Socioecological factors influencing women's HIV risk in the United States: qualitative findings from the women's HIV SeroIncidence study (HPTN 064)

Paula M Frew, Kimberly Parker, Linda Vo, Danielle Haley, Ann O'Leary, Dazon Dixon Diallo, Carol E Golin, Irene Kuo, Lydia Soto-Torres, Jing Wang, Adaora A Adimora, Laura A Randall, Carlos Del Rio, Sally Hodder, HIV Prevention Trials Network 064 (HTPN) Study Team, Paula M Frew, Kimberly Parker, Linda Vo, Danielle Haley, Ann O'Leary, Dazon Dixon Diallo, Carol E Golin, Irene Kuo, Lydia Soto-Torres, Jing Wang, Adaora A Adimora, Laura A Randall, Carlos Del Rio, Sally Hodder, HIV Prevention Trials Network 064 (HTPN) Study Team

Abstract

Background: We sought to understand the multilevel syndemic factors that are concurrently contributing to the HIV epidemic among women living in the US. We specifically examined community, network, dyadic, and individual factors to explain HIV vulnerability within a socioecological framework.

Methods: We gathered qualitative data (120 interviews and 31 focus groups) from a subset of women ages 18-44 years (N = 2,099) enrolled in the HPTN 064 HIV seroincidence estimation study across 10 US communities. We analyzed data from 4 diverse locations: Atlanta, New York City (the Bronx), Raleigh, and Washington, DC. Data were thematically coded using grounded theory methodology. Intercoder reliability was assessed to evaluate consistency of team-based coding practices.

Results: The following themes were identified at 4 levels including 1) exosystem (community): poverty prevalence, discrimination, gender imbalances, community violence, and housing challenges; 2) mesosystem (network): organizational social support and sexual concurrency; 3) microsystem (dyadic): sex exchange, interpersonal social support, intimate partner violence; and 4) individual: HIV/STI awareness, risk taking, and substance use. A strong theme emerged with over 80 % of responses linked to the fundamental role of financial insecurity underlying risk-taking behavioral pathways.

Conclusions: Multilevel syndemic factors contribute to women's vulnerability to HIV in the US. Financial insecurity is a predominant theme, suggesting the need for tailored programming for women to reduce HIV risk.

Trial registration: Clinicaltrials.gov, NCT00995176.

Keywords: HIV risk reduction; HIV/AIDS; Minorities; Sexual health; Socioecological model; Women.

Figures

Fig. 1
Fig. 1
Application of the Bronfrenbrenner ecological model

References

    1. Centers for Disease Control and Prevention . HIV among women. 2013.
    1. Centers for Disease Control and Prevention Estimated HIV incidence in the United States, 2007–2010. HIV Surveill Suppl Rep. 2012;17:4.
    1. Centers for Disease Control and Prevention (CDC) HIV/AIDS among women fact sheet. CDC fact sheet 2013. 2013.
    1. Des Jarlais DC, Friedman SR. HIV infection among intravenous drug users: epidemiology and risk reduction. AIDS. 1987;1(2):67–76.
    1. Moore RD. Epidemiology of HIV infection in the United States: implications for linkage to care. Clin Infect Dis. 2011;52(Suppl 2):S208–13. doi: 10.1093/cid/ciq044.
    1. Whetten K, Reif S. Overview: HIV/AIDS in the deep south region of the United States. AIDS Care. 2006;18(Suppl 1):S1–5. doi: 10.1080/09540120600838480.
    1. Hixson B, Omer S, del Rio C, Frew PM. Spatial clustering of HIV prevalence in Atlanta, Georgia, and population characteristics associated with case concentrations. J Urban Health. 2010: in press.
    1. Friedman SR, Cooper HLF, Osborne AH. Structural and social contexts of HIV risk among African Americans. Am J Public Health. 2009;99(6):1002–8. doi: 10.2105/AJPH.2008.140327.
    1. Kidder DP, Wolitski RJ, Royal S, Aidala A, Courtenay-Quirk C, Holtgrave DR, et al. Access to housing as a structural intervention for homeless and unstably housed people living with HIV: rationale, methods, and implementation of the housing and health study. AIDS Behav. 2007;11(6 Suppl):149–61. doi: 10.1007/s10461-007-9249-0.
    1. Newman PA, Williams CC, Massaquoi N, Brown M, Logie C. HIV prevention for Black women: structural barriers and opportunities. J Health Care Poor Underserved. 2008;19(3):829–41. doi: 10.1353/hpu.0.0043.
    1. Wingood GM, DiClemente RJ. The theory of gender and power: a social structural theory for guiding public health interventions. In: Emerging theories in public health practice and research. San Francisco: Jossey-Bass Wiley; 2002. p. 313–46.
    1. Wingood GM, Diclemente RJ, Mikhail I, McCree DH, Davies SL, Hardin JW, et al. HIV discrimination and the health of women living with HIV. Women Health. 2007;46(2–3):99–112. doi: 10.1300/J013v46n02_07.
    1. Newsome V, Airhihenbuwa CO. Gender ratio imbalance effects on HIV risk behaviors in African American women. Health Promot Pract. 2013;14(3):459–63. doi: 10.1177/1524839912460869.
    1. Ferguson YO, Quinn SC, Eng E, Sandelowski M. The gender ratio imbalance and its relationship to risk of HIV/AIDS among African American women at historically black colleges and universities. AIDS Care. 2006;18(4):323–31. doi: 10.1080/09540120500162122.
    1. Hankins C. Gender, sex, and HIV: how well are we addressing the imbalance? Curr Opin HIV AIDS. 2008;3(4):514–20. doi: 10.1097/COH.0b013e32830136b4.
    1. Jennings L, Rompalo AM, Wang J, Hughes J, Adimora AA, Hodder S, et al. Prevalence and correlates of knowledge of male partner HIV testing and serostatus among African-American women living in high poverty, high HIV prevalence communities (HPTN 064) AIDS Behav. 2015;19(2):291–301. doi: 10.1007/s10461-014-0884-y.
    1. Justman J, Befus M, Hughes J, Wang J, Golin CE, Adimora AA, et al. Sexual behaviors of US women at risk of HIV acquisition: a longitudinal analysis of findings from HPTN 064. AIDS Behav. 2015;19(7):1327–37. doi: 10.1007/s10461-014-0992-8.
    1. Singer M. AIDS and the health crisis of the U.S. urban poor: the perspective of critical medical anthropology. Soc Sci Med. 1994;39(7):931–48. doi: 10.1016/0277-9536(94)90205-4.
    1. Hodder SL, Justman J, Hughes JP, Wang J, Haley DF, Adimora AA, et al. HIV acquisition among women from selected areas of the United States: a cohort study. Ann Intern Med. 2013;158(1):10–8. doi: 10.7326/0003-4819-158-1-201301010-00004.
    1. Moreno CL, Morrill AC, El-Bassel N. Sexual risk factors for HIV and violence among Puerto Rican women in New York City. Health Soc Work. 2011;36(2):87–97. doi: 10.1093/hsw/36.2.87.
    1. Wolde-Yohannes S. Persisting failure to protect populations at risk from HIV transmission: African American women in the United States (US) J Public Health Policy. 2012;33(3):325–36. doi: 10.1057/jphp.2012.24.
    1. Bronfenbrenner U. International encyclopedia of education. 2. Oxford: Elsevier; 1994. Ecological models of human development.
    1. Adimora AA, Schoenbach VJ, Martinson F, Donaldson KH, Stancil TR, Fullilove RE. Concurrent sexual partnerships among African Americans in the rural south. Ann Epidemiol. 2004;14(3):155–60. doi: 10.1016/S1047-2797(03)00129-7.
    1. Aral SO. Partner Concurrency and the STD/HIV Epidemic. Curr Infect Dis Rep. 2010;12(2):134–9. doi: 10.1007/s11908-010-0087-2.
    1. Eshleman SH, Hughes JP, Laeyendecker O, Wang J, Brookmeyer R, Johnson-Lewis L, et al. Use of a multifaceted approach to analyze HIV incidence in a cohort study of women in the United States: HIV Prevention Trials Network 064 Study. J Infect Dis. 2013;207(2):223–31. doi: 10.1093/infdis/jis658.
    1. Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health. 2015;42(5):533–44. doi: 10.1007/s10488-013-0528-y.
    1. Dinenno EA, Oster AM, Sionean C, Denning P, Lansky A. Piloting a system for behavioral surveillance among heterosexuals at increased risk of HIV in the United States. Open AIDS J. 2012;6:169–76. doi: 10.2174/1874613601206010169.
    1. Broz D, Wejnert C, Pham HT, DiNenno E, Heffelfinger JD, Cribbin M, et al. HIV infection and risk, prevention, and testing behaviors among injecting drug users -- National HIV Behavioral Surveillance System, 20 U.S. cities, 2009. Morb Mortal Wkly Rep Surveill Summ. 2014;63(6):1–51.
    1. Cooper HL, Linton S, Kelley ME, Ross Z, Wolfe ME, Chen YT, et al. Racialized risk environments in a large sample of people who inject drugs in the United States. Int J Drug Policy. 2015;27:43–55. doi: 10.1016/j.drugpo.2015.07.015.
    1. Haley DF, Golin C, El-Sadr W, Hughes JP, Wang J, Roman Isler M, et al. Venue-based recruitment of women at elevated risk for HIV: an HIV Prevention Trials Network study. J Womens Health. 2014;23(6):541–51. doi: 10.1089/jwh.2013.4654.
    1. Linton SL, Cooper HL, Kelley ME, Karnes CC, Ross Z, Wolfe ME, et al. HIV infection among people Who inject drugs in the united states: geographically explained variance across racial and ethnic groups. Am J Public Health. 2015;105(12):2457–65. doi: 10.2105/AJPH.2015.302861.
    1. Valverde EE, Painter T, Heffelfinger JD, Schulden JD, Chavez P, DiNenno EA. Migration patterns and characteristics of sexual partners associated with unprotected sexual intercourse among Hispanic immigrant and migrant women in the United States. J Immigr Minor Health/Center Minor Public Health. 2015;17(6):1826–33. doi: 10.1007/s10903-014-0132-6.
    1. Curtis S, Gesler W, Smith G, Washburn S. Approaches to sampling and case selection in qualitative research: examples in the geography of health. Soc Sci Med. 2000;50(7–8):1001–14. doi: 10.1016/S0277-9536(99)00350-0.
    1. Kelly BC. Sampling and recruitment issues in qualitative drugs research: reflections on the study of club drug users in metro New York. Subst Use Misuse. 2010;45(5):671–83. doi: 10.3109/10826081003594799.
    1. Blackstock OJ, Frew P, Bota D, Vo-Green L, Parker K, Franks J, et al. Perceptions of community HIV/STI risk among U.S women living in areas with high poverty and HIV prevalence rates. J Health Care Poor Underserved. 2015;26(3):811–23. doi: 10.1353/hpu.2015.0069.
    1. QSR International . NVivo 8 Australia. 2008.
    1. Guest G, Shattuck D, Johnson L, Akumatey B, Clarke EE, Chen PL, et al. Changes in sexual risk behavior among participants in a PrEP HIV prevention trial. Sex Transm Dis. 2008;35(12):1002–8.
    1. Boeije HR. A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Qual Quant. 2002;36:391–409. doi: 10.1023/A:1020909529486.
    1. Strauss A, Corbin JM. Basics of qualitative research: techniques and procedures for developing grounded theory. Thousand Oaks: SAGE Publications; 1998. p. 312.
    1. Elliott AC, Woodward WA. Statistical analysis: quick reference guidebook. Thousand Oaks: Sage; 2007.
    1. Fawcett J. The relationship of theory and research. 3. Philadelphia: FA Davis Company; 1999.
    1. Inciardi JA, Surratt HL. Children in the streets of Brazil: drug use, crime, violence, and HIV risks. Subst Use Misuse. 1998;33(7):1461–80. doi: 10.3109/10826089809069809.
    1. Soto T, Komaie G, Neilands TB, Johnson MO. Exposure to crime and trauma among HIV-infected men who have sex with men: associations with HIV stigma and treatment engagement. J Assoc Nurses AIDS Care. 2013;24(4):299–307. doi: 10.1016/j.jana.2012.11.008.
    1. Aral SO, Wasserheit JN. Women at risk: issues in the primary prevention of AIDS. New York: Plenum Press; 1995. Interactions among HIV, other sexually transmitted diseases, socioeconomic status, and poverty in women; pp. 13–42.
    1. Riley ED, Gandhi M, Hare C, Cohen J, Hwang S. Poverty, unstable housing, and HIV infection among women living in the United States. Curr HIV/AIDS Rep. 2007;4(4):181–6. doi: 10.1007/s11904-007-0026-5.
    1. Bogart LM, Landrine H, Galvan FH, Wagner GJ, Klein DJ. Perceived discrimination and physical health among HIV-positive Black and Latino men who have sex with men. AIDS Behav. 2013;17(4):1431–41. doi: 10.1007/s10461-012-0397-5.
    1. Su X, Lau JT, Mak WW, Chen L, Choi KC, Song J, et al. Perceived discrimination, social support, and perceived stress among people living with HIV/AIDS in China. AIDS Care. 2013;25(2):239–48. doi: 10.1080/09540121.2012.701713.
    1. Gillies P, Tolley K, Wolstenholme J. Is AIDS a disease of poverty? AIDS Care. 1996;8(3):351–63. doi: 10.1080/09540129650125768.
    1. Adimora AA, Ramirez C, Auerbach JD, Aral SO, Hodder S, Wingood G, et al. Preventing HIV infection in women. J Acquir Immune Defic Syndr. 2013;63(Suppl 2):S168–73. doi: 10.1097/QAI.0b013e318298a166.
    1. Gregson S, Mushati P, Grusin H, Nhamo M, Schumacher C, Skovdal M, et al. Social capital and women’s reduced vulnerability to HIV infection in rural Zimbabwe. Popul Dev Rev. 2011;37(2):333–59. doi: 10.1111/j.1728-4457.2011.00413.x.
    1. Cene CW, Akers AY, Lloyd SW, Albritton T, Powell Hammond W, Corbie-Smith G. Understanding social capital and HIV risk in rural African American communities. J Gen Intern Med. 2011;26(7):737–44. doi: 10.1007/s11606-011-1646-4.
    1. Frumence G, Killewo J, Kwesigabo G, Nystrom L, Eriksson M, Emmelin M. Social capital and the decline in HIV transmission - A case study in three villages in the Kagera region of Tanzania. SAHARA J. 2010;7(3):9–20. doi: 10.1080/17290376.2010.9724964.
    1. Cooper HL, Linton S, Haley DF, Kelley ME, Dauria EF, Karnes CC, et al. Changes in exposure to neighborhood characteristics are associated with sexual network characteristics in a cohort of adults relocating from public housing. AIDS Behav. 2015;19(6):1016–30. doi: 10.1007/s10461-014-0883-z.
    1. Adimora AA, Schoenbach VJ, Martinson FE, Coyne-Beasley T, Doherty I, Stancil TR, et al. Heterosexually transmitted HIV infection among African Americans in North Carolina. J Acquir Immune Defic Syndr. 2006;41(5):616–23. doi: 10.1097/01.qai.0000191382.62070.a5.
    1. Aral SO, Adimora AA, Fenton KA. Understanding and responding to disparities in HIV and other sexually transmitted infections in African Americans. Lancet. 2008;372(9635):337–40. doi: 10.1016/S0140-6736(08)61118-6.
    1. Schwartz RM, Bruno DM, Augenbraun MA, Hogben M, Joseph MA, Liddon N, et al. Perceived financial need and sexual risk behavior among urban, minority patients following sexually transmitted infection diagnosis. Sex Transm Dis. 2011;38(3):230–4. doi: 10.1097/OLQ.0b013e3181f41b81.
    1. Sumartojo E, Doll L, Holtgrave D, Gayle H, Merson M. Enriching the mix: incorporating structural factors into HIV prevention. AIDS. 2000;14(Suppl 1):S1–2. doi: 10.1097/00002030-200006001-00001.
    1. Marshall BD, Kerr T, Shoveller JA, Patterson TL, Buxton JA, Wood E. Homelessness and unstable housing associated with an increased risk of HIV and STI transmission among street-involved youth. Health Place. 2009;15(3):753–60. doi: 10.1016/j.healthplace.2008.12.005.
    1. Elifson KW, Sterk CE, Theall KP. Safe living: the impact of unstable housing conditions on HIV risk reduction among female drug users. AIDS Behav. 2007;11(6 Suppl):45–55. doi: 10.1007/s10461-007-9306-8.
    1. Corneil TA, Kuyper LM, Shoveller J, Hogg RS, Li K, Spittal PM, et al. Unstable housing, associated risk behaviour, and increased risk for HIV infection among injection drug users. Health Place. 2006;12(1):79–85. doi: 10.1016/j.healthplace.2004.10.004.
    1. Ezzy D, de Visser R, Bartos M. Poverty, disease progression and employment among people living with HIV/AIDS in Australia. AIDS Care. 1999;11(4):405–14. doi: 10.1080/09540129947785.
    1. Bolton R. AIDS and promiscuity: muddles in the models of HIV prevention. Med Anthropol. 1992;14(2–4):145–223. doi: 10.1080/01459740.1992.9966072.
    1. Konkle-Parker DJ, Erlen JA, Dubbert PM. Barriers and facilitators to medication adherence in a southern minority population with HIV disease. J Assoc Nurses AIDS Care. 2008;19(2):98–104. doi: 10.1016/j.jana.2007.09.005.
    1. Denning P, DiNenno E. Communities in crisis: is there a generalized hiv epidemic in impoversished urban areas of the United States? XVIII International AIDS Conference: Center for Disease Control and Prevention; 2010.
    1. Kakietek J, Geberselassie T, Manteuffel B, Ogungbemi K, Krivelyova A, Bausch S, et al. It takes a village: community-based organizations and the availability and utilization of HIV/AIDS-related services in Nigeria. AIDS Care. 2013;25(Suppl 1):S78–87. doi: 10.1080/09540121.2012.740158.
    1. Frew PM, Archibald M, Hixson B, del Rio C. Socioecological influences on community involvement in HIV vaccine research. Vaccine. 2011;29(36):6136–43. doi: 10.1016/j.vaccine.2011.06.082.
    1. Mayer KH, Pape JW, Wilson P, Diallo DD, Saavedra J, Mimiaga MJ, et al. Multiple determinants, common vulnerabilities, and creative responses: addressing the AIDS pandemic in diverse populations globally. J Acquir Immune Defic Syndr. 2012;60(Suppl 2):S31–4. doi: 10.1097/QAI.0b013e31825c16d9.
    1. Frew PM, Archibald M, Schamel J, Saint-Victor D, Fox E, Smith-Bankhead N, et al. An integrated service delivery model to identify persons living with HIV and to provide linkage to HIV treatment and care in prioritized neighborhoods: a geotargeted, program outcome study. JMIR Public Health Surveill. 2015;1(2):e16. doi: 10.2196/publichealth.4675.
    1. Adimora AA, Schoenbach VJ. Social context, sexual networks, and racial disparities in rates of sexually transmitted infections. J Infect Dis. 2005;191(Suppl 1):S115–22. doi: 10.1086/425280.
    1. Drumright LN, Gorbach PM, Holmes KK. Do people really know their sex partners? Concurrency, knowledge of partner behavior, and sexually transmitted infections within partnerships. Sex Transm Dis. 2004;31(7):437–42. doi: 10.1097/01.OLQ.0000129949.30114.37.
    1. Flom PL, Friedman SR, Kottiri BJ, Neaigus A, Curtis R, Des Jarlais DC, et al. Stigmatized drug use, sexual partner concurrency, and other sex risk network and behavior characteristics of 18- to 24-year-old youth in a high-risk neighborhood. Sex Transm Dis. 2001;28(10):598–607. doi: 10.1097/00007435-200110000-00006.
    1. Garnett GP, Johnson AM. Coining a new term in epidemiology: concurrency and HIV. AIDS. 1997;11(5):681–3. doi: 10.1097/00002030-199705000-00017.
    1. El-Bassel N, Gilbert L, Wu E, Chang M, Gomes C, Vinocur D, et al. Intimate partner violence prevalence and HIV risks among women receiving care in emergency departments: implications for IPV and HIV screening. Emerg Med J. 2007;24(4):255–9. doi: 10.1136/emj.2006.041541.
    1. Bhandari S, Bullock LF, Bair-Merritt M, Rose L, Marcantonio K, Campbell JC, et al. Pregnant women experiencing IPV: impact of supportive and non-supportive relationships with their mothers and other supportive adults on perinatal depression: a mixed methods analysis. Issues Ment Health Nurs. 2012;33(12):827–37. doi: 10.3109/01612840.2012.712628.
    1. Renzetti CM. Identified intimate partner violence (IPV) as a risk for women in contracting HIV/AIDS and other sexually transmitted disease. Violence Against Women. 2013;19(7):811–3. doi: 10.1177/1077801213498472.
    1. Perez S, Johnson DM, Wright CV. The attenuating effect of empowerment on IPV-related PTSD symptoms in battered women living in domestic violence shelters. Violence Against Women. 2012;18(1):102–17. doi: 10.1177/1077801212437348.
    1. Sweet E, Nandi A, Adam EK, McDade TW. The high price of debt: Household financial debt and its impact on mental and physical health. Soc Sci Med. 2013;91:94–100. doi: 10.1016/j.socscimed.2013.05.009.
    1. Okechukwu CA, El Ayadi AM, Tamers SL, Sabbath EL, Berkman L. Household food insufficiency, financial strain, work-family spillover, and depressive symptoms in the working class: the Work, Family, and Health Network study. Am J Public Health. 2012;102(1):126–33. doi: 10.2105/AJPH.2011.300323.
    1. Gonzalez-Guarda RM, Vasquez EP, Urrutia MT, Villarruel AM, Peragallo N. Hispanic women’s experiences with substance abuse, intimate partner violence, and risk for HIV. J Transcult Nurs. 2011;22(1):46–54. doi: 10.1177/1043659610387079.
    1. Saylors K, Daliparthy N. Native women, violence, substance abuse and HIV risk. J Psychoactive Drugs. 2005;37(3):273–80. doi: 10.1080/02791072.2005.10400520.
    1. Meader N, Semaan S, Halton M, Bhatti H, Chan M, Llewellyn A, et al. An international systematic review and meta-analysis of multisession psychosocial interventions compared with educational or minimal interventions on the HIV sex risk behaviors of people who use drugs. AIDS Behav. 2013;17(6):1963–78. doi: 10.1007/s10461-012-0403-y.
    1. Golden SD, Perreira KM, Durrance CP. Troubled times, troubled relationships: how economic resources, gender beliefs, and neighborhood disadvantage influence intimate partner violence. J Interpers Violence. 2013;28(10):2134–55. doi: 10.1177/0886260512471083.
    1. Jones-Webb R, Karriker-Jaffe KJ. Neighborhood disadvantage, high alcohol content beverage consumption, drinking norms, and drinking consequences: a mediation analysis. J Urban Health. 2013;90(4):667–84. doi: 10.1007/s11524-013-9786-y.
    1. Bauermeister JA, Zimmerman MA, Caldwell CH. Neighborhood disadvantage and changes in condom use among African American adolescents. J Urban Health. 2011;88(1):66–83. doi: 10.1007/s11524-010-9506-9.
    1. Hackman DA, Betancourt LM, Brodsky NL, Hurt H, Farah MJ. Neighborhood disadvantage and adolescent stress reactivity. Front Hum Neurosci. 2012;6:277. doi: 10.3389/fnhum.2012.00277.
    1. Haines VA, Beggs JJ, Hurlbert JS. Neighborhood disadvantage, network social capital, and depressive symptoms. J Health Soc Behav. 2011;52(1):58–73. doi: 10.1177/0022146510394951.
    1. Karriker-Jaffe KJ, Zemore SE, Mulia N, Jones-Webb R, Bond J, Greenfield TK. Neighborhood disadvantage and adult alcohol outcomes: differential risk by race and gender. J Stud Alcohol Drugs. 2012;73(6):865–73. doi: 10.15288/jsad.2012.73.865.
    1. Georgia Department of Human Resources . Year 2002 epidemiologic profile for HIV prevention community planning in Georgia. 2002.
    1. Wingood GM, Rubtsova A, DiClemente RJ, Metzger D, Blank M. A new paradigm for optimizing HIV intervention synergy: the role of interdependence in integrating HIV prevention interventions. J Acquir Immune Defic Syndr. 2013;63(Suppl 1):S108–13. doi: 10.1097/QAI.0b013e318291fff4.
    1. Aziz MH, Wheeler DL, Bhamb B, Verma AK. Protein kinase C delta overexpressing transgenic mice are resistant to chemically but not to UV radiation-induced development of squamous cell carcinomas: a possible link to specific cytokines and cyclooxygenase-2. Cancer Res. 2006;66(2):713–22. doi: 10.1158/0008-5472.CAN-05-2684.
    1. Dworkin SL, Blankenship K. Microfinance and HIV/AIDS prevention: assessing its promise and limitations. AIDS Behav. 2009;13(3):462–9. doi: 10.1007/s10461-009-9532-3.
    1. Pronyk PM, Kim JC, Abramsky T, Phetla G, Hargreaves JR, Morison LA, et al. A combined microfinance and training intervention can reduce HIV risk behaviour in young female participants. AIDS. 2008;22(13):1659–65. doi: 10.1097/QAD.0b013e328307a040.
    1. Rosenberg MS, Seavey BK, Jules R, Kershaw TS. The role of a microfinance program on HIV risk behavior among Haitian women. AIDS Behav. 2011;15(5):911–8. doi: 10.1007/s10461-010-9860-3.
    1. Spielberg F, Crookston BT, Chanani S, Kim J, Kline S, Gray BL. Leveraging microfinance to impact HIV and financial behaviors among adolescents and their mothers in West Bengal: a cluster randomized trial. Int J Adolesc Med Health. 2013;25(2):157–66. doi: 10.1515/ijamh-2013-0024.
    1. Sales JM, Salazar LF, Wingood GM, DiClemente RJ, Rose E, Crosby RA. The mediating role of partner communication skills on HIV/STD-associated risk behaviors in young African American females with a history of sexual violence. Arch Pediatr Adolesc Med. 2008;162(5):432–8. doi: 10.1001/archpedi.162.5.432.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe