Browsing by Author "Li X"

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Antiretroviral Medication Adherence and Amplified HIV Transmission Risk Among Sexually Active HIV-Infected Individuals in Three Diverse International Settings.
(2016-Apr) Magidson JF; Li X; Mimiaga MJ; Moore AT; Srithanaviboonchai K; Friedman RK; Limbada M; Hughes JP; Cummings V; Gaydos CA; Elharrar V; Celentano D; Mayer KH; Safren SA; Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.; Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA.; FHI360, Durham, NC, USA.; University of Washington, Seattle, WA, USA.; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.; Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA. jmagidson@mgh.harvard.edu.; National Institute of Allergy and Infectious Disease (NIAID), Bethesda, MD, USA.; Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA.; Instituto de Pesquisa Clinica Evandro Chagas, Rio de Janeiro, Brazil.; Fred Hutchinson Cancer Research Center, Seattle, WA, USA.; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.; Department of Psychology, University of Miami, Coral Gables, FL, USA.; The Fenway Institute, Fenway Health, Boston, MA, USA.; Division of Infectious Diseases, Departments of Pathology and Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Harvard School of Public Health, Boston, MA, USA.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
Successful biomedical prevention/treatment-as-prevention (TasP) requires identifying individuals at greatest risk for transmitting HIV, including those with antiretroviral therapy (ART) nonadherence and/or 'amplified HIV transmission risk,' defined as condomless sex with HIV-uninfected/unknown-status partners when infectious (i.e., with detectable viremia or STI diagnosis according to Swiss criteria for infectiousness). This study recruited sexually-active, HIV-infected patients in Brazil, Thailand, and Zambia to examine correlates of ART nonadherence and 'amplified HIV transmission risk'. Lower alcohol use (OR = .71, p < .01) and higher health-related quality of life (OR = 1.10, p < .01) were associated with greater odds of ART adherence over and above region. Of those with viral load data available (in Brazil and Thailand only), 40 % met Swiss criteria for infectiousness, and 29 % had 'amplified HIV transmission risk.' MSM had almost three-fold (OR = 2.89, p < .001) increased odds of 'amplified HIV transmission risk' (vs. heterosexual men) over and above region. TasP efforts should consider psychosocial and contextual needs, particularly among MSM with detectable viremia.
Impact of enacted stigma on mental health, substance use, and HIV-related behaviors among sexual minority men in Zambia.
(2024-Feb) Zhang R; Qiao S; Aggarwal A; Yuan G; Muttau N; Sharma A; Lwatula C; Ngosa L; Kabwe M; Manasyan A; Menon A; Ostermann J; Weissman S; Li X; Harper GW; University of South Carolina, Columbia, South Carolina, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; University of Alabama at Birmingham, Birmingham, Alabama, USA.; Dignitate Zambia Limited, Lusaka, Zambia.; University of South Carolina, Columbia, South Carolina, USA. Electronic address: shanqiao@mailbox.sc.edu.; The Lotus Identity, Lusaka, Zambia.; University of Zambia, Lusaka, Zambia.; University of Michigan, Ann Arbor, Michigan, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
Sexual minority men (SMM) in Zambia face significant challenges including stigma, discrimination, and mental health issues, which further impact their HIV-related risk behaviors. This study aimed to investigate the associations between enacted stigma, substance abuse, HIV-related behaviors, and mental health (i.e., depression, anxiety, and post-traumatic stress disorder [PTSD] symptoms) among SMM in Zambia. SMM aged 18-35 years who reported having multiple and/or concurrent sexual partners or low and/or inconsistent condom use in the past three months were recruited from four districts in Zambia between February and November 2021. Participants completed an anonymous interviewer-administered survey. Key variables of interest were compared between participants with higher vs. lower levels of enacted stigma. Independent samples t-tests were used for continuous variables, and chi-squared tests were used for categorical variables. A total of 197 eligible SMM participated in the study (mean age = 24.41 years). Participants with a higher level of enacted stigma showed a higher level of anxiety symptoms (χ
The Impacts of Stigma Against Sexual Minority Men Within and Between Various Socioecological Levels: Breaking the Vicious Cycle in Zambia.
(2023) Qiao S; Garrett CM; Addo PNO; Adeagbo O; Moore DM; Muttau N; Sharma A; Lwatula C; Ngosa L; Kabwe M; Manasyan A; Menon JA; Weissman S; Li X; Harper GW; School of Public Health, University of Michigan, Ann Arbor, MI, USA.; Department of Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.; The Lotus Identity (TLI), Lusaka, Zambia.; University of Zambia, Lusaka, Zambia.; Department of Community and Behavioral Health, College of Public Health, The University of Iowa, Iowa City, IA, USA.; Department of Internal Medicine, School of Medicine Columbia, University of South Carolina, Columbia, SC, USA.; Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.; Dignitate Zambia Limited (DZL), Lusaka, Zambia.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA.; Department of Global Health, University of Washington, Seattle, WA, USA.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
Sexual minority men (SMM) face persistent stigma in Zambia. From a holistic perspective, we aim to explore its impacts within and between multiple socioecological levels, demonstrating how their interactions create a vicious cycle of barriers to the well-being of SMM. In-depth interviews were conducted with 20 purposively recruited SMM from Lusaka, Zambia. All interviews were audio-recorded, after written consent, transcribed verbatim, and iteratively coded employing inductive (i.e., data-driven) approaches for thematic analysis using NVivo. Results suggest three key themes: (1) interpersonal socially perpetuated sexual minority stigma (SMS); (2) multidirectional interactions between psychosocial well-being and risk-taking behaviors; and (3) institutionally perpetuated SMS as a barrier to seeking and receiving health care. SMS permeates across all levels of the socioecological model to negatively impact the psychosocial well-being of SMM while acting also as a barrier to accessing HIV prevention and care. Our study necessitates structural public health intervention to decrease stigma and discrimination against SMM in Zambia, in efforts to increase their psychosocial well-being as well as their access to and utilization of HIV care by breaking the vicious cycle of SMS that pervades through the intrapersonal, interpersonal, and institutional levels of the socioecological model.