Publications by authors named "Fehrenbacher A"

Article Synopsis
  • The text discusses the need for targeted strategies to increase HPV vaccination rates among adolescents in high-risk communities served by safety-net clinics, highlighting the importance of community involvement in selecting relevant approaches.
  • A modified concept mapping activity was conducted with community and clinic partners to sort and rate 38 evidence-based strategies (EBS) related to HPV vaccination, resulting in participants identifying eight key clusters for potential intervention.
  • The findings led the federally qualified health center (FQHC) to select specific EBS, focusing on reducing missed opportunities and improving staff workflow, to implement over the course of a year.
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Background: HIV infections disproportionately impact Latino gay and bisexual men (GBM) in the United States. Pre-Exposure Prophylaxis (PrEP) is a proven prevention strategy that can help reduce new HIV infections in this population. Unfortunately, PrEP adoption and persistence among Latino GBM remain low.

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The current study examines COVID-19 prevention behaviors and vaccine intentions among 83 youth at high risk for HIV. Most youth self-identified as Latinx (52%), cisgender men (84%), and homosexual (66%). Youth self-reported COVID-19 prevention behaviors and intentions to vaccinate.

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Background: Female entertainment workers (FEWs) in Cambodia experience a greater prevalence of human immunodeficiency virus (HIV), other sexually transmitted infections (STIs), psychological distress, substance abuse, and gender-based violence (GBV) than the general female population. Reaching FEWs with health education and linking them to services has been difficult because of their hidden and stigmatized status.

Objective: This study evaluated the efficacy of the Mobile Link intervention in improving FEWs' health by engaging and connecting them to existing HIV, sexual and reproductive health, and GBV services.

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In the influential 1995 article "Social Conditions as Fundamental Causes of Disease," Bruce Link and Jo Phelan described social and political factors as "fundamental causes" of death and disease. Whitney Pirtle has recently declared racial capitalism another such fundamental cause. Using the case of the water crisis in Flint, Michigan, she has argued that racial capitalism's role in that situation meets each of the criteria Link and Phelan's article outlines: racial capitalism influenced multiple disease outcomes, affected disease outcomes through multiple risk factors, involved access to flexible resources that can be used to minimize both risks and the consequences of disease, and was reproduced over time through the continual replacement of intervening mechanisms.

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Transgender women are more likely to exchange sex than cisgender individuals. This study investigated how social networks were associated with exchange sex among transgender women in Los Angeles County. From July 2015 to September 2016, transgender women (N = 271; "egos") reported their sexual and substance use behaviors and perceptions of the same behaviors among their peers (N = 2,619; "alters").

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Background: There are more than two million people living with HIV (PLH) in India, with more than 30% on antiretroviral treatment (ART) estimated to be non-adherent. This study aimed to (I) document adherence rates and related factors among ART patients in a large ART clinic in India, and (II) pilot test daily and weekly interactive voice response (IVR) calls to improve ART adherence and related outcomes.

Methods: ART patients reporting missing at least one dose in prior 6 months (N=362) were enrolled and assessed via self-report and medical record review.

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Purpose: Disparities persist in HIV infection among Black and Latino men who have sex with men (BLMSM) and Black and Latina transgender women (BLTW). Increasing uptake and subsequent consistent use of pre-exposure prophylaxis (PrEP), an effective biomedical strategy for preventing HIV acquisition, can dramatically reduce HIV incidence in these populations. The purpose of this study was to explore reasons for PrEP discontinuation among BLMSM and BLTW living in Los Angeles County to inform the development of support services for these populations to remain persistent with their PrEP regimen.

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Article Synopsis
  • Health care providers play a crucial role in promoting PrEP (pre-exposure prophylaxis) among populations heavily affected by HIV, as shown in a study of 20 PrEP providers in Los Angeles.
  • Providers generally follow CDC guidelines for PrEP eligibility but face challenges with low-risk adults who may not disclose sexual behaviors and emphasize patient autonomy.
  • The study highlights the need for better education and accessibility regarding PrEP for young people, especially when parental consent is not available, to ensure broader uptake among at-risk youth.
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The purpose of this qualitative study was to identify barriers and motivators to PrEP uptake from the perspective of Black and Latina transgender women (TW) who are currently using PrEP to suggest intervention and outreach activities to increase PrEP uptake in this population. The Information-Motivation-Behavioral Skills Model guided the development of the semi-structured interview guide. A thematic analysis approach was used to analyze the data.

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To determine the rate and correlates of incarceration among street-based female sex workers (FSWs). From April 2016 to January 2017, FSWs (n = 250) in Baltimore City, Maryland, were enrolled in a 12-month prospective cohort study. We analyzed baseline data and used zero-inflated negative binomial regression to model the incarceration rate.

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Intersectionality theory has been used primarily in legal research to provide a framework for understanding the experiences of populations situated within multiple systems of oppression, particularly in relation to anti-discrimination law and gender-based violence. Gender transformative approaches to health seek to move beyond individual-level change and instead centre on restructuring the power relationships that create and maintain gender inequalities. Intersectionality theory is well-suited for the study of gender transformation on health, but there is a lack of consensus on clearly defined intersectional methodology in the field of public health, particularly for quantitative studies.

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Article Synopsis
  • HIV disproportionately affects Black and Latina transgender women, making them a vulnerable group in the context of HIV prevention, specifically through the use of pre-exposure prophylaxis (PrEP).
  • The study explored the stigma associated with PrEP usage among Black and Latina transgender women in Los Angeles, revealing themes of anticipated and enacted stigma, as well as experiences of social support related to PrEP disclosure.
  • Findings highlighted the need for PrEP providers to equip these women with strategies for selective disclosure to reduce stigma and support peer-to-peer education to foster positive perceptions of PrEP.
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Background: Gay, bisexual, and transgender youth and homeless youth are at high risk for sexually transmitted infections (STIs). However, little recent data exist describing STI positivity by anatomical site among those groups. We determined the positivity of Chlamydia trachomatis (CT) infection, Neisseria gonorrhoeae (NG) infection, and syphilis antibody reactivity among lesbian, gay, bisexual, transgender, and homeless youth.

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Background: Transgender women in the United States experience numerous risk factors for HIV acquisition and transmission, including increased rates of homelessness, alcohol and drug use, sex work, and nonprescribed hormone and soft tissue-filler injections. In addition, transgender women face discrimination and social/economic marginalization more intense and deleterious than that experienced by lesbian, gay, or bisexual individuals, further worsening health outcomes. Although little research has been done specifically with young transgender women aged 35 years and younger, existing evidence suggests even further elevated rates of homelessness, substance use, and engagement in HIV transmission risk behaviors relative to their older transgender women and nontransgender young adult counterparts.

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Article Synopsis
  • Transgender women and MSM face stigma-related health issues that increase the risk of HIV, with low uptake of PrEP despite its effectiveness.
  • A study tested a peer navigator program, A.S.K.-PrEP, to help connect these groups to PrEP over five sessions.
  • Results showed that 90% of participants were linked to PrEP, and a majority maintained their usage at the 90-day check-in, indicating that the program is a promising way to improve PrEP access and adherence.
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Article Synopsis
  • Black men who have sex with men (BMSM) in the USA face a high risk of HIV, and PrEP is an effective tool to prevent infection, yet its usage is hindered by social stigma.
  • BMSM using PrEP shared experiences of stigma, such as being judged for perceived risky sexual behavior, facing relationship conflicts, and feeling judged by healthcare providers.
  • Addressing the stigma around PrEP within the Black community could improve its acceptance and sustainability among high-risk BMSM, ultimately aiding in HIV prevention efforts.
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Latino men who have sex with men (MSM) are a group critically affected by HIV. Pre-exposure Prophylaxis (PrEP) is a biomedical prevention strategy that can help reduce new infections in this population. However, PrEP use may expose users to experiences of PrEP-related stigma.

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People living with HIV/AIDS (PLH) experience high rates of depression and related psychosocial risk factors that vary by gender. This study examines gender differences in depression severity among antiretroviral therapy (ART) patients (n = 362) from a large government ART clinic in Kolkata, India. Hypotheses for multiple linear regression models were guided by an integrated gendered stress process model focusing on variables reflecting social status (age, partner status), stressors (stigma), and resources (income, social support).

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This study examines determinants of consistent condom use (CCU) among married and cohabiting female sex workers (FSW) in India. Although CCU with clients is normative in the study area, most FSW do not consistently use condoms with intimate partners. Multiple logistic regression models indicated that condom use with intimate partners was associated with relationship status, cohabitation, HIV knowledge, STI symptoms, and being offered more money for sex without a condom by clients.

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Consistent condom use (CCU) is the primary HIV/STI prevention option available to sex workers globally but may be undermined by economic insecurity, life-course vulnerabilities, behavioral factors, disempowerment, or lack of effective interventions. This study examines predictors of CCU in a random household survey of brothel-based female sex workers (n = 200) in two neighborhoods served by Durbar (the Sonagachi Project) in Kolkata, India. Multivariate logistic regression analyses indicated that CCU was significantly associated with perceived HIV risk, community mobilization participation, working more days in sex work, and higher proportion of occasional clients to regular clients.

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Article Synopsis
  • The article explores how choice, socioeconomic factors, and empowerment shape women's engagement in sex work, based on interviews with 37 participants from the Durbar community in Kolkata, India.
  • It highlights that many women enter sex work due to disempowerment from poverty, loss of male income earners, and lack of economic opportunities, often in the context of inadequate informal labor options.
  • The study finds that despite the stigma and resources lost by entering sex work, women achieve financial and personal autonomy through resources provided by the Durbar program, which enhances their agency and supports their families.
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