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1.
Heliyon ; 10(9): e30216, 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38765155

RESUMO

Background: In March 2020, Uganda enforced country-wide restrictions to control the spread of SARS-CoV-2, categorizing some health services, including family planning (FP), as non-essential. Globally, similar COVID-19 restrictions have been associated with increased vulnerability to reproductive coercion (RC) among women, due to changes in FP service availability and restricted access by partners. This study aims to investigate these dynamics in Uganda, specifically examining the impact of the COVID-19 lockdown on women's access to FP, their experiences of RC, and the relationship between RC and intimate partner violence (IPV). Methods: We conducted a cross-sectional analysis of data from 960 women participating in the AMBSO Population Health Surveillance Study (APHS) between August 2020 and March 2021 across Wakiso (N = 164) and Hoima (N = 796) districts in Uganda. Our analysis focused on women who were sexually active in the past month, using bivariate analyses to explore the associations between RC and recent experiences of sexual, physical, and verbal IPV. Findings: The most commonly reported FP methods were injectables (36.8 %) and implants (16 %). Despite the COVID-19 lockdown, less than one percent of participants reported an inability to access their preferred FP method. Notably, 3 % of the women experienced RC in the past 12 months. There was a significant association between RC and sexual IPV (p < 0.0001), as well as physical IPV (p < 0.0001). Instances of verbal IPV were observed to have tripled during the lockdown period. Interpretation: An increase in verbal IPV was found among women during the COVID-19 lockdown. Additionally, a notable association emerged between other forms of IPV and an increased risk of RC. Despite the lockdown, access to FP remained high, which could be attributed to the prevalent use of long-acting FP methods.

2.
Heliyon ; 10(8): e28503, 2024 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-38644866

RESUMO

Introduction: Comprehensive sexuality education (CSE) is associated with positive sexual and reproductive health (SRH) outcomes, including increased contraceptive use, lower rates of unintended pregnancy and prevention of sexual violence. However, implementation of and requirements for CSE vary across the United States which can negatively impact students, both during and beyond high school, including among college students. Methods: and Analysis: This paper describes the research protocol for a multi-staged approach for designing, implementing and evaluating an SRH course for up to 60 undergraduate students at a public university in California. Before the class is offered, we will conduct 20 in-depth interviews with current students, educators and course design experts to learn from their experiences and seek their guidance on course design. To evaluate the course, enrolled students will complete a pre-course and a post-course survey before and after class is taught, to assess students' attitudes and values relevant to educational concepts and the format and delivery of the course and its modules and activities. Approximately 20 students will take part in an in-depth exit interview, after completing the course, to gather perceptions about how the course impacted their knowledge and behavior. The goal is to refine materials for future in-person course offerings and develop a prototype for a fully online version of the course. Discussion: This study introduces a novel university-level course to provide young adult students comprehensive, evidence-based education on sexual and reproductive health from a public health perspective. The program leverages existing CSE efforts, enhancing them with academic rigor, inclusive content and digital inclusion. This approach, inclusive of diverse sexual orientations, content on pleasure and sexual violence prevention, aims to fill existing gaps in university curricula and also set a new standard in CSE. The project's innovative and multidisciplinary design offers a model for broader impact within a large public university system and beyond.

3.
Int J Qual Health Care ; 35(4)2023 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-37642351

RESUMO

Providers' disrespect and abuse of patients is a recognized but understudied issue affecting quality of care and likely affecting healthcare utilization. Little research has examined this issue among people living with HIV (PWH) who inject drugs, despite high stigmatization of this population. No research has examined this issue in the context of Russia. This study assesses patients' reports of disrespect and abuse from providers as a barrier to healthcare and examines the association between these reports and HIV care outcomes.We conducted a cross-sectional analysis of the associations between disrespect/abuse from health providers as a barrier to care and the following HIV care outcomes: (i) anti-retroviral treatment (ART) uptake ever, (ii) past 6-month visit to HIV provider, and (iii) CD4 count. Participants (N = 221) were people living with HIV who injected drugs and were not on ART at enrollment.Two in five participants (42%) reported a history disrespect/abuse from a healthcare provider that they cited as a barrier to care. Those reporting this concern had lower odds of ever use of ART (adjusted odds ratio 0.46 [95% CI 0.22, 0.95]); we found no significant associations for the other HIV outcomes. We additionally found higher representation of women among those reporting prevalence of disrespect/abuse from provider as a barrier to care compared to those not reporting this barrier (58.1% versus 27.3%).Almost half of this sample of PWH who inject drugs report disrespect/abuse from a provider as a barrier to healthcare, and this is associated with lower odds of receipt of ART but not with other HIV outcomes studied. There is need for improved focus on quality of respectful and dignified care from providers for PWH who inject drugs, and such focus may improve ART uptake in Russia.


Assuntos
Atenção à Saúde , Infecções por HIV , Humanos , Feminino , Estudos Transversais , Instalações de Saúde , Infecções por HIV/tratamento farmacológico , Avaliação de Resultados da Assistência ao Paciente , Federação Russa/epidemiologia
4.
AIDS Care ; 35(9): 1291-1298, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37170392

RESUMO

Intimate partner violence (IPV) has been associated with delays throughout the HIV care continuum. This study explored prospective associations between experiences of past-year IPV and two HIV care outcomes in the context of current universal test and treat guidelines using two consecutive rounds of an ongoing HIV surveillance study conducted in the Rakai region of Uganda. Longitudinal logistic regression models examined associations between IPV, use of antiretroviral therapy (ART) and viral load suppression (VS), adjusting for outcome variables at baseline. To address differences in ART retention by IPV, propensity scores were used to create inverse-probability-of-treatment-and-censoring-weighted (IPTCW) models. At baseline, of 1923 women with HIV (WWH), 34.6%, 26.5%, 13.5% reported past-year verbal, physical and sexual IPV; a lower proportion of persons who experienced physical IPV (79.4%) were VS than those who did not (84.3%; p = 0.01). The proportion VS at baseline also significantly differed by exposure to verbal IPV (p = 0.03). However, in adjusted longitudinal models, IPV was not associated with lower odds of ART use or VS at follow-up. Among WWH in the Rakai region, IPV does not appear to be a barrier to subsequent ART use or VS. However, given the prevalence of IPV in this population, interventions are needed.


Assuntos
Infecções por HIV , Violência por Parceiro Íntimo , Humanos , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Uganda/epidemiologia , Comportamento Sexual , Prevalência , Parceiros Sexuais , Fatores de Risco
6.
J Interpers Violence ; 38(1-2): NP1040-NP1059, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-35438584

RESUMO

Introduction: Intimate partner violence (IPV) is associated with several adverse public health outcomes and alcohol use is one of its risk factors. Proximity to alcohol selling points could be linked with problem drinking and IPV. We aimed to determine whether proximal location to alcohol and intensity of alcohol consumption are associated with IPV in rural southwest Uganda.Methods: We conducted a cross-sectional study in rural southwest Uganda with structured interviews at household level. We used the alcohol use disorders identification test (AUDIT) and the Conflict Tactics Scale to measure past year alcohol consumption and IPV (perpetration and victimization). We estimated Euclidean distances between participants' households and nearest alcohol outlets using geographic information systems. We used generalized estimating equation models to calculate adjusted odds ratios (aOR) for the factors associated with IPV.Results: We enrolled 742 participants and median age was 41 years (inter-quartile range or IQR 32-53) and 52.2% of respondents were male. The overall prevalence of IPV in the past year was 52.2%. In a multivariable regression model, women (aOR = 2.24, 95%CI 1.28, 3.91) compared to men, those living proximal to an alcohol selling point (OR = 1.77, 95% CI 1.38, 2.27) were more likely to experience IPV. There was a dose-response relationship between alcohol consumption and IPV. With non-drinkers as the reference category, the aORs were 4.54 (95% CI 2.04, 10.08) for casual drinkers, 10.53 (95% CI 4.15, 26.77) for hazardous drinkers and 15.31 (95% CI 4.73, 49.54) for alcohol dependent drinkers.Conclusion: IPV is very common and has a dose-response relationship with alcohol consumption and drinking outlet proximity. There is an urgent need for IPV and alcohol interventions programs in these rural communities. Policy to restrict proximity of alcohol outlets to residential locations should be examined as an intervention for alcohol consumption and IPV perpetration.


Assuntos
Alcoolismo , Violência por Parceiro Íntimo , Masculino , Feminino , Humanos , Adulto , População Rural , Parceiros Sexuais , Estudos Transversais , Uganda/epidemiologia , Prevalência , Fatores de Risco , Etanol , Consumo de Bebidas Alcoólicas/epidemiologia
7.
Violence Against Women ; 29(9): 1604-1622, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-36067069

RESUMO

Domestic violence restraining orders (DVROs), although a widely used legal intervention in preventing future risk of intimate partner violence (IPV), there is a lack of documentation on the facilitators and barriers of utilization of DVROs among IPV survivors in Los Angeles County (LAC). We conducted 19 key informant interviews with various professionals working in domestic violence prevention in LAC. Factors such as survivors' motivation, ease of navigating the legal procedures, and availability of community resources facilitate the use of DVROs. Fear, ambivalence, structural barriers to access DVROs, and issues with the criminal justice system make it harder for survivors to obtain DVROs.


Assuntos
Violência Doméstica , Violência por Parceiro Íntimo , Humanos , Los Angeles , Violência Doméstica/prevenção & controle , Violência por Parceiro Íntimo/prevenção & controle , Sobreviventes
8.
J Am Coll Health ; 71(5): 1328-1331, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-34242553

RESUMO

Graduate students are uniquely vulnerable to sexual violence and harassment (SVSH) and largely marginalized in campus-based prevention and response efforts. Objective: This study is a preliminary investigation of graduate students' experiences with on-campus SVSH training and knowledge and utilization of SVSH resources. Methods: We conducted 21 in-depth interviews and 8 focus group discussions with 43 graduate students on three public university campuses in California. Results: Graduate students had limited knowledge of SVSH services, and mandatory SVSH training curricula was perceived to center around "responsible employee" duties rather than information about how to prevent or seek help for SVSH themselves. Graduate students had mixed experiences seeking SVSH-related assistance. Conclusions: Graduate students should be prioritized in SVSH prevention and education efforts beyond required responsible employee training. Graduate students are invaluable to the everyday success of universities; accounting for their vulnerabilities in SVSH prevention and response is vital for campus communities everywhere.


Assuntos
Delitos Sexuais , Assédio Sexual , Humanos , Assédio Sexual/prevenção & controle , Estudantes , Universidades , Delitos Sexuais/prevenção & controle , Grupos Focais
9.
BMC Pregnancy Childbirth ; 22(1): 555, 2022 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-35818040

RESUMO

BACKGROUND: Congenital syphilis (CS) has reemerged as a global maternal and child health crisis. Kern County, California and East Baton Rouge Parish, Louisiana are among the highest CS morbidity regions in the United States. We previously reported on social-ecological and structural barriers to prenatal care and maternal syphilis testing and treatment in these two regions. The aim of this study was to examine perinatal patient's health preferences and perceptions of patient-provider relationships in the prenatal care clinic setting. METHODS: Between May 2018 and January 2019 we conducted 20 in-depth qualitative interviews with prenatal providers and 8 focus group discussions with pregnant and postpartum individuals in Kern County and East Baton Rouge Parish. We applied an adapted health services framework to analyze participants' understanding of health disparities and vulnerable populations; perinatal patient's health and prenatal care preferences; and participants' perspectives of clinical encounters in the context of prenatal care and maternal syphilis testing and treatment. RESULTS: Site-specific determinants of syphilis infection emerged but participants from both locations felt CS prevention efforts should be prioritized among youth, racial/ethnic minority populations, people experiencing socioeconomic limitations and people with other commonly occurring health conditions. Although perinatal patients expressed clear health preferences, they reported inconsistent receipt of respectful, patient-centered care. Inconsistencies were connected with limited ethnic and cultural competence among providers, and implicit, negative attitudes toward patients using substances, experiencing homelessness, or engaging in sex work. Providers clearly aimed to offer high quality prenatal care. However, some clinic and health systems level factors were thought to reduce positive and communicative patient-provider relationships, contributing to gaps in use of prenatal care and syphilis testing and treatment. CONCLUSIONS: Our findings suggest that interventions tailored to address setting-specific determinants (including clinic and health system factors) of disparities in CS risk could improve pregnant people's access to prenatal care and ensure they and their sex partners receive timely syphilis screening and treatment. We recommend all prenatal care providers receive training on how to identify and mitigate implicit biases and provide competent and compassionate patient-centered care.


Assuntos
Complicações Infecciosas na Gravidez , Sífilis Congênita , Sífilis , Adolescente , California , Criança , Etnicidade , Feminino , Humanos , Louisiana , Grupos Minoritários , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/prevenção & controle , Cuidado Pré-Natal , Sífilis/diagnóstico , Sífilis Congênita/diagnóstico , Sífilis Congênita/prevenção & controle , Estados Unidos
10.
JMIR Res Protoc ; 11(4): e31189, 2022 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-35380114

RESUMO

BACKGROUND: Intimate partner and sexual violence are pervasive public health issues on college and university campuses in the United States. Research is recommended for creating and maintaining effective, relevant, and acceptable prevention programs and response services for student survivors. OBJECTIVE: The University of California (UC) Speaks Up study aims to examine factors contributing to intimate partner and sexual violence on 3 UC campuses and use the findings to develop and test interventions and policies to prevent violence, promote health, and lay the groundwork for subsequent large-scale quantitative research. METHODS: A mixed methods study was conducted at UC Los Angeles, UC San Diego, and UC Santa Barbara. Phase I (2017-2020) involved a resource audit; cultural consensus modeling of students' perceptions of sexual consent; in-depth interviews (IDIs) and focus group discussions with students to understand perceptions of campus environment related to experiences as well as prevention of and responses to violence; and IDIs with faculty, staff, and community stakeholders to investigate institutional and community arrangements influencing students' lives and experiences. Phase II (2020-ongoing) involves IDIs with student survivors to assess the use and perceptions of campus and community services. Qualitative content analysis is used to generate substantive codes and subthemes that emerge, using a thematic analysis approach. RESULTS: In January 2019, we conducted 149 free-listing interviews and 214 web-based surveys with undergraduate and graduate and professional students for the cultural consensus modeling. Between February 2019 and June 2019, 179 IDIs were conducted with 86 (48%) undergraduate students, 21 (11.7%) graduate and professional students, 34 (19%) staff members, 27 (15.1%) faculty members, and 11 (6.1%) community stakeholders, and 35 focus group discussions (27/35, 77% with undergraduate students and 8/35, 23% with graduate and professional students) were conducted with 201 participants. Since September 2020, 50% (15/30) of the planned student survivor interviews have been conducted. This segment of data collection was disrupted by the COVID-19 pandemic. Recruitment is ongoing. CONCLUSIONS: Data analysis and phase II data collection are ongoing. The findings will be used to develop and test interventions for preventing violence, promoting health and well-being, and ensuring that survivor services are relevant and acceptable to and meet the needs of all individuals in the campus community, including those who are typically understudied. The findings will also be used to prepare for rigorous, UC-system-wide public health prevention research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/31189.

11.
J Interpers Violence ; 37(13-14): NP10565-NP10593, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35259318

RESUMO

Research has found associations between intercollegiate athletics and risk for sexual violence, and that sexual violence is more pervasive at colleges and universities with National Collegiate Athletic Association (NCAA) Division I athletic programs, relative to NCAA Division II, NCAA Division III and no athletic programs. Simultaneously, sports involvement is linked with prosocial values and there are documented developmental benefits of sports participation. College athletic programs hold promise for fostering sexual violence prevention but there is limited knowledge about how student-athletes conceptualize sexual violence and how athletes, coaches, and administrators perceive available prevention and response programs. We conducted seven Focus Group Discussions (FGDs) and 21 In-Depth Interviews (IDIs) with student-athletes, athletic directors, and coaches from public university Division I (n = 2) and Division II (n = 1) campuses. We assessed perceptions of sexual violence, knowledge and opinions of available prevention and response programs, and sought input on how to bridge gaps in campus sexual violence policies. Student-athletes associated sexual violence with alcohol in their relationships with peers and asymmetrical power dynamics in relationships with coaches and faculty. Athletes felt strong connections with teammates and sports programs but isolated from the larger campus. This created barriers to students' use of services and the likelihood of reporting sexual violence. Athletes felt the mandatory sexual violence prevention training, including additional NCAA components, were ineffective and offered to protect the university and its athletic programs from legal complications or cultural ridicule. Athletic staff were aware of policies and programs for reporting and referring sexual violence cases but their knowledge on how these served students was limited. Student-athletes were uncomfortable disclosing information regarding relationships and sexual violence to coaches and preferred peer-led prevention approaches.


Assuntos
Delitos Sexuais , Esportes , Atletas , Humanos , Delitos Sexuais/prevenção & controle , Estudantes , Universidades
12.
PLoS One ; 17(2): e0263827, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35171949

RESUMO

INTRODUCTION: Uganda confirmed its first COVID-19 case in March 2020, leading to country-wide closures and a stay-at-home order. Infectious disease pandemics can overwhelm adaptive coping capacity (e.g., general self-efficacy and resilience) and increase the risk for mental distress. For individuals experiencing intimate partner violence (IPV) and cohabitating with a perpetrator, stay-at-home orders can also increase risk of violence, which can further exacerbate mental distress. The present study explores women's perceived self-efficacy and resilient coping, mental health outcomes (depression and COVID-19 related anxiety), hazardous alcohol use and IPV in the context of Uganda's national 2020 lockdown. METHODS: A phone-based survey was undertaken from June-August of 2020 in Wakiso District, Uganda. The study sample consisted of Africa Medical and Behavioral Sciences Organization (AMBSO) Population Health Surveillance (APHS) study participants who agreed to be contacted for future research. The analytic sample was restricted to women aged 13-80 years. Bivariate analysis and multivariable models explored associations between experiences of IPV and measures of adaptive coping, mental health and alcohol use. RESULTS: A total of 556 women aged 13-79 years (mean age of 33.4 years) participated. Over half (55%) were currently married. The majority (60%) reported a decrease in alcohol use during the lockdown. Nearly half of the sample were experiencing physical or verbal IPV and reported an increase in violence during the lockdown. In adjusted analysis, alcohol use was associated with four times greater odds of recent physical IPV (aOR 4.06, 95% CI = 1.65-10.02, p = 0.0024), while participants had lower odds of experiencing any form of IPV as general self-efficacy increased (aOR 0.95, 95% CI = 0.91-0.99, p = 0.0308). CONCLUSION: Lockdown measures in Uganda may have mitigated increased alcohol consumption. IPV was exacerbated during lockdown; more than 2 in 5 IPV victims experienced increased physical or verbal violence. Development of programming and policies aimed at mitigating women's risk of IPV during future lockdowns are needed.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , COVID-19/psicologia , Violência por Parceiro Íntimo/psicologia , Saúde Mental , Adolescente , Adulto , Idoso , Ansiedade , Feminino , Humanos , Transtornos Mentais , Pessoa de Meia-Idade , Pandemias , Fatores de Risco , População Rural/estatística & dados numéricos , Uganda/epidemiologia , Adulto Jovem
13.
Glob Health Sci Pract ; 10(1)2022 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-35044929

RESUMO

INTRODUCTION: Evidence-based programs are needed to engage men and boys that encourage the transformation of concepts of masculinity that uphold patterns of intimate partner violence (IPV). This study explores the constructs of masculinity and male gender norms surrounding sexual attitudes and IPV among men and boys living in Rakai, Uganda. METHODS: Between April and August 2017, we conducted 38 interviews and 5 focus group discussions with men and boys aged 15 to 49 years and 4 focus groups with key stakeholders to understand how male use of violence is influenced by personal, community, and society-level concepts of masculinity. We adapted 2 constructs of masculinities, reputation and respectability, in the analysis to examine masculinities in relation to IPV in the rural Ugandan setting. RESULTS: Findings suggest men and boys upheld 2 types of masculinities: respectability versus reputation. Masculine attributes related to respectability (referred to as "responsible men") included having a job, house, wife, and many children and taking care of family. Masculine attributes related to reputation (referred to as "cool men") included having sexual prowess, multiple sexual partners, and the resources to buy nice things. Both masculine norms were used to justify dominance over women and IPV. The divergence of masculinity was observed among youth and young adults who participated in a gender-transformative program, suggesting the effectiveness of the program. DISCUSSION: The gender-transformative approach should provide men and boys a chance to reflect on dynamic, often conflicting, images of a man and should empower individuals to renegotiate and reconceptualize masculine norms. This critical reflection on masculinity, which resonates with men and boys, needs to be included when engaging men within HIV and IPV prevention programs.


Assuntos
Violência por Parceiro Íntimo , Masculinidade , Adolescente , Adulto , Criança , Feminino , Humanos , Violência por Parceiro Íntimo/prevenção & controle , Masculino , Homens , Pessoa de Meia-Idade , Parceiros Sexuais , Uganda , Adulto Jovem
14.
Violence Against Women ; 28(14): 3554-3587, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35040708

RESUMO

Campus-based sexual violence and sexual harassment (SVSH) are prevalent issues that impact students detrimentally. Guided by community-based participatory research, this qualitative study assessed undergraduate students' perceptions of available campus SVSH resources, gaps in services, and recommendations for solutions for SVSH at three universities in California via interviews and focus groups. Approximately half of participants were unaware of available SVSH services, while others had varying knowledge of service availability and experiences with services. Students want better-funded, trauma-informed, and survivor-centered services and providers who share their identities and lived experiences. We provide multi-level student-centered solutions to improve current campus-based SVSH prevention efforts.


Assuntos
Delitos Sexuais , Assédio Sexual , Grupos Focais , Humanos , Delitos Sexuais/prevenção & controle , Assédio Sexual/prevenção & controle , Estudantes , Universidades
15.
J Interpers Violence ; 37(21-22): NP19468-NP19490, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-34496663

RESUMO

In order to continue pushing college campuses to the forefront of survivor-centered practice and student-centered care, it is imperative that the barriers students experience in accessing campus sexual violence resource centers be documented and addressed. This research evaluates student and staff perceptions of barriers to accessing the Campus Assault Resources and Education (CARE) offices on three University of California (UC) campuses. Data were collected by researchers from UC Speaks Up, a cross-campus research initiative at UC Los Angeles (UCLA), UC Santa Barbara (UCSB), and UC San Diego (UCSD) aimed at understanding factors that both contribute to and prevent sexual violence among college students. This analysis only included data that yielded insights into CARE's accessibility. Thematic analysis of 63 interviews and 27 focus group discussions was conducted using Dedoose. The following six thematic codes emerged from the data: (1) awareness of office, (2) confidentiality of services, (3) physical accessibility, (4) accessibility for vulnerable and marginalized groups, (5) utilization experiences, and (6) limited institutional support. To increase the accessibility of sexual violence resource centers in higher education, this study indicates that universities and campus sexual violence resource centers should (1) encourage survivor-centered cross-campus collaborations between sexual violence resource centers and other campus entries, (2) add more trainings that are tailored to the needs of vulnerable and marginalized communities, (3) increase the resource's campus-wide office exposure through multiple prevention education opportunities, and (4) better fund sexual violence resource centers. Implications for future research are discussed to maximize this study's public health impact.


Assuntos
Vítimas de Crime , Delitos Sexuais , Confidencialidade , Humanos , Delitos Sexuais/prevenção & controle , Estudantes , Universidades
16.
J Interpers Violence ; 37(19-20): NP17133-NP17156, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-34176367

RESUMO

Intimate partner violence (IPV) is associated with poor HIV care linkage and retention, medication adherence, and viral suppression. However, limited knowledge exists regarding potential mechanisms linking IPV to these outcomes. We aimed to (a) identify the top barriers to accessing HIV care experienced by women living with HIV (WLHIV) who report a history of IPV and have suppressed viral load (VL) versus unsuppressed VL and (b) understand how these barriers influence VL, comparing WLHIV with a history of IPV to WLHIV without a history of IPV. Study data come from newly diagnosed WLHIV in rural Uganda participating in the standard-of-care control arm of a randomized trial (n = 152). Descriptive results ranking mean scores from highest to lowest showed that, among women with a history of IPV, irrespective of viral suppression status, paying for transportation to come to clinic, having to wait at the clinic for long periods of time, and finding a clinic within reasonable travel distance were the top three barriers to accessing HIV care. WLHIV with a history of IPV were significantly more likely to have unsuppressed VL versus suppressed VL if they reported higher levels of difficulty finding a clinic within reasonable travel distance (RRR = 1.7, 95% CI [1.1-2.7]), getting permission to take time off from work (RRR = 1.5, 95% CI [1.0-2.9]), and finding time to come to the clinic for an appointment (RRR = 1.6, 95% CI [1.0-2.6]). The same relationships were not present among WLHIV without a history of IPV, suggesting these barriers and their effect on VL may be uniquely related to IPV. Interventions should address IPV and HIV care continuum outcomes in tandem, targeting barriers to accessing HIV care likely associated with IPV. Additional research is necessary to better understand how IPV relates to HIV care barriers and VL.


Assuntos
Infecções por HIV , Violência por Parceiro Íntimo , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , População Rural , Uganda , Carga Viral
17.
Violence Against Women ; 28(6-7): 1483-1504, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-34139908

RESUMO

The syndemic relationship between harmful alcohol use, intimate partner violence (IPV), and HIV is well established across international settings. Less is known about how these health issues are perceived by women living with HIV (WLWH), who are disproportionately affected by these intertwined epidemics. A qualitative study was undertaken with 20 WLWH in Rakai, Uganda, to assess their perceptions of how these issues have affected their lives and their communities and to assess the acceptability of integrating a screening and brief intervention for alcohol use and IPV into HIV posttest counseling. Recommendations for intervention programming arising from the results are discussed.


Assuntos
Infecções por HIV , Violência por Parceiro Íntimo , Aconselhamento , Feminino , Infecções por HIV/prevenção & controle , Humanos , Caça , Violência por Parceiro Íntimo/psicologia , Uganda/epidemiologia
18.
Glob Public Health ; 17(12): 3465-3475, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-33242387

RESUMO

Women with agency (i.e. the ability to make choices and act on them) may experience reduced food insecurity (FI) and intimate partner violence (IPV). Reducing FI and IPV among women are global goals; however, research focused on agency among Eswatini women has been overlooked, though they experience high rates of FI and IPV. We analysed cross-sectional data from 406 Swazi women who sought care at one rural and one urban-public antenatal clinic in 2013-2014 to understand how FI and agency, our independent variables, are associated with IPV. We assessed the incidence rate ratio (IRR) of number of violent events (including emotional, physical and sexual IPV) in the previous 12 months using Poisson regressions. We found significant relationships between FI and IPV, where higher levels of FI were associated with IPV risk (weekly: IRR = 2.18, 95% CI = 1.82-2.61; Daily: IRR = 3.53, 95% CI = 2.89-4.32) and constrained agency increased women's risk of IPV (IRR = 1.44; 95% CI = 1.22-1.70). Our findings suggest that FI and agency independently impact women's experience(s) of IPV. Interventions focused on women simultaneously experiencing severe FI and constrained agency may have the highest impact; however, providing focused and moderate FI relief (e.g. reducing FI daily to monthly) could potentially reduce women's risk of experiencing violence.


Assuntos
Violência por Parceiro Íntimo , Cuidado Pré-Natal , Feminino , Humanos , Gravidez , Essuatíni , Estudos Transversais , Violência por Parceiro Íntimo/prevenção & controle , Violência por Parceiro Íntimo/psicologia , Segurança Alimentar , Fatores de Risco
19.
Sex Cult ; 25(5): 1653-1672, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34776727

RESUMO

Sexual violence and sexual harassment (SVSH) are pervasive across university campuses. SVSH research rarely focuses on graduate students, who occupy unique positions within university settings due to their multiple responsibilities (e.g., teaching, research, mentoring), including managing unequal power dynamics with mentors and advisors. As part of a larger qualitative study, we sought to better understand SVSH generally and, when applicable, experiences of SVSH among graduate students on three campuses. Our primary research questions were: (a) How graduate students understand SVSH on their campus and whether they are at risk, (b) How graduate students navigate power dynamics that position them to experience SVSH, and (c) What graduate student-centered solutions and improvements can make campuses safer, more equitable spaces for all students. To answer these questions, we conducted 21 in-depth interviews and 8 focus group discussions with a diverse group of graduate students across various graduate programs. Using grounded theory and implementing student-centered approaches to data collection and analysis, we identified multiple themes, including graduate students' uncertainty regarding SVSH on campus; and how power relations with faculty, combined with distrust of university processes, keep many graduate students silent about SVSH. Finally, employing graduate students' suggestions, we offer recommendations for how universities can improve campus climate and SVSH resources for graduate students.

20.
Drug Alcohol Depend ; 228: 109005, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34600249

RESUMO

BACKGROUND: Alcohol use is common among persons living with HIV (PWH) in Uganda and associated with poor HIV care outcomes; findings regarding the relationship between alcohol use and viral suppression (VS) have been inconclusive. METHODS: Data from two rounds (2017-2020) of the Rakai Community Cohort Study, an open population-based cohort study in the Rakai region, Uganda, were analyzed. Two alcohol exposures were explored: past year alcohol use and alcohol-related consequences. Multivariable models (GEE) were used to estimate associations between alcohol exposures and VS for the overall sample and stratified by sex, adjusting for repeated measurement. Causal mediation by ART use was explored. RESULTS: Over half (55 %) of participants (n = 3823 PWH) reported alcohol use at baseline; 37.8 % of those reporting alcohol use reported alcohol-related consequences. ART use and VS at baseline significantly differed by alcohol use with person reporting alcohol use being less likely to be on ART or VS. Alcohol use was significantly associated with decreased odds of VS among women but not men (adj. OR 0.72 95 % CI 0.58-0.89, p = 0.0031). However, among males who use alcohol, experiencing alcohol-related consequences was significantly associated with decreased odds of VS (adj. OR 0.69 95 % CI 0.54-0.88, p = 0.0034). The relationships between both alcohol exposures and VS were not significant in models restricted to persons on ART. CONCLUSIONS: We provide sex-stratified estimates of associations between two alcohol measures and VS in the context of current HIV treatment guidelines. This study confirms that alcohol use is adversely associated with VS but ART use mediates this pathway, suggesting that initiation and retention on ART are critical steps to addressing alcohol-related disparities in VS.


Assuntos
Consumo de Bebidas Alcoólicas , Infecções por HIV , Consumo de Bebidas Alcoólicas/epidemiologia , Estudos de Coortes , Feminino , Infecções por HIV/epidemiologia , Disparidades nos Níveis de Saúde , Humanos , Masculino , Uganda/epidemiologia
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