Strategies and outcomes of HIV status disclosure in HIV-positive young women with abuse histories

Young women with HIV and histories of physical and/or sexual abuse in childhood may be vulnerable to difficulties with disclosure to sexual partners. Abuse in childhood is highly prevalent in HIV-positive women, and has been associated with poorer communication, low assertiveness, low self worth, and increased risk for sexual and other risk behaviors that increase the risk of secondary transmission of HIV. HIV disclosure may be an important link between abuse and sexual risk behaviors. Qualitative interviews with 40 HIV-positive young women with childhood physical and/or sexual abuse were conducted; some women had also experienced adult victimization. Results suggest that HIV-positive women with abuse histories use a host of strategies to deal with disclosure of HIV status, including delaying disclosure, assessing hypothetical responses of partners, and determining appropriate stages in a relationship to disclose. Stigma was an important theme related to disclosure. We discuss how these disclosure processes impact sexual behavior and relationships and discuss intervention opportunities based on our findings

Examining HIV/AIDS within the context of incarceration in Jamaica

Background. Incarcerated populations are vulnerable to HIV infection and worldwide exhibit a higher prevalence rate of HIV compared to non-incarcerated populations. Interventions to provide HIV testing and treatment services in correctional centers would benefit those who are incarcerated and decrease the risk of transmission to the wider community upon release. Few countries in the developing world have implemented comprehensive HIV services as part of correctional healthcare, and a limited amount of research related to service provision in the correctional center context has been conducted. This dissertation presents data conducted as formative research for a demonstration project to provide HIV/STI testing and treatment services in the largest male correctional center in Jamaica. A prevalence estimate of HIV/STI for this population is presented. Psychosocial and structural factors that influence inmates' perception of and participation in HIV-related services in this context are explored. Design and methods. This study employed cross-sectional data to address the research aims. Data from the demonstration HIV/STI testing and treatment project was analyzed to determine an estimate of the prevalence of HIV/STI. A quantitative survey was conducted with a stratified random sample of 298 participants prior to their participation in pre-test counseling. Bivariate and logistic regression was employed to analyze the data. Additionally, semi-structured in-depth interviews were facilitated with a purposive sample of 25 inmates. Interviews were analyzed through content analysis. Results. The prevalence of HIV infection was 3.3% (n=1,017). The prevalence of chlamydia was 2.5% and for trichomoniasis it was 1.8%, but no cases of gonorrhea were found (n=396). Of the 298 participants in the quantitative survey, 60% chose to test for HIV. Multivariate logistic regression results indicate that participants who chose to test for HIV were more likely to report high HIV coping self efficacy (AOR 1.86; 95% CI 1.24-2.78, P value = .003), a perceived risk for HIV (AOR 2.51; 95% CI 1.57-4.01, P value = .000), and low HIV testing stigma (AOR 1.71; 95% CI 1.05-2.79, P value = .032). External HIV stigma and internal HIV stigma were not correlated with HIV test acceptance. However, participants who reported low external and internal stigma were more likely to report high HIV coping self efficacy (AOR 1.28; 95% CI 1.25-1.32, P value = .000; AOR 1.76; 95% CI 1.34-2.30, P value = .000 respectively). Participants who reported high HIV knowledge were also more likely to report high HIV coping self efficacy (AOR 2.33; 95% CI 1.04-5.22, P value = .040). A positive relationship between social support and HIV coping self efficacy was also found (AOR 2.09; 95% CI 1.19-3.68, P value = .010). Stress due to incarceration, limited access to social support, and the constant threat of violence are characteristics of prison life that may prohibit inmates' participation in HIV-related services. Fear of being labeled as a homosexual through participation in HIV services while incarcerated, and subsequent stigma and discrimination, is a major concern for inmates. Conclusions. There is a need for HIV testing and treatment services in Jamaican correctional centers. The HIV prevalence rate of 3.3% is higher than the rate in the non-incarcerated population, but low enough that provision of treatment and care services would not overburden the correctional health system. Programs to increase HIV coping self efficacy, social support, and HIV knowledge may increase HIV test acceptance. A reduction of HIV/AIDS stigma and discrimination is necessary is also necessary, and should serve as a guiding principle in policy and program development

High levels of unprotected anal intercourse and never testing for HIV among men who have sex with men in Nigeria: Evidence from a cross-sectional survey for the need for innovative approaches to HIV prevention

Objectives: To describe sexual risk behaviour, correlates of unprotected anal intercourse (UAI) and never testing for HIV and its implications for HIV prevention interventions among men who have sex with men (MSM) in Nigeria and other similar contexts. Methods: A cross-sectional survey was administered to 712 MSM in Abuja, Ibadan and Lagos, recruited through respondent-driven sampling (RDS). Levels of sexual risk behaviour and never having tested for HIV prior to the survey were calculated using weighted data for each city and unweighted data for the pooled sample. Correlates of UAI and never testing for HIV were determined using multiple logistic regression. Results: The risk for HIV and STI among MSM in Nigeria is high, with 43.4% reporting UAI at last sex, 45.1% never having been tested for HIV and 53.9% reporting exchange of sex for resources in the past 6 months. Correlates of UAI in multivariate analysis included living in Ibadan, marriage or cohabitation with a woman, identification as bisexual, not having tested for HIV and being HIV-positive. Correlates of not having tested for HIV in multivariate analysis included living in Ibadan, young age, less education, unemployment and report of UAI. Conclusions: HIV testing is low and associated with UAI. Findings merit targeted and innovative approaches for HIV prevention for MSM, especially access to HIV self-testing. Attention to social and structural determinants of health-seeking and sexual risk behaviour is also needed, including the criminalisation of homosexuality and social marginalisation of MSM

Daily activity spaces and drug use among female sex workers living with HIV in the Dominican Republic

The purpose of this study was to explore the daily activity spaces of female sex workers living with HIV in the Dominican Republic and assess the relationship between activity path and location-based risk exposure measures and daily drug use. The study employed a micro-longitudinal observational study design using an innovative 7-day travel diary to capture daily activity routes and a 7-day mobile health (mHealth) daily diary to collect daily substance use behaviors among 51 female sex workers. To estimate between-subject variability, a series of crude and adjusted modified log-Poisson repeated measures regression models with generalized estimating equations, clustering by individual with a compound symmetry working correlation structure were fit to estimate the relative risks and 95% confidence intervals. Controlling for individual level factors, findings showed that female sex workers exposed to a higher number of risk outlets (e.g., liquor stores, bars, hotels, nightclubs, brothels, etc.) within 200 and 100-meters of sex work locations were at an increased risk of daily drug use (RRadj: 1.03, 95%CI: 1.01, 1.05, RRadj: 1.05, 95%CI: 1.01, 1.09). No association was detected between activity path exposure and daily drug use. These findings illustrate the importance of moving beyond static residential neighborhood boundaries for measuring risk exposures and highlight the significant role that daily work environments have on drug harms among a highly stigmatized and vulnerable population

Attitudes, perceptions and potential uptake of male circumcision among older men in Turkana County, Kenya using qualitative methods.

In many communities, older men (i.e., over 25 years of age) have not come forward for Voluntary Medical Male Circumcision (VMMC) services. Reasons for low demand among this group of men are not well understood, and may vary across geographic and cultural contexts. This paper examines the facilitators and barriers to VMMC demand in Turkana County, Kenya, with a focus on older men. This is one of the regions targeted by the VMMC program in Kenya because the Turkana ethnic group does not traditionally circumcise, and the rates of HIV and STD transmission are high.Twenty focus group discussions and 69 in-depth interviews were conducted with circumcised and uncircumcised men and their partners to elicit their attitudes and perceptions toward male circumcision. The interviews were conducted in urban, peri-urban, and rural communities across Turkana. Our results show that barriers to circumcision include stigma associated with VMMC, the perception of low risk for HIV for older men and their "protection by marriage," cultural norms, and a lack of health infrastructure. Facilitators include stigma against not being circumcised (since circumcision is associated with modernity), protection against disease including HIV, and cleanliness. It was also noted that older men should adopt the practice to serve as role models to younger men.Both men and women were generally supportive of VMMC, but overcoming barriers with appropriate communication messages and high quality services will be challenging. The justification of circumcision being a biomedical procedure for protection against HIV will be the most important message for any communication strategy

Disclosure of HIV status to sex partners among HIV-infected men and women in Cape Town, South Africa

This study examines factors influencing HIV sero-status disclosure to sex partners among a sample of 630 HIV-infected men and women with recent sexual contact attending anti-retroviral therapy (ART) clinics in Cape Town, South Africa, with a focus on sex partner type, HIVrelated stigma, and ART as potential correlates. About 20% of the sample had not disclosed their HIV status to their most recent sex partners. HIV disclosure to sex partner was more likely among participants who had a steady sex partner [Adjusted odds ratio (AOR) = 2.7; 95% CI: 1.6-4.6], had a partner with known-HIV status [AOR = 7.8; 95% CI: 3.2-18.7]; perceived less stigma [AOR = 1.9; 95% CI: 1.2-2.9]; and were on ART [AOR = 1.6; 95% CI: 1.1-2.3]. Stratified analyses by the type of sex partner further reveals that stigma and ART were significantly associated with HIV disclosure within steady relationships but were not significant correlates of HIV disclosure with casual sex partners. The findings support a positive prevention strategy that emphasizes increased access to ART, and behavioral interventions to reduce casual sex partnerships for persons who are HIV-positive. Mitigating the influence of HIV stigma on HIV status disclosure particularly within steady sex partnerships is also important and may be accomplished through individual and couple counseling

Self-perceived health of older adults in Latin America and the Caribbean: a scoping review

Objective. To systematically map the existing evidence on self-perceived health among adults aged 60 and older in Latin America and the Caribbean, describe the use of the single-item measure of self-perceived health with this population, and identify gaps in the existing literature. Methods. Following PRISMA Extension for Scoping Reviews guidelines, eight databases were searched for publications that were published between 2009 and 2019 and reported self-perceived health of adults over 60 years old in Latin America and the Caribbean. Data on study characteristics, sample characteristics, and the use and analysis of the self-perceived health measure were charted. Results. The database and secondary searches identified 516 articles. After removing duplicates and assessing titles and abstracts for inclusion, 263 full-text articles were assessed for eligibility using the inclusion criteria and an additional 89 articles were excluded. Ultimately, 174 articles were included in the scoping review. Studies included participants from 17 countries in the region, led in frequency by Brazil with 120 articles. The self-perceived health question most often included a five-category response scale (130), and response options were predominantly divided into two (86) or three (48) categories for analysis. Conclusions. Information on the health and social needs of people aged 60 and older across Latin America and the Caribbean, particularly their perceptions of health, is limited. We highlight the need to expand research throughout the region, include particularly vulnerable populations, utilize data from longitudinal and qualitative studies, and call for transparency in how questions and responses are worded and analyzed. This review serves to inform future studies, programs, and policies directed at this population

Participatory geographic mapping and activity space diaries: innovative data collection methods for understanding environmental risk exposures among female sex workers in a low-to middle-income country

Background: A common approach for measuring place-based exposure is to use geographically-defined administrative boundaries and to link neighborhood characteristics at this level. This approach, however, may not be feasible in low-to middle-income countries where neighborhood-level data are limited or unavailable, and administrative boundaries are often unstandardized and not proportional to population size. Furthermore, such traditional approaches may not be appropriate for marginalized populations whose environments can be more difficult to study. In this paper, we describe two innovative and feasible methods to generate geospatial data to characterize and assess the role of risk environments on drug use among female sex workers living with HIV in the Dominican Republic. Methods: Participatory geographic mapping and daily activity space travel diaries were employed. Results: The methods presented in this study were feasible to implement, acceptable by study participants, and yielded rich geospatial data to analyze the impact of contextual factors on risk behaviors of female sex workers in a low-to middle-income country. Conclusion: Participatory geographic mapping and activity space diaries are two alternative methods for collecting geospatial data among hard-to-reach populations in resource constrained settings. Moreover, the methods are interactive and educational, allowing study participants to take an active role in the data collection process and potentially allowing for a deeper understanding of place-based effects on health and behavior