Steffanie Strathdee
University of California, San Diego, Medicine, Faculty Member
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Injection drug use is a growing but understudied problem in Tijuana, a city situated on the northwestern Mexico-U.S border. The authors studied factors associated with receptive needle sharing in an effort to inform prevention activities.... more
Injection drug use is a growing but understudied problem in Tijuana, a city situated on the northwestern Mexico-U.S border. The authors studied factors associated with receptive needle sharing in an effort to inform prevention activities. In 2003, street-recruited injection drug users (IDUs) in Tijuana underwent interviews on injection risk behaviors and rapid HIV antibody tests. Logistic regression was used to
Research Interests: Pharmacology, Psychology, Epidemiology, Addiction, Public Health, and 21 moreLogistic Regression, Multivariate Analysis, Mexico, Humans, Virus, Psychoactive Drugs, Female, Male, Sexual Behavior, Drug Addiction, Injecting Drug Use, Sterilization, Sharing, Prevalence, Middle Aged, HIV testing, Adult, Public health systems and services research, MEXICO, Risk Behavior, and Needle Sharing
Some studies have indicated that needle exchange programs (NEPs) can be effective in reducing drug-related risks for human immunodeficiency virus (HIV) seroconversion; however, others have reported higher HIV incidence rates among NEP... more
Some studies have indicated that needle exchange programs (NEPs) can be effective in reducing drug-related risks for human immunodeficiency virus (HIV) seroconversion; however, others have reported higher HIV incidence rates among NEP attendees. Since many studies rely on self-reports of NEP attendance, the authors investigated the extent to which differential misreporting of NEP attendance could bias risk estimates. Over a 3-year period from 1994 to 1997, self-reports of NEP attendance from participants in a prospective study in Baltimore, Maryland, were compared with NEP records. Of 1,315 participants, 459 (35%) had registered with the Baltimore NEP. There was 86.7% concordance between self-reported and actual NEP use; 11.0% reported NEP attendance but did not attend (overreported), and 2.2% reported not attending NEP but did attend (underreported). In multivariate analyses using generalized estimating equations, persons who overreported NEP attendance were more likely to have inj...
Research Interests: Program Evaluation, Prospective studies, Humans, Mathematical Sciences, Female, and 15 moreMale, Self Disclosure, Poisson regression, American, Maryland, Human immunodeficiency virus, Adult, Patient Participation, Bias (Epidemiology), Poisson Distribution, Logistic Models, Prospective Study, Generalized estimating equation, Confidence Interval, and Risk estimation
To enhance HIV surveillance within a non-nominal provincial testing system. Confirmatory HIV tests from a provincial laboratory were analyzed during 1995 and 1996. Enhancements included elimination of repeat positive tests for the same... more
To enhance HIV surveillance within a non-nominal provincial testing system. Confirmatory HIV tests from a provincial laboratory were analyzed during 1995 and 1996. Enhancements included elimination of repeat positive tests for the same individual using automated matching of non-nominal identifiers and nurse call-back of health care providers, completion of missing information through call-back and connection of providers with resources for patient care. Forty-seven percent of 2,683 reactive HIV tests were identified as duplicates for the same individual, meaning that 1,401 people tested positive for the first time. From laboratory test data to enhanced unduplicated data after call-back, the proportion of tests for which risk and ethnic information was unknown dropped from 37% to 11% and from 64% to 18% respectively (p < 0.0001). Enhanced non-nominal surveillance for HIV is a practical means of marrying the needs of public health for epidemiological information and the rights of p...
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Peace and stability in Eastern Europe is now at a crossroads with the rapidly deteriorating foreign policy crisis continuing to unfold in the Ukraine. However, largely overlooked in the context of other foreign policy and diplomatic... more
Peace and stability in Eastern Europe is now at a crossroads with the rapidly deteriorating foreign policy crisis continuing to unfold in the Ukraine. However, largely overlooked in the context of other foreign policy and diplomatic priorities are the serious public health consequences for the region following the annexation of Crimea and the subsequent decision to ban opioid substitution therapy in the disputed territory. On 1 May 2014, the Republic of Crimea officially announced it would end access to opioid substitution therapy, an essential harm reduction tool recognized by international organizations and virtually all other European countries. The policy development marks a critical reversal in the region's fight against its growing HIV epidemic and also threatens years of public health gains aimed at providing evidence-based and integrated treatment approaches to combat drug dependence and HIV. Beyond these risks, the Ukrainian conflict could also negatively impact control...
To explore experiences during childhood and adolescence that influenced reproductive and sexual health among women who had entered the sex industry in adolescence. A qualitative study was conducted using information provided by 25 female... more
To explore experiences during childhood and adolescence that influenced reproductive and sexual health among women who had entered the sex industry in adolescence. A qualitative study was conducted using information provided by 25 female sex workers (FSWs) from Tijuana, Mexico, who reported entering the sex industry when younger than 18 years. In-depth, semi-structured interviews were conducted with all participants between January 31, 2011, and July 8, 2011. Four interrelated themes that shaped health experiences-early sexual abuse, early illicit drug use, ongoing violence, and limited access to reproductive and sexual health care-were identified. Participants reporting these experiences were at risk of unintended teenaged pregnancy, spontaneous abortion or stillbirth, and untreated sexually transmitted infections. Programs and policies that address social, structural, and individual vulnerabilities during adolescence and adulthood are required to promote reproductive and sexual he...
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ABSTRACT
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Summary Given that syphilis is associated with HIV infection among people who inject drugs (PWID), we examined syphilis incidence among PWID in Tijuana, Mexico. From 2006 to 2007, 940 PWID (142 women and 798 men) were recruited via... more
Summary Given that syphilis is associated with HIV infection among people who inject drugs (PWID), we examined syphilis incidence among PWID in Tijuana, Mexico. From 2006 to 2007, 940 PWID (142 women and 798 men) were recruited via respondent-driven sampling and followed for 18 months. At semi-annual visits, participants were tested for syphilis and completed surveys, which collected information on socio-demographics, sexual behaviours, substance use and injection behaviours. Poisson regression was used to estimate syphilis incidence rates (IRs), incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Twenty-one participants acquired syphilis during follow-up (IR = 1.57 per 100 person-years, 95% CI: 1.02-2.41). In a multivariate analysis, syphilis incidence was higher among women (IRR = 3.90, 95% CI: 1.37-11.09), HIV-positive participants (IRR = 4.60, 95% CI: 1.58-13.39) and those who reported ever exchanging sex for drugs, money, or other goods (IRR = 2.74, 95% CI: 0.97-7....
Research Interests: Medical Microbiology, Risk Taking, Multivariate Analysis, Mexico, Syphilis, and 16 moreHumans, Female, Male, Sexual Behavior, Young Adult, Follow-up studies, Incidence, Risk factors, Clinical Sciences, Public health systems and services research, MEXICO, Risk Factors, Drug Users, Unsafe Sex, Logistic Models, and Needle Sharing
Men who have sex with men (MSM) in developing countries such as Mexico have received relatively little research attention. In Tijuana, Mexico, a border city experiencing a dynamic HIV epidemic, data on MSM are over a decade old. Our aims... more
Men who have sex with men (MSM) in developing countries such as Mexico have received relatively little research attention. In Tijuana, Mexico, a border city experiencing a dynamic HIV epidemic, data on MSM are over a decade old. Our aims were to estimate the prevalence and examine correlates of HIV infection among MSM in this city. We conducted a cross-sectional study of 191 MSM recruited through respondent-driven sampling (RDS) in 2012. Biological males over the age of 18 who resided in Tijuana and reported sex with a male in the past year were included. Participants underwent interviewer-administered surveys and rapid tests for HIV and syphilis with confirmation. A total of 33 MSM tested positive for HIV, yielding an RDS-adjusted estimated 20% prevalence. Of those who tested positive, 89% were previously unaware of their HIV status. An estimated 36% (95% CI: 26.4-46.5) had been tested for HIV in the past year, and 30% (95% CI: 19.0-40.0) were estimated to have ever used methamphet...
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Research Interests: Human Rights, Global Health, Molecular Epidemiology, Humans, Female, and 4 moreMale, Sex Workers, Lancet, and Viral Load
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Disclosure of sexually transmitted infections (STI)/HIV diagnoses to sexual partners is not mandated by public health guidelines in Mexico. To assess the feasibility of couples-based STI/HIV testing with facilitated disclosure as a... more
Disclosure of sexually transmitted infections (STI)/HIV diagnoses to sexual partners is not mandated by public health guidelines in Mexico. To assess the feasibility of couples-based STI/HIV testing with facilitated disclosure as a risk-reduction strategy within female sex workers' (FSW) primary partnerships, we examined STI/HIV test result disclosure patterns between FSWs and their primary, non-commercial male partners in two Mexico-US border cities. From 2010 to 2013, 335 participants (181 FSWs and 154 primary male partners) were followed for 24 months. At semiannual visits, participants were tested for STIs/HIV and reported on their disclosure of test results from the previous visit. Multilevel logistic regression was used to identify individual-level and partnership-level predictors of cumulative (1) non-disclosure of ≥1 STI test result and (2) non-disclosure of ≥1 HIV test result within couples during follow-up. Eighty-seven percent of participants reported disclosing all S...
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Research Interests: Global Health, Kenya, India, Canada, Humans, and 9 moreProstitution, Female, Sex Workers, Incidence, Risk factors, Lancet, Prevalence, Risk Factors, and Condoms
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The association between childhood sexual abuse and HIV risk among men who have sex with men (MSM) is well established. However, no studies have examined the potential impact of other forms of childhood maltreatment on HIV incidence in... more
The association between childhood sexual abuse and HIV risk among men who have sex with men (MSM) is well established. However, no studies have examined the potential impact of other forms of childhood maltreatment on HIV incidence in this population. We explored the impact of child physical abuse (CPA) on HIV seroconversion in a cohort of gay/bisexual men aged 15 to 30 in Vancouver, Canada. Cox proportional hazard models were used, controlling for confounders. Among 287 participants, 211 (73.5%) reported experiencing CPA before the age of 17, and 42 (14.6%) reporting URAI in the past year. After a median of 6.6 years follow-up, 16 (5.8%) participants HIV-seroconverted. In multivariate analysis, CPA was significantly associated with HIV seroconversion (adjusted hazard ratio [AHR] = 4.89, 95% confidence interval (CI): 1.65-14.48), after controlling for potential confounders. Our study uncovered a link between childhood physical violence and HIV incidence. Results highlight an urgent ...
Research Interests: Criminology, Psychology, Multidisciplinary, Probability, Humans, and 23 moreChild, Child Abuse, United States, Female, Male, Self Disclosure, American, Health Professionals, Physical Abuse, Risk factors, British Columbia, PLoS one, Aged, Prevalence, Middle Aged, Adult, Interpersonal Violence, Hiv seropositivity, Risk Factors, Cross Sectional Studies, Unsafe Sex, Cohort Studies, and Gastrointestinal Diseases
Research Interests: Program Evaluation, Poverty, Risk assessment, Telemedicine, Mexico, and 13 moreMedical Students, Humans, Program Development, Female, Undergraduate medical education, Male, Young Adult, Adult, Public health systems and services research, Southwestern United States, MEXICO, Risk Assessment, and Socioeconomic Factors
To compare characteristics of first-time needle exchange participants who enrolled at a mobile van-based exchange site versus a fixed pharmacy-based exchange site, in an area where both types of needle exchange programs were available.... more
To compare characteristics of first-time needle exchange participants who enrolled at a mobile van-based exchange site versus a fixed pharmacy-based exchange site, in an area where both types of needle exchange programs were available. Demographic and drug use data were collected on needle exchange program participants on enrollment. Participants were included if they were first-time participants at the Baltimore needle exchange program between December 1997 and March 1999, and if their first visit was at either one van-based site or at one of two pharmacy-based sites. Descriptive statistics and inferences were based on the type of needle exchange into which participants enrolled. Among 286 first-time participants, 92% were African American, 28% were women, 11% were currently employed, 55% completed high school, and the median age was 40 years. In multivariate analyses, van-based enrollment was more common among frequent injectors (odds ratio [OR] = 2.0), but less common among African American participants (OR = 0.21). Our data suggest that different venues for needle exchange program settings attract different types of drug injecting participants. This suggests that offering different venue types to reach participants with differing drug use patterns will be important to optimize risk reduction strategies.
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Research Interests: Infectious disease epidemiology, Global Health, Tobacco, Tuberculosis and Infectious Disease, Infectious Diseases, and 22 moreMultivariate Analysis, Mexico, Tuberculosis, Humans, Substance Abuse, Mycobacterium tuberculosis, Smoking, Female, M. tuberculosis, Male, Risk factors, Prevalence, Middle Aged, Saliva, Adult, Chi Square Distribution, MEXICO, Risk Factors, Drug Users, Cross Sectional Studies, Predictive value of tests, and Cotinine
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The objective of this study was to examine the association between adolescent exposure to and understanding of needle exchange programs (NEPs) and their perceptions of the impact of NEP on the decision to use illicit drugs. From November... more
The objective of this study was to examine the association between adolescent exposure to and understanding of needle exchange programs (NEPs) and their perceptions of the impact of NEP on the decision to use illicit drugs. From November 1998 to February 1999, ...
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Research Interests: Adolescent, Sex Industry and Workers, Mexico, Biological Sciences, Drug abuse and addiction, and 16 moreCalifornia, Humans, Prostitution, Female, Sexually transmitted infections, Male, Risk factors, Prevalence, Questionnaires, Adult, Vih Sida, MEXICO, Risk Factors, Female Sex Workers, Sexually Transmitted Diseases, and Unsafe Sex
Research Interests: Thailand, Risk Taking, Chlamydia trachomatis, Biological Sciences, Humans, and 16 moreBaltimore, Female, Sexually transmitted infections, Male, Sexual Behavior, Trichomonas vaginalis, Coinfection, Prevalence, Questionnaires, Adult, Bacterial Vaginosis, Condoms, Cross Sectional Studies, Sexually Transmitted Diseases, Neisseria gonorrhoeae, and Cohort Studies
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Despite increasing prevalence of HIV among U.S. Latinos, participation in HIV clinical trials is low. Barriers to HIV clinical trial participation in U.S. Latinos are not well understood. Using in-depth, semistructured interviews with HIV... more
Despite increasing prevalence of HIV among U.S. Latinos, participation in HIV clinical trials is low. Barriers to HIV clinical trial participation in U.S. Latinos are not well understood. Using in-depth, semistructured interviews with HIV care providers serving HIV-positive Latinos and focus groups with HIV-positive Mexican-origin Latinos, we assessed cross-cultural barriers (e.g., stigma and linguistic) to HIV clinical trials in San
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Research Interests: Adolescent, Logistic Regression, Mexico, Drug Use, Respondent Driven Sampling, and 15 moreHumans, Female, Male, Young Adult, Immigrant, Medical Care, Access to Health Care, HIV testing, Adult, Public health systems and services research, Head Public Health Service, MEXICO, Risk Behavior, Cross Sectional Studies, and Drug treatment
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Research Interests: Content Analysis, International Cooperation, Risk Taking, Adolescent, Urban Health, and 16 moreUrban, Law Enforcement, Mexico, Drug Use, Humans, United States, Female, Male, Injecting Drug Use, Qualitative Study, Sterilization, Middle Aged, Adult, Public health systems and services research, MEXICO, and Behavioral Research
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Injection drug use is of increasing concern along the USMexico border where Tijuana and Ciudad (Cd.) Juarez are located. Methamphetamine has long been manufactured and trafficked through Mexico, with low rates of use within Mexico. With... more
Injection drug use is of increasing concern along the USMexico border where Tijuana and Ciudad (Cd.) Juarez are located. Methamphetamine has long been manufactured and trafficked through Mexico, with low rates of use within Mexico. With methamphetamine use now ...
Research Interests: Domestic Violence, Content Analysis, Life Style, Qualitative Research, Risk Taking, and 24 morePublic Health, Mexico, Drug Use, Tuberculosis, Humans, Crime, United States, Female, Methamphetamine, Male, Injecting Drug Use, Qualitative Study, Sterilization, Immigrant, Middle Aged, Adult, Public health systems and services research, Street Drugs, Urban Population, MEXICO, Health Effect, Sexually Transmitted Diseases, Substance-Related Disorders, and Socioeconomic Factors
HIV prevalence is rising, especially among high risk females in Tijuana, Baja California, a Mexico-US border city situated on major migration and drug trafficking routes. We compared factors associated with HIV infection among male and... more
HIV prevalence is rising, especially among high risk females in Tijuana, Baja California, a Mexico-US border city situated on major migration and drug trafficking routes. We compared factors associated with HIV infection among male and female injection drug users (IDUs) ...
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J Acquir Immune Defic Syndr. Author manuscript; available in PMC 2009 August 29. ... J Acquir Immune Defic Syndr. 2009 May 1; 51(Suppl 1): S42S46. ... Department of Psychiatry, University of California, San Diego, La Jolla, CA and... more
J Acquir Immune Defic Syndr. Author manuscript; available in PMC 2009 August 29. ... J Acquir Immune Defic Syndr. 2009 May 1; 51(Suppl 1): S42S46. ... Department of Psychiatry, University of California, San Diego, La Jolla, CA and Mental Illness Research, Education and ...
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Of 924 FSWs, 18.0% had ever injected drugs. Among FSW-IDUs (N = 114), prevalence of HIV, syphilis titers ≥1:8, gonorrhea and Chlamydia was significantly higher at 12.3%, 22.7%, 15.2% and 21.2% compared to 4.8%, 13.1%, 5.2% and 11.9% among... more
Of 924 FSWs, 18.0% had ever injected drugs. Among FSW-IDUs (N = 114), prevalence of HIV, syphilis titers ≥1:8, gonorrhea and Chlamydia was significantly higher at 12.3%, 22.7%, 15.2% and 21.2% compared to 4.8%, 13.1%, 5.2% and 11.9% among other FSWs ...
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Deportees are a hidden yet highly vulnerable and numerous population. Significantly, little data exists about the substance use and deportation experiences of Mexicans deported from the United States. This pilot qualitative study... more
Deportees are a hidden yet highly vulnerable and numerous population. Significantly, little data exists about the substance use and deportation experiences of Mexicans deported from the United States. This pilot qualitative study describes illicit drug use behaviors among 24 Mexico-born male injection drug users (IDUs), ≥18 years old, residing in Tijuana, Mexico who self-identified as deportees from the United States. In-person interviews were conducted in Tijuana, Mexico in 2008. Content analysis of interview transcripts identified major themes in participants’ experiences. Few participants had personal or family exposures to illicit drugs prior to their first U.S. migration. Participants reported numerous deportations. Social (i.e., friends/family, post-migration stressors) and environmental factors (e.g., drug availability) were perceived to contribute to substance use initiation in the U.S. Drugs consumed in the United States included marijuana, heroin, cocaine, methamphetamine, and crack. More than half of men were IDUs prior to deportation. Addiction and justice system experiences reportedly contributed to deportation. After deportation, several men injected new drugs, primarily heroin or methamphetamine, or a combination of both drugs. Many men perceived an increase in their substance use after deportation and reported shame and loss of familial social and economic support. Early intervention is needed to stem illicit drug use in Mexican migrant youths. Binational cooperation around migrant health issues is warranted. Migrant-oriented programs may expand components that address mental health and drug use behaviors in an effort to reduce transmission of blood-borne infections. Special considerations are merited for substance users in correctional systems in the United States and Mexico, as well as substance users in United States immigration detention centers. The health status and health behaviors of deportees are likely to impact receiving Mexican communities. Programs that address health, social, and economic issues may aid deportees in resettling in Mexico.
Research Interests: Health Behavior, Early Intervention, Drugs And Addiction, Mental Health, Migration, and 29 moreContent Analysis, Qualitative Research, Risk Taking, Forced Migration, Urban Health, Urban, Mexico, Drug Use, Prisons, Prospective studies, Humans, Crime, Substance Use, United States, Deportation, Male, Young Adult, Qualitative Study, Social Environment, Risk factors, Health Status, Hiv Aids, Adult, Public health systems and services research, Illicit Drugs, MEXICO, Risk Factors, Pilot Projects, and Illicit Drug Use
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Amongst the 43 participants, most reported that it is common for IDUs to be arrested and detained for 36 h for carrying sterile or used syringes. Most reported that they or someone they knew had been beaten by police. Interviews suggested... more
Amongst the 43 participants, most reported that it is common for IDUs to be arrested and detained for 36 h for carrying sterile or used syringes. Most reported that they or someone they knew had been beaten by police. Interviews suggested five key themes relating to police influence ...
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This cross-sectional study was conducted at three government maternity hospitals in Kabul, Afghanistan from June through September, 2006. Consecutively-enrolled participants completed an interviewer-administered survey and whole blood... more
This cross-sectional study was conducted at three government maternity hospitals in Kabul, Afghanistan from June through September, 2006. Consecutively-enrolled participants completed an interviewer-administered survey and whole blood rapid testing with serum confirmation ...
Research Interests: Microbiology, Afghanistan, Medical Microbiology, Adolescent, Hepatitis C, and 17 moreLogistic Regression, Syphilis, Pregnancy, Hepatitis B, Humans, Child, Female, Male, Clinical Sciences, Middle Aged, Human immunodeficiency virus, Adult, Biological markers, Cross sectional Study, Cross Sectional Studies, Logistic Models, and Hepatitis B Vaccine
Research Interests: Criminology, Drugs And Addiction, Human Rights, Syndemics, Tuberculosis and Infectious Disease, and 16 morePublic Health, Central Asia, Hepatitis C, Law Enforcement, Prisons, Drug Policy, Tuberculosis, Humans, Crime, Corruption, War on Drugs, Hiv Aids, Street Drugs, Sexual Partners, Asia Central, and Public Policy
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Promoted globally as an evidence-based intervention in the prevention of HIV and treatment of heroin addiction among people who inject drugs (PWID), opioid substitution treatment (OST) can help control emerging HIV epidemics among PWID.... more
Promoted globally as an evidence-based intervention in the prevention of HIV and treatment of heroin addiction among people who inject drugs (PWID), opioid substitution treatment (OST) can help control emerging HIV epidemics among PWID. With implementation in December 2014, Kenya is the third Sub-Saharan African country to have introduced OST. We combine dynamic mathematical modelling with qualitative sociological research to examine the 'promise of methadone' to Kenya. We model the HIV prevention impact of OST in Nairobi, Kenya, at different levels of intervention coverage. We draw on thematic analyses of 109 qualitative interviews with PWID, and 43 with stakeholders, to chart their narratives of expectation in relation to the promise of methadone. The modelled impact of OST shows relatively slight reductions in HIV incidence (5-10%) and prevalence (2-4%) over 5 years at coverage levels (around 10%) anticipated in the planned roll-out of OST. However, there is a higher impa...
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Research Interests: Informed Consent, Adolescent, Urban Health, Urban, HIV, and 18 moreMexico, Respondent Driven Sampling, Syphilis, Length-biased Sampling, Humans, United States, Female, Blood sampling, Male, Missing Data, Data Collection, Prevalence, Middle Aged, Adult, Public health systems and services research, Urban Population, MEXICO, and Cross sectional Study
Overall, HIV prevalence was 2.8% (95% CI 2.33.4), ranging from 0.8% in Chicago to 6.3% in Los Angeles. Mean age was 24 years, 70% were male, 64% non-Hispanic (NH) white, 7% NH black, 17% Hispanic, and 12% were other/mixed race. HIV... more
Overall, HIV prevalence was 2.8% (95% CI 2.33.4), ranging from 0.8% in Chicago to 6.3% in Los Angeles. Mean age was 24 years, 70% were male, 64% non-Hispanic (NH) white, 7% NH black, 17% Hispanic, and 12% were other/mixed race. HIV infection was independently ...
Research Interests: Education, Housing, Risk Taking, Adolescent, Humans, and 17 moreCrime, United States, Female, Methamphetamine, Alcohol Drinking, Male, Young Adult, Heroin Dependence, Income, Ethnic Groups, Adult, Age Factors, Urban Population, Risk Behavior, Cross Sectional Studies, Unsafe Sex, and Socioeconomic Factors
Because people living with HIV now have greater life expectancy and reduced morbidity, there is a greater need for physicians to discuss HIV transmission risk reduction with these patients. Very limited data are available examining how... more
Because people living with HIV now have greater life expectancy and reduced morbidity, there is a greater need for physicians to discuss HIV transmission risk reduction with these patients. Very limited data are available examining how frequently this discussion is held. We examined the frequency of discussing HIV prevention and HIV care topics, as well as the associations of gender, race/ethnicity, and practice characteristics of physicians caring for persons with HIV. In a 4-city (Miami, Atlanta, Baltimore, Los Angeles) survey, 417 licensed physicians who primarily cared for patients with HIV were mailed a 58-item questionnaire about how frequently they discussed HIV transmission risk reduction, adherence to HIV antiretroviral treatment (ART), adherence to opportunistic infection (OI) prophylaxis, and how to take medicines. Multivariate logistic regression analyses were used to examine the association between physician gender, race/ethnicity, and practice characteristics, and the frequency of discussing these topics. A total of 317 physicians responded to the mailed questionnaire. Less than 40% of the physicians reported always discussing HIV transmission risk reduction with patients. In contrast, 83.9% and 65.0% reported always discussing adherence to ART and to OI prophylaxis, respectively. Of these physicians, 65.1% strongly agreed or somewhat agreed that they had sufficient time to provide the care and information needed to their patients. In multivariate analysis, the frequency of discussing HIV transmission risk reduction was higher for physicians who were Hispanic (P = 0.03) or Asian/Pacific Islander (P = 0.001), for physicians who reported they had enough time to provide care and information to patients (P = 0.003), and for physicians who cared for fewer patients (P = 0.05). The frequency of discussing HIV transmission risk reduction was suggestive of a higher rate for female physicians, but did not quite reach statistical significance. We observed a lower frequency of discussing the topic of HIV prevention compared with that of HIV care among the physicians surveyed. This infrequent discussion with patients with HIV represents a missed opportunity, and physicians should be encouraged to include discussion of prevention as a standard of care.
Research Interests: Logistic Regression, Georgia, Los Angeles, Multivariate Analysis, Pacific Islands, and 19 moreHumans, Gender Medicine, Baltimore, Female, Florida, Male, Gender Difference, HIV Prevention, Statistical Significance, Patient Compliance, Life Expectancy, Ethnic Groups, Clinical Sciences, Middle Aged, Questionnaires, Adult, Risk Reduction, Sex Factors, and Standard of Care
Research Interests: Program Evaluation, Health Promotion, Evaluation, Treatment Outcome, Risk Taking, and 19 morePublic Health, Adolescent, Urban Health, Counseling, Mexico, Self Efficacy, Humans, Public, Prostitution, Female, Condom use, Adult, MEXICO, Female Sex Workers, Behavioral Research, Condoms, Sexually Transmitted Diseases, Behavioral Intervention, and Unsafe Sex
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Research Interests: Research Design, Focus Groups, Risk, Urban Health, Los Angeles, and 26 moreMexico, Drug Use, Syphilis, California, Drug Policy, Tuberculosis, Humans, Biomedical Research, Case Study, Female, Male, San Francisco, Health Science, Injecting Drug Use, Data Collection, Human health, Questionnaires, Longitudinal Studies, Lessons Learned, Adult, Reproducibility of Results, Hiv seropositivity, MEXICO, Qualitative Method, Mixed Method, and Cross Sectional Studies
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Research Interests: Psychology, Mental Health, Logistic Regression, Mental Illness, Antiretroviral Therapy, and 12 moreHumans, Social Services, Injecting Drug Use, Hiv Infection, Public health systems and services research, Odds ratio, Highly Active Antiretroviral Therapy, Illicit Drugs, Substance-Related Disorders, Confidence Interval, Drug treatment, and AIDS care
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Research Interests: Women, Risk Taking, Adolescent, Gender Identity, Logistic Regression, and 21 moreHumans, Female, Sexual Behavior, Young Adult, Power Control, Massachusetts, Social Environment, Risk factors, Condom use, Prevalence, Asian Americans, Asian American, Adult, Public health systems and services research, Psychology of Power, Risk Factors, Risk Behavior, Condoms, Sexual Partners, Cross Sectional Studies, and Socioeconomic Factors
HIV testing and counseling has been associated with reductions in risk behaviors in some populations. This study examined whether involvement in a long-term study, including exposure to repeated HIV testing and counseling, was associated... more
HIV testing and counseling has been associated with reductions in risk behaviors in some populations. This study examined whether involvement in a long-term study, including exposure to repeated HIV testing and counseling, was associated with increased condom use among injection drug users (IDUs) through a retrospective analysis of an IDU cohort from Baltimore, MD, during 1994-1998. Eligibility included being aged 18 years or older, injecting within 10 years and not having initiated antiretroviral therapy. A logistic model of high versus low risk, based on condom use, was used. Of 322 eligible IDUs, most were male (66%) and African-American (94%). No significant change in the odds of inconsistent condom use was observed with continued study exposure. Condom use remained low, indicating a need for interventions to reduce sexual risks and HIV transmission in this population.
Research Interests: Research Methodology, Behavior, Risk Taking, Health, Medicine, and 23 moreCounseling, Antiretroviral Therapy, Humans, African American, Baltimore, Female, Male, Sexual Behavior, Behavior change, Condom use, Developed Countries, HIV testing, Longitudinal Studies, Adult, Public health systems and services research, Highly Active Antiretroviral Therapy, Risk Behavior, Logistic Model, Low Risk, Condoms, Sexual Risk Behavior, Long Term Study, and Cohort Studies
Research Interests: Engineering, Psychology, Demography, Physics, Chemistry, and 57 moreOccupational Health, Behavior, Health Education, Biology, Philippines, Treatment Outcome, Risk Taking, Public Health, Health Policy, Adolescent, Sex Industry and Workers, Medicine, Multidisciplinary, Catholicism, Mexico, Biological Sciences, Syphilis, South Africa, Humans, Business and Management, Young Adults, Prostitution, United States, Female, Male, Sexual Behavior, Young Adult, AIDS, Hiv Infection, Sex Workers, Social Environment, Sex Work/sex Workers Rights, Risk factors, PLoS one, Condom use, Peer group, Aged, Middle Aged, Hiv Aids, Social Values, Adult, Public health systems and services research, Odds ratio, Highly Active Antiretroviral Therapy, Educational Status, Disease Progression, MEXICO, Risk Factors, Health Psychology and Behavioral Medicine, Female Sex Workers, Condoms, Drug Users, Cross Sectional Studies, Environment, Substance-Related Disorders, Acquired immunodeficiency syndrome, and Socioeconomic Factors
Research Interests: Health Behavior, Health Services Research, Adolescent, Los Angeles, HIV, and 22 moreMultivariate Analysis, Biological Sciences, Humans, Health Service utilization, Health Services, United States, Female, Male, AIDS, Follow-up studies, Hiv Infection, Case Management, Middle Aged, Adult, Infection prevention and control, Medical Records, Health Care Costs, Standard of Care, Brief Intervention, Relative Risk, Viral Load, and Socioeconomic Factors
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Research Interests: Prejudice, Adolescent, Sexual Orientation, Bisexuality, Prospective studies, and 16 moreHumans, Public, Aggression, Male, Sexual Behavior, Incidence, Risk factors, British Columbia, Prevalence, Questionnaires, Adult, Chi Square Distribution, Risk Factors, Young Men, Proportional Hazards Models, and Logistic Models
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Research Interests: Sociology, Cultural Studies, Risk Taking, Culture and Mental Health, Canada, and 15 moreProspective studies, Humans, Male, HIV Prevention, Cohort Study, Gay men, Risk factors, Questionnaires, Adult, Public health systems and services research, Hiv seropositivity, Risk Factors, Semen, Sexual Partners, and Cohort Studies
Research Interests: Demography, Sex, Sexuality, Housing, Adolescent, and 24 moreBisexuality, Humans, Age, Virus, High School, Male, Sexual Behavior, Follow-up studies, Gay men, Income, Risk factors, British Columbia, Ethnic Groups, Clinical Sciences, Condom use, HIV testing, Questionnaires, Longitudinal Studies, Adult, Time Factors, European Continental Ancestry Group, Risk Factors, Condoms, and Cohort Studies
The identification of individuals at highest risk of HIV infection is critical for targeting prevention strategies. We evaluated the HIV status of the sex partners of injection drug users (IDUs) and rates of subsequent HIV seroconversion... more
The identification of individuals at highest risk of HIV infection is critical for targeting prevention strategies. We evaluated the HIV status of the sex partners of injection drug users (IDUs) and rates of subsequent HIV seroconversion among a prospective cohort study of IDUs. We performed an analysis of the time to HIV infection among baseline HIV-negative IDUs enrolled in the Vancouver Injection Drug Users Study. IDUs were stratified based on whether or not they reported having an HIV-positive sex partner. Kaplan-Meier methods were used to estimate cumulative HIV incidence rates, and Cox regression was used to determine adjusted relative hazards (RHs) for HIV seroconversion. Of 1013 initially HIV-negative IDUs, 4.8% had an HIV-positive partner at baseline. After 18 months, the cumulative HIV incidence rate was significantly elevated among those who reported having an HIV-positive sex partner (23.4% vs. 8.1%; log-rank P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In a Cox regression model adjusting for all variables that were associated with the time to HIV infection in univariate analyses, including drug use characteristics, having an HIV-positive sex partner (RH = 2.42 [95% confidence interval: 1.30 to 4.60]; P = 0.005) remained independently associated with time to HIV seroconversion. Having an HIV-positive sex partner was strongly and independently associated with seroconversion after adjustment for risk factors related to drug use. Our findings may aid public health workers in their efforts to identify IDUs who should be targeted with education and prevention efforts and indicate the need for ongoing development of prevention interventions for IDU sex partners who are HIV discordant.
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Research Interests: Child health, Contraception, Public Health, Adolescent, Multidisciplinary, and 20 moreMultivariate Analysis, Maternal and Child Health, South Africa, Humans, Reproductive health, Female, Young Adult, Cost effectiveness, PLoS one, mother to child transmission of HIV /AIDS prevention, Survey data, Adult, Public health systems and services research, Highly Active Antiretroviral Therapy, Sexual Activity, Medical Records, Logistic Regression Model, Condoms, Primary Prevention, and Logistic Models
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Research Interests: Psychology, Drugs And Addiction, Mexico, Syphilis, Humans, and 7 moreFemale, Male, Adult, MEXICO, Drug Users, Injections, and The American
The present study sought to identify demographic, structural, behavioral, and psychological subgroups for which the Antiretroviral Treatment Access Study (ARTAS) intervention had stronger or weaker effects in linking recently diagnosed... more
The present study sought to identify demographic, structural, behavioral, and psychological subgroups for which the Antiretroviral Treatment Access Study (ARTAS) intervention had stronger or weaker effects in linking recently diagnosed HIV-positive persons to medical care. The study, carried out from 2001 to 2003, randomized 316 participants to receive either passive referral or a strengths-based linkage intervention to facilitate entry into HIV primary care. The outcome was attending at least one HIV primary care visit in each of two consecutive 6-month periods. Participants (71% male; 29% Hispanic; 57% black non-Hispanic), were recruited from sexually transmitted disease clinics, hospitals and community-based organizations in four U.S. cities. Thirteen effect modifier variables measured at baseline were examined. Subgroup differences were formally tested with interaction terms in unadjusted and adjusted log-linear regression models. Eighty-six percent (273/316) of participants had complete 12-month follow-up data. The intervention significantly improved linkage to care in 12 of 26 subgroups. In multivariate analysis of effect modification, the intervention was significantly (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) stronger among Hispanics than other racial/ethnic groups combined, stronger among those with unstable than stable housing, and stronger among those who were not experiencing depressive symptoms compared to those who were. The ARTAS linkage intervention was successful in many but not all subgroups of persons recently diagnosed with HIV infection. For three variables, the intervention effect was significantly stronger in one subgroup compared to the counterpart subgroup. To increase its scope, the intervention may need to be tailored to the specific needs of groups that did not respond well to the intervention.
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Douching is a common practice among certain groups of women and MSM, and it is conducted for the purpose of cleanliness as part of bodily hygiene maintenance. Although there has been considerable research about female vaginal douching,... more
Douching is a common practice among certain groups of women and MSM, and it is conducted for the purpose of cleanliness as part of bodily hygiene maintenance. Although there has been considerable research about female vaginal douching, understandings of rectal douching (RD) for MSM are limited. In the epidemiological and medical literature, RD is presented as a behaviour that removes
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Given growing concern of the sexual risks associated with crystal methamphetamine use and the dearth of research characterizing the use of methamphetamine among street-based sex workers (FSWs), this study aimed to characterize the... more
Given growing concern of the sexual risks associated with crystal methamphetamine use and the dearth of research characterizing the use of methamphetamine among street-based sex workers (FSWs), this study aimed to characterize the prevalence and individual, social, and structural contexts of crystal methamphetamine use among FSWs in a Canadian setting. Drawing on data from a prospective cohort, we constructed multivariate
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We consider studies for evaluating the short-term effect of a treatment of interest on a time-to-event outcome. The studies we consider are partially controlled in the following sense: (1) Subjects’ exposure to the ...
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INTRODUCTION: Human Immunodeficiency Virus (HIV) has an estimated prevalence of 0.9% in India (5.2 million). Anti-retroviral drugs (ARV) are the treatments of choice and non-adherence is an important factor in treatment failure and... more
INTRODUCTION: Human Immunodeficiency Virus (HIV) has an estimated prevalence of 0.9% in India (5.2 million). Anti-retroviral drugs (ARV) are the treatments of choice and non-adherence is an important factor in treatment failure and development of resistance, as well as being a powerful predictor of survival. This study assesses adherence to ARV in HIV positive patients in Bangalore, India, a country
Research Interests: Psychology, Statistical Analysis, Medical Microbiology, Health Belief Model, Medication Adherence, and 49 moreTransportation, Treatment Outcome, Adolescent, Tanzania, Drug Use, Antiretroviral Therapy, Humans, Child, African American, Female, Male, Statistical Significance, Infant, Patient Compliance, Hiv Infection, Scaling up, Caregivers, Educational Attainment, Meta Analysis, Systematic review, Health Status, Clinical Sciences, Aged, Middle Aged, Prisoners, Human immunodeficiency virus, Questionnaires, Adult, Cross Section, Public health systems and services research, Sex Factors, Analysis of Variance, Patient Care, Highly Active Antiretroviral Therapy, Health Beliefs, Sub Saharan Africa, STD, Side Effect, Drug Users, Cross Sectional Studies, Family Size, Treatment Refusal, Questionnaire Survey, Confidence Interval, Drug treatment, AIDS care, Viral Load, Food Restriction, and Socioeconomic Factors
OBJECTIVE: Among sex workers (SWs) in Vancouver, Canada, this study identified social, drug use, sex work, environmental-structural, and client-related factors associated with being offered and accepting more money after clients' demand... more
OBJECTIVE:
Among sex workers (SWs) in Vancouver, Canada, this study identified social, drug use, sex work, environmental-structural, and client-related factors associated with being offered and accepting more money after clients' demand for sex without a condom.
DESIGN:
Cross-sectional study using baseline (February 2010 to October 2011) data from a longitudinal cohort of 510 SWs.
METHODS:
A 2-part multivariable regression model was used to identify factors associated with 2 separate outcomes: (1) being offered more money for sex without a condom in the last 6 months; and (2) accepting more money, among those who had been offered more money.
RESULTS:
The sample included 490 SWs. In multivariable analysis, being offered more money for sex without a condom was more likely for SWs who used speedballs, had higher average numbers of clients per week, had difficulty accessing condoms, and had clients who visited other SWs. Accepting more money for sex without a condom was more likely for SWs self-reporting as a sexual minority and who had experienced client violence and used crystal methamphetamine less than daily (versus none) and less likely for SWs who solicited mainly indoors for clients (versus outdoor/public places).
CONCLUSIONS:
These results highlight the high demand for sex without a condom by clients of SWs. HIV prevention efforts should shift responsibility toward clients to reduce offers of more money for unsafe sex. Programs that mitigate the social and economic risk environments of SWs alongside the removal of criminal sanctions on sex work to enable condom use within safer indoor workspaces are urgently required.
Among sex workers (SWs) in Vancouver, Canada, this study identified social, drug use, sex work, environmental-structural, and client-related factors associated with being offered and accepting more money after clients' demand for sex without a condom.
DESIGN:
Cross-sectional study using baseline (February 2010 to October 2011) data from a longitudinal cohort of 510 SWs.
METHODS:
A 2-part multivariable regression model was used to identify factors associated with 2 separate outcomes: (1) being offered more money for sex without a condom in the last 6 months; and (2) accepting more money, among those who had been offered more money.
RESULTS:
The sample included 490 SWs. In multivariable analysis, being offered more money for sex without a condom was more likely for SWs who used speedballs, had higher average numbers of clients per week, had difficulty accessing condoms, and had clients who visited other SWs. Accepting more money for sex without a condom was more likely for SWs self-reporting as a sexual minority and who had experienced client violence and used crystal methamphetamine less than daily (versus none) and less likely for SWs who solicited mainly indoors for clients (versus outdoor/public places).
CONCLUSIONS:
These results highlight the high demand for sex without a condom by clients of SWs. HIV prevention efforts should shift responsibility toward clients to reduce offers of more money for unsafe sex. Programs that mitigate the social and economic risk environments of SWs alongside the removal of criminal sanctions on sex work to enable condom use within safer indoor workspaces are urgently required.