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Wirtz AL, Poteat T, Borquez A, Linton S, Stevenson M, Case J, Brown C, Lint A, Miller M, Radix A, Althoff KN, Schneider JS, Haw JS, Wawrzyniak AJ, Rodriguez A, Cooney E, Humes E, Pontes C, Seopaul S, White C, Beyrer C, Reisner SL. Enhanced Cohort Methods for HIV Research and Epidemiology (ENCORE): Protocol for a Nationwide Hybrid Cohort for Transgender Women in the United States. JMIR Res Protoc 2024; 13:e59846. [PMID: 39190916 PMCID: PMC11387927 DOI: 10.2196/59846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/12/2024] [Accepted: 06/18/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND In the United States, transgender women are disproportionately impacted by HIV and prioritized in the national strategy to end the epidemic. Individual, interpersonal, and structural vulnerabilities underlie HIV acquisition among transgender women and fuel syndemic conditions, yet no nationwide cohort monitors their HIV and other health outcomes. OBJECTIVE Our objective is to develop a nationwide cohort to estimate HIV incidence, identify risk factors, and investigate syndemic conditions co-occurring with HIV vulnerability or acquisition among US transgender women. The study is informed by the Syndemics Framework and the Social Ecological Model, positing that stigma-related conditions are synergistically driven by shared multilevel vulnerabilities. METHODS To address logistical and cost challenges while minimizing technology barriers and research distrust, we aim to establish a novel, hybrid community hub-supported digital cohort (N=3000). The digital cohort is the backbone of the study and is enhanced by hubs strategically located across the United States for increased engagement and in-person support. Study participants are English or Spanish speakers, are aged ≥18 years, identify as transgender women or along the transfeminine spectrum, reside in 1 of the 50 states or Puerto Rico, and do not have HIV (laboratory confirmed). Participants are followed for 24 months, with semiannual assessments. These include a questionnaire and laboratory-based HIV testing using self-collected specimens. Using residential zip codes, person-level data will be merged with contextual geolocated data, including population health measures and economic, housing, and other social and structural factors. Analyses will (1) evaluate the contribution of hub support to the digital cohort using descriptive statistics; (2) estimate and characterize syndemic patterns among transgender women using latent class analysis; (3) examine the role of contextual factors in driving syndemics and HIV prevention over time using multilevel regression models; (4) estimate HIV incidence in transgender women and examine the effect of syndemics and contextual factors on HIV incidence using Poisson regression models; and (5) develop dynamic, compartmental models of multilevel combination HIV prevention interventions among transgender women to simulate their impact on HIV incidence through 2030. RESULTS Enrollment launched on March 15, 2023, with data collection phases occurring in spring and fall. As of February 24, 2024, a total of 3084 individuals were screened, and 996 (32.3%) met the inclusion criteria and enrolled into the cohort: 2.3% (23/996) enrolled at a hub, and 53.6% (534/996) enrolled through a community hub-supported strategy. Recruitment through purely digital methods contributed 61.5% (1895/3084) of those screened and 42.7% (425/996) of those enrolled in the cohort. CONCLUSIONS Study findings will inform the development of evidence-based interventions to reduce HIV acquisition and syndemic conditions among US transgender women and advance efforts to end the US HIV epidemic. Methodological findings will also have critical implications for the design of future innovative approaches to HIV research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/59846.
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Affiliation(s)
- Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
- Department of Public Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Tonia Poteat
- Division of Healthcare in Adult Populations, Duke University School of Nursing, Durham, NC, United States
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, United States
| | - Sabriya Linton
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Megan Stevenson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - James Case
- Johns Hopkins School of Nursing, Baltimore, MD, United States
| | - Carter Brown
- National Black Transgender Advocacy Coalition, Carrolton, TX, United States
| | - Arianna Lint
- Arianna's Center, Fort Lauderdale, FL, United States
| | - Marissa Miller
- Trans Solutions Research and Resource Center, Indianapolis, IN, United States
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, NY, United States
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jason S Schneider
- Division of General Internal Medicine, Department of Medicine, Emory University, Atlanta, GA, United States
| | - J Sonya Haw
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University, Atlanta, GA, United States
| | - Andrew J Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Allan Rodriguez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Erin Cooney
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elizabeth Humes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Ceza Pontes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Shannon Seopaul
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Camille White
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Sari L Reisner
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MD, United States
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Chen S, Zhu YY, Chu ZX, Zhou H, Liu M, Jiang YJ, Hu QH. Trajectories of anxiety and depression among Chinese men who have sex with men on pre-exposure prophylaxis: a group-based trajectory model approach. BMC Public Health 2024; 24:365. [PMID: 38310254 PMCID: PMC10837939 DOI: 10.1186/s12889-024-17854-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/23/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Anxiety and depression can influence adherence to Pre-exposure Prophylaxis (PrEP). However, there is limited research on the temporal dynamics of anxiety and depression among men who have sex with men (MSM) using PrEP. METHODS From December 2018 to November 2020, we administered the Hospital Anxiety and Depression Scale (HADS) to participants in the China Real-World Oral Intake of PrEP (CROPrEP) to measure their anxiety and depression levels. The group-based trajectory model (GBTM) depicted the dynamic changes of anxiety and depression scores over time. RESULTS A total of 1023 MSM were included, with 4523 follow-up assessments. The GBTM categorized the trajectories into three distinct patterns: consistently low (54.8% for anxiety, 60.7% for depression), consistently moderate (39.3% for anxiety, 31.4% for depression), and high but bell-shaped (5.9% for anxiety, 7.9% for depression). Higher anxiety levels were associated with being aged 18-30 years old, earning less than US$619 per month, female-identifying, adopting the bottom sexual role with men, and having two or more anal sex partners in the past three months; similarly, higher depression levels correlated with a monthly income under US$619, female-identifying, sexual behavior as bottom and a positive syphilis at baseline. PrEP adherence was notably lower in the high but bell-shaped anxiety and depression group compared to the other groups, particularly at the 12th-month follow-up. CONCLUSIONS Close monitoring of anxiety and depression levels in MSM on PrEP is crucial. Provision of targeted mental health support is essential to enhance PrEP effectiveness.
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Affiliation(s)
- Shuo Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Centre for Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yan-Yan Zhu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Centre for Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Zhen-Xing Chu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Centre for Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hui Zhou
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Centre for Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Miao Liu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Centre for Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yong-Jun Jiang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Centre for Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Qing-Hai Hu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Centre for Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China.
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
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Gomillia CE, Burns PA, Xavier Hall CD, Beach LB. The Association of Depression, Social Determinants and PrEP Uptake Among Black Sexual Minority Men in the Deep South. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01793-1. [PMID: 37702972 DOI: 10.1007/s40615-023-01793-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/14/2023]
Abstract
Despite its known efficacy in reducing HIV acquisition, pre-exposure prophylaxis (PrEP) uptake and utilization remains alarmingly low among key populations, including Black sexual minority men (SMM). Additionally, research has shown that SMM are at elevated risk of adverse mental health outcomes, including depression, anxiety, illegal drug use, and suicidality. However, there is limited data examining the impact of depression on PrEP uptake among Black SMM. This study analyzes survey data obtained from the ViiV ACCELERATE! Initiative between January 2016 and September 2017 to examine the association between depressive symptoms and uptake of PrEP among a sample of HIV-negative Black SMM ages 18-65 years (N=170) residing in Mississippi, the poorest state in the USA. We found that PrEP-eligible Black SMM reporting depressive symptoms were 60% less likely to take PrEP (aOR = 0.40, CI: 0.18-0.74, p = 0.05). Similarly, PrEP-eligible men lacking health insurance were 63% less likely to start PrEP (aOR = 0.37; CI: 0.17-0.94; p = 0.035). Given the low uptake of PrEP among Black SMM, there is an urgent need for the development and implementation of combination HIV prevention interventions that incorporate access to mental health services among this highly stigmatized and marginalized population.
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Affiliation(s)
- Courtney E Gomillia
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, TR202, Jackson, MS, 39216, USA.
| | - Paul A Burns
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, TR202, Jackson, MS, 39216, USA
| | - Casey D Xavier Hall
- College of Nursing, Florida State University, Tallahassee, FL, USA
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Lauren B Beach
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
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Okonkwo N, Rwema JOT, Lyons C, Liestman B, Nyombayire J, Olawore O, Nsanzimana S, Mugwaneza P, Kagaba A, Sullivan P, Allen S, Karita E, Baral S. The Relationship Between Sexual Behavior Stigma and Depression Among Men Who have Sex with Men and Transgender Women in Kigali, Rwanda: a Cross-sectional Study. Int J Ment Health Addict 2022; 20:3228-3243. [PMID: 36532817 PMCID: PMC9754158 DOI: 10.1007/s11469-021-00699-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 11/27/2022] Open
Abstract
To evaluate the role of sexual behavior stigma as a determinant of depressive symptoms among men who have sex with men (MSM) and transgender women (TGW) in Kigali, Rwanda. MSM/TGW aged ≥18 years were recruited using respondent-driven sampling (RDS) between March-August, 2018. Mental health was assessed using the Patient Health Questionnaire (PHQ-9). Sexual behavior stigma from friends and family, healthcare workers, and community members was assessed using a validated instrument. Multinomial logistic regression models were used to determine the association between sexual behavior stigma and depressive symptoms and depression. Secondary analyses further compared depression and depressive symptoms among MSM and TGW. Among the 736 participants included, 14% (106/736) identified as TGW. Depression 8.9% (RDS-adjusted, 7.6%; 95% CI, 4.6-10.6) and mild/moderate symptoms of depression 26.4% (RDS-adjusted, 24.1%; 95% CI, 19.4-28.7) were common and higher among TGW compared to MSM (p < 0.001). Anticipated (41%), perceived (36%), and enacted (45%) stigmas were highly prevalent, and were also significantly higher among TGW (p < 0.001). In multivariable RDS-adjusted analysis, anticipated (relative risk ratio (RRR), 1.88; 95% CI, 1.11-3.19) and perceived (RRR, 2.06; 95% CI, 1.12-3.79) stigmas were associated with a higher prevalence of depressive symptoms. Anticipated (RRR, 4.78; 95% CI, 1.74-13.13) and enacted (RRR, 3.09; 95% CI, 1.61-5.93) stigmas were also associated with a higher prevalence of depression. In secondary analyses, the significant differences between MSM and TGW were lost after adjusting for stigma. These data demonstrate a high burden of depressive symptoms and depression among MSM/TGW in Kigali. Conceptually, stigma is a likely antecedent of mental health stress among MSM and TGW suggesting the potential utility of scaling up stigma mitigation interventions to improve the quality of life and mental health outcomes among sexual and gender minority communities in Rwanda.
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Affiliation(s)
- N. Okonkwo
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jean Olivier Twahirwa Rwema
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133 Baltimore, MD, 21205, USA
| | - C. Lyons
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133 Baltimore, MD, 21205, USA
| | - B. Liestman
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133 Baltimore, MD, 21205, USA
| | | | - O. Olawore
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133 Baltimore, MD, 21205, USA
| | - S. Nsanzimana
- Rwanda Biomedical Center, HIV and AIDS Division, Kigali, Rwanda
| | - P. Mugwaneza
- Rwanda Biomedical Center, HIV and AIDS Division, Kigali, Rwanda
| | - A. Kagaba
- Health Development Initiative, Kigali, Rwanda
| | - P. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - S. Allen
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - E. Karita
- Projet San Francisco, Kigali, Rwanda
| | - S. Baral
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133 Baltimore, MD, 21205, USA
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5
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Shuper PA, Varatharajan T, Kinitz DJ, Gesink D, Joharchi N, Bogoch II, Loutfy M, Rehm J. Perceived influence of alcohol consumption, substance use, and mental health on PrEP adherence and condom use among PrEP-prescribed gay, bisexual, and other men-who-have-sex-with-men: a qualitative investigation. BMC Public Health 2022; 22:1875. [PMID: 36207757 PMCID: PMC9540691 DOI: 10.1186/s12889-022-14279-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/30/2022] [Indexed: 12/02/2022] Open
Abstract
Background Gay, bisexual, and other men-who-have-sex-with-men (GBMSM) continue to be disproportionately affected by Human Immunodeficiency Virus (HIV). Although HIV pre-exposure prophylaxis (PrEP) offers an effective means of reducing incident HIV among this population, the HIV-preventive success of oral-based PrEP is contingent upon regimen adherence. Elevated rates of alcohol-, substance use-, and mental health-related issues among GBMSM potentially hinder PrEP-taking efforts, however the evidence for this remains mixed. Accordingly, the present study entailed a comprehensive qualitative investigation to explore PrEP-prescribed GBMSM’s perceptions surrounding the influence of alcohol, substance use, and mental health on PrEP adherence. Methods PrEP-prescribed GBMSM (age ≥ 18 years; prescribed PrEP for ≥ 3 months) were recruited from two PrEP-delivery clinics in Toronto, Canada for focus groups as part of the formative phase of an alcohol-, substance use-, and mental health-focused randomized controlled intervention trial. Focus group discussions qualitatively explored perceived strengths and barriers associated with adherence to PrEP treatment; with an emphasis on alcohol, substance use, and mental health concerns. Condom use among PrEP-prescribed GBMSM within the context of these concerns was also discussed. Results A total of five focus groups involving 35 GBMSM were conducted (4–10/group; mean age = 42.4; white = 71.4%). Although participants themselves generally reported successfully adhering to their PrEP regimens—resulting from a strong, underlying motivation for self-care—they recognized the detrimental impact that alcohol, substance use, and mental health had on adherence among their peers. In this regard, alcohol and substances were perceived as detracting from adherence only when consumption was excessive or temporally linked to PrEP dosing. Pronounced mental health issues (e.g., severe depression) were also seen as hindering adherence, although these effects were nuanced and perceived as person-dependent. Alcohol and substances were linked to condomless sex, regardless of PrEP use, and PrEP was therefore viewed as an HIV-protective ‘safety net.’ Conclusions Overall, findings suggest that PrEP adherence can often be successfully achieved in the presence of alcohol-, substance use-, and mental health-related issues. Augmenting self-care, and addressing pronounced addictions- and mental health-related concerns, may enhance PrEP treatment among GBMSM.
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Affiliation(s)
- Paul A Shuper
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, 33 Russell St., Toronto, ON, M5S 2S1, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada.
| | | | - David J Kinitz
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada
| | - Narges Joharchi
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, 33 Russell St., Toronto, ON, M5S 2S1, Canada
| | - Isaac I Bogoch
- Divisions of General Internal Medicine and Infectious Diseases, University Health Network, 200 Elizabeth St., Toronto, ON, M5G 2C4, Canada.,Department of Medicine, Medical Sciences Building, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Mona Loutfy
- Department of Medicine, Medical Sciences Building, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Women's College Hospital, 76 Grenville S.t, Toronto, ON, M5S 1B2, Canada.,Maple Leaf Medical Clinic, 14 College St., Toronto, ON, M5G 1K2, Canada
| | - Jürgen Rehm
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, 33 Russell St., Toronto, ON, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada.,Department of Psychiatry, University of Toronto, 250 College St., Toronto, ON, M5T 1R8, Canada.,Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany.,Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Straße 46, 01187, Dresden, Germany.,Faculty of Medicine, Institute of Medical Science, Medical Sciences Building, University of Toronto, King's College Circle, Room 2374, Toronto, ON, M5S 1A8, Canada.,Program On Substance Abuse & WHO CC, Public Health Agency of Catalonia, 81-95 Roc Boronat St., 08005, Barcelona, Spain.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Street 8, b. 2, Moscow, 119991, Russian Federation
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6
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Ren J, Qi X, Cao W, Wang Z, Guo Y, Gaoshan J, Liang X, Tang K. Early Sexual Initiation Is Associated with Suicide Attempts among Chinese Young People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073966. [PMID: 35409650 PMCID: PMC8997714 DOI: 10.3390/ijerph19073966] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 02/06/2023]
Abstract
This study aimed to investigate the association between early sexual initiation and suicide attempts (SAs) among Chinese young people. Our analysis included 9131 college students who had sexual experience from a national sample of 31 provincial administrative regions. Self-reported age at first intercourse was categorized as ≤15, 15–18, and ≥18 years, and the experience of SAs was recorded and analyzed. Compared with females whose sexual debut age was ≥18 years, those ≤15 years (defined as early sexual initiation) had higher odds of SAs in both the forced debut group (odds ratio (OR) 17.04, 95% confidence interval (CI) 4.87–59.66) and the voluntary debut group (OR 37.63, 95% CI 14.96–94.66). Early sexual initiators who lived in rural areas were more inclined to have SAs (female: OR 65.76, 95% CI 19.80–218.42; male: OR 15.39, 95% CI 1.64–144.19). Early sexual initiators who never had parent–child communication about sex were more likely to report having SAs (female: OR 37.81, 95% CI 12.28–116.46). Sexual debut during adolescence, particularly early sexual initiation, was a crucial risk factor for SAs among both sexes. Comprehensive sexuality education and smooth parental communication about sex will provide a supportive environment for young people and hence reduce the potential risks of SAs.
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Affiliation(s)
- Jianing Ren
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China; (J.R.); (X.Q.); (Z.W.)
- School of Public Health, Peking University, Beijing 100191, China
| | - Xinran Qi
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China; (J.R.); (X.Q.); (Z.W.)
- School of Nursing, Capital Medical University, Beijing 100069, China
| | - Wenzhen Cao
- School of Public Health and Management, Wenzhou Medical University, Wenzhou 325035, China;
| | - Zhicheng Wang
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China; (J.R.); (X.Q.); (Z.W.)
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing 100084, China
| | - Yueping Guo
- School of Journalism and Communication, Graduate School of Chinese Academy of Social Sciences, Beijing 102488, China;
| | - Junjian Gaoshan
- Department for Health, University of Bath, Bath BA2 7AY, UK;
| | - Xiao Liang
- China Family Planning Association, Beijing 100035, China;
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China; (J.R.); (X.Q.); (Z.W.)
- Correspondence:
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7
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Lin C, Li L, Liu J, Fu X, Chen J, Cao W, Li Y. HIV PrEP services for MSM in China: a mixed-methods study. AIDS Care 2022; 34:310-314. [PMID: 33650447 PMCID: PMC8410894 DOI: 10.1080/09540121.2021.1896661] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a promising HIV prevention method. However, the rollout of PrEP among men who have sex with men (MSM) is facing challenges. This study sought to understand PrEP acceptability and service use challenges among MSM in China. The study was conducted in 2018 in Guangdong Province using a mixed-methods approach. Among 489 HIV-negative MSM who completed an online survey, 374 (76.5%) had heard of PrEP before. The most common PrEP information sources were internet/social media (32.1%) and community-based organizations (30.4%). Two-thirds (n=328) of the MSM would accept PrEP even the protective efficacy is less than 100%, 60.1% (n=294) expressed willingness to use PrEP once it is approved in China, and 59.3% (n=290) were willing to pay out of pocket. Employment, disclosure of MSM status, and mental health issues were associated with PrEP acceptability. In-depth interviews with 30 MSM revealed that high cost, low accessibility, and stigma in clinic settings were barriers to PrEP using. Primary care-based PrEP services were acceptable, but patients' confidentiality was a concern. PrEP promotion efforts should address social and mental health challenges among MSM and mobilize primary care systems and community-based organizations to achieve the best result.
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Affiliation(s)
- Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, U.S.A
| | - Li Li
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, U.S.A
| | - Jun Liu
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Xiaobing Fu
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Jun Chen
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, U.S.A.,Department of Epidemiology, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, U.S.A
| | - Wei Cao
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, U.S.A.,Department of Epidemiology, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, U.S.A
| | - Yan Li
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
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Cerecero-Garcia D, Vermandere H, Bojorquez I, Gómez-Castro J, Arturo Sánchez-Ochoa J, Martínez-Dávalos A, Huerta-Icelo I, Bautista-Arredondo S. Profiles of Depressive Symptoms Among Men Who Have Sex With Men and Transgender Women During the COVID-19 Outbreak in Mexico: A Latent Class Analysis. Front Public Health 2021; 9:598921. [PMID: 34164361 PMCID: PMC8215204 DOI: 10.3389/fpubh.2021.598921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 04/06/2021] [Indexed: 12/20/2022] Open
Abstract
The impact of the COVID-19 outbreak on mental health among HIV high-risk populations is not known. We assess the prevalence of depressive symptoms (DS) and explore the association with characteristics related to the COVID-19 pandemic. We conducted an online survey among 881 men who have sex with men (MSM) and transgender women (TGW) assessing the presence of DS using the Center for Epidemiological Studies Depression Scale (CESD-10); results were compared with previously self-reported DS and national data. We applied latent class analysis (LCA) to identify classes of participants with similar COVID-19 related characteristics. The overall prevalence of significant DS was 53.3%. By LCA posterior probabilities we identified three classes: (1) minimal impact of COVID-19 (54.1%), (2) objective risk for COVID-19 (41.5%), and (3) anxiety and economic stress caused by COVID-19 (4.4%). Multivariate logistic regression showed that compared with those in class one, the odds to have significant DS were almost five times higher for those in class three. Our findings suggest high levels of depression among MSM and TGW in Mexico during the COVID-19 pandemic and highlight the need for the provision of targeted psychological interventions to minimize the impacts of COVID-19 on the mental health.
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Affiliation(s)
- Diego Cerecero-Garcia
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Heleen Vermandere
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Ietza Bojorquez
- Department of Population Studies, El Colegio de la Frontera Norte, Tijuana, Mexico
| | - José Gómez-Castro
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | | | - Ivonne Huerta-Icelo
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
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Collins PY, Velloza J, Concepcion T, Oseso L, Chwastiak L, Kemp CG, Simoni J, Wagenaar BH. Intervening for HIV prevention and mental health: a review of global literature. J Int AIDS Soc 2021; 24 Suppl 2:e25710. [PMID: 34164934 PMCID: PMC8222838 DOI: 10.1002/jia2.25710] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/22/2021] [Accepted: 03/26/2021] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Numerous effective HIV prevention options exist, including behaviour change interventions, condom promotion and biomedical interventions, like voluntary medical male circumcision and pre-exposure prophylaxis. However, populations at risk of HIV also face overlapping vulnerabilities to common mental disorders and severe mental illness. Mental health status can affect engagement in HIV risk behaviours and HIV prevention programmes. We conducted a narrative review of the literature on HIV prevention among key populations and other groups vulnerable to HIV infection to understand the relationship between mental health conditions and HIV prevention outcomes and summarize existing evidence on integrated approaches to HIV prevention and mental healthcare. METHODS We searched five databases for studies published from January 2015 to August 2020, focused on HIV prevention and mental health conditions among key populations and individuals with serious mental illness. Studies were included if they evaluated an HIV prevention intervention or assessed correlates of HIV risk reduction and included assessment of mental health conditions or a mental health intervention. RESULTS AND DISCUSSION We identified 50 studies meeting our inclusion criteria, of which 26 were randomized controlled trials or other experimental designs of an HIV prevention intervention with or without a mental health component. Behaviour change interventions were the most common HIV prevention approach. A majority of studies recruited men who have sex with men and adolescents. Two studies provided distinct approaches to integrated HIV prevention and mental health service delivery. Overall, a majority of included studies showed that symptoms of mental disorder or distress are associated with HIV prevention outcomes (e.g. increased risky sexual behaviour, poor engagement in HIV prevention behaviours). In addition, several studies conducted among groups at high risk of poor mental health found that integrating a mental health component into a behaviour change intervention or linking mental health services to combination prevention activities significantly reduced risk behaviour and mental distress and improved access to mental healthcare. CONCLUSIONS Evidence suggests that mental health conditions are associated with poorer HIV prevention outcomes, and tailored integrated approaches are urgently needed to address overlapping vulnerabilities among key populations and other individuals at risk.
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Affiliation(s)
- Pamela Y Collins
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleWAUSA
| | | | | | - Linda Oseso
- HIV Vaccine Trials Network, Vaccine and Infectious Disease DivisionFred HutchSeattleWAUSA
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleWAUSA
| | | | - Jane Simoni
- Department of PsychologyUniversity of WashingtonSeattleWAUSA
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10
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Audet CM, Graves E, Emílio AM, Matino A, Paulo P, Aboobacar AM, Fonseca CL, Van Rompaey S, De Schacht C. Effect of a storytelling intervention on the retention of serodiscordant couples in ART/PrEP services at antenatal clinic in Namacurra province in Zambézia, Mozambique. Contemp Clin Trials Commun 2021; 22:100782. [PMID: 34095604 PMCID: PMC8167234 DOI: 10.1016/j.conctc.2021.100782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 04/01/2021] [Accepted: 04/28/2021] [Indexed: 11/21/2022] Open
Abstract
Background Sub-Saharan Africa reported 550,000 new HIV infections among women in 2018. Pregnancy and the postpartum period are associated with an increased risk of HIV acquisition (adjusted risk ratio [RR]: 2.8 during pregnancy and 4.0 in postpartum period vs. non-pregnant or postpartum women, respectively). Acquisition of HIV during pregnancy and breastfeeding increases risk of mother to child transmission. We propose to test the impact of a peer-delivered oral storytelling intervention to increase retention in, and adherence to, pre-exposure prophylaxis (PrEP)/combination antiretroviral treatment (ART) among expectant couples. Design We propose a randomized controlled trial (RCT) (35 intervention and 35 control couples) at a health facility where 11% of expectant couples were in serodiscordant relationships in 2018. Couples randomized to the storytelling arm will be visited by a two community volunteers and who successfully adhered to PrEP/ART during a recent pregnancy. This expert couple will orate to participating couples three stories (at 1, 3 and 5 weeks after study enrollment) designed to empower, educate, and establish “ideal” interpersonal communication strategies within couples/families, and support adherence practices among participants. The primary outcome among HIV-uninfected women will be adherence to PrEP at 3 months. Conclusions PrEP among at-risk pregnant women must be implemented so that high levels of adherence and retention are achievable for them and their partners. We will test our storytelling intervention to identify an optimal strategy for PrEP education and family engagement in a region with high HIV prevalence. Our results will have an impact by effectively engaging serodiscordant couples in prevention/treatment during pregnancy and beyond.
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Affiliation(s)
- Carolyn M Audet
- Vanderbilt University Medical Center, Vanderbilt Institute for Global Health, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA.,Vanderbilt University Medical Center, Department of Health Policy, 2525 West End Ave, Suite 1200, Nashville, TN, 37203, USA
| | - Erin Graves
- Vanderbilt University Medical Center, Vanderbilt Institute for Global Health, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA
| | - Almiro M Emílio
- Friends in Global Health, Avenida dos Trabalhadores, 424, Quelimane, Mozambique
| | - Ariano Matino
- Friends in Global Health, Avenida dos Trabalhadores, 424, Quelimane, Mozambique
| | - Paula Paulo
- Friends in Global Health, Avenida dos Trabalhadores, 424, Quelimane, Mozambique
| | - Arifo M Aboobacar
- Provincial Health Directorate, Ministry of Health, Province of Zambézia, Quelimane, Mozambique
| | - Carlota L Fonseca
- Friends in Global Health, Avenida da Maguiguana, 32 R/C, Maputo, Mozambique
| | - Sara Van Rompaey
- Friends in Global Health, Avenida da Maguiguana, 32 R/C, Maputo, Mozambique
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11
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Baldwin A, Light B, Allison WE. Pre-Exposure Prophylaxis (PrEP) for HIV Infection in Cisgender and Transgender Women in the U.S.: A Narrative Review of the Literature. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1713-1728. [PMID: 34075504 PMCID: PMC8213571 DOI: 10.1007/s10508-020-01903-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/18/2020] [Accepted: 12/09/2020] [Indexed: 05/11/2023]
Abstract
Using a socioecological approach, this review describes the peer-reviewed literature on oral pre-exposure prophylaxis (PrEP) among both cisgender (cis women) and transgender women (trans women) in the U.S. A search of the PubMed database and HIV-related conference abstracts generated over 2,200 articles and abstracts. Of these, 103 fulfilled review inclusion criteria. Most of the existing research presents findings on individual-level factors associated with PrEP use such as willingness and perceived barriers. There was far less investigation of factors related to PrEP at more distal ecological levels. Though trans women are at greater risk of HIV infection than cisgender women, less is known about this population group with respect to PrEP despite their inclusion in many major clinical trials. Further, the literature is characterized by a persistent conflation of sex and gender which makes it difficult to accurately assess the reviewed research on HIV prevention and PrEP apart from risk group. Informed by these findings, we highlight specific opportunities to improve access to PrEP and reduce socioecological barriers to PrEP care engagement for cisgender and transgender women.
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Affiliation(s)
- Aleta Baldwin
- Department of Public Health, California State University, Sacramento, Solano Hall 3014, 6000 J Street, Sacramento, CA, 95819, USA.
| | - Brenda Light
- School of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Waridibo E Allison
- Division of Infectious Disease, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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12
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Carneiro PB, Westmoreland DA, Patel VV, Grov C. Factors Associated with Being PrEP-Naïve Among a U.S. National Cohort of Former-PrEP and PrEP-Naïve Participants Meeting Objective Criteria for PrEP Care. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1793-1803. [PMID: 32794000 PMCID: PMC7881054 DOI: 10.1007/s10508-020-01791-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 06/11/2023]
Abstract
There is an urgent need to increase uptake and persistence in HIV pre-exposure prophylaxis (PrEP) in PrEP-eligible candidates. Little is known about the similarities and differences between groups of PrEP-naïve and former users, an important consideration for future interventions. We explored factors associated with being PrEP-naïve in a U.S. national cohort of naïve and former-PrEP users, all of whom met objective criteria for PrEP care at enrollment. Data were derived from the Together 5000 cohort study, an Internet-based U.S. national cohort of cisgender and trans men and trans women who have sex with men. Participants were recruited via ads on men-for-men geosocial networking apps. All participants were not on PrEP at the time of enrollment. We conducted bivariate analysis to explore differences between the two groups and used multivariable logistic regression to assess factors associated with being PrEP-naïve. Of the 6283 participants, 5383 (85.7%) were PrEP-naïve and 900 (14.3%) were former-PrEP users. There were significant differences between PrEP-naïve and former-PrEP users across multiple demographic variables, in addition to PrEP-related and psychosocial variables. Factors associated with being PrEP-naïve included younger age, sexual identity other than gay/queer, lower perception of candidacy for PrEP care, less willingness to take PrEP, lower access to PrEP care, and individual-level barriers such as health- and provider-related concerns. Programs and policies designed to address uptake and persistence of PrEP should be aware of these differences. Providing care in non-traditional LGBTQ-care settings, home-based PrEP interventions, and provision by healthcare providers other than physicians could improve uptake. Future research should investigate mechanisms that can improve uptake and persistence in communities in need of PrEP.
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Affiliation(s)
- Pedro B Carneiro
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, 55 W 125th St., 7th Floor Mailroom, New York, NY, 10027, USA
| | - Drew A Westmoreland
- CUNY Institute for Implementation Science in Population Health, New York, NY, USA
| | - Viraj V Patel
- Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Health System, New York, NY, USA
| | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, 55 W 125th St., 7th Floor Mailroom, New York, NY, 10027, USA.
- CUNY Institute for Implementation Science in Population Health, New York, NY, USA.
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13
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Wood SM, Morales KH, Metzger D, Davis A, Fiore D, Petsis D, Barnett K, Koenig HC, Dowshen N, Gross R, Frank I. Mental Health, Social Influences, and HIV Pre-exposure Prophylaxis (PrEP) Utilization Among Men and Transgender Individuals Screening for HIV Prevention Trials. AIDS Behav 2021; 25:524-531. [PMID: 32860114 PMCID: PMC8546869 DOI: 10.1007/s10461-020-03004-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The effects of mental health comorbidities and social support on the HIV pre-exposure prophylaxis (PrEP) care continuum are unknown. We conducted a cross-sectional study of men and transgender individuals, ≥ 18 years-old, with ≥ 2 male or transgender partners, or recent condomless anal intercourse. Surveys assessed demographics, mental health treatment, depressive symptomatology, social support, and PrEP-related social contacts. Logistic regression assessed associations between these factors and PrEP uptake and persistence. Participants (n = 247) were 89% cis-male and 46% African-American. Median age was 27 (IQR:23-33). Thirty-seven percent had ever used PrEP, of whom 18% discontinued use. High depressive symptomology was identified in 11% and 9% were receiving mental health treatment. There were no significant associations between depressive symptoms or mental health treatment on the odds of PrEP uptake or discontinuation. Each additional PrEP contact conferred a greater odds of uptake (aOR:1.24, 95% CI: 1.09-1.42). Network-level targets may produce fruitful interventions to increase PrEP uptake.
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Affiliation(s)
- Sarah M Wood
- The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
- Roberts Center for Pediatric Research, The Children's Hospital of Philadelphia, 11th Floor, Room 11212, 2716 South St., Philadelphia, PA, 19146, USA.
| | - Knashawn H Morales
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - David Metzger
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Annet Davis
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Danielle Fiore
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Danielle Petsis
- The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Kezia Barnett
- The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Helen C Koenig
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Nadia Dowshen
- The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Robert Gross
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ian Frank
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
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14
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Levintow SN, Pence BW, Powers KA, Sripaipan T, Ha TV, Chu VA, Quan VM, Latkin CA, Go VF. Estimating the Effect of Depression on HIV Transmission Risk Behaviors Among People Who Inject Drugs in Vietnam: A Causal Approach. AIDS Behav 2021; 25:438-446. [PMID: 32833193 PMCID: PMC7444452 DOI: 10.1007/s10461-020-03007-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The burden of depression and HIV is high among people who inject drugs (PWID), yet the effect of depression on transmission risk behaviors is not well understood in this population. Using causal inference methods, we analyzed data from 455 PWID living with HIV in Vietnam 2009-2013. Study visits every 6 months over 2 years measured depressive symptoms in the past week and injecting and sexual behaviors in the prior 3 months. Severe depressive symptoms (vs. mild/no symptoms) increased injection equipment sharing (risk difference [RD] = 3.9 percentage points, 95% CI -1.7, 9.6) but not condomless sex (RD = -1.8, 95% CI -6.4, 2.8) as reported 6 months later. The cross-sectional association with injection equipment sharing at the same visit (RD = 6.2, 95% CI 1.4, 11.0) was stronger than the longitudinal effect. Interventions on depression among PWID may decrease sharing of injection equipment and the corresponding risk of HIV transmission.Clinical trial registration ClinicalTrials.gov NCT01689545.
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15
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Miltz AR, Rodger AJ, Phillips AN, Sewell J, Edwards S, Allan S, Sherr L, Johnson AM, Burman WJ, Lampe FC. Opposing associations of depression with sexual behaviour: implications for epidemiological investigation among gay, bisexual and other men who have sex with men. Sex Transm Infect 2021; 97:613-618. [PMID: 33431606 PMCID: PMC8606445 DOI: 10.1136/sextrans-2020-054634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/18/2020] [Accepted: 12/06/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this report is to investigate the nature of the relationship between depression and condomless sex (CLS) among gay, bisexual and other men who have sex with men (GBMSM). METHODS Data are from the Antiretrovirals, Sexual Transmission Risk and Attitude (ASTRA) study of people living with HIV and attending one of eight HIV outpatient clinics in England (2011-2012) and the Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) study of HIV-negative/unknown status individuals attending one of 20 genitourinary medicine clinics in England (2013-2014). This analysis included GBMSM only. For each study, the prevalence of depressive symptoms (Patient Health Questionnaire-9 score ≥10) was presented according to three categories of sex in the past 3 months (considering anal/vaginal sex with men/women and anal sex with men in separate definitions): (1) no sex, (2) condom-protected sex only and (3) CLS. Multinomial logistic regression with 'condom-protected sex only' as the reference group was used to adjust for age and (for ASTRA participants) time since HIV diagnosis. RESULTS There were opposing associations of depression with recent sexual behaviour: the prevalence of depression was higher among those who reported no sex and those who reported CLS, compared with those who reported condom-protected sex only. Among the 2170 HIV-positive GBMSM in ASTRA, considering anal/vaginal sex with men/women, the prevalence of depressive symptoms was 32%, 20% and 28%, respectively, among men reporting no sex (n=783), condom-protected sex only (n=551) and CLS (n=836) (global p<0.001). Among the 1477 HIV-negative GBMSM in AURAH, the prevalence of depressive symptoms was 12%, 8% and 13%, respectively, for no sex (n=137), condom-protected sex only (n=487) and CLS (n=853) (global p=0.017). Patterns were similar after adjustment and when only considering anal sex between men. CONCLUSIONS Depression may be linked both to lack of sexual activity and to sexual risk taking. When investigating associations between depression and CLS, it is important to separate out individuals reporting condom-protected sex only from those reporting no sex.
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Affiliation(s)
- Ada R Miltz
- Institute for Global Health, University College London, London, UK
| | - Alison J Rodger
- Institute for Global Health, University College London, London, UK
| | | | - Janey Sewell
- Institute for Global Health, University College London, London, UK
| | - Simon Edwards
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Sris Allan
- City of Coventry NHS Healthcare Centre, Coventry, UK
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Anne M Johnson
- Institute for Global Health, University College London, London, UK
| | | | - Fiona C Lampe
- Institute for Global Health, University College London, London, UK
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16
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Johnson K. The Increased Risk for HIV and Other Sexually Transmitted Infections Among Substance-Using and Depressed Women in the Legal System. JOURNAL OF HEALTHCARE, SCIENCE AND THE HUMANITIES 2021; 11:225-250. [PMID: 36818208 PMCID: PMC9930520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
This study was conducted in Alabama's Black Belt Counties to examine the association between household food insecurity and self-reported health status. Data were collected from 400 households to measure household food insecurity and self-reported general health status using the U.S. Food Security Module. In bivariate analyses, household food insecurity was Policy changes to increase economic resources and access to federal food programs are needed to reduce household food insecurity in this region. Gendered experiences in the context of consequences of poverty should not be ignored.
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Affiliation(s)
- Karen Johnson
- University of Alabama, Little Hall, 670 Judy Bonner Drive, Tuscaloosa, AL 35401, ph: (718) 709-1907, fax: 205-348-9419,
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A non-specialist depression care pathway for adolescents living with HIV and transitioning into adult care in Peru: a nested, proof of concept pilot study. Glob Ment Health (Camb) 2021; 8:e17. [PMID: 34104457 PMCID: PMC8157815 DOI: 10.1017/gmh.2021.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 04/05/2021] [Accepted: 04/22/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Adolescents living with HIV (ALWH) are disproportionally impacted by depression, experiencing worse HIV outcomes. Integrated depression and HIV care may support antiretroviral adherence. This study pilot tested for proof of concept a basic depression care pathway for ALWH to inform depression care integration with HIV services in Peru. METHODS ALWH were screened for depression with the Patient Health Questionnaire-9 (PHQ-9). Participants with PHQ-9 scores of ⩾10 or suicidal ideation (SI) were eligible for Psychological First Aid (PFA) delivered by non-mental health specialists. Participants with PHQ-9 re-assessments of ⩾20 or SI were referred to specialized services. RESULTS Twenty-eight (11 female, 17 male) ALWH aged 15-21 years participated; n = 20 (71%) identified as heterosexual. Most (18/28) acquired HIV at birth. Baseline PHQ-9 scores were 0-4, n = 3 (11%); 5-9, n = 9 (32%); 10-14, n = 10 (36%); 15-19, n = 4 (14%); and 20-27, n = 2 (7%). Eleven participants (40%) reported SI. Among participants with PHQ-9 > 4, 92% (23/25) were not severe. Of the 21 (75%) of participants eligible for PFA, n = 9 (32%) accepted at least one session, of which n = 3 (33%) were linked to specialized care. CONCLUSIONS A simple care pathway operationalizing depression screening and non-specialist delivered emotional support is a first step toward integrated depression and HIV care for ALWH.
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18
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Tang W, Wang Y, Huang W, Wu D, Yang F, Xu Y, Ong JJ, Fu H, Yang B, Wang C, Ma W, Wei C, Tucker JD. Adolescent and non-consensual anal sexual debut among Chinese men who have sex with men: a cross-sectional study. BMC Infect Dis 2020; 20:732. [PMID: 33028241 PMCID: PMC7541224 DOI: 10.1186/s12879-020-05466-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/01/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Adolescent sexual debut and non-consensual sex have been linked to higher sexual risk and STI infection in adulthood among men who have sex with men (MSM) in high-income countries. This study aimed to examine adolescent and non-consensual anal sexual debut among Chinese MSM and to evaluate factors associated with adolescent sexual debut and non-consensual anal sex. METHODS A cross-sectional study was conducted recently among Chinese men assigned male sex at birth, ≥18 years old, and who had ever engaged in anal sex with a man. Participants answered questions regarding socio-demographics, condomless sex, age at anal sexual debut with a man, and whether the first anal sex was consensual. Factors associated with an adolescent sexual debut (< 18 years old) and non-consensual sex at sexual debut were evaluated. We defined adolescent sexual debut as having anal sex with another man at 17 years old or younger, and the participants were asked whether their first male-to-male anal sex was non-consensual. RESULTS Overall, 2031 eligible men completed the survey. The mean age of sexual debut was 20.7 (SD = 4.3) years old. 17.6% (358/2031) of men reported adolescent sexual debut, and 5.0% (101/2031) reported a non-consensual sexual debut. The adolescent sexual debut was associated with having more male sexual partners (adjusted OR 1.10, 95% CI 1.06-1.15) and condomless anal sex in the last three months (AOR = 1.71, 95% CI 1.34-2.18). MSM whose sexual debut was non-consensual were more likely to have condomless anal sex (AOR = 1.76, 95% CI 1.17-2.66), and to have reported an adolescent sexual debut (AOR = 2.72, 95% CI 1.75-4.21). CONCLUSIONS Many Chinese MSM reported adolescent sexual debut and non-consensual sex, both of which are associated with sexual risk behaviors and drive STI transmission. These findings highlight the need for designing tailored interventions for MSM who experienced adolescent sexual debut and non-consensual sex at debut.
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Affiliation(s)
- Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, 510095, China.
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China.
| | - Yehua Wang
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
| | - Wenting Huang
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
| | - Dan Wu
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
| | - Fan Yang
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
| | - Yongshi Xu
- Dermatology Hospital of Southern Medical University, Guangzhou, 510095, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Central Clinical School, Monash University, Melbourne, Australia
| | - Hongyun Fu
- Division of Community Health and Research, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, 510095, China
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Cheng Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, 510095, China
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Wei Ma
- School of Public Health, Shandong University, Jinan, China
| | | | - Joseph D Tucker
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Miltz AR, Rodger AJ, Lepri AC, Sewell J, Nwokolo NC, Allan S, Scott C, Ivens D, Lascar M, Speakman A, Phillips AN, Sherr L, Collins S, Elford J, Lampe FC. Investigating Conceptual Models for the Relationship Between Depression and Condomless Sex Among Gay, Bisexual, and Other Men Who have Sex with Men: Using Structural Equation Modelling to Assess Mediation. AIDS Behav 2020; 24:1793-1806. [PMID: 31782068 PMCID: PMC7220884 DOI: 10.1007/s10461-019-02724-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study is to investigate five hypothesized mechanisms of causation between depression and condomless sex with ≥ 2 partners (CLS2+) among gay, bisexual, and other men who have sex with men (GBMSM), involving alternative roles of self-efficacy for sexual safety and recreational drug use. Data were from the AURAH cross-sectional study of 1340 GBMSM attending genitourinary medicine clinics in England (2013–2014). Structural equation modelling (SEM) was used to investigate which conceptual model was more consistent with the data. Twelve percent of men reported depression (PHQ-9 ≥ 10) and 32% reported CLS2+ in the past 3 months. AURAH data were more consistent with the model in which depression was considered to lead to CLS2+ indirectly via low self-efficacy for sexual safety (indirect Beta = 0.158; p < 0.001) as well as indirectly via higher levels of recreational drug use (indirect Beta = 0.158; p < 0.001). SEM assists in understanding the relationship between depression and CLS among GBMSM.
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Affiliation(s)
- A R Miltz
- Institute for Global Health, University College London, London, UK.
| | - A J Rodger
- Institute for Global Health, University College London, London, UK
| | - A Cozzi Lepri
- Institute for Global Health, University College London, London, UK
| | - J Sewell
- Institute for Global Health, University College London, London, UK
| | | | - S Allan
- City of Coventry Healthcare Centre, Coventry, UK
| | - C Scott
- West London Centre for Sexual Health, London, UK
| | - D Ivens
- Royal Free Hospital, London, UK
| | - M Lascar
- Whipps Cross Hospital, London, UK
| | - A Speakman
- Institute for Global Health, University College London, London, UK
| | - A N Phillips
- Institute for Global Health, University College London, London, UK
| | - L Sherr
- Institute for Global Health, University College London, London, UK
| | | | - J Elford
- City, University of London, London, UK
| | - F C Lampe
- Institute for Global Health, University College London, London, UK
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Using Motivational Interviewing to Increase PrEP Uptake Among Black Women at Risk for HIV: an Open Pilot Trial of MI-PrEP. J Racial Ethn Health Disparities 2020; 7:913-927. [PMID: 32078743 DOI: 10.1007/s40615-020-00715-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 12/16/2022]
Abstract
Black women in the USA are at the highest risk among women for HIV. Pre-exposure prophylaxis (PrEP) prevents HIV transmission, but uptake among Black women remains low. An open pilot trial was conducted on MI-PrEP, a brief culturally tailored intervention incorporating motivational interviewing (MI) strategies to improve PrEP uptake and motivation. MI-PrEP is the first behavioral intervention developed to promote PrEP uptake among women in the USA. In Miami, FL, ten Black women who met eligibility criteria (e.g., sexual partner with HIV) were enrolled. These women participated in the two sessions of MI-PrEP and a 1-month follow-up. Participants completed measures on PrEP (motivation, uptake [verified via medical records], adherence, and barriers), medical mistrust, and an exit interview. These preliminary findings showed acceptability and feasibility with high satisfaction ratings; increases in PrEP uptake, knowledge, and motivation to use; and decreases in PrEP barriers and medical mistrust. Greater attention is needed on the psychosocial and structural factors among Black women who may benefit from PrEP.
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Miltz A, Lampe F, McCormack S, Dunn D, White E, Rodger A, Phillips A, Sherr L, Sullivan AK, Reeves I, Clarke A, Gafos M. Prevalence and correlates of depressive symptoms among gay, bisexual and other men who have sex with men in the PROUD randomised clinical trial of HIV pre-exposure prophylaxis. BMJ Open 2019; 9:e031085. [PMID: 31826890 PMCID: PMC6924847 DOI: 10.1136/bmjopen-2019-031085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES The aim of this analysis is to: (i) assess the prevalence of clinically significant depressive symptoms at baseline and follow-up for participants in the PROUD trial of HIV pre-exposure prophylaxis (PrEP), examining changes in prevalence over time and (ii) investigate the association of socioeconomic and psychosocial factors with depression. METHODS PROUD was an open label randomised trial evaluating the benefit of PrEP for 544 HIV-negative gay, bisexual and other men who have sex with men (GBMSM) in England. Enrolment was between 2012 and 2014, with at least 2 years follow-up. Prevalence of depression (score ≥10 on Patient Health Questionnaire-9) was assessed and compared across time-points (using McNemar's χ2 tests) and between trial arms (using χ2 tests). Cross-sectional associations with socioeconomic and psychosocial factors were examined using baseline data in modified Poisson regression models and combined 12 and 24 month follow-up data in generalised estimating equations (GEEs). Prevalence ratios (PRs) were presented as unadjusted PR and adjusted PR (aPR) for age, UK birth, sexual identity, university education, London study clinic site and calendar time (and follow-up time-point in GEEs). RESULTS Depression increased significantly from baseline (9.1%; 49/540) to the 12 month (14.4%; 59/410) and 24 month (14.4%; 48/333) follow-ups, possibly explained by underreporting at baseline. The prevalence of depression did not differ by study trial arm, at any time-point. In the baseline analysis, younger age, unemployment and crystal methamphetamine use, was associated with depression. In combined analysis of 12 and 24 month data, measures of intimate partner violence (IPV) (lifetime IPV victimisation aPR 2.57 (95% CI: 1.71 to 3.86)), internalised homophobia (aPR 1.91 (95% CI: 1.29 to 2.83)) and concealment of sexual identity (aPR 1.75 (95% CI: 1.16 to 2.65)), were strongly associated with depression. CONCLUSIONS There is a high concomitant burden of psychosocial factors with depression among GBMSM. TRIAL REGISTRATION NUMBER ISRCTN (ISRCTN94465371) and ClinicalTrials.gov (NCT02065986).
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Affiliation(s)
- Ada Miltz
- Institute for Global Health, University College London, London, UK
| | - Fiona Lampe
- Institute for Global Health, University College London, London, UK
| | | | - David Dunn
- MRC CTU, University College London, London, UK
| | - Ellen White
- MRC CTU, University College London, London, UK
| | - Alison Rodger
- Institute for Global Health, University College London, London, UK
| | - Andrew Phillips
- Institute for Global Health, University College London, London, UK
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Ann K Sullivan
- Chelsea and Westminster Healthcare NHS Trust, London, UK
| | - Iain Reeves
- Homerton University Hospital NHS Trust, London, UK
| | - Amanda Clarke
- Brighton & Sussex University Hospital NHS Trust, Brighton & Sussex Medical School, Brighton, UK
| | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Abstract
BACKGROUND Low adherence can undermine the efficacy of daily oral pre-exposure prophylaxis (PrEP). Mental health conditions, particularly depression, could be associated with low PrEP adherence, especially for women. SETTING We analyzed data from 1013 Kenyan and Ugandan HIV-uninfected participants in the Partners Demonstration Project, an open-label study of PrEP delivered to HIV-uninfected members of serodiscordant couples. METHODS Participants completed quarterly visits over 2 years and were encouraged to use PrEP until their partners living with HIV had ≥6 months of antiretroviral therapy use (when viral suppression was expected). PrEP adherence was measured daily with electronic medication event monitoring system caps and dichotomized into low (<80% of expected bottle openings) and high adherence. Depression was assessed annually using the 16-item Hopkins Symptom Checklist screening tool; scores >1.75 indicate "probable depression." The association between probable depression and PrEP adherence was assessed separately for men and women using generalized estimating equations and marginal structural models. RESULTS At enrollment, 39 (11.7% of 334) women and 64 (9.4% of 679) men reported symptoms indicating probable depression, and these proportions decreased during follow-up (P < 0.001 for women and men). Probable depression was significantly associated with low PrEP adherence among women (adjusted risk ratio = 1.77; 95% confidence interval: 1.14 to 2.77; P = 0.01); there was no association between depression and adherence among men (P = 0.50). Marginal structural models and sensitivity analyses confirmed these findings. CONCLUSIONS Depression was relatively uncommon in this population and was an independent risk factor for low PrEP adherence among women. For PrEP programs targeting African women, integration of depression screening may improve PrEP effectiveness.
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Dopaminergic impact of cART and anti-depressants on HIV neuropathogenesis in older adults. Brain Res 2019; 1723:146398. [PMID: 31442412 DOI: 10.1016/j.brainres.2019.146398] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/09/2019] [Accepted: 08/19/2019] [Indexed: 01/21/2023]
Abstract
The success of combination antiretroviral therapy (cART) has transformed HIV infection into a chronic condition, resulting in an increase in the number of older, cART-treated adults living with HIV. This has increased the incidence of age-related, non-AIDS comorbidities in this population. One of the most common comorbidities is depression, which is also associated with cognitive impairment and a number of neuropathologies. In older people living with HIV, treating these overlapping disorders is complex, often creating pill burden or adverse drug-drug interactions that can exacerbate these neurologic disorders. Depression, NeuroHIV and many of the neuropsychiatric therapeutics used to treat them impact the dopaminergic system, suggesting that dopaminergic dysfunction may be a common factor in the development of these disorders. Further, changes in dopamine can influence the development of inflammation and the regulation of immune function, which are also implicated in the progression of NeuroHIV and depression. Little is known about the optimal clinical management of drug-drug interactions between cART drugs and antidepressants, particularly in regard to dopamine in older people living with HIV. This review will discuss those interactions, first examining the etiology of NeuroHIV and depression in older adults, then discussing the interrelated effects of dopamine and inflammation on these disorders, and finally reviewing the activity and interactions of cART drugs and antidepressants on each of these factors. Developing better strategies to manage these comorbidities is critical to the health of the aging, HIV-infected population, as the older population may be particularly vulnerable to drug-drug interactions affecting dopamine.
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Abstract
Tremendous biomedical advancements in HIV prevention and treatment have led to aspirational efforts to end the HIV epidemic. However, this goal will not be achieved without addressing the significant mental health and substance use problems among people living with HIV (PLWH) and people vulnerable to acquiring HIV. These problems exacerbate the many social and economic barriers to accessing adequate and sustained healthcare, and are among the most challenging barriers to achieving the end of the HIV epidemic. Rates of mental health problems are higher among both people vulnerable to acquiring HIV and PLWH, compared with the general population. Mental health impairments increase risk for HIV acquisition and for negative health outcomes among PLWH at each step in the HIV care continuum. We have the necessary screening tools and efficacious treatments to treat mental health problems among people living with and at risk for HIV. However, we need to prioritize mental health treatment with appropriate resources to address the current mental health screening and treatment gaps. Integration of mental health screening and care into all HIV testing and treatment settings would not only strengthen HIV prevention and care outcomes, but it would additionally improve global access to mental healthcare.
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Gafos M, Horne R, Nutland W, Bell G, Rae C, Wayal S, Rayment M, Clarke A, Schembri G, Gilson R, McOwan A, Sullivan A, Fox J, Apea V, Dewsnap C, Dolling D, White E, Brodnicki E, Wood G, Dunn D, McCormack S. The Context of Sexual Risk Behaviour Among Men Who Have Sex with Men Seeking PrEP, and the Impact of PrEP on Sexual Behaviour. AIDS Behav 2019; 23:1708-1720. [PMID: 30306439 PMCID: PMC6570678 DOI: 10.1007/s10461-018-2300-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
There are still important gaps in our understanding of how people will incorporate PrEP into their existing HIV prevention strategies. In this paper, we explore how PrEP use impacted existing sexual risk behaviours and risk reduction strategies using qualitative data from the PROUD study. From February 2014 to January 2016, we conducted 41 in-depth interviews with gay, bisexual and other men who have sex with men (GBMSM) enrolled in the PROUD PrEP study at sexual health clinics in England. The interviews were conducted in English and were audio-recorded. The recordings were transcribed, coded and analysed using framework analysis. In the interviews, we explored participants' sexual behaviour before joining the study and among those using or who had used PrEP, changes to sexual behaviour after starting PrEP. Participants described the risk behaviour and management strategies before using PrEP, which included irregular condom use, sero-sorting, and strategic positioning. Participants described their sexual risk taking before initiating PrEP in the context of the sexualised use of drugs, geographical spaces linked with higher risk sexual norms, and digitised sexual networking, as well as problematic psychological factors that exacerbated risk taking. The findings highlight that in the main, individuals who were already having frequent condomless sex, added PrEP to the existing range of risk management strategies, influencing the boundaries of the 'rules' for some but not all. While approximately half the participants reduced other risk reduction strategies after starting PrEP, the other half did not alter their behaviours. PrEP provided an additional HIV prevention option to a cohort of GBMSM at high risk of HIV due to inconsistent use of other prevention options. In summary, PrEP provides a critical and necessary additional HIV prevention option that individuals can add to existing strategies in order to enhance protection, at least from HIV. As a daily pill, PrEP offers protection in the context of the sex cultures associated with sexualised drug use, digitised sexual applications and shifting social norms around sexual fulfilment and risk taking. PrEP can offer short or longer-term options for individuals as their sexual desires change over their life course offering protection from HIV during periods of heightened risk. PrEP should not be perceived or positioned in opposition to the existing HIV prevention toolkit, but rather as additive and as a tool that can and is having a substantial impact on HIV.
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Affiliation(s)
- Mitzy Gafos
- London School of Hygiene and Tropical Medicine, London, UK.
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
| | - Rob Horne
- School of Pharmacy, University College London, London, UK
| | | | - Gill Bell
- Sheffield Health, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Caroline Rae
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sonali Wayal
- Centre for Population Research in Sexual Health and HIV, Mortimer Market Centre, Institute for Global Health, UCL, London, UK
| | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Amanda Clarke
- Claude Nicol Centre, Royal Sussex County Hospital, Brighton, UK
| | - Gabriel Schembri
- Manchester Centre for Sexual Health, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Richard Gilson
- The Mortimer Market Centre, Institute for Global Health, University College London, London, UK
| | - Alan McOwan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Ann Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Julie Fox
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vanessa Apea
- Ambrose King Centre, Barts Health NHS Trust, London, UK
| | - Claire Dewsnap
- Sheffield Health, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - David Dolling
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Ellen White
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Elizabeth Brodnicki
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Gemma Wood
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - David Dunn
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Hojilla JC, Vlahov D, Glidden DV, Amico KR, Mehrotra M, Hance R, Grant RM, Carrico AW. Skating on thin ice: stimulant use and sub-optimal adherence to HIV pre-exposure prophylaxis. J Int AIDS Soc 2019; 21:e25103. [PMID: 29577616 PMCID: PMC5867332 DOI: 10.1002/jia2.25103] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/08/2018] [Indexed: 12/04/2022] Open
Abstract
Introduction Stimulant and heavy alcohol use are prevalent and associated with elevated risk for HIV seroconversion among men who have sex with men (MSM) and transgender women. In addition, each can pose difficulties for antiretroviral adherence among people living with HIV. Scant research has examined the associations of stimulant and heavy alcohol use with adherence to daily oral pre‐exposure prophylaxis (PrEP) among MSM and transgender women. To address this gap in the literature, we evaluated the hypothesis that stimulant use and binge drinking are prospectively associated with sub‐optimal PrEP adherence. Methods We analysed data from participants in a nested case‐cohort in the iPrEx open label extension. Stimulant use (i.e. powder cocaine, crack‐cocaine, cocaine paste, methamphetamine, cathinone) and binge drinking (i.e. ≥5 drinks in a single day) in the last 30 days were assessed. Baseline urine was tested for stimulants using immunoassays to reduce misclassification. Sub‐optimal adherence was defined as tenofovir drug concentrations in dried blood spots less than 700 fmol per punch, indicative of less than four doses per week. We tested the prospective association of stimulant use and binge drinking with sub‐optimal adherence at the 4‐week follow‐up visit. Results and Discussion Data from 330 participants were analysed. The majority of the participants were MSM (89%) with a median age at baseline of 29 years (interquartile range 24 to 39). Approximately 16% (52/330) used stimulants and 22% (72/330) reported binge drinking in the last 30 days. Stimulant users had fivefold greater odds of sub‐optimal PrEP adherence compared to non‐users in adjusted analysis (adjusted odds ratio [aOR] 5.04; [95% CI 1.35 to 18.78]). Self‐reported binge drinking was not significantly associated with sub‐optimal adherence after adjusting for stimulant use and baseline confounders (aOR 1.16 [0.49 to 2.73]). Depressive symptoms, being transgender, and number of sex partners were also not significantly associated with sub‐optimal PrEP adherence (p > 0.05). Conclusions Stimulant use is a risk factor for sub‐optimal PrEP adherence in the month following PrEP initiation. Comprehensive prevention approaches that reduce stimulant use may optimize PrEP adherence. Creating adherence plans that specifically address PrEP dosing in the context of ongoing stimulant use should also be considered.
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Affiliation(s)
| | | | | | | | - Megha Mehrotra
- University of CaliforniaSan FranciscoSan FranciscoCAUSA
- J. David Gladstone InstitutesSan FranciscoCAUSA
| | | | - Robert M Grant
- University of CaliforniaSan FranciscoSan FranciscoCAUSA
- J. David Gladstone InstitutesSan FranciscoCAUSA
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Reisner SL, Perez-Brumer A, Oldenburg CE, Gamarel KE, Malone J, Leung K, Mimiaga MJ, Rosenberger JG, Biello KB. Characterizing HIV risk among cisgender men in Latin America who report transgender women as sexual partners: HIV risk in Latin America men. Int J STD AIDS 2019; 30:378-385. [PMID: 30537903 PMCID: PMC9897015 DOI: 10.1177/0956462418802687] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cisgender men (CM) who report transgender women (TW) as sexual partners are an understudied population in the HIV epidemic in Latin America. The current study sought to characterize this group in a 2012 cross-sectional online survey of Latin American CM who were members of a sexual networking website for men who have sex with men (N = 11,847). Multivariable logistic regression models were fit to estimate demographic, behavioral, and psychosocial correlates of having a TW sexual partner and engaging in condomless sex. Overall, 0.9% (n = 106) reported a TW sexual partner in the last 12 months; of these, 76.4% (n = 81) reported condomless sex in the last three months. Identifying as bisexual or heterosexual compared to gay, and specifying a versatile sexual role preference compared to insertive were associated with reporting a recent TW sex partner (all p < 0.05). HIV-negative serostatus, lifetime STI history, and alcohol dependence were associated with recent condomless sex (all p < 0.05). CM with TW sexual partners have distinct HIV-related vulnerabilities. Future research is needed to understand CM who report TW sexual partners, including their sexual preferences and practices, sexual networks, exposure to stigma, biomedical prevention interest and uptake, and acceptability of integrating alcohol abuse screening into sexual health services.
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Affiliation(s)
- Sari L Reisner
- Division of General Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore MD
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | | | - Kristi E Gamarel
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jowanna Malone
- Johns Hopkins Bloomberg School of Public Health, Baltimore MD
| | - Kingsley Leung
- Johns Hopkins Bloomberg School of Public Health, Baltimore MD
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Katie B. Biello
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
- Center for Health Equity Research, Brown University, Providence, RI
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Associations between perceived barriers and benefits of using HIV pre-exposure prophylaxis and medication adherence among men who have sex with men in Western China. BMC Infect Dis 2018; 18:575. [PMID: 30442106 PMCID: PMC6238290 DOI: 10.1186/s12879-018-3497-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 11/01/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To investigate the associations between the perceived barriers and benefits of using HIV pre-exposure prophylaxis medication, including worries about the side effects, disliking taking drugs, perceived burden of taking medication, positive expectations as to the efficacy of the drugs, favourable doctor-patient relationships, and medication adherence among men who have sex with men (MSM) to provide a target for improving medication adherence and reducing HIV infection among MSM. METHODS MSM were recruited in western China from April 2013 to October 2014, administered oral tenofovir (TDF) daily and followed up every 12 weeks for 2 years. At each follow-up, the medication rate was calculated based on the self-reported number of missed doses over 2 weeks, and then, the medication adherence was evaluated. The barriers and benefits perceived during medication were obtained by a self-administered questionnaire, and their effects on medication adherence were analysed by linear mixed models. RESULTS A total of 411 participants were enrolled in this study, and 1561 follow-up observation points were obtained. The average medication rate was 0.62 ± 0.37, and the medication rate increased with longer follow-up (P < 0.05). The medication rate was higher among MSM who were divorced (compared to those who were unmarried, P < 0.0001). MSM with more positive expectations as to the efficacy of the drugs showed higher rates of medication (P < 0.0001), while those who were more worried about side effects had a lower medication rate (P = 0.0208). In contrast, the dislike of taking the drugs and the burden perceived during medication had no effects on the actual medication rate of taking TDF (P > 0.05). CONCLUSION How to obtain and maintain high medication adherence among MSM is the key to the PrEP intervention strategy for effective reduction of HIV infection. For MSM in China, we should deepen their understanding of the effectiveness and safety of PrEP and increase their confidence in PrEP, thereby improving their medication adherence. TRIAL REGISTRATION ChiCTR-TRC-13003849 . Registered on 24/06/2013.
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Reed JB, Patel RR, Baggaley R. Lessons from a decade of voluntary medical male circumcision implementation and their application to HIV pre-exposure prophylaxis scale up. Int J STD AIDS 2018; 29:1432-1443. [PMID: 30114997 PMCID: PMC6287252 DOI: 10.1177/0956462418787896] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Oral pre-exposure prophylaxis (PrEP) has the ability to curb HIV incidence worldwide and bring us closer to ending the HIV epidemic. Scale up of PrEP service delivery has many similar challenges to those faced by voluntary medical male circumcision (VMMC) services roll-out. This article outlines ten important lessons learned during the scale up of VMMC services in sub-Saharan Africa and their application to current oral PrEP implementation efforts to promote faster expansion for public health impact.
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Affiliation(s)
- Jason B Reed
- HIV-Malaria-Infectious Diseases, Jhpiego, Baltimore, MD, USA
| | - Rupa R Patel
- Division of Infectious Diseases, Washington University in St. Louis, St Louis, MO, USA
| | - Rachel Baggaley
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
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30
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De Boni RB, Machado IK, De Vasconcellos MTL, Hoagland B, Kallas EG, Madruga JV, Fernandes NM, Cerqueira NB, Moreira RI, Goulart SP, Veloso VG, Grinsztejn B, Luz PM. Syndemics among individuals enrolled in the PrEP Brasil Study. Drug Alcohol Depend 2018; 185:168-172. [PMID: 29454927 DOI: 10.1016/j.drugalcdep.2017.12.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/30/2017] [Accepted: 12/02/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Concurrent psychosocial problems may synergistically increase the risk of HIV infection (syndemics), representing a challenge for prevention. We aimed to evaluate the prevalence and associated factors of syndemics among men who have sex with men (MSM) and transgender women (TGW) enrolled in the Brazilian pre-exposure prophylaxis demonstration study (PrEP Brasil Study). METHODS Secondary cross-sectional analysis of the PrEP Brasil Study was performed. Of 450 HIV-seronegative MSM/TGW enrolled in the PrEP Brasil Study- conducted at Rio de Janeiro and São Paulo, Brazil- 421 participants with complete data were included in the present analysis. Syndemics was defined as occurrence of ≥2 of the following conditions: polysubstance (≥2) use, binge drinking, positive depression screen, compulsive sexual behavior, and intimate partner violence (IPV). RESULTS The prevalence of recent polysubstance use was 22.8%, binge drinking 51.1%, positive depression screening 5.2%, compulsive sexual behavior 7.1%, and IPV 7.3%. Syndemics prevalence was 24.2%, and associated factors were younger age (adjusted Odds Ratio (aOR) 0.95, 95% Confidence Interval (95% CI) 0.92-0.98 per year increase), TGW vs. MSM (aOR 3.09, 95% CI: 1.2-8.0), some college education or more vs. less than college (aOR 2.49, 95% CI: 1.31-4.75), and multiple male sexual partners in prior 3 months (aOR 1.69, 95% CI: 0.92-3.14). CONCLUSION Given the high prevalence of syndemics, particularly of polysubstance use and binge drinking, PrEP delivery offers an opportunity to diagnose and intervene in mental and social well-being.
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Affiliation(s)
- Raquel B De Boni
- National Institute of Infectology Evandro Chagas, Lapclin STD/AIDS, Avenida Brasil 4.365, Fiocruz, Rio de Janeiro, Brazil
| | - Iona K Machado
- Columbia College of Physicians and Surgeons, 630 W. 168 St., New York City, NY, USA
| | | | - Brenda Hoagland
- National Institute of Infectology Evandro Chagas, Lapclin STD/AIDS, Avenida Brasil 4.365, Fiocruz, Rio de Janeiro, Brazil
| | - Esper G Kallas
- Division of Clinical Immunology and Allergy, University of São Paulo, São Paulo, Brazil
| | - José Valdez Madruga
- Centro de Referencia e Treinamento DST/AIDS, 81 Vila Mariana, São Paulo, Brazil
| | - Nilo M Fernandes
- National Institute of Infectology Evandro Chagas, Lapclin STD/AIDS, Avenida Brasil 4.365, Fiocruz, Rio de Janeiro, Brazil
| | - Natalia B Cerqueira
- Division of Clinical Immunology and Allergy, University of São Paulo, São Paulo, Brazil
| | - Ronaldo I Moreira
- National Institute of Infectology Evandro Chagas, Lapclin STD/AIDS, Avenida Brasil 4.365, Fiocruz, Rio de Janeiro, Brazil
| | - Silvia P Goulart
- Division of Clinical Immunology and Allergy, University of São Paulo, São Paulo, Brazil
| | - Valdilea G Veloso
- National Institute of Infectology Evandro Chagas, Lapclin STD/AIDS, Avenida Brasil 4.365, Fiocruz, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- National Institute of Infectology Evandro Chagas, Lapclin STD/AIDS, Avenida Brasil 4.365, Fiocruz, Rio de Janeiro, Brazil
| | - Paula M Luz
- National Institute of Infectology Evandro Chagas, Lapclin STD/AIDS, Avenida Brasil 4.365, Fiocruz, Rio de Janeiro, Brazil.
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Abstract
: Pre-exposure prophylaxis (PrEP) is a potent and underutilized HIV prevention tool. In this paper we review the state of knowledge regarding PrEP implementation for men who have sex with men and transgender persons in early adopting countries. We focus on implementation of PrEP in demonstration projects and clinical care, and describe the status of PrEP availability and uptake. We report on approaches to identifying appropriate PrEP candidates in real-world settings and on best practices for clinical monitoring. This includes the exclusion of undiagnosed HIV infection prior to PrEP initiation and longitudinal measurement of renal function, in light of safety data. Since adherence is the primary factor moderating the effectiveness of PrEP, we discuss effective adherence support interventions. Additionally, we review the evidence for risk compensation with PrEP use and opportunities to provide PrEP as part of comprehensive and inclusive preventive health programs. We summarize cost-effectiveness studies, including their variable conclusions because of differing underlying assumptions, and discuss the importance of budgetary impact for public health programs and health care insurers. Further, we emphasize a need for greater engagement of health care providers in PrEP to increase access. We conclude with recommendations for ways to improve future efforts at implementing PrEP.
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32
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Ethical Issues to Consider in the Design of HIV Prevention Trials Involving Transgender People. J Acquir Immune Defic Syndr 2017; 72 Suppl 3:S252-5. [PMID: 27429192 PMCID: PMC4969064 DOI: 10.1097/qai.0000000000001089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although transgender women have been included in HIV prevention pre-exposure prophylaxis studies, no pre-exposure prophylaxis study has focused exclusively on transgender persons. Drawing on the cardinal principles of ethics espoused in the Belmont Report, this work highlights, among other issues, that (1) the principle of Justice requires the HIV prevention field to focus exclusively on transgender persons, (2) the disclosure of potential study-related risks to study participants demonstrates Respect for Persons, and (3) devising risk mitigation plans, optimizing a proposed study's standard of care, and the provision of ancillary care satisfy the principle of Beneficence.
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33
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Kalichman SC, Eaton L. Alcohol-antiretroviral interactive toxicity beliefs as a potential barrier to HIV pre-exposure prophylaxis among men who have sex with men. J Int AIDS Soc 2017; 20:21534. [PMID: 28715159 PMCID: PMC5577742 DOI: 10.7448/ias.20.1.21534] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 07/03/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) offers as much as 90% protection against HIV transmission. However, the effectiveness of PrEP depends on uptake and adherence to even intermittent dosing. Along with intoxication leading to unintentional non-adherence, believing that alcohol mixed with pharmaceuticals is harmful (i.e., interactive toxicity beliefs) may lead to poor uptake and intentional non-adherence. METHODS HIV-negative sexually active men who have sex with men (N = 272) at a large Gay Pride event in Atlanta, GA, completed anonymous surveys of demographic characteristics, sexual behaviour, alcohol use and PrEP-related alcohol interactive toxicity beliefs. RESULTS A total of 118 (43%) men surveyed had two or more male sex partners and condomless anal sex in the previous six months. Alcohol use was reported by over 90% of men and it was common for participants to believe that mixing alcohol and antiretrovirals is toxic; 75% endorsed at least one interactive toxicity belief. Among the 118 men who had engaged in condomless anal sex and had multiple sex partners, one in three stated that they were not interested in PrEP and men not interested in PrEP were significantly more likely to binge drink and hold interactive toxicity beliefs. CONCLUSIONS These results mirror studies that find interactive toxicity beliefs are a potent predictor of intentional antiretroviral non-adherence among people living with HIV and suggest interactive toxicity beliefs may impede PrEP uptake and adherence. Messages to increase PrEP awareness and adherence may also take steps to counter erroneous beliefs about mixing alcohol with antiretrovirals in the context of PrEP.
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Affiliation(s)
- Seth C Kalichman
- Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA
| | - Lisa Eaton
- Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA
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34
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Johnston LG, Mon MM, Steinhaus M, Sass J. Correlates of Forced Sex Among Young Men Who Have Sex With Men in Yangon and Monywa, Myanmar. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1001-1010. [PMID: 27278964 DOI: 10.1007/s10508-016-0761-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 04/09/2016] [Accepted: 04/16/2016] [Indexed: 06/06/2023]
Abstract
Forced sex at an early age is associated with a variety of negative factors including increased illness, high-risk sexual and substance-use behaviors, and mental and psychological stress. These sequelae may be compounded for men who have sex with men (MSM), especially young MSM and those with feminine gender identity and expression. This survey examined the prevalence and associations of forced sex among young MSM in two cities in Myanmar. In 2013-2014, surveys using respondent-driven sampling collected data on 200 young MSM in Yangon and 200 in Monywa. One quarter of young MSM in Yangon and 21 % in Monywa reported ever experiencing forced sex. In a multivariable model, having problems with family members and having any MSM friends with many partners had higher odds of experiencing forced sex. Having maternal acceptance of same-sex attraction (compared to acceptance by both parents) and becoming aware of their same-sex attraction at or above the age of 16 had lower odds of experiencing forced sex. Focused research is needed to understand the family and other social dynamics affecting vulnerability to forced sex, as well as specific sexual risks associated with forced sex among young MSM, including HIV acquisition and transmission risks.
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Affiliation(s)
- Lisa G Johnston
- UNESCO Asia-Pacific Regional Bureau for Education, Bangkok, Thailand.
- , 18 Camino de Vecinos, Santa Fe, NM, 87507, USA.
| | - Myo Myo Mon
- Epidemiology Research Division, Department of Medical Research, Yangon, Myanmar
| | - Mara Steinhaus
- UNESCO Asia-Pacific Regional Bureau for Education, Bangkok, Thailand
| | - Justine Sass
- UNESCO Asia-Pacific Regional Bureau for Education, Bangkok, Thailand
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35
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Mehrotra ML, Glidden DV, McMahan V, Amico KR, Hosek S, Defechereux P, Mayer KH, Veloso VG, Bekker LG, Avelino-Silva VI, Schechter M, Grant RM. The Effect of Depressive Symptoms on Adherence to Daily Oral PrEP in Men who have Sex with Men and Transgender Women: A Marginal Structural Model Analysis of The iPrEx OLE Study. AIDS Behav 2016; 20:1527-34. [PMID: 27125241 DOI: 10.1007/s10461-016-1415-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We assessed the role of depressive symptoms on adherence to daily oral FTC/TDF for HIV PrEP in cisgender men who have sex with men (MSM) and transgender women who have sex with men (TGW) using data from the iPrEx OLE study. A marginal structural logistic regression model was used to estimate the effect of time-varying CES-D scores on having protective levels of drug concentration, adjusting for confounding by sexual practices over time, prior adherence, and baseline demographic characteristics. We found a non-monotonic relationship between CES-D score and odds of protective FTC/TDF levels in MSM. We found evidence that the effect of depression on adherence varied between MSM and TGW, and that depressive symptoms did not contribute greatly to decreased adherence on a population scale. We recommend that depressive symptoms not preclude the prescription of PrEP, and that MSM and TGW be studied separately.
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