Panel IV Discussion: The Future of 1st Amendment Protections: Examining the Use of Brutality on those Fighting Against Violence

The 1st Amendment to the United States Constitution provides that Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances”. 35 Texas Constitution, Article I, Section 27, states, “The citizens shall have the right, in a peaceable manner, to assemble together for their common good.’’ What constitutes peaceful protest and limitations on such speech has been questioned for decades. Law enforcement agencies have, over the years, used various means of restricting free speech and peaceful assembly. Recall, during the civil rights movement of the 1960s, snarling dogs and high-powered water hoses were used in addition to other brutal physical attacks and excessive use of force on adults and children alike. This presentation examined current jurisprudence surrounding these issues. It questions what the future of the First Amendment right to protest does and should looks like while affirming the need to defend this critical right in protecting democracy. It further demonstrates the need to expand the constitutional protection for peaceful protestors as it relates to racial and social justice

Evaluating the impact of three HIV counselling and testing strategies on male most-at-risk population in Nigeria: A segmented regression analysis

Background: Alternative HIV counselling and testing (HCT) delivery models, such as mobile HTC, have been shown to increase access to and uptake of HCT. We evaluated the effects of three strategies in increasing uptake of HCT among male most-at-risk population (M-MARPS). Methods: Three HCT strategies implemented between July, 2009, and July, 2012, among men who have sex with men and injecting drug users in three states in Nigeria were evaluated in a longitudinal analysis. The first strategy (S1) was facility based with a community mobilisation component using key opinion leaders (KOLs). The second strategy (S2) involved KOLs referring M-MARPS to nearby mobile HCT teams, while the third (S3) involved mobile M-MARPS peers conducting the HCT. Segmented linear regression was used to assess the effect of different strategies on uptake of HCT among M-MARPS. Findings: A total of 1988, 14 726, and 14 895 M-MARPS received HCT through S1, S2, and S3 methods, respectively. Overall, S3 (12·7%; 1853 of 14 622) identified the highest proportion of HIV-positive M-MARPS compared with S1 (9·0%; 177 of 1956) and S2 (3·3%; 480 of 14 671; p \u3c 0·0001). Also S3 (13·2%; 1729 of 13 074) identified the highest proportion of new HIV diagnosis compared with S1 (8·2%; 132 of 1618) and S2 (2·9%; 355 of 12 034), respectively (p \u3c 0·0001). For the total number of M-MARPS reached by each strategy, there was no immediate (271; p=0·539) or long-term change (53; p=0·334) in the total number of clients reached by S2 compared with S1. Compared with S2, S3 showed a significant immediate decrease (3068; p=0·029) but a sustained long-term increase (822; p=0·007) in the total number of M-MARPS reached with HCT. Interpretation: Peer-mediated HCT (S3) had the highest impact on the total number of M-MARPS reached, identifying HIV-positive M-MARPS and new testers. Since HCT is a key intervention strategy for effective HIV/AIDS control, training M-MARPS peers to provide HCT is a high-impact approach in delivering HCT to M-MARPS

Evaluating the effect of HIV prevention strategies on uptake of HIV counselling and testing among male most-at-risk-populations in Nigeria; a cross-sectional analysis.

OBJECTIVE: The aim of this study was to evaluate the effects of three strategies in increasing uptake of HIV counselling and testing (HCT) among male most-at-risk-population (M-MARPs) using programmatic data. DESIGN: HIV prevention strategies were evaluated in a cross-sectional analysis. METHODS: Three HCT strategies were implemented between July 2009 and July 2012 among men who have sex with men (MSM) and people who inject drugs (PWIDs) in four states in Nigeria. The first strategy (S1), involved key opinion leaders (KOLs) who referred M-MARPs to health facilities for HCT. The second strategy (S2) involved KOLs referring M-MARPs to nearby mobile HCT teams while the third (S3) involved mobile M-MARPs peers conducting the HCT. χ(2) statistics were used to test for differences in the distribution of categorical variables across groups while logistic regression was used to measure the effect of the different strategies while controlling for confounding factors. RESULTS: A total of 1988, 14 726 and 14 895 M-MARPs were offered HCT through S1, S2 and S3 strategies, respectively. Overall, S3 (13%) identified the highest proportion of HIV-positive M-MARPs compared with S1 (9%) and S2 (3%), p≤0.001. Also S3 (13%) identified the highest proportion of new HIV diagnosis compared with S1 (8%) and S2 (3%), respectively, p≤0.001. When controlled for age, marital status and occupation, MSM reached via S3 were 9 times (AOR: 9.21; 95% CI 5.57 to 15.23) more likely to uptake HCT when compared with S1 while PWIDs were 21 times (AOR: 20.90; 95% CI 17.33 to 25.21) more likely to uptake to HCT compared with those reached via S1. CONCLUSIONS: Peer-led HCT delivered by S3 had the highest impact on the total number of M-MARPs reached and in identifying HIV-positive M-MARPs and new testers. Training M-MARPs peers to provide HCT is a high impact approach in delivering HCT to M-MARPs

Patterns of drug use among people who inject drugs (PWID) and their implications for sexually transmitted infections in northern Nigeria

Background: Drug use impairs judgment and leads to sexual risk behaviours. The prevalence of HIV among PWID in Kano (4.8%) and Kaduna (5.8%) respectively are higher than the national HIV prevalence among PWID (4.2%). However the national prevalence of sexually transmitted infections (STI) among PWID is about 6%. In this study we sought to determine drug use profile, prevalence and correlates of STIs among PWID in northern Nigeria. Methods: Data of drug use, sexual and injecting risk behaviors were collected from structured risk assessment forms between May and October 2013 and evaluated in a cross sectional study. Chi-square test was used to compare differences between categorical variables and logistic regression analysis was conducted to identify factors associated with patterns of drug use and sexual risk behaviour. Results: A total of 385 drug users (9% females and 91% males) with mean age of 30 years were interviewed. More than 94% injected drugs in the last 12 months. Mean age of drug use debut was 15.4 years, while mean duration of drugs use was 15 years. Types of drugs injected included heroine (30%), cocaine (24%), amphetamine (8%), crack (10.4%) and pentazocine (39.2%). Over 80% of heroin users and 72.3% of cocaine users, had unprotected sex with casual partner in the last 6 months. About 28% of drug users experienced one form of sexually transmitted infection in the last 6 months. Logistic regression analysis showed that amphetamine users were 11 times more likely to have STI (Adjusted OR=11.52, 95%CI=4.27-31.10) followed by heroin users (Adjusted OR=4.99, 95%CI=2.46-10.13) and pentazocine users (Adjusted OR=2.86, 95%CI=1.41-5.81). Conclusions: This study strongly suggested that drug use significantly predisposes PWID to sexual risk behaviours and STIs. In addition, exposure to STIs seems to significantly vary with the type of drugs used. Therefore, there is a need for appropriate HIV/STI prevention programing for PWID in northern Nigeria

Comparison of audio computer assisted self-interview and face-to-face interview methods in eliciting HIV-related risks among men who have sex with men and men who inject drugs in Nigeria

Introduction: Face-to-face (FTF) interviews are the most frequently used means of obtaining information on sexual and drug injecting behaviours from men who have sex with men (MSM) and men who inject drugs (MWID). However, accurate information on these behaviours may be difficult to elicit because of sociocultural hostility towards these populations and the criminalization associated with these behaviours. Audio computer assisted self-interview (ACASI) is an interviewing technique that may mitigate social desirability bias in this context. Methods: This study evaluated differences in the reporting of HIV-related risky behaviours by MSM and MWID using ACASI and FTF interviews. Between August and September 2010, 712 MSM and 328 MWID in Nigeria were randomized to either ACASI or FTF interview for completion of a behavioural survey that included questions on sensitive sexual and injecting risk behaviours. Data were analyzed separately for MSM and MWID. Logistic regression was run for each behaviour as a dependent variable to determine differences in reporting methods. Results: MSM interviewed via ACASI reported significantly higher risky behaviours with both women (multiple female sexual partners 51% vs. 43%, p = 0.04; had unprotected anal sex with women 72% vs. 57%, p = 0.05) and men (multiple male sex partners 70% vs. 54%, p ≤ 0.001) than through FTF. Additionally, they were more likely to self-identify as homosexual (AOR: 3.3, 95%CI:2.4–4.6) and report drug use in the past 12 months (AOR:40.0, 95%CI: 9.6–166.0). MWID interviewed with ACASI were more likely to report needle sharing (AOR:3.3, 95%CI:1.2–8.9) and re-use (AOR:2.2, 95%CI:1.2–3.9) in the past month and prior HIV testing (AOR:1.6, 95%CI 1.02–2.5). Conclusion: The feasibility of using ACASI in studies and clinics targeting key populations in Nigeria must be explored to increase the likelihood of obtaining more accurate data on high risk behaviours to inform improved risk reduction strategies that reduce HIV transmission

Demographic characteristics of the study population.

<p>Demographic characteristics of the study population.</p

Experience and preference regarding the use of ACASI (N = 94).

<p><b>Note:</b> *1 = did not like it at all, 5 = liked it very much.</p

Reported HIV risks by interview modes among MWID (N = 328).

<p><b><i>Note:</i></b> AOR = adjusted odds ratio, CI = confidence interval,</p><p>: significant at <i>p</i><.05,</p><p>: significant at <i>p</i><.01.</p><p>Age, education, and HIV status were adjusted for in the regression models looking at reported HIV risks among ACASI method vs. FTF interview method.</p><p>^a significant levels were determined using t-test comparing 2 continuous variables.</p