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.

 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

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.
• 
  More at:  https://twitter.com/hiv_insight

Identifying Factors Associated with Changes in CD4(+) Count in HIV-Infected Adults in Saskatoon, Saskatchewan

To assess the impact of clinical and social factors unique to HIV-infected adults in Saskatoon, Saskatchewan, regarding the rate of CD4(+) count change, and to identify factors associated with a risk of CD4(+) count decline.

Four hundred eleven HIV-infected patients were identified from January 1, 2003 to November 30, 2011. Two hundred eighteen (53%) were male, mean (± SD) age was 35.6 ±10.1 years, 257 (70.8%) were First Nations or Métis, 312 (80.2%) were hepatitis C virus (HCV) coinfected and 300 (73.3%) had a history of injection drug use (IDU). In univariate models, age, ethnicity, HCV, IDU, antiretroviral therapy and social assistance were significant. Using ethnicity, HCV and IDU, three multivariate models (models 1, 2, 3) were built due to high correlation. First Nations or Métis ethnicity, HCV coinfection and a history of IDU were associated with significantly lower CD4(+) counts in multivariate models. Older age and social assistance were associated with significantly lower CD4(+) counts in models 1 and 3. Age was marginally significant in model 2 (P=0.055). Not prescribed antiretroviral therapy was associated with a significantly negative CD4(+) count slope in all multivariate models.

The unique epidemiology of this HIV-infected population may be contributing to CD4(+) count change. Increased attention and resources focused on this high-risk population are needed to prevent disease progression and to improve overall health and quality of life.

Below:  High correlation among patients coinfected with hepatitis C virus (HCV), injection drug use (IDU) and self-identifying as First Nations or Métis ethnicity (AB). (Note: 53 [12.9%] patients did not possess any of these cofactors and 67 [16.3%] had missing information regarding at least one of these cofactors)

Below: Time to antiretroviral therapy (ART) initiation among First Nations patients compared with patients of other ethnicities

Read more at: http://ht.ly/SdcF2

By: Hunt K1, Mondal P2, Konrad S1, Skinner S3, Gartner K3, Lim HJ1.

• 1Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan;
• 2School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan;
• 3Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan.

HIV among Indigenous Peoples: A Review of the Literature on HIV-Related Behaviour Since the Beginning of the Epidemic

Below: Number of articles published by year and focus country

Below: Determinants of HIV Risk Behavior among Indigenous Peoples (adapted from Meade and Sikkema [26]) Solid lines represent determinants that impact HIV behavior. Note: Dashed lines represent hypothesized relationships between determinants

From the early days of the HIV epidemic, Indigenous peoples were identified as a population group that experiences social and economic determinants—including colonialism and racism—that increase exposure to HIV. There are now substantial disparities in HIV rates between Indigenous and non-Indigenous peoples in some countries. We conducted a comprehensive literature review to assess the evidence on HIV-related behaviors and determinants in four countries—Australia, Canada, New Zealand and the United States—in which Indigenous peoples share important features of colonization and marginalization. We identified 107 articles over more than 20 years. The review highlights the determinants of HIV-related behaviors including domestic violence, stigma and discrimination, and injecting drug use. Many of the factors associated with HIV risk also contribute to mistrust of health services, which in turn contributes to poor HIV and health outcomes among Indigenous peoples.

Read more at: http://ht.ly/RL5j1 HT https://twitter.com/Sydney_Uni