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2.
BMJ Open ; 10(4): e032876, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32241785

RESUMO

INTRODUCTION: In the USA, transgender women are among the most vulnerable to HIV. In particular, transgender women of colour face high rates of infection and low uptake of important HIV prevention tools, including pre-exposure prophylaxis (PrEP). This paper describes the design, sampling methods, data collection and analyses of the TURNNT ('Trying to Understand Relationships, Networks and Neighbourhoods among Transgender women of colour') study. In collaboration with communities of transgender women of colour, TURNNT aims to explore the complex social and environmental (ie, neighbourhood) structures that affect HIV prevention and other aspects of health in order to identify avenues for intervention. METHODS AND ANALYSES: TURNNT is a prospective cohort study, which will recruit 300 transgender women of colour (150 Black/African American, 100 Latina and 50 Asian/Pacific Islander participants) in New York City. There will be three waves of data collection separated by 6 months. At each wave, participants will provide information on their relationships, social and sexual networks, and neighbourhoods. Global position system technology will be used to generate individual daily path areas in order to estimate neighbourhood-level exposures. Multivariate analyses will be conducted to assess cross-sectional and longitudinal, independent and synergistic associations of personal relationships (notably individual social capital), social and sexual networks, and neighbourhood factors (notably neighbourhood-level social cohesion) with PrEP uptake and discontinuation. ETHICS AND DISSEMINATION: The TURNNT protocol was approved by the Columbia University Institutional Review Board (reference no. AAAS8164). This study will provide novel insights into the relationship, network and neighbourhood factors that influence HIV prevention behaviours among transgender women of colour and facilitate exploration of this population's health and well-being more broadly. Through community-based dissemination events and consultation with policy makers, this foundational work will be used to guide the development and implementation of future interventions with and for transgender women of colour.

3.
Am J Epidemiol ; 2020 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-32128570

RESUMO

Religion and spirituality are important social determinants that drive public health practice. The field of epidemiology has played a vital role in answering long-standing questions of whether religion is causally associated with health and mortality. As epidemiologists (e.g., Kawachi (Am J Epidemiol. 2019 https://doi.org/10.1093/aje/kwz204) and Chen and VanderWeele (Am J Epidemiol. 2018;187(11):2355-2364)) spark new conversations about methods (e.g., outcomes-wide analysis) used to establish causal inference between religion and health, epidemiology needs to engage with other aspects such as emerging trends and historical predictors. Two key aspects epidemiologist will need to address are: (a) changing patterns in religious and spiritual identification (specifically, how does traditional mechanisms (e.g., social support) hold up with emerging trends where more people are now identifying as spiritual but not religious, and the proportion of people who never attend services are increasing?); and (b) the role of place and how to establish causal inference between predictors characterizing area-level religious environments (e.g., denomination-specific church membership/adherent rates) and how these influence individual- and population-level health outcomes.

4.
Int J Public Health ; 65(3): 291-302, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32086535

RESUMO

OBJECTIVES: We examined the longitudinal associations of social capital on self-rated health and differences by race/ethnicity in older adults. METHODS: We used Health and Retirement Study, a nationally representative sample of US adults aged ≥ 50 years evaluated every 2 years (2006-2014) (N = 18,859). We investigated the relationship between social capital indicators (neighborhood social cohesion/physical disorder, positive/negative social support) with self-rated health accounting for age, gender, education and stratified by race/ethnicity. We used structural equation multilevel modeling estimating the associations: within-wave and between-persons. RESULTS: We observed between-persons-level associations among social capital indicators and self-rated health. Individuals with overall levels of positive social support and neighborhood social cohesion tended to have overall better self-rated health [correlations 0.21 (p < 0.01) and 0.29 (p < 0.01), respectively]. For Hispanics, the correlations with self-rated health were lower for neighborhood social cohesion (0.19) and negative social support (- 0.09), compared to Whites (0.29 and - 0.20). African-Americans showed lower correlations of positive social support (0.14) compared to Whites (0.21) and Hispanics (0.28). CONCLUSIONS: Interventions targeting social capital are in need, specifically those reinforcing positive social support and neighborhood social cohesion and diminishing neighborhood physical disorder and negative social support of older adults.

5.
Spat Spatiotemporal Epidemiol ; 32: 100306, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32007280

RESUMO

Drug- and alcohol-poisoning deaths remain current public health problems. Studies to date have typically focused on individual-level predictors of drug overdose deaths, and there remains a limited understanding of the spatiotemporal patterns and predictors of the joint outcomes. We use a hierarchical Bayesian spatiotemporal multivariate Poisson regression model on data from (N = 167) ZIP-codes between 2009 and 2014 in New York City to examine the spatiotemporal patterns of the joint occurrence of drug (opioids) and alcohol-poisoning deaths, and the covariates associated with each outcome. Results indicate that rates of both outcomes were highly positively correlated across ZIP-codes (cross-correlation: 0.57, 95% credible interval (CrI): 0.29, 0.77). ZIP-codes with a higher prevalence of heavy drinking had higher alcohol-poisoning deaths (relative risk (RR):1.63, 95% CrI: 1.26, 2.05) and drug-poisoning deaths (RR: 1.29, 95% CrI: 1.03, 1.59). These spatial patterns may guide public health planners to target specific areas to address these co-occurring epidemics.

6.
Ann Epidemiol ; 42: 33-41, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31899083

RESUMO

PURPOSE: In the United States (U.S.), southern states have the highest HIV incidence. Uptake of pre-exposure prophylaxis (PrEP) has been slow among Black people, particularly in the South. We know little about how area-level HIV risk influences one's willingness to use PrEP. METHODS: 169 Black participants across 142 ZIP codes in the South completed the 2016 National Survey on HIV in the Black Community. We performed log-binomial regression to estimate the prevalence risk associated with residing in the upper 25th percentile of increases in new HIV diagnosis (2014-2015) within ZIP code and an individual's willingness to use PrEP, adjusting for individual and area-level covariates. RESULTS: Participants were 68% female, mean age of 36 years, and 24% willing to use PrEP. Among the ZIP codes, 23% were within Atlanta, GA. The median increase in new HIV diagnoses was 25 per 100,000 population from 2014 to 2015 (IQR, 14-49). Participants living in ZIP codes within the upper 25th (compared-to-lower 75th) percentile of new HIV diagnoses were more willing to use PrEP (adjusted prevalence ratio (aPR) = 2.02, 95% CI = 1.06-3.86, P = .03). Area-level socioeconomic factors attenuated that association (aPR = 1.63, 95% CI = 0.78-3.39, P = .19). CONCLUSIONS: Area-level factors may influence PrEP uptake among Black people in the South.

7.
AIDS Behav ; 2019 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-31884571

RESUMO

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.

8.
Drug Alcohol Depend ; 205: 107615, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31704384

RESUMO

BACKGROUND: Psychosocial factors have rarely been studied to understand racial differences in opioid use disorders (OUD). We investigate religious involvement and Black-White differences in OUD risk between 2004-05 and 2012-13. METHODS: We use Non-Hispanic Black and White adults from the National Epidemiologic Survey on Alcohol and Related Conditions (wave 2, N = 26,661 and NESARC-III, N = 26,960) (NESARC). We conducted survey-weighted logistic regression to examine whether race moderates the association between religious involvement and lifetime DSM-IV and -5 OUD and whether those differences change (i.e., are modified) by time, adjusted for covariates such as age, education, and urbanicity. Religious involvement measures were service attendance, social interaction, and subjective religiosity/spirituality. RESULTS: The prevalence of lifetime DSM-IV (3.82 vs 1.66) and DSM-5 (2.49 vs 1.32) OUD in NESARC-III was higher among White compared to Black respondents. Never attending services declined for both races over time. Race moderated the association between service attendance (F(4,65) = 14.9, p = 0.000), social interaction (F(4,65) = 34.4, p = 0.000) and subjective religiosity/spirituality (F(2,65) = 7.03, p = 0.000) on DSM-IV OUD in wave 2 and using DSM-5 OUD in NESARC-III (F(1,113) = 2.79, p = 0.066). Race differences in religion and DSM-IV OUD risk was modified by time (i.e., survey year) (all p < 0.000). For instance, higher service attendance was associated with lower DSM-IV risk for Black respondents in wave 2 but higher risk in NESARC-III. There were no changes in regression slopes among White respondents. CONCLUSIONS: Religious involvement may be important for prevention and treatment practices that respond to racial differences in risk of OUD. Replicate studies should examine other religious factors and specific types of opioids.

9.
BMC Public Health ; 19(1): 1458, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694587

RESUMO

BACKGROUND: The overweight/obesity epidemic is a public health issue in the United States (US), that disproportionately affect certain racial/ethnic minority groups. Perceived discrimination has been implicated as a health risk factor. However, research on race/ethnicity, perceived discrimination, and obesity has been mixed. Researchers suggest that perceptions of discrimination may be dependent upon nativity status. This study evaluated the role that nativity status and race/ethnicity play in the relationship between perceived discrimination and overweight/obesity. METHODS: We used Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (2004-2005) [N = 33,319]). Multinomial logistic regression assessed a three-way interaction (perceived discrimination × race/ethnicity × nativity) on overweight and obesity, adjusting for sociodemographic factors and health-related behaviors. RESULTS: The three-way interaction was significant for overweight [F (17, 49) = 3.35; p < 0.001] and obesity [F (17, 49) = 5.05; p < 0.001]. Among US-born individuals, US-born non-Hispanic Blacks had a decreased risk of being obese compared to US-born non-Hispanic Whites at mean levels of perceived discrimination [aRRR = 0.71; 95% CI (0.51-0.98); p = 0.04). Among foreign-born individuals, foreign-born South Americans had an increased risk of being overweight at mean levels of perceived discrimination compared to foreign-born non-Hispanic Whites [aRRR = 8.07; 95% CI (1.68-38.77); p = 0.01], whereas foreign-born Dominicans had a decreased risk of being obese compared to foreign-born non-Hispanic Whites [aRRR = 0.05; 95% CI (0.01-0.20); p < 0.001]. CONCLUSION: Perceived racial discrimination is a risk factor for overweight/obesity for certain groups. Race/ethnicity and nativity may play important roles in the relationship between perceived discrimination and overweight/obesity. Future research is needed to identify the behavioral and psychological pathways that link perceived discrimination and overweight/obesity.


Assuntos
Grupos Étnicos/psicologia , Grupos Minoritários/psicologia , Obesidade/psicologia , Sobrepeso/psicologia , Discriminação Social/psicologia , Adulto , Feminino , Inquéritos Epidemiológicos , Hispano-Americanos/psicologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/etnologia , Sobrepeso/epidemiologia , Sobrepeso/etnologia , Percepção , Fatores de Risco , Discriminação Social/etnologia , Estados Unidos/epidemiologia , Adulto Jovem
10.
Glob Public Health ; 14(12): 1744-1756, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31390958

RESUMO

Adult HIV prevalence in Kenya was 5.9% in 2017. However, in the counties of Kisumu, Siaya, and Homa Bay, HIV prevalence was over 15%. Biomedical interventions, including home-based testing and counselling (HBTC), HIV treatment and pre-exposure prophylaxis (PrEP) provide opportunities to reduce HIV transmission, particularly in rural communities with limited access to health services. Faith-based institutions play an important role in the Kenyan social fabric, providing over 40% of all health care services in Kenya, but have played limited roles in promoting HIV prevention interventions. We conducted qualitative interviews with 45 medical professionals and focus groups with 93 faith leaders in Kisumu and Busia Counties, Kenya. We explored their knowledge, opinions, and experiences in promoting biomedical HIV prevention modalities, including HBTC and PrEP. Knowledge about and engagement in efforts to promote HIV prevention modalities varied; few health providers had partnered with faith leaders on HIV prevention programmes. Faith leaders and health providers agreed about the importance of increasing faith leaders' participation in HIV prevention and were positive about increasing their HIV prevention partnerships. Most faith leaders requested capacity building to better understand biomedical HIV prevention modalities and expressed interest in collaborating with clinical partners to spread awareness about HIV prevention modalities.

11.
AIDS Behav ; 23(Suppl 3): 319-330, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31444712

RESUMO

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.


Assuntos
Afro-Americanos/psicologia , Continuidade da Assistência ao Paciente , Organizações Religiosas , Infecções por HIV/etnologia , Infecções por HIV/psicologia , Afro-Americanos/estatística & dados numéricos , Epidemias , Infecções por HIV/prevenção & controle , Humanos , Espiritualidade , Estados Unidos
12.
J Cancer Surviv ; 13(5): 804-814, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446591

RESUMO

PURPOSE: Breast cancer-related lymphedema is an adverse effect of breast cancer surgery affecting nearly 30% of US breast cancer survivors (BCS). Our previous analysis showed that, even 12 years after cancer treatment, out-of-pocket healthcare costs for BCS with lymphedema remained higher than for BCS without lymphedema; however, only half of the cost difference was lymphedema-related. This follow-up analysis examines what, above and beyond lymphedema, contributes to cost differences. METHODS: This mixed methods study included 129 BCS who completed 12 monthly cost diaries in 2015. Using Cohen's d and multivariable analysis, we compared self-reported costs across 13 cost categories by lymphedema status. We elicited quotes about specific cost categories from in-person interviews with 40 survey participants. RESULTS: Compared with BCS without lymphedema, BCS with lymphedema faced 122% higher mean overall monthly direct costs ($355 vs $160); had significantly higher co-pay, medication, and other out-of-pocket costs, lower lotion costs; and reported inadequate insurance coverage and higher costs that persisted over time. Lotion and medication expenditure differences were driven by BCS' socioeconomic differences in ability to pay. CONCLUSIONS: Elevated patient costs for BCS with lymphedema are for more than lymphedema itself, suggesting that financial coverage for lymphedema treatment alone may not eliminate cost disparities. IMPLICATIONS FOR CANCER SURVIVORS: The economic challenges examined in this paper have long been a concern of BCS and advocates, with only recent attention by policy makers, researchers, and providers. BCS identified potential policy and programmatic solutions, including expanding insurance coverage and financial assistance for BCS across socioeconomic levels.

13.
Behav Med ; 45(2): 134-142, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31343966

RESUMO

Black Americans are greatly affected by HIV disparities and exhibit high levels of medical mistrust, including HIV conspiracy beliefs, a form of mistrust around HIV's origin and treatment. A 2002-2003 national survey of Black Americans found that 48% believed that "HIV is a manmade virus." However, the extent to which such beliefs remain widespread is unknown. Moreover, HIV conspiracy beliefs have been associated with greater HIV risk, but have also been associated with a higher testing likelihood-and no research to date has attempted to explain these seemingly contradictory findings. We obtained updated data on prevalence and correlates of HIV conspiracy beliefs from the US National Survey on HIV in the Black Community, a nationally representative e-mail survey of 868 Black individuals aged 18-50 years (February-April 2016). Substantial percentages agreed that HIV is man-made (31%) and that the government is withholding a cure for HIV (40%). HIV conspiracy beliefs and HIV risk were both significantly associated with a higher HIV testing likelihood. The association between HIV conspiracy beliefs and HIV testing was significantly mediated by individual-level HIV risk (73% of total effect), but not by area-level socioeconomic position (an ecological determinant of higher HIV prevalence). Mistrust remains high among Black Americans, but the association of mistrust with prevention behaviors is complex. People who do not trust the public health system may also be at greater risk-and thus, more likely to get tested, potentially due to greater access to community-based testing venues that engage higher risk populations.


Assuntos
Afro-Americanos/psicologia , Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Programas de Rastreamento/psicologia , Confiança/psicologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Classe Social , Adulto Jovem
14.
Environ Int ; 129: 247-255, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31146159

RESUMO

Polychlorinated biphenyls (PCBs) are chemicals used in a variety of products before they were widely banned due to toxic effects in humans and wildlife. Because of continued persistence and ubiquity of these contaminants, risk of exposure to people living in industrialized countries is still high. Experimental research show that developmental exposure to PCB may alter function of brain pleasure centers and potentially influence disinhibitory behaviors, including tobacco and alcohol use. Yet, the potential effects of developmental PCB exposure on adolescent substance use have not been studied in humans. We used the Child Health and Development Studies (CHDS), a prospective birth cohort study in the Oakland and East Bay areas of California, to investigate associations between prenatal exposure to PCB congeners (66, 74, 99, 118, 138, 153, 170, 180, 187, and 203) and later disinhibitory behaviors in adolescents, specifically alcohol consumption and smoking, in a randomly selected sample (n = 554). Total prenatal PCB exposure was not associated with disinhibitory behaviors, among adolescents. However, the adjusted odds ratio (aOR) for being a current smoker, was higher in subjects within the third quartile of maternal PCB 66 exposure compared to those below the median (aOR = 1.93; 95% CI 1.05, 3.55). The aOR for drinking >2 alcoholic beverages per week, were also higher for adolescents within the third (aOR = 1.46; 95% CI 0.86, 2.47) and fourth quartile of PCB 66 exposure (aOR = 1.39; 95% CI 0.83, 2.35), but the differences did not reach statistical significance. These results suggest that this specific PCB congener may play a role inducing neurodevelopmental alterations that could potentially increase the risk of becoming a long-term user of tobacco and possibly alcohol. There were no notable differences between magnitude or direction of effect between boys and girls. Future replicate analyses with larger longitudinal samples and animal experimental studies of potential underlying mechanisms are warranted.


Assuntos
Bifenilos Policlorados/toxicidade , Efeitos Tardios da Exposição Pré-Natal , Adolescente , Animais , Encéfalo/efeitos dos fármacos , California , Feminino , Humanos , Exposição Materna , Razão de Chances , Oregon , Bifenilos Policlorados/análise , Gravidez , Estudos Prospectivos , Assunção de Riscos
15.
PLoS One ; 14(3): e0213022, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30861033

RESUMO

BACKGROUND: Gay, bisexual, and other men who have sex with men (GBM) have the highest proportion of incident HIV infection. Pre-exposure prophylaxis (PrEP) use and screening for sexually transmitted infections (STIs) are primary HIV prevention strategies, however, uptake remains low. Social capital, collective resources generated through social connections, are associated with lower HIV risk and infection. We investigated social capital in association with PrEP indicators among GBM. METHODS: Analyses included (N = 376) GBM from the 2014 National HIV Behavioral Surveillance (NHBS) in New Orleans. Multiple regression methods assessed the association between one item within each of eight domains from the Onyx and Bullen Social Capital Scale and: awareness and willingness to use PrEP. Analyses are adjusted for age, race, education, sexual intercourse with women, and health insurance. RESULTS: Forty percent of GBM were 18-29 years, 52 percent White. Sixty percent were willing to use PrEP. Social capital was above 50 percent across 7 of 8 indicators. Community group participation (vs no participation) was associated with higher likelihoods of PrEP awareness (adjusted Prevalence Ratio [aPR] = 1.41, 95% Confidence Interval [CI] = 1.02, 1.95). None of the seven remaining social capital indicators were significantly associated with any of the PrEP outcomes. CONCLUSIONS: Community groups and organizations could be targeted for interventions to increase uptake of HIV prevention strategies among GBM in New Orleans.


Assuntos
Redes Comunitárias , Infecções por HIV/prevenção & controle , Profilaxia Pré-Exposição , Grupos de Autoajuda , Minorias Sexuais e de Gênero/educação , Adolescente , Adulto , Grupo com Ancestrais do Continente Europeu/educação , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Incidência , Masculino , Nova Orleans/epidemiologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Adulto Jovem
16.
J Affect Disord ; 250: 439-446, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901581

RESUMO

BACKGROUND: Suicide and alcohol use disorders (AUD) have high public health and economic costs. We investigate the relationship between religious features that are external to the individual (hereafter, contextual religiosity) and individuals' risk of AUD and suicidal thoughts. METHODS: Data are from Wave 2 of the National Epidemiological Survey on Alcohol and Related Conditions (analytic N = 34,326). Regression analysis assessed whether contextual (i.e., Geographic state) religiosity and membership rates of Catholics and the three major Protestant traditions, are associated with DSM-IV AUD risk in the past 12 months and suicidal thoughts since last interview, controlling for individual and state-level covariates. In a secondary analysis, we test for interactions between individual race/ethnicity and contextual religiosity on the outcomes since prior work suggested differences by race and individual religiosity. RESULTS: Some contextual religious variables were significantly associated with AUD risk but not suicidal thoughts. Individuals living in a state with higher membership rates of Evangelical Protestant had higher AUD risk (Adjusted Relative Risk [ARR]=1.27, 95%CI=1.08-1.49). Individuals living in states with higher membership rates of Historically Black Protestant had a lower risk of AUD (ARR=0.83, 95% CI=0.72-0.96). The interaction between individual race and contextual-level religious variables on the outcomes were not significant. LIMITATIONS: NESARC is an observational cross-sectional so causality between religiosity and the outcomes cannot be established. CONCLUSIONS: The risk of AUD among individuals varies depending on the religious membership rates among Protestant groups within their geographic state of residence. Contextual religiosity may impact AUD risk above and beyond one's individual religiosity.


Assuntos
Alcoolismo/epidemiologia , Religião e Psicologia , Ideação Suicida , Tentativa de Suicídio/estatística & dados numéricos , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Causalidade , Estudos Transversais , Manual Diagnóstico e Estatístico de Transtornos Mentais , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Estados Unidos
17.
AIDS Behav ; 23(3): 649-660, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30725397

RESUMO

The effect of non-injection substance use on HIV viral load (VL) is understudied in international settings. Data are from HPTN063, a longitudinal observational study of HIV-infected individuals in Brazil, Thailand, and Zambia, with focus on men with VL data (Brazil = 146; Thailand = 159). Generalized linear mixed models (GLMM) assessed whether non-injection substance use (stimulants, cannabis, alcohol, polysubstance) was associated with VL undetectability. ART adherence and depressive symptoms were examined as mediators of the association. In Thailand, substance use was not significantly associated with VL undetectability or ART adherence, but alcohol misuse among MSM was associated with increased odds of depression (AOR = 2.75; 95% CI 1.20, 6.32, p = 0.02). In Brazil, alcohol misuse by MSM was associated with decreased odds of undetectable VL (AOR = 0.34; 95% CI 0.13, 0.92, p = 0.03). Polysubstance use by heterosexual men in Brazil was associated with decreased odds of ART adherence (AOR = 0.25; 95% CI 0.08, 0.78, p = 0.02). VL suppression appears attainable among non-injection substance users. Substance use interventions among HIV-positive men should address depression, adherence, and VL undetectability.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Depressão/psicologia , Infecções por HIV/psicologia , HIV-1/efeitos dos fármacos , Heterossexualidade/psicologia , Homossexualidade Masculina/psicologia , Adesão à Medicação/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Carga Viral , Adulto , Brasil/epidemiologia , Usuários de Drogas , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Humanos , Estudos Longitudinais , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Tailândia/epidemiologia , Adulto Jovem , Zâmbia/epidemiologia
18.
JMIR Public Health Surveill ; 5(1): e12405, 2019 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-30714945

RESUMO

BACKGROUND: Uptake of pre-exposure prophylaxis (PrEP) among black individuals in the United States is low and may be associated with the limited availability of clinics where PrEP is prescribed. OBJECTIVE: We aimed to determine the association between spatial access to clinics where PrEP is prescribed and willingness to use PrEP. METHODS: We identified locations of clinics where PrEP is prescribed from AIDSVu.org and calculated the density of PrEP clinics per 10,000 residents according to the ZIP code. Individual-level data were obtained from the 2016 National Survey on HIV in the Black Community. We used multilevel modelling to estimate the association between willingness to use PrEP and clinic density among participants with individual-level (HIV risk, age, gender, education, income, insurance, doctor visit, census region, urban/rural residence) and ZIP code-level (%poverty, %unemployed, %uninsured, %black population, and density of health care facilities) variables. RESULTS: All participants identified as black/African American. Of the 787 participants, 45% were men and 23% were found to be at high risk based on the self-reported behavioral characteristics. The mean age of the participants was 34 years (SD 9), 54% of participants resided in the South, and 26% were willing to use PrEP. More than one-third (38%) of the sample had to drive more than 1 hour to access a PrEP provider. Participants living in areas with higher PrEP clinic density were significantly more willing to use PrEP (one SD higher density of PrEP clinics per 10,000 population was associated with 16% higher willingness [adjusted prevalence ratio=1.16, 95% CI: 1.03-1.31]). CONCLUSIONS: Willingness to use PrEP was associated with spatial availability of clinics where providers prescribe PrEP in this nationally representative sample of black African Americans.

19.
Glob Public Health ; 14(8): 1098-1111, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30717633

RESUMO

Few studies evaluate knowledge and willingness to use pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in middle-income countries. Brazil added PrEP to public drug formularies in December 2017, but little is known about local knowledge and attitudes about PrEP among MSM outside metropolitan areas in Southern Brazil. The cross-sectional HIV Surveillance Survey Project in Brazil estimates HIV and STD prevalence among MSM in 12 state capitals. Among 32 participants at the Salvador, Bahia study site, we used qualitative interviews to assess knowledge, willingness, and barriers to PrEP use among MSM; few MSM had previous knowledge of PrEP and were willing to use PrEP. Clinical, behavioural, social, and structural factors influencing participants' knowledge and willingness to take PrEP included concerns about efficacy and side effects, access to culturally congruent services for MSM, and stigma. Some participants reported that learning about PrEP online positively influenced their willingness to use PrEP. Participants' opinions about PrEP's contribution to risk compensation varied. Interventions to provide culturally congruent care and destigmatise PrEP for MSM at high risk for HIV acquisition, particularly those conducted collaboratively with Brazil's civil society movement, may enhance the public health effort to expand access to PrEP in Brazil.

20.
Cult Health Sex ; 21(12): 1349-1366, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30724712

RESUMO

Efforts to reduce HIV among gay, bisexual and other men who have sex with men include increasing awareness and uptake of pre-exposure prophylaxis (PrEP). Social capital may facilitate engagement in HIV prevention. Membership of social groups including chosen families (i.e. friends as family relationships) - one potential indicator of social capital - may be protective against HIV risk and infection. In this cross-sectional quantitative study, we examined social capital items and social group membership in association with PrEP outcomes. In 2014, the New Orleans arm of the National HIV Behavioral Surveillance recruited 353 HIV-negative men, of whom 46% identified as Black, Latino or Other Race and 54% as Non-Hispanic White, using venue-based sampling to complete a structured survey. Multivariable logistic regression models tested the relations between social group membership and social capital with PrEP indicators. Men who reported community group participation were more likely to be aware of PrEP compared to those who did not. Men in chosen families associated with a family name were least likely to be aware of and willing to take PrEP compared to those not in any other social groups. Social group membership is a potential social capital indicator for assessing HIV prevention among men.

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