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Matthew J Mimiaga - One of the best experts on this subject based on the ideXlab platform.
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global burden of hiv among men who engage in transactional Sex a systematic review and meta analysis
PLOS ONE, 2014Co-Authors: Kenneth H Mayer, Matthew J Mimiaga, Sari L Reisner, Catherine E Oldenburg, Amaya Perezbrumer, Jason Mattie, Till BarnighausenAbstract:Background Men who engage in transactional Sex, the exchange of Sex for Money, goods, or other items of value, are thought to be at increased risk of HIV, but there have been no systematic attempts to characterize HIV burden in this population. We undertook a systematic review and meta-analysis to quantify the burden in this population compared with that of men in the general population to better inform future HIV prevention efforts. Methods We searched seven electronic databases, national surveillance reports, and conference abstracts for studies of men who engage in transactional Sex published between 2004–2013. Random effects meta-analysis was used to determine pooled HIV prevalence and prevalence ratios (PR) for the difference in HIV prevalence among men who engage in transactional Sex as compared to general population men. Findings Of 66 studies included representing 31,924 men who had engaged in transactional Sex in 28 countries, pooled biological assay-confirmed HIV prevalence was 10.5% (95% CI = 9.4 to 11.5%). The highest pooled HIV prevalence was in Sub-Saharan Africa (31.5%, 95% CI = 21.6 to 41.5%), followed by Latin America (19.3%, 95% CI = 15.5 to 23.1%), North America (16.6%, 95% CI = 3.7 to 29.5%), and Europe (12.2%, 95% CI = 6.0 to 17.2%). Men who engaged in transactional Sex had an elevated burden of HIV compared to the general male population (PR = 20.7, 95% CI = 16.8 to 25.5). Conclusions The global burden of HIV is disproportionately high among men who engage in transactional Sex compared with the general male population. There is an urgent need to include this population in systematic surveillance as well as to scale-up access to quality HIV prevention programs.
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engagement with peer health educators is associated with willingness to use pre exposure prophylaxis among male Sex workers in ho chi minh city vietnam
Aids Patient Care and Stds, 2014Co-Authors: Catherine E Oldenburg, Kenneth H Mayer, Elizabeth F Closson, Thi Nguyen, Nguyen N N Trang, Donn J Colby, Katie B Biello, Hang X Lan, Matthew J MimiagaAbstract:Men who have Sex with men (MSM), including male Sex workers (MSW), in Vietnam are at high risk for HIV transmission and acquisition, due to specific psychosocial and contextual factors including stigma and discrimination.1,2 MSW are particularly vulnerable due to the local legal environment, power dynamics (i.e., dependence on Sex for livelihood), and individual-level risk.3 However, despite increasing HIV prevalence,4 few HIV prevention interventions have been specifically developed for this population. Identification of HIV prevention strategies that are tailored to the needs of MSW are urgently needed. The iPrEx trial demonstrated the efficacy of taking daily oral pre-exposure prophylaxis (PrEP) to reduce HIV transmission among MSM.5 To date, little research has specifically considered the acceptability of PrEP among MSW in Vietnam. PrEP may be a particularly useful intervention for MSW as it is a user-controlled intervention. Peer educators (PE) are valuable sources of HIV prevention information for MSW in Vietnam,6 and may have a role to play in the development and administration of PrEP interventions. We assessed factors associated with access to PE and the association between contact with a PE and willingness to take PrEP as a potential strategy for implementation of PrEP interventions. In 2010, a behavioral and psychosocial survey was undertaken with 300 MSW in Ho Chi Minh City (HCMC), Vietnam, which assessed past experience with HIV prevention activities and interest in PrEP. The survey was developed following an initial qualitative phase.6 Detailed methods have been described previously.7 Briefly, participants were recruited by PE from a Vietnamese NGO working with MSM, using venue-based sampling stratified on where participants met clients (i.e., street, brothel). Eligible participants were at least 15 years of age, biologically male, Vietnamese citizens who reported exchanging Sex for Money or goods at least once in the previous month. The survey was anonymous, and participants gave verbal informed consent after receiving information about the study from one of the research staff. Study procedures were approved by the Institutional Review Boards at Beth Israel Deaconess Medical Center and the Ho Chi Minh City Provincial AIDS Committee. The survey contained items pertaining to past participation in HIV prevention programs including if they had received HIV prevention materials (i.e., condoms, personal lubricant, or informational brochures), knowledge of HIV testing and counseling services, HIV/STI testing history, and contact with PE in the previous 12 months. Questions pertaining to willingness to participate in future HIV prevention interventions were adapted from prior studies by our group8 and asked if they would take a daily pill if it would protect against HIV and how likely they were to take the pill if it had side effects. Demographic and behavioral factors were also assessed. Descriptive statistics were calculated for responses regarding past HIV prevention activities and willingness to take PrEP. Logistic regression models were used to analyze the association between demographic and behavioral factors and (1) past contact with a PE; and (2) being at least “somewhat likely” to take a daily pill for HIV prevention if it had side effects. A multivariable model for each outcome was built using backwards elimination starting with all potential covariates, with a p value cutoff of 0.2 to determine the final variables to retain in the model. An alpha level of 0.05 was considered significant. Stata 12.0 (StataCorp, College Station, TX) was used for all analyses. Of 300 participants in the original study, 281 (93.7%) were HIV-uninfected and included in these analyses.9 Table 1 lists the proportion of participants who indicated previous participation in HIV prevention activities and interest in PrEP. More than 2/3 of participants had previous contact with a PE. Most (95.4%) participants indicated that they would take PrEP, although substantially fewer indicated they would take PrEP given side effects (56.7%). Table 1. Proportion of Participants Who Have Participated or Would Participate in HIV Prevention Interventions (N=281) Table 2 displays bivariate and multivariable models assessing factors associated with (1) contact with a PE in the previous year, and (2) being at least “somewhat likely” to take PrEP if it had side effects. MSW who reported previous contact with a PE (AOR 2.28, 95% CI 1.25–4.14) indicated increased willingness to use PrEP. In a multivariable model, older age (AOR 1.09, 95% CI 1.01–1.16) was associated with increased contacts with PE, and identifying as bong lâ (effeminate, AOR 0.29, 95% CI 0.11–0.75), or trai thang (“straight boy”, AOR 0.43, 95% CI 0.23–0.80) versus bong kin (masculine) was associated with decreased contact with PE. Table 2. Bivariate and Multivariable Logistic Regression Models Assessing Factors Associated with Contact with Peer Educator in Last 12 Months and Willingness to Take Pre-Exposure Prophylaxis (PrEP) If It Involved Side Effects Participants who had previous contact with a PE more frequently indicated that they would take PrEP than those who had not. As PrEP becomes available for MSM in Vietnam, PE will likely play a large role in recruiting and educating participants about the efficacy of PrEP, adherence, and safer Sex practices, and counseling related to stigma, side effects, and local resources. Training PE may increase the acceptability of PrEP for Vietnamese MSM, and their role in the expansion of PrEP services in Vietnam should be carefully considered. Given the high penetrance of PE in this population, leveraging this existing infrastructure may improve the feasibility and success of future HIV prevention interventions such as PrEP. Strategies to increase access to PE among key subpopulations are important to improve the scope and quality of programs based on this model. In this study, older men were more likely to have been reached by PE in the past year. This could reflect differences in social networks,10 and they are likely to have had more opportunities to be reached by peers, compared to younger men who have recently “come out.” Younger participants are a particularly vulnerable group, and future work should consider how to engage them in HIV prevention services.11 Participants identifying as bong lộ or trai thang versus bong kin less frequently indicated engagement with PE. While bong lộ are more visible than other MSM identities in Vietnam,12 due to this visibility, they may also be more susceptible to stigma and therefore less likely to be willing to engage in peer education services in public settings. Similarly, trai thang may not want to be seen in public or be less willing to engage in peer education since they identify as “straight”.12 Investments should be made to identify strategies to facilitate engagement with PE by bong lộ or trai thang. This study has several potential limitations. Data collection relied on self-report, which could result in under- or over-reporting of sensitive behaviors. Questionnaires were administered by interviewers, which could result in social desirability bias. Finally, questions regarding side effects related to PrEP did not specify the specific side effects may be, or how severe they could be. More in-depth questions could elucidate which side effects would be barriers to taking PrEP among this population. PE may have the ability to access vulnerable hidden populations that are not reached by mainstream HIV prevention messages, which could maximize uptake of interventions such as PrEP. The results of this study indicate that integrating PE into future PrEP interventions may be an effective way to engage MSW in PrEP. The development of interventions that reach MSW and ensuring they are aware of choices and strategies for HIV prevention will be an important component of a comprehensive HIV prevention strategy in for MSW in Vietnam.
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self perceived hiv risk and the use of risk reduction strategies among men who engage in transactional Sex with other men in ho chi minh city vietnam
Aids Care-psychological and Socio-medical Aspects of Aids\ hiv, 2013Co-Authors: Matthew J Mimiaga, Kenneth H Mayer, Sari L Reisner, Elizabeth F Closson, Nicholas S Perry, Brandon Perkovich, Thi Nguyen, Nguyen N N Trang, Dinh Duc Thien, Donn J ColbyAbstract:An emerging HIV epidemic can be seen among men who have Sex with men (MSM) in Vietnam, with prevalence as high as 18%. Transactional Sex represents a risk factor for HIV transmission/acquisition among MSM globally, particularly in urban contexts, but remains largely underinvestigated in Ho Chi Minh City (HCMC), Vietnam. In 2010, 23 MSM who reported exchanging Sex for Money in the last month completed a brief survey and semistructured qualitative interview at The Life Centre, a non-governmental organization in HCMC, to assess sociodemographics, individual- and structural-level HIV risk factors and explore acceptable future prevention interventions. Participants' mean age was 24 years. Equal proportions of respondents self-identified as heteroSexual/straight, homoSexual/gay, and biSexual. Participants had a mean of 158 male clients in the past year, with a median of 60 male clients in the past year (interquartile range [IQR]=70) and reported inconsistent condom use and inaccurate perceptions of HIV risk. Ne...
Kate Shannon - One of the best experts on this subject based on the ideXlab platform.
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early Sex work initiation independently elevates odds of hiv infection and police arrest among adult Sex workers in a canadian setting
Journal of Acquired Immune Deficiency Syndromes, 2014Co-Authors: Shira M Goldenberg, Jill Chettiar, Annick Simo, Jay G Silverman, Steffanie A Strathdee, Julio S G Montaner, Kate ShannonAbstract:Author(s): Goldenberg, Shira M; Chettiar, Jill; Simo, Annick; Silverman, Jay G; Strathdee, Steffanie A; Montaner, Julio SG; Shannon, Kate | Abstract: ObjectivesTo explore factors associated with early Sex work initiation and model the independent effect of early initiation on HIV infection and prostitution arrests among adult Sex workers (SWs).DesignBaseline data (2010-2011) were drawn from a cohort of SWs who exchanged Sex for Money within the last month and were recruited through time location sampling in Vancouver, Canada. Analyses were restricted to adults ≥18 years old.MethodsSWs completed a questionnaire and HIV/Sexually transmitted infection testing. Using multivariate logistic regression, we identified associations with early Sex work initiation (l18 years old) and constructed confounder models examining the independent effect of early initiation on HIV and prostitution arrests among adult SWs.ResultsOf 508 SWs, 193 (38.0%) reported early Sex work initiation, with 78.53% primarily street-involved SWs and 21.46% off-street SWs. HIV prevalence was 11.22%, which was 19.69% among early initiates. Early initiates were more likely to be Canadian born [adjusted odds ratio (AOR): 6.8, 95% confidence interval (CI): 2.42 to 19.02], inject drugs (AOR: 1.6, 95% CI: 1.0 to 2.5), and to have worked for a manager (AOR: 2.22, 95% CI: 1.3 to 3.6) or been coerced into Sex work (AOR: 2.3, 95% CI: 1.14 to 4.44). Early initiation retained an independent effect on increased risk of HIV infection (AOR: 2.5, 95% CI: 1.3 to 3.2) and prostitution arrests (AOR: 2.0, 95% CI: 1.3 to 3.2).ConclusionsAdolescent Sex work initiation is concentrated among marginalized, drug, and street-involved SWs. Early initiation holds an independent increased effect on HIV infection and criminalization of adult SWs. Findings suggest the need for evidence-based approaches to reduce harm among adult and youth SWs.
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survival Sex work involvement among street involved youth who use drugs in a canadian setting
Journal of Public Health, 2010Co-Authors: Jill Chettiar, Kate Shannon, Thomas Kerr, Ruth Zhang, Evan WoodAbstract:Background Drug users engaged in survival Sex work are at heightened risk for drug- and Sexual-related harms. We examined factors associated with survival Sex work among street-involved youth in Vancouver, Canada. Methods From September 2005 to November 2007, baseline data were collected for the At-Risk Youth Study (ARYS), a prospective cohort of street-recruited youth aged 14–26 who use illicit drugs. Using multiple logistic regression, we compared youth who reported exchanging Sex for Money, drugs etc. with those who did not. Results The sample included 560 youth: median age 22; 179 (32%) female; 63 (11%) reporting recent survival Sex work. Factors associated with survival Sex work in multivariate analyses included non-injection crack use [adjusted odds ratio (AOR) ¼ 3.45, 95% confidence interval (CI): 1.75–6.78], female gender (AOR ¼ 3.02, 95% CI: 1.66–5.46), Aboriginal ethnicity (AOR ¼ 2.35, 95% CI: 1.28–4.29) and crystal methamphetamine use (AOR ¼ 2.02, 95% CI: 1.13–3.62). In subanalyses, the co-use of crack cocaine and methamphetamine was shown to be driving the association between methamphetamine and survival Sex work.
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survival Sex work and increased hiv risk among Sexual minority street involved youth
Journal of Acquired Immune Deficiency Syndromes, 2009Co-Authors: Brandon D L Marshall, Kate Shannon, Thomas Kerr, Ruth Zhang, Evan WoodAbstract:Objectives—Exchanging Sex for Money, drugs, or other commodities for survival is associated with an array of HIV risks. We sought to determine if street-involved drug-using Sexual minority youth are at greater risk for survival Sex work and are more likely to engage in risk behaviors with clients. Methods—We examined factors associated with survival Sex work among participants enrolled in the At Risk Youth Study using logistic regression. Self-reported risk behaviors with clients were also examined. Results—Of 558 participants eligible for this analysis, 75 (13.4%) identified as a Sexual minority and 63 (11.3%) reported survival Sex work in the past 6 months. Sexual minority males (adjusted odds ratio = 16.1, P < .001) and Sexual minority females (adjusted odds ratio = 6.87, P < 0.001) were at significantly greater risk for survival Sex work. Sexual minority youth were more likely to report inconsistent condom use with clients (odds ratio = 4.30, P = 0.049) and reported a greater number of clients in the past 6 months (median = 14 vs. 3, P = 0.008). Conclusions—Sexual minority street youth are not only more likely to engage in survival Sex work but also demonstrate elevated HIV risk behavior. These findings suggest that harm reduction and HIV prevention programs for Sexual minority youth who exchange Sex are urgently required.
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community based hiv prevention research among substance using women in survival Sex work the maka project partnership
Harm Reduction Journal, 2007Co-Authors: Kate Shannon, Vicki Bright, Shari Allinott, Debbie Alexson, Kate Gibson, Mark W TyndallAbstract:Substance-using women who exchange Sex for Money, drugs or shelter as a means of basic subsistence (ie. survival Sex) have remained largely at the periphery of HIV and harm reduction policies and services across Canadian cities. This is notwithstanding global evidence of the multiple harms faced by this population, including high rates of violence and poverty, and enhanced vulnerabilities to HIV transmission among women who smoke or inject drugs. In response, a participatory-action research project was developed in partnership with a local Sex work agency to examine the HIV-related vulnerabilities, barriers to accessing care, and impact of current prevention and harm reduction strategies among women in survival Sex work. This paper provides a brief background of the health and drug-related harms among substance-using women in survival Sex work, and outlines the development and methodology of a community-based HIV prevention research project partnership. In doing so, we discuss some of the strengths and challenges of community-based HIV prevention research, as well as some key ethical considerations, in the context of street-level Sex work in an urban setting.
Thomas Kerr - One of the best experts on this subject based on the ideXlab platform.
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survival Sex work involvement among street involved youth who use drugs in a canadian setting
Journal of Public Health, 2010Co-Authors: Jill Chettiar, Kate Shannon, Thomas Kerr, Ruth Zhang, Evan WoodAbstract:Background Drug users engaged in survival Sex work are at heightened risk for drug- and Sexual-related harms. We examined factors associated with survival Sex work among street-involved youth in Vancouver, Canada. Methods From September 2005 to November 2007, baseline data were collected for the At-Risk Youth Study (ARYS), a prospective cohort of street-recruited youth aged 14–26 who use illicit drugs. Using multiple logistic regression, we compared youth who reported exchanging Sex for Money, drugs etc. with those who did not. Results The sample included 560 youth: median age 22; 179 (32%) female; 63 (11%) reporting recent survival Sex work. Factors associated with survival Sex work in multivariate analyses included non-injection crack use [adjusted odds ratio (AOR) ¼ 3.45, 95% confidence interval (CI): 1.75–6.78], female gender (AOR ¼ 3.02, 95% CI: 1.66–5.46), Aboriginal ethnicity (AOR ¼ 2.35, 95% CI: 1.28–4.29) and crystal methamphetamine use (AOR ¼ 2.02, 95% CI: 1.13–3.62). In subanalyses, the co-use of crack cocaine and methamphetamine was shown to be driving the association between methamphetamine and survival Sex work.
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survival Sex work and increased hiv risk among Sexual minority street involved youth
Journal of Acquired Immune Deficiency Syndromes, 2009Co-Authors: Brandon D L Marshall, Kate Shannon, Thomas Kerr, Ruth Zhang, Evan WoodAbstract:Objectives—Exchanging Sex for Money, drugs, or other commodities for survival is associated with an array of HIV risks. We sought to determine if street-involved drug-using Sexual minority youth are at greater risk for survival Sex work and are more likely to engage in risk behaviors with clients. Methods—We examined factors associated with survival Sex work among participants enrolled in the At Risk Youth Study using logistic regression. Self-reported risk behaviors with clients were also examined. Results—Of 558 participants eligible for this analysis, 75 (13.4%) identified as a Sexual minority and 63 (11.3%) reported survival Sex work in the past 6 months. Sexual minority males (adjusted odds ratio = 16.1, P < .001) and Sexual minority females (adjusted odds ratio = 6.87, P < 0.001) were at significantly greater risk for survival Sex work. Sexual minority youth were more likely to report inconsistent condom use with clients (odds ratio = 4.30, P = 0.049) and reported a greater number of clients in the past 6 months (median = 14 vs. 3, P = 0.008). Conclusions—Sexual minority street youth are not only more likely to engage in survival Sex work but also demonstrate elevated HIV risk behavior. These findings suggest that harm reduction and HIV prevention programs for Sexual minority youth who exchange Sex are urgently required.
Mishka Terplan - One of the best experts on this subject based on the ideXlab platform.
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contraception and clean needles feasibility of combining mobile reproductive health and needle exchange services for female exotic dancers
American Journal of Public Health, 2012Co-Authors: Eva Moore, Jennifer Han, Christine Seriochapman, Cynthia Mobley, Catherine Watson, Mishka TerplanAbstract:Young women engaged in exotic dancing have a higher need for reproductive health services than women not in this profession, and many also use drugs or exchange Sex for Money or drugs. Few report receiving reproductive health services. We describe a public health, academic, and community partnership that provided reproductive health services on needle exchange mobile vans in the "red light district" in downtown Baltimore, Maryland. Women made 220 visits to the vans in the first 21 months of the program's operation, and 65% of these visits involved provision of contraception. Programmatic costs were feasible. Joint provision of needle exchange and reproductive health services targeting exotic dancers has the potential to reduce unintended pregnancies and link pregnant, substance-abusing women to reproductive care, and such programs should be implemented more widely.
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17 contraception and clean needles feasibility of combining mobile reproductive health and needle exchange services prioritizing female exotic dancers
Journal of Adolescent Health, 2012Co-Authors: Eva Moore, Jennifer Han, Christine Seriochapman, Cynthia Mobley, Catherine Watson, Mishka TerplanAbstract:Young women engaged in exotic dancing have a higher need for reproductive health services than women not in this profession, and many also use drugs or exchange Sex for Money or drugs. Few report receiving reproductive health services. We describe a public health, academic, and community partnership that provided reproductive health services on needle exchange mobile vans in the “red light district” in downtown Baltimore, Maryland. Women made 220 visits to the vans in the first 21 months of the program’s operation, and 65% of these visits involved provision of contraception. Programmatic costs were feasible. Joint provision of needle exchange and reproductive health services targeting exotic dancers has the potential to reduce unintended pregnancies and link pregnant, substance-abusing women to reproductive care, and such programs should be implemented more widely. (Am J Public Health. 2012;102:1833–1836. doi:10.2105/AJPH.2012.300842)
Evan Wood - One of the best experts on this subject based on the ideXlab platform.
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survival Sex work involvement among street involved youth who use drugs in a canadian setting
Journal of Public Health, 2010Co-Authors: Jill Chettiar, Kate Shannon, Thomas Kerr, Ruth Zhang, Evan WoodAbstract:Background Drug users engaged in survival Sex work are at heightened risk for drug- and Sexual-related harms. We examined factors associated with survival Sex work among street-involved youth in Vancouver, Canada. Methods From September 2005 to November 2007, baseline data were collected for the At-Risk Youth Study (ARYS), a prospective cohort of street-recruited youth aged 14–26 who use illicit drugs. Using multiple logistic regression, we compared youth who reported exchanging Sex for Money, drugs etc. with those who did not. Results The sample included 560 youth: median age 22; 179 (32%) female; 63 (11%) reporting recent survival Sex work. Factors associated with survival Sex work in multivariate analyses included non-injection crack use [adjusted odds ratio (AOR) ¼ 3.45, 95% confidence interval (CI): 1.75–6.78], female gender (AOR ¼ 3.02, 95% CI: 1.66–5.46), Aboriginal ethnicity (AOR ¼ 2.35, 95% CI: 1.28–4.29) and crystal methamphetamine use (AOR ¼ 2.02, 95% CI: 1.13–3.62). In subanalyses, the co-use of crack cocaine and methamphetamine was shown to be driving the association between methamphetamine and survival Sex work.
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survival Sex work and increased hiv risk among Sexual minority street involved youth
Journal of Acquired Immune Deficiency Syndromes, 2009Co-Authors: Brandon D L Marshall, Kate Shannon, Thomas Kerr, Ruth Zhang, Evan WoodAbstract:Objectives—Exchanging Sex for Money, drugs, or other commodities for survival is associated with an array of HIV risks. We sought to determine if street-involved drug-using Sexual minority youth are at greater risk for survival Sex work and are more likely to engage in risk behaviors with clients. Methods—We examined factors associated with survival Sex work among participants enrolled in the At Risk Youth Study using logistic regression. Self-reported risk behaviors with clients were also examined. Results—Of 558 participants eligible for this analysis, 75 (13.4%) identified as a Sexual minority and 63 (11.3%) reported survival Sex work in the past 6 months. Sexual minority males (adjusted odds ratio = 16.1, P < .001) and Sexual minority females (adjusted odds ratio = 6.87, P < 0.001) were at significantly greater risk for survival Sex work. Sexual minority youth were more likely to report inconsistent condom use with clients (odds ratio = 4.30, P = 0.049) and reported a greater number of clients in the past 6 months (median = 14 vs. 3, P = 0.008). Conclusions—Sexual minority street youth are not only more likely to engage in survival Sex work but also demonstrate elevated HIV risk behavior. These findings suggest that harm reduction and HIV prevention programs for Sexual minority youth who exchange Sex are urgently required.