Factors associated with HIV testing among male motorbike taxi drivers in urban Vietnam

Using the Attitude-Skills-Knowledge (ASK) model, this study examined the prevalence of, and factors associated with, human immunodeficiency virus (HIV) testing among male motorbike taxi drivers (MMTDs). In a cross-sectional design, using quantitative approaches, 291 MMTDs were recruited from 135 sites across 13 districts in Hanoi, Vietnam, for a face-to-face interview. Applying the ASK model modified as a central theory, logistic regression was used to identify determinants of HIV testing. Although many MMTDs engaged in multiple risk behaviours for HIV, only 20.6% had been tested for HIV during the past 12 months. The tested model included one factor of the ASK model, HIV prevention knowledge (adjusted odds ratio [AOR] = 4.76; 95% confidence interval [CI] = 2.12–10.7) and five additional factors: being married (AOR = 3.13; 95% CI = 1.25–4.78), preferring sex with men or with both men and women (AOR = 8.72; 95% CI = 1.48–51.5), having lower number of lifetime sex partners (AOR = 0.66; 95% CI = 0.49–0.88), higher number of past year sex partners (AOR = 2.97: 95% CI = 1.21–7.31) and discussing condom use when having sex with partners (AOR = 0.08; 95% CI = 0.01–7.31). This modified ASK model provided better fit than the ASK model, as it explained more variance in HIV testing (47 vs. 29.8%). Recognising factors associated with HIV testing among MMTDs enables us to create suitable public health intervention strategies.     

High prevalence of depression symptomology among adolescents in Soweto,South Africa associated with being female and cofactors relating to HIV transmission

Adolescents in HIV endemic settings are a priority demographic with respect to HIV prevention. Some studies have shown that behaviours associated with HIV transmission, may be mediated by mental health factors such as depression. We undertook this study to explore the prevalence and associations of depression symptomology among adolescents living in the HIV endemic community of Soweto, South Africa through the Botsha Bophelo Adolescent Health Study (BBAHS). We estimated the prevalence of depression using the Centre for Epidemiological Studies of Depression Scale, using a score of ≥24 to indicate ‘probable depression’. Among the 789 adolescents (14–19 years) with depression scores, 262 (33%) met the criteria for probable depression (99 [38%] men and 163 [62%] women; p = 0.061). In multivariable logistic regression, factors independently associated with depression included being female (AOR = 2.44, 95% CI: 1.45–4.00), marijuana use (AOR = 2.67, 95% CI: 1.21–5.93), physical violence (AOR = 1.63, 95% CI: 1.01–2.62), pregnancy (AOR = 2.00, 95% CI: 1.03–3.88) and incarceration (AOR = 2.09, 95% CI: 0.99–4.42). These data indicate that a concerning proportion of adolescents in Soweto may be suffering from depression and those screened as potentially depressed, were more likely to be female and have cofactors relating to increased risk for HIV. As part of a comprehensive HIV prevention strategy, we recommend that depression screening for adolescents be integrated into public and school health programs that triage those suffering into treatment programs.     

The Relationship Between Parental Stress and Postpartum Depression Among Adolescent Mothers Enrolled in a Randomized Controlled Prevention Trial

Given the high co-occurrence of depression and parental stress among adolescent mothers, we evaluated the relationship between parental stress and postpartum depression among primiparous adolescent mothers. We conducted an observational analysis among a cohort of 106 adolescent mothers at 289 postpartum visits who were enrolled in a randomized controlled trial to prevent postpartum depression. Parental stress was measured using the Parenting Stress Index, short form. The Structured Clinical Interview for DSM-IV Childhood Diagnoses was administered to assess for postpartum depression; subthreshold depression was assessed using the Children’s Depression Rating Scale, revised version. Generalized estimating equations were utilized to assess the relationship of parental stress on postpartum depression during the first 6 months postpartum. We present adjusted odds ratios (AOR) controlling for study arm, age, born in the United States, prior history of depression, and number of study visits. The median age was 16 years, 53 % were Latina, and 16 % reported a past history of depression. Nineteen adolescents (19 %) were diagnosed with postpartum depression and 25 % experienced high levels of parental stress through 6 months postpartum. Adolescent mothers who reported higher levels of parental stress were at significantly increased risk for postpartum depression [AOR 1.06 (95 % CI 1.04–1.09); p < 0.0001]. High levels of parental stress predicted subsequent postpartum depression when assessing parental stress at visits prior to a depression diagnosis to determine whether we could establish a temporal association [AOR 1.06 (95 % CI 1.02–1.09); p < 0.01]. Parental stress was also a risk factor for subthreshold depression [AOR 1.04 (95 % CI 1.01–1.07); p < 0.01]. Parental stress was a significant risk factor for developing both postpartum depression as well as subthreshold depression among adolescent mothers. Interventions that target a reduction in parental stress may lead to less depression severity among primiparous adolescent mothers.     

Perceived risk of HIV infection among deported male injection drug users in Tijuana,Mexico

Deported injection drug users (IDUs) in Mexico may be vulnerable to HIV infection following expulsion from the USA. We examined factors associated with HIV risk perception among a sample of deportees in Tijuana. From January to April 2010, 313 male IDUs who reported ever being deported from the USA completed a questionnaire. Overall, 35% (N = 110) of deportees perceived HIV risk. In multivariate logistic regression analyses, factors independently associated with HIV risk perception included ever having a steady female partner in Tijuana post-deportation (adjusted odds ratio [AOR]: 2.26; 95% confidence interval [CI]: 1.01–5.07) and years spent in a US prison (AOR: 1.29 per year; 95% CI: 1.13–1.48). Conversely, years of drug injection use (AOR: 0.95 per year; 95% CI: 0.91–0.99), ever witnessing family members use drugs prior to first migration trip (AOR: 0.24; 95% CI: 0.09–0.65), years of residence in the USA (AOR: 0.91 per year; 95% CI: 0.84–0.98) and being a Tijuana native (AOR: 0.40; 95% CI: 0.16–0.99) were negatively associated with HIV risk perception. US–Mexico border cities that receive deported migrants should target HIV prevention interventions to specific subgroups, including drug-using male deportees. Interventions should consider migrant's time in the USA, the role of their social networks, and reducing missed opportunities for HIV testing/education.     

Utilization Patterns and Perceptions of Playground Users in New York City

Playgrounds are assumed to be an important resource for physical activity. This study investigates seasonal utilization, user preferences, and perceptions of safety and upkeep of public playgrounds in New York City. A cross-sectional survey was conducted from May 2010 to January 2011 across 10 playgrounds in low/middle income neighborhoods in each of the five boroughs in New York City. A total of 1,396 adults accompanying children were surveyed. Outcomes included playground as main place of outdoor play, and perceptions of playground upkeep and safety. Covariates included socio-demographics and other characteristics of playground users. Multivariable logistic regression with playground/season fixed effects were used. Utilization varied substantially across the four seasons. Blacks had higher odds of reporting the playground as the main place of outdoor play (AOR 1.78, 95 % CI 1.13–2.80, p < .05). High income users had lower odds of reporting the playground as the main place of outdoor play ($60–$80,000: AOR 0.47, 95 % CI 0.29–0.76, p < .01, $80,000+: AOR 0.47, 95 % CI 0.28–0.79, p < .01). Racial differences in perceived upkeep and safety were not significant once playground/season fixed effects were included, highlighting the importance of neighborhood conditions. Women were more likely to report feeling unsafe within playgrounds (AOR 1.51, 95 % CI 1.12–2.02, p < .01). While some playground utilization is driven by individual characteristics, perceptions of public resources influences utilization and cannot be separated from neighborhood conditions. Increasing access to opportunities for physical activity for children requires new strategies beyond playground improvements.     

Characteristics of Children Eligible for Public Health Insurance but Uninsured: Data from the 2007 National Survey of Children’s Health

To describe the state variation, demographic and family characteristics of children eligible for public health insurance but uninsured. Using data from the National Survey of Children’s Health we selected a subset of children living in households with incomes <200 % of the federal poverty level, who are generally eligible for Medicaid or CHIP. We used multiple logistic regression to examine associations between insurance status among this group of eligible children and certain demographic factors, family characteristics, and state of residence. In adjusted models children aged 6–11 and 12–17 years were more likely to be eligible but uninsured compared to those aged 0–5 years (AOR 1.57; 95 % CI 1.15–2.16 and AOR 1.93; 95 % CI 1.41–2.64). Children who received school lunch (AOR 0.67; 95 % CI 0.52–0.86) and SNAP (AOR 0.33; 95 % CI 0.24–0.46) were less likely to be eligible but uninsured compared to those children not receiving those needs based services; however, a majority (58.7 %) of eligible uninsured children were enrolled in the school lunch program. Five states (Texas, California, Florida, Georgia, New York) accounted for 46 % of the eligible uninsured children. Vermont had the lowest adjusted estimate of eligible uninsured children (3.6 %) and Nevada had the highest adjusted estimate (35.5 %). Using nationally representative data we have identified specific state differences, demographic and household characteristics that could help guide federal and local initiatives to improve public health insurance enrollment for children who are eligible but uninsured.     

Stigma,discrimination and HIV outcomes among people living with HIV in Rio de Janeiro,Brazil: The intersection of multiple social inequalities

Limited research has examined the social context surrounding stigma and discrimination and HIV outcomes among people living with HIV (PLHIV). We surveyed 900 PLHIV in Brazil and examined the relationship between stigma, discrimination and HIV outcomes utilising multivariable logistic regression. HIV stigma and discrimination were inversely associated with age (AOR Stigma 0.65, 95% CI 0.49–0.88; AOR Discrimination 0.72, 95% CI 0.54–0.95) and income (AOR Stigma 0.74, 95% CI 0.55–0.99; AOR Discrimination 0.62, 95% CI 0.46–0.82). Stigma was inversely associated with education (AOR 0.71, 95% CI 0.52–0.96) and no history of sex work (AOR 0.56, 95% CI 0.35–0.90), and positively associated with having children (AOR 1.71, 95% CI 1.18–2.48). Discrimination was inversely associated with no history of drug use (AOR 0.63, 95% CI 0.42–0.95). Stigma and discrimination were found to be inversely associated with overall health (AOR Stigma 0.54, 95% CI 0.40–0.74; AOR Discrimination 0.71, 95% CI 0.52–0.97). Discrimination was associated with having a sexually transmitted infection since HIV diagnosis (AOR 1.63, 95% CI 1.14–2.32). Findings suggest that future interventions should address multiple social inequalities faced by PLHIV to reduce HIV stigma and discrimination and improve health and HIV outcomes.     

Extracurricular School-Based Social Change Communication Program Associated with Reduced HIV Infection Among Young Women in South Africa

ABSTRACT

Background: Young women in South Africa are at high risk for HIV, particularly after they leave school. There are few studies examining the long-term impact of school-based public health interventions aimed at protecting young women from HIV. We undertook a long-term evaluation of an extracurricular, school-based HIV prevention program, that leveraged off a mass media television series in South Africa.

Methods: We recruited 403 women aged 18–28 years. One hundred and seventy were members of Soul Buddyz Clubs (SBCs) between 2004 and 2008 and 233 were matched controls from the same communities as the ex-Buddyz. Face-to-face interviews were conducted and HIV testing undertaken. Analysis was restricted to 320 women who had ever had sex (136 ex-Buddyz and 184 controls). Multivariate analysis in Stata v14 was conducted.

Findings: 16.4% of women tested HIV positive. Ex-Buddyz were more likely to be HIV negative than controls (AOR 2.92, 95% CI 1.26–6.77, p = 0.013). Ex-Buddyz were more likely to have only had one sexual partner in the past year (AOR 2.14, 95% CI 1.17–3.89, p = 0.013) and 1.7 times more likely to have used a condom at first sex (95% CI 0.99–2.92, p = 0.053).

Interpretation: Participation in an SBC is associated with a decrease in young women’s HIV risk and suggests an impact on some key risky sexual behaviors. School-based prevention programs that leverage off of other media platforms demonstrate a positive outcome on health status.     

Families matter: Social relationships and adolescent HIV testing behaviors in Ndola,Zambia

A cross-sectional survey among 550 randomly selected 16–19-year-olds in Ndola, Zambia, assessed the influence of individual (e.g., HIV knowledge), relational (e.g., discussed HIV testing with family), and environmental factors (e.g., distance) on adolescents’ use of HIV counseling and testing. A multivariable logistic regression analysis comparing respondents who have taken an HIV test to respondents who have not found that at the relational level believing that one’s family would not be upset if the youth has taken an HIV test (adjusted odds ratio [AOR] = 5.08; 95% confidence interval [CI] = 1.16–22.35); and having discussed with a family member whether or not to take an HIV test (AOR = 3.51; 95% CI = 1.08–11.47) were significantly related to adolescent testing. At the individual-level, having ever had sex (AOR = 6.43; 95% CI = 2.14–19.30) and being out-of-school (AOR = 2.95; 95% CI = 1.32–6.59) were also strongly associated with HIV testing. Environmental measures were not found to be significantly related to HIV testing. These findings support the need to examine not only individual characteristics but also relational level factors, particularly the role of families, when implementing and evaluating adolescent HIV testing strategies. Programs to increase communication about HIV testing and counseling within families should be tested in a prospective design in order to assess the impact on young people’s decisions to learn their HIV status and subsequent health seeking and protective behaviors.     

Factors associated with adherence to Antiretroviral Therapy (ART) among adult people living with HIV and attending their clinical care,Eastern Ethiopia

Background

To attain a successful treatment outcome, Antiretroviral Therapy (ART) treatment for people living with HIV requires more than 95 % adherence level. The adherence level varies depending on different population contexts. Thus, the objective of this study was to investigate ART adherence level among HIV positive patients attending their clinical care in public health facilities in Harar and Dire Dawa, Eastern Ethiopia.

Methods

We conducted a cross-sectional study among 626 ART attendees. Data were collected using a structured questionnaire with a face-to-face interview. ART adherence was considered when taking all antiretroviral treatment in a correctly prescribed doses at a right time (no dose missed or delayed for greater than or equal to 90 min) in the week prior to the study. Multivariable logistic analysis was applied to examine the association between the dependent and independent variables. Statistical significance was set at p-value <0.05.

Results

The level of ART adherence was 85 %. Adherence was more likely among patients of 35–44 years (AOR?=?2.39; 95 % CI?=?1.15–5.01), had monthly income of 501.00–999.00 Ethiopian Birr (ETB) (AOR?=?6.73; 95 % CI?=?2.71–16.75), no history of opportunistic infection (AOR?=?2.81; 95 % CI?=?1.47–5.36), and had good family support (AOR?=?2.61; 95 % CI?=?1.45–4.72). However, those who did not disclose their sero-status (AOR?=?0.45; 95 % CI?=?0.21–0.97) and did experience depression (AOR?=?0.36; 95 % CI?=?0.21–0.61) were less likely adherent than their counter parts.

Conclusions

The level of ART adherence was sub-optimal. Concerted and collaborative efforts through effective and efficient interventions are needed in view of the identified factors in order to improve the adherence level.

     

Characteristics of Mothers with Depressive Symptoms Outside the Postpartum Period

Numerous studies have investigated the deleterious effects of maternal depression on child outcomes. Knowledge of characteristics of these mothers is incomplete, as most studies utilize small samples or limit investigation to the postpartum period. Utilizing data from a nationally representative sample of 7,211 fathers and mothers living in households with children aged 5–17 years who participated in the Medical Expenditure Panel Survey (MEPS) 2004–2006, the Patient Health Questionnaire-2 (PHQ-2) was used to assess parental depressive symptoms, the Short Form-12 (SF-12) was used to examine paternal and maternal physical health, and the Columbia Impairment Scale was used to measure child behavioral or emotional problems. In multivariate analyses, maternal unemployment (AOR 1.76, 95 % CI 1.31–2.35); living with smokers (AOR 1.82, 95 % CI 1.12–2.94); poor maternal physical health (AOR 2.31; 95 % CI 1.81–2.94); living with children with behavioral or emotional problems (AOR 2.95, 95 % CI 2.30–3.96); and paternal depressive symptoms (AOR 5.11, 95 % CI 1.97–13.25) each were independently associated with increased rates of maternal depressive symptoms. This paper is the first we are aware of to use a nationally representative sample to investigate characteristics associated with maternal depressive symptoms and found that maternal unemployment, living with smokers, poor maternal physical health, having children with behavioral or emotional problems, and paternal depressive symptoms are each independently associated with maternal depressive symptoms. In these data, paternal depressive symptoms are associated with the greatest risk of mothers exhibiting depressive symptoms, a finding that we believe has never before been shown.     

Preconception Health Indicators: A Comparison Between Non-Appalachian and Appalachian Women

To compare preconception health indicators (PCHIs) among non-pregnant women aged 18–44 years residing in Appalachian and non-Appalachian counties in 13 U.S. states. Data from the 1997–2005 Behavioral Risk Factor Surveillance System were used to estimate the prevalence of PCHIs among women in states with ≥1 Appalachian county. Counties were classified as Appalachian (n = 36,496 women) or non-Appalachian (n = 88,312 women) and Appalachian counties were categorized according to economic status. Bivariate and multivariable logistic regression models examined differences in PCHIs among women by (1) Appalachian residence, and (2) economic classification. Appalachian women were younger, lower income, and more often white and married compared to women in non-Appalachia. Appalachian women had significantly higher odds of reporting <high school education (adjusted odds ratio (AOR) 1.19, 95 % confidence interval (CI) 1.10–1.29), fair/poor health (AOR 1.14, 95 % CI 1.06–1.22), no health insurance (AOR 1.12, 95 % CI 1.05–1.19), no annual checkup (AOR 1.12, 95 % CI 1.04–1.20), no recent Pap test (AOR 1.20, 95 % CI 1.08–1.33), smoking (AOR 1.08, 95 % CI 1.03–1.14), <5 daily fruits/vegetables (AOR 1.11, 95 % CI 1.02–1.21), and overweight/obesity (AOR 1.05, 95 % CI 1.01–1.09). Appalachian women in counties with weaker economies had significantly higher odds of reporting less education, no health insurance, <5 daily fruits/vegetables, overweight/obesity, and poor mental health compared to Appalachian women in counties with the strongest economies. For many PCHIs, Appalachian women did not fare as well as non-Appalachians. Interventions sensitive to Appalachian culture to improve preconception health may be warranted for this population.     

Factors Affecting Dental Attendance of Children of New Immigrant Parents: A Cross-Sectional Study

To explore factors affecting children’s dental attendance among new immigrants. Participants in this cross-sectional study were 314 new immigrant child-parent pairs. Parents’ demographics, oral health knowledge, perceptions, child’s caries status, and oral health behaviours were analysed as determinants for dental attendance. Only 43 % of children had a dental visit within the year. Parents believing in the effectiveness of parental checking were four times more likely to seek dental care for their child [adjusted OR (adOR) 4.48, 95 % CI 1.79–11.13]. Parents perceiving dental check-up as a painful experience were 67 % less likely to visit the dentist (adOR 0.33, 95 % CI 0.17–0.63). Lack of insurance and time reduced the odds of a dental visit by 65 and 59 %, respectively (adOR 0.35, 95 % CI 0.16–0.68; adOR 0.41, 95 % CI 0.12–0.99). The care-seeking behaviour of new immigrant children was determined by parents’ perceived ability to detect caries, availability of time and dental insurance, and their perceived dental experience.     

Appreciating Reasons for Nonadherence in Women

Women aged 15–24 years have an HIV infection rate twice that of men the same age. In this study we examined reasons why HIV-infected women taking antiretroviral therapy (ART) report missing HIV medications. Women (N = 206) on ART were 2.2 times more likely to endorse reasons pertaining to forgetfulness versus reasons pertaining to problems taking pills (OR = 2.2, 95% CI = 1.63, 2.94, p <.001). There was a difference between the adherent and nonadherent groups in types of reasons overall (p <.001, 95% CI = –3.82, –2.03). Using a patient-centered approach to understand type of nonadherence (intentional vs. unintentional) may support development of novel interventions.     

Mindfulness-integrated reproductive health package for adolescents with parental HIV infection: a group-randomized controlled trial

We assessed the effect of a mindfulness-integrated reproductive health (Mind-RH) intervention on knowledge on RH among adolescents with parental HIV and determined their associated factors. A group-randomized controlled trial was conducted among adolescents aged 10–16 years with HIV-infected parent(s) using Mind-RH intervention package. Four selected townships were randomized into two study townships and two control townships. Knowledge on RH and evaluation of mindfulness practice by mindfulness-based self-efficacy scale-revised were assessed at baseline, 3 months and 6 months. Multivariate multilevel regression was used to identify influencing factors of RH knowledge. A total of 160 adolescents (80 per group) were included. A significant improvement of mindfulness scores at 3 months was found overall and sustained at 6 months (p < 0.01). Univariate analysis showed significantly higher knowledge scores in the intervention group than in the control group at 3 and 6 months (p < 0.001). After adjusting for family type, age and HIV status of the adolescents, RH knowledge scores increased at 3 and 6 months in both groups, but at a higher rate at 3 months for adolescents in the intervention group. Early adolescents, HIV negative adolescents and those from extended families had lower knowledge scores (p < 0.01). The Mind-RH package significantly improved knowledge and mindfulness of adolescents with parental HIV. Longer follow-up is required to evaluate the long-term impact of this intervention.     

The Impacts of the COVID-19 Pandemic on HIV Testing Utilization Among Men Who Have Sex With Men in China: Cross-sectional Online Survey

BackgroundThe COVID-19 pandemic has created disruptions in HIV prevention and sexual health services for men who have sex with men (MSM).ObjectiveThis study compared HIV testing utilization in 3 different reference periods (period 1: before the COVID-19 outbreak, November 2019-January 2020; period 2: after the outbreak, February-April 2020; and period 3: after the pandemic was under initial control, May-July 2020). Factors associated with HIV testing utilization after the COVID-19 outbreak (combined periods 2 and 3) were also investigated.MethodsParticipants were MSM aged ≥18 years living in Shenzhen, China. Those self-reporting as HIV positive were excluded. A total of 595 participants recruited through multiple sources completed a self-administered online survey during August-September 2020. HIV testing utilization after the COVID-19 outbreak was the dependent variable, and multivariate logistic regression models were fitted.ResultsHIV testing utilization was significantly lower in period 2 than in period 1 (n=262 vs 363, 44.0% vs 61.0%, P<.001). However, HIV testing utilization was not significantly higher in period 3 than in period 2 (n=277 vs 262, 46.6% vs 44.0%, P=.21). The prevalence of HIV testing utilization after the COVID-19 outbreak was seen in 331 (55.6%) participants. After adjusting for significant background characteristics, condomless anal intercourse (CAI) with regular male sex partners (RPs; adjusted odds ratio [AOR] 2.15, 95% CI 1.29-3.57) and sexualized drug use (SDU; AOR 2.94, 95% CI 1.41-6.06) both before and after the COVID-19 outbreak, CAI with RPs (AOR 2.07, 95% CI 1.06-4.07) and nonregular male sex partners (NRPs; AOR 3.57, 95%CI: 1.43-8.89) only after the COVID-19 outbreak was positively associated with the dependent variable. Regarding HIV prevention service utilization, HIV testing utilization before the COVID-19 outbreak (AOR 10.75, 95% CI 7.22-16.02) and the use of sexually transmitted infection (STI) testing (AOR 7.02, 95% CI 4.10-12.02), other HIV/STI prevention (AOR 3.15, 95% CI 2.16-4.60), and preexposure prophylaxis (PrEP; AOR 3.58, 95% CI 1.54-8.34) after the COVID-19 outbreak were associated with higher HIV testing utilization. The current perceived risk of HIV infection was higher than that before the COVID-19 outbreak (AOR 1.15, 95% CI 1.01-1.30), and perceived COVID-19 preventive measures taken by HIV testing service providers to be effective (AOR 1.52, 95% CI 1.29-1.78) and perceived higher behavioral control to undergo HIV testing (AOR 1.18, 95% CI 1.00-1.40) were positively associated with HIV testing utilization. Concerns about COVID-19 infection during HIV testing (AOR 0.78, 95% CI 0.68-0.89), avoiding crowded places (AOR 0.68, 95% CI 0.48-0.98), and HIV testing service providers reducing their working hours (AOR 0.59, 95% CI 0.48-0.98) were negatively associated with the dependent variable.ConclusionsHIV testing utilization among Chinese MSM declined after the COVID-19 outbreak and did not increase after the pandemic was under initial control. Removing structural barriers to accessing HIV testing caused by COVID-19, modifying perceptions related to HIV testing, and making use of HIV self-testing (HIVST) might be useful strategies to improve HIV testing among MSM during the pandemic.     

Conceptualisations of masculinity and self-reported medication adherence among HIV-positive Latino men in Los Angeles,California, USA

HIV-positive Latino men have been found to have poorer medication adherence compared to Whites. This study sought to identify how cultural conceptualisations of masculinity are associated with self-reported medication adherence among Latino men. A total of 208 HIV-positive men reported the number of doses of antiretroviral medication missed in the previous seven days (dichotomised at 100% adherence versus less). Conceptualisations of masculinity consisted of traditional machismo (e.g., power and aggressive attitudes, which are normally associated with negative stereotypes of machismo) and caballerismo (e.g., fairness, respect for elders and the importance of family). Multivariate logistic regression was used to identify factors associated with adherence. The mean adherence was 97% (SD = 6.5%; range = 57–100%). In all, 77% of the participants reported 100% adherence in the previous seven days. Caballerismo was associated with a greater likelihood (OR = 1.77; 95% CI: 1.08–2.92; p = 0.03) and machismo with a lower likelihood (OR = 0.60; 95% CI: 0.38–0.95; p = 0.03) of medication adherence. In addition, higher medication side-effects were found to be associated with a lower likelihood (OR = 0.59; 95% CI: 0.43–0.81; p = 0.001) of medication adherence. These findings reinforce the importance of identifying cultural factors that may affect medication adherence among HIV-positive Latino men resident in the USA.     

Girl Child Marriage and Its Effect on Fertility in Pakistan: Findings from Pakistan Demographic and Health Survey, 2006–2007

Child marriage (before 18 years) is prevalent in Pakistan, which disproportionately affects young girls in rural, low income and low education households. Our study aims to determine the association between early marriage and high fertility and poor fertility health indicators among young women in Pakistan beyond those attributed to social vulnerabilities. Nationally representative data from Pakistan Demographic and Health Survey, 2006–2007, a cross-sectional observational survey, were limited to ever-married women aged 20–24 years (n = 1,560; 15 % of 10,023) to identify differences in poor fertility outcomes [high fertility (three or more childbirths); rapid repeat childbirth (<24 months between births); unwanted pregnancy (any ever); pregnancy termination (any stillbirth, miscarriage or abortion ever)] by early (<18) versus adult (≥18) age at marriage. Associations between child marriage and fertility outcomes were assessed by calculating adjusted odds ratios (AORs) using logistic regression models after controlling for demographics, social equity indicators (education, wealth index, rural residence), contraception use, marriage duration and culture-specific factors (husband’s desire for more children, son preference). Overall, 50 % of ever-married women aged 20–24 years in Pakistan were married before the age of 18 years. Girl child marriage was significantly (p < 0.001) associated with low social equity indicators (poverty, rural residence, and no formal education). Adjusted logistic regression models showed that girl child marriage was significantly associated with high fertility (AOR 6.62; 95 % CI 3.53–12.43), rapid repeat childbirth (AOR 2.88; 95 % CI 1.83–4.54), unwanted pregnancy (AOR 2.90; 95 % CI 1.75–4.79), and pregnancy termination (AOR 1.75; 95 % CI 1.10–2.78). Girl child marriage affects half of all ever-married women aged 20–24 years in Pakistan, and increases their risk for high fertility and poor fertility health indicators, highlighting the need of increasing the age of marriage among women in Pakistan. Efforts to eliminate girl child marriage by strict law enforcement, promoting civil, sexual and reproductive health rights for women can help eliminate girl child marriage in Pakistan.     

Timely Access to Quality Health Care Among Georgia Children Ages 4 to 17 Years

We examined factors associated with children’s access to quality health care, a major concern in Georgia, identified through the 2010 Title V Needs Assessment. Data from the 2007 National Survey of Children’s Health were merged with the 2008 Area Resource File and Health Resources and Services Administration medically underserved area variable, and restricted to Georgia children ages 4–17 years (N = 1,397). The study outcome, access to quality health care was derived from access to care (timely utilization of preventive medical care in the previous 12 months) and quality of care (compassionate/culturally effective/family-centered care). Andersen’s behavioral model of health services utilization guided independent variable selection. Analyses included Chi-square tests and multinomial logit regressions. In our study population, 32.8 % reported access to higher quality care, 24.8 % reported access to moderate quality care, 22.8 % reported access to lower quality care, and 19.6 % reported having no access. Factors positively associated with having access to higher/moderate versus lower quality care include having a usual source of care (USC) (adjusted odds ratio, AOR:3.27; 95 % confidence interval, 95 % CI 1.15–9.26), and special health care needs (AOR:2.68; 95 % CI 1.42–5.05). Lower odds of access to higher/moderate versus lower quality care were observed for non-Hispanic Black (AOR:0.31; 95 % CI 0.18–0.53) and Hispanic (AOR:0.20; 95 % CI 0.08–0.50) children compared with non-Hispanic White children and for children with all other forms of insurance coverage compared with children with continuous-adequate-private insurance. Ensuring that children have continuous, adequate insurance coverage and a USC may positively affect their access to quality health care in Georgia.