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1.
Am J Mens Health ; 15(6): 15579883211063343, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34859712

RESUMO

Compared with women and girls, proportionately fewer men and boys in sub-Saharan Africa receive HIV testing, treatment, and other services. This study determined factors associated with never testing for HIV and examined never testing as a predictor of sexual risk behavior among men in Zambia. The sample included 2,609 men aged 15 to 24 from the 2018 Zambia Demographic and Health Survey. Logistic regression results revealed that compared with men who ever tested for HIV, men who never tested were more likely to be younger, have less education, have no children, be unemployed, and belong to the low wealth bracket. They also had a higher likelihood of not using a condom at last sex but were less likely to have more than five lifetime sexual partners. HIV prevention programs can use sociodemographic characteristics to identify those who have a lower likelihood of testing for HIV. Prevention programs can use sociodemographic characteristics to develop profiles of those who may especially need to be targeted by initiatives to promote HIV testing. Awareness does not always engender behavior change; therefore, in addition to knowledge of HIV status, risk reduction should also be emphasized.


Assuntos
Infecções por HIV , Preservativos , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Masculino , Assunção de Riscos , Comportamento Sexual , Zâmbia/epidemiologia
2.
Am J Health Behav ; 44(6): 840-847, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-33081880

RESUMO

Objective: In this study, I examined the association between age of substance use initiation and sexual violence (SV) among adolescent girls. Methods: Data were drawn from the 2017 Youth Risk Behavior Survey, and the sample included 7526 girls. Logistic regression was used to estimate the relationship between age of initiation of alcohol use, marijuana use and cigarette smoking, and SV, assessed by forced sexual intercourse and experiencing SV. Results: A dose-response association was observed between age of substance use initiation and SV. Across all 3 substance use variables and for both SV outcomes, those who initiated substance use before age 15 were more likely to experience SV than those who initiated at or after age 15, who, in turn, had a higher likelihood of experiencing SV than those who had never initiated substance use. Conclusion: Early initiation of substance use may be a meaningful marker of risk for SV victimization in later adolescence. SV prevention programs could use early initiation of substance use to identify adolescents who are at increased risk for SV and provide them with targeted interventions. To be more effective, primary prevention of SV may need to begin targeting substance use in early adolescence.


Assuntos
Comportamento do Adolescente , Vítimas de Crime , Delitos Sexuais , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Feminino , Humanos , Assunção de Riscos , Comportamento Sexual , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
3.
PLoS One ; 8(9): e73574, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24039987

RESUMO

BACKGROUND: While behavioral factors such as early age of sexual debut, inconsistent use of condoms and multiple sexual partners have been studied in Africa, less is known about how characteristics such as impulsivity and externalizing behaviors relate to HIV-related sexual risk-taking in that region. The purpose of this study was to develop a culturally adapted behavioral disinhibition index in a sample of adolescents and young adults in Malawi. We then sought to examine the relationship between the index and sexual risk behavior as measured by multiple sexual partners and number of lifetime sexual partners. METHODS: Cross-sectional data were collected from 2342 participants in rural Malawi aged 15 to 29 years. We constructed a disinhibitory behavior score (DBS) using questions assessing disinhibitory behaviors. Bivariate analyses were conducted to assess the relationships among the individual DBS component behaviors. We utilized multivariable logistic regression to determine the association of the DBS with multiple sexual partners, and negative binomial regression to model the relationship between the DBS and number of lifetime sexual partners. FINDINGS: Nearly all the DBS component behaviors were significantly associated in the bivariate analyses. The DBS was associated with having multiple sexual partners (OR 1.97; 95% CI 1.57-2.48) in the multivariable logistic regression analysis. Further, negative binomial regression results demonstrated that the DBS was associated with an increased number of lifetime sexual partners (OR 1.11; 95% CI 1.07-1.16). CONCLUSIONS: HIV preventive programs in Africa should take into consideration disinhibitory behaviors that may be associated with sexual risk-taking. The DBS can be used as a simple tool to identify those who may be more likely to engage in these behaviors and provide useful information regarding which groups of individuals particularly need to be targeted for behavior change interventions.


Assuntos
Assunção de Riscos , Comportamento Sexual , Adolescente , Comportamento do Adolescente , Adulto , Estudos Transversais , Feminino , Infecções por HIV/etiologia , Humanos , Malaui , Masculino , Parceiros Sexuais , Adulto Jovem
4.
J Adolesc Health ; 53(2): 215-21, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23587785

RESUMO

PURPOSE: Although a number of studies have demonstrated an association between alcohol use frequency and sexual risk behavior, few have used longitudinal data. This study examined alcohol use frequency in adolescence as a predictor of HIV sexual risk behavior in adulthood. METHODS: We collected data among 1,368 participants in Colorado. During adolescence (time 1), respondents were asked about the frequency of using alcohol during the previous 12 months. In adulthood (time 2), the same respondents were asked about their sexual risk behavior during the previous 12 months. Sexual risk behavior items were used to construct an index, which was categorized to indicate low-, medium-, and high-risk study participants. The relationship between alcohol use patterns and risky sexual behavior was modeled using ordinal regression. RESULTS: Compared with individuals who drank no alcohol in the past 12 months at time 1, the odds of being in a higher risk group of sexual behavior as opposed to a lower one at time 2 were 1.56 (95% CI, 1.04-2.35) among those who drank 6-19 times. Similarly, the odds of being in a higher risk group relative to a lower one among those who drank ≥20 times or were 1.78 (95% CI, 1.05-3.02). CONCLUSIONS: Alcohol use patterns in adolescence may be useful markers for programs that aim to prevent risky sexual behavior. Based on alcohol intake patterns, it may be possible to identify frequent alcohol users that need to be targeted with appropriate alcohol use and HIV risk reduction messages.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Infecções por HIV/transmissão , Assunção de Riscos , Comportamento Sexual/psicologia , Adolescente , Adulto , Colorado , Feminino , Humanos , Estudos Longitudinais , Inquéritos e Questionários
5.
BMC Public Health ; 10: 556, 2010 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-20849580

RESUMO

BACKGROUND: Many public health researchers conducting studies in resource-constrained settings have experienced negative 'rumours' about their work; in some cases they have been reported to create serious challenges and derail studies. However, what may appear superficially as 'gossip' or 'rumours' can also be regarded and understood as metaphors which represent local concerns. For researchers unaccustomed to having concerns expressed from participants in this manner, possible reactions can be to be unduly perturbed or conversely dismissive.This paper represents a retrospective examination of a malnutrition study conducted by an international team of researchers in Zambia, Southern Africa. The fears of mothers whose children were involved in the study and some of the concerns which were expressed as rumours are also presented. This paper argues that there is an underlying logic to these anxieties and to dismiss them simply as 'rumours' or 'gossip' would be to overlook the historic and socio-economic factors which have contributed to their production. METHODS: Qualitative interviews were conducted with the mothers whose children were involved in the study and with the research nurses. Twenty five face-to-face interviews and 2 focus group discussions (FGDs) were conducted with mothers. In addition, face-to-face interviews were conducted with research nurses participating in the trial. RESULTS: A prominent anxiety expressed as rumours by the mothers whose children were involved in the study was that recruitment into the trial was an indicator that the child was HIV-infected. Other anxieties included that the trial was a disguise for witchcraft or Satanism and that the children's body parts would be removed and sold. In addition, the liquid, milk-based food given to the children to improve their nutrition was suspected of being insufficiently nutritious, thus worsening their condition.The form which these anxieties took, such as rumours related to the stealing of body parts and other anxieties about a stigmatised condition, provide an insight into the historical, socio-economic and cultural influences in such settings. CONCLUSIONS: Employing strategies to understand local concerns should accompany research aims to achieve optimal success. The concerns raised by the participants we interviewed are not unique to this study. They are produced in countries where the historic, socio-economic and cultural settings communicate anxieties in this format. By examining this study we have shown that by contextualizing these 'rumours', the concerns they express can be constructively addressed and in turn result in the successful conduct of research aims.


Assuntos
Ensaios Clínicos como Assunto , Participação da Comunidade , Enganação , Desnutrição , Ansiedade , Grupos Focais , Humanos , Entrevistas como Assunto , Mães/psicologia , Estudos Retrospectivos , Estereotipagem , Zâmbia
6.
Int J Cardiol ; 134(3): 330-5, 2009 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-19178965

RESUMO

BACKGROUND: Chronic kidney disease (CKD) and diabetes mellitus (DM) are common comorbidities in heart failure (HF) and each is associated with poor outcomes. However, the effects of multimorbidity related to having both CKD and DM compared to CKD alone have not been well studied in a propensity-matched population of chronic HF patients. METHODS: Of the 7788 ambulatory chronic HF patients in the Digitalis Investigation Group trial, 3527 had CKD, of whom 1095 had DM. Based on the absence or presence of DM, patients were categorized CKD-only and CKD-DM, respectively. Propensity scores for CKD-DM were calculated for each patient and were used to match 987 pairs of CKD-only and CKD-DM patients. Hazard ratios (HR) and 95% confidence intervals (CI) comparing CKD-DM patients with CKD-only patients were estimated using matched Cox regression models. RESULTS: All-cause mortality occurred in 47.0% (rate, 1783/10,000 person-years of follow-up) of CKD-DM patients and 39.6% (rate, 1414/10,000 person-years) of CKD-only patients (HR when CKD-DM is compared with CKD-only, 1.25; 95%-CI, 1.07-1.46; p=0.006). All-cause hospitalization occurred in 75.4% (rate, 5710/10,000 person-years) and 67.8% (rate, 4213/10,000 person-years) of CKD-DM and CKD-only patients respectively (HR, 1.32; 95%-CI, 1.15-1.52; p<0.0001). Respective HR and 95%-CI for other outcomes were: cardiovascular mortality (1.27; 1.06-1.52; p=0.009), HF mortality (1.34; 1.04-1.72; p=0.025); cardiovascular hospitalization (1.29; 1.12-1.49; p=0.001) and HF hospitalization (1.37; 1.16-1.63; p<0.0001). CONCLUSIONS: Compared with comorbidity due to CKD alone, multimorbidity with CKD and DM was associated with poor outcomes in chronic HF patients.


Assuntos
Complicações do Diabetes/epidemiologia , Diabetes Mellitus/epidemiologia , Insuficiência Cardíaca/epidemiologia , Falência Renal Crônica/epidemiologia , Idoso , Complicações do Diabetes/fisiopatologia , Diabetes Mellitus/fisiopatologia , Método Duplo-Cego , Feminino , Seguimentos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Morbidade
7.
Am J Cardiol ; 103(1): 88-92, 2009 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-19101236

RESUMO

Diabetes mellitus (DM) and chronic kidney disease (CKD) are common in patients with chronic heart failure (HF) and are associated with poor outcomes. However, the impact of multimorbidity due to DM and CKD on outcomes, relative to co-morbidity due to DM alone, has not been well studied in these patients. Of the 7,788 patients with chronic HF in the Digitalis Investigation Group trial, 2,218 had DM. We categorized these patients into those with DM alone (DM-only n = 1,123) and those with both DM and CKD (DM-CKD n = 1,095). Propensity scores for DM-CKD, calculated for each of the 2,218 patients, were used to match 699 pairs of patients with DM-only or DM-CKD. Matched Cox regression models were used to estimate associations between DM-CKD and outcomes. All-cause mortality occurred in 44% (rate 1,648/10,000 person-years) of patients with DM-CKD and 39% (rate 1,349/10,000 person-years of follow-up) of patients with DM-only (hazard ratio when DM-CKD was compared with DM-only 1.34, 95% confidence interval [CI] 1.11 to 1.62, p = 0.003). All-cause hospitalization occurred in 76% (rate 5,799/10,000 person-years) and 73% (rate 4,909/10,000 person-years) of patients with DM-CKD and DM-only, respectively (hazard ratio 1.16, 95% CI 0.99 to 1.36, p = 0.064). Respective hazard ratios for other outcomes were cardiovascular mortality 1.33 (95% CI 1.07 to 1.66, p = 0.010), HF mortality 1.41 (95% CI 1.02 to 1.96, p = 0.040), cardiovascular hospitalization 1.17 (95% CI 0.99 to 1.39, p = 0.064), and HF hospitalization 1.26 (95% CI 1.03 to 1.55, p = 0.026). In conclusion, compared with co-morbidity due to DM alone, the presence of multimorbidity due to DM and CKD was associated with increased mortality and morbidity in patients with chronic HF.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Complicações do Diabetes/epidemiologia , Insuficiência Cardíaca/epidemiologia , Falência Renal Crônica/epidemiologia , Idoso , Canadá/epidemiologia , Causas de Morte/tendências , Intervalos de Confiança , Complicações do Diabetes/complicações , Feminino , Seguimentos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Razão de Chances , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
8.
Complement Ther Med ; 16(3): 155-62, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18534328

RESUMO

OBJECTIVE: To explore biomedical and traditional health care providers' (BHPs and THPs, respectively) perceptions of good quality of care and opinions on weaknesses in the services they provide to patients with STIs and HIV/AIDS. METHODS: Using data from a cross-sectional survey, we post-coded two open-ended questions related to THPs' and BHPs' perceptions on good quality of care and on provided care. The post-coding was done following Donabedian's framework of assessment of quality of care, and allowed transformation of qualitative data into quantitative. The analysis is based on comparison of frequencies, proportions and subsequent chi-square tests and odds ratios. SETTING: Ndola and Kabwe, Zambia Main measures: Proportions of responses from 152 BHPs and 144 THPs. RESULTS: Substantial proportions of providers from both sectors perceived drugs availability (63% of BHPs and 70% of THPs) and welcoming attitude (73% of BHPs and 64% of THPs) as important components of good quality care. BHPs were more likely than THPs to mention proper examination, medical management (provider's technical ability) and explanation of causes and prognosis of the disease as important. More THPs than BHPs cited short waiting time and cost of care. A majority of BHPs (87%) and of THPs (80%) reported deficiencies in their STIs and HIV/AIDS-related services. Both groups regarded training of providers and nutritional support and health education to patients as lacking. None of the THPs alluded to voluntary counselling and testing (VCT) or supportive/home-based care as aspects needing improvement. CONCLUSION: Drugs availability and welcoming attitude were two aspects of quality highly valued by THPs and BHPs. Future collaborative interventions need to respond to aspects of joint concern including training of providers, nutritional support and health education to patients. Further, there is an imperative of expanding and adapting VCT, home-based care and palliative care to THPs for better care of STIs and HIV/AIDS.


Assuntos
Infecções por HIV/terapia , Serviços de Saúde do Indígena/organização & administração , Medicinas Tradicionais Africanas , Avaliação das Necessidades , Qualidade da Assistência à Saúde , Infecções Sexualmente Transmissíveis/terapia , Síndrome da Imunodeficiência Adquirida/terapia , Atitude do Pessoal de Saúde , Comportamento Cooperativo , Estudos Transversais , Pesquisas sobre Atenção à Saúde , Humanos , Relações Interprofissionais , Zâmbia
9.
Health Policy ; 78(2-3): 330-9, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16290128

RESUMO

Traditional, complementary and alternative medicine (TM/CAM) is globally increasing in popularity. The World Health Organization (WHO) has advocated for the integration of TM/CAM in national public health policies to enhance health care resources. Interest in collaboration between traditional and biomedical health sectors has been renewed in attempts to strengthen control of the AIDS epidemic. However, studies exploring communities' views on the prerequisites for such collaboration are inexistent. We conducted 21 focus group discussions with community members in two Zambian urban centres (Ndola and Kabwe) to explore their perspectives on preconditions for useful collaboration between traditional and modern health workers in the management of STIs and HIV/AIDS. This study shows that laypersons' perspectives can be rich and inform complex policy issues. Five categories indicating key areas of actions were identified, including protection of traditional medicine and of compensation of healers, education of both groups of providers and adequate community involvement. The respect for some degree of secrecy in traditional medicine was also called for. As part of efforts to strengthen available resources for better care of STI/HIV/AIDS, this study provides policymakers, researchers and practitioners with an outline of fundamentals in terms of needed crucial changes at health policy level, among providers and in the community for sustainable collaboration between modern and traditional health practitioners.


Assuntos
Redes Comunitárias/organização & administração , Comportamento Cooperativo , Infecções por HIV/terapia , Medicina Tradicional , Infecções Sexualmente Transmissíveis/terapia , Adolescente , Adulto , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , População Urbana , Zâmbia
10.
Int J STD AIDS ; 15(10): 685-90, 2004 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-15479506

RESUMO

Mother-to-child transmission of HIV (MTCT) is a major contributor to Zambia's HIV burden. Based on our experience in Zambia, we felt that provider perceptions, knowledge base, and practice patterns toward HIV-positive mothers may pose as significant obstacles to preventing MTCT. Two hundred and twenty-five health care providers throughout Zambia were surveyed in 2002. Providers reported widespread stigma associated with HIV. Physicians (OR = 1.9), providers with research affiliations (OR = 2.3), and those located in Lusaka (OR = 9.0) were more likely to offer HIV testing. Only 30% routinely prescribed antiretroviral treatment (ART) to reduce MTCT. Practitioners from district facilities, those from Lusaka, and those employed at research facilities were more likely to prescribe ART routinely (OR = 2.8, 10.1 and 3.4 respectively). Among those never prescribing ART, most cited a lack of availability (83%). Our results highlight the need for further provider education, critical appraisal of the current system for HIV testing, and widespread distribution of ART.


Assuntos
Terapia Antirretroviral de Alta Atividade/estatística & dados numéricos , Atitude do Pessoal de Saúde , Infecções por HIV/transmissão , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Complicações Infecciosas na Gravidez , Adulto , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Pesquisas sobre Atenção à Saúde , Humanos , Recém-Nascido , Masculino , Programas de Rastreamento , Centros de Saúde Materno-Infantil , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Inquéritos e Questionários , Zâmbia/epidemiologia
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