Publications by authors named "Willi McFarland"

305 Publications

Nonprescribed Sex Hormone Use Among Trans Women: The Complex Interplay of Public Policies, Social Context, and Discrimination.

Transgend Health 2020 Dec 11;5(4):205-215. Epub 2020 Dec 11.

Departamento de Saúde Coletiva, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil.

Trans women are systematically excluded from basic human rights, possibly due to social contexts of transphobia. In health care, such barriers may result in nonprescribed sex hormone use and lead to significant health complications. As few studies investigated this phenomenon, we analyzed factors associated with nonprescribed sex hormone use by trans women in seven municipalities of São Paulo, Brazil. Muriel was a cross-sectional study (2014/2015), in which 673 transgender people answered a face-to-face survey. This analysis focused on trans women (=616). Poisson regression models were used to assess factors associated with nonprescribed sex hormone use. A direct acyclic graph was built with knowledge on the matter and was used for covariate selection. A total of 90.7% of participants reported ever taking sex hormones. Most of those detailed nonprescribed use, which was associated with sex work, starting to use hormones before 18, identifying as and lower education. Having the chosen name honored in public health services was found to be protective against this outcome. A high proportion of nonprescribed sex hormone use was observed in our sample. Our findings suggest barriers to health care and the need for trans women to resort to medically unsupervised transition procedures. Among sex workers, this may also be due to higher economic and access needs than other groups. Ensuring social rights and providing adequate health care services may lessen nonprescribed sex hormone use, preventing subsequent risks and resulting in better health outcomes for trans women.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/trgh.2020.0012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906234PMC
December 2020

Homelessness, HIV testing, and the reach of public health efforts for people who inject drugs, San Francisco, California.

Drug Alcohol Depend 2021 Feb 9;221:108560. Epub 2021 Feb 9.

Department of Psychology, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19122, United States.

Background: There is a dearth of literature that explicitly examines associations between housing and HIV testing among people who inject drugs (PWID). Thus, the present study investigated the links between housing status and HIV testing for PWID.

Methods: Respondent-driven sampling recruited 382 HIV-negative PWID, who completed structured interviews in San Francisco. Logistic regression determined whether housing statuses in the past 12 months ([1] owned/rented, [2] single-room occupancy hotels [SROs], [3] living with friends/family/partners, [4] shelters, [5] outdoors) were associated with getting HIV tested in the past 12 months while adjusting for sociodemographics and receptive sharing of injection paraphernalia in the past 12 months.

Results: PWID who lived in SROs had greater odds of being tested for HIV than PWID who did not live in SROs (aOR = 1.95, CI: 1.06-3.60) while adjusting for covariates. Although bivariable analyses indicated that receptively sharing syringes was more common for PWID who lived with others (χ[3] = 7.94, p = 0.047) or lived outdoors (χ[3] = 9.50, p = 0.023) than those who did not, respectively, PWID who lived with others (aOR = 1.72, CI = 0.95-3.14) or lived outdoors (aOR = 1.37, CI = 0.74-2.53) did not show greater odds of HIV testing in multivariable analyses.

Conclusions: PWID who lived in SROs had greater odds of HIV testing than PWID who did not live in SROs. Although PWID who lived with others or outdoors showed greater HIV risk, they did not show greater odds of HIV testing. Public health efforts may be reaching PWID in SROs, but more work is needed to reach PWID who live with other people or outdoors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.drugalcdep.2021.108560DOI Listing
February 2021

HIV Prevention Responsibility Beliefs Among Men Who Have Sex with Men in the PrEP Era.

J Acquir Immune Defic Syndr 2021 Feb 12. Epub 2021 Feb 12.

University of California, San Francisco, CA, USA San Francisco Department of Public Health, San Francisco, CA, USA.

Background: Beliefs regarding responsibility for preventing HIV transmission may differ between individuals and their sexual partners. We assessed HIV prevention responsibility beliefs among men who have sex with men (MSM) participating in the 2017 National HIV Behavioral Surveillance survey.

Methods: MSM were recruited using time-location sampling at clubs, bars and street locations in San Francisco. HIV prevention responsibility beliefs were assessed on a four-point scale (1=strongly disagree to 4=strongly agree). Associations were assessed using generalizing estimating equations to adjust for behaviors within multiple partnerships.

Results: A total of 316 HIV-negative men and 76 HIV-positive men reported on 1,336 partnerships. HIV-negative compared to HIV-positive men had higher endorsement of mutual responsibility (mean 3.7 vs. 3.5; p<0.01). Both groups had similar levels of endorsing responsibility on the HIV-negative or HIV-positive partner. HIV-positive men endorsing equal responsibility were more likely to know their partner's HIV status (p<0.01) and less likely to have serodiscordant condomless anal intercourse (CAI) (p<0.01) than men who did not endorse equal responsibility. HIV-negative men in partnerships with pre-exposure prophylaxis (PrEP) use were more likely to know their partner's HIV status (p=0.02) and have serodiscordant CAI (p=0.04) than men not in partnerships with PrEP use.

Conclusions: HIV-negative and HIV-positive men accept responsibility for preventing HIV. The finding that HIV-negative men in partnerships with PrEP use who engage in serodiscordant CAI is concerning because they are still at risk for other sexually transmitted infections, which are presently at elevated levels in San Francisco and other U.S. cities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/QAI.0000000000002659DOI Listing
February 2021

The Prevalence of HIV Among Men Who Have Sex With Men (MSM) and Young MSM in Latin America and the Caribbean: A Systematic Review.

AIDS Behav 2021 Feb 15. Epub 2021 Feb 15.

Department of Public Health, San Francisco, CA, USA.

Young men who have sex with men (YMSM) under 25 years old are among the few populations with increasing numbers of new HIV infections in parts of the world where HIV incidence is declining overall. In this systematic review, we synthesize the literature on HIV prevalence among MSM in Latin America and the Caribbean focusing on YMSM. Results were stratified according to study population sampling method used (probability and non-probability based). Forty-seven studies from 17 countries were published in the last 10 years. Among studies using probability-based sampling method (N = 21), HIV prevalence among MSM ranged from 1.2 to 32.6%. HIV prevalence tended to increase over time in studies sampling at different time points. HIV prevalence among YMSM exceeded 5.0% in more than a half of studies (51%; N = 22/43). Our review corroborates the high and potentially rising incidence of HIV among YMSM and characterizes the region's greatest challenge to ending the epidemic.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10461-021-03180-5DOI Listing
February 2021

Awareness and uptake of pre-exposure prophylaxis for HIV among low-income, HIV-negative heterosexuals in San Francisco.

Int J STD AIDS 2021 Feb 3:956462420986663. Epub 2021 Feb 3.

7152San Francisco Department of Public Health, Center for Public Health Research, San Francisco, CA, USA.

We examined pre-exposure prophylaxis (PrEP) awareness and uptake among low-income heterosexual men and women in San Francisco in 2019. Of 294 HIV-negative survey participants, 42.5% were aware of PrEP. Few women (12.5%) and men (8.9%) had discussed PrEP with a healthcare provider; 3.8% of women and 0% of men had used PrEP in the last year. White participants (adjusted odds ratio (aOR) 5.39, 95% CI 1.02, 28.56), women (aOR 2.19, 95% CI 1.30, 3.70), and age 60 years or above (aOR 4.00, 95% CI 1.12, 14.34) had greater odds of being aware of PrEP. Testing for HIV or sexually transmitted infection in the past year was marginally associated with a greater PrEP awareness. Our findings reveal gaps in PrEP implementation associated with social disparities among low-income heterosexuals. Testing services and targeted promotional and educational materials are needed lest high-risk, low-income populations are left behind in San Francisco's aggressive "Getting to Zero" efforts.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0956462420986663DOI Listing
February 2021

Intercategorical and Intracategorical Experiences of Discrimination and HIV Prevalence Among Transgender Women in San Francisco, CA: A Quantitative Intersectionality Analysis.

Am J Public Health 2021 Mar 21;111(3):446-456. Epub 2021 Jan 21.

Paul Wesson, Eric Vittinghoff, and Caitlin Turner are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Sean Arayasirikul, Willi McFarland, and Erin Wilson are with the Center for Public Health Research, San Francisco Department of Public Health.

To examine differences in HIV prevalence and experiences of discrimination within the trans women community in California's San Francisco Bay Area. Intersectional positions were constructed on the basis of race/ethnicity (non-Hispanic White, non-Hispanic Black, Latina) and gender identity (female identifying, transgender identifying). We used baseline data from the Trans*National study (2016-2017) to construct regression models that estimated racial/ethnic differences in the attribution of discrimination experienced and, along with surrogate measures for intersectionality, estimated risk among those who were dually marginalized (racial/ethnic minority and transgender identifying). Margins plots were used to visually compare absolute risk across all intersectional positions. Black and Latina trans women were more likely to be HIV positive than non-Hispanic White trans women. In several of the study domains, we estimated a lower risk of reporting discrimination among dually marginalized trans women than among White female-identifying trans women. Quantitative intersectionality methods highlight the diversity of experiences within the trans women community and reveal potential measurement challenges. Despite facing multiple forms of systemic marginalization, racial/ethnic minority trans women report less discrimination than White trans women. Subjective reporting of discrimination likely undercounts risks among racial/ethnic minorities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2105/AJPH.2020.306055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7893335PMC
March 2021

Prevalence and Correlates of Nonprescription Hormone Use Among Trans Women in São Paulo, Brazil.

LGBT Health 2021 Jan 13. Epub 2021 Jan 13.

Department of Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil.

The purpose of this study was to determine the prevalence and correlates of nonprescription hormone use among Brazilian trans women. This study is a cross-sectional survey of trans women in São Paulo, Brazil, recruited by respondent-driven sampling in 2017-2019. Of 790 trans women, 36.8% were taking nonprescribed hormones. Nonprescribed hormone use was higher with younger age, lower education, homelessness, and using estrogen plus progesterone. Lower use was associated with accessing health care and having trans-specific health needs met. Marginalized Brazilian trans women exhibit high use of nonprescription hormones, which may have health consequences and requires further examination and research.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/lgbt.2020.0059DOI Listing
January 2021

Unsafe Injection Is Associated with Higher HIV Testing after Bayesian Adjustment for Unmeasured Confounding.

Arch Iran Med 2020 12 1;23(12):848-855. Epub 2020 Dec 1.

Department of Internal Medicine, Division of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico Health Sciences Center.

Background: To apply a novel method to adjust for HIV knowledge as an unmeasured confounder for the effect of unsafe injection on future HIV testing.

Methods: The data were collected from 601 HIV-negative persons who inject drugs (PWID) from a cohort in San Francisco. The panel-data generalized estimating equations (GEE) technique was used to estimate the adjusted risk ratio (RR) for the effect of unsafe injection on not being tested (NBT) for HIV. Expert opinion quantified the bias parameters to adjust for insufficient knowledge about HIV transmission as an unmeasured confounder using Bayesian bias analysis.

Results: Expert opinion estimated that 2.5%-40.0% of PWID with unsafe injection had insufficient HIV knowledge; whereas 1.0%-20.0% who practiced safe injection had insufficient knowledge. Experts also estimated the RR for the association between insufficient knowledge and NBT for HIV as 1.1-5.0. The RR estimate for the association between unsafe injection and NBT for HIV, adjusted for measured confounders, was 0.96 (95% confidence interval: 0.89,1.03). However, the RR estimate decreased to 0.82 (95% credible interval: 0.64, 0.99) after adjusting for insufficient knowledge as an unmeasured confounder.

Conclusion: Our Bayesian approach that uses expert opinion to adjust for unmeasured confounders revealed that PWID who practice unsafe injection are more likely to be tested for HIV - an association that was not seen by conventional analysis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.34172/aim.2020.113DOI Listing
December 2020

Non-B variants of HIV-1 in San Francisco, California.

Infect Genet Evol 2020 Dec 12:104677. Epub 2020 Dec 12.

Department of Medicine, University of California, San Francisco, CA 94158, USA. Electronic address:

The HIV-1 epidemic in the US has historically been dominated by subtype B. HIV subtype diversity has not been extensively examined in most US cities to determine whether non-B variants have become established, as has been observed in many other global regions. We describe the diversity of non-B variants and present evidence of local transmission of non-B HIV in San Francisco. Viral sequences collected from patients between 2000 and 2016 were matched to the San Francisco HIV/AIDS case registry. HIV subtype was determined using COMET. Phylogenies were reconstructed using the pol region of subtypes A, C, D, G, CRF01_AE, CRF02_AG, and CRF07_BC, with reference sequences from the LANL HIV database. Associations of non-B subtypes and circulating recombinant forms (CRFs) with patient characteristics were assessed using multivariable logistic regression. Out of 11,381 sequences, 10,669 were from 7235 registry cases, of which 141 (2%) had non-B subtypes and CRFs and 72 (1%) had unique recombinant forms. CRF01_AE (0.8%) and subtype C (0.5%) were the most prevalent non-B forms. The frequency of non-B subtypes and CRFs increased in San Francisco during years 2000-2016. Out of 146 transmission events involving non-B study sequences, 18% indicated local transmission within the study population and 74% appeared to be inward migration of the virus. Compared to 7016 cases with only subtype B, 141 cases with non-B sequences were more likely to be of non-US country of birth (aOR = 11.02; p < 0.001), of Asian/Pacific-Islander race/ethnicity (aOR = 3.17; p < 0.001), and diagnosed after 2009 (aOR = 4.81; p < 0.001). Results suggest that most non-B infections were likely acquired outside the US and that local transmission of non-B forms has occurred but so far has not produced extensive transmission networks. Thus, non-B variants were not widely established in San Francisco, an observation that differs from cities worldwide with more diverse epidemics.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.meegid.2020.104677DOI Listing
December 2020

HIV in Iran: onset, responses, and future directions.

AIDS 2021 Mar;35(4):529-542

Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, USA.

Iran, a country in the Middle East and North Africa (MENA) region, has been actively involved in the fight against HIV/AIDS over the past three decades. The unique features of the HIV epidemic in Iran are reflected by the modes of transmission and its recent changes to improve management and prevention programs. In this review, we recount the initial onset and subsequent spread of HIV infection in Iran, beginning with the first case diagnosed to the ongoing responses and most recent achievements in controlling this epidemic. Although in the MENA region, Iran is one of the pioneers in implementing pertinent policies including harm reduction services to decrease HIV incidence, drug injection still continues to be the major risk of infection. In line with other nations, the programs in Iran aim at the UNAIDS 90-90-90 targets (UNAIDS 90-90-90 global targets to end the AIDS epidemic by 2020: by 2020, 90% of all people living with HIV will know their HIV status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and 90% of all people receiving antiretroviral therapy will have viral suppression) and to eliminate mother-to-child HIV transmission. In this article, we discuss the strengths and shortcomings of the current HIV programs and offer suggestions to provide a better perspective to track and respond to the HIV epidemic. More generally, our account of the national religious and cultural circumstances as well as obstacles to the approaches chosen can provide insights for decision-makers in other countries and institutions with comparable settings and infrastructures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/QAD.0000000000002757DOI Listing
March 2021

Changing trends in the types of drug used and infectious disease prevalence among drug users in jiangsu province, china.

Int J Drug Policy 2020 Nov 21;88:103034. Epub 2020 Nov 21.

Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 710, San Francisco, California, USA.

Background: In recent years, a boom of synthetic drugs, especially methamphetamine has been documented in China, however, the situation in Jiangsu was unclear. The objective of this study was to evaluate the changing trends in types of drug used, examine the prevalence trends of HIV, syphilis and HCV over time and compare the demographic, drug and sexual behaviors among different types of people who use drugs (PWD) in Jiangsu Province, China.

Methods: Consecutive cross-sectional studies were conducted from 2011 to 2015 in nine compulsory detoxification centers, which were HIV sentinel surveillance sites, in Jiangsu Province, China. A structured questionnaire was administered in a face-to-face interview with each participant to collect demographic, behavioral and laboratory information. Participants were classified into three types: opioids PWD (using heroin, opium, morphine and dolantin); stimulant PWD (using cocaine, methamphetamine, methylene dioxymetham-phetamine and Magu); poly-drug PWD (using opioids and stimulant drugs simultaneously).

Results: Among a total of 16,164 PWD recruited from 2011 to 2015, the proportion of opioids PWD declined from 40.1% in 2011 to 11.8% in 2015, while the proportion of stimulant PWD increased from 53.6% to 84.3%. Overall HIV, syphilis, and HCV prevalence for the period was 0.3%, 9.6% and 31.6%, respectively. As types of drugs used shifted from opioids to stimulants, HIV prevalence increased (P = 0.031) while HCV decreased (P<0.001). HIV, syphilis and HCV prevalence trends varied across the three subgroups. Injection and needle-sharing behaviors differed between opioids and stimulant PWD, whereas unsafe sexual behaviors were similar. Poly-drug PWD might have higher risks for these infections due to combinations of unsafe sexual and injection behaviors.

Conclusion: Although the trend of drugs used have changed over time, HIV, syphilis and HCV infection risk behaviors among PWD still exist. Therefore, traditional intervention strategies should seek to address the challenge of increasing stimulant PWD. Access to convenient testing services, as well as pre- and post-exposure prophylaxis for HIV risk reduction should be improved among PWD. Antiviral treatment for HCV should be added to medical insurance coverage as soon as possible in Jiangsu Province.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.drugpo.2020.103034DOI Listing
November 2020

Impact of Mass Screening on the Number of Confirmed Cases, Recovered Cases, and Deaths Due to COVID-19 in Iran: An Interrupted Time Series Analysis.

Arch Iran Med 2020 11 1;23(11):776-781. Epub 2020 Nov 1.

HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

Background: Mass screening for the coronavirus disease 2019 (COVID-19) began in Iran on March 23, 2020, with the purpose of improving early detection of patients for their own health and to prevent onward transmission to others. In this study, we evaluated the impact of the change towards mass screening on new cases reported, cases recovered, and deaths due to COVID-19.

Methods: This study analyzed the daily reports on the number of new cases confirmed by polymerase chain reaction (PCR) testing, cases recovered, and deaths due to COVID-19 provided to the Ministry of Health and Medical Education of Iran. Changes in trends on these outcomes were evaluated using interrupted time series analysis.

Results: From February 19 to May 6, 2020, a total of 519544 COVID-19 tests were done and 101650 diagnoses were made (case/ test ratio 19.6%). For the same period, 6418 deaths due to COVID-19 were reported (case fatality ratio 6.3%). The number of cases detected increased significantly over the period of scale-up of mass screening (=0.003), as did the number of recovered cases (=0.001). The number of deaths due to COVID-19 did not change before versus after mass screening.

Conclusion: Following the scale-up of mass screening for COVID-19 in Iran, the rate of new cases detected and reported recovered accelerated significantly. Mass screening is likely to have detected many mild and asymptomatic cases that were infectious. Our data support the role that mass screening, coupled with isolation and contract tracing, can have in slowing the COVID-19 epidemic.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.34172/aim.2020.103DOI Listing
November 2020

High HIV prevalence among transgender women in Paraguay.

Int J STD AIDS 2020 Nov 22;31(13):1308-1314. Epub 2020 Oct 22.

Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, USA.

Transgender women have been understudied and underserved in Paraguay; data are urgently needed to understand their HIV prevention and care needs. To estimate HIV prevalence and related risk and preventive behaviors among trans women in Paraguay, we conducted a cross-sectional survey in 2017. We employed starfish sampling - a hybrid venue-based and peer-referral method combining recruitment at randomly sampled venues and randomly selected clients from program lists, followed by short-chain referrals of eligible peers. Among 304 trans women enrolled, HIV prevalence was 24.8% (95% confidence interval [CI] 18.5-31.2%), with risk increasing with age (adjusted odds ratio [AOR] 1.06 per year, 95% CI 1.03-1.10), residence in Asunción department (AOR 4.75, 95% CI 1.57-14.36), and cocaine use (AOR 2.09, 95% CI 1.11-3.95). Trans women in Paraguay need to be prioritized for interventions with high HIV prevention efficacy. Substance use interventions to address cocaine use may also yield prevention benefits for trans women in our context.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0956462420945550DOI Listing
November 2020

High HIV prevalence among transgender women in Paraguay.

Int J STD AIDS 2020 Nov 22;31(13):1308-1314. Epub 2020 Oct 22.

Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, USA.

Transgender women have been understudied and underserved in Paraguay; data are urgently needed to understand their HIV prevention and care needs. To estimate HIV prevalence and related risk and preventive behaviors among trans women in Paraguay, we conducted a cross-sectional survey in 2017. We employed starfish sampling - a hybrid venue-based and peer-referral method combining recruitment at randomly sampled venues and randomly selected clients from program lists, followed by short-chain referrals of eligible peers. Among 304 trans women enrolled, HIV prevalence was 24.8% (95% confidence interval [CI] 18.5-31.2%), with risk increasing with age (adjusted odds ratio [AOR] 1.06 per year, 95% CI 1.03-1.10), residence in Asunción department (AOR 4.75, 95% CI 1.57-14.36), and cocaine use (AOR 2.09, 95% CI 1.11-3.95). Trans women in Paraguay need to be prioritized for interventions with high HIV prevention efficacy. Substance use interventions to address cocaine use may also yield prevention benefits for trans women in our context.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0956462420945550DOI Listing
November 2020

Awareness and Willingness to use HIV Pre-exposure Prophylaxis (PrEP) Among Trans Women in China: A Community-Based Survey.

AIDS Behav 2021 Mar 28;25(3):866-874. Epub 2020 Sep 28.

Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 710, San Francisco, CA, 94102-6033, USA.

China's national guidelines call for increasing HIV pre-exposure prophylaxis (PrEP) use to reverse the epidemic in populations at highest risk. However, few data exist on PrEP awareness and willingness among trans women in China. Our research aim was to fill this data gap through a cross-sectional survey among trans women in Nanjing and Suzhou cities of Jiangsu province. Respondent-driven sampling (RDS) was used to recruit participants to gauge their awareness of and willingness to use PrEP. Logistic regression analysis was used to characterize associations with awareness of PrEP and willingness to use PrEP. Of 222 HIV-negative/unknown serostatus trans women, 33.3% were aware of PrEP and 49.1% were willing to use PrEP. PrEP awareness was associated with a university degree or above (adjusted odds ratio [AOR] 2.77, 95% CI 1.31-5.89) and not using alcohol with sex (AOR 2.02, 95% CI 1.00-4.09). Willingness to use PrEP was higher among trans women with one (AOR 3.56, 95% CI 1.68-7.54) or multiple sexual partners (AOR 2.53, 95% CI 1.24-5.15) compared to those with no partners. This study witnessed low awareness of PrEP, yet substantial willingness to use PrEP. Implementation research to identify ways to promote, scale up access, and assess effectiveness of PrEP for trans women is urgently needed in China.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10461-020-03050-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886947PMC
March 2021

HIV Prevalence, Risk Factors for Infection, and Uptake of Prevention, Testing, and Treatment among Female Sex Workers in Namibia.

J Epidemiol Glob Health 2020 12 19;10(4):351-358. Epub 2020 Jun 19.

Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Windhoek, Namibia.

Background: In most settings, Female Sex Workers (FSW) bear a disproportionate burden of Human Immunodeficiency Virus (HIV) disease worldwide. Representative data to inform the development of behavioral and biomedical interventions for FSW in Namibia have not been published.

Objectives: Our objectives were to measure HIV prevalence, identify risk factors for infection, and describe uptake of prevention, testing, and treatment among FSW in Namibia.

Methods: We conducted cross-sectional surveys using Respondent-driven Sampling (RDS) in the Namibian cities of Katima Mulilo, Oshikango, Swakopmund/Walvis Bay, and Windhoek. Participating FSW completed behavioral questionnaires and rapid HIV testing.

Results: City-specific ranges of key indicators were: HIV prevalence (31.0-52.3%), reached by prevention programs in the past 12 months (46.9-73.6%), condom use at last sex with commercial (82.1-91.1%) and non-commercial (87.0-94.2%) partners, and tested for HIV within past 12 months or already aware of HIV-positive serostatus (56.9-82.1%). Factors associated with HIV infection varied by site and included: older age, having multiple commercial or non-commercial sex partners, unemployment, being currently out of school, and lower education level. Among HIV-positive FSW, 57.1% were aware of their HIV-positive serostatus and 33.7% were on antiretroviral treatment.

Discussion: Our results indicate extremely high HIV prevalence and low levels of case identification and treatment among FSW in Namibia. Our results, which are the first representative community-based estimates among FSW in Namibia, can inform the scale-up of interventions to reduce the risk for HIV acquisition and onward transmission, including treatment as prevention and pre-exposure prophylaxis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2991/jegh.k.200603.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758860PMC
December 2020

Sex-seeking mobile application use and risk behavior among men who have sex with men in Brazil.

Int J STD AIDS 2020 Oct 11;31(12):1161-1168. Epub 2020 Sep 11.

Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP USP), Ribeirão Preto, Brazil.

This is a cross-sectional study based on an open web survey with the primary objective to assess associations between the use of apps for seeking sex partners and vulnerabilities related to human immunodeficiency virus (HIV) acquisition among men who have sex with men (MSM) in Brazil. Participants were recruited to the study through ads posted in social media such as Twitter, Facebook, and WhatsApp. Consenting respondents completed a questionnaire on demographics, history of sexually transmitted infections (STIs), and risk behaviors and perceptions, including calculation of the Risk Behavior Score for HIV infection proposed by Rocha et al. Among the 859 participants, 714 (83.1%) reported they used apps for seeking sex partners. Use of apps for seeking sex partners was associated with high-risk behavior for HIV infection, self-reported syphilis, self-perception of HIV risk, and use of marijuana. The use of apps for seeking sex partners has rapidly become the norm for MSM in Brazil. The associations with STIs and risk behaviors should be seen as an opening to improve public health, presenting opportunities to promote knowledge, safer sex practices, and referral to HIV/STI screening and prevention interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0956462420945940DOI Listing
October 2020

Syphilis Testing Among Female Prisoners in Brazil: Results of a National Cross-sectional Survey.

J Assoc Nurses AIDS Care 2021 Mar-Apr 01;32(2):140-150

Rosane da Silva Santana, RN, MS (Adult and Child Health), is a PhD Student, Department of Community Health, Federal University of Ceará, Fortaleza, Ceará, Brazil. Ligia Kerr, MD, PhD, is a Professor, Department of Community Health, Federal University of Ceará, Fortaleza, Ceará, Brazil. Rosa Maria Salani Mota, MD, PhD, is a Professor, Department of Statistics and Applied Mathematics, Federal University of Ceará, Fortaleza, Ceará, Brazil. Carl Kendall, PhD, is a Professor, Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, USA. Roberto da Justa Neto, MD, PhD, is an Associate Professor, Department of Physiotherapy, Federal University of Ceará, Fortaleza, Ceará, Brazil. Hermelinda Maia Macena, RN, PhD, is a Professor, Department of Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil. David Seal, PhD, is a Professor, Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, USA. Alvaro Francisco Lopes Sousa, RN, PhD, is a Postdoctoral Fellow, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil, and Research in Global Health and Tropical Medicine (GHMT), Instituto de Higiene e Medicina Tropical, Lisboa, Portugal. Willi McFarland, MD, PhD, is a Professor, Global Health Sciences, University of California, San Francisco, USA.

Abstract: Brazil has the third largest prison population in the world and is also experiencing a high and rising rate of syphilis infection. To establish the gaps in syphilis testing, we examined data from a nationally representative sample of incarcerated women in Brazil. Data originated from a cross-sectional survey designed to represent all regions of Brazil (N = 1,327). Data were collected by Audio Computer-Assisted Self-Interview, including variables in several blocks or domains. 49.2% had a lifetime history of being tested for syphilis. Increased likelihood of syphilis testing was significantly associated with completed elementary education (odds ratio ajustado [AOR] 1.75, 95% confidence interval [CI] 1.28-2.40), completed high school or more (AOR 2.04, 95% CI 1.36-3.06), income below minimum wage (AOR 1.46, 95% CI 1.10-1.94), homelessness (AOR 1.83, 95% CI 1.21-2.76), having heard of the female condom (AOR 1.92, 95% CI 1.25-2.95), received a condom in prison (AOR 1.56, 95% CI 1.11-2.21) or in public health services (AOR 1.50, 95% CI 1.13-1.98), lifetime history of pregnancy (AOR 2.55, 95% CI 1.67-3.89), had a gynecological examination (AOR 1.73, 95% CI 1.05-2.83), and perceived they had some chance (AOR 1.61, 95% CI 1.17-2.20) or a big chance (AOR 1.89, 95% CI 1.31-2.73) that they were likely to have been infected with HIV before entering prison.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JNC.0000000000000203DOI Listing
September 2020

Barriers and motivators to participation and retention in HIV/HCV cohort studies among people who inject drugs: a community consultation in Iran.

Subst Abuse Treat Prev Policy 2020 08 5;15(1):56. Epub 2020 Aug 5.

Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.

Background: The lack of robust estimates of HIV/HCV incidence among people who inject drugs (PWID) in Iran calls for well-designed prospective cohort studies. Successful recruitment and follow-up of PWID in cohort studies may require formative assessment of barriers PWID are faced with in participation and retention in cohort studies and factors they think may facilitate their engagement in such studies. Using a focus group discussion (FGD) format, we conducted a consultation with PWID in southeast Iran to recognize those barriers and motivators.

Methods: Using targeted sampling and through snowball referrals, we recruited PWID (aged≥18, injected in last 6 months) from community-based drop-in centers (DICs), homeless shelters, and through outreach efforts to participate in four FGDs (one women-only). Socio-demographic characteristics, injection behaviors and self-reported HCV/HIV testing and diagnosis history were obtained. Then, a semi-structured FGD guide was applied to explore barriers and motivators to participation and retention in cohort studies among study participants. All FGD sessions were recorded and transcribed verbatim, removing any identifying information. The content of FGDs were analyzed by thematic analysis using an inductive approach.

Results: In total, 30 individuals (10 women) participated in the study. The median age of participants was 35 (IQR 31-40), with majority (73.3%) reporting injecting drug use within the last month. Only 40.0% reported ever being tested for HCV whereas a larger proportion (63.4%) reported ever being tested for HIV. While the majority were willing to participate in cohort studies, breach of confidentiality, fear of positive test results, perceived required commitment, and marginalization were reported as barriers to participation and retention in such studies. Monetary incentive, the thought of a better life, protection from police interventions and trust between health workers and PWID were addressed as motivators of engagement in cohort studies among PWID.

Conclusions: Strategies to enhance data security and reduce stigma associated with injecting drug use along with involving peer workers in research, providing pre and post-test counselling and education and addressing the needs of more marginalized groups potentially through integrated healthcare programs and housing support are among few approaches that may help address barriers and strengthen the motivators for successful cohort studies among this population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13011-020-00298-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405425PMC
August 2020

COVID-19 Among People Living with HIV: A Systematic Review.

AIDS Behav 2021 Jan;25(1):85-92

HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

This systematic review summarizes the evidence on the earliest patients with COVID-19-HIV co-infection. We searched PubMed, Scopus, Web of Science, Embase, preprint databases, and Google Scholar from December 01, 2019, to June 1, 2020. From an initial 547 publications and 75 reports, 25 studies provided specific information on COVID-19 patients living with HIV. Studies described 252 patients, 80.9% were male, the mean age was 52.7 years, and 98% were on antiretroviral treatment (ART). Co-morbidities in addition to HIV and COVID-19 (multimorbidity) included hypertension (39.3%), obesity or hyperlipidemia (19.3%), chronic obstructive pulmonary disease (18.0%), and diabetes (17.2%). Two-thirds (66.5%) had mild to moderate symptoms, the most common being fever (74.0%) and cough (58.3%). Among patients who died, the majority (90.5%) were over 50 years old, male (85.7%), and had multimorbidity (64.3%). Our findings highlight the importance of identifying co-infections, addressing co-morbidities, and ensuring a secure supply of ART for PLHIV during the COVID-19 pandemic.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10461-020-02983-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7391049PMC
January 2021

HIV antiretroviral therapy and prevention use in US blood donors: a new blood safety concern.

Blood 2020 Sep;136(11):1351-1358

Vitalant Research Institute, San Francisco, CA.

Antiretroviral therapy (ART) to treat and pre-exposure prophylaxis (PrEP) to prevent HIV infection are effective tools to help end the HIV epidemic. However, their use could affect HIV transfusion-transmission risk. Three different ART/PrEP prevalence analyses in blood donors were conducted. First, blood samples from HIV-positive and a comparison group of infection-nonreactive donors were tested under blind using liquid chromatography-tandem mass spectrometry for ART. Second, blood donor samples from infection-nonreactive, 18- to 45-year-old, male, first-time blood donors in 6 US locations were tested for emtricitabine and tenofovir. Third, in men who have sex with men (MSM) participating in the 2017 Centers for Disease Control and Prevention National HIV Behavioral Surveillance (NHBS) from 5 US cities, self-reported PrEP use proximate to donation was assessed. In blind testing, no ART was detected in 300 infection-nonreactive donor samples, but in 299 HIV confirmed-infected donor samples, 46 (15.4%; 95% confidence interval [CI], 11.5% to 20.0%) had evidence of ART. Of the 1494 samples tested from first-time male donors, 9 (0.6%; 95% CI, 0.03% to 1.1%) had tenofovir and emtricitabine. In the NHBS MSM survey, 27 of 591 respondents (4.8%; 95% CI, 3.2% to 6.9%) reported donating blood in 2016 or 2017 and PrEP use within the same time frame as blood donation. Persons who are HIV positive and taking ART and persons taking PrEP to prevent HIV infection are donating blood. Both situations could lead to increased risk of HIV transfusion transmission if blood screening assays are unable to detect HIV in donations from infected donors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1182/blood.2020006890DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483439PMC
September 2020

Prevalence and correlates of initiating injection drug use before the age of 18 years in Iran: results of a national survey.

J Addict Dis 2020 Jul-Sep;38(3):334-338. Epub 2020 Jun 29.

HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

In this study, we sought to determine factors relating to initiating injection drug use before the age of 18 years in Iran. In this cross-sectional survey, people who inject drugs were recruited using facility-based sampling in 10 cities in Iran in 2014. Adults (≥18 year) who reported injecting drugs at least one time during the last year were included. A structured questionnaire collected behaviors related to injection, sexual risk, and HIV testing. Based on the reported age of first injection, we grouped participants into that initiating injection drug use by before 18-year old versus 18- and after 18-year old. Of 2356 participants, 199 (8.5%, 95% CI 7.4-9.6) started injecting before the age of 18 years. Initiating injection drug use before the age of 18 years were more likely to be <30-year old (39.4% vs. 19.7%,  < .001), report syringe and needle sharing (15.0% vs. 5.4%,  < .001), have sex with other men (24.3% vs. 15.6%,  < .001), and have complete knowledge about HIV (92.5% vs. 86.4%,  < .001). People who started injection at younger ages had higher risk profiles and should be prioritized for substance use treatment, harm reduction, and HIV prevention programs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/10550887.2020.1765076DOI Listing
June 2020

Fentanyl self-testing in a community-based sample of people who inject drugs, San Francisco.

Int J Drug Policy 2020 Aug 6;82:102787. Epub 2020 Jun 6.

Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA USA. Electronic address:

Background: Fentanyl test strips (FTS) can prevent overdose by identifying unknown fentanyl-laced drugs. We measured FTS use amongst people who inject drugs (PWID) in San Francisco.

Methods: Data were from a cross-sectional survey of PWID in 2018, recruited by respondent-driven sampling. Participants were asked about FTS use in the last 12 months.

Results: Of 458 PWID surveyed, 45.4% had used an FTS in the last 12 months. FTS use was higher among PWID younger in age (adjusted odds ratio [AOR] 0.97 per year, 95% confidence interval [CI] 0.95-0.98), witnessing overdose (AOR 2.40, 95% CI 1.36-4.23), currently owning naloxone (AOR 2.92, 95% CI 1.76-4.87), and receiving overdose training (AOR 1.62, 95% CI 1.04-2.51). FTS use was lower among Black/African Americans (AOR 0.56, 95% CI 0.34-0.93). Amongst FTS users, 80.2% had a positive result, of whom 43.4% did not change their use of the drug, 26.5% abstained from using it, and 30.1% used a lower dose.

Conclusion: Efforts to promote the use of FTS may have reached under half of PWID in San Francisco. Avenues need to be found to increase the role of FTS as a harm reduction approach to prevent overdose, particularly for older and Black/African American PWID.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.drugpo.2020.102787DOI Listing
August 2020

Prevalence and disparities in opioid overdose response training among people who inject drugs, San Francisco: Naloxone training among injectors in San Francisco.

Int J Drug Policy 2020 Jun 4:102778. Epub 2020 Jun 4.

San Francisco Department of Public Health; University of California, San Francisco. Electronic address:

Background: Expanding naloxone training stands to reduce opioid-related overdose deaths. The current study assessed the prevalence of overdose response training and use of naloxone among people who inject drugs (PWID).

Methods: Data were from a survey of PWID in San Francisco in 2018, recruited by respondent-driven sampling (RDS). Eligibility criteria were age over 18 years, injected non-prescribed drugs in the last year, San Francisco residence, and referral by another participant. Interviews collected demographic characteristics and injection-related behavior.

Results: The sample (N=458) was majority male (67.5%) and over 45.5 years. Over three-fourths (76.0%) injected primarily opioids. Overall, 62.9% received overdose response training and 68.8% owned a naloxone kit. A majority (77.9%) had witnessed an overdose in the past year, of whom 55.8% used naloxone the last time they witnessed an overdose. Receiving overdose response training was significantly lower among persons of non-white race/ethnicity compared to whites (adjusted odds ratio [AOR] 0.43, 95% CI 0.27, 0.69) and higher among those who owned naloxone (AOR 6.29, 95% confidence interval [CI] 3.95, 10.02) and used syringe exchange programs (AOR 3.51, 95% CI 1.41, 8.79).

Conclusion: While the majority of PWID have had overdose response training, gaps and disparities persist in promotion of naloxone use.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.drugpo.2020.102778DOI Listing
June 2020

Stigma, discrimination, violence, and HIV testing among men who have sex with men in four major cities in Ghana.

AIDS Care 2020 08 4;32(8):1036-1044. Epub 2020 May 4.

Regional Institute for Population Studies, University of Ghana, Accra, Ghana.

LGBTQ populations experience human rights abuses worldwide; data need to document the health impact of these experiences in Africa. In Ghana, we measured events of sexuality-based stigma, discrimination, and violence among men who have sex with men (MSM) and the impact on HIV testing behavior. Data are from respondent-driven sampling surveillance surveys in Accra/Tema, Kumasi, Cape Coast/Takoradi, and Koforidua. Discrimination was common among MSM: 6.2%-30.6% were refused services, 29.0%-48.9% experienced verbal/symbolic violence, 2.8%-12.8% experienced physical violence, 12.3%-30.0% experienced sexual violence due to their sexuality in the preceding year. MSM who experienced sexual violence in their first male sexual encounter were less likely to ever test for HIV in Accra/Tema and Cape Coast/Takoradi. Further studies are needed to examine the impact of stigma and violence on MSM's HIV health-seeking behavior in Ghana. Structural interventions are needed to mitigate the consequences of stigma and discrimination on MSM health and well-being.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09540121.2020.1757020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368816PMC
August 2020

Rates and Correlates of HIV Incidence in Namibia's Zambezi Region From 2014 to 2016: Sentinel, Community-Based Cohort Study.

JMIR Public Health Surveill 2020 06 24;6(2):e17107. Epub 2020 Jun 24.

Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States.

Background: Direct measures of HIV incidence are needed to assess the population-level impact of prevention programs but are scarcely available in the subnational epidemic hotspots of sub-Saharan Africa. We created a sentinel HIV incidence cohort within a community-based program that provided home-based HIV testing to all residents of Namibia's Zambezi region, where approximately 24% of the adult population was estimated to be living with HIV.

Objective: The aim of this study was to estimate HIV incidence, detect correlates of HIV acquisition, and assess the feasibility of the sentinel, community-based approach to HIV incidence surveillance in a subnational epidemic hotspot.

Methods: Following the program's initial home-based testing (December 2014-July 2015), we purposefully selected 10 clusters of 60 to 70 households each and invited residents who were HIV negative and aged ≥15 years to participate in the cohort. Consenting participants completed behavioral interviews and a second HIV test approximately 1 year later (March-September 2016). We used Poisson models to calculate HIV incidence rates between baseline and follow-up and multivariable Cox proportional hazard models to assess the correlates of seroconversion.

Results: Among 1742 HIV-negative participants, 1624 (93.23%) completed follow-up. We observed 26 seroconversions in 1954 person-years (PY) of follow-up, equating to an overall incidence rate of 1.33 per 100 PY (95% CI 0.91-1.95). Among women, the incidence was 1.55 per 100 PY (95% CI 1.12-2.17) and significantly higher among those aged 15 to 24 years and residing in rural areas (adjusted hazard ratio [aHR] 4.26, 95% CI 1.39-13.13; P=.01), residing in the Ngweze suburb of Katima Mulilo city (aHR 2.34, 95% CI 1.25-4.40; P=.01), who had no prior HIV testing in the year before cohort enrollment (aHR 3.38, 95% CI 1.04-10.95; P=.05), and who had engaged in transactional sex (aHR 17.64, 95% CI 2.88-108.14; P=.02). Among men, HIV incidence was 1.05 per 100 PY (95% CI 0.54-2.31) and significantly higher among those aged 40 to 44 years (aHR 13.04, 95% CI 5.98-28.41; P<.001) and had sought HIV testing outside the study between baseline and follow-up (aHR 8.28, 95% CI 1.39-49.38; P=.02). No seroconversions occurred among persons with HIV-positive partners on antiretroviral treatment.

Conclusions: Nearly three decades into Namibia's generalized HIV epidemic, these are the first estimates of HIV incidence for its highest prevalence region. By creating a sentinel incidence cohort from the infrastructure of an existing community-based testing program, we were able to characterize current transmission patterns, corroborate known risk factors for HIV acquisition, and provide insight into the efficacy of prevention interventions in a subnational epidemic hotspot. This study demonstrates an efficient and scalable framework for longitudinal HIV incidence surveillance that can be implemented in diverse sentinel sites and populations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/17107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7381049PMC
June 2020

High HIV Incidence Among Young and Racial/Ethnic Minority Transgender Women in San Francisco: Results of a Longitudinal Cohort Study.

J Acquir Immune Defic Syndr 2020 05;84(1):e7-e10

Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/QAI.0000000000002315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363166PMC
May 2020

Lifetime Syphilis Prevalence and Associated Risk Factors Among Female Prisoners in Brazil.

Sex Transm Dis 2020 02;47(2):105-110

Global Health Sciences, University of California, San Francisco, San Francisco, CA.

Background: In 2016, approximately 42,000 women were incarcerated in Brazil. The objectives of this study were to measure the lifetime prevalence of syphilis and sociodemographic and behavior correlates of antibody positivity among female prisoners in Brazil.

Methods: We conducted a cross-sectional survey of 1327 incarcerated women in 2014 to 2015 sampled through a multistage cluster design to represent the penitentiary system throughout Brazil. A rapid treponemal antibody test approved by the Ministry of Health (Rapid Test DPP Sífilis Bio-Manguinhos) was used to detect lifetime history of infection. Analyses were adjusted using weights based on the inverse of the product of the probabilities of the sampling units at each stage of the design. Variables significantly associated with syphilis infection at P < 0.05 in multivariate analyses were retained in the final model.

Results: Prevalence of syphilis antibody among female prisoners in Brazil was 11.6% (95% confidence interval [CI], 9.8%-13.8%). Higher syphilis prevalence was associated with black/Afro-Brazilian or mixed race/ethnicity (adjusted odds ratio [AOR], 1.78; 95% CI, 1.10-2.87), homelessness (AOR, 4.58; 95% CI, 2.78-7.56), abortion (AOR, 1.56; 95% CI, 1.02-2.38), and sexual violence (AOR, 1.59; 95% CI, 1.01-2.49). Syphilis prevalence was lower among women who had received condoms in school (AOR, 0.28; 95% CI, 0.08-1.00) as a marker for reproductive health education.

Conclusions: Women within the vast Brazilian prison system demonstrate a high lifetime cumulative incidence of syphilis. Our data advocate for increased screening and treatment of syphilis of incarcerated women and help identify women at higher risk within the prison system and within their communities of origin.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/OLQ.0000000000001113DOI Listing
February 2020

Identity, stigma, and HIV risk among transgender women: a qualitative study in Jiangsu Province, China.

Infect Dis Poverty 2019 Dec 1;8(1):94. Epub 2019 Dec 1.

San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 710, San Francisco, CA, 94102-6033, USA.

Background: Transgender women have multiple disparities globally, including social rejection and stigma, HIV infection and untreated mental health problems. However, few data on transgender women are available in China. Therefore, this study aimed to explore transgender women's experiences on gender identity, disclosure, discrimination, transgender-specific medical care, and perceptions of HIV and sexually transmitted infections (STI) risk in China.

Methods: A qualitative study was conducted in Nanjing and Suzhou city, China in 2018. Key informant interviews (n = 14) and focus group discussions (n = 2) with diverse transgender women were implemented. Text was transcribed and translated, and Dedoose™ software was used for coding, analysis and interpretation by the research team.

Results: Chinese transgender women share experiences with transgender women worldwide, including a long and challenging identity search, stigma and discrimination, poor access to trans-specific services and unmet needs for mental health care. Features unique to them include terms used for self-identification, culturally-shaped expectations for reproduction, and ideals of placing the familial and societal welfare over personal fulfillment. Social networks of this population appear sparse, scattered, and underground. Familial rejection was experienced by nearly all respondents. Perceptions of HIV and STI risk and history of HIV testing were notably low.

Conclusions: Transgender women in China face high social rejection and discrimination along with unmet need for various types of healthcare. Scaling up transgender-specific services including gender-affirming medical care, mental health care and HIV/STI prevention are warranted to address the social, medical and mental health of transgender women in China.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s40249-019-0606-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6885322PMC
December 2019

High HIV prevalence and associated risk factors among transgender women in China: a cross-sectional survey.

J Int AIDS Soc 2019 11;22(11):e25417

Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, USA.

Introduction: Transgender women may face the highest prevalence of HIV of any population, experiencing a disproportionate burden of disease frequently confirmed in surveys throughout the developing and developed world. However, few studies have been conducted specifically for transgender women in China. This study aimed to measure HIV prevalence and explore risk factors for infection in a diverse sample of Chinese transgender women to help advocate for prevention and care interventions for this population.

Methods: From July 2018 to May 2019, we adapted a respondent-driven sampling (RDS) approach to recruit a diverse sample of 250 transgender women through chains of peer referrals in two cities of eastern China, Nanjing and Suzhou. Eligible participants (i.e. 18 years of age or older, living in Jiangsu province and assigned male sex at birth but currently self-identified as a gender different from male) completed a self-administered questionnaire on a mobile phone to collect demographic characteristics and risk behaviours and underwent HIV testing.

Results And Discussion: The survey sample was young (82% under age 35 years), with 28.8% having a university degree, 39.2% reporting work at entertainment venues, 47.6% ever having taken hormones and 6.4% being diagnosed with an STI in the last year. One in five (20.8%) reported having engaged in sex work. HIV prevalence was 14.8% (95% CI 10.6 to 19.8), with 75.6% of those testing HIV positive reporting they were already aware of their serostatus. In multivariate analysis, HIV prevalence was significantly higher among transgender women above the age of 24 years, those who work at entertainment venues, who never have taken hormones, and who had been diagnosed with an STI in the last year.

Conclusions: The prevalence of HIV among transgender women in our study, at 14.8%, is among the highest detected in any population in eastern China. Chinese transgender women may therefore follow the disparity in the burden of HIV noted worldwide. Data support policies to prioritize transgender women for HIV testing outreach, for in-depth research to better understand the specific drivers of infection in this population, and for trans-friendly HIV care and prevention programmes to address their specific needs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jia2.25417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6856602PMC
November 2019