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1.
AIDS Care ; 30(10): 1322-1328, 2018 10.
Article in English | MEDLINE | ID: mdl-29716392

ABSTRACT

Injection drug use (IDU) and food insecurity (FI) are highly prevalent among individuals living with HIV-hepatitis C virus (HCV) co-infection. We quantified the association between IDU and FI among co-infected individuals using biannual data from the Canadian Co-infection Cohort (N = 608, 2012-2015). IDU (in the past six months) and IDU frequency (non-weekly/weekly in the past month) were self-reported. FI (in the past six months) and FI severity (marginal FI, moderate FI, and severe FI) were measured using the Household Food Security Survey Module. Generalized estimating equations were used to estimate risk ratios (RR) quantifying the associations between IDU, IDU frequency, and FI with Poisson regression. The associations between IDU, IDU frequency, and FI severity were quantified by relative-risk ratios (RRR) estimated with multinomial regression. At the first time-point in the analytical sample, 54% of participants experienced FI in the past six months, 31% engaged in IDU in the six months preceding the FI measure, and 24% injected drugs in the past month. After adjustment for confounding, IDU in the past six months (RR = 1.15, 95% confidence interval [CI] = 1.04-1.28) as well as non-weekly (RR = 1.15, 95% CI = 1.02-1.29) and weekly IDU (RR = 1.21, 95% CI = 1.07-1.37) in the past month are associated with FI. Weekly IDU in the past month is also strongly associated with severe FI (RRR = 2.68, 95% CI = 1.47-4.91). Our findings indicate that there is an association between IDU and FI, particularly weekly IDU and severe FI. This suggests that reductions in IDU may mitigate FI, especially severe FI, in this vulnerable subset of the HIV-positive population.


Subject(s)
HIV Infections/complications , Hepatitis C, Chronic/complications , Substance Abuse, Intravenous/epidemiology , Adult , Canada/epidemiology , Female , Food Supply/statistics & numerical data , HIV Infections/epidemiology , Hepatitis C, Chronic/epidemiology , Humans , Longitudinal Studies , Male
2.
AIDS Care ; 30(5): 643-649, 2018 05.
Article in English | MEDLINE | ID: mdl-29374972

ABSTRACT

Depressive symptoms are associated with poor HIV viral control and immune recovery among people living with HIV. However, no prior studies assessed this association exclusively among people co-infected with HIV-hepatitis C virus (HCV). While people with HIV only and those with HIV-HCV co-infection share many characteristics, co-infected people may become more susceptible to the effects of depressive symptoms on health outcomes. We assessed this association exclusively among people co-infected with HIV-HCV in Canada using data from the Food Security & HIV-HCV Sub-Study (FS Sub-Study) of the Canadian Co-Infection Cohort (CCC). Stabilized inverse probability weighted marginal structural model was used to account for potential time-varying confounders. A total of 725 participants were enrolled between 2012 and 2015. At baseline, 52% of participants reported depressive symptoms, 75% had undetectable HIV viral load, and median CD4 count was 466 (IQR 300-665). People experiencing depressive symptoms had 1.32 times (95% CI: 1.07, 1.63) the risk of having detectable HIV viral load, but had comparable CD4 count to people who did not experience depressive symptoms (fold change of CD4 = 0.96, 95% CI: 0.91, 1.03). Presence of depressive symptoms is a risk factor for incomplete short-term HIV viral suppression among people co-infected with HIV-HCV. Therefore, depressive symptoms screening and related counseling may improve HIV related health outcomes and reduce HIV transmission.


Subject(s)
Depression/immunology , HIV Infections/psychology , Hepatitis C/psychology , Adult , CD4 Lymphocyte Count , Cohort Studies , Coinfection/psychology , Depression/virology , Female , HIV Infections/immunology , Humans , Male , Middle Aged , Risk Factors , Sustained Virologic Response , Viral Load
3.
AIDS Care ; 30(5): 663-671, 2018 05.
Article in English | MEDLINE | ID: mdl-29082788

ABSTRACT

Up to half of people living with HIV in resource-rich settings experience moderate to severe food insecurity. Food insecurity, in turn, has been linked to adverse health outcomes including poor antiretroviral adherence, poor HIV viral suppression, frailty, and mortality. We estimated the prevalence of food insecurity among 649 adults living with HIV and recruited from community-based AIDS service organizations in Ontario, Canada. Food security was assessed using the Canadian Household Food Security module. We used logistic regression modeling to identify demographic, socioeconomic, and psychosocial factors independently associated with food insecurity. Almost three-fourths of participants (70.3%) were food insecure and a third (31%) reported experiencing hunger. The prevalence of food insecurity in this sample is approximately six times higher than that of the general population. Factors independently associated with food insecurity were: having dependent children at home, residing in large urban areas, low annual household income (<$40,000), difficulty meeting housing-related expenses, cigarette smoking, harmful drug use, and depression. Broad, multisector interventions that address income, housing affordability, substance use and mental health issues are needed and could offset future public health expenditures.


Subject(s)
Food Supply/statistics & numerical data , HIV Infections/epidemiology , Adult , Child , Cigarette Smoking/epidemiology , Community Health Services , Depression/epidemiology , Family Characteristics , Female , Housing/economics , Humans , Hunger , Income , Male , Middle Aged , Ontario/epidemiology , Prevalence , Substance-Related Disorders/epidemiology , Surveys and Questionnaires , Urban Population/statistics & numerical data
4.
J Acquir Immune Defic Syndr ; 77(2): 144-153, 2018 02 01.
Article in English | MEDLINE | ID: mdl-29135650

ABSTRACT

BACKGROUND: Associations between HIV-related stigma and reduced antiretroviral therapy (ART) adherence are widely established, yet the mechanisms accounting for this relationship are underexplored. There has been less attention to HIV-related stigma and its associations with ART initiation and current ART use. We examined pathways from HIV-related stigma to ART initiation, current ART use, and ART adherence among women living with HIV in Canada. METHODS: We used baseline survey data from a national cohort of women living with HIV in Canada (n = 1425). Structural equation modeling using weighted least squares estimation methods was conducted to test the direct effects of HIV-related stigma dimensions (personalized, negative self-image, and public attitudes) on ART initiation, current ART use, and 90% ART adherence, and indirect effects through depression and HIV disclosure concerns, adjusting for sociodemographic factors. RESULTS: In the final model, the direct paths from personalized stigma to ART initiation (ß = -0.104, P < 0.05) and current ART use (ß = -0.142, P < 0.01), and negative self-image to ART initiation (ß = -0.113, P < 0.01) were significant, accounting for the mediation effects of depression and HIV disclosure concerns. Depression mediated the pathways from personalized stigma to ART adherence, and negative self-image to current ART use and ART adherence. Final model fit indices suggest that the model fit the data well [χ(25) = 90.251, P < 0.001; comparative fit index = 0.945; root-mean-square error of approximation = 0.044]. CONCLUSIONS: HIV-related stigma is associated with reduced likelihood of ART initiation and current ART use, and suboptimal ART adherence. To optimize the benefit of ART among women living with HIV, interventions should reduce HIV-related stigma and address depression.


Subject(s)
Anti-Retroviral Agents/therapeutic use , HIV Infections/drug therapy , HIV Infections/psychology , Medication Adherence/psychology , Social Stigma , Adult , Antiretroviral Therapy, Highly Active , Canada , Cross-Sectional Studies , Female , Humans , Middle Aged
5.
Prev Med ; 101: 18-22, 2017 Aug.
Article in English | MEDLINE | ID: mdl-28528170

ABSTRACT

Although digital reports of disease are currently used by public health officials for disease surveillance and decision making, little is known about environmental factors and compositional characteristics that may influence reporting patterns. The objective of this study is to quantify the association between climate, demographic and socio-economic factors on digital reporting of disease at the US county level. We reference approximately 1.5 million foodservice business reviews between 2004 and 2014, and use census data, machine learning methods and regression models to assess whether digital reporting of disease is associated with climate, socio-economic and demographic factors. The results show that reviews of foodservice businesses and digital reports of foodborne illness follow a clear seasonal pattern with higher reporting observed in the summer, when most foodborne outbreaks are reported and to a lesser extent in the winter months. Additionally, factors typically associated with affluence (such as, higher median income and fraction of the population with a bachelor's degrees) were positively correlated with foodborne illness reports. However, restaurants per capita and education were the most significant predictors of illness reporting at the US county level. These results suggest that well-known health disparities might also be reflected in the online environment. Although this is an observational study, it is an important step in understanding disparities in the online public health environment.


Subject(s)
Demography/statistics & numerical data , Disease Outbreaks/statistics & numerical data , Foodborne Diseases/epidemiology , Population Surveillance/methods , Climate , Female , Humans , Male , Public Health , Seasons , Socioeconomic Factors , United States/epidemiology
6.
AIDS Behav ; 21(3): 792-802, 2017 Mar.
Article in English | MEDLINE | ID: mdl-26912217

ABSTRACT

While research has begun addressing food insecurity (FI) in HIV-positive populations, knowledge regarding FI among individuals living with HIV-hepatitis C virus (HCV) co-infection is limited. This exploratory study examines sociodemographic, socioeconomic, behavioral, and clinical factors associated with FI in a cohort of HIV-HCV co-infected individuals in Canada. We analyzed longitudinal data from the Food Security and HIV-HCV Co-infection Study of the Canadian Co-infection Cohort collected between November 2012-June 2014 at 15 health centres. FI was measured using the Household Food Security Survey Module and classified using Health Canada criteria. Generalized estimating equations were used to assess factors associated with FI. Among 525 participants, 59 % experienced FI at their first study visit (baseline). Protective factors associated with FI (p < 0.05) included: enrolment at a Quebec study site (aOR: 0.42, 95 % CI: 0.27, 0.67), employment (aOR: 0.55, 95 % CI: 0.35, 0.87), and average personal monthly income (aOR per $100 CAD increase: 0.98, 95 % CI: 0.97, 0.99). Risk factors for FI included: recent injection drug use (aOR: 1.98, 95 % CI: 1.33, 2.96), trading away food (aOR: 5.23, 95 % CI: 2.53, 10.81), and recent experiences of depressive symptoms (aOR: 2.11, 95 % CI: 1.48, 3.01). FI is common in this co-infected population. Engagement of co-infected individuals in substance use treatments, harm reduction programs, and mental health services may mitigate FI in this vulnerable subset of the HIV-positive population.


Subject(s)
Coinfection/epidemiology , Food Supply/statistics & numerical data , HIV Infections/epidemiology , Hepatitis C, Chronic/epidemiology , Adult , Canada , Cohort Studies , Female , Humans , Male , Risk Factors , Substance Abuse, Intravenous/epidemiology , Young Adult
7.
AIDS Care ; 29(6): 696-704, 2017 06.
Article in English | MEDLINE | ID: mdl-27609532

ABSTRACT

People living with HIV/AIDS (PHA) often concurrently cope with mental health disorders that may greatly influence HIV and other health-related outcomes. The objective of this study was to examine the prevalence and correlates of self-reported mental health disorder diagnosis among a cohort of harder-to-reach HIV-positive individuals in British Columbia, Canada. Between 2007 and 2010, 1000 PHA who had initiated ART were enrolled in the Longitudinal Investigation into Supportive and Ancillary health services (LISA) study. Socio-demographic, behavioral, health-care utilization and psychosocial information was collected through interviewer-led questionnaires and linked to longitudinal clinical variables through the provincial Drug Treatment Program at the BC Centre for Excellence in HIV/AIDS. We identified the prevalence of all-type and specific mental health disorders among this population. Of the 916 participants included in this analysis, 494 (54%) reported ever having a mental health disorder diagnosis. Mood (85%) and anxiety (65%) disorders were the two most frequently reported mental health conditions. Self-reported all-type mental health disorder was independently associated with decreased overall functioning (adjusted odds ratio [AOR] = 0.90, 95% confidence interval [CI] = 0.83-0.98) and life satisfaction (AOR = 0.81, 95% CI = 0.74-0.89), and having higher stigma score (AOR = 1.11, 95%CI = 1.02-1.21). Participants reporting any mental health disorder were more likely to report a history of sexual assault (AOR = 2.45, 95% CI = 1.75-3.43) and to have used case management services (AOR = 1.63, 95%CI = 1.17-2.27). Our findings uncovered a high burden of mental health disorders among harder-to-reach PHA and suggest that PHA with at least one mental health disorder diagnosis are disproportionately impacted by sexual violence and stigma.


Subject(s)
HIV Infections/epidemiology , HIV Infections/psychology , Mental Disorders/epidemiology , Mental Disorders/psychology , Adult , Anxiety Disorders/diagnosis , Anxiety Disorders/epidemiology , Anxiety Disorders/psychology , British Columbia/epidemiology , Case Management , Comorbidity , Cross-Sectional Studies , Female , Health Services/statistics & numerical data , Humans , Longitudinal Studies , Male , Mental Disorders/diagnosis , Middle Aged , Mood Disorders/diagnosis , Mood Disorders/epidemiology , Mood Disorders/psychology , Odds Ratio , Patient Acceptance of Health Care/statistics & numerical data , Prevalence , Sex Offenses/psychology , Sex Offenses/statistics & numerical data , Social Stigma , Surveys and Questionnaires
8.
PLoS One ; 11(8): e0157630, 2016.
Article in English | MEDLINE | ID: mdl-27487041

ABSTRACT

OBJECTIVE: People living with HIV in high-resource settings suffer severe levels of food insecurity; however, limited evidence exists regarding dietary intake and sub-components that characterize food insecurity (i.e. food quantity, quality, safety or procurement) in this population. We examined the prevalence and characteristics of food insecurity among people living with HIV across British Columbia, Canada. DESIGN: This cross-sectional analysis was conducted within a national community-based research initiative. METHODS: Food security was measured using the Health Canada Household Food Security Scale Module. Logistic regression was used to determine key independent predictors of food insecurity, controlling for potential confounders. RESULTS: Of 262 participants, 192 (73%) reported food insecurity. Sub-components associated with food insecurity in bivariate analysis included: < RDI consumption of protein (p = 0.046); being sick from spoiled/unsafe food in the past six months (p = 0.010); and procurement of food using non-traditional methods (p <0.05). In multivariable analyses, factors significantly associated with food insecurity included: procurement of food using non-traditional methods [AOR = 11.11, 95% CI: 4.79-25.68, p = <0.001]; younger age [AOR = 0.92, 95% CI: 0.86-0.96, p = <0.001]; unstable housing [AOR = 4.46, 95% CI: 1.15-17.36, p = 0.031]; household gross annual income [AOR = 4.49, 95% CI: 1.74-11.60, p = 0.002]; and symptoms of depression [AOR = 2.73, 95% CI: 1.25-5.96, p = 0.012]. CONCLUSIONS: Food insecurity among people living with HIV in British Columbia is characterized by poor dietary quality and food procurement methods. Notably, participants who reported procuring in non-traditional manners were over 10 times more likely to be food insecure. These findings suggest a need for tailored food security and social support interventions in this setting.


Subject(s)
Food Supply/methods , Food Supply/statistics & numerical data , HIV Infections/epidemiology , Adult , British Columbia/epidemiology , Cross-Sectional Studies , Family Characteristics , Female , Humans , Logistic Models , Male , Middle Aged , Nutrition Surveys , Nutritive Value , Prevalence , Risk Factors , Socioeconomic Factors
10.
Lancet ; 385(9962): 29-35, 2015 Jan 03.
Article in English | MEDLINE | ID: mdl-25458732

ABSTRACT

BACKGROUND: The WHO declared the 2014 west African Ebola epidemic a public health emergency of international concern in view of its potential for further international spread. Decision makers worldwide are in need of empirical data to inform and implement emergency response measures. Our aim was to assess the potential for Ebola virus to spread across international borders via commercial air travel and assess the relative efficiency of exit versus entry screening of travellers at commercial airports. METHODS: We analysed International Air Transport Association data for worldwide flight schedules between Sept 1, 2014, and Dec 31, 2014, and historic traveller flight itinerary data from 2013 to describe expected global population movements via commercial air travel out of Guinea, Liberia, and Sierra Leone. Coupled with Ebola virus surveillance data, we modelled the expected number of internationally exported Ebola virus infections, the potential effect of air travel restrictions, and the efficiency of airport-based traveller screening at international ports of entry and exit. We deemed individuals initiating travel from any domestic or international airport within these three countries to have possible exposure to Ebola virus. We deemed all other travellers to have no significant risk of exposure to Ebola virus. FINDINGS: Based on epidemic conditions and international flight restrictions to and from Guinea, Liberia, and Sierra Leone as of Sept 1, 2014 (reductions in passenger seats by 51% for Liberia, 66% for Guinea, and 85% for Sierra Leone), our model projects 2.8 travellers infected with Ebola virus departing the above three countries via commercial flights, on average, every month. 91,547 (64%) of all air travellers departing Guinea, Liberia, and Sierra Leone had expected destinations in low-income and lower-middle-income countries. Screening international travellers departing three airports would enable health assessments of all travellers at highest risk of exposure to Ebola virus infection. INTERPRETATION: Decision makers must carefully balance the potential harms from travel restrictions imposed on countries that have Ebola virus activity against any potential reductions in risk from Ebola virus importations. Exit screening of travellers at airports in Guinea, Liberia, and Sierra Leone would be the most efficient frontier at which to assess the health status of travellers at risk of Ebola virus exposure, however, this intervention might require international support to implement effectively. FUNDING: Canadian Institutes of Health Research.


Subject(s)
Air Travel/statistics & numerical data , Disease Outbreaks , Ebolavirus/pathogenicity , Hemorrhagic Fever, Ebola/epidemiology , Mass Screening/standards , Models, Statistical , Guinea/epidemiology , Hemorrhagic Fever, Ebola/transmission , Humans , Liberia/epidemiology , Public Health , Risk Factors , Sierra Leone/epidemiology
12.
PLoS One ; 9(6): e100501, 2014.
Article in English | MEDLINE | ID: mdl-24963804

ABSTRACT

INTRODUCTION: The association between childhood sexual abuse and HIV risk among men who have sex with men (MSM) is well established. However, no studies have examined the potential impact of other forms of childhood maltreatment on HIV incidence in this population. METHODS: We explored the impact of child physical abuse (CPA) on HIV seroconversion in a cohort of gay/bisexual men aged 15 to 30 in Vancouver, Canada. Cox proportional hazard models were used, controlling for confounders. RESULTS: Among 287 participants, 211 (73.5%) reported experiencing CPA before the age of 17, and 42 (14.6%) reporting URAI in the past year. After a median of 6.6 years follow-up, 16 (5.8%) participants HIV-seroconverted. In multivariate analysis, CPA was significantly associated with HIV seroconversion (adjusted hazard ratio [AHR] = 4.89, 95% confidence interval (CI): 1.65-14.48), after controlling for potential confounders. CONCLUSION: Our study uncovered a link between childhood physical violence and HIV incidence. Results highlight an urgent need for screening of young gay and bisexual men for histories of violence, and social and structural supports to prevent HIV transmission in this population.


Subject(s)
Child Abuse/statistics & numerical data , HIV Seropositivity/epidemiology , Homosexuality, Male/statistics & numerical data , Unsafe Sex/statistics & numerical data , Adult , British Columbia/epidemiology , Child , Child Abuse/psychology , Cohort Studies , Female , HIV Seropositivity/psychology , Homosexuality, Male/psychology , Humans , Male , Unsafe Sex/psychology
14.
AIDS Care ; 26(4): 459-65, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24015838

ABSTRACT

Food insecurity may be a barrier to achieving optimal HIV treatment-related outcomes among illicit drug users. This study therefore, aimed to assess the impact of severe food insecurity, or hunger, on plasma HIV RNA suppression among illicit drug users receiving antiretroviral therapy (ART). A cross-sectional Multivariate logistic regression model was used to assess the potential relationship between hunger and plasma HIV RNA suppression. A sample of n = 406 adults was derived from a community-recruited open prospective cohort of HIV-positive illicit drug users, in Vancouver, British Columbia (BC), Canada. A total of 235 (63.7%) reported "being hungry and unable to afford enough food," and 241 (59.4%) had plasma HIV RNA < 50 copies/ml. In unadjusted analyses, self-reported hunger was associated with lower odds of plasma HIV RNA suppression (Odds Ratio = 0.59, 95% confidence interval [CI]: 0.39-0.90, p = 0.015). In multivariate analyses, this association was no longer significant after controlling for socio-demographic, behavioral, and clinical characteristics, including 95% adherence (Adjusted Odds Ratio [AOR] = 0.65, 95% CI: 0.37-1.10, p = 0.105). Multivariate models stratified by 95% adherence found that the direction and magnitude of this association was not significantly altered by the adherence level. Hunger was common among illicit drug users in this setting. Although, there was an association between hunger and lower likelihood of plasma HIV RNA suppression, this did not persist in adjusted analyses. Further research is warranted to understand the social-structural, policy, and physical factors shaping the HIV outcomes of illicit drug users.


Subject(s)
Antiretroviral Therapy, Highly Active/methods , Food Supply , HIV Infections/drug therapy , Hunger , Medication Adherence , RNA, Viral/blood , Substance Abuse, Intravenous/complications , Adult , Anti-HIV Agents/therapeutic use , British Columbia , Canada , Cross-Sectional Studies , Drug Users , Female , HIV Infections/blood , HIV Infections/complications , Humans , Logistic Models , Male , Middle Aged , Multivariate Analysis , Nutritional Status , Prospective Studies , RNA, Viral/drug effects , Socioeconomic Factors , Treatment Outcome
15.
AIDS Behav ; 18 Suppl 5: S490-504, 2014 Oct.
Article in English | MEDLINE | ID: mdl-24297517

ABSTRACT

As an increasing number of countries implement integrated food and nutrition security (FNS) and HIV programs, global stakeholders need clarity on how to best measure FNS at the individual and household level. This paper reviews prominent FNS measurement tools, and describes considerations for interpretation in the context of HIV. There exist a range of FNS measurement tools and many have been adapted for use in HIV-endemic settings. Considerations in selecting appropriate tools include sub-types (food sufficiency, dietary diversity and food safety); scope/level of application; and available resources. Tools need to reflect both the needs of PLHIV and affected households and FNS program objectives. Generalized food sufficiency and dietary diversity tools may provide adequate measures of FNS in PLHIV for programmatic applications. Food consumption measurement tools provide further data for clinical or research applications. Measurement of food safety is an important, but underdeveloped aspect of assessment, especially for PLHIV.


Subject(s)
Diet/standards , Food Supply , Nutrition Surveys/instrumentation , Nutritional Status , Surveys and Questionnaires/standards , Food , Food Safety , HIV Infections/diagnosis , HIV Infections/psychology , HIV Infections/therapy , Humans , Nutritional Requirements , Nutritive Value
16.
AIDS Behav ; 18 Suppl 5: S476-89, 2014 Oct.
Article in English | MEDLINE | ID: mdl-24292252

ABSTRACT

Integration of HIV and food security services is imperative to improving the health and well-being of people living with HIV. However, consensus does not exist on definitions and measures of food security to guide service delivery and evaluation in the context of HIV. This paper reviews definitions and indicators of food security used by key agencies; outlines their relevance in the context of HIV; highlights opportunities for harmonized monitoring and evaluation indicators; and discusses promising developments in data collection and management. In addition to the commonly used dimensions of food availability, access, utilization and stability, we identify three components of food security-food sufficiency, dietary quality, and food safety-that are useful for understanding and measuring food security needs of HIV-affected and other vulnerable people. Harmonization across agencies of food security indicators in the context of HIV offers opportunities to improve measurement and tracking, strengthen coordination, and inform evidence-based programming.


Subject(s)
Food Safety , Food Supply , HIV Infections/therapy , Anti-Retroviral Agents/therapeutic use , HIV Infections/diagnosis , Health Services Needs and Demand , Humans , Hunger , Nutrition Assessment , Nutritional Status , Nutritive Value , Terminology as Topic
17.
Curr HIV/AIDS Rep ; 10(4): 398-407, 2013 Dec.
Article in English | MEDLINE | ID: mdl-24272070

ABSTRACT

An emerging body of evidence suggests that intergenerational sexual partnerships may increase risk of HIV acquisition among young men who have sex with men (YMSM). However, no studies have comprehensively evaluated literature in this area. We applied a scoping review methodology to explore the relationships between age mixing, HIV risk behavior, and HIV seroconversion among YMSM. This study identified several individual, micro-, and meso-system factors influencing HIV risk among YMSM in the context of intergenerational relationships: childhood maltreatment, coming of age and sexual identity, and substance use (individual-level factors); family and social support, partner characteristics, intimate partner violence, connectedness to gay community (micro-system factors); and race/ethnicity, economic disparity, and use of the Internet (meso-system factors). These thematic groups can be used to frame future research on the role of age-discrepant relationships on HIV risk among YMSM, and to enhance public health HIV education and prevention strategies targeting this vulnerable population.


Subject(s)
HIV Infections/transmission , Homosexuality, Male , Intergenerational Relations , Age Factors , Domestic Violence , Family Relations , Health Education/standards , Humans , Male , Risk Factors , Social Support , Substance-Related Disorders/complications
18.
PLoS One ; 8(5): e61277, 2013.
Article in English | MEDLINE | ID: mdl-23723968

ABSTRACT

OBJECTIVES: Little is known about the potential impact of food insecurity on mortality among people living with HIV/AIDS. We examined the potential relationship between food insecurity and all-cause mortality among HIV-positive injection drug users (IDU) initiating antiretroviral therapy (ART) across British Columbia (BC). METHODS: Cross-sectional measurement of food security status was taken at participant ART initiation. Participants were prospectively followed from June 1998 to September 2011 within the fully subsidized ART program. Cox proportional hazard models were used to ascertain the association between food insecurity and mortality, controlling for potential confounders. RESULTS: Among 254 IDU, 181 (71.3%) were food insecure and 108 (42.5%) were hungry. After 13.3 years of median follow-up, 105 (41.3%) participants died. In multivariate analyses, food insecurity remained significantly associated with mortality (adjusted hazard ratio [AHR] = 1.95, 95% CI: 1.07-3.53), after adjusting for potential confounders. CONCLUSIONS: HIV-positive IDU reporting food insecurity were almost twice as likely to die, compared to food secure IDU. Further research is required to understand how and why food insecurity is associated with excess mortality in this population. Public health organizations should evaluate the possible role of food supplementation and socio-structural supports for IDU within harm reduction and HIV treatment programs.


Subject(s)
Anti-HIV Agents/therapeutic use , Food Supply , HIV Infections/mortality , Adult , Antiretroviral Therapy, Highly Active , British Columbia/epidemiology , Drug Users , Female , HIV Infections/drug therapy , Humans , Incidence , Male , Multivariate Analysis
19.
Soc Psychiatry Psychiatr Epidemiol ; 48(5): 795-803, 2013 May.
Article in English | MEDLINE | ID: mdl-23064395

ABSTRACT

PURPOSE: Studies suggest that people who are food insecure are more likely to experience mental illness. However, little is known about which aspects of food insecurity place individuals most at risk of mental illness. The purpose of this study was to establish the prevalence of mental illness among food insecure Canadians, and examine whether mental illness differs between those who are consuming insufficient amounts of food versus poor quality foods. METHODS: This analysis utilized the publically available dataset from the Canadian Community Health Survey cycle 4.1. Bivariable and multivariable logistic regression were used to examine the associations between food insecurity and mental health disorder diagnosis, while adjusting for potential confounders. Stratified analyses were used to identify vulnerable sub-groups. RESULTS: Among 5,588 Canadian adults (18-64 years) reporting food insecurity, 58 % reported poor food quality and 42 % reported food insufficiency. The prevalence of mental health diagnosis was 24 % among participants with poor food quality, and 35 % among individuals who were food insufficient (hunger). After adjusting for confounders, adults experiencing food insufficiency had 1.69 adjusted-odds [95 % confidence interval (CI): 1.49-1.91] of having a mental health diagnosis. Stratified analyses revealed increased odds among women (a-OR 1.89, 95 % CI 1.62-2.20), single parent households (a-OR 2.05, 95 % CI 1.51-2.78), and non-immigrants (a-OR 1.88, 95 % CI 1.64-2.16). CONCLUSION: The prevalence of mental illness is alarmingly high in this population-based sample of food insecure Canadians. These findings suggest that government and community-based programming aimed at strengthening food security should integrate supports for mental illness in this population.


Subject(s)
Food Supply/standards , Mental Disorders/epidemiology , Mental Disorders/psychology , Adolescent , Adult , Canada/epidemiology , Confounding Factors, Epidemiologic , Female , Food Supply/statistics & numerical data , Health Surveys , Humans , Hunger , Logistic Models , Male , Mental Disorders/diagnosis , Middle Aged , Prevalence , Residence Characteristics , Socioeconomic Factors , Transients and Migrants/psychology , Transients and Migrants/statistics & numerical data , Young Adult
20.
Global Health ; 8: 1, 2012 Jan 10.
Article in English | MEDLINE | ID: mdl-22233652

ABSTRACT

BACKGROUND: The International Health Regulations (IHRs) (2005) was developed with the aim of governing international responses to public health risks and emergencies. The document requires all 194 World Health Organization (WHO) Member States to detect, assess, notify and report any potential public health emergency of international concern (PHEIC) under specific timelines. Annex 2 of the IHR outlines decision-making criteria for State-appointed National Focal Points (NFP) to report potential PHEICs to the WHO, and is a critical component to the effective functioning of the IHRs. METHODS: The aim of the study was to review and evaluate the functioning of Annex 2 across WHO-reporting States Parties. Specific objectives were to ascertain NFP awareness and knowledge of Annex 2, practical use of the tool, activities taken to implement it, its perceived usefulness and user-friendliness. Qualitative telephone interviews, followed by a quantitative online survey, were administered to NFPs between October, 2009 and February, 2010. RESULTS: A total of 29 and 133 NFPs participated in the qualitative and quantitative studies, respectively. Qualitative interviews found most NFPs had a strong working knowledge of Annex 2; perceived the tool to be relevant and useful for guiding decisions; and had institutionalized management, legislation and communication systems to support it. NFPs also perceived Annex 2 as human and disease-centric, and emphasized its reduced applicability to potential PHEICs involving bioterrorist attacks, infectious diseases among animals, radio-nuclear and chemical spills, and water- or food-borne contamination. Among quantitative survey respondents, 88% reported having excellent/good knowledge of Annex 2; 77% reported always/usually using Annex 2 for assessing potential PHEICs; 76% indicated their country had some legal, regulatory or administrative provisions for using Annex 2; 95% indicated Annex 2 was always/usually useful for facilitating decisions regarding notifiability of potential PHEICs. CONCLUSION: This evaluation, including a large sample of WHO-reporting States Parties, found that the IHR's Annex 2 is perceived as useful for guiding decisions about notifiability of potential PHEICs. There is scope for the WHO to expand training and guidance on application of the IHR's Annex 2 to specific contexts. Continued monitoring and evaluation of the functioning of the IHR is imperative to promoting global health security.

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