THE ROLE OF COMMUNITY SAVINGS GROUPS IN ADDRESSING HIV AMONG FEMALE SEX WORKERS IN IRINGA, TANZANIA

Background: Financial insecurity has been linked to heightened HIV risk among female sex workers (FSW). Community empowerment (CE) approaches have demonstrated effectiveness in reducing HIV risk and vulnerability through FSW taking collective action to address structural barriers to their health and human rights. This study examines organically formed community savings groups among FSW in Iringa, Tanzania for their potential role within a CE approach to addressing HIV among FSW. Methods: Logistic regression was used to determine the associations between financial security, community savings group participation, and consistent condom use (CCU) among a cohort of 496 FSW in Iringa. Mediation analysis was used to assess whether community savings group participation mediates the relationship between financial security and CCU. Qualitative methods included 27 in-depth interviews with 15 FSW and 4 focus group discussions with 35 FSW who participate in community savings groups as well as 10 key informant interviews with group collectors. Content analysis was conducted to identify salient themes including those related to the dynamic nature of participants’ sex work and financial realities, the meaning and importance of community savings groups to the women, and overall group operations and functioning. Results: In quantitative analysis, FSW who participated in community savings groups had nearly two times greater odds of CCU in the last 30 days with new clients than women who did not participate in the groups (aOR: 1.80; 95% CI: 1.08, 2.97). Higher financial security (i.e. monthly income) was positively associated with CCU (aOR: 1.54; 95% CI: 0.94, 2.53) and mediation analysis suggested that community savings group participation partially mediates the relationship between financial security and CCU. Qualitatively, women described savings groups as an important addition to their often unsteady income, which can leave them vulnerable to high-risk sex with clients. Savings groups were described as providing a safety net women utilized in times of financial need, making them less likely to engage in high-risk sex with clients. Women described a sense of agency resulting from group participation playing out in their ability to negotiate condom use and be more selective about clients. Savings groups helped participants afford health care and HIV-infected participants described saving from the groups enabled them to cover the costs of eating healthy foods, medications, and transportation for clinic appointments. Beyond the individual level, groups were seen as fostering a sense of solidarity and collective identity. Participants expressed their desires to formally register their groups and be recognized by the larger community. Conclusion: Findings suggest that community savings groups may improve financial security and enhance individual agency in decision making influencing sexual risk behaviors among FSW. They may also impact the overall health and well-being of FSW and help HIV-infected FSW achieve improved HIV treatment and care outcomes. Through greater social cohesion and collective action among FSW the groups further efforts for their social and economic inclusion. Community savings groups may be an important economic empowerment strategy within a CE framework for FSW communities and enable sex workers to intervene on structural factors contributing to their HIV vulnerability and ultimately to gain more equal access to resources

A qualitative assessment of stakeholder perceptions and socio-cultural influences on the acceptability of harm reduction programs in Tijuana, Mexico

<p>Abstract</p> <p>Background</p> <p>The Mexico-U.S. border region is experiencing rising rates of blood-borne infections among injection drug users (IDUs), emphasizing the need for harm reduction interventions.</p> <p>Methods</p> <p>We assessed the religious and cultural factors affecting the acceptability and feasibility of three harm reduction interventions – Needle exchange programs (NEPs), syringe vending machines, and safer injection facilities (SIFs) – in Tijuana, Mexico. In-depth qualitative interviews were conducted with 40 community stakeholders to explore cultural and societal-related themes.</p> <p>Results</p> <p>Themes that emerged included Tijuana's location as a border city, family values, and culture as a mediator of social stigma and empathy towards IDUs. Perception of low levels of both awareness and socio-cultural readiness for harm reduction interventions was noted. Religious culture emerged as a theme, highlighting the important role religious leaders play in determining community responses to harm reduction and rehabilitation strategies for IDUs. The influence of religious culture on stakeholders' opinions concerning harm reduction interventions was evidenced by discussions of family and social values, stigma, and resulting policies.</p> <p>Conclusion</p> <p>Religion and politics were described as both a perceived benefit and deterrent, highlighting the need to further explore the overall influences of culture on the acceptability and implementation of harm reduction programs for drug users.</p

Multi-Level Considerations for Optimal Implementation of Long-Acting Injectable Antiretroviral Therapy to Treat People Living with HIV: Perspectives of Health Care Providers Participating in Phase 3 Trials

BACKGROUND: Long-acting injectable antiretroviral therapy (LA ART) has been shown to be non-inferior to daily oral ART, with high patient satisfaction and preference to oral standard of care in research to date, and has recently been approved for use in the United States and Europe. This study examined the perspectives of health care providers participating in LA ART clinical trials on potential barriers and solutions to LA ART roll-out into real world settings. METHODS: This analysis draws on two data sources: (1) open-ended questions embedded in a structured online survey of 329 health care providers participating in the ATLAS-2 M trial across 13 countries; and (2) in-depth interviews with 14 providers participating in FLAIR/ ATLAS/ATLAS-2 M trials in the United States and Spain. Both assessments explored provider views and clinic dynamics related to the introduction of LA ART and were analyzed using thematic content analysis. The Consolidated Framework for Implementation Research (CFIR) was drawn on as the conceptual framework underpinning development of a model depicting study findings. RESULTS: Barriers and proposed solutions to LA ART implementation were identified at the individual, clinic and health system levels. Provider perceptions of patient level barriers included challenges with adhering to frequent injection appointments and injection tolerability. Proposed solutions included patient education, having designated staff for clinic visit retention, and clinic flexibility with appointment scheduling. The main provider concern was identifying appropriate candidates for LA ART; proposed solutions focused on patient provider communication and decision making. Clinic level barriers included the need for additional skilled individuals to administer injections, shifts in workflow as demand increases and the logistics of cold-chain storage. Proposed solutions included staff hiring and training, strategic planning around workflow and logistics, and the possibility of offering injections in other settings, including the home. Health system level barriers included cost and approvals from national regulatory bodies. Potential solutions included governments subsidizing treatment, ensuring cost is competitive with oral ART, and offering co-pay assistance. CONCLUSIONS: Results suggest the importance of multi-level support systems to optimize patient-provider communication and treatment decision-making; clinic staffing, workflow, logistics protocols and infrastructure; and cost-related factors within a given health system

Context and Considerations for the Development of Community-Informed Health Communication Messaging to Support Equitable Uptake of COVID-19 Vaccines Among Communities of Color in Washington, DC.

BACKGROUND: Communities of color have been disproportionately impacted by COVID-19. We explored barriers and facilitators to COVID-19 vaccine uptake among African American, Latinx, and African immigrant communities in Washington, DC. METHODS: A total of 76 individuals participated in qualitative interviews and focus groups, and 208 individuals from communities of color participated in an online crowdsourcing contest. RESULTS: Findings documented a lack of sufficient, accurate information about COVID-19 vaccines and questions about the science. African American and African immigrant participants spoke about the deeply rooted historical underpinnings to their community\u27s vaccine hesitancy, citing the prior and ongoing mistreatment of people of color by the medical community. Latinx and African immigrant participants highlighted how limited accessibility played an important role in the slow uptake of COVID-19 vaccines in their communities. Connectedness and solidarity found were found to be key assets that can be drawn upon through community-driven responses to address social-structural challenges to COVID-19 related vaccine uptake. CONCLUSIONS: The historic and ongoing socio-economic context and realities of communities of color must be understood and respected to inform community-based health communication messaging to support vaccine equity for COVID-19 and other infectious diseases

Representations of poverty in British newspapers: a case of ‘othering’ the threat?

The meanings of social problems like poverty develop within the public sphere. This paper uses the theory of social representations to examine how poverty is represented in British newspapers. Poverty has been discussed and interpreted in numerous ways, and newspapers not only provide a platform for these elaborations but also contribute to shaping public understanding on the issue. The study sampled news coverage on poverty in four British newspapers during two randomly chosen one-month periods in the years 2001 and 2011. The data set of news reports (n = 274) was thematically analysed to examine representations of poverty. The study found that in the domestic context, media represents poverty as a problem limited to vulnerable groups such as children and the elderly. With a lack of discussion on the wider socio-economic causes and contributing factors, poverty within the UK appears as an ‘orphan phenomenon’ with an unknown genesis. In contrast, the representations of poverty outside the UK are vivid and elaborate, and the news reports hold the socio-political inefficiency of countries responsible for poverty. The study also found that the media uses poverty to make sense of catastrophic events in society: the September 11, 2001 terrorist attacks in the United States and the London riots of 2011 were both anchored using poverty. This paper discusses the representational dynamics of these findings and argues that the media representations distance general society from poverty, representing it as a problem of the othe

Examining adherence barriers among women with HIV to tailor outreach for long-acting injectable antiretroviral therapy

Background: Long-acting (LA) injectable antiretroviral therapy (ART) has been found non-inferior to daily oral ART in Phase 3 trials. LA ART may address key barriers to oral ART adherence and be preferable to daily pills for some people living with HIV. To date, women have been less represented than men in LA ART research. Using longitudinal data from the Women's Interagency HIV Study (WIHS) cohort of women living with HIV in the United States, we examined barriers and facilitators of daily oral ART adherence that may be related to or addressed by LA ART. Methods: We conducted a secondary analysis of WIHS cohort data from 1998 to 2017 among participants seen for at least 4 visits since 1998 who reported using ART at least once (n = 2601). Two dichotomous outcomes, patient-reported daily oral ART adherence and viral suppression were fit using generalized linear models, examining the role of socio-demographic and structural factors. Results: At study enrollment, the median age was 40.5 years, 63% of participants were African American and 22% were Latina. The majority (82%) reported taking ART more than 75% of the time and 53% were virally suppressed. In multivariate analysis, several sub-groups of women had lower odds of reported adherence and viral suppression: 1) younger women (adherence aOR: 0.71; viral suppression aOR: 0.63); 2) women who inject drugs (adherence aOR: 0.38; viral suppression aOR: 0.50) and those with moderate (adherence aOR: 0.59; viral suppression aOR: 0.74) and heavy alcohol consumption (adherence aOR: 0.51; viral suppression aOR: 0.69); 3) those with depressive symptoms (adherence aOR: 0.61; viral suppression aOR: 0.76); and 4) those with a history of going on and off ART (adherence aOR: 0.62, viral suppression aOR: 0.38) or changing regimens (adherence aOR: 0.83, viral suppression aOR: 0.56). Conclusions: Current injectable contraceptive users (vs. non-users) had greater odds of oral ART adherence (aOR: 1.87) and viral suppression (aOR: 1.28). Findings identify profiles of women who may benefit from and be interested in LA ART. Further research is warranted focused on the uptake and utility of LA ART for such key subpopulations of women at high need for innovative approaches to achieve sustained viral suppression

Examining adherence barriers among women with HIV to tailor outreach for long-acting injectable antiretroviral therapy

Background Long-acting (LA) injectable antiretroviral therapy (ART) has been found non-inferior to daily oral ART in Phase 3 trials. LA ART may address key barriers to oral ART adherence and be preferable to daily pills for some people living with HIV. To date, women have been less represented than men in LA ART research. Using longitudinal data from the Women’s Interagency HIV Study (WIHS) cohort of women living with HIV in the United States, we examined barriers and facilitators of daily oral ART adherence that may be related to or addressed by LA ART. Methods We conducted a secondary analysis of WIHS cohort data from 1998 to 2017 among participants seen for at least 4 visits since 1998 who reported using ART at least once (n = 2601). Two dichotomous outcomes, patient-reported daily oral ART adherence and viral suppression were fit using generalized linear models, examining the role of socio-demographic and structural factors. Results At study enrollment, the median age was 40.5 years, 63% of participants were African American and 22% were Latina. The majority (82%) reported taking ART more than 75% of the time and 53% were virally suppressed. In multivariate analysis, several sub-groups of women had lower odds of reported adherence and viral suppression: 1) younger women (adherence aOR: 0.71; viral suppression aOR: 0.63); 2) women who inject drugs (adherence aOR: 0.38; viral suppression aOR: 0.50) and those with moderate (adherence aOR: 0.59; viral suppression aOR: 0.74) and heavy alcohol consumption (adherence aOR: 0.51; viral suppression aOR: 0.69); 3) those with depressive symptoms (adherence aOR: 0.61; viral suppression aOR: 0.76); and 4) those with a history of going on and off ART (adherence aOR: 0.62, viral suppression aOR: 0.38) or changing regimens (adherence aOR: 0.83, viral suppression aOR: 0.56). Conclusions Current injectable contraceptive users (vs. non-users) had greater odds of oral ART adherence (aOR: 1.87) and viral suppression (aOR: 1.28). Findings identify profiles of women who may benefit from and be interested in LA ART. Further research is warranted focused on the uptake and utility of LA ART for such key subpopulations of women at high need for innovative approaches to achieve sustained viral suppression

The Beta intervalling effect during a deep economic crisis - evidence from Greece

Purpose – The intervalling effect bias of beta refers to the sensitivity of beta estimation with respect to the reference time interval on which returns are measured and its manifestation may indicate the degree of market inefficiencies. The purpose of this paper is to study the intervalling effect bias within an environment and during a sample period that embraces the evolution of a deep economic crisis and show in particular that its intensity is profoundly magnified. Design/methodology/approach – The Athens Stock Exchange is studied via the market model during the sample period 2007-2012 that embraces the Greek debt restructuring. Two portfolios are formed to distinguish between large and small market capitalizations, three reference intervals are considered for measurement of returns (daily, weekly, monthly) and the respective betas are calculated via OLS simple regression. The results are compared to similar studies. The results are further confirmed by using a second proxy for the market portfolio. Findings – The intensity of the intervalling effect bias was very pronounced during this sample period with regard to all aspects of the phenomenon that similar studies have reported and to which the results of this paper are compared. Originality/value – This is the first time that the intervalling effect is examined in conjunction to a deep economic crisis environment. The intensity of the intervalling effect reflects the depth of the inefficiencies of a market for some period. As a consequence, some function measuring this intensity may be devised to serve as a measure of market inefficiencies