35 results on '"Shangani, Sylvia"'
Search Results
2. Integrating HIV and mental health interventions to address a global syndemic among men who have sex with men
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Operario, Don, Sun, Shufang, Bermudez, Amiel Nazer, Masa, Rainier, Shangani, Sylvia, van der Elst, Elise, and Sanders, Eduard
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- 2022
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3. Sexual Prejudice and Comfort to Provide Services to Men Who Have Sex with Men Among HIV Healthcare Workers in Western Kenya: Role of Interpersonal Contact
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Shangani, Sylvia, Genberg, Becky, Harrison, Abigail, Pellowski, Jennifer, Wachira, Juddy, Naanyu, Violet, and Operario, Don
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- 2022
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4. Community Health Care Providers' Perspectives on Human Immunodeficiency Virus Pre-Exposure Prophylaxis Use Among Black Women in Eastern Virginia
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Pitchford, Kayla, primary, Shangani, Sylvia, additional, Dawson, Charlotte, additional, Masa, Rainier, additional, and Heron, Kristin, additional
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- 2024
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5. The Association of Food Insecurity, Mental Health, and Healthcare Access and Use Among Lesbian, Gay, and Bisexual Adults in the United States: Results From the 2021 National Health Interview Survey
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Masa, Rainier, primary, Shangani, Sylvia, additional, Baruah, Dicky, additional, and Operario, Don, additional
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- 2023
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6. The Association of Food Insecurity, Mental Health, and Healthcare Access and Use Among Lesbian, Gay, and Bisexual Adults in the United States: Results From the 2021 National Health Interview Survey.
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Masa, Rainier, Shangani, Sylvia, Baruah, Dicky, and Operario, Don
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MENTAL health services , *FOOD security , *MENTAL health , *HEALTH services accessibility , *MEDICAL care use , *BISEXUALITY , *ETHNIC differences - Abstract
Purpose: We sought to describe the prevalence of food insecurity and its relationship with mental health, health care access, and use among lesbian, gay, and bisexual (LGB) adults in the U.S. Design and Setting: We analyzed data from the National Health Interview Survey (NHIS), a cross-sectional study of noninstitutionalized adults from all 50 states and the District of Columbia. Sample: The study sample was restricted to LGB adults ≥18 years (N = 1178) from the 2021 NHIS survey. Measures: Food security was assessed using the 10-item U.S Adult Food Security Survey Module. Study outcomes were mental health (depression, anxiety, life satisfaction, and serious psychological distress), health care utilization, and medication adherence. Analysis: Descriptive statistics and linear and generalized linear regressions. Results: The study sample consisted of 69% White, 14% Hispanic/Latinx, 9% Black, and 8% people of other races. Approximately half (53%) identified as bisexual and 47% identified as gay or lesbian. Eleven percent were food insecure. Sexual orientation, income-to-poverty ratio, and health insurance were significant correlates of food insecurity. In multivariable analyses, food insecurity was significantly associated with mental illness (including depression, anxiety, and serious psychological distress), limited health care access and use (including inability to pay medical bills, delay in getting medical and mental health care, and going without needed medical and mental health care), and medication nonadherence (including skipping medication, taking less medication, delay filling prescription, and going without needed prescription). Conclusion: Food insecurity is a constant predictor of adverse mental health and low medical and mental health care use rates among LGB adults in the United States. Achieving food security in LGB people requires improving their financial and nonfinancial resources to obtain food. [ABSTRACT FROM AUTHOR]
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- 2024
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7. Food insecurity and depressive symptoms among young people living with HIV in Eastern Zambia.
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Shangani, Sylvia, Masa, Rainier, Zimba, Mathias, Zimba, Gilbert, and Operario, Don
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- 2024
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8. Food insecurity and depressive symptoms among young people living with HIV in Eastern Zambia
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Shangani, Sylvia, primary, Masa, Rainier, additional, Zimba, Mathias, additional, Zimba, Gilbert, additional, and Operario, Don, additional
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- 2023
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9. A systematic review of early adoption of implementation science for HIV prevention or treatment in the United States
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Shangani, Sylvia, Bhaskar, Nidhi, Richmond, Natasha, Operario, Don, and van den Berg, Jacob J.
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- 2021
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10. How intersectional constructions of sexuality, culture, and masculinity shape identities and sexual decision-making among men who have sex with men in coastal Kenya
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Midoun, Miriam, Shangani, Sylvia, Mbete, Bibi, Babu, Shadrack, Hackman, Melissa, van der Elst, Elise M., Sanders, Eduard J., Smith, Adrian D., and Operario, Don
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- 2016
11. Community Healthcare Providers’ Perspectives on HIV Pre-Exposure Prophylaxis (PrEP) Use among Black Women
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Pitchford, Kayla, Shangani, Sylvia, Dawson, Charlotte, and Heron, Kristin
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The most at-risk population among women for HIV diagnosis in the U.S. are Black women, who account for 61% of all new HIV cases. Pre-exposure prophylaxis (PrEP) is a safe and effective HIV prevention method for people at risk of HIV acquisition. Despite being disproportionately affected by HIV, Black women’s knowledge, perceived benefits, and uptake of PrEP remain low. The socio-ecological model may be useful for understanding why there is a low uptake of PrEP among Black women by examining the complex interplay between individual, relationship, community, and societal factors. The current study used the socio-ecological framework to explore provider perspectives on the barriers and facilitators of PrEP uptake among Black women in Eastern Virginia. Semi-structured interviews were conducted with a purposeful sample of one PrEP prescriber and 14 community healthcare workers. Healthcare providers identified barriers to PrEP uptake among Black women at the individual (e.g., basic needs not met, lack of childcare, low medical literacy), interpersonal (e.g., perception partner(s) are safe), community (e.g., long waitlists, military culture lacks anonymity), organizational (e.g., clinic materials focus on men), and societal (e.g., PrEP ads focus on gay men, stigma, lack of trust in the medical community) levels. Providers also identified factors that facilitate PrEP uptake at the individual (e.g., flexible work schedule, current/past STI diagnosis), interpersonal (e.g., partner is HIV positive), organizational (e.g., more female screeners/providers, PrEP materials that include women, encouraging PrEP for everyone), community (e.g., making PrEP information available where Black women go), and societal (e.g., HIV education in schools) levels. These findings highlight unique barriers to accessing and taking PrEP for Black women in the U.S., and potential factors that could facilitate PrEP use. Examining barriers and facilitators may be important to guide future research that considers multi-level interventions to improve uptake of PrEP among Black women.
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- 2023
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12. Experiences with COVID-19 Stress Among Hispanic/Latino Farmworkers.
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Berumen-Flucker, Brenda, Galadima, Hadiza, Shangani, Sylvia, Kekeh, Michele, and Akpinar-Elci, Muge
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Hispanics/Latinos, particularly those that identify as foreign-born, are overrepresented in the agricultural sector in the U.S. Over the course of the COVID-19 pandemic, this subpopulation of farmworkers was recognized as an invaluable group of essential workers unable to implement COVID-19 protections. Previously validated COVID-19 stress scale measures were identified, adapted, and translated to collect COVID-19 stress data from Hispanic/Latino agricultural workers in two heavily agricultural counties in northeastern North Carolina. Participants were recruited using purposive convenience sampling. Data collection took place from June to November of 2021. The majority of Hispanic/Latino agricultural workers surveyed reported experiencing worries about catching COVID-19 (92.00%) and being infected with the virus (95.95%). A small proportion of the surveyed population indicated experiencing COVID-19 traumatic stress. More than half of participants were concerned about the impacts COVID-19 would have on their ability to see (53.42%) and provide for their families (58.33%). Farmworkers bore relatively heavy stress burdens associated with the COVID-19 pandemic. Because this group is a vulnerable population at risk for adverse health outcomes, reports numerous barriers to healthcare access, and faces health and safety challenges related to acculturative stress, understanding their experiences with COVID-19 is essential for the development of protective and preventative efforts to improve outcomes among Hispanic/Latino farmworkers. [ABSTRACT FROM AUTHOR]
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- 2023
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13. Childhood sexual abuse, alcohol and drug use problems among Black sexual minority men in six US Cities: Findings from the HPTN 061 study
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Shangani, Sylvia, primary, van den Berg, Jacob J., additional, Dyer, Typhanye V., additional, Mayer, Kenneth H., additional, and Operario, Don, additional
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- 2022
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14. Improving Engagement in the HIV Care Cascade: A Systematic Review of Interventions Involving People Living with HIV/AIDS as Peers
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Genberg, Becky L., Shangani, Sylvia, Sabatino, Kelly, Rachlis, Beth, Wachira, Juddy, Braitstein, Paula, and Operario, Don
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- 2016
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15. Sexual Prejudice Scale
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Shangani, Sylvia, primary, Genberg, Becky, additional, Harrison, Abigail, additional, Pellowski, Jennifer, additional, Wachira, Juddy, additional, Naanyu, Violet, additional, and Operario, Don, additional
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- 2022
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16. Sexual Prejudice and Comfort to Provide Services to Men Who Have Sex with Men Among HIV Healthcare Workers in Western Kenya: Role of Interpersonal Contact
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Shangani, Sylvia, primary, Genberg, Becky, additional, Harrison, Abigail, additional, Pellowski, Jennifer, additional, Wachira, Juddy, additional, Naanyu, Violet, additional, and Operario, Don, additional
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- 2021
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17. Socioeconomic Status and Psychosocial Resources Mediate Racial/Ethnic Differences in Psychological Health Among Gay and Bisexual Men: A Longitudinal Analysis Using Structural Equation Modeling
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Masa, Rainier, primary, Shangani, Sylvia, additional, and Operario, Don, additional
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- 2021
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18. Engagement in HIV Prevention and Treatment Among Key Populations in Kenya
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Shangani, Sylvia
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- 2020
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19. Cultural adaptation and validation of a measure of prejudice against men who have sex with men among healthcare providers in western Kenya
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Shangani, Sylvia, primary, Genberg, Becky, additional, Harrison, Abigail, additional, Pellowski, Jennifer, additional, Wachira, Juddy, additional, Naanyu, Violet, additional, and Operario, Don, additional
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- 2020
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20. Cultural adaptation and validation of a measure of prejudice against men who have sex with men among healthcare providers in western Kenya.
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Shangani, Sylvia, Genberg, Becky, Harrison, Abigail, Pellowski, Jennifer, Wachira, Juddy, Naanyu, Violet, and Operario, Don
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HIV infection risk factors , *ADAPTABILITY (Personality) , *THERAPEUTICS , *RESEARCH , *HEALTH services accessibility , *CONFIDENCE intervals , *ATTITUDE (Psychology) , *RESEARCH methodology evaluation , *MULTIVARIATE analysis , *MEDICAL personnel , *PREJUDICES , *SOCIAL stigma , *ATTITUDES toward sex , *PSYCHOMETRICS , *HEALTH literacy , *CULTURAL competence , *FACTOR analysis , *DESCRIPTIVE statistics , *SCALE analysis (Psychology) , *QUESTIONNAIRES , *RESEARCH funding , *MEN who have sex with men , *STATISTICAL correlation , *DATA analysis software ,RESEARCH evaluation - Abstract
Sexual prejudice toward men who have sex with men (MSM) is a pressing concern in sub-Saharan Africa (SSA). Given the high HIV infection risk among this population, sexual prejudice perpetuated by healthcare providers, affects access to and willingness of MSM to seek HIV care services. However, data on healthcare providers' attitudes towards MSM in SSA are limited, and there are no locally-adapted measures of sexual prejudice. We adapted a scale to measure sexual prejudice with a sample of 147 healthcare providers in western Kenya. Results from exploratory factor analysis revealed a single-factor structure. The scale demonstrated high internal consistency with Cronbach's α = 0.91. Healthcare providers who had prior interpersonal contact with MSM, had ever been trained on counselling MSM, and had higher knowledge about MSM health needs reported lower sexual prejudice scores, compared with peers who lacked these experiences (p < 0.001). In contrast, healthcare providers who had experienced secondary stigma (negative judgments from peers and community) for providing care to MSM reported higher scores of sexual prejudice scale (p < 0.001) compared with providers who had not experienced secondary stigma. The scale provides a contextualised tool to assess healthcare providers' attitudes toward MSM in Kenya and countries in SSA with similar cultural norms. [ABSTRACT FROM AUTHOR]
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- 2022
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21. Intersectional minority stress disparities among sexual minority adults in the USA: the role of race/ethnicity and socioeconomic status
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Shangani, Sylvia, primary, Gamarel, Kristi E., additional, Ogunbajo, Adedotun, additional, Cai, Jieyi, additional, and Operario, Don, additional
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- 2019
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22. Awareness and Acceptability of pre-exposure prophylaxis (PrEP) among gay, bisexual and other men who have sex with men (GBMSM) in Kenya
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Ogunbajo, Adedotun, primary, Kang, Augustine, additional, Shangani, Sylvia, additional, Wade, Ryan M., additional, Onyango, Daniel P., additional, Odero, Wilson W., additional, and Harper, Gary W., additional
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- 2019
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23. Stigma and Healthcare-Seeking Practices of Men Who Have Sex with Men in Western Kenya: A Mixed-Methods Approach for Scale Validation
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Shangani, Sylvia, primary, Naanyu, Violet, additional, Operario, Don, additional, and Genberg, Becky, additional
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- 2018
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24. Experiences of Kenyan healthcare workers providing services to men who have sex with men: qualitative findings from a sensitivity training programme
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van der Elst, Elise M., Gichuru, Evans, Omar, Anisa, Kanungi, Jennifer, Duby, Zoe, Midoun, Miriam, Shangani, Sylvia, Graham, Susan M., Smith, Adrian D., Sanders, Eduard J., and Operario, Don
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Medical personnel -- Training -- Services -- Research ,HIV patients -- Care and treatment -- Research ,Gays -- Health aspects -- Research ,Health - Abstract
Introduction: Men who have sex with men (MSM) in Kenya are at high risk for HIV and may experience prejudiced treatment in health settings due to stigma. An on-line computer-facilitated MSM sensitivity programme was conducted to educate healthcare workers (HCWs) about the health issues and needs of MSM patients. Methods: Seventy-four HCWs from 49 ART-providing health facilities in the Kenyan Coast were recruited through purposive sampling to undergo a two-day MSM sensitivity training. We conducted eight focus group discussions (FGDs) with programme participants prior to and three months after completing the training programme. Discussions aimed to characterize HCWs' challenges in serving MSM patients and impacts of programme participation on HCWs' personal attitudes and professional capacities. Results: Before participating in the training programme, HCWs described secondary stigma, lack of professional education about MSM, and personal and social prejudices as barriers to serving MSM clients. After completing the programme, HCWs expressed greater acknowledgement of MSM patients in their clinics, endorsed the need to treat MSM patients with high professional standards and demonstrated sophisticated awareness of the social and behavioural risks for HIV among MSM. Conclusions: Findings provide support for this approach to improving health services for MSM patients. Further efforts are needed to broaden the reach of this training in other areas, address identified barriers to HCW participation and evaluate programme effects on patient and HCW outcomes using rigorous methodology. Keywords: on-line computer facilitated MSM sensitivity programme; healthcare worker; stigma; MSM; Kenya; HIV., Introduction Men who have sex with men (MSM) in sub-Saharan Africa experience a high burden of HIV infection [1-3]. Strong epidemiological evidence comes from studies in Kenya [4-7], where an [...]
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- 2013
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25. Intersectional minority stress disparities among sexual minority adults in the USA: the role of race/ethnicity and socioeconomic status.
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Shangani, Sylvia, Gamarel, Kristi E., Ogunbajo, Adedotun, Cai, Jieyi, and Operario, Don
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MINORITY stress , *SEXUAL minorities , *ETHNICITY , *RACE , *ADULTS - Abstract
Few studies have examined the intersection of race/ethnicity and socioeconomic status on the experience of minority stressors among sexual minority adults. We examined whether there are differences in reports of minority stressors by race/ethnicity and socioeconomic status, and whether socioeconomic status moderates the associations between race/ethnicity and minority stressors. We analysed data from Project Stride, a community-based sample of 396 self-identified lesbian, gay and bisexual adults in New York City. We conducted a hierarchical multiple regression analysis to examine the associations between race/ethnicity and socioeconomic status on minority stressors. In adjusted models, African American and Latino sexual minority adults experienced greater anticipated stigma relative to their white counterparts. Socioeconomic status significantly moderated the association of race/ethnicity and enacted stigma. For African Americans, higher socioeconomic status was associated with more enacted stigma, whereas higher socioeconomic status was associated with reduced enacted stigma among whites. Minority stress processes are likely to operate differently for sexual minority people of colour compared with white sexual minority people, and for higher-socioeconomic status versus lower-socioeconomic status sexual minority people. Future research should consider the intersectional axes of identity that contribute to enacted stigma and disparities in mental and physical health, especially for US African American sexual minority adults. [ABSTRACT FROM AUTHOR]
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- 2020
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26. Behavioral Surveillance Survey--Adapted version
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Shangani, Sylvia, primary, Naanyu, Violet, additional, Operario, Don, additional, and Genberg, Becky, additional
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- 2018
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27. Unconditional government cash transfers in support of orphaned and vulnerable adolescents in western Kenya: Is there an association with psychological wellbeing?
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Shangani, Sylvia, primary, Operario, Don, additional, Genberg, Becky, additional, Kirwa, Kipruto, additional, Midoun, Miriam, additional, Atwoli, Lukoye, additional, Ayuku, David, additional, Galárraga, Omar, additional, and Braitstein, Paula, additional
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- 2017
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28. Effectiveness of peer-led interventions to increase HIV testing among men who have sex with men: a systematic review and meta-analysis
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Shangani, Sylvia, primary, Escudero, Daniel, additional, Kirwa, Kipruto, additional, Harrison, Abigail, additional, Marshall, Brandon, additional, and Operario, Don, additional
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- 2017
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29. Men who have sex with men sensitivity training reduces homoprejudice and increases knowledge among Kenyan healthcare providers in coastal Kenya
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Wolf, R Cameron, Cheng, Alison Surdo, Kapesa, Laurent, van der Elst, Elise M, Gichuru, Evans, Omar, Anisa, Kanungi, Jennifer, Duby, Zoe, Midoun, Miriam, Shangani, Sylvia, Graham, Susan M, Smith, Adrian D, Sanders, Eduard J, Operario, Don, Wirtz, Andrea L, Jumbe, Vincent, Trapence, Gift, Kamba, Dunker, Umar, Eric, Ketende, Sosthenes, Berry, Mark, Strömdahl, Susanne, Beyrer, Chris, Baral, Stefan D, Gichuru, Evanson, Wahome, Elizabeth, Musyoki, Helgar, Muraguri, Nicolas, Fegan, Greg, Bekker, Linda-Gail, Bender, Bonnie, Kennedy, Caitlin E, Fielding-Miller, Rebecca, Adams, Darrin, Dludlu, Phumlile, Sithole, Bheki, Fonner, Virginia A, Mnisi, Zandile, Kerrigan, Deanna, Papworth, Erin, Ceesay, Nuha, An, Louis, Thiam-Niangoin, Marguerite, Ky-Zerbo, Odette, Holland, Claire, Dramé, Fatou Maria, Grosso, Ashley, Diouf, Daouda, Park, Ju Nyeong, Kassegne, Sethson, Moukam, Laure, Billong, Serge Clotaire, Macauley, Issac, Yomb, Yves Roger, Nkoume, Nathalie, Mondoleba, Valentin, Eloundou, Jules, LeBreton, Matthew, Tamoufe, Ubald, Crawford, Emily E, Batist, Elizabeth, Brown, Benjamin, Scheibe, Andrew, Mabuza, Xolile, Sithole, Bhekie, Maziya, Sibusiso, Kerrigan, Deanna L, Green, Jessica L, and Castor, Delivette
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Malawi ,men who have sex with men ,people who inject drugs ,behavioural risks ,Review Article ,prevention ,risk factors ,reproductive and urinary physiology ,positive health dignity and prevention ,Central Africa ,Sub-Saharan Africa ,homoprejudice ,public health ,sexual behaviour ,virus diseases ,The epidemiology of HIV and prevention needs among men who have sex with men in Africa ,homosexuality ,Supplement 3 ,Editorial ,HIV epidemiology ,HIV/AIDS ,epidemiology ,social network ,on-line computer facilitated MSM sensitivity programme ,Research Article ,socio-economic status ,education ,prevalence ,African men who have sex with men (MSM) ,healthcare worker ,West Africa ,respondent-driven sampling (RDS) ,community-based ,MSM ,men who have sex with men (MSM) ,outreach ,people living with HIV ,self-esteem ,Homophobia Scale ,MSM behaviour ,healthcare workers ,HIV ,Kenya ,HIV programmes ,sensitivity training ,stigma and discrimination ,stigma ,Africa ,sex work ,Swaziland ,qualitative research - Abstract
Introduction Men who have sex with men (MSM) in Kenya are at high risk for HIV and may experience prejudiced treatment in health settings due to stigma. An on-line computer-facilitated MSM sensitivity programme was conducted to educate healthcare workers (HCWs) about the health issues and needs of MSM patients. Methods Seventy-four HCWs from 49 ART-providing health facilities in the Kenyan Coast were recruited through purposive sampling to undergo a two-day MSM sensitivity training. We conducted eight focus group discussions (FGDs) with programme participants prior to and three months after completing the training programme. Discussions aimed to characterize HCWs’ challenges in serving MSM patients and impacts of programme participation on HCWs’ personal attitudes and professional capacities. Results Before participating in the training programme, HCWs described secondary stigma, lack of professional education about MSM, and personal and social prejudices as barriers to serving MSM clients. After completing the programme, HCWs expressed greater acknowledgement of MSM patients in their clinics, endorsed the need to treat MSM patients with high professional standards and demonstrated sophisticated awareness of the social and behavioural risks for HIV among MSM. Conclusions Findings provide support for this approach to improving health services for MSM patients. Further efforts are needed to broaden the reach of this training in other areas, address identified barriers to HCW participation and evaluate programme effects on patient and HCW outcomes using rigorous methodology., Introduction There are limited data characterizing the burden of HIV among men who have sex with men (MSM) in Malawi. Epidemiologic research and access to HIV prevention, treatment and care services have been traditionally limited in Malawi by criminalization and stigmatization of same-sex practices. To inform the development of a comprehensive HIV prevention intervention for Malawian MSM, we conducted a community-led assessment of HIV prevalence and correlates of infection. Methods From April 2011 to March 2012, 338 MSM were enrolled in a cross-sectional study in Blantyre, Malawi. Participants were recruited by respondent-driven sampling methods (RDS), reaching 19 waves. Trained staff administered the socio-behavioural survey and HIV and syphilis voluntary counselling and testing. Results Crude HIV and syphilis prevalence estimates were 15.4% (RDS-weighted 12.5%, 95% confidence interval (CI): 7.3–17.8) and 5.3% (RDS-weighted 4.4%, 95% CI: 3.1–7.6), respectively. Ninety per cent (90.4%, unweighted) of HIV infections were reported as being previously undiagnosed. Participants were predominantly gay-identified (60.8%) or bisexually identified (36.3%); 50.7% reported recent concurrent relationships. Approximately half reported consistent condom use (always or almost always) with casual male partners, and proportions were relatively uniform across partner types and genders. The prevalence of perceived and experienced stigma exceeded 20% for almost all variables, 11.4% ever experienced physical violence and 7% were ever raped. Current age >25 years (RDS-weighted adjusted odds ratio (AOR) 3.9, 95% CI: 1.2–12.7), single marital status (RDS-weighted AOR: 0.3; 95% CI: 0.1–0.8) and age of first sex with a man, Introduction Healthcare workers (HCWs) in Africa typically receive little or no training in the healthcare needs of men who have sex with men (MSM), limiting the effectiveness and reach of population-based HIV control measures among this group. We assessed the effect of a web-based, self-directed sensitivity training on MSM for HCWs (www.marps-africa.org), combined with facilitated group discussions on knowledge and homophobic attitudes among HCWs in four districts of coastal Kenya. Methods We trained four district “AIDS coordinators” to provide a two-day training to local HCWs working at antiretroviral therapy-providing facilities in coastal Kenya. Self-directed learning supported by group discussions focused on MSM sexual risk practices, HIV prevention and healthcare needs. Knowledge was assessed prior to training, immediately after training and three months after training. The Homophobia Scale assessed homophobic attitudes and was measured before and three months after training. Results Seventy-four HCWs (68% female; 74% clinical officers or nurses; 84% working in government facilities) from 49 health facilities were trained, of whom 71 (96%) completed all measures. At baseline, few HCWs reported any prior training on MSM anal sexual practices, and most HCWs had limited knowledge of MSM sexual health needs. Homophobic attitudes were most pronounced among HCWs who were male, under 30 years of age, and working in clinical roles or government facilities. Three months after training, more HCWs had adequate knowledge compared to baseline (49% vs. 13%, McNemar's test p, Introduction Despite the knowledge that men who have sex with men (MSM) are more likely to be infected with HIV across settings, there has been little investigation of the experiences of MSM who are living with HIV in sub-Saharan Africa. Using the framework of positive health, dignity and prevention, we explored the experiences and HIV prevention, care and treatment needs of MSM who are living with HIV in Swaziland. Methods We conducted 40 in-depth interviews with 20 HIV-positive MSM, 16 interviews with key informants and three focus groups with MSM community members. Qualitative analysis was iterative and included debriefing sessions with a study staff, a stakeholders’ workshop and coding for key themes using Atlas.ti. Results The predominant theme was the significant and multiple forms of stigma and discrimination faced by MSM living with HIV in this setting due to both their sexual identity and HIV status. Dual stigma led to selective disclosure or lack of disclosure of both identities, and consequently a lack of social support for care-seeking and medication adherence. Perceived and experienced stigma from healthcare settings, particularly around sexual identity, also led to delayed care-seeking, travel to more distant clinics and missed opportunities for appropriate services. Participants described experiences of violence and lack of police protection as well as mental health challenges. Key informants, however, reflected on their duty to provide non-discriminatory services to all Swazis regardless of personal beliefs. Conclusions Intersectionality provides a framework for understanding the experiences of dual stigma and discrimination faced by MSM living with HIV in Swaziland and highlights how programmes and policies should consider the specific needs of this population when designing HIV prevention, care and treatment services. In Swaziland, the health sector should consider providing specialized training for healthcare providers, distributing condoms and lubricants and engaging MSM as peer outreach workers or expert clients. Interventions to reduce stigma, discrimination and violence against MSM and people living with HIV are also needed for both healthcare workers and the general population. Finally, research on experiences and needs of MSM living with HIV globally can help inform comprehensive HIV services for this population., Introduction The West and Central Africa (WCA) sub-region is the most populous region of sub-Saharan Africa (SSA), with an estimated population of 356 million living in 24 countries. The HIV epidemic in WCA appears to have distinct dynamics compared to the rest of SSA, being more concentrated among key populations such as female sex workers (FSWs), men who have sex with men (MSM), people who inject drugs (PWID) and clients of FSWs. To explore the epidemiology of HIV in the region, a systematic review of HIV literature among key populations in WCA was conducted since the onset of the HIV epidemic. Methods We searched the databases PubMed, CINAHL and others for peer-reviewed articles regarding FSWs, MSM and PWID in 24 countries with no date restriction. Inclusion criteria were sensitive and focused on inclusion of any HIV prevalence data among key populations. HIV prevalence was pooled, and in each country key themes were extracted from the literature. Results The search generated 885 titles, 214 abstracts and 122 full articles, of which 76 met inclusion and exclusion criteria providing HIV prevalence data. There were 60 articles characterizing the burden of disease among FSWs, eight for their clients, one for both, six for MSM and one for PWID. The pooled HIV prevalence among FSWs was 34.9% (n=14,388/41,270), among their clients was 7.3% (n=435/5986), among MSM was 17.7% (n=656/3714) and among PWID from one study in Nigeria was 3.8% (n=56/1459). Conclusions The disproportionate burden of HIV among FSWs appears to be consistent from the beginning of the HIV epidemic in WCA. While there are less data for other key populations such as clients of FSWs and MSM, the prevalence of HIV is higher among these men compared to other men in the region. There have been sporadic reports among PWID, but limited research on the burden of HIV among these men and women. These data affirm that the HIV epidemic in WCA appears to be far more concentrated among key populations than the epidemics in Southern and Eastern Africa. Evidence-based HIV prevention, treatment and care programmes in WCA should focus on engaging populations with the greatest burden of disease in the continuum of HIV care., Introduction Despite men who have sex with men (MSM) being a key population for HIV programming globally, HIV epidemiologic data on MSM in Central Africa are sparse. We measured HIV and syphilis prevalence and the factors associated with HIV infection among MSM in Cameroon. Methods Two hundred and seventy-two and 239 MSM aged ≥18 from Douala and Yaoundé, respectively, were recruited using respondent-driven sampling (RDS) for this cross-sectional surveillance study in 2011. Participants completed a structured questionnaire and HIV and syphilis testing. Statistical analyses, including RDS-weighted proportions, bootstrapped confidence intervals and logistic regressions, were used. Results Crude and RDS-weighted HIV prevalence were 28.6% (73/255) and 25.5% (95% CI 19.1–31.9) in Douala, and 47.3% (98/207) and 44.4% (95% CI 35.7–53.2) in Yaoundé. Active syphilis prevalence in total was 0.4% (2/511). Overall, median age was 24 years, 62% (317/511) of MSM identified as bisexual and 28.6% (144/511) identified as gay. Inconsistent condom use with regular male partners (64.1%; 273/426) and casual male and female partners (48.5%; 195/402) was common, as was the inconsistent use of condom-compatible lubricants (CCLs) (26.3%; 124/472). In Douala, preferring a receptive sexual role was associated with prevalent HIV infection [adjusted odds ratio (aOR) 2.33, 95% CI 1.02–5.32]. Compared to MSM without HIV infection, MSM living with HIV were more likely to have ever accessed a health service targeting MSM in Douala (aOR 4.88, 95% CI 1.63–14.63). In Yaoundé, MSM living with HIV were more likely to use CCLs (aOR 2.44, 95% CI 1.19–4.97). Conclusions High HIV prevalence were observed and condoms and CCLs were used inconsistently indicating that MSM are a priority population for HIV prevention, treatment and care services in Douala and Yaoundé. Building the capacity of MSM community organizations and improving the delivery and scale-up of multimodal interventions for MSM that are sensitive to concerns about confidentiality and the complex individual, social, community-level and policy challenges are needed to successfully engage young MSM in the continuum of HIV care. In addition to scaling up condom and CCL access, evaluating the feasibility of novel biomedical interventions, including antiretroviral pre-exposure prophylaxis and early antiretroviral therapy for MSM living with HIV in Cameroon, is also warranted., Introduction Men who have sex with men (MSM) are disproportionately burdened by HIV in Senegal, across sub-Saharan Africa and throughout the world. This is driven in part by stigma, and limits health achievements and social capital among these populations. To date, there is a limited understanding of the feasibility of prospective HIV prevention studies among MSM in Senegal, including HIV incidence and cohort retention rates. Methods One hundred and nineteen men who reported having anal sex with another man in the past 12 months were randomly selected from a sampling frame of 450 unique members of community groups serving MSM in Dakar. These men were enrolled in a 15-month pilot cohort study implemented by a community-based partner. The study included a structured survey instrument and biological testing for HIV, syphilis and hepatitis B virus at two time points. Results Baseline HIV prevalence was 36.0% (43/114), with cumulative HIV prevalence at study end being 47.2% (51/108). The annualized incidence rate was 16% (8/40 at risk for seroconversion over 15 months of follow-up, 95% confidence interval 4.6–27.4%). Thirty-seven men were lost to follow up, including at least four deaths. Men who were able to confide in someone about health, emotional distress and sex were less likely to be HIV positive (OR 0.36, p < 0.05, 95% CI 0.13, 0.97). Conclusions High HIV prevalence and incidence, as well as mortality in this young population of Senegalese MSM indicate a public health emergency. Moreover, given the high burden of HIV and rate of incident HIV infections, this population appears to be appropriate for the evaluation of novel HIV prevention, treatment and care approaches. Using a study implemented by community-based organizations, there appears to be feasibility in implementing interventions addressing the multiple levels of HIV risk among MSM in this setting. However, low retention across arms of this pilot intervention, and in the cohort, will need to be addressed for larger-scale efficacy trials to be feasible., Introduction Men who have sex with men (MSM) in Cape Town's townships remain in need of targeted HIV-prevention services. In 2012, a pilot community-based HIV-prevention programme was implemented that aimed to reach MSM in five Cape Town townships, disseminate HIV-prevention information and supplies, and promote the use of condoms and HIV services. Methods Convenience sampling was used to recruit self-identified MSM who were 18 years old or older in five Cape Town townships. The six-month pilot programme trained five community leaders who, along with staff, provided HIV-prevention information and supplies to MSM through small-group meetings, community-based social activities and inter-community events. After the completion of the pilot programme, in-depth interviews and focus group discussions (FGDs) were conducted with a subset of conveniently sampled participants and with each of the community leaders. Qualitative data were then analyzed thematically. Results Overall, 98 mostly gay-identified black MSM consented to participate, 57 community-based activities were facilitated and 9 inter-community events were conducted. Following their enrolment, 60% (59/98) of participants attended at least one pilot activity. Of those participants, 47% (28/59) attended at least half of the scheduled activities. A total of 36 participants took part in FGDs, and five in-depth interviews were completed with community leaders. Participants reported gaining access to MSM-specific HIV-prevention information, condoms and water-based lubricant through the small-group meetings. Some participants described how their feelings of loneliness, social isolation, self-esteem and self-efficacy were improved after taking part. Conclusions The social activities and group meetings were viable strategies for disseminating HIV-prevention information, condoms and water-based lubricant to MSM in this setting. Many MSM were also able to receive social support, reduce social isolation and improve their self-esteem. Further research is needed to explore factors affecting attendance and the sustainability of these activities. Perspectives of MSM who did not attend pilot activities regularly were not equally represented in the final qualitative interviews, which could bias the findings. The use of community-based activities and small-group meetings should be explored further as components to ongoing HIV-prevention interventions for MSM in this setting., Introduction Similar to other Southern African countries, Swaziland has been severely affected by HIV, with over a quarter of its reproductive-age adults estimated to be living with the virus, equating to an estimate of 170,000 people living with HIV. The last several years have witnessed an increase in the understanding of the potential vulnerabilities among men who have sex with men (MSM) in neighbouring countries with similarly widespread HIV epidemics. To date, there are no data characterizing the burden of HIV and the HIV prevention, treatment and care needs of MSM in Swaziland. Methods In 2011, 324 men who reported sex with another man in the last 12 months were accrued using respondent-driven sampling (RDS). Participants completed HIV testing using Swazi national guidelines as well as structured survey instruments administered by trained staff, including modules on demographics, individual-level behavioural and biological risk factors, social and structural characteristics and uptake of HIV services. Population and individual weights were computed separately for each variable with a data-smoothing algorithm. The weights were used to estimate RDS-adjusted univariate estimates with 95% bootstrapped confidence intervals (BCIs). Crude and RDS-adjusted bivariate and multivariate analyses were completed with HIV as the dependent variable. Results Overall, HIV prevalence was 17.6% (n=50/284), although it was strongly correlated with age in bivariate- [odds ratio (OR) 1.2, 95% BCI 1.15–1.21] and multivariate-adjusted analyses (adjusted OR 1.24, 95% BCI 1.14–1.35) for each additional year of age. Nearly, 70.8% (n=34/48) were unaware of their status of living with HIV. Condom use with all sexual partners and condom-compatible-lubricant use with men were reported by 1.3% (95% CI 0.0–9.7). Conclusions Although the epidemic in Swaziland is driven by high-risk heterosexual transmission, the burden of HIV and the HIV prevention, treatment and care needs of MSM have been understudied. The data presented here suggest that these men have specific HIV acquisition and transmission risks that differ from those of other reproductive-age adults. The scale-up in HIV services over the past decade has likely had limited benefit for MSM, potentially resulting in a scenario where epidemics of HIV among MSM expand in the context of slowing epidemics in the general population, a reality observed in most of the world., While still an understudied area, there is a growing body of studies highlighting epidemiologic data on men who have sex with men (MSM) in sub-Saharan Africa (SSA) which challenge the attitudes of complacency and irrelevancy among donors and country governments that are uncomfortable in addressing key populations (KPs). While some of the past inaction may be explained by ignorance, new data document highly elevated and sustained HIV prevalence that is seemingly isolated from recent overall declines in prevalence. The articles in this series highlight new studies which focus on the stark epidemiologic burden in countries from concentrated, mixed and generalized epidemic settings. The issue includes research from West, Central, East and Southern Africa and explores the pervasive impact of stigma and discrimination as critical barriers to confronting the HIV epidemic among MSM and the intersecting stigma and marginalization found between living with HIV and sexual minority status. Interventions to remove barriers to service access, including those aimed at training providers and mobilizing communities even within stigmatized peri-urban settings, are featured in this issue, which further demonstrates the immediate need for comprehensive action to address HIV among MSM in all countries in the region, regardless of epidemic classification.
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- 2013
30. Factors associated with HIV testing among men who have sex with men in Western Kenya: a cross-sectional study
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Shangani, Sylvia, primary, Naanyu, Violet, additional, Mwangi, Ann, additional, Vermandere, Heleen, additional, Mereish, Ethan, additional, Obala, Andrew, additional, Vanden Broeck, Davy, additional, Sidle, John, additional, and Operario, Don, additional
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- 2016
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31. How intersectional constructions of sexuality, culture, and masculinity shape identities and sexual decision-making among men who have sex with men in coastal Kenya
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Midoun, Miriam, primary, Shangani, Sylvia, additional, Mbete, Bibi, additional, Babu, Shadrack, additional, Hackman, Melissa, additional, van der Elst, Elise M., additional, Sanders, Eduard J., additional, Smith, Adrian D., additional, and Operario, Don, additional
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- 2015
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32. Factors associated with HIV testing among men who have sex with men in Western Kenya: a cross-sectional study.
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Shangani, Sylvia, Naanyu, Violet, Mwangi, Ann, Vermandere, Heleen, Mereish, Ethan, Obala, Andrew, Vanden Broeck, Davy, Sidle, John, and Operario, Don
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DIAGNOSIS of HIV infections ,HIV prevention ,TRANSGENDER people ,CROSS-sectional method ,DISEASES - Abstract
HIV diagnosis is an important step in the HIV cascade of prevention and treatment. However, men who have sex with men in low- and middle-income countries have limited access to HIV care services. We examined factors associated with prior HIV testing among men who have sex with men in western Kenya. We recruited 95 men who have sex with men aged 18 years and older, and who reported at least one sexual contact with a man in the past 6 months; however, this analysis is restricted to 89 participants who completed questions on HIV testing. Logistic regression model was used to determine factors associated with HIV testing in the past one year. Results indicate that 23 (26%) had not been tested in the past 12 months. Bivariate analyses demonstrated that condomless anal sex (odds ratio = 3.29, 95% confidence interval = 1.18-9.17) and comfort with healthcare providers (odds ratio = 1.15, 95 % CI = 1.05-1.26) were associated with higher odds of HIV testing in the past 12 months. Experiencing social stigma was associated with lower odds of HIV testing in the last 12 months (odds ratio = 0.91, 95% confidence interval = 0.84-0.94). In multivariable models, social stigma remained significantly associated with lower odds of HIV testing in the last 12 months odds ratio = 0.90, 95% confidence interval = 0.82-0.99) after inclusion of sexual risk and individual level variables. Development of men who have sex with men-sensitive HIV-testing services, addressing stigma, and training healthcare workers to provide culturally sensitive services may assist in effectively engaging men who have sex with men in the HIV treatment cascade. [ABSTRACT FROM AUTHOR]
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- 2017
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33. Nonadherence to Clinic Appointments Among HIV-Infected Children in an Ambulatory Care Program in Western Kenya
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Nyandiko, Winstone, primary, Vreeman, Rachel, additional, Liu, Hai, additional, Shangani, Sylvia, additional, Sang, Edwin, additional, Ayaya, Samuel, additional, and Braitstein, Paula, additional
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- 2013
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34. Experiences of Kenyan healthcare workers providing services to men who have sex with men: qualitative findings from a sensitivity training programme.
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Elst, Elise M, Gichuru, Evans, Omar, Anisa, Kanungi, Jennifer, Duby, Zoe, Midoun, Miriam, Shangani, Sylvia, Graham, Susan M, Smith, Adrian D, Sanders, Eduard J, and Operario, Don
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MEDICAL personnel training ,GROUP relations training ,MEN who have sex with men ,HIV-positive men ,AIDS - Abstract
Introduction Men who have sex with men (MSM) in Kenya are at high risk for HIV and may experience prejudiced treatment in health settings due to stigma. An on-line computer-facilitated MSM sensitivity programme was conducted to educate healthcare workers (HCWs) about the health issues and needs of MSM patients. Methods Seventy-four HCWs from 49 ART-providing health facilities in the Kenyan Coast were recruited through purposive sampling to undergo a two-day MSM sensitivity training. We conducted eight focus group discussions (FGDs) with programme participants prior to and three months after completing the training programme. Discussions aimed to characterize HCWs' challenges in serving MSM patients and impacts of programme participation on HCWs' personal attitudes and professional capacities. Results Before participating in the training programme, HCWs described secondary stigma, lack of professional education about MSM, and personal and social prejudices as barriers to serving MSM clients. After completing the programme, HCWs expressed greater acknowledgement of MSM patients in their clinics, endorsed the need to treat MSM patients with high professional standards and demonstrated sophisticated awareness of the social and behavioural risks for HIV among MSM. Conclusions Findings provide support for this approach to improving health services for MSM patients. Further efforts are needed to broaden the reach of this training in other areas, address identified barriers to HCW participation and evaluate programme effects on patient and HCW outcomes using rigorous methodology. [ABSTRACT FROM AUTHOR]
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- 2013
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35. Nonadherence to clinic appointments among HIV-infected children in an ambulatory care program in western Kenya.
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Nyandiko W, Vreeman R, Liu H, Shangani S, Sang E, Ayaya S, and Braitstein P
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- Acquired Immunodeficiency Syndrome drug therapy, Ambulatory Care, Ambulatory Care Facilities, Anti-HIV Agents therapeutic use, Child, Child, Preschool, Female, Humans, Kenya, Male, Medication Adherence, Retrospective Studies, Treatment Outcome, Acquired Immunodeficiency Syndrome mortality, Patient Compliance
- Abstract
Background: Nonadherence to clinic appointments is associated with poor outcomes in HIV-infected adults. We describe the effect of cumulative clinic adherence (CCA) to clinic appointments on mortality and loss to follow-up (LTFU) among HIV-infected children in Kenya., Methods: We analyzed retrospective clinical data from HIV-infected children in the United States Agency for International Development-Academic Model Providing Access to Healthcare Partnership in Kenya between 2001 and 2009. We defined CCA as the proportion of days adherent to clinic visits after enrollment. We examined the effects of CCA on both death and LTFU, controlling for demographic and clinical factors at enrollment and over time. Cox proportional hazards models with time-varying coefficients were used to calculate adjusted hazard ratios (AHR) associated with each 10% increase in CCA on mortality and LTFU., Results: Among 3255 HIV-infected children, 1668 (51.2%) were male, median enrollment age of 5.2 years (interquartile range: 3.6-7.4). Of 2393 children with CD4 within 3 months after enrollment, 1125 (47.0%) were severely immune suppressed, 567 became LTFU, and 88 died. Children with higher CCA had a higher risk of both mortality and LTFU at 3 and 6 months. Higher CCA became protective at 24 months for mortality, AHR at 24 months: 0.7 (95% confidence interval: 0.6 to 0.9), and at 12 months for LTFU, AHR at 24 months: 0.7 (95% confidence interval: 0.7 to 0.7)., Conclusions: Children adherence to clinic visits during the first 6 months of HIV care was associated with a higher risk of death and LTFU, but by 24 months, children with better CCA had a reduced risk of LTFU and mortality.
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- 2013
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