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HIV Prevalence and Risk Factors in Populations Experiencing Marginalization

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (30 June 2022) | Viewed by 31079

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Dr. Erin C. Wilson

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Guest Editor

Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA 94102, USA
Interests: transgender populations; HIV; stigma; discrimination; social epidemiology; mHealth; low- and middle-income country (LMIC) research
Special Issues, Collections and Topics in MDPI journals

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Dear Colleagues,

HIV continues to disproportionately impact populations facing marginalization in society. As the U.S. and other countries move steadily toward zero new infections, the epidemiology of HIV reveals that those who remain at high risk of HIV are those who face additional epidemics related to stigma and discrimination. Structures enforced through racism, xenophobia, sexism and transphobia, among others, result in violence and discrimination. In turn, violence and discrimination result in less access to economic and health resources, social isolation, mental distress, substance use, and increased risk of HIV. Meanwhile, the HIV prevention and treatment pendulum has swung to biomedical approaches. Without addressing the underlying inequity that is at the core of prevention and treatment engagement, efforts to meet global goals for no new infections will be stalled. An overdue and essential next step in HIV research is to examine and intervene upon upstream causes of HIV risk for populations who are marginalized in society. This Special Issue of the International Journal of Environmental Research and Public Health (IJERPH) focuses on the current state of knowledge on the links between marginalization and HIV. New research papers tackling a rigorous examination of this link, using new measures and methods to do so, are welcome to this Issue. Papers examining multi-level interventions that address stigma and discrimination are also welcome. Intervention and social epidemiological papers are requested from low- and middle-income countries as well as high-income countries. Other manuscript types accepted include methodological papers and commentaries specifying new policy directions for HIV research with populations facing marginalization.

Dr. Erin C. Wilson
Guest Editor

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Keywords

stigma
marginalization
HIV
sexual and gender minority
immigrant
young people
people who use substances
poverty
racial minority
ethnic minority

Related Special Issue

2nd Edition of HIV Prevalence and Risk Factors in Populations Experiencing Marginalization in International Journal of Environmental Research and Public Health (2 articles)

Published Papers (10 papers)

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Research

Jump to: Review

10 pages, 345 KiB

Open AccessArticle

Adverse Childhood Experiences among a Sample of Youth Living with HIV in the Deep South

by Tiffany Chenneville, Hunter Drake, Alexandra Cario and Carina Rodriguez

Int. J. Environ. Res. Public Health 2022, 19(15), 9740; https://doi.org/10.3390/ijerph19159740 - 8 Aug 2022

Viewed by 1767

Abstract

The southern region of the United States, often referred to as the Deep South, is disproportionately affected by HIV. In fact, the highest rates of new HIV infections occur in the Deep South. Approximately one in five new HIV infections are among youth. Youth living with HIV (YLWH) have several behavioral health risks, including co-occurring mental health and substance abuse disorders, which negatively affect medication adherence, contribute to less engagement in HIV care, and result in poor health outcomes. Research suggests that adverse childhood experiences (ACEs) contribute to HIV risk behaviors and that people living with HIV may be more vulnerable to the negative health outcomes and adverse effects of stressors. Using existing program evaluation data, we examined data from 41 YLWH aged 17–24 screened for ACEs in an integrated care setting. Most participants were Black/African American young men who identified as homosexual, bisexual, or questioning, and who acquired HIV behaviorally. Approximately, one-third of YLWH screened positive or in the high-risk range on an ACEs screener. Scores fell in the intermediate range for nearly half of the sample. Results did not reveal a significant relationship between ACEs and HIV biological indicators. In this paper, we describe these findings and the importance of incorporating trauma-informed approaches into HIV prevention and treatment programs targeting youth in the Deep South. Full article

(This article belongs to the Special Issue HIV Prevalence and Risk Factors in Populations Experiencing Marginalization)

15 pages, 384 KiB

Open AccessArticle

“Family before Anyone Else”: A Qualitative Study on Family, Marginalization, and HIV among Hispanic or Latino/a/x Mexican Sexual Minority Males

by Moctezuma García, S. Raquel Ramos, Lisa Aponte-Soto, Tiarney D. Ritchwood and Laurie A. Drabble

Int. J. Environ. Res. Public Health 2022, 19(15), 8899; https://doi.org/10.3390/ijerph19158899 - 22 Jul 2022

Cited by 7 | Viewed by 2223

Abstract

This study explored the influence family relationships have on HIV-related factors among Hispanic or Latino/a/x Mexican sexual minority cisgender males in San Antonio, TX, US. A total of 15 young adults (7 people living with HIV; PLWH) ages 21–30 completed a semi-structured interview. Data were transcribed verbatim and analyzed using thematic analysis. The following themes emerged: (1) family support; (2) mother-son relationships; (3) father-son relationships; (4) sibling support; (5) family marginalization of sexual minorities; and (6) internalized homophobia. People who reported being HIV negative were more likely to have a prominent mother-son relationship, strong sense of family, supportive siblings, and family acceptance as a sexual minority. PLWH were more likely to report a weak sense of family, being raised in a maternal-led household, and less likely to have a relationship with their father and siblings. Marginalization among participants regardless of HIV status included exposure to religious rhetoric stigmatizing sexual minorities and fathers’ reinforcing Mexican traditional gender norms. In addition to encountering homophobia, PLWH were further marginalized by family members due to their HIV status. The findings suggest a need for greater attention to examining the impact of familial support of Hispanic or Latino/a/x Mexican sexual minority cisgender males as young adults with or at risk of HIV. Full article

(This article belongs to the Special Issue HIV Prevalence and Risk Factors in Populations Experiencing Marginalization)

13 pages, 308 KiB

Open AccessArticle

“My Friends Would Believe My Word”: Appropriateness and Acceptability of Respondent-Driven Sampling in Recruiting Young Tertiary Student Men Who Have Sex with Men for HIV/STI Research in Nairobi, Kenya

by Samuel Waweru Mwaniki, Peter Mwenda Kaberia, Peter Mwangi Mugo and Thesla Palanee-Phillips

Int. J. Environ. Res. Public Health 2022, 19(12), 7331; https://doi.org/10.3390/ijerph19127331 - 15 Jun 2022

Cited by 5 | Viewed by 1856

Abstract

(1) Background: We conducted formative research to assess the appropriateness and acceptability of respondent-driven sampling (RDS) in recruiting tertiary student men who have sex with men (TSMSM) into a prospective human immunodeficiency virus/sexually transmitted infection (HIV/STI) biobehavioral survey in Nairobi, Kenya. (2) Methods: Between September and October 2020, semi-structured qualitative interviews were held with service providers from organizations that serve MSM (n = 3), and TSMSM (n = 13). Interviews were conducted in English, audio-recorded and transcribed, then thematically analyzed using NVivo version 11. (3) Results: Service providers reflected that RDS was appropriate due to the large though concealed networks of TSMSM. TSMSM perceived RDS to be acceptable based on their large social network sizes and the trust that existed amongst themselves. TSMSM were concerned about participating due to the risk of being outed as MSM and hence emphasized that researchers needed to assure them of their confidentiality and include MSM as part of the study team to encourage participation. (4) Conclusions: RDS was perceived as both an appropriate and acceptable sampling method. Use of RDS should be considered as a strategy for recruiting young, marginalized populations for HIV/STI research. Full article

(This article belongs to the Special Issue HIV Prevalence and Risk Factors in Populations Experiencing Marginalization)

12 pages, 542 KiB

Open AccessArticle

Trends in the Epidemiology and Outcomes of Pneumocystis Pneumonia among Human Immunodeficiency Virus (HIV) Hospitalizations

by Kalaimani Elango, Mayuri Mudgal, Swetha Murthi, Prashanth Reddy Yella, Savan Nagrecha, Vedhapriya Srinivasan, Vijaykumar Sekar, Maria Koshy, Sathishkumar Ramalingam and Kulothungan Gunasekaran

Int. J. Environ. Res. Public Health 2022, 19(5), 2768; https://doi.org/10.3390/ijerph19052768 - 27 Feb 2022

Cited by 9 | Viewed by 2247

Abstract

Introduction: Pneumocystis Pneumonia (PCP) is a common opportunistic infection among people living with the human immunodeficiency virus (HIV). This study’s objective was to assess temporal trends in PCP epidemiology among hospitalized patients with HIV/AIDS in the US and to compare data for hospitalizations with HIV with PCP to those without PCP. Methods: The national inpatient sample (NIS) data were analyzed from 2002–2014. The discharge coding identified hospitalized patients with HIV or AIDS and with or without PCP. Results: We identified 3,011,725 hospitalizations with HIV/AIDS during the study period; PCP was present in 5% of the patients with a diagnosis of HIV. The rates of PCP progressively declined from 6.7% in 2002 to 3.5 % in 2014 (p < 0.001). Overall mortality in patients with HIV was 3.3% and was significantly higher in those with PCP than without PCP (9.9% vs. 2.9%; p < 0.001). After adjusting for demographics and other comorbidities, PCP had higher odds of hospital mortality 3.082 (OR 3.082; 95% CI, 3.007 to 3.159; p < 0.001). Conclusion: From 2002 to 2014, the rate of PCP in HIV patients has decreased significantly in the United States but is associated with substantially higher mortality. Full article

(This article belongs to the Special Issue HIV Prevalence and Risk Factors in Populations Experiencing Marginalization)

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11 pages, 364 KiB

Open AccessArticle

High Rates of Sexualized Drug Use or Chemsex among Brazilian Transgender Women and Young Sexual and Gender Minorities

by Emilia M. Jalil, Thiago S. Torres, Claudia C. de A. Pereira, Alessandro Farias, Jose D. U. Brito, Marcus Lacerda, Daila A. R. da Silva, Nickols Wallys, Gabriela Ribeiro, Joyce Gomes, Thiffany Odara, Ludymilla Santiago, Sophie Nouveau, Marcos Benedetti, Cristina Pimenta, Brenda Hoagland, Beatriz Grinsztejn and Valdilea G. Veloso

Int. J. Environ. Res. Public Health 2022, 19(3), 1704; https://doi.org/10.3390/ijerph19031704 - 2 Feb 2022

Cited by 18 | Viewed by 2987

Abstract

(1) Background: We aimed to estimate sexualized drug use (SDU) prevalence and its predictors among sexual and gender minorities. (2) Methods: We used an online and on-site survey to enroll sexual/gender minorities people between October–December/2020, and multivariate logistic regression to obtain SDU correlates. (3) Results: We enrolled 3924 individuals (280 transgender women [TGW], 3553 men who have sex with men [MSM], and 91 non-binary), 29.0% currently on pre-exposure prophylaxis (PrEP). SDU prevalence was 28.8% (95% confidence interval [CI] 27.4–30.2). TGW had 2.44-times increased odds (95%CI 1.75–3.39) of engaging in SDU compared to MSM, regardless of PrEP use. PrEP use (aOR 1.19, 95%CI 1.00–1.41), South/Southeast region (aOR 1.26, 95%CI 1.04–1.53), younger age (18–24 years: aOR 1.41, 95%CI 1.10–1.81; 25–35 years: aOR 1.24, 95%CI 1.04–1.53), white race/color (aOR 1.21, 95%CI 1.02–1.42), high income (aOR 1.32, 95%CI 1.05–1.67), binge drinking (aOR 2.66, 95%CI 2.25–3.14), >5 sexual partners (aOR 1.88, 95%CI 1.61–2.21), condomless anal sex (aOR 1.49, 95%CI 1.25–1.79), self-reported sexually transmitted infection (aOR 1.40, 95%CI 1.14–1.71), and higher perceived HIV-risk (aOR 1.37, 95%CI 1.14–1.64) were associated with SDU. (4) Conclusions: TGW had the highest SDU odds. SDU may impact HIV vulnerability among key populations and should be addressed in HIV prevention approaches. Full article

(This article belongs to the Special Issue HIV Prevalence and Risk Factors in Populations Experiencing Marginalization)

14 pages, 385 KiB

Open AccessArticle

Prevalence of Intimate Partner Violence, Substance Use Disorders and Depression among Incarcerated Women in Lima, Perú

by Elena Cyrus, Jorge Sanchez, Purnima Madhivanan, Javier R. Lama, Andrea Cornejo Bazo, Javier Valencia, Segundo R. Leon, Manuel Villaran, Panagiotis Vagenas, Michael Sciaudone, David Vu, Makella S. Coudray and Frederick L. Atice

Int. J. Environ. Res. Public Health 2021, 18(21), 11134; https://doi.org/10.3390/ijerph182111134 - 23 Oct 2021

Cited by 3 | Viewed by 3050

Abstract

Background: Globally, there is evidence supporting the co-occurrence of intimate partner violence (IPV), substance use disorders (SUD) and mental health disorders among women in prisons, however, there is limited research investigating these domains in the Andean region where rates of female incarceration have increased. The study objective was to explore the prevalence of IPV, SUD and depression among incarcerated women in a Peruvian prison and explore associations among these variables and related correlates. Methods: 249 incarcerated women responded to a questionnaire about IPV, substance use, depression, and sexual behavior, and were screened for HIV/sexually transmitted diseases (STDs). Univariate analysis and logistic regression were used to estimate relative risk and the influence of substance use and depression on IPV rates. Results: Twelve months prior to incarceration, of the women with sexual partners pre-incarceration (n = 212), 69.3% experienced threats of violence, 61.4% experienced ≥1 acts of physical violence, and 28.3% reported ≥1 act of sexual aggression. Pre-incarceration, 68.1% of drug-using women had a SUD, and 61.7% of those who consumed alcohol reported hazardous/harmful drinking. There were 20 (8.0%) HIV/STD cases; and 67.5% of the women reported depressive symptoms. Compared to women with no experiences of physical violence, a greater proportion of women who experienced least l violent act had depressive symptoms and engaged in sex work pre-incarceration. Depression was associated with physical violence (adjusted relative risk = 1.35, 95% confidence interval: 1.14–1.58). Recommendations: The findings provide evidence of a syndemic of IPV, substance abuse and depression among incarcerated women in a Peruvian prison. To help guide policy makers, further research is needed to determine if this is indicative of trends for other at-risk women in the region, and viable options to treat these women during incarceration to prevent recidivism and other long-term negative sequalae. Full article

(This article belongs to the Special Issue HIV Prevalence and Risk Factors in Populations Experiencing Marginalization)

17 pages, 998 KiB

Open AccessArticle

Stigma Mechanisms and Outcomes among Sub-Saharan African Descendants in Belgium—Contextualizing the HIV Stigma Framework

by Lazare Manirankunda, Aletha Wallace, Charles Ddungu and Christiana Nöstlinger

Int. J. Environ. Res. Public Health 2021, 18(16), 8635; https://doi.org/10.3390/ijerph18168635 - 16 Aug 2021

Cited by 7 | Viewed by 2379

Abstract

HIV-related stigma and discrimination are recognized barriers to HIV prevention, testing and treatment among people of Sub-Saharan African descent (SSA) origin living in Belgium, but insights into HIV related-stigma mechanisms and outcomes are lacking for this population with high HIV prevalence. Guided by Earnshaw and Chaudoir’s stigma framework (2009), we conducted this qualitative study using 10 focus-groups with 76 SSA community members and 20 in-depth interviews with SSA descendants living with HIV to explore specific HIV-stigma mechanisms and outcomes and underlying drivers. Inductive and deductive thematic analysis showed high degrees of stigma among SSA communities driven by fear of HIV acquisition and misconceptions in a migration context, negatively affecting SSA descendants living with HIV. The results allowed for contextualization of the framework: At the community level, prejudices and stereotypes were major stigma mechanisms, while physical distancing, gossips, sexual rejection, violence and increased HIV prevalence emerged as stigma outcomes. Among SSA descendants living with HIV, enacted, anticipated and internalized stigmas were validated as stigma mechanisms, with witnessed stigma as an additional mechanism. Self-isolation, community avoidance and low utilization of non-HIV specialized healthcare were additional outcomes. These results are relevant for tailoring interventions to reduce HIV-related stigma. Full article

(This article belongs to the Special Issue HIV Prevalence and Risk Factors in Populations Experiencing Marginalization)

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12 pages, 294 KiB

Open AccessArticle

Structural, Personal and Socioenvironmental Determinants of HIV Transmission among Transgender Women in Indonesia

by Nelsensius Klau Fauk, Maria Silvia Merry, Theodorus Asa Siri, Lillian Mwanri and Paul Russell Ward

Int. J. Environ. Res. Public Health 2021, 18(11), 5814; https://doi.org/10.3390/ijerph18115814 - 28 May 2021

Cited by 6 | Viewed by 3687

Abstract

Transgender populations are considered as a highly vulnerable group to HIV infection. This study aimed to understand structural, personal and socioenvironmental factors and the mechanisms through which these factors facilitate HIV transmission among transgender women (waria) in Yogyakarta, Indonesia. A qualitative inquiry using one-on-one in-depth interviews was employed to collect data from participants (n = 29). Thematic analysis was used to guide data analysis. Findings showed that poverty in families, a sense of responsibility to support family necessities, limited employment options and low education attainment were the structural factors driving participants’ engagement in sex work practices and unprotected anal intercourse, which facilitated HIV transmission among them. Personal need fulfilment and the desire for savings were personal factors driving their engagement in these high-risk practices that supported HIV transmission. Social relationships, social influence and the participants’ living environment were socioenvironmental factors that also supported sex work practices and HIV transmission among the participants. The findings indicate the need for capacity building in terms of knowledge and skills for waria populations to prepare and enable them to gain meaningful employment to prevent the vicious cycle of HIV transmission among them. As structural factors seemed to be the main drivers predisposing waria to HIV acquisition, further studies to explore effective HIV/AIDS interventions that address economic aspects of waria in Yogyakarta and other similar settings in Indonesia are recommended. Full article

(This article belongs to the Special Issue HIV Prevalence and Risk Factors in Populations Experiencing Marginalization)

17 pages, 565 KiB

Open AccessArticle

Stigma and Discrimination towards People Living with HIV in the Context of Families, Communities, and Healthcare Settings: A Qualitative Study in Indonesia

by Nelsensius Klau Fauk, Karen Hawke, Lillian Mwanri and Paul Russell Ward

Int. J. Environ. Res. Public Health 2021, 18(10), 5424; https://doi.org/10.3390/ijerph18105424 - 19 May 2021

Cited by 45 | Viewed by 7083

Abstract

HIV stigma and discrimination are a major challenge facing people living with HIV (PLHIV) globally. As part of a larger qualitative study with PLHIV in Yogyakarta and Belu, Indonesia, this paper describes the participants’ perceptions about drivers of HIV stigma and discrimination towards them within families, communities and healthcare settings, and highlights issues of HIV stigma as a social process. Participants were recruited using a snowball sampling technique. Data analysis was guided by the framework analysis for qualitative data, and conceptualization and discussion of the study findings were guided by the HIV stigma framework. The findings showed that participants experienced stigma and discrimination across settings, including in families and communities by family and community members, and in healthcare settings by healthcare professionals. The lack of knowledge about HIV, fear of contracting HIV, social and moral perceptions about HIV and PLHIV were perceived facilitators or drivers of stigma and discrimination towards PLHIV. HIV stigma and discrimination were also identified as a process linked to the whole groups of people within families or communities, which occurred within social context in Yogyakarta and Belu. The findings indicate the need for HIV education for family and community members, and healthcare providers to enhance their knowledge of HIV and improve acceptance of PLHIV within families, communities and healthcare settings. Full article

(This article belongs to the Special Issue HIV Prevalence and Risk Factors in Populations Experiencing Marginalization)

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Review

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13 pages, 771 KiB

Open AccessReview

Self-Testing as a Hope to Reduce HIV in Transgender Women—Literature Review

by Julia Budzyńska, Rafał Patryn, Ilona Kozioł, Magdalena Leśniewska, Agnieszka Kopystecka and Tomasz Skubel

Int. J. Environ. Res. Public Health 2022, 19(15), 9331; https://doi.org/10.3390/ijerph19159331 - 30 Jul 2022

Cited by 2 | Viewed by 2450

Abstract

So far, the rate of HIV-positive people who do not know their sero-status is about 14% and the percentage is higher among transgender women (TGW). They represent one of the most vulnerable groups to infection. HIV self-testing (HIVST) may be a way to reduce transmission of the virus. The aim of this analysis and in-depth review was to collect available data on factors that may influence the use and dissemination of HIVST among TGW. This review was conducted in accordance with PRISMA guidelines for systematic reviews and meta-analyses. All data from 48 papers were used. From the available literature, HIVST is a convenient and preferred method of testing due to its high confidentiality and possibility of being performed at home. However, there are barriers that limit its use, including marginalization of transgender people, stigma by medical personnel, lack of acceptance of sexual partners, and even cultural standards. Therefore, there is a need for activities that promote and inform on the possibility of using HIVST as well as enable easier access to it. Full article

(This article belongs to the Special Issue HIV Prevalence and Risk Factors in Populations Experiencing Marginalization)

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