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Echeverría-Guevara A, Coelho LE, Veloso VG, Pimenta MC, Hoagland B, Moreira RI, Leite I, Jalil EM, Cardoso SW, Torres TS, Grinsztejn B. Travestis, transgender women and young MSM are at high risk for PrEP early loss to follow-up in Rio de Janeiro, Brazil. Braz J Infect Dis 2022; 27:102733. [PMID: 36586721 PMCID: PMC9871061 DOI: 10.1016/j.bjid.2022.102733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/18/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Oral pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir (FTC/TDF) is highly effective in preventing HIV infection. This study aimed to identify factors associated with PrEP early loss to follow-up (ELFU) among gay, bisexual and other men who have sex with men (MSM), travestis and transgender women (TGW). METHODOLOGY This was a prospective cohort study evaluating TGW and MSM who initiated PrEP at the Evandro Chagas National Institute of Infectious Diseases (INI-Fiocruz) from 2014 to 2020. ELFU was defined as not returning for a PrEP visit within 180 days after first dispensation. Exposure variables included age, gender, race, education, transactional sex, condomless anal intercourse [CAI] (both in the past six months), binge drinking and substance use (both in past three months) and syphilis diagnosis at baseline. Multilevel logistic regression models with random intercepts and fixed slopes were used to identify factors associated with ELFU accounting for clustering of participants according to their PrEP initiation study/context (PrEP Brasil, PrEParadas, ImPrEP and PrEP SUS). RESULTS Among 1,463 participants, the median age was 29 years (interquartile range 24-36), 83% self-identified as MSM, 17% as TGW, 24% were black, 37% mixed-black/pardo and 30% had < 12 years of education. Fifteen percent reported transactional sex, 59% reported CAI, 67% binge drinking, 33% substance use, and 15% had a syphilis diagnosis. Overall, 137 participants (9.7%) had ELFU. Younger age (18-24 years) (adjusted odds ratio [aOR] 1.9, 95%CI:1.2-3.2), TGW (aOR 2.8, 95%CI:1.6-4.8) and education < 12 years (aOR 1.9, 95%CI:1.2-2.9) were associated with greater odds of ELFU. CONCLUSION TGW, young individuals and those with lower education were at higher risk of PrEP ELFU. Our results suggest that the development of specific strategies targeting these populations should be a priority, through policies that aim to reduce the incidence of HIV infection.
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Affiliation(s)
- Amanda Echeverría-Guevara
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
| | - Lara E. Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Valdiléa G. Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Maria C. Pimenta
- Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis, Ministério da Saúde, Brasília, DF, Brazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Ronaldo I. Moreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Iuri Leite
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Emília M. Jalil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Sandra W. Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Thiago S. Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
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Reekie A, Gratrix J, Smyczek P, Woods D, Poshtar K, Courtney K, Ahmed R. A Cross-Sectional, Retrospective Evaluation of Opt-Out Sexually Transmitted Infection Screening at Admission in a Short-Term Correctional Facility in Alberta, Canada. JOURNAL OF CORRECTIONAL HEALTH CARE 2022; 28:429-438. [PMID: 36475978 DOI: 10.1089/jchc.21.08.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Incarcerated populations experience higher rates of sexually transmitted infections (STIs) than the general population, alongside inconsistent testing strategies. In response, universal opt-out STIs (chlamydia, gonorrhea, syphilis, and HIV) screening was implemented at admission in a short-term correctional facility in Alberta, Canada, for individuals ≤35 years. A cross-sectional, retrospective evaluation of testing outcomes between March 2018 and February 2020 was completed. Descriptive statistics were used to stratify STIs by gender, age group, and date for univariate analysis. Despite low uptake (31.2%), opt-out screening resulted in high positivity rates (14.9%, 10.8%, 29.5%, and 0.3%, respectively) and treatment completion (93.7%) while capturing a high proportion (52.6%) of asymptomatic cases. Opt-out screening at admission is feasible and can improve STI testing in high-risk individuals experiencing incarceration in Canada.
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Affiliation(s)
- Alexandra Reekie
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jennifer Gratrix
- Department of STI Services, Alberta Health Services-Provincial STI Program, Edmonton, Alberta, Canada
| | - Petra Smyczek
- Department of STI Services, Alberta Health Services-Provincial STI Program, Edmonton, Alberta, Canada
| | - Dan Woods
- Department of Corrections, Alberta Health Services-Corrections Health, Edmonton, Alberta, Canada
| | - Katherine Poshtar
- Department of Corrections, Alberta Health Services-Corrections Health, Edmonton, Alberta, Canada
| | - Keith Courtney
- Department of Corrections, Alberta Health Services-Corrections Health, Edmonton, Alberta, Canada
| | - Rabia Ahmed
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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The Prevalence of HIV Among Men Who Have Sex With Men (MSM) and Young MSM in Latin America and the Caribbean: A Systematic Review. AIDS Behav 2021; 25:3223-3237. [PMID: 33587242 DOI: 10.1007/s10461-021-03180-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2021] [Indexed: 12/11/2022]
Abstract
Young men who have sex with men (YMSM) under 25 years old are among the few populations with increasing numbers of new HIV infections in parts of the world where HIV incidence is declining overall. In this systematic review, we synthesize the literature on HIV prevalence among MSM in Latin America and the Caribbean focusing on YMSM. Results were stratified according to study population sampling method used (probability and non-probability based). Forty-seven studies from 17 countries were published in the last 10 years. Among studies using probability-based sampling method (N = 21), HIV prevalence among MSM ranged from 1.2 to 32.6%. HIV prevalence tended to increase over time in studies sampling at different time points. HIV prevalence among YMSM exceeded 5.0% in more than a half of studies (51%; N = 22/43). Our review corroborates the high and potentially rising incidence of HIV among YMSM and characterizes the region's greatest challenge to ending the epidemic.
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Figueroa JP, Duncan JP, Bailey A, Skyers N. The HIV epidemic in Jamaica: a need to strengthen the National HIV Program. Rev Panam Salud Publica 2020; 44:e157. [PMID: 33245295 PMCID: PMC7679044 DOI: 10.26633/rpsp.2020.157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/04/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives To assess the status of the HIV epidemic and programmatic implementation in Jamaica while identifying strategies for achieving effective HIV control. Methods The assessment included a review of the core indicators of the UNAIDS Global Monitoring Framework, a desk review of program reports, and unstructured interviews of stakeholders. Results HIV prevalence among adults in Jamaica was 1.5% in 2018 with an estimated 32 617 persons living with HIV (PLHIV) and 27 324 persons (83.8%) diagnosed with HIV; 12 711 (39.0% of all PLHIV or 46.5% aware of their status) were on anti-retroviral therapy (ART) in the public health sector and 61.8% PLHIV on ART were virally suppressed. HIV prevalence among men who have sex with men remains high (31.4% in 2011, 29.6% in 2017) but has declined among female sex workers (12% in 1990, 2% in 2017). HIV prevalence among public sexually transmitted infection clinic attendees, prison inmates and the homeless has increased in recent years. During 2018 approximately 200 000 persons (14% of the population 15-49 years) were tested with 1 165 newly diagnosed PLHIV, indicating that many of the estimated 1 600 newly infected persons in 2018 were unaware of their status. Conclusions Critical policy initiatives are needed to reduce barriers to HIV services, ensure young persons have access to condoms and contraceptives, affirm the rights of the marginalized, reduce stigma and discrimination, and introduce pre-exposure prophylaxis. While HIV spread in Jamaica has slowed, the UNAIDS Fast Track goals are lagging. The HIV program must be strengthened to effectively control the epidemic.
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Affiliation(s)
- J Peter Figueroa
- The University of the West Indies, Mona Kingston Jamaica The University of the West Indies, Mona, Kingston, Jamaica
| | - Jacqueline P Duncan
- The University of the West Indies, Mona Kingston Jamaica The University of the West Indies, Mona, Kingston, Jamaica
| | - Althea Bailey
- The University of the West Indies, Mona Kingston Jamaica The University of the West Indies, Mona, Kingston, Jamaica
| | - Nicola Skyers
- Ministry of Health and Wellness Kingston Jamaica Ministry of Health and Wellness, Kingston, Jamaica
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Hamilton A, Shin S, Taggart T, Whembolua GL, Martin I, Budhwani H, Conserve D. HIV testing barriers and intervention strategies among men, transgender women, female sex workers and incarcerated persons in the Caribbean: a systematic review. Sex Transm Infect 2020; 96:189-196. [PMID: 31506346 PMCID: PMC7062576 DOI: 10.1136/sextrans-2018-053932] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/16/2019] [Accepted: 08/13/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND This systematic review summarises evidence on the HIV testing barriers and intervention strategies among Caribbean populations and provides pertinent implications for future research endeavours designed to increase rates of HIV testing in the region. METHODS We used a systematic approach to survey all literature published between January 2008 and November 2018 using four electronic databases (MEDLINE/PubMed, Embase, Web of Science and Global Health). Only peer-reviewed articles published in English that examined HIV testing uptake and interventions in the Caribbean with men, men who have sex with men, female sex workers, transgender women and incarcerated individuals were included. RESULTS Twenty-one studies met the inclusion criteria. Lack of confidentiality, access to testing sites, stigma, discrimination, poverty and low HIV risk perception were identified as key barriers to HIV testing. These barriers often contributed to late HIV testing and were associated with delayed treatment initiation and decreased survival rate. Intervention strategies to address these barriers included offering rapid HIV testing at clinics and HIV testing outreach by trained providers and peers. CONCLUSION HIV testing rates remain unacceptably low across the Caribbean for several reasons, including stigma and discrimination. Future HIV testing interventions should target places where at-risk populations congregate, train laypersons to conduct rapid tests and consider using oral fluid HIV self-testing, which allows individuals to test at home.
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Affiliation(s)
- Akeen Hamilton
- Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, University of South Carolina System, Columbia, SC, USA
| | - Stephen Shin
- University of North Carolina at Chapel Hill, Department of Sociology, Chapel Hill, NC, USA
| | - Tamara Taggart
- George Washington University, Department of Prevention and Community Health, Washington, DC, USA
- Yale School of Public Health, Department of Social and Behavioral Sciences, New Haven, CT, USA
| | - Guy-Lucien Whembolua
- Yale School of Public Health, Department of Social and Behavioral Sciences, New Haven, CT, USA
| | - Indira Martin
- Government of the Bahamas Ministry of Health, Nassau, Bahamas
| | - Henna Budhwani
- University of Alabama at Birmingham, Department of Health Care Organization and Policy, Birmingham, AL, USA
| | - Donaldson Conserve
- Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, University of South Carolina System, Columbia, SC, USA
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Nom NAM, Kyaw KWY, Kumar AMV, Hone S, Thida T, Nwe TW, Soan P, Htun T, Oo HN. HIV Care Cascade among Prisoners of the Mandalay Central Prison in Myanmar: 2011-2018. Trop Med Infect Dis 2020; 5:tropicalmed5010004. [PMID: 31906265 PMCID: PMC7157648 DOI: 10.3390/tropicalmed5010004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 11/16/2022] Open
Abstract
Prisoners have a higher HIV prevalence and higher rates of attrition from care as compared with the general population. There is no published evidence on this issue from Myanmar. We assessed (1) HIV test uptake, HIV positivity, and enrollment in care among newly admitted prisoners between 2017 and 18 (2) Treatment outcomes among HIV-positive prisoners enrolled in care between 2011 and 18. This was a cohort study involving secondary analysis of program data. Among 26,767 prisoners admitted to the Mandalay Central Prison between 2017 and 2018, 10,421 (39%) were HIV-tested, 547 (5%) were HIV-positive, and 376 (69%) were enrolled in care. Among the 1288 HIV-positive prisoners enrolled in care between 2011 and 2018, 1178 (92%) were started on antiretroviral therapy. A total of 883 (69%) were transferred out (post-release) to other health facilities, and among these, only 369 (42%) reached their destination health facilities. The final outcomes (censored on 30 June 2019) included the following: (i) Alive and in care 495 (38%), (ii) death 138 (11%), (iii) loss to follow-up 596 (46%), and (iv) transferred out after reaching the health facilities 59 (5%). We found major gaps at every step of the HIV care cascade among prisoners, both inside and outside the prison. Future research should focus on understanding the reasons for these gaps and designing appropriate interventions to fill these gaps.
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Affiliation(s)
- Nang A Mwe Nom
- National AIDS Programme, Ministry of Health and Sports, Sagaing 02371, Myanmar
- Correspondence: ; Tel.: +95-9-962057357
| | - Khine Wut Yee Kyaw
- International Union against Tuberculosis and Lung Disease, 75006 Paris, France; (K.W.Y.K.); (A.M.V.K.)
- International Union against Tuberculosis and Lung Disease, Mandalay 05021, Myanmar;
| | - Ajay M. V. Kumar
- International Union against Tuberculosis and Lung Disease, 75006 Paris, France; (K.W.Y.K.); (A.M.V.K.)
- International Union against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi 110016, India
- Yenepoya Medical College, Yenepoya University, Mangaluru 575018, India
| | - San Hone
- National AIDS Programme, Ministry of Health and Sports, Nay Pyi Taw 15011, Myanmar; (S.H.); (P.S.); (H.N.O.)
| | - Thida Thida
- Department of Medical Research, Ministry of Health and Sports, Pyin Oo Lwin 05085, Myanmar;
| | - Thet Wai Nwe
- Central Epidemiology Unit, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw 15011, Myanmar;
| | - Pyae Soan
- National AIDS Programme, Ministry of Health and Sports, Nay Pyi Taw 15011, Myanmar; (S.H.); (P.S.); (H.N.O.)
| | - Thurain Htun
- International Union against Tuberculosis and Lung Disease, Mandalay 05021, Myanmar;
| | - Htun Nyunt Oo
- National AIDS Programme, Ministry of Health and Sports, Nay Pyi Taw 15011, Myanmar; (S.H.); (P.S.); (H.N.O.)
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Francis-Graham S, Ekeke NA, Nelson CA, Lee TY, Haj SE, Rhodes T, Vindrola C, Colbourn T, Rosenberg W. Understanding how, why, for whom, and under what circumstances opt-out blood-borne virus testing programmes work to increase test engagement and uptake within prison: a rapid-realist review. BMC Health Serv Res 2019; 19:152. [PMID: 30849986 PMCID: PMC6408812 DOI: 10.1186/s12913-019-3970-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 02/21/2019] [Indexed: 12/28/2022] Open
Abstract
Background Prisons represent a unique opportunity to diagnose blood-borne viruses. Opt-out testing is receiving increasing interest, as a result of mounting evidence to suggest that the manner in which a test offer is delivered, affects test uptake. Although the effectiveness of opt-out testing within the prison setting has been established, robust explanations are required for the variation in outcomes reported. Methods Rapid-realist review methodology was used to synthesise the literature on prison-based opt-out testing. The review was carried out in three phases. Phase one: An expert panel provided literature relevant to the implementation of opt-out testing within the English prison estate. Unstructured searches were also conducted to identify other social programmes where “opt-out” had been used to increase uptake. Phase two: a systematic search of six peer-review and five grey literature databases was carried out to identify empirical data on opt-out testing within the prison setting. Phase three: Additional non-exhaustive searches were carried out to identify literature that reinforced emergent concepts. The development of programme theory took place with each iteration and was validated in consultation with stakeholders. Results Programme theory was constructed for two outcomes: the proportion of intake offered a test and the proportion offered that accepted testing. The proportion of intake offered testing was influenced by the timing of the test offer, which was often delayed due to barriers to prisoner access. The decision to accept testing was influenced by concerns about confidentiality, fear of a positive diagnosis, a prisoner’s personal interpretation of risk, discomfort with invasive procedures, trust in healthcare, and the fidelity of the opt-out offer. Conclusions This review identified important implementation considerations that moderate the effectiveness of opt-out testing programmes. It also highlighted a lack of appreciation for the theoretical underpinnings of opt-out programmes and tension around how to implement testing in a manner that adheres to both default theory and informed consent. It is anticipated that results will be used to inform the design and implementation of subsequent versions of these programmes, as well as catalyse further in-depth analysis into their operation within the unique context of prison. Review registration CRD42017068342. Electronic supplementary material The online version of this article (10.1186/s12913-019-3970-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Seth Francis-Graham
- The National Institute for Health Research: Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, London, UK. .,The Institute for Global Health, University College London, London, UK. .,The Institute for Liver and Digestive Health, Division of Medicine, University College London, London, UK.
| | | | | | - Tin Yan Lee
- The Chinese University of Hong Kong, Hong Kong, China
| | | | - Tim Rhodes
- The National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, the London School of Hygiene and Tropical Medicine, London, UK
| | - Cecilia Vindrola
- The Institute of Epidemiology & Health, University College London, London, UK
| | - Tim Colbourn
- The Institute for Global Health, University College London, London, UK
| | - William Rosenberg
- The National Institute for Health Research: Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK.,The Institute for Liver and Digestive Health, Division of Medicine, University College London, London, UK
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SAYYAH M, RAHIM F, KAYEDANI GA, SHIRBANDI K, SAKI-MALEHI A. Global View of HIV Prevalence in Prisons: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2019; 48:217-226. [PMID: 31205875 PMCID: PMC6556176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We aimed to estimate the global prevalence of HIV, as well as cross-countries comparison in people who are in prison. METHODS We systematically assessed published studies reporting HIV prevalence among prisoners in the world. We searched international datasets banks, including PubMed, SCOPUS, Cumulative Index to Nursing and ISI web of science along with local databases and included original articles reporting data on the prevalence of HIV from 1980 to 2017. RESULTS We included 72 studies that reported HIV prevalence for 2,275,930 adult male and female prisoners. The pooled estimate of HIV prevalence was 3.4% (95% CI 3.2%-3.6%); however, the prevalence of HIV across individual studies varied considerably (ranging from 0 in Bosnia and Herzegovina to More than 20% in Iran, Zambia, Spain) and statistical heterogeneity was substantial (I2=0.99, Q=121; P<0.0001). The prevalence of HIV among prisoners in the continents Asia, Africa, North America and Europe was estimated as 3.0% (95% CI 3.3%-4.3 %), 6% (95% CI -0.0%-2.0%), 4% (95% CI 3.0%-4.0%), 5.0% (95% CI 0.0%-11%), respectively. CONCLUSION Protecting prisoners' health protects general public health. Successful HIV preventive measures in prisons include provision of HIV education and information; clean needles and syringes; drug treatment; and condoms. Governments have a moral and ethical obligation to prevent the spread of HIV/AIDS in prisons and to provide compassionate care, treatment and support for those infected.
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Affiliation(s)
- Mehdi SAYYAH
- Education Development Center (EDC), Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fakher RAHIM
- Research Center of Thalassemia & Hemoglobinopathy, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran,Corresponding Author:
| | - Gholam Abbas KAYEDANI
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, Department of Virology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kiarash SHIRBANDI
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Ahvaz, Iran
| | - Amal SAKI-MALEHI
- Department of Biostatistics and Epidemiology, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Wirtz AL, Yeh PT, Flath NL, Beyrer C, Dolan K. HIV and Viral Hepatitis Among Imprisoned Key Populations. Epidemiol Rev 2018; 40:12-26. [PMID: 29688317 DOI: 10.1093/epirev/mxy003] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 01/11/2018] [Indexed: 12/28/2022] Open
Abstract
Prisons and other closed facilities create opportunities for transmission of human immunodeficiency virus (HIV) and viral hepatitis during detention and after release. We conducted a systematic review and meta-analysis of peer-reviewed publications (2005-2015) to describe the prevalence of HIV, hepatitis C virus, and hepatitis B virus among key populations in prisons worldwide and to compare estimates of infection with those of other prison populations. Most data were reported for people who inject drugs (PWID; n = 72) and for men who have sex with men (MSM; n = 21); few data were reported on sex workers (SW; n = 6), or transgender women (n = 2). Publications were identified from 29 countries, predominantly middle- and high-income countries. Globally, PWID had 6 times the prevalence of HIV (pooled prevalence ratio (PPR) = 6.0, 95% CI: 3.8, 9.4), 8 times the prevalence of hepatitis C virus (PPR = 8.1, 95% CI: 6.4, 10.4), and 2 times the prevalence of hepatitis B virus (PPR = 2.0, 95% CI: 1.5, 2.7) compared with noninjecting prisoner populations. Among these articles, only those from Iran, Scotland, Spain, and Italy included the availability of methadone therapy; 2 articles included information on access to needle exchange programs by PWID detainees. HIV prevalence was more than 2 times higher among SW (PPR = 2.6, 95% CI: 2.2, 3.1) and 5 times higher among MSM (PPR = 5.3, 95% CI: 3.5, 7.9) compared with other prisoners. None of these articles reported HIV prevention coverage among SW or transgender women; 1 described HIV and sexually transmitted infection screening for MSM in prison. Prevention programs specific to key populations are important, particularly for populations that are criminalized and/or may cycle in and out of prison.
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Affiliation(s)
- Andrea L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ping T Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Natalie L Flath
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Baltimore City Health Department, Baltimore, Maryland
| | - Chris Beyrer
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kate Dolan
- University of New South Wales, Sydney, New South Wales, Australia
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Abel S, Cuzin L, Da Cunha S, Bolivard JM, Fagour L, Miossec C, Pircher M, Thioune M, Césaire R, Cabié A. Reaching the WHO target of testing persons in jails in prisons will need diverse efforts and resources. PLoS One 2018; 13:e0202985. [PMID: 30161176 PMCID: PMC6116985 DOI: 10.1371/journal.pone.0202985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 08/12/2018] [Indexed: 12/03/2022] Open
Abstract
Background The Caribbean is the second most affected region in the world by human immunodeficiency virus (HIV), and HIV prevalence is significantly higher among persons in jails and prisons than in the free population. The aim of our study was to assess the screening rates of HIV, hepatitis B and C, syphilis and human T cell leukaemia virus type 1 among newly-arrived persons in 2014, at Ducos facility in Martinique and the testing process performance. Methods This is an observational monocentric study conducted within the prison’s health unit. The study population consisted of all individuals incarcerated between 01/01/14 and 31/12/14. At the initial medical visit, HIV and STI testing were proposed to every newcomer. The rate of acceptance was calculated, as well as the screening process performance. Results In 2014 778 new persons were incarcerated, among those, 461 (59.3%) were tested. The main reasons for missing the testing opportunity were due to organization of the judiciary system (persons on electronic monitoring or day parole, transferred or quickly released before completion of the process) or to individual refusal. Finally, 75 persons did not get their results (all of them negative), 41 of them due to the medical staff work overload. Conclusions HIV and STI testing rates among newcomers at Ducos have notable room for improvement. The future availability of combined (HIV, HBV, HCV and syphilis) rapid tests may be very useful in case of short term incarceration, if their cost is not prohibitive. Reaching higher levels of testing will also require more resources.
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Affiliation(s)
- Sylvie Abel
- Prison Medical Unit, Martinique University Hospital, Fort de France, France
- Infectious and Tropical Diseases Unit, Martinique University Hospital, Fort de France, France
| | - Lise Cuzin
- Infectious and Tropical Diseases Unit, Martinique University Hospital, Fort de France, France
- INSERM, UMR 1027, Toulouse, France
- * E-mail:
| | - Séverine Da Cunha
- Prison Medical Unit, Martinique University Hospital, Fort de France, France
| | | | - Laurence Fagour
- Virology Laboratory, Martinique University Hospital, Fort de France, France
| | - Charline Miossec
- Parasitology Laboratory, Martinique University Hospital, Fort de France, France
| | - Mathilde Pircher
- Prison Medical Unit, Martinique University Hospital, Fort de France, France
- Infectious and Tropical Diseases Unit, Martinique University Hospital, Fort de France, France
| | - Marême Thioune
- Prison Medical Unit, Martinique University Hospital, Fort de France, France
- Infectious and Tropical Diseases Unit, Martinique University Hospital, Fort de France, France
| | - Raymond Césaire
- Virology Laboratory, Martinique University Hospital, Fort de France, France
- Antilles University, EA4537, Fort de France, France
| | - André Cabié
- Infectious and Tropical Diseases Unit, Martinique University Hospital, Fort de France, France
- Antilles University, EA4537, Fort de France, France
- Inserm CIC1424, Martinique University Hospital, Fort de France, France
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Brennan DJ, Bauer GR, Bradley K, Tran OV. Methods Used and Topics Addressed in Quantitative Health Research on Gay, Bisexual and Other Men Who Have Sex With Men: A Systematic Review of the Literature. JOURNAL OF HOMOSEXUALITY 2016; 64:1519-1538. [PMID: 27754799 DOI: 10.1080/00918369.2016.1247537] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Research on sexual minority men (gay, bisexual, and other men who have sex with men) was examined with regard to the measures of sexual orientation used, the methods of research, and the main health outcomes under study. A systematic review of English-language quantitative studies was conducted focused on the health of sexual minority men published in 2010 (n = 250). The results provide a snapshot of the literature and revealed that research on sexual minority men overwhelmingly focused on HIV, STIs, and sexual health for which sexual orientation was most commonly defined behaviorally. For topics of mental health or body/fitness outcomes, sexual orientation was most commonly defined by identity. Most study samples were venue-based, and only 8.8% of published papers drew data from population-based samples. The findings suggest that there exists a need for research on sexual minority men's health beyond STIs and HIV that will examine mental and physical health outcomes beyond sexual risk, uses probability-based samples, and addresses intersectional concerns related to race/ethnicity and age.
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Affiliation(s)
- David J Brennan
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Ontario , Canada
| | - Greta R Bauer
- b Schulich School of Medicine & Dentistry , Western University , London , Ontario , Canada
| | - Kaitlin Bradley
- b Schulich School of Medicine & Dentistry , Western University , London , Ontario , Canada
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12
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Rumble C, Pevalin DJ, O'Moore É. Routine testing for blood-borne viruses in prisons: a systematic review. Eur J Public Health 2015. [PMID: 26219884 PMCID: PMC4668329 DOI: 10.1093/eurpub/ckv133] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: People in prison have a higher burden of blood-borne virus (BBV) infection than the general population, and prisons present an opportunity to test for BBVs in high-risk, underserved groups. Changes to the BBV testing policies in English prisons have recently been piloted. This review will enable existing evidence to inform policy revisions. We describe components of routine HIV, hepatitis B and C virus testing policies in prisons and quantify testing acceptance, coverage, result notification and diagnosis. Methods: We searched five databases for studies of both opt-in (testing offered to all and the individual chooses to have the test or not) and opt-out (the individual is informed the test will be performed unless they actively refuse) prison BBV testing policies. Results: Forty-four studies published between 1989 and 2013 met the inclusion criteria. Of these, 82% were conducted in the USA, 91% included HIV testing and most tested at the time of incarceration. HIV testing acceptance rates ranged from 22 to 98% and testing coverage from 3 to 90%. Mixed results were found for equity in uptake. Six studies reported reasons for declining a test including recent testing and fear. Conclusions: While the quality of evidence is mixed, this review suggests that reasonable rates of uptake can be achieved with opt-in and, even better, with opt-out HIV testing policies. Little evidence was found relating to hepatitis testing. Policies need to specify exclusion criteria and consider consent processes, type of test and timing of the testing offer to balance acceptability, competence and availability of individuals.
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Affiliation(s)
- Caroline Rumble
- 1 Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - David J Pevalin
- 2 University of Essex, Wivenhoe Park, Colchester CO4 3SQ, UK
| | - Éamonn O'Moore
- 3 Health and Justice, Public Health England, Reading RG1 7EB, UK
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13
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Figueroa JP. Review of HIV in the Caribbean: significant progress and outstanding challenges. Curr HIV/AIDS Rep 2015; 11:158-67. [PMID: 24623473 DOI: 10.1007/s11904-014-0199-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This paper reviews the recent literature on HIV in the Caribbean and discusses the challenges faced. HIV incidence in the Caribbean has declined by 49 % in the past decade, coverage of persons living with HIV among those eligible for antiretroviral treatment as per national guidelines was 70 % in 2012, and some countries are meeting the target of virtual elimination of mother-to-child transmission. HIV prevalence in the Caribbean is 1 % with features of both a generalized and concentrated HIV epidemic. HIV prevalence among female sex workers has declined but remains unacceptably high among men who have sex with men. Social and cultural factors, gender norms, and strong stigma associated with HIV and homosexuality contribute to the continued spread of HIV. Caribbean countries and their partners have invested significant resources, creative effort and impressive research in strengthening the HIV response nationally and regionally. However, in order to control the HIV epidemic, leaders at all levels, and the people, must address fundamental structural barriers in society that deny marginalized persons their rights, undermine public health goals, and impede universal access to HIV prevention, treatment, and care.
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Affiliation(s)
- J Peter Figueroa
- Department of Community Health and Psychiatry, University of the West Indies, Mona, Kingston 7, Jamaica,
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Carter M, Gallo M, Anderson C, Snead MC, Wiener J, Bailey A, Costenbader E, Legardy-Williams J, Hylton-Kong T. Intravaginal cleansing among women attending a sexually transmitted infection clinic in Kingston, Jamaica. W INDIAN MED J 2013; 62:56-61. [PMID: 24171329 PMCID: PMC4450344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Although common worldwide, intravaginal cleansing is associated with poor health outcomes. We sought to describe intravaginal cleansing among women attending a sexually transmitted infection (STI) clinic in Jamaica. METHODS We examined intravaginal cleansing ("washing up inside the vagina", douching, and products or materials used) among 293 participants in a randomized trial of counselling messages at an STI clinic in Kingston. We focussed on information on intravaginal cleansing performed in the 30 days and three days preceding their baseline study visit. We describe reported cleansing behaviours and used logistic regression to identify correlates of intravaginal cleansing. RESULTS Fifty-eight per cent of participants reported intravaginal cleansing in the previous 30 days, and 46% did so in the three days before baseline. Among those who cleansed in the previous 30 days, 88% reported doing so for hygiene unrelated to sex, and three-fourths reported generally doing so more than once per day. Soap (usually with water) and water alone were the most common products used for washing; commercial douches or detergents were reported infrequently. Intravaginal cleansing in the three days before the baseline visit was positively associated with having more than one sex partner in the previous three months (adjusted odds ratio [AOR], 1.9; 95% CI, 1.1, 3.2), and negatively associated with experiencing itching in the genital area at baseline (AOR, 0.6; 95% CI, 0.4, 1.0). CONCLUSIONS A large proportion of women attending STI clinics in Jamaica engage in frequent intravaginal cleansing, indicating a need for clinicians to discuss this topic with them accordingly.
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Affiliation(s)
- M Carter
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, GA 30341, USA.
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15
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Kouyoumdjian FG, Leto D, John S, Henein H, Bondy S. A systematic review and meta-analysis of the prevalence of chlamydia, gonorrhoea and syphilis in incarcerated persons. Int J STD AIDS 2012; 23:248-54. [PMID: 22581947 DOI: 10.1258/ijsa.2011.011194] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Communicable diseases are common in people who are incarcerated. We aimed to define the prevalence of chlamydia, gonorrhoea and syphilis in people who are incarcerated and to identify subgroups with the highest risk of infection. We searched for prevalence studies of chlamydia, gonorrhoea or syphilis in incarcerated populations. Pooled estimates were generated, and meta-regression was conducted. Random effects models yielded pooled prevalence estimates of 5.75% (95% confidence interval [CI] 5.01, 6.48) and 12.31% (95% CI 10.61, 14.01) for chlamydia in men and women, 1.4% (95% CI 1.09, 1.70) and 5.73% (4.76, 6.69) for gonorrhoea in men and women, and 2.45% (95% CI 2.08, 2.82) and 6.10% (95% CI 4.75, 7.46) for syphilis in men and women, respectively. Each infection was associated with female gender in meta-regression models. Chlamydia, gonorrhoea and syphilis are highly prevalent in these populations. Primary and secondary prevention efforts could improve individual and population health.
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Affiliation(s)
- F G Kouyoumdjian
- University of Toronto, Dalla Lana School of Public Health, Toronto, Canada.
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16
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Muhammed OT, Akpa OM, Atilola GO, Komolafe I. Seroprevalence of HIV/AIDS and HIV risk factors among prison inmates in Ogun State, Nigeria. HIV & AIDS REVIEW 2012. [DOI: 10.1016/j.hivar.2012.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Andrinopoulos K, Figueroa JP, Kerrigan D, Ellen JM. Homophobia, stigma and HIV in Jamaican prisons. CULTURE, HEALTH & SEXUALITY 2011; 13:187-200. [PMID: 20972916 PMCID: PMC3010280 DOI: 10.1080/13691058.2010.521575] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Success in addressing HIV and AIDS among men who have sex with men, a key population in the global epidemic, is impeded by homophobia. Homophobia as a barrier to HIV prevention and AIDS treatment is a particularly acute problem in the prison setting. In this qualitative study, we explore HIV and AIDS, stigma and homosexuality in the largest all male prison in Jamaica by conducting iterative in-depth interviews with 25 inmates. Participant narratives unveil a purposeful manipulation of beliefs related to homosexuality that impedes an effective response to HIV and AIDS both in prison and wider society. Findings indicate that homophobia is both a social construction and a tangible tool used to leverage power and a sense of solidarity in a larger political and economic landscape. This use of homophobia may not be unique to Jamaica and is an important issue to address in other low- and middle-income post-colonialist societies.
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Affiliation(s)
- Katherine Andrinopoulos
- Department of International Health and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA.
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Andrinopoulos K, Kerrigan D, Figueroa JP, Reese R, Ellen JM. HIV coping self-efficacy: a key to understanding stigma and HIV test acceptance among incarcerated men in Jamaica. AIDS Care 2010; 22:339-47. [PMID: 20390514 PMCID: PMC2855689 DOI: 10.1080/09540120903193633] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Although prisons have been noted as important venues for HIV testing, few studies have explored the factors within this context that may influence HIV test acceptance. Moreover, there is a dearth of research related to HIV and incarcerated populations in middle and low-income countries, where both the burden of HIV and the number of people incarcerated is higher compared to high-income countries. This study explores the relationship between HIV coping self-efficacy, HIV-related stigma, and HIV test acceptance in the largest prisons in Jamaica. A random sample of inmates (n=298) recruited from an HIV testing demonstration project were asked to complete a cross-sectional quantitative survey. Participants who reported high HIV coping self-efficacy (adjusted odds ratio (AOR) 1.86: 95% confidence interval CI 1.24-2.78, p-value=0.003), some perceived risk of HIV (AOR 2.51: 95% (CI) 1.57-4.01, p-value=0.000), and low HIV testing stigma (AOR 1.71: 95% CI 1.05-2.79, p-value=0.032) were more likely to test for HIV. Correlates of HIV coping self-efficacy included external and internal HIV stigma (AOR 1.28: 95% CI 1.25-1.32, p-value=0.000 and AOR 1.76: 95% CI 1.34-2.30, p-value=0.000, respectively), social support (AOR 2.09: 95% CI 1.19-3.68, p-value=0.010), and HIV knowledge (AOR 2.33: 95% CI 1.04-5.22, p-value=0.040). Policy and programs should focus on the interrelationships of these constructs to increase participation in HIV testing in prison.
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Affiliation(s)
- Katherine Andrinopoulos
- Department of International Health and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA.
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