Carinne M. Brody

AIDS-related stigma and mental disorders among people living with HIV: a cross-sectional study in Cambodia.

Background AIDS-related stigma and mental disorders are the most common conditions in people living with HIV (PLHIV). We therefore conducted this study to examine the association of AIDS-related stigma and discrimination with mental disorders among PLHIV in Cambodia. Methods A two-stage cluster sampling method was used to select 1,003 adult PLHIV from six provinces. The People Living with HIV Stigma Index was used to measure stigma and discrimination, and a short version of general health questionnaire (GHQ-12) was used to measure mental disorders. Multivariate logistic regression analysis was conducted. Results The reported experiences of discrimination in communities in the past 12 months ranged from 0.8% for reports of being denied health services to 42.3% for being aware of being gossiped about. Internal stigma was also common ranging from 2.8% for avoiding going to a local clinic and/or hospital to 59.6% for deciding not to have (more) children. The proportions of PLHIV who reported fear of stigma and discrimination ranged from 13.9% for fear of being physically assaulted to 34.5% for fear of being gossiped about. The mean score of GHQ-12 was 3.2 (SD = 2.4). After controlling for several potential confounders, higher levels of mental disorders (GHQ-12≥ 4) remained significantly associated with higher levels of experiences of stigma and discrimination in family and communities (AOR = 1.9, 95% CI = 1.4–2.6), higher levels of internal stigma (AOR = 1.7, 95% CI = 1.2–2.3), and higher levels of fear of stigma and discrimination in family and communities (AOR = 1.5, 95% CI = 1.1–2.2). Conclusions AIDS-related stigma and discrimination among PLHIV in Cambodia are common and may have potential impacts on their mental health conditions. These findings indicate a need for community-based interventions to reduce stigma and discrimination in the general public and to help PLHIV to cope with this situation.

Factors Associated with Inconsistent Condom Use among Men Who Have Sex with Men in Cambodia

Background Compared to the general population, men who have sex with men (MSM) are at greater risk for HIV and less understood due to their more hidden and stigmatized nature. Moreover, the discrepancy in findings in the literature merits further investigations in MSM populations from different cultures and settings. We therefore conducted this study to explore factors associated with inconsistent condom use among high-risk MSM in Cambodia. Methods This cross-sectional study was conducted in 2014 among 367 MSM randomly selected from Battembang and Siem Reap using a two-stage cluster sampling method. A structured questionnaire was used for face-to-face interviews to collect information on characteristics of respondents, HIV testing history, self-perception of HIV risk, substance use, sexual behaviors, mental disorders, and HIV knowledge. Multivariable logistic regression analysis was performed to identify factors independently associated with inconsistent condom use. Results On average, 62.3% of respondents reported that they always used condoms over the past three months. The rates varied with types of sexual partners; the proportion of respondents who reported always using condoms was 55.1%, 64.2%, 75.9%, 73.0%, 78.1%, and 70.3%, for sexual partners who were girlfriends, boyfriends, female sex workers, male sex workers, female clients, or male clients, respectively. After adjustment, inconsistent condom use was significantly associated with age of ≥25 (AOR = 1.77, 95% CI = 1.09–2.86), self-rated quality of life as good or very good (AOR = 4.37, 95% CI = 1.79–5.67), self-perception of higher HIV risk compared to the general population (AOR = 2.37, 95% CI = 1.35–4.17), illicit drug use in the past three months (AOR = 5.76, 95% CI = 1.65–10.09), and reported consistent lubricant use when selling anal sex to men in the past three months (AOR = 2.85, 95% CI = 1.07–8.12). Conclusions We found risky sexual behaviors to be considerably high among MSM in this study, especially among those who used illicit drugs or were older than 25. HIV education and social marketing should be expanded and specifically designed for MSM to better educate on the increased risk of HIV with unprotected anal sex and illicit drug use as risk factors, and the importance of the use of both condoms and lubricant during anal intercourse.

Factors associated with induced abortion among female entertainment workers: a cross-sectional study in Cambodia.

Objective To explore risk factors associated with induced abortion among sexually active female entertainment workers (FEWs) in Cambodia. Design Cross-sectional study. Setting Phnom Penh and Siem Reap, Cambodia. Participants This study included 556 FEWs aged 18–47 years randomly selected from entertainment establishments in the two cities in 2014 using a two-stage cluster sampling method. Data were collected through face-to-face interviews using a structured questionnaire. Primary outcome measure History of induced abortion during the time working as a FEW. Results Of the total sample, 45.6% reported currently using a contraceptive method with condom (42.4%) being the most common method, followed by pills (25.6%). One-fourth (25%) of the respondents reported having been pregnant at least once, and 21.4% reported having at least one induced abortion during the time working as a FEW. After controlling for other covariates in a multivariate logistic regression model, FEWs with a history of induced abortion remained significantly more likely to be currently working in a karaoke bar (AOR=1.75, 95% CI 1.10 to 2.78), to have worked longer as a FEW (AOR=1.42, 95% CI 1.06 to 1.43), to have had a greater number of sexual partners in the past 12 months (AOR=1.86, 95% CI 1.02 to 1.54), to be currently using a contraceptive method (AOR=1.52, 95% CI 1.01 to 2.29), to be able to find condoms when they needed them (AOR=2.03, 95% CI 1.09 to 3.82), and to report inconsistent condom use with non-commercial partners in the past 3 months (AOR=1.62, 95% CI 1.06 to 3.44). Conclusions This study highlights the high rates of unwanted pregnancies that ended in induced abortions among FEWs in Cambodia. Access of FEWs to quality sexual and reproductive healthcare services is deemed a high priority. Integrated interventions to improve sexual and reproductive health among these vulnerable women should be tailored to reach the most-at-risk groups.

Can self-help group programs improve women’s empowerment? A systematic review

ABSTRACT This mixed-methods systematic review focuses on the impact of women’s self-help groups (SHGs) on women’s economic, social, psychological, and political empowerment. Both governmental and non-governmental institutions spend formidable resources facilitating SHGs in low-and middle-income countries in South Asia and other developing countries, under the premise that access to microfinance, training, and group support can enhance women’s empowerment. We found that women’s economic SHGs have positive effects on economic and political empowerment, women’s mobility, and women’s control over family planning. The estimated effect sizes range from 0.06–0.41 standardised mean differences. We did not find evidence for positive effects of SHGs on psychological empowerment. The qualitative research further suggests that the positive effects of SHGs on empowerment run through mechanisms that are associated with familiarity in handling money, independence in financial decision-making, solidarity, social networks, and respect from the household and other community members. However, the included evaluations often did not include sufficient information about the specifics of the activities that were implemented by the SHGs. As a result, it remains unclear which of the various SHG models are most effective. Finally, our triangulation of the quantitative and qualitative findings indicates that SHGs do not have adverse consequences for domestic violence.

Sex with sweethearts: Exploring factors associated with inconsistent condom use among unmarried female entertainment workers in Cambodia

BackgroundDespite the success in promoting condom use in commercial relationships, condom use with regular, noncommercial partners remains low among key populations in Cambodia. This study explores factors associated inconsistent condom use with sweethearts among unmarried sexually active female entertainment workers (FEWs).MethodsIn 2014, the probability proportional to size sampling method was used to randomly select 204 FEWs from entertainment venues in Phnom Penh and Siem Reap for face-to-face interviews. Multivariate logistic regression analysis was conducted to examine independent determinants of inconsistent condom use.ResultsOf total, 31.4% of the respondents reported consistent condom use with sweethearts in the past three months. After adjustment, respondents who reported inconsistent condom use with sweethearts remained significantly less likely to report having received any form of sexual and reproductive health education (AOR = 0.49, 95% CI = 0.22–0.99), but more likely to report having been tested for HIV in the past six months (AOR = 2.19, 95% CI = 1.03–4.65). They were significantly more likely to report having used higher amount of alcohol in the past three months (AOR = 1.29, 95% CI = 1.01–1.99) and currently using a contraceptive method other than condoms such as pills (AOR = 4.46, 95% CI = 1.34–10.52) or other methods (AOR = 9.75, 95% CI = 2.07–9.86).ConclusionsThe rate of consistent condom use in romantic relationships among unmarried FEWs in this study is considerably low. The importance of consistent condom use with regular, non-commercial partners should be emphasized in the education sessions and materials, particularly for FEWs who use non-barrier contraceptive methods.

Are Text Messages a Feasible and Acceptable Way to Reach Female Entertainment Workers in Cambodia with Health Messages? A Cross-Sectional Phone Survey

Background Despite great achievements in reducing the prevalence of HIV, eliminating new HIV infections remains a challenge in Cambodia. Entertainment venues such as restaurants, karaoke bars, beer gardens, cafes, pubs, and massage parlors are now considered important venues for HIV prevention efforts and other health outreach interventions. Objective The purpose of this study was to explore phone use and texting practices of female entertainment workers (FEWs) in order to determine if text messaging is a feasible and acceptable way to link FEWs to health services. Methods This cross-sectional phone survey was conducted in May 2015 with 97 FEWs aged 18–35 years and currently working at an entertainment venue in Phnom Penh. Results Of the 96 respondents, 51% reported sending text messages daily; of them, 47% used Khmer script and 45% used Romanized Khmer. Younger FEWs were more likely to report daily texting (P<.001). Most FEWs (98%) in this study reported feeling comfortable receiving private health messages despite the fact that 39% were sharing their phone with others. Younger FEWs were less likely to share their phone with others (P=.02). Of all of the FEWs, 47% reported owning a smartphone, and younger women were more likely to own a smartphone than were older women (P=.08). Conclusions The findings from this study support the development of mHealth interventions targeting high-risk groups in urban areas of Cambodia. Our data suggest that mHealth interventions using texting may be a feasible way of reaching FEWs in Phnom Penh.

Mobile Link – a theory-based messaging intervention for improving sexual and reproductive health of female entertainment workers in Cambodia: study protocol of a randomized controlled trial

BackgroundIn Cambodia, HIV prevalence is concentrated in key populations including among female entertainment workers (FEWs) who may engage in direct or indirect sex work. Reaching FEWs with sexual and reproductive health (SRH) services has been difficult because of their hidden and stigmatized nature. Mobile-phone-based interventions may be an effective way to reach this population and connect them with the existing services. This article describes study design and implementation of a randomized controlled trial (RCT) of a mobile health intervention (the Mobile Link) aiming to improve SRH and related outcomes among FEWs in Cambodia.MethodsA two-arm RCT will be used to determine the effectiveness of a mobile-phone-based text/voice messaging intervention. The intervention will be developed through a participatory process. Focus group discussions and in-depth interviews have been conducted to inform and tailor behavior change theory-based text and voice messages. During the implementation phase, 600 FEWs will be recruited and randomly assigned into one of the two arms: (1) a control group and (2) a mobile phone message group (either text messages [SMS] or voice messages [VM], a delivery method chosen by participants). Participants in the control group will also receive a weekly monitoring survey, which will provide real-time information to implementing partners to streamline outreach efforts and be able to quickly identify geographic trends. The primary outcome measures will include self-reported HIV and sexually transmitted infections (STI) testing and treatment, condom use, contraceptive use, and gender-based violence (GBV).DiscussionIf the Mobile Link trial is successful, participants will report an increase in condom use, linkages to screening and treatment for HIV and STI, and contraception use as well as a reduction in GBV. This trial is unique in a number of ways. First, the option of participation mode (SMS or VM) allows participants to choose the message medium that best links them to services. Second, this is the first RCT of a mobile-phone-based behavior change intervention using SMS/VMs to support linkage to SRH services in Cambodia. Lastly, we are working with a hidden, hard-to-reach, and dynamic population with which existing methods of outreach have not been fully successful.Trial registrationClinical trials.gov, NCT03117842. Registered on 31 March 2017.

Sexual behaviors, HIV knowledge, HIV testing attitudes and recent HIV testing among female entertainment workers in Cambodia: A cross-sectional study

Background In Cambodian context, female entertainment workers (FEWs) are young women working at establishments such as karaoke bars, restaurants, beer gardens or massage parlors. FEWs may sell sex to male patrons and are considered a high-risk group for HIV. This study aimed to identify factors associated with recent HIV testing among FEWs in Cambodia to inform future prevention activities. Methods Data were collected in 2014 as part of the evaluation of a larger HIV prevention project. A two-stage cluster sampling method was used to select participants from Phnom Penh and Siem Reap for face-to-face interviews using a structured questionnaire. A logistic regression model was constructed to identify independent factors associated with recent HIV testing. Results Data were collected from 667 FEWs with a mean age of 25.6 (SD = 5.5). Of total, 81.7% reported ever having had an HIV test, and 52.8% had at least one test in the past six months. After adjustment for other covariates, factors independently associated with recent HIV testing included living in Phnom Penh (AOR = 2.17, 95% CI = 1.43–3.28), having received HIV education in the past six months (AOR = 3.48, 95% CI = 2.35–5.15), disagreeing with a statement that ‘I would rather not know if I have HIV’ (AOR = 2.15, 95% CI = 1.41–3.30), agreeing with a statement that ‘getting tested for HIV helps people feel better’ (AOR = 0.32, 95% CI = 0.13–0.81) and not using a condom in the last sexual intercourse with a non-commercial partner (AOR = 0.48, 95% CI = 0.26–0.88). Conclusions FEWs with greater knowledge and positive attitudes towards HIV testing got tested for HIV more frequently than those with lesser knowledge and less positive attitudes. These findings suggest that future interventions should focus on disseminating tailored health messages around testing practices as well as specific topics such as condom use with non-commercial partners.

Non-communicable diseases and related risk behaviors among men and women living with HIV in Cambodia: findings from a cross-sectional study

BackgroundThere is a growing concern for an increasing burden of non-communicable diseases (NCDs) in people living with HIV. This concern is evident especially in developing countries where dietary and lifestyle risk factors associated with NCDs are becoming more prominent. This study explored the prevalence of diabetes mellitus, hypertension, and hyperlipidemia and related risk factors in men and women living with HIV in Cambodia.MethodsThis cross-sectional study was conducted among 510 adult people living with HIV randomly selected from one city and four provinces in Cambodia. A structured questionnaire was used to collect data on socio-demographic characteristics, health behaviors, medical history, and antiretroviral therapy (ART). Anthropometric and biological measurements were performed. Descriptive statistics were used to calculate proportions and means of the measured variables. An independent Student’s t-test was used for continuous variables. Chi square test or Fisher’s exact test was used for categorical variables to explore gender differences.ResultsPrevalence of diabetes mellitus, hypertension, and hyperlipidemia was 9.4, 15.1, and 33.7%, respectively. The prevalence of hyperlipidemia was significantly higher among men compared to women. Mean systolic and diastolic blood pressures were also significantly higher among men. Regarding risk factors, 17.3% of participants were overweight, and 4.1% were obese. Tobacco and alcohol use was common, particularly among men. Fruit and vegetable consumption was considerably low among both men and women. Physical activity levels were also low. About 40% of participants reported having a job that involved mostly sitting or standing; 46.3% reported engaging in moderate activities; and 11.8% reported engaging in vigorous activities during leisure time. A significantly higher proportion of men compared to women engaged in vigorous activities both at work and during leisure time.ConclusionsThe prevalence of diabetes mellitus, hypertension, and hyperlipidemia among men and women living with HIV in Cambodia is considerably high. Related risk factors were also common. Given the comorbidity of NCDs and HIV, policy and programmatic interventions are required, including integration of NCD screening into HIV programs. Distinctions in the levels of diseases and in health behaviors between men and women suggest that interventions need to be tailor-made and gender-specific, targeting their respective diseases and behaviors.

The Effects Of Economic Self-Help Group Programs On Women's Empowerment: A Systematic Review

HIV epidemic are still a global public health concern. In the HIV history is well documented through scientific literature, the effectivity of the antiretroviral therapies (ART). ART has dramatically improved the life expectancy of HIV. Even though, it’s necessary to monitor the causes of death of people with HIV/AIDS. The objective of this study was to estimate mortality risk in people diagnosed with HIV/AIDS in Puerto Rico (PR) from 2006 through 2011. We used a population-based study from the PR AIDS Surveillance System, a total of N=2,290 deaths were reported for the study period. The Cox Proportional Hazards Regression Method was used to identify determinants of mortality. The 71% were males. The 23.5% of deaths were related to HIV/AIDS. Age and Sex adjust death rates was 4.9 deaths per 1,000 population and a fatality rate was 22.2%. The Hazard Ratio [HR] for a HIV/AIDS cause of death in intravenous drug user [IDU] was HR=1.53; 95% confidence interval [IC], 1.37, 1.70 (p<0.001); in AIDS stage HR=7.53; 95% IC, 2.42, 23.4 (p<0.001); and with CD4 cell count ≥ 500 copies HR= 0.20; 95% IC, 0.16, 0.26 (<0.001). Deaths of people with HIV/AIDS in Puerto Rico were not related to the traditional HIV/AIDS causes of death. IDU population, males, AIDS stage of the disease and with low CD4 cell count has higher risk to die to HIV/AIDS cause of death. We recommended designing specific tertiary prevention strategies for IDU population.A cardiovascular disease (ACD) is the number one killer in adult population. South Asians have the highest rates of premature coronary artery diseases. At least 25% of coronary patients have sudden death or nonfatal myocardial infarction without prior symptoms. However, understanding coronary heart disease risk (CHDR) of people with subclinical ACD is critically important for initiating intensive primary prevention. We conducted a cross-sectional cluster survey of 752 subjects in a semi-urban population in India. Smoking status, total Cholesterol, HDL, LDL, TG, blood pressure and anthropometric was collected. 10-year CHDR of the population was estimated using Framingham criteria. Univariate and multivariate analysis was done to test the association between variables and CHDR. We found that 62.0%, 28.5% and 9.5% men; and 97.1%, 2.5% and 0.4% women respectively were at mild, moderate and severe CHDR. Of men <40 years 0.8%, 40-60 years 14.4%, and >60 years 27.3% were at high CHDR; and among women, only the postmenopausal group were high CHDR. TG, LDL and systolic BP correlated directly; and height and biceps skinfold inversely with the CHDR in men. Systolic BP and TG correlated directly and height inversely with the CHDR in women. To conclude, men of all the age groups and women >60 years were at high risk for CHD over next 10-years. WHR was the best anthropometric predictor for CHD risk in both genders. Smoking and low HDL levels attributed significantly to the CHD risk in men compared to women. Further studies are warranted for implementing CHDR reduction intervention program in the population.Chronic kidney disease (CKD) is increasing globally and in Saudi Arabia it affects approximately 8% annual increment of dialysis population. It is associated with a high symptom burden. Previous studies have largely reported on the prevalence of symptoms only in the haemodialysis population. This study examined symptom burden across disease stages and treatment groups in advanced CKD, and their correlation with demographic and clinical factors. Using a cross-sectional design, a convenience sample of 436 patients with CKD was recruited from three hospitals in Saudi Arabia. The CKD Symptom Burden Index (CKD-SBI) was used to measure 32 CKD symptoms. Demographic and clinical data were also collected. Of the sample 75.5% were receiving dialysis (haemodialysis, n = 287; peritoneal dialysis, n = 42) and 24.5% were non-dialysis (CKD stage 4, n = 69; CKD stage 5, n = 38). Average symptom reported was 13.01 ± 7.67. Fatigue and pain were common and burdensome across all symptom dimensions.Approximately one-third of participants experienced sexual symptoms. Dialysis patients reported greater symptom burden, especially patients on haemodialysis. Haemodialysis treatment, older age and being female were independently associated with greater total symptom burden. In conclusion, symptom burden is high among advanced stages of CKD, particularly among those receiving dialysis. Although fatigue, pain and sexual dysfunction are key contributors to symptom burden in CKD, these symptoms are often under-recognised and warrant routine assessment. The CKD-SBI offers a valuable tool to assess symptom burden, leading to the commencement of timely and appropriate interventions.Background: The literature demonstrated that stethoscope, the most used medical device, can be more contaminated than hands. There is a big concern on disinfecting the health professional hands, contrarily, lack of time and attention make the stethoscope disinfection quite rare, although it should be disinfected before every visit. This pilot study, evaluates an innovative solution for stethoscopes’ membrane disinfection in a real environment.H infections with Toxocaracanis and cati are clinically important subjects and a frequent cause of misdiagnosis or delayed diagnosis. Despite the recognition of toxocariasis as an important clinical illness there have been few reviews of therapy for these infections and no definitive treatment protocols have been published, especially in albendazole and mebendazole resistant cases. Only a handful of agents have been used in therapy, and the agents which are available may vary in significantly in efficacy and have adverse effects or be contraindicated in certain clinical situations. When evaluating the clinical efficacy of agents used against toxocara infections, it is difficult to compare studies. They vary as to entry methodology (whether randomization was done and if treatment was blinded or open), population studied (children, adults), syndromes treated: visceral larva migrans (VLM), covert toxocariasismilder version of VLM and ocular larva migrans (OLM), measures (clinical efficacy and/or blood results negativity), and duration of follow-up. Nevertheless, conclusions may be drawn from the studies when viewed as a whole, and statements can be made about the relative efficacy of the agents. In this paper we present our own experiences and initial results about the efficacy of agents currently used for the treatment of toxocariasis in albendazole and mebendazole resistant cases. The total of 58 patients primarily treated with albendazole and/ or mebendazole were treated with two of the medicines most commonly used for resistant cases of this infection. 26 with visceral larva migrans, 26 with covert toxocariasis and 6 with ocular larva migrans. Diethycarbamazine and thiabendazole were used in their usual posologic schedules. The total cure rates achieved with diethylcarbamazine and thiabendazole were, respectively: 75% and 70% in VLM patients, 85% and 80% in covert toxocariasis. We did not achieve any clinical efficacy or blood results negativity in patients with OLM. Side effects were of minor importance both in patients treated with thiabendazole and diethylcarbamazine.H avian influenza viruses (AIVs) have become endemic and circulated in poultry industries in Korea since the first outbreak in 1996. We surveyed H9N2 AIVs in Korean chicken farms and live bird markets from 2009 to 2014. A total of 156 H9N2 AIVs was isolated, and we compared the genetic characteristics of theAIV isolates withH5N1 and H5N8 highly pathogenic influenza viruses (HPAIVs) isolated in Korea. Phylogenetic analysis classified the H9N2 AIVs into three categories of genotypes and showed that genetic reassortment had occurred among H9N2 AIVs, HPAIVs and AIVs isolated from wild birds. The first group of H9N2 AIVs were closely related to A/chicken/Korea/01310/2001 H9N2 (01310) which has been used for an H9N2 vaccine strain in Korea. The other two groups showed there assortment of polymerase genes each other between H9N2 AVI and HPAIV. The PB1 genes were similar to H5N8 HPAIV isolated in 2014, and the PB2 genes were closely related to H5N1 HPAIs. The PA genes of the second group were from 01310-like lineage, but those of the third group from HPAIVlike lineage. Considering that many kinds of the similar genetic reassortants of H9N2 AIVs have been reported in the several East Asian countries and H9N2 AIVs are thought as one of the potential pandemic candidates, continuous surveillance and monitorings should be conducted and investigated for the control of further epidemics.