Economic vulnerability,violence, and sexual risk factors for HIV among female sex workers in Tijuana,Mexico

AIDS and Behavior - Economic vulnerability is often reported to underlie involvement in sex work among female sex workers (FSW), but may also create urgency in women’s work, limiting...     

Do cultural and linguistic competence matter in Latinos' completion of mandated substance abuse treatment?

ABSTRACT: BACKGROUND: Increasing evidence suggests that culturally and linguistically responsive programs may improve substance abuse treatment outcomes among Latinos. However, little is known about whether individual practices or culturally and linguistically responsive contexts support efforts by first-time Latino clients to successfully complete mandated treatment. METHODS: We analyzed client and program data from publicly funded treatment programs contracted through the criminal justice system in California. A sample of 5,150 first-time Latino clients nested within 48 treatment programs was analyzed using multilevel logistic regressions. RESULTS: Outpatient treatment, homelessness, and a high frequency of drug use at intake were associated with decreased odds of treatment completion among Latinos. Programs that routinely offered a culturally and linguistically responsive practice---namely, Spanish-language translation---were associated with increased odds of completion of mandated treatment. CONCLUSIONS: These preliminary findings suggest that concrete practices such as offering Spanish translation improve treatment adherence within a population that is at high risk of treatment dropout.     

Preventing syndemic Zika virus,HIV/STIs and unintended pregnancy: dual method use and consistent condom use among Brazilian women in marital and civil unions

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

Development and Measurement of the Treatment Perceptions Survey (TPS) for Clients with Substance Use Disorders

The Journal of Behavioral Health Services & Research - Statistical reliability of the Treatment Perceptions Survey (TPS) questionnaire was examined using data from 19 California counties. The...     

Homelessness and polysubstance use: A qualitative study on recovery and treatment access solutions around an urban library in Southern California,USA

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

Patterns of treatment utilization and methamphetamine use during first 10 years after methamphetamine initiation

The study examined joint trajectories of methamphetamine (MA) use and substance abuse treatment utilization and identified differences among pattern groups for a sample of 348 treated for MA use. Results from group-based trajectory modeling showed that treatment utilization during the first 10 years after initiation of MA use could be categorized into three distinctive patterns: about half the MA users have a pattern of low treatment utilization; one-fourth follow a quicker-to-treatment trajectory with higher probability of treatment during the first 5 years of MA use and less treatment in the next 5 years; and one-fourth have a slower-to-treatment trajectory with more treatment during the second half of the 10-year period. Four MA use patterns were identified: consistently low use, moderate, and high use, as well as a decreasing use pattern. Periods of greater likelihood of treatment participation were associated with periods of decreasing or lower frequency of MA use.     

Underage youth trading sex in the Philippines: trafficking and HIV risk

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

Social and Structural Factors Associated with Consistent Condom Use Among Female Entertainment Workers Trading Sex in the Philippines

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