Abstract
Sizananni Effect – A Five Year Evaluation on an HIV Prevention Youth Camp Program
Su-I Hou, DrPH, CPH, MCHES, RN1, Powell Gwynn, PhD2, Scott Ogletree2, Philip Lilienthal3 and Emily Crowder3
(1)University of Central Florida, Orlando, FL, (2)Clemson University, Clemson, SC, (3)Global Camps Africa, Reston, VA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Purpose: This study reports a five-year evaluation of a peer-led youth camp program (Camp Sizanani) on HIV knowledge, related stigma beliefs and disclosure concerns, as well as youth development skills among youth development in South Africa. Methods: Global Camps Africa partners with local schools and organizations to identify disadvantaged youths who were at high risk of HIV/AIDS. This camp program wrapped HIV/AIDS preventive-education in fun and games, combined it with trained caring adults. Previously validated scales on HIV knowledge, stigma, disclosure, and three youth development scales (resilience, locus of control, & sense of hope) were used before and after the camp Sizananni. Results: Twelve camp sessions were conducted during 2011 ~ 2015 (n=1,268). The average age was 14.09 years, 58% were girls, about a third of the campers indicated having boy or girl friends, 13% reported having friends with benefits, and 40% personally knew someone with HIV/AIDS. At post-test, campers showed increased scores on goal-orientation (6 item), resilience (14 items), and sense of hope (14 items) (all p<.001). HIV knowledge scores (10-items) were improved (5.92 vs. 6.08; p<.01), and stigma related beliefs were significantly decreased (all p<.05). Overall, campers perceived increased knowledge towards HIV/AIDS in general (3.08 vs. 3.39; p<.000) and HIV testing specifically (2.83 vs. 3.18; p<.000) after the camps. Campers also reported increased HIV testing intention (p<.001) and condom use intention (mean 4.00 vs. 4.28; p<.001). Conclusion: Program evaluation results demonstrate effectiveness and significant impact of the Camp Sizanani among disadvantaged South Africa youths.
Advocacy for health and health education Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Other professions or practice related to public health
Abstract
Evaluation of knowledge as a factor in adherence and prevalence of cervical cancer screening of women infected with HIV (WLHIV) in Lima, Peru
Jeanne Delgado, BS1, Luis Menacho, MD2, Fernando Roman, BS2, Gitau Mburu, MD, MPH3 and Robinson Cabello, MD4
(1)David Geffen School of Medicine, University of California, Los Angeles, CA, USA, Los Angeles, CA, (2)Asociación Via Libre, Lima, Peru, (3)International HIV/AIDS Alliance, Hove, United Kingdom, (4)Asociación Civil Vía Libre, Lima, Peru
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
We explored the frequency of Papanicoloau smears (Pap) among WLHIV and assessed if knowledge of cervical cancer (CC) risk and screening guidelines was associated with adherence to screening recommendations.
We surveyed 44 HIV-infected women at an HIV clinic in Lima, Peru in 2014. Knowledge of CC risk and screening guidelines was assessed through 10 questions regarding recommended frequency and purpose of Pap screening for WLHIV. A score of 1 was attained per correct answer enabling a composite score out of 10 for each woman. “Adequate awareness” was judged as 8/10 correct answers. Bivariate analysis was performed with Fisher's exact test.
39% (17/44) of WLHIV were adherent by obtaining a Pap within 12 months of enrollment while 61% (27/44) were not. The average composite score for adherent WLHIV was 7.2 (IQR 4.5-9.5). For non-adherent WLHIV it was 6 (IQR 3-9) with 52% (14/27) reaching adequate awareness of ≥8/10. Notably, 70% (19/27) of non-adherents knew the recommended frequency of screening for WLHIV is “Every year following two normal results”. Adherence was associated with being screened twice in the first year of HIV diagnosis (p=0.03).
Non-adherence showed no association with lower knowledge of CC risk and screening guidelines; there were minimal differences in knowledge between groups. Though, women screened early after HIV diagnosis were associated with continuing to follow screening guidelines. Although educated on CC risk, more than half of WLHIV remain non-adherent. Attention to the behavioral, social, and structural barriers to screening is needed among WLHIV in Peru.
Assessment of individual and community needs for health education Epidemiology Planning of health education strategies, interventions, and programs Social and behavioral sciences
Abstract
Convenience without Disclosure: Perceived benefits and challenges of integrated methadone and antiretroviral therapy in Dar es Salaam, Tanzania
Alexis Cooke, MPH1, Haneefa Saleem, PhD, MPH2, Saria Hassan, MD3, Dorothy Mushi, MD, MMED4, Jessie Mbwambo, MD, MMED4 and Barrot Lambidn, PhD, MPH5
(1)University of California at Los Angeles, Los Angeles, CA, (2)Center for Disaster and Humanitarian Assistance Medicine, Rockville, MD, (3)Yale School of Medicine, New Haven, CT, (4)Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of, (5)RTI International, San Francisco, CA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Integration of HIV and methadone services is a vital component of effective HIV prevention, care and treatment. This research examined perceived benefits and challenges to, and recommendations for, integrating HIV services into a methadone clinic in Dar es Salaam, Tanzania.
Methods: We conducted in-depth interviews with 12 providers and 20 HIV-positive clients (10 women and 10 men) at a methadone clinic in Dar es Salaam in January and February 2015. We used thematic content analysis to identify perceived benefits and challenges to and recommendations for an integrated service model.
Results: Patients were interested in receiving HIV care and treatment within the methadone clinic, and felt it would allow them to receive care and lab results more timely. Patients identified potential challenges including: added provider workload, stigma regarding HIV status, and logistical constraints that may impede adherence.
Providers felt that integrating care would help improve efficiency and allow for more comprehensive care to patients. Factors identified by providers as challenges include: limited space in the clinic, technological issues regarding the laboratory database and CD4 testing machine, and need for provider training.
Patient recommendations included: improvements to privacy within the clinic, dispensing HIV medication separately from methadone, and giving clients options regarding ART dispensing. Provider recommendations included: added staff training, maintaining a reliable power source, and creation of new treatment spaces.
Conclusions: This integrated care model provides opportunities to improve quality of care and HIV clinical outcomes. Understanding potential challenges and recommendations regarding care integration early on helps create an integrated care model that meets the needs of HIV-positive methadone clients.
Administer health education strategies, interventions and programs Implementation of health education strategies, interventions and programs Public health or related research
Abstract
Typologies of the Gender-Based Violence, HIV, and Alcohol Use Syndemic and Associated Risks among Youth Living in the Slums of Kampala, Uganda
Monica H. Swahn, PhD1, Rachel Culbreth, MPH1, Laura Salazar, PhD1, Katherine Masyn, PhD1 and Rogers Kasirye, MA2
(1)Georgia State University, Atlanta, GA, (2)Uganda Youth Development Link, Kampala, Uganda
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Purpose: The HIV epidemic in Uganda appears to be exacerbated by co-occurring substance use and gender-based violence (GBV), a syndemic commonly referred to as the SAVA syndemic. The purpose of this study is to determine the prevalence of the SAVA syndemic at the individual level and the psychosocial correlates that increase risk among youth living in the slums of Kampala, Uganda.
Methods: Analyses are based on cross-sectional data collected in 2014. Participants comprised a convenience sample (N=1,134) of urban service-seeking youth living on the streets or in the slums, 12-18 years of age who were participating in a Uganda Youth Development Link drop-in center. Multinomial logistic regression was used to determine the odds of being classified in 7 different categories of GBV, HIV, and alcohol use. Typologies were analyzed for associations with risk and protective factors. GBV was operationalized as both perpetration and victimization.
Results: Risk and protective factors in the analyses (i.e., age, sex, commercial sex work, observing parental abuse of each other, depression/suicidality, and parental living status) were all statistically significantly associated with self-reported SAVA. Engaging in commercial sex work was associated with typologies characterized by alcohol use. Observing parental abuse was associated with various combinations of the syndemic, mostly categorized by GBV and alcohol use, as well as experiencing all three, alcohol, HIV, and GBV (AOR: 5.75; 95% CI: 2.72, 12.19).
Implications: Given the high prevalence of GBV, HIV, and alcohol use among youth in this population, prevention and interventions to reduce these outcomes are needed.
Epidemiology
Abstract
Multi-level factors related to clandestine sexual reassignment surgery and HIV vulnerability among transgender women in Tamil Nadu, India
Jonathan Garcia, PhD1, Angela Chaudhuri, DDS MPH2, Prachi Patel, MBA2, Mikaela Davis2 and Amber Jean Coyne, Masters of Public Health3
(1)Oregon State University, Corvallis, OR, (2)Swasti, Bangalore, India, (3)Oregon State University, Albany, OR
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
BACKGROUND: Transgender women (TW) in India experience among the highest rates of HIV, which have been associated with extreme social marginalization and stigma. In addition, little is known about the individual and community-level factors shaping sexual autonomy and clandestine sexual reassignment surgeries (SRS).
METHODS: Data were collected from TW (n=806) from 8 community organizations (COs) in Tamil Nadu who completed a questionnaire pertaining to issues of identity (i.e., expression and formation) and health needs. Community-level factors assessed at 8 COs included HIV testing, prevalence of clandestine SRS, and structural factors. Mixed methods analyses employed a comparative case study approach using IBM SPSS and Atlas.ti, along the axes of: individual sexual health and autonomy, community-level structures, and sociocultural context.
RESULTS: Vulnerabilities to clandestine SRS and HIV infection were generated through three mechanisms: (1) TW practiced sex work to cope with social and economic marginalization created by government institutions and social services; (2) TW gained support for clandestine SRS and other risk-producing ‘feminizing' practices from traditional community associations and fictive families; and (3) TW reported greater sexual autonomy (36.36% versus 9.15%) and HIV testing (71% versus 49%) at community organizations that addressed violence, food insufficiency, and encouraged political participation.
CONCLUSION: This study advances transgender sexual health by identifying multi-level determinants of clandestine SRS and HIV vulnerability. Further research is needed to implement safer SRS services and to address structural barriers to transgender sexual health.
Advocacy for health and health education Assessment of individual and community needs for health education Diversity and culture Provision of health care to the public Public health or related research Social and behavioral sciences
Abstract
Applying syndemic theory to assess risk factors for HIV/AIDS in the Indigenous communities of Imbabura , Ecuador
Shirley Bejarano, MSc.1, Vanessa Chee, PhD, MA1, Isabel Hernandez, RN, MPH2, Mercedes Flores, RN, MPH3, Nelson Yamberla3, Miguel Reina-Ortiz, MD, MS, MPH, PhD1, Enrique Teran, M.D., Ph.D3, Ricardo Izurieta, MD, MPH, DrPH, DTM&H1, Julie Baldwin, PhD4 and Dinorah Martinez Tyson, PhD, MPH, MA1
(1)University of South Florida, Tampa, FL, (2)Pontificia Universidad Catolica del Ecuador, Quito, Ecuador, (3)Universidad San Francisco de Quito, Quito, Ecuador, (4)Northern Arizona University, Flagstaff, AZ
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background:
Indigenous peoples around the world experience dire health disparities. In Latin America, HIV/AIDS is becoming more prevalent among Indigenous populations. In recent years, an increase of HIV/AIDS prevalence has been reported in Ecuador's Indigenous communities. Very few studies have focused on HIV/AIDS in the Indigenous communities of Ecuador's Andean region.
Methods:
Guided by syndemic theory, a qualitative study was conducted to explore HIV risk and resilience among the Andean Indigenous communities in the province of Imbabura, Ecuador. A total of eight focus groups (n=59) with men and women and nineteen in-depth interviews with key informants (i.e., Ministry of Health, NGOs, and community stakeholders) were conducted. The data were analyzed using applied thematic analysis techniques.
Results:
The preliminary findings showed that the indigenous communities have an overall understanding of HIV/AIDS. Nonetheless, risk factors for HIV/AIDS still persist and center around the following overarching themes: (1) leaving the community for work, (2) alcohol and drug consumption, and (3) mistrust of health professionals. The risk factors found within these themes differed by gender (e.g., some of the men that left the community for work engaged in unprotected sex) and age group (e.g., younger population were perceived to have a higher risk of using drugs which increased the risk of unprotected sex.)
Conclusion:
The themes were interrelated and consequently may exacerbate the risk for HIV/AIDS among these Indigenous communities. Further research is needed to identify strategies and interventions to minimize the repercussions of factors, which may contribute to an increased risk for HIV/AIDS among Indigenous communities of Imbabura province, Ecuador. The syndemic effect of these three themes on the risk of HIV/AIDS transmission among these communities will be discussed in comparison to other Latin-American Indigenous communities.
Diversity and culture Public health or related research
Abstract
Understanding sociocultural factors that influence HIV testing among couples in southeast Nigeria: Qualitative evidence from the Healthy Beginning Initiative
John Ehiri, PhD, MPH, MSc1, Juliet Iwelunmor, PhD2, Theddus Iheanacho, MBBS, DTM&H3, Sarah Blackstone, MPH4, Micheal Obiefune, MD5, Donatus Nnadi, MBBS, MPH6, Frances Ahunanya7, Ngozi Ogbonna7, Aaron Hunt, MPH8, Dina Patel, MSN9 and Echezona Ezeanolue, MD, MPH10
(1)University of Arizona, Mel & Enid Zuckerman College of Public Health, Tucson, AZ, (2)University of Illinois at Urbana Chamapaign, Champaign, IL, (3)Yale School of Medicine, New Haven, (4)University of Illinois at Urbana-Champ, Champaign, IL, (5)Sunrise Foundation, Enugu, Nigeria, (6)4. Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Nigeria, (7)Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Nigeria, (8)University of Nevada, Las Vegas, NV, (9)University of Nevada School of Medicine, Las Vegas, NV, (10)University of Nevada Las Vegas, Las Vegas, NV
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: With support from the US President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund for HIV, TB and Malaria, Nigeria offers free PMTCT services. However, uptake of services is low and pediatric transmission of HIV remains a significant public health challenge. Using the PEN-3 cultural model as the theoretical framework, we examined social, cultural, and contextual factors that influenced uptake of HIV counseling and testing among pregnant women and their male partners through a qualitative study of participants in the Healthy Beginning Initiative (HBI), a congregation-based program to prevent mother-to-child transmission of HIV in southeast Nigeria.
Methods: Eight focus group discussion sessions and free-listing exercises with 83 pregnant women and their male partners. Perspectives of participants who tested, and those who did not test for HIV were obtained.
Results: The most cited reasons for getting tested for HIV included: gaining knowledge of HIV status, marriage, prevention of mother-to-child transmission, and prevention of disease transmission to others. Reasons for not testing for HIV included: fear of test results/health outcomes, fear of infection from needles used during testing, stigma, and concern about negative consequences for marriage/intimate partner relationship.
Conclusion: There are numerous barriers influencing HIV testing as well as positive and unique factors that promote HIV testing. Public health practitioners and policymakers need to consider how socio-cultural and religious factors that are unique to specific local contexts may promote or hinder uptake of available interventions to prevent HIV/AIDS.
Conduct evaluation related to programs, research, and other areas of practice Planning of health education strategies, interventions, and programs Program planning Provision of health care to the public Systems thinking models (conceptual and theoretical models), applications related to public health
Abstract
Promoting mental health of people living with HIV infection: Potential contribution of home based service
Kalpana Poudel-Tandukar, PhD1 and Krishna C. Poudel, PhD2
(1)University of Massachusetts, Amherst, MA, (2)University of Massachusetts Amherst, Amherst, MA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Purpose: Home-based service has a potential to improve mental health outcomes as this approach provides tailored responses to a myriad concerns of HIV-infected persons. Family plays an important role to alleviate the impact of stress appraisal by providing a solution to problems and reducing the perceived importance of a problem so that individual is less reactive to perceived stress. We examined the association between home-based services and anxiety or depression among HIV-infected persons.
Methods: A cross-sectional study was conducted among 294 HIV-infected persons under antiretroviral therapy living in Kathmandu, Nepal. We used a structured questionnaire to measure socio-demographic information and history of receiving home-based services in the past three months, and the Hopkins Symptoms Check List 25 to measure symptoms of anxiety and depression. Relationships were assessed using multiple logistic regression analysis.
Results: Participants were, on average, 34.1 years old, 89.8% were male, and 52.7% were currently married. Fifty-seven percent of participants received home-based care in the past three-months. A total of 21 (7.1%) and 28 (9.5%) participants met criteria for anxiety and depression, respectively. The participants who received home-based care were less likely to meet criteria for anxiety [adjusted odds ratio (AOR) 95% confidence interval (95% CI)= 0.09 (0.01–0.51)] as well as depression [AOR (95% CI)= 0.18 (0.05–0.62)] than those who did not receive such care.
Implications: Home-based services provided benefit against anxiety and depression among HIV-infected persons. Home-based intervention could be a potential strategy to improve mental health status among HIV-infected persons in resource-limited settings.
Chronic disease management and prevention Provision of health care to the public Public health or related research
Abstract
Improving HIV knowledge and reducing tolerance for interpersonal violence: How community characteristics shape media effects among Ethiopian Women
Rajiv N. Rimal, PhD and Mark C. Edberg, PhD, MA
The George Washington University Milken Institute School of Public Health, Washington, DC
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Residents of communities with low HIV knowledge and strong norms promoting violence against women are less likely to change behavior. In such communities, individuals' use of modern media should counteract the normative effect. This hypothesis was tested across four media (television, radio, newspapers, cellphone) in Ethiopia to predict women's knowledge about HIV and tolerance for violence against women.
Data (N=15,913) come from the Ethiopian DHS, a nationally representative survey of women in all regions of the country. Each enumeration area was taken as a separate community (total communities=650). Communities were classified as low, medium, or high on knowledge and tolerance for violence (K-TFV) measures (where high = high knowledge and low tolerance for violence). Regressions were run to predict individual-level K-TFV, from community-level K-TFV, media use, and their interaction, controlling for age and education.
Community-level K-TFV and media use were significant predictors of individual K-TFV (all Ps<.001). Significant interactions between community-level K-TFV and media (all Ps<.05) showed that when community K-TFV was high, media use did not differentially predict individual K-TFV. But when community K-TFV was low, media use was positively associated with higher individual K-TFV. This pattern held true eight out of eight times (4 media x 2 outcomes).
Findings suggest that modern media use connects individuals in low-scoring communities to an additional “discursive community,” where HIV and violence against women are discussed in ways that differ from their community norms. Thus the change from normative baseline may be more significant. These findings can inform media selection for interventions.
Communication and informatics Planning of health education strategies, interventions, and programs Program planning Public health or related education Public health or related research Social and behavioral sciences
Abstract
Coping and Quality of Life: Focus on HIV positive men and women in Punjab, India
Naina Sharma-Uppal, PhD1 and Rosy Chhabra, PsyD2
(1)Punjabi University, Patiala, India, (2)Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: People living with HIV/AIDS (PLWHAs) in India come from incredibly diverse cultures and backgrounds and face many challenges in the community due to lack of awareness and stigma. PLWHAs in India face rejection by family and friends, violent physical attacks, refusal of medical treatment, and denied the last religious rites. These conditions cause extreme mental and physical stress that drains their ability to effectively cope with the disease.
Methods: This study examined the role of coping styles on quality of life (QOL) of PLWHAs in low SES families in Punjab, India (n= 225; 18-49 years; and 51% males). The sample was recruited from local Antiretroviral Treatment Centers. Data (basic demographics, COPE inventory and MOS-HIV health survey) was collected via individual interviews.
Results: Pearson product moment coefficient of correlation was computed to study the relationship of coping styles with QOL. Results show that problem-focused and emotion-focused coping styles tend to facilitate better physical, role and cognitive functioning and QOL of PLWHAs. Individuals using in-efficacious coping style have poor mental health which affects their treatment prognosis and quality of life. The results reflect significant gender differences on various dimensions of coping styles viz. focus on and venting of emotions, use of social support, denial, religious coping, humor, use of emotional support and substance use.
Conclusions: The results highlight the need of training programs for counselors working in the ART centers in reinforcing efficacious coping styles in their clients for longer survival time and better QOL.
Planning of health education strategies, interventions, and programs Public health or related research Social and behavioral sciences