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Mudiope P, Mathers B, Nangendo J, Samuel M, Mutamba BB, Alamo S, Nanyenya N, Makumbi F, Laker-Oketta M, Wanyenze R. Characterising People who inject drugs, and association with HIV infection: A Situation Analysis in Kampala city, Uganda. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.31.24308282. [PMID: 38853844 PMCID: PMC11160897 DOI: 10.1101/2024.05.31.24308282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Background Uganda has implemented targeted interventions to address the rising burden of injection drug use, yet barriers persist in reaching persons who inject drugs (PWID). This study describes the characteristics of people who inject drugs, physical and mental health states, and associated risk behaviors, to inform the designing of programs that are tailored to client's needs and preferences. Methods A cross-sectional survey was conducted between August and December 2023 at selected hotspots in Kampala, interviewing 499 PWID aged ≥18 years. Data was collected using a semi-structured questionnaire administered by peer educators and Uganda Harm Reduction Network (UHRN) counselors. Measurements included socio-demographics, injecting drug use and sexual risk behaviors, and medical history. HIV serostatus was dtermined by self-report and testing for participants who had no recent history of testing and consented to be tested. Binary logistic regression was used to establish the relationship between HIV infection and risky drug- and sexual behaviors of PWID. Results Participants were predominantly Ugandan (95.2%), male (73.2%), unmarried (55.9%), unemployed (81.8%), with higher levels of education and varying ages. Mental disorders were prevalent, with 48.7% reporting at least one underlying condition, including depression (30.8%) and anxiety (9.6%). Physical health issues were also noted, with reported cases of fever (32.9%), cough (32.5%), malaria (22%) and sexually transmitted infections (STIs) (15%).Regarding drug use patterns, the majority (82.6%) were introduced to drugs by close acquaintances, with 70.9% categorized as people who inject drugs. HIV prevalence among injecting drug users was 3.7%, with higher rates among females (8.4%) and non-Ugandans (16.7%). Being female and experiencing difficulty accessing sterile injection materials were associated with HIV-positive status, highlighting the complex interplay between socio-demographic factors, risk behaviors, and HIV infection among individuals with injecting drug use Disorder in Uganda. Conclusion Our study provides a comprehensive insight into the socio-demographic, mental, physical health, and HIV risk behavoir of PWID in Kampala, Uganda. The findings indicate significant vulnerabilities to injecting drug use, mental disorders, and high-risk behaviors that predispose this population to HIV infection. Despite a low HIV prevalence compared to previous estimates, the interplay between drug use, risky injecting practices, and sexual behaviors suggests an urgent need for targeted interventions to address these intertwined challenges.
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Affiliation(s)
- Peter Mudiope
- Makerere University School of Public Health, Kampala Uganda
| | - Bradley Mathers
- Global HIV, Hepatitis and Sexually Transmitted Infections Programms, World Health Organization, Geneva, Switzerland
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Joanita Nangendo
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mutyaba Samuel
- Makerere University School of Public Health, Kampala Uganda
| | | | - Stella Alamo
- United States of America Centers for Disease Control and Prevention, Kampala, Uganda
| | | | | | - Miriam Laker-Oketta
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rhoda Wanyenze
- Makerere University School of Public Health, Kampala Uganda
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Dickson-Gomez J, Krechel S, Katende D, Johnston B, Twaibu W, Glasman L, Ogwal M, Musinguzi G. The Role of Context in Integrating Buprenorphine into a Drop-In Center in Kampala, Uganda, Using the Consolidated Framework for Implementation Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10382. [PMID: 36012015 PMCID: PMC9407835 DOI: 10.3390/ijerph191610382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/02/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Although Africa has long borne the brunt of the human immunodeficiency virus (HIV) epidemic, until recently, the continent has been considered largely free of illicit drug use and injection drug use in particular. In Uganda, the number of people who use or inject drugs (PWUD and PWID, respectively) has increased, and PWID are a key population at high risk for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection. However, harm reduction practices, including providing clean injection equipment and medication-assisted treatment (MAT), have only recently been piloted in the country. This project aims to integrate buprenorphine into a harm reduction drop-in center (DIC). METHODS The Consolidated Framework for Implementation Research was used to guide our preparations to integrate buprenorphine into existing practices at a harm reduction DIC. We conducted key informant interviews with members of a community advisory board and DIC staff to document this process, its successes, and its failures. RESULTS Results indicate that criminalization of drug use and stigmatization of PWUD challenged efforts to provide buprenorphine treatment in less regulated community settings. CONCLUSIONS DIC staff and their commitment to harm reduction and advocacy facilitated the process of obtaining necessary approvals.
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Affiliation(s)
- Julia Dickson-Gomez
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Sarah Krechel
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Dan Katende
- Uganda Harm Reduction Network, Kampala 31762, Uganda
| | - Bryan Johnston
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Wamala Twaibu
- Uganda Harm Reduction Network, Kampala 31762, Uganda
| | - Laura Glasman
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Moses Ogwal
- School of Public Health, Makerere University, Kampala 7072, Uganda
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Shimane T, Takahashi M, Kobayashi M, Takagishi Y, Takeshita Y, Kondo A, Omiya S, Takano Y, Yamaki M, Matsumoto T. Gender Differences in the Relationship between Methamphetamine Use and High-risk Sexual Behavior among Prisoners: A Nationwide, Cross-sectional Survey in Japan. J Psychoactive Drugs 2021; 54:9-17. [PMID: 33977855 DOI: 10.1080/02791072.2021.1918805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aimed to examine the relationship between methamphetamine (MA) use and high-risk sexual behavior among newly incarcerated prisoners in Japan. We conducted a secondary analysis using cross-sectional survey data, which constituted a nationwide prison sample surveyed between July and November 2017. In total, 699 participants (462 male and 237 female prisoners), who completed the self-administered questionnaire during imprisonment were recruited for the study. The prevalence of high-risk sexual behaviors was as follows: inconsistent condom use (78.4% male, 81.7% female), multiple sexual partners (61.3% male, 41.3% female), history of sexually transmitted diseases (14.1% male, 23.6% female), and trading sex for drugs (15.6% male, 17.7% female). A logistic regression analysis showed that MA use during sex increased the likelihood of high-risk sexual behavior in both male (adjusted odds ratio [AOR] = 5.86; 95% confidence interval [CI] = 3.41-10.07) and female prisoners (AOR = 2.58; 95% CI = 1.33-5.00). Additionally, in female prisoners, a history of sharing MA injection (AOR = 1.60; 95% CI = 1.06-2.42) increased high-risk sexual behavior. Our results indicate that harm reduction programs tailored according to the specific necessities of each gender to reduce high-risk sexual behaviors among MA users should be included in Japanese drug policies.
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Affiliation(s)
- Takuya Shimane
- Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masaru Takahashi
- Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.,Ochanomizu University, Tokyo, Japan
| | - Michiko Kobayashi
- Research Department, Research and Training Institute, Ministry of Justice of Japan, Urayasu, Chiba, Japan
| | - Yuriko Takagishi
- Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Psychology, Surugadai University, Saitama, Japan
| | - Yoshiko Takeshita
- Kawagoe Juvenile Prison, Ministry of Justice of Japan, Saitama, Japan
| | - Ayumi Kondo
- Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Soichiro Omiya
- Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.,Joetsu University of Education, Niigata, Japan
| | - Youichi Takano
- Yokohama Prison, Ministry of Justice of Japan, Kanagawa, Japan
| | - Mayuko Yamaki
- Training Institute for Correctional Personnel, Ministry of Justice of Japan, Tokyo, Japan
| | - Toshihiko Matsumoto
- Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
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Ahuja N, Schmidt M, Dillon PJ, Alexander AC, Kedia S. Online Narratives of Methamphetamine Use and Risky Sexual Behavior: Can Shame-Free Guilt Aid in Recovery? ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:323-332. [PMID: 32671499 DOI: 10.1007/s10508-020-01777-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 06/10/2020] [Accepted: 06/13/2020] [Indexed: 06/11/2023]
Abstract
Methamphetamine (meth) use is a recurring public health challenge in the U.S. In 2016, approximately 1.6 million Americans reported using meth. Meth use is associated with a number of adverse outcomes, including those associated with users' sexual health. In particular, meth use is linked to an increased risk for sexually transmitted infections and unplanned pregnancies. While studies have examined associations between substance use of various types-including meth use, and shame and guilt-few studies have examined relationships among substance use, sexual risk behaviors, and shame and guilt. No qualitative studies, to our knowledge, have studied all three of these phenomena in a sample of meth users. The present qualitative study explored the sexual risk behaviors and associated feelings of shame and guilt in relation to meth use. It draws from anonymous letters and stories (N = 202) posted to an online discussion forum by meth users and their family members. A grounded theory analysis of these narratives identified four primary themes pertaining to meth use and sexual behaviors: (1) feeling heightened sexual arousal and stimulation on meth, (2) experiencing sexual dissatisfaction on meth, (3) responding to sexual arousal and dissatisfaction, and (4) feeling ashamed and/or guilty. Ultimately, the present findings indicate that feelings of shame and guilt may arise more from the consequences of sexual risk behaviors stemming from meth use rather than meth use itself. The emotional toll of meth-induced sexual risk behaviors, particularly shame and guilt over the loss of meaningful relationships and self-respect due to multiple sexual partners, may provide an important opportunity for interventionists.
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Affiliation(s)
- Nikhil Ahuja
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA
| | - Michael Schmidt
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA
| | - Adam C Alexander
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Satish Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA.
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Beattie TS, Smilenova B, Krishnaratne S, Mazzuca A. Mental health problems among female sex workers in low- and middle-income countries: A systematic review and meta-analysis. PLoS Med 2020; 17:e1003297. [PMID: 32931504 PMCID: PMC7491736 DOI: 10.1371/journal.pmed.1003297] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 08/13/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The psychological health of female sex workers (FSWs) has emerged as a major public health concern in many low- and middle-income countries (LMICs). Key risk factors include poverty, low education, violence, alcohol and drug use, human immunodeficiency virus (HIV), and stigma and discrimination. This systematic review and meta-analysis aimed to quantify the prevalence of mental health problems among FSWs in LMICs, and to examine associations with common risk factors. METHOD AND FINDINGS The review protocol was registered with PROSPERO, number CRD42016049179. We searched 6 electronic databases for peer-reviewed, quantitative studies from inception to 26 April 2020. Study quality was assessed with the Centre for Evidence-Based Management (CEBM) Critical Appraisal Tool. Pooled prevalence estimates were calculated for depression, anxiety, post-traumatic stress disorder (PTSD), and suicidal behaviour. Meta-analyses examined associations between these disorders and violence, alcohol/drug use, condom use, and HIV/sexually transmitted infection (STI). A total of 1,046 studies were identified, and 68 papers reporting on 56 unique studies were eligible for inclusion. These were geographically diverse (26 countries), representing all LMIC regions, and included 24,940 participants. All studies were cross-sectional and used a range of measurement tools; none reported a mental health intervention. Of the 56 studies, 14 scored as strong quality, 34 scored as moderate, and 8 scored as weak. The average age of participants was 28.9 years (age range: 11-64 years), with just under half (46%) having up to primary education or less. The pooled prevalence rates for mental disorders among FSWs in LMICs were as follows: depression 41.8% (95% CI 35.8%-48.0%), anxiety 21.0% (95% CI: 4.8%-58.4%), PTSD 19.7% (95% CI 3.2%-64.6%), psychological distress 40.8% (95% CI 20.7%-64.4%), recent suicide ideation 22.8% (95% CI 13.2%-36.5%), and recent suicide attempt 6.3% (95% CI 3.4%-11.4%). Meta-analyses found significant associations between violence experience and depression, violence experience and recent suicidal behaviour, alcohol use and recent suicidal behaviour, illicit drug use and depression, depression and inconsistent condom use with clients, and depression and HIV infection. Key study limitations include a paucity of longitudinal studies (necessary to assess causality), non-random sampling of participants by many studies, and the use of different measurement tools and cut-off scores to measure mental health problems and other common risk factors. CONCLUSIONS In this study, we found that mental health problems are highly prevalent among FSWs in LMICs and are strongly associated with common risk factors. Study findings support the concept of overlapping vulnerabilities and highlight the urgent need for interventions designed to improve the mental health and well-being of FSWs.
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Affiliation(s)
- Tara S. Beattie
- Department of Global Health and Development, The London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Shari Krishnaratne
- Department of Global Health and Development, The London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - April Mazzuca
- School of Population and Public Health, University of British Columbia, Canada
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Dickson-Gomez J, Twaibu W, Christenson E, Dan K, Anguzu R, Homedi E, Mbona Tumwesigye N. Injection and sexual risk among people who use or inject drugs in Kampala, Uganda: An exploratory qualitative study. PLoS One 2020; 15:e0231969. [PMID: 32320448 PMCID: PMC7176107 DOI: 10.1371/journal.pone.0231969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 04/03/2020] [Indexed: 01/22/2023] Open
Abstract
Background Countries in Sub-Saharan Africa (SSA) have seen rapid increases in injection drug use since 2008. In Uganda, the Global Sate of Harm report and studies conducted by Makerere University Crane Surveys have estimated HIV prevalence among people who inject drugs (PWID) at approximately 17%. The objective of the research was to document injection and other drug-related risks among people who use drugs in Uganda to develop comprehensive HIV/HCV prevention interventions. Methods Between August and September 2018, we conducted qualitative interviews among male and female people who use drugs. Interview topics included the availability and accessibility of clean syringes, injection risks, overdose, sexual-risk behaviors, and the availability and accessibility of harm reduction and drug treatment services. Results Participants reported several injection-related risks including sharing and reusing syringes, pooling and mixing drugs in the same container, measuring drugs using syringes, getting prefilled injections from dealers, being injected by other people who inject drugs, and using contaminated water or blood to dilute drugs. Participants reported a scarcity of harm reduction services, although a few appear to have participated in the syringe exchange pilot conducted by the Uganda Harm Reduction Network (UHRN). Even fewer reported knowing organizations that helped people who use drugs abstain from or reduce their use. Medication assisted therapy (MAT) and naloxone to reverse overdoses are not currently available. Conclusions Comprehensive prevention and treatment services are needed in Uganda and should include expanded syringe exchange programs, social network HIV testing, HCV testing, provision of naloxone and MAT, and linkage to and retention in HIV care.
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Affiliation(s)
- Julia Dickson-Gomez
- Division of Epidemiology, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- * E-mail:
| | | | - Erica Christenson
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Katende Dan
- Uganda Harm Reduction Network, Kampala, Uganda
| | - Ronald Anguzu
- Division of Epidemiology, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Ethan Homedi
- Division of Epidemiology, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
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Berg RC, Molin SB, Nanavati J. Women Who Trade Sexual Services from Men: A Systematic Mapping Review. JOURNAL OF SEX RESEARCH 2020; 57:104-118. [PMID: 31264896 DOI: 10.1080/00224499.2019.1624680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Most research on transactional sex frame men as buyers and females as sellers of sex. We conducted a systematic mapping review of the empirical research on transactional sex where women form the demand (buyer) and men the supply (seller). We included 46 studies, of which 25 explicitly researched women as buyers of sex from male sellers, and 21 studies where this topic was a subset of larger topics. The majority of research on women who trade sexual services from men is published in the last 15 years, by female researchers, using cross-sectional or qualitative/ethnographic design, and from the perspective of males as sellers. While the women appear to be mature and financially independent, the men are young and socioeconomically vulnerable. Men's main motivation for the sexual-economic exchanges with women is financial, whereas women's motivations are largely satisfaction of sexual needs and a stereotyped erotic fantasy of black male hypersexuality. Condoms are often not used. Our review shows that there is a - possibly growing and diversifying - female consumer demand for male sexual services, and transactional sex where women trade sex from men is a complex social phenomenon firmly grounded in social, economic, political, and sexual relations.
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Affiliation(s)
- Rigmor C Berg
- Division of Health Services, Norwegian Institute of Public Health and Department of Community Medicine, University of Tromso
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Okafor CN, Christodoulou J, Bantjes J, Qondela T, Stewart J, Shoptaw S, Tomlinson M, Rotherman-Borus MJ. Understanding HIV Risk Behaviors Among Young Men in South Africa: A Syndemic Approach. AIDS Behav 2018; 22:3962-3970. [PMID: 30003507 PMCID: PMC6330132 DOI: 10.1007/s10461-018-2227-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Young men in South Africa experience several adverse socio-structural and psychosocial factors that may contribute HIV risk behaviors. This study applied a syndemic framework to explore whether these syndemic factors are interconnected and work in synergy to increase HIV risk behaviors. Five syndemic factors were assessed including: binge drinking, polydrug use, depressive symptoms, violence and food insecurity on two HIV risk behaviors: multiple sex partners and transactional sex. Participants were (N = 1233) young men aged 18-29 years from a township in Cape Town, South Africa. Bivariate logistic regression analysis demonstrated that many of the syndemic factors were related to one another. Pairwise interactions (on an additive scale) among the syndemic factors revealed significant positive interactions between binge drinking and violence on greater odds of reporting multiple sex partners (aOR = 5.10, 95% CI 3.10, 8.29; p = < .001) compared to reporting neither factor. Also, food insecurity and violence (aOR = 2.89, 95% CI 1.63, 5.11; p = < .001) as well as food insecurity and polydrug use (aOR = 2.73, 95% CI 1.54, 4.84; p = < .001) were significantly associated with greater odds of transactional sex compared to reporting neither factor. Our findings highlight a synergistic relationship between some adverse socio-structural and psychosocial factors on HIV risk behaviors. HIV prevention programs that address multiple syndemic factors simultaneously may achieve greater impact on HIV risk reduction.
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Affiliation(s)
- Chukwuemeka N Okafor
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave (Room 37-121CHS), Los Angeles, CA, 90095-1688, USA.
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, USA.
| | - Joan Christodoulou
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, Los Angeles, USA
| | - Jason Bantjes
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Tembinkosi Qondela
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Jackie Stewart
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, USA
| | - Mark Tomlinson
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Mary Jane Rotherman-Borus
- UCLA Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA
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Urada LA, Smith LR, Yore J, Triplett DP, Hucks-Ortiz C, Raj A. Sex Trade and Health Care Utilization Among People Living with HIV/AIDS. AIDS Behav 2018; 22:2553-2563. [PMID: 29748844 PMCID: PMC6443569 DOI: 10.1007/s10461-018-2131-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
People living with HIV/AIDS (PLWH) are more likely to have a history of trading sex, but little research has examined whether trading sex is associated with lower health care utilization amongst PLWH. This study assesses this association with PLWH (N = 583) recruited and surveyed from seven community sites in six US cities participating in a multi-site community-based HIV test and treat initiative. Participants were 90.6% Black or Latino, 30.4% homeless, and 9.0% (1 in 11) sold sex (past 90 days). Most reported receiving HIV clinical care (63.9%, past 6 months) and HIV case management (68.9%, past year), but 35.7% reported a missed health care appointment (past 3 months). In adjusted regression models, trading sex was associated with a missed health care appointment (OR = 2.44) and receiving psychological assistance (OR = 2.31), past 90 days, but not receipt of HIV care or supportive HIV services. Trading sex may compromise consistent health care utilization among PLWH.
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Affiliation(s)
- Lianne A Urada
- School of Social Work, San Diego State University, Hepner Hall #119, 5500 Campanile Drive, San Diego, CA, 92182-4119, USA.
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA.
| | - Laramie R Smith
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | - Jennifer Yore
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | - Daniel P Triplett
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | | | - Anita Raj
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
- Department of Education Studies, Division of Social Sciences, University of California San Diego, La Jolla, USA
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