‘HIV and work don't go together’: Employment as a social determinant of HIV outcomes among men who have sex with men and transgender women in the Dominican Republic

Men who have sex with men (MSM) and transgender women are disproportionately affected by HIV in the Dominican Republic. Little is known about their experiences living with HIV as a chronic condition. We explored employment as a social determinant of well-being with HIV. We conducted 42 qualitative in-depth interviews with MSM (n?=?16) and transgender women (n?=?5) living with HIV; each participant completed 2 interviews to facilitate depth and iterative analysis. We used narrative analysis and systematic coding to identify salient themes related to employment and the HIV experience and developed a conceptual model of the pathways between HIV stigma, unemployment, and HIV outcomes. Early life experiences, including rejection from families and school, resulted in limited work opportunities, especially among transgender women. Following HIV diagnosis, participants across all socio-economic levels lost jobs and/or were unable to get jobs due to illegal HIV testing and HIV stigma and discrimination. Not being able to work impacted mental health, engagement in HIV care, and overall well-being. We conclude that lack of employment is a salient concern among MSM and transgender women living with HIV. Holistic, multi-level programmes that address illegal HIV testing and discriminatory hiring practices are urgently needed to facilitate engagement in care and long-term well-being.     

中国跨性别MSM人群高危性行为特征及HIV/梅毒检测研究

目的 了解中国跨性别MSM人群及非跨性别MSM的高危性行为特征及HIV/梅毒检测情况,并比较两个人群的差异,为制定针对性的防治措施提供依据。 方法 利用互联网招募跨性别MSM及非跨性别MSM,收集其高危性行为、HIV/梅毒检测史等资料进行分析。 结果 本研究共从30个省份招募MSM 1 320例,其中52例(3.94%)为跨性别MSM。跨性别MSM人群及非跨性别MSM自我报告的HIV感染率分别为11.11%,5.67%。多因素分析显示,跨性别MSM人群更可能选择跨性别者作为性伴(调整后OR(aOR)=8.113,95%CI:2.559~25.692),更少与女性伴侣居住(aOR=0.102,95%CI:0.021~0.402);跨性别MSM人群的HIV及梅毒检测率均低于非跨MSM(aOR HIV=0.363,95%CI:0.203~0.652;aORsyphilis=0.423,95%CI:0.203~0.907)。 结论 跨性别MSM人群HIV感染率较高而检测率较低,需要进一步促进该人群的HIV/梅毒检测,从而控制HIV/梅毒在该人群的进一步传播。HIV/梅毒在该人群的进一步传播。     

Sex work,discrimination, drug use and violence: a pattern for HIV risk among transgender sex workers compared to MSM sex workers and other MSM in Guatemala

ABSTRACT

The risk of HIV infection is higher among transgender women and cisgender men who have sex with men (MSM) compared to the general population due in part to social and contextual factors. This study aimed to determine the prevalence and association of alcohol and drug abuse, discrimination and violence among transgender sex workers compared to cisgender male sex workers and cisgender men who had not received money for sex in Guatemala City. In 2010, transgender women and cisgender men who had had sex with men or transgender women were recruited into a cross-sectional behavioural survey. Among transgender women, 86% received money for sex in the past year. Transgender sex workers were more likely to use drugs and binge drink, three times as likely to be discriminated against and eight times as likely to be forced to have sex compared to non-sex worker men. Male sex workers were twice as likely to use illicit drugs or experience physical violence and six times as likely to experience forced sex compared to non-sex worker men. Transgender and male sex workers would benefit from harm reduction for substance use, violence prevention, response and strategies to mitigate discrimination.     

HIV and transgender women in Kampala,Uganda – Double Jeopardy

Transgender women in Kampala face stigma, high HIV acquisition or transmission risk and poor access to health services. We explored the HIV and gender-related contexts of their lives. Snowball sampling was used to enrol 45 participants between July-October 2013. Data collection included audio-computer-assisted self-interviews, qualitative face-to-face interviews and blood tests for HIV and CD4. One in five respondents tested HIV positive. Emergent themes revealed highly varied forms of gender identity and gender expression. Almost all respondents asserted that they frequently engaged in sex work, mainly due to lack of employment. HIV-related themes included limited access to non-stigmatising health services, inconsistent condom use, inaccurate perceptions of self and partners' risk, alcohol use, receptive anal sex with men, multiple sex partners, frequent self and enacted stigma, and violence. Findings highlight the urgency of providing members of this marginalised population with tailored, innovative, comprehensive and effective HIV prevention programmes that address structural issues such as access to HIV services and limited employment as well as behavioural issues such as inconsistent condom use, multiple sexual partners, self and enacted stigma, violence and alcohol use.     

Depression and discrimination in the lives of women,transgender and gender liminal people in Ontario,Canada

This article uses an intersectionality lens to explore how experiences of race, gender, sexuality, class and their intersections are associated with depression and unmet need for mental healthcare in a population of 704 women and transgender/gender liminal people from Ontario, Canada. A survey collecting demographic information, information about mental health and use of mental healthcare services, and data for the Everyday Discrimination Scale and the PHQ‐9 Questionnaire for Depression was completed by 704 people via Internet or pen‐and‐paper between June 2011 and June 2012. Bivariate and regression analyses were conducted to assess group differences in depression and discrimination experiences, and predictors of depression and unmet need for mental healthcare services. Analyses revealed that race, gender, class and sexuality all corresponded to significant differences in exposure to discrimination, experiences of depression and unmet needs for mental healthcare. Use of interaction terms to model intersecting identities and exclusion contributed to explained variance in both outcome variables. Everyday discrimination was the strongest predictor of both depression and unmet need for mental healthcare. The results suggest lower income and intersections of race with other marginalised identities are associated with more depression and unmet need for mental healthcare; however, discrimination is the factor that contributes the most to those vulnerabilities. Future research can build on intersectionality theory by foregrounding the role of structural inequities and discrimination in promoting poor mental health and barriers to healthcare.     

朝阳市2012年男男性行为人群HIV感染现状分析

目的 对2012年辽宁省朝阳市男男性行为人群(MSM)艾滋病病毒(HIV)感染现状进行调查,以分析其相关影响因素,从而为干预措施的制定提供可参考的依据。方法 采用MSM工作组推荐方法招募研究对象,由专业人员进行问卷调查和实验室检测,使用Epi Data 3.1建立数据库,采用SPSS 17.0进行统计分析。结果 对475名MSM调查前1年中有122人(25.7%)进行HIV抗体检测,且有120人(98.4%)知晓检测结果;被调查者首次性行为中位年龄为21.5岁,且近6个月性伴侣中位数量为5个,其中有47人(9.9%)为得到钱的男性提供性服务,有35人(7.4%)经付钱方式接受男性提供的性服务,147人(31.0%)与女性发生性关系;梅毒与HIV感染者分别为29例(6.1%)、12例(2.5%),二者共患为2例(0.4%)。结论 大多数MSM人群均见高危性行为,HIV感染率呈逐年上升态势,主要原因为多性伴侣等不安全性行为。     

Intersectional stigma among midlife and older Black women living with HIV

Abstract

HIV-related stigma is a barrier to the prevention and treatment of HIV. For midlife and older Black women, the nature and intensity of HIV-related stigma may be compounded by their multiple marginalised social status based on gender, race, and age. We examined the perceptions and experiences of HIV-related stigma among midlife and older Black women living in Prince George’s County, Maryland, USA. Between 2014 and 2015, we conducted semi-structured interviews with a sample of 35 midlife and older Black women living with HIV. Using a modified grounded theory approach, we explored emergent themes related to the manifestation and experience of intersectional stigma and changes in stigma experience over time. Our findings suggest that intersectional stigma is a central feature in midlife and older Black women’s lives, with women reporting experiences of intersectional stigma at the interpersonal/familial, community, and institutional/structural levels. Although women acknowledged gradual acceptance of their HIV-positive status over time, they continued to experience negative responses related to gender, race, age, and disease. Our findings indicate that a more robust understanding of the impact of HIV-related stigma requires work to consider the complex manifestations of intersectional stigma among an increasingly aging population of Black women in the USA.     

Optimising HIV programming for transgender women in Brazil

In Brazil, little data is available to inform HIV prevention programming for travestis and transgender (‘trans’) women, despite the existence of a social movement that has gained strength in recent years. We conducted formative research in Rio de Janeiro to gather trans women’s perspectives on combination HIV prevention approaches. Framing the analysis within the model of gender affirmation, we found that several social and contextual factors inhibited participants’ access to HIV prevention and treatment. Experienced and anticipated gender-related discrimination and HIV stigma were linked to the avoidance of HIV testing, health services and HIV status disclosure. Participants recommended HIV prevention interventions which combined socio-structural interventions, such as peer-based empowerment and social support, with biomedical interventions such as pre-exposure prophylaxis (PrEP). Participants expressed a preference for programmes and interventions that emphasised a gender-affirmative approach, promoted autonomy and aimed to reduce stigma and discrimination in public health services.     

HIV test uptake among MSM in China: Implications for enhanced HIV test promotion campaigns among key populations

Despite global efforts to increase HIV test uptake among men who have sex with men (MSM), social stigma and negative attitudes toward homosexuality hinder the effectiveness of traditional test promotion campaigns. Increasing HIV test uptake requires greater understanding of the conditions that facilitate decisions to get tested. We conducted an online survey hosted by two of the most highly frequented MSM web portals in China. A generalised ordered logistic regression analysis was conducted to determine factors associated with HIV testing behaviour. Compared to men who had never tested for HIV, men who had tested in the past year were more likely to have never engaged in sex with women, have multiple male sex partners in the past 3 months and have disclosed their sexual orientation to others. MSM found testing at local Chinese Centers for Disease Control and Prevention (80.7%), gay men's community-based organisations (80.2%) and public hospitals (70.9%) to be acceptable, while saunas (50.5%) and gay bars (41.8%) were found to be unacceptable testing venues. Our study shows that MSM in China prefer to test at venues that guarantee confidentiality, quality and quick results. Our study also suggests that self-testing may be a feasible approach to increase test uptake.     

跨性别女性人群心理特征及相关行为分析

目的了解跨性别女性人群的心理特征及相关行为。方法 2016年1月—2017年10月,在山东省采用滚雪球抽样的方法抽取调查对象并进行面对面问卷调查。结果本次共调查160人,调查对象最小19岁,最大44岁,平均年龄27岁(中位数);汉族为主,占93.1%;多数未婚,占80.0%;高中以上文化程度居多,占83.1%;74.4%为非独生子女。性取向选择男性119人,占74.4%,64.3%的人有过无保护性接受性肛交性行为。26人做过变性手术,占16.3%。属于完全女性心理性别者占51.2%,心理性别模糊者占48.8%;两者在婚姻状况(P=0.003)、是否有固定工作(P=0.013)、生活环境(P=0.002)、性取向(P=0.0001)、何种装扮从事社会生活(P=0.0001)、是否与女性发生过性行为(P=0.002)、是否从事商业性行为(P=0.012)、是否做过变性手术(P=0.001)、是否因为跨性别受到过暴力或虐待(P=0.004)等方面差异有统计学意义。结论跨性别女性人群存在感染艾滋病的危险,其心理性别可分为完全女性心理性别和模糊心理性别,前者更有感染艾滋病的风险,建议对该人群开展针对性的宣传教育、干预和检测。     

MSM艾滋病自愿咨询检测服务模式探索

目的通过在男男性行为人群(MSM)中开展艾滋病自愿咨询检测试点(VCT)工作,探索MSM社区艾滋病自愿咨询检测服务模式,提高MSM的艾滋病自愿咨询检测利用、结果告知及随访服务。方法采用设立社区咨询点、结合干预工作进行检测转介、提供符合人群特点的检测咨询,实行首询负责制的方法开展艾滋病自愿咨询检测服务。结果通过试点工作,形成了一套由MSM社区组织、各级疾控部门和医疗机构紧密合作,包括咨询检测、结果告知、追踪确诊和随访在内的MSM社区艾滋病自愿咨询检测服务模式。试点期间,成都同乐健康咨询服务中心共有2 218人次、泸州和南充市各有537人和311人接受了社区艾滋病自愿咨询检测服务。结论通过在MSM中开展社区艾滋病自愿咨询检测试点工作,提高了MSM对艾滋病自愿咨询检测的利用率,加强了检测后结果告知和随访服务。     

温州市主动求询男男性接触者人群ＨＩＶ 感染状况和影响因素分析

摘要：目的　了解温州市主动到艾滋病自愿咨询检测门诊（ｖｏｌｕｎｔａｒｙｃｏｕｎｓｅｌｉｎｇａｎｄｔｅｓｔｉｎｇ,ＶＣＴ）求询的
男男性接触者（ｍｅｎ ｗｈｏｈａｖｅｓｅｘ ｗｉｔｈ ｍｅｎ,ＭＳＭ） 人群艾滋病病毒（ｈｕｍａｎｉｍｍｕｎｏｄｅｆｉｃｉｅｎｃｙｖｉｒｕｓ,
ＨＩＶ）感染状况及其影响因素,为今后制定防控措施提供依据。方法　对２０１１－２０１３年主动到温州市所有
ＶＣＴ 门诊接受咨询检测的ＭＳＭ 人群的基本信息及检测情况进行统计分析,描述性分析ＭＳＭ 人群的人口
学特征,高危行为特点及ＨＩＶ 感染情况,χ
２ 检验、多因素非条件ｌｏｇｉｓｔｉｃ回归分析不同人口学特征人群的
ＨＩＶ 感染率差异,犘＜０．０５为差异有统计学意义。结果　本研究中１６００ 名主动求询ＭＳＭ 中青壮年占
８５．３８％ （１３６６／１６００）,未婚占６５．１９％ （１０４３／１６００）,高中及以上占６７．００％ （１０７２／１６００）。近３ 年
ＨＩＶ 抗体阳性检出率为８．６９％,总体呈现出上升趋势;梅毒阳性检出率为４．３１％。单因素分析显示,年
龄（χ
２＝７．１６,犘＝０．０３）、婚姻状况（χ
２＝６．３４,犘＝０．０４）、文化程度（χ
２＝８．１６,犘＜０．０１）、既往接受
ＨＩＶ 检测（χ
２＝１０．００,犘＜０．０１）、梅毒感染（χ
２＝１２．２４,犘＜０．０１）与ＨＩＶ 感染相关。多因素ｌｏｇｉｓｔｉｃ回
归分析显示,文化程度高中及以上ＨＩＶ 感染风险较初中及以下的低（犗犚＝０．６４,９５％ 犆犐：０．４５～０．９１）;
既往有接受过ＨＩＶ 检测比未接受过检测者感染ＨＩＶ 的风险高（犗犚＝１．６４,９５％ 犆犐：１．１５～２．３４）;梅毒
感染可以增加ＨＩＶ 感染的风险（犗犚＝２．３８,９５％ 犆犐：１．２７～４．４５）。结论　温州市主动求询ＭＳＭ 人群中
ＨＩＶ 抗体阳性检出率较高,应该充分利用ＶＣＴ 点的窗口作用,对ＭＳＭ 人群开展有效、深入的咨询检测
服务和人文关怀,降低ＭＳＭ 人群ＨＩＶ 感染的风险。
关键词：自愿咨询检测;男男性接触者;艾滋病病毒;影响因素
中图分类号：Ｒ５１２．９１　　文献标识码：Ａ　　文章编号：１００９ ６６３９ （２０１４）０５ ０４０４ ０４     

兰州市2006-2013年男男性接触人群艾滋病流行病学调查研究

目的了解兰州市男男性接触人群（MSM）性行为特征、人类免疫缺陷病毒（HIV）和梅毒感染状况以及影响因素,为制定本市MSM人群艾滋病（AIDS）干预策略提供依据。方法招募MSM志愿者,采用＂滚雪球＂的方法于2006-2013年对本市MSM进行一对一问卷调查并进行血清学检测,使用EpiData 3.1软件录入数据,SPSS 16.0软件进行数据整理和统计分析。结果本研究共调查2 090人,检出HIV阳性者93例,感染率为4.45%,梅毒阳性者264例,感染率为12.63%;连续8年的MSM人群的HIV感染率经χ2检验（χ2=30.149,P〈0.05）,差异有统计学意义;连续8年的MSM人群的梅毒感染率经χ2检验（χ2=92.406,P〈0.05）,差异有统计学意义。86.36%（1 805/2 090）的MSM最近6个月发生过同性性行为,安全套坚持使用率为43.55%（786/1 805）;26.60%（556/2 090）的MSM最近6个月发生过异性性行为,安全套坚持使用率为34.89%（194/556）;6.04%（109/1 805）的MSM最近6个月发生过商业同性性行为,安全套坚持使用率为56.88%（62/109）。结论兰州市MSM艾滋病知晓率较高,高危性行为比较严重,HIV和梅毒感染率较高,应该加强该人群高危性行为的干预。     

HIV现场快速检测在浴池男男性接触人群中的应用

目的通过现场快速检测方法在浴池MSM人群艾滋病性病干预检测的应用,建立和完善可行的干预流程,探讨浴池MSM人群初筛阳性者高流失情况的解决方法。方法按自愿原则分2组,1组为现场快检组,在浴池对MSM人群开展快速检测HIV抗体;另1组为常规检测组,现场采血。两组均进行人口学、性行为学特征问卷调查和血清常规HIV、梅毒的检测。结果 180名调查对象中,87名自愿参加现场快检,发现初筛HIV抗体阳性10名,感染率11.49%;93名参加常规检测,发现初筛HIV抗体阳性15名,感染率16.13%,现场快检与常规检测HIV阳性发现率差异无统计学意义(P>0.05)。未婚人员参加现场快检较常规检测比例高(P<0.05)。检测对象结果整体告知92.78%,常规检测与现场快检结果告知情况差异无统计学意义(P>0.05)。HIV初筛阳性者常规检测追踪到位率60.00%,失访率40.00%;现场快检追踪到位率100.00%,现场快检失访率明显低于常规检测(P<0.05)。结论现场快速检测HIV抗体方法在浴室MSM人群干预中具有很强的实用性,值得推广使用。     

Syndemics of depression,alcohol use,and victimisation,and their association with HIV-related sexual risk among men who have sex with men and transgender women in India

We examined the presence and co-occurrence of psychosocial health conditions (depression, frequent alcohol use, and victimisation) among men who have sex with men (MSM) and transgender (TG) women in India, and their cumulative association with sexual risk. A survey questionnaire was administered among a convenience sample of 600 participants (MSM?=?300; TG women?=?300) recruited through six non-governmental organisations in four states. Prevalences of the number of psychosocial health conditions among MSM were: none?=?31.3%, one?=?43%, two?=?20%, and three?=?5.7%; and among TG women: none?=?9%; one?=?35.33%, two?=?38.33%, and three?=?17.33%. In bivariate and multivariate models, these conditions were positively and additively related to sexual risk, providing evidence for a syndemic of psychosocial health conditions among MSM and TG women and their synergistic effect on sexual risk. In addition to the number of syndemic conditions, resilient coping and social support were significant predictors of sexual risk among MSM and TG women, respectively. HIV preventive interventions in India should screen for and address co-occurring psychosocial health conditions – experiences of violence, mental health issues, and alcohol use – among MSM and TG women.     

杭州市男男性接触人群艾滋病病毒感染现状及感染者特征分析

目的了解杭州市男男性接触者（MSM）艾滋病病毒感染情况,并对感染者的社会行为特征进行分析,为艾滋病健康教育及高危行为干预计划的改进和完善提供依据。方法对2009-2011年杭州市614名MSM人群进行问卷调查,收集社会人口学和危险行为资料,采集外周静脉血进行HIV抗体检测。结果本组在614名MSM人群中共检出HIV感染者65例,HIV抗体阳性率为10.59%;HIV感染者以未婚、低龄化、高学历为主,艾滋病知识总知晓率为84.13%。65例HIV感染者均在最近半年与男性发生过肛交性行为,与男性最近一次性行为安全套使用率为62.17%;最近半年与异性发生性行为者20人,与异性发生性行为最近一次安全套使用率为33.25%。结论杭州市MSM人群HIV感染率较高,HIV感染者存在认知与行为分离、无保护男男性行为现象,应加强对MSM人群及其感染者的健康教育和行为干预。     

Counting results: performance-based financing and HIV testing among MSM in China

In this paper, I examine the use of performance-based financing to scale-up HIV testing in men who have sex with men, or MSM, by global health initiatives in China. This mechanism, which ties financing directly to the achievement of targets and indicators, assures that measurable results are produced from health interventions and accounts for financial spending. On the one hand, its adoption into HIV programming in China articulates with broader shifts in global health that place currency on particular forms of evidence. At the same time, performance-based financing reshapes how HIV interventions are carried out and what counts in these programmes. The suturing of financing to outputs directs what gets counted and how, and as a consequence leads to the production of measurable results as an end in and of themselves. Based on 22 months of ethnographic research carried out in China, I explore the effects of this mechanism and, in doing so, ask what gets left out in the pursuit of evidence. In particular, I demonstrate how the demand for outputs undermines HIV prevention in MSM, thus risking the very lives these interventions are intended to save.     

襄阳市MSM人群艾滋病新发感染影响因素探讨

目的 掌握襄阳市男男性行为人群(MSM)艾滋病病毒(HIV)新发感染影响因素,为制定防控措施提供依据。 方法 采用滚雪球法召集襄阳市MSM,对其进行艾滋病防治知识、行为等方面的问卷调查,检测HIV抗体、梅毒和丙型肝炎抗体。对数据进行描述性、单因素和多因素分析。 结果 襄阳市MSM人群HIV新感染率估算值为4.72%(95%CI=3.03%～6.42%)。单因素分析显示,年龄、本地居住时间、文化程度、艾滋病防治知识得分、最近一次同性肛交时使用安全套、最近六个月同性性行为坚持使用安全套、最近一年曾被诊断患过性病、最近一年接受同伴教育、梅毒感染共9个因素与艾滋病新发感染相关(P≤0.10)。多因素分析显示,最近六个月同性肛交时坚持使用安全套(OR=0.16,95%CI=0.05～0.54,P=0.00)是HIV新发感染的保护性因素,且影响最大。年龄大于等于60岁(OR=4.78,95%CI=0.92～24.75,P=0.04)、本地居住时间12个月以内(OR=4.36,95%CI=1.37～13.81,P=0.01)、文化程度初中及以下(OR=2.44,95%CI=1.05～5.70,P=0.04)、梅毒阳性(OR=4.44,95%CI=1.25～15.77,P=0.02)是危险因素。 结论 襄阳市MSM人群HIV新发感染率较高。应采取有效措施提高该人群安全套坚持使用率,加大对60岁及以上、本地居住时间12个月以内、文化程度初中及以下、梅毒阳性的MSM人群综合干预措施力度。     

Immigration as a crisis tendency for HIV vulnerability among racialised women living with HIV in Ontario,Canada: an anti-oppressive lens

South Asian immigrant women in Canada face unique structural barriers that influence their HIV vulnerability. Using an intersectional and anti-oppressive lens, we explored the role of immigration in bringing about changes in gender roles and the structure of gender relations and their effect on HIV risk among immigrant women as they experienced crisis tendencies in the face of hegemonic masculinity. Informed by Connell’s theory of gender, the study entailed in-depth interviews with 12 self-identified South Asian immigrant women living in the Greater Toronto Area, in Ontario, Canada. A thematic analysis yielded four themes: power relations, emotional relations, gendered division of labour and social norms. Our findings revealed interdependencies between immigration and each of structural, individual and normative factors (the themes) as they pertain to crisis tendencies when patriarchy is disrupted. Given the rapid increase in global immigration, the connections between transnationalism and hegemony, and the established link between immigration and HIV, future research should extend this work to other immigrant communities.     

Differences in substance use and sexual partnering between men who have sex with men,men who have sex with men and women and transgender women

Men who have sex with men (MSM), men who have sex with men and women (MSM/W) and transgender women (TGW) remain the populations most severely and disproportionately impacted upon by HIV in Los Angeles County. Baseline data from community-based HIV-prevention programmes serving these populations were analysed to explore differences in demographic characteristics, substance use and sexual partnering between the three groups. Despite high HIV prevalence overall (MSM 34.7% versus MSM/W 16.1% versus TGW 21.9%, p < .001), there were striking differences in risk behaviours. Higher rates of homelessness were reported by MSM/W compared to MSM and TGW. Lower rates of education and less substance use were reported by TGW (62.2%), compared to MSM (79.7%) and MSM/W (92.6%). A much higher number of male sexual exchange partners were reported by TGW (MSM 1.04 [SD = 4.8] versus MSM/W 1.54 [SD = 10.3] versus TGW 12.37 [SD = 23.9], p < .001). Findings support the need for HIV-prevention interventions that specifically address the unique risk patterns among each population in order to curb HIV acquisition and transmission.