Criminal Justice Involvement among Young People Exchanging Sex in Detroit.

For young adult sex workers, the risk of arrest and incarceration are dramatically influenced by the venue of sex exchange and individual and neighborhood characteristics. Using a unique venue-based survey sample of young adults in Detroit who are exchanging sex, multivariable logistic regression models were used to identify associations with arrest and incarceration. Criminal justice involvement was normative, and risk was increased by working on the street venue, using drugs, lacking stable housing, juvenile arrest or incarceration, dropping out of school before age 18, and neighborhood characteristics.

Geospatial mapping of access to timely essential surgery in sub-Saharan Africa.

Introduction: Despite an estimated one-third of the global burden of disease being surgical, only limited estimates of accessibility to surgical treatment in sub-Saharan Africa exist and these remain spatially undefined. Geographical metrics of access to major hospitals were estimated based on travel time. Estimates were then used to assess need for surgery at country level.

Access to Health Care Services among Young People Exchanging Sex in Detroit.

Within the related epidemics of sex exchange, drug use, and poverty, access to health care is shaped by intersecting identities, policy, and infrastructure. This study uses a unique survey sample of young adults in Detroit, who are exchanging sex on the street, in strip clubs, and at after-hours parties and other social clubs. Factors predicting access to free or affordable health care services, such as venue, patterns of sexual exchange influence, drug use and access to transportation, were examined using multivariable logistic regression and qualitative comparative analysis.

Psychological distress among Ugandan adolescents living with HIV: Examining stressors and the buffering role of general and religious coping strategies.

HIV infection increases the risk of psychological distress among adolescents living with HIV (ALHIV), which, in turn, increases risky behaviours such as medication non-adherence, substance use, and sexual risk-taking. The majority of studies on psychological distress among ALHIV have been conducted in high-income countries; data on the prevalence and correlates of psychological distress among ALHIV in sub-Saharan Africa (SSA) are scarce, yet over two-thirds of the global population of ALHIV resides in SSA. The purpose of this study was to identify the contextually relevant correlates of psychological distress among Ugandan ALHIV.

Examining the relationship between psychological distress and adherence to anti-retroviral therapy among Ugandan adolescents living with HIV.

Psychological distress is common among adolescents living with HIV (ALHIV) worldwide, and has been associated with non-adherence to anti-retroviral therapy (ART), leading to poor virologic suppression, drug resistance, and increased risk for AIDS morbidity and mortality. However, only a few studies have explored the relationship between psychological distress and ART adherence among adolescents in sub-Saharan Africa. The paper examines the relationship between psychological distress and ART adherence, and effect of psychosocial resources on ART adherence.

Modeling the community-level effects of male incarceration on the sexual partnerships of men and women.

Men who have been incarcerated experience substantial changes in their sexual behavior after release from jail and prison, and high rates of incarceration may change sexual relationship patterns at a community level. Few studies, however, address how rates of incarceration affect community patterns of sexual behavior, and the implications of those patterns for HIV and STD risk. We describe a "proof of principle" computational model that tests whether rates of male incarceration could, in part, explain observed population-level differences in patterns of sexual behavior between communities with high rates of incarceration and those without.

Disclosure of HIV Status to Perinatally Infected Adolescents in Urban Uganda: A Qualitative Study on Timing, Process, and Outcomes.

Disclosure of HIV status to children and adolescents living with HIV remains a challenge in pediatric HIV care. Many of the current disclosure guidelines from national and international bodies recommend that perinatally infected children be informed of their HIV status prior to adolescence, but rates of disclosure in both high- and low-income countries remains low. The applicability of the recommendations to low-income countries remains largely unknown, as few studies have explored the disclosure process in these settings.

Psychosocial challenges and strategies for coping with HIV among adolescents in Uganda: a qualitative study.

Although more than 90% of youth perinatally infected with HIV live in sub-Saharan Africa, little is known about the psychosocial factors that impact their wellbeing, or how these youth cope with these challenges. The purpose of this study was to identify the psychosocial challenges and coping strategies among perinatal HIV-infected adolescents in Uganda. In-depth interviews were conducted with a purposive sample of 38 HIV-infected adolescents aged 12-19 years at a large HIV treatment center in Kampala.

Development of a psychosocial distress measure for Ugandan adolescents living with HIV.

Psychological distress among adolescents living with HIV (ALH) has been associated with risky behaviors including non-adherence to anti-retroviral therapy, leading to increased risk for AIDS morbidity and mortality. Efforts to establish the nature, prevalence, and impact of psychological distress among ALH in Uganda are hindered by the lack of culturally relevant assessment tools. The purpose of this study was to develop and test a measure for psychological distress for Ugandan ALH aged 12-19 years (N = 508; 53.

Sexual and reproductive health: progress and outstanding needs.

We examine progress towards the 1994 International Conference on Population and Development (ICPD) commitment to provide universal access to sexual and reproductive health (SRH) services by 2014, with an emphasis on changes for those living in poor and emerging economies. Accomplishments include a 45% decline in the maternal mortality ratio (MMR) between 1990 and 2013; 11.5% decline in global unmet need for modern contraception; ~21% increase in skilled birth attendance; and declines in both the case fatality rate and rate of abortion.

Gendered Patterns of Migration in Rural South Africa.

Gender is increasingly recognized as fundamental to understanding migration processes, causes and consequences. In South Africa, it is intrinsic to the social transformations fueling high levels of internal migration and complex forms of mobility. While female migration in Africa has often been characterized as less prevalent than male migration, and primarily related to marriage, in South Africa a feminization of internal migration is underway, fueled by women's increasing labor market participation.

Gender attitudes and fertility aspirations among young men in five high fertility East African countries.

The relationship between women's attitudes toward gender equality and their fertility aspirations has been researched extensively, but few studies have explored the same associations among men. Using recent Demographic and Health Survey data from five high fertility East African countries, we examine the association between young men's gender attitudes and their ideal family size. Whereas several DHS gender attitude responses were associated with fertility aspirations in select countries, men's greater tolerance of wife beating was consistently associated with higher fertility aspirations across all countries, independent of education, income, or religion.

Incarceration and sexual risk: examining the relationship between men's involvement in the criminal justice system and risky sexual behavior.

In this study, we used data from Add Health Waves II and III to compare men who had been incarcerated to those who had not, and examined whether incarceration was associated with increased numbers of sexual partners and increased odds of concurrent partnerships. We used multivariate regression and propensity-score matching to compare sexual behavior of Wave III male respondents who had been incarcerated with those who had not, and compared sexual behavior at Wave II to identify differences in sexual behavior prior to incarceration. Incarceration was associated with an increased rate of lifetime sexual partnership, but this was attenuated by substance use.

The social legacy of AIDS: fertility aspirations among HIV-affected women in Uganda.

Objectives: We investigated the impact of HIV status on fertility desires in Uganda.

Methods: We surveyed 1594 women aged 18 to 49 years visiting outpatient services at Mbarara Regional Hospital, from May through August 2010. Of these, 59.

Black-white blood pressure disparities: depressive symptoms and differential vulnerability to blood lead.

Background: Blacks have higher hypertension rates than whites, but the reasons for these disparities are unknown. Differential vulnerability, through which stress alters vulnerability to the effects of environmental hazards, is an emergent notion in environmental health that may contribute to these disparities.

Objectives: We examined whether blacks and whites exhibit different associations between blood lead (BPb) and blood pressure (BP) and whether depressive symptoms may play a role.

Prevalence of the metabolic syndrome in a rural population in Ghana.

Background: The Metabolic syndrome (MS) which is a constellation of cardiometabolic risk factors including dyslipidaemia, hypertension, hyperglycaemia, central obesity, and endothelial dysfunction was hitherto relatively uncommon among Africans south of the Sahara. This study seeks to determine the prevalence of MS, its components and risk factors among a rural population in Ghana based on two popular international algorithms.

Methods: This was a cross-sectional survey of a rural population in Ghana conducted between November and December, 2007.

A novel look at racial health disparities: the interaction between social disadvantage and environmental health.

Objectives: We explored the notion that social disadvantage increases vulnerability to the health effects of environmental hazards. Specifically, we examined (1) whether race modifies the association between blood lead and blood pressure and (2) whether socioeconomic status (SES) plays a role in this modifying effect.

Methods: Using the National Health and Nutrition Examination Survey (2001-2008) and linear regression, we estimated the association between blood lead and blood pressure.

The built environment & the impact of neighborhood characteristics on youth sexual risk behavior in Cape Town, South Africa.

Youth sexual risk behavior is often described in social terms, and there has been limited attention to date on how measures of the built environment, including access to municipal services, impact sexual risk behavior, particularly in resource-limited countries. Using the Cape Area Panel Study, we assessed the impact of neighborhood conditions (six single items and a built environment index (BEI)), net of individual socio-demographic factors. The results suggest that built environment factors are associated with sexual risk behavior.

Policy talk: incentives for rural service among nurses in Ghana.

Like many countries in sub-Saharan Africa, Ghana is faced with the simultaneous challenges of increasing its health workforce, retaining them in country and promoting a rational distribution of staff in remote or deprived areas of the country. Recent increases in both public-sector doctor and nurse salaries have contributed to a decline in international out-migration, but problems of geographic mal-distribution remain. As part of a research project on human resources in the Ghanaian health sector, this study was conducted to elicit in-depth views from nursing leaders and practicing nurses in rural and urban Ghana on motivations for urban vs rural practice, job satisfaction and potential rural incentives.

Development and evaluation of an agent-based model of sexual partnership.

The agent-based model presented here builds on existing models, allowing for multiple partnerships, including those overlapping in time, to examine sexual partnerships, with the goal of hypothesis testing and guiding data collection. Within each model run, agents are assigned characteristics (including quality, aspiration, courtship duration, and ideal number of lifetime partners) and then search for partners; existing couples choose whether they should break up, remain dating, or become sexual partners. Model behavior was tested across a wide range of parameters and compared with empirical data.

For money or service?: a cross-sectional survey of preference for financial versus non-financial rural practice characteristics among Ghanaian medical students.

Background: Health worker shortage and maldistribution are among the biggest threats to health systems in Africa. New medical graduates are prime targets for recruitment to deprived rural areas. However, little research has been done to determine the influence of workers' background and future plans on their preference for rural practice incentives and characteristics.

Willingness to work in rural areas and the role of intrinsic versus extrinsic professional motivations - a survey of medical students in Ghana.

Background: Retaining health workers in rural areas is challenging for a number of reasons, ranging from personal preferences to difficult work conditions and low remuneration. This paper assesses the influence of intrinsic and extrinsic motivation on willingness to accept postings to deprived areas among medical students in Ghana.

Methods: A computer-based survey involving 302 fourth year medical students was conducted from May-August 2009.

Key factors leading to reduced recruitment and retention of health professionals in remote areas of Ghana: a qualitative study and proposed policy solutions.

Background: The ability of many countries to achieve national health goals such as the Millennium Development Goals remains hindered by inadequate and poorly distributed health personnel, including doctors. The distribution of doctors in Ghana is highly skewed, with a majority serving in two major metropolitan areas (Accra and Kumasi), and inadequate numbers in remote and rural districts. Recent policies increasing health worker salaries have reduced migration of doctors out of Ghana, but made little difference to distribution within the country.

Gender, migration and HIV in rural KwaZulu-Natal, South Africa.

Objectives: Research on migration and HIV has largely focused on male migration, often failing to measure HIV risks associated with migration for women. We aimed to establish whether associations between migration and HIV infection differ for women and men, and identify possible mechanisms by which women's migration contributes to their high infection risk.

Design: Data on socio-demographic characteristics, patterns of migration, sexual behavior and HIV infection status were obtained for a population of 11,677 women aged 15-49 and men aged 15-54, resident members of households within a demographic surveillance area participating in HIV surveillance in 2003-04.

Rural practice preferences among medical students in Ghana: a discrete choice experiment.

Objective: To determine how specific job attributes influenced fourth year medical students' stated preference for hypothetical rural job postings in Ghana.

Methods: Based on discussions with medical student focus groups and physicians in practice and in the Ministry of Health, we created a discrete choice experiment (DCE) that assessed how students' stated preference for certain rural postings was influenced by various job attributes: a higher salary, free superior housing, an educational allowance for children, improved equipment, supportive management, shorter contracts before study leave and a car. We conducted the DCE among all fourth year medical students in Ghana using a brief structured questionnaire and used mixed logit models to estimate the utility of each job attribute.