Stefan Baral
Dados Biográficos
| ID | 3824565 |
|---|---|
| NOME | Stefan Baral |
| PRENOMES | Stefan |
| SOBRENOME | Baral |
| ASSINATURA | BARAL S |
| AFILIAÇÕES | Johns Hopkins University |
| VERIFICADO | Não |
| TOTAL DE OBRAS | 58 |
| TOTAL DE CITAÇÕES | 13 |
| TOTAL COMO AUTOR | 57 |
| TOTAL COMO EDITOR | 1 |
| PRIMEIRO ANO DE PUBLICAÇÃO | 2007 |
| ANO MAIS RECENTE DE PUBLICAÇÃO | 2026 |
| ÍNDICE H | 2 |
Stigma’s every day, all day long”
In 2025, gendered inequities in HIV risk and harm remain for women who use drugs (WWUD). WWUD also have low levels of HIV prevention service engagement and likely experience intersectional stigma. The present study sought to explore WWUD's experiences with intersectional stigma and how those experiences shape HIV prevention service use to better inform the development of tailored intervention efforts. Individual in-depth interviews were conducted…
It would have been easier for me to give up if I were alone”
Findings suggest both pathways of potential ICM effectiveness and impact and sustainability shortfalls, calling for larger-scale evaluation and complementary structural approaches, such as those bolstering FSW social cohesion and tackling socio-economic barriers
The Role of Healthcare-Related Experiences in Willingness and Preference for Long-Acting Injectable PrEP (LAI-PrEP) Among Transfeminine People in the United States
Transgender women and transfeminine people (TWTFP) experience disproportionately high HIV prevalence, low HIV pre-exposure prophylaxis (PrEP) coverage, and negative healthcare experiences. Long-acting injectable PrEP (LAI-PrEP) and daily oral-PrEP are delivered under different healthcare interaction protocols. We examined the role of healthcare-related experiences on willingness and preference for LAI-PrEP among a U.S. nationwide sample of sexual…
Profiles of Sexual Economic Exchanges among Women in Kisumu, Kenya
Sexual economic exchanges, including sex work and transactional sex, have been consistently associated with HIV acquisition among young women in sub-Saharan Africa. Heterogeneity in HIV vulnerability across overlapping types of sexual economic exchange has not been sufficiently explored, limiting appropriate and effective linkage to prevention interventions. From January 2017 to May 2018, cross-sectional data were captured at screening for entry …
Facilitators and Barriers to Pre-Exposure Prophylaxis (PrEP) Use Among Black Young and Older Adult Women in Baltimore
Mpox stigma during the 2022 outbreak among men who have sex with men in the United States
Mpox emerged on the global scale in 2022 and predominately affected gay, bisexual, and other men who have sex with men (GBMSM). Stigma related to mpox is a potential harm for individuals experiencing multiple levels of marginalization who may already be discriminated against in family, healthcare, and other social domains. To understand perceived mpox stigma among cisgender GBMSM in the United States (US), we conducted a study within the American…
HIV Pre-exposure prophylaxis (PrEP) modalities and service delivery preferences among black cisgender emerging and older adult women in Baltimore, Maryland
To improve PrEP equity and initiation of current and emerging PrEP modalities, it is crucial to integrate the lived experiences and preferences of Black cisgender women and enhance their representation in PrEP messaging
Intersecting gender, ethnicity, and sexual orientation identities and HIV stigma
Stigma remains a significant burden for people living with HIV and while studies have examined the impacts of gender, ethnicity, and sexual orientation on stigma separately, little is known about how these factors may intersect and potentially exacerbate levels of stigma. This study examines how these intersecting social positions may relate to levels of internalised, enacted and anticipated HIV stigma. Participants were recruited in Ontario, Alb…
Association between homelessness and PrEP uptake among men who have sex with men
ART coverage and viral suppression among female sex workers living with HIV in eThekwini, South Africa
In South Africa >60% of female sex workers (FSW) are living with HIV, the majority of whom are not virally suppressed. Identifying multi-level determinants of viral suppression is central to developing implementation strategies to promote retention in HIV care and viral suppression among FSW with unmet treatment needs. Adult cisgender FSW living with HIV for ≥6 months, conducting sex work as their primary source of income, and residing in Durban …
The impact of Covid-19 restrictions on HIV prevention and treatment services for key populations in South Africa
Service provision rebounded from the initial shock created by pandemic-related restrictions, and HIV services were largely maintained for KP in South Africa. These results suggest that HIV service delivery among programs designed for KP was able to be flexible and resilient to the evolving restrictions. The results of this study can inform plans for future pandemics and large-scale disruptions to the delivery of HIV services
Sexual violence affecting female sex workers in Côte d’Ivoire
Findings confirm a high burden of sexual violence among female sex workers in Côte d'Ivoire, and a need to implement large structural changes that enable female sex workers to seek protection as well as health resources after experiencing sexual violence. This may include reform in the form of targeted social, clinical and mental health resources, along with community development opportunities
Homoprejudiced Violence Experiences and High-Risk Sexual Behaviors among Chinese Men Who Have Sex with Men
Risk Compensation After Initiation of Daily Oral Pre-exposure Prophylaxis Among Sexual and Gender Minorities in Nigeria
The relationship between underage initiation of selling sex and depression among female sex workers in Eswatini
Results highlight the need for trauma-informed and adolescent-friendly mental health services in settings free of stigma toward female sex workers in Eswatini
Mobility and HIV vulnerabilities among female sex workers in Guinea-Bissau
These results suggest that while some prevention services including HIV prevention information reach mobile FSW in Guinea-Bissau more than their non-mobile counterparts, the higher rates of condomless sex among mobile FSW suggest that HIV prevention needs may remain unmet for mobile FSW in Guinea-Bissau. Additionally, the results suggest a nuanced relationship between mobility, place of residence, and HIV and social vulnerabilities and prevention…
A Systematic Review of Gender-Based Violence Prevention and Response Interventions for HIV Key Populations
Gender-based violence (GBV) is that perpetrated based on sex, gender identity, or perceived adherence to socially defined gender norms. This human rights violation is disproportionately experienced by HIV key populations including female sex workers (FSW), people who inject drugs (PWID), and men who have sex with men (MSM). Consequently, addressing GBV is a global priority in HIV response. There is limited consensus about optimal interventions an…
Sexual and Reproductive Health Service Needs Associated with Underage Initiation of Selling Sex among Adult Female Sex Workers in Guinea-Bissau
These data suggest that early initiation of selling sex among adult FSW in Guinea-Bissau is common. Social services for youth and integrated HIV and reproductive health services are critical to address the persisting sexual and reproductive health needs of FSW who started selling sex while underage
Sex Work, Health, and Human Rights
Introduction\nThis open access book provides a comprehensive overview of the health inequities and human rights issues faced by sex workers globally across diverse contexts, and outlines evidence-based strategies and best practices.\nSex workers face severe health and social inequities, largely as the result of structural factors including punitive and criminalized legal environments, stigma, and social and economic exclusion and marginalization.…
The Relationship Between Sexual Behavior Stigma and Depression Among Men Who have Sex with Men and Transgender Women in Kigali, Rwanda
Individual and partnership characteristics associated with consistent condom use in a cohort of cisgender men who have sex with men and transgender women in Nigeria
These findings suggest that individuals in relationships where partners were more open and encouraged safer sex were more likely to consistently use condoms. HIV prevention programs should consider leveraging communication to sexual partners to encourage condom use as this may support condom use with other sexual partners. Given sustained and growing HIV and STI epidemics among MSM and TGW, even with pre-exposure prophylaxis scale-up, it is cruci…
Impact of experienced HIV stigma on health is mediated by internalized stigma and depression
We developed a mediation model to explain how HIV-related stigma negatively impacts health. We found that that enacted stigma, or experiences of prejudice or discrimination, can lead to internalized stigma, or internalization of negative thoughts regarding one's HIV status and/or increased depressive symptoms which then may lead to worse overall health. Highlighting the importance of internalized stigma and depression has the potential to shape t…
Willingness to utilize supervised injection facilities among people who inject drugs in Iran
Supervised consumption service use and recent non-fatal overdose among people who inject drugs in Toronto, Canada
Assessing differential impacts of Covid-19 on black communities
Purpose: Given incomplete data reporting by race, we used data on COVID-19 cases and deaths in U.S. counties to describe racial disparities in COVID-19 disease and death and associated determinants. Methods: Using publicly available data (accessed April 13, 2020), predictors of COVID-19 cases and deaths were compared between disproportionately (≥13%) black and all other (<13% black) counties. Rate ratios were calculated, and population attributab…
Stigma, sexual health, and human rights among women who have sex with women in Lesotho
In recent years, gender and sexual minorities have become increasingly visible across sub-Saharan Africa, marking both the progression and violation of their human rights. Using data from a study with sexual minorities in Lesotho, this analysis leveraged the social ecological model to examine relationships between stigma, human rights, and sexual health among women who have sex with women in Lesotho. A community-based participatory approach was u…
Sexual identity stigma and social support among men who have sex with men in Lesotho
Men who have sex with men (MSM) face sexual identity stigma in many settings, which can increase risk for HIV by limiting access to care. This paper examines the roles of social support, sexual identity stigma, and sexual identity disclosure among MSM in Lesotho, a lower-middle income country within South Africa. Qualitative data were collected from 23 in-depth interview and six focus group participants and content analysis was performed to extra…
Fertility-related research needs among women at the margins
Fertility-related research encompasses fertility intentions, preconception care, research amongst pregnant women, and post-partum outcomes of mothers and children. However, some women remain under-represented within this domain of study. Women frequently missing within fertility-related research include those who are already the most vulnerable to health disparities, including female sex workers, lesbian, gay, bisexual, and transgender women, wom…
Assessing the effects of anti-homosexuality legislation in Uganda on HIV prevention, treatment, and care services
Uganda's response to the HIV epidemic has been lauded for its robustness and achievements. However, a key component of HIV prevention programming has been missing, for men who have sex with men (MSM). The main reason cited has been criminalization of male homosexual behavior. In 2009, the Anti-Homosexuality Bill (AHB) was introduced in the parliament to enhance existing anti-homosexuality law. A multi-disciplinary team made a Health Impact Assess…
Elevated Risk for HIV Infection among Men Who Have Sex with Men in Low- and Middle-Income Countries 2000–2006
HIV Prevalence, Risks for HIV Infection, and Human Rights among Men Who Have Sex with Men (MSM) in Malawi, Namibia, and Botswana
BACKGROUND: In the generalized epidemics of HIV in southern Sub-Saharan Africa, men who have sex with men have been largely excluded from HIV surveillance and research. Epidemiologic data for MSM in southern Africa are among the sparsest globally, and HIV risk among these men has yet to be characterized in the majority of countries. METHODOLOGY: A cross-sectional anonymous probe of 537 men recruited with non-probability sampling among men who rep…
Male sex workers in Moscow, Russia
The Russian federation has been undergoing a concentrated epidemic of HIV-1 with high rates of infection among injecting drug users. Less is known about the relative risk and contribution to the country's HIV epidemic by other at-risk populations including sex workers and men who have sex with men. The goals of this project were to explore demographic characteristics, substance use patterns, and estimate the prevalence of sexually transmitted inf…
Burden of HIV among female sex workers in low-income and middle-income countries
Assessing the effects of anti-homosexuality legislation in Uganda on HIV prevention, treatment, and care services
Uganda's response to the HIV epidemic has been lauded for its robustness and achievements. However, a key component of HIV prevention programming has been missing, for men who have sex with men (MSM). The main reason cited has been criminalization of male homosexual behavior. In 2009, the Anti-Homosexuality Bill (AHB) was introduced in the parliament to enhance existing anti-homosexuality law. A multi-disciplinary team made a Health Impact Assess…
Rewriting the narrative of the epidemiology of HIV in sub-Saharan Africa
The fight against HIV remains complicated with contracting donor resources and high burden of HIV among reproductive age adults still often limiting independent economic development. In the widespread HIV epidemics of sub-Saharan Africa (SSA), it is proposed that key populations with specific HIV acquisition and transmission risk factors, such as men who have sex with men (MSM), female sex workers (FSW), and people who use drugs (PUD), are less r…
A systematic review of interventions to reduce HIV‐related stigma and discrimination from 2002 to 2013
The Global HIV Epidemics among Sex Workers
Since the beginning of the epidemic sex workers have experienced a heightened burden of HIV across settings, despite their higher levels of HIV protective behaviors (UNAIDS, 2009). Unfairly, sex workers have often been framed as 'vectors of disease' and 'core transmitters' rather than workers and human beings with rights in terms of HIV prevention and beyond. By gaining a deeper understanding of the epidemiologic and broader policy and social con…
Use of Dual Protection Among Female Sex Workers in Swaziland [
CONTEXT: Female sex workers are at heightened risk of both HIV infection and unwanted pregnancy. Nonbarrier modern contraceptives are highly effective at preventing pregnancy, but offer no HIV protection. A better understanding of sex workers' use of condoms and nonbarrier methods is needed to help them meet their contraceptive and STI protection needs. METHODS: A 2011 respondent-driven sampling survey collected reproductive health and contracept…
Modified social ecological model
The MSEM is a flexible model for guiding epidemiologic studies among key populations at risk for HIV in diverse sociocultural contexts. Successful HIV prevention strategies for key populations require effective integration of evidence-based biomedical, behavioral, and structural interventions. While the focus of epidemiologic studies has traditionally been on describing individual-level risk factors, the future necessitates comprehensive epidemio…
Correlates of prior HIV testing among men who have sex with men in Cameroon
Supporting regular HIV testing and linkage to care is important in a context of high HIV prevalence and limited use of condoms and condom-compatible lubricants. Building the capacity of MSM organizations and mainstream health services to deliver affordable, integrated, confidential, and MSM-sensitive HIV testing may assist in effectively engaging more MSM in the HIV treatment cascade. Giving specific attention to MSM who are younger, of lower soc…
There is hunger in my community”
Informants described a risk cycle of hunger, sex work, and HIV infection. The two latter drive an increased need for 'healthy foods' and an alienation from social networks that offer material and emotional support against hunger. Services and interventions for sex workers which address the pathways through which food insecurity generates vulnerability to HIV and social marginalization, build sex workers collective efficacy to mobilize, consider p…
Sexual violence against female sex workers in The Gambia
FSW who experience sexual violence by a client are more likely to experience poor sexual, reproductive and mental health outcomes. Responding to sexual violence among FSW, including providing survivors with access to post-exposure prophylaxis, emergency contraception, and mental health services, must be a priority given the prevalence of forced sex and links with poor health outcomes. Efforts to reduce sexual violence against FSW is a vital strat…
Stigma, sexual health, and human rights among women who have sex with women in Lesotho
In recent years, gender and sexual minorities have become increasingly visible across sub-Saharan Africa, marking both the progression and violation of their human rights. Using data from a study with sexual minorities in Lesotho, this analysis leveraged the social ecological model to examine relationships between stigma, human rights, and sexual health among women who have sex with women in Lesotho. A community-based participatory approach was u…
Sexual identity stigma and social support among men who have sex with men in Lesotho
Men who have sex with men (MSM) face sexual identity stigma in many settings, which can increase risk for HIV by limiting access to care. This paper examines the roles of social support, sexual identity stigma, and sexual identity disclosure among MSM in Lesotho, a lower-middle income country within South Africa. Qualitative data were collected from 23 in-depth interview and six focus group participants and content analysis was performed to extra…
Fertility-related research needs among women at the margins
Fertility-related research encompasses fertility intentions, preconception care, research amongst pregnant women, and post-partum outcomes of mothers and children. However, some women remain under-represented within this domain of study. Women frequently missing within fertility-related research include those who are already the most vulnerable to health disparities, including female sex workers, lesbian, gay, bisexual, and transgender women, wom…
Global Epidemiology of HIV Infection and Related Syndemics Affecting Transgender People
INTRODUCTION: Transgender populations have been underrepresented in HIV epidemiologic studies and consequently in HIV prevention, care, and treatment programs. Since 2012, there has been a dramatic increase in research focused on transgender people. Studies highlight the burden of HIV and risk determinants, including intersecting stigmas, as drivers of syndemics among transgender populations. This review synthesizes the most recent global epidemi…
Exploring Lived Experiences of Violence and Coping Among Lesbian, Gay, Bisexual and Transgender Youth in Kingston, Jamaica
Objectives: This study explored experiences of violence and coping among lesbian, gay, bisexual and transgender (LGBT) youth in Kingston, Jamaica. Methods: We conducted three focus groups with LGBT youth (18–29 years old), one with gay men (n = 10); one with transgender women (n = 8); and the third with lesbian and bisexual women (n = 5). Thematic analysis was used to understand lived experiences of violence and coping. Results: Findings revealed…
Social cohesion, social participation and HIV testing among men who have sex with men in Swaziland
Social cohesion and social participation are social factors that may help reduce HIV risks and optimize health-seeking behaviors. We examined the association between these factors and HIV testing in the last 12 months among men who have sex with men (MSM) in Swaziland using a cross-sectional survey conducted with 326 men, 18 years of age or older reporting having sex with another man in the last 12 months. Social capital analyses included measure…
Suicidal ideation among MSM in three West African countries
BACKGROUND: Suicidal ideation is understudied among men who have sex with men (MSM) across Sub-Saharan Africa. AIMS: This study aimed to explore social capital and sexual behavior stigma associated with suicidal ideation among MSM in the West African nations of The Gambia, Burkina Faso and Togo. METHODS: Participants were recruited using respondent-driven sampling and snowball sampling across multiple cities (n = 1555) from July 2011 to August 20…
HIV and the criminalisation of drug use among people who inject drugs
Using a social ecological framework to characterize the correlates of HIV among men who have sex with men in Lomé, Togo
In the mixed and concentrated HIV epidemics of West Africa, the relative disproportionate burden of HIV among men who have sex with men (MSM) compared to other reproductive-age men is higher than that observed in Southern and Eastern Africa. Our aim is to describe the correlates of HIV infection among MSM living in Lomé, Togo, using the Modified Social Ecological Model (MSEM). A total of 354 MSM ≥18 years of age were recruited using respondent dr…
Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals
Marginalization and social change processes among lesbian, gay, bisexual and transgender persons in Swaziland
Swaziland has among the highest national adult HIV prevalence globally. There is limited knowledge of HIV vulnerabilities and prevention engagement among lesbian, gay, bisexual and transgender (LGBT) persons in the context of Swaziland's criminalization of consensual same-sex practices. This study explored social processes of marginalization to assess how they could potentiate HIV vulnerabilities and limit engagement in HIV prevention services. A…
An assessment of stigma and human right violations among men who have sex with men in Abuja, Nigeria
BACKGROUND: There have been several barriers in effectively engaging men who have sex with men for STI/HIV prevention and treatment programming in Nigeria including social stigma, policies, and laws criminalizing same-sex practices. The objective of this study was to describe the human rights context for MSM in Abuja and characterize factors associated with having had a genital ulcer disease in the previous 12 months, a health outcome associated …
Medicine (48 obras) · HIV/AIDS Research and Interventions (44 obras) · HIV, Drug Use, Sexual Risk (35 obras) · Environmental health (31 obras) · Sex work and related issues (31 obras) · Demography (29 obras) · Family medicine (29 obras) · Men who have sex with men (27 obras) · Psychology (25 obras) · Public health (23 obras)