Enacted Stigma and HIV Risk Behaviours among Sexual Minority Indigenous Youth in Canada, New Zealand, and the United States

Enacted stigma has been linked to increased HIV risk behaviours among sexual minority youth, but despite higher rates of HIV and other STIs, there is very little research with Indigenous youth. 

In this study, secondary analyses of three population-based, school surveys were conducted to explore the associations between HIV risk and enacted stigma among sexual minority Indigenous youth in Canada, the US, and New Zealand. Data were analyzed and interpreted with guidance from Indigenous and sexual minority research team members, Indigenous advisory groups, and community consultations. 

In all three countries, Indigenous sexual minority youth were more likely to experience enacted stigma (such as bullying, discrimination, exclusion, harassment, or school-based violence) and report increased HIV risk behaviours (such as lack of condom use, multiple sexual partners, pregnancy involvement, and injection drug use) compared to heterosexual peers. Data were analyzed by age, gender, and sexual orientation, and for some groups, higher levels of enacted stigma was associated with higher HIV risk. 

The findings highlight the need for more research, including identifying protective factors, and developing interventions that focus on promoting resilience, addressing the levels of stigma and homophobic violence in school, and restoring historical traditions of positive status for Indigenous sexual minority people.

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

By:  Elizabeth Saewyc, PhD, RN, FSAHM, FCAHS, Terryann Clark, PhD, MPH, RN, Lucy Barney, MSN, RN, Dana Brunanski, MA, and Yuko Homma, PhD

Elizabeth Saewyc: ac.cbu@cyweas.htebazile (https://nursing.ubc.ca/our-people/elizabeth-saewyc); Terryann Clark: zn.ca.dnalkcua@kralc.t; Lucy Barney: ac.ashp@yenrabl; Dana Brunanski:ac.hcv@iksnanurb.anad; Yuko Homma: ac.cbu@ammoh.okuy

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The Impact of a Community-Based Risky Drinking Intervention (Beat da Binge) on Indigenous Young People

BACKGROUND:

Alcohol misuse imposes substantial harm on Indigenous Australians whose health status is poorer than non-Indigenous Australians. Although Indigenous youth are over represented in Indigenous alcohol harms, few interventions addressing alcohol-related harm among Indigenous youth have been evaluated. Given this paucity of evidence, a survey was designed to evaluate the effects of a whole-of-community, anti-binge drinking intervention for young people in an Indigenous community in far north Queensland, Australia.

METHODS:

A cross sectional, baseline-post intervention study assessed the impact of a two year anti-binge drinking intervention targeting young people (18-24 years). A survey was developed and implemented at baseline and again two-years post-intervention, administered by young local people employed as research assistants. Survey respondents were recruited through snowballing techniques. Survey items asked about respondents' knowledge of binge drinking and standard drinks, involvement in alcohol-free social activities, frequency of short-term risky drinking (binge drinking), and mean alcohol expenditure during short-term risky drinking occasions. The intervention was called Beat da Binge. Two major events and multiple minor activities each year were implemented, focusing on drinking education, alcohol-free community-wide social events, and youth-specific sporting and social activities to facilitate self-empowerment.

RESULTS:

Beat da Binge was associated with a statistically significant 10 % reduction in the proportion of survey respondents who reported that they had engaged in an episode of short-term risky drinking, in the frequency of short-term risky drinking for all beverage types except wine (ranging from 4 % to 31 % reductions), in mean expenditure on alcohol during short-term risky drinking sessions ($6.25) and in the proportion of activities with family/friends that usually include alcohol (7 %). There were also statistically significant increases in awareness of binge drinking and standard drinks (28 % and 21 % respectively). In addition to alcohol-specific outcomes, there was a statistically significant 8 % increase in the proportions of respondents engaged in training as their main weekday activity, which was partly off-set by a 13 % reduction in those whose main weekday activity was family care or home-related tasks.

CONCLUSIONS:

Reductions in the proportion of survey respondents who reported binge drinking, along with increases in awareness and involvement in alcohol-free social activities suggest the community-based intervention was effective. The potential impact of sample selection and self-reporting limitations on results need further investigation. There is an urgent need for Indigenous, community-driven public health programs that are well evaluated to both improve Indigenous health and the strength of the current evidence base to inform future community interventions.

Full article at:   http://goo.gl/h5fP0j

By:  Jainullabudeen TA1, Lively A2, Singleton M3, Shakeshaft A4, Tsey K5, McCalman J6, Doran C7, Jacups S8.

• 1National Drug and Alcohol Research Centre, UNSW Australia, Sydney, NSW, 2052, Australia. Ansari.Abudeen@racp.edu.au.
• 2Gindaja Treatment Centre, Yarrabah, Qld, Australia. ailsa@gindaja.org.
• 3Gindaja Treatment Centre, Yarrabah, Qld, Australia. michele.singleton@bigpond.com.
• 4National Drug and Alcohol Research Centre, UNSW Australia, Sydney, NSW, 2052, Australia. a.shakeshaft@unsw.edu.au.
• 5The Cairns Institute, James Cook University, Townsville City, QLD, 4811, Australia. komla.tsey@jcu.edu.au.
• 6The Cairns Institute, James Cook University, Townsville City, QLD, 4811, Australia. janya.mccalman@jcu.edu.au.
• 7School of Human Health and Social Sciences, Central Queensland University, 160 Ann Street Brisbane, QLD, 4000, Brisbane, Australia. c.doran@cqu.edu.au.
• 8The Cairns Institute, James Cook University, Townsville City, QLD, 4811, Australia. susan.jacups2@jcu.edu.au.
• BMC Public Health. 2015 Dec 30;15(1):1319. doi: 10.1186/s12889-015-2675-4 

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Social Determinants of Health Associated to HIV of Indigenous Women in North Oaxaca, México

The vulnerability to the human immunodeficiency virus (HIV) infection may increase based on specific social determinants of health, which can also affect the lack of adherence to a safe sexual behavior and access to antiretroviral treatment in indigenous women. Consequently, it is necessary to review, through a documentary study, what are those determinants in the case of a group of indigenous women from the North of Oaxaca and how these aspects affect those women, as well as the important role of nursing for the best approach. 

Social determinants are classified into 3 levels: macro (socioeconomic status, income, migration and education), meso (culture, gender and access to health services) and micro (lifestyles and adoption of safe sex). Indigenous women with limited resources become easy targets of HIV by engaging in risky sexual behaviors inadvertently. The nurse is a key professional who can influence behaviors of women through effective interventions that help foster self-confidence and empowerment, using the resources that the person possesses.

Purchase full article [in Spanish] at:  http://goo.gl/6dRjSz

By:   Juan-Martínez B¹, Castillo-Arcos LD².

¹División Ciencias de la Salud e Ingenierías, Universidad de Guanajuato, Celaya, Guanajuato, México.

²Facultad Ciencias de la Salud, Universidad Autónoma del Carmen, Ciudad del Carmen, Campeche, México. Electronic address: lubiacastilloa@gmail.com.

Enferm Clin. 2015 Dec 17. pii: S1130-8621(15)00180-1. doi: 10.1016/j.enfcli.2015.11.003.

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Ethnicity & HIV Risk Behaviour, Testing & Knowledge in Guatemala

OBJECTIVES:

To describe levels of risky sexual behaviour, HIV testing and HIV knowledge among men and women in Guatemala by ethnic group and to identify adjusted associations between ethnicity and these outcomes.

DESIGN:

Data on 16,205 women aged 15-49 and 6822 men aged 15-59 from the 2008-2009 Encuesta Nacional de Salud Materno Infantil were used to describe ethnic group differences in sexual behaviour, HIV knowledge and testing. We then controlled for age, education, wealth and other socio-demographic factors in a multivariate logistic regression model to examine the effects of ethnicity on outcomes related to age at sexual debut, number of lifetime sex partners, comprehensive HIV knowledge, HIV testing and lifetime sex worker patronage (men only).

RESULTS:

The data show low levels of risky sexual behaviour and low levels of HIV knowledge among indigenous women and men, compared to other respondents. Controlling for demographic factors, indigenous women were more likely than other women never to have been tested for HIV and to lack comprehensive HIV knowledge. They were less likely to report early sexual debut and three or more lifetime sexual partners. Indigenous men were more likely than other men to lack comprehensive HIV knowledge and demonstrated lower odds of early sexual debut, 10 or more lifetime sexual partners and sex worker patronage.

CONCLUSIONS:

The Mayan indigenous population in Guatemala, while broadly socially vulnerable, does not appear to be at elevated risk for HIV based on this analysis of selected risk factors. Nonetheless, low rates of HIV knowledge and testing may be cause for concern. Programmes working in indigenous communities should focus on HIV education and reducing barriers to testing. Further research into the factors that underlie ethnic self-identity and perceived ethnicity could help clarify the relative significance of these measures for HIV risk and other health outcomes.

Full article at:   http://goo.gl/Rxe4bb

By:   Taylor TM¹, Hembling J, Bertrand JT.

¹ Global Health Systems and Development , Tulane University , New Orleans , LA , USA.

Ethn Health. 2015;20(2):163-77. doi: 10.1080/13557858.2014.893562. Epub 2014 May 16.

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An Ethnographic Study of HIV/AIDS among Ayoreo Sex Workers: Cultural Factors & Risk Perception

Abstract

AIMS AND OBJECTIVES:

To describe and understand Ayoreo sex workers' perceptions of HIV/AIDS and to identify factors that may affect the prevention of risk behaviours.

BACKGROUND:

According to recent HIV/AIDS incidence reports, being female, indigenous and a sex worker means belonging to a maximum-risk group, left in the background in terms of strategies for the fight against HIV. Although there has been research into intervention models in these populations, it is important to detail the perceptions of the problem from the perspective of sex workers from the affected ethnic groups.

DESIGN:

This study used an ethnographic methodology that included participant observation and semi-structured interviews.

METHODS:

The research was conducted in two phases. First, participant observation was chosen to access and observe the behaviour of Ayoreo sex workers. The second phase was a semi-structured interview with sex workers and key informants. The interviews, together with the field notes, were transcribed and analysed, following inductive strategies to find emerging themes.

RESULTS:

Here, we present the results related to four emerging themes: the cultural acceptance of sex work as a useful economic activity; the lack of concern for sexually transmitted illnesses and the stigmatisation of people who are HIV seropositive; external factors that increase vulnerability such as difficulties in using a condom; and conflictive and unbalanced relationships between the Ayoreo people and the health system and health professionals.

CONCLUSIONS:

The health- and sexual reproduction-related culture, the knowledge and attitudes of sex workers, external factors, and relationships with the health system and health professionals continue to place Ayoreo sex workers in high-risk conditions in relation to sexually transmitted diseases and HIV/AIDS.

RELEVANCE TO CLINICAL PRACTICE:

Employing cultural care as its base, nursing could develop programmes and interventions culturally adapted for the prevention of disease and the promotion of health in these populations.

Purchase full article at:   http://goo.gl/ziaUAz

By:   López-Entrambasaguas OM¹, Granero-Molina J, Fernández-Sola C.

¹High Guadalquivir Public Hospital, Andújar, Jaén, Spain.

 

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HIV Diagnoses among MSM, 2005-20014, U.S.

Via:   http://ht.ly/VEvcz 

Medication Use & Knowledge in a Sample of Indigenous & Non-Indigenous Prisoners

To (a) characterise medication use and knowledge, according to Indigenous status, and (b) identify independent correlates of medication knowledge in a sample of adult prisoners.

Cross-sectional survey of 1,231 adult prisoners in Queensland, interviewed within six weeks of release. Measures included self-reported demographic and health-related characteristics, self-reported use of medications, the Hayes Ability Screening Index (HASI) and the Short-Form Health Survey (SF-36). Objective medication data were abstracted from prison medical records. A medication knowledge score was calculated to reflect the agreement between self-reported and objective medication use.

46% of participants were taking at least one medication. The most common class of medication was Central Nervous System (30% of participants). Medication knowledge was generally poor, with one quarter of prisoners unable to accurately identify any of their medications. Independent correlates of poor medication knowledge included not taking Central Nervous System medications, identifying as Indigenous and age >54.

Around half prisoners are taking medications in prison, but most have poor knowledge of what these medications are. Medication knowledge is associated with better adherence and may contribute to improved health outcomes post-release. Changes to prescribing and dispensing practices in prison may improve medication knowledge and health outcomes in this profoundly marginalised group.

Purchase full article at: http://goo.gl/K5jhgn

By: Carroll M1, Kinner SA, Heffernan EB.

• 1Melbourne School of Population and Global Health, The University of Melbourne, Victoria. 

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Striking Subgroup Differences in Substance-Related Mortality After Release from Prison

To compare the incidence, timing and risk factors for substance-related death between Indigenous and non-Indigenous ex-prisoners in Queensland, Australia.

Retrospective cohort study.

All adult prisons in the state of Queensland, Australia, linked to deaths registered in Australia.

We obtained records for all adults released from prison in Queensland, Australia from 1 January 1994 to 31 December 2007. Among this cohort of 42 015 individuals we observed 82 315 releases from prison and 2158 deaths in the community by the end of 2007, of which 661 were substance-related deaths.

Incarceration data were obtained from Queensland Corrective Services and linked probabilistically with deaths recorded in the Australian National Death Index.

In the first year after release, Indigenous ex-prisoners were more likely to die from alcohol-related causes but less likely to die of drug-related causes than were non-Indigenous ex-prisoners. Among non-Indigenous prisoners only, the risk of substance-related death was significantly higher in the first 4 weeks when compared with the risk after 1 year post-release. Most evaluated risk factors for substance-related death were similar for Indigenous and non-Indigenous ex-prisoners; however, the hazard of death increased with age more for Indigenous ex-prisoners than for non-Indigenous ex-prisoners.

In Australia, patterns of substance-related death in ex-prisoners differ markedly according to Indigenous status. Efforts to prevent substance-related deaths in ex-prisoners should consider heterogeneity in the target population and tailor responses accordingly.

  

Purchase full article at: http://goo.gl/WjaOKp

By: Forsyth SJ1, Alati R, Ober C, Williams GM, Kinner SA.

• 1School of Population Health, University of Queensland, Brisbane, Queensland, Australia.  

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Structural Factors that Increase HIV/STI Vulnerability among Indigenous People in the Peruvian Amazon

We examined structural factors—social, political, economic, and environmental—that increase vulnerability to HIV among indigenous people in the Peruvian Amazon. Indigenous adults belonging to 12 different ethnic groups were purposively recruited in four Amazonian river ports and 16 indigenous villages. Qualitative data revealed a complex set of structural factors that give rise to environments of risk where health is constantly challenged. Ferryboats that cross Amazonian rivers are settings where unprotected sex—including transactional sex between passengers and boat crew and commercial sex work—often take place. Population mobility and mixing also occurs in settings like the river docks, mining sites, and other resource extraction camps, where heavy drinking and unprotected sex work are common. Multilevel, combination prevention strategies that integrate empirically based interventions with indigenous knowledge are urgently needed, not only to reduce vulnerability to HIV transmission, but also to eliminate the structural determinants of indigenous people’s health...

People think the captain is in charge here, but is not like that; those with access to the food are in charge, we are in charge. If we see an attractive man we give them bigger portions or an extra drumstick; that’s how we convince them to have sex with us...

Groups of three or four gays come from time to time to cut hair and stay in the villages for a few days. At night, they buy beer for everyone and sometimes after they get drunk they have sex with young men...

The findings about the role that the Amazon River and its tributaries play in increasing the vulnerability for HIV/STIs among indigenous people is extremely important for the HIV-prevention community. As a physical or environmental force, the rivers provide the means for the transport of people and goods from rural to urban settings, and vice versa, which allows for the iterative formation of risky settings and situations. Our study demonstrated that sex work was readily available in most settings related to the rivers, such as the port cities, where land-based and floating brothels operate day and night. Most indigenous men who worked at the ports were by themselves (having left their families in the village) and lacked meaningful social support. They often engaged in the normative activities of the setting, such as heavy alcohol consumption and unprotected sex with sex workers. Additionally, the finding that unprotected sex among boat passengers and crew occurred regularly, and that no prevention programs were in place, is alarming and requires urgent action from the prevention community.

The direct and ever-increasing contact between indigenous people and outsiders in the Peruvian Amazon, as a result of the resource-extraction industries and in- and out-migration to and from port cities, presents a complex risk environment that might help fuel the spread of HIV/STIs in this impoverished region. HIV-related research in other aquatic environments throughout the globe has found similar results (Allison & Seeley, 2004). In Goa, on the coastline of India, fishermen migrate out of their villages for work at the docks, often leaving their wives and family behind. At the port cities, they engage in unprotected sex with sex workers and nonspousal partners (Bailey, 2011). In Kenya, a study among fishermen on the shores of Lake Victoria showed that the majority of the fishermen reported extramarital sex and low levels of condom use (Kwena et al., 2010)...

Full article at: http://goo.gl/nEK7Q0

By: E. Roberto Orellana,1 Isaac E. Alva,2 Cesar P. Cárcamo,2 and Patricia J. García2

²

1Portland State University, Portland, Oregon, USA

2Universidad Peruana Cayetano Heredia, Lima, Peru

1Portland State University, Portland, Oregon, USA

  

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Illicit & Injecting Drug Use among Indigenous Young People in Urban, Regional & Remote Australia

To examine patterns of illicit drug use among Australian Indigenous young people, identify correlates of frequent use separately in urban, regional and remote settings and characterise those who inject.

Cross-sectional design at 40 Indigenous events. Self-complete surveys were administered to Indigenous people aged 16-29 years using mobile devices.

2,877 participants completed the survey. 

• One in five reported using cannabis at least weekly in the previous year, but the use of other drugs was less prevalent. 
• Patterns of drug use were largely similar across regions, although more participants in urban and regional areas reported using ecstasy (12% vs 11% vs 5%) and cocaine (6% vs 3% vs 1%) and more reported weekly cannabis use (18% vs 22% vs 14%). 
• Injecting was rare (3%) but those who did inject reported a high incidence of needle sharing (37%). 
• Methamphetamine (37%), heroin (36%) and methadone (26%) were the most commonly injected drugs, and injecting was related to prison experience (AOR 5.3 95% CI 2.8-10.0).

Attention is needed in relation to cannabis use, particularly among those Indigenous young people living in regional and urban settings. Also, although injecting is uncommon, it is associated with prison involvement. Priority must be given to reducing the numbers of Indigenous youth entering justice settings, delaying the age at first entry to justice settings, and reducing the risk of BBV acquisition while in custody through, for example, prison-based NSP, BBV education, and Indigenous-specific treatment that emphasises connection to country and culture. 

Via: http://ht.ly/SsR8L Purchase full article at: http://goo.gl/zMxDWR

By: Bryant J1, Ward J2, Wand H3, Byron K4, Bamblett A4, Waples-Crowe P5, Betts S6, Coburn T7, Delaney-Thiele D8, Worth H9, Kaldor J3, Pitts M10.

• 1Centre for Social Research in Health, University of New South Wales, Sydney, Australia.
• 2Infectious Diseases Research Aboriginal and Torres Strait Islander Health, South Australian Health and Medical Research Institute, Adelaide, Australia.
• 3The Kirby Institute, University of New South Wales, Sydney, Australia.
• 4Victorian Aboriginal Community Controlled Health Organisation, Melbourne, Australia.
• 5Moondani Balluk Indigenous Unit, Victoria University, Melbourne, Australia.
• 6Aboriginal Health Council of South Australia, Adelaide, Australia.
• 7Queensland Aboriginal and Islander Health Council, Brisbane, Australia.
• 8Aboriginal Medical Service Western Sydney, Sydney, Australia.
• 9School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
• 10Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia.
• 
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Consumption of Indigenous Medicines by Pregnant Women in North India for Selecting Sex of the Foetus: What Can It Lead To?

Background

Sex ratio is an important indicator of development. Despite all the measures undertaken for improvement, it remains an issue of concern in India, with Haryana having a very low sex ratio in the country. Studies have been conducted indicating that consumption of indigenous drugs used for sex selection (SSD) could be strongly associated with adverse effects on the foetal development, including congenital malformations. Some samples of SSDs were collected from parts of North India and analysed in a standard laboratory for its components.

Methods

Thirty SSDs used by the local community were procured from various sources in north India through a rigorous process of collection. These were subjected to laboratory tests to investigate the presence of phytoestrogen and testosterone. Following sample extraction, thin layer chromatography and high performance liquid chromatography were carried out for analysing phytoestrogen content.

Results

SSDs were available in various forms such as powder, tablets, mostly from faith healers. Around 87 % of the samples collected from sources like doctors, quacks and faith healers were to be taken by the pregnant women after conception; 63 % drugs were strongly positive for phytoestrogens (genistein, daidzein, formononetin) and 20 % drugs were positive for testosterone. The average dose of the components as calculated after analyses was as follows: daidzein - 14.1 mg/g sample, genistein - 8.6 mg/g sample, formononetin - 5 mg/g sample.

Conclusion

These SSDs could be potentially detrimental to the growth and development of the foetus. This is likely to have implications on the health of the community. In view of the results obtained in our study, we strongly attest the importance in curbing this harmful practice by banning the supply of the drugs as well as by advocating behavioural changes in the community.

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Aboriginal People Are Disproportionately Affected by Hepatitis. We Know Why

‘The evidence suggests Aboriginal people are more likely to be searched for drugs, more likely to be arrested if they do have drugs on them and more likely to be sent to prison if they are arrested.’

Read at:  http://ht.ly/Q6RRp HT @IndigenousX

Generational Sex Work & HIV Risk among Indigenous Women in a Street-Based Urban Canadian Setting

Via; http://ht.ly/Q6Ek3 HT @bccfe

Abstract

In Canada, Indigenous women are over-represented among new HIV infections and street-based sex workers. Scholars suggest that Aboriginal women's HIV risk stems from intergenerational effects of colonisation and racial policies. 

This research examined generational sex work involvement among Aboriginal and non-Aboriginal women and the effect on risk for HIV acquisition. The sample included 225 women in street-based sex work and enrolled in a community-based prospective cohort, in partnership with local sex work and Aboriginal community partners. Bivariate and multivariate logistic regression modeled an independent relationship between Aboriginal ancestry and generational sex work and the impact of generational sex work on HIV infection among Aboriginal sex workers. 

Aboriginal women (48%) were more likely to be HIV-positive, with 34% living with HIV compared to 24% non-Aboriginal women. In multivariate logistic regression model, Aboriginal women remained three times more likely to experience generational sex work (AOR:2.97; 95%CI:1.5,5.8). Generational sex work was significantly associated with HIV (AOR = 3.01, 95%CI: 1.67-4.58) in a confounder model restricted to Aboriginal women. High prevalence of generational sex work among Aboriginal women and three-fold increased risk for HIV infection are concerning. Policy reforms and community-based, culturally safe and trauma informed HIV-prevention initiatives are required for Indigenous sex workers.