Beattie, Tara S; Pollock, James; Kabuti, Rhoda; Abramsky, Tanya; Kung'u, Mary; Babu, Hellen; Maisha Fiti Study Champions; Huibner, Sanja; Udayakumar, Suji; Nyamweya, Chrispo; +12 more... Okumu, Monica; Mahero, Anne; Beksinska, Alicja; Panneh, Mamtuti; Ngurukiri, Pauline; Irungu, Erastus; Adhiambo, Wendy; Muthoga, Peter; Seeley, Janet; Weiss, Helen; Kaul, Rupert; Kimani, Joshua; (2024) Are violence, harmful alcohol/substance use and poor mental health associated with increased genital inflammation?: A longitudinal cohort study with HIV-negative female sex workers in Nairobi, Kenya. PLOS global public health, 4 (8). e0003592-. ISSN 2767-3375 DOI: https://doi.org/10.1371/journal.pgph.0003592
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Abstract
Violence, alcohol use, substance use and poor mental health have been linked with increased HIV acquisition risk, and genital inflammation enhances HIV susceptibility. We examined whether past 6 month experience of these exposures was associated with increased genital inflammation, thereby providing a biological link between these exposures and HIV acquisition risk. The Maisha Fiti study was a longitudinal mixed-methods study of female sex workers in Nairobi, Kenya. Behavioural-biological surveys were conducted at baseline (June-December 2019) and endline (June 2020-March 2021). Analyses were restricted to HIV-negative women (n = 746). Women with raised levels of at least 5 of 9 genital inflammatory cytokines were defined as having genital inflammation. Multivariable logistic regression models were used to estimate (i) baseline associations between genital inflammation and violence, harmful alcohol/substance use, and poor mental health, and (ii) longitudinal associations between these exposures at different survey rounds, and genital inflammation at follow-up. Inflammation data was available for 711 of 746 (95.3%) women at baseline; 351 (50.1%) had genital inflammation, as did 247 (46.7%) at follow-up. At baseline, 67.8% of women had experienced physical and/or sexual violence in the past 6 months, 33.9% had harmful alcohol use, 26.4% had harmful substance use, 25.5% had moderate/severe depression/anxiety, and 13.9% had post-traumatic stress disorder. In adjusted analyses, there was no evidence that these exposures were associated cross-sectionally or longitudinally with genital inflammation. We report no associations between past 6 month experience of violence, harmful alcohol/substance use, or poor mental health, and immune parameters previously associated with HIV risk. This suggests that the well-described epidemiological associations between these exposures and HIV acquisition do not appear to be mediated by genital immune changes, or that any such changes are relatively short-lived. High prevalences of these exposures suggest an urgent need for sex-worker specific violence, alcohol/substance use and mental health interventions.
Item Type | Article |
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Faculty and Department |
Faculty of Public Health and Policy > Dept of Global Health and Development Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology & International Health (2023-) |
Research Centre | ?? 226579 ?? |
PubMed ID | 39190654 |
Elements ID | 228374 |
Official URL | http://dx.doi.org/10.1371/journal.pgph.0003592 |
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