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Open Access Publications from the University of California

Scholarly Works (40 results)

  • Article
  • Peer Reviewed
UC San Diego Previously Published Works (2010)
Injecting drug use is a major driver of HIV infections in Eastern Europe, the Commonwealth of Independent States, North Africa, the Middle East, and many parts of Asia and North America. We provide a global overview of the epidemiology of HIV infection among drug users and present current drug use trends that may constitute important epidemic drivers. We describe trends in ethnic disparities among injecting drug using (IDU) populations in the United States, and comment upon how these trends may now be changing. We present examples where HIV infection among non-IDUs who use cocaine, crack, and methamphetamine by other routes of administration is similar to that among IDUs, and discuss potential mechanisms of HIV spread in this overlooked population. Finally, we comment upon the potential implications of these observations for HIV interventions among IDU and non-IDU populations, taking into account different strategies that are needed in settings where HIV and/or injecting drug use has been established, or threatens to emerge.
    Cover page: Epidemiology of HIV Among Injecting and Non-injecting Drug Users: Current Trends and Implications for Interventions
    • Thesis
    • Peer Reviewed
    UC San Diego Electronic Theses and Dissertations (2016)

    Background: Despite improved availability of antiretrovirals (ARVs) in sub-Saharan Africa (SSA), vertical HIV transmission continues to result in thousands of HIV-infected infants each year. Contributing to this are barriers to accessing medications and health services that women encounter throughout their reproductive lifespans. This includes before pregnancy (contraceptive non-use), during pregnancy (ARV non-adherence), peripartum (non-hospital deliveries), and postpartum (infant ARV non-use) periods. This dissertation sought to evaluate barriers to preventing vertical HIV transmission throughout women’s reproductive lifespans.

    Objectives: Specific aims include: 1) assessing associations between gender equitable attitudes and dual contraceptive use among couples with HIV; 2) evaluating the association between maternal ARV adherence and infant ARV administration; and 3) enumerating patient costs of accessing infant HIV care.

    Methods: Data from three studies were used to achieve these objectives. Aim 1 used cross-sectional data collected from 103 couples in Kenya. Aim 2 used data from a cross-sectional survey (n=384) and focus group discussions (FGDs) (n=6, 5-9 participants each) conducted with HIV-positive mothers in Uganda. Aim 3 used cross-sectional and FGD data from 49 HIV-positive mothers in Uganda.

    Results: Aim 1 findings demonstrated that female and male partner gender equitable attitudes significantly interacted to influence dual contraceptive use (AOR: 1.02, 95% CI: 1.01-1.04). Aim 2 findings showed that infant ARV administration was significantly associated with lack of maternal ARV adherence (AOR: 3.55, 95% CI: 1.36-9.26) and maternal attendance in a support group (AOR: 2.50, 95% CI: 1.06-5.83). FGDs supported these quantitative findings, explaining how support group attendance facilitated ARV administration, while poor ARV health messaging contributed to lack of administration. Finally, aim 3 findings showed that the cost of attending one HIV clinic visit averaged $5.46 USD (SD=$3.63), which is equivalent to 3-4 days’ income. FGDs identified that transportation costs, informal service charges, and opportunity costs contributed to this expense.

    Conclusions: These results contribute to our understanding of influences on prevention of vertical HIV transmission in SSA. Several recommendations for intervention and further research were identified, including increasing male partner inclusion in reproductive healthcare and improving support for women with HIV. Additionally, cost analyses are needed to support policies assuring access to vertical HIV prevention programs.

      Cover page: Maternal Influences on Vertical Transmission of HIV in Kenya and Uganda
      • Article
      • Peer Reviewed
      UC San Diego Previously Published Works (2016)
      We examined African American women's experiences of communication with their male intimate partners a couple of hours before and after an incident of unwanted sex. We also examined women's experiences of disclosure following an incident of unwanted sex. Semi-structured qualitative interviews were conducted with a community-based sample of sexually active African American women (n = 19) reporting at least one incident of sexual coercion (i.e., being pressured into unwanted sex without consent) by an intimate male partner since the age of 18. Our analysis was guided by "the sexual division of power" from Connell's (1987) theory of gender and power. Data were analyzed inductively by examining the interviews for common themes in the following domains: communication before the unwanted sex, communication after the unwanted sex, and disclosure to others. Men pressured partners for unwanted sex through verbal and non-verbal tactics, ranging from pestering and blunt requests for sex to verbal bullying and violence. Many women responded by clearly saying no. However, many women also described eventually ceasing to resist their partners and engaging in unwanted sex. After the unwanted sex, men actively and passively avoided discussing the incident. Although many women discussed the unwanted sex with family and friends, less women disclosed to trained professionals. In some cases, women did not discuss the incident with anyone at all. These findings indicate that, when addressing sexual violence against women, there is a need to target men as well as the norms of masculinity that underpin physical and sexual violence against women.
        Cover page: “Come on Baby. You Know I Love You”: African American Women’s Experiences of Communication with Male Partners and Disclosure in the Context of Unwanted Sex
        • Article
        • Peer Reviewed
        UCLA Previously Published Works (2020)
        Since the introduction of antiretroviral therapy, the number of women living with HIV (WLHIV) continues to increase. Despite the decrease in HIV diagnosis among women in California, less than half of WLHIV are retained in HIV care. Structural barriers put women at increased risk for delayed HIV diagnosis, delayed entry into HIV care, and poorer treatment outcomes. The objective of this qualitative analysis is to identify how structural barriers negatively impact women's sustained engagement in HIV care in Southern California. WLHIV accessing local HIV support services participated in a qualitative study by completing a semi-structured interview and brief survey between January and April 2015 (n = 30). Poverty, unemployment, housing instability, and needs for transportation emerged as the dominant structural barriers for women when discussing their challenges with sustained engagement in HIV care. System-level interventions that decrease these noted barriers may help improve HIV care continuum for women living in Southern California.
          Cover page: Structural Barriers to Women’s Sustained Engagement in HIV Care in Southern California
          • Article
          • Peer Reviewed
          UC San Diego Previously Published Works (2023)
          Given the potential for retraumatization among survivors of sexual violence engaged in research, we aimed to provide pertinent knowledge and exemplification of the integration of trauma-informed practice to research with survivors. Grounded in trauma-informed care, we discuss the need for trauma-informed research, drawing upon experiences and data from a longitudinal case-control study on sexual violence. Through trauma-informed research settings, we can improve research experiences for survivors of sexual violence, as demonstrated by positive experiences of participants in The THRIVE Study. By meeting the needs of survivors, researchers can increase participation while maximizing the research quality and advancement of research.
            Cover page: Engagement of Sexual Violence Survivors in Research: Trauma-Informed Research in the THRIVE Study
            • Article
            • Peer Reviewed
            UC San Diego Previously Published Works (2022)
            Adolescent girls who report intimate partner violence (IPV) are at an increased risk of experiencing reproductive coercion (RC); both these forms of gender-based violence (GBV) are associated with unintended pregnancy. Yet little is known about these experiences among adolescent girls in Mexico. Qualitative data were collected as part of formative research for the adaptation of an evidence-based intervention to address RC and IPV in community health centers in Tijuana, Mexico. From September, 2017 to January, 2018, adolescent girls aged 16 to 20 years old (n = 20) seeking voluntary family planning (FP) services were identified and recruited from two publicly funded community health centers. We conducted semi-structured, in-depth interviews and analyzed the transcripts using inductive and deductive techniques. Participants in this sample commonly described experiencing IPV and RC (including pregnancy coercion and contraceptive sabotage), which many girls reported resulted in unintended pregnancy. Further, participants narratives and general lack of knowledge on how to cope with IPV or RC illuminated the acceptability of offering GBV prevention intervention within FP clinics serving this population. Findings highlight an urgent need to prevent IPV and RC, and reduce risk for unintended pregnancy among adolescent girls in this region and the potential of FP clinics to serve as a safe space for intervention delivery. Findings contribute to the limited qualitative evidence from Mexico, describing adolescent girls experiences of IPV and RC, strategies for preventing pregnancy in the context of RC, and opportunities for support from FP providers.
              Cover page: At Least I Didnt Get Raped: A Qualitative Exploration of IPV and Reproductive Coercion among Adolescent Girls Seeking Family Planning in Mexico.
              • Article
              • Peer Reviewed
              UC San Diego Previously Published Works (2015)

              Background

              Hostage-taking, an overlooked phenomenon in public health, constitutes a severe form of intimate partner violence and may be a precursor to female homicide within relationships characterized by substance use. Criminal justice studies indicate that most hostage incidents are male-driven events with more than half of all cases associated with a prior history of violence and substance use. Methamphetamine use increases a woman's risk of partner violence, with methamphetamine-using individuals being up to nine times more likely to commit homicide. As homicide is the most lethal outcome of partner violence and methamphetamine use, this study aims to characterize the potential role of hostage-taking within these intersecting epidemics.

              Methods

              Methamphetamine-using women enrolled in an HIV behavioural intervention trial (FASTLANE-II) who reported experiences of partner violence were purposively selected to participate in qualitative sub-studies (Women's Study I & II). Twenty-nine women, ages 26-57, participated in semi-structured interviews that discussed relationship dynamics, partner violence, drug use and sexual practices.

              Results

              Findings indicated four cases of women being held hostage by a partner, with two women describing two separate hostage experiences. Women discussed partner jealousy, drug withdrawal symptoms, heightened emotional states from methamphetamine use, and escalating violent incidents as factors leading up to hostage-taking. Factors influencing lack of reporting incidents to law enforcement included having a criminal record, fear of partner retaliation, and intentions to terminate the relationship when the partner is incarcerated.

              Conclusion

              Educating women on the warning signs of hostage-taking within the context of methamphetamine use and promoting behaviour change among male perpetrators can contribute to reducing the risk of homicide. Furthermore, bridging the gap between health services and law enforcement agencies and providing comprehensive services that address the needs of methamphetamine-using women in violent relationships can prevent or minimize potential harm to vulnerable women.
                Cover page: Live to tell: Narratives of methamphetamine-using women taken hostage by their intimate partners in San Diego, CA
                • Article
                • Peer Reviewed
                UC Irvine Previously Published Works (2021)

                Background

                Individuals who have experienced repeat sexual violence victimization face adverse mental and physical health outcomes, including immune and stress response functioning. We aim to further understand repeat sexual violence victimization to develop responsive and appropriate treatment for survivors of sexual violence.

                Methods

                We present the immunological and contextual findings of a participant (N = 1) who experienced repeat sexual violence victimization during her enrollment in The THRIVE Study, a prospective case-control study of women aged 14-45 years, who have experienced recent consensual vaginal penetration ("controls") or forced vaginal penetration ("cases"). Participants complete a survey, HIV/sexually transmitted infection, and pregnancy testing, blood sampling for C-reactive protein and adrenocorticotrophic hormone, collection of cervicovaginal fluid for immunological biomarkers, and self-collection of saliva samples for cortisol measurements, across study visits (Baseline, 1, and 3 months).

                Results

                The case study participant, aged 18 years upon enrollment, experienced sexual trauma before four of five study visits. Trends in the mental health indicators demonstrate reciprocal fluctuations in adverse mental health and resilience in accordance with revictimization and circumstantial changes. Suppressed immune biomarkers appear to correlate with increased adverse mental health, while mental health recovery trends with immunological recovery. The participant presents with dysregulated hypothalamic-pituitary-adrenal axis diurnal profile.

                Conclusions

                This profile illustrates the intra-individual biobehavioral impact of experience with revictimization over the course of 6 months, capturing experiences that are rarely studied either longitudinally or with the depth of the current research. The findings underscore the value of monitoring cervicovaginal immune functioning and hypothalamic-pituitary-adrenal axis dysregulation in coordination with changes in mental health over the course of repeated sexual trauma.
                  Cover page: The biobehavioral impacts of sexual violence: Findings from an acute repeat survivor of vaginal rape
                  • Article
                  • Peer Reviewed
                  UC San Diego Previously Published Works (2016)
                  The Substance Abuse, Violence, and HIV/AIDS (SAVA) syndemic model describes how the confluence of the three epidemics of substance abuse, violence, and HIV risk work synergistically to create excess burden among populations. We sought to identify risk factors associated with recent intimate partner violence (IPV) victimization among heterosexual methamphetamine (meth)-using men (n = 108) and women (n = 122) enrolled in FASTLANE-II, an HIV behavioral intervention in San Diego, CA. Women and men reported high rates of physical-only (women: 20%; men: 18%) and sexual (women: 25%; men: 23%) IPV. Multinomial regression analysis revealed that individuals who reported lower social support and individuals who reported a greater likelihood of engaging in risky sexual behaviors while high on meth were more likely to report IPV versus no IPV. Women who reported a greater likelihood of engaging in risky sexual behaviors while high on meth were 1.58 times more likely to report physical-only IPV versus no IPV, while men who reported similar behaviors were 1.15 times more likely to report physical-only IPV versus no IPV. Our findings highlight the influence of interpersonal factors on IPV. This research supports further study on gender-specific risk/protective factors and the development of gender-specific interventions targeting the SAVA syndemic among meth users.
                    • Article
                    • Peer Reviewed
                    UC San Diego Previously Published Works (2015)

                    Objectives

                    Multiple pathways link gender-based violence (GBV) to HIV and other sexually transmitted infections among women and girls who use or inject drugs. The aim of this article is to synthesize global literature that examines associations among the synergistic epidemics of substance abuse, violence, and HIV/AIDS, known as the SAVA syndemic. It also aims to identify a continuum of multilevel integrated interventions that target key SAVA syndemic mechanisms.

                    Methods

                    We conducted a selective search strategy, prioritizing use of meta-analytic epidemiological and intervention studies that address different aspects of the SAVA syndemic among women and girls who use drugs worldwide from 2000 to 2015 using PubMed, MEDLINE, and Google Scholar.

                    Results

                    Robust evidence from different countries suggests that GBV significantly increases the risk of HIV and other sexually transmitted infections among women and girls who use drugs. Multiple structural, biological, and behavioral mechanisms link GBV and HIV among women and girls. Emerging research has identified a continuum of brief and extended multilevel GBV prevention and treatment interventions that may be integrated into a continuum of HIV prevention, testing, and treatment interventions to target key SAVA syndemic mechanisms among women and girls who use drugs.

                    Conclusions

                    There remain significant methodological and geographical gaps in epidemiological and intervention research on the SAVA syndemic, particularly in low- and middle-income countries. This global review underscores the need to advance a continuum of multilevel integrated interventions that target salient mechanisms of the SAVA syndemic, especially for adolescent girls, young women, and transgender women who use drugs.
                      Cover page: Targeting the SAVA (Substance Abuse, Violence, and AIDS) Syndemic Among Women and Girls
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