Challenging dominant policy paradigms of care for children orphaned by AIDS: dynamic patterns of care in Kwazulu-Natal, Republic of South Africa

Although caring for children orphaned by AIDS is increasingly acknowledged as a priority area for HIV/AIDS and development programs, there is limited knowledge on caregivers. Rapidly growing numbers of children orphaned by AIDS warrants increased attention from researchers, policy makers, and program planners. This paper explores dominant theoretical and policy paradigms of care for children orphaned by AIDS. Then, drawing from an analysis of interviews with staff at nongovernmental organizations and community based organizations, and focus groups with caregivers gathered during fieldwork conducted between July 10 and September 8, 2006 in KwaZulu-Natal Province, Republic of South Africa, this paper contrasts local understandings of childcare with theoretical and policy notions of care. Findings from this qualitative study suggest that childcare practices are more diverse and complex than those currently recognized within existing theoretical and policy formulations. Such findings lead to the conclusion that current policy approaches towards care for children orphaned by AIDS face a potentially detrimental disconnect with local realities of care. Re-formulating policies to take into account how local practices of childcare are shifting in dynamic ways in response to the pandemic will be essential for the formulation effective policies and programs

Systematic Review of Abstinence-Plus HIV Prevention Programs in High-Income Countries

In their systematic review, Underhill and colleagues found that abstinence-plus programs appear to reduce short-term and long-term HIV risk behavior among youth in high-income countries

Pre-exposure Prophylaxis State of the Science: Empirical Analogies for Research and Implementation

Pre-exposure prophylaxis (PrEP) has the potential to become a powerful biomedical approach to HIV prevention; however, its success depends on behavioral and social factors that may determine its appropriate use. This article is designed to facilitate interdisciplinary empirical analogies relevant to PrEP implementation, reviewing behavioral and social science findings that may provide lessons critical to the success of PrEP as a biomedical–behavioral prevention strategy. As we prepare for the dissemination of new biomedical approaches to HIV prevention, integrating the state of the science across disciplines may result in innovative strategies for implementation that can enhance their success

The Association of Food Insecurity, Mental Health, and Healthcare Access and Use Among Lesbian, Gay, and Bisexual Adults in the United States: Results From the 2021 National Health Interview Survey

Purpose We sought to describe the prevalence of food insecurity and its relationship with mental health, health care access, and use among lesbian, gay, and bisexual (LGB) adults in the U.S. Design and Setting We analyzed data from the National Health Interview Survey (NHIS), a cross-sectional study of noninstitutionalized adults from all 50 states and the District of Columbia. Sample The study sample was restricted to LGB adults ≥18 years (N = 1178) from the 2021 NHIS survey. Measures Food security was assessed using the 10-item U.S Adult Food Security Survey Module. Study outcomes were mental health (depression, anxiety, life satisfaction, and serious psychological distress), health care utilization, and medication adherence. Analysis Descriptive statistics and linear and generalized linear regressions. Results The study sample consisted of 69% White, 14% Hispanic/Latinx, 9% Black, and 8% people of other races. Approximately half (53%) identified as bisexual and 47% identified as gay or lesbian. Eleven percent were food insecure. Sexual orientation, income-to-poverty ratio, and health insurance were significant correlates of food insecurity. In multivariable analyses, food insecurity was significantly associated with mental illness (including depression, anxiety, and serious psychological distress), limited health care access and use (including inability to pay medical bills, delay in getting medical and mental health care, and going without needed medical and mental health care), and medication nonadherence (including skipping medication, taking less medication, delay filling prescription, and going without needed prescription). Conclusion Food insecurity is a constant predictor of adverse mental health and low medical and mental health care use rates among LGB adults in the United States. Achieving food security in LGB people requires improving their financial and nonfinancial resources to obtain food

Pre-exposure prophylaxis as an opportunity for engagement in HIV prevention among South African adolescents

Pre-exposure prophylaxis (PrEP) offers a potential biomedical strategy to reduce HIV incidence among adolescent populations disproportionately affected by HIV. There is limited evidence on the social and clinical implications, including engagement in HIV prevention efforts, of PrEP for South African adolescents, who face high HIV risk. We conducted a mixed-methods study in Western Cape, South Africa from 2015 to 2016. Adolescents (N = 35) aged 16–17 and clinical service providers working with adolescents (N = 25) were recruited from community and clinic settings. Adolescents and service providers completed a survey about their overall perceptions of PrEP and completed interviews guided by semi-structured protocols. We performed descriptive analysis of quantitative data using SPSS and thematic analysis of qualitative data using NVivo. The majority of adolescents endorsed future PrEP use for themselves and partners, and all clinical service providers endorsed future PrEP use for sexually active adolescents. Both adolescents and service providers identified PrEP as an opportunity to engage youth as active participants in HIV prevention. Service providers also viewed PrEP as a potential mechanism for shifting life trajectories. Findings from this study enhance our understanding of the considerations needed to engage adolescents and clinical service providers in the roll-out of oral PrEP in South Africa

Social Media Use and Prevention of HIV and Other Sexually Transmitted Infections among At-Risk College Students in the United States

The purpose of this study was to evaluate college students\u27 self-perceptions of HIV/STI risk, potential barriers to HIV/STI testing, use of social media, and technology-based HIV/STI health interventions. Surveys were administered to 97 US college students. Participants were categorized into three groups based on sexual behaviors: (1) men who have sex with men (MSM), (2) men who have sex with women (MSW), and (3) women who have sex with men (WSM). MSM (n=24) were significantly more likely MSW/WSM (n=72) to report being tested in the past year for HIV (p\u3c.01) and other STIs (p\u3c.01). Only 35% reported HIV testing and 24% reported STI testing in the past year. MSM were more likely than MSW to report having met a sexual partner through social media (p\u3c.01), while no WSM reported doing so. The average number of partners met online in the past year was 7.8 (range=1-20). Those who had met a partner online were more willing to receive e-mail or text message HIV/STI testing reminders (p\u3c.05)

Mental Health of Older Adults by Sexual Minority Status: Evidence From the 2021 National Health Interview Survey

This study explored differences among older adults in mental health by sexual minority status. Data came from the 2021 U.S. National Health Interview Survey. The study sample included older adults (or those aged ≥50 years, N = 15,559), and of those, two percent (n = 380) self-identified as lesbian, gay, or bisexual (LGB). Older LGB adults had significantly higher odds of reporting a diagnosis of depression and anxiety and experiencing serious psychological distress than older non-LGB adults. Additionally, older LGB adults reported higher odds of experiencing depression and anxiety more frequently than older non-LGB adults. Significant covariates included age, sex, housing, food security, and social support. Increased risk for mental illness may be long-term consequences of stigma and discrimination that this population has experienced over the life course. The combination of structural interventions and affirming mental healthcare that recognizes the cumulative negative experience among older LGB adults is necessary to achieve mental health equity

Integrating HIV and mental health interventions to address a global syndemic among men who have sex with men

In this Series paper, we review evidence on the co-occurring and synergistic epidemics (syndemic) of HIV and mental health problems worldwide among men who have sex with men (MSM). The multilevel determinants of this global syndemic include structural factors that enable stigma, systematic bias, and violence towards MSM across geographical and cultural contexts. Cumulative exposure to these factors over time results in population-level inequities in the burden of HIV infections and mental health problems among MSM. Evidence for this syndemic among MSM is strongest in the USA, Canada, western Europe, and parts of Asia and Latin America, with emerging evidence from sub-Saharan Africa. Integrated interventions are needed to address syndemics of HIV and mental health problems that challenge the wellbeing of MSM populations worldwide, and such interventions should consider various mental health conditions (eg, depression, anxiety, trauma, and suicidality) and their unique expressions and relationships with HIV outcomes depending on cultural contexts. In addition, interventions should identify and intervene with locally relevant structural factors that result in HIV and mental health vulnerabilities among MSM

Unconditional Government Cash Transfer In Support of Orphaned and Vulnerable Adolescents in Western Kenya: Is There an Association with Psychological Wellbeing?

Background Orphaned and vulnerable adolescents (OVA) in sub-Saharan Africa are at greater risk for adverse psychological outcomes compared with their non-OVA counterparts. Social interventions that provide cash transfers (CTs) have been shown to improve health outcomes among young people, but little is known about their impact on the psychological wellbeing of OVA. Objective Among OVA in western Kenya, we assessed the association between living in a household that received monthly unconditional government CTs and psychological wellbeing. Methods We examined the likelihood of depression, anxiety, post-traumatic stress symptoms (PTSS) and positive future outlook among 655 OVA aged between 10 and 18 years who lived in 300 randomly selected households in western Kenya that either received or did not receive unconditional monthly CTs. Results The mean age was 14.0 (SD 2.4) years and 329 (50.2%) of the participants were female while 190 (29.0%) were double orphans whose biological parents were both deceased. After adjusting for socio-demographic, caregiver, and household characteristics and accounting for potential effects of participant clustering by sub-location of residence, OVA living in CT households were more likely to have a positive future outlook (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.08, 1.99), less likely to be anxious (OR 0.57, 95% CI 0.42, 0.78), and less likely to have symptoms of post-traumatic stress (OR 0.50, 95% CI 0.29, 0.89). We did not find statistically significant differences in odds of depression by CT group. Conclusion OVA in CT households reported better psychological wellbeing compared to those in households not receiving CTs. CT interventions may be effective for improving psychological wellbeing among vulnerable adolescents in socioeconomically deprived households