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Alegria M, Vera M, Freeman DH Jr, Robles R, Santos MC, Rivera CL. HIV infection, risk behaviors, and depressive symptoms among Puerto Rican sex workers
Abstract and Figures
This paper examines the association of depressive symptoms with human immunodeficiency virus (HIV) infection and risk behaviors among 127 sex workers. Data were obtained by a structured interview and blood specimens tested for HIV. Findings showed a high prevalence rate of depressive symptoms for all sex workers regardless of HIV infection status. Results of a logistic regression analysis indicated that the use of injected drugs and engaging in unprotected intercourse with clients were strongly associated with a high level of depressive symptoms.
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... typology, depression was more prevalent among the men who have sex with men, followed by people who inject drugs, and lastly by female sex workers. These fi ndings aligned with the fi ndings of the study conducted in Puerto Rico by Alegria, et al.which found high levels of depressive symptoms among people who inject drugs[18].Aside from depression, substance use disorder was also of high prevalence among the key populations which was recorded highest among the PWIDs, followed by MSM and lastly by FSW. The result is similar to the outcome of the study carried out in Nigeria byOchonye, et al. in 2019 in which one of their fi ndings indicated that high prevalence of substance use among members of Key populations[16]. ...
Nigeria ranks third among countries with the highest burden of Human Immuno-Deficiency Virus (HIV) infection in the world. The 2019 Nigeria National HIV/AIDS Indicator and Impact Survey showed that 1.9 million people were living with HIV and AIDS in Nigeria as of 2018 [1].
... In sub-Saharan Africa, studies show high levels of substance use among FSW and associations between substance use and poor physical health and cognitive outcomes (9)(10)(11). Globally, FSW are speci cally more vulnerable to depression than the general population due to these numerous risk factors (12)(13)(14)(15)(16). It is estimated that the pooled prevalence of depression among FSW in LMICs is 41.8% (8). ...
Introduction:
Over half of female sex workers (FSW) in South Africa are living with HIV and clinical depression has been frequently documented among FSW. Data characterizing structural determinants of depression and the role of syndemic theory, an aggregation of multiple risk factors, on viral suppression among FSW in South Africa are limited.
Methods:
Between July 2018-March 2020, non-pregnant, cisgender women (≥ 18 years), reporting sex work as their primary income source, and diagnosed with HIV for ≥ 6 months were enrolled into the Siyaphambili trial in eThekwini, South Africa. Using baseline data, robust Poisson regression models were used to assess correlates of depression and associations between depression and syndemic factors on viral suppression.
Results:
Of 1,384 participants, 459 (33%) screened positive for depression, defined as a score of ≥ 10 on the PHQ-9. Physical and sexual violence, drug use, alcohol use, anticipated stigma and internalized stigma were univariately associated with depression and included the multivariate model. In the multivariate regression, prevalence of depression was higher among participants experiencing sexual violence (PR = 1.47 95% CI:1.24,1.73), physical violence 5 times or more in < 6 months (PR = 1.38 95% CI:1.07, 1.80), using illicit drugs in the last month (PR = 1.23 95%:CI 1.04, 1.48), and reporting higher levels of internalized stigma (PR = 1.11, 95% CI:1.04,1.18). Depression in the absence of the Substance Abuse, Violence and AIDS SAVA syndemic factors was associated with increased prevalence of non-viral suppression (aPR 1.24; 95% CI:1.08,1.43), and the SAVA substance use and violence syndemic was associated with an increase in non-viral suppression among non-depressed FSW (aPR 1.13; 95% CI:1.01, 1.26). Compared to those experiencing neither factors, those jointly experiencing depression and the SAVA syndemics were at increased risk for non-viral suppression (aPR 1.15; 95% CI:1.02,1.28).
Conclusion:
Substance use, violence, and stigma were all associated with depression. Depression and syndemic factors (substance use + violence) were related to non-viral suppression; we did not observe higher non-suppression amongst those experiencing both depression and syndemic factors. Training for non-mental health providers in screening for depression and its risk factors among FSW, along with proactive referral to support may help to address unmet mental health needs and HIV treatment outcomes.
Trial registration: Clinical Trial Number: NCT03500172
Introduction:
Over half of female sex workers (FSW) in South Africa are living with HIV and clinical depression has been frequently documented among FSW. Data characterizing structural determinants of depression and the role of syndemic theory, synergistically interacting disease states, on viral suppression among FSW in South Africa are limited.
Methods:
Between July 2018-March 2020, non-pregnant, cisgender women (≥ 18 years), reporting sex work as their primary income source, and diagnosed with HIV for ≥ 6 months were enrolled into the Siyaphambili trial in eThekwini, South Africa. Using baseline data, robust Poisson regression models were used to assess correlates of depression and associations between depression and syndemic factors on viral suppression.
Results:
Of 1,384 participants, 459 (33%) screened positive for depression, defined as a score of ≥ 10 on the PHQ-9. Physical and sexual violence, drug use, alcohol use, anticipated stigma and internalized stigma were univariately associated with depression (all p's < 0.05) and included the multivariate model. In the multivariate regression, prevalence of depression was higher among participants experiencing sexual violence (PR = 1.47 95% CI:1.24,1.73), physical violence 5 times or more in < 6 months (PR = 1.38 95% CI:1.07, 1.80), using illicit drugs in the last month (PR = 1.23 95%:CI 1.04, 1.48), and reporting higher levels of internalized stigma (PR = 1.11, 95% CI:1.04,1.18). Depression in the absence of the Substance Abuse, Violence and AIDS SAVA syndemic factors was associated with increased prevalence of unsuppressed viral load (aPR 1.24; 95% CI:1.08,1.43), and the SAVA substance use and violence syndemic was associated with an increase in unsuppressed viral load among non-depressed FSW (aPR 1.13; 95% CI:1.01, 1.26). Compared to those experiencing neither factors, those jointly experiencing depression and the SAVA syndemics were at increased risk for unsuppressed viral load (aPR 1.15; 95% CI:1.02,1.28).
Conclusion:
Substance use, violence, and stigma were all associated with depression. Depression and syndemic factors (substance use + violence) were related to unsuppressed viral load; we did not observe higher unsuppressed viral load amongst those experiencing both depression and syndemic factors. Our findings point to the need to understand the unmet mental health needs of FSW living with HIV.
Trial registration:
Clinical Trial Number: NCT03500172.
Mental illness accounts directly for 14% of the global burden of disease and significantly more indirectly, and recent reports recognise the need to expand and improve mental health delivery on a global basis, especially in low and middle income countries. This text defines an approach to mental healthcare focused on the provision of evidence-based, cost-effective treatments, founded on the principles of sharing the best information about common problems and achieving international equity in coverage, options and outcomes. The coverage spans a diverse range of topics and defines five priority areas for the field. These embrace the domains of global advocacy, systems of development, research progress, capacity building, and monitoring. The book concludes by defining the steps to achieving equality of care globally. This is essential reading for policy makers, administrators, economists and mental health care professionals, and those from the allied professions of sociology, anthropology, international politics and foreign policy.
Female sex workers (FSW) experience many structural vulnerabilities (SV; e.g., violence, economic insecurity) which contribute to increased risk of HIV and mental distress. However, little research has examined how SV co-occur to shape HIV risk, and none have studied mental distress. Among FSW (n = 385) in Baltimore, Maryland, latent class analysis of five binary indicators (housing insecurity; financial dependence on others; client-perpetrated physical or sexual violence; food insecurity) determined classes of SV and differential HIV risk behavior and mental health outcomes. A 3-class model fit the data best: minimal SV (i.e., low probabilities of all indicators); material needs (i.e., housing, food insecurity); and high SV (i.e., high probability of all indicators). Compared to minimal SV, high SV and material needs had significantly greater adjusted probability of drug injection and poorer adjusted depression, post-traumatic stress disorder, and mental distress scores. The high SV class had significantly higher probability of reporting condomless sex with clients compared to material needs and minimal SV. Results show the deleterious effect of co-occurring SV on HIV risk behaviors among FSW with particular emphasis on co-occurring food and housing insecurities. This is the first study of co-occurring SV on mental health outcomes in this key population.
The trend of violence negatively affects individuals, families and community. Violence has no relationship with age, sex, gender, ethnicity, race, religion, economic status, or education but in most of the cases, women are the victims. The approaches related to the study of women’s problems range from the study of gerontology to psychiatry and criminology. This study tries to articulate the unspeakable cruelties done by a woman to a woman.
• We evaluated the extent to which depressive disorders, psychiatric distress, and psychosocial stressors are related to three measures of human immunodeficiency virus (HIV) illness, both cross-sectionally and during a 6-month period, in a community sample of 124 HIV-positive homosexual men. The dependent variables are immune status measured by CD4 and CD8 cell subsets, number of signs and symptoms commonly associated with HIV infection, and a cumulative index of HIV illness stage. We chose to focus on CD4 cell count because it is the immune marker most closely linked to the clinical consequences of HIV infection. We found no relationships between the independent variables and immune status or illness stage. The HIV-positive men who were depressed or distressed or who reported more life stressors had no greater immunosuppression or more advanced illness stage than did the others, either concurrently or across occasions. We did find a suggestive pattern of association between depressive disorders, distress, and stressors and the number of HIV-related symptoms, which warrants further study.
We tested 1305 female prostitutes from eight areas of the United States for antibodies to human T-cell lymphotropic virus type I/II. Overall, 6.7% were human T-cell lymphotropic virus type I/II seropositive (with antibodies to both gag and env gene products). The seroprevalence rates ranged from 0% in southern Nevada to 25.4% in Newark, NJ. Human T-cell lymphotropic virus type I/II seropositivity was independently associated with race (odds ratio, 4.68), intravenous drug use (odds ratio, 2.94), hepatitis B seropositivity (odds ratio, 2.87), recruitment in Newark (odds ratio, 2.34), and more years of sexual activity (odds ratio, 1.08 per year of sexual activity). Groups with high rates included blacks, Hispanics, and American Indians, and the rates in these groups were significantly higher than among whites and Asian Americans for women both with and without a history of intravenous drug use. Among intravenous drug users, the only other independent associations were more years of sexual activity and recruitment in Newark; and in non-intravenous drug users, hepatitis B seropositivity. These data show that human T-cell lymphotropic virus type I/II infection is present among female prostitutes in some areas of the United States. Further studies are needed to evaluate patterns of transmission and long-term health effects.
(JAMA. 1990;263:60-64)
Continues work begun in 1987 to monitor the AIDS epidemic and to investigate issues related to HIV transmission, reporting on changing patterns of sexual behaviour and intravenous drug use. Two populations of interest in the second decade of the epidemic (women and adolescents) are considered, and the study also discusses preventative measures designed to curb the future spread of HIV infection. The first two chapters describe the evolving nature of the epidemic, and the range of prevention activities, with particular emphasis on women, and the next three review the effects of HIV infection in adolescents and female prostitutes, and the challenge of protecting the blood supply whilst simultaneously ensuring adequacy of supply. The final chapter reviews factors that affect the quality of data collected in surveys of AIDS-related behaviours. -P.Hardiman
In the United States, women account for an increasing number and percentage of adults with the acquired immunodeficiency syndrome (AIDS). Overall, 51% of women with AIDS were infected through intravenous drug use and 29% through heterosexual contact; the proportion of intravenous drug users decreased, while the proportion attributed to heterosexual contact increased, between 1986 and 1990. Most women with AIDS were black or Hispanic (72%); residents of large metropolitan areas (73%), especially cities along the Atlantic coast; and of reproductive age (15 to 44 years) (85%). However, the proportion of women with AIDS reported by smaller cities and rural areas has increased from 22% in 1986 to 28% in 1990. The male-to-female ratio of heterosexuals with AIDS has remained about 2.4:1 since 1987. A comparison of women with AIDS to heterosexual men with AIDS showed that these two groups were similar by age, race, and geographic distribution. Also, survival times from AIDS diagnosis to death for women and heterosexual men with AIDS were not significantly different.
(JAMA. 1991;265:2971-2975)
Synopsis
Histories of depression-related symptoms were obtained from 3845 randomly selected adult residents of Kansas City, Missouri, and Washington County, Maryland. Depressed persons were slightly more common in Kansas City than in Washington County but within the latter area no urban–rural differences were observed. More depressed persons were found among blacks than among whites. Slightly more white females than males were depressed; no significant differences were found between black females and males. After adjustment for the effects of other independent variables, the probability of having symptoms of depression was highest among persons who were young adults, unmarried, not employed outside the home, poorly paid, and not well educated.
We evaluated the extent to which depressive disorders, psychiatric distress, and psychosocial stressors are related to three measures of human immunodeficiency virus (HIV) illness, both cross-sectionally and during a 6-month period, in a community sample of 124 HIV-positive homosexual men. The dependent variables are immune status measured by CD4 and CD8 cell subsets, number of signs and symptoms commonly associated with HIV infection, and a cumulative index of HIV illness stage. We chose to focus on CD4 cell count because it is the immune marker most closely linked to the clinical consequences of HIV infection. We found no relationships between the independent variables and immune status or illness stage. The HIV-positive men who were depressed or distressed or who reported more life stressors had no greater immunosuppression or more advanced illness stage than did the others, either concurrently or across occasions. We did find a suggestive pattern of association between depressive disorders, distress, and stressors and the number of HIV-related symptoms, which warrants further study.
Homosexual and bisexual men with acquired immunodeficiency syndrome (AIDS) differ, and bisexual men play an important role in the sexual transmission of human immunodeficiency virus (HIV) to women.
To describe AIDS in these groups, we examined AIDS cases reported nationally through June 1990.
Among 65 389 men who reported having had sex with men since 1977, 26% were bisexual. More Black (41%) and Hispanic men (31%) than White men (21%) reported bisexual behavior. Bisexual men were twice as likely to report intravenous drug use (20%) as were homosexual men (9%), regardless of race or ethnicity. Among 3555 women with heterosexually acquired AIDS, 11% reported sexual contact with a bisexual man and no other risk factor, although in some states approximately half reported such contact. In 1989, the AIDS rate due to sex with a bisexual man was three and five times higher among Hispanic and Black women, respectively, than among White women.
Differences between bisexual and homosexual men with AIDS and the relative importance of AIDS in women due to sexual contact with bisexual men should be considered in the development of HIV prevention programs.
Although considerable attention has been placed on the role of prostitutes in the AIDS epidemic, little attention has been directed to features of prostitutes' work lives which are relevant to the control of AIDS. This article reviews several aspects of prostitution in the United States which have implications for control of the epidemic. The article first reviews the epidemiology of human immunodeficiency virus (HIV) infection among prostitutes. The legalized system of prostitution in Nevada serves as a basis for comparison to illegal prostitution. This article examines the effectiveness of mandatory testing of prostitutes for monitoring and controlling the epidemic. And finally, a peer education approach as a means to control HIV infection among prostitutes is explored.