What explains gender inequality in HIV infection among high-risk people? A Blinder-Oaxaca decomposition

Background Despite clear evidence on role of gender in vulnerability and exposure to HIV infection, information on gender-related inequalities in HIV and related factors are rarely documented. The aim of this study was to measure gender inequality in HIV infection and its determinates in Tehran city, the capital of Iran. Methods The study used the data of 20,156 medical records of high-risk people who were admitted to Imam Khomeini Voluntary Counseling and Testing site in Tehran from 2004 to 2018. The Blinder-Oaxaca decomposition was used to quantify the contribution of explanatory variables to the gap in the prevalence of HIV infection between female and male. Results The age-adjusted proportion of HIV infection was 9.45% (95%Cl: 9.02, 9.87). The absolute gap in the prevalence of HIV infection between male and female was 4.50% (95% CI: − 5.33, − 3.70%). The Blinder-Oaxaca decomposition indicated that most explanatory factors affecting the differences in HIV infection were job exposure, drug abuse, history of imprisonment, injection drug, heterosexual unsafe sex, and having an HIV-positive spouse. Conclusion The results can provide evidence for health policymakers to better planning and conducting gender-based preventive and screening programs. Policies aiming at promoting HIV preventive behaviors among male may reduce the gap in HIV infection between female and male in Iran.

Analysis Adherence of Treatment and Sexual Behavior on Housewives with HIV/AIDS who Visits at Care Support and Treatment Service Cukir Public Health Center

The use of ARV drugs aims to reduce HIV/AIDS-related deaths and increase life expectancy in addition to clinical improvement of people living with HIV. Antiretroviral apart from being an antiviral is also useful for preventing HIV transmission to sexual partners, as well as HIV transmission from mother to child. In the end, it is hoped that this will reduce the number of cases of people infected with new HIV in various countries. Non-adherence to taking ARVs and unsafe sexual behavior can lead to high transmission rates. This study aims to analyze medication adherence and sexual behavior among housewives with HIV/AIDS who visited the CST service at the Cukir Health Center. This study uses a qualitative method with a case study approach. Data was collected through in-depth interviews with semi-structured interview guidelines, and documentation with 18 PLWHA. Data analysis was carried out descriptively with triangulation methods and data analysis. The results of the analysis illustrate that there is still a lack of perception of vulnerability, perception of pain and perception of benefits for PLWHA, especially unsafe sex behavior of PLWHA.

Embodying (In)justice and Embodied Truths

Chapter 2 discusses application of ecosocial theory to analyze the health impacts of Jim Crow and its legal abolition, racialized and economic breast cancer inequities involving the breast cancer estrogen receptor, and the joint health impacts of physical and social hazards at work (including racism, sexism, and heterosexism) and relationship hazards (involving unsafe sex and violence). It also uses ecosocial theory to develop and apply measures of structural injustice, including historical redlining (1930s US government policies imposing racial residential segregation) and contemporary racialized economic segregation. The chapter additionally explains the construct of “emergent embodied phenotypes” and the different types of histories involved in disease processes: societal, individual (lifecourse), pathological/cellular, and evolutionary. It concludes by providing selected examples of how others, in diverse disciplines and settings worldwide, have employed the ecosocial theory of disease distribution to conceptualize and analyze embodiment of (in)justice across a wide range of exposures and outcomes.

Ecosocial Theory, Embodied Truths, and the People's Health

This book employs the ecosocial theory of disease distribution to combine critical political and economic analysis with a deep engagement with biology, in societal, ecological, and historical context. It illuminates what embodying (in)justice entails and the embodied truths revealed by population patterns of health. Chapter 1 explains ecosocial theory and its focus on multilevel spatiotemporal processes of embodying (in)justice, across the lifecourse and historical generations, as shaped by the political economy and political ecology of the societies in which people live. The counter is to dominant narratives that attribute primary causal agency to people’s allegedly innate biology and their allegedly individual (and decontextualized) health behaviors. Chapter 2 discusses application of ecosocial theory to analyze: the health impacts of Jim Crow and its legal abolition; racialized and economic breast cancer inequities; the joint health impacts of physical and social hazards at work (including racism, sexism, and heterosexism) and relationship hazards (involving unsafe sex and violence); and measures of structural injustice. Chapter 3 explores embodied truths and health justice, in relation to: police violence; climate change; fossil fuel extraction and sexually transmitted infectious disease: health benefits of organic food—for whom? ; public monuments, symbols, and the people’s health; and light, vision, and the health of people and other species. The objective is to inform critical and practical research, actions, and alliances to advance health equity—and to strengthen the people’s health—in a deeply troubled world on a threatened planet.

Cancer burden in Nepal, 1990–2017: An analysis of the Global Burden of Disease study

Introduction Cancer is the second leading cause of death and a major public health problem in the world. This study reports the trend and burden of cancer from 1990 to 2017 along with its risk factors in Nepal. Methods This study used the database of the Institute of Health Metrics and Evaluation’s Global Burden of Diseases on cancer from Nepal to describe the most recent data available (2017) and trends by age, gender, and year from 1990 to 2017. The data are described as incidence, prevalence, disability-adjusted life years (DALY), and percentage change. Results In 2017, the age-standardized cancer incidence and mortality rates were 101.8/100,000 and 86.6/100,000 respectively in Nepal. Cancer contributed to 10% of total deaths and 5.6% of total DALYs in Nepal. The most common cancers were the breast, lung, cervical, stomach and oral cavity cancers. The number of new cancer cases and deaths in Nepal have increased from 1990 to 2017 by 92% and 95% respectively. On the other hand, age-standardized incidence and mortality rates decreased by 5% and 7% respectively. The leading risk factors of cancer were tobacco use, dietary factors, unsafe sex, air pollution, drug use, and physical inactivity. Conclusions This study highlighted the burden of cancer in Nepal, contributing to a significant number of new cancer cases, deaths and DALY. A comprehensive approach including prevention, early diagnosis and treatment, and rehabilitation should be urgently taken to reduce the burden of cancer.

Exploring unsafe sexual practices among truck drivers at Meerut District, India: a cross-sectional study

Background: Despite implementation of HIV prevention programmes for truck drivers in India, unsafe sex behavior among truck drivers has been documented. Objective: The objective of this study was to assess knowledge about HIV Transmission and modes of prevention, pattern of condom use with high risk partners and explore the practice of unsafe sex and its risk factors among truck drivers. Methods: This exploratory cross-sectional study design was conducted on a recruited convenient sample of 100 truck drivers above 18 years from March to May 2015. Binary logistic regression was used to compute unadjusted odds ratio [95% Confidence Interval] for establishing association of risk factors with unsafe sex. Results: Overall, only 7% had complete knowledge about HIV/AIDS transmission and prevention. 54% of truck drivers have sex with a high risk partner (commercial sexual worker or men having sex with men) and thirty-eight percent reported unsafe sexual practices due to inconsistent condom use with them. The various risk factors found significantly associated with unsafe sex were mean age of first intercourse (OR= 0.92, 95% CI: 0.75 – 0.97), access to pornography (OR = 4.4, 95% CI: 1.8 – 10.7) and conuming psychoactive substance before sex (OR = 4.06, 95% CI: 1.09 – 15.02). Conclusion: Socio-demographic, occupational factors, pornography access and consuming psychoactive substances seems to influence the sexual behaviour of truckers. Keywords: Unsafe sex; truck drivers; psychoactive substance; HIV; AIDS.

Perception and Practices relating to Hepatitis B Infection among In-school Adolescents in Ogun State, Nigeria

Objective: This study examined the perception and practices relating to Hepatitis B infection among In-school adolescents in Ogun State, Nigeria. Methods: A cross-sectional study of 300 in-school adolescents selected by a multi-stage sampling method. Data were elicited using a pretested self-administered questionnaire which included questions relating to respondents' risky practices, and a 35-point Hepatitis B perception scale. Descriptive statistics, as well as Chi-square statistics, were generated using IBM SPSS Version 23, and the significance level was set at 0.05. Results: The mean age of the respondents was 14.31 ± 1.73years and slightly over half (51.7%) were females. Less than half (45%) of the adolescents perceived themselves to be susceptible to Hepatitis B infection, while 31% perceived Hepatitis B infection to be a serious disease. Almost half (49%) of the adolescents had unfavorable perceptions. The most common risky practices among the respondents were sharing skin-piercing instruments with their family members (79%) and friends (68.7%). There are significant associations between sex (gender) and risky practices such as the practices of unsafe sex (X2= 9.11; p=0.10); having multiple sexual partners (X2= 12.08; p =0.02); and sharing skin-piercing instruments (X2= 5.52; p=0.01) with more males reporting the above practices than females. Conclusion/Recommendation: To minimize the identified risky practices and unfavorable perception, educational intervention programs aimed at promoting Hepatitis B virus preventive behaviors and increasing the level of perception of vulnerability and seriousness of HBV infection among in-school adolescents should be conducted.

The correlation between sexual behaviors and sexual transmitted diseases in men

Sexually transmitted diseases (STDs) have been a public health issue in many developing countries, especially in Vietnam. Unsafe sex is considered to be one of the main causes to increase infected person. Therefore, we conducted a study on 3005 men who presented to the Andrology and Sexual Medicine Units of Hanoi Medical University Hospital to analyze the correlation between sexual behaviors and sexually transmitted diseases in men. The result showed that the mean age at first sex (AFS) was 21 years old. The median number of stable sexual partners was 2, the overall rate of STDs was 9.95%, in particular, the proportion of STDs in single men was higher than the married group (11.8% and 7.5%, p < 0.001), men having first intercourse before 25 years old had the rate of STDs was higher compared with their counterpart (21.1% vs. 13.2%, p = 0.002). Subjects with multiple unstable sexual partners were 2.11 times more likely to be infected with STDs, and the risk of infecting STDs would rise 6% for each additional sex partner.

Circumcision as an Intervening Strategy against HIV Acquisition in the Male Genital Tract

Unsafe sex with HIV-infected individuals remains a major route for HIV transmission, and protective strategies, such as the distribution of free condoms and pre-or post-prophylaxis medication, have failed to control the spread of HIV, particularly in resource-limited settings and high HIV prevalence areas. An additional key strategy for HIV prevention is voluntary male circumcision (MC). International health organizations (e.g., the World Health Organization, UNAIDS) have recommended this strategy on a larger scale, however, there is a general lack of public understanding about how MC effectively protects against HIV infection. This review aims to discuss the acquisition of HIV through the male genital tract and explain how and why circumcised men are more protected from HIV infection during sexual activity than uncircumcised men who are at higher risk of HIV acquisition.

High levels of used syringe use and unsafe sex among people who inject drugs in Kumasi, Ghana: an urgent call for a comprehensive harm reduction approach

Background Drug use is a growing concern in Ghana. People who inject drugs (PWID) are highly vulnerable to HIV and other infectious diseases. Ghana’s National Strategic Plan for HIV/AIDS 2016–2020 identifies PWID as a key population, but efforts to address the needs of PWID have lagged behind those targeting sex workers and men who have sex with men. Lack of information about PWID is a critical barrier to implementing effective HIV prevention and treatment. We aimed to learn more about the vulnerability of the PWID population in order to inform much-needed harm reduction interventions. Methods From April to July 2018, we conducted a mixed methods study in Kumasi, Ghana, to identify all major drug using locations, count the numbers of PWID to obtain rough population size estimations, and administer anonymous surveys to 221 PWID regarding drug use and sexual behavior. We also tested for HIV, HCV, and HBV from syringes used by survey participants. Results Key informants identified five major drug using locations and estimated the total PWID population size to be between 600 and 2000. Enumerators counted between 35 and 61 individuals present at each of the five bases. Sharing syringes and reusing discarded syringes are common practices. Over half of survey participants (59%) reported past-month syringe sharing (34% used a used syringe and 52% gave away a used syringe). Individuals with higher injection frequency (≥ 21 times weekly) and who injected with four or more people had higher odds of syringe sharing. Of the survey participants reporting sex in the last month (23%), most reported having one partner, but only 12% used condoms. Nearly all women (11/13) reported exchanging sex for drugs and 6/13 reported exchanging sex for money in the last six months. Fifteen percent of participants (all men) reported paying for sex using drugs or money. Of the used syringes, prevalence estimates were 3% (HIV), 2% (HCV), and 9% (HBV). Conclusions Our findings confirm the urgent need to implement harm reduction interventions targeting PWID and to build a strong and enabling legal and policy environment in Ghana to support these efforts.