Joint effects of alcohol and stimulant use disorders on self-reported sexually transmitted infections in a prospective study of Cambodian female entertainment and sex workers

Female entertainment and sex workers (FESW) have high rates of alcohol and amphetamine-type stimulant (ATS) use, increasing risk for HIV/sexually transmitted infections (STI), and other negative outcomes. A prospective cohort of 1,198 FESW in a HIV/ATS use prevention intervention in Cambodia was assessed for alcohol and stimulant use disorders (AUD and SUD) using the Alcohol and Substance Use Involvement (ASSIST) scale. STI history was measured by self-report at baseline and at quarterly follow-up visits. Participants were asked if they had been diagnosed with an STI by a medical provider in the past 3 months. Marginal structural models were used to estimate joint effects of AUD and SUD on recent STI. At baseline, one-in-four screened AUD positive and 7% screened positive for SUD. At 18-months, 26% reported ≥1 recent STI. Accounting for time-varying and other known confounders, the adjusted odds ratio (AOR) for recent STI associated with AUD alone and SUD alone were 2.8 (95% CI:1.5–5.1) and 3.5 (95% CI:1.1–11.3), respectively. The AOR for joint effects of AUD and SUD was 5.7 (95% CI:2.2–15.2). AUD and SUD are independently and jointly associated with greater odds of STI among Cambodian FESW. Further research is critical for understanding how AUD and SUD potentiate biological and behavioural pathways that influence STI acquisition and to inform HIV risk-reduction interventions in FESW.

HIV Vulnerabilities and Risk Perception of Justice-Involved Women

Women with histories of justice involvement are not only more likely to enter prison with a diagnosis of HIV infection, but also are up to 15 times more likely to be HIV positive than women in the general U.S. population. Given the growing prevalence of both women affected by HIV and women in the criminal justice system, an urgent need exists for prevention interventions tailored for justice-involved women. This formative qualitative study uses semi-structured interviews to examine formerly incarcerated women’s perspectives on their HIV risks and behaviors. Findings inform future HIV-risk reduction interventions for justice-involved women.

Condomless Anal Intercourse by Partner Type Among Chinese Men Who Have Sex With Men in Tianjin

HIV prevalence and incidence is high among men who have sex with men (MSM) in China, underscoring the need to support and optimize HIV risk reduction strategies for this population. We sought to estimate the prevalence of condomless anal sex among MSM living in Tianjin, China. We recruited 595 HIV-negative MSM living in Tianjin to participate in a HIV study between 2013 and 2014. Data were collected after a voluntary counseling and testing session through a face-to-face survey. We used multivariable logistic regressions to examine the association between sociodemographic characteristics and HIV risk correlates and MSM's likelihood of engaging in condomless anal intercourse with main and casual partners in the prior 6 months. Results are presented. HIV risk reduction efforts should be developed to be sensitive and responsive to the unique experiences of Chinese MSM. We discuss opportunities for future work, including the development HIV risk reduction interventions.

The Role of Psychiatric Disorders in HIV Transmission and Prevention

Adults with severe mental illness (SMI) have been disproportionately affected by the HIV/AIDS epidemic, with prevalence estimates ranging from 1% to 8% in the United States and up to 27% internationally. Compared to the general population, adults with SMI tend to engage in higher rates of sexual and drug use behaviors associated with HIV transmission. In addition, psychiatric illness can develop secondary to HIV infection and contribute to further transmission on HIV to others. HIV risk behavior is driven by several direct and indirect factors, including psychiatric symptoms, substance use, traumatic experience, socioeconomic status, and HIV infection itself. This chapter addresses the complex multidimensional relationship between psychiatric disorders and transmission of HIV as well as its prevention. This chapter also presents several HIV risk reduction interventions designed for vulnerable men and women in outpatient mental health clinics and the community.

A Contextualized Approach to Faith-Based HIV Risk Reduction for African American Women

HIV/AIDS has a devastating impact on African Americans, particularly women and young adults. We sought to characterize risks, barriers, and content and delivery needs for a faith-based intervention to reduce HIV risk among African American women ages 18 to 25. In a convergent parallel mixed methods study, we conducted four focus groups ( n = 38) and surveyed 71 young adult women. Data were collected across four African American churches for a total of 109 participants. We found the majority of women in this sample were engaged in behaviors that put them at risk for contracting HIV, struggled with religiously based barriers and matters of sexuality, and had a desire to incorporate their intimate relationships, parenting, and financial burdens into faith-based HIV risk-reduction interventions. Incorporating additional social context–related factors into HIV risk-reduction interventions for young African American women is critical to adapting and developing HIV interventions to reduce risk among young adult women in faith settings.