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Millender E, Harris RM, Bagneris JR, Marks LR, Barcelona V, Wong FY, Crusto CA, Taylor JY. The Cumulative Influence of Perceived Discrimination, Stress, and Coping Responses on Symptoms of Depression Among Young African American Mothers. J Am Psychiatr Nurses Assoc 2024; 30:322-332. [PMID: 35833679 PMCID: PMC9839894 DOI: 10.1177/10783903221105281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND African American women have an elevated risk for experiencing depressive symptoms, and discrimination, stress, and coping contribute to symptoms of depression. AIMS We aimed to examine the associations between discrimination, stress, and coping on symptoms of depression among young African American mothers. METHODS In this retrospective study, we utilized a hierarchical linear regression to explore the effects of perceived racial discrimination, stress, and general and discrimination-related coping responses on depressive symptoms in a sample of African American mothers (N = 250). The data were drawn from the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure study (InterGEN), a study conducted between 2014 and 2019 and based in Connecticut. RESULTS After accounting for maternal age, level of education, and income, greater perceived racial discrimination (p = .03), higher levels of stress (p < .001), greater engagement in avoidance coping (p < .001), and use of passive coping responses to discrimination (p = .04) were uniquely associated with increased depressive symptoms. Other forms of coping, specifically, problem-solving and support seeking, did not appear to influence depressive symptoms in this sample. CONCLUSION The findings highlight the negative impact of discrimination, heightened stress, and maladaptive coping on the emotional health of young African American mothers.
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Affiliation(s)
- Eugenia Millender
- Center of Population Sciences for Health Equity, Florida State University, Tallahassee, FL, USA
| | | | | | | | | | - Frank Y. Wong
- Center of Population Sciences for Health Equity, Florida State University, Tallahassee, FL, USA
| | | | - Jacquelyn Y. Taylor
- Center for Research on People of Color, Columbia University School of Nursing, New York, NY, USA
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Wang L, Harris R, Simoni JM, Yue Q, Fu J, Zheng H, Ning Z, Xavier Hall CD, Burns PA, Wong FY. Health Service Utilization and Its Associations with Depression and Sexual Risk Behaviors Among Transgender Women in Shanghai, China. Transgend Health 2023; 8:516-525. [PMID: 38130986 PMCID: PMC10732171 DOI: 10.1089/trgh.2021.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose Given the limited research on health care utilization among transgender women in China, we described the use of primary health care and gender-affirming health care, and the associations between utilization of gender-affirming health care and depression and sexual risk behaviors. Methods We conducted a cross-sectional survey in 2017 among a purposive sample of transgender women in Shanghai, China (N=199). We examined correlates of health care utilization and its association with depression and sexual risk behaviors with Chi-square (χ2), Fisher's exact tests, and analysis of variance. Results The majority of the sample (78.5%) only had physician appointments when having an illness, while about one-fifth of the sample had physician appointments for yearly checkups. Nineteen out of 199 participants (9.5%) received gender-affirming surgery, among which only five used hormone therapy prescribed by a doctor (26.3%). Receiving some form of gender-affirming surgery was associated with higher depression scores [Welch's F(2, 12.22)=4.16, p=0.04], engagement in sex work (p=0.001), having 7 or more male sexual partners in the last 30 days (p=0.003), lifetime unprotected sex with a man (p=0.050), and unprotected sex with a main partner (p=0.043). Compared with transgender women who received both breast augmentation and vulvo-vaginoplasty (mean=5.86), those who received breast augmentation only (mean=12.33) scored higher on depression (p=0.04). Conclusions Access to gender-affirming health care is low among transgender women in this study. The utilization of gender-affirming surgery is associated with depression and sexual risk behaviors. Findings suggest China should establish national guidelines on transgender-related health care and set up more clinics to provide consultation and services for the transgender population in China.
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Affiliation(s)
- Liying Wang
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Rachel Harris
- Center for Population Sciences and Health Equity, Florida State University, Tallahassee, Florida, USA
- College of Social Work, Florida State University, Tallahassee, Florida, USA
| | - Jane M. Simoni
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Qing Yue
- Department of HIV/STD Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jie Fu
- Department of HIV/STD Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Huang Zheng
- Shanghai Piaoxue Multicultural Media Ltd., Shanghai, China
| | - Zhen Ning
- Department of HIV/STD Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Casey D. Xavier Hall
- Institute for Sexual and Gender Minority Health and Wellbeing (ISGMH), Northwestern University, Evanston, Illinois, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Paul A. Burns
- Department of Population Health Science, John D. Bower School of Population Health, University Mississippi Medical Center, Jackson, Mississippi, USA
| | - Frank Y. Wong
- Center for Population Sciences and Health Equity, Florida State University, Tallahassee, Florida, USA
- Department of Population Health Science, John D. Bower School of Population Health, University Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Psychology, University of Hawaiʽi at Mānoa, Honolulu, Hawaiʽi, USA
- School of Public Health, Fudan University, Shanghai, China
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3
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Wang L, Hong C, He N, Xavier Hall CD, Simoni JM, Wong FY. Depression as a mediator between intimate partner violence (IPV) and CD4 cell count among men who have sex with men (MSM) living with HIV in China. AIDS Care 2023; 35:1667-1676. [PMID: 37018752 DOI: 10.1080/09540121.2023.2195608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 03/20/2023] [Indexed: 04/07/2023]
Abstract
Intimate partner violence (IPV) is associated with adverse mental and physical outcomes among men who have sex with men (MSM) living with HIV. Few studies focus on psychological IPV, such as verbal threats. This study examined the associations between different forms of IPV and depression and CD4+ cell count, with depression as a mediator for the association between IPV and CD4+ cell count. Data for these analyses were derived from a larger cross-sectional study on HIV-HCV co-infection among MSM in Shanghai, China (N = 1623). We estimated the average causal mediation effects (ACME) and average direct effects (ADE) through three steps. About 16% of participants experienced IPV, with forced sex (7%), verbal threats (5%), and thrown objects (4%) being most common. Verbal threats showed the strongest link with depression and low CD4+ cell count. Depression fully mediated the relationship between verbal abuse and low CD4+ cell count, suggesting it as a potential pathway between psychological IPV and poorer HIV-related health outcomes. More research on psychological IPV is warranted to examine its health impacts. Mental health could be a potential focus of intervention to enhance HIV-related health outcomes among MSM with IPV experience.
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Affiliation(s)
- Liying Wang
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Chenglin Hong
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA, USA
| | - Na He
- School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Casey D Xavier Hall
- Institute for Sexual and Gender Minority Health and Wellbeing (ISGMH), Northwestern University, Chicago, IL, USA
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Gender, Women & Sexuality Studies, University of Washington, Seattle, WA, USA
| | - Frank Y Wong
- School of Public Health, Fudan University, Shanghai, People's Republic of China
- Center for Population Sciences and Health Equity, Florida State University, Tallahassee, FL, USA
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, USA
- John D. Bower School of Population Health, Department of Population Health Science, University Mississippi Medical Center, Jackson, MS, USA
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4
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He J, Ding Y, Wong FY, He N. Health-care access and utilization among HIV-infected men who have sex with men in two Chinese municipalities with or without lockdown amidst early COVID-19 pandemic. AIDS Care 2022; 34:1390-1399. [PMID: 35179422 DOI: 10.1080/09540121.2022.2041163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
City lockdown is critical to successfully contain the COVID-19 pandemic. The impact of lockdown and COVID-19 pandemic on healthcare among vulnerable population has yet to be explicated. A cross-sectional survey was conducted among HIV-infected men who have sex with men (MSM) in Wuhan with city lockdown and Shanghai without lockdown, and healthcare interruptions were evaluated and compared. A logistic regression analysis was employed to examine associates of HIV-related healthcare interruptions and compromised mental health. Compared to participants in Shanghai (N = 440), HIV-infected MSM in Wuhan (N = 503) had significantly higher proportion of untimely availability of antiretroviral drugs (ARVs) (20.6% vs. 8.4%), obtaining ARVs from outside institutions (29.1% vs. 8.1%), postponed non-AIDS treatment (6.4% vs. 2.8%) and untimely follow-up appointments (33.4% vs. 14.5%). HIV-related healthcare interruptions were positively associated with lockdown (OR = 4.89, 95% CI: 3.49-6.85) and non-local residence (OR = 1.91, 95% CI: 1.37-2.64). Compromised mental health, including insomnia and generalized anxiety disorders, was associated with non-local residence (OR = 1.35, 95% CI: 1.01-1.81) and healthcare interruptions (OR = 1.34, 95% CI: 1.01-1.79). HIV-infected MSM are vulnerable to healthcare interruptions and mental health problems during the COVID-19 pandemic, underscoring the need for tailored intervention strategies to minimize deleterious health consequences.
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Affiliation(s)
- Jiayu He
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, People's Republic of China.,Key Laboratory of Health Technology Assessment of Ministry of Health, Fudan University, Shanghai, People's Republic of China
| | - Yingying Ding
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, People's Republic of China
| | - Frank Y Wong
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, People's Republic of China.,Center for Population Sciences and Health Equity, Florida State University, Tallahassee, FL, USA.,Department of Psychology, University of Hawaìi at Mānoa, Honolulu, HI, USA
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, People's Republic of China.,Key Laboratory of Health Technology Assessment of Ministry of Health, Fudan University, Shanghai, People's Republic of China
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Burns PA, Hall CDX, Poteat T, Mena LA, Wong FY. Living While Black, Gay, and Poor: The Association of Race, Neighborhood Structural Disadvantage, and PrEP Utilization Among a Sample of Black Men Who Have Sex With Men in the Deep South. AIDS Educ Prev 2021; 33:395-410. [PMID: 34596429 PMCID: PMC10134438 DOI: 10.1521/aeap.2021.33.5.395] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Utilizing the Andersen Healthcare Utilization Model, we examined the role of neighborhood context on pre-exposure prophylaxis (PrEP) utilization among a sample of Black men who have sex with men (MSM) residing in a medium-sized city in the Deep South. Data were derived from a sample of 142 Black MSM aged 18-64 years who were eligible for PrEP from a community-based study known as "ACCELERATE!" We used multilevel structural equation modeling to assess PrEP use. Social support, sexual risk, and health care access were predictive of PrEP use. Notably, residing in a neighborhood with concentrated poverty was associated with decreased PrEP use. Our findings reveal neighborhood structural disadvantage is associated with decreased PrEP use among Black MSM, after adjusting of individual-level sociodemographic characteristics. There is an urgent need to develop HIV prevention interventions and programs that explicitly address structural-level factors to eliminate racial/ethnic differences in HIV.
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Affiliation(s)
- Paul A. Burns
- University of Mississippi Medical Center. John D. Bower School of Population Health | Center for HIV/AIDS Research, Education and Policy, 2500 North State Street, TR202-09, Jackson, MS 39216 USA
| | - Casey D. Xavier Hall
- Northwestern University, Department of Medical Social Sciences at Feinberg School of Medicine | Institute for Sexual and Gender Minority Health and Wellbeing, 625 N Michigan Ave, Suite 1400, Chicago, IL 60611
| | - Tonia Poteat
- University of North Carolina-Chapel Hill, School of Medicine | Department of Social Medicine and Center for Health Equity Research 321 S. Columbia Street, Chapel Hill, NC 27599
| | - Leandro A. Mena
- University of Mississippi Medical Center. John D. Bower School of Population Health | Center for HIV/AIDS Research, Education and Policy, 2500 North State Street, TR202-09, Jackson, MS 39216 USA
- Univerisity of Mississippi Medical Center, School of Medicine, Department of Infectious Diseases, 2500 North State Street, Jackson, MS 39216 USA
| | - Frank Y. Wong
- University of Mississippi Medical Center. John D. Bower School of Population Health | Center for HIV/AIDS Research, Education and Policy, 2500 North State Street, TR202-09, Jackson, MS 39216 USA
- Florida State University, College of Nursing | Center for Population Sciences and Health Equity, 2010 Levy Avenue, Building B, Suite 3600, Tallahassee, FL 32310
- University of Hawaiì at Mānoa, Department of Psychology, Sakamaki C 400, 2530 Dole St C 400, Honolulu, HI 96822
- Fudan University, School of Public Health-Epidemiology, Shanghai, China
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Hall CDX, Luu M, Nehl EJ, He N, Zheng T, Haardörfer R, Wong FY. Do the same socio-demographic variables predict testing uptake and sero-status? HIV and syphilis among an observational sample of Chinese men who have sex with men in Shanghai, China. Int J STD AIDS 2021; 31:939-949. [PMID: 32772687 DOI: 10.1177/0956462420909733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
HIV and syphilis are pronounced among men who have sex with men (MSM) in China and often occur as co-infections, while testing remains low. Few studies examine common predictors across these outcomes. This observational venue-based sample of 546 MSM in Shanghai, China used a common set of psychosocial predictors to construct logistic models for the outcomes (HIV non-testing, syphilis non-testing, HIV sero-status, and syphilis sero-status). Fifty-seven (10.7%) participants tested positive for HIV, 126 (23.5%) for syphilis, and 33% of HIV-positive participants had a co-infection. Non-sex working MSM had consistently higher odds of HIV and syphilis non-testing (OR= 2.2, 95% CI 1.4-3.5, p < 0.001; OR = 2.4, 95, 95% CI 1.5-3.8, p < 0.001, respectively) compared to 'money boy' sex workers. Participants with a 0 score on HIV knowledge had 4.1 times (95% CI 1.4-12.5, p = 0.01) the odds of reporting HIV non-testing, 6.0 (95% CI 1.96-18.5, p < 0.01) times the odds of reporting non-testing for syphilis, and 8.44 times (95% CI 1.19-59.7, p = 0.03) the odds of testing positive for HIV, compared to a score of 8. The results highlighted the importance of integrating HIV/syphilis education and promoting testing for both HIV and syphilis among all sub-groups of MSM in China.
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Affiliation(s)
- Casey D Xavier Hall
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Minh Luu
- Department of Behavioral Sciences and Health Education, Emory University's Rollins School of Public Health, Atlanta, GA, USA
| | - Eric J Nehl
- Department of Behavioral Sciences and Health Education, Emory University's Rollins School of Public Health, Atlanta, GA, USA
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Tony Zheng
- Shanghai Piaoxue Multicultural Medua, Ltd, Shanghai, China
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Emory University's Rollins School of Public Health, Atlanta, GA, USA
| | - Frank Y Wong
- Department of Behavioral Sciences and Health Education, Emory University's Rollins School of Public Health, Atlanta, GA, USA.,Center for Indigenous Nursing Research for Health Equity, Florida State University, Tallahassee, FL, USA.,Department of Psychology, University of Hawai'i, Mānoa, Honolulu, HI, USA
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7
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Wang L, Barile JP, Simoni JM, Harris R, Yue Q, Fu J, Zheng H, Ning Z, Wong FY. Intimate Partner Violence Among Chinese Transwomen: Associations With Sexual Risk Behaviors and HIV Testing. Sex Transm Dis 2021; 48:362-369. [PMID: 33060544 DOI: 10.1097/olq.0000000000001317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) is an emerging risk factor for HIV infection. Given the high vulnerability of and limited research on transwomen in China, we described IPV, sexual risk behaviors, HIV, and sexually transmitted infection (STIs) testing rates and results, and investigated the pathways that link IPV to HIV infection among this population. METHODS We conducted a cross-sectional survey and collected blood samples for HIV and syphilis testing among transwomen in Shanghai, China (n = 199). With logistic regression, we examined sexual risk behaviors and HIV/STI testing history among participants with and without IPV experience. RESULTS More than half of the respondents reported IPV (57.3%), and the prevalence of unprotected sex ranged from 51.9% (with sex workers) to 87.8% (oral sex); 85.9% had ever tested for HIV and 49.3% for other STIs. Self-reported positivity results were as follows: HIV (2.3%), herpes simplex virus type 2 (8.3%), gonorrhea (18.8%), and syphilis (17.8%). Laboratory-confirmed positivity values were 5.0% for HIV and 6.5% for syphilis. Respondents with a history of IPV were significantly less likely to report HIV testing in the past 12 months (adjusted odds ratio, 0.20; 95% confidence interval, 0.10-0.38). CONCLUSIONS Transwomen self-reported a high prevalence of IPV, which was related to a lower probability of HIV testing. The prevalence of HIV and other STIs was lower than reported in previous studies of Chinese transwomen, whereas the HIV/STI testing rates were higher. Findings suggest transwomen in China are at risk for IPV and need enhanced HIV prevention services to promote HIV testing in an IPV setting.
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Affiliation(s)
- Liying Wang
- From the Department of Psychology, University of Washington, Seattle, WA
| | - John P Barile
- Department of Psychology, University of Hawaii at Mānoa, Honolulu, HI
| | - Jane M Simoni
- From the Department of Psychology, University of Washington, Seattle, WA
| | - Rachel Harris
- College of Social Work, Florida State University, Tallahassee, FL
| | - Qing Yue
- Department of HIV/STD Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention
| | - Jie Fu
- Department of HIV/STD Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention
| | - Huang Zheng
- Shanghai Piaoxue Multicultural Media Ltd., Shanghai, China
| | - Zhen Ning
- Department of HIV/STD Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention
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Millender E, Barile JP, R Bagneris J, Harris RM, De Faria L, Wong FY, Crusto CA, Taylor JY. Associations between social determinants of health, perceived discrimination, and body mass index on symptoms of depression among young African American mothers. Arch Psychiatr Nurs 2021; 35:94-101. [PMID: 33593522 PMCID: PMC7890049 DOI: 10.1016/j.apnu.2020.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/09/2020] [Accepted: 09/12/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The association between symptoms of depression and risks for cardiovascular disease (CVD) remains equivocal for African American (AA) mothers. We examined the association between social determinants of health (perceived discrimination), and cardiovascular risk (BMI) on symptoms of depression in a sample of young AA mothers. METHODS Secondary data from 219 adult AA mothers between the ages of 21 and 46 with an average BMI of 29.8 and yearly family income of $14,999 were analyzed using a latent growth model that evaluated four time points to assess changes in symptoms of depression. RESULTS Initial BMI was significantly associated with initial symptoms of depression (b = 0.12, p = .019). Perceived discrimination (unfair treatment) was associated with higher initial symptoms of depression (b = 1.14, p = .017). CONCLUSION The findings suggest that elevated BMI and perceived discrimination are associated with higher reported symptoms of depression among young, socioeconomically disadvantaged AA mothers. These results advance the scientific understanding of young AA mothers' risk for symptoms of depression and CVD by elucidating the impact of perceived discrimination and social experiences on mental health. Further studies of SDoH and CVD risk factors and perceived racism and depression are needed to shed light on the long-term mental health impact on AA mothers and their children.
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Affiliation(s)
- Eugenia Millender
- Center for Population Sciences and Health Equity Associate Professor, College of Nursing, Florida State University, 2010 Levy Ave., Tallahassee, FL 32310, United States of America.
| | - John P Barile
- Department of Psychology, the University of Hawai'i at Mānoa, 2530 Dole St., Sakamaki Hall C404, Honolulu, HI 96822-2294, United States of America.
| | - Jessica R Bagneris
- Center for Population Sciences and Health Equity Associate Professor, College of Nursing, Florida State University, 2010 Levy Ave., Tallahassee, FL 32310, United States of America.
| | - Rachel M Harris
- Center for Population Sciences and Health Equity Associate Professor, College of Nursing, Florida State University, 2010 Levy Ave., Tallahassee, FL 32310, United States of America.
| | - Ludmila De Faria
- Clinical Associate Professor, Department of Psychiatry, University of Florida, United States of America.
| | - Frank Y Wong
- Center for Population Sciences and Health Equity Associate Professor, College of Nursing, Florida State University, 2010 Levy Ave., Tallahassee, FL 32310, United States of America.
| | - Cindy A Crusto
- Department of Psychiatry, Yale University School of Medicine, 300 George St, New Haven, CT 06511, United States of America; Department of Psychology, University of Pretoria, cnr Lynwood Road and Roper Street, Hatfield Pretoria 0002, South Africa.
| | - Jacquelyn Y Taylor
- Columbia University School of Nursing and Center for Research on People of Color, 560 W 168th Street, Room 605, New York, New York 10032, United States of America.
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Shi R, Chen X, Lin H, Shen W, Xu X, Zhu B, Xu X, Ding Y, Wong FY, He N. Association of HIV infection with metabolic syndrome among normal or underweight young adults: evidence from the CHART cohort. Biosci Trends 2021; 14:450-456. [PMID: 33328394 DOI: 10.5582/bst.2020.03351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Metabolic syndrome (MS) is common among obese people. Little is known about the magnitude and characteristics of MS in people living with HIV (PLWH) in Asian countries in general and China in particular. Using baseline data collected between February 2017 through January 2020 from the Comparative HIV and Aging Research in Taizhou (CHART) cohort in China, we examined MS among 2,227 PLWH and 5,264 matched people without HIV, respectively. MS was defined using the criteria set forth by the International Diabetes Federation (IDF). Approximately 76.7% of PLWH had body mass index (BMI) < 24.0 kg/m2, significantly higher than people without HIV (50.3%). Among participants with BMI < 24.0 kg/m2, PLWH had a significantly higher prevalence of MS than people without HIV (20.6% vs. 14.5%; aOR: 1.41, 95% CI: 1.19-1.68) overall, and at an age of 18-29 (10.4% vs. 3.4%, aOR: 3.49, 95% CI: 1.99-6.11) and 30-44 years (17.3% vs. 8.5%, aOR: 2.03, 95% CI: 1.47-2.81), respectively. Among participants with BMI ≥ 24.0 kg/m2, MS prevalence was not significantly different between PLWH and people without HIV overall, but significantly lower in PLWH than people without HIV for those aged over 60 years (65.9% vs. 77.8%, aOR: 0.53, 95% CI: 0.32-0.88). Among PLWH, MS was significantly associated with older age and higher CD4 cell count, and with stavudine (d4T) use only in the group of BMI < 24.0 kg/m2. Our finding is indicative of a relatively higher risk for early onset of MS among HIV-infected young adults with lower BMI. Research is needed to elucidate the pathogenic mechanism for MS among PLWH.
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Affiliation(s)
- Ruizi Shi
- School of Public Health, Fudan University, Shanghai, China; and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment of Ministry of Health, Fudan University, Shanghai, China
| | - Xiaoxiao Chen
- Taizhou City Center for Disease Control and Prevention, Zhejiang Province, China
| | - Haijiang Lin
- School of Public Health, Fudan University, Shanghai, China; and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.,Taizhou City Center for Disease Control and Prevention, Zhejiang Province, China
| | - Weiwei Shen
- Taizhou City Center for Disease Control and Prevention, Zhejiang Province, China
| | - Xiaohui Xu
- School of Public Health, Fudan University, Shanghai, China; and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Bowen Zhu
- School of Public Health, Fudan University, Shanghai, China; and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Xiaoyi Xu
- School of Public Health, Fudan University, Shanghai, China; and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Yingying Ding
- School of Public Health, Fudan University, Shanghai, China; and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Frank Y Wong
- School of Public Health, Fudan University, Shanghai, China; and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.,Center for Indigenous Nursing Research for Health Equity, Florida State University, Tallahassee, FL, U.S.A.,Department of Psychology, College of Social Sciences, University of Hawai'i at Mānoa, Honolulu, HI, U.S.A.,Department of Population Science, John D. Bower School of Population Health, University of Mississippi Medical Center, MS, U.S.A
| | - Na He
- School of Public Health, Fudan University, Shanghai, China; and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment of Ministry of Health, Fudan University, Shanghai, China
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Xu X, Lin H, Chen X, Zhu B, Shen W, Ning C, Qiao X, Xu X, Shi R, Liu X, Wong FY, He N, Ding Y. Differences in hypertension and prehypertension among people living with and without HIV in China: role of HIV infection and antiretroviral therapy. HIV Med 2021; 22:409-417. [PMID: 33421323 DOI: 10.1111/hiv.13040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Hypertension is a growing health concern in people living with HIV (PLWH). However, association between HIV infection and hypertension is equivocal. METHODS In all, 1472 PLWH and 2944 HIV-negative individuals frequency-matched by age and sex were derived from the baseline survey of Comparative HIV and Aging Research in Taizhou (CHART), China. Prehypertension was defined as systolic blood pressure (BP) of 120-139 mmHg and/or diastolic blood pressure of 80-89 mmHg. RESULTS Despite the fact that prevalence of hypertension was overall lower among PLWH than among HIV-negative people (21.1% vs. 29.1%, P < 0.001), it was similar at ages 18-29 (7.6% vs. 8.5%) and 30-44 years (17.1% vs. 18.5%) but significantly lower in PLWH at ages 45-59 (26.1% vs. 40.7%) and 60-75 years (37.1% vs. 57.3%). Prehypertension prevalence was consistently higher in PLWH across all age groups. In the model adjusting for traditional risk factors, HIV infection was associated with hypertension (adjusted odds ratio [aOR] = 1.27, 95% confidence interval: 1.04-1.55) and prehypertension (aOR = 1.77, 95% CI: 1.51-2.08), and attenuated after additional adjustment for abdominal obesity. Age-stratified analysis showed that these associations of HIV with hypertension were observed at ages 18-29 and 30-44 years and associations with prehypertension were observed at ages 18-29, 30-44 and 45-59 years only. Years since HIV diagnosis and stavudine use were the HIV-specific factors independently associated with hypertension or/and prehypertension. CONCLUSIONS HIV infection is independently associated with prehypertension and hypertension especially at younger ages, and this risk may increase as treatment becomes prolonged. Our findings reinforce the urgent necessity for active BP screening and control strategies be adopted for PLWH in China.
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Affiliation(s)
- X Xu
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - H Lin
- Taizhou City Center for Disease Control and Prevention, Taizhou City, Zhejiang Province, China
| | - X Chen
- Taizhou City Center for Disease Control and Prevention, Taizhou City, Zhejiang Province, China
| | - B Zhu
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - W Shen
- Taizhou City Center for Disease Control and Prevention, Taizhou City, Zhejiang Province, China
| | - C Ning
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - X Qiao
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - X Xu
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - R Shi
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - X Liu
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - F Y Wong
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.,Center for Population Sciences and Health Equity (C-PSHE), Florida State University, Tallahassee, FL, USA.,Department of Psychology, University of Hawai`i at Mānoa, Honolulu, HI, USA
| | - N He
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment of Ministry of Health, Fudan University, Shanghai, China
| | - Y Ding
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
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11
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Wong FY, Gogos A, Hale N, Ingelse SA, Brew N, Shepherd KL, van den Buuse M, Walker DW. Impact of hypoxia-ischemia and dopamine treatment on dopamine receptor binding density in the preterm fetal sheep brain. J Appl Physiol (1985) 2020; 129:1431-1438. [PMID: 33054660 DOI: 10.1152/japplphysiol.00677.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Dopamine is often used to treat hypotension in preterm infants who are at risk of hypoxic-ischemic (HI) brain injury due to cerebral hypoperfusion and impaired autoregulation. There is evidence that systemically administered dopamine crosses the preterm blood-brain barrier. However, the effects of exogenous dopamine and cerebral HI on dopaminergic signaling in the immature brain are unknown. We determined the effect of HI and dopamine on D1 and D2 receptor binding and expressions of dopamine transporter (DAT) and tyrosine hydroxylase (TH) in the striatum of the preterm fetal sheep. Fetal sheep (99 days of gestation, term = 147days) were unoperated controls (n = 6) or exposed to severe HI using umbilical cord occlusion and saline infusion (UCO + saline, n = 8) or to HI with dopamine infusion (UCO + dopamine, 10 µg/kg/min, n = 7) for 74 h. D1 and D2 receptor densities were measured by autoradiography in vitro. DAT, TH, and cell death were measured using immunohistochemistry. HI resulted in cell death in the caudate nucleus and putamen, and dopamine infusion started before HI did not exacerbate or ameliorate these effects. HI led to reduced D1 and D2 receptor densities in the caudate nucleus and reduction in DAT protein expression in the caudate and putamen. Fetal brains exposed to dopamine in addition to HI were not different from those exposed to HI alone in these changes in dopaminergic parameters. We conclude that dopamine infusion does not alter the striatal cell death or the reductions in D1 and D2 receptor densities and DAT protein expression induced by HI in the preterm brain.NEW & NOTEWORTHY This is the first study on the effects of hypoxia-ischemia and dopamine treatment on the dopaminergic pathway in the preterm brain. In the striatum of fetal sheep (equivalent to ∼26-28 wk of human gestation), we demonstrate that hypoxia-ischemia leads to cell death, reduces D1 and D2 receptors, and reduces dopamine transporter. Intravenous dopamine infusion at clinical dosage used in preterm human infants does not alter the striatal cell death, D1 and D2 receptor density levels, and DAT protein expressions after hypoxia-ischemia in the preterm brain.
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Affiliation(s)
- F Y Wong
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia.,Monash Newborn, Monash Medical Centre, Melbourne, Australia
| | - A Gogos
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
| | - N Hale
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Australia
| | - S A Ingelse
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Australia
| | - N Brew
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Australia
| | - K L Shepherd
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| | - M van den Buuse
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - D W Walker
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Australia.,School of Health & Biomedical Sciences, RMIT University, Melbourne, Australia
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12
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Wong JA, Dang LT, Phan NT, Le TK, Vu NC, Vu TD, James S, Katona P, Katona L, Rosen J, Wong FY, Nguyen CK. Effectiveness of an Automated Error Checking and Feedback System to Improve Text Message Reporting for Disease Surveillance in Viet Nam. Telemed J E Health 2020; 27:448-453. [PMID: 32673154 DOI: 10.1089/tmj.2020.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Viet Nam currently relies on a manual paper-based system to track and monitor 28 major infectious diseases. This inefficient system takes 2 or more months to complete. Method: We designed and pilot tested the use of text messaging to report certain infectious disease symptoms in rural areas of northern Viet Nam. The project was divided into three 6-month phases carried out in two provinces. The current analysis focuses on the implementation of a two-way feedback system between Phases II and III, which aims at (1) evaluating whether this system improves efficiency by determining the number of correctly (vs. incorrectly) formatted text messages; (2) assessing this system's influence on accuracy by comparing text messages with their respective official paper-based documented forms; and (3) determining whether the amount of information required to report through text messages influences the efficiency and accuracy of the text messages. Results: Between Phases II and III, results revealed a significant improvement in correctly formatted texts in comparison to incorrectly formatted texts. As the number of fields required to report increased, the number of correctly formatted texts (efficiency) as well as the number of matched text messages (accuracy) decreased. Conclusion: Our research demonstrates that an automated error bidirectional feedback system can significantly improve both the efficiency and accuracy of a Short Message Service-based method for disease surveillance. Also, our data may suggest that two-way communication has better engaged health care staff to follow reporting protocols as well as to maintain accuracy from their clinic's own data.
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Affiliation(s)
| | - Linh Thuy Dang
- Institute of Population, Health and Development, Hanoi, Vietnam
| | - Ngoc Tran Phan
- Institute of Population, Health and Development, Hanoi, Vietnam
| | - Thuy Kim Le
- Dartmouth College, Hanover, New Hampshire, USA
| | - Nguyen Cong Vu
- Institute of Population, Health and Development, Hanoi, Vietnam
| | - Thiem Dinh Vu
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Peter Katona
- University of California, Los Angeles, Los Angeles, California, USA
| | - Lindsay Katona
- Santa Barbara Cottage Hospital, Santa Barbara, California, USA
| | | | - Frank Y Wong
- Florida State University, Tallahassee, Florida, USA.,University of Hawaii at Mānoa, Honolulu, Hawaii, USA
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13
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Hall CD, Ibragimov U, Luu MN, Wong FY. Actives, passives and power: heteronormative gender norms and their implications for intimate partner violence among men who have sex with men in Tajikistan. Cult Health Sex 2020; 22:630-645. [PMID: 31184271 DOI: 10.1080/13691058.2019.1623913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 05/22/2019] [Indexed: 06/09/2023]
Abstract
Global research reveals that gender-role norms have a profound effect on socio- and psycho-sexual expression (e.g. sexual positioning) among gay and bisexual men, which in turn may affect mental health and sexual risks. However, little is known about these factors among gay and bisexual men in Muslim-majority countries such as Tajikistan. Using a combination of in-depth individual interviews and focus-group assessments, this exploratory, qualitative study examined how gender roles might function as a social determinant for the practice of sexual positioning, which in turn may influence intimate partner violence (IPV), sexual risk and relational power. Results suggest that being the 'active' partner in sexual relationships closely aligns with the construct of hegemonic masculinity, affording actives more power in male-male relationships which may in some cases result in IPV directed against 'passives'. Despite this imbalance, passives also hold power in some cases, such as easier access to public resources such as the police and gay and bisexual focused services. Further research should examine gender norms and sexual positioning relative to IPV and sexual risks among Muslim men in Tajikistan.
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Affiliation(s)
- Casey D Hall
- Department of Behavioral Sciences & Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Umedjon Ibragimov
- Department of Behavioral Sciences & Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Minh N Luu
- Department of Behavioral Sciences & Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Frank Y Wong
- Center for Indigenous Nursing Research for Health Equity, Florida State University, Tallahassee, FL, USA
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14
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Tran BX, Wong FY, Huy-Pham KT, Latkin CA, Hai-Ha G, Thu-Vu G, Ho CSH, Ho RCM. Evolution of Interdisciplinary Landscapes of HIV/AIDS Studies from 1983 to 2017: Results from the Global Analysis for Policy in Research (GAPRESEARCH). AIDS Rev 2020; 21:184-194. [PMID: 31834329 DOI: 10.24875/aidsrev.19000083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In recent years, there have been numerous calls by researchers to adopt multi-disciplinary and international perspectives to address the HIV pandemic. Meaningful and prudent public health policy should be based on sound empirical data and research. Henceforth, our study aims to contribute to the current literature by conducting a comprehensive global mapping and determine the landscapes of HIV/AIDS research covering the years between 1983 and 2017. Bibliometric and content analysis was used to describe trends in research productivity, usages, research collaborations, and clusters of research topics. Exploratory factor analysis, Jaccard's similarity index, and Ward dendrogram were applied to abstracts' contents to determine the development of interdisciplinary research landscapes. The United States of America continues to lead in research production and be main hub for author- and country-level collaborations. Research employing an epidemiological, social, and/or behavioral perspective for studying HIV/AIDS was found to dwarf in the presence of basic and biomedical HIV research. Interdisciplinary approaches to HIV research have been increasing with the creation of various research landscapes: strong constructs of studies examining health status, clinical responses, and HIV treatment, risk behaviors have been formed, while research topics relating to psycho-behavioral and cultural aspects as well as services have emerged along. To effectively prevent and control the disease, more researches are needed to provide culturally relevant and/or contextualized evidence of effective interventions. It is also necessary to enhance the ability and partnership of local researchers as well as invest in research infrastructure at national and regional levels to implement high-quality studies since they are the "gate-keepers" who could respond to local changes in a timely manner. These types of research could be a helpful guide for international donors, governments, and academicians to set up research priorities in target groups and settings, and to develop future research agendas globally.
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Affiliation(s)
- Bach X Tran
- Department of Health Economics, Institute for Preventive Medicine and Public Health, Hanoi Medical University. Hanoi, Vietnam
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Frank Y Wong
- Center for Indigenous Nursing Research for Health Equity, College of Nursing, Florida State University, Florida, USA
| | - Kiet T Huy-Pham
- Department of Health Economics, Institute for Preventive Medicine and Public Health, Hanoi Medical University. Hanoi, Vietnam
| | - Carl A Latkin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Giang Hai-Ha
- Department of Health Technology Assessment, Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Giang Thu-Vu
- Center of Excellence in Evidence-Based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore
| | - Roger C M Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- fNIRS Group, Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
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15
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He N, Ding Y, Li J, Yuan S, Xu L, Qiao S, Xu X, Zhu B, Shi R, Barile JP, Wong FY. HIV and Aging in Mainland China: Implications for Control and Prevention Research. Curr HIV/AIDS Rep 2020; 16:439-447. [PMID: 31773404 DOI: 10.1007/s11904-019-00473-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The last 15 years have witnessed a dramatic change in HIV-related epidemiology amidst improvements in treatment and care in China. With proper treatment, HIV is now considered a chronic disease. As a consequence, many people living with HIV (PLWH) now present age-related comorbidities. We reviewed 13 topical issues concerning the epidemiology of aging with HIV in mainland China. RESULTS Many of aging-related issues associated with the biological and physical aspects of living with HIV addressed in mainland China are consistent with the global literature. Greater prevalence of age-related comorbidities among PLWH was observed. Beyond biological mechanisms associated with HIV infection and traditional risk factors, other factors play a vital role in the aging process among PLWH. A stronger focus on screening, prevention, and management of non-HIV co-morbidities among PLWH is now warranted. Macro-social factors need to be integrated into next generation of clinical and/or behavioral HIV research to inform disease progression and management as well as prevention.
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Affiliation(s)
- Na He
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China. .,Key Laboratory of Health Technology Assessment of Ministry of Health, Fudan University, Shanghai, China.
| | - Yingying Ding
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Jing Li
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Shiying Yuan
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Lulu Xu
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Shijie Qiao
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Xiaohui Xu
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Bowen Zhu
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Ruizi Shi
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - John P Barile
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Frank Y Wong
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China. .,Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, USA. .,Center for Indigenous Nursing Research for Health Equity, Florida State University, Tallahassee, FL, USA.
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16
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Ding Y, Ma Z, He J, Xu X, Qiao S, Xu L, Shi R, Xu X, Zhu B, Li J, Wong FY, He N. Evolving HIV Epidemiology in Mainland China: 2009-2018. Curr HIV/AIDS Rep 2020; 16:423-430. [PMID: 31773403 DOI: 10.1007/s11904-019-00468-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW This review is intended to provide an overview of the evolution of HIV epidemiology over the past decade in China. RECENT FINDINGS We provided a succinct overall view of the epidemic, followed by surveillance data, profiles of key populations, HIV molecular epidemiology, and drug resistance, as well as survival in the age of antiretroviral therapy usage. For each topical issue, we first reviewed the latest empirical evidence, followed by a brief summary assessment. We briefly addressed the challenges and opportunities of the next generation of HIV control and prevention efforts in China. Notably, macro-social factors need to be integrated into the next generation of clinical and/or behavioral HIV research to inform disease progression and management, as well as control and prevention.
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Affiliation(s)
- Yingying Ding
- Department of Epidemiology, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Zhonghui Ma
- Department of Epidemiology, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Jiayu He
- Department of Epidemiology, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Xiaoyi Xu
- Department of Epidemiology, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Shijie Qiao
- Department of Epidemiology, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Lulu Xu
- Department of Epidemiology, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Ruizi Shi
- Department of Epidemiology, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Xiaohui Xu
- Department of Epidemiology, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Bowen Zhu
- Department of Epidemiology, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Jing Li
- Department of Epidemiology, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Frank Y Wong
- Center for Indigenous Nursing Research for Health Equity, Florida State University, Tallahassee, FL, USA.,Department of Psychology, University of Hawai`i at Mānoa, Honolulu, HI, USA
| | - Na He
- Department of Epidemiology, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China. .,Key Laboratory of Health Technology Assessment of Ministry of Health, Fudan University, P. O. Box 289, 138 Yi Xue Yuan Road, Shanghai, 200032, China.
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17
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Liu C, Ding Y, Ning Z, Gao M, Liu X, Wong FY, He N. Factors influencing uptake of pre-exposure prophylaxis: some qualitative insights from an intervention study of men who have sex with men in China. Sex Health 2019; 15:39-45. [PMID: 28859729 DOI: 10.1071/sh17075] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/02/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is a biomedical approach for preventing the acquisition of HIV in populations at substantial risk for HIV. However, its uptake among men who have sex with men (MSM) is low in China. The study aimed to identify factors that might influence MSM's uptake and use of PrEP. METHODS In-depth interviews were conducted with 32 self-identified MSM from a PrEP intervention study evaluating daily oral tenofovir disoproxil fumarate (TDF) to prevent HIV infection. Of these men, 11 were presently using the 'TDF' group; 8 from the 'change-over' group (i.e. initially used PrEP but subsequently quitted); and 13 from the non-user group. Data were analysed using thematic approach. RESULTS Perception of low HIV risk, mistrust of the national PrEP program, and concerns of side effects were the main reasons for not wanting to use PrEP. Also, lack of main sexual partner's support, difficulties in adhering to the daily TDF regimen, and the inconvenient schedules in securing the medicine were the major reasons for not wanting to use or quitting the use of PrEP. On the other hand, perceived high HIV risk, beliefs in efficacy of PrEP, and worries of transmitting HIV to families were the major motives for PrEP uptake. CONCLUSIONS Findings suggest that PrEP implementation strategies should first address issues including but not limited to accurate self-assessment of HIV risk, mistrust and limited knowledge about medical trials and PrEP, and ease of accessing PrEP.
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Affiliation(s)
- Chunxing Liu
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China
| | - Yingying Ding
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China
| | - Zhen Ning
- Shanghai Center for Disease Control and Prevention, Shanghai 200336, China
| | - Meiyang Gao
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China
| | - Xing Liu
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China
| | - Frank Y Wong
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China
| | - Na He
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China
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18
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Tran BX, Wong FY, Pham KTH, Latkin CA, Ha GH, Vu GT, Ho CSH, Ho RCM. Evolution of Interdisciplinary Landscapes of HIV/Acquired Immune Deficiency Syndromes Studies from 1983 to 2017: Results from the Global Analysis for Policy in Research (GAPRESEARCH). AIDS Rev 2019; 21:s113961211409. [PMID: 31588138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION In recent years, there have been numerous calls by researchers to adopt multi-disciplinary and international perspectives to address the human immunodeficiency virus (HIV) pandemic. Meaningful and prudent public health policy should be based on sound empirical data and research. Henceforth, our study aims to contribute to the current literature by conducting a comprehensive global mapping and determine the landscapes of HIV/acquired immune deficiency syndromes (AIDS) research covering the years between 1983 and 2017. METHODS Bibliometric and content analysis was used to describe trends in research productivity, usages, research collaborations, and clusters of research topics. Exploratory factor analysis, Jaccard's similarity index, and Ward dendrogram were applied to abstracts' contents to determine the development of interdisciplinary research landscapes. RESULTS The United States of America continues to lead in research production and be main hub for author- and country-level collaborations. Research employing an epidemiological, social, and/or behavioral perspective for studying HIV/AIDS was found to dwarf in the presence of basic and biomedical HIV research. Interdisciplinary approaches to HIV research have been increasing with the creation of various research landscapes: strong constructs of studies examining health status, clinical responses, and HIV treatment, risk behaviors have been formed, while research topics relating to psycho-behavioral and cultural aspects as well as services have emerged along. CONCLUSIONS To effectively prevent and control the disease, more researches are needed to provide culturally relevant and/or contextualized evidence of effective interventions. It is also necessary to enhance the ability and partnership of local researchers as well as invest in research infrastructure at national and regional levels to implement high-quality studies since they are the "gate-keepers" who could respond to local changes in a timely manner. These types of research could be a helpful guide for international donors, governments, and academicians to set up research priorities in target groups and settings, and to develop future research agendas globally.
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Affiliation(s)
- Bach X Tran
- Department of Health Economics, Institute for Preventive Medicine and Public Health, Hanoi Medical University. Hanoi, Vietnam
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University. Baltimore, Maryland, USA
| | - Frank Y Wong
- Center for Indigenous Nursing Research for Health Equity, College of Nursing, Florida State University. Florida, USA
| | - Kiet Tuan Huy Pham
- Department of Health Economics, Institute for Preventive Medicine and Public Health, Hanoi Medical University. Hanoi, Vietnam
| | - Carl A Latkin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University. Baltimore, Maryland, USA
| | - Giang Hai Ha
- Department of Health Technology Assessment, Institute for Global Health Innovations, Duy Tan University. Da Nang, Vietnam
| | - Giang Thu Vu
- Center of Excellence in Evidence-Based Medicine, Nguyen Tat Thanh University. Ho Chi Minh City, Vietnam
| | - Cyrus S. H. Ho
- Department of Psychological Medicine, National University Hospital. Singapore, Singapore
| | - Roger C. M. Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University. Ho Chi Minh City, Vietnam
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore. Singapore, Singapore
- fNIRS Group, Institute for Health Innovation and Technology (iHealthtech), National University of Singapore. Singapore, Singapore
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19
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Ibragimov U, Haardörfer R, Cooper HLF, Dunkle KL, Zule WA, Wong FY. Pharmacists' attitudes and practices about selling syringes to people who inject drugs in Tajikistan: Results of a syringe purchase audit and a survey. Int J Drug Policy 2019; 71:62-72. [PMID: 31226505 DOI: 10.1016/j.drugpo.2019.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 04/08/2019] [Accepted: 06/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND In Tajikistan, governmental policies leave the decision whether or not to sell syringes to people who inject drugs (PWID) to pharmacists' discretion. This exploratory study tests a theory-driven model explaining Tajikistani pharmacists' actual syringe sale practices to inform future HIV advocacy activities. METHODS Data were collected via attempts to purchase syringes without prescription and a subsequent survey among a sample of 232 pharmacists in two cities (Dushanbe and Kulob) in Tajikistan in 2015. The survey collected data on attitudes and beliefs related to selling syringes to PWID, stigma against PWID and background contextual factors such as social conservatism, HIV and drug use knowledge. Structural equation modelling was used to assess the relationships between syringe sale practice and pharmacists' attitudinal and background factors. RESULTS The majority (87.9%, n = 204) of sampled pharmacists agreed to sell syringes to the study research assistants without a prescription. According to the final model, agreeing to sell syringes was moderately associated with the reported intent to provide syringes without prescription (β = 0.36, p < 0.001), lower stigma against PWID (β=-0.43, p = 0.01), and stronger social conservatism (β = 0.35, p = 0.02). Intent to provide syringes correlated with positive attitudes towards provision of syringes (β = 0.35, p = 0.008), which in turn were negatively associated with stigma (β=-0.54, p < 0.001) and positively with age (β = 0.20, p = 0.03). Stigma against PWID was directly associated with social conservatism (β = 0.47, p < 0.001) and inversely with university-level education (β=-0.28, p < 0.001). CONCLUSION We demonstrated the accessibility of over-the-counter syringes in urban pharmacies of Tajikistan and emphasized the role of stigma in shaping pharmacists' syringe sale practices. Advocacy interventions should target pharmacists to reduce stigmatization of PWID and ensure access to clean syringes.
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Affiliation(s)
- Umedjon Ibragimov
- HIV/AIDS and Harm Reduction Association of Tajikistan, 51/3 N. Makhsum Str., office 59, Dushanbe, 734042, Tajikistan; Department of Behavioral Sciences & Health Education, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, 30032, GA, USA.
| | - Regine Haardörfer
- Department of Behavioral Sciences & Health Education, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, 30032, GA, USA
| | - Hannah L F Cooper
- Department of Behavioral Sciences & Health Education, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, 30032, GA, USA
| | - Kristin L Dunkle
- Gender and Health Division, South African Medical Research Council, Francie van Zijl Drive, Parowvallei, Cape, PO Box 19070,7505, Tygerberg, South Africa
| | - William A Zule
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA
| | - Frank Y Wong
- College of Nursing, Florida State University, 98 Varsity Way, Tallahassee, FL, 32306, USA; Department of Psychology, College of Social Sciences, University of Hawai'i at Mānoa, 2530 Dole Street, Sakamaki Hall C 400, Honolulu, HI, 96822, USA; School of Public Health, Fudan University, Yixueyan Road No. 138, Shanghai, 200032, China
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20
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Tan QT, Wong FY, Alcantara VS, Ganguly R, Loh KWJ. Abstract P4-10-12: Gestational breast cancer in Singapore women. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-10-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Gestational breast cancer (GBC), diagnosed during pregnancy or in the first postpartum year, is expected to rise in incidence due to increasing maternal age. GBC poses unique challenges in diagnosis and treatment as clinicians seek to provide optimal treatment for these young patients without compromising neonatal outcomes. We present our retrospective findings from the first study on gestational breast cancer in Singapore.
Methods
We performed a retrospective study on 88 patients with gestational breast cancer diagnosed from April 2003 to April 2017 at three centres in Singapore. Demographic details, tumour histopathological characteristics, stage, treatment and outcomes data was collected and analysed.
Results
Eighty-eight patients were diagnosed with GBC at a median age of 35.9 years (26-43 years). Fifty (56.8%) were diagnosed intrapartum and 38 (43.2%) were diagnosed postpartum. Seventeen (19.8%) had a family history of breast cancer but none had proven BRCA mutation. Seventeen patients (19.3%) presented with stage 1, 36 (40.9%) with stage 2, 25 (28.4%) with stage 3, 5 (5.7%) with stage 4 disease. Seventeen patients underwent termination of pregnancy (27.9% of patients diagnosed during pregnancy). Seventeen (19.3%) of patients received neoadjuvant chemotherapy, 8 of whom received it during pregnancy. Forty-eight (54.5%) received adjuvant chemotherapy, 4 of whom received it during pregnancy. Two patients received palliative chemotherapy during pregnancy. Aside from one case of hearing impairment, there was no other documented neonatal complication for patients who received intrapartum chemotherapy.
The 5-year and 10-year overall survival (OS) was 80% and 66%. According to the Singapore National Cancer Registry, the 5-year OS for women younger than 44 years of age was 88.9%, therefore suggesting a lower OS in patients with GBC. The 5-year and 10 year disease-free survival (DFS) of our patients was 73% and 60% respectively. Diagnosis of cancer postpartum conferred a higher risk (hazard ratio (95%CI) 1.86 (0.55, 6.28) of mortality compared to those diagnosed intrapartum. Univariate Cox proportional hazard regression model showed that nodal positivity and clinical stage were significantly associated with DFS while only clinical stage was significantly associated with OS. Race was found to affect survival with Malay patients having a lower DFS compared to Chinese patients.
Conclusion
GBC patients in Singapore have a lower survival rate. Diagnosis of cancer postpartum confers a higher risk of mortality. This might be due to a delay in diagnosis and treatment. Malay patients have a lower survival compared to Chinese patients. Studies into genetic and social factors might shed light on how ethnicity affects survival of these patients.
Citation Format: Tan QT, Wong FY, Alcantara VS, Ganguly R, Loh KW-J. Gestational breast cancer in Singapore women [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-10-12.
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Affiliation(s)
- QT Tan
- KK Women's and Children's Hospital, Singapore, Singapore; National Cancer Centre Singapore, Singapore, Singapore; Singapore General Hospital, Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore
| | - FY Wong
- KK Women's and Children's Hospital, Singapore, Singapore; National Cancer Centre Singapore, Singapore, Singapore; Singapore General Hospital, Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore
| | - VS Alcantara
- KK Women's and Children's Hospital, Singapore, Singapore; National Cancer Centre Singapore, Singapore, Singapore; Singapore General Hospital, Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore
| | - R Ganguly
- KK Women's and Children's Hospital, Singapore, Singapore; National Cancer Centre Singapore, Singapore, Singapore; Singapore General Hospital, Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore
| | - KW-J Loh
- KK Women's and Children's Hospital, Singapore, Singapore; National Cancer Centre Singapore, Singapore, Singapore; Singapore General Hospital, Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore
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21
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Liu Y, Zhang Y, Ning Z, Zheng H, Ding Y, Gao M, Wong FY, He N. Intimate partner violence victimization and HIV infection among men who have sex with men in Shanghai, China. Biosci Trends 2018; 12:142-148. [PMID: 29760357 DOI: 10.5582/bst.2018.01035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Intimate partner violence (IPV) and its association with HIV infection among men who have sex men (MSM) in China are not understood. In this study, 732 MSM recruited from Shanghai, China between March and August 2015 were administered with a questionnaire survey and HIV blood testing. IPV victimization was measured by 25 forced-choice items capturing lifetime experience of physical, sexual, psychological, deprivation or neglect, and other forms of violence. Of them, 179 (24.3%) reported having experienced at least one type of IPV victimization. In separate multivariable analyses, sexual violence was associated with age over 35 years (AOR = 0.26, 95% CI: 0.07-1.02), ever had male-to-male commercial sex (AOR = 2.53, 95%CI: 1.19-5.39), and diagnosis of a sexually transmitted infection (STI) (AOR = 2.14, 95%CI: 0.98-4.66). Both psychological violence (AOR = 2.53, 95%CI: 1.25-5.12)and deprivation or neglect violence (AOR = 1.75, 95%CI: 1.14-2.68) were associated with ever had sex with a casual male partner(s). Having experienced at least one type of IPV victimization was significantly associated with ever had sex with a causal partner(s) (AOR = 1.72, 95%CI: 1.15-2.57) and ever had a diagnosis of a STI (AOR = 1.80, 95% CI: 1.12-2.88). HIV infection was marginally associated with having experienced any form of IPV victimization. IPV victimization is common among MSM, especially young MSM, in China, although its association with HIV infection is not conclusive in our sample. Nonetheless, our findings highlight the importance of the needs of individualized IPV interventions for certain target risk groups of MSM.
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Affiliation(s)
- Ying Liu
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University.,Collaborative Innovation Center of Social Risks Governance in Health, Fudan University.,Putuo District Center for Disease Control and Prevention
| | - Yuyan Zhang
- Putuo District Center for Disease Control and Prevention
| | - Zhen Ning
- Shanghai Center for Disease Control and Prevention
| | | | - Yingying Ding
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University.,Collaborative Innovation Center of Social Risks Governance in Health, Fudan University
| | - Meiyang Gao
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University
| | - Frank Y Wong
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University.,Department of Tropical Medicine, John A. Burns School of Medicine, University of Hawai'i at Mānoa.,Department of Psychology, College of Social Sciences, University of Hawai'i at Mānoa
| | - Na He
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University.,Collaborative Innovation Center of Social Risks Governance in Health, Fudan University
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22
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Ning Z, Fu J, Zhuang M, Park JA, Ibragimov U, He N, Wong FY. HIV and syphilis epidemic among MSM and non-MSM aged 50 and above in Shanghai, China: A yearly cross-sectional study, 2008-2014. Glob Public Health 2018; 13:1625-1633. [PMID: 29419357 DOI: 10.1080/17441692.2018.1427271] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The magnitude of the HIV and syphilis epidemic among Chinese men ages 50 and older is unclear. In this study, we aimed to characterise and compare the prevalence of HIV and syphilis infections; linkage to care among those infected with HIV; and the geographic distribution of the two epidemics among elderly men who have sex with men (MSM) and non-MSM in Shanghai, China. This cross-sectional study involved 12,910 men ages 50 and above who participated in the HIV voluntary and counselling testing programme each year from 2008 to 2014. HIV prevalence among MSM in our sample ranged between 4.9% and 15.4%, while syphilis frequency among non-MSM decreased from 26.0% to 18.7%. Further, in 2014, MSM participants had a higher HIV prevalence than non-MSM (4.9% vs 1.8%), whereas syphilis was higher in older non-MSM compared to MSM (18.7% vs 12.4%). Among those infected with HIV, 121/211 (53.75%) of participants were linked to HIV treatment, where the linkage rate was comparable to that in Kunming [Zhao, S., Zhao, G., Zhang, W., liao, B., Chu C., Wang J., & Li, L. (2015). Compare the difference of efficiency between voluntary counseling testing and provider-initiated testing counseling for identifying HIV/AIDS in Kunming. Chinese Journal of AIDS & STD, 21(7), 623-625]. The high burden of HIV and syphilis among men ages 50 and older in Shanghai, China highlights the need to target older Chinese men, both MSM and non-MSM, with prevention efforts.
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Affiliation(s)
- Zhen Ning
- a Department of Epidemiology , Fudan University School of Public Health , Shanghai , People's Republic of China.,b Department of HIV/STD Prevention and Control , Shanghai Municipal Centre for Disease Control and Prevention , Shanghai , People's Republic of China
| | - Jie Fu
- b Department of HIV/STD Prevention and Control , Shanghai Municipal Centre for Disease Control and Prevention , Shanghai , People's Republic of China
| | - Minghua Zhuang
- b Department of HIV/STD Prevention and Control , Shanghai Municipal Centre for Disease Control and Prevention , Shanghai , People's Republic of China
| | - Jason A Park
- c Department of Medicine , Boston University School of Medicine , Boston , MA , USA
| | - Umedjon Ibragimov
- d Rollins School of Public Health , Emory University , Atlanta , GA , USA
| | - Na He
- a Department of Epidemiology , Fudan University School of Public Health , Shanghai , People's Republic of China
| | - Frank Y Wong
- a Department of Epidemiology , Fudan University School of Public Health , Shanghai , People's Republic of China.,e Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School of Medicine , University of Hawai'i at Mānoa , Honolulu , HI , USA
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23
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Ding Y, Lin H, Liu X, Zhang Y, Wong FY, Sun YV, Marconi VC, He N. Hypertension in HIV-Infected Adults Compared with Similar but Uninfected Adults in China: Body Mass Index-Dependent Effects of Nadir CD4 Count. AIDS Res Hum Retroviruses 2017; 33:1117-1125. [PMID: 28562067 DOI: 10.1089/aid.2017.0008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Hypertension is a growing problem in the HIV population. The relationship between low nadir CD4 count and hypertension in the HIV-infected population has been reported. However, the effect of nadir CD4 on hypertension due to a different body mass index (BMI) is yet to be fully elucidated. In this cross-sectional study, 345 HIV-infected participants aged ≥40 years were recruited. They were frequency matched and compared with age, sex, and education with HIV-uninfected adults (n = 345). Hypertension prevalence was lower in HIV-infected than in HIV-uninfected participants (23.8% vs. 31.9%; p = .011), but this association was not significant after adjusting for potential confounders. Among HIV-infected individuals, older age, overweight, with a family history of cardiovascular diseases, and nadir CD4 count <50 cells/μl were independently associated with hypertension. Stratifying individuals with BMI category revealed that nadir CD4 count-regardless if it was operationalized as a dichotomous variable (<50 cells/μl) or continuous variable-was found to be associated with hypertension among individuals who were underweight and obese, but not among those who were normal weight and overweight. Among HIV-uninfected individuals, older age and having a waist circumference above cutoff were significantly associated with hypertension. This is one of the first studies to demonstrate that the association of nadir CD4 and hypertension is observed in underweight and obese HIV-infected patients. While these results suggest that the relationship between nadir CD4 count and hypertension might be mediated by body weight, future longitudinal studies will be needed to validate the findings, including its causal pathways.
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Affiliation(s)
- Yingying Ding
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Haijiang Lin
- Department of AIDS/STD Control and Prevention, Taizhou City Center for Disease Control and Prevention, Taizhou City, China
| | - Xing Liu
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Yucheng Zhang
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Frank Y. Wong
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Mānoa, Honolulu, Hawaii
| | - Yan V. Sun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Vincent C. Marconi
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia
| | - Na He
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
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24
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Ibragimov U, Cooper HL, Haardörfer R, Dunkle KL, Zule WA, Wong FY. Stigmatization of people who inject drugs (PWID) by pharmacists in Tajikistan: sociocultural context and implications for a pharmacy-based prevention approach. Harm Reduct J 2017; 14:64. [PMID: 28915888 PMCID: PMC5602909 DOI: 10.1186/s12954-017-0190-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/07/2017] [Indexed: 11/30/2022] Open
Abstract
Background Pharmacies are an important source of sterile syringes for people who inject drugs (PWID) in Tajikistan who are under high risk of HIV and hepatitis C virus. Accessibility of sterile syringes at pharmacies without prescription may depend on pharmacists’ attitudes towards PWID. This qualitative inquiry examines meanings and processes of stigmatization of PWID among pharmacists and pharmacy students in Tajikistan. Methods We conducted semi-structured interviews with 19 pharmacists and 9 students (N = 28) in the cities of Dushanbe and Kulob, Tajikistan. The interview topics included personal attitudes towards drug use and PWID, encounters with PWID, awareness and beliefs related to drug dependence and HIV, and attitudes and practices related to providing syringes to PWID. Interview transcripts were analysed using thematic analysis methods. Results The main themes included the significance of religion in defining attitudes towards drug use, labelling of PWID, negative stereotypes (PWID are prone to crime, violence, and irrational aggression; inflict harm to families and society; are able to control drug use), emotions triggered by PWID (fear, sympathy) and discrimination against PWID (rejection, isolation, ostracism, limiting resources to PWID). The religious ban on drug use and pharmacists’ moral and legal responsibility for the consequences of drug use were frequently mentioned as reasons for rejecting syringe sales. Still, many participants acknowledged the need for distributing syringes to PWID to prevent HIV. Conclusions Stigma against PWID in Tajikistan plays an important role in shaping pharmacists’ attitudes towards provision of services to this population. Local sociocultural context, in particular religious beliefs and social conservatism, may facilitate stigmatizing beliefs.
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Affiliation(s)
- Umedjon Ibragimov
- HIV/AIDS and Harm Reduction Association of Tajikistan, 73/3 I. Somoni Str., office 59, 734064, Dushanbe, Tajikistan. .,Department of Behavioral Sciences & Health Education, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, 30032, USA.
| | - Hannah L Cooper
- Department of Behavioral Sciences & Health Education, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, 30032, USA
| | - Regine Haardörfer
- Department of Behavioral Sciences & Health Education, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, 30032, USA
| | - Kristin L Dunkle
- Gender and Health Division, South African Medical Research Council, Francie van Zijl Drive, Parowvallei, PO Box 19070, Cape, Tygerberg, 7505, South Africa
| | - William A Zule
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA
| | - Frank Y Wong
- Department of Tropical Medicine, John A. Burns School of Medicine, University of Hawai'i at Mānoa, 651 Ilalo St, Honolulu, HI, 96813, USA.,School of Public Health, Fudan University, 220 Handan Rd, WuJiaoChang, Yangpu Qu, Shanghai Shi, 200433, China
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25
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Ding Y, Lin H, Liu X, Wong FY, Sun YV, Marconi VC, He N. Higher Prevalence of Frailty Among a Sample of HIV-Infected Middle-aged and Older Chinese Adults Is Associated With Neurocognitive Impairment and Depressive Symptoms. J Infect Dis 2017; 215:687-692. [PMID: 28329145 DOI: 10.1093/infdis/jix032] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 03/01/2017] [Indexed: 11/14/2022] Open
Abstract
We investigated the prevalence and correlates of prefrailty/frailty, determined on the basis of the Fried criteria, in Chinese patients with and those without human immunodeficiency virus (HIV) infection. HIV-infected patients were more likely to be frail or prefrail than controls, and this association remained significant after adjustment for potential confounders (odds ratio, 3.79). After additional adjustment for neurocognitive impairment and depressive and insomnia symptoms, this association remained significant but attenuated (odds ratio, 2.16). In the HIV-infected group, these 3 variables were independently associated with prefrailty/frailty. These findings suggest that neurocognitive impairment and depressive and/or insomnia symptoms may account for a higher prevalence of prefrailty/frailty in HIV-infected patients but require further longitudinal investigation.
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Affiliation(s)
- Yingying Ding
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai
| | - Haijiang Lin
- Taizhou City Center for Disease Control and Prevention, Taizhou City, China
| | - Xing Liu
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai
| | - Frank Y Wong
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, USA
| | - Yan V Sun
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Vincent C Marconi
- Hubert Department of Global Health, Rollins School of Public Health, Emory University , Atlanta, Georgia, USA.,Department of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai
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Nakamura S, Walker DW, Wong FY. Cerebral haemodynamic response to somatosensory stimulation in near-term fetal sheep. J Physiol 2016; 595:1289-1303. [PMID: 27805787 DOI: 10.1113/jp273163] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/20/2016] [Indexed: 01/03/2023] Open
Abstract
KEY POINTS Cerebral haemodynamic response to neural stimulation has been extensively investigated in animal and clinical studies, in both adult and paediatric populations, but little is known about cerebral haemodynamic functional response in the fetal brain. The present study describes the cerebral haemodynamic response measured by near-infrared spectroscopy to somatosensory stimulation in fetal sheep. The cerebral haemodynamic response in the fetal sheep brain changes from a positive (increase in oxyhaemoglobin (oxyHb)) response pattern to a negative or biphasic response pattern when the duration of somatosensory stimulation is increased, probably due to cerebral vasoconstriction with prolonged stimulations. In contrast to adult studies, we have found that changes in fetal cerebral blood flow and oxyHb are positively increased in response to somatosensory stimulation during hypercapnia. We propose this is related to reduced vascular resistance and recruitment of cerebral vasculature in the fetal brain during hypercapnia. ABSTRACT Functional hyperaemia induced by a localised increase in neuronal activity has been suggested to occur in the fetal brain owing to a positive blood oxygen level-dependent (BOLD) signal recorded by functional magnetic resonance imaging following acoustic stimulation. To study the effect of somatosensory input on local cerebral perfusion we used near-infrared spectroscopy (NIRS) in anaesthetised, partially exteriorised fetal sheep where the median nerve was stimulated with trains of pulses (2 ms, 3.3 Hz) for durations of 1.8, 4.8 and 7.8 s. Signal averaging of cerebral NIRS responses to 20 stimulus trains repeated every 60 s revealed that a short duration of stimulation (1.8 s) increased oxyhaemoglobin in the contralateral cortex consistent with a positive functional response, whereas longer durations of stimulation (4.8, 7.8 s) produced more variable oxyhaemoglobin responses including positive, negative and biphasic patterns of change. Mean arterial blood pressure and cerebral perfusion as monitored by laser Doppler flowmetry always showed small, but coincident increases following median nerve stimulation regardless of the type of response detected by the NIRS in the contralateral cortex. Hypercapnia significantly increased the baseline total haemoglobin and deoxyhaemoglobin, and in 7 of 8 fetal sheep positively increased the changes in contralateral total haemoglobin and oxyhaemoglobin in response to the 7.8 s stimulus train, compared to the response recorded during normocapnia. These results show that activity-driven changes in cerebral perfusion and oxygen delivery are present in the fetal brain, and persist even during periods of hypercapnia-induced cerebral vasodilatation.
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Affiliation(s)
- S Nakamura
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Melbourne, Victoria, 3168, Australia
| | - D W Walker
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Melbourne, Victoria, 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Melbourne, Victoria, 3168, Australia
| | - F Y Wong
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Melbourne, Victoria, 3168, Australia.,Department of Paediatrics, Monash University, Clayton, Melbourne, Victoria, 3168, Australia.,Monash Newborn, Monash Medical Centre, Clayton, Melbourne, Victoria, 3168, Australia
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27
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Ibragimov U, Wong FY. Qualitative examination of enacted stigma towards gay and bisexual men and related health outcomes in Tajikistan, Central Asia. Glob Public Health 2016; 13:597-611. [PMID: 27568790 DOI: 10.1080/17441692.2016.1224910] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Gay and bisexual men (GBM) in Tajikistan are an extremely stigmatised group at high risk for sexually transmitted infections and HIV. However, there is a paucity of research on how and in what way stigma affects their lives. We conducted a qualitative study to examine the impact of stigma on GBM's lives in Tajikistan, focusing on stigma enactors, settings, factors affecting vulnerability of GBM and health consequences. Eight individual in-depth interviews and 3 focus-group discussions with 13 participants (N = 21) from GBM community were conducted in two cities of Tajikistan. Results reveal that police frequently engage in blackmail and perpetrate sexual and physical violence against GBM. Service providers often discriminate against GBM limiting their access to health and legal services. Exposure to stigma results in chronic stress affecting mental health of GBM. Fear of disclosure, low social cohesion, absence of prominent opinion leaders and activists reduce resilience of GBM community to stigma. State-sanctioned violations of human rights of marginalised populations and lack of effective legal protection mechanisms have enabled widespread harassment of GBM. These findings warrant further research on stigma leading to the development of culturally adapted and tailored multilevel structural interventions, including broad legal and policy reforms.
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Affiliation(s)
- Umedjon Ibragimov
- a Department of Behavioural Sciences & Health Education , Emory University Rollins School of Public Health , Atlanta , GA , USA.,b HIV/AIDS and Harm Reduction Association of Tajikistan , Dushanbe , Tajikistan
| | - Frank Y Wong
- a Department of Behavioural Sciences & Health Education , Emory University Rollins School of Public Health , Atlanta , GA , USA.,c Hubert Department of Global Health , Emory University Rollins School of Public Health , Atlanta , GA , USA.,d Department of Epidemiology , Emory University Rollins School of Public Health , Atlanta , GA , USA.,e Department of Sociology , Emory College, Emory University , Atlanta , GA , USA.,f School of Public Health, Fudan University , Shanghai , People's Republic of China
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Wong FY, Thompson EE, Huang ZJ, Park RJ, DiGangi J, De Leon JM. Alcohol, Drugs, Sex, and HIV Risk Behaviors among a Community Sample of Black and Coloured South Africans. Journal of Drug Issues 2016. [DOI: 10.1177/002204260703700301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to examine substance use and HIV risk behaviors among a community sample of Black and Coloured South Africans. Eligible participants aged 18 and above were recruited from one historically Black and one historically Coloured township in Cape Town. Blacks and Coloureds were about equally as likely to use at least one soft drug (e.g., cannabis). Coloureds were more likely to use at least one hard drug, with methamphetamines being most common. Alcohol before sex was the primary “driver” of having unprotected sex and served as a mediator of other risk factors such as drug use before sex and problem drinking. Furthermore, hard drug users were much more likely to use soft drugs than vice versa. The independent and mediating role of soft drugs suggest that soft drug (vs. hard drug) use should not be overlooked at least in the context of HIV prevention.
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Ibragimov U, Harnisch JA, Nehl EJ, He N, Zheng T, Ding Y, Wong FY. Estimating self-reported sex practices, drug use, depression, and intimate partner violence among MSM in China: a comparison of three recruitment methods. AIDS Care 2016; 29:125-131. [PMID: 27367038 DOI: 10.1080/09540121.2016.1201191] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Men who have sex with men (MSM) are the group at highest risk for HIV in China. Researchers have used various recruitment methods to reach this population hidden from the hetero-normative culture. To inform future recruitment strategies, we compared estimates of socio-demographic characteristics, HIV risk behaviors, depression, and intimate partner violence (IPV) across three samples of MSM and money boys in Shanghai, China. Data were collected from three community-based samples of MSM and money boys (n = 1352) recruited via respondent-driven sampling (RDS) (n = 404), community popular opinion leaders (CPOL) (n = 385), and Internet and venue-based sampling (VBS) (n = 546). Different recruitment methods generated samples with statistically significant differences among a number of socio-demographic characteristics, sexual behaviors, drug use, depression scores, and exposure to IPV. Specifically, RDS participants had lower education (p = .002), income levels (p < .001), and were more likely to report condomless sex with a woman (p < .001). CPOL participants were younger (p < .001), more likely to report lifetime condomless anal sex (p = .009), more than 10 male partners in the past 30 days (p < .001), and were less likely to experience violence by a male intimate partner (p = .001). VBS participants had lowest depression score (p = .005) and were more likely to report lifetime drug use (p = .003). Our findings reinforce that each recruitment method may reach a sub-group of MSM with a specific risk profile, so multiple methods may be needed to obtain a representative sample of MSM. Interventions may use specific recruitment methods to target certain segments of the MSM population.
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Affiliation(s)
- Umedjon Ibragimov
- a Department of Behavioral Sciences & Health Education , Emory University Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Jessica A Harnisch
- a Department of Behavioral Sciences & Health Education , Emory University Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Eric J Nehl
- a Department of Behavioral Sciences & Health Education , Emory University Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Na He
- a Department of Behavioral Sciences & Health Education , Emory University Rollins School of Public Health, Emory University , Atlanta , GA , USA.,b Department of Epidemiology , Fudan University School of Public Health , Shanghai , China
| | - Tony Zheng
- c Shanghai Piaoxue Cultural Media, Ltd ., Shanghai , China
| | - Yingying Ding
- b Department of Epidemiology , Fudan University School of Public Health , Shanghai , China
| | - Frank Y Wong
- a Department of Behavioral Sciences & Health Education , Emory University Rollins School of Public Health, Emory University , Atlanta , GA , USA.,d Hubert Department of Global Health , Emory University Rollins School of Public Health , Atlanta , GA , USA.,e Department of Epidemiology , Emory University Rollins School of Public Health , Atlanta , GA , USA.,f Department of Sociology , Emory College, Emory University , Atlanta , GA , USA
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Abstract
There remains a profound need for innovative and effective interventions designed for young men who have sex with men (YMSM) generally, and racial and ethnic minority YMSM, YMSM living in rural communities, and low-income YMSM, particularly, to prevent HIV and improve health outcomes in the United States. This introduction to this theme issue, "Behavioral HIV Prevention Interventions for Diverse YMSM," of AIDS Education and Prevention identifies some of the research needs, priorities, and opportunities that emerged during a seminal NIMHD-sponsored workshop on HIV prevention behavioral interventions for diverse YMSM. It provides researchers, practitioners, and federal partners guidance in next steps to reduce the impact of the HIV epidemic among YMSM. The needs, priorities, and opportunities identified serve as a foundation to push both the science and the practice of HIV prevention forward. We recognize that considerably more research is needed, and this issue highlights intervention research-where we have been and where we should go. With the disparities faced by YMSM, we must act rapidly to do the work it will take to meet their prevention needs, reduce infections, and save lives.
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Affiliation(s)
- Scott D Rhodes
- Department of Social Sciences and Health Policy; Section of Infectious Diseases; The Maya Angelou Center for Health Equity; and The Clinical and Translational Institute, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Frank Y Wong
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Hall CD, Murdock D, Nehl EJ, Wong FY. Unheard Voices: The Need for HIV Research and Prevention Priorities for YMSM in the Global Context. AIDS Educ Prev 2016; 28:272-276. [PMID: 27244194 DOI: 10.1521/aeap.2016.28.3.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This commentary considers the AIDS Education and Prevention special issue (volume 28, number 3) entitled "Behavioral HIV Prevention Interventions for Diverse Young Men Who Have Sex with Men (MSM)." The research presented in this special issue highlights the importance of addressing sub-populations of young MSM in order to better understand the unique realities and risk-factors affecting HIV epidemics and intervention needs. Here, we focus on several broad topics raised in this special issue and comment on their implications for HIV research and practice targeting young MSM in low- and middle-income countries. We consider issues relevant to reaching hidden populations, tailoring interventions, and integrating new communications and bio-medical technologies in research and practice in low-resource settings.
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Affiliation(s)
| | | | | | - Frank Y Wong
- Rollins School of Public Health, Emory University, Atlanta, Georgia
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Nehl EJ, Han JH, Lin L, Nakayama KK, Wu Y, Wong FY. Substance Use among a National Sample of Asian/Pacific Islander Men Who Have Sex with Men in the U.S. J Psychoactive Drugs 2015; 47:51-9. [PMID: 25715072 DOI: 10.1080/02791072.2014.994795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The objectives of this study were to describe drug use among Asian/Pacific Islander (API) men who have sex with men (MSM) and to examine how nativity (and acculturation as a secondary correlate) predicted such use. A total of 445 self-identified API MSM from seven metropolitan cities participated in a national HIV serological testing and psychosocial and behavioral assessment study. Results indicate clubbing was significantly associated with higher levels of substance use. Additionally, participants who were U.S.-born were more likely to have reported marijuana use and those with higher levels of acculturation reported less marijuana use. Our bivariate findings suggest that foreign-born status and acculturation experience may provide a protective effect against marijuana use among API MSM. These associations largely did not hold in our multivariate models. Future research should more fully examine the role of acculturation and nativity in substance use behaviors.
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Affiliation(s)
- Eric J Nehl
- a Assistant Research Professor, Emory University's Rollins School of Public Health , Atlanta , GA
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Lin L, Brown KB, Yu F, Yang J, Wang J, Schrock JM, Bodomo AB, Yang L, Yang B, Nehl EJ, Tucker JD, Wong FY. Health Care Experiences and Perceived Barriers to Health Care Access: A Qualitative Study Among African Migrants in Guangzhou, Guangdong Province, China. J Immigr Minor Health 2015; 17:1509-17. [PMID: 25294415 PMCID: PMC4390408 DOI: 10.1007/s10903-014-0114-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Guangzhou, one of China's largest cities and a main trading port in South China, has attracted many African businessmen and traders migrating to the city for financial gains. Previous research has explored the cultural and economic roles of this newly emerging population; however, little is known about their health care experiences while in China. Semi-structured interviews and focus groups were used to assess health care experiences and perceived barriers to health care access among African migrants in Guangzhou, China. Overall, African migrants experienced various barriers to accessing health care and were dissatisfied with local health services. The principal barriers to care reported included affordability, legal issues, language barriers, and cultural differences. Facing multiple barriers, African migrants have limited access to care in Guangzhou. Local health settings are not accustomed to the African migrant population, suggesting that providing linguistically and culturally appropriate services may improve access to care for the migrants.
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Affiliation(s)
- Lavinia Lin
- Emory University Rollins School of Public Health, 1518 Clifton Road, N.E., Atlanta, GA, 30322, USA,
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Lin L, Brown KB, Hall BJ, Yu F, Yang J, Wang J, Schrock JM, Bodomo AB, Yang L, Yang B, Nehl EJ, Tucker JD, Wong FY. Overcoming barriers to health-care access: A qualitative study among African migrants in Guangzhou, China. Glob Public Health 2015; 11:1135-47. [PMID: 26400191 DOI: 10.1080/17441692.2015.1076019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Guangzhou is China's third most populous city, and the region's burgeoning manufacturing economy has attracted many young African businessmen and entrepreneurs to the city. The aims of this study were to examine strategies that African migrants in Guangzhou have adopted in response to health-care barriers, and explore their perceptions of how to address their needs. Twenty-five semi-structured interviews and two focus groups were conducted among African migrants residing in Guangzhou, China. Facing multiple barriers to care, African migrants have adopted a number of suboptimal and unsustainable approaches to access health care. These included: using their Chinese friends or partners as interpreters, self-medicating, using personal connections to medical doctors, and travelling to home countries or countries that offer English-speaking doctors for health care. Health-care providers and health organisations in Guangzhou have not yet acquired sufficient cultural competence to address the needs of African migrants residing in the city. Introducing linguistically and culturally competent health-care services in communities concentrated with African migrants may better serve the population. With the growing international migration to China, it is essential to develop sustainable approaches to improving health-care access for international migrants, particularly those who are marginalised.
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Affiliation(s)
- Lavinia Lin
- a Department of Behavioral Sciences and Health Education , Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Katherine B Brown
- b College of Physicians and Surgeons, Columbia University , New York , NY , USA
| | - Brian J Hall
- c Department of Psychology, Faculty of Social Sciences , University of Macau , Taipa, Macau (SAR) , People's Republic of China
| | - Fan Yu
- a Department of Behavioral Sciences and Health Education , Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Jingqi Yang
- a Department of Behavioral Sciences and Health Education , Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Jason Wang
- a Department of Behavioral Sciences and Health Education , Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Joshua M Schrock
- a Department of Behavioral Sciences and Health Education , Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Adams B Bodomo
- d African Studies Department , Global African Diaspora Studies (GADS) Research Platform, University of Vienna , Vienna , Austria
| | - Ligang Yang
- e Guangdong Provincial Center for Skin Diseases and STD Control , Guangzhou , Guangdong Province , People's Republic of China
| | - Bin Yang
- e Guangdong Provincial Center for Skin Diseases and STD Control , Guangzhou , Guangdong Province , People's Republic of China
| | - Eric J Nehl
- a Department of Behavioral Sciences and Health Education , Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Joseph D Tucker
- f UNC Project-China , Guangzhou , Guangdong Province , People's Republic of China
| | - Frank Y Wong
- a Department of Behavioral Sciences and Health Education , Rollins School of Public Health, Emory University , Atlanta , GA , USA
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Abstract
Many countries (e.g., Egypt, Russia, and Uganda) have very draconian laws against LGBT individuals. Despite facing such adversity or hostility many LGBT individuals do strive and maintain their sense of self-worth. How do they do it? The collection of papers in this special issue attempts to provide some answers to this question. I will attempt to analyze two overlapping issues in these papers, and how they might inform LGBT research using a resilience lens.
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Affiliation(s)
- Frank Y Wong
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA,
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Yan H, Ding Y, Wong FY, Ning Z, Zheng T, Nehl EJ, He N. Epidemiological and molecular characteristics of HIV infection among money boys and general men who have sex with men in Shanghai, China. Infect Genet Evol 2015; 31:135-41. [PMID: 25653132 DOI: 10.1016/j.meegid.2015.01.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/19/2015] [Accepted: 01/25/2015] [Indexed: 11/26/2022]
Abstract
To examine and compare the epidemiological and molecular characteristics of HIV infection between money boys (MBs) and general men who have sex with men (MSM) in Shanghai, China. Using a venue-based sampling strategy, a total of 535 MSM including 226 MBs and 309 general MSM were recruited to participate in a cross-sectional survey including a face-to-face questionnaire interview and HIV testing. Genotyping of HIV-1 pol gene was performed for HIV-positive participants. Compared with general MSM, MBs reported more sexual partners, more alcohol and drug use and more sex after alcohol or drug use. HIV prevalence was 10.7% overall, 14.6% for MBs and 7.8% for general MSM (p=0.011). Two independent multiple logistic regression analyses indicated that HIV infection was positively associated with non-Han ethnicity (Odds Ratio [OR]=4.79, 95% Confidence Interval [CI]: 1.08-21.28) and sex after drug use in the past 6months (OR=3.59, 95% CI: 1.50-8.61) among MBs, and with sex after drug use in the past 6months (OR=3.38, 95% CI: 1.10-10.34) among general MSM as well. HIV-1 pol gene was successfully amplified and sequenced for 52 (91.2%) of HIV-positive participants. Of them, 53.8% were genotyped as CRF01_AE, 36.5% as CRF07_BC and 9.6% as subtype B. Two CRF01_AE subtype-infected participants (3.8%), a 50years old MB and a 24years old general MSM, harbored viruses with a M46L mutation conferring resistance to protease inhibitors (PI). MSM particularly MBs in Shanghai, China were at high risk of HIV infection, underscoring an urgent need for joint intervention efforts for drug use and sexual behaviors. HIV drug resistance surveillance is also warranted although the relatively low prevalence of HIV drug resistance implies the effectiveness of current antiretroviral treatment regimen.
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Affiliation(s)
- Huamei Yan
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
| | - Yingying Ding
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
| | - Frank Y Wong
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA; The Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Zhen Ning
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China; Shanghai Center for Disease Control and Prevention, Shanghai, China
| | - Tony Zheng
- Shanghai Piaoxue Cultural Media Limited, Shanghai, China
| | - Eric J Nehl
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China; Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Abstract
BACKGROUND This study explores patterns of drug use and related correlates among a sample of men who have sex with men (MSM) and men who sell sex to other men (aka "money boys") in China. OBJECTIVES Data were collected from MSM and money boys (MBs) in Shanghai, China using a Community Popular Opinion Leader (CPOL) research design with a self-administered cross-sectional survey to: (1) describe drug use and drug use correlates and (2) examine relationships between drug use and sexual behaviors in general MSM and MBs. METHODS The sample consisted of 402 MSM (203 MBs) who live in Shanghai, China. Descriptive statistics and regression analyses were used to explore associations between drug use and sexual behaviors and make comparisons between MBs and general MSM. RESULTS MBs reported using more drugs in the last week, 3 months and ever; sex after using drugs, and unprotected sex after using drugs more frequently than general MSM. Additionally, many MBs reported receiving free drugs from their clients and those who did receive free drugs were very likely to report having unprotected sex. CONCLUSIONS It is crucial to increase research and include Chinese MSM and their drug use in the Chinese policy conversation. These data suggest that drug use and sexual behaviors after drug use among Chinese MSM differ widely based upon selling sex and separate intervention strategies may be appropriate.
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Affiliation(s)
- Eric J Nehl
- 1Department of Behavioral Sciences & Health Education, Rollins School of Public Health, Emory University , Atlanta, Georgia , USA
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Wang F, Li H, Tan PH, Chua ET, Yeo RMC, Lim FLWT, Kim SW, Tan DYH, Wong FY. Validation of a nomogram in the prediction of local recurrence risks after conserving surgery for Asian women with ductal carcinoma in situ of the breast. Clin Oncol (R Coll Radiol) 2014; 26:684-91. [PMID: 25194727 DOI: 10.1016/j.clon.2014.08.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/09/2014] [Accepted: 07/10/2014] [Indexed: 11/19/2022]
Abstract
AIMS At our centre, ductal carcinoma in situ (DCIS) was commonly treated with breast-conservation therapy (BCT). Local recurrence after BCT is a major concern. The aims of our study were to review the outcomes of DCIS treatment in our patients and to evaluate a nomogram from Memorial Sloan Kettering Cancer Centre (MSKCC) for predicting ipsilateral breast tumour recurrence (IBTR) in our Asian population. MATERIALS AND METHODS Chart reviews of 716 patients with pure DCIS treated from 1992 to 2011 were carried out. Univariable Cox regression analyses were used to evaluate the effects of the 10 prognostic factors of the MSKCC nomogram on IBTR. We constructed a separate National Cancer Centre Singapore (NCCS) nomogram based on multivariable Cox regression via reduced model selection by applying the stopping rule of Akaike's information criterion to predict IBTR-free survival. The abilities of the NCCS nomogram and the MSKCC nomogram to predict IBTR of individual patients were evaluated with bootstrapping of 200 sets of resamples and the NCCS dataset, respectively. Harrell's c-index was calculated for each nomogram to evaluate the concordance between predicted and observed responses of individual subjects. RESULTS Study patients were followed up for a median of 70 months. Over 95% of patients received adjuvant radiotherapy. The 5 and 10 year actuarial IBTR-free survival rates for the cohort were 95.5 and 92.6%, respectively. In the multivariate analysis, independent prognostic factors for IBTR included use of adjuvant endocrine therapy, presence of comedonecrosis and younger age at diagnosis. These factors formed the basis of the NCCS nomogram, which had a similar c-index (NCCS: 0.696; MSKCC: 0.673) compared with the MSKCC nomogram. CONCLUSION The MSKCC nomogram was validated in an Asian population. A simpler NCCS nomogram using a different combination of fewer prognostic factors may be sufficient for the prediction of IBTR in Asians, but requires external validation to compare for relative performance.
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Affiliation(s)
- F Wang
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - H Li
- Unit of Health Services Research, Singapore General Hospital, Singapore
| | - P H Tan
- Department of Pathology, Singapore General Hospital, Singapore
| | - E T Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - R M C Yeo
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - F L W T Lim
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - S W Kim
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - D Y H Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - F Y Wong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.
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Dong C, Huang ZJ, Martin MC, Huang J, Liu H, Deng B, Lai W, Liu L, Yang Y, Hu Y, Qin G, Zhang L, Song Z, Wei D, Nan L, Wang Q, Deng H, Zhang J, Wong FY, Yang W. The impact of social factors on human immunodeficiency virus and hepatitis C virus co-infection in a minority region of Si-chuan, the People's Republic of China: a population-based survey and testing study. PLoS One 2014; 9:e101241. [PMID: 24988219 PMCID: PMC4079678 DOI: 10.1371/journal.pone.0101241] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 06/04/2014] [Indexed: 11/30/2022] Open
Abstract
Background While many human immunodeficiency virus (HIV) studies have been performed in Liangshan, most were focused only on HIV infection and based on a sampling survey. In order to fully understand HIV and hepatitis C virus (HCV) prevalence and related risk factors in this region, this study implemented in 2009, included a survey, physical examination, HIV and HCV test in two towns. Methods All residents in two towns of the Butuo county were provided a physical examination and blood tests for HIV and HCV, and then followed by an interview for questionnaire. Results In total, 10,104 residents (92.4%) were enrolled and 9,179 blood samples were collected for HIV and HCV testing, 6,072 were from individuals >14 years old. The rates of HIV, HCV, and HIV/HCV co-infection were 11.4%, 14.0%, and 7.7%, respectively for >14-year-old residents. The 25–34 yr age group had the highest prevalence of HIV, HCV, and HIV/HCV co-infections, reaching 24.4%, 26.2% and 16.0%, respectively. Overall, males had a much higher prevalence of all infections than females (HIV: 16.3% vs. 6.8%, HCV: 24.6% vs. 3.9%, HIV/HCV co-infected: 14.7% vs. 1.1%, respectively; P = 0.000). Approximately half of intravenous drug users tested positive for HIV (48.7%) and 68.4% tested positive for HCV. Logistic regression analysis showed that five factors were significantly associated with HIV and HCV infection: gender (odds ratio [OR] = 5.8), education (OR = 2.29); occupation (student as reference; farmer: OR = 5.02, migrant worker: OR = 6.12); drug abuse (OR = 18.0); and multiple sexual partners (OR = 2.92). Knowledge of HIV was not associated with infection. Conclusion HIV and HCV prevalence in the Liangshan region is very serious and drug use, multiple sexual partners, and low education levels were the three main risk factors. The government should focus on improving education and personal health awareness while enhancing drug control programs.
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Affiliation(s)
- Caiting Dong
- Department of HIV Control and Prevention, Si-chuan Center for Disease Control and Prevention, Chengdu, China
| | - Z. Jennifer Huang
- Department of International Health, Georgetown University, Washington DC, United States of America
| | - Maria C. Martin
- Department of Pediatrics - Adolescent & Young Adult Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Jun Huang
- Department of HIV Control and Prevention, Si-chuan Center for Disease Control and Prevention, Chengdu, China
| | - Honglu Liu
- Department of HIV Control and Prevention, Si-chuan Center for Disease Control and Prevention, Chengdu, China
| | - Bin Deng
- Department of HIV Control and Prevention, Si-chuan Center for Disease Control and Prevention, Chengdu, China
| | - Wenhong Lai
- Department of HIV Control and Prevention, Si-chuan Center for Disease Control and Prevention, Chengdu, China
| | - Li Liu
- Department of HIV Control and Prevention, Si-chuan Center for Disease Control and Prevention, Chengdu, China
| | - Yihui Yang
- Department of HIV Control and Prevention, Si-chuan Center for Disease Control and Prevention, Chengdu, China
| | - Ying Hu
- Department of HIV Control and Prevention, Si-chuan Center for Disease Control and Prevention, Chengdu, China
| | - Guangming Qin
- Department of HIV Control and Prevention, Si-chuan Center for Disease Control and Prevention, Chengdu, China
| | - Linglin Zhang
- Department of HIV Control and Prevention, Si-chuan Center for Disease Control and Prevention, Chengdu, China
| | - Zhibin Song
- Department of HIV Control and Prevention, Liangshan Prefecture Health Bureau, Xichang, Si-chuan, China
| | - Daying Wei
- Department of HIV Control and Prevention, Lianshan Center for Disease Control and Prevention, Xichang, Si-chuan, China
| | - Lei Nan
- Department of HIV Control and Prevention, Lianshan Center for Disease Control and Prevention, Xichang, Si-chuan, China
| | - Qixing Wang
- Department of HIV Control and Prevention, Lianshan Center for Disease Control and Prevention, Xichang, Si-chuan, China
| | - Hongxia Deng
- Department of HIV Control and Prevention, Butuo Health Bureau, Butuo, Si-chuan, China
| | - Jianxun Zhang
- Department of HIV Control and Prevention, Butuo Health Bureau, Butuo, Si-chuan, China
| | - Frank Y. Wong
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, Georgia, United States of America
| | - Wen Yang
- Department of HIV Control and Prevention, Si-chuan Center for Disease Control and Prevention, Chengdu, China
- * E-mail:
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Tran A, Lin L, Nehl EJ, Talley CL, Dunkle KL, Wong FY. Prevalence of Substance Use and Intimate Partner Violence in a Sample of A/PI MSM. J Interpers Violence 2014; 29:2054-2067. [PMID: 24390356 PMCID: PMC8080275 DOI: 10.1177/0886260513516006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
This study evaluates the prevalence of three forms of intimate partner violence (IPV) (i.e., experience of physical, psychological/symbolic, and sexual battering) among a national sample of Asian/Pacific Islander (A/PI) men who have sex with men (MSM) in the United States and identifies their characteristics. The study also reports the differences of substance use behavior between MSM with and without a previous history of IPV. Our sample was recruited through venue-based sampling from seven metropolitan cities as part of the national Men of Asia Testing for HIV (MATH) study. Among 412 MSM, 29.1% experienced IPV perpetrated from a boyfriend or same-gender partner in the past 5 years. Within the previous 5 years, 62.5%, 78.3%, and 40.8% of participants experienced physical, psychological/symbolic, and sexual battering, respectively. Collectively, 35.8% of participants reported that they have experienced at least one type of victimization and 64.2% have experienced multiple victimizations (two or three types of battering victimization). Overall, 21.2% of our sample reported any substance use within the past 12 months. The present findings suggest that individuals with a history of IPV in the past 5 years were more likely to report substance use (33.6%) compared to those without a history of IPV experience (16.1%).
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Affiliation(s)
- Alvin Tran
- Emory University, Atlanta, GA, USA Harvard University, Boston, MA, USA
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Berg CJ, Nehl EJ, Wang X, Ding Y, He N, Wong FY. Utilization of cessation resources among HIV-positive and HIV-negative men who smoke and who have sex with men in Chengdu, China. Nicotine Tob Res 2014; 16:1283-8. [PMID: 24827789 DOI: 10.1093/ntr/ntu064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Given the implications for smoking among individuals living with HIV and the high rates of smoking and HIV among men who have sex with men (MSM) in China, we examined differences in prior use of and future interest in various cessation resources among MSM smokers with or without HIV. METHODS We conducted a cross-sectional survey of 381 MSM; HIV status was provided by 350 MSM, and complete data was provided by a total of 344 (188 HIV-positive and 156 HIV-negative) current smokers (past 30 days) recruited by a nongovernmental organization in Chengdu in 2012-2013. Participants reported tobacco and alcohol use; psychosocial factors; past-year quit attempts; health care provider interactions on smoking; and prior use of and interest in cessation resources. RESULTS Smokers living with HIV were more likely to have used behavioral interventions (p < .001) and pharmacotherapy (p = .033). Those who were HIV-positive were also more interested in behavioral interventions (p = .002) and pharmacotherapy (p = .008). Correlates of interest in behavioral interventions in the regression model included lower cigarette consumption (p = .011), higher confidence in quitting (p = .035), greater likelihood of attempting to quit in the past year (p = .026), and being HIV-positive (p = .008). Correlates of interest in pharmacotherapy included greater depressive symptoms (p = .047) and being HIV-positive (p = .015). CONCLUSIONS Smokers living with HIV were more likely to have ever attempted to quit smoking, to have used cessation resources, and to be interested in using cessation aids. These findings indicate the promise of greater dissemination of cessation resources, particularly if Chinese clinical practices are strengthened to offer cessation support.
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Affiliation(s)
- Carla J Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Eric J Nehl
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Xiaodong Wang
- Chengdu Tongle Health Service and Counseling Center, Chengdu City, Cichuan Province, China
| | - Yingying Ding
- Department of Epidemiology, Fudan University School of Public Health, Shanghai, China
| | - Na He
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology, Fudan University School of Public Health, Shanghai, China
| | - Frank Y Wong
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
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Berg CJ, Nehl EJ, Wang X, Ding Y, He N, Johnson BA, Wong FY. Healthcare provider intervention on smoking and quit attempts among HIV-positive versus HIV-negative MSM smokers in Chengdu, China. AIDS Care 2014; 26:1201-7. [PMID: 24601710 DOI: 10.1080/09540121.2014.892565] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Given the implications for smoking among HIV-positive individuals and high smoking and HIV rates among men who have sex with men (MSM) in China, we examined sociodemographic, smoking-related, psychosocial, and substance use factors in relation to HIV status; receiving some sort of healthcare provider intervention regarding smoking; and having made a quit attempt in the past year in a sample of MSM smokers in Chengdu. We conducted a cross-sectional survey of 381 MSM smokers recruited by a nongovernmental organization in Chengdu in 2012-2013. Of these, 350 disclosed their HIV status and 344 (188 HIV-positive and 156 HIV-negative) provided completed data. Half (50.0%) reported at least one quit attempt in their lifetime; 30.5% reported a quit attempt in the past year. The majority (59.4%) reported that a healthcare provider had intervened in some way (assessed smoking, advised quitting, provided assistance), most commonly by assessing smoking status (50.0%). HIV-positive individuals were more likely to report a healthcare provider intervening on their smoking (p < .001). Those who received provider intervention were more likely to have attempted to quit ever (p = .009) and in the past year (p < .001). Those HIV-positive were more likely to have attempted to quit since diagnosis if a provider had intervened (p = .001). Multivariate regression documented that being HIV-positive (p < .001), greater cigarette consumption (p = .02), less frequent drinking (p = .03), and greater depressive symptoms (p = .003) were significant correlates of healthcare provider intervention. Multivariate regression also found that healthcare provider intervention (p = .003), older age (p = .01), and higher autonomous motivation (p = .007) were significant correlates of attempting to quit in the past year. Given the impact of healthcare provider intervention regarding smoking on quit attempts among MSM, greater training and support is needed to promote consistent intervention on smoking in the clinical setting among HIV-positive and HIV-negative MSM smokers.
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Affiliation(s)
- Carla J Berg
- a Department of Behavioral Sciences & Health Education , Rollins School of Public Health, Emory University , Atlanta , GA , USA
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Lin L, Nehl EJ, Tran A, He N, Zheng T, Wong FY. Sexually transmitted infection testing practices among 'money boys' and general men who have sex with men in Shanghai, China: objective versus self-reported status. Sex Health 2014; 11:94-6. [PMID: 24636349 DOI: 10.1071/sh13199] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 02/09/2014] [Indexed: 11/23/2022]
Abstract
Little is known about sexually transmitted infection (STI) testing among Chinese men who have sex with men (MSM). This study describes the prevalence of STI testing, associated factors and the validity of STI self-reporting among Chinese MSM. Findings indicated a high prevalence of STIs and low testing rates among MSM in Shanghai. Monthly income was significantly associated with STI testing (odds ratio: 0.37, 95% confidence interval (CI): 0.18 to 0.76). Depression was significantly associated with STI testing for general MSM (odds ratio: 1.09, 95% CI: 1.01 to 1.17). Syphilis self-reported status had the highest validity (k=0.33, χ(2)=3.76, 95% CI: -0.003 to 0.65). Efforts are needed to ensure that STI testing services are accessible to MSM in China. Future HIV and STI interventions should be tailored to the needs of different subsets of MSM.
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Affiliation(s)
- Lavinia Lin
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA
| | - Eric J Nehl
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA
| | - Alvin Tran
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA
| | - Na He
- Department of Epidemiology, Fudan University School of Public Health, Shanghai 200032, China
| | - Tony Zheng
- Shanghai Piaoxue Cultural Media Ltd, Shanghai, China
| | - Frank Y Wong
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA
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Yan H, Wong FY, Zheng T, Ning Z, Ding Y, Nehl EJ, Lin L, He N. Social support and depressive symptoms among 'money' boys and general men who have sex with men in Shanghai, China. Sex Health 2014; 11:285-7. [PMID: 24919661 DOI: 10.1071/sh14017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 02/27/2014] [Indexed: 12/18/2022]
Abstract
The primary objective was to examine prevalence and correlates of social support and depressive symptoms among male sex workers (known as 'money boys' (MBs)) and general men who have sex with men (MSM) in Shanghai. The Social Provision Scale (SPS), which consists of 24 items, scored out of 4 for social provision, was used to evaluate the functions of social relationships. The score for each item ranges from 1 to 4, with a higher score indicating more social provision. The overall mean SPS score was 68.1 (s.d.=6.53) for MBs and 69.3 (s.d.=6.99) for general MSM. Depression was measured with a 12-item version of the Center for Epidemiological Studies Depression Scale (CES-D), where a score of 9 has been recommended as the cutoff score to indicate possible depressive symptoms. The prevalence of depressive symptoms was 57.9%, with MBs having a higher level of depressive symptoms than general MSM (70.0% v. 46.1%) (odds ratio=1.86, 95% confidence interval=1.07-3.24). Social support was a protective factor for depressive symptoms (odds ratio=0.92, 95% confidence interval=0.89-0.96). MSM in China, particularly MBs, are vulnerable to low social support and high depressive symptoms, highlighting the need for tailored psychological programs targeting this population.
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Affiliation(s)
- Huamei Yan
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai 200032, China
| | - Frank Y Wong
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Tony Zheng
- Shanghai Piaoxue Cultural Media Limited, Shanghai 200023, China
| | - Zhen Ning
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai 200032, China
| | - Yingying Ding
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai 200032, China
| | - Eric J Nehl
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Lavinia Lin
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai 200032, China
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Huang L, Nehl EJ, Lin L, Meng G, Liu Q, Ross MW, Wong FY. Sociodemographic and sexual behavior characteristics of an online MSM sample in Guangdong, China. AIDS Care 2013; 26:648-52. [PMID: 24124988 DOI: 10.1080/09540121.2013.844760] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Public health research and interventions often assume that men who have sex with men (MSM) who use the Internet in China have similar characteristics to those in Western countries, though with little empirical evidence. This study aimed to describe and examine the sociodemographic and basic sexual behavioral characteristics of an online sample of MSM in Guangdong, China. In 2010, a total of 1100 MSM were recruited from an lesbian, gay, bisexual, and transgender (LGBT)-oriented website and were asked about their sociodemographic and sexual behavior characteristics. The majority of the participants (77.9%) self-identified as homosexual, and the mean age was 30.0 years (SD = 6.7). About 80% of the participants had attained a college degree and only 4.8% were unemployed. About 60% had a monthly salary of more than CNY 3000 (476 USD), and more than 10% were married. The majority (71.7%) had used condoms in the last anal sex. Nearly half of the participants have never been tested for HIV or other sexually transmitted infections (STIs) (47.3% and 47.7%, respectively). More than 80% were willing to be contacted by researchers after the survey. Findings indicate that the sociodemographic characteristics of Chinese MSM who use the Internet are relatively similar to those in the Western countries. However, Chinese MSM are less likely to self-identify as homosexual and be tested for HIV and other STIs than Western MSM. On a positive note, Chinese MSM would be likely to engage in e-technology research showing potential feasibility of an online HIV/STI intervention.
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Affiliation(s)
- L Huang
- a GZTZ.ORG (XQ Solutions) , Guangzhou , PR China
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Zheng P, Qian H, Wang F, Sun S, Nehl EJ, Wong FY. Awareness of tobacco advertising, perceived harms of smoking, and beliefs about tobacco control among a sample of Shanghainese in China. Health Educ Res 2013; 28:879-887. [PMID: 23912156 DOI: 10.1093/her/cyt075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study aims to examine beliefs among residents of Shanghai, China concerning tobacco advertising and control policies concurrent with new restrictions on tobacco use and advertising in the city. A total of 518 residents of Shanghai completed a telephone interview survey. We found that 51% of participants had seen or heard of the Zhonghua cigarette brand's 'Love China' tobacco ad campaign in the past 2 years, 59% believed that the campaign would influence people to buy this specific cigarette brand as a gift, and 30% believed that it would encourage smoking. More than 75% of respondents would support legislation banning tobacco advertising in all public places, and 88% would support legislation prohibiting smoking in all public places. Multivariate analyses indicated that those who were female, more than 50 years, have accepted college and above education, and perceived greater benefits to smoking cessation were more likely to support banning tobacco advertising and prohibiting smoking in public places. Non-smokers were more likely to support prohibiting smoking in public places. The findings suggest that although tobacco advertising is widely prevalent in Shanghai, it is disliked by the public. Respondents showed high levels of support for tobacco control policies.
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Affiliation(s)
- PinPin Zheng
- Department of Preventive of Medicine, Fudan University's SPH, 138 Yixueyuan Road, Shanghai 200032, People's Republic of China, Medical College of Fudan University, P.O. Box 275, 138 Yixueyuan Road, Shanghai 200032, People's Republic of China, Journalism School of Fudan University, 400 Guoding Road, Shanghai 200433, People's Republic of China, Department of Behavioral Sciences & Health Education, Emory University's Rollins SPH, 1518 Clifton Road, Atlanta, Georgia 30322, USA and Hubert Department of Global Health, Emory University's Rollins SPH, 1518 Clifton Road, Atlanta, Georgia 30322, USA
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Lemieux AF, Nehl EJ, Lin L, Tran A, Yu F, Wong FY. A pilot study examining depressive symptoms, Internet use, and sexual risk behaviour among Asian men who have sex with men. Public Health 2013; 127:1041-4. [PMID: 24074630 DOI: 10.1016/j.puhe.2013.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 04/08/2013] [Accepted: 04/12/2013] [Indexed: 11/29/2022]
Affiliation(s)
- A F Lemieux
- Department of Communication, Georgia State University, USA; Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, USA; Department of Pediatrics, School of Medicine, Emory University, USA.
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Yu F, Nehl EJ, Zheng T, He N, Berg CJ, Lemieux AF, Lin L, Tran A, Sullivan PS, Wong FY. A syndemic including cigarette smoking and sexual risk behaviors among a sample of MSM in Shanghai, China. Drug Alcohol Depend 2013; 132:265-70. [PMID: 23517682 PMCID: PMC3726538 DOI: 10.1016/j.drugalcdep.2013.02.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 02/11/2013] [Accepted: 02/11/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We explored possible correlates of cigarette smoking and their associations with levels of smoking among a sample of Chinese men who have sex with men (MSM). We also explored the syndemic associations of substance use and psychosocial problems on sexual risk behaviors. METHODS Cross-sectional data collection from 404 MSM in Shanghai, China. RESULTS MSM exhibit a high prevalence of smoking (66.3%). Both light and heavy smoking were associated with alcohol and drug use, depression, intimate partner violence, sexual attitudes, and gay identity (though the associations for light smokers were moderate compared to those for heavy smokers). CONCLUSIONS Our findings indicate the presence of a health syndemic among MSM, and suggest that smoking prevention and cessation and other substance abuse interventions should be integrated into efforts preventing sexual risk behaviors among MSM.
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Affiliation(s)
- F Yu
- Department of Behavioral Sciences & Health Education, Emory University's Rollins School of Public Health, 1518 Clifton Road, NE, Atlanta, GA 30322, United States
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Lin H, He N, Zhou S, Ding Y, Qiu D, Zhang T, Wong FY. Behavioral and molecular tracing of risky sexual contacts in a sample of Chinese HIV-infected men who have sex with men. Am J Epidemiol 2013; 177:343-50. [PMID: 23348006 PMCID: PMC3566707 DOI: 10.1093/aje/kws256] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Contact tracing, coupled with molecular epidemiologic investigation, is especially useful for identifying an infection with few cases in the population, such as human immunodeficiency virus (HIV) infection in China. No such research is available on Chinese men who have sex with men (MSM). From 2008 to 2010 in Taizhou Prefecture in China, every newly diagnosed HIV-infected MSM was invited to participate as an “index case” in a contact tracing survey by providing contact information for up to 8 sexual contacts, who themselves were approached to receive voluntary HIV counseling and testing. Those who tested HIV-positive were then subjected to another contact tracing survey. This process was repeated until no more sexual contacts were reported or tested positive. A total of 100 HIV-infected MSM served as “index cases,” including the initial 49 cases identified through routine surveillance programs and 51 cases from the present survey. Traced MSM exhibited little willingness to receive voluntary counseling and testing. CRF01_AE (HIV type 1) was the dominant subtype. Seven of 49 independent sexual networks were deemed HIV transmission clusters. Fear of stigma or discrimination may deter Chinese MSM from receiving voluntary counseling and testing. Nonetheless, the integration of behavioral network analysis and HIV phylogenetic analysis provides enhanced evidence for developing tailored prevention strategies for HIV-infected MSM.
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Affiliation(s)
| | - Na He
- Correspondence to Dr. Na He, Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China (e-mail: )
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Abstract
Mass media in China play a significant role in the dissemination of HIV/AIDS knowledge to the general public. Previous studies have described how the Chinese mass media portray HIV/AIDS in general, but no study has yet to examine changes in patterns of HIV/AIDS reporting over time. This study aims to describe and examine newspaper coverage of HIV/AIDS in China from 2000 to 2010. A systematic search of the China Core Newspapers Database was conducted to identify HIV/AIDS-focused news articles; we found 3648 articles. Results show that coverage rates of HIV/AIDS in newspapers remained low, with only about three articles published per newspaper per year between 2000 and 2010. The sources focused primarily on prevention methods (23.7%), development of a cure or vaccine (21.2%), and education and awareness (17.2%). The HIV/AIDS-related topic covered in an article varied significantly depending on scope (national vs. local) of the newspaper (χ(2)=130.37, p<0.001) and article type (χ(2)=455.72, p<0.001). Totally, more articles were classified as positive than negative from 2002 to 2010. Findings indicate that the HIV/AIDS news-reporting pattern has shifted in the past decade, with more news stories disclosing information about prevention or treatment. However, coverage of HIV/AIDS remains insufficient. Enhancing collaboration between health educators and media sources can be an important strategy in disseminating HIV/AIDS knowledge.
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Affiliation(s)
- Junling Gao
- a Key Laboratory of Public Health Safety, School of Public Health, Ministry of Education , Fudan University , Shanghai , China
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