Interpersonal Violence and Hiv Sexual Risk Behaviors: The Influence of Alcohol Harm Reduction and Early Initiation of Sex Work Among Female Sex Workers in Mombasa, Kenya

Female sex workers (FSWs) are at high risk of interpersonal violence and HIV infection. The first paper investigated whether an alcohol harm reduction intervention was associated with reduced interpersonal violence or HIV sexual risk behaviors among FSWs in Mombasa, Kenya. The sample was comprised of 818 FSWs in Mombasa, Kenya who were 18 years or older, associated with HIV prevention drop-in centers and moderate risk drinkers. General linear mixed models examined associations between intervention assignment (alcohol harm reduction or nutrition intervention) and recent violence from paying and non-paying sex partners and HIV sexual risk behavior (engagement in sex work, total number of sex partners) at 6 and 12 months post-enrollment. The alcohol intervention was associated with statistically significant decreases in engagement in sex work and sexual violence from paying partners at 6 and 12 months post-enrollment and physical violence from paying sex partners at 12 months post-enrollment. Future research should explore mechanisms through which alcohol reduction leads to reduced violence among FSWs (i.e., reduced risk-taking, economic empowerment). More research is needed to understand whether alcohol reduction leads to reduced violence among FSWs who continue to engage in sex work or through discontinuation of sex work. Between 20-40% of FSWs worldwide began sex work before age 18. The second paper investigates whether early initiation of sex work (sex work at 17 or younger) was associated with recent interpersonal violence or HIV sexual risk behaviors. Logistic regression was performed, adjusting for drop-in center, current age, HIV status, and childhood abuse. Twenty percent of the sample reported early initiation of sex work. Early initiators were significantly more likely to experience recent physical and sexual violence from paying partners and less likely to report consistent condom use with paying partners. Early initiation was not associated with violence or HIV sexual risk with non-paying partners. FSWs who initiated sex work early are at particularly high risk of violence from paying partners. Interventions to prevent violence and reduce HIV sexual risk behaviors among adolescent FSWs and adult FSWs who initiated sex work early are needed. More work is needed to prevent early initiation of sex work.Doctor of Philosoph

Public Stigma of Mental Illness in the United States: A Systematic Literature Review

Public stigma is a pervasive barrier that prevents many individuals in the U.S. from engaging in mental health care. This systematic literature review aims to: (1) evaluate methods used to study the public’s stigma toward mental disorders, (2) summarize stigma findings focused on the public’s stigmatizing beliefs and actions and attitudes toward mental health treatment for children and adults with mental illness, and (3) draw recommendations for reducing stigma towards individuals with mental disorders and advance research in this area. Public stigma of mental illness in the U.S. was widespread. Findings can inform interventions to reduce the public’s stigma of mental illness

Mobile Phone Interventions for Adolescent Sexual and Reproductive Health: A Systematic Review

CONTEXT: Interventions for adolescent sexual and reproductive health (ASRH) are increasingly using mobile phones but may not effectively report evidence. OBJECTIVE: To assess strategies, findings, and quality of evidence on using mobile phones to improve ASRH by using the mHealth Evidence Reporting and Assessment (mERA) checklist recently published by the World Health Organization mHealth Technical Evidence Review Group. DATA SOURCES: Systematic searches of 8 databases for peer-reviewed studies published January 2000 through August 2014. STUDY SELECTION: Eligible studies targeted adolescents ages 10 to 24 and provided results from mobile phone interventions designed to improve ASRH. DATA EXTRACTION: Studies were evaluated according to the mERA checklist, covering essential mHealth criteria and methodological reporting criteria. RESULTS: Thirty-five articles met inclusion criteria. Studies reported on 28 programs operating at multiple levels of the health care system in 7 countries. Most programs (82%) used text messages. An average of 41% of essential mHealth criteria were met (range 14%-79%). An average of 82% of methodological reporting criteria were met (range 52%-100%). Evidence suggests that inclusion of text messaging in health promotion campaigns, sexually transmitted infection screening and follow-up, and medication adherence may lead to improved ASRH. LIMITATIONS: Only 3 articles reported evidence from lower- or middle-income countries, so it is difficult to draw conclusions for these settings. CONCLUSIONS: Evidence on mobile phone interventions for ASRH published in peer-reviewed journals reflects a high degree of quality in methods and reporting. In contrast, current reporting on essential mHealth criteria is insufficient for understanding, replicating, and scaling up mHealth interventions

Early Sex Work Initiation and Violence against Female Sex Workers in Mombasa, Kenya

Between 20 and 40 % of female sex workers (FSWs) began sex work before age 18. Little is known concerning whether early initiation of sex work impacts later experiences in adulthood, including violence victimization. This paper examines the relationship between early initiation of sex work and violence victimization during adulthood. The sample included 816 FSWs in Mombasa, Kenya, recruited from HIV prevention drop-in centers who were 18 years or older and moderate-risk drinkers. Early initiation was defined as beginning sex work at 17 or younger. Logistic regression modeled recent violence as a function of early initiation, adjusting for drop-in center, age, education, HIV status, supporting others, and childhood abuse. Twenty percent of the sample reported early initiation of sex work. Although both early initiators and other FSWs reported commonly experiencing recent violence, early initiators were significantly more likely to experience recent physical and sexual violence and verbal abuse from paying partners. Early initiation was not associated with physical or sexual violence from non-paying partners. Many FSWs begin sex work before age 18. Effective interventions focused on preventing this are needed. In addition, interventions are needed to prevent violence against all FSWs, in particular, those who initiated sex work during childhood or adolescence

Early sex work initiation and condom use among alcohol-using female sex workers in Mombasa, Kenya: a cross-sectional analysis

Early initiation of sex work is prevalent among female sex workers (FSWs) worldwide. The objectives of this study were to investigate if early initiation of sex work was associated with: (1) consistent condom use, (2) condom negotiation self-efficacy or (3) condom use norms among alcohol-using FSWs in Mombasa, Kenya

Substance use service availability in HIV treatment programs: Data from the global IeDEA consortium, 2014-2015 and 2017

Background: Substance use is common among people living with HIV and has been associated with suboptimal HIV treatment outcomes. Integrating substance use services into HIV care is a promising strategy to improve patient outcomes. Methods: We report on substance use education, screening, and referral practices from two surveys of HIV care and treatment sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. HIV care and treatment sites participating in IeDEA are primarily public-sector health facilities and include both academic and community-based hospitals and health facilities. A total of 286 sites in 45 countries participated in the 2014–2015 survey and 237 sites in 44 countries participated in the 2017 survey. We compared changes over time for 147 sites that participated in both surveys. Results: In 2014–2015, most sites (75%) reported providing substance use-related education on-site (i.e., at the HIV clinic or the same health facility). Approximately half reported on-site screening for substance use (52%) or referrals for substance use treatment (51%). In 2017, the proportion of sites providing on-site substance use-related education, screening, or referrals increased by 9%, 16%, and 8%, respectively. In 2017, on-site substance use screening and referral were most commonly reported at sites serving only adults (compared to only children/adolescents or adults and children/adolescents; screening: 86%, 37%, and 59%, respectively; referral: 76%, 47%, and 46%, respectively) and at sites in high-income countries (compared to upper middle income, lower middle income or low-income countries; screening: 89%, 76%, 68%, and 45%, respectively; referral: 82%, 71%, 57%, and 34%, respectively). Conclusion: Although there have been increases in the proportion of sites reporting substance use education, screening, and referral services across IeDEA sites, gaps persist in the integration of substance use services into HIV care, particularly in relation to screening and referral practices, with reduced availability for children/adolescents and those receiving care within resource-constrained settings

Physical and sexual violence, childhood sexual abuse and HIV/STI risk behaviour among alcohol-using women engaged in sex work in Mongolia

Although the prevalence of human immunodeficiency virus (HIV) in Mongolia is low, it could increase without strategic prevention strategies. Female sex workers (FSWs) often experience barriers to prevention, including interpersonal violence. This study investigated if childhood sexual abuse (CSA) or recent physical or sexual violence was associated with HIV sexual risk behaviours and if CSA modified associations between recent violence and HIV sexual risk behaviours. Two-hundred twenty-two women who (1) were at least 18 years old and clients at the National AIDS Foundation; (2) reported vaginal or anal sex in the past 90 days in exchange for money or goods and (3) met criteria for harmful alcohol use in the past year were enrolled. In-person interviews assessed sexual risk behaviours and violence in childhood and adulthood. Negative binomial regression, ordinary least squares regression and modified Poisson regression were performed. Sexual risk with paying partners was associated with penetrative CSA and sexual violence by paying partners. CSA and recent violence were not associated with sexual risk behaviours with intimate partners. CSA modified the association between recent sexual violence and unprotected sex with intimate partners. Findings highlight the need for integrated violence and sexual risk reduction services to ensure safe and effective prevention for FSWs

Exploring COVID-19 Vaccine Decision Making: Insights from ‘One-Shot Wonders’ and ‘Booster Enthusiasts’

Within the USA, the uptake of the updated COVID-19 vaccines is suboptimal despite health authority recommendations. This study used qualitative methods to examine factors influencing COVID-19 vaccine decision making and the effects of anxiety and depression on these decisions within the CHASING COVID Cohort (C3). Between October and December 2023, we conducted 25 interviews with participants from 16 different US states, 14 of whom endorsed recent symptoms of anxiety and/or depression. Using grounded theory methodology for coding and thematic analysis, we categorized participants into “One-Shot Wonders” and “Booster Enthusiasts”. Our findings indicate that the US COVID-19 vaccination environment has shifted from active promotion to a notable absence of COVID-19 discussions, leading to reduced worry about infection and severe illness, diminished perception of the benefits of the vaccine on personal and community levels, and fewer cues to action. Initially influential factors like family, personal experiences, and physician recommendations lost impact over time. Although the relationship between symptoms of depression and anxiety and vaccination was not prominent, one case highlighted a direct relationship. The study emphasizes the importance of timely and accurate public health messaging adaptable to individuals’ needs and misconceptions, highlighting the need for dynamic communication strategies in future initiatives with rapidly changing landscapes

Health and Wellness Photovoice Project: Engaging Consumers With Serious Mental Illness in Health Care Interventions

People with serious mental illnesses (SMI) are at increased risk for cardiovascular disease and premature mortality. We used photovoice in two supportive housing agencies to engage consumers with SMI to inform the implementation of health care interventions. Sixteen consumers participated in six weekly sessions in which they took photographs about their health and discussed the meanings of these photographs in individual interviews and group sessions. We identified several implementation themes related to consumers’ preferences. Peer-based approaches were preferred more than clinician-driven models. Participants expressed a desire to learn practical skills through hands-on activities to modify health behaviors. Consumers expressed a desire to increase their physical activity. Participants revealed in their photographs and narratives the important role that communities’ food environments play in shaping eating habits. In this article, we show how photovoice can generate valuable community knowledge to inform the translation of health care interventions in supportive housing agencies

A national prospective cohort study of SARS/COV2 pandemic outcomes in the U.S.: The CHASING COVID Cohort

Introduction: The Chasing COVID Cohort (C 3 ) study is a US-based, geographically and socio-demographically diverse sample of adults (18 and older) enrolled into a prospective cohort study during the upswing of the U.S. COVID-19 pandemic. Methods: We used internet-based strategies to enroll C 3 participants beginning March 28th, 2020. Following baseline questionnaire completion, study participants will be contacted monthly (for 6 months) to complete assessments of engagement in non-pharmaceutical interventions (e.g., use of cloth masks, avoiding large gatherings); COVID-19 symptoms; SARS/COV2 testing and diagnosis; hospitalizations; healthcare access; and uptake of health messaging. Dried blood spot (DBS) specimens will be collected at the first follow-up assessment (last week of April 2020) and at month 3 (last week of June 2020) and stored until a validated serologic test is available. Results: As of April 20, 2020, the number of people that completed the baseline survey and provided contact information for follow-up was 7,070. Participants resided in all 50 US states, the District of Columbia, Puerto Rico, and Guam. At least 24% of participants were frontline workers (healthcare and other essential workers). Twenty-three percent (23%) were 60+ years, 24% were Black or Hispanic, 52% were men, and 52% were currently employed. Nearly 20% reported recent COVID-like symptoms (cough, fever or shortness of breath) and a high proportion reported engaging in non-pharmaceutical interventions that reduce SARS/COV2 spread (93% avoided groups \u3e20, 58% wore masks; 73% quarantined). More than half (54%) had higher risk for severe COVID-19 illness should they become infected with SARS/COV2 based on age, underlying health conditions (e.g., chronic lung disease), or daily smoking. Discussion: A geographically and socio-demographically diverse group of participants was rapidly enrolled in the C3 during the upswing of the SARS/COV2 pandemic. Strengths of the C3 include the potential for direct observation of, and risk factors for, seroconversion and incident COVID disease (among those with or without antibodies to SARS/COV2) in areas of active transmission