4 research outputs found
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Persons living with HIV in sero-discordant partnerships experience improved HIV care engagement compared with persons living with HIV in sero-concordant partnerships: a cross-sectional analysis of four African countries
Background
Persons living with HIV (PLWH) who are members of sero-discordant and sero-concordant relationships may experience psychological stressors or motivators that affect HIV care. We assessed the association between sero-discordance status, antiretroviral therapy (ART) uptake, and viral suppression in the African Cohort Study (AFRICOS).
Methods
AFRICOS enrolls PLWH and HIV-uninfected individuals at 12 sites in Uganda, Kenya, Tanzania, and Nigeria. At enrollment, we determined ART use through self-report. Viral suppression was defined as HIV RNA < 1000 copies/mL. We analyzed PLWH who were index participants within two types of sexual dyads: sero-discordant or sero-concordant. Binomial regression models were used to estimate prevalence ratios (PRs) and 95% confidence intervals (95% CIs) for factors associated with ART use and viral suppression at study enrollment.
Results
From January 2013 through March 2018, 223 index participants from sero-discordant dyads and 61 from sero-concordant dyads were enrolled. The majority of the indexes were aged 25–34 years (50.2%), female (53.4%), and married (96.5%). Sero-discordant indexes were more likely to disclose their status to partners compared with sero-concordant indexes (96.4% vs. 82.0%, p < 0.001). After adjustment, sero-discordant index participants were more likely to be on ART (aPR 2.8 [95% CI 1.1–6.8]), but no more likely to be virally suppressed. Results may be driven by unique psycho-social factors and global implementation of treatment as prevention.
Conclusions
PLWH in sero-discordant sexual partnerships demonstrated improved uptake of ART compared with those in sero-concordant partnerships. Interventions are needed to increase care engagement by individuals in sero-concordant relationships to improve HIV outcomes
Age-disparate and intergenerational sex partnerships and HIV: the role of gender norms among adolescent girls and young women in Malawi
Abstract Background Age-mixing (age-disparate [5–9 years difference] and intergenerational [≥ 10 years difference]) partnerships are hypothesized drivers of HIV in adolescent girls and young women (AGYW; 15–24 years). These partnerships are often associated with increased gender inequities which undermine women’s agency and assertiveness. We assessed whether age-mixing partnerships were associated with HIV in Malawi and if endorsement of inequitable gender norms modifies this relationship. Methods We analyzed data from the Malawi Population-based HIV Impact Assessment, a nationally representative household survey conducted in 2015–2016. Participants underwent HIV testing and completed questionnaires related to actively endorsed gender norms and sexual risk behavior. We used multivariate logistic regression and multiplicative interaction to assess associations among AGYW who reported the age of their primary sex partner from the last year. Results The analysis included 1,958 AGYW (mean age = 19.9 years, SD = 0.1), 459 (23.4%) and 131 (6.7%) of whom reported age-disparate and intergenerational partnerships, respectively. AGYW in age-mixing partnerships accounted for 13% of all AGYW and were older, more likely to reside in urban areas, to be married or cohabitating with a partner, and to have engaged in riskier sexual behavior compared with AGYW in age-concordant partnerships (p < 0.05). HIV prevalence among AGYW in age-disparate and intergenerational partnerships was 6.1% and 11.9%, respectively, compared with 3.2% in age-concordant partnerships (p < 0.001). After adjusting for residence, age, education, employment, wealth quintile, and ever been married or cohabitated as married, AGYW in age-disparate and intergenerational partnerships had 1.9 (95% CI: 1.1–3.5) and 3.4 (95% CI: 1.6–7.2) greater odds of HIV, respectively, compared with AGYW in age-concordant partnerships. Among the 614 (31% of the study group) who endorsed inequitable gender norms, AGYW in age-disparate and intergenerational partnerships had 3.5 (95% CI: 1.1–11.8) and 6.4 (95% CI: 1.5–27.8) greater odds of HIV, respectively, compared with AGYW in age-concordant partnerships. Conclusions In this Malawi general population survey, age-mixing partnerships were associated with increased odds of HIV among AGYW. These findings highlight inequitable gender norms as a potential focus for HIV prevention and could inform interventions targeting structural, cultural, and social constraints of this key group
Additional file 1 of Age-disparate and intergenerational sex partnerships and HIV: the role of gender norms among adolescent girls and young women in Malawi
Supplementary Material
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Representation and inclusion among members and affiliates of the Society for Epidemiologic Research: Findings from the 2021 Diversity and Inclusion Survey
Diverse representation and inclusion are stated priorities for scientific institutions and professional
societies, including the Society for Epidemiologic Research (SER). Prior studies have reported
persistent underrepresentation and exclusion of marginalized groups across the sciences. We
conducted a representation and inclusion survey among SER affiliates in 2021, following up on a
similar 2018 survey. In 2021, we observed broad representation from diverse groups across multiple
dimensions. However, across both surveys we found persistent underrepresentation of several
marginalized groups, including Black or African American and Hispanic/Latinx people. Some
groups reported feeling excluded in both the 2018 and 2021 surveys, and there was
disproportionately high representation from a subset of higher-ranked US academic institutions. For
several indicators of inclusion, perceptions of inclusion were more positive among White
respondents compared to other respondents. Opportunities to work towards achieving SER’s
diversity and inclusion aims include increasing outreach to epidemiology trainees and Minority
Serving Institutions, addressing cultural and financial barriers to participation, and improving access
for epidemiologists with disabilities. Iterative follow-up work with diversity and inclusion scholars
could improve our understanding of barriers to diversity and inclusion within SER and, more
broadly, the field of epidemiology