Alissa Davis

Intimate Partner Violence and Correlates With Risk Behaviors and HIV/STI Diagnoses Among Men Who Have Sex With Men and Men Who Have Sex With Men and Women in China: A Hidden Epidemic.

Background Intimate partner violence (IPV) research has primarily focused on heterosexual couples but has largely ignored IPV among men who have sex with men (MSM). We examined IPV prevalence among MSM and men who have sex with men and women (MSMW) in China. Methods Men who have sex with men older than 16 years were recruited through 3 MSM-focused Web sites in China. An online survey containing items on sociodemographics, risk behaviors, IPV, and self-reported HIV or sexually transmitted infection diagnosis was completed. Multivariate regression was used to examine associations between IPV and risk behaviors and an HIV or sexually transmitted infection diagnosis. Results Among 610 participants, 182 (29.8%) reported experiencing at least 1 type of IPV. Men who have sex with both men and women were at significantly greater risk for IPV (adjusted odds ratio [AOR], 1.65; 95% confidence interval [CI], 1.08–2.53) compared with MSM. Men who had experienced IPV were more likely to have participated in group sex (AOR, 1.86; 95% CI, 1.08–3.21), to have had sex in exchange for gifts or money (AOR, 5.06; 95% CI, 2.47–10.35), and to report a positive HIV diagnosis (AOR, 2.59; 95% CI, 1.22–5.51). Conclusions There is a hidden epidemic of IPV among MSM in China, especially among MSMW. The hidden nature of MSM and MSMW suggests the need for a clinical environment more conducive to disclosure. Research is needed to understand the pathways linking IPV and HIV risk among MSM to optimize the design of effective interventions.

Trichomonas vaginalis and Human Immunodeficiency Virus Coinfection Among Women Under Community Supervision: A Call for Expanded T. vaginalis Screening.

Background The United States has a large community supervision population, a growing number of whom are women. Trichomonas vaginalis infection is strongly associated with an increased risk of human immunodeficiency virus (HIV) acquisition and transmission, particularly among women, but there is a paucity of research on HIV and T. vaginalis co-infection among women under community supervision. Methods This article examines the prevalence of T. vaginalis infection and T. vaginalis and HIV coinfection at baseline among women under community supervision in New York City. It also examines the 12-month outcomes of women treated for T. vaginalis. Women received biological tests for HIV and T. vaginalis at baseline and 12 months follow-up. Results Of the 333 women tested for sexually transmitted infections, 77 women (23.1%) tested positive for T. vaginalis at baseline and 44 (13.3%) were HIV positive. Human immunodeficiency virus–positive women had significantly higher rates of T. vaginalis infection than HIV-negative women (36.4% vs 21.3%, P ⩽ 0.05). Sixteen women (4.8%) were coinfected with T. vaginalis and HIV. Of the 77 women who were positive for T. vaginalis infection at baseline, 58 (75.3%) received treatment by a health care provider. Of those who received treatment, 17 (29.3%) tested positive for T. vaginalis at the 12-month follow-up. Conclusions Given the high prevalence of T. vaginalis among this sample of women, particularly among HIV-positive women, and high levels of reinfection or persistent infection, screening for T. vaginalis among women under community supervision may have a substantial impact on reducing HIV acquisition and transmission among this high-risk population.

Differences in risk behaviours, HIV/STI testing and HIV/STI prevalence between men who have sex with men and men who have sex with both men and women in China.

Differences in risk behaviours between men who have sex with men (MSM) and men who have sex with both men and women (MSMW) have important implications for HIV and sexually transmitted infection (STI) transmission. We examined differences in risk behaviours, HIV/STI testing, self-reported HIV/STI diagnoses, and linkage to HIV care between MSM and MSMW across China. Participants were recruited through three MSM-focused websites in China. An online survey containing items on socio-demographics, risk behaviours, testing history, self-reported HIV/STI diagnosis, and linkage to and retention in HIV care was completed from September to October 2014. Chi square tests and logistic regression analyses were conducted. MSMW were less likely to use a condom during last anal sex (p ≤ 0.01) and more likely to engage in group sex (p ≤ 0.01) and transactional sex (p ≤ 0.01) compared to MSM. Self-reported HIV/STI testing and positivity rates between MSM and MSMW were similar. Among HIV-infected MSM, there was no difference in rates of linkage to or retention in antiretroviral therapy when comparing MSM and MSMW. Chinese MSM and MSMW may benefit from different HIV and STI intervention and prevention strategies. Achieving a successful decrease in HIV/STI epidemics among Chinese MSM and MSMW will depend on the ability of targeted and culturally congruent HIV/STI control programmes to facilitate a reduction in risk behaviours.

Depression, suicidal ideation, and related factors of methadone maintenance treatment users in Guangzhou, China.

ABSTRACT Mental health problems are prevalent among drug users. Methadone maintenance treatment (MMT) is an evidence-based effective treatment for drug addiction; however, there are few studies investigating depression, suicidal ideation, and their related factors among MMT users. In this cross-sectional study, 648 MMT users were recruited from six MMT clinics in Guangzhou, China. Data were collected through face-to-face interviews by trained interviewers. Of all participants, 270 (42.7%) exhibited probable depression (Depression Subscale of the Chinese short version of Depression, Anxiety, and Stress Scale (DASS-D), score ≥ 10) and 99 (15.3%) reported having suicidal ideation in the last six months. After adjusting for significant socio-demographic characteristics, all studied variables, including drug use history, social support, family support for MMT use, and satisfaction toward MMT services were significantly associated with both probable depression and suicidal ideation in the last six months. Furthermore, depression fully mediated the associations between drug use history, satisfaction toward MMT services, and suicidal ideation. In the final multivariate models, probable depression was associated with social support (OR = 0.88, 95% CI = 0.83–0.93) and satisfaction toward MMT services provided by doctors (OR = 0.59, 95% CI = 0.40–0.86), while for suicidal ideation, social support (OR = 0.85, 95% CI = 0.78–0.92) and probable depression (OR = 5.94, 95% CI = 3.39–10.42) were significant. The findings suggest that there are unmet mental health needs among MMT users. For countries with limited resources of psychological services, mental health care toward MMT users should be implanted into current health care settings and incorporate components such as social support, familys understanding of MMT, and service satisfaction.

Coping strategies and behavioural changes following a genital herpes diagnosis among an urban sample of underserved Midwestern women

This study focused on understanding the coping strategies and related behavioural changes of women who were recently diagnosed with herpes simplex virus type 2. In particular, we were interested in how coping strategies, condom use, and acyclovir uptake evolve over time. Twenty-eight women screening positive for herpes simplex virus type 2 were recruited through a public health STD clinic and the Indianapolis Community Court. Participants completed three semi-structured interviews with a woman researcher over a six-month period. The interviews focused on coping strategies for dealing with a diagnosis, frequency of condom use, suppressive and episodic acyclovir use, and the utilisation of herpes simplex virus type 2 support groups. Interview data were analysed using content analysis to identify and interpret concepts and themes that emerged from the interviews. Women employed a variety of coping strategies following an herpes simplex virus type 2 diagnosis. Of the women, 32% reported an increase in religious activities, 20% of women reported an increase in substance use, and 56% of women reported engaging in other coping activities. A total of 80% of women reported abstaining from sex immediately following the diagnosis, but 76% of women reported engaging in sex again by the six-month interview. Condom and medication use did not increase and herpes simplex virus type 2 support groups were not utilised by participants. All participants reported engaging in at least one coping mechanism after receiving their diagnosis. A positive diagnosis did not seem to result in increased use of condoms for the majority of participants and the use of acyclovir was low overall.

Individual, social, and structural factors affecting antiretroviral therapy adherence among HIV-positive people who inject drugs in Kazakhstan

BACKGROUND HIV-infected people who inject drugs (PWID) are particularly vulnerable to suboptimal ART adherence. The fastest-growing HIV epidemics globally are driven by injection drug use, but only a small percentage of HIV-positive PWID have achieved viral suppression. Virally suppressed individuals have better HIV-related health outcomes and effectively no risk of transmitting HIV to others. Hence, ART adherence is important for both HIV treatment and HIV prevention. There is a paucity of data on barriers and facilitators of ART adherence among PWID in low and middle income countries, which is problematic given the growing HIV epidemics among PWID in these countries. METHODS Using the Theory of Triadic Influence, this paper examines individual, interpersonal, and structural barriers and facilitators of ART adherence among HIV-positive PWID in four cities in Kazakhstan. Eight focus groups were conducted (two in each city) with a total of 57 participants. Data were coded and analyzed by three researchers. RESULTS We found a number of barriers and facilitators to ART adherence among PWID at the individual, interpersonal, and structural levels. Individual barriers to ART adherence include misperceptions about ART, forgetfulness due to the effects of illicit drug use, and medication side effects. Interpersonal facilitators of ART adherence include social support and good relationships with healthcare providers. Structural barriers include poverty, legal challenges, disruptions in the ART supply, and stigma and discrimination. CONCLUSION The paper highlights important factors related to ART adherence for HIV-positive PWID and identifies potential strategies for intervention efforts, including couple-based interventions, electronic reminders, linkage to drug treatment services, and patient navigation. Effectively enhancing adherence to ART among PWID will likely require multi-level approaches and strategies. Further research should be conducted on potential methods and interventions for improving ART adherence among this vulnerable population.

Multi-level risk factors associated with sex trading among women living with HIV in Kazakhstan: A neglected key population

Little is known about the prevalence and risk factors associated with sex trading among HIV-positive women. A total of 242 HIV-positive women were recruited in five regions in Kazakhstan. These women completed a survey containing items on socio-demographics, HIV stigma, intimate partner violence, and partner risk behaviors. Multivariate regression was used to examine associations between risk factors and sex trading after controlling for socio-demographic factors. Fifty-six (23.1%) women reported trading sex in the past 90 days. Women who reported recent sex trading were more likely than women who did not trade sex in the past 90 days to experience intimate partner violence (adjusted odds ratio [AOR]: 2.25; 95% confidence interval [CI]: 1.08–4.73), to have been homeless in the past 90 days (AOR: 4.12; 95% CI: 1.19–14.29), and to know or suspect a male partner had a sexually transmitted infection (AOR: 2.20; 95% CI: 1.07–4.53), had sex with another partner (AOR: 4.53; 95% CI: 2.25–9.14), or injected drugs in the past year (AOR: 3.31; 95% CI: 1.64–6.65). These findings underscore the need for comprehensive HIV prevention and intervention programs that address the multi-level risk factors associated with sex trading for women infected with HIV.

Preferred methods of sexually transmitted infection service delivery among an urban sample of underserved midwestern men.

Semistructured interviews were completed with a sample of 25 men residing in an urban area of the Midwestern United States to elicit preferred methods of sexually transmitted infection service delivery. Results highlight the influence of stigma, social support, and perceived risk on sexually transmitted infection screening uptake and preferred methods of screening.

P3.074 Men’s Preferences For STD Screening Programs: Initial Prevalence of STD in the Study Population

Background STD control efforts in the US and western Europe have had less than desirable impact, in part due to an inability to reach populations of men at risk for these diseases. We are currently conducting a study of programme options, including self-collection of specimens and community based access to test kits, that would increase men’s utilisation of screening services. Methods Using peer-incentivized referral, a type of snowball sampling, beginning with men attending an STD clinic in the US, we are interviewing men in the community to determine the optimal combination of programme features that would encourage asymptomatic STD screening. To demonstrate the relevance of these men’s opinions in terms of reaching a high prevalence group, they were tested for STDs at the time of their interview. Urine samples were collected and rectal sampling was offered to all men. STD testing was performed using nucleic acid amplification testing. Results To date, 25 men from the community have been enrolled and interviewed. 40% of participants were black, 40% were white, and 20% were Hispanic. The median age of participants is 24. Urine samples were available for testing from all 25 men and rectal samples were available from 5 men. 4 (16%) men tested positive for a STD: 2 (8%) men tested positive for chlamydia and 2 (8%) men tested positive for trichomonas. No gonococcal infections were detected. None of the rectal samples had a positive result. Conclusion While these results represent pilot data, the study is ongoing and given the nature of snowball sampling, the sample size will expand rapidly. Early prevalence rates are higher than have been reported in nationally representative surveys in the US. This suggests that we are recruiting from a population of interest to gather opinions about preferred screening options.

P4.017 Bacterial STD Rates and Preferred Methods of STD Service Delivery Among a Sample of Underserved Midwestern Men

Background Asymptomatic sexually transmitted infections remain a significant public health concern as treatment is frequently not sought by individuals who are not experiencing symptoms. Few studies have utilised social networks as a means for recruiting participants to explore novel approaches to STD testing, service delivery, and prevention information. Methods As part of a larger study, a diverse sample of 25 men (10 Black, 10 White, 5 Latino), between the ages of 18 and 54 (M = 30.1, SD = 12.7) who primarily identified as heterosexual (n = 23), were recruited within a large underserved urban area in the Midwestern United States. Semi-structured interviews were completed to elicit items and themes around preferred methods of STD services delivery and STD information. To identify rates of common bacterial infections among our sample, participants were screened for gonorrhoea, chlamydia, and trichomonas. Results Of our sample, 16% (n = 4) tested positive for a bacterial STI, with 8% (n = 2) testing positive for chlamydia and 8% (n = 2) testing positive for trichomonas. A number of themes emerged from the data in regards to preferred STD delivery services and STD information gathering, including: (1) perceived stigma from their social networks, (2) potential financial costs incurred, and (3) perceived barriers to accessing STD screening venues. Seeking out STD screening was mitigated by two factors: (1) a lack of perceived sexual risk and (2) lack of potential STD symptoms. Participants acquired and preferred to access sexual health information via internet resources and their own social networks. Conclusions Results highlight a variety of psychosocial variables that influence STD screening uptake and preferred methods of screening. Our findings provide further evidence for the need to tailor the development of STD screening and treatment options that are acceptable to asymptomatic men in traditionally underserved areas.