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.     

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.     

High-risk behaviors in women who use crack: knowledge of HIV serostatus and risk behavior

PURPOSE: To determine whether crack cocaine-using women who are aware of their HIV serostatus have made modifications in risk behaviors, we compared known HIV-positive (HIV+) and HIV-negative (HIV-) users with respect to sexual risk behaviors, prevalence of sexually transmitted infections (STIs) and vaginitis, and correlates of unprotected sex. METHODS: We used a cross-sectional design with street outreach, recruitment, and interviews of sexually active crack cocaine using women. Women received testing for HIV, STIs, and vaginitis. RESULTS: Sixty-one HIV+ and 117 HIV- women were enrolled. HIV+ women were significantly more likely to be African-American. There were no significant differences in drug use, types of sexual partners, number of paying partners, attitudes regarding condoms, or STI diagnoses. HIV+ women were less likely to engage in unprotected sex compared with HIV- women (56% vs. 75%, adjusted odds ratio [AOR], 0.36; 95% confidence interval [CI], 0.13-0.99). Among HIV+ women, unprotected sex was negatively associated with stronger beliefs regarding the protective value of condoms (AOR, 0.07; 95% CI, 0.01-0.67) and concurrent injection-drug use (AOR, 0.19; 95% CI, 0.04-0.99). CONCLUSIONS: Although the majority of crack using HIV+ crack using women in this sample continued to engage in high-risk sexual activities, they were less likely to do so than HIV- women. Interventions targeting this population are needed.     

War and HIV: Sex and gender differences in risk behaviour among young men and women in post-conflict Gulu District,Northern Uganda

Despite growing knowledge of the dynamics of HIV infection during conflict, far less is known about the period that follows cessation of hostilities and its implications for population health. This study sought to fill a lacuna in epidemiological evidence by examining HIV infection and related vulnerabilities of young people living in resource-scarce, post-emergency transit camps that are now home to thousands of displaced people following two decades of war in northern Uganda. In 2010, a cross-sectional demographic and behavioural survey was conducted with 384 transit camp residents aged 15–29 years old in Gulu District. Biological specimens were collected for rapid and confirmatory HIV testing. Separate multivariable logistic regression models by sex identified risk factors for HIV infection. HIV prevalence was 15.6% (95% confidence interval [CI]: 10.8%, 21.6%) among females and 9.9% (95% CI: 6.1%, 15.0%) among males. The strongest correlate of HIV infection among men was a non-consensual sexual debut (adjusted odds ratio [AOR] 3.24; 95% CI: 1.37–7.67), and having practiced dry sex (AOR 7.62; 95% CI: 1.56–16.95) was the strongest correlate among women. Conflict-affected men and women experience vulnerability to HIV infection in different ways than may have originally been understood. Post-conflict programme planners must therefore design and implement contextualised, evidence-based responses to HIV that are sensitive to gender and cultural issues.     

A syndemic of psychosocial and mental health problems in Liberia: Examining the link to transactional sex among young pregnant women

ABSTRACT

Transactional sex may be a driver of the rising HIV epidemic in Liberia, especially among young women. The goal of this study was to explore the independent and additive effects of psychosocial conditions on engagement in transactional sex among 191 pregnant women in Monrovia, Liberia. Between March and August 2016, women receiving prenatal services completed a cross-sectional structured questionnaire. These data were used to examine the independent and additive effects of exposure to trauma, depression, post-traumatic stress disorder symptoms, and intimate partner violence on transactional sex. Overall, the results are in support of our hypothesis that these psychosocial conditions cluster together and are independently associated with transactional sex. Multivariate logistic regression analysis demonstrated an additive effect of the number of psychosocial conditions experienced on transactional sex. Women experiencing 2 psychosocial conditions had 5.96 greater odds of engaging in transactional sex compared to women reporting 0 conditions (AOR: 5.96, 95% CI: 2.22–15.99), and women experiencing 3 or 4 psychosocial conditions had 11.91 greater odds of engaging in transactional sex compared to women report 0 conditions (AOR: 11.91, 95% CI: 4.12–34.45). Our results demonstrate the need for comprehensive HIV prevention programming inclusive of mental health support and IPV prevention for Liberian women.     

HIV Testing of Tuberculosis Patients by Public and Private Providers in New York City

Thirty percent of tuberculosis (TB) patients in New York City in 2007 were not tested for HIV, which may be attributable to differential testing behaviors between private and public TB providers. Adult TB cases in New York City from 2001 to 2007 (n = 5,172) were evaluated for an association between TB provider type (private or public) and HIV testing. Outcomes examined were offers of HIV tests and patient refusal of HIV testing, using multivariate logistic and binomial regression, respectively. HIV test offers were less frequent among patients who visited only private providers than patients who visited only public providers [males: adjusted odds ratio (aOR) 0.33, 95 % confidence interval (CI) 0.15–0.74; females: aOR 0.26, 95 % CI 0.12–0.57]. Changing from private to public providers was associated with an increase in HIV tests offered among male patients (aOR 1.96, 95 % CI 1.04–3.70). Among patients who did not use substances, those who visited only private providers were more likely to refuse HIV testing than those who visited only public providers [males: adjusted prevalence ratio (aPR) 1.26, 95 % CI 0.99–1.60; females: aPR 1.78, 95 % CI 1.43–2.22]. Patients of private providers were less likely to have an HIV test performed during their TB treatment. Education of TB providers should emphasize HIV testing of all TB patients, especially among patients who are traditionally considered low-risk.     

Revictimization Is Associated With Higher Cardiometabolic Risk in Sexual Minority Women

ObjectivesAlthough there is evidence that interpersonal trauma is associated with cardiometabolic risk in women, previous studies have not assessed the potential role of revictimization (victimization in both childhood and adulthood) among sexual minority women.MethodsWe used data from the Chicago Health and Life Experiences of Women study to examine the associations of revictimization (including physical, sexual, and any revictimization) with self-reported psychosocial factors, health behaviors, and cardiometabolic risk factors (e.g., obesity, hypertension, and diabetes). We tested multiple logistic regression models, adjusted for covariates, to estimate odds ratios of the associations between revictimization and cardiometabolic risk.ResultsThe sample included 615 sexual minority women with a mean age of 40.0 years; 38.7% White. Eighty-three (13.5%) and 101 (16.4%) participants reported experiencing sexual revictimization and physical revictimization, respectively. Each form of revictimization was associated with higher odds of reporting lifetime depression and recent binge eating, but lower odds of having high social support. Physical revictimization was associated with higher odds of obesity (adjusted odds ratio [AOR], 2.38; 95% confidence interval [CI], 1.38–4.10) and hypertension (AOR, 3.31; 95% CI, 1.70–6.46). Similarly, participants who reported any revictimization were more likely to have obesity (AOR, 2.36; 95% CI, 1.42–3.92) and hypertension (AOR, 2.60; 95% CI, 1.31–5.26). No form of revictimization was associated with a higher odds of diabetes.ConclusionsThe higher odds of obesity and hypertension observed among sexual minority women who reported revictimization reinforce the need for early interventions to reduce cardiometabolic risk in this vulnerable population.     

Community Characteristics Associated with HIV Risk among Injection Drug Users in the San Francisco Bay Area: A Multilevel Analysis

Community characteristics have been associated with racial and ethnic health disparities for a wide range of ailments and conditions. Previous research has found that rates of AIDS cases among injection drug users (IDUs) vary by community characteristics. However, few studies have examined whether community characteristics are associated with HIV risk behaviors among IDUs. To address this gap in the literature, we examined the associations between census-tract-level community characteristics and injection-related and sex-related HIV risk behaviors among IDUs in the San Francisco Bay Area. Individual HIV risk behaviors were collected from 4,956 IDUs between 1998 and 2002. Using 2000 US census data, we constructed four census-level community measures: percent African American, percent male unemployment, percent of households that receive public assistance, and median household income. All community variables were measured continuously. Multilevel modeling was used to determine if community characteristics were associated with recent (in the last 6 months) receptive and distributive syringe sharing, multiple sex partners, and unprotected sex risk while controlling for potential individual-level confounders. In bivariate analysis, most of the census-tract-level community characteristics were significantly associated with injection-related HIV risk, while no community characteristics were associated with sex-related risk. However, results from multivariate multilevel models indicate that only percent African American in a census tract was associated with receptive [adjusted odds ratio (AOR) = 0.93; 95% confidence interval (CI) = 0.89, 0.99] and distributive syringe sharing (AOR = 0.94; 95% CI = 0.92, 0.99), net of individual-level characteristics. Accounting for individual-level factors in the multivariate model in the sex-related risk models revealed a significant inverse relationship between percent African American and propensity to engage in unprotected sex (AOR = 0.95; 95% CI = 0.92, 0.99); community-level characteristics remained unassociated with multiple sex partners. In this exploratory analysis, percent African American in a census tract was inversely associated with injection-related risk. The census-tract-level community characteristics we examined seem to exert little influence on individual risk among long-term chronic IDUs. More research is needed examining the influence of other community characteristics that were unmeasured in this paper but might be related to sex and drug risk among IDUs such as shooting galleries, crack houses, drug markets, and availability of preventive HIV services.     

云南省德宏州2005-2010年未婚孕产妇艾滋病病毒感染及其影响因素分析

目的:了解云南省德宏州未婚孕产妇艾滋病流行趋势,探讨影响未婚孕产妇感染艾滋病病毒(HIV)的危险因素。方法:收集2005-2010年间进入德宏州各级医院和计划生育服务站就诊的未婚孕产妇的社会人口学、行为学和HIV感染信息,对HIV阳性者血清进行BED-捕获酶联免疫试验(BED-CEIA)以检测其是否系新近感染者。结果:德宏州2005-2010年间共调查12 742例未婚孕产妇,HIV感染率和新近感染率分别为0.71%和0.25%。2007年HIV感染率和新近感染率最高,分别为1.13%和0.86%。多因素logistic回归分析结果显示,缅甸籍(AOR:2.57;95%CI:1.13～5.84)未婚孕产妇HIV感染率较高,而高中/中专文化程度(AOR:0.19;95%CI:0.06～0.58)、"丈夫"/男朋友无吸毒史(AOR:0.18;95%CI:0.04～0.75)未婚孕产妇HIV感染率较低。结论:德宏州未婚孕产妇HIV感染率及新近感染率较高。缅甸籍、"丈夫"/男朋友吸毒史、文化水平低是导致未婚孕产妇感染HIV的高危因素。有必要加强未婚孕产妇人群艾滋病防控工作。     

Healthcare-related correlates of recent HIV testing in New York City

Objective

To examine healthcare-related correlates of recent HIV testing among New York City (NYC) residents, controlling for socio-demographic and HIV-related risk factors.

Methods

Using the NYC 2007 Community Health Survey (population-based telephone survey, n = 8911), recent HIV testing was examined for its association with healthcare-related variables, including medical screening for other conditions, controlling for other HIV testing correlates using multiple logistic regression.

Results

Factors associated with a recent HIV test included: provider recommendation for an HIV test (adjusted odds ratio [AOR]: 10.1, 95% confidence interval [CI]:7.6-13.5), Medicaid versus private insurance (AOR: 1.6, 95% CI: 1.2-2.1), and having a personal doctor (AOR: 1.6, 95% CI: 1.3-2.1). The proportion of HIV tests attributed to each factor (attributable-fraction [AF]) was 49% for provider recommendation, 33% for having a personal doctor, and 8.3% for Medicaid insurance. Among subgroups eligible for other medical screening, factors associated with recent HIV testing included recent receipt of blood lipid testing (AOR: 2.2, 95% CI: 1.6-3.0; AF: 45%), and Pap smear (AOR: 2.7, 95% CI: 2.1-3.5; AF: 52%). Recent receipt of mammography and colonoscopy was not associated with recent HIV testing.

Conclusions

A substantial proportion of recent HIV testing coverage among New Yorkers may be attributable to healthcare-related factors. Joint medical screening may provide opportunities to increase population HIV testing coverage.     

Estimating levels of HIV testing coverage and use in prevention of mother-to-child transmission among women of reproductive age in Zambia

Background

Mother to child transmission of HIV (MTCT) still remains a challenge affecting many countries. Globally, an estimated 150,000 children were newly infected with HIV in 2015, over 90% of them in Sub-Saharan Africa through MTCT. In Zambia approximately 500,000 babies are born and 40,000 acquire the infection vertically if there is no intervention annually. This study estimated the HIV testing coverage and associated factors among Zambian women of reproductive age 15–49?years.

Methods

A cross-sectional study based on data extracted from the Zambia Demographics and Health Survey [Zambia Demographic and Health Survey. Central Statistical Office (CSO), Ministry of Health (MOH), Tropical Diseases Research Centre (TDRC), University of Zambia, and Macro International Inc. 2009. 2014]. Women aged 15–49?years, 15,388 who reported having ever tested for HIV or not comprised the de facto eligible sample. Extracted data comprised women’s demographic characteristics; their full birth history and records of antenatal care for the most recent birth within a 5?year period preceding the survey. A weighted multiple logistic regression model was done to determine factors associated with the odds of HIV testing coverage among women of reproductive age.

Results

Out of 15,388 women in the study, 12,413 (81%) reported ever tested for HIV. Of the 6461 women who attended antenatal care (ANC) 6139 (95%) reported ever tested for HIV. Additionally, 6139 (95%) out of 6461 of the women were given information on PMTCT during ANC sessions. Testing coverage was higher among women aged 20–24?years compared to women aged 15–19?years [AOR 2.1, 95% CI 1.14–3.84; p?=?0.017]. Women with higher socio-economic status had 6.6 times the odds of having ever tested compared to women with lower status [AOR 6.6, 95% CI 3.04–14.14; p?<?0.001].

Conclusions

In this study we have demonstrated that HIV testing coverage is higher among women of reproductive age. HIV testing among women attending ANC is also higher. Older women with higher socio-economic status are more likely to take up HIV testing compared to their young counterparts.

     

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.     

The HIV prevalence among pregnant women in the Amsterdam region (1988–1991)

The objective of the study was to monitor the HIV prevalence in the years 1988–1991 among pregnant women in the Amsterdam region, visitors to an abortion clinic and 3 outpatient infertility clinics. All women attending these clinics were asked to participate in the study on a voluntary basis and were tested with informed consent. The women were questioned about risk-bearing behaviour of themselves and their sexual partner(s). In the period 1988–1991, of the 23,827 eligible pregnant women, 22,165 women participated (93.0%). Twenty-seven women were found to be positive for HIV antibodies (0.12%, 95% CI: 0.08%–0.17%), of whom twenty belonged to a known HIV risk group or had a partner who belonged to one of these groups and 7 women had no known HIV risk. Seventeen of the 27 women had a foreign nationality. The annual HIV prevalence among pregnant women was: 1988: 0.28%; 1989: 0.10%; 1990: 0.10%; 1991: 0.11%. In the years 1990 and 1991, of the 1,128 eligible women visiting the abortion clinic 953 (84.5%) were tested. Eleven women were HIV-seropositive (1.15%, 95% CI: 0.6%–2.0%), of whom 9 were from an AIDS endemic region, 1 woman had a partner from this region and 1 woman had no known HIV risk. Four African women had HIV-2 antibodies. At the 3 outpatient infertility clinics 1 woman was found to be HIV-positive (0.13%; 95% CI: 0.02–0.9). She had no other risk than a partner from an AIDS endemic area. In the Amsterdam region there was a steady and low HIV prevalence (0.1%) among pregnant women through the years 1988–1991. The prevalence in the abortion clinic was ten times higher. The program was able to detect possible high risk groups within the population. Migration and travelling can play an important role in the spread of HIV in the general heterosexual population.     

Social Network Members’ Roles and Use of Mental Health Services Among Drug Users in New York City

Depression is more common among drug users (15–63 %) than the general population (5–16 %). Lack of social support network members may be associated with low mental health service (MHS) use rates observed among drug users. We investigated the relationship between social network members’ roles and MHS use among frequent drug users using Social Ties Associated with Risk of Transition into Injection Drug Use data (NYC 2006–2009). Surveys assessed depression, MHS use, demographics, drug use and treatment, and social network members’ roles. Participants reporting lifetime depressive episode with start/end dates and information on social/risk network members were included (n = 152). Adjusting for emotional support and HIV status, having one or more informational support network members remained associated with MHS use at last depressive episode (adjusted odds ratio (AOR) 3.37, 95 % confidence interval (CI) 1.38–8.19), as did history of drug treatment (AOR 2.75, 95 % CI 1.02–7.41) and no legal income (AOR 0.23, 95 % CI 0.08–0.64). These data suggest that informational support is associated with MHS utilization among depressed drug users.     

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.     

Implementation of guidelines for HIV counseling and voluntary HIV testing of pregnant women

OBJECTIVES: This study assessed HIV counseling and testing among pregnant women. METHODS: A survey was administered to 9115 women who gave birth at 66 Chicago-area hospitals in 1997 and 1998. RESULTS: Fifty-eight percent of the women received HIV counseling, and 65% were offered testing. Fifty-six percent were tested for HIV. Among the women tested, 88% were given their test result. Women were more likely to be tested if they received HIV counseling and were more likely to be offered testing if they received such counseling. CONCLUSIONS: Rates of HIV counseling for, and offers of testing to, pregnant women need to be increased.     

HIV-positive women report more lifetime partner violence: findings from a voluntary counseling and testing clinic in Dar es Salaam,Tanzania

OBJECTIVES: Experiences of partner violence were compared between HIV-positive and HIV-negative women. METHODS: Of 340 women enrolled, 245 (72%) were followed and interviewed 3 months after HIV testing to estimate the prevalence and identify the correlates of violence. RESULTS: The odds of reporting at least 1 violent event was significantly higher among HIV-positive women than among HIV-negative women (physical violence odds ratio [OR] = 2.63; 95% confidence interval [CI] = 1.23, 5.63; sexual violence OR = 2.39; 95% CI = 1.21, 4.73). Odds of reporting partner violence was 10 times higher among younger (< 30 years) HIV-positive women than among younger HIV-negative women (OR = 9.99; 95% CI = 2.67, 37.37). CONCLUSIONS: Violence is a risk factor for HIV infection that must be addressed through multilevel prevention approaches.     

Correlates of HIV infection among incarcerated women: Implications for improving detection of HIV infection

The prevalence of HIV infection in correctional settings is several-fold higher than found in community settings. New approaches to identifying HIV infection among prisoners are urgently needed. In order to determine the HIV seroprevalence and to identify the correlates of HIV infection among female prisoners, an anonymous, but linked HIV serosurvey was conducted at Connecticut’s sole correctional facility for women (census=1,100). After removing all individual identifiers for inmates’ standardized clinical and risk behavior information, data are linked by a third source to blinded HIV-testing information by a third party. This three-step sequential process allows for anonymous HIV testing that can still be linked with deidentified clinical and behavioral data. Of the 3,315 subjects with complete information, 250 (7,5%) were HIV+. Of these, 157 (63%) selfreported being HIV+. Using multiple logistic regression analysis, having sex with a known HIV+ person [adjusted odds ratio (AOR)=9.1] and injection drug use (AOR=6.1) were the most highly correlated risk factors for HIV, whereas leukopenia (AOR=9.4) and hypoalbuminemia (AOR=7.2) were the most significant laboratory markers. Other independent correlates of HIV included self-report of syphilis (AOR=1.9) or genital herpes infection (AOR=2.7) and being Black (AOR=2.1) or Hispanic (AOR=2.2). The prevalence of HIV and HIV-risk behaviors is high among incarcerated women. Existing voluntary HIV counseling and testing programs do not completely target high-risk groups who remain part of the evolving epidemic. Defined demographic, behavioral, and clinical assessments may provide useful information for encouraging targeted counseling and testing. Newer targeted approaches merit further study to determine the effectiveness of this approach. Alternative methods of facilitating more widespread HIV testing, such as saliva tests, rapid serologic tests, and more routine testing in high HIV-prevalence areas should be considered both for clinical and for public health benefits.     

Interpersonal and structural contexts of intimate partner violence among female sex workers in conflict-affected northern Uganda

Intimate partner violence (IPV) is the most prevalent form of violence against women, yet remains under-researched among sex workers in sub-Saharan Africa. We explored the interpersonal and structural determinants of recent IPV among female sex workers in northern Uganda. This analysis drew on data from a community-based cross-sectional study (conducted May 2011–January 2012), involving 379 female sex workers in Gulu, northern Uganda. Using logistic regression and multivariable modeling, we examined the correlates of recent male-perpetrated physical or sexual IPV. Of 379 women with noncommercial partners, 59 percent reported having experienced recent moderate/severe physical or sexual IPV. Reporting recent client violence (adjusted odds ratio (AOR): 3.67; 95 percent confidence interval [CI]: 2.31–5.83), doing what their partner wanted (AOR: 2.46; 95 percent CI: 1.46–4.13), and forced sexual debut (AOR: 1.92; 95 percent CI: 1.20–3.05) were independently associated with moderate/severe IPV; recent police arrest and/or incarceration were/was marginally significantly associated with IPV (AOR: 2.25; 95 percent CI: 0.86–5.88, p = 0.097). Greater odds of IPV among sex workers were associated with recent workplace violence, forced sexual debut, and gendered power dynamics favoring male partner control. Programs and policies promoting the safety and health of marginalized women and addressing gender dynamics and violence are needed.     

Factors associated with HIV testing: results from an Italian General Population Survey

BACKGROUND: HIV testing, with appropriate counseling, can help prevent the spread of HIV infection. This study is the first national survey in Italy that examines factors associated with serotesting among Italian heterosexuals and is part of a European Concerted Action. METHODS: In 1998, a cross-sectional telephone survey was conducted on a random sample (n = 2,603) of the Italian population ages 18-49 years. Associations between HIV testing and risky sexual behaviors (multiple sexual partners in the past 5 years, intercourse with prostitutes, not always using condoms with a new sexual partner) and sociodemographic variables are examined separately for men and women using multiple logistic regression. RESULTS: The prevalence of having ever been tested for HIV, whether voluntarily or not, among heterosexual men and women is 27.0 and 32.8%, respectively. Voluntary testing is reported by 8.4% of heterosexual men and 6.1% of heterosexual women. Multivariate analysis shows that having multiple sexual partners significantly increases the odds of testing (Men: OR = 2.10; 95% CI: 1.3-3.4. Women: OR = 3.03; 95% CI: 1.7-5.4). Multiple logistic regression, controlling for risky behavior, shows also that persons ages 30-39 years have significantly higher probability of being tested than younger subjects (Men: OR = 3.30; 95% CI: 1.4-7.9. Women: OR = 2.61; 95% CI:1.1-6.4). Better educated women tend to have a higher probability of testing, but this increase is not significant at the 5% level. CONCLUSIONS: The prevalence of voluntary serotesting in Italy is lower than in other countries. Risky sexual behavior is associated with higher odds of testing; however, a high proportion of at-risk heterosexuals never sought testing. Particular attention should be dedicated to younger persons and to less educated women.