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Zachek CM, Coelho LE, Clark JL, Domingues RMSM, Luz PM, Friedman RK, de Andrade ÂCV, Veloso VG, Lake JE, Grinsztejn B, De Boni RB. Reproductive health syndemics impact retention in care among women living with HIV in Rio de Janeiro, Brazil. Braz J Infect Dis 2023; 27:102779. [PMID: 37230150 PMCID: PMC10245108 DOI: 10.1016/j.bjid.2023.102779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/29/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023] Open
Abstract
Syndemic psychosocial and reproductive factors affecting women's retention in HIV care remain understudied. We analyzed correlates of non-retention in a cohort of women with HIV in Brazil from 2000‒2015. Participants self-reported exposure to physical/sexual violence, illicit drug use, adolescent pregnancy, or induced abortion. Lifetime history of these psychosocial stressors were used to create a syndemic score based on the presence or absence of these conditions. All dichotomous variables were summed (range 0 to 4), with greater scores indicating more syndemic factors experienced. Logistic regression models identified predictors of non-retention, defined as < 2 HIV viral load or CD4 results within the first year of enrollment. Of 915 women, non-retention was observed for 18%. Prevalence of syndemic factors was adolescent pregnancy (53.2%), physical/sexual violence (38.3%), induced abortion (27.3%), and illicit drug use (17.2%); 41.2% experienced ≥ 2 syndemic conditions. Syndemic scores of 2 and 3 were associated with non-retention, as well as low education, years with HIV and seroprevalent syphilis. Psychosocial and reproductive syndemics can limit women's retention in HIV care. Syphilis infection predicted non-retention and could be explored as a syndemic factor in future studies.
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Affiliation(s)
- Christine M Zachek
- University of California San Francisco, School of Medicine, San Francisco, CA, USA.
| | - Lara E Coelho
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Jesse L Clark
- University of California Los Angeles David Geffen School of Medicine, Department of Medicine, Los Angeles, CA, USA
| | - Rosa M S M Domingues
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Paula M Luz
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Ruth K Friedman
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | | | - Valdilea G Veloso
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Jordan E Lake
- The University of Texas Health Science Center at Houston (UTHealth), Department of Medicine, Houston, TX, USA
| | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Raquel B De Boni
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
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Silva JKBD, Santos JMD, Moreira WC, Romero ROG, Leadebal ODCP, Nogueira JDA. Modelo multinível na identificação de fatores de risco comportamentais e estruturais ao HIV: revisão integrativa. Rev Bras Enferm 2023. [DOI: 10.1590/0034-7167-2021-0853pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO Objetivos: investigar estudos que adotaram o modelo de análise multinível na identificação de fatores de risco comportamentais e estruturais, que estão associados a infecção pelo HIV. Métodos: revisão integrativa da literatura com estudos disponíveis na íntegra, obtidos nas bases EMBASE, CINAHL, Pubmed e Scopus, cujos descritores selecionados foram os termos constantes: “HIV”, “multilevel analysis”, “behavior”. Resultados: a pesquisa resultou em 236 artigos. Destes, dez artigos compuseram a amostra. Desvantagem econômica, características de vizinhança, instabilidade habitacional, encarceramento, sexo transacional, múltiplos parceiros, abuso de substâncias e idade da primeira relação sexual foram classificados como fatores de risco estruturais e comportamentais ao HIV. Redução da desvantagem socioeconômica, fornecimento de estabilidade habitacional e uso de preservativos foram associados a fatores de proteção à exposição ao HIV. Conclusões: com a aplicabilidade do modelo multinível nos estudos de investigação de fatores de risco, foi possível identificar os elementos estruturais e comportamentais de risco ao HIV.
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da Silva JKB, dos Santos JM, Moreira WC, Romero ROG, Leadebal ODCP, Nogueira JDA. Multilevel model in the identification of behavioral and structural risk factors for HIV: integrative review. Rev Bras Enferm 2022; 76:e20210853. [PMID: 36542051 PMCID: PMC9749773 DOI: 10.1590/0034-7167-2021-0853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 08/21/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES to investigate studies that adopted the multilevel analysis model to identify behavioral and structural risk factors associated with HIV infection. METHODS an integrative review of the literature with studies available in full, obtained from EMBASE, CINAHL, Pubmed, and Scopus, whose selected descriptors were the indexed terms: "HIV", "multilevel analysis" and "behavior". RESULTS the search resulted in 236 studies. Out of these, ten studies comprised the sample. Economic disadvantage, neighborhood characteristics, housing instability, incarceration, transactional sex, multiple partners, substance abuse, and age at first intercourse were classified as structural and behavioral risk factors for HIV. Reduced socioeconomic disadvantage, provision of housing stability, and condom use were associated with protective factors for HIV exposure. CONCLUSIONS by applying the multilevel model in risk factor research studies, it was possible to identify the structural and behavioral elements of HIV risk.
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Implementation of HIV Interventions Into Faith-Based Organizations: Models and Methodological Considerations. J Acquir Immune Defic Syndr 2020; 82 Suppl 3:S305-S313. [PMID: 31764268 DOI: 10.1097/qai.0000000000002221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Implementation of evidence-based interventions aimed at reducing and treating HIV can have a wider spread if funneled through faith-based organizations. However, there is a paucity of frameworks or process models aimed at providing the best practices to implement HIV interventions into faith-based community organizations. SETTING Implementation framework and process model for African American faith settings. RESULTS Presented here is a systems multilevel implementation framework and implementation process model for integrating HIV interventions into faith-based organizations. We conclude with presentation of key methodological considerations and recommendations and discuss strategies for moving implementation science forward in faith-based organizations. CONCLUSION Because of their key role in the African American community, faith-based settings must be engaged in implementing evidence-based HIV interventions. Through use of a multilevel systems framework and process model, the methods and approaches of implementation science can be leveraged to encourage the spread of HIV interventions in the African American community.
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Leblanc NM, Alexander K, Carter S, Crean H, Ingram L, Kobie J, McMahon J. The Effects of Trauma, Violence, and Stress on Sexual Health Outcomes Among Female Clinic Clients in a Small Northeastern U.S. Urban Center. ACTA ACUST UNITED AC 2020; 1:132-142. [PMID: 32617533 PMCID: PMC7325490 DOI: 10.1089/whr.2019.0027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: Threats to sexual health can emerge across one's life span and are influenced by individual and interpersonal experiences, as well as certain environmental exposures. Although previous research has recognized the importance of ecological frameworks to understand the complexity of health and behaviors in marginalized communities, there continues to be a dearth of research that truly utilizes this perspective to gain insight into the multifaceted factors that can concurrently influence threats to sexual health among women. Methods: A sample of 279 ethnoracially diverse women were recruited from a U.S. northeastern small urban center health clinic to participate in a parent study on trauma and immunity. A hierarchical block analysis was conducted to investigate associations between women's experiences of trauma, stress and violence (i.e., childhood trauma (CHT), intimate partner violence (IPV), neighborhood stressors), and sexual health outcomes and behaviors (i.e., lifetime sexually transmitted infection [STI] diagnosis, concurrent partnerships, and lifetime sex trading). Results: In the full hierarchical model, IPV and life stress trauma were associated with lifetime sex trading and partner concurrency. Also in the full model, sexual CHT was associated with lifetime STI acquisition and partner concurrency, while emotional CHT was associated with lifetime sex trading. Lastly, as neighborhood disorder increased, so did the number of lifetime sex trading partners. Conclusion: Sexual health assessments in clinical and community settings require a holistic, comprehensive, and meaningful approach to inform person-centered health promotion intervention. Prevention and treatment interventions require a focus on parents and families, and should assist adolescents and young adults to adopt therapies for healing from these experiences of trauma, violence, and stress. Interventions to enhance sexual health promotion must also include the following: advocacy for safe environments, social policy that addresses lifelong impacts of CHT, and fiscal policy that addresses economic vulnerability among women and threatens sexual health. Further recommendations are discussed.
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Affiliation(s)
- Natalie M Leblanc
- School of Nursing, University of Rochester Medical Center, Rochester, New York, USA
| | - Kamila Alexander
- Department of Community Public Health Nursing, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Sierra Carter
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
| | - Hugh Crean
- School of Nursing, University of Rochester Medical Center, Rochester, New York, USA
| | | | - James Kobie
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James McMahon
- School of Nursing, University of Rochester Medical Center, Rochester, New York, USA
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Zachek CM, Coelho LE, Domingues RMSM, Clark JL, De Boni RB, Luz PM, Friedman RK, de Andrade ÂCV, Veloso VG, Lake JE, Grinsztejn B. The Intersection of HIV, Social Vulnerability, and Reproductive Health: Analysis of Women Living with HIV in Rio de Janeiro, Brazil from 1996 to 2016. AIDS Behav 2019; 23:1541-1551. [PMID: 30652206 DOI: 10.1007/s10461-019-02395-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Comprehensive care for sexual and reproductive health (SRH) and social needs for women living with HIV remains limited globally. We aimed to assess trends in baseline sociodemographic, clinical, sexual, and reproductive characteristics among a cohort of HIV-infected women in Rio de Janeiro from 1996 to 2016. Participants were stratified into four time periods based on year of enrollment; we compared cross-sectional data from each period. Of 1361 participants (median age 36), most were black or mixed race (60.1%), unemployed (52.1%), and without secondary education (54%). Adolescent pregnancy was common (51.5%), and 18.3% reported sexual debut at < 15 years old. Nearly half (45.2%) had < 5 lifetime sexual partners, yet prior syphilis and oncogenic human papillomavirus prevalence were 10.9% and 43.1%, respectively. Lifetime prevalence of induced abortion was 30.3%, and 16% used no contraceptive method. Future research should explore interactions between social vulnerability, HIV, and poor SRH outcomes and healthcare models to alleviate these disparities.
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Philbin MM, Parish C, Pereyra M, Feaster DJ, Cohen M, Wingood G, Konkle-Parker D, Adedimeji A, Wilson TE, Cohen J, Goparaju L, Adimora AA, Golub ET, Metsch LR. Health Disparities and the Digital Divide: The Relationship between Communication Inequalities and Quality of Life among Women in a Nationwide Prospective Cohort Study in the United States. JOURNAL OF HEALTH COMMUNICATION 2019; 24:405-412. [PMID: 31198091 PMCID: PMC6620144 DOI: 10.1080/10810730.2019.1630524] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Background: Communication inequalities can affect health-seeking behaviors yet the relationship between Internet use and overall health is inconclusive. Communication-related inequalities vary by race/ethnicity and SES but existing research primarily includes middle-class Whites. We therefore examined the relationship between communication-related inequalities-measured by daily Internet use-and health-related quality of life (QOL) using a nationwide prospective cohort study in the United States that consists of primarily low income, minority women. Methods: We examined Internet use and QOL among participants in the Women's Interagency HIV Study. Data collection occurred from October 2014-September 2015 in Chicago, New York, Washington DC, San Francisco, Atlanta, Chapel Hill, Birmingham/Jackson and Miami. We used multi-variable analyses to examine the relationship between daily Internet use and QOL. Results: The sample of 1,915 women was 73% African American and 15% Hispanic; 53% reported an annual income of ≤$12,000. Women with daily Internet use reported a higher QOL at six months, as did women with at least a high school diploma, income >$12,000, and non-White race; older women and those with reported drug use, depressive symptoms and loneliness had lower QOL. Conclusions: Overcoming communication inequalities may be one pathway through which to improve overall QOL and address public health priorities. Reducing communication-related inequalities-e.g, by providing reliable Internet access-and thus improving access to health promoting information, may lead to improved health outcomes.
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Affiliation(s)
- Morgan M Philbin
- a Department of Sociomedical Sciences , Columbia University Mailman School of Public Health , New York , NY , USA
| | - Carrigan Parish
- a Department of Sociomedical Sciences , Columbia University Mailman School of Public Health , New York , NY , USA
| | - Margaret Pereyra
- a Department of Sociomedical Sciences , Columbia University Mailman School of Public Health , New York , NY , USA
| | - Daniel J Feaster
- b Department of Public Health Sciences, Division of Biostatistics , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Mardge Cohen
- c Cook County Health & Hospital System , Departments of Medicine/CORE Center at John H. Stroger Jr Hospital of Cook County , Chicago , IL , USA
| | - Gina Wingood
- a Department of Sociomedical Sciences , Columbia University Mailman School of Public Health , New York , NY , USA
| | - Deborah Konkle-Parker
- d Division of Infectious Diseases , University of Mississippi Medical Center , Jackson , MS , USA
| | - Adebola Adedimeji
- e Department of Epidemiology & Population Health , Albert Einstein College of Medicine , Bronx , NY , USA
| | - Tracey E Wilson
- f Department of Community Health Sciences , School of Public Health, SUNY Downstate Medical Center , Brooklyn , NY , USA
| | - Jennifer Cohen
- g Department of Clinical Pharmacy , UCSF School of Pharmacy , San Francisco , CA , USA
| | - Lakshmi Goparaju
- h Department of Medicine , Georgetown University Medical Center , Washington , D.C. , USA
| | - Adaora A Adimora
- i Division of Infectious Diseases , University of North Carolina School of Medicine , Chapel Hill , NC , USA
- j Department of Epidemiology , Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Elizabeth T Golub
- k Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Lisa R Metsch
- a Department of Sociomedical Sciences , Columbia University Mailman School of Public Health , New York , NY , USA
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O'Brien DT, Farrell C, Welsh BC. Broken (windows) theory: A meta-analysis of the evidence for the pathways from neighborhood disorder to resident health outcomes and behaviors. Soc Sci Med 2018; 228:272-292. [PMID: 30885673 DOI: 10.1016/j.socscimed.2018.11.015] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/12/2018] [Accepted: 11/07/2018] [Indexed: 01/01/2023]
Abstract
The criminological "broken windows" theory (BWT) has inspired public health researchers to test the impact of neighborhood disorder on an array of resident health behaviors and outcomes. This paper identifies and meta-analyzes the evidence for three mechanisms (pathways) by which neighborhood disorder is argued to impact health, accounting for methodological inconsistencies across studies. A search identified 198 studies (152 with sufficient data for meta-analysis) testing any of the three pathways or downstream, general health outcomes. The meta-analysis found that perceived disorder was consistently associated with mental health outcomes, as well as substance abuse, and measures of overall health. This supported the psychosocial model of disadvantage, in which stressful contexts impact mental health and related sequelae. There was no consistent evidence for disorder's impact on physical health or risky behavior. Further examination revealed that support for BWT-related hypotheses has been overstated owing to data censoring and the failure to consistently include critical covariates, like socioeconomic status and collective efficacy. Even where there is evidence that BWT impacts outcomes, it is driven by studies that measured disorder as the perceptions of the focal individual, potentially conflating pessimism about the neighborhood with mental health.
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Affiliation(s)
- Daniel T O'Brien
- School of Public Policy & Urban Affairs, Northeastern University, Boston Area Research Initiative, Northeastern & Harvard Universities, USA.
| | - Chelsea Farrell
- School of Criminology & Criminal Justice, Northeastern University, USA
| | - Brandon C Welsh
- School of Criminology & Criminal Justice, Northeastern University, USA
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Haley DF, Edmonds A, Schoenbach VJ, Ramirez C, Hickson DA, Wingood GM, Bolivar H, Golub E, Adimora AA. Associations between county-level voter turnout, county-level felony voter disenfranchisement, and sexually transmitted infections among women in the Southern United States. Ann Epidemiol 2018; 29:67-73.e1. [PMID: 30442564 DOI: 10.1016/j.annepidem.2018.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 10/02/2018] [Accepted: 10/22/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Voting may play a critical role in the allocation of social and structural resources to communities, which in turn shapes neighborhood environments, and ultimately, an individual's sexually transmitted infection (STI) risk. We assessed relationships among county-level voter turnout and felony voter disenfranchisement, and STIs. METHODS This cross-sectional multilevel analysis included 666 women in Alabama, Florida, Georgia, Mississippi, and North Carolina enrolled in the Women's Interagency HIV Study between 2013 and 2015. Having a baseline bacterial STI (chlamydia, gonorrhea, trichomoniasis, or early syphilis) was determined by laboratory testing. We used generalized estimating equations to test relationships between county-level voter turnout in the 2012 general election, county-level percentage of felony disenfranchised voters, and STI prevalence. RESULTS Eleven percent of participants had an STI. Higher voter turnout corresponded to lower STI prevalence (prevalence ratio = 0.84, 95% confidence interval = 0.73-0.96 per 4 percentage point higher turnout). Greater felony voter disenfranchisement corresponded to higher STI prevalence (prevalence ratio = 1.89, 95% confidence interval = 1.10-3.24 per 4 percentage point higher disenfranchisement). CONCLUSIONS STI prevalence was inversely associated with voter turnout and positively associated with felony voter disenfranchisement. Research should assess causality and mechanisms through which civic engagement shapes sexual health. Expanding political participation, including eliminating discriminatory voting laws, could influence sexual health.
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Affiliation(s)
- Danielle F Haley
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA and Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA.
| | - Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Victor J Schoenbach
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Catalina Ramirez
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - DeMarc A Hickson
- Department of Epidemiology and Biostatistics, Jackson State University, School of Public Health, Jackson, MS
| | - Gina M Wingood
- Department of Sociomedical Sciences, Lerner Center for Public Health Promotion, Mailman School of Public Health, Columbia University, New York, NY
| | - Hector Bolivar
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL
| | - Elizabeth Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Adaora A Adimora
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA and Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Neighborhood Health Care Access and Sexually Transmitted Infections Among Women in the Southern United States: A Cross-Sectional Multilevel Analysis. Sex Transm Dis 2018; 45:19-24. [PMID: 28876296 DOI: 10.1097/olq.0000000000000685] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The United States has experienced an increase in reportable sexually transmitted infections (STIs) while simultaneously experiencing a decline in safety net services for STI testing and treatment. This multilevel study assessed relationships between neighborhood-level access to health care and STIs among a predominantly Human Immunodeficiency Virus (HIV)-seropositive cohort of women living in the south. METHODS This cross-sectional multilevel analysis included baseline data from HIV-seropositive and HIV-seronegative women enrolled in the Women's Interagency HIV Study sites in Alabama, Florida, Georgia, Mississippi, and North Carolina between 2013 and 2015 (N = 666). Administrative data (eg, United States Census) described health care access (eg, percentage of residents with a primary care provider, percentage of residents with health insurance) in the census tracts where women lived. Sexually transmitted infections (chlamydia, gonorrhea, trichomoniasis, or early syphilis) were diagnosed using laboratory testing. Generalized estimating equations were used to determine relationships between tract-level characteristics and STIs. Analyses were conducted using SAS 9.4. RESULTS Seventy percent of participants were HIV-seropositive. Eleven percent of participants had an STI. A 4-unit increase in the percentage of residents with a primary care provider was associated with 39% lower STI risk (risk ratio, 0.61, 95% confidence interval, 0.38-0.99). The percentage of tract residents with health insurance was not associated with STIs (risk ratio, 0.98, 95% confidence interval, 0.91-1.05). Relationships did not vary by HIV status. CONCLUSIONS Greater neighborhood health care access was associated with fewer STIs. Research should establish the causality of this relationship and pathways through which neighborhood health care access influences STIs. Structural interventions and programs increasing linkage to care may reduce STIs.
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Li YH, Cuccaro P, Chen H, Abughosh S, Mehta PD, Essien EJ. HIV-related sexual decisions made by African-American adolescents living in different family structures: study from an ecodevelopmental perspective. HIV AIDS (Auckl) 2018; 10:19-31. [PMID: 29576732 PMCID: PMC5851572 DOI: 10.2147/hiv.s144594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose of this study was to explore the association between the dynamics of family structure and sexual behaviors of African-American adolescents using the ecodevelopmental theory. METHODS This study stratified data from 1,617 African-American adolescents of the Add Health Wave I respondents with an identified family composition. It examined the associations between family structure, parenting function, and adolescents' sexual decision-making: age of first sexual intercourse, sexual initiation before age 16, and using a condom during the first and last sexual intercourse. RESULTS Emotional connection between parents and children (feeling more love from the father: β=0.17, P=0.0312; feeling more love from the mother: β=0.3314, P=0.0420) and mothers' less permissive attitude toward adolescents' sexual experience in their teens (β=0.33, P=0.0466) are positively associated with late age of sexual initiation of adolescents living in two-parent households. School-level factors (β=0.07, P=0.0008) and the adolescents' characteristics (being older: 0.42, P=0.0002; heterosexuality: β=2.28, P=0.0091) are the factors most positively related to the age of sexual initiation for those living with a single parent. Immediate social determinants, other than family factors (such as land use of immediate area [rural]: β=9.84, P<0.0001; the condition of living unit: β=1.55, P=0.0011; and safety of neighborhood: β=4.46, P=0.004), are related to late age of sexual initiation among those living with other relatives/alone. A higher tendency of condom use consistency was present in adolescents living with two parents compared to those living in other family structures. CONCLUSION Less parent/child connection and parent/family influence were found in African-American adolescents living with other relatives or alone, suggesting that living with two residential parents plays an essential role in their late sexual initiation and could account for an important element to combat high HIV incidence of African-American adolescents.
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Affiliation(s)
- Ya-Huei Li
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Texas Medical Center, Houston, TX, USA
| | - Paula Cuccaro
- Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Houston, TX, USA
| | - Hua Chen
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Texas Medical Center, Houston, TX, USA
| | - Susan Abughosh
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Texas Medical Center, Houston, TX, USA
| | - Paras D Mehta
- Department of Industrial Organizational Psychology, University of Houston, Houston, TX, USA
| | - Ekere J Essien
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Texas Medical Center, Houston, TX, USA
- Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Houston, TX, USA
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12
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Edelman N. Towards a critical epidemiology approach for applied sexual health research. J Health Psychol 2017; 23:161-174. [DOI: 10.1177/1359105317743768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Critical approaches may benefit epidemiological studies of sexual health. This article proposes a critical approach, reconcilable with social epidemiological enquiry. Key aims of critical epidemiology for sexual health are identified, from which three criticisms of practice emerge: (1) lack of attention to socio-cultural contexts, (2) construction of ‘risk’ as residing in the individual and (3) enactment of public health agendas which privilege and pathologise certain behaviours. These reflect and construct an apolitical understanding of population health. This article proposes features of a critical epidemiology that represent a morally driven re-envisioning of the focus, analysis and interpretation of epidemiological studies of sexual health.
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Affiliation(s)
- Natalie Edelman
- University of Brighton, UK
- Brighton and Sussex Medical School, UK
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13
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Associations between neighborhood characteristics and sexual risk behaviors among HIV-infected and HIV-uninfected women in the southern United States. Ann Epidemiol 2017; 27:252-259.e1. [PMID: 28476327 DOI: 10.1016/j.annepidem.2017.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 03/27/2017] [Accepted: 03/31/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE Neighborhood characteristics shape sexual risk in HIV-uninfected adults in the United States (US). We assess relationships between census tract characteristics and sexual risk behaviors in a predominantly HIV-infected cohort of women living in the Southern US. METHODS This cross-sectional multilevel analysis included data from 737 HIV-infected and HIV-uninfected women enrolled in the Women's Interagency HIV Study. Administrative data captured characteristics of census tracts where women lived; participant-level data were gathered via survey. We used principal components analysis to condense tract-level variables into components: social disorder (e.g., violent crime rate), and social disadvantage (e.g., alcohol outlet density). We used hierarchical generalized linear models to assess relationships between tract-level characteristics and condomless vaginal intercourse, anal intercourse, and condomless anal intercourse. RESULTS Greater social disorder was associated with less anal intercourse (OR = 0.63, 95% CI = 0.43-0.94) and condomless anal intercourse (OR = 0.49, 95% CI = 0.30-0.80), regardless of HIV status. There were no statistically significant additive or multiplicative interactions between tract characteristics and HIV status. CONCLUSIONS Neighborhood characteristics are associated with sexual risk behaviors among women living in the Southern US, these relationships do not vary by HIV status. Future studies should establish temporality and explore the causal pathways through which neighborhoods influence sexual risk.
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