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Town MA, Walters KL, Orellana ER. Discriminatory distress, HIV risk behavior, and community participation among American Indian/Alaska Native men who have sex with men. ETHNICITY & HEALTH 2021; 26:646-658. [PMID: 30560701 PMCID: PMC6581640 DOI: 10.1080/13557858.2018.1557115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 11/23/2018] [Indexed: 06/09/2023]
Abstract
Objectives Research regarding men who have sex with men (MSM) indicates that exposure to discrimination based on race and sexuality are positively associated with increased incidence of unprotected anal intercourse (UAI). In an effort to better understand this association, we assessed the associations of discriminatory distress with UAI among a sample of 183 American Indian and Alaska Native (AI/AN) MSM using survey data drawn from the HONOR Project. Design The HONOR Project examined the relationship between trauma, coping, and health behaviors among Two-Spirits (a contemporary name for gender and sexual minorities among American Indian and Alaska Native people). Results Using multivariable logistic regression techniques, our analysis showed participants reporting higher mean levels of distress from two-spirit discrimination had higher odds of reporting UAI (OR = 1.99, 95% CI, 1.19-3.32) compared to those reporting lower levels of distress. This analysis also showed lower odds of engaging in UAI among participants reporting higher levels of participation in LGBT specific online forums (OR = 0.86, CI = 0.75, 0.99; p < .05) and attending Two-Spirit events (OR = 0.82, CI = 0.71, 0.94; p < .01). Conclusions Future prevention research and program designs should address the differential impact of discrimination and community participation on sexual behavior specifically among AI/AN MSM.
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Affiliation(s)
- Matthew A. Town
- Department of Public Health, Pacific University, Forest Grove, Oregon, United States
| | - Karina L. Walters
- School of Social Work, University of Washington, Seattle, Washington, United States
| | - E. Roberto Orellana
- School of Social Work, Portland State University, Portland, Oregon, United States
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Day GE, Lanier AP, Bulkow L, Kelly JJ, Murphy N. Cancers of the breast, uterus, ovary and cervix among Alaska Native women, 1974–2003. Int J Circumpolar Health 2016; 69:72-86. [PMID: 20167158 DOI: 10.3402/ijch.v69i1.17388] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Gretchen Ehrsam Day
- Office of Alaska Native Health Research, Division of Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK 99508, USA
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Improvements in HIV treatment outcomes among indigenous and non-indigenous people who use illicit drugs in a Canadian setting. J Int AIDS Soc 2016; 19:20617. [PMID: 27094914 PMCID: PMC4837333 DOI: 10.7448/ias.19.1.20617] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 01/03/2016] [Accepted: 03/02/2016] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION In many settings worldwide, members of indigenous groups experience a disproportionate burden of HIV. In Canada, there is an urgent need to improve HIV treatment outcomes for indigenous people living with HIV (IPLWH), to not only reduce HIV/AIDS-associated morbidity and mortality but also curb elevated rates of viral transmission. Thus, by comparing indigenous and non-indigenous participants in an ongoing longitudinal cohort of HIV-positive people who use illicit drugs, we sought to investigate longitudinal changes in three HIV treatment indicators for IPLWH who use illicit drugs during a community-wide treatment-as-prevention (TasP) initiative in British Columbia, Canada. METHODS We used data from the ACCESS study, an ongoing observational prospective cohort of HIV-positive illicit drug users recruited from community settings in Vancouver, British Columbia. Cohort data are linked to comprehensive retrospective and prospective clinical records in a setting of no-cost HIV/AIDS treatment and care. We used multivariable generalized estimating equations (GEE) to evaluate longitudinal changes in the proportion of participants with exposure to antiretroviral therapy (ART) in the previous 180 days, optimal adherence to ART (i.e. ≥ 95% vs. < 95%) and non-detectable HIV-1 RNA viral load (VL <50 copies/mL plasma). RESULTS Between 2005 and 2014, 845 individuals were recruited, including 326 (39%) self-reporting any indigenous ancestry, and contributed 6732 interviews and 13,495 VL measurements. Among indigenous participants, the proportion with recent ART increased from 51 to 94% and non-detectable VL from 23 to 65%. In multivariable models, later interview period was positively associated with recent ART (adjusted odds ratio (AOR) = 1.16 per interview period, 95% confidence interval (CI): 1.11 to 1.20) and non-detectable VL (AOR = 1.07, 95% CI: 1.04 to 1.10). In adjusted models comparing indigenous and non-indigenous participants, we did not observe differences between the two groups (all p>0.1). CONCLUSIONS In this large and long-term study involving community-recruited HIV-positive illicit drug users, we observed a substantial and increasing proportion of indigenous participants reach several important thresholds in HIV care at rates indistinguishable from non-indigenous participants. The current findings highlight the important role of TasP on vulnerable populations in this setting and contribute to the evidence base supporting the immediate scale-up of ART to address HIV/AIDS-associated morbidity, mortality and viral transmission.
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Rukundo GZ, Mishara BL, Kinyanda E. Burden of Suicidal Ideation and Attempt among Persons Living with HIV and AIDS in Semiurban Uganda. AIDS Res Treat 2016; 2016:3015468. [PMID: 27073694 PMCID: PMC4814631 DOI: 10.1155/2016/3015468] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/07/2016] [Accepted: 02/16/2016] [Indexed: 11/18/2022] Open
Abstract
Although the impact of HIV/AIDS has changed globally, it still causes considerable morbidity and mortality, including suicidality, in countries like Uganda. This paper describes the burden and risk factors for suicidal ideation and attempt among 543 HIV-positive attending two HIV specialized clinics in Mbarara municipality, Uganda. The rate of suicidal ideation was 8.8% (n = 48; 95% CI: 6.70-11.50) and suicidal attempt was 3.1% (17, 95% CI 2.00-5.00). The factors associated with increased risk for suicidal ideation and attempts were state anger (OR = 1.06, 95% CI: 1.03-1.09; p = 0.001); trait anger (OR 1.10, 95% CI 1.04-1.16, p = 0.002); depression (OR 1.13, 95% CI 1.07-1.20, p = 0.001); hopelessness (OR 1.12, 95% CI 1.02-1.23, p = 0.024); anxiety (OR 1.06, 95% CI 1.03-1.09); low social support (OR 0.19, 95% CI 0.07-0.47, p = 0.001); inability to provide for others (OR 0.19, 95% CI 0.07-0.47, p = 0.001); and stigma (OR 2.48, 95% CI 1.11-5.54, p = 0.027). At multivariate analysis, only state anger remained statistically significant. HIV/AIDS is associated with several clinical, psychological, and social factors which increase vulnerability to suicidal ideation and attempts. Making suicide risk assessment and management an integral part of HIV care is warranted.
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Affiliation(s)
- Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Brian Leslie Mishara
- Centre for Research and Intervention on Suicide and Euthanasia and Psychology Department, Université du Québec à Montréal, Montréal, QC, Canada H3C 3P8
| | - Eugene Kinyanda
- Uganda Medical Research Council, Entebbe and Department of Psychiatry, Makerere College of Health Sciences, Kampala, Uganda
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Negin J, Aspin C, Gadsden T, Reading C. HIV Among Indigenous peoples: A Review of the Literature on HIV-Related Behaviour Since the Beginning of the Epidemic. AIDS Behav 2015; 19:1720-34. [PMID: 25731659 PMCID: PMC4551545 DOI: 10.1007/s10461-015-1023-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
From the early days of the HIV epidemic, Indigenous peoples were identified as a population group that experiences social and economic determinants-including colonialism and racism-that increase exposure to HIV. There are now substantial disparities in HIV rates between Indigenous and non-Indigenous peoples in some countries. We conducted a comprehensive literature review to assess the evidence on HIV-related behaviors and determinants in four countries-Australia, Canada, New Zealand and the United States-in which Indigenous peoples share important features of colonization and marginalization. We identified 107 articles over more than 20 years. The review highlights the determinants of HIV-related behaviors including domestic violence, stigma and discrimination, and injecting drug use. Many of the factors associated with HIV risk also contribute to mistrust of health services, which in turn contributes to poor HIV and health outcomes among Indigenous peoples.
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Affiliation(s)
- Joel Negin
- Sydney School of Public Health, University of Sydney, Edward Ford Building (A27), Sydney, NSW, 2006, Australia,
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Reilley B, Bloss E, Byrd KK, Iralu J, Neel L, Cheek J. Death rates from human immunodeficiency virus and tuberculosis among American Indians/Alaska Natives in the United States, 1990-2009. Am J Public Health 2014; 104 Suppl 3:S453-9. [PMID: 24754664 PMCID: PMC4035874 DOI: 10.2105/ajph.2013.301746] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVES We used race-corrected data and comprehensive diagnostic codes to better compare HIV and tuberculosis (TB) mortality from 1999 to 2009 between American Indian/Alaska Natives (AI/ANs) and Whites. METHODS National Vital Statistics Surveillance System mortality data were adjusted for AI/AN racial misclassification through linkage with Indian Health Service registration records. We compared average annual 1990 to 2009 HIV and TB death rates (per 100,000 people) for AI/AN persons with those for Whites; Hispanics were excluded. RESULTS Although death rates from HIV in AI/AN persons were significantly lower than those in Whites from 1990 to 1998 (4.2 vs 7.0), they were significantly higher than those in Whites from 1999 to 2009 (3.6 vs 2.0). Death rates from TB in AI/AN persons were significantly higher than those in Whites, with a significant disparity during both 1990 to 1998 (3.3 vs 0.3) and 1999 to 2009 (1.5 vs 0.1). CONCLUSIONS The decrease in death rates from HIV and TB was greater among Whites, and death rates remained significantly higher among AI/AN individuals. Public health interventions need to be prioritized to reduce the TB and HIV burden and mortality in AI/AN populations.
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Affiliation(s)
- Brigg Reilley
- Brigg Reilley, Jonathan Iralu, and Lisa Neel are with the Indian Health Service, Albuquerque, NM. Emily Bloss and Kathy K. Byrd are with the Centers for Disease Control and Prevention, Atlanta, GA. James Cheek is with Department of Family and Community Medicine, University of New Mexico, Albuquerque
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Hepatitis C virus in American Indian/Alaskan Native and Aboriginal peoples of North America. Viruses 2013; 4:3912-31. [PMID: 23342378 PMCID: PMC3528296 DOI: 10.3390/v4123912] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Liver diseases, such as hepatitis C virus (HCV), are “broken spirit” diseases. The prevalence of HCV infection for American Indian/Alaskan Native (AI/AN) in the United States and Canadian Aboriginals varies; nonetheless, incidence rates of newly diagnosed HCV infection are typically higher relative to non-indigenous people. For AI/AN and Aboriginal peoples risk factors for the diagnosis of HCV can reflect that of the general population: predominately male, a history of injection drug use, in midlife years, with a connection with urban centers. However, the face of the indigenous HCV infected individual is becoming increasingly female and younger compared to non-indigenous counterparts. Epidemiology studies indicate that more effective clearance of acute HCV infection can occur for select Aboriginal populations, a phenomenon which may be linked to unique immune characteristics. For individuals progressing to chronic HCV infection treatment outcomes are comparable to other racial cohorts. Disease progression, however, is propelled by elevated rates of co-morbidities including type 2 diabetes and alcohol use, along with human immunodeficiency virus (HIV) co-infection relative to non-indigenous patients. Historical and personal trauma has a major role in the participation of high risk behaviors and associated diseases. Although emerging treatments provide hope, combating HCV related morbidity and mortality will require interventions that address the etiology of broken spirit diseases.
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Walters KL, Beltran R, Evans-Campbell T, Simoni JM. Keeping our hearts from touching the ground: HIV/AIDS in American Indian and Alaska Native women. Womens Health Issues 2011; 21:S261-5. [PMID: 22055677 PMCID: PMC3226975 DOI: 10.1016/j.whi.2011.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 08/05/2011] [Accepted: 08/05/2011] [Indexed: 11/19/2022]
Abstract
HIV/AIDS is a critical and growing challenge to American Indian and Alaska Native (AIAN) women's health. Conceptually guided by the Indigenist Stress-Coping Model, this paper explores the historical and contemporary factors implicated in the HIV epidemic among AIAN women and the co-occurring epidemics of sexual violence and substance abuse. The authors also outline multiple indicators of resiliency in AIAN communities and stress the need for HIV prevention interventions for AIAN women to capitalize on cultural and community strengths.
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Affiliation(s)
- Karina L Walters
- School of Social Work and Indigenous Wellness Research Institute, University of Washington, Seattle, Washington 98105, USA.
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Gryczynski J, Johnson JL. Challenges in public health research with American Indians and other small ethnocultural minority populations. Subst Use Misuse 2011; 46:1363-71. [PMID: 21810071 DOI: 10.3109/10826084.2011.592427] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
As a result of the historical legacy of conquest, colonization, and cultural destruction, indigenous peoples often represent just a small segment of the population in many countries throughout the world. In the United States, American Indians/Alaska Natives are not only one of the smallest minority groups in the nation, but are also very culturally diverse. Disparities in health outcomes often occur along racial and ethnic lines, and culture can play an important role in shaping health behavior. Research on the distribution and patterning of disease and risk behaviors among population subgroups is critical for advancing evidence-based public health policy and practice. This article provides a brief overview of key challenges in conducting behavioral health research with American Indians at both community and population levels. Many of the issues raised also apply to other small ethnocultural minority groups.
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Affiliation(s)
- Jan Gryczynski
- Friends Research Institute, Baltimore, Maryland 21201, USA.
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Abstract
The world's almost 400 million Indigenous people have low standards of health. This poor health is associated with poverty, malnutrition, overcrowding, poor hygiene, environmental contamination, and prevalent infections. Inadequate clinical care and health promotion, and poor disease prevention services aggravate this situation. Some Indigenous groups, as they move from traditional to transitional and modern lifestyles, are rapidly acquiring lifestyle diseases, such as obesity, cardiovascular disease, and type 2 diabetes, and physical, social, and mental disorders linked to misuse of alcohol and of other drugs. Correction of these inequities needs increased awareness, political commitment, and recognition rather than governmental denial and neglect of these serious and complex problems. Indigenous people should be encouraged, trained, and enabled to become increasingly involved in overcoming these challenges.
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Affiliation(s)
- Michael Gracey
- Unity of First People of Australia, Perth, WA, Australia.
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Kaufman CE, Shelby L, Mosure DJ, Marrazzo J, Wong D, de Ravello L, Rushing SC, Warren-Mears V, Neel L, Eagle SJ, Tulloch S, Romero F, Patrick S, Cheek JE. Within the Hidden Epidemic: Sexually Transmitted Diseases and HIV/AIDS Among American Indians and Alaska Natives. Sex Transm Dis 2007; 34:767-77. [PMID: 17538516 DOI: 10.1097/01.olq.0000260915.64098.cb] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To review the epidemiology, research, and prevention programs for sexually transmitted diseases in American Indians and Alaska Natives (AI/ANs). STUDY DESIGN We reviewed the current national and regional trends in sexually transmitted diseases (STDs) for AI/ANs from 1998-2004, peer-reviewed studies from January 1996, through May 2006, and reports, unpublished documents, and electronic resources addressing AI/AN STD prevention and control. RESULTS STD prevalence among AI/ANs remains high. For example, the case rate of C. trachomatis in the North Central Plains AI/AN populations is 6 times the overall US rate. Trends for C. trachomatis also show sustained increases. Little research exists on STDs for this population, and most is focused on HIV/AIDS. Fear of compromised confidentiality, cultural taboos, and complex financial and service relationships inhibit effective surveillance, prevention, and management. CONCLUSIONS Recommendations for STD control in this population include improved local surveillance and incorporation of existing frameworks of health and healing into prevention and intervention efforts. Research defining the parameters of cultural context and social epidemiology of STDs is necessary.
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Affiliation(s)
- Carol E Kaufman
- American Indian and Alaska Native Programs, University of Colorado at Denver and Health Sciences Center, Aurora, Colorado 80045, USA.
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Jones DS. JONES RESPONDS. Am J Public Health 2007. [DOI: 10.2105/ajph.2007.116137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- David S. Jones
- The author is with the Center for the Study of Diversity in Science, Technology, and Medicine, Massachusetts Institute of Technology, Cambridge, Mass, and the Department of Social Medicine, Harvard Medical School, Boston, Mass
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