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1.
Am J Epidemiol ; 193(4): 636-645, 2024 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-37968380

RESUMO

Extreme climate events are related to women's exposure to different forms of violence. We examined the relationship between droughts and physical, sexual, and emotional intimate partner violence (IPV) in India by using 2 different definitions of drought: precipitation-based drought and socioeconomic drought. We analyzed data from 2 rounds of a nationally representative survey, the National Family Health Survey, where married women were asked about their experiences of IPV in the previous year (2015-2016 and 2019-2021; n = 122,696). Precipitation-based drought was estimated using remote sensing data and geographic information system (GIS) mapping, while socioeconomic drought status was collected from government records. Logistic regression models showed precipitation-based drought to increase the risk of experiencing physical IPV and emotional IPV. Similar findings were observed for socioeconomic drought; women residing in areas classified as drought-impacted by the government were more likely to report physical IPV, sexual IPV, and emotional IPV. These findings support the growing body of evidence regarding the relationship between climate change and women's vulnerability, and highlight the need for gender responsive strategies for disaster management and preparedness.


Assuntos
Secas , Violência por Parceiro Íntimo , Humanos , Feminino , Fatores de Risco , Violência , Índia/epidemiologia , Parceiros Sexuais/psicologia , Prevalência
2.
AIDS Behav ; 26(10): 3210-3219, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35380288

RESUMO

Economic vulnerability is often reported to underlie involvement in sex work among female sex workers (FSW), but may also create urgency in women's work, limiting women's negotiating power with clients and in turn, increasing their vulnerability for violence and HIV. This study assessed economic vulnerability in relation to violence and sexual risk behaviors for HIV among a sample of FSW in Tijuana, Mexico. FSW at least 18 years of age were recruited through venue-based sampling for a survey (n = 228) and in-depth interviews (n = 50) to investigate HIV risk factors in this region. Using crude and adjusted logistic regression models, we assessed lack of financial support from others as well as reports of financial hardship separately in relation to experiencing sexual violence (e.g. by clients, police, relationship partners, in the past 6 months), physical violence (past 6 months), STI diagnosis, and inconsistent condom use (past 30 days). Qualitative interviews (n = 50), conducted with a subsample of the survey participants, were also examined for related themes. FSW who reported no financial support were more likely to report sexual violence (OR = 2.1; 95% CI:1.1-4.2). FSW who reported financial hardship were more likely to experience sexual violence (OR = 1.9; 95% CI:1.1-3.6) and physical violence (OR = 1.9; 95% CI:1.1-3.6), as well as to report past 30-day inconsistent condom use (OR = 2.4; 95%CI: 1.3-4.6) and to test positive for an STI (OR = 1.9; 95% CI:1.1-3.4). Qualitative data substantiated these findings. Findings suggest that interventions to improve economic well-being may be useful to prevent the intersecting concerns of violence and HIV among FSW.


Assuntos
Infecções por HIV , Profissionais do Sexo , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , México/epidemiologia , Fatores de Risco , Sexo sem Proteção , Violência
3.
AIDS Behav ; 22(8): 2553-2563, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29748844

RESUMO

People living with HIV/AIDS (PLWH) are more likely to have a history of trading sex, but little research has examined whether trading sex is associated with lower health care utilization amongst PLWH. This study assesses this association with PLWH (N = 583) recruited and surveyed from seven community sites in six US cities participating in a multi-site community-based HIV test and treat initiative. Participants were 90.6% Black or Latino, 30.4% homeless, and 9.0% (1 in 11) sold sex (past 90 days). Most reported receiving HIV clinical care (63.9%, past 6 months) and HIV case management (68.9%, past year), but 35.7% reported a missed health care appointment (past 3 months). In adjusted regression models, trading sex was associated with a missed health care appointment (OR = 2.44) and receiving psychological assistance (OR = 2.31), past 90 days, but not receipt of HIV care or supportive HIV services. Trading sex may compromise consistent health care utilization among PLWH.


Assuntos
Administração de Caso/estatística & dados numéricos , Infecções por HIV/terapia , Pessoas Mal Alojadas/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Trabalho Sexual/estatística & dados numéricos , Adolescente , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Idoso , Agendamento de Consultas , Feminino , Serviços de Saúde/estatística & dados numéricos , Hispânico ou Latino/estatística & dados numéricos , Humanos , Seguro Saúde/estatística & dados numéricos , Modelos Logísticos , Masculino , Programas de Rastreamento , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Razão de Chances , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Inquéritos e Questionários , População Branca/estatística & dados numéricos , Adulto Jovem
4.
Cult Health Sex ; 20(9): 1006-1022, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29231077

RESUMO

Syndemic Zika virus, HIV and unintended pregnancy call for an urgent understanding of dual method (condoms with another modern non-barrier contraceptive) and consistent condom use. Multinomial and logistic regression analysis using data from the Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS), a nationally representative household survey of reproductive-aged women in Brazil, identified the socio-demographic, fertility and relationship context correlates of exclusive non-barrier contraception, dual method use and condom use consistency. Among women in marital and civil unions, half reported dual protection (30% condoms, 20% dual methods). In adjusted models, condom use was associated with older age and living in the northern region of Brazil or in urban areas, whereas dual method use (versus condom use) was associated with younger age, living in the southern region of Brazil, living in non-urban areas and relationship age homogamy. Among condom users, consistent condom use was associated with reporting Afro-religion or other religion, not wanting (more) children and using condoms only (versus dual methods). Findings highlight that integrated STI prevention and family planning services should target young married/in union women, couples not wanting (more) children and heterogamous relationships to increase dual method use and consistent condom use.


Assuntos
Preservativos/estatística & dados numéricos , Comportamento Contraceptivo , Infecções por HIV/prevenção & controle , Casamento , Gravidez não Planejada , Infecção por Zika virus/prevenção & controle , Adolescente , Adulto , Brasil/epidemiologia , Coito Interrompido , Anticoncepcionais Femininos , Dispositivos Anticoncepcionais Femininos , Anticoncepcionais Orais , Implantes de Medicamento , Feminino , Infecções por HIV/epidemiologia , Humanos , Dispositivos Intrauterinos , Modelos Logísticos , Pessoa de Meia-Idade , Métodos Naturais de Planejamento Familiar , Gravidez , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Inquéritos e Questionários , Sindemia , Adulto Jovem , Infecção por Zika virus/epidemiologia
5.
AIDS Behav ; 21(12): 3271-3278, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29032411

RESUMO

Compared to HIV research on men who have sex with men, less is known about the risks and vulnerabilities for HIV among Male to Female (MTF) transgender persons, particularly in different geographic regions like Mexico. In Tijuana, Mexico, a border city experiencing a dynamic HIV epidemic, no precedent data exists on the MTF transgender population. Our aims were to estimate HIV prevalence and examine the behaviors and characteristics of the population. We conducted a cross-sectional study of 100 MTF transgender persons recruited through time location sampling in 2012. Participants underwent interviewer-administered (paper and pen) surveys and rapid tests for HIV. Descriptive univariate analyses were conducted on various factors, including sociodemographics, substance use, accessing social services (requested vs. received), stigma, and sex behaviors. A total of 22% tested positive for HIV, a prevalence higher than other key populations at risk for HIV in Tijuana.


Assuntos
Infecções por HIV/epidemiologia , Assunção de Riscos , Pessoas Transgênero/estatística & dados numéricos , Transexualidade/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Comportamento Sexual/estatística & dados numéricos , Estigma Social , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto Jovem
6.
AIDS Behav ; 21(8): 2270-2282, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28669024

RESUMO

This paper measures syndemic substance use disorder, violence, and mental health and compares the syndemic among HIV-infected heterosexual men, heterosexual women, and men who have sex with men (MSM). Data were from a sample of high needs substance-using, HIV-infected people in South Florida between 2010 and 2012 (n = 481). We used confirmatory factor analysis to measure a syndemic latent variable and applied measurement invariance models to identify group differences in the data structure of syndemic co-morbidities among heterosexual men, heterosexual women, and MSM. We found that variables used to measure the syndemic fit each sub-group, supporting that substance use disorder, violence, and mental health coincide in HIV-infected individuals. Heterosexual men and MSM demonstrated similar syndemic latent variable factor loadings, but significantly different item intercepts, indicating that heterosexual men had larger mean values on substance use disorder, anxiety, and depression than MSM. Heterosexual men and heterosexual women demonstrated significantly different syndemic variable factor loadings, indicating that anxiety and depression contribute more (and substance use contributes less) to the syndemic in heterosexual men compared to heterosexual women. MSM and heterosexual women demonstrated similar syndemic latent variable factor loadings and intercepts, but had significantly different factor residual variances indicating more variance in violent victimization and depression for MSM and more variance in stress for heterosexual women than what is captured by the observed syndemic indicators. Furthermore, heterosexual women had a larger syndemic factor mean than MSM, indicating that the syndemic burden is greater among heterosexual women than MSM. Our findings support that measurement invariance can elucidate differences in the syndemic to tailor interventions to sub-group needs.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Infecções por HIV/epidemiologia , Heterossexualidade/estatística & dados numéricos , Minorias Sexuais e de Gênero/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Violência/estatística & dados numéricos , Adulto , Bissexualidade , Vítimas de Crime , Feminino , Florida/epidemiologia , Homossexualidade , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Comportamento Sexual
7.
AIDS Care ; 26(12): 1586-91, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25068199

RESUMO

This study examines the socio-structural sexual health risks of female youth (aged 14-17) working in bar/spa venues and brothels in the Philippines, compared to their older counterparts. Aside from this study, few female sex work studies have interviewed youth under 18. On four southern Philippines islands, 770 female sex workers (FSWs), aged 14-48, were recruited from bar/spa venues and brothels to participate in a socio-structural HIV prevention study. Controlling for the effects of a larger HIV prevention intervention study involving 1484 female bar/spa workers, the minors, compared to older FSWs, had less education (AOR: 0.81, CI: 0.70-0.94), less children (AOR: 0.19, CI: 0.10-0.37), and were more likely to work in illegal brothels (AOR: 4.60, CI: 1.66-12.75) and to be high on drugs during sex (AOR: 2.26, CI: 1.39-3.67). It was less likely that anyone talked to them about HIV prevention (AOR: 0.32, CI: 0.15-0.72), but more likely they were recruited by venue owners (AOR: 5.67, 1.56-20.56) and were told by their managers to have sex without a condom (AOR: 6.80, CI: 2.06-22.39). Results suggest a need for organizational and policy level interventions to protect adolescent females from working in unsafe environments in the Philippines and to prevent youth from being recruited into high-risk situations.


Assuntos
Preservativos/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Profissionais do Sexo/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Filipinas , Pobreza , Fatores de Risco , Inquéritos e Questionários
8.
Int J STD AIDS ; 35(2): 147-154, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37934459

RESUMO

BACKGROUND: Economic hardship (e.g., difficulty to pay for basic needs) has been associated with increased HIV/STI risk among female sex workers (FSW), and may be exacerbated by high levels of substance use. Few studies have assessed the intersection of economic hardship, substance use, and HIV/STI risk among FSW. METHODS: Quantitative data were collected via questionnaires among 469 FSW residing in Tijuana and Ciudad Juarez, Mexico. Using logistic regression, we assessed the role of economic hardship on the association between substance use (past 30-days alcohol use, drug use, or injection drugs use with clients, and past 6-months drug use) and testing positive for an STI (also an indicator of HIV risk). RESULTS: Drug use in the preceding six months was significantly associated with testing positive for an STI (AOR = 1.8, CI: 1.1 = 2.9, p = .02); no difference in this association was found by whether women reported economic hardship. Past 30-day drug use with clients was associated with STI infection, but only among those who did not report economic hardship (AOR = 1.5, 95% CI: 1.1-1.9, p < .01). CONCLUSIONS: Findings suggest that economic hardship influences the association between substance use and increased risk for HIV/STI among FSW; however, these associations may be more complex than previously hypothesized.


Assuntos
Infecções por HIV , Profissionais do Sexo , Infecções Sexualmente Transmissíveis , Transtornos Relacionados ao Uso de Substâncias , Feminino , Humanos , Infecções por HIV/epidemiologia , Infecções Sexualmente Transmissíveis/epidemiologia , Fatores de Risco , México/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Sexo sem Proteção
9.
Front Psychiatry ; 15: 1368619, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38807689

RESUMO

Background: Parental migration is common in Mexico and Latin America, where individuals pursue work to improve their family's economic opportunities and children remain home in their community under the care of the remaining parent or extended family. A research gap remains about the impact of parental migration on mental health and substance use in children who remain at home. The current study explored risk and resilience factors relating to mental health and substance use among Mexican youth remaining at home when one or more parents migrate. Methods: This qualitative study applied attachment theory and thematic analysis to analyze 26 in-depth interviews with youth (17-21 years old), parents, and a focus group with high-school teachers in a town with history of migration both domestically and internationally (Yucatan, México). Results: Respondents across groups perceived that parental migration was related to 1) less parental/caregiver oversight and support due to family demands on the remaining parent and 2) the deterioration of youth mental health. Lack of youth oversight and the poor mental health of youth were perceived as drivers of youth seeking out and consuming alcohol and substances. In terms of parental remittances, youth reported observing among their peers increased access to material goods such as clothing and technology (e.g., smartphones) and increased access to alcohol. Resilience factors included parental awareness of the role of good communication with youth and teachers and youth access to and utilization of self-care resources such as mutual aid meetings for substance use recovery. Conclusion: Poor mental health and substance use among youth and parents were perceived to be related to parental absence, stressors on the remaining parent or family, and undermined healthy parent-child attachment. Youth themselves are a source of insight for recommendations on interventions to reduce youth isolation and substance use risk. We recommend the intentional engagement of youth in developing intervention research and tailoring evidence-based interventions to mitigate parental absence's impact and promote parent-child attachment for youth and families remaining at home.

10.
AIDS Behav ; 17(2): 523-35, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22223297

RESUMO

This paper examined socio-structural factors of consistent condom use among female entertainment workers at high risk for acquiring HIV in Metro Manila, Quezon City, Philippines. Entertainers, aged 18 and over, from 25 establishments (spa/saunas, night clubs, karaoke bars), who traded sex during the previous 6 months, underwent cross-sectional surveys. The 143 entertainers (42% not always using condoms, 58% always using condoms) had median age (23), duration in sex work (7 months), education (9 years), and 29% were married/had live-in boyfriends. In a logistic multiple regression model, social-structural vs. individual factors were associated with inconsistent condom use: being forced/deceived into sex work, less manager contact, less STI/HIV prevention knowledge acquired from medical personnel/professionals, not following a co-workers' condom use advice, and an interaction between establishment type and alcohol use with establishment guests. Interventions should consider the effects of physical (force/deception into work), social (peer, manager influence), and policy (STI/HIV prevention knowledge acquired from medical personnel/professionals) environments on consistent condom use.


Assuntos
Preservativos/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Saúde Ocupacional/normas , Profissionais do Sexo/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Valores Sociais , Adulto , Catolicismo/psicologia , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Política de Saúde , Humanos , Grupo Associado , Filipinas/epidemiologia , Saúde Pública , Fatores de Risco , Assunção de Riscos , Profissionais do Sexo/psicologia , Comportamento Sexual/psicologia
11.
PLoS One ; 18(10): e0292121, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37878555

RESUMO

BACKGROUND: Online misogyny is a violation of women's digital rights. Empirical studies on this topic are however lacking, particularly in low- and middle- income countries. The current study aimed to estimate whether prevalence of online misogyny on Twitter in India changed since the pandemic. METHODS: Based on prior theoretical work, we defined online misogyny as consisting of six overlapping forms: sexist abuses, sexual objectification, threatening to physically or sexually harm women, asserting women's inferiority, justifying violence against women, and dismissing feminist efforts. Qualitative analysis of a small subset of tweets posted from India (40,672 tweets) substantiated this definition and taxonomy for online misogyny. Supervised machine learning models were used to predict the status of misogyny across a corpus of 30 million tweets posted from India between 2018 and 2021. Next, interrupted time series analysis examined changes in online misogyny prevalence, before and during COVID-19. RESULTS: Qualitative assessment showed that online misogyny in India existed most in the form of sexual objectification and sexist abusive content, which demeans women and shames them for their presumed sexual activity. Around 2% of overall tweets posted from India between 2018 and 2021 included some form of misogynistic content. The absolute volume as well as proportion of misogynistic tweets showed significant increasing trends after the onset of COVID-19, relative to trends prior to the pandemic. CONCLUSION: Findings highlight increasing gender inequalities on Twitter since the pandemic. Aggressive and hateful tweets that target women attempt to reinforce traditional gender norms, especially those relating to idealized sexual behavior and framing of women as sexual beings. There is an urgent need for future research and development of interventions to make digital spaces gender equitable and welcoming to women.


Assuntos
COVID-19 , Mídias Sociais , Humanos , Feminino , COVID-19/epidemiologia , Prevalência , Violência , Identidade de Gênero
12.
Artigo em Inglês | MEDLINE | ID: mdl-35886311

RESUMO

Nationwide, public libraries are experiencing an increase in "on-premise" opioid overdoses and other issues (e.g., suicide attempts) affecting unstably housed library users. The public library presents a unique opportunity to access an otherwise hidden population. In partnership with the San Diego Central Library, researchers led focus groups, in-depth interviews, and surveys with 63 library patrons experiencing homelessness or housing instability (n = 49) and library staff (n = 14) (January-June 2019). Using a consensus organizing framework and mixed methods approach, the researchers conducted in-depth interviews exploring the library's strengths and opportunities for patrons experiencing homelessness, the barriers to meeting their aspirations, and whether having a social worker at the library or other policy changes in government or the library could help. Specifically, participants answered inquiries about the opportunities for the library to address substance use and human trafficking. In brief surveys, library patrons and staff provided views on the patrons' educational needs, library staff's training needs, and changes needed in government or library policies. Results revealed the desire of the library patrons (69%) and staff (93%) to have a library social worker who could link patrons to housing services, substance use harm reduction or treatment, and address food-insecure youth/families and human trafficking/sexual exploitation. Participants also valued peer advocates with lived homelessness experiences. Over 70% of the unstably housed patrons said they would like library patrons to participate in peer leadership training. Other significant themes were the need for crisis prevention and intervention, connecting patrons to resources and each other, and creating consistent assistance. Libraries urgently need more on-premise support to address patrons' pressing housing, health, and mental health needs.


Assuntos
Pessoas Mal Alojadas , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Pessoas Mal Alojadas/psicologia , Habitação , Humanos , Problemas Sociais , Assistentes Sociais , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
13.
Health Soc Care Community ; 30(1): e175-e183, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-33988284

RESUMO

People experiencing homelessness face many obstacles and barriers when it comes to getting help for their substance use. Recently, there has been an increase in substance use and opioid overdoses at public libraries, which are easily accessible public places for those struggling with homelessness. We aimed to understand this population's experience with recovery. This has led to an exploration of the intersection of experiencing homelessness and substance use-related problems and its impact on barriers for recovery, along with facilitators to treatment and recovery. From January to June 2019, researchers interviewed 22 library patrons experiencing homelessness and actively using substances at a Southern Californian library in a major metropolitan area. Data were coded and analysed using a thematic analysis. Researchers independently coded text files for data analysis and discussed codes until consensus was reached. Library patrons who reported substance use were a mean age of 39 (range: 22-63); over half were white people (59%) and male (59%); 77% reported currently sleeping on the street; 18% lived in shelters. Themes for barriers to recovery were experiencing withdrawal, access to resources and coping with being homeless. Themes related to facilitators to treatment and recovery were Narcan access and overdose education, connectedness and trauma recovery. People experiencing homelessness are hard to reach and those using substances pose even more vulnerabilities. Many patrons attribute their circumstances to their substance use and disconnectedness to resources and supports to quit. Further research is needed on best practices for multidisciplinary care coordination for this population.


Assuntos
Pessoas Mal Alojadas , Transtornos Relacionados ao Uso de Substâncias , Adulto , Habitação , Humanos , Masculino , Pesquisa Qualitativa , Problemas Sociais , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia
14.
SSM Popul Health ; 18: 101074, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35378865

RESUMO

This study aimed to understand whether maternal child marriage and past year intimate partner violence (IPV) impact stunting among Sri Lankan children under 5 years old, and, secondarily, whether proximity to conflict is associated with stunting. Additionally, we assessed whether proximity to conflict moderates the relationships between maternal child marriage and past year IPV (sexual, physical, and emotional). We tested these questions using logistic regression analyses of the 2016 Sri Lankan Demographic and Health Survey (n = 4941 mother-child dyads). In country-wide adjusted analyses, we did not find associations between maternal child marriage or IPV and stunting (p > 0.05). Children in districts proximal and central to conflict were significantly less likely to be stunted compared to children in districts distal to conflict (proximal adjusted odds ratio/aOR: 0.43, 95% confidence interval/CI: 0.22-0.82; central aOR: 0.53, CI: 0.29-0.98). We found significant interaction effects on stunting between proximity to conflict and both sexual and emotional IPV, which we further explored in stratified analyses. In districts distal to conflict, maternal sexual IPV was significantly associated with increased odds of stunting (aOR: 2.71, CI: 1.16-6.35), and in districts central to conflict, maternal emotional IPV was significantly associated with increased odds of stunting (aOR: 1.80, CI: 1.13-2.89). Maternal emotional IPV was significantly associated with decreased odds of stunting in districts proximal to conflict (aOR: 0.42, CI: 0.18-0.96). Maternal child marriage and physical IPV were not associated with stunting in Sri Lanka. Variations in associations between maternal IPV and stunting across Sri Lanka may reflect the lasting and differential impact of conflict, as well as differential humanitarian responses which may have improved child nutrition practices and resources in districts central and proximal to conflict. Policies and programs addressing stunting in Sri Lanka should consider the role of maternal IPV as well as community-level variations based on proximity to conflict.

15.
Confl Health ; 16(1): 5, 2022 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-35164806

RESUMO

BACKGROUND: Studies from many contexts indicate that proximity to conflict is associated with increased likelihood of intimate partner violence (IPV), and girl child marriage is associated with both proximity to conflict and increased IPV. In this study, we consider whether girl child marriage acts as a mediator of the association between proximity to conflict and IPV in the context of Sri Lanka, which sustained long-term conflict until 2009. METHODS: We analyzed responses of currently partnered women between ages 18 and 49 in the 2016 Sri Lankan Demographic and Health Survey (N = 13,691). Using logistic regression analyses, we measured associations between proximity to conflict (residence in districts which were central, proximal, or distal to the regions where the war occurred) and the outcomes of IPV and girl child marriage, and secondarily assessed girl child marriage as a possible mediator of the association between proximity to conflict and past year IPV. RESULTS: Women residing in districts central to conflict, as compared to districts distal to conflict, had increased odds of past year sexual, physical, and emotional IPV, with the odds of sexual IPV increasing the most (adjusted odds ratio/aOR 4.19, 95% confidence interval/CI 2.08-8.41). Residing in districts proximal to conflict compared to those distal to conflict was associated with lower odds of past year physical and emotional IPV, with the greatest decrease in emotional IPV (aOR 0.31, CI 0.18-0.54). Girl child marriage was more likely in districts central to conflict as opposed to those distal to conflict (aOR 1.89, CI 1.22-2.93), and partially mediated the relationship between centrality to conflict and IPV. CONCLUSIONS: Our findings demonstrate that residing in districts central to conflict compared to those distal to conflict is associated with greater odds of IPV and girl child marriage in post-conflict Sri Lanka, with girl child marriage partially mediating the association between centrality to conflict and IPV. Residence in districts proximal to conflict appears protective against IPV. Future research should investigate what factors are responsible for decreased IPV in districts proximal to violence, and whether these factors can be reproduced to mitigate the increased prevalence of IPV in districts central to conflict.

16.
AIDS Care ; 23 Suppl 1: 83-95, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21660754

RESUMO

This article aims to address female sex workers at high risk for contracting HIV in China by recommending evidence-based socio-structural interventions and policies at the national level that have yielded effective outcomes in other countries. National governments such as the Philippines and Hong Kong have utilized the Social Hygiene Clinic (SHC) model. A similar national policy can be highly effective in China. Evidence-based research study results indicate significant reductions in STI and consistent condom use among female sex workers in both China and the Philippines. Consistent condom use in both countries continues to be significantly associated with interpersonal- and venue-level factors. Individuals who had higher appointment-keeping ratios in the Philippines had higher rates of consistent condom use (OR = 2.7, 95% CI = 1.6-3.7) and significantly lower rates of STI (OR = 0.43, 95% CI = 0.26-0.57). By beginning with provinces, which already have a good relationship between establishment venues and the local Health Department, China can develop city ordinances and establishment regulations that begin to require regular examinations of female sex workers and entertainers in the local STI clinic.


Assuntos
Infecções por HIV/prevenção & controle , Trabalho Sexual , Infecções Sexualmente Transmissíveis/prevenção & controle , Instituições de Assistência Ambulatorial/organização & administração , China/epidemiologia , Preservativos/estatística & dados numéricos , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/terapia , Conhecimentos, Atitudes e Prática em Saúde , Política de Saúde , Nível de Saúde , Humanos , Política Organizacional , Sexo Seguro , Trabalho Sexual/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/terapia
17.
Artigo em Inglês | MEDLINE | ID: mdl-34769591

RESUMO

The opioid epidemic is a public health crisis that disproportionately affects our unsheltered neighbors. Because medication-assisted treatment (MAT) is effective for preventing deaths from drug overdose and retention is associated with better health outcomes, there is a clear need for more research on factors impacting retention in care. This retrospective cohort analysis examines the relationship between attendance in counseling and retention on buprenorphine for three or more months for individuals experiencing homelessness being treated at a Federally Qualified Health Center (FQHC) and Public Health Service Act §330(h) Health Care for the Homeless Program grantee in San Diego County, California. The cohort included 306 adults experiencing homelessness who had at least one prescription for buprenorphine and participated in a MAT program between 2017 and 2019. The sample included 64.4% men, almost exclusively white, and 35% lived in a place not meant for human habitation. Of the sample, 97 patients were retained at 3 months and 209 were not. Results from a logistic regression model showed that counseling appointments were positively associated with retention at three months (OR = 1.57, p < 0.001). Findings from this study inform future MAT program design components for people experiencing homelessness.


Assuntos
Buprenorfina , Pessoas Mal Alojadas , Transtornos Relacionados ao Uso de Opioides , Adulto , Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Aconselhamento , Feminino , Humanos , Masculino , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Estudos Retrospectivos
18.
Sexes ; 2(1): 26-49, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34485751

RESUMO

Human Trafficking (HT) persists in the US, despite multi-level measures designed to mitigate its societal costs. HT instruction for healthcare providers is growing, but there is a dearth of resources and training presenting obstacles for victims accessing suitable healthcare services. Voices of survivors are also scant in the literature, despite the fact that their recommendations would appear essential when designing best practices. This study aimed to methodically gather recommendations from sex trafficking (ST) survivors who sought medical care during their victimization. An exploratory concurrent mixed-methods design was used, and semi-structured interviews (N = 22) were conducted between March 2016 and March 2017, in San Diego, CA, and Philadelphia, PA. Data were analyzed through a coding system to identify meaningful analytical themes. Study participants were recruited through survivor-centered organizations, and their identification was kept anonymous and confidential. Findings included three main themes: (A) Red Flags; (B) supportive healthcare practices; and (C) resources for ST-patient study participants' recommendations aimed to improve healthcare practice in response to their medical needs in a compassionate and caring manner, with trust building, rapport, and an opportunity to instill hope among ST-patients. Implementing Compassionate Care approaches when caring for ST-patients could positively impact patient-provider interactions, while creating opportunities for intervention.

19.
Artigo em Inglês | MEDLINE | ID: mdl-33917190

RESUMO

This paper examines the prevalence of and potential for community mobilization (CM) and its association with HIV/STI risk, substance use, and violence victimization among women, particularly those using substances, in the sex trade in Tijuana, Mexico. METHODS: 195 women participated in Mujeres Unidas (K01DA036439 Urada) under a longitudinal survey study, "Proyecto Mapa de Salud" (R01DA028692, PI: Brouwer). Local health/social service providers (N = 16) were also interviewed. RESULTS: 39% of women who participated in community mobilization activities used substances. In adjusted analyses (n = 135), participation in CM activities (n = 26) was more likely among women who did not report substance use (AOR: 4.36, CI: 1.11-17.16), perceived a right to a life free from violence (AOR: 9.28, CI: 2.03-59.26), talked/worked with peers in the sex trade to change a situation (AOR: 7.87, CI: 2.03-30.57), witnessed violence where they worked (AOR: 4.45, CI: 1.24-15.96), and accessed free condoms (AOR: 1.54, CI: 1.01-2.35). Forty-five of the women using substances demonstrated their potential for engaging in asset-based community development (ABCD) with service providers in Mujeres Unidas meetings. CONCLUSION: Women using substances, vs. those who did not, demonstrated their potential to engage in ABCD strategies. Women's empowerment, safety, and health could be enhanced by communities engaging in ABCD strategies that build and bridge social capital for marginalized women who otherwise have few exit and recovery options.


Assuntos
Infecções por HIV , Infecções Sexualmente Transmissíveis , Transtornos Relacionados ao Uso de Substâncias , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , México , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Violência
20.
Artigo em Inglês | MEDLINE | ID: mdl-33669672

RESUMO

Homelessness is a persistent problem in the United States in general and in Southern California especially. While progress has been made in reducing the number of people experiencing homelessness in the United States from 2007 (647,000) to 2019 (567,000), it remains an entrenched problem. The purpose of this paper is to outline a novel, interdisciplinary academic-practice partnership model to address homelessness. Where singular disciplinary approaches may fall short in substantially reducing homelessness at the community and population level, our model draws from a collective impact model which coordinates discipline-specific approaches through mutually reinforcing activities and shared metrics of progress and impact to foster synergy and sustainability of efforts. This paper describes the necessary capacity-building at the institution and community level for the model, the complementary strengths and contributions of each stakeholder discipline in the proposed model, and future goals for implementation to address homelessness in the Southern California region.


Assuntos
Pessoas Mal Alojadas , Fortalecimento Institucional , Humanos , Estados Unidos
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