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Wayal S, Gerressu M, Weatherburn P, Gilbart V, Hughes G, Mercer CH. A qualitative study of attitudes towards, typologies, and drivers of concurrent partnerships among people of black Caribbean ethnicity in England and their implications for STI prevention. BMC Public Health 2020; 20:188. [PMID: 32028917 PMCID: PMC7003336 DOI: 10.1186/s12889-020-8168-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 01/07/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Partner concurrency, (having sexual partnerships overlapping in time), especially when condoms are not used, can facilitate sexually transmitted infections (STI) transmission. In Britain, STI diagnoses rates and the reporting of concurrency are higher among black Caribbeans than other ethnic groups. We explored attitudes towards, drivers, characteristics, and contexts of concurrent partnerships, and their implications for STI risk among black Caribbeans in England. METHODS Purposive sampling, by sex and age-groups, was used to recruit participants (overall n = 59) from five sexual health clinics and community settings in London and Birmingham, England. Audio-recorded four focus group discussions (n = 28 participants), and in-depth interviews (n = 31) were conducted (June 2014-December 2015). Transcribed data were thematically analysed using Framework Analysis. RESULTS 'Main plus' and 'non-main' concurrency were identified in this population. Main plus concurrency involves an individual having a main partner with whom s/he has a "relationship" with, and the individual and/or their partner secretly or explicitly have other non-main partners. In contrast, non-main concurrency entails having multiple, non-committed partners overlapping in time, where concurrency is usually taken as a given, making disclosure to partners irrelevant. While main partnerships were usually long-term, non-main partnerships ranged in duration from a single event through to encounters lasting several months/years. Condomless sex was common with ex/long-term/married/cohabiting partners; whereas condoms were typically used with non-main partners. However, condom use declined with partnership duration and familiarity with partners. Awareness of partners' concurrency facilitated condom use, STI-testing, and partner notification. While unresolved feelings, or sharing children with ex-partners, usually facilitated main plus concurrency; non-main concurrency was common among young, and single people. Gender norms, notions of masculinity, and sexual desires influenced concurrency. Black Caribbean popular music, social media, peer pressure, and relationship norms among black Caribbeans were also perceived to encourage concurrency, especially among men and young people. CONCLUSIONS Concurrency among black Caribbeans is shaped by a complex interaction between emotional/psychological, interpersonal, sociocultural, and structural factors. Concurrency type, its duration, and awareness influence sexual health choices, and thus STI risk in this population. Collecting these data during clinic consultations could facilitate offering partner notification methods tailored to concurrency type. Gender- and age-specific, culturally-sensitive interventions addressing STI risks associated with concurrency are needed.
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Affiliation(s)
- Sonali Wayal
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), London, WC1E 6JB UK
- HIV & STI Department, Public Health England, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, NW9 5EQ UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Makeda Gerressu
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), London, WC1E 6JB UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Peter Weatherburn
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
- Sigma Research, Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Victoria Gilbart
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Gwenda Hughes
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), London, WC1E 6JB UK
- HIV & STI Department, Public Health England, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, NW9 5EQ UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Catherine H. Mercer
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), London, WC1E 6JB UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
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Aicken CRH, Wayal S, Blomquist PB, Fabiane SM, Gerressu M, Hughes G, Mercer CH. Pathways to, and use of, sexual healthcare among Black Caribbean sexual health clinic attendees in England: evidence from cross-sectional bio-behavioural surveys. BMC Health Serv Res 2019; 19:668. [PMID: 31533716 PMCID: PMC6749649 DOI: 10.1186/s12913-019-4396-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 08/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In England, people of Black Caribbean (BC) ethnicity are disproportionately affected by sexually transmitted infections (STI). We examined whether differences in sexual healthcare behaviours contribute to these inequalities. METHODS We purposively selected 16 sexual health clinics across England with high proportions of attendees of BC ethnicity. During May-September 2016, attendees at these clinics (of all ethnicities) completed an online survey that collected data on health service use and sexual behaviour. We individually linked these data to routinely-collected surveillance data. We then used multivariable logistic regression to compare reported behaviours among BC and White British/Irish (WBI) attendees (n = 627, n = 1411 respectively) separately for women and men, and to make comparisons by gender within these ethnic groups. RESULTS BC women's sexual health clinic attendances were more commonly related to recent bacterial STI diagnoses, compared to WBI women's attendances (adjusted odds ratio, AOR 3.54, 95% CI 1.45-8.64, p = 0.009; no gender difference among BC attendees), while BC men were more likely than WBI men (and BC women) to report attending because of a partner's symptoms or diagnosis (AOR 1.82, 95% CI 1.14-2.90; AOR BC men compared with BC women: 4.36, 95% CI 1.42-13.34, p = 0.014). Among symptomatic attendees, BC women were less likely than WBI women to report care-seeking elsewhere before attending the sexual health clinic (AOR 0.60, 95% CI 0.38-0.97, p = 0.039). No ethnic differences, or gender differences among BC attendees, were observed in symptom duration, or reporting sex whilst symptomatic. Among those reporting previous diagnoses with or treatment for bacterial STI, no differences were observed in partner notification. CONCLUSIONS Differences in STI diagnosis rates observed between BC and WBI ethnic groups were not explained by the few ethnic differences which we identified in sexual healthcare-seeking and use. As changes take place in service delivery, prompt clinic access must be maintained - and indeed facilitated - for those at greatest risk of STI, regardless of ethnicity.
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Affiliation(s)
- Catherine R. H. Aicken
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), Mortimer Market Centre, London, WC1E 6JB UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, in partnership with PHE, and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
- School of Health Sciences, University of Brighton, Village Way, Falmer, Brighton, BN1 9PH UK
| | - Sonali Wayal
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), Mortimer Market Centre, London, WC1E 6JB UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, in partnership with PHE, and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Paula B. Blomquist
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England (PHE), 61 Colindale Ave, London, NW9 5EQ UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, in partnership with PHE, and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Stella M. Fabiane
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), Mortimer Market Centre, London, WC1E 6JB UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, in partnership with PHE, and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Makeda Gerressu
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), Mortimer Market Centre, London, WC1E 6JB UK
| | - Gwenda Hughes
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England (PHE), 61 Colindale Ave, London, NW9 5EQ UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, in partnership with PHE, and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
- Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil
| | - Catherine H. Mercer
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), Mortimer Market Centre, London, WC1E 6JB UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, in partnership with PHE, and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
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Aicken CR, Wayal S, Blomquist P, Fabiane S, Gerressu M, Hughes G, Mercer CH. Ethnic variations in sexual partnerships and mixing, and their association with STI diagnosis: findings from a cross-sectional biobehavioural survey of attendees of sexual health clinics across England. Sex Transm Infect 2019; 96:283-292. [PMID: 31422350 PMCID: PMC7279208 DOI: 10.1136/sextrans-2018-053739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 05/14/2019] [Accepted: 07/13/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Ethnic differences in partnership types and sexual mixing patterns may contribute to elevated STI diagnosis rates among England's Black Caribbean (BC) population. We examined the differences between BC and White British/Irish (WBI) sexual health clinic (SHC) attendees' reported partnerships and sexual mixing, and whether these differences could explain ethnic inequalities in STI, focusing on attendees reporting only opposite-sex partners (past year). METHODS We surveyed attendees at 16 SHCs across England (May to September 2016), and linked their survey responses to routinely collected data on diagnoses of bacterial STI or trichomoniasis ±6 weeks of clinic attendance ('acute STI'). Behaviourally-heterosexual BC and WBI attendees (n=1790) reported details about their ≤3 most recent opposite-sex partners (past 3 months, n=2503). We compared BC and WBI attendees' reported partnerships and mixing, in gender-stratified analyses, and used multivariable logistic regression to examine whether they independently explained differences in acute STI. RESULTS We observed differences by ethnic group. BC women's partnerships were more likely than WBI women's partnerships to involve age-mixing (≥5 years age difference; 31.6% vs 25.5% partnerships, p=0.013); BC men's partnerships were more often 'uncommitted regular' (35.4% vs 20.7%) and less often casual (38.5% vs 53.1%) than WBI men's partnerships (p<0.001). Acute STI was higher among BC women than WBI women (OR: 2.29, 95% CI 1.24 to 4.21), with no difference among men. This difference was unaffected by partnerships and mixing: BC women compared with WBI women adjusted OR: 2.31 (95% CI 1.30 to 4.09) after adjusting for age and partner numbers; 2.15 (95% CI 1.07 to 4.31) after additionally adjusting for age-mixing, ethnic-mixing and recent partnership type(s). CONCLUSION We found that differences in sexual partnerships and mixing do not appear to explain elevated risk of acute STI diagnosis among behaviourally-heterosexual BC women SHC attendees, but this may reflect the measures used. Better characterisation of 'high transmission networks' is needed, to improve our understanding of influences beyond the individual level, as part of endeavours to reduce population-level STI transmission.
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Affiliation(s)
- Catherine Rh Aicken
- Institute for Global Health, University College London, London, UK .,School of Health Sciences, University of Brighton, Brighton, UK
| | - Sonali Wayal
- Institute for Global Health, University College London, London, UK
| | - Paula Blomquist
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Stella Fabiane
- Institute for Global Health, University College London, London, UK.,MRC Clinical Trials Unit, University College London, London, UK
| | - Makeda Gerressu
- Institute for Global Health, University College London, London, UK
| | - Gwenda Hughes
- Institute for Global Health, University College London, London, UK.,Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
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Mercer CH, Clifton S, Prior G, Aldridge RW, Bonell C, Copas AJ, Field N, Gibbs J, Macdowall W, Mitchell KR, Tanton C, Thomson N, Unemo M, Sonnenberg P. Collecting and exploiting data to understand a nation's sexual health needs: Implications for the British National Surveys of Sexual Attitudes and Lifestyles (Natsal). Sex Transm Infect 2019; 95:159-161. [PMID: 30890634 PMCID: PMC6580741 DOI: 10.1136/sextrans-2018-053571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 09/25/2018] [Accepted: 09/28/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Soazig Clifton
- Institute for Global Health, University College London, London, UK.,NatCen Social Research, London, UK
| | | | - Robert W Aldridge
- Institute of Health Informatics, University College London, London, UK
| | - Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew J Copas
- Institute for Global Health, University College London, London, UK
| | - Nigel Field
- Institute for Global Health, University College London, London, UK
| | - Jo Gibbs
- Institute for Global Health, University College London, London, UK
| | - Wendy Macdowall
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Kirstin R Mitchell
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Clare Tanton
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Örebro, Sweden.,National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Pam Sonnenberg
- Institute for Global Health, University College London, London, UK
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Assessing Timely Presentation to Care Among People Diagnosed with HIV During Hospital Admission: A Population-Based Study in Ontario, Canada. AIDS Behav 2018. [PMID: 29536283 DOI: 10.1007/s10461-018-2063-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Timely presentation to care for people newly diagnosed with HIV is critical to optimize health outcomes and reduce onward HIV transmission. Studies describing presentation to care following diagnosis during a hospital admission are lacking. We sought to assess the timeliness of presentation to care and to identify factors associated with delayed presentation. We conducted a population-level study using health administrative databases. Participants were all individuals older than 16 and newly diagnosed with HIV during hospital admission in Ontario, Canada, between April 1, 2007 and March 31, 2015. We used modified Poisson regression models to derive relative risk ratios for the association between sociodemographic and clinical variables and the presentation to out-patient HIV care by 90 days following hospital discharge. Among 372 patients who received a primary HIV diagnosis in hospital, 83.6% presented to care by 90 days. Following multivariable analysis, we did not find associations between patient sociodemographic or clinical characteristics and presentation to care by 90 days. In a secondary analysis of 483 patients diagnosed during hospitalization but for whom HIV was not recorded as the principal reason for admission, 73.1% presented to care by 90 days. Following multivariable adjustment, we found immigrants from countries with generalized HIV epidemics (RR 1.265, 95% CI 1.133-1.413) were more likely to present to care, whereas timely presentation was less likely for people with a mental health diagnosis (RR 0.817, 95% CI 0.742-0.898) and women (RR 0.748, 95% CI 0.559-1.001). Future work should evaluate mechanisms to facilitate presentation to care among these populations.
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Coyle RM, Miltz AR, Lampe FC, Sewell J, Phillips AN, Speakman A, Dhar J, Sherr L, Sadiq ST, Taylor S, Ivens DR, Collins S, Elford J, Anderson J, Rodger A. Ethnicity and sexual risk in heterosexual people attending sexual health clinics in England: a cross-sectional, self-administered questionnaire study. Sex Transm Infect 2018. [PMID: 29519911 PMCID: PMC6204969 DOI: 10.1136/sextrans-2017-053308] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objectives In the UK, people of black ethnicity experience a disproportionate burden of HIV and STI. We aimed to assess the association of ethnicity with sexual behaviour and sexual health among women and heterosexual men attending genitourinary medicine (GUM) clinics in England. Methods The Attitudes to and Understanding of Risk of Acquisition of HIV is a cross-sectional, self-administered questionnaire study of HIV negative people recruited from 20 GUM clinics in England, 2013–2014. Modified Poisson regression with robust SEs was used to calculate adjusted prevalence ratios (aPR) for the association between ethnicity and various sexual risk behaviours, adjusted for age, study region, education and relationship status. Results Questionnaires were completed by 1146 individuals, 676 women and 470 heterosexual men. Ethnicity was recorded for 1131 (98.8%) participants: 550 (48.6%) black/mixed African, 168 (14.9%) black/mixed Caribbean, 308 (27.2%) white ethnic groups, 105 (9.3%) other ethnicity. Compared with women from white ethnic groups, black/mixed African women were less likely to report condomless sex with a non-regular partner (aPR (95% CI) 0.67 (0.51 to 0.88)), black/mixed African and black/mixed Caribbean women were less likely to report two or more new partners (0.42 (0.32 to 0.55) and 0.44 (0.29 to 0.65), respectively), and black/mixed Caribbean women were more likely to report an STI diagnosis (1.56 (1.00 to 2.42)). Compared with men from white ethnic groups, black/mixed Caribbean men were more likely to report an STI diagnosis (1.91 (1.20 to 3.04)), but did not report risk behaviours more frequently. Men and women of black/mixed Caribbean ethnicity remained more likely to report STI history after adjustment for sexual risk behaviours. Discussion Risk behaviours were reported less frequently by women of black ethnicity; however, history of STI was more prevalent among black/mixed Caribbean women. In black/mixed Caribbean men, higher STI history was not explained by ethnic variation in reported risk behaviours. The association between STI and black/mixed Caribbean ethnicity remained after adjustment for risk behaviours.
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Affiliation(s)
- Rachel Margaret Coyle
- Research Department of Infection and Population Health, University College London, Royal Free Hospital, London, UK
| | - Ada Rose Miltz
- Research Department of Infection and Population Health, University College London, Royal Free Hospital, London, UK
| | - Fiona C Lampe
- Research Department of Infection and Population Health, University College London, Royal Free Hospital, London, UK
| | - Janey Sewell
- Research Department of Infection and Population Health, University College London, Royal Free Hospital, London, UK
| | - Andrew N Phillips
- Research Department of Infection and Population Health, University College London, Royal Free Hospital, London, UK
| | - Andrew Speakman
- Research Department of Infection and Population Health, University College London, Royal Free Hospital, London, UK
| | - Jyoti Dhar
- Staffordshire and Stoke on Trent Partnership NHS Trust, Leicester, UK
| | - Lorraine Sherr
- Research Department of Infection and Population Health, University College London, Royal Free Hospital, London, UK
| | - S Tariq Sadiq
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Stephen Taylor
- Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Daniel R Ivens
- Marlborough Department of Sexual Health, Royal Free Hospital, London, UK
| | | | - Jonathan Elford
- School of Health Sciences, City University London, London, UK
| | - Jane Anderson
- Centre for the Study of Sexual Health and HIV, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Alison Rodger
- Research Department of Infection and Population Health, University College London, Royal Free Hospital, London, UK
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FUREGATO M, CHEN Y, MOHAMMED H, MERCER CH, SAVAGE EJ, HUGHES G. Examining the role of socioeconomic deprivation in ethnic differences in sexually transmitted infection diagnosis rates in England: evidence from surveillance data. Epidemiol Infect 2016; 144:3253-3262. [PMID: 27511704 PMCID: PMC9150192 DOI: 10.1017/s0950268816001679] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/14/2016] [Accepted: 07/10/2016] [Indexed: 11/07/2022] Open
Abstract
Differences by ethnic group in STI diagnosis rates have long been recognized in England. We investigated whether these may be explained by ethnic disparities in socioeconomic deprivation (SED). Data on all diagnoses made in sexual health clinics in England in 2013 were obtained from the mandatory STI surveillance system. Poisson regression was used to calculate incidence rate ratios (IRRs) of STIs, by ethnicity, with and without adjustment for index of multiple deprivation (IMD) a measure of area-level deprivation. Unadjusted IRRs (95% confidence intervals) were highest for gonorrhoea [8·18 (7·77-8·61) and 5·76 (5·28-6·29)] and genital herpes [4·24 (3·99-4·51) and 3·58 (3·23-3·98)] for people of black Caribbean and non-Caribbean/non-African black ethnicity and IRRs were highest for syphilis [8·76 (7·97-9·63)] and genital warts [2·23 (2·17-2·29)] for people of non-British/non-Irish white ethnicity compared to white British ethnicity. After adjustment for IMD, IRRs for gonorrhoea [5·76 (5·47-6·07)] and genital herpes [3·73 (3·50-3·97)] declined but remained highest for black Caribbeans and IRRs for syphilis [7·35 (6·68-8·09)] and genital warts [2·10 (2·04-2·16)] declined but remained highest for non-British/non-Irish white compared to white British. In England, ethnic disparities in STI diagnosis rates are partially explained by SED, but behavioural and contextual factors likely contribute. Clinic and community-based interventions should involve social peer networks to ensure they are targeted and culturally sensitive.
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Affiliation(s)
- M. FUREGATO
- National Infection Service, Public Health England, London, UK
| | - Y. CHEN
- Centre for Sexual Health and HIV Research, University College London, London, UK
| | - H. MOHAMMED
- National Infection Service, Public Health England, London, UK
| | - C. H. MERCER
- Centre for Sexual Health and HIV Research, University College London, London, UK
| | - E. J. SAVAGE
- National Infection Service, Public Health England, London, UK
| | - G. HUGHES
- National Infection Service, Public Health England, London, UK
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Implementation and Operational Research: Engagement in HIV Care Among Persons Enrolled in a Clinical HIV Cohort in Ontario, Canada, 2001-2011. J Acquir Immune Defic Syndr 2015; 70:e10-9. [PMID: 26322672 PMCID: PMC4623844 DOI: 10.1097/qai.0000000000000690] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is Available in the Text. Ensuring that people living with HIV are accessing and staying in care is vital to achieving optimal health outcomes including antiretroviral therapy (ART) success. We sought to characterize engagement in HIV care among participants of a large clinical cohort in Ontario, Canada, from 2001 to 2011.
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Lutfi K, Trepka MJ, Fennie KP, Ibanez G, Gladwin H. Racial residential segregation and risky sexual behavior among non-Hispanic blacks, 2006-2010. Soc Sci Med 2015. [PMID: 26210657 DOI: 10.1016/j.socscimed.2015.07.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sexually transmitted infections (STIs) including human immunodeficiency virus (HIV) have disproportionately affected the non-Hispanic black population in the United States. A person's community can affect his or her STI risk by the community's underlying prevalence of STIs, sexual networks, and social influences on individual behaviors. Racial residential segregation-the separation of racial groups in a residential context across physical environments-is a community factor that has been associated with negative health outcomes. The objective of this study was to examine if non-Hispanic blacks living in highly segregated areas were more likely to have risky sexual behavior. Demographic and sexual risk behavior data from non-Hispanic blacks aged 15-44 years participating in the National Survey of Family Growth were linked to Core-Based Statistical Area segregation data from the U.S. Census Bureau. Five dimensions measured racial residential segregation, each covering a different concept of spatial variation. Multilevel logistic regressions were performed to test the effect of each dimension on sexual risk behavior controlling for demographics and community poverty. Of the 3643 participants, 588 (14.5%) reported risky sexual behavior as defined as two or more partners in the last 12 months and no consistent condom use. Multilevel analysis results show that racial residential segregation was associated with risky sexual behavior with the association being stronger for the centralization [aOR (95% CI)][2.07 (2.05-2.08)] and concentration [2.05 (2.03-2.07)] dimensions. This suggests risky sexual behavior is more strongly associated with neighborhoods with high concentrations of non-Hispanic blacks and an accumulation of non-Hispanic blacks in an urban core. Findings suggest racial residential segregation is associated with risky sexual behavior in non-Hispanic blacks 15-44 years of age with magnitudes varying by dimension. Incorporating additional contextual factors may lead to the development of interventions that promote healthier behaviors and lower rates of HIV and other STIs.
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Affiliation(s)
- Khaleeq Lutfi
- Robert Stempel College of Public Health & Social Work, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA.
| | - Mary Jo Trepka
- Robert Stempel College of Public Health & Social Work, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA.
| | - Kristopher P Fennie
- Robert Stempel College of Public Health & Social Work, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA.
| | - Gladys Ibanez
- Robert Stempel College of Public Health & Social Work, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA.
| | - Hugh Gladwin
- Global & Sociocultural Studies, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA.
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Prause N, Steele VR, Staley C, Sabatinelli D. Late positive potential to explicit sexual images associated with the number of sexual intercourse partners. Soc Cogn Affect Neurosci 2014; 10:93-100. [PMID: 24526189 DOI: 10.1093/scan/nsu024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Risky sexual behaviors typically occur when a person is sexually motivated by potent, sexual reward cues. Yet, individual differences in sensitivity to sexual cues have not been examined with respect to sexual risk behaviors. A greater responsiveness to sexual cues might provide greater motivation for a person to act sexually; a lower responsiveness to sexual cues might lead a person to seek more intense, novel, possibly risky, sexual acts. In this study, event-related potentials were recorded in 64 men and women while they viewed a series of emotional, including explicit sexual, photographs. The motivational salience of the sexual cues was varied by including more and less explicit sexual images. Indeed, the more explicit sexual stimuli resulted in enhanced late positive potentials (LPP) relative to the less explicit sexual images. Participants with fewer sexual intercourse partners in the last year had reduced LPP amplitude to the less explicit sexual images than the more explicit sexual images, whereas participants with more partners responded similarly to the more and less explicit sexual images. This pattern of results is consistent with a greater responsivity model. Those who engage in more sexual behaviors consistent with risk are also more responsive to less explicit sexual cues.
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Affiliation(s)
- Nicole Prause
- Department of Psychiatry, University of California, 760 Westwood Blvd 38-145, Los Angeles, CA 90024, USA, The Mind Research Network and University of New Mexico, 101 Yale Blvd. NE, Albuquerque, NM, 87106 USA, Idaho State University, Counseling and Testing Center, 921 South 8th Avenue, Pocatello, ID, 83209 USA, and Department of Psychology, University of Georgia, Athens, GA, 30602-3013 USA
| | - Vaughn R Steele
- Department of Psychiatry, University of California, 760 Westwood Blvd 38-145, Los Angeles, CA 90024, USA, The Mind Research Network and University of New Mexico, 101 Yale Blvd. NE, Albuquerque, NM, 87106 USA, Idaho State University, Counseling and Testing Center, 921 South 8th Avenue, Pocatello, ID, 83209 USA, and Department of Psychology, University of Georgia, Athens, GA, 30602-3013 USA
| | - Cameron Staley
- Department of Psychiatry, University of California, 760 Westwood Blvd 38-145, Los Angeles, CA 90024, USA, The Mind Research Network and University of New Mexico, 101 Yale Blvd. NE, Albuquerque, NM, 87106 USA, Idaho State University, Counseling and Testing Center, 921 South 8th Avenue, Pocatello, ID, 83209 USA, and Department of Psychology, University of Georgia, Athens, GA, 30602-3013 USA
| | - Dean Sabatinelli
- Department of Psychiatry, University of California, 760 Westwood Blvd 38-145, Los Angeles, CA 90024, USA, The Mind Research Network and University of New Mexico, 101 Yale Blvd. NE, Albuquerque, NM, 87106 USA, Idaho State University, Counseling and Testing Center, 921 South 8th Avenue, Pocatello, ID, 83209 USA, and Department of Psychology, University of Georgia, Athens, GA, 30602-3013 USA
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Gerressu M, Mercer CH, Cassell JA, Brook G, Dave S. The importance of distinguishing between black Caribbeans and Africans in understanding sexual risk and care-seeking behaviours for sexually transmitted infections: evidence from a large survey of people attending genitourinary medicine clinics in England. J Public Health (Oxf) 2012; 34:411-20. [PMID: 22408067 DOI: 10.1093/pubmed/fds007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In the UK, black Caribbean and African populations experience disproportionately high rates of sexually transmitted infections (STIs) and HIV. Often studies do not differentiate between these populations notwithstanding differences in STI epidemiology and sociodemographics. METHODS Patterns of care-seeking behaviour for STIs were explored separately for black Caribbean (n = 345), black African (n = 193) and white people through a cross-sectional survey of 2824 people attending five genitourinary medicine (GUM) clinics in England. RESULTS Black Caribbean men were least likely to use, or try to use, their general practice surgery prior to GUM clinic attendance (16.6%). Symptomatic black Caribbean and African men were least likely to delay seeking care (30.8 and 26.3%, respectively). Symptomatic black Caribbean men faced the least provider delay in accessing care (27.3%). Black Caribbean men and women were most likely, and black African men and women least likely, to be diagnosed with an STI (49.7 and 32.0% versus 26.8 and 16.3%, respectively). Among symptomatic women, black Caribbeans and, among symptomatic men, black Africans were most likely to report abstaining from sex (46.3 and 73.1%, respectively). CONCLUSIONS Our analyses highlight the importance of distinguishing between black ethnic groups and the need for future studies to ensure sufficiently large samples to permit such analyses.
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Affiliation(s)
- M Gerressu
- Centre for Sexual Health and HIV Research, University College London, London WC1E6JB, UK.
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