Spatial distribution and factors associated with HIV testing among adolescent girls and young women in Sierra Leone.

BACKGROUND: Sierra Leone faces a significant challenge in addressing HIV/AIDS, particularly among adolescent girls and young women. This age group is considered highly vulnerable due to biological factors and social inequalities. Understanding the prevalence of HIV testing in this demographic is crucial for designing effective prevention and treatment strategies. This study investigated the spatial distribution of HIV testing and its associated factors among adolescent girls and young women in Sierra Leone. METHODS: Data from the 2019 Sierra Leone Demographic and Health Survey was used for the study. The sample comprised 6,062 adolescent girls and young women between the ages of 15 and 24. Spatial autocorrelation and Moran's I statistic were employed to analyze the spatial distribution of HIV testing. An analysis utilising mixed-effect multilevel binary logistic regression was performed to determine the factors associated with HIV testing. The findings were presented as adjusted odds ratios (aOR) and a 95% confidence interval (CI). RESULTS: The national prevalence of HIV testing among adolescents and young women in Sierra Leone was 42.1% [40.3,43.9]. Kailahun, Kambia, Tonkolil, some parts of the Western rural area, and Bonthe districts were found to be statistically significant hotspot for HIV testing. Whereas, Karene, Falaba, Bo, kenema, and some parts of Pujuhun were statistically cold spot districts. Adolescent girls and young women aged 20-24 [aOR = 1.63, 95% CI = 1.29, 2.07] had higher odds of HIV testing than those aged 15-19. Those with secondary/higher education [aOR = 1.87, 95% CI = 1.40, 2.51] had higher odds of HIV testing than those with no education. The odds of HIV testing was higher among adolescent girls and young women who use the Internet [aOR = 1.75, 95% CI = 1.32, 2.33] than those who did not use internet. Adolescent girls and young women with one [aOR = 16.56, 95% CI = 12.31, 22.29] and two or more parity [aOR = 16.37, 95% CI = 10.86, 24.68] had higher odds of HIV testing than those with no parity. The likelihood of HIV testing was higher among adolescent girls and young women who had sex below 18 [aOR = 4.54, 95% CI = 3.25, 6.34] and those who had sex at 18+ [aOR = 5.70, 95% CI = 3.84, 8.45] compared to those who had never had sex. Adolescent girls and young women who visited health facilities in the past 12 months [aOR = 1.82, 95% CI = 1.46, 2.26] had higher odds of HIV testing than those who did not. CONCLUSION: Despite some positive trends, HIV testing rates among adolescent girls and young women in Sierra Leone remain moderate. Spatial autocorrelation analysis consistently revealed hotspots and cold spots for HIV testing, with Kailahun, Kambia, Tonkolil, some parts of the Western rural area, and Bonthe districts remaining persistent hotspots. Age, education, internet use, sexual history, parity, and healthcare access are significant factors influencing testing behaviour. To improve testing rates, the government and policymakers should prioritize educational campaigns, expand internet access, integrate HIV testing into routine healthcare, and address stigma associated with HIV.

The combined effect of air pollution and non-optimal temperature on mortality in Shandong Province, China: establishment of air health index.

PURPOSE: The air health index (AHI) captures the combined effects of air pollution and non-optimal temperatures and helps assess the atmospheric environment's overall health risk. Shandong Province is a crucial industrial base in China, and the health effects of air pollution and non-optimal temperature cannot be ignored. To construct an AHI for Shandong Province and assess the district-level mortality burden due to AHI in the study area. METHODS: Daily district-specific mortality, meteorological, and air pollution data over 2013-2018 were collected in Shandong Province, China. The AHI construction eventually incorporated PM2.5 and NO2, O3, and non-optimal temperatures. Attributable fraction (AF) and attributable number (AN) were used to estimate the district-specific mortality burden attributable to AHI. RESULTS: The average AHI value observed in Shandong Province was 6. Our research revealed a positive association between the total AHI and total mortality, with an overall trend of a slow increase followed by a rapid increase. The exposure-response curves, when stratified by gender, age, and cause of death, were approximately consistent with the overall trend. The provincial attributable fraction (AF) was 5.31% (95% CI 4.58%, 5.91%), and the attributable number (AN) was 188,246 (95% CI 162,396, 209,533). Overall, higher ANs mainly appeared in the southwestern area, while higher values of AF were observed in the central-eastern and central-northern areas. CONCLUSIONS: The air health index performs well in predicting death burden and can convey health risks related to exposure to the ambient environment to the public.

Spatial mapping and predictors of ever-tested for HIV in adolescent girls and young women in Ethiopia.

Background: Adolescent girls and young women (AGYW) are expected to be healthy in life. However, the unique health challenges faced by AGYW include unsafe sex practices and substance abuse. Only 46.3% of AGYW in Africa are aware of their HIV status, and difficulties are underlined in HIV testing among adolescents and young people. To demarcate the areas with low and high HIV testing, this study aimed to map predictors of ever-tested for HIV among adolescent girls and young women in Ethiopia. Methods: Secondary data analysis was conducted using the dataset from the 2016 Ethiopia Demographic and Health Survey (EHDS). We conducted spatial autocorrelation and Moran's I statistics to investigate the regional variance of HIV being ever-tested in AGYW. In addition, spatial regression analyses such as ordinary least squares (OLS) regression and geographically weighted regression (GWR) were carried out to determine the predictors of being ever-tested for HIV among AGYW. Results: Addis Ababa, some parts of Amhara, Dire Dawa, Gambela, and Tigray were the primary regions and city administrations for being ever-tested for HIV among AGYW. A lesser proportion of AGYW being ever-tested for HIV was found in Somalia, Afar, Benshangul Gumuz, and southern nations. Spatial regression analyses identified an age range of 15-19 years, being Muslim, having no formal education, having no knowledge about HIV, and experiencing severe stigma as predictors of being ever-tested for HIV among AGYW. Conclusion: The proportion of AGYW being ever-tested for HIV was high in Addis Ababa, some parts of Amhara, Dire Dawa, Gambela, and Tigray. Spatial regression analyses identified that AGYW aged 15-19 years, having no formal education, having no knowledge about HIV, and experiencing severe community stigma as predictors negatively affecting the proportion of being ever-tested for HIV, while being Muslim was a predictor that positively affected the proportion of being ever-tested for HIV. The governments and other stakeholders should focus on increasing HIV testing among these special groups of the population.

The mediation effect of social support between stigma and social alienation in patients with stroke.

Background: Social alienation is prevalent and causes adverse outcomes in stroke. Previous studies have linked stigma with social alienation. However, little is known about the mechanisms behind this relationship. This study explored the mediation effects of social support between stigma and social alienation. Methods: A cross-sectional design was used to study 248 patients with stroke admitted to a tertiary rehabilitation hospital in Beijing, China, from December 2022 to July 2023. Patients were assessed using a general information questionnaire, the Stroke Stigma Scale, the Social Support Rating Scale, and the Generalized Social Alienation Scale. The PROCESS macro in SPSS was used to examine the mediation model. Results: The results showed that stigma has a negative effect on social support (ß = -0.503, p<0.001); stigma has a positive effect on social alienation (ß = 0.768, p<0.001). Social support mediated the relationship between stigma and social alienation, with a mediation effect of 0.131 (95%CI: 0.060, 0.214), and indirect effects accounted for 17.06% of the total effect. Conclusion: Social support mediated the relationship between stigma and social alienation. These findings suggest that intervention targeting the enhancement of social support may prevent or reduce social alienation among patients with stroke.

Impact of Social Media Use on HIV Testing and Related Mediator among Men Who Have Sex with Men in Shandong Province, China.

In China, HIV testing is the important first step of HIV prevention and treatment cascades but is not widely adopted by men who have sex with men (MSM). However, social media has been increasingly used to promote and improve HIV testing. This study aimed to assess the impact of social media use on HIV testing and explore the mediator in the relationship between social media and HIV testing. The authors conducted a cross-sectional study among 935 MSM participants in 11 cities in Shandong Province from 14 September to 6 December 2020. Multivariable regression was conducted to assess the relationship between social media use and HIV testing uptake, and mediation analysis was used to assess the mediation effect of HIV testing self-efficacy in the relationship between social media use and HIV testing. The present study findings showed that social media use was related to HIV testing (aOR = 3.024, 95% CI: 1.869, 4.892) and HIV self-testing uptake (aOR = 1.894, 95% CI: 1.228, 2.922), but was not related to HIV facility-based testing (aOR = 1.709, 95% CI: 0.806, 3.625, p = 0.162). A mediation effect of HIV testing self-efficacy was found between social media use and HIV testing (indirect effect: 0.13, 95% CI: 0.01, 0.29), facility-based testing (indirect effect: 0.05, 95% CI: 0.003, 0.16), and self-testing uptake (indirect effect: 0.07, 95% CI: 0.01, 0.16). Social media could be an effective tool to improve HIV testing, and healthcare providers should pay more attention to HIV testing self-efficacy in HIV testing promotion.