Factors associated with Consistent Condom Use among Internally Displaced Women in Leogane, Haiti

OBJECTIVES:

Scant research has examined factors associated with condom use among internally displaced women in postdisaster settings, such as in postearthquake Haiti. The study objective was to examine social ecological factors associated with consistent condom use among internally displaced women in postearthquake Haiti.

METHODS:

A cross-sectional survey was conducted in 2012 with a peer-driven recruitment sample of internally displaced women in Leogane, Haiti. Peer health workers administered tablet-based structured interviews to a convenience sample of 175 internally displaced women.

RESULTS:

The 128 participants who reported being sexually active in the last 4 weeks were included in the analyses. Two-thirds (65.2%) reported consistent condom use in the last month. In multivariate logistic regression analyses controlled for age and income, participants that reported sex work, depression, higher number of sex partners and shorter relationship duration had lower odds of consistent condom use in the past month. Participants who reported no experiences of intimate partner violence, lower self-rated health, higher sexual relationship power and more meals per day, had a higher likelihood of reporting consistent condom use.

CONCLUSIONS:

This research provides the first assessment of contextual factors associated with consistent condom use among women displaced from a natural disaster such as Haiti's 2010 earthquake. Findings demonstrate the importance of social ecological approaches to understand intrapersonal (eg, sex work and depression), interpersonal (eg, relationship power, intimate partner violence and relationship duration) and structural (eg, food insecurity) factors associated with internally displaced women's condom use. Results can inform future sexual health research and interventions in international disaster contexts.

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By:  Logie CH1, Daniel C2, Wang Y3.

• 1Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
• 2Faculty of Social Work, Adelphi University, Garden City, New York, USA.
• 3Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada. 
• Sex Transm Infect. 2016 Mar 31. pii: sextrans-2015-052400. doi: 10.1136/sextrans-2015-052400.

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Associations of Financial Stressors & Physical Intimate Partner Violence Perpetration

Background

Contextual factors, such as exposure to stressors, may be antecedents to IPV perpetration. These contextual factors may be amenable to modification through intervention and prevention. However, few studies have examined specific contextual factors. To begin to address this gap, we examined the associations between financial stressors and three types of physical IPV perpetration.

Methods

This analysis used data from Wave IV of The National Longitudinal Study of Adolescent to Adult Health. We used logistic regression to examine the associations of financial stressors and each type of IPV (minor, severe, causing injury), and multinomial logit regression to examine the associations of financial stressors and patterns of co-occurring types of IPV perpetration (only minor; only severe; minor and severe; minor, severe, and causing injury; compared with no perpetration).

Results

Fewer men perpetrated threats/minor physical IPV (6.7 %) or severe physical IPV (3.4 %) compared with women (11.4 % and 8.8 %, respectively). However, among physical IPV perpetrators, a higher percentage of men (32.0 %) than women (21.0 %) reported their partner was injured as a result of the IPV. In logistic regression models of each type of IPV perpetration, both the number of stressors experienced and several types of financial stressors were associated with perpetrating each type of IPV. Utilities nonpayment, housing nonpayment, food insecurity, and no phone service were associated with increased odds of perpetrating each form of IPV in adjusted analysis. Eviction was associated with perpetrating severe physical IPV but not threats/minor IPV or IPV causing injury. In multinomial logit regression comparing patterns of IPV perpetration to perpetrating no physical IPV, the relationships of financial stressors were less consistent. Food insecurity was associated with perpetrating only minor physical IPV. Comparatively, overall number of financial stressors and four types of financial stressors (utilities nonpayment, housing nonpayment, food insecurity, and disconnected phone service) were associated with perpetrating all three forms of physical IPV.

Conclusions

Combined with prior research, our results suggested interventions to improve financial well-being may be a novel way to reduce physical IPV perpetration.

Estimated proportion and 95 % confidence estimates of exposure to financial stressors and perpetration of three forms of physical IPV

	Men	Women	Difference
	Percent (95 % CI)		P-valuea
Financial stressors
Number of financial stressors			<.0001
None	77.2 (75.4–79.1)	72.3 (70.2–74.5)
1–2	16.3 (14.2–18.4)	18.8 (16.8–20.8)
3–4	5.2 (4.1–6.2)	7.3 (6.0–8.6)
5–6	1.4 (0.9–1.8)	1.5 (1.0–2.0)
Utilities nonpayment
Yes	12.7 (11.5–14.0)	17.6 (15.7–19.4)	<.0001
No	87.3 (86.0–88.5)	82.4 (80.6–84.3)
Housing nonpayment
Yes	9.4 (8.4–10.4)	10.2 (9.0–11.3)	.26
No	90.6 (89.6–91.6)	89.8 (88.7–91.0)
Food insecurity
Yes	9.9 (8.7–11.1)	14.0 (12.6–15.3)	<.0001
No	90.1 (88.9–91.3)	86.0 (84.7–87.4)
No phone service
Yes	7.8 (6.8–8.8)	10.4 (9.3–11.5)	<.0001
No	92.2 (91.2–93.2)	89.6 (88.5–90.7)
Utilities turned off
Yes	5.4 (4.6–6.3)	5.4 (4.6–6.1)	.82
No	94.6 (93.7–95.4)	94.7 (93.9–95.4)
Evicted
Yes	1.0 (0.7–1.4)	1.0 (0.7–1.4)	.93
No	99.0 (95.6–99.3)	98.9 (98.6–99.3)
Intimate partner violence perpetration
Threats/Minor physical
Yes	6.7 (5.7–7.5)	11.4 (10.1–12.7)	<.0001
No	93.4 (92.5–94.3)	88.6 (87.3–89.9)
Severe physical
Yes	3.4 (2.9–4.0)	8.8 (7.8–9.9)	<.0001
No	96.6 (96.0–97.2)	91.2 (90.1–92.2)
If Yes to physical, caused injury
Yes	32.0 (25.6–38.5)	21.0 (17.7–24.4)	.003
No	68.0 (61.5–74.4)	79.0 (75.6–82.3)

aChi-square test

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

By:  Laura M. Schwab-Reese, Corinne Peek-Asa, and Edith Parker

Department of Community & Behavioral Health, University of Iowa College of Public Health, Iowa City, IA 52240 USA

Department of Occupational & Environmental Health, University of Iowa College of Public Health, Iowa City, IA 52240 USA

Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado, Anschutz Medical Campus, 13123 E 16th Ave, B390, Aurora, CO 80045 USA

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Food Insecurity Is Associated with HIV, Sexually Transmitted Infections & Drug Use among Men in the U.S.

OBJECTIVE:

To examine the population-level association between food insecurity, HIV risk factors, and HIV serostatus among men, the group representing the majority of HIV diagnoses in the United States (US).

DESIGN:

Cross-sectional secondary data analysis using the National Health and Nutrition Examination Survey (NHANES) 1999-2012, a nationally representative survey of the civilian non-institutionalized US population.

METHODS:

Logistic regression with design weights and complex survey commands was used to estimate nationally-representative associations between food insecurity and HIV serostatus (primary outcome), herpes simplex virus 2 (HSV-2), self-reported STIs, and past-year illicit drug use among men, adjusting for potential confounders. Food security was measured using the 18-item Household Food Security Survey.

RESULTS:

We analyzed data for 9150 men representing 61 million individuals in the US. Unadjusted HIV prevalence was 1.5% among food insecure men, compared to 0.4% among food secure men (p < 0.001). In adjusted models, food insecure men had over 2 times higher odds of HIV seropositivity compared to food secure men (adjusted odds ratio (AOR) = 2.10; 95% CI 1.01-4.37; p < 0.05). Food insecurity was associated with higher odds of HSV-2 seropositivity (AOR = 1.28; 95% CI 1.04-1.57; p < 0.05), self-reported STIs (AOR = 1.54; 95% CI 1.08-2.20; p < 0.05), and illicit drug use (AOR = 1.57; 95% CI 1.14-2.15; p < 0.01). Results were robust to sensitivity analyses restricted to lower incomes.

CONCLUSIONS:

Food insecurity is associated with prevalent HIV, STIs and illicit drug use among men in the US. Further research is needed to establish whether and through what mechanisms improved food security may help prevent new HIV infections.

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By:  Palar K1, Laraia B, Tsai AC, Johnson M, Weiser SD.

• 1 Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA 
• School of Public Health, University of California Berkeley, Berkeley, CA 
• Massachusetts General Hospital, MGH Global Health, Boston, MA 
• Center for AIDS Prevention Studies, Department of Medicine, UCSF.
• AIDS. 2016 Mar 16. 

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Food Insecurity & Intimate Partner Violence Against Women: Results from the California Women's Health Survey

OBJECTIVE:

To investigate the association between food insecurity and intimate partner violence in a population-based sample of heterosexual women.

DESIGN:

Logistic regression was used to evaluate the association between three levels of food insecurity and intimate partner violence.

SETTING:

Data from 6 years of the California Women's Health Survey.

SUBJECTS:

Randomly selected women (n 16 562) aged 18 years and older from the State of California, USA.

RESULTS:

We found: 

1. that African-American women had a higher prevalence of food insecurity and were more likely to report severe intimate partner violence; 
2. a strong positive association between food insecurity and intimate partner violence; 
3. evidence of effect modification of the association between food insecurity and intimate partner violence by marital status; and 
4. higher odds of intimate partner violence among those reporting more severe food insecurity.

CONCLUSIONS:

Food insecurity is an important risk indicator for intimate partner violence among women. Understanding the factors that put women, especially minority women, at greatest risk facilitates intervention development.

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By:  Ricks JL1, Cochran SD1, Arah OA1, Williams JK2, Seeman TE1.

• 1Department of Epidemiology, Fielding School of Public Health, University of California,Los Angeles, CA, USA.
• 2Department of Psychiatry & Biobehavioral Sciences,Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA. 
• Public Health Nutr. 2016 Apr;19(5):914-23. doi: 10.1017/S1368980015001986. Epub 2015 Jun 22.

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Food Insecurity among People Who Inject Drugs in Los Angeles & San Francisco

OBJECTIVE:

We estimated the prevalence of food insecurity among people who inject drugs (PWID) in Los Angeles and San Francisco and explored correlates of food insecurity.

DESIGN:

A cross-sectional study that measured 30 d food insecurity using the US Adult Food Security Survey ten-item Module developed by the US Department of Agriculture. Food insecurity was defined as including low and very low food security.

SETTING:

Two cities in the state of California, USA.

SUBJECTS:

Male and female active PWID (n 777).

RESULTS:

Among participants, 58% reported food insecurity and 41 % reported very low food security. Food-insecure PWID were more likely to report being homeless, chest pain in the past 12 months, acquiring syringes from someone who goes to a syringe exchange program and feeling at risk for arrest for possession of drug paraphernalia.

CONCLUSIONS:

Current food insecurity was common among PWID in these two cities, yet few factors were independently associated with food insecurity. These data suggest that broad strategies to improve food access for this high-risk population are urgently needed.

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By:  Schmitz J1, Kral AH2, Chu D1, Wenger LD2, Bluthenthal RN1.

• 1Department of Preventive Medicine,Keck School of Medicine,University of Southern California,Los Angeles,CA,USA.
• 2RTI International,San Francisco,CA,USA. 

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Food Insecurity in HIV-Hepatitis C Virus Co-Infected Individuals in Canada: The Importance of Co-Morbidities

While research has begun addressing food insecurity (FI) in HIV-positive populations, knowledge regarding FI among individuals living with HIV-hepatitis C virus (HCV) co-infection is limited. 

This exploratory study examines sociodemographic, socioeconomic, behavioral, and clinical factors associated with FI in a cohort of HIV-HCV co-infected individuals in Canada. We analyzed longitudinal data from the Food Security and HIV-HCV Co-infection Study of the Canadian Co-infection Cohort collected between November 2012-June 2014 at 15 health centres. FI was measured using the Household Food Security Survey Module and classified using Health Canada criteria. Generalized estimating equations were used to assess factors associated with FI. 

Among 525 participants, 59 % experienced FI at their first study visit (baseline). Protective factors associated with FI (p < 0.05) included: enrolment at a Quebec study site, employment, and average personal monthly income. Risk factors for FI included: recent injection drug use, trading away food, and recent experiences of depressive symptoms. 

FI is common in this co-infected population. Engagement of co-infected individuals in substance use treatments, harm reduction programs, and mental health services may mitigate FI in this vulnerable subset of the HIV-positive population.

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By:  Cox J1,2,3, Hamelin AM4, McLinden T4, Moodie EE4, Anema A5,6, Rollet-Kurhajec KC7, Paradis G4, Rourke SB8,9,10, Walmsley SL11,12, Klein MB7; Canadian Co-infection Cohort Investigators.

• 1Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada. joseph.cox@mcgill.ca.
• 2Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada. joseph.cox@mcgill.ca.
• 3CIHR Canadian HIV Trials Network, Vancouver, BC, Canada. joseph.cox@mcgill.ca.
• 4Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada.
• 5Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
• 6Department of Medicine, Boston Children's Hospital, Boston, MA, USA.
• 7Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.
• 8Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
• 9The Ontario HIV Treatment Network, Toronto, ON, Canada.
• 10Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
• 11Department of Medicine, University of Toronto, Toronto, ON, Canada.
• 12Division of Infectious Diseases, University Health Network, Toronto, ON, Canada. 

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Quality of Life among Ghanaian Adolescents Living with Perinatally Acquired HIV

In Sub-Saharan Africa, increasing numbers of children with perinatally acquired HIV (PAHIV) are living into adolescence. These adolescents face numerous unique challenges such as parent illness/death and years of medication use. Optimizing care for these youth requires an understanding of the factors that contribute to physical health, psychological well-being, social relationships, and quality of life (QOL). 

This mixed methods study collected quantitative questionnaire data from 40 Ghanaian adolescents with PAHIV (50% female, 12-19 years old) who received care through an adolescent HIV clinic in Kumasi, Ghana. The study also presents results from qualitative interviews conducted with 20 adolescents. 

Results from quantitative analyses suggested that a significant number of participants were not virally suppressed (67%) and participants reported barriers to treatment adherence, limited social support, concerns about disclosure and HIV-related stigma, limited resources, and lower than expected QOL. 

Salient themes from the qualitative analyses included limited understanding of how HIV is transmitted, the interplay between food insecurity and treatment adherence and the need for developing safe relationships through which adolescents can discuss their illness without fear of accidental disclosure of their HIV status.

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By:  Enimil A1,2, Nugent N3,4, Amoah C5,6, Norman B7,8, Antwi S1,2, Ocran J9, Kwara A10,11, Barker DH3,4.

• 1 Directorate of Child Health , Komfo Anokye Teaching Hospital , Kumasi , Ghana.
• 2 Department of Child Health , Kwame Nkrumah University of Science and Technology , Kumasi , Ghana.
• 3 Department of Psychiatry , Rhode Island Hospital , Providence , RI , USA.
• 4 Department of Psychiatry and Human Behavior , Alpert Medical School, Brown University , Providence , RI , USA.
• 5 Psychiatry Department , Komfo Anokye Teaching Hospital , Kumasi , Ghana.
• 6 Department of Behavioural Sciences , School of Medical Sciences, Kwame Nkrumah University of Science and Technology , Kumasi , Ghana.
• 7 Directorate of Medicine , Komfo Anokye Teaching Hospital , Kumasi , Ghana.
• 8 Department of Medicine , Kwame Nkrumah University of Science and Technology , Kumasi , Ghana.
• 9i Department of Sociology , University of Ghana , Accra , Ghana.
• 10 Department of Medicine , The Miriam Hospital , Providence , RI , USA.
• 11 Department of Medicine , Alpert Medical School, Brown University , Providence , RI , USA. 
• AIDS Care. 2016 Apr;28(4):460-4. doi: 10.1080/09540121.2015.1114997. Epub 2015 Dec 7.

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Daily Consumption of Ready-To-Use Peanut-Based Therapeutic Food Increased Fat Free Mass, Improved Anemic Status But Has No Impact on the Zinc Status of People Living with HIV/AIDS

BACKGROUND:

Food insecurity in sub-Saharan Africa and malnutrition constitute the main obstacles for successful treatment of people living with HIV/AIDS (PLWH). The aim of this study was to assess the effect of consuming daily 100 g RUTF (ready-to-use therapeutic food) as supplement, on body composition, anemia and zinc status of hospitalized PLWH in Senegal.

METHODS:

A Controlled clinical trial was conducted in 65 PLWH randomly allocated to receive either standard hospital diet alone (Control group: n = 33), or the standard diet supplemented with 100 g RUTF/day (RUTF group: n = 32). Supplementation was continued at home during 9 weeks. Individual dietary intakes were measured and compared to the Recommended Dietary Allowances. Body composition was determined using Bio-Impedance Analysis. Hemoglobin was measured by HemoCue and plasma zinc (PZ) concentration by atomic absorption spectrometry. PZ was adjusted to infection (CRP and α1-AGP). All measures were conducted on admission, discharge and after 9 weeks home-based follow up.

RESULTS:

34 and 24 % of the patients in RUTF and Control groups were suffering from severe malnutrition (BMI < 16 kg/m(2)), respectively. In both groups, more than 90 % were anemic and zinc deficiency affected over 50 % of the patients. Food consumed by the Control group represented 75, 14 and 55 % of their daily recommended intake (DRI) of energy, iron and zinc, respectively. When 100 g of RUTF was consumed with the standard diet, the DRI of energy and zinc were 100 % covered (2147 kcal, 10.4 mg, respectively), but not iron (2.9 mg). After 9 weeks of supplementation, body weight, and fat-free mass increased significantly by +11 % (p = 0.033), and +11.8 % (p = 0.033) in the RUTF group, but not in the Control group, while percentage body fat was comparable between groups (p = 0.888). In the RUTF group, fat free mass gain is higher in the patients on ART (+11.7 %, n = 14; p = 0.0001) than in those without ART (+6.2 %, n = 6; p = 0.032). Anemia decreased significantly with the supplementation, but zinc status, measured using plasma zinc concentration, remained unchanged.

CONCLUSION:

Improving PLWH' diet with 100 g RUTF for a long period has a positive impact on muscle mass and anemia but not on the zinc status of the patients.

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By:  Diouf A1, Badiane A2, Manga NM3, Idohou-Dossou N4, Sow PS5, Wade S6.

• 1Laboratoire de Nutrition, Département de Biologie Animale, Faculté des Sciences et Techniques, Université Cheikh Anta Diop de Dakar, Dakar, BP 5005, Dakar - Fann, Sénégal. adama.diouf@ucad.edu.sn.
• 2Laboratoire de Nutrition, Département de Biologie Animale, Faculté des Sciences et Techniques, Université Cheikh Anta Diop de Dakar, Dakar, BP 5005, Dakar - Fann, Sénégal. badiane21@yahoo.fr.
• 3Service des Maladies Infectieuses, Centre Hospitalier National Universitaire de Fann, Dakar, Sénégal. noelmagloiremanga@yahoo.fr.
• 4Laboratoire de Nutrition, Département de Biologie Animale, Faculté des Sciences et Techniques, Université Cheikh Anta Diop de Dakar, Dakar, BP 5005, Dakar - Fann, Sénégal. nicole.dossou@ucad.edu.sn.
• 5Service des Maladies Infectieuses, Centre Hospitalier National Universitaire de Fann, Dakar, Sénégal. papasalifsow@gmail.com.
• 6Laboratoire de Nutrition, Département de Biologie Animale, Faculté des Sciences et Techniques, Université Cheikh Anta Diop de Dakar, Dakar, BP 5005, Dakar - Fann, Sénégal. salimata.wade@ucad.edu.sn. 

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