sub-Saharan Africa: a systematic review protocol. BMJ Open 2020; 10:e039495. [PMID: 33109669 PMCID: PMC7592303 DOI: 10.1136/bmjopen-2020-039495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Female sex workers (FSWs) are a known high-risk group that are at increased risk of HIV transmission due to exposure to multiple sexual partners and inability to negotiate safe sex attributed to challenging economic circumstances. Previous systematic reviews have examined the effectiveness of HIV interventions prioritising FSWs and have shown that targeted interventions improve access to HIV prevention and treatment services. Interventions that increase FSWs' uptake of services are well documented; however, evidence on specific interventions aimed at improving FSWs' continuity in HIV care along the treatment cascade is lacking. This systematic review aims to document the performance of community-based interventions along the HIV treatment cascade. METHODS AND ANALYSIS We will use a sensitive search strategy for electronic bibliographic databases, bibliographies of included articles and grey literature sources. In addition, the Joint United Nations Programme on HIV/AIDS and the WHO websites, peer-reviewed conference papers and grey literature sources will be searched for additional reports of sex work programmes. We will include randomised controlled trials, cross-sectional surveys and cohort interventions where community-based HIV services were provided to FSWs and measure the performance of the HIV intervention on one or more cascade stages. We will conduct a systematic review of studies published from 2004 to present within the sub-Saharan Africa region. We will report quantitative study outcomes of HIV testing and diagnosis, linkage to care, initiation on antiretroviral therapy and viral suppression. We will analyse the data using the random-effects meta-analysis method, and funnel plots will be used to assess the publication bias. ETHICS AND DISSEMINATION This systematic review will not require ethical approval; we will publish data from manuscripts. The results of this study will be disseminated in peer-reviewed journals and conference presentations. PROSPERO REGISTRATION NUMBER CRD42020157623.
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Affiliation(s)
- Lydia Atuhaire
- Division of Epidemiology & Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Olatunji Adetokunboh
- Division of Epidemiology & Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Cape town, South Africa
| | - Constance Shumba
- School of Nursing and Midwifery, Aga Khan University East Africa, Nairobi, Kenya
- Department of Population Health, Aga Khan University East Africa, Nairobi, Kenya
| | - Peter S Nyasulu
- Division of Epidemiology & Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Public Health, Faculty of Medicine and Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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16
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Virkud AV, Arimi P, Ssengooba F, Mulholland GE, Herce ME, Markiewicz M, Weir S, Edwards JK. Access to HIV prevention services in East African cross-border areas: a 2016-2017 cross-sectional bio-behavioural study. J Int AIDS Soc 2020; 23 Suppl 3:e25523. [PMID: 32602638 PMCID: PMC7325514 DOI: 10.1002/jia2.25523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/11/2020] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION East African cross-border areas are visited by mobile and vulnerable populations, such as men, female sex workers, men who have sex with men, truck drivers, fisher folks and young women. These groups may not benefit from traditional HIV prevention interventions available at the health facilities where they live, but may benefit from services offered at public venues identified as places where people meet new sexual partners (e.g. bars, nightclubs, transportation hubs and guest houses). The goal of this analysis was to estimate availability, access and uptake of prevention services by populations who visit these venues. METHODS We collected cross-sectional data using the Priorities for Local AIDS Control Efforts sampling method at cross-border locations near or along the land and lake borders of Kenya, Rwanda, Tanzania and Uganda from June 2016-February 2017. This bio-behavioural survey captured information from a probability sample of 11,428 individuals at 833 venues across all areas. Data were weighted using survey sampling weights and analysed using methods to account for the complex sampling design. RESULTS Among the 85.6% of persons who had access to condoms, 60.5% did not use a condom at their last anal or vaginal sexual encounter. Venues visited by high percentages of persons living with HIV were not more likely than other venues to offer condoms. In 12 of the 22 cross-border areas, male or female condoms were available at less than 33% of the venues visited by persons having difficulty accessing condoms. In 17 of the 22 cross-border areas, education outreach visits in the preceding six months occurred at less than 50% of the venues where participants had low effective use of condoms. CONCLUSIONS Individuals visiting venues in cross-border areas report poor access to and low effective use of condoms and other prevention services. Availability of HIV prevention services differed by venue and population type and cross-border area, suggesting opportunities for more granular targeting of HIV prevention interventions and transnational coordination of HIV programming.
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Affiliation(s)
- Arti V Virkud
- Department of EpidemiologyUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Peter Arimi
- U.S. Agency for International DevelopmentKenya/East Africa Regional MissionNairobiKenya
| | - Freddie Ssengooba
- College of Health SciencesSchool of Public HealthMakerere UniversityKampalaUganda
| | - Grace E Mulholland
- Department of EpidemiologyUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Michael E Herce
- Department of MedicineDivision of Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Milissa Markiewicz
- MEASURE EvaluationCarolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Sharon Weir
- Department of EpidemiologyUniversity of North Carolina at Chapel HillChapel HillNCUSA
- MEASURE EvaluationCarolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Jessie K Edwards
- Department of EpidemiologyUniversity of North Carolina at Chapel HillChapel HillNCUSA
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17
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Russell C, Tahlil K, Davis M, Winston A, Amaambo T, Hamunime N, Pietersen I, Jordan MR, Tang AM, Hong SY. Barriers to condom use among key populations in Namibia. Int J STD AIDS 2020; 30:1417-1424. [PMID: 31795925 DOI: 10.1177/0956462419875884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Key populations (KPs), particularly female sex workers (FSWs) and men who have sex with men (MSM), are at increased risk for HIV. Namibia is a global priority for HIV prevention interventions. Marginalized communities must be provided effective and culturally appropriate means to prevent HIV, namely condom use. This cross-sectional analysis of data collected by The Society for Family Health was conducted from 2016 to 2017 in Namibia. Demographics and consistent condom use (CCU) barriers were analyzed among 621 FSWs, MSM, and Other KPs. From the data, 37% FSWs, 24% MSM, and 28% Other KPs were HIV-positive. One-quarter of FSWs and Other KPs reported CCU, while 46% MSM reported CCU. Consistent condom users were more likely to be HIV-negative, have achieved a higher education and use condom-compatible lubricant (CCL). In a multivariate model, higher education, being HIV-negative, and always using CCL remained independent correlates of CCU. Substance use and condom unavailability were the most commonly identified barriers to CCU. FSWs reported client-focused reasons for not using condoms. To the best of our knowledge, this is the first peer-reviewed study assessing condom use behavior and associated factors among FSWs and MSM in Namibia.
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Affiliation(s)
- Colin Russell
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Kadija Tahlil
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Margaret Davis
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Anna Winston
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | | | - Ndapewa Hamunime
- Directorate of Special Programmes, Ministry of Health and Social Services, Windhoek, Namibia
| | - Ismelda Pietersen
- Directorate of Special Programmes, Ministry of Health and Social Services, Windhoek, Namibia
| | - Michael R Jordan
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.,Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA
| | - Alice M Tang
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Steven Y Hong
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.,Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA
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Kounta CH, Sagaon-Teyssier L, Coulaud PJ, Mora M, Maradan G, Bourrelly M, Keita AA, Yoro SAB, Anoma C, Coulibaly C, Dah ETT, Agbomadji S, Mensah E, Bernier A, Couderc C, Dembélé Keita B, Laurent C, Spire B. Transactional sex among men who have sex with men participating in the CohMSM prospective cohort study in West Africa. PLoS One 2019; 14:e0217115. [PMID: 31693669 PMCID: PMC6834336 DOI: 10.1371/journal.pone.0217115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/21/2019] [Indexed: 01/22/2023] Open
Abstract
Although the HIV epidemic is generalized in West Africa, some population groups such as men who have sex with men (MSM), especially those engaged in transactional sex (TS), are thought to be particularly more vulnerable to HIV than others. However, few data are available to help identify their health-related needs with a view to implementing targeted prevention interventions. To fill this knowledge gap, we aimed to characterize MSM reporting TS (MSM-TS) and to identify factors associated with their sexual practices using data from the prospective cohort study CohMSM, which was conducted in Burkina Faso, Côte d’Ivoire, Mali and Togo. Three stigmatization sub-scores were constructed (experienced, perceived and internalized). The generalized estimating equation method was used for data analysis. Of the total 630 HIV-negative MSM recruited in CohMSM, 463, 410 and 244 had a follow-up visit at 6, 12 and 18 months, respectively. In a total of 1747 follow-up visits, 478 TS encounters were reported by 289 MSM-TS (45.9%). Of the latter, 91 regularly reported TS (31.5%), 55 (19.0%) stopped reporting TS after baseline, and 53 (18.3%) reported TS after baseline and 90 (31.1%) occasionally reported TS. The following variables, regarding the previous 6 months, were positively associated with TS: being younger (aOR[95%CI]:1.86[1.39–2.50]), less educated (aOR[95%CI]:1.49[1.09–2.03]), unmarried status (aOR[95%CI]:1.79[1.10–2.93]), satisfaction with current sex life (aOR[95%CI]:1.41[1.06–1.88]), group sex with men (aOR[95%CI]:2.07[1.46–2.94]), multiple male sexual partners (aOR[95%CI]:1.85[1.40–2.44]), receptive or versatile anal sex with male partners (aOR [95%CI]:1.48[1.12–1.96]), giving benefits in exchange for sex with a man (aOR[95%CI]:2.80[1.97–3.98]), alcohol consumption (aOR[95%CI]:1.44[1.08–1.93]) and drug use (aOR[95%CI]:1.82[1.24–2.68]) during sex, and finally experiencing stigmatization (aOR [95%CI]:1.15[1.07–1.25]). Condom use during anal sex (aOR[95%CI]:0.73[0.53–0.99]) was negatively associated with TS.
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Affiliation(s)
- Cheick Haïballa Kounta
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Pierre-Julien Coulaud
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Gwenaelle Maradan
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Michel Bourrelly
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | | | | | | | | | - Elias Ter Tiero Dah
- Association Africaine Solidarité, Ouagadougou, Burkina Faso.,Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | | | | | | | | | | | | | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
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Kuteesa MO, Seeley J, Cook S, Webb EL. Multi-level experiences and determinants of alcohol misuse and illicit drug use among occupational groups at high-risk of HIV in sub-Saharan Africa: A thematic synthesis of qualitative findings. Glob Public Health 2019; 15:715-733. [PMID: 31640453 PMCID: PMC7175470 DOI: 10.1080/17441692.2019.1679216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Occupational groups at high-risk of HIV in sub-Saharan Africa (SSA) may be at increased risk of substance use because of occupation-related factors. We synthesised qualitative data on determinants and context of alcohol misuse and illicit drug use in these groups. We systematically searched five databases for qualitative studies reporting on alcohol misuse or illicit drug use in fisherfolk, uniformed personnel, miners, truckers, motorcycle taxi riders, and sex workers in SSA. Qualitative data and interpretations were extracted and synthesised using a systematic iterative process to capture themes and overarching concepts. We searched for papers published prior to January 2018. We identified 5692 papers, and included 21 papers in our review, published from 1993 to 2017. Most studies were conducted among fisherfolk (n = 4) or sex workers (n = 12). Ten papers reported on alcohol use alone, three on illicit drug use alone and eight on both. Substance use was commonly examined in the context of work and risky behaviour, key drivers identified included transactional sex, availability of disposable income, poverty, gender inequalities and work/living environments. Substance use was linked to risky behaviour and reduced perceived susceptibility to HIV. Our review underscores the importance of multilevel, integrated HIV prevention and harm reduction interventions in these settings.
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Affiliation(s)
- Monica O Kuteesa
- Department of HIV interventions and Epidemiology, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- Department of HIV interventions and Epidemiology, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Cook
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily L Webb
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
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20
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Zhang C, McMahon J, Simmons J, Brown LL, Nash R, Liu Y. Suboptimal HIV Pre-exposure Prophylaxis Awareness and Willingness to Use Among Women Who Use Drugs in the United States: A Systematic Review and Meta-analysis. AIDS Behav 2019; 23:2641-2653. [PMID: 31297684 DOI: 10.1007/s10461-019-02573-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
In the United States (U.S.), more than 12 million women reported illicit drug use in the past month. Drug use has been linked to increased risk for HIV, but little is known about the uptake of HIV pre-exposure prophylaxis (PrEP) to prevent HIV among women who use drugs (WWUD). Following the PRISMA guideline, we conducted a multi-database literature search to assess engagement along the PrEP care continuum among WWUD in the U.S. Seven studies with a total of 755 women were included in the review: 370 (49%) Black, 126 (16.7%) Hispanics, and 259 (34.3%) Whites. Employing random-effect models, data indicate 20.6% (95% CI 8.7%, 32.4%) of WWUD were aware of PrEP, and 60.2% (95% CI 52.2%, 68.2%) of those aware were also willing to use PrEP. Notwithstanding study limitations, our findings suggest there may be potential to increase PrEP uptake among WWUD, but efforts must first concentrate on improving PrEP awareness among this population.
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Affiliation(s)
- Chen Zhang
- School of Nursing, University of Rochester Medical Center, 255 Crittenden Blvd, Rochester, NY, 14622, USA.
| | - James McMahon
- School of Nursing, University of Rochester Medical Center, 255 Crittenden Blvd, Rochester, NY, 14622, USA
| | - Janie Simmons
- Department of Social & Behavioral Sciences, College of Global Public Health, New York University, New York City, NY, USA
| | - L Lauren Brown
- Nashville CARES, Nashville, TN, USA
- Infectious Diseases Division, Vanderbilt University Medical Center, Nashville, USA
| | - Robertson Nash
- Vanderbilt Comprehensive Care Clinic, Nashville, TN, USA
| | - Yu Liu
- Division of Epidemiology, Department of Public Health Science, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
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21
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Probandari A, Setyani RA, Pamungkasari EP, Widyaningsih V, Demartoto A. Improving knowledge, acceptance, and utilization of female condoms among sex workers through a peer education: a mixed methods study in Surakarta Municipality, Central Java Province, Indonesia. Health Care Women Int 2019; 41:600-618. [PMID: 31385750 DOI: 10.1080/07399332.2019.1639710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Female sex workers (FSW) are high-risk for HIV infection. The authors conducted a quasi-experimental study by providing peer education on 110 FSWs, and routine HIV education on 120 controls, in Surakarta Indonesia. An additional qualitative study was performed to explain the contextual factors contributing to the effectiveness of peer education. The difference in difference approach showed that peer education improved knowledge, acceptance, and utilization of female condom. The improvements were related to the clients' perceptions, access, and available interactive communication with the peer educator. The peer education program should be enhanced to support the prevention of HIV/AIDS.
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Affiliation(s)
- Ari Probandari
- Research Group of Disease Control, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia.,Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Rizka Ayu Setyani
- School of Midwifery, Respati University, Yogyakarta, Indonesia.,Master of Public Health Program, Graduate School, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Eti Poncorini Pamungkasari
- Research Group of Disease Control, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia.,Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Vitri Widyaningsih
- Research Group of Disease Control, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia.,Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Argyo Demartoto
- Department of Sociology, Faculty of Politics and Social Science, Universitas Sebelas Maret, Surakarta, Indonesia
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22
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Masa R, Chowa G. The Association of Material Hardship with Medication Adherence and Perceived Stress Among People Living with HIV in Rural Zambia. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2019; 6:17-28. [PMID: 31788412 PMCID: PMC6884321 DOI: 10.1007/s40609-018-0122-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The intersection of poverty and HIV/AIDS has exacerbated socioeconomic inequalities in Zambia. For example, the downstream consequences of HIV/AIDS are likely to be severe among the poor. Current research has relied on multidimensional indicators of poverty, which encompass various forms of deprivation, including material. Although comprehensive measures help us understand what constitutes poverty and deprivation, their complexity and scope may hinder the development of appropriate and feasible interventions. These limitations prompted us to examine whether material hardship, a more practicable, modifiable aspect of poverty, is associated with medication adherence and perceived stress among people living with HIV (PLHIV) in Zambia. We used cross-sectional data from 101 PLHIV in Lundazi District, Eastern Province. Data were collected using a questionnaire and hospital records. Material hardship was measured using a five-item scale. Perceived stress was measured using the ten-item perceived stress scale. Adherence was a binary variable measured using a visual analog scale and medication possession ratio (MPR) obtained from pharmacy data. We analyzed the data with multivariable linear and logistic regressions using multiply imputed datasets. Results indicated that greater material hardship was significantly associated with MPR nonadherence (odds ratio = 0.83) and higher levels of perceived mental distress (β = 0.34). Our findings provide one of the first evidence on the association of material hardship with treatment and mental health outcomes among PLHIV. The findings also draw attention to the importance of economic opportunities for PLHIV and their implications for reducing material hardship and improving adherence and mental health status.
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Affiliation(s)
- Rainier Masa
- School of Social Work, University of North Carolina, Chapel Hill, NC, USA
- Global Social Development Innovations, University of North Carolina, Chapel Hill, NC, USA
- Centre for Social Development in Africa, University of Johannesburg, Auckland Park, South Africa
| | - Gina Chowa
- School of Social Work, University of North Carolina, Chapel Hill, NC, USA
- Global Social Development Innovations, University of North Carolina, Chapel Hill, NC, USA
- Centre for Social Development in Africa, University of Johannesburg, Auckland Park, South Africa
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23
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Lawal AM, Olley BO. Psychosocial factors predicting risky sexual behaviour among long distance truck drivers in Lagos, Nigeria. SAHARA J 2017; 14:213-221. [PMID: 29179657 PMCID: PMC5801510 DOI: 10.1080/17290376.2017.1405838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Long distance truck drivers (LDTDs) have been identified as one of the groups at higher risk for human immunodeficiency virus (HIV) infection. Understanding how certain social and psychological variables that have a strong theoretical basis contribute to sexual risk behaviour will guide in the implementation process of HIV risk-reduction intervention in the trucking population. In line with the conceptualisation of Information, Motivation and Behavioural skills model, we examined the extent that HIV knowledge, attitude towards condom use, peer support to condom use, perceived vulnerability to HIV/AIDS, and condom use self-efficacy will independently and jointly explain sexual risk behaviours of LDTDs in a haulage company in Lagos, Nigeria. A cross-sectional survey design was used and 154 drivers with ages ranging from 27 to 68 years (M = 44.03, SD = 8.82) completed copies of a questionnaire comprising demographics and measures of psychological variables. Psychological factors that included HIV knowledge, attitude towards condom use, perceived vulnerability to HIV/AIDS, peer support to condom use, and condom use self-efficacy significantly jointly predicted sexual risk behaviours (R2 = .59, F(5, 148) = 42.63; p < .05), by accounting for about 59% of the explained variance in sexual risk behaviours. Social factors that included age, number of years of education, number of wives, number of intercourses in the last three months, number of partners apart from primary partners, and number of weeks spent outside home significantly jointly predicted sexual risk behaviour (R2 = .15, F(6, 147) = 4.39; p < .05) by accounting for about 15% of the explained variance in sexual risk behaviour among the drivers. It is concluded that all the psychological and social factors examined as predictor variables could jointly play important roles in prevention intervention programmes for reducing sexual risk behaviours of LDTDs. Stakeholders should sensitise LDTDs on the need to realise that they are a high-risk group and are more vulnerable to HIV infection; thus, behaviour change is indispensable in their sexual relationships.
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Affiliation(s)
- Abiodun Musbau Lawal
- BSc Psychology, MSc Clinical Psychology & PhD Clinical Psychology, Lecturer I, Department of Psychology, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Benjamin Oladapo Olley
- BSc Psychology, MSc Clinical Psychology & PhD Clinical Psychology, Associate Professor, Department of Psychology, University of Ibadan, Ibadan, Nigeria
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Abstract
CONTEXT Psychological distress is higher in women working in sex industry. The various psycho social issues are associated with female commercial sex workers (FCSWs). The host of psychosocial vulnerabilities including, childhood sexual abuse, exposure to childhood physical abuse, poverty, interpersonal violence in adulthood, sexually transmitted diseases, and substance use, forms a fertile ground for psychiatric morbidity. AIM This study aims to assess the psychiatric morbidity among FCSWs in Shillong, India. MATERIALS AND METHODS In the present study, 100 FCSWs were selected. For the recruitment of sample, simple random sampling procedure was followed; sociodemographic data sheet and the Mini International Neuropsychiatric Interview were administered. RESULTS In the study, it was found that 9% of the respondents reported having major depressive episode (current), 25% of the respondents reported major depressive episode (past), 3% were having major depressive episode with melancholic features (current), 21% of the respondents reported posttraumatic stress disorder (PTSD), 8% of the respondents reported to have alcohol dependence, 3% of the respondents reported to have nonalcohol psychoactive substance use disorder, 8% of the respondents were found to have generalized anxiety disorder, and 9% of the respondents were found to have antisocial personality disorder. CONCLUSIONS There is a prevalence of mental health problems in the FCSW. Assessment of the psychiatric morbidity in FCSW is significant in developing health policy and interventions to reduce their impact on their well-being. It is the immediate need that the governmental and nongovernmental agencies, mental health professionals, and workers in this area need to be sensitized to the issue of mental health status of the commercial sex workers.
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Affiliation(s)
- Marboh Goretti Iaisuklang
- Department of Psychiatric Social Work, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India
| | - Arif Ali
- Department of Psychiatric Social Work, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India
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25
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Mazeingia YT, Olijjira L, Dessie Y. Anal sexual experience and HIV risk awareness among female sex workers in Dire Dawa, eastern Ethiopia. Glob Health Res Policy 2017; 2:27. [PMID: 29202095 PMCID: PMC5683548 DOI: 10.1186/s41256-017-0047-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/20/2017] [Indexed: 11/15/2022] Open
Abstract
Background Female sex workers have been disproportionately affected with HIV and anal sexual experience elevate their vulnerability. Anal intercourse has more risk of HIV transmission than vaginal intercourse for receptors that coupled with low condom and proper lubricant use behavior during anal sex. Besides majority of them did not understand HIV transmission risk of anal intercourse. In Ethiopia, studies on anal sexual experience is almost none existent, so the purpose of this study is to explored anal sexual experience and HIV transmission risk awareness among female sex worker in Dire Dawa, Eastern Ethiopia. Method Qualitative study with thematic analysis approach was conducted among 18 female sex workers and recruitment of study participants performed until saturation of information. The principal investigator conducted in-depth interviews using local language (Amharic) and it was recorded on audio recorder. Tape recorded data was transcribed and translated to English and entered into open code version 3.4 for coding and theme identification. Data collection conducted simultaneously with data analysis. Result Female sex workers practiced anal sex for different themes like financial influence, coercion, intentionally, peer pressure and as a sign of intimacy and love. Coercion, negative attitudes, poor awareness about HIV transmission risks of anal sex and protection capacity of condom and proper lubricants are the identified themes for not using condom and proper lubricants during anal sex by female sex workers. Inaccessibility and unavailability of health services for issues related to anal sex was the core reason for female sex workers’ misperception and risk anal sexual experience. Conclusion Female sex workers practiced anal sex without risk reduction approaches and they did not understand exacerbated risk of anal sex to HIV transmission. Stakeholders including ministry of health need to incorporate potential awareness raising tasks and programs about risk of anal sex and methods of risk reduction for female sex workers. Electronic supplementary material The online version of this article (doi:10.1186/s41256-017-0047-6) contains supplementary material, which is available to authorized users.
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26
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Ishtiaq R, Asif A, Jamil AR, Irfan A, Ishtiaq D. Knowledge and Attitude About Sexually Transmitted Infections Amongst Truck Drivers in Southern Punjab, Pakistan. Cureus 2017; 9:e1118. [PMID: 28451477 PMCID: PMC5406173 DOI: 10.7759/cureus.1118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION There is very limited knowledge about sexually transmitted infections (STIs) transmission and prevention present amongst high-risk groups such as truck drivers in Pakistan because of lack of awareness and understanding about barrier techniques. OBJECTIVE The aim of this study was to collect and access the data gathered from truck drivers about symptoms of STIs, their attitude towards hazards of multiple sexual partners, homosexuality, transmission and consequences of STIs, and their perception about preventing it using condoms and other barrier methods. METHODS This study was conducted at small roadside tea stalls and local rest areas on Karachi road, Lodhran near the city of Bahawalpur in Southern Punjab, Pakistan. A structured questionnaire was designed, and 50 willing truck drivers of the city of Bahawalpur were included and interviewed. It was a cross-sectional study. Data was collected on knowledge about the STIs and use of barrier methods like condoms. Quantitative data was assessed and analyzed using SPSS version 23.0 (IBM, NY, USA). RESULTS Fifty truck drivers of Bahawalpur were interviewed via standardized questionnaire in this study. All of them provided answers about their knowledge of STIs. Twenty drivers (40%) reported burning micturition, and only two (four percent) knew the real cause of it. Thirty-two (64%) of them were well aware of the use of condoms. Thirty-eight (76%) truck drivers had the knowledge about the adverse effects of multiple sex partners. CONCLUSION The truck drivers of Bahawalpur city are quite vulnerable to STIs and this demonstrates the importance of prevention programs that can target this particular group. A significant number of the respondents had serious gaps in their knowledge about STIs like acquired immunodeficiency syndrome (AIDS), especially its modes of transmission, signs, and symptoms. The knowledge of other routes of human immunodeficiency virus (HIV) transmission like needle sharing and blood transfusion, and precautionary steps should be given due respect in HIV/AIDS awareness programs.
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Affiliation(s)
- Rizwan Ishtiaq
- General Medicine, Quaid-e-Azam Medical College, Bahawalpur, Pakistan
| | - Ammar Asif
- General Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
| | | | - Areba Irfan
- General Medicine, Quaid-e-Azam Medical College, Bahawalpur, Pakistan
| | - Daniyal Ishtiaq
- General Medicine, Rawalpindi Medical College, Rawalpindi, Pakistan
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27
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Mbonye M, Siu GE, Kiwanuka T, Seeley J. Relationship dynamics and sexual risk behaviour of male partners of female sex workers in Kampala, Uganda. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2017; 15:149-55. [PMID: 27399044 DOI: 10.2989/16085906.2016.1197134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Regular male partners of female sex workers (FSWs) represent an important population to reach with HIV-prevention interventions. This paper discusses the relationship dynamics and HIV/sexually transmitted infection risk behaviour of men involved with self-identified FSWs in Kampala. Between 2011 and 2014 we conducted repeat in-depth interviews with 42 male partners of FSWs attending a clinic for women at high risk of HIV-infection in Kampala. Men publicly struggled with the stigma of dating women who are considered to be engaged in a shamed profession, but privately saw meaning in these relationships. In coping with the stigma, some described the work of their partners in terms that distanced them from sex work, while others struggled to have the control that "being a man" demanded since they could not monitor all movements of their partners. Dealing with HIV disclosure was hard and seeking support was difficult for some of the men, leading to missed opportunities and guilt. Despite challenges, relationships with sex workers offered men some benefits such as access to much needed care and treatment. A few men also admitted to being motivated by material and financial benefits from sex workers who they perceived as being rich and this was one factor that helped them sustain the relationships. These findings offer insights into the complex relationship dynamics within high risk sexual partnerships. However, the findings suggest that effective interventions that are couple centred can be established to promote better health.
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Affiliation(s)
- Martin Mbonye
- a Medical Research Council/Uganda Virus Research Institute , Entebbe , Uganda
| | - Godfrey E Siu
- a Medical Research Council/Uganda Virus Research Institute , Entebbe , Uganda.,c Child Health and Development Centre , College of Health Sciences Makerere University , Kampala , Uganda
| | - Thadeus Kiwanuka
- a Medical Research Council/Uganda Virus Research Institute , Entebbe , Uganda
| | - Janet Seeley
- a Medical Research Council/Uganda Virus Research Institute , Entebbe , Uganda.,b London School of Hygiene and Tropical Medicine , London , UK
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28
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Coleman CL. Correlates of Condom Use Among Substance Using Older Seropositive MSM: Implications for Mental Health Practice. Issues Ment Health Nurs 2016; 37:727-733. [PMID: 27715353 DOI: 10.1080/01612840.2016.1212293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The purpose of this study was to describe the correlates of condom use among a sample of N = 60 substance using seropositive men who have sex with (MSM). The mean age of the study participants was 52 ranging 50-75 years of age. Seventy-percent of study participants reporting smoking marijuana, 62% using cocaine, 25% heroin, 37% alcohol, and 30% amphetamines. Among those reporting substance use, 75% reported it was a hassle to use condoms, 42% indicated pleasure decreased with condom use, 72% indicated safer sex is boring, 72% reported the idea of using condoms is unappealing, 78% reported condoms ruined sex, and 71% said condoms interfered with romance. A multiple logistic regression analysis revealed low self-esteem, relationship status, attitudes towards condom use, and depression predicted condom use χ2 = 20.79, df = 6, ρ =.002. The study findings have implications for mental health nursing practice with seropositive African American MSM.
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Tumwine JK. Infections and non-communicable diseases that just refuse to go away. Afr Health Sci 2013; 13:i-iv. [PMID: 24940353 PMCID: PMC4056496 DOI: 10.4314/ahs.v13i4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
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