Risks for tuberculosis in Kazakhstan: implications for prevention.

SETTING: Four regions in Kazakhstan where participants were recruited from June 2012 to May 2014. OBJECTIVE: To examine associations between incarceration history and tobacco, alcohol, and drug consumption, and human immunodeficiency virus (HIV) infection and diabetes mellitus (DM) with TB. DESIGN: This matched case-control study included 1600 participants who completed a survey on sociodemographics, history of incarceration, tobacco, alcohol and drug use, and HIV and DM diagnosis. Conditional logistic regression analysis was used to examine associations between a TB diagnosis and risk factors. RESULTS: Participants who had ever smoked tobacco (aOR 1.73, 95%CI 1.23-2.43, P  0.01), ever drank alcohol (aOR 1.41, 95%CI 1.03-1.93, P  0.05), were HIV-positive (aOR 36.37, 95%CI 2.05-646.13, P  0.05) or had DM (aOR 13.96, 95%CI 6.37-30.56, P  0.01) were more likely to have TB. CONCLUSIONS: The association between TB and tobacco use, alcohol use, HIV and DM in Kazakhstan suggests a need for comprehensive intervention and prevention approaches that also address tobacco and alcohol use, DM and HIV.

Tuberculosis report among injection drug users and their partners in Kazakhstan.

OBJECTIVES: Tuberculosis (TB) is a major threat to global public health. Kazakhstan has the second highest percentage of multidrug-resistant tuberculosis (MDR-TB) cases among incident tuberculosis cases in the world (WHO 2013). A high burden of MDR-TB suggests TB prevention, control, and treatment programs are failing. This study provides an epidemiologic profile of TB among injection drug users (IDUs), a high-risk and chronically underserved population, in Kazakhstan. STUDY DESIGN: Cross-sectional study. METHODS: The authors studied the characteristics and risk environment of IDUs with self-reported previous active TB and their primary sexual partners in Almaty, Kazakhstan. 728 individuals (364 couples) participated in a couple-based study in 2009. RESULTS: 16.75% of participants reported at least one positive TB test (x-ray) in their lifetime. In a multivariable logistic regression adjusting for couple-based sampling, persons with positive TB test were significantly more likely to be older (odds ratio (OR) 7.26, 95% confidence interval (CI): 1.73, 30.43), male (OR 5.53, 95% CI: 2.74, 11.16), have a shorter duration of injection drug use (OR 0.17, 95% CI: 0.04, 0.65), have received high social support from their significant other (OR 2.13, 95% CI: 1.03, 4.40) and more likely (non-significantly) to have been incarcerated (OR 7.03, 95% CI: 0.64, 77.30). CONCLUSIONS: Older men with a history of incarceration and recent injection drug use were more likely to have positive TB test in Kazakhstan. Social network support, while potentially positive for many aspects of population health, may increase risk of TB among IDUs in this context. Public health policies that target high-risk populations and their at-risk networks may be necessary to stem the rise of MDR-TB in Central Asia.

Social and behavioural HIV/AIDS research in Jordan: a systematic review.

This systematic review evaluated the extent of HIV/AIDS research conducted in Jordan related to behavioural and/or social outcomes. MEDLINE, CINAHL, PsycINFO and OVID (1980-2009) were searched as well as the International AIDS Society abstract archives (2000-2009). Existing reviews and primary studies were cross-referenced for further citations, and unpublished literature and ongoing trials were searched by contacting experts and active researchers in the field. Google Scholar was used to search in peer-reviewed local or regional journals not included in the above-mentioned databases. Searches were also conducted of Arabic literature. Only 8 relevant studies were identified; all were descriptive cross-sectional studies, either quantitative or qualitative. Convenience samples were used in the majority of the studies, severely limiting the generalizability of the findings. The studies focused on HIV/AIDs knowledge and attitudes in the general population and among health professionals; at-risk populations were not assessed.

Social and behavioural HIV/AIDS research in Jordan: a systematic review

This systematic review evaluated the extent of HIV/AIDS research conducted in Jordan related to behavioural and/or social outcomes. MEDLINE, CINAHL, PsyclNFO and OVID [1980-2009] were searched as well as the International AIDS Society abstract archives [2000-2009]. Existing reviews and primary studies were cross-referenced for further citations, and unpublished literature and ongoing trials were searched by contacting experts and active researchers in the field. Google Scholar was used to search in peer-reviewed local or regional journals not included in the above-mentioned databases. Searches were also conducted of Arabic literature. Only 8 relevant studies were identified; all were descriptive cross-sectional studies, either quantitative or qualitative. Convenience samples were used in the majority of the studies, severely limiting the generalizability of the findings. The studies focused on HIV/AIDs knowledge and attitudes in the general population and among health professionals; at-risk populations were not assessed

Linking drug-related activities with experiences of partner violence: a focus group study of women in methadone treatment.

This study examines various contexts in which drug-related activities may be linked with intimate partner violence among women in methadone treatment. We conducted 14 focus groups with 68 predominantly Latina and African American women, who reported recent partner abuse. Guided by Goldstein's tripartite model, gender theory, and trauma theory, our inquiry explored how partner violence may be related to psychopharmacological effects of drug use and to conflicts over procuring and splitting drugs. We also examined whether women used drugs to cope with the violence. Across the focus groups, women reported that their low social status and perceived sexual availability as "drug-using women," their partner's substance use, their own verbal aggression under the influence of crack and alcohol, and conflicts over procuring and splitting drugs played a role in their victimization. The findings further suggest that conflicts over gender role expectations interact with drug-related activities, increasing the likelihood of a violent outcome.

Intimate partner sexual abuse among women on methadone.

This article reports findings on the prevalence and correlates of intimate partner sexual abuse (using the Revised Conflict Tactics Scale) among a sample of women in methadone treatment in New York City. Results indicate that, during the course of the intimate relationship, approximately 15% of women had experienced intimate partner sexual assault and 47% were sexually assaulted and/or coerced. Nine percent had experienced intimate partner sexual assault and 38% intimate partner sexual coercion in the past year of the relationship. Bivariate analyses revealed that women who were sexually abused in the 12 months prior to the interview tended also to be physically abused by intimate partners. Women who were unemployed, poor, crack-cocaine or injecting-drug users, and were physically and/or sexually abused as children, were at increased risk of experiencing intimate partner sexual abuse in adulthood. In multivariate models, only extreme poverty and sexual abuse in childhood emerged as risk factors for intimate partner sexual abuse in adulthood.

The role of community consultants in designing an HIV prevention intervention.

This article describes the significant role of community members during the intervention development phase of a randomized clinical trial of an HIV prevention intervention for African American and Latina women and their main sexual partners. Sixteen women and 13 male partners were engaged as "consultants" in a series of focus group discussions aimed at exploring their reactions and ideas about potential topics and approaches for the intervention. Each individual participated in three focus groups-two single-sex groups and a third that brought women and their male partners together. Focus group data extended our knowledge about the impact of relationship dynamics on safer sex negotiation and allowed us to design an intervention that is contextually specific and pragmatic. Target community members can provide critical input during the intervention development process and should be recognized as viable and meaningful collaborators in all phases of intervention research.

Sex trading and psychological distress among women on methadone.

This study examined the relationship between sex trading and psychological distress among a nonrandom sample of women recruited from 3 methadone maintenance clinics in New York City. Face-to-face interviews with 280 women (M age = 40.7) revealed that 32% had traded sex for money or drugs in the previous year. Compared to other participants, these women reported less education and higher rates of incarceration in the past year, sexually transmitted diseases, childhood sexual abuse, partner abuse, and current regular crack/cocaine and alcohol use. Hierarchical multiple regression analysis indicated that sex traders scored 0.41 units higher than non-sex traders on the General Severity Index of the Brief Symptom Inventory after controlling for all relevant covariates. The findings emphasize the need to consider the interrelation of psychological distress, abuse, and addiction in designing public health interventions addressing methadone maintained women.

HIV risks of men in methadone maintenance treatment programs who abuse their intimate partners: a forgotten issue.

Accumulating findings suggest a relationship between partner violence and HIV risk among women, however, this issue has yet to be adequately researched among men. This study examines the relationship between perpetrating intimate partner violence and HIV risk behavior among a sample of men in methadone maintenance treatment programs (MMTPs). Data were collected on 273 sexually active men, who were recruited from four inner-city MMTP clinics. More than a third of the sample reported perpetrating intimate physical abuse and 15% reported severe physical abuse in the past 12 months. Results from multiple logistic regression analyses indicate that after adjusting for demographic, poverty, and drug-use factors, men who abused an intimate partner were almost 4 times more likely to have more than one intimate partner, almost 3 times more likely to have unprotected anal sex, and 2.6 times more likely to have sex with a drug-injecting sexual partner than their counterparts. This study showed that men who perpetrated partner violence were at higher risk for HIV transmission. HIV prevention interventions need to consider the complex relationship between partner violence and HIV risk.

Correlates of partner violence among female street-based sex workers: substance abuse, history of childhood abuse, and HIV risks.

This study examines the prevalence of physical and sexual abuse by intimate and commercial sexual partners among street-based sex workers and explores correlates of partner abuse by commercial partners using the following factors: sociodemographics, substance abuse, sexual behavior, and physical and sexual childhood abuse. One hundred thirteen street sex workers were recruited from December 1996 through May 1997 while receiving services from the Foundations for Research on Sexually Transmitted Diseases (FROST'D), a nonprofit organization based in New York City. Partner abuse is a common occurrence among street sex workers. Two of three street prostitutes have experienced lifetime physical or sexual abuse by either an intimate or commercial partner. In addition, one of eight reported physical and sexual abuse by both intimate and commercial partners during her lifetime. Women who were homeless in the last year, those who reported exchanging for drugs and money as their main source of income, used injection drugs in the past year and had sex in crack houses, and who were human immunodeficiency virus (HIV)-positive were more likely to be report combined physical and sexual abuse. Understanding the relationship between partner violence, victim's substance abuse, and HIV-risk behavior is important for the development of public policies and treatment and prevention strategies to address the constellation of problems that drug-using female street sex workers face.

The converging epidemics of mood-altering-drug use, HIV, HCV, and partner violence: a conundrum for methadone maintenance treatment.

BACKGROUND: Accumulating evidence suggests that partner violence may be associated with HIV risk behavior and drug use among women in methadone maintenance treatment programs (MMTPs), yet the mechanisms linking these overlapping problems remain unclear. The main purpose of this qualitative study is to explore in detail how drug-related activities and HIV risk behavior occur in the context of a recent episode of partner violence among women in MMTPs. METHOD: We conducted and analyzed in-depth interviews with 31 women who reported having experienced physical or sexual violence by an intimate partner during the past year. Guided by existing research, feminist theory and trauma theory, we constructed a set of questions which were designed to explore multiple ways in which drug-related activities or HIV risk behavior may be linked directly or indirectly to the recent event. To examine the extent and significance of the woman sand/or her partner s drug-related activities or sexual HIV risk issues occurring immediately before, during and/or after the most recent event, we adapted a series of techniques for thematic analysis of qualitative data. RESULTS: Of the 31 women who reported recent events: 83.8 % (n=26) recalled recent events in which there was some drug-involvement; 40% (n=13) indicated that both she and her partner were involved in drug-related activities during the most recent event of partner abuse; 35% (n=11) reported that the partner was drug-involved; and only two women (6.4%) indicated that they alone had been drug-involved. One-fifth (19.3%, n=6) of the women indicated that they had used drugs immediately after the event because they were upset or in physical pain. One-fifth of the women (n=6) reported that they had coerced, unprotected sex during or after the most recent incident. CONCLUSIONS: The multiple ways in which the use of mood-altering drugs are related to partner violence and the occurrence of coerced, unprotected sex underscore the need to design specific interventions for preventing drug relapse, and HIV and HCV infection among abused women in MMTPs. Treatment and policy implications of study findings are discussed.

Sex trading and psychological distress in a street-based sample of low-income urban men.

This article examines the relationship between sex trading and psychological distress and assesses sexual human immunodeficiency virus (HIV) risk behaviors and HIV seroprevalence in a sample of young men recruited from the streets of Harlem. The authors interviewed 477 men, aged 18 to 29 years, of whom 43 (9.0%) had received money or drugs in exchange for sex in the preceding 30 days and were categorized as sex traders. Psychological distress was measured by using the Brief Symptom Inventory (BSI). Sex traders scored significantly higher than non-sex traders on the General Severity Index and on all nine subscales of the BSI. According to multivariate analysis after adjusting for perceived HIV risk, current regular crack cocaine use and homelessness, sex traders scored 0.173 units higher on the General Severity Index than non-sex traders (p < .001). More of the sex traders tested positive for HIV (41% versus 19%, p < .001). The alarmingly high HIV seroprevalence rate in sex traders in this sample underscores the need to redouble HIV prevention efforts for this population. The high levels of psychological distress and crack cocaine dependence among sex traders may undermine their ability to adopt safer sex behaviors and should be considered in intervention designs.

Fear and violence: raising the HIV stakes.

Through focus group methodology, the study examines three contexts that delineate the co-occurrence of intimate partner violence and sexual risk behaviors among 68 women on methadone. First, it explores the ways in which the presence of physical abuse in an intimate relationship prevents women from asking their partners to use a condom. Second, it describes the ways in which the couple's drug involvement increases the risk of physical and sexual violence, and concomitant sexual HIV risks. Third, it discusses the context in which sexual assault and rape occur in these established intimate relationships and how these abusive events increase women's risks of becoming infected with HIV. The research is guided by feminist theory, which affords powerful insight into the contexts in which women are put at risk for HIV and partner violence. The study provides a discussion on the implications of the findings to HIV prevention for women who are risk for both HIV and partner violence.

Predictors of female condom use among women exchanging street sex in New York City.

BACKGROUND: Alternative female-initiated barrier methods, such as the female condom, are needed among women exchanging street sex to enhance their ability to protect themselves from HIV and STD infection. OBJECTIVE: To describe predictors of female condom use among 96 women exchanging sex for money and drugs on the streets of New York City. STUDY DESIGN: A total of 113 sex workers received a baseline interview, a demonstration on proper female condom use, and 10 female condoms. A total of 101 sex workers received a followed-up evaluation at 2 weeks, of which 96 were included in data analysis. Predictors of condom use were analyzed for (1) any type of use; and (2) use with commercial partners. RESULTS: The strongest predictors of female condom use among this sample of sex workers were (1) living with someone with a drug or alcohol problem; (2) having heard of the female condom; and (3) homelessness. Current physical or sexual abuse by a commercial partner and marriage decreased the probability of female condom use. CONCLUSIONS: Female condom distribution encouraged sex workers who may be most vulnerable or who reported characteristics or behaviors associated with the highest sexually transmitted disease and HIV risk to try female condoms with commercial partners. Implications for intervention development include the need to develop innovative programs provided on the street (e.g., through peers) that can access homeless, drug-using sex workers in the most at-risk environments.

PIP: This study investigated the characteristics of street sex workers that influence the initial use of the female condom in New York City. Interviews, demonstration of proper female condom use and distribution of 10 female condoms were conducted among 113 female sex workers. Only 96 respondents were included in the study after a 2-week follow-up evaluation. Measure variables used in the study included sociodemographic characteristics, drug history, sexual risk behavior, and victimization, while dependent variables were female condom use for any reason and female condom use with commercial sexual partners. Results revealed that the 3 strongest variables associated with female condom use were the following: 1) living with anyone with a drug-alcohol problem; 2) having heard of the female condom; and 3) physical or sexual abuse by a commercial partner. This study emphasized the need to develop innovative programs that focus on street workers, with information promotion carried out in areas of sex work strolls which addresses the issues of accessibility and ease of use among sex workers.

Detecting cocaine and opiates in urine: comparing three commercial assays.

Urine screening is a potentially useful tool for detecting drugs of abuse in treatment, criminal justice, and other human service settings. This article examines the relative accuracy and other features of three drug screening assays sold by commercial laboratories: (1) Abbott Diagnostics ADx machine and reagents; (2) ONTRAK, manufactured by Roche Diagnostics; and (3) EZ-SCREEN, manufactured by Environmental Diagnostics. Urine samples (n=345) were collected from indigent men and women in a work and life skills program, and tested for cocaine and opiates with each of the kits. The ADx fluorescent immunoassay was presumed to be the most sensitive and specific screening method, and comparisons with the two visually-determined test kits supported this assumption. Of the two visual test kits, ONTRAK was the more specific assay, and was lower in cost and simplest to perform. Decision makers could employ similar evaluative methods in selecting drug testing materials.

Acceptability of female condom use among women exchanging street sex in New York City.

Greater access to alternative female-initiated barrier methods, such as the female condom, is needed among women exchanging street sex. This study describes knowledge of and experience with the female condom among 101 women exchanging sex for money and drugs on the streets of New York City, and examines the acceptability of female condom use as an alternative barrier method for HIV/STD prevention among this population. Female condom use among this sample of sex workers was found to be related to having a regular sexual partner, living with someone who is a drug or alcohol abuser, not being homeless, using alcohol or intravenous heroin, having heard of the device, and having discussed the device with other women or with a regular sexual partner. Despite decreased acceptability post-use, most sex workers indicated an intention for future female condom use.

PIP: This study describes the knowledge and experience of the female condom among 101 women exchanging sex for money and drugs on the streets of New York City, and examines the acceptability of female condom use as an alternative barrier method for HIV and sexually transmitted disease (STD) prevention among this population. Samples included were African American, never married, and with an average age of 35.9 years. The result shows that women who were single and never married were more likely to use the female condom than those who were married, separated, divorced, or widowed. Moreover, those who lived with someone having drug or alcohol problems were more likely to use female condoms than their counterparts than those who were homeless, women with a place to live were more likely to use female condoms. These suggest that the female condom may be feasible alternative barrier method for STD and HIV prevention among women engaging in commercial sex work. Despite decreased acceptability post-use, most sex workers indicated an intention for future female condom use.

Correlates of condom coupon redemption among urban sexually transmitted disease clinic patients.

This study expands upon coupon distribution strategies used to measure male condom acquisition in HIV/AIDS prevention by incorporating both female and male condoms and examining factors related to coupon redemption among urban STD clinic patients.

PIP: In this study, condom coupon redemption (CR) rates were examined for male and female condoms. The study also explored the relationship between demographic and sexual behavior characteristics and CR and describes male and female participants requesting female condoms. The participants of this study were 100 patients, 55 male and 45 female, recruited from STD clinics by means of posted advertisements. Logistic regression analysis was used to explore the association between sexual risk factors, unprotected sexual intercourse, recent multiple sexual partners, STDs, and CR. Demographic screening revealed that 39% of the 100 participants redeemed coupons and females were more likely to redeem coupons than males. No association was found between sexual risk behavior and CR. Redeemers were slightly less sexually active than nonredeemers. Among coupon redeemers, 65% of women and 44% of men reported that they used the female condom at least once and 64% said that the device was easy to insert. Non-Latino women were the predominant users of female condoms, and more Latino men requested female condoms. This study found that there was no association between sexual risk behaviors and CR. CR, incorporating both condom types, would then provide a stronger measure of consumer preference of one type over the other.

Acceptability of the female condom among STD clinic patients.

This study examines the acceptability of the female condom among African American and Latino patients from two inner-city sexually transmitted disease (STD) clinics through focus group discussions. Prior to the initial focus group sessions, 90% (n = 90) had heard about the female condom, 8% (n = 8) had seen it, and 2% (n = 2) had used it. Among the 41 participants (22 males and 19 females) attending a second focus group session, 85.4% (n = 35) had used the female condom at least once. Female study participants who had previous experience inserting a barrier contraceptive device, such as a diaphragm, indicated that they felt more comfortable inserting the female condom than those who had never used such a device. Male participants indicated that they were more comfortable using the female condom with their steady partners than with casual partners, whereas female participants indicated no such distinctions. These and other study findings suggest that need to promote and expand the use of the female condom as a device that protects women from STD transmissions including HIV and AIDS.

PIP: The acceptability of the female condom was explored through mixed-gender focus group discussions involving 100 Black and Hispanic men and women recruited from two US inner-city sexually transmitted disease clinics. Before the initial group sessions, 90 participants (90%) had heard about the female condom, 8 (8%) had seen it, and 2 (2%) had used the device. Female participants initially reacted negatively to the condom's appearance, size, and obtrusiveness and expressed uncertainty about how it could be inserted. Male participants, on the other hand, focused on utilitarian rather than aesthetic issues. After handling the device, more than half of female and male participants endorsed a more positive attitude. Women with previous experience with a barrier contraceptive device such as the vaginal diaphragm were more likely to feel comfortable about female condom use. Among the 22 males and 19 females who returned for a second group session after having been given a supply of female condoms to try, 35 (85.4%) had used the device at least once. 10 participants noted that bringing up the topic of female condom use enabled them to discuss safer sex practices with their steady partners for the first time. Women who, in the initial discussions, viewed the female condom as a means of gaining control over their sexuality, gained awareness of the need for substantial male support and cooperation. Men were more comfortable using the device with regular than casual partners, but women made no such distinction. Although it is acknowledged that participants who returned for the second discussion may have had more favorable experiences than those who did not, the preliminary data suggest that the female condom is acceptable to men and women at risk of HIV. HIV/AIDS prevention campaigns aimed at promoting female condom use should address the technical skills and knowledge of female anatomy needed for method use, empowerment and negotiation skills, and ways to eroticize female condom use.

Stages of change profiles among incarcerated drug-using women.

This study investigated the utility and psychometric properties of the University of Rhode Island Change Assessment Scale (URICA) in a sample of 257 female inmates from a large urban prison. It addressed three major issues: (a) whether URICA captures stages of change among female offenders with a recent history of drug abuse; (b) whether distinct, reliable subgroup profiles would emerge from a cluster analysis of the URICA scale; and (c) whether women in these clusters would differ in their demographic characteristics, drug-use patterns, or psychological symptoms. Results indicate that the URICA is a useful, reliable, and valid tool to assess stages of change in drug-using incarcerated women. Consistent with other studies conducted with different populations, the scale yielded five distinct stages: precontemplation, contemplation, preparation, action, and maintenance. Cluster analysis using the hierarchical agglomerate method classified the subjects into five clusters, which correlated with subjects' psychological symptoms. Intervention implications of URICA are discussed.

Correlates of intention to use the female condom among women taking methadone.

PIP: The correlates of high-risk women's intentions to use the female condom were investigated in a descriptive study involving 148 sexually active women from 3 US methadone clinics. 51% of women were Latina and 38% were African-American; the mean age was 39 years. Male condoms, douching, sterilization, and withdrawal were the most frequently used contraceptive methods in the 90 days preceding the study. 56% had heard of the female condom, but only 6% had used it. Of the 139 women who had never used the female condom, 32% indicated they intended to use it in the future. Such intention was significantly, positively correlated with age under 39 years, African-American ethnicity, and the belief the female condom offers users a sense of personal control over their sexuality. Those who intended to use the female condom were more likely to have previously used male condoms, believe their partners would be supportive of the device, think female condom use could be erotic and fun, feel confident in their ability to negotiate safer sex, and to welcome an additional option for practicing safer sex. They were also less likely than their counterparts, who did not intend to use a female condom, to believe use of this method would imply they had a sexually transmitted disease or were too eager to have sex. Compared with women who did not intend to use the female condom, those who did were more likely to discuss the device with at least 1 member of their social network. These findings confirm the necessity of considering gender relations and social networks in the design of female condom promotion strategies.^ieng