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1.
BMC Public Health ; 24(1): 501, 2024 Feb 16.
Artículo en Inglés | MEDLINE | ID: mdl-38365688

RESUMEN

BACKGROUND: Housing instability is highly prevalent among intimate partner violence (IPV) survivors, and the coupling consequences of structural racism, sexism, classism, and the COVID-19 pandemic, may create more barriers to safe and adequate housing, specifically for Black women IPV survivors. In particular, the consequences of the COVID-19 pandemic had the potential to amplify disadvantages for Black women IPV survivors, yet very little research has acknowledged it. Therefore, the current study sought to assess the experiences of housing insecurity among Black women experiencing intimate partner violence (IPV) while navigating racism, sexism, and classism during the COVID-19 pandemic. METHODS: From January to April 2021, we conducted in-depth interviews with 50 Black women experiencing IPV in the United States. Guided by intersectionality, a hybrid thematic and interpretive phenomenological analytic approach was used to identify sociostructural factors shaping housing insecurity. RESULTS: Our findings demonstrate the various ways in which the COVID-19 pandemic shaped Black women IPV survivors' ability to obtain and sustain safe housing. We derived five themes to capture factors contributing to housing experiences: challenges with separate and unequal neighborhoods; pandemic-related economic inequalities; economic abuse limitations; and strategies to maintain housing. CONCLUSIONS: Obtaining and maintaining safe housing during the COVID-19 pandemic was difficult for Black women IPV survivors who were also navigating racism, sexism, and socioeconomic position. Interventions are needed to reduce the impact of these intersecting systems of oppression and power to facilitate the resources necessary for Black women IPV survivors to identify safe housing.


Asunto(s)
COVID-19 , Violencia de Pareja , Humanos , Femenino , Pandemias , Inestabilidad de Vivienda , COVID-19/epidemiología , Marco Interseccional , Vivienda
2.
Curr HIV/AIDS Rep ; 20(5): 296-311, 2023 10.
Artículo en Inglés | MEDLINE | ID: mdl-37768511

RESUMEN

PURPOSE OF REVIEW: Intimate partner violence (IPV) remains a critical challenge to HIV prevention and treatment efforts across the globe. We examined recently published (January 9, 2017-January 9, 2023) integrated behavioral interventions designed to address IPV and HIV across the care continuum. RECENT FINDINGS: Fifteen studies (involving n = 10,947 participants) met the inclusion criteria for this review. Majority (n = 13) of studies focused on IPV and HIV prevention whereas two studies addressed IPV and HIV care engagement among women living with HIV. Ten studies were conducted on the African continent representing 5 countries. Most interventions (n = 11) focused on individual-level outcomes among cisgender women although two involved male partners. About half of the interventions reviewed (n = 8) showed effectiveness on both IPV and HIV outcomes compared to control groups. Integrated HIV/IPV interventions are needed to address the synergistic nature of these epidemics among marginalized populations. Future studies should focus on developing and implementing strength-based interventions among people living with HIV, men, transgender people, and Black women in the USA. Additionally, researchers and program managers should consider addressing structural and internalized stigma as potential behavioral mechanisms for improving health among people simultaneously experiencing or at-risk for HIV and IPV.


Asunto(s)
Infecciones por VIH , Violencia de Pareja , Personas Transgénero , Humanos , Masculino , Femenino , Infecciones por VIH/prevención & control , Infecciones por VIH/epidemiología , Violencia de Pareja/prevención & control , Terapia Conductista
3.
AIDS Behav ; 27(7): 2298-2316, 2023 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-36622485

RESUMEN

Black women are disproportionately affected by HIV in the U.S. PrEP could decrease the risk of acquiring HIV. This scoping review seeks to understand the experiences of Black women along the PrEP Care Continuum. We searched PubMed, Embase, PsycInfo, and Google Scholar to identify peer-reviewed studies published between July 16, 2012, and December 15, 2021. Articles were included if they discussed PrEP among Black women in the U.S. Two authors screened titles/abstracts and full-text articles. One author extracted and thematically summarized findings (n = 33). Black women reported low levels of PrEP awareness and knowledge, and negative experiences with providers. Women also experienced negative perceptions of PrEP from their social networks, stigma, and mistrust. Future research should focus on helping Black women to overcome PrEP-related barriers. Additionally, future research should further examine barriers to PrEP initiation, adherence, and retention for Black women, as only three studies discussed these aspects of the Continuum.


RESUMEN: Las mujeres negras se ven afectadas de manera desproporcionada por el VIH en los EE. UU. La PrEP podría disminuir el riesgo de contraer el VIH. Esta revisión de alcance busca comprender las experiencias de las mujeres negras a lo largo del continuo de atención de la PrEP. Realizamos búsquedas en PubMed, Embase, PsycInfo y Google Scholar para identificar estudios revisados ​​por pares publicados entre el 16 de julio de 2012 y el 15 de diciembre de 2021. Se incluyeron artículos si discutían la PrEP entre mujeres negras en los EE. UU. Dos autores examinaron títulos/resúmenes y -Artículos de texto. Un autor extrajo y resumió temáticamente los hallazgos (n = 33). Las mujeres negras informaron niveles bajos de conciencia y conocimiento sobre la PrEP y experiencias negativas con los proveedores. Las mujeres también experimentaron percepciones negativas de la PrEP en sus redes sociales, estigma y desconfianza. La investigación futura debería centrarse en ayudar a las mujeres negras a superar las barreras relacionadas con la PrEP. Además, la investigación futura debe examinar más a fondo las barreras para el inicio, la adherencia y la retención de la PrEP para las mujeres negras, ya que solo 3 estudios analizaron estos aspectos del Continuum.


Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Profilaxis Pre-Exposición , Humanos , Estados Unidos/epidemiología , Femenino , Fármacos Anti-VIH/uso terapéutico , Conocimientos, Actitudes y Práctica en Salud , Infecciones por VIH/prevención & control , Infecciones por VIH/tratamiento farmacológico , Continuidad de la Atención al Paciente
4.
Health Promot Pract ; 24(4): 764-775, 2023 07.
Artículo en Inglés | MEDLINE | ID: mdl-35414273

RESUMEN

Integrating pregnancy and HIV prevention services would make reproductive health care settings an optimal venue for the promotion and delivery of preexposure prophylaxis (PrEP) to cisgender women. However, these settings have been slow to adopt PrEP. Planned parenthood clinicians and leaders possess critical insight that can help accelerate PrEP implementation in reproductive health care settings and elements of the Consolidated Framework for Implementation Research (i.e., relative priority of the intervention to staff, implementation climate, available resources to implement the intervention, and staff access to knowledge and information about the intervention) can shed light on elements of Planned Parenthood's inner setting that can facilitate PrEP implementation. In this study, individual 60-min interviews were conducted with clinical care team members (n = 10), leadership team members (n = 6), and center managers (n = 2) to explore their perspectives on PrEP implementation and associated training needs. Transcripts were transcribed verbatim and thematically analyzed. Despite having variable PrEP knowledge, participants (100% women, 61% non-Hispanic White) expressed positive attitudes toward implementing PrEP. Barriers and facilitators toward providing PrEP were reported at the structural, provider, and patient levels. Participants desired PrEP training that incorporated culturally competent patient-provider communication. Although participants identified ways that Planned Parenthood uniquely enabled PrEP implementation, barriers must be overcome to optimize promotion and delivery of PrEP to cisgender women.


Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Profilaxis Pre-Exposición , Humanos , Femenino , Masculino , Infecciones por VIH/prevención & control , Infecciones por VIH/tratamiento farmacológico , Fármacos Anti-VIH/uso terapéutico , Salud Reproductiva
5.
AIDS Behav ; 26(7): 2266-2278, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-35032282

RESUMEN

Pre-exposure prophylaxis is an effective women-controlled HIV prevention strategy but women experiencing intimate partner violencefear partners' interference and subsequent violence could limit its utility. This study explores provider perceptions of safety planning strategies to prevent escalating violence, mitigate partner interference, and promote daily oral PrEP adherence. We conducted interviews (N = 36) with healthcare providers (n = 18) and IPV service providers (n = 18) in Baltimore and New Haven. Using the Contextualized Assessment for Strategic Safety Planning model we organized data into two categories: the appraisal process and strategic safety planning. Themes revealed during the appraisal process, providers conduct routine IPV screening, facilitate HIV risk perception, and offer PrEP. Strategic safety planning utilizes concealment tactics, informal sources of support, role playing and cover stories. Future interventions to enhance PrEP services among women exposed to IPV should implement safety planning strategies, integrate PrEP care with IPV services, and employ novel PrEP modalities to maximize effectiveness.


RESUMEN: La profilaxis previa a la exposición (PrEP) es una estrategia eficaz de prevención del VIH controlada por las mujeres, pero las mujeres que experimentan violencia de pareja íntima (IPV) temen que la interferencia de la pareja y la posterior violencia puedan limitar su utilidad. Este estudio explora las percepciones de los proveedores sobre las estrategias de planificación de seguridad para prevenir la escalada de violencia, mitigar la interferencia de la pareja y promover la adherencia diaria a la PrEP oral. Realizamos entrevistas (N = 36) con proveedores de atención médica (n = 18) y proveedores de servicios de IPV (n = 18) en Baltimore y New Haven. Utilizando el modelo de Evaluación contextualizada para la planificación estratégica de la seguridad, organizamos los datos en dos categorías: el proceso de evaluación y la planificación estratégica de la seguridad. Temas revelados durante el proceso de evaluación, los proveedores realizan pruebas de detección de VPI de rutina, facilitan la percepción del riesgo de VIH y ofrecen PrEP. La planificación estratégica de seguridad utiliza tácticas de ocultación, fuentes informales de apoyo, juegos de roles e historias de cobertura. Las intervenciones futuras para mejorar los servicios de PrEP entre las mujeres expuestas a IPV deben implementar estrategias de planificación de seguridad, integrar la atención de PrEP con los servicios de IPV y emplear nuevas modalidades de PrEP para maximizar la efectividad.


Asunto(s)
Infecciones por VIH , Violencia de Pareja , Profilaxis Pre-Exposición , Femenino , Infecciones por VIH/prevención & control , Humanos , Violencia de Pareja/prevención & control , Parejas Sexuales , Violencia
6.
BMC Public Health ; 22(1): 1604, 2022 08 23.
Artículo en Inglés | MEDLINE | ID: mdl-35999528

RESUMEN

BACKGROUND: Black cisgender women in the U.S. South bear a disproportionate burden of HIV compared to cisgender women in other racial and ethnic groups and in any other part of the US. Critical to decreasing new HIV infections is the improved delivery of pre-exposure prophylaxis (PrEP) for Black cisgender women as it remains underutilized in 2021. Informed by intersectionality, the study sought to characterize the sociostructural influences on Black cisgender women's deliberations about PrEP within the context of interlocking systems of oppression including racism, sexism, and classism. METHODS: Six focus groups were conducted with 37 Black women residing in Jackson, Mississippi. This sample was purposively recruited to include Black cisgender women who were eligible for PrEP but had never received a PrEP prescription. RESULTS: Six themes were identified as concerns during PrEP deliberation among Black women: 1) limited PrEP awareness, 2) low perceived HIV risk, 3) concerns about side effects, 4) concerns about costs, 5) limited marketing, and 6) distrust in the healthcare system. Three themes were identified as facilitators during PrEP deliberations: 1) women's empowerment and advocacy, 2) need for increased PrEP-specific education, and 3) the positive influence of PrEP-engaged women's testimonials. Black women shared a limited awareness of PrEP exacerbated by the lack of Black women-specific marketing. Opportunities to support Black women-specific social marketing could increase awareness and knowledge regarding PrEP's benefits and costs. Black women also shared their concerns about discrimination in healthcare and distrust, but they felt that these barriers may be addressed by patient testimonials from PrEP-engaged Black women, empowerment strategies, and directly addressing provider biases. CONCLUSIONS: An effective response to PrEP implementation among Black women in the South requires developing programs to center the needs of Black women and carry out active strategies that prioritize peer advocacy while reinforcing positive and mitigating negative influences from broader social and historical contexts.


Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Profilaxis Pre-Exposición , Racismo , Fármacos Anti-VIH/uso terapéutico , Población Negra , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Humanos , Mississippi
7.
AIDS Behav ; 25(10): 3425-3436, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33974167

RESUMEN

Intimate partner violence (IPV) relates to HIV susceptibility and acquisition. Existing research examined barriers to pre-exposure prophylaxis (PrEP) uptake among women but few studies assess uptake and delivery among IPV service providers, along with provider-, clinic-, and structural-level barriers. We conducted 34 semi-structured interviews with PrEP-eligible cisgender heterosexual women experiencing IPV, Reproductive Health providers, PrEP providers, and IPV service providers in Northeast US. Systems theory was used to examine barriers from individuals who either work closely with or are part of the population. The framework method was used to draw descriptive and explanatory conclusions. Findings suggest limited knowledge for Reproductive Health and IPV Service Providers. Providers often did not feel equipped to discussed PrEP in visits or focused efforts solely on safety. Expanding PrEP awareness is necessary and marketing should include women. Future research should investigate how providers can work collaboratively across sectors to ensure women receive comprehensive trauma-informed care.


RESUMEN: La violencia de pareja (IPV) se relaciona con la susceptibilidad y la adquisición del VIH. Las investigaciones existentes examinaron las barreras a la aceptación de la profilaxis previa a la exposición (PrEP) entre las mujeres, pero pocos estudios evalúan la aceptación y la entrega entre los proveedores de servicios de IPV, junto con las barreras a nivel de proveedor, clínica y estructura. Realizamos 34 entrevistas semiestructuradas con mujeres heterosexuales cisgénero elegibles para PrEP que experimentan IPV, proveedores de salud reproductiva, proveedores de la PrEP y proveedores de servicios contra la violencia de género en el noreste de EE.UU. Se utilizó la teoría de sistemas para examinar las barreras de las personas que trabajan estrechamente con la población o que forman parte de ella. Se utilizó el método del marco para extraer conclusiones descriptivas y explicativas. Los resultados sugieren un conocimiento limitado para los proveedores de servicios de salud reproductiva y de IPV. Los proveedores a menudo no se sentían preparados para hablar de la PrEP en las visitas o centraban sus esfuerzos únicamente en la seguridad. Es necesario ampliar el conocimiento de la PrEP y el marketing debe incluir a las mujeres. La investigación futura debería investigar cómo los proveedores pueden trabajar en colaboración entre sectores para garantizar que las mujeres reciban una atención integral informada sobre el trauma.


Asunto(s)
Infecciones por VIH , Violencia de Pareja , Profilaxis Pre-Exposición , Instituciones de Atención Ambulatoria , Femenino , Infecciones por VIH/prevención & control , Personal de Salud , Humanos
8.
AIDS Care ; 33(2): 219-228, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-32408837

RESUMEN

Women with syndemic conditions, i.e., two or more co-occurring epidemics, are at elevated risk for HIV acquisition and are therefore prime candidates for pre-exposure prophylaxis (PrEP). However, PrEP uptake remains low among women, especially among Black and Hispanic women. This study examined associations of syndemic conditions with PrEP attitudes and HIV risk among women, and the moderating effect of race and ethnicity. In 2017, 271 non-Hispanic Black, non-Hispanic White, and Hispanic, PrEP-eligible women engaged in care at Planned Parenthood in the northeastern region of the U.S. completed an online survey. Participants reported syndemic conditions (i.e., intimate partner violence, depression, substance use), PrEP attitudes (e.g., PrEP interest), HIV sexual risk (e.g., multiple male sexual partners), and sociodemographics. Structural equation modeling was used to examine the effects of syndemic conditions on PrEP attitudes and HIV risk, and the moderating effect of race and ethnicity. Women with more syndemic conditions had a higher odds of reporting multiple male sexual partners. Syndemic conditions were positively associated with PrEP attitudes for Hispanic women than non-Hispanic Black and White women. Women with syndemic conditions, particularly Hispanic women, may be receptive to interventions promoting PrEP.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Depresión/psicología , Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Profilaxis Pre-Exposición , Trastornos Relacionados con Sustancias/etnología , Violencia/psicología , Adulto , Fármacos Anti-VIH/uso terapéutico , Actitud , Población Negra/estadística & datos numéricos , Depresión/etnología , Etnicidad , Femenino , Infecciones por VIH/etnología , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Trastornos Relacionados con Sustancias/psicología , Sindémico , Violencia/etnología , Población Blanca/estadística & datos numéricos
9.
BMC Infect Dis ; 21(1): 1102, 2021 Oct 26.
Artículo en Inglés | MEDLINE | ID: mdl-34702165

RESUMEN

BACKGROUND: Pre-exposure prophylaxis (PrEP) has the potential to reduce transmission of HIV among Black cisgender women in the Southern United States (U.S.); however, national data suggests that PrEP initiation is lowest in the South and among Black women compared to other U.S. regions and white women. This study applied intersectionality and PrEP multilevel resilience frameworks to assess how socio-structural and clinical contexts shaped PrEP persistence among Black cisgender women in Mississippi. METHODS: Semi-structured interviews were conducted with eight Black cisgender women in Jackson, Mississippi. This sample was purposively recruited to include PrEP-initiated Black cisgender women. RESULTS: Six themes identified that shaped PrEP care among Black cisgender women: (1) internal assets, (2) sole responsibility to HIV prevention, (3) added protection in HIV serodifferent relationships, (4) financial issues, (5) trust and distrust in the medical system, and (6) side effects. Black cisgender women reported that PrEP persistence increased control over their sexual health, reduced anxiety about HIV, and promoted self-care. Black cisgender women also indicated that medication assistance programs increased PrEP affordability resulting in continued persistence. CONCLUSIONS: In addition to preventing HIV, PrEP may yield secondary positive impacts on the health and relationships of Black cisgender women. However, very few Black cisgender women in the South are using PrEP given intersectional barriers and thus necessitates adaptive strategies to support PrEP initiation and persistence. Efforts aimed at increasing the coverage of PrEP among Black cisgender women should consider implementation strategies responsive to lived realities of Black women.


Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Seguro , Profilaxis Pre-Exposición , Fármacos Anti-VIH/uso terapéutico , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Humanos , Mississippi , Estados Unidos
10.
AIDS Behav ; 24(7): 2062-2072, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31884571

RESUMEN

Concurrent sexual partnerships (i.e., relationships that overlap in time) contribute to higher HIV acquisition risk. Social capital, defined as resources and connections available to individuals is hypothesized to reduce sexual HIV risk behavior, including sexual concurrency. Additionally, we do not know whether any association between social capital and sexual concurrency is moderated by gender. Multivariable logistic regression tested the association between social capital and sexual concurrency and effect modification by gender. Among 1445 African Americans presenting for care at an urban STI clinic in Jackson, Mississippi, mean social capital was 2.85 (range 1-5), mean age was 25 (SD = 6), and 62% were women. Sexual concurrency in the current year was lower for women compared to men (45% vs. 55%, χ2(df = 1) = 11.07, p = .001). Higher social capital was associated with lower adjusted odds of sexual concurrency for women compared to men (adjusted Odds Ratio [aOR] = 0.62 (95% CI 0.39-0.97), p = 0.034), controlling for sociodemographic and psychosocial covariates. Interventions that add social capital components may be important for lowering sexual risk among African Americans in Mississippi.


Asunto(s)
Negro o Afroamericano/estadística & datos numéricos , Infecciones por VIH/epidemiología , Conducta Sexual/psicología , Parejas Sexuales , Capital Social , Adulto , Negro o Afroamericano/psicología , Estudios Transversales , Femenino , Infecciones por VIH/prevención & control , Humanos , Masculino , Mississippi/epidemiología , Factores de Riesgo , Factores Sexuales , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/prevención & control
11.
AIDS Behav ; 24(2): 560-567, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30915581

RESUMEN

Intimate partner violence (IPV) is associated with pre-exposure prophylaxis (PrEP) acceptability among US women, but whether IPV influences other steps along the PrEP care continuum remains unclear. This study estimated the causal effects of IPV on the early stages of the PrEP care continuum using doubly robust (DR) estimation (statistical method allowing causal inference in non-randomized studies). Data were collected (2017-2018) from a cohort study of 124 US women without and 94 women with IPV experiences in the past 6 months (N = 218). Of the 218 women, 12.4% were worried about getting HIV, 22.9% knew of PrEP, 32.1% intended to use PrEP, and 40.4% preferred an "invisible" PrEP modality. IPV predicts HIV-related worry (DR estimate = 0.139, SE = 0.049, p = 0.004). IPV causes women to be more concerned about contracting HIV. Women experiencing IPV are worried about HIV, but this population may need trauma-informed approaches to help facilitate their PrEP interest and intentions.


Asunto(s)
Infecciones por VIH/prevención & control , Violencia de Pareja/psicología , Cumplimiento de la Medicación , Profilaxis Pre-Exposición/métodos , Maltrato Conyugal/psicología , Adulto , Estudios de Cohortes , Continuidad de la Atención al Paciente , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Aceptación de la Atención de Salud , Adulto Joven
12.
Matern Child Health J ; 24(3): 360-368, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31916142

RESUMEN

INTRODUCTION: Few studies have investigated how intimate partner violence (IPV), and patterns of IPV experiences, may impact children's school attendance in low- and middle-income countries. METHODS: Using baseline data from a sub-sample of 659 women in Mexico City enrolled in a randomized controlled trial who reported having a child under age 18 and in school, multilevel latent class analysis (LCA) was used to classify women based on their reported IPV experiences. Multilevel risk regression analyses examined associations between latent class membership and IPV-related disruptions in children's schooling. Latent classes were identified in a prior study. RESULTS: Overall, 23.3% of women reported their child's school attendance was disrupted due to IPV. LCA identified four distinct classes of IPV experiences: Low Physical and Sexual Violence (39.1%); Low Physical and High Sexual Violence class (14.8%), High Physical and Low Sexual Violence and Injuries (36.5%); and High Physical and Sexual Violence and Injuries (9.6%). Compared with women in the Low Physical and Sexual Violence class, women in the High Physical and Sexual Violence and Injuries class and women in the High Physical and Low Sexual Violence and Injuries class were at greater risk of IPV disrupting children's school attendance (ARR 3.39, 95% CI 2.34, 4.92; ARR 2.22, 95% CI 1.54, 3.19, respectively). No other statistically significant associations emerged. DISCUSSION: High disruptions in children's school attendance due to IPV were reported and were differentially related to patterns of IPV experiences. Findings underscore the need to understand underlying mechanisms. Future work integrating both violence against women and violence against children is needed.


Asunto(s)
Absentismo , Violencia de Pareja/psicología , Violencia de Pareja/estadística & datos numéricos , Delitos Sexuales/psicología , Delitos Sexuales/estadística & datos numéricos , Estudiantes/psicología , Adolescente , Conducta del Adolescente/psicología , Adulto , Niño , Conducta Infantil/psicología , Preescolar , Femenino , Humanos , Análisis de Clases Latentes , Masculino , México , Pobreza , Instituciones Académicas , Adulto Joven
13.
Clin Infect Dis ; 69(5): 884-889, 2019 08 16.
Artículo en Inglés | MEDLINE | ID: mdl-30689766

RESUMEN

Clinical guidelines for human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) developed by the US Centers for Disease Control and Prevention have been instrumental in the implementation of PrEP in medical practices throughout the country. However, the eligibility criteria contained within may inadvertently limit PrEP access for some patients. We describe the following key considerations and caveats related to these criteria: promotion of a selective vs universal approach to sexual health education involving PrEP; misalignment between criteria stated in the table and text boxes; problematic categorization and confounding of sexual orientation, gender identity, and risk behavior; underemphasis of network/community-level drivers of HIV transmission; oversimplification of serodiscordant risk; and lack of clarity surrounding the relevance of condoms to PrEP eligibility. We offer concrete recommendations to address the identified issues and strengthen future iterations of the guidelines, applying these recommendations in an alternative table of "criteria."


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/prevención & control , Guías de Práctica Clínica como Asunto , Profilaxis Pre-Exposición/normas , Centers for Disease Control and Prevention, U.S. , Toma de Decisiones Clínicas , Condones , Femenino , Humanos , Masculino , Atención al Paciente/normas , Profilaxis Pre-Exposición/organización & administración , Asunción de Riesgos , Conducta Sexual , Estados Unidos
14.
Prev Med ; 118: 257-263, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30393017

RESUMEN

The purpose of this research was to assess the association between Gender Inequality Index and prevalence of lifetime intimate partner violence (IPV) among women and men at the state-level. Recently developed 2017 state-level prevalence estimates of IPV among a nationally-representative sample of U.S. non-institutionalized adults between 2010 and 2012 from the National Intimate Partner and Sexual Violence Survey was combined with calculated indexes for state-level gender inequality. Gender Inequality Index, created by the United Nations, reflects gender-based disadvantage in reproductive health, empowerment, and labor market participation. Correlations and linear regressions were used to examine associations between gender inequality and IPV. Gender Inequality Index values ranged from 0.149 to 0.381. The lifetime prevalence of IPV ranged between 27.8% and 45.3% for women and between 18.5% and 38.6% for men. Across states, the Gender Inequality Index was positively correlated with the prevalence of any form of IPV (r = 0.28, p < .05) and psychological IPV among women (r = 0.41, p < .01). The adjusted regression model showed a positive association between gender inequality and psychological IPV among women (B = 1.61, SE = 0.57, p = .007). Structural changes to gender inequality may help to reduce occurrences of IPV and improve the wellbeing and livelihood of women and girls.


Asunto(s)
Relaciones Interpersonales , Violencia de Pareja/estadística & datos numéricos , Conducta Sexual/estadística & datos numéricos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estados Unidos
15.
AIDS Behav ; 23(6): 1518-1529, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30565093

RESUMEN

Syndemic theory could explain the elevated HIV risk among transgender women (TGW) in India. Using cross-sectional data of 300 TGW in India, we aimed to: identify latent classes of four syndemic conditions (Depression-D, Alcohol use-A, Violence victimization-V, HIV-positive status), test whether syndemic classes mediate the association between stigma and sexual risk, and test whether social support and resilient coping moderate the association between syndemic classes and sexual risk. Four distinct classes emerged: (1) DAV Syndemic, (2) AV Syndemic, (3) DV Syndemic, and (4) No Syndemic. TGW in the DAV Syndemic (OR 9.80, 95% CI 3.45, 27.85, p < 0.001) and AV Syndemic classes (OR 2.74, 95% CI 1.19, 6.32, p < 0.01) had higher odds of inconsistent condom use in the past month than the No Syndemic class. Social support significantly moderated the effect of DAV Syndemic class on inconsistent condom use. DAV Syndemic was found to be a significant mediator of the effect of transgender identity stigma on sexual risk. HIV prevention programs among TGW need to: (a) incorporate multi-level multi-component interventions to address syndemic conditions, tailored to the nature of syndemic classes; (b) reduce societal stigma against TGW; and (c) improve social support to buffer the impact of syndemics on sexual risk.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Víctimas de Crimen/estadística & datos numéricos , Trastorno Depresivo/epidemiología , Infecciones por VIH/epidemiología , Estigma Social , Sindémico , Personas Transgénero/estadística & datos numéricos , Violencia/estadística & datos numéricos , Adolescente , Adulto , Consumo de Bebidas Alcohólicas/psicología , Estudios Transversales , Trastorno Depresivo/psicología , Femenino , Infecciones por VIH/psicología , Humanos , India/epidemiología , Masculino , Violencia/psicología , Adulto Joven
16.
AIDS Behav ; 23(Suppl 3): 319-330, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31444712

RESUMEN

Nearly half of HIV infections in the United States are concentrated among African Americans, and over half of new HIV infections occur in the South. African Americans have poorer outcomes in the entire continua of HIV and PrEP care. Complex social, structural, and behavioral factors contribute to our nation's alarming racial disparities in HIV infection, particularly in the Deep South. Despite the importance of faith, spirituality and religious practice in the lives of many African Americans, there has been little scientific investment exploring how African Americans' religious participation, faith and spirituality may impact our nation's HIV epidemic. This article summarizes the state of the science on this critical issue. We also identify opportunities for new scholarship on how faith, spirituality and religious participation may impact HIV care continuum outcomes in the South and call for greater federal research investment on these issues.


Asunto(s)
Negro o Afroamericano/psicología , Continuidad de la Atención al Paciente , Organizaciones Religiosas , Infecciones por VIH/etnología , Infecciones por VIH/psicología , Negro o Afroamericano/estadística & datos numéricos , Epidemias , Infecciones por VIH/prevención & control , Humanos , Espiritualidad , Estados Unidos
17.
AIDS Behav ; 22(4): 1190-1200, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-28887703

RESUMEN

Previous research suggests that intimate partner violence (IPV) is associated with acceptability of and adherence to pre-exposure prophylaxis (PrEP). However, very few studies have examined whether the type (i.e., physical, sexual, and psychological IPV) and timing (i.e., lifetime, past-year) of IPV experiences differentially relate to PrEP awareness, interest, and perceived PrEP coercion. Therefore, the objective of this study is to examine associations between lifetime and past-year physical, sexual, and psychological IPV experiences on PrEP awareness, interest, and perceived PrEP coercion. Data were collected from an online survey administered to 210 women and men. Past-year physical IPV experiences (AOR 4.53, 95% CI 1.85, 11.11) were significantly associated with being interested in using PrEP. Lifetime sexual (AOR 3.69, 95% CI 1.62, 8.40), psychological IPV (AOR 4.70, 95% CI 1.01, 21.89), and past-year sexual IPV experiences (AOR 3.01, 95% CI 1.10, 8.27) were also significantly associated with believing a recent partner would attempt to control the participant's use of PrEP, if she or he were currently using it. Understanding that engaging in PrEP care is influenced differently by the type and timing of IPV has potential implications for PrEP candidacy guidelines and interventions.


Asunto(s)
Coerción , Infecciones por VIH/prevención & control , Violencia de Pareja/psicología , Profilaxis Pre-Exposición/métodos , Parejas Sexuales/psicología , Adolescente , Adulto , Concienciación , Femenino , Humanos , Violencia de Pareja/estadística & datos numéricos , Masculino , Conducta Sexual/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto Joven
18.
AIDS Care ; 30(9): 1156-1160, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-29682990

RESUMEN

Gender inequities place women at an increased risk for HIV acquisition, and this association may particularly disenfranchize young pregnant women. Intimate partner violence (IPV) and food insecurity may contribute to gender differences in power, thereby influencing HIV disparities between women and men. Factors influencing gender disparities in HIV are unique and country-specific within sub-Saharan Africa, yet these factors are understudied among women in Liberia. This paper sought to examine the unique contributions and intersections of intimate partner violence (IPV) and food insecurity with HIV-related risk factors among young pregnant women in Liberia. Between March 2016 and August 2016, cross-sectional data collected from 195 women aged 18-30, residing in Monrovia, Liberia who were receiving prenatal services were used to examine the independent and interaction effects of IPV and food insecurity on HIV-related risk factors (i.e., sexual partner concurrency, economically-motivated relationships). IPV (31.3%) and food insecurity (47.7%) were prevalent. Young women who experience IPV are more likely to report food insecurity (p < 0.05). Young women who experienced IPV and food insecurity were more likely to start a new relationship for economic support (ps < 0.05). Young women who experience IPV and food insecurity were more likely to report engaging in transactional sex (ps < 0.05). There were no significant interaction effects between IPV and food insecurity (ps > 0.05). IPV and food insecurity each uniquely heighten young Liberian women's vulnerability to HIV. Intervention and policy efforts are need to promote and empower women's sexual health through integrated sexual and reproductive health services, and reduce IPV and food insecurity among pregnant Liberian women.


Asunto(s)
Abastecimiento de Alimentos/estadística & datos numéricos , Infecciones por VIH/epidemiología , Violencia de Pareja/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Liberia/epidemiología , Masculino , Embarazo , Prevalencia , Factores de Riesgo , Conducta Sexual , Salud de la Mujer , Adulto Joven
19.
Am J Community Psychol ; 61(1-2): 240-250, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-29377159

RESUMEN

The purpose of the study was to (a) explore the relationship between sexual cultural scripting and traditional masculine norms on changes in intimate partner violence (IPV) perpetration, and (b) examine traditional masculine norms as an effect modifier among young heterosexual men. This study is a secondary data analysis of a prospective cohort study of 119 young heterosexual men who were followed for 6 months. The adjusted logistic regression results revealed that sexual cultural scripting norms were associated with an increased odds of emotional IPV perpetration and traditional masculine norms were associated with an increased odds of physical IPV perpetration in the past 6 months. There were no significant interaction effects between sexual cultural scripting and traditional masculine norms on IPV perpetration. These findings suggest that socially constructed norms and beliefs surrounding masculinity, femininity, and how women and men interact in sexual relationships are important constructs for understanding the etiology of young men's use of violence against a female partner. While primary IPV interventions targeting young men do address masculinity, sexual cultural scripting is an additional concept that should also be addressed.


Asunto(s)
Violencia de Pareja , Masculinidad , Normas Sociales , Adolescente , Adulto , Estudios Transversales , Humanos , Modelos Logísticos , Masculino , Prevalencia , Adulto Joven
20.
Health Care Women Int ; 39(9): 968-974, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30148421

RESUMEN

Women who experience reproductive coercion are at risk for poor reproductive health, but no study has examined prenatal distress as a consequence. Using cross-sectional data of 195 pregnant women aged 18-30 in Monrovia, Liberia, we examined the association between reproductive coercion and prenatal distress. The prevalence of current reproductive coercion was 9%. Young pregnant women who experienced reproductive coercion had more prenatal distress than women without these experiences. Reproductive coercion can heighten pregnancy-specific concerns for young Liberian women. Family-planning programs and providers should assess current reproductive coercion among young pregnant women and find ways to help women mitigate pregnancy concerns.

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