12 results on '"Vermund, Sten H."'
Search Results
2. Expanded antiretroviral treatment, sexual networks, and condom use: Treatment as prevention unlikely to succeed without partner reduction among men who have sex with men in China.
- Author
-
Lou, Jie, Hu, Peipei, Qian, Han-Zhu, Ruan, Yuhua, Jin, Zhen, Xing, Hui, Shao, Yiming, and Vermund, Sten H.
- Subjects
ANTIRETROVIRAL agents ,MEN who have sex with men ,SEXUAL partners ,SEX customs ,CONDOMS ,MEDICAL care - Abstract
Background: To project the impact of partner reduction on preventing new HIV infections among men who have sex with men (MSM) under varying conditions of enhanced HIV testing and treatment (T&T) and condom use in Beijing, China. Methods and findings: A complex network model was fitted to predict the number of new HIV infections averted from 2014 to 2023 under four scenarios of sexual behavior risk reduction (S)—: Male sexual partners decrease (reduced by a random value m from 1–50) while condom use increases (risk constant p is a random value between 0.2 and 1]); : Both sexual partners and condom use decrease (m 1, 50; p 1, 1.8); : Sexual partners reduce (m 1, 10) while condom use increases or decreases (p 0.2, 1.8); : Only MSM with ≥100 male sexual partners reduce their partners (m 1, 50) while condom use increases (p 0.2, 1). HIV prevalence will reach 23.2% by 2023 among Beijing MSM if T&T remains at the 2013 level. The three most influential factors are: T&T coverage; partner reduction (m); and the background risk (p). Under scenarios 1–4 of sexual behavioral changes with enhanced T&T interventions, the cumulative HIV new infections prevented over the 10 years will be 46.8% for (interquartile range [IQR] 32.4%, 60.1%); 29.7% for (IQR 18.0%, 41.4%), 23.2% for (IQR 12.2%, 37.0%) and 11.6% for (IQR 4.0%, 26.6%), respectively. The reproduction number R
0 could drop below 1 if there were a substantial reduction of male sexual partners and/or expanded condom use. Conclusion: Partner reduction is a vital factor within HIV combination interventions to reduce HIV incidence among Beijing MSM, with substantial additional benefits derived from condom use. T&T without substantial partner reduction and increased condom use is less promising unless its implementation were extremely (and improbably) efficient. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
3. Antiretroviral Therapy Program Expansion in Zambézia Province, Mozambique: Geospatial Mapping of Community-Based and Health Facility Data for Integrated Health Planning.
- Author
-
Moon, Troy D., Ossemane, Ezequiel B., Green, Ann F., Ndatimana, Elisée, José, Eurico, Buehler, Charlotte P., Wester, C. William, Vermund, Sten H., and Olupona, Omo
- Subjects
ANTIRETROVIRAL agents ,ANTI-HIV agents ,HEALTH planning ,CARTOGRAPHIC services - Abstract
Objective: To generate maps reflecting the intersection of community-based Voluntary Counseling and Testing (VCT) delivery points with facility-based HIV program demographic information collected at the district level in three districts (Ile, Maganja da Costa and Chinde) of Zambézia Province, Mozambique; in order to guide planning decisions about antiretroviral therapy (ART) program expansion. Methods: Program information was harvested from two separate open source databases maintained for community-based VCT and facility-based HIV care and treatment monitoring from October 2011 to September 2012. Maps were created using ArcGIS 10.1. Travel distance by foot within a 10 km radius is generally considered a tolerable distance in Mozambique for purposes of adherence and retention planning. Results: Community-based VCT activities in each of three districts were clustered within geographic proximity to clinics providing ART, within communities with easier transportation access, and/or near the homes of VCT volunteers. Community HIV testing results yielded HIV seropositivity rates in some regions that were incongruent with the Ministry of Health’s estimates for the entire district (2–13% vs. 2% in Ile, 2–54% vs. 11.5% in Maganja da Costa, and 23–43% vs. 14.4% in Chinde). All 3 districts revealed gaps in regional disbursement of community-based VCT activities as well as access to clinics offering ART. Conclusions: Use of geospatial mapping in the context of program planning and monitoring allowed for characterizing the location and size of each district’s HIV population. In extremely resource limited and logistically challenging settings, maps are valuable tools for informing evidence-based decisions in planning program expansion, including ART. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
4. Modeling the Impact on HIV Incidence of Combination Prevention Strategies among Men Who Have Sex with Men in Beijing, China.
- Author
-
Lou, Jie, Blevins, Meridith, Ruan, Yuhua, Vermund, Sten H., Tang, Sanyi, Webb, Glenn F., Shepherd, Bryan E., He, Xiong, Lu, Hongyan, Shao, Yiming, and Qian, Han-Zhu
- Subjects
HIV infections ,HUMAN sexuality ,ANTIRETROVIRAL agents ,MATHEMATICAL models ,SENSITIVITY analysis ,CONDOM use - Abstract
Objective: To project the HIV/AIDS epidemics among men who have sex with men (MSM) under different combinations of HIV testing and linkage to care (TLC) interventions including antiretroviral therapy (ART) in Beijing, China. Design: Mathematical modeling. Methods: Using a mathematical model to fit prevalence estimates from 2000–2010, we projected trends in HIV prevalence and incidence during 2011–2020 under five scenarios: (S1) current intervention levels by averaging 2000–2010 coverage; (S2) increased ART coverage with current TLC; (S3) increased TLC/ART coverage; (S4) increased condom use; and (S5) increased TLC/ART plus increased condom use. Results: The basic reproduction number based upon the current level of interventions is significantly higher than 1 ( confidence interval (CI), 1.83–2.35), suggesting that the HIV epidemic will continue to increase to 2020. Compared to the 2010 prevalence of 7.8%, the projected HIV prevalence in 2020 for the five prevention scenarios will be: (S1) Current coverage: 21.4% (95% CI, 9.9–31.7%); (S2) Increased ART: 19.9% (95% CI, 9.9–28.4%); (S3) Increased TLC/ART: 14.5% (95% CI, 7.0–23.8%); (S4) Increased condom use: 13.0% (95% CI, 9.8–28.4%); and (S5) Increased TLC/ART and condom use: 8.7% (95% CI, 5.4–11.5%). HIV epidemic will continue to rise () for S1–S4 even with hyperbolic coverage in the sensitivity analysis, and is expected to decline () for S5. Conclusion: Our transmission model suggests that Beijing MSM will have a rapidly rising HIV epidemic. Even enhanced levels of TLC/ART will not interrupt epidemic expansion, despite optimistic assumptions for coverage. Promoting condom use is a crucial component of combination interventions. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
5. Educational Intervention Increased Referrals to Allopathic Care by Traditional Healers in Three High HIV-Prevalence Rural Districts in Mozambique.
- Author
-
Audet, Carolyn M., Salato, José, Blevins, Meridith, Amsalem, David, Vermund, Sten H., and Gaspar, Felisbela
- Subjects
ALTERNATIVE medicine ,AIDS treatment ,HIV infections ,DISEASE prevalence ,MEDICAL education ,TRADITIONAL medicine ,SYMPTOMS ,HEALTH facilities ,EPIDEMIOLOGY ,HEALTH outcome assessment - Abstract
Introduction: Delayed uptake of clinical services impedes favorable clinical outcomes in Mozambique. Care is delayed among patients who initiate care with traditional healers; patients with conditions like human immunodeficiency virus (HIV) or tuberculosis are rarely referred to the health system in a timely fashion. Methods: We conducted a pre-post educational intervention with traditional healers, assessing healer referral rates and HIV knowledge in three rural districts in Zambézia Province. Results: The median monthly referral rate prior to the intervention was 0.25 patients (interquartile range [IQR]: 0–0.54) compared with a post-intervention rate of 0.34 patients (IQR: 0–0.71), a 35% increase (p = 0.046). A median HIV knowledge score of 67% (IQR: 59–78) was noted 4-months pre-intervention and a median score of 81% (IQR: 74–89) was recorded 2½ months post-intervention (p<0.001). One hundred and eleven healers referred 127 adults, 36 pregnant women, and 188 children to health facilities. Referred patients were most likely to be diagnosed with bronchopneumonia (20% adults; 13% children) and/or malaria (15% adults; 37% children). Of 315 non-pregnant persons referred, 3.5% were tested for HIV and 2.5% were tested for tuberculosis. Discussion: We engaged traditional healers with some success; referral rates were low, but increased post-intervention. Once seen in the clinics, patients were rarely tested for HIV or tuberculosis, though symptoms suggested screening was indicated. We found increased referral rates through an inexpensive intervention with traditional healers, a viable, cost-effective method of directing patients to health facilities. However, quality improvement within the clinics is necessary before a substantial impact can be expected. [ABSTRACT FROM AUTHOR]
- Published
- 2013
- Full Text
- View/download PDF
6. Attitudes Toward HIV Pre-Exposure Prophylaxis Among Men Who Have Sex with Men in Western China.
- Author
-
Zhang, Yan, Peng, Bin, She, Ying, Liang, Hao, Peng, Hong-Bin, Qian, Han-Zhu, Vermund, Sten H., Zhong, Xiao-Ni, and Huang, Ailong
- Subjects
HIV prevention ,CONFIDENCE intervals ,EPIDEMIOLOGY ,GAY men ,HIV infections ,PATIENT compliance ,QUESTIONNAIRES ,DATA analysis ,DESCRIPTIVE statistics - Abstract
Pre-exposure prophylaxis (PrEP), as demonstrated in recently published clinical trials, is one promising approach for controlling the emerging epidemic among men who have sex with men (MSM). We evaluated the attitudes towards use of PrEP among MSM in western China. A total of 1402 participants completed a self-administered questionnaire. Overall, 22% of the participants reported that they had heard of PrEP, <1% had ever used medicine to prevent HIV, and 64% reported that they were absolutely willing to use PrEP if it were proven to be safe and effective. The predictors of willingness to use PrEP included lower education, moderate income compared with the lowest income, never or rarely finding sexual partners through the Internet in the past 6 months, sexually transmitted infection (STI) history, more knowledge of AIDS, worrying about HIV as a threat to themselves and their family, having previously heard of PrEP, and believing that PrEP was effective in preventing HIV. This study demonstrates that Chinese MSM have moderate awareness of PrEP and a high interest in using it. [ABSTRACT FROM AUTHOR]
- Published
- 2013
- Full Text
- View/download PDF
7. HIV/AIDS-Related Attitudes and Practices Among Traditional Healers in Zambézia Province, Mozambique.
- Author
-
Audet, Carolyn M., Blevins, Meridith, Moon, Troy D., Sidat, Mohsin, Shepherd, Bryan E., Pires, Paulo, Vergara, Alfredo, and Vermund, Sten H.
- Subjects
THERAPEUTICS ,ALTERNATIVE medicine ,ATTITUDE (Psychology) ,CHI-squared test ,CONFIDENCE intervals ,EPIDEMIOLOGY ,HEALERS ,HIV infections ,INTERVIEWING ,RESEARCH methodology ,MEDICAL personnel ,MEDICAL referrals ,MEDICINE ,MULTIVARIATE analysis ,SCIENTIFIC observation ,QUESTIONNAIRES ,RESEARCH funding ,STATISTICS ,QUALITATIVE research ,LOGISTIC regression analysis ,DATA analysis ,QUANTITATIVE research ,INTEGRATIVE medicine ,CROSS-sectional method ,HEALTH literacy ,DATA analysis software ,DESCRIPTIVE statistics - Abstract
Objectives: To document HIV knowledge, treatment practices, and the willingness of traditional healers to engage with the health system in Zambézia Province, Mozambique. Settings/location: Traditional healers offer culturally acceptable services and are more numerous in Mozambique than are allopathic providers. Late presentation of human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) is reported among persons who have first sought care from traditional healers. Design: One hundred and thirty-nine (139) traditional healers were interviewed in their native languages (Chuabo or Lomwe) in Zambézia Province. Furthermore, 24 traditional healers were observed during patient encounters. Healers answered a semistructured questionnaire regarding their knowledge of HIV/AIDS, general treatment practices, attitudes toward the allopathic health system, and their beliefs in their abilities to cure AIDS. Results: Traditional healers were older and had less formal education than the general population. Razor cutting in order to rub herbs into bloodied skin was observed, and healers reported razor cutting as a routine practice. Healers stated that they did not refer HIV patients to clinics for two principal reasons: (1) patient symptoms/signs of HIV were unrecognized, and (2) practitioners believed they could treat the illness effectively themselves. Traditional healers were far more likely to believe in a spiritual than an infectious origin of HIV disease. Prior HIV/AIDS training was not associated with better knowledge or referral practices, though 81% of healers were interested in engaging allopathic providers. Conclusions: It was found that the HIV-related practices of traditional healers probably increase risk for both HIV-infected and uninfected persons through delayed care and reuse of razors. Mozambican traditional healers attribute HIV pathogenesis to spiritual, not infectious, etiologies. Healers who had received prior HIV training were no more knowledgeable, nor did they have better practices. The willingness expressed by 4 in 5 healers to engage local formal health providers in HIV/AIDS care suggests a productive way forward, though educational efforts must be effective and income concerns considered. [ABSTRACT FROM AUTHOR]
- Published
- 2012
- Full Text
- View/download PDF
8. Poor Clinical Outcomes for HIV Infected Children on Antiretroviral Therapy in Rural Mozambique: Need for Program Quality Improvement and Community Engagement.
- Author
-
Vermund, Sten H., Blevins, Meridith, Moon, Troy D., José, Eurico, Moiane, Linda, Tique, José A., Sidat, Mohsin, Ciampa, Philip J., Shepherd, Bryan E., and Vaz, Lara M. E.
- Subjects
- *
AIDS in children , *HIV infections , *SEXUALLY transmitted diseases , *HIV-positive persons - Abstract
Introduction: Residents of Zambézia Province, Mozambique live from rural subsistence farming and fishing. The 2009 provincial HIV prevalence for adults 15–49 years was 12.6%, higher among women (15.3%) than men (8.9%). We reviewed clinical data to assess outcomes for HIV-infected children on combination antiretroviral therapy (cART) in a highly resource-limited setting. Methods: We studied rates of 2-year mortality and loss to follow-up (LTFU) for children <15 years of age initiating cART between June 2006–July 2011 in 10 rural districts. National guidelines define LTFU as >60 days following last-scheduled medication pickup. Kaplan-Meier estimates to compute mortality assumed non-informative censoring. Cumulative LTFU incidence calculations treated death as a competing risk. Results: Of 753 children, 29.0% (95% CI: 24.5, 33.2) were confirmed dead by 2 years and 39.0% (95% CI: 34.8, 42.9) were LTFU with unknown clinical outcomes. The cohort mortality rate was 8.4% (95% CI: 6.3, 10.4) after 90 days on cART and 19.2% (95% CI: 16.0, 22.3) after 365 days. Higher hemoglobin at cART initiation was associated with being alive and on cART at 2 years (alive: 9.3 g/dL vs. dead or LTFU: 8.3–8.4 g/dL, p<0.01). Cotrimoxazole use within 90 days of ART initiation was associated with improved 2-year outcomes Treatment was initiated late (WHO stage III/IV) among 48% of the children with WHO stage recorded in their records. Marked heterogeneity in outcomes by district was noted (p<0.001). Conclusions: We found poor clinical and programmatic outcomes among children taking cART in rural Mozambique. Expanded testing, early infant diagnosis, counseling/support services, case finding, and outreach are insufficiently implemented. Our quality improvement efforts seek to better link pregnancy and HIV services, expand coverage and timeliness of infant diagnosis and treatment, and increase follow-up and adherence. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
9. Co-infection with human immunodeficiency virus and tuberculosis in Asia.
- Author
-
Vermund, Sten H. and Yamamoto, Naoki
- Subjects
TUBERCULOSIS ,HIV infections ,INFECTIOUS disease transmission ,MYCOBACTERIAL diseases - Abstract
Summary: Asia has the highest numbers of tuberculosis cases (60% of the global total) and has experienced a marked rise in HIV seroprevalence (22% of the global total) in key subpopulations of these highly populous nations. Thus, co-infected patients are a challenge for practitioners and public health workers alike. The U.S.–Japan Cooperative Medical Science Program is spearheading interdisciplinary collaborations in Asia to address the many outstanding research priorities for HIV–tuberculosis co-infection. There is an urgency to this agenda for many reasons, including the frequency with which tuberculosis accounts for the death of HIV-infected persons in Asia, and the continued rise of multiple drug-resistant Mycobacterium tuberculosis. We review briefly the public health situation in Asia, highlighting research questions from US–Japan–Asian partner joint meetings, and cite salient studies to indicate trends and challenges. [Copyright &y& Elsevier]
- Published
- 2007
- Full Text
- View/download PDF
10. Expansion of HIV/AIDS in China: Lessons from Yunnan Province
- Author
-
Xiao, Yan, Kristensen, Sibylle, Sun, Jiangping, Lu, Lin, and Vermund, Sten H.
- Subjects
- *
HIV infections , *AIDS , *EPIDEMICS - Abstract
Abstract: In this article we systematically and critically review the Chinese and English language literature on human immunodeficiency virus (HIV)-related studies in Yunnan Province, Southwestern China. Yunnan Province had the first Chinese HIV outbreak and is still the worst affected area in the nation. Since 1989, HIV infection has extended from injecting drug users into the general population through sexual transmission. Since the economic reform of the 1980s, changed social norms and increased migration have spawned increases in HIV-related risk behaviors such as drug use and commercial sex work. A smaller size of “bridge” populations and lower sexual contact rates between persons in “bridge” and general populations may explain the slower expansion of the HIV epidemic in Yunnan compared to nearby Southeast Asian nations. In 2004, women in antenatal care had a 0.38% HIV prevalence province wide, although >1% infection rates are seen in those counties with high injection drug rates. Patterns of drug trafficking have spread the unusual recombinant HIV subtypes first seen in Yunnan to far-flung regions of China. Increased efforts of Yunnan''s HIV control program are correlated with an improved general HIV awareness, but risk behaviors continue at worrisome rates. Future efforts should focus on changing risk behaviors, including harm reduction and condom promotion, especially among the “bridge” groups. The resurgence of commercial sex work in Yunnan, and the high frequency of workers migrating into provinces far from home and family are all sociocultural factors of considerable importance for future HIV and sexually transmitted disease control in China. [Copyright &y& Elsevier]
- Published
- 2007
- Full Text
- View/download PDF
11. Serologic responses to recombinant Pneumocystis jirovecii major surface glycoprotein among Ugandan patients with respiratory symptoms
- Author
-
Laurence Huang, Judith Koch, Kieran R. Daly, J. Lucian Davis, Robert J. Blount, Peter D. Walzer, Alfred Andama, William Worodria, Adithya Cattamanchi, Leah G. Jarlsberg, Kpandja Djawe, and Vermund, Sten H
- Subjects
Male ,HIV opportunistic infections ,Pulmonology ,Epidemiology ,lcsh:Medicine ,HIV Infections ,Global Health ,Pneumocystis carinii ,Immunoglobulin G ,Serology ,Risk Factors ,Uganda ,Hospital Mortality ,Prospective Studies ,lcsh:Science ,Immune Response ,0303 health sciences ,Fungal protein ,Multidisciplinary ,Membrane Glycoproteins ,biology ,Pneumonia, Pneumocystis ,Fungal Diseases ,Middle Aged ,Recombinant Proteins ,3. Good health ,Lower Respiratory Tract Infections ,Infectious Diseases ,Fungal ,HIV/AIDS ,Medicine ,Infectious diseases ,Female ,Antibody ,Infection ,Research Article ,Adult ,Adolescent ,General Science & Technology ,Immunology ,International HIV-Associated Opportunistic Pneumonias (IHOP) Study ,Enzyme-Linked Immunosorbent Assay ,Viral diseases ,Infectious Disease Epidemiology ,Antibodies ,Immunomodulation ,Fungal Proteins ,03 medical and health sciences ,Young Adult ,Immune system ,Antigen ,Clinical Research ,Pneumocystis jirovecii ,Humans ,Immunoassays ,Biology ,Antibodies, Fungal ,030304 developmental biology ,AIDS-Related Opportunistic Infections ,030306 microbiology ,Pneumocystis ,lcsh:R ,Immunity ,Immunoregulation ,HIV ,Pneumonia ,biology.organism_classification ,Virology ,Good Health and Well Being ,Immunoglobulin M ,Respiratory Infections ,biology.protein ,Immunologic Techniques ,Clinical Immunology ,lcsh:Q ,Biomarkers - Abstract
Background: Little is known about the serologic responses to Pneumocystis jirovecii major surface glycoprotein (Msg) antigen in African cohorts, or the IgM responses to Msg in HIV-positive and HIV-negative persons with respiratory symptoms. Methods: We conducted a prospective study of 550 patients, both HIV-positive (n=467) and HIV-negative (n=83), hospitalized with cough $2 weeks in Kampala, Uganda, to evaluate the association between HIV status, CD4 cell count, and other clinical predictors and antibody responses to P. jirovecii. We utilized ELISA to measure the IgM and IgG serologic responses to three overlapping recombinant fragments that span the P. jirovecii major surface glycoprotein: MsgA (amino terminus), MsgB (middle portion) and MsgC1 (carboxyl terminus), and to three variations of MsgC1 (MsgC3, MsgC8 and MsgC9). Results: HIV-positive patients demonstrated significantly lower IgM antibody responses to MsgC1, MsgC3, MsgC8 and MsgC9 compared to HIV-negative patients. We found the same pattern of low IgM antibody responses to MsgC1, MsgC3, MsgC8 and MsgC9 among HIV-positive patients with a CD4 cell count ,200 cells/ml compared to those with a CD4 cell count $200 cells/ml. HIV-positive patients on PCP prophylaxis had significantly lower IgM responses to MsgC3 and MsgC9, and lower IgG responses to MsgA, MsgC1, MsgC3, and MsgC8. In contrast, cigarette smoking was associated with increased IgM antibody responses to MsgC1 and MsgC3 but was not associated with IgG responses. We evaluated IgM and IgG as predictors of mortality. Lower IgM responses to MsgC3 and MsgC8 were both associated with increased in-hospital mortality. Conclusions: HIV infection and degree of immunosuppression are associated with reduced IgM responses to Msg. In addition, low IgM responses to MsgC3 and MsgC8 are associated with increased mortality.
- Published
- 2012
12. Condom negotiations among female sex workers in the Philippines: environmental influences
- Author
-
Donald E. Morisky, Jay G. Silverman, Lianne A. Urada, Steffanie A. Strathdee, Nymia Pimentel-Simbulan, and Vermund, Sten H
- Subjects
Safe Sex ,Viral Diseases ,Non-Clinical Medicine ,Epidemiology ,Philippines ,lcsh:Medicine ,Poison control ,HIV Infections ,Global Health ,Social and Behavioral Sciences ,Social Environment ,law.invention ,Condoms ,0302 clinical medicine ,Unsafe Sex ,Sociology ,law ,Risk Factors ,Medicine ,Psychology ,030212 general & internal medicine ,lcsh:Science ,Reproductive health ,education.field_of_study ,Multidisciplinary ,Negotiating ,Data Collection ,Substance Abuse ,virus diseases ,Justice and Strong Institutions ,Infectious Diseases ,Sexual Partners ,HIV/AIDS ,Female ,Public Health ,0305 other medical science ,Research Article ,Adult ,Adolescent ,General Science & Technology ,Sexual Behavior ,Population ,Context (language use) ,03 medical and health sciences ,Young Adult ,Condom ,Behavioral and Social Science ,Humans ,education ,Sex work ,Peace ,030505 public health ,Sex Workers ,business.industry ,Sex trafficking ,Prevention ,lcsh:R ,HIV ,Sex Work ,Cross-Sectional Studies ,Sexually Transmitted Infections ,Women's Health ,lcsh:Q ,business ,Demography - Abstract
Background Social and structural influences of condom negotiation among female sex workers (FSWs) remain understudied. This study assesses environmental and individual factors associated with condom negotiation among FSWs at high risk for acquiring HIV in a large urban setting of Metro Manila, Philippines. Methods Female bar/spa workers (N = 498), aged 18 and over, underwent interview-led surveys examining their sexual health practices in the context of their risk environments. Data were collected from April 2009-January 2010 from 54 venues. Multiple logistic regressions were conducted to assess socio-behavioral factors (e.g., age, education, length of time employed as an entertainer, and alcohol/drug use) and socio-structural factors (e.g., venue-level peer/manager support, condom rule/availability, and sex trafficking) associated with condom negotiation, adjusting for individuals nested within venues. Results Of 142 FSWs who traded sex in the previous 6 months (included in the analysis), 24% did not typically negotiate condom use with venue patrons. Factors in the physical environment - trafficked/coerced into work (AOR = 12.92, 95% CI = 3.34–49.90), economic environment - sex without a condom to make more money (AOR = 1.52, 95% CI 1.01–2.30), policy environment - sex without a condom because none was available (AOR = 2.58, 95% CI = 1.49–4.48), and individual risk - substance use (AOR = 2.36, 95% CI = 1.28–4.35) were independently associated with FSWs' lack of condom negotiation with venue patrons. Conclusions Factors in the physical, economic, and policy environments, over individual (excepting substance use) and social level factors, were significantly associated with these FSWs' condom negotiations in the Philippines. Drawing upon Rhodes' risk environment framework, these results highlight the need for policies that support safer sex negotiations among sex workers in the context of their risk environments. Interventions should reduce barriers to condom negotiation for FSWs trafficked/coerced into their work, substance using, and impacted by economic conditions and policies that do not support condom availability.
- Published
- 2012
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.