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Abraham SA, Cudjoe O, Nartey YA, Agyare E, Annor F, Tawiah BO, Nyampong M, Owusu KK, Abdulai M, Addo SA, Obiri-Yeboah D. Unravelling the experiences of incarcerated individuals living with HIV on ART: a qualitative study in Ghanaian prisons. INTERNATIONAL JOURNAL OF PRISON HEALTH 2024; 20:186-199. [PMID: 38984601 PMCID: PMC11342671 DOI: 10.1108/ijoph-06-2023-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
PURPOSE The Joint United Nations Programme on HIV/AIDS (UNAIDS) goal to end the acquired immunodeficiency syndrome (AIDS) epidemic as a public health threat by 2030 emphasises the importance of leaving no one behind. To determine progress towards the elimination goal in Ghana, an in-depth understanding of human immunodeficiency virus (HIV) care from the perspective of vulnerable populations such as persons living with HIV in incarceration is necessary. This study aims to explore the experiences of incarcerated individuals living with HIV (ILHIV) and on antiretroviral therapy (ART) in selected Ghanaian prisons to help inform policy. DESIGN/METHODOLOGY/APPROACH The study adopted a qualitative approach involving in-depth interviews with 16 purposively selected ILHIV on ART from purposively selected prisons. Interviews were conducted between October and December 2022. Thematic analysis was performed using the ATLAS.Ti software. FINDINGS Three themes were generated from the analysis: waking up to a positive HIV status; living with HIV a day at a time; and being my brother's keeper: preventing HIV transmission. All participants underwent HIV screening at the various prisons. ILHIV also had access to ART although those on remand had challenges with refills. Stigma perpetuated by incarcerated individuals against those with HIV existed, and experiences of inadequate nutrition among incarcerated individuals on ART were reported. Opportunities to improve the experiences of the ILHIV are required to improve care and reduce morbidity and mortality. ORIGINALITY/VALUE Through first-hand experiences from ILHIV in prisons, this study provides the perception of incarcerated individuals on HIV care in prisons. The insights gained from this study can contribute to the development of targeted interventions and strategies to improve HIV care and support for incarcerated individuals.
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Affiliation(s)
- Susanna Aba Abraham
- Department of Adult Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Obed Cudjoe
- Department of Medical Laboratory Science, University of Cape Coast College of Health and Allied Sciences, Cape Coast, Ghana
| | - Yvonne Ayerki Nartey
- Department of Internal Medicine, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Elizabeth Agyare
- Clinical Microbiology/Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana and National HIV/AIDS Control Programme, Accra, Ghana
| | - Francis Annor
- Directorate of Research Innovation and Consultancy, University of Cape Coast, Cape Coast, Ghana
| | | | | | | | | | | | - Dorcas Obiri-Yeboah
- Department of Microbiology and Immunology, University of Cape Coast College of Health and Allied Sciences, Cape Coast, Ghana; Directorate of Research Innovation and Consultancy, University of Cape Coast, Cape Coast, Ghana and Clinical Microbiology/Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
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Hotton AL, Lee F, Sheeler D, Ozik J, Collier N, Edali M, Ardestani BM, Brewer R, Schrode KM, Fujimoto K, Harawa NT, Schneider JA, Khanna AS. Impact of post-incarceration care engagement interventions on HIV transmission among young Black men who have sex with men and their sexual partners: an agent-based network modeling study. LANCET REGIONAL HEALTH. AMERICAS 2023; 28:100628. [PMID: 38026447 PMCID: PMC10679934 DOI: 10.1016/j.lana.2023.100628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 10/21/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023]
Abstract
Background Understanding the impact of incarceration on HIV transmission among Black men who have sex with men is important given their disproportionate representation among people experiencing incarceration and the potential impact of incarceration on social and sexual networks, employment, housing, and medical care. We developed an agent-based network model (ABNM) of 10,000 agents representing young Black men who have sex with men in the city of Chicago to examine the impact of varying degrees of post-incarceration care disruption and care engagement interventions following release from jail on HIV incidence. Methods Exponential random graph models were used to model network formation and dissolution dynamics, and network dynamics and HIV care continuum engagement were varied according to incarceration status. Hypothetical interventions to improve post-release engagement in HIV care for individuals with incarceration (e.g., enhanced case management, linkage to housing and employment services) were compared to a control scenario with no change in HIV care engagement after release. Finding HIV incidence at 10 years was 4.98 [95% simulation interval (SI): 4.87, 5.09 per 100 person-years (py)] in the model population overall; 5.58 (95% SI 5.38, 5.76 per 100 py) among those with history of incarceration, and 12.86 (95% SI 11.89, 13.73 per 100 py) among partners of agents recently released from incarceration. Sustained post-release HIV care for agents with HIV and experiencing recent incarceration resulted in a 46% reduction in HIV incidence among post-incarceration partners [incidence rate (IR) per 100 py = 5.72 (95% SI 5.19, 6.27) vs. 10.61 (95% SI 10.09, 11.24); incidence rate ratio (IRR) = 0.54; (95% SI 0.48, 0.60)] and a 19% reduction in HIV incidence in the population overall [(IR per 100 py = 3.89 (95% SI 3.81-3.99) vs. 4.83 (95% SI 4.73, 4.92); IRR = 0.81 (95% SI 0.78, 0.83)] compared to a scenario with no change in HIV care engagement from pre-to post-release. Interpretation Developing effective and scalable interventions to increase HIV care engagement among individuals experiencing recent incarceration and their sexual partners is needed to reduce HIV transmission among Black men who have sex with men. Funding This work was supported by the following grants from the National Institutes of Health: R01DA039934; P20 GM 130414; P30 AI 042853; P30MH058107; T32 DA 043469; U2C DA050098 and the California HIV/AIDS Research Program: OS17-LA-003; H21PC3466.
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Affiliation(s)
- Anna L. Hotton
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Francis Lee
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Daniel Sheeler
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Jonathan Ozik
- Argonne National Laboratory, Lemont, IL, USA
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Nicholson Collier
- Argonne National Laboratory, Lemont, IL, USA
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL, USA
| | - Mert Edali
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Industrial Engineering, Yildiz Technical University, Besiktas, Istanbul, 34349, Turkey
| | | | - Russell Brewer
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Katrina M. Schrode
- Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Kayo Fujimoto
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nina T. Harawa
- Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - John A. Schneider
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Aditya S. Khanna
- Center for Alcohol and Addiction Studies and Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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Feelemyer J, Abrams J, Mazumdar M, Irvine NM, Scheidell JD, Turpin RE, Dyer TV, Brewer RA, Hucks-Ortiz C, Caniglia EC, Remch M, Scanlon F, Gaydos CA, Sandh S, Cleland CM, Mayer KH, Khan MR. Age Differences in the Associations Between Incarceration and Subsequent Substance Use, Sexual Risk-Taking, and Incident STI Among Black Sexual Minority Men and Black Transgender Women in the HIV Prevention Trials 061 Cohort. Am J Mens Health 2023; 17:15579883231204120. [PMID: 37942721 PMCID: PMC10637158 DOI: 10.1177/15579883231204120] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/30/2023] [Accepted: 09/12/2023] [Indexed: 11/10/2023] Open
Abstract
Incarceration can lead to different risk behaviors often due to increased distress and disruption of social networks. It is not well known, however, how these associations may differ by age. In this study, we measure age differences in longitudinal associations between incarceration and substance use, sex risk, and sexually transmitted infection (STI) among Black sexual minority men and Black transgender women (BSMM/BTW). We recruited BSMM/BTW from 2009 to 2011 that were part of the HIV Prevention Trials Network 061 study. We compared those less than 30 years old (n = 375) to those 30 years old or greater (n = 794) examining substance use, sex risk, and STI infection stratified by age. Logistic regression with inverse probability weighting was used for the statistical analysis. Approximately 59% of the sample reported incarceration history. In adjusted analysis, incarceration was more strongly associated with alcohol use and stimulant use among older individuals as was sexual risk behaviors including buying and selling sex. Concurrent partnerships were associated with the younger age groups. STI incidence was associated with younger individuals while associations with HIV infection were similar for the two age groups. Understanding differences in substance use and STI risk among age cohorts is imperative to the design and implementation of re-entry programs. Younger BSMM/BTW participating in re-entry support programs may benefit in particular from HIV/STI prevention and care efforts, while post-release substance abuse treatment and harm reduction programs should target older individuals with continued substance abuse.
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Affiliation(s)
- Jonathan Feelemyer
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Jasmyn Abrams
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Medha Mazumdar
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Natalia M Irvine
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Joy D Scheidell
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Rodman E Turpin
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | - Typhanye V Dyer
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | - Russell A Brewer
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | | | - Ellen C Caniglia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Molly Remch
- UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Faith Scanlon
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | | | - Simon Sandh
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Charles M Cleland
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Maria R Khan
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Diagnosis, Treatment, and Prevention of HIV Infection among Detainees: A Review of the Literature. Healthcare (Basel) 2022; 10:healthcare10122380. [PMID: 36553904 PMCID: PMC9777892 DOI: 10.3390/healthcare10122380] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Detainees are one of the most vulnerable populations to human immunodeficiency virus (HIV). This is mostly caused by the lack of knowledge on the topic among the inmates; the lack of prophylaxis; the high percentage of risky behaviors in jail, such as sexual abuse, unprotected sexual intercourses, and injective drug use; and the generally low perception of the risk of transmission. It has also been observed that the problem does not cease to exist at the moment of release, but it also may be aggravated by the weak support system or the total absence of programs for people living with HIV/AIDS (PLWHA) to avoid discontinuation of antiretroviral drugs. Difficulty in providing housing and jobs and, therefore, a form of stability for ex-detainees, also contributes to none adherence to antiretroviral therapy. Among the detainees, there are also categories of people more susceptible to discrimination and violence and, therefore, to risky behaviors, such as black people, Hispanics, transgender people, and men who have sex with men (MSM). We reviewed the literature in order to provide a more complete picture on the situation of PLWHA in jail and to also analyze the difficulties of ex-detainees in adhering to HIV therapy.
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Brewer R, Ramani SL, Khanna A, Fujimoto K, Schneider JA, Hotton A, Wilton L, Escobedo T, Harawa NT. A Systematic Review up to 2018 of HIV and Associated Factors Among Criminal Justice-Involved (CJI) Black Sexual and Gender Minority Populations in the United States (US). J Racial Ethn Health Disparities 2022; 9:1357-1402. [PMID: 34296420 PMCID: PMC8297427 DOI: 10.1007/s40615-021-01076-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022]
Abstract
Black men who have sex with men (BMSM) and Black transgender women (BTW) are impacted by dual epidemics of HIV and incarceration. We advanced understanding of the relationship between criminal justice involvement, HIV, and other key HIV-related characteristics among these key populations in the US. We conducted a systematic review up to 2018 and 47 articles met the inclusion criteria of scientific publications involving quantitative findings of US-based HIV-related studies focused on criminal justice-involved (CJI) BMSM and BTW. Overall, there was a dearth of studies focused specifically on BTW. Criminal justice involvement was relatively high among BMSM and BTW and more pronounced among BTW. The current evidence favors no association between incarceration and HIV acquisition among BMSM with limited information about BTW. Criminal justice involvement was associated with a greater likelihood of STIs among BMSM with mixed results for sexual risk behaviors. Criminal justice settings served as an important venue for HIV testing/diagnosis for both BMSM and BTW. However, these settings were not conducive for subsequent stages of the HIV care continuum. Studies pointed to an independent association between criminal justice involvement, substance use, housing instability, and greater odds of incarceration among BMSM who were unemployed and had limited education. Future incarceration was associated with high levels of perceived racism among BMSM. Among young BMSM, high network criminal justice prevalence was also associated with sexual risk behaviors, poorer mental health outcomes, drug use, and housing instability. CJI BMSM and BTW represent a critical subpopulation to end the HIV epidemic in the US.
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Affiliation(s)
- Russell Brewer
- Department of Medicine, University of Chicago, 5837 S. Maryland Ave, MC5065, Chicago, IL, 60637, USA.
| | - Santhoshini L Ramani
- Department of Medicine, University of Chicago, 5837 S. Maryland Ave, MC5065, Chicago, IL, 60637, USA
| | - Aditya Khanna
- Department of Behavioral and Social Science, Brown University, Providence, RI, USA
| | - Kayo Fujimoto
- Division of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - John A Schneider
- Department of Medicine, University of Chicago, 5837 S. Maryland Ave, MC5065, Chicago, IL, 60637, USA
| | - Anna Hotton
- Department of Medicine, University of Chicago, 5837 S. Maryland Ave, MC5065, Chicago, IL, 60637, USA
| | - Leo Wilton
- State University of New York at Binghamton, Binghamton, NY, USA
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Tania Escobedo
- Department of Medicine, University of Chicago, 5837 S. Maryland Ave, MC5065, Chicago, IL, 60637, USA
| | - Nina T Harawa
- David Geffen School of Medicine, General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA, USA
- College of Medicine, Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
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Harawa NT, Schrode KM, Daniels J, Javanbakht M, Hotton A, Makgoeng S, Ragsdale A, Schneider J, Fujimoto K, Bolan R, Gorbach P. Factors predicting incarceration history and incidence among Black and Latino men who have sex with men (MSM) residing in a major urban center. PLoS One 2022; 17:e0265034. [PMID: 35259198 PMCID: PMC8903243 DOI: 10.1371/journal.pone.0265034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/22/2022] [Indexed: 11/18/2022] Open
Abstract
We analyzed data from a cohort of Black and Latino men who have sex with men (MSM) in order to identify correlates of prevalent and incident incarceration, including potential predictors related to their status as sexual and gender minorities (SGMs). Baseline and follow-up self-administered survey data were examined from Los Angeles County participants' ages 18-45 years at enrollment who were either HIV negative or living with HIV, but recruited to over represent men who used drugs and men with unsuppressed HIV infection. Multivariable logistic regression models were developed to identify predictors of baseline incarceration history and of incident incarceration over study follow-up among 440 and 338 participants, respectively. Older age, Black race, low socioeconomic status, homelessness, stimulant use, and depression symptoms were associated with baseline incarceration history. The only SGM-related factor associated with baseline incarceration history was having experienced violence based on sexual orientation identity. Just one statistically significant, independent positive predictor of incident incarceration was identified: prior incarceration, whereas having four or more friends that could lend money was a statistically significant protective factor against incident incarceration. Fundamental Cause Theory provides a useful framework to explain identified predictors of incarceration. Addressing poverty, housing instability, inadequate access to health care, and their root causes is critical to reducing incarceration rates in this population, as is expanded access to both diversion and anti-recidivism programs and to evidence-based treatment for stimulant use disorders.
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Affiliation(s)
- Nina T. Harawa
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States of America
- Department of Psychiatry and Human Behaviors, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States of America
- * E-mail:
| | - Katrina M. Schrode
- Department of Psychiatry and Human Behaviors, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States of America
| | - Joseph Daniels
- Department of Psychiatry and Human Behaviors, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States of America
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Anna Hotton
- Department of Medicine, University of Chicago, Chicago, IL, United States of America
| | - Solomon Makgoeng
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Amy Ragsdale
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States of America
| | - John Schneider
- Department of Medicine, University of Chicago, Chicago, IL, United States of America
- Chicago Center for HIV Elimination, Chicago, IL, United States of America
| | - Kayo Fujimoto
- Division of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Robert Bolan
- Department of Health Services, Los Angeles LGBT Center, Los Angeles, CA, United States of America
| | - Pamina Gorbach
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States of America
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Dangerfield DT, Heidari O, Cooper J, Allen S, Lucas GM. Motivations for opioid and stimulant use among drug using black sexual minority men: A life course perspective. Drug Alcohol Depend 2020; 215:108224. [PMID: 32777690 PMCID: PMC7502465 DOI: 10.1016/j.drugalcdep.2020.108224] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION HIV-related disparities persist among U.S. Black sexual minority men (BSMM). Generational differences in drug use trends and the HIV/AIDS epidemic have created different risk trajectories for BSMM. This study explored age-related differences in the profiles, motivations, and contexts of opioid and stimulant use among drug using BSMM. METHODS Participants were recruited using active and passive strategies and in-depth qualitative interviews were conducted among 30 BSMM in Baltimore, MD from December 2018 to March 2019. Exploratory drug testing was conducted to confirm drug use and identify the presence of synthetic materials. Thematic analysis was conducted guided by Life Course theoretical domains. RESULTS Participants' ages ranged from 25-63 (mean age 41, SD = 12.4); 40 % were under age 35, 60 % were age 35 and older. Most (86.7 %) were living with HIV. Older BSMM attributed drug use initiation to social trends and sexual partners; younger men shared that prescription painkiller use led to misuse to address emotional pain. Across age groups, childhood sexual abuse and other major events along the life course increased BSMM's drug use as a coping strategy. DISCUSSION AND CONCLUSION HIV and drug use interventions should support BSMM through targeted mental health services and trauma-informed healthcare models.
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Gheibi Z, Dianatinasab M, Haghparast A, Mirzazadeh A, Fararouei M. Gender difference in all-cause mortality of people living with HIV in Iran: findings from a 20-year cohort study. HIV Med 2020; 21:659-667. [PMID: 32876392 DOI: 10.1111/hiv.12940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 07/09/2020] [Accepted: 07/11/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Gender differences in the efficacy of treatment and the mortality of HIV-infected patients have not yet been fully elucidated. For the first time, we used data from a 20-year cohort of people living with HIV (PLWH) in four provinces (Fars, Bushehr, Bandar Abbas, and Kohgiluyeh and Boyer-Ahmad) in the southern part of Iran to assess the gender difference in all-cause mortality in PLWH in Iran. METHODS We analysed data for 1216 patients aged ≥ 15 years who were diagnosed with HIV/AIDS between 1997 and 2017. Three hundred and fourteen (25.8%) were women. RESULTS The death rate from all causes among women was 13.7% vs. 43.8% among men (P < 0.001). All-cause mortality was significantly associated with gender [the adjusted hazard ratio (aHR) for men compared with women was 3.20], not being on antiretroviral therapy (ART) compared with being on ART at the last visit (aHR 5.42), older age (aHR 1.03), delayed HIV diagnosis compared with early diagnosis (aHR 1.72), history of incarceration (aHR 1.57), higher log CD4 count at diagnosis (aHR 0.54), and prophylaxis for Pneumocystis pneumonia (aHR 0.09). CONCLUSIONS The results of this 20-year cohort study suggest that gender is an important predictor of survival among HIV-infected patients. Improving early HIV diagnosis and early ART initiation in men, as well as increased access to hepatitis C virus treatment are needed to increase the survival rate of HIV-infected patients in Iran.
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Affiliation(s)
- Z Gheibi
- Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M Dianatinasab
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran.,Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - A Haghparast
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A Mirzazadeh
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - M Fararouei
- Shiraz HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Takada S, Ettner SL, Harawa NT, Garland WH, Shoptaw SJ, Cunningham WE. Life Chaos is Associated with Reduced HIV Testing, Engagement in Care, and ART Adherence Among Cisgender Men and Transgender Women upon Entry into Jail. AIDS Behav 2020; 24:491-505. [PMID: 31396766 PMCID: PMC6994355 DOI: 10.1007/s10461-019-02570-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Life chaos, the perceived inability to plan for and anticipate the future, may be a barrier to the HIV care continuum for people living with HIV who experience incarceration. Between December 2012 and June 2015, we interviewed 356 adult cisgender men and transgender women living with HIV in Los Angeles County Jail. We assessed life chaos using the Confusion, Hubbub, and Order Scale (CHAOS) and conducted regression analyses to estimate the association between life chaos and care continuum. Forty-eight percent were diagnosed with HIV while incarcerated, 14% were engaged in care 12 months prior to incarceration, mean antiretroviral adherence was 65%, and 68% were virologically suppressed. Adjusting for sociodemographics, HIV-related stigma, and social support, higher life chaos was associated with greater likelihood of diagnosis while incarcerated, lower likelihood of engagement in care, and lower adherence. There was no statistically significant association between life chaos and virologic suppression. Identifying life chaos in criminal-justice involved populations and intervening on it may improve continuum outcomes.
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Affiliation(s)
- Sae Takada
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
- Veterans Affairs Health Services Research and Development Service, Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, USA.
| | - Susan L Ettner
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Nina T Harawa
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- College of Medicine, Charles R. Drew University, Los Angeles, CA, USA
| | - Wendy H Garland
- Los Angeles County Department of Public Health, Division of HIV and STD Programs, Los Angeles, CA, USA
| | - Steve J Shoptaw
- Department of Family Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - William E Cunningham
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
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Brewer R, Issema R, Moore M, Chrestman S, Mukherjee S, Odlum M, Schneider JA. Correlates of Durable Viral Suppression (DVS) Among Criminal Justice-involved (CJI) Black Men Living with HIV in Louisiana. AIDS Behav 2019; 23:2980-2991. [PMID: 31250229 DOI: 10.1007/s10461-019-02578-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Durable viral suppression (DVS) is needed to reduce HIV transmission risk and prevent new HIV infections. We examined changes in viral suppression and correlates of DVS among 97 criminal justice-involved (CJI) Black men living with HIV in Louisiana enrolled in a linkage, re-engagement, and retention in care intervention. Most participants (75%) were Black men who have sex with men. Forty-four percent (44%) were virally suppressed at baseline and only 20% had achieved DVS over a 12-month period. Multinomial logistic regression analyses showed that compared with DVS participants, those with no viral suppression (NVS) and some viral suppression (SVS) were more likely to have lived with HIV for a longer period of time and were less likely to be adherent at baseline. Medication adherence was critical for DVS among this sample of CJI Black men living with HIV who represent a high priority population for HIV care and treatment interventions.
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Affiliation(s)
- Russell Brewer
- Department of Medicine, University of Chicago, Chicago, IL, USA.
- Chicago Center for HIV Elimination, Chicago, IL, USA.
| | - Rodal Issema
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, Chicago, IL, USA
| | - Mary Moore
- Dillard University, New Orleans, LA, USA
| | | | - Snigdha Mukherjee
- Educational Commission for Foreign Graduates (ECFG), Philadelphia, PA, USA
| | | | - John A Schneider
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, Chicago, IL, USA
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11
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Antoniou T, Mishra S, Matheson F, Smith-Merrill D, Challacombe L, Rowe J, DiCenso AM, Kouyoumdjian FG, Wobeser W, Kendall C, Loutfy M, Tsang J, Kanee L, Strike C. Using concept mapping to inform the development of a transitional reintegration intervention program for formerly incarcerated people with HIV. BMC Health Serv Res 2019; 19:761. [PMID: 31660976 PMCID: PMC6816153 DOI: 10.1186/s12913-019-4595-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
Background Accessing HIV-related care is challenging for formerly incarcerated people with HIV. Interventions informed by the perspectives of these individuals could facilitate engagement with care and address competing priorities that may act as barriers to this process. Methods We used concept mapping to identify and prioritize the main obstacles to engaging with HIV-related care following prison release. In brainstorming sessions, formerly incarcerated people with HIV generated responses to a focused prompt regarding the main barriers to reengaging with care. These were consolidated in 35 statements. Next, participants sorted the consolidated list of responses into groups and rated each from lowest to highest in terms of its importance and feasibility of being addressed. We used cluster analysis to generate concept maps that were interpreted with participants. Results Overall, 39 participants participated in brainstorming sessions, among whom 18 returned for rating and sorting. Following analysis, a seven-cluster map was generated, with participants rating the ‘Practical Considerations’ (e.g. lack of transportation from prison) and ‘Survival Needs’ (e.g. securing housing and food) clusters as most important. Although ratings were generally similar between women and men, women assigned greater importance to barriers related to reconnecting with children. Conclusions Using concept mapping, we worked with formerly incarcerated people with HIV to identify and prioritize key challenges related to accessing health and social services following prison release. Transitional intervention programs should include programs and processes that address meeting basic subsistence needs and overcoming logistical barriers related to community re-entry.
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Affiliation(s)
- Tony Antoniou
- Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, 410 Sherbourne Street, 4th Floor, Toronto, Ontario, M4X 1K2, Canada. .,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
| | - Sharmistha Mishra
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Flora Matheson
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Centre of Criminology and Sociolegal Studies, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Janet Rowe
- Prisoners HIV/AIDS Support Action Network, Toronto, Ontario, Canada
| | | | - Fiona G Kouyoumdjian
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Claire Kendall
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.,C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Mona Loutfy
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Jenkin Tsang
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Lauren Kanee
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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12
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Extended-release Naltrexone Improves Viral Suppression Among Incarcerated Persons Living with HIV and Alcohol use Disorders Transitioning to the Community: Results From a Double-Blind, Placebo-Controlled Trial. J Acquir Immune Defic Syndr 2019; 79:92-100. [PMID: 29781884 DOI: 10.1097/qai.0000000000001759] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To determine whether extended-release naltrexone (XR-NTX) would improve or maintain viral suppression (VS) among incarcerated individuals with HIV and alcohol use disorders (AUDs) transitioning to the community. DESIGN A randomized, double-blind, placebo-controlled trial was conducted among incarcerated individuals with HIV and AUDs transitioning to the community from 2010 through 2016. METHODS Eligible participants (N = 100) were randomized 2:1 to receive 6 monthly injections of XR-NTX (n = 67) or placebo (n = 33) starting at release and continued for 6 months. The primary and secondary outcomes were the proportion that maintained or improved VS at <200 and <50 copies per milliliter from baseline to 6 months, respectively, using an intention-to-treat analysis. RESULTS Participants allocated to XR-NTX improved VS from baseline to 6 months for <200 copies per milliliter (48.0%-64.2%, P = 0.024) and for <50 copies per milliliter (31.0%-56.7%, P = 0.001), whereas the placebo group did not (<200 copies/mL: 64%-42.4%, P = 0.070; <50 copies/mL: 42.0%-30.3%, P = 0.292). XR-NTX participants were more likely to achieve VS than the placebo group at 6 months (<200 copies/mL: 64.2% vs. 42.4%; P = 0.041; <50 copies/mL: 56.7% vs. 30.3%; P = 0.015). XR-NTX independently predicted VS [<200 copies/mL: adjusted odds ratio (aOR) = 2.68, 95% confidence interval (CI) = 1.01 to 7.09, P = 0.047; <50 copies/mL: aOR = 4.54; 95% CI = 1.43 to 14.43, P = 0.009] as did receipt of ≥3 injections (<200 copies/mL: aOR = 3.26; 95% CI = 1.26 to 8.47, P = 0.010; <50 copies/mL: aOR = 6.34; 95% CI = 2.08 to 19.29, P = 0.001). Reductions in alcohol consumption (aOR = 1.43, 95% CI = 1.03 to 1.98, P = 0.033) and white race (aOR = 5.37, 95% CI = 1.08 to 27.72, P = 0.040) also predicted VS at <50 copies per milliliter. CONCLUSIONS XR-NTX improves or maintains VS after release to the community for incarcerated people living with HIV and AUDs.
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13
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Methamphetamine use drives decreases in viral suppression for people living with HIV released from a large municipal jail: Results of the LINK LA clinical trial. Drug Alcohol Depend 2019; 202:178-184. [PMID: 31352308 PMCID: PMC6686887 DOI: 10.1016/j.drugalcdep.2019.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 05/08/2019] [Accepted: 05/08/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND People living with HIV (PLWH) often experience decreases in HIV viral suppression (VS) after release from jail. The Linking Inmates to Care in LA (LINK LA) peer navigation intervention helped maintain VS 12 months after release from jail compared to standard of care. In this study, we analyzed correlates of substance use and tested whether substance use was an independent correlate of decreased VS in LINK LA participants. METHODS We analyzed LINK LA data collected at baseline, 3, and 12 months. We defined high-risk drug use as any reported methamphetamine, cocaine, or opioid use in the 30 days prior to a study visit (or jail entry at baseline). We used generalized linear mixed models to test associations of sociodemographic variables with type of substance used, and we tested correlates of VS while controlling for time, the intervention, and their interaction. RESULTS At baseline (n = 356), 71% of participants reported high-risk drug use: 58%, methamphetamine; 17%, cocaine; 7%, heroin; and 4%, prescription opioids. Non-Hispanic Whites and those younger than 35 were most likely to use methamphetamine; Blacks were most likely to use cocaine; people who inject drugs were most likely to use opioids. Participants who used high-risk drugs had 53% lower adjusted odds than non-users of maintaining VS (AOR 0.47, 95% CI 0.31-0.70, p < 0.001). CONCLUSION High-risk drug use, dominated by methamphetamine use, independently correlated with decreased VS among recently incarcerated PLWH. Improving HIV care continuum outcomes among populations leaving jail requires attention to efforts to address high-risk drug use.
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14
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Dangerfield DT, Harawa NT, Fernandez MI, Hosek S, Lauby J, Joseph H, Frank HG, Bluthenthal RN. Age Cohort Differences in Sexual Behaviors Among Black Men Who Have Sex With Men and Women. JOURNAL OF SEX RESEARCH 2018; 55:1012-1021. [PMID: 29377734 PMCID: PMC6146075 DOI: 10.1080/00224499.2017.1423016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Little attention has focused on generational or age-related differences in human immunodeficiency virus/sexually transmitted infection (HIV/STI) risk behaviors among Black men who have sex with men and women (BMSMW). We examined sexual risk behaviors between BMSMW ages 40 and under compared to over age 40. Analysis was conducted using Centers for Disease Control and Prevention (CDC)-sponsored intervention data among BMSMW in Los Angeles, Chicago, and Philadelphia (n = 546). Pearson's chi-square tests were conducted to evaluate associations between age groups and behavioral outcomes. Logistic regression was used to evaluate the odds of behavioral outcomes by age group, adjusting for sexual orientation and study location, within strata of HIV status. HIV-positive BMSMW over age 40 had 62% reduced odds of having a nonmain female partner of HIV-negative or unknown status compared to those ages 40 and under (adjusted odds ratio [AOR] 0.38, 95% confidence interval [CI] = 0.15, 0.95). Among HIV-negative BMSMW, the older cohort was associated with greater odds of having condomless insertive anal intercourse (IAI) with most recent main male partner (AOR 2.44, 95% CI = 1.12, 5.32) and having a concurrent partnership while with their recent main female partner (AOR = 2.6, 95% CI = 1.10, 4.67). For both groups, odds of engaging in certain risk behaviors increased with increasing age. Prevention efforts should consider generational differences and age in HIV risks among BMSMW.
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Affiliation(s)
| | - Nina T. Harawa
- Department of Medicine, UCLA Geffen School of Medicine & Department of Psychiatry and Human Behavior, Charles R. Drew University of Medicine and Science, Los Angeles, CA
| | - M. Isabel Fernandez
- College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL
| | - Sybil Hosek
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, IL
| | - Jennifer Lauby
- Research & Evaluation, Public Health Management Corporation, Philadelphia, PA
| | - Heather Joseph
- U.S. Public Health Service, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Ricky N. Bluthenthal
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, CA
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15
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Baćak V, Thurman K, Eyer K, Qureshi R, Bird JDP, Rivera LM, Kim SA. Incarceration as a Health Determinant for Sexual Orientation and Gender Minority Persons. Am J Public Health 2018; 108:994-999. [PMID: 29927654 PMCID: PMC6050838 DOI: 10.2105/ajph.2018.304500] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2018] [Indexed: 11/04/2022]
Abstract
Incarceration is considerably more prevalent among sexual and gender minority persons (SGM) than among the general population. Once behind bars, they are at the greatest risk for health-related harms. Although a growing number of studies have assessed health disparities produced by mass incarceration, scholars are yet to systematically assess the health consequences of incarceration on the basis of sexual orientation and gender identity. We invite public health scholars to study the effects of incarceration on health in the SGM population and provide a roadmap to aid these research efforts. First, we document the disproportionate presence of SGM persons in jails and prisons. Second, we note health-related risks that are the most salient for this population. Third, we recommend examining heterogeneity in the effects of incarceration by teasing out distinct risks for groups defined by sexual orientation, gender identity, and race/ethnicity. Fourth, we note methodological challenges with respect to measurement and assessing causality. Finally, we discuss the importance of health care access and quality and the need to study health during incarceration and afterward.
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Affiliation(s)
- Valerio Baćak
- Valerio Baćak is with the School of Criminal Justice, Rutgers University-Newark, Newark, NJ. Kate Thurman is with the Rutgers Center for Gender, Sexuality, Law & Policy, Rutgers Law School, Newark. Katie Eyer and Suzanne A. Kim are with the Rutgers Law School, Newark. Rubab Qureshi is with the School of Nursing, Rutgers University-Newark. Jason D. P. Bird is with the Department of Social Work, Rutgers University-Newark. Luis M. Rivera is with the Department of Psychology, Rutgers University-Newark
| | - Kate Thurman
- Valerio Baćak is with the School of Criminal Justice, Rutgers University-Newark, Newark, NJ. Kate Thurman is with the Rutgers Center for Gender, Sexuality, Law & Policy, Rutgers Law School, Newark. Katie Eyer and Suzanne A. Kim are with the Rutgers Law School, Newark. Rubab Qureshi is with the School of Nursing, Rutgers University-Newark. Jason D. P. Bird is with the Department of Social Work, Rutgers University-Newark. Luis M. Rivera is with the Department of Psychology, Rutgers University-Newark
| | - Katie Eyer
- Valerio Baćak is with the School of Criminal Justice, Rutgers University-Newark, Newark, NJ. Kate Thurman is with the Rutgers Center for Gender, Sexuality, Law & Policy, Rutgers Law School, Newark. Katie Eyer and Suzanne A. Kim are with the Rutgers Law School, Newark. Rubab Qureshi is with the School of Nursing, Rutgers University-Newark. Jason D. P. Bird is with the Department of Social Work, Rutgers University-Newark. Luis M. Rivera is with the Department of Psychology, Rutgers University-Newark
| | - Rubab Qureshi
- Valerio Baćak is with the School of Criminal Justice, Rutgers University-Newark, Newark, NJ. Kate Thurman is with the Rutgers Center for Gender, Sexuality, Law & Policy, Rutgers Law School, Newark. Katie Eyer and Suzanne A. Kim are with the Rutgers Law School, Newark. Rubab Qureshi is with the School of Nursing, Rutgers University-Newark. Jason D. P. Bird is with the Department of Social Work, Rutgers University-Newark. Luis M. Rivera is with the Department of Psychology, Rutgers University-Newark
| | - Jason D P Bird
- Valerio Baćak is with the School of Criminal Justice, Rutgers University-Newark, Newark, NJ. Kate Thurman is with the Rutgers Center for Gender, Sexuality, Law & Policy, Rutgers Law School, Newark. Katie Eyer and Suzanne A. Kim are with the Rutgers Law School, Newark. Rubab Qureshi is with the School of Nursing, Rutgers University-Newark. Jason D. P. Bird is with the Department of Social Work, Rutgers University-Newark. Luis M. Rivera is with the Department of Psychology, Rutgers University-Newark
| | - Luis M Rivera
- Valerio Baćak is with the School of Criminal Justice, Rutgers University-Newark, Newark, NJ. Kate Thurman is with the Rutgers Center for Gender, Sexuality, Law & Policy, Rutgers Law School, Newark. Katie Eyer and Suzanne A. Kim are with the Rutgers Law School, Newark. Rubab Qureshi is with the School of Nursing, Rutgers University-Newark. Jason D. P. Bird is with the Department of Social Work, Rutgers University-Newark. Luis M. Rivera is with the Department of Psychology, Rutgers University-Newark
| | - Suzanne A Kim
- Valerio Baćak is with the School of Criminal Justice, Rutgers University-Newark, Newark, NJ. Kate Thurman is with the Rutgers Center for Gender, Sexuality, Law & Policy, Rutgers Law School, Newark. Katie Eyer and Suzanne A. Kim are with the Rutgers Law School, Newark. Rubab Qureshi is with the School of Nursing, Rutgers University-Newark. Jason D. P. Bird is with the Department of Social Work, Rutgers University-Newark. Luis M. Rivera is with the Department of Psychology, Rutgers University-Newark
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16
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Re-entry experiences of Black men living with HIV/AIDS after release from prison: Intersectionality and implications for care. Soc Sci Med 2018; 211:78-86. [PMID: 29913303 DOI: 10.1016/j.socscimed.2018.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 05/28/2018] [Accepted: 06/08/2018] [Indexed: 01/06/2023]
Abstract
RATIONALE Both the HIV epidemic and incarceration disproportionately affect Black men in the United States. A critical period for incarcerated Black men living with HIV/AIDS is re-entry into the community, which is often associated with adverse health outcomes. Additionally, Black men living with HIV/AIDS involved in the criminal justice system are burdened by multiple, intersecting disadvantaged identities and social positions. OBJECTIVE This study aimed to examine community re-entry experiences among Black men living with HIV/AIDS from an intersectional perspective. METHOD In-depth, semi-structured interviews were conducted with 16 incarcerated Black men in Wisconsin, at pre-release from prison and six months after re-entry. Thematic analysis guided by intersectionality theory was used to analyze interview transcripts. RESULTS Seven emerged themes included Intersectional Identities and Social Positions, Family Support, Neighborhood Violence, Relationship with Law Enforcement, Employment, Mental Health Concerns, and Medical Care and Medication Management. Intersecting identities and social positions interact with factors at multiple levels to inform health and HIV care. A conceptual framework was developed to illustrate relationships among themes. CONCLUSIONS Findings demonstrate the relevance of intersectionality theory in HIV care with Black men involved in criminal justice system. Incorporating a social-ecological perspective into intersectionality framework could be useful in theoretical and empirical research. Disenfranchised communities may particularly benefit from interventions that address community- and systemic-level issues.
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17
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Vermund SH. The Continuum of HIV Care in the Urban United States: Black Men Who Have Sex With Men (MSM) Are Less Likely Than White MSM to Receive Antiretroviral Therapy. J Infect Dis 2017; 216:790-794. [PMID: 28368523 PMCID: PMC5853891 DOI: 10.1093/infdis/jix009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/05/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Sten H Vermund
- Vanderbilt Institute for Global Health and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
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18
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Batchelder AW, Safren S, Mitchell AD, Ivardic I, O’Cleirigh C. Mental health in 2020 for men who have sex with men in the United States. Sex Health 2017; 14:59-71. [PMID: 28055823 PMCID: PMC5953431 DOI: 10.1071/sh16083] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/26/2016] [Indexed: 11/23/2022]
Abstract
Despite continued advances in HIV prevention and treatment, gay and bisexual men and other men who have sex with men (MSM) remain the population most impacted by HIV/AIDS in the US and many other Western countries. Additionally, MSM are disproportionately affected by various psychological problems, including depression, distress, trauma and substance use. These challenges frequently co-occur, and are associated with higher rates of behaviours related to HIV acquisition and transmission, HIV infection, and, for those living with HIV/AIDS, lower levels of treatment engagement. Moreover, racial disparities exist among MSM in the US; for example, young African American MSM bear a disproportionate burden of the continuing HIV epidemic, likely related to disparate HIV prevalence in partner pools as well as long-standing structural inequities. In this review, the mental health challenges facing MSM primarily in the US, related to HIV and STI prevention and across the HIV care cascade, including HIV diagnosis, engagement and retention in care, and antiretroviral adherence, are illustrated. Disparities among MSM including racial and ethnic, age-related and structural barriers associated with HIV prevention and treatment, as well as current interventions, are also described. Moving forward towards 2020, resources will be needed to assess and implement scalable intervention strategies to address psychological and social barriers to HIV and STI risk reduction and treatment for MSM, with a particular focus on the most vulnerable subpopulations. As access to prevention and treatment strategies expand, and new breakthroughs continue to emerge, behavioural strategies will continue to be needed to reduce risk and increase uptake and engagement among MSM most at risk through 2020 and beyond.
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Affiliation(s)
- Abigail W. Batchelder
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 7th floor, Boston, MA 02114, USA
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA
| | - Steven Safren
- Department of Psychology, University of Miami, PO Box 248185, Coral Gables, FL 33124, USA
| | - Avery D. Mitchell
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA
- Department of Psychology and Neuroscience, University of North Carolina, 235 E. Cameron Avenue, Chapel Hill, NC 27599, USA
| | - Ivan Ivardic
- Department of Psychology, University of Miami, PO Box 248185, Coral Gables, FL 33124, USA
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 7th floor, Boston, MA 02114, USA
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA
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19
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Beckwith C, Castonguay BU, Trezza C, Bazerman L, Patrick R, Cates A, Olsen H, Kurth A, Liu T, Peterson J, Kuo I. Gender Differences in HIV Care among Criminal Justice-Involved Persons: Baseline Data from the CARE+ Corrections Study. PLoS One 2017; 12:e0169078. [PMID: 28081178 PMCID: PMC5231337 DOI: 10.1371/journal.pone.0169078] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 12/07/2016] [Indexed: 11/17/2022] Open
Abstract
Background HIV-infected individuals recently released from incarceration have suboptimal linkage and engagement in community HIV care. We conducted a study to evaluate an information and communication technology intervention to increase linkage to community care among HIV-infected persons recently involved in the criminal justice (CJ) system. Baseline characteristics including risk behaviors and HIV care indicators are reported and stratified by gender. Methods We recruited HIV-infected individuals in the District of Columbia jail and persons with a recent history of incarceration through community and street outreach. Participants completed a baseline computer-assisted personal interview regarding HIV care and antiretroviral treatment (ART) adherence, substance use, and sexual behaviors. CD4 and HIV plasma viral load testing were performed at baseline or obtained through medical records. Data were analyzed for the sample overall and stratified by gender. Results Of 110 individuals, 70% were community-enrolled, mean age was 40 (SD = 10.5), 85% were Black, and 58% were male, 24% female, and 18% transgender women. Nearly half (47%) had condomless sex in the three months prior to incarceration. Although drug dependence and hazardous alcohol use were highly prevalent overall, transgender women were more likely to have participated in drug treatment than men and women (90%, 61%, and 50% respectively; p = 0.01). Prior to their most recent incarceration, 80% had an HIV provider and 91% had ever taken ART. Among those, only 51% reported ≥90% ART adherence. Fewer women (67%) had received HIV medications during their last incarceration compared to men (96%) and transgender women (95%; p = 0.001). Although neither was statistically significant, transgender women and men had higher proportions of baseline HIV viral suppression compared to women (80%, 69%, and 48.0% respectively, p>0.05); a higher proportion of women had a CD4 count ≤200 compared to men and transgender women (17%, 8% and 5% respectively; p>0.05). Conclusions In this study, HIV-infected persons with recent incarceration in Washington, DC reported important risk factors and co-morbidities, yet the majority had access to HIV care and ART prior to, during, and after incarceration. Self-reported ART adherence was sub-optimal, and while there were not statistically significant differences, CJ-involved women appeared to be at greatest risk of poor HIV outcomes. Trial registration Registered on ClinicalTrials.gov on 10/16/2012. Reference number: NCT01721226.
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Affiliation(s)
- Curt Beckwith
- The Miriam Hospital, Providence, RI, United States of America.,Brown University Alpert School of Medicine, Providence, RI, United States of America
| | - Breana Uhrig Castonguay
- George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Claudia Trezza
- George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Lauri Bazerman
- The Miriam Hospital, Providence, RI, United States of America
| | - Rudy Patrick
- George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Alice Cates
- George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Halli Olsen
- George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Ann Kurth
- Yale University School of Nursing, New Haven, CT, United States of America
| | - Tao Liu
- Brown University School of Public Health, Providence, RI, United States of America
| | - James Peterson
- George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Irene Kuo
- George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
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