Tara McCrimmon

Efficacy of a Computerized Intervention on HIV and Intimate Partner Violence Among Substance-Using Women in Community Corrections: A Randomized Controlled Trial.

OBJECTIVES To test the efficacy of a computerized, group-based HIV and intimate partner violence (IPV) intervention on reducing IPV victimization among substance-using women mandated to community corrections. METHODS Between November 2009 and January 2012, we randomly allocated 306 women from community corrections in New York City to 3 study arms of a computerized HIV and IPV prevention trial: (1) 4 group sessions intervention with computerized self-paced IPV prevention modules (Computerized Women on the Road to Health [WORTH]), (2) traditional HIV and IPV prevention intervention group covering the same HIV and IPV content as Computerized WORTH without computers (Traditional WORTH), and (3) a Wellness Promotion control group. Primary outcomes were physical, injurious, and sexual IPV victimization in the previous 6 months at 12-month follow-up. RESULTS Computerized WORTH participants reported significantly lower risk of physical IPV victimization, severe injurious IPV victimization, and severe sexual IPV victimization at 12-month follow-up when compared with control participants. No significant differences were seen between Traditional WORTH and control participants for any IPV outcomes. CONCLUSIONS The efficacy of Computerized WORTH across multiple IPV outcomes highlights the promise of integrating computerized, self-paced IPV prevention modules in HIV prevention groups.

Masculinities and social contexts of HIV risk practices among Central Asian male migrant workers.

Background: Migrant workers worldwide are at high risk of acquiring and transmitting HIV and sexually transmitted infections. Over the past decade Central Asia has experienced an increase in new HIV infections and migration and mobility within the region. These trends call for mixed methods research to explore the environmental and mobility contexts in which HIV risk behaviors occur among Central Asian migrants, particularly those in Kazakhstan, a common destination country. Methods: This study took place in Almaty’s Baraholka Market, which employs 30,000 workers including many migrant workers from Central Asian countries. We used a convenience sampling approach to recruit 48 male migrant workers from Uzbekistan, Tajikistan, Kyrgyzstan, and Kazakhstan. Through in-depth interviews, we examined both their engagement in a number of sexual HIV risk behaviors (including having outside partners, sex trading, and condom use) as well as the meaning they attributed to such behaviors. We also address micro-social contexts (employment, types of relationships, infidelity, and access to resources), macro-contexts (gender roles and power dynamics) and structural contexts (mobility and policing) to examine how environmental influences influenced HIV risks. Results: Findings suggest that men in this study attributed sex with extramarital partners to sexual desires when wives are unable to have sex, mobility and separation, need for variety, and lack of satisfaction in marriage. Factors influencing condom use included trust, sexual pleasure, intention to protect one’s health, and alcohol use. Participants had low levels of knowledge about HIV/AIDS; believed HIV did not affect their community or social networks, and had limited access to health care. Conclusions: Study findings call for a combination of contextually sustainable HIV/STI prevention strategies that target migrant workers in Central Asia.

Feasibility and preliminary effects of a screening, brief intervention and referral to treatment model to address gender-based violence among women who use drugs in Kyrgyzstan: Project WINGS (Women Initiating New Goals of Safety).

INTRODUCTION AND AIMS Intimate partner violence (IPV) and other forms of gender-based violence (GBV) are serious public health threats among women who use drugs or engage in binge drinking in Kyrgyzstan. This study aimed to evaluate the feasibility and preliminary effects of a two-session IPV and GBV screening, brief intervention and referral to treatment model (WINGS) with HIV counselling and testing for women who use drugs or engage in binge drinking in Kyrgyzstan, using a pre/post-design. DESIGN AND METHODS We screened 109 women from harm reduction non-government organisations in Kyrgyzstan, of whom 78 were eligible, 73 participated in the intervention study, and 66 completed a 3-month post-intervention follow-up. To assess the effects of the intervention, we used random-effect Poisson and Logistic regression analyses for continuous and dichotomous outcomes respectively. RESULTS At baseline, 73% reported any physical or sexual IPV victimisation, and 60% reported any physical or sexual GBV victimisation in the past year. At the 3-month follow-up, participants reported experiencing 59% fewer physical IPV incidents in the prior 90 days than at baseline (P < 0.001) and 27% fewer physical GBV incidents than at baseline (P < 0.01). From baseline to the 3-month follow-up, participants also reported a 65% reduction in the odds of using any illicit drugs (P < 0.05) and were more likely to report receiving GBV-related services (P < 0.001). DISCUSSION AND CONCLUSION The high rates of participation, attendance and retention and significant reductions in IPV and GBV victimisation and drug use from baseline to the 3-month follow-up suggest the feasibility and promising effects of this brief intervention. [Gilbert L, Jiwatram-Negron T, Nikitin D, Rychkova O, McCrimmon T, Ermolaeva I, Sharonova N, Mukambetov A, Hunt T. Feasibility and preliminary effects of a screening, brief intervention and referral to treatment model to address gender-based violence among women who use drugs in Kyrgyzstan: Project WINGS (Women Initiating New Goals of Safety). Drug Alcohol Rev 2017;36:125-133].

Intimate partner violence and HIV risks among migrant women in Central Asia

Objectives: Despite substantial research documenting the relationships between intimate partner violence (IPV) victimization and HIV risks among women worldwide, few studies have examined these relationships among the growing population of migrant women who are disproportionately affected by these co-occurring problems. This cross-sectional study examined associations between lifetime IPV victimization and HIV risks among female migrants in Almaty, Kazakhstan. Methods: Survey interviews and testing for HIV and Syphilis were conducted among a random sample of 225 female migrant vendors who were employed in one of the largest markets in Central Asia. Multivariate regression estimated associations between experiencing any lifetime physical and/or sexual IPV victimization measured by the revised conflict tactics scale (CTS2) and a number of HIV risks, controlling for potentially confounding sociodemographic variables, drug and alcohol use, and mobility patterns. Results: Of the total sample, 28.9% reported ever experiencing physical or sexual IPV. Multiple associations were found between a history of IPV victimization and a range of HIV risks, including sex with multiple partners, unprotected sex with a non-primary partner, a higher number of unprotected sex acts with non-primary partners, and a higher number of self-reported sexually transmitted infections (STIs). Conclusions: The multiple associations found between IPV and HIV risks in this sample underscore the importance of redoubling women-specific HIV prevention efforts that consider both IPV and mobility.

Project WINGS (Women Initiating New Goals of Safety): A randomised controlled trial of a screening, brief intervention and referral to treatment (SBIRT) service to identify and address intimate partner violence victimisation among substance-using women receiving community supervision

BACKGROUND The high rate of intimate partner violence (IPV) victimisation found among substance-using women receiving community supervision underscores the need for effective IPV victimisation screening, brief intervention and referral to treatment services (SBIRT) for this population. AIMS This randomised controlled trial (RCT) aims to assess the feasibility, safety and efficacy of a single-session computerised self-paced IPV SBIRT (Computerised WINGS) in identifying IPV victimisation among women under community supervision and increasing access to IPV services, compared to the same IPV SBIRT service delivered by a case manager (Case Manager WINGS). METHODS This RCT was conducted with 191 substance-using women in probation and community court sites in New York City. RESULTS No significant differences were found between Computerised and Case Manager WINGS arms on any outcomes. Both arms reported identical high rates of any physical, sexual or psychological IPV victimisation in the past year (77% for both arms) during the intervention. Both arms experienced significant increases from baseline to the 3-month follow-up in receipt of IPV services, social support, IPV self-efficacy and abstinence from drug use. CONCLUSIONS Findings suggest that both modalities of WINGS show promise in identifying and addressing IPV victimisation among substance-using women receiving community supervision.

Microfinance for women at high risk for HIV in Kazakhstan: study protocol for a cluster-randomized controlled trial

BackgroundAmong women at high risk for HIV and other sexually transmitted diseases (STIs), gender and economic issues limit the impact of behavioral prevention strategies. Women in Kazakhstan with dual risks of sex trading and drug use face elevated risk for HIV and STIs and may benefit from an economic empowerment intervention which combines HIV-risk reduction (HIVRR) education with financial skills-building and asset-building to promote reduced reliance on sex trading for income.Methods/designThe study employs a two-arm, cluster-randomized controlled trial (c-RCT) design. We will use cluster randomization to assign 350 women in approximately 50 cohorts to a traditional four-session HIV-risk-reduction intervention combined with a six-session financial literacy intervention, enrollment in a 24-session vocational training program and receipt of matched savings (HIVRR+MF); or to the four-session HIV-risk-reduction intervention alone (HIVRR). Repeated behavioral and biological assessments will be conducted at baseline, then at 6, 9, and 15 months post randomization/session 1.DiscussionThis study responds to an identified need in the academic literature for rigorous testing of structural interventions, including combination microfinance and HIV-prevention interventions.Trial registrationClinicalTrials.gov, ID: NCT02406482. Registered on 30 March 2015.

Islamic Influence on HIV Risk and Protection Among Central Asian Male Migrant Workers in Kazakhstan

HIV incidence is increasing in Central Asia, where migrant workers experience risks for acquiring sexually transmitted HIV. As a social and structural factor that may influence perceptions and behavior, we examine how Islam shapes HIV risk and protection. Phenomenological qualitative interviews examine religion and contexts of HIV risk among 48 male Central Asian migrant workers residing in Almaty, Kazakhstan. Men described nonvaginal sex, alcohol use, premarital sex, and extramarital sex as forbidden or frowned upon. Religious networks were unlikely to discuss HIV risks, and some men viewed religious affiliation or practices as protective. Marital practices including neke (religious marriage), polygyny, and bride kidnapping may be linked to risk. Findings suggest adhering to Islamic ideals may be protective for some men, but for others, assumptions of protection may enhance risk. HIV prevention strategies among Central Asian migrants may be strengthened by attention to religious and cultural understandings of risk and protection.

Reducing opioid overdose in Kazakhstan: A randomized controlled trial of a couple-based integrated HIV/HCV and overdose prevention intervention “Renaissance”

OBJECTIVES To evaluate the efficacy of a couple-based integrated HIV/HCV and overdose prevention intervention on non-fatal and fatal overdose and overdose prevention behaviors among people who use heroin or other opioids in Almaty, Kazakhstan. METHODS We selected 479 participants who reported lifetime heroin or opioid use from a sample of 600 participants (300 couples) enrolled in a randomized controlled trial (RCT) conducted between May 2009 and February 2013. Participants were randomized to either (1) a 5-session couple-based HIV/HCV and overdose prevention intervention condition or (2) a 5-session Wellness Promotion and overdose prevention comparison condition. We used multilevel mixed-effects model with modified Poisson regression to estimate effects of the intervention as risk ratios (RR) and the corresponding 95% CIs. RESULTS About one-fifth (21.9%) of the sample reported that they had experienced an opioid overdose in the past 6 months at baseline. At the 12-month follow-up, both the intervention and comparison conditions reported significant reductions in non-fatal overdose and injection heroin/opioid use and significant increases in drug treatment attendance and naloxone use to prevent death from overdose. However, we found no differences between the study arms on any of these outcomes. There were three intervention condition participants (1.3%), compared to seven comparison condition participants (2.9%) who died from opioid overdose during the 12-month follow up period although this difference was not significant. DISCUSSION There were no significant conditions on any outcomes: both conditions showed promising effects of reducing non-fatal overdose and overdose risks. Integrating overdose prevention into a couple-based HIV/HCV intervention may be an efficient strategy to target the syndemic of opioid overdose, HIV and HCV in Kazakhstan.

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.

Project Nova: A Combination HIV Prevention and Microfinance Intervention for Women Who Engage in Sex Work and Use Drugs in Kazakhstan

Innovative combination HIV-prevention and microfinance interventions are needed to address the high incidence of HIV and other STIs among women who use drugs. Project Nova is a cluster-randomized, controlled trial for drug-using female sex workers in two cities in Kazakhstan. The intervention was adapted from prior interventions for women at high risk for HIV and tailored to meet the needs of female sex workers who use injection or noninjection drugs. We describe the development and implementation of the Nova intervention and detail its components: HIV-risk reduction, financial-literacy training, vocational training, and a matched-savings program. We discuss session-attendance rates, barriers to engagement, challenges that arose during the sessions, and the solutions implemented. Our findings show that it is feasible to implement a combination HIV-prevention and microfinance intervention with highly vulnerable women such as these, and to address implementation challenges successfully.ResumenExiste la necesidad de una intervención innovadora que combine intervenciones de prevención del VIH y microfinanzas para manejar la alta incidencia de VIH u otras enfermedades de transmisión sexual con mujeres que usan drogas. Nova es un Ensayo Clínico Controlado Aleatorio Grupal para mujeres trabajadoras sexuales que usan drogas en dos ciudades en Kazakstán. La intervención fue adaptada de otras intervenciones anteriores dirigidas a mujeres con alto riesgo de contraer VIH y diseñada para satisfacer las necesidades de las mujeres trabajadoras sexuales que se inyectan o consumen drogas. Este documento describe el desarrollo y la implementación de la intervención Nova. Describimos los componentes de la intervención Nova, los cuales incluyen reducción del riesgo de VIH, entrenamiento en conocimiento financiero, entrenamiento vocacional, y programa de ahorros igualados. También describimos las tasas de asistencia a las sesiones, barreras para la participación, desafíos durante la implementación de las sesiones, y las soluciones implementadas. Los resultados muestran que es posible implementar una combinación de intervención de reducción del riesgo de VIH y micro-finanzas con mujeres altamente vulnerables y resolver problemas para manejar exitosamente los desafíos de la implementación.