Community engagement in the provision of culturally competent
            HIV
            and
            STI
            prevention services: lessons from the French experience in the era of Pr
            EP

Abstract BackgroundTrans-women sex workers bear the greatest brunt of HIV and other sexually transmitted infections (STI). Trans-women are 49 times more at risk of HIV infections compared to the general population. However, they remain underserved and continue to grapple with access to and utilisation of HIV/STI prevention services. This study explored barriers to access and utilisation of HIV/STI prevention services and associated coping mechanisms. MethodsThis exploratory qualitative study was conducted among trans-women sex workers in the Greater Kampala Metropolitan area, Uganda. A total of 22 in-depth interviews, 6 key informant interviews and 9 focus group discussions were conducted to obtain data on barriers to access and utilisation of HIV and other STI prevention and care services, and coping strategies of trans-women sex workers. Data were analysed through thematic analysis using a hybrid of inductive and deductive approaches.ResultsIndividual level barriers to access and utilisation of HIV/STI prevention and care services included internalised stigma and low socio-economic status. Health system barriers included social exclusion and lack of recognition by other key population groups; stigmatisation by some healthcare providers; breach of confidentiality by some healthcare providers; limited hours of operation of some key population-friendly healthcare facilities; discrimination by straight patients and healthcare providers; stockout of STI drugs; inadequate access to well-equipped treatment centres and high cost of drugs. At community level, transphobia hindered access and utilisation of HIV/STI prevention and care services. The coping strategies included use of substitutes such as lotions, avocado or yoghurt to cope with a lack of lubricants. Herbs were used as substitutes for STI drugs, while psychoactive substances were used to cope with stigma and discrimination, and changing the dress code to hide their preferred gender identity. Conclusions Individual, community and health system level barriers hindered access and utilisation of HIV/STI prevention and care services among the trans-women sex workers. There is a need to create an enabling environment in order to enhance access to and utilisation of HIV/STI prevention and care services for trans-women sex workers through sensitisation of healthcare providers, other key population groups and the community at large on the transgender identity.

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Community engagement with African American clergy: faith-based model for culturally competent practice

Aging & Mental Health ◽

10.1080/13607863.2017.1364343 ◽

2017 ◽

Vol 22 (11) ◽

pp. 1510-1515 ◽

Cited By ~ 4

Author(s):

Kim L. Stansbury ◽

Gillian L. Marshall ◽

Jodi Hall ◽

Gaynell M. Simpson ◽

Karen Bullock

Keyword(s):

African American ◽

Community Engagement ◽

Culturally Competent ◽

Faith Based ◽

African American Clergy ◽

Culturally Competent Practice ◽

American Clergy

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Using the PEN‐3 model to plan culturally competent domestic violence intervention and prevention services in Chinese American and immigrant communities

Health Education ◽

10.1108/09654280910936585 ◽

2009 ◽

Vol 109 (2) ◽

pp. 125-139 ◽

Cited By ~ 11

Author(s):

Alice G. Yick ◽

Jody Oomen‐Early

Keyword(s):

Domestic Violence ◽

Chinese American ◽

Immigrant Communities ◽

Culturally Competent ◽

Prevention Services ◽

Violence Intervention ◽

Domestic Violence Intervention

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896. Examining the Impact of the COVID-19 Pandemic on Delivery of HIV Care and Prevention Services Among Patients in a Ryan White Clinic

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1091 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S539-S539

Author(s):

Michelle Zhang ◽

Sharlay Butler ◽

Jason Kennedy ◽

Molly McKune ◽

Ghady Haidar ◽

...

Keyword(s):

Viral Load ◽

Viral Suppression ◽

Retention In Care ◽

Hiv Treatment ◽

Hiv Care ◽

Viral Load Suppression ◽

Sti Prevention ◽

Prevention Services ◽

The Impact ◽

Non Parametric

Abstract Background We sought to characterize the impact of the COVID-19 pandemic on HIV-related outcomes in a cohort of patients by examining rates of viral load (VL) suppression, retention-in-care, PrEP access, and STIs. Methods This was a single center, retrospective study of adults receiving HIV treatment or HIV/STI prevention services from 01/2019 - 12/2020. HIV outpatient visits were identified through HRSA’s CareWARE. Visits (in-person, telehealth) only included HIV primary care. HRSA core performance measures were utilized (Table 1). STI positivity rates and descriptive characteristics were calculated. New and refill PrEP prescriptions were tabulated. Chi-square tests compared unmatched non-parametric variables; McNemar’s test matched non-parametric variables. Multivariable logistic regression identified variables associated with retention in care and viral suppression. Results 1721 patients received care; 1234 were seen in both years, 334 only in 2019, 153 only in 2020. The number of telehealth visits increased significantly: video (0% to 31%, < 0.001), phone (0% to 0.4%, p < 0.001). Though the proportion of kept appointments increased (57.2% vs 61.2%), the annual retention in care rate decreased from 74.5% to 70.9% (p = 0.002). Overall, 9.7% of patients had detectable VLs at any point. Compared to 2019, a lower proportion of patients maintained VL suppression in 2020, (91.6% vs 83.5% p = 0.075). More patients did not have a VL drawn in 2020 than in 2019 (10.3% vs 2.0 %, p < 0.001). Patients with detectable VLs in 2019 were more likely than those who were undetectable to have detectable VLs in 2020 (OR 18.2, 95% CI 9.91-33.42). Black race was associated with higher likelihood of lack of VL suppression (OR = 2.0; 95% CI 1.10-3.66). There were no significant differences between gender or age groups in rates of viral suppression, number screened for bacterial STIs or positive results. Visits for new and refill PrEP prescriptions decreased by 59% and 7%, respectively. Conclusion Rates of viral load suppression and retention in care decreased in 2020 compared to 2019. The proportion of clinic visits attended increased after the integration of telemedicine in 2020. These data may be used to inform evidence-based interventions to improve the HIV continuum of care through telehealth. Disclosures Ghady Haidar, MD, Karuys (Grant/Research Support)

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“It’s worse with fellow patients… they judge you as evil”: Barriers to access and utilisation of HIV/STIs prevention and care services among trans-women sex workers in the greater Kampala metropolitan area, Uganda.

10.21203/rs.3.rs-40093/v1 ◽

2020 ◽

Author(s):

Tonny Ssekamatte ◽

John Bosco Isunju ◽

Naomi Muyanga ◽

Esther Buregyeya ◽

Richard K Mugambe ◽

...

Keyword(s):

Health System ◽

Metropolitan Area ◽

Sex Workers ◽

Healthcare Providers ◽

Sti Prevention ◽

Prevention Services ◽

Care Services ◽

Barriers To Access ◽

Key Population ◽

Trans Women

Abstract Background Trans-women sex workers bear the greatest brunt of HIV and other sexually transmitted infections (STI). Trans-women are 49 times more at risk of HIV infections compared to the general population. However, they remain underserved and continue to grapple with challenges in access to and utilisation of HIV/STI prevention services. Our study explored the barriers to access and utilisation of HIV/STI prevention services and associated coping mechanisms. Methodology This exploratory qualitative study was conducted among trans-women sex workers in the Greater Kampala Metropolitan area, Uganda. Twenty-two in-depth interviews, six key informant interviews and nine focus group discussions were conducted to obtain data on barriers to access and utilisation of HIV and other STI prevention and care services, and coping strategies of trans-women sex workers. Data were analysed through thematic analysis under a hybrid of inductive and deductive approaches. Results Barriers to access and utilisation of HIV/STI prevention and care services were classified as individual, community and health system barriers. Individual barriers included internalised stigma and low socio-economic status. Health system barriers included discrimination by some healthcare providers, stigmatisation by fellow patients, stockout of lubricants drugs and other medical supplies, inadequate access to trans-specific STI drugs, and high cost of drugs. Community barriers comprised social exclusion and lack of recognition by other key population groups, and transphobia. The coping strategies included the use of substitutes such as lotions, avocado, egg white or yoghurt to cope with a lack of lubricants. Herbs were used as substitutes for STI drugs, while psychoactive substances were used to cope with stigma and discrimination, and changing the dress code to mimic gender identity. Conclusion Trans-women sex workers grapple with access to HIV/STI prevention and care services. Individual, community and healthcare facility level barriers hindered trans-women sex workers from access and utilisation of HIV/STI prevention and care services. There is a need to create an enabling environment in order to enhance access to and utilisation of HIV/STI prevention and care services for trans-women sex workers through sensitisation of healthcare providers, other key population groups and the community on the transgender identity.

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Barriers to access and utilisation of HIV/STIs prevention and care services among trans-women sex workers in the greater Kampala metropolitan area, Uganda

BMC Infectious Diseases ◽

10.1186/s12879-020-05649-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Tonny Ssekamatte ◽

John Bosco Isunju ◽

Muyanga Naume ◽

Esther Buregyeya ◽

Richard K. Mugambe ◽

...

Keyword(s):

Healthcare System ◽

Metropolitan Area ◽

Sex Workers ◽

Healthcare Providers ◽

Sti Prevention ◽

Prevention Services ◽

Care Services ◽

Barriers To Access ◽

Key Population ◽

Trans Women

Abstract Background Trans-women sex workers bear the greatest brunt of HIV and other sexually transmitted infections (STI). Trans-women are 49 times more at risk of HIV infections compared to the general population. However, they remain underserved and continue to grapple with access to and utilisation of HIV/STI prevention services. This study explored barriers to access and utilisation of HIV/STI prevention services and associated coping mechanisms. Methods This exploratory qualitative study was conducted among trans-women sex workers in the Greater Kampala Metropolitan area, Uganda. A total of 22 in-depth interviews, 6 key informant interviews and 9 focus group discussions were conducted to obtain data on barriers to access and utilisation of HIV and other STI prevention and care services, and coping strategies of trans-women sex workers. Data were analysed through thematic analysis using a hybrid of inductive and deductive approaches. Results Individual level barriers to access and utilisation of HIV/STI prevention and care services included internalised stigma and low socio-economic status. Healthcare system barriers included social exclusion and lack of recognition by other key population groups; stigmatisation by some healthcare providers; breach of confidentiality by some healthcare providers; limited hours of operation of some key population-friendly healthcare facilities; discrimination by straight patients and healthcare providers; stockout of STI drugs; inadequate access to well-equipped treatment centres and high cost of drugs. At community level, transphobia hindered access and utilisation of HIV/STI prevention and care services. The coping strategies included use of substitutes such as lotions, avocado or yoghurt to cope with a lack of lubricants. Herbs were used as substitutes for STI drugs, while psychoactive substances were used to cope with stigma and discrimination, and changing the dress code to hide their preferred gender identity. Conclusions Individual, community and healthcare system barriers hindered access and utilisation of HIV/STI prevention and care services among the trans-women sex workers. There is a need to create an enabling environment in order to enhance access to and utilisation of HIV/STI prevention and care services for trans-women sex workers through sensitisation of healthcare providers, other key population groups and the community at large on the transgender identity.

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S21.4 Spurring innovation in improving community engagement for STI prevention

10.1136/sextrans-2019-sti.96 ◽

2019 ◽

Author(s):

Weiming Tang

Keyword(s):

Community Engagement ◽

Sti Prevention

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STI Prevention Services Online: Moving Beyond the Proof of Concept

Sexually Transmitted Diseases ◽

10.1097/olq.0b013e318180280d ◽

2008 ◽

Vol 35 (8) ◽

pp. 770-771 ◽

Cited By ~ 6

Author(s):

Cornelis A. Rietmeijer ◽

Mary McFarlane

Keyword(s):

Proof Of Concept ◽

Sti Prevention ◽

Prevention Services

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Safe Return: Working Toward Preventing Domestic Violence When Men Return from Prison

Federal Sentencing Reporter ◽

10.1525/fsr.2011.24.1.57 ◽

2011 ◽

Vol 24 (1) ◽

pp. 57-61 ◽

Cited By ~ 2

Author(s):

Mike Bobbitt ◽

Robin Campbell ◽

Gloria L. Tate

Keyword(s):

Domestic Violence ◽

Intimate Partner Violence ◽

Partner Violence ◽

Intimate Partner ◽

Culturally Competent ◽

Family Strengths ◽

Prevention Services ◽

Safety Risks ◽

Before And After ◽

Domestic Violence Perpetrators

This article is excerpted from Mike Bobbitt, Robin Campbell, and Gloria L. Tate's longer report of the same name published by the Vera Institute of Justice in 2006. Only a very few state and federal institutions offer services that address domestic violence among inmates during incarceration, and a smaller number provide prevention services to those reentering or their families that could reduce the risk of intimate partner violence upon release. Furthermore, only a small portion of domestic violence perpetrators may be identified as needing related in-prison programming. In 2005, the Safe Return Initiative designed a series of roundtable discussions to highlight these important issues and develop appropriate responses. The resulting report stressed that attention must be paid to conducting interventions in a culturally competent manner both before and after release and building on existing family strengths while also offering support to protect families from safety risks.

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