In response to the orphan crisis in sub-Saharan Africa, the international child welfare commu- ni... more In response to the orphan crisis in sub-Saharan Africa, the international child welfare commu- nity has agreed on a model that aims to increase the capacity of families and communities. Yet, little is known thus far about the service content and efficacy of programs based on the model. This project examined a community-based program in Uganda that provides support and
Kazakhstan and other countries in Central Asia are experiencing a rapidly growing HIV epidemic, w... more Kazakhstan and other countries in Central Asia are experiencing a rapidly growing HIV epidemic, which has historically been driven by injection drug use, but is more recently being fueled by heterosexual transmission. This paper examines HIV and HCV infection, as well as sexual and drug-related risks among female partners of men who inject drugs (MWID), comparing females who inject drugs (FWID) to non-injecting female partners on socio-demographic, relationship context, and structural characteristics. The prevalence rate of HIV was 30.1% among FWID and 10.4% among non-IDU female partners of MWID. The prevalence rate of HCV was 89.8% among FWID and 14.8% among female non-IDUs. Less than one-fifth of all female participants had access to HIV education and services or harm reduction programs. Although high rates of non-injection drug use and sexual risk behaviors were found among both FWID and non-injecting female partners of MWID, we found that FWID were more likely to be HIV seroposi...
ABSTRACT Background: This study examines predictors of partner notification (PN) confirmed by a t... more ABSTRACT Background: This study examines predictors of partner notification (PN) confirmed by a test counselor among people who inject drugs (PWID) and their sexual partners in Kazakhstan. Methods: We used baseline data from an HIV couple-based intervention study, restricting the sample to couples where both partners knew they were hepatitis C virus (HCV)-positive prior to participation in the study (N = 136 individuals). Cross-tabulation and logistic regression were used to examine predictors of PN, including socio-demographic characteristics, sexual and drug risk behaviors, and access to health services. Results: Of the sample, 68 (50%) participants notified their partners of their HCV status. PN was associated with participation in a needle/syringe exchange program and sexually transmitted infection counseling or education in the past 6 months. In the adjusted model, concurrent HIV infection (OR = 2.4, p < 0.05), having more than one sexual partner (OR = 2.5, p < 0.05), and participation in a needle exchange program (OR = 4.3, p < 0.01) were positively associated with notifying one's partner. Conclusions: The findings from this study emphasize the importance of service access among PWID and point to the need for additional research on HCV counseling and notification strategies as a component of health services for injection drug users.
This study is designed to address the need for evidence-based HIV/STI prevention approaches for d... more This study is designed to address the need for evidence-based HIV/STI prevention approaches for drug-involved women under criminal justice community supervision. We tested the efficacy of a group-based traditional and multimedia HIV/STI prevention intervention (Project WORTH: Women on the Road to Health) among drug-involved women under community supervision. We randomized 306 women recruited from community supervision settings to receive either: (1) a four-session traditional group-based HIV/STI prevention intervention (traditional WORTH); (2) a four-session multimedia group-based HIV/STI prevention intervention that covered the same content as traditional WORTH but was delivered in a computerized format; or (3) a four-session group-based Wellness Promotion intervention that served as an attention control condition. The study examined whether the traditional or multimedia WORTH intervention was more efficacious in reducing risks when compared to Wellness Promotion; and whether multimedia WORTH was more efficacious in reducing risks when compared to traditional WORTH. Primary outcomes were assessed over the 12-month post-intervention period and included the number of unprotected sex acts, the proportion of protected sex acts, and consistent condom use. At baseline, 77% of participants reported unprotected vaginal or anal sex (n = 237) and 63% (n = 194) had multiple sex partners. Women assigned to traditional or multimedia WORTH were significantly more likely than women assigned to the control condition to report an increase in the proportion of protected sex acts (β = 0.10; 95% CI = 0.02-0.18) and a decrease in the number of unprotected sex acts (IRR = 0.72; 95% CI = 0.57-0.90). The promising effects of traditional and multimedia WORTH on increasing condom use and high participation rates suggest that WORTH may be scaled up to redress the concentrated epidemics of HIV/STIs among drug-involved women in the criminal justice system. ClinicalTrials.gov NCT01784809.
This paper examines prevalence rates of HIV, HCV, and syphilis among a sample of injecting drug u... more This paper examines prevalence rates of HIV, HCV, and syphilis among a sample of injecting drug users (IDUs) and their heterosexual intimate partners (N = 728) from Almaty, Kazakhstan. The study uses baseline data from Project Renaissance, a couple-based HIV prevention intervention delivered to a couple where one or both partners are IDUs. HIV prevalence rates among female and male IDUs were 28 %. Among the full sample, 75 % had HCV, and 13 % tested positive for the syphilis antibody test. Only 10 % of the sample ever visited a needle exchange program. One-fourth (25.3 %) had never been tested for HIV. One-quarter of those who tested positive were unaware of their status. Being HIV positive was associated with a history of incarceration, being an IDU, and having access to needle exchange programs. The findings call for increasing efforts to improve access to HIV testing, prevention, treatment, and care for IDUs in Almaty, Kazakhstan.
This systematic review examines the relationship between religion and sexual HIV risk behavior. I... more This systematic review examines the relationship between religion and sexual HIV risk behavior. It focuses primarily on how studies have conceptualized and defined religion, methodologies, and sexual risk outcomes. We also describe regions where studies were conducted and mechanisms by which religion may be associated with sexual risk. We included 137 studies in this review, classifying them as measuring: (1) only religious affiliation (n = 57), (2) only religiosity (n = 48), and (3) both religious affiliation and religiosity (n = 32). A number of studies identified lower levels of sexual HIV risk among Muslims, although many of these examined HIV prevalence rather than specific behavioral risk outcomes. Most studies identified increased religiosity to be associated with lower levels of sexual HIV risk. This finding persists but is weaker when the outcome considered is condom use. The paper reviews ways in which religion may contribute to increase and reduction in sexual HIV risk, gaps in research, and implications for future research on religion and HIV.
In response to the orphan crisis in sub-Saharan Africa, the international child welfare commu- ni... more In response to the orphan crisis in sub-Saharan Africa, the international child welfare commu- nity has agreed on a model that aims to increase the capacity of families and communities. Yet, little is known thus far about the service content and efficacy of programs based on the model. This project examined a community-based program in Uganda that provides support and
Kazakhstan and other countries in Central Asia are experiencing a rapidly growing HIV epidemic, w... more Kazakhstan and other countries in Central Asia are experiencing a rapidly growing HIV epidemic, which has historically been driven by injection drug use, but is more recently being fueled by heterosexual transmission. This paper examines HIV and HCV infection, as well as sexual and drug-related risks among female partners of men who inject drugs (MWID), comparing females who inject drugs (FWID) to non-injecting female partners on socio-demographic, relationship context, and structural characteristics. The prevalence rate of HIV was 30.1% among FWID and 10.4% among non-IDU female partners of MWID. The prevalence rate of HCV was 89.8% among FWID and 14.8% among female non-IDUs. Less than one-fifth of all female participants had access to HIV education and services or harm reduction programs. Although high rates of non-injection drug use and sexual risk behaviors were found among both FWID and non-injecting female partners of MWID, we found that FWID were more likely to be HIV seroposi...
ABSTRACT Background: This study examines predictors of partner notification (PN) confirmed by a t... more ABSTRACT Background: This study examines predictors of partner notification (PN) confirmed by a test counselor among people who inject drugs (PWID) and their sexual partners in Kazakhstan. Methods: We used baseline data from an HIV couple-based intervention study, restricting the sample to couples where both partners knew they were hepatitis C virus (HCV)-positive prior to participation in the study (N = 136 individuals). Cross-tabulation and logistic regression were used to examine predictors of PN, including socio-demographic characteristics, sexual and drug risk behaviors, and access to health services. Results: Of the sample, 68 (50%) participants notified their partners of their HCV status. PN was associated with participation in a needle/syringe exchange program and sexually transmitted infection counseling or education in the past 6 months. In the adjusted model, concurrent HIV infection (OR = 2.4, p < 0.05), having more than one sexual partner (OR = 2.5, p < 0.05), and participation in a needle exchange program (OR = 4.3, p < 0.01) were positively associated with notifying one's partner. Conclusions: The findings from this study emphasize the importance of service access among PWID and point to the need for additional research on HCV counseling and notification strategies as a component of health services for injection drug users.
This study is designed to address the need for evidence-based HIV/STI prevention approaches for d... more This study is designed to address the need for evidence-based HIV/STI prevention approaches for drug-involved women under criminal justice community supervision. We tested the efficacy of a group-based traditional and multimedia HIV/STI prevention intervention (Project WORTH: Women on the Road to Health) among drug-involved women under community supervision. We randomized 306 women recruited from community supervision settings to receive either: (1) a four-session traditional group-based HIV/STI prevention intervention (traditional WORTH); (2) a four-session multimedia group-based HIV/STI prevention intervention that covered the same content as traditional WORTH but was delivered in a computerized format; or (3) a four-session group-based Wellness Promotion intervention that served as an attention control condition. The study examined whether the traditional or multimedia WORTH intervention was more efficacious in reducing risks when compared to Wellness Promotion; and whether multimedia WORTH was more efficacious in reducing risks when compared to traditional WORTH. Primary outcomes were assessed over the 12-month post-intervention period and included the number of unprotected sex acts, the proportion of protected sex acts, and consistent condom use. At baseline, 77% of participants reported unprotected vaginal or anal sex (n = 237) and 63% (n = 194) had multiple sex partners. Women assigned to traditional or multimedia WORTH were significantly more likely than women assigned to the control condition to report an increase in the proportion of protected sex acts (β = 0.10; 95% CI = 0.02-0.18) and a decrease in the number of unprotected sex acts (IRR = 0.72; 95% CI = 0.57-0.90). The promising effects of traditional and multimedia WORTH on increasing condom use and high participation rates suggest that WORTH may be scaled up to redress the concentrated epidemics of HIV/STIs among drug-involved women in the criminal justice system. ClinicalTrials.gov NCT01784809.
This paper examines prevalence rates of HIV, HCV, and syphilis among a sample of injecting drug u... more This paper examines prevalence rates of HIV, HCV, and syphilis among a sample of injecting drug users (IDUs) and their heterosexual intimate partners (N = 728) from Almaty, Kazakhstan. The study uses baseline data from Project Renaissance, a couple-based HIV prevention intervention delivered to a couple where one or both partners are IDUs. HIV prevalence rates among female and male IDUs were 28 %. Among the full sample, 75 % had HCV, and 13 % tested positive for the syphilis antibody test. Only 10 % of the sample ever visited a needle exchange program. One-fourth (25.3 %) had never been tested for HIV. One-quarter of those who tested positive were unaware of their status. Being HIV positive was associated with a history of incarceration, being an IDU, and having access to needle exchange programs. The findings call for increasing efforts to improve access to HIV testing, prevention, treatment, and care for IDUs in Almaty, Kazakhstan.
This systematic review examines the relationship between religion and sexual HIV risk behavior. I... more This systematic review examines the relationship between religion and sexual HIV risk behavior. It focuses primarily on how studies have conceptualized and defined religion, methodologies, and sexual risk outcomes. We also describe regions where studies were conducted and mechanisms by which religion may be associated with sexual risk. We included 137 studies in this review, classifying them as measuring: (1) only religious affiliation (n = 57), (2) only religiosity (n = 48), and (3) both religious affiliation and religiosity (n = 32). A number of studies identified lower levels of sexual HIV risk among Muslims, although many of these examined HIV prevalence rather than specific behavioral risk outcomes. Most studies identified increased religiosity to be associated with lower levels of sexual HIV risk. This finding persists but is weaker when the outcome considered is condom use. The paper reviews ways in which religion may contribute to increase and reduction in sexual HIV risk, gaps in research, and implications for future research on religion and HIV.
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Papers by Stacey Shaw