Intimate Partner Violence Norms Cluster within Households: An Observational Social Network Study in Rural Honduras

Background

Intimate partner violence (IPV) is a complex global problem, not only because it is a human rights issue, but also because it is associated with chronic mental and physical illnesses as well as acute health outcomes related to injuries for women and their children. Attitudes, beliefs, and norms regarding IPV are significantly associated with the likelihood of both IPV experience and perpetration.

Methods

We investigated whether IPV acceptance is correlated across socially connected individuals, whether these correlations differ across types of relationships, and whether social position is associated with the likelihood of accepting IPV. We used sociocentric network data from 831 individuals in rural Honduras to assess the association of IPV acceptance between socially connected individuals across 15 different types of relationships, both within and between households. We also investigated the association between network position and IPV acceptance.

Results

We found that having a social contact that accepts IPV is strongly associated with IPV acceptance among individuals. For women the clustering of IPV acceptance was not significant in between-household relationships, but was concentrated within households. For men, however, while IPV acceptance was strongly clustered within households, men’s acceptance of IPV was also correlated with people with whom they regularly converse, their mothers and their siblings, regardless of household. We also found that IPV was more likely to be accepted by less socially-central individuals, and that the correlation between a social contact’s IPV acceptance was stronger on the periphery, suggesting that, as a norm, it is held on the periphery of the community.

Conclusion

Our results show that differential targeting of individuals and relationships in order to reduce the acceptability and, subsequently, the prevalence of IPV may be most effective. Because IPV norms seem to be strongly held within households, the household is probably the most logical unit to target in order to implement change. This approach would include the possible benefit of a generational effect. Finally, in social contexts in which perpetration of IPV is not socially acceptable, the most effective strategy may be to implement change not at the center but at the periphery of the community.

Below:  Shows one village’s network from 2 perspectives. The left panel depicts all ties from a randomly selected group of individuals. Note that IPV acceptance is clustered among socially connected individuals and that IPV is generally more accepted on the periphery of the network. The right panel depicts only within household ties from the same randomly selected group. Note the strong clustering of IPV norms at the household level

Below:  Shows the differential correlation between egos and alter across relationship types depending upon whether or not they live in the same household

Below:  The dynamics around ego and alters network characteristics provide possible clues as to norms. Highly connected egos are less likely to accept IPV (left panel). When alters are poorly connected in the community, the correlation between ego’s and alter’s IPV acceptance is higher (right panel)

By:  Holly B. Shakya, D. Alex Hughes, Derek Stafford, Nicholas A. Christakis, James H. Fowler, and Jay G. Silverman

Department of Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, #0507, La Jolla, CA 92093-0507 USA

Department of Political Science, University of California San Diego, La Jolla, CA USA

Department of Political Science, University of Michigan, Ann Arbor, MI USA

Department of Sociology, Yale University, New Haven, CT USA

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HIV Drug Resistance Surveillance in Honduras after a Decade of Widespread Antiretroviral Therapy

We assessed HIV drug resistance (DR) in individuals failing ART (acquired DR, ADR) and in ART-naïve individuals (pre-ART DR, PDR) in Honduras, after 10 years of widespread availability of ART.

365 HIV-infected, ART-naïve, and 381 ART-experienced Honduran individuals were enrolled in 5 reference centres in Tegucigalpa, San Pedro Sula, La Ceiba, and Choluteca between April 2013 and April 2015. Plasma HIV protease-RT sequences were obtained. HIVDR was assessed using the WHO HIVDR mutation list and the Stanford algorithm. Recently infected (RI) individuals were identified using a multi-assay algorithm.

PDR to any ARV drug was 11.5% (95% CI 8.4–15.2%). NNRTI PDR prevalence (8.2%) was higher than NRTI (2.2%) and PI (1.9%, p<0.0001). No significant trends in time were observed when comparing 2013 and 2014, when using a moving average approach along the study period or when comparing individuals with >500 vs. <350 CD4+ T cells/μL. PDR in recently infected individuals was 13.6%, showing no significant difference with PDR in individuals with longstanding infection (10.7%). The most prevalent PDR mutations were M46IL (1.4%), T215 revertants (0.5%), and K103NS (5.5%). The overall ADR prevalence in individuals with <48 months on ART was 87.8% and for the ≥48 months on ART group 81.3%. ADR to three drug families increased in individuals with longer time on ART (p = 0.0343). M184V and K103N were the most frequent ADR mutations. PDR mutation frequency correlated with ADR mutation frequency for PI and NNRTI (p<0.01), but not for NRTI. Clusters of viruses were observed suggesting transmission of HIVDR both from ART-experienced to ART-naïve individuals and between ART-naïve individuals.

The global PDR prevalence in Honduras remains at the intermediate level, after 10 years of widespread availability of ART. Evidence of ADR influencing the presence of PDR was observed by phylogenetic analyses and ADR/PDR mutation frequency correlations.

Below:  HIVDR mutation frequency comparison in individuals with recent and longstanding infection. Recently infected individuals were identified using a multi-assay algorithm as described in Methods. Only mutations present in any of the comparison groups are shown. Mutations considered for the analysis include WHO TDR surveillance mutations as well as mutations contributing with penalty scores in the Stanford algorithm. For a comprehensive list of mutations considered refer to Table 4. NRTI, Nucleoside RT Inhibitors; NNRTI, Non-nucleoside RT Inhibitors; PI, protease inhibitors; * p<0.05 Fisher’s exact test.

Below:  Correlations between PDR and ADR mutation frequency in Honduras. Pearson correlation coefficients were calculated for PDR mutation frequency vs. ADR mutation frequency at <48 and ≥48 months on ART, for the whole study period, for all DR mutations together and dividing them into ARV families. Each point represents one mutation. Some of the most relevant DR mutations are shown. PDR, pre-antiretroviral treatment drug resistance; ADR, acquired drug resistance; NRTI, Nucleoside RT Inhibitors; NNRTI, Non-nucleoside RT Inhibitors; PI, protease inhibitors.

Below:  HIVDR mutation frequency in Honduras meta-analysis 2002–2015. HIVDR mutation frequency was compared using data from two previously published studies: Lloyd et al. (median sampling year 2002) [13], and Murillo et al. (median sampling year 2006) [14]; and the present study (median sampling year 2014). Only mutations present in any of the comparison groups are shown. Mutations considered for the analysis include only WHO TDR surveillance mutations. NRTI, Nucleoside RT Inhibitors; NNRTI, Non-nucleoside RT Inhibitors; PI, protease inhibitors. * p<0.05 Fisher’s exact test.

Full article at:  http://goo.gl/uHQ8dl

By:

Santiago Avila-Ríos, Claudia García-Morales, Daniela Tapia-Trejo, Gustavo Reyes-Terán

Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico

Rita I. Meza, Sandra M. Nuñez, Leda Parham

HIV National Programme and National Laboratory, Honduran Ministry of Health, Tegucigalpa, Honduras

Norma A. Flores

Instituto Nacional Cardio Pulmonar, Tegucigalpa, Honduras

Diana Valladares, Luisa M. Pineda

Hospital Mario Catarino Rivas, San Pedro Sula, Honduras

Dixiana Flores, Roxana Motiño

Unidad de Salud Metropolitana, La Ceiba, Honduras

Víctor Umanzor

Hospital del Sur, Choluteca, Honduras

Candy Carbajal, Wendy Murillo, Ivette Lorenzana, Elsa Y. Palou

Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras

Elsa Y. Palou

Hospital Escuela Universitario, Tegucigalpa, Honduras

 

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Monitoring of HIV treatment in Seven Countries in the WHO Region of the Americas

To determine the prevalence of adequate monitoring and the costs of measuring CD4+ T-lymphocytes (CD4+ cell) and human immunodeficiency virus (HIV) viral load in people receiving antiretroviral therapy (ART) in seven countries in the WHO Region of the Americas. Methods We obtained retrospective, longitudinal data for 14 476 adults who started a first ART regimen at seven HIV clinics in Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru between 2000 and 2011. We estimated the proportion of 180-day periods with adequate monitoring, which we defined as at least one CD4+ cell count and one viral load measurement. Factors associated with adequate monitoring were analysed using regression methods. The costs of the tests were estimated.

The median follow-up time was 50.4 months; the proportion of 180-day periods with adequate CD4+ cell counts was 69% while the proportion with adequate monitoring was 62%. Adequate monitoring was more likely in participants who were older, who started ART more recently, whose first regimen included a non-nucleoside reverse transcriptase inhibitor or who had a CD4+ cell count less than 200 cells/µl at ART initiation. The cost of one CD4+ cell count ranged from 7.37 United States dollars (US$) in Argentina to US$ 64.09 in Chile; the cost of one viral load measurement ranged from US$ 20.34 in Brazil to US$ 186.28 in Haiti.

In HIV-infected participants receiving ART in the WHO Region of the Americas, CD4+ cell count and viral load monitoring was often carried out less frequently than regional guidelines recommend. The laboratory costs of monitoring varied greatly.

Table 1 Antiretroviral treatment programmes in seven countries in the WHO Region of the Americas, 2000-2011 

Characteristic			Site of adult HIV clinica
	Argentina	Brazil	Chile	Haiti	Honduras	Mexico	Peru
No. of participants in study	1285	2446	1080	5696	789	772	2408
Start of universal access to ART, year	2000	1991b	2003	2003	2003	2002	2004
Type of clinic	Private	Public	Public	NGO	Public	Public	Public
Guidelines used for monitoring ART efficacy	SADI, MOH	MOH	MOH	MOH, PAHO	MOH	MOH	MOH
Recommended periodicity of CD4+ cell count monitoring	3-4 months	3-6 months	3-4 monthsc	6 months	6 months	4-6 months	6 months
Cost of one CD4+ cell count, US$d	7.37	17.62	64.09	32.6	14.31 33.39	59.67	38.12e
Source of funding for CD4+ cell count monitoring	Refund from Argentine government, social insurance	Brazilian government	Chilean government	PEPFAR, GFATM	Honduran government, social insurance	Mexican government	Peruvian government
Cost of one HIV viral load measurement, US$d	55.26	20.34	119.14	186.28f	33.39g160.19h	119.27	86.32
Source of funding for HIV viral load monitoring	Refund from Argentine government, social insurance	Brazilian government	Chilean government	Researchfunded	Honduran government, social insurance	Mexican government	Peruvian government

Table 2 Characteristics of participants receiving ART in seven countries in the WHO Region of the Americas, 2000-2011 

Participants' characteristic				Site of adult HIV clinica
	Argentina	Brazil	Chile	Haiti	Honduras Mexico		Peru		Total (n = 14 476)
		(n= 2446) (n=1080) (n=5696)			(n = 789) (n = 772)			(n = 2408)
Age in years, median (IQR)	(33-46)	38 38 39	(32-45)	(32-46)	36 34 (30-43) (29-42)		(29-43)	35	37
									(31-45)
Male sex, no. (%)	925 (72)	1611 (66)	952 (88)	2480 (44) 422 (53) 673 (87)			1691 (70)		8754 (60)
Probable cause of infection, no. (%) Heterosexual sex	340 (26)	1136 (46)	285 (26)	0 (0) 471 (60) 219 (28)			1562 (65)		4013 (28)
Homosexual sex	181 (14)	833 (34)	785 (73)	0 (0) 49 (6) 514 (67)			831 (35)		3193 (22)
Other	55 (4)	81 (3)	9 (1)	0 (0) 3 (0) 17 (2)			13 (1)		178 (1)
Unknown	709 (55)	396 (16)	1 (0)	5696 (100) 266 (34) 22 (3)			2 (0)		7092 (49)
CD4+ cell count at ART initiation, no. (%) Data missing	306 (24)	426 (17)	302 (28)	772 (14) 151 (19) 132 (17)			326 (14)		2415 (17)
200-350 cells/µL < 200 cells/µL	306 (24)	771 (32)	373 (35)	3035 (53) 447 (57) 355 (45)			1222 (51)		6509 (45)
200-350 cells/µL	349 (27)	650 (27)	234 (22)	1537 (27) 146 (19) 184 (24)			526 (22)		3626 (25)
350 cells/µL	324 (25)	599 (24)	171 (16)	352 (6) 45 (6) 101 (13)			334 (14)		1926 (13)
Prior AIDS-defining eventb at ART initiation, no. (%)	54 (4)	172 (7)	292 (27)	1223 (21) 252 (32) 332 (43)			848 (35)		3173 (22)
Prior AIDS-defining event or CD4+ cell count < 200 cells/µL at ART initiation	335 (26)	871 (36)	541 (50)	3423 (60) 536 (68) 486 (63)			1515 (63)		7707 (53)
NNRTI-based ART regimen, no. (%)	869 (68)	1270 (52)	858 (79)	5279 (93) 745 (94) 607 (79)			2024 (84)		11 652 (80)

Full article at: http://goo.gl/QBS4Ey

By: 

Pablo F Belaunzarán-Zamudioa, Yanink N Caro-Vegaa, Bryan E Shepherdb, Brenda E Crabtree-Ramíreza, Paula M Luzc, Beatriz Grinsztejnc, Carina Cesard, Pedro Cahnd, Claudia Cortése, Marcelo Wolffe, Jean W Papef, Denis Padgettg, Eduardo Gotuzzoh, Catherine McGowani, Juan G Sierra-Maderoa

^a Clínica de Inmuno-Infectología, Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Calle Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, México Distrito Federal, CP 14080, Mexico.

^b Department of Biostatistics, Vanderbilt University, Nashville, United States of America (USA).

^c Instituto de Pesquisa Clínica Evandro Chagas, Fundacão Oswaldo Cruz, Rio de Janeiro, Brazil.

^d Fundación Huésped, Buenos Aires, Argentina.

^e Fundación Arriarán, Universidad de Chile, Santiago, Chile.

^f Le Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti.

^g Instituto Hondureño de Seguridad Social and Hospital Escuela, Tegucigalpa, Honduras.

^h Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru.

ⁱDepartment of Medicine, Vanderbilt University, Nashville, USA.

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Migration, Multiple Sexual Partnerships & Sexual Concurrency in the Garífuna Population of Honduras

The Garífuna, an ethnic minority group in Honduras, have been disproportionately affected by HIV. Previous research suggests that migration and high rates of multiple sexual partnerships are major drivers of the epidemic. 

Using data from a 2012 population-based survey, we assessed whether temporary migration was associated with 

1. multiple sexual partnerships and
2. sexual concurrency among Garífuna men and women in Honduras. 

Among both men and women, temporary migration in the last year was associated with an increased likelihood of multiple sexual partnerships and with concurrency, though only the association between migration and multiple sexual partnerships among men was statistically significant. 

Migration may contribute to HIV/STI vulnerability among Garífuna men and women via increases in these sexual risk behaviors. Research conducted among men and women at elevated risk of HIV should continue to incorporate measures of mobility, including history of internal migration.

Via:  http://goo.gl/Jrdqum Purchase full article at: http://goo.gl/xe13Vm

By: Gandhi AD1, Pettifor A, Barrington C, Marshall SW, Behets F, Guardado ME, Farach N, Ardón E, Paz-Bailey G.

1HIV Center for Clinical and Behavioral Studies, Columbia University and The New York State Psychiatric Institute, 1051 Riverside Drive, Unit 15, 10032, New York, NY, USA,

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Family Planning for Strangers: An Experiment on the Validity of Reported Contraceptive Use

Below:  Scatterplot for Reported Sterilization and TFR in Urban Latin American DHS data, 42 surveys from 15 countries, including OLS Regression Prediction Line (R2 = 0.14; p = 0.015).

Sterilization levels reported in the Dominican Republic appear well above what we would normally expect given prevailing patterns in the region. We suspect that the use of strangers as interviewers—the normative approach in data collection in both developed and developing country settings—may be partly responsible for this result, and may underlie a long history of bias in family planning data. We present findings from a field experiment conducted in a Dominican town in 2010, where interviewer assignment was randomized by level of preexisting level of familiarity between interviewer and respondent. In our data, sterilization use is higher when the interviewer is an outsider, as opposed to someone known to the respondent or from the same community. In addition, high sterilization use is correlated with a propensity of respondents to present themselves in a positive light to interviewers. These results call into question the routine use of strangers and outsiders as interviewers in demographic and health surveys.

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