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Abstract HIV risk perception and Intimate partner violence (IPV) are related to HIV infection in women. However, there is a lack of information regarding on the association between risk perception and IPV in the Mexican population. This study aimed to identify and characterize subgroups based on their risk perception through the analysis of latent classes and to evaluate the variables associated with HIV risk perception. An online survey was conducted to assess sexual and preventive behavior, HIV risk perception, and intimate partner violence. Three hundred thirty-two women participated; the sampling was for convenience. Two latent classes were identified: a group with risk perception (85%) and one without risk perception (14.6%). The variables associated with the risk perception were a sexual attraction to men, not having a stable partner, perceiving oneself as at risk of acquiring HIV due to sexual behavior, and the presence of IPV. HIV prevention programs for women must address the stigmas related to HIV, such as the idea that the risk only occurs when they have multiple sexual partners, promote accurate HIV risk perception and prevent IPV in all its expressions and contexts.
Resumen En mujeres, la violencia de pareja está relacionada a una mayor probabilidad de adquirir la infección por VIH. De igual forma, una inadecuada percepción de riesgo de adquirir el virus coloca a las mujeres en una situación vulnerable. Existe una falta de información ente la asociación de la VPI y la percepción de riesgo es mujeres mexicanas. Este estudio persiguió dos objetivos: el primero fue identificar y caracterizar subgrupos en función de su percepción de riesgo a través del análisis de clases latentes; el segundo objetivo consistió en evaluar las variables asociadas con la percepción de riesgo de VIH. Se realizó una encuesta en línea para evaluar el comportamiento sexual y preventivo, la percepción del riesgo de VIH y la VP. Participaron 332 mujeres; el muestreo fue por conveniencia. Se identificaron dos clases latentes: un grupo con percepción de riesgo (85%) y otro sin percepción de riesgo (14,6%). Las variables asociadas a la percepción de riesgo fueron atracción sexual por hombres, no tener pareja estable, percibirse en riesgo de adquirir el VIH por la conducta sexual y haber sufrido de violencia de pareja en los últimos seis meses. Se concluye que los programas de prevención del VIH para mujeres deben abordar los estigmas relacionados con el VIH, como la idea de que el riesgo solo ocurre cuando tienen múltiples parejas sexuales, promover una percepción precisa del riesgo del VIH y principalmente, prevenir la VP en todas sus expresiones y contextos; así como también dar atención personalizada a mujeres que ya sufren de violencia de pareja.
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BACKGROUND: Globally, the US-Mexico Border is one of the largest drug trafficking regions, with Ciudad Juarez (CJ) and El Paso (EP) making up the second-largest border crossing in the world. Border communities are places where the risk of drug use harm and infectious diseases such as HIV are augmented due to the confluence of factors operating across the physical, social, economic and policy environment. Although the two cities are economically, culturally, and socially intertwined, each has distinct criminal justice systems and policy practices aimed at curtailing substance use. Between 2008 and 2011, the CJ/EP region experienced an unprecedented level of violence that stemmed from the intersection of police militarization and drug cartel wars, which profoundly shaped every aspect of life. Little research has documented the impact of drug cartel wars on the drug use and health harms of people who inject drugs (PWID) living in CJ and EP. The purpose of the study is to understand the effect that the drug cartel war had on the drug use harms and HIV risk of PWID. METHODS: We conducted 40 in-depth interviews with people who inject drugs who resided in CJ or EP and had used heroin or crack cocaine in the last 30 days, and asked how police militarization and drug cartel war affected their daily lives. The risk environment framework informed the analysis and interpretation of findings. RESULTS: Findings indicated that the risk environment was profoundly altered as PWID residing in CJ experienced profound changes in their daily lives that promoted engagement in behaviors that increased drug use and health harms including HIV risk, exacerbated trauma, and prevented use of substance use treatment and harm reduction services. The risk environment was also altered in EP, where PWID experienced drug supply shortages, violent policing practices, and reduced availability of harm reduction services. Findings underscore the permeability of risk environments across geographical borders. CONCLUSION: The intersection of law enforcement militarization and drug cartel wars can be conceptualized as a 'big event' because it disrupts the drug market economy, leads to drug shortages, promotes entrance into the drug market economy by people who use drugs, reshapes drug use sites, and constrains the provision of harm reduction services. The stability of the harm reduction system in CJ was negatively impacted and limited the ability of individuals to reduce harm. Our findings show that drug cartel wars render the CJ/EP region extremely susceptible to drug use and health harms, while also creating vulnerability by severely restricting its ability to respond. Traditional recommendations to intervene to limit the impact of risk environments on the drug use harms of PWID need to be reconsidered in the context of drug cartel wars.
Assuntos
Usuários de Drogas , Infecções por HIV , Abuso de Substâncias por Via Intravenosa , Transtornos Relacionados ao Uso de Substâncias , Humanos , Polícia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , México , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , ViolênciaRESUMO
Cryptococcal meningitis is a serious infection of the central nervous system that is predominant in developing countries, caused by fungi of the genus Cryptococcus, and which affects immunosuppressed patients, especially those with HIV. Here, we aim to diagnose and characterize the clinical-epidemiological profile of cryptococcosis in patients admitted to two tertiary public hospitals in northeastern Brazil. The study is divided into three moments: (1) the isolation of fungus and diagnosis from biological samples collected between 2017 and 2019, (2) a description of the clinical and epidemiological characteristics of the patients, and (3) the experimental tests related to an in vitro susceptibility antifungal profile. The species were identified by MALDI-TOF/MS. Among the 100 patients evaluated, 24 (24.5%) were diagnosed with cryptococcosis based on positive culture. Clinical-epidemiological analysis showed a slightly higher prevalence in men between 30 and 39 years. When comparing the date of HIV diagnosis and the development of cryptococcosis, it was observed that 50% received the diagnosis of infection by cryptococcosis after or equal to a period of 12 months from being diagnosed with HIV; the other 50% received it within the first 30 days of the HIV diagnosis. Neurocryptococcosis was the most prevalent clinical form, and, at the time of hospital admission, the most common clinical signs were high fever (75%), intense headache (62.50%), and neck stiffness (33.33%). The cerebrospinal fluid showed 100% sensitivity and positivity for direct examination by India ink, and fungal culture. The mortality rate in this study was 46% (11/24), a lower rate than in the other literature. An antifungigram showed that 20 (83.33%) isolates were susceptible to amphotericin B and 15 (62.5%) to fluconazole. Mass spectrometry identified 100% of the isolates as Cryptococcus neoformans. In Brazil, this infection is not mandatory notifiable. Therefore, although there is little information on the subject, it is obsolete and does not express the reality of the facts, mainly in the northeast region, where this information is insufficient. The data obtained in this research contribute to the epidemiological knowledge of this mycosis in Brazil and will serve as a basis for future globally comparative epidemiological studies.
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Criptococose , Cryptococcus neoformans , Infecções por HIV , Masculino , Humanos , Brasil/epidemiologia , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Criptococose/epidemiologia , Criptococose/complicações , Criptococose/diagnóstico , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Infecções por HIV/microbiologiaRESUMO
This study aimed to identify factors associated with HIV risk perception among Mexican transgender women (TGW). This cross-sectional survey was conducted online and at a public HIV clinic in Mexico City. Participants were ≥ 18 years old, self-identified as TGW, and reported not living with HIV. They answered questions on sexual behavior, HIV risk perception, and pre-exposure prophylaxis (PrEP) awareness. We performed a multivariate logistic regression to accomplish the study's objective. One hundred ninety-one TGW completed the survey. High HIV risk perception was associated with > 5 sexual partners, condomless receptive anal sex, sex with a male partner(s) of unknown HIV status, and PrEP awareness. Although most TGW reported low HIV risk perception, over half had risk sexual behavior, reflecting inaccurate risk assessment. Future interventions to improve accurate risk perception among TGW should promote HIV transmission and prevention knowledge and increase PrEP awareness and uptake.
RESUMEN: Este estudio tuvo como objetivo identificar los factores asociados con la percepción de riesgo al VIH entre las mujeres trans (MT) mexicanas. El reclutamiento de esta encuesta transversal se realizó en línea y en una clínica pública de VIH en la Ciudad de México. Las participantes tenían ≥ 18 años, se autoidentificaron como MT y reportaron no vivir con VIH. Respondieron preguntas sobre su comportamiento sexual, percepción del riesgo al VIH y conocimiento de la profilaxis preexposición (PrEP). Se realizó un análisis de regresión logística multivariado para cumplir con el objetivo del estudio. Ciento noventa y uno participantes completaron la encuesta. La percepción de alto riesgo al VIH se asoció con > 5 parejas sexuales, sexo anal receptivo sin condón, sexo con una pareja masculina de estado serológico desconocido y conocimiento de la PrEP. Aunque la mayoría de las MT informaron baja percepción del riesgo al VIH, más de la mitad reportaron conductas sexuales de riesgo, lo que refleja una evaluación de riesgo inexacta. Futuras intervenciones para mejorar la percepción precisa del riesgo entre las MT deben centrarse en promover el conocimiento de transmisión y la prevención del VIH, así como aumentar el conocimiento y la aceptación de la PrEP.
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Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Pessoas Transgênero , Masculino , Humanos , Feminino , Adolescente , Homossexualidade Masculina , Infecções por HIV/prevenção & controle , Estudos Transversais , México , Percepção , Fármacos Anti-HIV/uso terapêuticoRESUMO
The aim of this study is to describe the discordance between the self-perceived risk and actual risk of HIV among young men who have sex with men (YMSM) and its associated factors. An online, cross-sectional study was conducted with 405 men recruited from an Argentinian NGO in 2017. Risk discordance (RD) was defined as the expression of the underestimation of risk, that is, as a lower self-perception of HIV risk, as measured with the Perceived Risk of HIV Scale, than the current risk of HIV infection, as measured by the HIV Incidence Risk Index. Multivariate logistic regression models were used to analyze the associations between the RD and the explanatory variables. High HIV risk was detected in 251 (62%), while 106 (26.2%) showed high self-perceived risk. RD was found in 230 (56.8%) YMSM. The predictors that increased RD were consistent condom use with casual partners (aOR = 3.8 [CI 95:1.5-11.0]), the use of Growler to meet partners (aOR = 10.38 [CI 95:161-121.94]), frequenting gay bars (aOR = 1.9 [95% CI:1.1-3.5]) and using LSD (aOR = 5.44 [CI 95:1.32-30.29]). Underestimation of HIV risk in YMSM is associated with standard HIV risk behavior and modulated by psychosocial aspects. Thus, prevention campaigns aimed at YMSM should include these factors, even though clinical practice does not. Health professionals should reconsider adapting their instruments to measure the risk of HIV in YMSM. It is unknown what score should be used for targeting high-risk YMSM, so more research is needed to fill this gap. Further research is needed to assess what score should be used for targeting high-risk in YMSM.
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Infecções por HIV , Minorias Sexuais e de Gênero , Masculino , Humanos , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/psicologia , Comportamento Sexual/psicologia , Estudos Transversais , Argentina/epidemiologiaRESUMO
Gay, bisexual and other men who have sex with men are disproportionately affected by HIV in Guatemala; interpersonal violence may increase behaviours that augment the risk of HIV in this group. Although 44% of Guatemalans identify as Indigenous, little information exists on the experiences of Indigenous sexual minority individuals. In this study, we sought to compare different forms of violence and HIV-related behaviours by Indigenous identity among gay, bisexual and other men who have sex with men; and determine if associations between violence and HIV-related behaviours differed by Indigenous identity. We used cross-sectional survey data from 716 Spanish-speaking, adult men recruited from urban centres to examine the prevalence of and relationship between different forms of interpersonal violence and HIV-related behaviours using logistic regression analyses, including the moderating effect of Indigenous identity. In general, fewer Indigenous participants reported interpersonal violence victimisation and HIV-related behaviours compared to their non-Indigenous counterparts. In weighted multivariable analyses, non-Indigenous participants who reported physical and/or sexual violence were over five times as likely to report transactional sex (OR = 5.17, 95% CI 2.11-12.68, p < 0.001), but the relationship was not significant for Indigenous participants. Findings suggest that Indigenous sexual minority men have unique contexts and that additional strengths-based research is needed to ensure that actions and efforts to promote violence and HIV prevention meet their needs.
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Infecções por HIV , Minorias Sexuais e de Gênero , Infecções Sexualmente Transmissíveis , Adulto , Masculino , Humanos , Homossexualidade Masculina , Estudos Transversais , Guatemala , Assunção de Riscos , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Comportamento Sexual , Infecções Sexualmente Transmissíveis/epidemiologia , ViolênciaRESUMO
Introduction: The presence of metabolic syndrome and cardiovascular risk in HIV positive patients has been overlooked in patients with HIV infection. Objectives: To evaluate the frequency of metabolic syndrome and compare cardiovascular risk stratification according to the Framingham, PROCAM, and SCORE equations in HIV patients. Methodology: A cross-sectional study of 760 HIV-infected adults from January 2016 to December 2018. The presence of metabolic syndrome was assessed using the ATP-III criteria, and the cardiovascular risk score was examined. Results: The most frequent comorbidities were smoking, hypercholesterolemia, and high blood pressure. Student's T test was carried out, showing differences in the classification of low to moderate risk. The number of HIV-infected male patients identified as having moderate cardiovascular risk according to the Framingham risk equation was two folds compared to those with the PROCAM and SCORE systems. Conclusions: This study showed a high prevalence of patients with low cardiovascular risk. It is appropriate to consider cardiovascular risk factors in patients with HIV, since they are very frequently associated with adverse outcomes of this type.
Introducción: La presencia del síndrome metabólico y el riesgo cardiovascular en pacientes VIH positivos ha sido desestimado en pacientes con infección por VIH. Objetivos: Evaluar la frecuencia del síndrome metabólico y comparar la estratificación del riesgo cardiovascular según las ecuaciones de Framingham, PROCAM y SCORE en pacientes con VIH. Metodología: estudio transversal de 760 adultos infectados por el VIH en el periodo enero de 2016-diciembre de 2018. Se evaluó la presencia de síndrome metabólico a través de los criterios del ATP-III y se examinó la puntuación de riesgo cardiovascular. Resultados: Las comorbilidades más frecuentes fueron el tabaquismo, la hipercolesterolemia y la hipertensión arterial. Se realizó la prueba T de Student, y a partir de ella se lograron apreciar diferencias en categorización de riesgo bajo a moderado. El número de pacientes varones infectados por el VIH identificados como de riesgo cardiovascular moderado según la ecuación de riesgo de Framingham fue mayor del doble en comparación con los sistemas PROCAM y SCORE. Conclusiones: El estudio mostró una alta prevalencia de pacientes con bajo riesgo cardiovascular. Es pertinente considerar los factores de riesgo cardiovascular en pacientes con VIH, ya que estos se encuentran frecuentemente asociados con desenlaces adversos de este tipo.
Introdução: A presença da síndrome metabólica e do risco cardiovascular em pacientes HIV positivos tem sido negligenciada em pacientes com infecção por HIV. Objetivos: Avaliar a frequência da síndrome metabólica e comparar a estratificação do risco cardiovascular de acordo com as equações de Framingham, PROCAM e SCORE em pacientes com HIV. Metodologia: estudo transversal de 760 adultos infectados com HIV no período de Janeiro de 2016-Dezembro de 2018. A presença de síndrome metabólica foi avaliada através de critérios ATP-III e a pontuação de risco cardiovascular foi examinada. Resultados: As comorbilidades mais frequentes foram o tabagismo, a hipercolesterolêmia e a hipertensão. Realizou-se o teste T Student, e a partir dele foram apreciadas as diferenças de categorização de risco baixo a moderado. O número de pacientes masculinos infectados com HIV identificados como de risco cardiovascular moderado de acordo com a equação de risco de Framingham foi mais do dobro em comparação com o PROCAM e SCORE. Conclusões: O estudo mostrou uma elevada prevalência de pacientes com baixo risco cardiovascular. É pertinente considerar fatores de risco cardiovascular em pacientes com HIV, uma vez que estes estão frequentemente associados a resultados cardiovasculares adversos.
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HIV , Prevalência , Fatores de Risco , MortalidadeRESUMO
BACKGROUND: Valid and reliable instruments are needed to measure the multiple dimensions of perceived risk. The Perceived Risk of HIV Scale is an 8-item measure that assesses how people think and feel about their risk of infection. We set out to perform a cross-cultural adaptation of the scale to Brazilian Portuguese among key populations (gay, bisexual and other men who have sex with men and transgender/non-binary) and other populations (cisgender heterosexual men and cisgender women). METHODS: Methodological study with cross-sectional design conducted online during October/2019 (key populations [sample 1] and other populations) and February-March/2020 (key populations not on pre-exposure prophylaxis [sample 2]). Cross-cultural adaptation of the Perceived Risk of HIV Scale followed Beaton et al. 2000 guidelines and included confirmatory factor analysis, differential item functioning (DIF) using the Multiple-Indicator Multiple-Cause model, and concurrent validity to verify if younger individuals, those ever testing for HIV, and engaging in high-risk behaviors had higher scores on the scale. RESULTS: 4342 participants from key populations (sample 1 = 235; sample 2 = 4107) and 155 participants from other populations completed the measure. We confirmed the single-factor structure of the original measure (fit indices for sample 1 plus other populations: CFI = 0.98, TLI = 0.98, RMSEA = 0.07; sample 2 plus other populations: CFI = 0.97, TLI = 0.95, RMSEA = 0.09). For the comparisons between key populations and other populations, three items (item 2: "I worry about getting infected with HIV", item 4: "I am sure I will not get infected with HIV", and item 8: "Getting HIV is something I have") exhibited statistically significant DIF. Items 2 and 8 were endorsed at higher levels by key populations and item 4 by other populations. However, the effect of DIF on overall scores was negligible (0.10 and 0.02 standard deviations for the models with other populations plus sample 1 and 2, respectively). Those ever testing for HIV scored higher than those who never tested (p < .001); among key populations, those engaging in high-risk behaviors scored higher than those reporting low-risk. CONCLUSION: The Perceived Risk of HIV Scale can be used among key populations and other populations from Brazil.
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Comparação Transcultural , Etnicidade/psicologia , Infecções por HIV/psicologia , Homossexualidade Masculina/psicologia , Medição de Risco/normas , Minorias Sexuais e de Gênero/psicologia , Inquéritos e Questionários/normas , Pessoas Transgênero/psicologia , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Etnicidade/estatística & dados numéricos , Análise Fatorial , Feminino , Infecções por HIV/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Medição de Risco/métodos , Minorias Sexuais e de Gênero/estatística & dados numéricos , Pessoas Transgênero/estatística & dados numéricos , Adulto JovemRESUMO
In Brazil, pre-exposure prophylaxis (PrEP) is currently available for gay, bisexual, and other men who have sex with men. As PrEP use depends on an individual's perceived risk, we explored pathways by which potentially modifiable behaviors lead to high perceived HIV risk. Using online surveys (N = 16,667), we conducted a path analysis on the basis of ordered sequences of multivariate logistic regressions. High perceived HIV risk was low (26.3%) compared to condomless receptive anal sex (41.4%). While younger age increased the odds of binge drinking and of condomless receptive anal sex, it was associated with decreased odds of high perceived HIV risk. In contrast, use of stimulants increased the odds of condomless receptive anal sex and of high perceived HIV risk. Our results suggest that binge drinking and use of stimulants are key points in different pathways to high-risk sexual behavior and may lead to different perceptions of HIV risk.
RESUMEN: En Brasil, la profilaxis previa a la exposición (PrEP) está disponible actualmente para hombres homosexuales, bisexuales y otros hombres que tienen sexo con hombres. Como el uso de PrEP depende del riesgo percibido de una persona, exploramos vías por las cuales los comportamientos potencialmente modificables conducen a un alto riesgo percibido de VIH. Utilizando datos de encuestas en línea (N = 16.667), realizamos un análisis de ruta sobre la base de secuencias ordenadas de regresiones logísticas multivariadas. El alto riesgo percibido de VIH fue bajo (26,3%) en comparación con el sexo anal receptivo sin condón (41,4%). La edad más joven aumentó las probabilidades de consumo de alcohol en exceso y del sexo anal receptivo sin condón, todavía se asoció con una menor probabilidad de alta percepción de riesgo sobre VIH. Sin embargo, el uso de estimulantes aumentó las probabilidades de tener sexo anal receptivo sin condón y de un alto riesgo percibido de VIH. Nuestros resultados sugieren que el consumo excesivo de alcohol y el uso de estimulantes son puntos clave en diferentes vías de conductas sexuales de alto riesgo y pueden llevar a diferentes percepciones del riesgo de VIH.
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Consumo Excessivo de Bebidas Alcoólicas/epidemiologia , Preservativos/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Adulto , Consumo Excessivo de Bebidas Alcoólicas/complicações , Brasil/epidemiologia , Estudos Transversais , Infecções por HIV/epidemiologia , Homossexualidade Masculina/psicologia , Humanos , Masculino , Profilaxia Pré-Exposição , Comportamento Sexual , Parceiros Sexuais , Transtornos Relacionados ao Uso de Substâncias/epidemiologiaRESUMO
BACKGROUND: A low prevalence of HIV in sickle cell disease (SCD) patients has been reported in the literature though mechanisms for this are not understood. METHODS: HIV risk behaviors were compared between SCD cases and non-SCD controls using a self-administered audio computer-assisted self-interview. SCD cases were recruited from a multi-center SCD cohort established in Brazil; controls were recruited from SCD social contacts. Categorical variables were analyzed using Chi-Square or Fisher exact test. Continuous variables were compared using the Mann-Whitney U test. RESULTS: There were 152 SCD cases and 154 age/location matched controls enrolled at three participating Brazilian centers during 2016-17. No significant differences in number of sexual partners (lifetime or previous 12 months), male-to-male sex partners or intravenous drug use were observed. Cases received more transfusions, surgeries, and acupuncture treatment. CONCLUSIONS: Besides the risk of transfusion-transmitted HIV, which is now exceedingly rare, SCD and non-SCD participants demonstrated similar HIV risk behaviors. Causes other than risk behaviors such as factors inherent to SCD pathophysiology may explain the reported low prevalence of HIV in SCD.
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Anemia Falciforme/epidemiologia , Infecções por HIV/epidemiologia , Comportamentos de Risco à Saúde , Adolescente , Adulto , Idoso , Transfusão de Sangue , Brasil/epidemiologia , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Parceiros Sexuais , Abuso de Substâncias por Via IntravenosaRESUMO
A dearth of empirical research exists on female sex workers in Central America who begin selling sex under age 18. Data were collected from adult female sex workers (N = 1216) sampled using census and modified time-location sampling in three urban centers of Guatemala. In adjusted analyses, female sex workers who entered the sex trade under age 16 years were more likely to be HIV positive (AOR = 4.6, 95% CI 1.6, 13.2), have not received HIV education in their first year of sex trade (AOR = 2.8, 95% CI 1.5, 5.5), have experienced violence to force commercial sex (AOR = 4.6, 95% CI 2.2, 9.8) and have not used condoms in their first month (AOR = 2.8, 95% CI 1.3, 6.1) , relative to those who entered as adults. An interaction between age at entry and foreign migration at entry was found for HIV risk. Efforts to prevent adolescent sex trade entry are needed and may also help to reduce HIV rates in Guatemala.
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Preservativos/estatística & dados numéricos , Infecções por HIV/diagnóstico , Trabalho Sexual/estatística & dados numéricos , Profissionais do Sexo , Adolescente , Adulto , Estudos Transversais , Feminino , Guatemala/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Humanos , Comportamento Sexual , MigrantesRESUMO
Drug use during sex increases risks for HIV acquisition. Male clients of female sex workers (FSW) represent both a key population at risk for HIV as well as a transmission bridge population. In Tijuana, Mexico, drug use is prevalent and there is a need to understand male clients' drug use during sex with FSW. Characteristics of sex work venues may confer higher risks for drug use, risky sex, and HIV/STI. It is essential to understand the venue-related social and structural factors associated with drug use during sex in order to inform HIV prevention interventions with male clients in this region. We used a Mixed-Methods Sequential Explanatory Design to conduct an enriched examination of drug use during sex among male clients of FSW in Tijuana. Findings from logistic regression analysis showed that drug use during sex was significantly correlated with police harassment (AOR = 4.06, p < .001) and methamphetamine use (AOR = 33.77, p < .001). In-depth interview data provided rich meaning behind and context around the quantitative associations. Social and structural interventions to reduce police harassment, methamphetamine use, and promote condom availability are needed to reduce risks for HIV among male clients of FSW in Tijuana.
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Infecções por HIV/transmissão , Trabalho Sexual/estatística & dados numéricos , Profissionais do Sexo , Infecções Sexualmente Transmissíveis/transmissão , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Sexo sem Proteção/psicologia , Adolescente , Adulto , Preservativos , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Masculino , México/epidemiologia , Prevalência , Medição de Risco , Fatores de Risco , Assunção de Riscos , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/psicologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Sexo sem Proteção/estatística & dados numéricos , Adulto JovemRESUMO
BACKGROUND: Brazil has the largest population of individuals living with HIV/AIDS in Latin America, with a disproportional prevalence of infection among gays, bisexuals and other men who have sex with men (MSM). Of relevance to prevention and treatment efforts, Brazilian MSM from different regions may differ in behaviors and risk perception related to HIV. METHODS: We report on MSM living in 29 different cities: 26 Brazilian state capitals, the Federal District and two large cities in São Paulo state assessed in three web-based surveys (2016-2018) advertised on Grindr, Hornet and Facebook. Using logistic regression models, we assessed the association of risk behavior with HIV perceived risk as well as factors associated with high-risk behavior. RESULTS: A total of 16,667 MSM completed the survey. Overall, MSM from the North and Northeast were younger, more black/mixed-black, of lower income and lower education compared to MSM from the South, Southeast and Central-west. Though 17% had never tested for HIV (with higher percentages in the North and Northeast), condomless receptive anal sex (previous 6 months) and high-risk behavior as per HIV Incidence Risk scale for MSM were observed for 41 and 64%, respectively. Sexual behavior and HIV perceived risk had low variability by city and high-risk behavior was strongly associated with high HIV perceived risk. Younger age, being gay/homosexual, having a steady partner, binge drinking, report of sexually transmitted infection (STI) and ever testing for HIV were associated with increased odds of high-risk behavior. Awareness and willingness to use PrEP increased from 2016 to 2018 in most cities. CONCLUSIONS: Overall, MSM socio-demographic characteristics were heterogeneous among Brazilian cities, but similarities were noted among the cities from the same administrative region with a marked exception of the Federal District not following the patterns for the Central-West. Combination HIV prevention is most needed among young men who self-identify as gay/homosexual, report binge drinking or prior STI.
Assuntos
Conscientização , Homossexualidade Masculina , Adesão à Medicação/psicologia , Profilaxia Pré-Exposição , Assunção de Riscos , Comportamento Sexual/psicologia , Minorias Sexuais e de Gênero , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Adolescente , Adulto , Negro ou Afro-Americano , Brasil , Cidades , Estudos Transversais , Humanos , Incidência , Modelos Logísticos , Masculino , Comportamento Sexual/fisiologia , Parceiros Sexuais/psicologia , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: The feminization and ethnic diversification of HIV infection, has resulted in a call for gender- and culture-specific prevention strategies for at-risk groups including Latinos in the United States. The steadily changing demographic profile of the AIDS epidemic challenges prevention strategies to remain relevant and up-to-date, particularly in populations of women midlife and older where an understanding of risk remains under explored. As the CDC requests country-specific HIV risk profiles for Latino communities in the US, understanding the socio-economic, behavioral and personal risk reasons of HIV risk for older Dominican women is critical for prevention. METHODS: We conducted focus group discussions informed by the Theory of Gender and Power (TGP). The three constructs of the TGP: 1) Affective influences/social norms; 2) Gender-specific norms and. 3) Power and Authority guided the thematic analysis and identified themes that described the socio-cultural and contextual reasons that that contribute to perceptions of HIV risk. RESULTS: Sixty Dominican American women ages 57-73 participated in our focus group discussions. Sexual Division of Labour: 1) Economic Dependence; 2) Financial Need and 3) Education and Empowerment. Sexual Division of Power: 4) HIV Risk and 5) Relationship Dynamics. Cathexis: Affective Influences/Social Norms: 6) HIV/AIDS Knowledge and 7) Prevention and Testing. Importantly, participants were concerned about partner fidelity when visiting the Dominican Republic, as the country accounts for the second highest HIV rates in the Caribbean. CONCLUSIONS: Our results confirm previous findings about perceptions of HIV risk and provide additional insight into aging-related aspects of HIV risk for Latino women midlife and older.
Assuntos
Atitude Frente a Saúde/etnologia , Infecções por HIV/etnologia , Infecções por HIV/psicologia , Hispânico ou Latino/psicologia , Idoso , República Dominicana/etnologia , Feminino , Grupos Focais , Hispânico ou Latino/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Medição de Risco , Comportamento Sexual/etnologia , Parceiros Sexuais/psicologia , Estados UnidosRESUMO
BACKGROUND: Research has documented consistent associations between entry into sex work as a minor and sexual HIV risk. However, previous studies have not examined whether substance use and related HIV risk are elevated among those who enter sex work under age 18. METHODS: Quantitative data were collected via time-location sampling of 603 female sex workers (FSWs) ages 18 years and older residing in two Mexico-US border cities. Age of entry into sex work (categorized as 15 years or younger, 16-17 years, or 18 years and older) was assessed as a predictor of substance use (forced and voluntary) within the first month post-entry and recent (past 30 days) substance use with clients. RESULTS: Compared to those who entered as adults, participants who entered sex work at age 15 or younger were significantly more likely to report drug use (AOR = 5.2, CI = 2.9-8.9) and forced drug use within the first 30 days of entry (AOR= 6.0, CI = 1.9-18.9), as well as past month drug use with clients (AOR= 3.4, CI = 1.9-5.8). Similar results were found among participants who entered sex work at age 16-17. CONCLUSIONS: Increased risk of recent substance use with clients indicates continuing elevated risk for those entering sex work at these early ages. Early and forced substance use at entry may underlie the elevated risk of HIV infection consistently observed among this population.
Assuntos
Infecções por HIV/epidemiologia , Profissionais do Sexo , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Fatores Etários , Cidades , Feminino , Humanos , Incidência , Masculino , México/epidemiologia , Fatores de Risco , Trabalho Sexual , Comportamento Sexual , Adulto JovemRESUMO
Syndemics approaches explore the convergence of psychosocial factors that elevate HIV vulnerabilities. Less research has explored syndemics among lesbian, gay, bisexual and transgender (LGBT) persons in contexts where criminalization has downstream impacts on LGBT discrimination, such as Jamaica. We implemented a cross-sectional survey with LGBT persons (n = 911) in Jamaica. We conducted structural equation modeling to examine direct and indirect effects of a latent syndemics construct (binge drinking, depressive symptoms, childhood/adult abuse) on HIV vulnerabilities (lifetime sex partners, perceived HIV risk, condom self-efficacy) and the mediating role of protective factors (social support, resilient coping). Direct paths from syndemics to lifetime sex partners, perceived HIV risk, and condom self-efficacy were significant. Resilient coping and social support partially mediated the association between syndemics and condom use self-efficacy. Resilient coping partially mediated the relationship between syndemics and lifetime sex partners. Interventions can target syndemic issues to reduce HIV vulnerabilities among Jamaican LGBT persons.
Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Fatores de Proteção , Minorias Sexuais e de Gênero/psicologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Sindemia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Resiliência Psicológica , Apoio Social , Adulto JovemRESUMO
BACKGROUND: Bacterial vaginosis (BV) is the most common cause of vaginitis among women worldwide and is associated with increased susceptibility to sexually transmitted infections (STIs), including HIV. We aimed to determine the impact of the HIV risk environment on BV among female sex workers who inject drugs (FSW-PWIDs) in Tijuana and Ciudad Juarez, Mexico. METHODS: We performed a cross-sectional analysis utilizing baseline data from a randomized controlled trial evaluating a behavioral HIV prevention intervention. Participants underwent testing for BV using the OSOM BVBlue® Rapid Test (Genzyme Diagnostics, San Diego, CA) and completed a survey eliciting information on the HIV risk environment, sexual risk behaviors, and substance use. We applied logistic regression to identify correlates of BV in the physical, social, economic, and political HIV risk environments stratified by study site (Ciudad Juarez vs. Tijuana). RESULTS: In total, 584 HIV-negative FSW-PWIDs (300 Ciudad Juarez; 284 Tijuana) were enrolled. The prevalence of BV was 39% (n = 228), which was higher in Ciudad Juarez (56.7%) compared to Tijuana (20.4%). In both cities, micro-level components of the physical HIV risk environment were associated with BV. In Ciudad Juarez, BV was associated with past experiences or threats of physical violence in response to proposed condom use (adjusted odds ratio [aOR] = 3.66, 95% confidence interval [CI]: 1.74-7.69, p = 0.001) and lifetime residence in Ciudad Juarez (aOR = 1.74, 95% CI: 1.05-2.87, p = 0.031). In Tijuana, BV was associated with the number of hours spent on the street daily in the past six months looking for, using, or dealing drugs, engaging in other income generating activities, or sleeping (aOR = 1.05, 95% CI: 1.001-1.097, p = 0.045). CONCLUSIONS: Our findings suggest that FSW-PWIDs' risk of BV may be shaped by the microphysical HIV risk environment. Addressing components of the physical risk environment, including interventions to reduce gender-based violence, may alleviate the burden of BV and subsequent susceptibility to HIV/STIs among FSW-PWIDs in the Mexico/US border region. TRIAL REGISTRATION: National Institute of Health (NIH) Clinical Trials Identifier NCT00840658 , and date of NIH trial registration February 7, 2009.
Assuntos
Infecções por HIV/epidemiologia , Profissionais do Sexo/psicologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Vaginose Bacteriana/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , México/epidemiologia , Prevalência , Fatores de Risco , Profissionais do Sexo/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos/epidemiologiaRESUMO
This study examines the role that duty plays in men's and women's perceptions of HIV-related risk in Mexico, and how gender and migration influence these perceptions. We draw on qualitative data from the 2014 Study of Health and Migration in Mexico (SHMM), which included 24 in-depth interviews with migrant men and non-migrant women living in a medium-sized city in Guanajuato, Mexico. While men report migrating out of responsibility to provide for their families, this sense of duty also had implications for their sexual health behaviours. Duty permeates how residents in this migrant-sending community described their perceptions of HIV risk, with men and women drawing consistently on three aspects of duty: fidelity, gendered sexual expectations, and the burden of HIV prevention. We argue that a strong sense of duty can prompt gender role expansion for migrant men and limit gender role expansion for non-migrant women.
Assuntos
Infecções por HIV , Migrantes , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Entrevistas como Assunto , Masculino , México , Pessoa de Meia-Idade , Pesquisa Qualitativa , Medição de Risco , Fatores SexuaisRESUMO
BACKGROUND: Globally, men who have sex with men (MSM) experience social marginalization and criminalization that increase HIV vulnerability by constraining access to HIV prevention and care. People who sell sex also experience criminalization, rights violations, and violence, which elevate HIV exposure. MSM who sell sex may experience intersectional stigma and intensified social marginalization, yet have largely been overlooked in epidemiological and social HIV research. In Jamaica, where same sex practices and sex work are criminalized, scant research has investigated sex selling among MSM, including associations with HIV vulnerability. OBJECTIVE: We aimed to examine social ecological factors associated with selling sex among MSM in Jamaica, including exchanging sex for money, shelter, food, transportation, or drugs/alcohol (past 12 months). METHODS: We conducted a cross-sectional survey with a peer-driven sample of MSM in Kingston, Ocho Rios, and Montego Bay. Multivariable logistic regression analyses were conducted to estimate intrapersonal/individual, interpersonal/social, and structural factors associated with selling sex. RESULTS: Among 556 MSM, one-third (n = 182; 32.7%) reported selling sex. In the final multivariable model, correlates of selling sex included: individual/intrapersonal (lower safer sex self-efficacy [AOR: 0.85, 95% CI: 0.77, 0.94]), interpersonal/social (concurrent partnerships [AOR: 5.52, 95% CI: 1.56, 19.53], a higher need for social support [AOR: 1.08, 95% CI: 1.03, 1.12], lifetime forced sex [AOR: 2.74, 95% 1.65, 4.55]) and structural-level factors (sexual stigma [AOR: 1.09, 95% CI: 1.04, 1.15], food insecurity [AOR: 2.38, 95% CI: 1.41, 4.02], housing insecurity [AOR: 1.94, 95% CI: 1.16, 3.26], no regular healthcare provider [AOR: 2.72, 95% CI: 1.60, 4.64]). CONCLUSIONS: This study highlights social ecological correlates of selling sex among MSM in Jamaica, in particular elevated stigma and economic insecurity. Findings suggest that MSM in Jamaica who sell sex experience intensified social and structural HIV vulnerabilities that should be addressed in multi-level interventions to promote health and human rights.
Assuntos
Homossexualidade Masculina/psicologia , Trabalho Sexual/psicologia , Meio Social , Adulto , Estudos Transversais , Humanos , Jamaica , Masculino , Estigma Social , Apoio Social , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto JovemRESUMO
INTRODUCTION AND AIMS: Patterns of polydrug use among people who inject drugs (PWID) may be differentially associated with overdose and unique human immunodeficiency virus (HIV) risk factors. Subgroups of PWID in Tijuana, Mexico, were identified based on substances used, route of administration, frequency of use and co-injection indicators. DESIGN AND METHODS: Participants were PWID residing in Tijuana age ≥18 years sampled from 2011 to 2012 who reported injecting an illicit substance in the past month (n = 735). Latent class analysis identified discrete classes of polydrug use characterised by 11 indicators of past 6 months substance use. Multinomial logistic regression examined class membership association with HIV risk behaviours, overdose and other covariates using an automated three-step procedure in mplus to account for classification error. RESULTS: Participants were classified into five subgroups. Two polydrug and polyroute classes were defined by use of multiple substances through several routes of administration and were primarily distinguished from each other by cocaine use (class 1: 5%) or no cocaine use (class 2: 29%). The other classes consisted primarily of injectors: cocaine, methamphetamine and heroin injection (class 3: 4%); methamphetamine and heroin injection (class 4: 10%); and heroin injection (class 5: 52%). Compared with the heroin-only injection class, memberships in the two polydrug and polyroute use classes were independently associated with both HIV injection and sexual risk behaviours. DISCUSSION AND CONCLUSIONS: Substance use patterns among PWID in Tijuana are highly heterogeneous, and polydrug and polyroute users are a high-risk subgroup who may require more tailored prevention and treatment interventions. [Meacham MC, Roesch SC, Strathdee SA, Lindsay S, Gonzalez-Zuniga P, Gaines TL. Latent classes of polydrug and polyroute use and associations with human immunodeficiency virus risk behaviours and overdose among people who inject drugs in Tijuana, Baja California, Mexico. Drug Alcohol Rev 2018;37:128-136].