Vulnerability to HIV Among Women Formerly Incarcerated and Women with Incarcerated Sexual Partners

HIV risk was assessed in association with a history of incarceration and having a sexual partner with a history of incarceration in a population sample of low-income young women residing in San Francisco. Of the 235 women surveyed, 23% reported prior incarceration and 42% reported having a sexual partner with a history of incarceration. Prevalence of sexually transmitted infections (STIs) (including HIV) was no higher among previously incarcerated women or those with a sexual partner with a history of incarceration. Women with a prior incarceration were significantly more likely to report injecting drugs, exchanging sex for money or drugs, and history of forced sex. Women reporting sexual partners with a history of incarceration were significantly more likely to report incarceration history, history of STIs, and history of forced sex. Interventions aimed at reducing substance abuse, STIs, commercial/survival sex, and the effects of sexual coercion need to be strengthened for women within and transitioning out of correctional facilities.     

The changing demographics of women living with HIV/AIDS in southern Alberta from 1982 to 2006

INTRODUCTION:

Women account for a growing proportion of HIV infections in Canada. This has implications with respect to prevention, diagnosis and treatment.

OBJECTIVE:

To describe the female population presenting for HIV care in southern Alberta and to examine the impact of opt-out pregnancy screening.

METHODS:

A retrospective review of demographic and clinical characteristics of all patients presenting to the Southern Alberta HIV Clinic (SAC) care program from 1982 to 2006, was performed.

RESULTS:

The proportion of newly diagnosed patients who were female increased from 7.5% before 1998 to 21.5% after 1998. Women were more likely to be from vulnerable populations, such as intravenous drug users (31.3% versus 13.7%, P<0.001), aboriginals/Métis (21.5% versus 8.7%, P<0.001), blacks (28.9% versus 4.9%, P<0.001) and immigrants (36.6% versus 14.7%, P<0.001). Heterosexual intercourse was the main risk factor for HIV acquisition (43.7%). Women were less likely than men to have requested HIV testing (20.9% versus 37.8%, P<0.001). Opt-out pregnancy screening accounted for 12.7% of HIV-positive tests in women, following its introduction in 1998. Of the women diagnosed by pregnancy screening, 62.1% were from HIV-endemic countries. There was an association between reason for testing and CD4 count at presentation; women who requested their HIV test had higher median CD4 counts than those diagnosed because of illness (478 cells/mL, interquartile range [IQR]=370 cells/mL versus 174 cells/mL, IQR=328 cells/mL, P<0.001) or pregnancy screening (478 cells/mL, IQR=370 cells/mL versus 271 cells/mL, IQR=256 cells/mL, P=0.001).

CONCLUSIONS:

Women were less likely than men to have requested HIV testing and were more likely to be diagnosed by population-based screening methods. Women, especially vulnerable groups, account for a growing number and proportion of newly diagnosed HIV infections in Alberta. The implications of expanded screening in this population merit further consideration.     

The Influence of Gender on Factors Associated with HIV Transmission Risk Among Young Russian Injection Drug Users

HIV infection rates are dramatically increasing in the Russian Federation. Epidemiological studies indicate that the greatest rise of HIV incidence has been among injection drug users (IDU). Young adults (N = 188) who reported injecting drug use completed surveys and interviews that assessed injection drug use behavior, sexual behavior, and HIV‐related knowledge. The average age of participants was 21.3 years. Multiple linear regression analysis found male gender and younger age at sexual debut was positively and significantly associated with having multiple sexual partners. Gender moderated the effects of sexual debut and number of times injected drugs were used in the past month. Males who initiate sex at a younger age were more likely to report multiple sex partners and females who reported higher frequency of drug use were more likely to report multiple sex partners. Gender is an important factor, as well as moderator of risk behavior among Russian injection drug users. Delaying sexual debut, particularly for males, may be an effective strategy to reduce subsequent risk behavior. Prevention efforts among IDUs need to address sexual risk behavior in conjunction with injection risk behavior.     

Determinants of HIV Risk Reduction Behaviors Among Female Partners of Men with Hemophilia and HIV Infection

Determinants of safer sexual behaviors (abstinence or consistent condom use) among female partners of HIV-infected adult men with hemophilia were examined. A model was proposed predicting that emotional adjustment, communication skills, self-efficacy, and perceived advantages of condom use would influence the practice of safer sexual behaviors. Confidential surveys were completed by 119 seronegative female partners of men with hemophilia and HIV infection who received care from one of 27 hemophilia treatment centers across the United States. The proposed model was tested using LISREL, and the model explained 40% of the variance in safer sexual behaviors. Emotional adjustment was a significant predictor of both intimate and emotional communication skills. Intimate and emotional communication skills were related to self-efficacy for communicating about safer sex, which in turn influenced both communication about safer sex and perceived advantages of condom use. Communication about safer sex with a partner and perceived advantages of condom use had direct effects on safer sexual behaviors. HIV prevention interventions with women known to have seropositive partners should be multifaceted. Skill-building interventions emphasizing communication skills, increasing self-efficacy for communication about safer sex with a partner, and promoting positive attitudes about safer sex should be considered.     

Impact of HIV-Related Stigma on Health Behaviors and Psychological Adjustment Among HIV-Positive Men and Women

HIV-related stigmatization remains a potent stressor for HIV-positive people. This study examined the relationships among stigma-related experiences and depression, medication adherence, serostatus disclosure, and sexual risk among 221 HIV-positive men and women. In bivariate analyses that controlled for background characteristics, stigma was associated with depressive symptoms, receiving recent psychiatric care, and greater HIV-related symptoms. Stigma was also associated with poorer adherence and more frequent serostatus disclosure to people other than sexual partners, but showed no association to sexual risk behavior. In a multivariate analysis that controlled for all correlates, depression, poor adherence, and serostatus disclosure remained as independent correlates of stigma-related experiences. Findings confirm that stigma is associated with psychological adjustment and adherence difficulties and is experienced more commonly among people who disclose their HIV status to a broad range of social contacts. Stigma should be addressed in stress management, health promotion, and medication adherence interventions for HIV-positive people.     

Psychological reactance and HIV-related stigma among women living with HIV

Psychological reactance is defined as the drive to re-establish autonomy after it has been threatened or constrained. People living with HIV may have high levels of psychological reactance due to the restrictions that they may perceive as a result of living with HIV. People living with HIV may also exhibit levels of HIV-related stigma. The relationship between psychological reactance and HIV-related stigma is complex yet understudied. Therefore, the main aim of this study was to examine the association between psychological reactance and HIV-related stigma among women living with HIV. Data were obtained from one time-point (a cross-sectional assessment) of a longitudinal HIV disclosure study. Psychological reactance was measured using the 18-item Questionnaire for the Measurement of Psychological Reactance. HIV-related stigma was measured using the HIV Stigma Scale, which has four domains: personalized, disclosure concerns, negative self-image, and concerns with public attitudes. Principal component analysis was used to derive components of psychological reactance. Linear regression models were used to determine the association between overall psychological reactance and its components, and stigma and its four domains, and depressive and anxiety symptoms. The associations between stigma and mental health were also examined. Three components of psychological reactance were derived: Opposition, Irritability, and Independence. Overall psychological reactance and irritability were associated with all forms of stigma. Opposition was linked to overall and negative self-image stigma. Overall psychological reactance, opposition, and irritability were positively associated with anxiety symptoms while opposition was also associated with Centers for Epidemiologic Studies-Depression depressive symptoms. There were also positive associations between all forms of stigma, and depressive and anxiety symptoms. Health-care providers and counselors for women living with HIV addressing feelings of irritability and opposition toward others may reduce HIV-related stigma. Future research should examine the link between psychological reactance, mental health, and HIV-related stigma among other populations living with HIV.     

Drug Use and Risk for HIV Among Women Arrestees in California

The rate of women entering the criminal justice system, particularly from drug-related crimes, is increasing. This study examined the characteristics and HIV risk behaviors of drug-using women arrestees in 13 California counties (N = 532). The injecting drug users (IDUs) (18%) were compared with the noninjecting drug users. The IDUs were older, more often White than African American, and were more likely to have a history of STDs, previous arrest, and polydrug use. Although the IDUs were at higher risk for HIV from their injection drug use and greater involvement in sex work, a substantial number of non-IDUs also engaged in high-risk sexual behaviors. Only a small percentage of the women sampled tested positive for HIV antibodies, however, the generally high-risk profile of this sample of drug-using women arrestees suggests that they would benefit from interventions that link them with needed treatment and services.     

HIV-Related Stigma among People with HIV and their Families: A Qualitative Analysis

We examined the interconnectedness of stigma experiences in families living with HIV, from the perspective of multiple family members. Semi-structured interviews were conducted with 33 families (33 parents with HIV, 27 children under age 18, 19 adult children, and 15 caregivers). Parents were drawn from the HIV Cost and Services Utilization Study, a representative sample of people in care for HIV in US. All of the families recounted experiences with stigma, including 100% of mothers, 88% of fathers, 52% of children, 79% of adult children, and 60% of caregivers. About 97% of families described discrimination fears, 79% of families experienced actual discrimination, and 10% of uninfected family members experienced stigma from association with the parent with HIV. Interpersonal discrimination seemed to stem from fears of contagion. Findings indicate a need for interventions to reduce HIV stigma in the general public and to help families cope with stigma.     

Improving Dietary Habits in Disadvantaged Women With HIV/AIDS: The SMART/EST Women's Project

There is a lack of information on whether brief nutrition education can succeed in improving longer-term dietary patterns in disadvantaged populations with HIV/AIDS. In the SMART/EST II Women's Project 466 disadvantaged women with HIV/AIDS were randomized to one of four groups and received a two-phase training consisting of a coping skills/stress management and nutrition education provided either in a group or individually. At baseline the majority of participants had excessive fat and sugar consumption and suboptimal intakes of vegetables, fruits, calcium-rich foods and whole grains. Dietary patterns for all participants improved after the nutrition intervention primarily due to decreases in high fat and high sugar foods such as soda and fried foods and were still significantly better 18 months later. There were only short-term differences in improvements between the four groups. These findings support the value of even brief nutrition education for disadvantaged women living with HIV/AIDS.     

男男性行为人群HIV感染者/AIDS病人耻辱感的影响因素

目的了解北京市男男性行为人群(MSM)艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人耻辱感现状,分析影响因素,探索降低耻辱感的科学方法。方法通过方便抽样选取262名MSM人群HIV感染者/AIDS病人,进行一般情况和耻辱感的问卷调查。结果耻辱量表四个维度得分分别为个人耻辱(53.22±8.13)分、担心公开(33.20±3.73)分、负面自我形象(35.84±6.40)分、关注公众态度(61.31±8.44)分。耻辱感随着感染情况告知家人、好友的人数增多而降低(P<0.05),在婚者的耻辱感低于离异/丧偶者。结论如何获得家人和周围好友的情感支持,是降低HIV感染者/AIDS病人耻辱感的关键因素。     

Disclosure of Serostatus Among Youth Living with HIV

Disclosure of serostatus and predictors of disclosure were examined among youth living with HIV (YLH). Disclosure patterns, sociodemographic characteristics, sexual and substance-use risk history, and current health status were examined among 350 youth living with HIV aged 13–23 years (27% African-American, 38% Latino; 72% male) who had AIDS (n = 35), were symptomatic (n = 108), or asymptomatic (n = 201). Most youth disclosed their serostatus to family (87%); unexpectedly, young men (93%) were more likely to disclose to friends than were young women (79%). Being younger at diagnosis was significantly associated with disclosure to family; young men disclosed more often to friends. Most youth disclosed to all their sexual partners (69%); higher rates of disclosure to sexual partners were associated with having fewer partners and being African-American. Condom use was significantly associated with disclosure for young women, and tended to be related for young men. Although many YLH disclose their serostatus to their partners, condom use is not increased. Interventions are needed to increase condom use among YLH, as well as to encourage disclosure to partners by the 30% of YLH who do not disclose.     

Partner Violence and Sexual HIV Risk Behaviors Among Women in Methadone Treatment

To examine associations between recent partner violence and sexual HIV risk behaviors and their implications for HIV prevention among women in methadone treatment, we conducted structured interviews covering demographics, drug use, trauma history, partner violence, and sexual risk behavior with 147 sexually active women who were at risk of HIV infection. Almost one third (30.5%) of the women reported that they had been physically or sexually abused by a spouse or boyfriend during the previous year. Multiple logistic regression analysis indicated that after adjusting for potential confounders, recently abused women were less likely to report using condoms (OR = 0.41, CI = 0.17, 0.99) and more likely than non-recently abused women to report having contracted a sexually transmitted disease (STD) (OR = 3.6, CI = 1.6, 8.5), exchanged sex for money (OR = 2.4, CI = 1.1, 5.4), and having had sex with an HIV-infected partner (OR = 2.5, CI = 1.0, 6.1). The study findings underscore the importance of developing HIV-risk reduction strategies that target the specific needs of abused women in drug treatment.     

The Influence of Power on HIV Risk Among Pregnant Women in Rural Haiti

Given that condom use is not directly under a woman's control, the sexual division of power may play an important role in sexual behavior among pregnant women. We assessed the influence of factors related to the theory of gender and power (e.g., relationship power, abuse history, and sexual communication) on sexual behavior (e.g., two or more partners in the year prior to pregnancy, condom use, condom-use intentions, and STI diagnosis) among 196 pregnant women recruited from five community dispensaries in rural Haiti. Results showed that gender and power factors significantly related to sexual behavior. Gender and power factors were most significant for condom use and intention to use condoms, accounting for 18 and 25% of the variance above and beyond HIV knowledge and demographic covariates, respectively. These results suggest the need to create prevention interventions that restore power imbalances, provide support for women suffering abuse, and strengthen communication skills.     

Awareness of Hepatitis C Infection Among Women With and At Risk for HIV

BACKGROUND Treatment guidelines recommend all HIV/HCV-co-infected persons be considered for hepatitis C virus (HCV) treatment, yet obstacles to testing and accessing treatment for HCV continue for women. OBJECTIVE To assess awareness of HCV, and describe diagnostic referrals and HCV treatment among women in the Women’s Interagency HIV Study (WIHS). DESIGN Prospective epidemiologic cohort. PARTICIPANTS Of 3,768 HIV-infected and uninfected women in WIHS, 1,166 (31%) were HCV antibody positive. MEASUREMENTS AND MAIN RESULTS Awareness of HCV infection and probability of referrals for diagnostic evaluations and treatment using logistic regression. Follow-up HCV information was available for 681 (390 died, 15 withdrew, 80 missed visit) in 2004. Of these 681, 522 (76.7%) reported knowing their HCV diagnosis. Of these, 247 of 522 (47.3%) stated their providers recommended a liver biopsy, whereas 139 of 247 or 56.3% reported having a liver biopsy. A total of 170 of 522 (32.6%) reported being offered treatment and 74.1% (n = 126 of 170) reported receiving HCV treatment. In multivariate regression analyses, African-American race, Hispanic/Latina ethnicity, poverty, and current crack/cocaine/heroin use were negatively associated with treatment referrals, whereas elevated alanine aminotransferase (ALT) was associated with increased likelihood of referral and increased likelihood of treatment. CONCLUSION One quarter of women with HCV in this cohort were not aware of their diagnosis. Among those aware of their HCV, 1 in 4 received liver biopsy and treatment for HCV. Both provider and patient education interventions regarding HCV testing and HCV treatment options and guidelines are needed to enhance HCV awareness and participation in HCV evaluation and treatment. Part of this work was presented at the XV International AIDS Conference, July 11, 2004. The WIHS centers (Principal Investigators) are located at New York City/Bronx Consortium (Kathryn Anastos); Brooklyn, NY (Howard Minkoff); Washington DC Metropolitan Consortium (Mary Young); the Connie Wofsy Study Consortium of Northern California (Ruth Greenblatt); Los Angeles County/Southern California Consortium (Alexandra Levine); Chicago Consortium (Mardge Cohen); Data Coordinating Center (Stephen Gange).     

Risk Factors for HIV/AIDS Among American Indian/Alaska Native Women

Abstract

This article illuminates the main risks that American Indian/Alaska Native women face for contracting the human immunodeficiency virus, and their challenges in living with HIV disease, by presenting a case study of one Native woman's experiences. The woman, a member of a Midwestern Indian tribe, was a participant in a larger in-depth qualitative longitudinal study of 55 women living with HIV. The findings about her path to healing provide insights for understanding and serving this neglected ethnic population, and her words eloquently articulate the struggles of women of color living in dignity with HIV. The article explores potential venues for reaching Native women with culturally relevant prevention and intervention methods, emphasizing the importance of Native culture and Spirituality.