19 results on '"Abo Kouame"'
Search Results
2. Bayesian Estimation of MSM Population Size in Côte d’Ivoire
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Abhirup Datta, Wenyi Lin, Amrita Rao, Daouda Diouf, Abo Kouame, Jessie K. Edwards, Le Bao, Thomas A. Louis, and Stefan Baral
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aids ,bayesian model ,côte d’ivoire ,hiv ,msm population ,small area estimation ,Political institutions and public administration (General) ,JF20-2112 ,Probabilities. Mathematical statistics ,QA273-280 - Abstract
Côte d’Ivoire has among the most generalized HIV epidemics in West Africa with an estimated half million people living with HIV. Across West Africa, key populations, including gay men and other men who have sex with men (MSM), are often disproportionately burdened with HIV due to specific acquisition and transmission risks. Quantifying population sizes of MSM at the subnational level is critical to ensuring evidence-based decisions regarding the scale and content of HIV prevention interventions. While survey-based direct estimates of MSM numbers are available in a few urban centers across Côte d’Ivoire, no data on MSM population size exists in other areas without any community group infrastructure to facilitate sufficient access to communities of MSM. The data are used in a Bayesian regression setup to produce estimates of the numbers of MSM in areas of Côte d’Ivoire prioritized in the HIV response. Our hierarchical model imputes missing covariates using geo-spatial information and allows for proper uncertainty quantification leading to confidence bounds for predicted MSM population size estimates. This process provided population size estimates where there are no empirical data, to guide the prioritization of further collection of empirical data on MSM and inform evidence-based scaling of HIV prevention and treatment programs for MSM across Côte d’Ivoire.
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- 2019
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3. Effect of isoniazid preventive therapy on risk of death in west African, HIV-infected adults with high CD4 cell counts: long-term follow-up of the Temprano ANRS 12136 trial
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Anani Badje, MPH, Raoul Moh, PhD, Delphine Gabillard, MSc, Calixte Guéhi, PhD, Mathieu Kabran, PharmD, Jean-Baptiste Ntakpé, MPH, Jérôme Le Carrou, PhD, Gérard M Kouame, MPH, Eric Ouattara, PhD, Eugène Messou, PhD, Amani Anzian, MD, Albert Minga, PhD, Joachim Gnokoro, MD, Patrice Gouesse, MD, Arlette Emieme, PharmD, Thomas-d'Aquin Toni, PhD, Cyprien Rabe, MD, Baba Sidibé, MD, Gustave Nzunetu, MD, Lambert Dohoun, MD, Abo Yao, MPH, Synali Kamagate, MD, Solange Amon, MD, Amadou-Barenson Kouame, MD, Aboli Koua, MD, Emmanuel Kouamé, MD, Marcelle Daligou, MD, Denise Hawerlander, MD, Simplice Ackoundzé, MD, Serge Koule, MD, Jonas Séri, MD, Alex Ani, MD, Fassery Dembélé, MD, Fatoumata Koné, MD, Mykayila Oyebi, MD, Nathalie Mbakop, MD, Oyewole Makaila, MD, Carolle Babatunde, MD, Nathaniel Babatunde, MD, Gisèle Bleoué, MD, Mireille Tchoutedjem, MD, Alain-Claude Kouadio, MD, Ghislaine Sena, MD, Sahinou-Yediga Yededji, MD, Sophie Karcher, MSc, Prof Christine Rouzioux, PhD, Abo Kouame, MD, Rodrigue Assi, MD, Alima Bakayoko, MD, Prof Serge K Domoua, PhD, Nina Deschamps, MPH, Prof Kakou Aka, MD, Prof Thérèse N'Dri-Yoman, MD, Prof Roger Salamon, PhD, Valérie Journot, PhD, Prof Hughes Ahibo, PhD, Prof Timothée Ouassa, PhD, Prof Hervé Menan, PhD, Prof André Inwoley, PhD, Christine Danel, PhD, Prof Serge P Eholié, PhD, Dr Xavier Anglaret, PhD, Anani Badje, Raoul Moh, Delphine Gabillard, Calixte Guéhi, Mathieu Kabran, Jean-Baptiste Ntakpé, Jérôme Le Carrou, Gérard-Menan Kouame, Eric Ouattara, Eugène Messou, Amani Anzian, Albert Minga, Joachim Gnokoro, Patrice Gouesse, Arlette Emieme, Thomas-d'Aquin Toni, Cyprien Rabe, Baba Sidibé, Gustave Nzunetu, Lambert Dohoun, Yao Abo, Synali Kamagate, Solange Amon, Amadou-Barenson Kouame, Aboli Koua, Emmanuel Kouamé, Marcelle Daligou, Denise Hawerlander, Simplice Ackoundzé, Serge Koule, Jonas Séri, Alex Ani, Fassery Dembélé, Fatoumata Koné, Mykayila Oyebi, Nathalie Mbakop, Oyewole Makaila, Carolle Babatunde, Nathaniel Babatunde, Gisèle Bleoué, Mireille Tchoutedjem, Alain-Claude Kouadio, Ghislaine Sena, Sahinou-Yediga Yededji, Sophie Karcher, Christine Rouzioux, Abo Kouame, Rodrigue Assi, Alima Bakayoko, Serge-K. Domoua, Nina Deschamps, Kakou Aka, Thérèse N'Dri-Yoman, Roger Salamon, Valérie Journot, Hughes Ahibo, Timothée Ouassa, Hervé Ménan, André Inwoley, Ben-Ahoussi Ndja, Blandine Adou, Constance Kanga, Eba Aoussi, Emmanuel Bissagnene, Olivier Ba-Gomis, Yves-Alain Zike, Claude Akakpo, Madeleine Sassan-Morokro, Max Mobio, Bamba Doféré, Koman Mesmin, Alain Attia, Alassane Mahassadi, Apollinaire Horo, Armel Oussou, Marie-Laure Chaix, Gilles Peytavin, Mariatou Koné, Kouamé N'Guessan, Raïmi Fassassi, Serge Niangoran, Annabel Desgrées-du-Loû, France Lert, Rosemary Dray Spira, Kevin Jean, Romuald Konan, Franck Bohoussou, Cyril Yao-Yapi, Larissa N'guessan-Koffi, Bertine Siloué, Adoulaye Cissé, Adrienne Aboua, Sylvie Konan, Antoine Kouamé, Celestin N'Chot, Elvis Amani, Gwenaëlle Clouet, Bruno Debono, Geneviève Chêne, Mireille Dosso, Pierre-Marie Girard, Vincent Jarlier, Jean-Marie Masumbuko, Christian Perronne, Papa-Salif Sow, Christine Danel, Serge-Paul Eholié, and Xavier Anglaret
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Public aspects of medicine ,RA1-1270 - Abstract
Background: Temprano ANRS 12136 was a factorial 2 × 2 trial that assessed the benefits of early antiretroviral therapy (ART; ie, in patients who had not reached the CD4 cell count threshold used to recommend starting ART, as per the WHO guidelines that were the standard during the study period) and 6-month isoniazid preventive therapy (IPT) in HIV-infected adults in Côte d'Ivoire. Early ART and IPT were shown to independently reduce the risk of severe morbidity at 30 months. Here, we present the efficacy of IPT in reducing mortality from the long-term follow-up of Temprano. Methods: For Temprano, participants were randomly assigned to four groups (deferred ART, deferred ART plus IPT, early ART, or early ART plus IPT). Participants who completed the trial follow-up were invited to participate in a post-trial phase. The primary post-trial phase endpoint was death, as analysed by the intention-to-treat principle. We used Cox proportional models to compare all-cause mortality between the IPT and no IPT strategies from inclusion in Temprano to the end of the follow-up period. Findings: Between March 18, 2008, and Jan 5, 2015, 2056 patients (mean baseline CD4 count 477 cells per μL) were followed up for 9404 patient-years (Temprano 4757; post-trial phase 4647). The median follow-up time was 4·9 years (IQR 3·3–5·8). 86 deaths were recorded (Temprano 47 deaths; post-trial phase 39 deaths), of which 34 were in patients randomly assigned IPT (6-year probability 4·1%, 95% CI 2·9–5·7) and 52 were in those randomly assigned no IPT (6·9%, 5·1–9·2). The hazard ratio of death in patients who had IPT compared with those who did not have IPT was 0·63 (95% CI, 0·41 to 0·97) after adjusting for the ART strategy (early vs deferred), and 0·61 (0·39–0·94) after adjustment for the ART strategy, baseline CD4 cell count, and other key characteristics. There was no evidence for statistical interaction between IPT and ART (pinteraction=0·77) or between IPT and time (pinteraction=0·94) on mortality. Interpretation: In Côte d'Ivoire, where the incidence of tuberculosis was last reported as 159 per 100 000 people, 6 months of IPT has a durable protective effect in reducing mortality in HIV-infected people, even in people with high CD4 cell counts and who have started ART. Funding: National Research Agency on AIDS and Viral Hepatitis (ANRS).
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- 2017
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4. HIV prevalence and behavioral and psychosocial factors among transgender women and cisgender men who have sex with men in 8 African countries: A cross-sectional analysis.
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Tonia Poteat, Benjamin Ackerman, Daouda Diouf, Nuha Ceesay, Tampose Mothopeng, Ky-Zerbo Odette, Seni Kouanda, Henri Gautier Ouedraogo, Anato Simplice, Abo Kouame, Zandile Mnisi, Gift Trapence, L Leigh Ann van der Merwe, Vicente Jumbe, and Stefan Baral
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Medicine - Abstract
INTRODUCTION:Sub-Saharan Africa bears more than two-thirds of the worldwide burden of HIV; however, data among transgender women from the region are sparse. Transgender women across the world face significant vulnerability to HIV. This analysis aimed to assess HIV prevalence as well as psychosocial and behavioral drivers of HIV infection among transgender women compared with cisgender (non-transgender) men who have sex with men (cis-MSM) in 8 sub-Saharan African countries. METHODS AND FINDINGS:Respondent-driven sampling targeted cis-MSM for enrollment. Data collection took place at 14 sites across 8 countries: Burkina Faso (January-August 2013), Côte d'Ivoire (March 2015-February 2016), The Gambia (July-December 2011), Lesotho (February-September 2014), Malawi (July 2011-March 2012), Senegal (February-November 2015), Swaziland (August-December 2011), and Togo (January-June 2013). Surveys gathered information on sexual orientation, gender identity, stigma, mental health, sexual behavior, and HIV testing. Rapid tests for HIV were conducted. Data were merged, and mixed effects logistic regression models were used to estimate relationships between gender identity and HIV infection. Among 4,586 participants assigned male sex at birth, 937 (20%) identified as transgender or female, and 3,649 were cis-MSM. The mean age of study participants was approximately 24 years, with no difference between transgender participants and cis-MSM. Compared to cis-MSM participants, transgender women were more likely to experience family exclusion (odds ratio [OR] 1.75, 95% CI 1.42-2.16, p < 0.001), rape (OR 1.95, 95% CI 1.63-2.36, p < 0.001), and depressive symptoms (OR 1.30, 95% CI 1.12-1.52, p < 0.001). Transgender women were more likely to report condomless receptive anal sex in the prior 12 months (OR 2.44, 95% CI 2.05-2.90, p < 0.001) and to be currently living with HIV (OR 1.81, 95% CI 1.49-2.19, p < 0.001). Overall HIV prevalence was 25% (235/926) in transgender women and 14% (505/3,594) in cis-MSM. When adjusted for age, condomless receptive anal sex, depression, interpersonal stigma, law enforcement stigma, and violence, and the interaction of gender with condomless receptive anal sex, the odds of HIV infection for transgender women were 2.2 times greater than the odds for cis-MSM (95% CI 1.65-2.87, p < 0.001). Limitations of the study included sampling strategies tailored for cis-MSM and merging of datasets with non-identical survey instruments. CONCLUSIONS:In this study in sub-Saharan Africa, we found that HIV burden and stigma differed between transgender women and cis-MSM, indicating a need to address gender diversity within HIV research and programs.
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- 2017
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5. Characterizing social cohesion and gender identity as risk determinants of HIV among cisgender men who have sex with men and transgender women in Côte d’Ivoire
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Fatou Maria Drame, Stefan Baral, Ibrahima Ba, Daouda Diouf, Benjamin Liestman, Carrie Lyons, Amara Bamba, Alexander Moran, Abo Kouame, Rebecca Ezouatchi, Ayden I. Scheim, and Sosthenes Ketende
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Adult ,Male ,Epidemiology ,Sexual Behavior ,Social Stigma ,Population ,Human immunodeficiency virus (HIV) ,HIV Infections ,medicine.disease_cause ,Logistic regression ,Risk Assessment ,Transgender Persons ,01 natural sciences ,Article ,Transgender women ,Odds ,Men who have sex with men ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Transgender ,Prevalence ,Humans ,Medicine ,030212 general & internal medicine ,Homosexuality, Male ,0101 mathematics ,education ,education.field_of_study ,Gender identity ,business.industry ,010102 general mathematics ,virus diseases ,Cote d'Ivoire ,Cross-Sectional Studies ,Social Capital ,Female ,business ,Transsexualism ,Demography - Abstract
PURPOSE: HIV prevalence has been previously estimated among cisgender men who have sex with men (MSM) in Côte d’Ivoire; however, limited data exist relating to the role of social cohesion and gender identity within this population. This study aims to examine these factors as risk determinants of HIV among MSM in Côte d’Ivoire. METHODS: We conducted a cross-sectional study using respondent-driven sampling for recruitment with a structured sociobehavioral instrument and testing for HIV. After respondent-driven sampling adjustment, chi-squared tests and bivariate logistic regression and multivariate logistic regression analyses were performed to characterize social and identity-based risk determinants of biologically confirmed prevalent HIV infection. RESULTS: HIV prevalence was 11.2% (n = 146/1301). Transgender woman identity was associated with higher odds of HIV compared with cisgender MSM (aOR = 3.4, 95% CI [2.0–5.8], P < .001). Having a combined social cohesion score of medium (aOR = 0.4, 95% CI [0.2–0.8], P < .01) or high (aOR = 0.2, 95% CI [0.1–0.3], P < .001) was associated with lower odds of HIV compared with a low score. CONCLUSION: These data suggest that social cohesion is a determinant of prevalent HIV infection in Côte d’Ivoire among gay men, other cisgender MSM, and transgender women. The differences in HIV burden and social cohesion between transgender women and cisgender MSM highlight the need to better target the diversity of people traditionally included in the MSM umbrella to ensure comprehensive HIV prevention and treatment interventions.
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- 2020
6. Bayesian Estimation of MSM Population Size in Côte d’Ivoire
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Stefan Baral, Wenyi Lin, Jessie K. Edwards, Abo Kouame, Amrita Rao, Le Bao, Thomas A. Louis, Abhirup Datta, and Daouda Diouf
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Public Administration ,Human immunodeficiency virus (HIV) ,Psychological intervention ,hiv ,medicine.disease_cause ,01 natural sciences ,bayesian model ,West africa ,Men who have sex with men ,law.invention ,010104 statistics & probability ,Small area estimation ,0302 clinical medicine ,law ,immune system diseases ,côte d’ivoire ,030212 general & internal medicine ,reproductive and urinary physiology ,education.field_of_study ,Bayes estimator ,Applied Mathematics ,Population size ,1. No poverty ,virus diseases ,3. Good health ,Geography ,Transmission (mechanics) ,Scale (social sciences) ,Statistics, Probability and Uncertainty ,lcsh:Probabilities. Mathematical statistics ,Bayesian linear regression ,aids ,Statistics and Probability ,small area estimation ,Population ,Cote d ivoire ,Bayesian inference ,Article ,03 medical and health sciences ,Acquired immunodeficiency syndrome (AIDS) ,Environmental health ,parasitic diseases ,medicine ,0101 mathematics ,education ,fungi ,medicine.disease ,lcsh:Political institutions and public administration (General) ,msm population ,lcsh:JF20-2112 ,lcsh:QA273-280 ,Demography - Abstract
Côte d’Ivoire has one of the largest HIV epidemics in West Africa with around half million people living with HIV. Key populations like gay men and other men who have sex with men (MSM) are often disproportionately burdened with HIV due to specific acquisition and transmission risks. Quantifying the MSM population sizes at subnational level is critical to improving the HIV prevention interventions. While survey-based direct estimates of MSM numbers are available at a few urban centers in Cˆote d’Ivoire, no data on MSM population size exists at other areas without any community infrastructure to facilitate sufficient access to the MSM community. We use this limited data in a Bayesian regression setup to produce first empirically calculated estimates of the numbers of MSM in all areas of Cˆote d’Ivoire prioritized in the HIV response. Our hierarchical model imputes missing covariates using geospatial information and allows for proper uncertainty quantification leading to meaningful confidence bounds for the predicted MSM population size estimates. The intended impact of this process is to increase uptake and use of high quality, comprehensive epidemiologic and interventional data in program planning. These estimates will help design future surveys and support the planning of the scale and content of HIV prevention and treatment programs for MSM in Cˆote d’Ivoire.
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- 2019
7. Financial burdens of HIV and chronic disease on people living with HIV in Côte d’Ivoire: A cross-sectional out-of-pocket expenditure study
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Stelmach, Rachel D., primary, Rabkin, Miriam, additional, Abo, Kouame, additional, Ahoba, Irma, additional, Gildas Anago, Mahena, additional, Boccanera, Rodrigo, additional, Brou, Hermann, additional, Flueckiger, Rebecca, additional, Hartsough, Kieran, additional, Msukwa, Martin, additional, Zech, Jennifer, additional, Young, Felicity, additional, and Nugent, Rachel, additional
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- 2021
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8. High HIV Prevalence and Low HIV-Service Engagement Among Young Women Who Sell Sex: A Pooled Analysis Across 9 Sub-Saharan African Countries
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Seni Kouanda, Harry Hausler, Vincent Palokinam Pitche, Anato Simplice, Nancy Phaswana-Mafuya, Daouda Diouf, Ghislaine Fouda, Abo Kouame, Tampose Mothopeng, Sharmistha Mishra, Sheree Schwartz, Katherine B. Rucinski, Stefan Baral, Bai Cham, Sindy Matse, Ubald Tamoufe, and 31228550 - Phaswana-Mafuya, M. Nancy
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medicine.medical_specialty ,Adolescent ,Service delivery framework ,Girls ,Health care utilization ,Human immunodeficiency virus (HIV) ,HIV Infections ,030312 virology ,medicine.disease_cause ,03 medical and health sciences ,Young Adult ,Epidemiology ,medicine ,Prevalence ,Humans ,Pharmacology (medical) ,Women ,Generalized estimating equation ,Africa South of the Sahara ,Sex work ,0303 health sciences ,Sex Workers ,Sub-Saharan Africa ,business.industry ,HIV ,Patient Acceptance of Health Care ,Hiv prevalence ,Confidence interval ,Infectious Diseases ,Respondent ,Female ,business ,Demography - Abstract
Background: Epidemiological data are needed to characterize the age-specific HIV burden and engagement in HIV services among young, marginalized women in sub-Saharan Africa. Setting: Women aged ≥18 years who reported selling sex were recruited across 9 countries in Southern, Central, and West Africa through respondent driven sampling (N = 6592). Methods: Individual-level data were pooled and age-specific HIV prevalence and antiretroviral therapy (ART) coverage were estimated for each region using generalized linear mixed models. HIV-service engagement outcomes (prior HIV testing, HIV status awareness, and ART use) were compared among women living with HIV across age strata (18–19, 20–24, and ≥25 years) using generalized estimating equations. Results: By age 18%–19%, 45.4% [95% confidence interval (CI): 37.9 to 53.0], 5.8% (95% CI: 4.3 to 7.8), and 4.0% (95% CI: 2.9 to 5.4) of young women who sell sex were living with HIV in Southern, Central, and West Africa respectively. Prevalence sharply increased during early adulthood in all regions, but ART coverage was suboptimal across age groups. Compared with adult women ≥25, young women aged 18–19 were less likely to have previously tested for HIV [prevalence ratio (PR) 0.76; 95% CI: 0.72 to 0.80], less likely to already be aware of their HIV status (PR 0.48; 95% CI: 0.35 to 0.64), and less likely to be taking ART (PR 0.67; 95% CI: 0.59 to 0.75). Conclusions: HIV prevalence was already high by age 18–19 in this pooled analysis, demonstrating the need for prevention efforts that reach women who sell sex early in their adolescence. ART coverage remained low, with women in the youngest age group the least engaged in HIV-related services. Addressing barriers to HIV service delivery among young women who sell sex is central to a comprehensive HIV response
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- 2020
9. The role of sex work laws and stigmas in increasing HIV risks among sex workers
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Daouda Diouf, Stefan Baral, Carrie Lyons, Tampose Mothopeng, Sarah M. Murray, Fatou Maria Drame, Bai Cham, Sheree Schwartz, Anato Simplice, Zandile Mnisi, Kate Shannon, Mamadú Aliu Djaló, Ubald Tamoufe, Nancy Phaswana-Mafuya, Seni Kouanda, Abo Kouame, and 31228550 - Phaswana-Mafuya, M. Nancy
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0301 basic medicine ,Adult ,medicine.medical_specialty ,Adolescent ,Epidemiology ,Science ,Human immunodeficiency virus (HIV) ,General Physics and Astronomy ,Sex workers ,Stigma (botany) ,HIV Infections ,medicine.disease_cause ,General Biochemistry, Genetics and Molecular Biology ,Article ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,5. Gender equality ,Surveys and Questionnaires ,medicine ,Prevalence ,Humans ,030212 general & internal medicine ,Young adult ,lcsh:Science ,10. No inequality ,Africa South of the Sahara ,Sex work ,Multidisciplinary ,Sex Workers ,Incidence (epidemiology) ,Incidence ,1. No poverty ,Hiv incidence ,virus diseases ,General Chemistry ,16. Peace & justice ,030112 virology ,Sex Work ,3. Good health ,Risk factors ,Law ,lcsh:Q ,Female ,Psychology ,HIV infections - Abstract
Globally HIV incidence is slowing, however HIV epidemics among sex workers are stable or increasing in many settings. While laws governing sex work are considered structural determinants of HIV, individual-level data assessing this relationship are limited. In this study, individual-level data are used to assess the relationships of sex work laws and stigmas in increasing HIV risk among female sex workers, and examine the mechanisms by which stigma affects HIV across diverse legal contexts in countries across sub-Saharan Africa. Interviewer-administered socio-behavioral questionnaires and biological testing were conducted with 7259 female sex workers between 2011–2018 across 10 sub-Saharan African countries. These data suggest that increasingly punitive and non-protective laws are associated with prevalent HIV infection and that stigmas and sex work laws may synergistically increase HIV risks. Taken together, these data highlight the fundamental role of evidence-based and human-rights affirming policies towards sex work as part of an effective HIV response., HIV incidence among sex workers remains high in many settings. Here, the authors utilize individual-level data across ten countries in sub-Saharan Africa and suggest that increasingly punitive and non-protective laws are associated with HIV, and that stigmas and sex work laws may operate jointly in increasing HIV risk.
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- 2020
10. Physical and Sexual Violence Affecting Female Sex Workers in Abidjan, Côte d'Ivoire: Prevalence, and the Relationship with the Work Environment, HIV, and Access to Health Services
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Kate Shannon, Ashley Grosso, Amara Bamba, Rebecca Ezouatchi, Fatou Maria Drame, Sosthenes Ketende, Daouda Diouf, Ibrahima Ba, Abo Kouame, Stefan Baral, and Carrie Lyons
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Adult ,0301 basic medicine ,Adolescent ,Population ,Poison control ,HIV Infections ,Risk Assessment ,Article ,Health Services Accessibility ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Environmental health ,Prevalence ,Humans ,Mass Screening ,Medicine ,Pharmacology (medical) ,030212 general & internal medicine ,education ,Sex work ,Reproductive health ,education.field_of_study ,Sex Workers ,Sexual violence ,business.industry ,Sex Offenses ,Middle Aged ,030112 virology ,Cote d'Ivoire ,Infectious Diseases ,Physical abuse ,Physical Abuse ,Sexual abuse ,Female ,Sex offense ,business - Abstract
Violence is a human rights violation, and an important measure in understanding HIV among female sex workers (FSW). However, limited data exist regarding correlates of violence among FSW in Cote d'Ivoire. Characterizing prevalence and determinants of violence and the relationship with structural risks for HIV can inform development and implementation of comprehensive HIV prevention and treatment programs. FSW > 18 years were recruited through respondent driven sampling (RDS) in Abidjan, Cote d'Ivoire. In total, 466 participants completed a socio-behavioral questionnaire and HIV testing. Prevalence estimates of violence were calculated using crude and RDS-adjusted estimates. Relationships between structural risk factors and violence were analyzed using χ tests and multivariable logistic regression. The prevalence of physical violence was 53.6% (250/466), and sexual violence was 43.2% (201/465) among FSW in this study. Police refusal of protection was associated with physical (adjusted Odds Ratio [aOR]: 2.8; 95% confidence interval [CI]: 1.7 to 4.4) and sexual violence (aOR: 3.0; 95% CI: 1.9 to 4.8). Blackmail was associated with physical (aOR: 2.5; 95% CI: 1.5 to 4.2) and sexual violence (aOR: 2.4; 95% CI: 1.5 to 4.0). Physical violence was associated with fear (aOR: 2.2; 95% CI: 1.3 to 3.1) and avoidance of seeking health services (aOR: 2.3; 95% CI: 1.5 to 3.8). Violence is prevalent among FSW in Abidjan and associated with features of the work environment and access to care. These relationships highlight layers of rights violations affecting FSW, underscoring the need for structural interventions and policy reforms to improve work environments, and to address police harassment, stigma, and rights violations to reduce violence and improve access to HIV interventions.
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- 2017
11. Characterizing Cross-Culturally Relevant Metrics of Stigma Among Men Who Have Sex With Men Across 8 Sub-Saharan African Countries and the United States
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Jeremy C. Kane, Jura Augustinavicius, Travis H. Sanchez, Carrie Lyons, Seni Kouanda, Trevor A. Crowell, Fatou Maria Drame, Kevon Mark P. Jackman, Iliassou Mfochive Njindam, Zandile Mnisi, Rebecca G. Nowak, Man Charurat, Tampose Mothopeng, Maria Zlotorzynska, Qian Li Xue, Sarah M. Murray, Abo Kouame, Daouda Diouf, Oluwasolape Olawore, Stefan Baral, Ubald Tamoufe, and Simplice Anato
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Adult ,Cross-Cultural Comparison ,Male ,Sub saharan ,Social stigma ,Adolescent ,Psychometrics ,Epidemiology ,Sexual Behavior ,Social Stigma ,Psychological intervention ,Stigma (botany) ,Black People ,HIV Infections ,Factor structure ,Men who have sex with men ,03 medical and health sciences ,Sexual and Gender Minorities ,Young Adult ,0302 clinical medicine ,Pandemic ,Health care ,Humans ,030212 general & internal medicine ,Africa South of the Sahara ,030505 public health ,business.industry ,Original Contribution ,Middle Aged ,Patient Acceptance of Health Care ,United States ,Benchmarking ,Cross-Sectional Studies ,0305 other medical science ,business ,Psychology ,Factor Analysis, Statistical ,Demography - Abstract
Overcoming stigma affecting gay, bisexual, and other men who have sex with men (MSM) is a foundational element of an effective response to the human immunodeficiency virus (HIV) pandemic. Quantifying the impact of stigma mitigation interventions necessitates improved measurement of stigma for MSM around the world. In this study, we explored the underlying factor structure and psychometric properties of 13 sexual behavior stigma items among 10,396 MSM across 8 sub-Saharan African countries and the United States using cross-sectional data collected between 2012 and 2016. Exploratory factor analyses were used to examine the number and composition of underlying stigma factors. A 3-factor model was found to be an adequate fit in all countries (root mean square error of approximation = 0.02–0.05; comparative fit index/Tucker-Lewis index = 0.97–1.00/0.94–1.00; standardized root mean square residual = 0.04–0.08), consisting of “stigma from family and friends,” “anticipated health-care stigma,” and “general social stigma,” with internal consistency estimates across countries of α = 0.36–0.80, α = 0.72–0.93, and α = 0.51–0.79, respectively. The 3-factor model of sexual behavior stigma cut across social contexts among MSM in the 9 countries. These findings indicate commonalities in sexual behavior stigma affecting MSM across sub-Saharan Africa and the United States, which can facilitate efforts to track progress on global stigma mitigation interventions.
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- 2019
12. The relationship between depression and sexual health service utilization among men who have sex with men (MSM) in Côte d'Ivoire, West Africa
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Ben Liestman, Stefan Baral, Abo Kouame, Amara Bamba, Sosthenes Ketende, Daouda Diouf, Rebecca Ezouatchi, Fatou Maria Drame, Shauna Stahlman, Mark B. Ulanja, and Carrie Lyons
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Adult ,Male ,medicine.medical_specialty ,Sexual health services ,Social stigma ,Epidemiology ,Social Stigma ,HIV Infections ,Men who have sex with men ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Surveys and Questionnaires ,Health care ,Humans ,Medicine ,030212 general & internal medicine ,Homosexuality, Male ,10. No inequality ,Reproductive health ,Depression ,Delivery of Health Care, Integrated ,business.industry ,lcsh:Public aspects of medicine ,030503 health policy & services ,Public health ,Public Health, Environmental and Occupational Health ,Gender ,HIV ,lcsh:RA1-1270 ,Patient Acceptance of Health Care ,Mental health ,Health equity ,Patient Health Questionnaire ,Cote d'Ivoire ,Cross-Sectional Studies ,Cote D’Ivoire ,Sexual Health ,0305 other medical science ,business ,Research Article ,Demography - Abstract
Background In Cote D’Ivoire, there has been limited coverage of evidence-based sexual health services specifically supporting men who have sex with men (MSM). To date, there has been limited study of the determinants of engagement in these services including multiple intersecting stigmas and depression. Methods 1301 MSM aged 18 years and older, were recruited using respondent-driven sampling in Abidjan, Yamoussoukro, Gagnoa and Bouake, Cote d’Ivoire from January 2015 to October 2015. Inclusion criteria included anal sex with another man in the past 12 months were to complete a structured questionnaire including the Patient Health Questionnaire (PHQ)-9 to screen for depression. Chi-Square tests were used to test difference in healthcare utilization across variables, and multiple logistic regression was used to test the association between depression and health care utilization represented by HIV and sexually transmittable infection testing and treatment. Results Depression (aOR:1.40, 95% CI: 1.07–1.84), being aged 25–29 years (aOR:1.84, 95% CI: 1.11–3.03),unemployed (aOR:0.64, 95% CI: 0.42–0.98), being a student (aOR:0.67, 95% CI: 0.48–0.96), being identified as male (aOR:0.44, 95% CI: 0.29–0.67), and identifying as homosexual (aOR:0.74, 95% CI:0.56–0.99) were significantly associated with utilization of sexual health care services in the final multivariable model. Healthcare enacted stigma (aOR: 1.55, 95% CI: 1.03–2.33) was associated with utilizing sexual health care services, but perceived healthcare stigma, social stigma and family stigma were not. Conclusion Given higher levels of depressive symptomatology among those engaging in sexual health care services, this engagement represents an opportunity for service integration which may have synergistic benefits for both sexual and mental health. Moreover, MSM in Cote D’Ivoire who had engaged in sexual health services were more likely to report having experienced health-care enacted stigma. Taken together, these results reinforce the need for stigma mitigation interventions to support sustained engagement in HIV prevention, treatment and care services as a means of reducing health disparities among MSM in Cote d’Ivoire.
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- 2019
13. Sexual behavior stigma and depression among transgender women and cisgender men who have sex with men in Côte d'Ivoire
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Daouda Diouf, Fatou Maria Drame, Carrie Lyons, Stefan Baral, Rebecca Ezouatchi, Abo Kouame, Ibrahima Ba, Benjamin Liestman, Ayden I. Scheim, and Amara Bamba
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Adult ,Male ,Epidemiology ,Sexual Behavior ,Social Stigma ,Psychological intervention ,01 natural sciences ,Transgender Persons ,Transgender women ,Article ,Men who have sex with men ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Transgender ,Prevalence ,Medicine ,Humans ,030212 general & internal medicine ,0101 mathematics ,Homosexuality, Male ,business.industry ,Depression ,010102 general mathematics ,Social Discrimination ,Mental health ,Stigma (anatomy) ,Patient Health Questionnaire ,Cote d'Ivoire ,Cross-Sectional Studies ,Sexual behavior ,Female ,business ,Prejudice ,Demography - Abstract
PURPOSE: Transgender women (TGW) and cisgender men who have sex with men (cisMSM) across sub-Saharan Africa experience health inequalities relative to other adults. Recent research has also revealed health inequalities between these often-conflated groups. Among TGW and cisMSM in Côte d’Ivoire, we sought to determine whether transgender female identity was associated with probable depression, and whether sexual behavior stigma mediated this association. METHODS: In 2015–2016, a cross-sectional respondent-driven sampling survey of adult TGW and cisMSM was conducted across five cities. We conducted a 3-way decomposition of mediation and interaction of gender identity and sexual behavior stigma. Depression was measured by the nine-item Patient Health Questionnaire (PHQ-9). RESULTS: Of 1301 participants, 339 (26.1%) were TGW. The prevalence of probable depression was 22.7% among TGW and 12.2% among cisMSM (p
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- 2018
14. HIV prevalence and behavioral and psychosocial factors among transgender women and cisgender men who have sex with men in 8 African countries: A cross-sectional analysis
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Tampose Mothopeng, Anato Simplice, Abo Kouame, Nuha Ceesay, Gift Trapence, Henri Gautier Ouedraogo, Stefan Baral, Vicente Jumbe, Seni Kouanda, Daouda Diouf, L Leigh Ann van der Merwe, Tonia Poteat, Benjamin Ackerman, Ky Zerbo Odette, and Zandile Mnisi
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RNA viruses ,Male ,Social stigma ,Epidemiology ,Cross-sectional study ,Social Stigma ,lcsh:Medicine ,HIV Infections ,Pathology and Laboratory Medicine ,Men who have sex with men ,Geographical Locations ,Sexual and Gender Minorities ,0302 clinical medicine ,Immunodeficiency Viruses ,5. Gender equality ,Risk Factors ,Transgender ,Prevalence ,Medicine ,030212 general & internal medicine ,10. No inequality ,HIV diagnosis and management ,General Medicine ,Middle Aged ,16. Peace & justice ,3. Good health ,HIV epidemiology ,Medical Microbiology ,Viral Pathogens ,Viruses ,Infectious diseases ,Female ,Pathogens ,0305 other medical science ,Psychosocial ,Research Article ,Adult ,medicine.medical_specialty ,Adolescent ,Anti-HIV Agents ,Sexual Behavior ,HIV prevention ,Men WHO Have Sex with Men ,Viral diseases ,Microbiology ,Transgender Persons ,03 medical and health sciences ,Retroviruses ,Humans ,Homosexuality, Male ,Microbial Pathogens ,Africa South of the Sahara ,Medicine and health sciences ,Preventive medicine ,Gynecology ,Psychological and Psychosocial Issues ,030505 public health ,business.industry ,Lentivirus ,lcsh:R ,Organisms ,Biology and Life Sciences ,HIV ,Odds ratio ,Mental health ,Health Surveys ,Diagnostic medicine ,Health Care ,Public and occupational health ,Cross-Sectional Studies ,People and Places ,Africa ,Sexual orientation ,Population Groupings ,Pre-Exposure Prophylaxis ,business ,Sexuality Groupings ,Demography - Abstract
Introduction Sub-Saharan Africa bears more than two-thirds of the worldwide burden of HIV; however, data among transgender women from the region are sparse. Transgender women across the world face significant vulnerability to HIV. This analysis aimed to assess HIV prevalence as well as psychosocial and behavioral drivers of HIV infection among transgender women compared with cisgender (non-transgender) men who have sex with men (cis-MSM) in 8 sub-Saharan African countries. Methods and findings Respondent-driven sampling targeted cis-MSM for enrollment. Data collection took place at 14 sites across 8 countries: Burkina Faso (January–August 2013), Côte d’Ivoire (March 2015–February 2016), The Gambia (July–December 2011), Lesotho (February–September 2014), Malawi (July 2011–March 2012), Senegal (February–November 2015), Swaziland (August–December 2011), and Togo (January–June 2013). Surveys gathered information on sexual orientation, gender identity, stigma, mental health, sexual behavior, and HIV testing. Rapid tests for HIV were conducted. Data were merged, and mixed effects logistic regression models were used to estimate relationships between gender identity and HIV infection. Among 4,586 participants assigned male sex at birth, 937 (20%) identified as transgender or female, and 3,649 were cis-MSM. The mean age of study participants was approximately 24 years, with no difference between transgender participants and cis-MSM. Compared to cis-MSM participants, transgender women were more likely to experience family exclusion (odds ratio [OR] 1.75, 95% CI 1.42–2.16, p < 0.001), rape (OR 1.95, 95% CI 1.63–2.36, p < 0.001), and depressive symptoms (OR 1.30, 95% CI 1.12–1.52, p < 0.001). Transgender women were more likely to report condomless receptive anal sex in the prior 12 months (OR 2.44, 95% CI 2.05–2.90, p < 0.001) and to be currently living with HIV (OR 1.81, 95% CI 1.49–2.19, p < 0.001). Overall HIV prevalence was 25% (235/926) in transgender women and 14% (505/3,594) in cis-MSM. When adjusted for age, condomless receptive anal sex, depression, interpersonal stigma, law enforcement stigma, and violence, and the interaction of gender with condomless receptive anal sex, the odds of HIV infection for transgender women were 2.2 times greater than the odds for cis-MSM (95% CI 1.65–2.87, p < 0.001). Limitations of the study included sampling strategies tailored for cis-MSM and merging of datasets with non-identical survey instruments. Conclusions In this study in sub-Saharan Africa, we found that HIV burden and stigma differed between transgender women and cis-MSM, indicating a need to address gender diversity within HIV research and programs., In a cross-sectional analysis of data from African countries, Tonia Poteat and colleagues report on risk factors for infection and HIV prevalence in transgender women and men who have sex with men., Author summary Why was this study done? Sub-Saharan Africa includes countries with the most broadly generalized HIV epidemics. Transgender women have unmet HIV prevention and treatment needs around the world; however, study of their specific needs across sub-Saharan Africa has been limited. What did the researchers do and find? We merged HIV test results and survey data from studies initially focused on gay men and other men who have sex with men (MSM) in 8 countries in sub-Saharan Africa, then specifically assessed transgender women separately from cisgender MSM. We identified 937 transgender women among the total sample of 4,586 individuals. We found that transgender women were more likely than cisgender MSM to test positive for HIV as well as report experiences of stigma, depressive symptoms, and condomless sex. What do these findings mean? Gender identities are as complex across sub-Saharan Africa as they are in other regions. These data highlight the limitations of an essentialist gender binary framework for HIV prevention and treatment programs in sub-Saharan Africa. Advancing HIV prevention and treatment in sub-Saharan Africa necessitates specifically studying the appropriate content and implementation of programs that reach transgender women.
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- 2017
15. Characterizing the HIV risks and potential pathways to HIV infection among transgender women in Côte d'Ivoire, Togo and Burkina Faso
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Benjamin Liestman, Seni Kouanda, Sosthenes Ketende, Daouda Diouf, Amara Bamba, Shauna Stahlman, Jules Tchalla, Fatou Maria Drame, Odette Ky-Zerbo, Marcel Lougue, Stefan Baral, Simplice Anato, Rebecca Ezouatchi, and Abo Kouame
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sub-Saharan Africa ,Male ,Safe Sex ,Social Stigma ,Psychological intervention ,HIV Infections ,structural equation modelling ,law.invention ,Men who have sex with men ,0302 clinical medicine ,law ,Risk Factors ,Transgender ,Prevalence ,sexual risk behaviours ,030212 general & internal medicine ,education.field_of_study ,Infectious Diseases ,Sexual Partners ,Togo ,epidemiology ,Female ,0305 other medical science ,Research Article ,Adult ,medicine.medical_specialty ,transgender women ,Sexual Behavior ,Population ,Transgender Persons ,03 medical and health sciences ,Young Adult ,Acquired immunodeficiency syndrome (AIDS) ,Condom ,Burkina Faso ,medicine ,Humans ,Homosexuality, Male ,education ,Sex work ,Gynecology ,030505 public health ,business.industry ,Public Health, Environmental and Occupational Health ,HIV ,Odds ratio ,medicine.disease ,Sex Work ,Cote d'Ivoire ,stigma ,business ,Demography - Abstract
Introduction: Transgender women are at high risk for the acquisition and transmission of HIV. However, there are limited empiric data characterizing HIV-related risks among transgender women in sub-Saharan Africa. The objective of these analyses is to determine what factors, including sexual behaviour stigma, condom use and engagement in sex work, contribute to risk for HIV infection among transgender women across three West African nations. Methods: Data were collected via respondent-driven sampling from men who have sex with men (MSM) and transgender women during three- to five-month intervals from December 2012 to October 2015 across a total of six study sites in Togo, Burkina Faso and Cote d’Ivoire. During the study visit, participants completed a questionnaire and were tested for HIV. Chi-square tests were used to compare the prevalence of variables of interest between transgender women and MSM. A multilevel generalized structural equation model (GSEM) was used to account for clustering of observations within study sites in the multivariable analysis, as well as to estimate mediated associations between sexual behaviour stigma and HIV infection among transgender women. Results: In total, 2456 participants meeting eligibility criteria were recruited, of which 453 individuals identified as being female/transgender. Transgender women were more likely than MSM to report selling sex to a male partner within the past 12 months ( p< 0.01), to be living with HIV ( p< 0.01) and to report greater levels of sexual behaviour stigma as compared with MSM ( p< 0.05). In the GSEM, sexual behaviour stigma from broader social groups was positively associated with condomless anal sex (adjusted odds ratio (AOR)=1.33, 95% confidence interval (CI)=1.09, 1.62) and with selling sex (AOR=1.23, 95% CI=1.02, 1.50). Stigma from family/friends was also associated with selling sex (AOR=1.42, 95% CI=1.13, 1.79), although no significant associations were identified with prevalent HIV infection. Conclusions: These data suggest that transgender women have distinct behaviours from those of MSM and that stigma perpetuated against transgender women is impacting HIV-related behaviours. Furthermore, given these differences, interventions developed for MSM will likely be less effective among transgender women. This situation necessitates dedicated responses for this population, which has been underserved in the context of both HIV surveillance and existing responses. Keywords: HIV; transgender women; stigma; sub-Saharan Africa; epidemiology; sexual risk behaviours; structural equation modelling. (Published: 17 July 2016) Citation: Stahlman S et al. Journal of the International AIDS Society 2016, 19(Suppl 2) :20774 http://www.jiasociety.org/index.php/jias/article/view/20774 | http://dx.doi.org/10.7448/IAS.19.3.20774
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- 2016
16. Task-sharing with nurses to enhance access to HIV treatment in Côte d'Ivoire
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McNairy, Margaret L., primary, Bashi, Jules B., additional, Chung, Hannah, additional, Wemin, Louise, additional, Lorng, Marie-Nicole Akpro, additional, Brou, Hermann, additional, Nioble, Cyprien, additional, Lokossue, A., additional, Abo, Kouame, additional, Achi, Delphine, additional, Ouattara, Kiyali, additional, Sess, Daniel, additional, Sanogo, Pongathie Adama, additional, Ekra, Alexandre, additional, Ettiegne-Traore, Virginie, additional, Diabate, Conombo J., additional, Abrams, Elaine J., additional, and El-Sadr, Wafaa M., additional
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- 2017
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- View/download PDF
17. An Urgent Need for Integration of Family Planning Services Into HIV Care
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Schwartz, Sheree, primary, Papworth, Erin, additional, Thiam-Niangoin, Marguerite, additional, Abo, Kouame, additional, Drame, Fatou, additional, Diouf, Daouda, additional, Bamba, Amara, additional, Ezouatchi, Rebecca, additional, Tety, Josiane, additional, Grover, Elise, additional, and Baral, Stefan, additional
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- 2015
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18. The relationship between depression and sexual health service utilization among men who have sex with men (MSM) in Côte d'Ivoire, West Africa
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Mark B. Ulanja, Carrie Lyons, Sosthenes Ketende, Shauna Stahlman, Daouda Diouf, Abo Kouamé, Rebecca Ezouatchi, Amara Bamba, Fatou Drame, Ben Liestman, and Stefan Baral
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Depression ,Sexual health services ,Men who have sex with men ,Epidemiology ,Gender ,HIV ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background In Cote D’Ivoire, there has been limited coverage of evidence-based sexual health services specifically supporting men who have sex with men (MSM). To date, there has been limited study of the determinants of engagement in these services including multiple intersecting stigmas and depression. Methods 1301 MSM aged 18 years and older, were recruited using respondent-driven sampling in Abidjan, Yamoussoukro, Gagnoa and Bouake, Cote d’Ivoire from January 2015 to October 2015. Inclusion criteria included anal sex with another man in the past 12 months were to complete a structured questionnaire including the Patient Health Questionnaire (PHQ)-9 to screen for depression. Chi-Square tests were used to test difference in healthcare utilization across variables, and multiple logistic regression was used to test the association between depression and health care utilization represented by HIV and sexually transmittable infection testing and treatment. Results Depression (aOR:1.40, 95% CI: 1.07–1.84), being aged 25–29 years (aOR:1.84, 95% CI: 1.11–3.03),unemployed (aOR:0.64, 95% CI: 0.42–0.98), being a student (aOR:0.67, 95% CI: 0.48–0.96), being identified as male (aOR:0.44, 95% CI: 0.29–0.67), and identifying as homosexual (aOR:0.74, 95% CI:0.56–0.99) were significantly associated with utilization of sexual health care services in the final multivariable model. Healthcare enacted stigma (aOR: 1.55, 95% CI: 1.03–2.33) was associated with utilizing sexual health care services, but perceived healthcare stigma, social stigma and family stigma were not. Conclusion Given higher levels of depressive symptomatology among those engaging in sexual health care services, this engagement represents an opportunity for service integration which may have synergistic benefits for both sexual and mental health. Moreover, MSM in Cote D’Ivoire who had engaged in sexual health services were more likely to report having experienced health-care enacted stigma. Taken together, these results reinforce the need for stigma mitigation interventions to support sustained engagement in HIV prevention, treatment and care services as a means of reducing health disparities among MSM in Cote d’Ivoire.
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- 2019
- Full Text
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19. An urgent need for integration of family planning services into HIV care: the high burden of unplanned pregnancy, termination of pregnancy, and limited contraception use among female sex workers in Côte d'Ivoire.
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Schwartz S, Papworth E, Thiam-Niangoin M, Abo K, Drame F, Diouf D, Bamba A, Ezouatchi R, Tety J, Grover E, and Baral S
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- Adolescent, Adult, Cote d'Ivoire epidemiology, Female, Health Services Accessibility, Humans, Pregnancy, Public Health, Young Adult, Abortion, Induced statistics & numerical data, Contraceptive Agents, Female, HIV Infections prevention & control, Pregnancy, Unplanned, Sex Education
- Abstract
Background: HIV infection and unintended pregnancy are occupational risks of commercial female sex work (FSW). The burden of unintended pregnancy among FSW including maternal and infant outcomes in the context of HIV is largely unknown., Methods: FSW ≥18 years were recruited through respondent driven sampling into a cross-sectional study in Abidjan, Côte d'Ivoire. Participants completed a sociobehavioral questionnaire and HIV counseling and testing. Pregnancy history by HIV status and contraceptive use were described, and Poisson regression used to estimate correlates of termination of pregnancy (TOP)., Results: From March to July 2014, 466 FSW were enrolled. Unintended pregnancy was common, and 64% of participants had ≥1 TOP. Half of FSW experiencing TOPs did so without a medical professional, resulting in frequent complications. Contraceptive use was lowest among younger FSW, and 37% of 20-24 year olds reported multiple TOPs. FSW with a TOP history reported 19% less consistent condom use with clients than women who never had a TOP (adjusted-prevalence ratio, 0.81; 95% confidence interval: 0.74 to 0.88), whereas use of reliable nonbarrier contraceptive methods was comparable between the groups. Although FSW were engaged in HIV testing and prevention services, only 59% of FSW had received HIV testing before childbirth during their last pregnancy, and 30% of HIV-infected FSW had lost ≥1 children., Conclusions: Low contraceptive use and high burden of unintended pregnancy result in poor reproductive outcomes for FSW and avoidable mother-to-child HIV transmission risks. Integration of family planning and antenatal services into HIV prevention and care programs accessed by FSW could enhance reproductive outcomes and HIV prevention goals.
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- 2015
- Full Text
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