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Antonini M, Pontes PS, Melo ES, de Souza Alves R, Gir E, Sorensen W, Reis RK. Serodiscordance predictors among couples in the HIV context: implications for health care. BMC Public Health 2021; 21:1849. [PMID: 34645401 PMCID: PMC8513240 DOI: 10.1186/s12889-021-11835-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background After HIV diagnosis, people maintain, reestablish their sexual lives, or build new relationships, often with HIV seronegative partners. Therefore, understanding the factors concerning couple-vulnerability is essential in order to design effective HIV preventive strategies. We examined HIV serodiscordant couples prevalence and their associated factors from a Brazilian city. Methods This is a cross-sectional analytical study carried out with people living with HIV (PLHIV) who had an active sex life and were engagement in HIV health care follow-up. Data were collected using a semi-structured questionnaire during individual interviews. We analyzed data using bivariate and multiple logistic regression analyses. Results There was 72.0% of HIV serodiscordant partnerships. Those who inconsistently used condoms (aOR: 0.3[0.13–0.7]) and/or had HIV detectable viral load (aOR: 0.29 [0.12–0.7]) were less likely to have an HIV serodiscordant sexual partner. On other hand, the lack of HIV transmission counseling by the health service (aOR: 5.08 [2.02–12.76]), or those who had a casual partner (aOR: 8.12 [1.7–38.8]) or a steady and casual one concomitantly (aOR: 24.82 [1.46–420.83]), were more likely to indicate an HIV serodiscordant partnership. Conclusion The findings showed a high prevalence of serodiscordant partnerships in PLHIV. Greater visibility among couples in the health services is needed as well as a reassessment in order to provide PLHIV and their sexual partners with care strategies, by the health professionals. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11835-0.
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Affiliation(s)
- Marcela Antonini
- Department of General and Specialized Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Bandeirantes Ave, 3900, Vila Monte Alegre SP, CEP, Ribeirão Preto, 14040-902, Brazil.
| | - Priscila Silva Pontes
- Department of General and Specialized Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Bandeirantes Ave, 3900, Vila Monte Alegre SP, CEP, Ribeirão Preto, 14040-902, Brazil
| | - Elizabete Santos Melo
- Paulista University at São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Regina de Souza Alves
- Department of General and Specialized Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Bandeirantes Ave, 3900, Vila Monte Alegre SP, CEP, Ribeirão Preto, 14040-902, Brazil
| | - Elucir Gir
- Department of General and Specialized Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Bandeirantes Ave, 3900, Vila Monte Alegre SP, CEP, Ribeirão Preto, 14040-902, Brazil
| | - William Sorensen
- Department of Health and Kinesiology, University of Texas at Tyler, Tyler, TX, USA
| | - Renata Karina Reis
- Department of General and Specialized Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Bandeirantes Ave, 3900, Vila Monte Alegre SP, CEP, Ribeirão Preto, 14040-902, Brazil
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Kajubi P, Ruark A, Hearst N, Ruteikara S, Green EC. Assessment of an HIV-prevention intervention for couples in peri-urban Uganda: pervasive challenges to relationship quality also challenge intervention effectiveness. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2020; 19:249-262. [PMID: 33119459 DOI: 10.2989/16085906.2020.1811357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Reducing multiple and concurrent partnerships has been identified as a priority in generalised HIV epidemics, yet developing successful interventions to bring about such behaviour change has proven challenging. We offered a three-session intervention aimed to improve couple relationship quality and address HIV risk factors, particularly concurrent sexual partnerships (CSP), in a peri-urban community of Kampala, Uganda. Before launching the intervention, a different group of community members participated in eight single-gender focus group discussions (FGDs) which explored issues of couple relationship quality and satisfaction. Findings from the FGDs guided the intervention. All 162 couples invited to the intervention completed a survey pre- and post-intervention. In FGDs, women and men discussed challenges faced in their relationships, including pervasive dissatisfaction, financial constraints, deception and lack of trust, poor communication, lack of sexual satisfaction, and concurrent sexual partnerships. A difference-in-difference analysis showed no measurable impact of the intervention on relationship quality or sexual risk behaviours over a six-month follow-up among 183 individuals who participated in the intervention, although many stated in response to open-ended questions that they had experienced positive relationship changes. Qualitative findings suggest high demand for couple-focused interventions but also reveal many individual-, couple-, community- and structural-level factors which contribute to women and men seeking concurrent sexual partnerships. More intensive interventions may be needed to overcome these barriers to behaviour change and reduce HIV risk. These findings also raise questions about how to interpret divergent qualitative and quantitative data, a topic which has received little attention in the literature.
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Affiliation(s)
- Phoebe Kajubi
- The Uganda Academy for Health Innovation & Impact, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda; Currently at Child Health and Development Centre, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Allison Ruark
- Department of Medicine, Brown University, Providence, USA; currently Department of Applied Health Sciences, Wheaton College, Wheaton, IL, USA.,Ukwanda Centre for Rural Health, Stellenbosch University, South Africa
| | - Norman Hearst
- Department of Family and Community Medicine, School of Medicine, University of California, San Francisco, USA
| | | | - Edward C Green
- Department of Anthropology, The George Washington University, Washington, DC, USA
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Tompkins K, Brown J, Tozay S, Reeves E, Pewu K, Johnson H, Williams G, Conneh T, Diggs J, DeMarco J, King K, McMillian D, Merenbloom C, Fischer W, Wohl DA. The impact of semen testing for Ebola virus RNA on sexual behavior of male Ebola survivors in Liberia. PLoS Negl Trop Dis 2020; 14:e0008556. [PMID: 32925964 PMCID: PMC7515181 DOI: 10.1371/journal.pntd.0008556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 09/24/2020] [Accepted: 07/02/2020] [Indexed: 12/31/2022] Open
Abstract
Sexual transmission of Ebola virus (EBOV) is well established and has been implicated in multiple resurgences during the West African Ebola epidemic. Given the persistence of viral RNA in semen, guidelines from the World Health Organization (WHO) recommend abstinence or condom use for at least 1 year or until two semen PCR tests are negative. To better understand the impact of semen testing on sexual behavior, male EVD survivors were surveyed regarding their sexual behavior before and after semen testing. Of the 171 men who enrolled, 148 reported being sexually active following discharge from an ETU with 59% reporting episodes of condomless sex. At least one semen sample for testing was provided by 149 men and 13 of these men had EBOV RNA detected in their semen. When comparing sexual behaviors before and after semen testing, a positive semen test result had limited impact on behavior. Of those with seminal EBOV RNA detected, 61% reported no change in behavior pre- and post-semen testing with 46% engaging in condomless sex before and after testing and only 1 adopted safer sex behaviors following receipt of a positive result. Similarly, among men with undetectable EBOV in their semen, 66% reported no change in sexual behaviors with semen testing, with 55% forgoing condoms during sex. In only 11% was a negative semen result followed by abandoning condoms. There were no known sexual transmission events of Ebola virus in this cohort despite viral presence in semen during periods of condomless sex. This highlights the need to better understand the infectious potential of viral RNA persistence and determine what constitutes effective counseling for survivors and their partners. Ebola virus (EBOV) is established as a sexually transmitted infection, however there is limited information on the sexual behaviors of Ebola survivors. We surveyed a cohort of male Ebola survivors regarding sexual activity and condom use and offered semen testing to assess EBOV persistence in semen. We found that a large majority of men who were sexually active prior to contracting Ebola Virus Disease remained sexually active after their recovery with most reporting only intermittent condom use. Semen testing for the presence of Ebola virus had limited impact on sexual behaviors, with most continuing to report engaging in condomless sex whether EBOV was detected or not. This finding has implications for use of semen testing for outbreak control as well as counseling for Ebola survivors and their partners.
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Affiliation(s)
- Kathleen Tompkins
- The Institute of Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Jerry Brown
- The John F. Kennedy Hospital, Monrovia, Liberia
| | - Sam Tozay
- The University of North Carolina Liberia Project, Paynesville, Liberia
| | - Edwina Reeves
- The University of North Carolina Liberia Project, Paynesville, Liberia
| | - Korto Pewu
- The University of North Carolina Liberia Project, Paynesville, Liberia
| | - Harrietta Johnson
- The University of North Carolina Liberia Project, Paynesville, Liberia
| | - Gerald Williams
- The University of North Carolina Liberia Project, Paynesville, Liberia
| | - Tonia Conneh
- The University of North Carolina Liberia Project, Paynesville, Liberia
| | - Joseph Diggs
- The University of North Carolina Liberia Project, Paynesville, Liberia
| | - Jean DeMarco
- The Institute of Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Katherine King
- The Institute of Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Darrius McMillian
- The Institute of Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Carson Merenbloom
- The Institute of Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - William Fischer
- The Institute of Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Division of Pulmonary and Critical Care Medicine, The University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - David Alain Wohl
- The Institute of Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Bannink Mbazzi F, Namukwaya Z, Amone A, Ojok F, Etima J, Byamugisha J, Katabira E, Fowler MG, Homsy J, King R. "[Repeat] testing and counseling is one of the key [services] that the government should continue providing": participants' perceptions on extended repeat HIV testing and enhanced counseling (ERHTEC) for primary HIV prevention in pregnant and lactating women in the PRIMAL study, Uganda. BMC Public Health 2020; 20:694. [PMID: 32414405 PMCID: PMC7227345 DOI: 10.1186/s12889-020-08738-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 04/20/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The 'Primary HIV Prevention among Pregnant and Lactating Ugandan Women' (PRIMAL) randomized controlled trial aimed to assess an enhanced counseling strategy linked to extended postpartum repeat HIV testing and enhanced counseling among 820 HIV-negative pregnant and lactating women aged 18-49 years and 410 of their male partners to address the first pillar of the WHO Global Strategy for the Prevention of Mother-to-Child HIV transmission (PMTCT). This paper presents findings of qualitative studies aimed at evaluating participants' and service providers' perceptions on the acceptability and feasibility of the intervention and at understanding the effects of the intervention on risk reduction, couple communication, and emotional support from women's partners. METHODS PRIMAL Study participants were enrolled from two antenatal care clinics and randomized 1:1 to an intervention or control arm. Both arms received repeat sexually transmitted infections (STI) and HIV testing at enrolment, labor and delivery, and at 3, 6, 12, 18 and 24 months postpartum. The intervention consisted of enhanced quarterly counseling on HIV risk reduction, couple communication, family planning and nutrition delivered by study counselors through up to 24 months post-partum. Control participants received repeat standard post-test counseling. Qualitative data were collected from intervention women participants, counsellors and midwives at baseline, midline and end of the study through 18 focus group discussions and 44 key informant interviews. Data analysis followed a thematic approach using framework analysis and a matrix-based system for organizing, reducing, and synthesizing data. RESULTS At baseline, FGD participants mentioned multiple sexual partners and lack of condom use as the main risks for pregnant and lactating women to acquire HIV. The main reasons for having multiple sexual partners were 1) the cultural practice not to have sex in the late pre-natal and early post-natal period; 2) increased sexual desire during pregnancy; 3) alcohol abuse; 4) poverty; and 5) conflict in couples. Consistent condom use at baseline was limited due to lack of knowledge and low acceptance of condom use in couples. The majority of intervention participants enrolled as couples felt enhanced counselling improved understanding, faithfulness, mutual support and appreciation within their couple. Another benefit mentioned by participants was improvement of couple communication and negotiation, as well as daily decision-making around sexual needs, family planning and condom use. Participants stressed the importance of providing counselling services to all couples. CONCLUSION This study shows that enhanced individual and couple counselling linked to extended repeat HIV and STI testing and focusing on HIV prevention, couple communication, family planning and nutrition is a feasible and acceptable intervention that could enhance risk reduction programs among pregnant and lactating women. TRIAL REGISTRATION ClinicalTrials.gov registration number NCT01882998, date of registration 21st June 2013.
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Affiliation(s)
- Femke Bannink Mbazzi
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda.
- Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium.
| | - Zikulah Namukwaya
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Alexander Amone
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | - Juliane Etima
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynecology, Makerere University School of Medicine, Kampala, Uganda
| | - Elly Katabira
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
- College of Health Sciences, School of Medicine, Makerere University, Kampala, Uganda
| | - Mary Glenn Fowler
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jaco Homsy
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Rachel King
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
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5
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Courtenay-Quirk C, Pals S, Howard AA, Ujamaa D, Henjewele C, Munuo G, Urasa P, Nyamkara M. Increasing partner HIV testing and linkage to care in TB settings: findings from an implementation study in Pwani, Tanzania. AIDS Care 2018; 30:1600-1604. [PMID: 30021448 DOI: 10.1080/09540121.2018.1499863] [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: 10/28/2022]
Abstract
Couples HIV testing for tuberculosis (TB) patients and their partners may be an effective means to identify HIV-positive persons and strengthen linkage to HIV care. We evaluated an intervention to increase HIV testing and linkage to care (LTC) of newly diagnosed persons and re-linkage for TB/HIV patients in Pwani, Tanzania. In 2014, 12 TB settings within two regional clusters participated; each cluster included ≥1 referral hospital, health center, and directly observed therapy center. Three months after introducing tools to record HIV service delivery, TB clinic staff and peer education volunteers in Cluster 1 received training on HIV partner testing and linkage/re-linkage, and staff in the second cluster received training 3 months thereafter. Twelve months after tools were introduced, clinic records were abstracted to assess changes in couples HIV testing, LTC, and re-linkage. Staff interviews assessed the feasibility and acceptability of the service delivery model. HIV prevalence was high among TB patients during the study period (44.9%; 508/1132), as well as among others who received HIV testing (19.8%; 253/1288). Compared to pre-implementation, couples HIV testing increased in both clusters from 1.8% to 35.2%. Documented LTC increased (from 5.7% to 50.0%) following the introduction of the tools. Additional increases in LTC (from 57.9% to 79.3%) and re-linkage (from 32.9% to 53.7%) followed Cluster 1 training, but no additional increases after Cluster 2 training. Staff perceived little burden associated with service delivery. This study demonstrated a feasible, low-burden approach to expand couples HIV testing and linkage of HIV-positive persons to care. TB settings in sub-Saharan Africa serve populations at disproportionate risk for HIV infection and should be considered key venues to expand access to effective HIV prevention strategies for both patients and their partners. HIV services in TB settings should include HIV testing, condom distribution, and linkage to appropriate additional services.
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Affiliation(s)
- Cari Courtenay-Quirk
- a Division of Global HIV and Tuberculosis , Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Sherri Pals
- a Division of Global HIV and Tuberculosis , Centers for Disease Control and Prevention , Atlanta , GA , USA
| | | | | | | | - Godwin Munuo
- e Centers for Disease Control and Prevention , Dar es Salaam , Tanzania
| | - Peris Urasa
- f National AIDS Control Program , Ministry of Health and Social Welfare , Dar es Salaam , Tanzania
| | - Mwanaisha Nyamkara
- g National TB and Leprosy Program , Ministry of Health and Social Welfare , Dar es Salaam , Tanzania
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6
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Desmond N, Nagelkerke N, Lora W, Chipeta E, Sambo M, Kumwenda M, Corbett EL, Taegtemeyer M, Seeley J, Lalloo DG, Theobald S. Measuring sexual behaviour in Malawi: a triangulation of three data collection instruments. BMC Public Health 2018; 18:807. [PMID: 29954360 PMCID: PMC6022416 DOI: 10.1186/s12889-018-5717-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 06/17/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is a need for valid approaches to measure sexual interactions to assess the impact of behavioural interventions and to predict the impact of behaviour changes. Different methods of asking about sexual behaviour often yield conflicting answers and men often report higher levels of heterosexual activity than women. To better understand self-reported sexual behaviour data and how best to collect it, we analyzed data collected as part of a larger project (ST IMPACTS) on the social and behavioural impact of introducing community-level HIV self-testing (HIVST) with counseling (semi-supervised with pre- and generic post-test counseling provided on delivery or collection of test kits) in an urban Malawian setting. METHODS Information on sexual behaviour was collected from HIV self-testers over a three-month period. Three different methods were used: retrospective face-to-face interviews (FTFI); audio computer assisted self-interviews (ACASI) and a prospective coital diary. Both retrospective instruments were used before and after the three-month study period. Frequency and cross-tabulation, as well as scatterplots, were used for exploratory analyses. Chi-square tests were used to test for differences in proportions. Spearman's correlation coefficient was used to explore associations between both continuous and ordinal variables and Wilcoxon's paired sample and Mann-Whitney test was used to test for differences in such variables or between variables. RESULTS There was reasonable agreement between the two retrospective methods although both yielded inconsistent answers e.g. with lower reported numbers of life-time sexual partners at the end than at the beginning of the study period. The diary method elicited higher reported levels of sex with multiple partners than both retrospective instruments which may be due to inadequate recall. Over the study period 37.4% of men and 19.7% of women reported multiple sexual partners using the diary. There was no clear relationship between reported sexual behaviour and HIV status (prevalence 9.6%). CONCLUSIONS Diaries may therefore have higher validity for sensitive behaviour reporting and thus be the preferred method in similar African contexts in measuring sexual behaviours.
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Affiliation(s)
- Nicola Desmond
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK. .,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
| | - Nico Nagelkerke
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Wezzie Lora
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Effie Chipeta
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,College of Medicine, University of Malawi, Blantyre, Malawi
| | - Mwiza Sambo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Moses Kumwenda
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,College of Medicine, University of Malawi, Blantyre, Malawi
| | - Elizabeth L Corbett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | | | - Janet Seeley
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - David G Lalloo
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Sally Theobald
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
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Muldoon KA, King R, Zhang W, Birungi J, Nanfuka M, Tibengana S, Afolabi O, Moore DM. Sexual Health Consequences of Forced Sexual Debut Among Ugandan Women in HIV Serodiscordant Partnerships: Results From the HAARP Study. JOURNAL OF INTERPERSONAL VIOLENCE 2018; 33:1731-1747. [PMID: 29739290 DOI: 10.1177/0886260517752155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Sexual coercion, especially forced sexual debut, is associated with lifelong adverse health consequences. This is compounded in regions, such as Uganda, where the dual impact of HIV and violence critically shapes women's sexual health risks. Among a sample of women in HIV serodiscordant relationships, we investigated the prevalence and consequences of forced sexual debut. Data for this analysis come from the Highly Active Antiretroviral Treatment as Prevention (HAARP) Study, a cohort of HIV serodiscordant couples in Jinja, Eastern Uganda, and investigates the role of forced sexual debut on two outcomes: age of sexual debut and having more than three lifetime sexual partners. Bivariate and multivariate linear regressions were used to model age at sexual debut using β and adjusted (A) β and 95% confidence intervals (CIs). Bivariate and multivariate logistic regressions were used to model having more than three lifetime sexual partners and used odds ratios (ORs) and adjusted OR (AOR) and 95% CI. A total of 574 women were included in this analysis, median age 35 years, and 241 (41.99%) were living with HIV. A quarter (24.21%) of women experienced forced sexual debut at the median age of 16 years. Forced sexual debut was significantly associated with earlier age of sexual debut (β = -1.17, 95% CI: [-1.64, -0.68]). Forced sexual debut was significantly associated with having more than three sexual partners (AOR: 1.99, 95% CI: [1.33, 2.99]), in addition to older age (AOR: 1.02, 95% CI: [1.01, 1.05]). Speaking Lusoga, the primary language in Jinja (the study site) was associated with lower odds of having more than three sexual partners (AOR: 0.63, 95% CI: [0.43, 0.92]). Forced sexual debut was a common experience significantly associated with younger age of sexual debut and higher number of lifetime sexual partners. Safe and consensual first sexual experiences for young women play an important role in reducing HIV risk and lay the foundation for healthy and safe sexual health.
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Affiliation(s)
- Katherine A Muldoon
- 1 Ottawa Hospital Research Institute, Ontario, Canada
- 2 University of Ottawa, Ontario, Canada
| | - Rachel King
- 3 University of California, San Francisco, USA
| | - Wendy Zhang
- 4 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | | | | | | | - Omoboade Afolabi
- 4 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - David M Moore
- 4 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- 6 University of British Columbia, Vancouver, Canada
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