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Storholm ED, Ogunbajo A, Nacht CL, Opalo C, Horvath KJ, Lyman P, Flynn R, Reback CJ, Blumenthal J, Moore DJ, Bolan R, Morris S. Facilitators of PrEP Persistence among Black and Latinx Transgender Women in a PrEP Demonstration Project in Southern California. Behav Med 2024; 50:63-74. [PMID: 35993278 PMCID: PMC9943802 DOI: 10.1080/08964289.2022.2105794] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/28/2022] [Accepted: 07/19/2022] [Indexed: 11/02/2022]
Abstract
Black and Latinx transgender women in the United States (U.S.) are at disproportionately high risk for HIV. Although HIV pre-exposure prophylaxis (PrEP) reduces the risk of HIV infection, uptake and persistence (i.e., ability to continue taking PrEP over time) can be a challenge for Black and Latinx transgender women due to myriad social and structural forces. In this qualitative study, we present unique data on the facilitators of PrEP persistence from Black and Latinx transgender women who initiated PrEP and exhibited varying levels of persistence during a demonstration project in Southern California. PrEP persistence was assessed by collecting quantitative intracellular tenofovir-diphosphate (TFV-DP) levels on dried blood spot (DBS) samples collected at weeks 12 and 48. Informed by the socioecological framework, we conducted and analyzed interviews using qualitative content analysis to determine themes on the facilitators of PrEP persistence. Individual-level facilitators included the use of reminders, having high individual-level HIV risk perception, feeling empowered to take PrEP, and reporting having improved peace of mind and mental health because of taking PrEP. Interpersonal/Community-level facilitators included feeling motivation to prevent HIV in the community, motivation to prevent HIV in the context of sex work, and having high community-level risk perception. Structural-level facilitators included having positive experiences in affirming healthcare settings and having PrEP visits combined with other gender-related healthcare visits. Interventions aiming to increase PrEP uptake and persistence among Black and Latinx transgender women in the U.S. should harness the multiple levels of support exhibited by those who were able to start and persist on PrEP in the face of the myriad social and structural barriers.
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Affiliation(s)
- Erik D. Storholm
- School of Public Health, San Diego State University
- RAND Corporation
- Center for HIV Identification, Prevention and Treatment Services, Department of Family Medicine, University of California Los Angeles
| | - Adedotun Ogunbajo
- RAND Corporation
- Department of Behavioral and Social Sciences, Brown University School of Public Health
| | | | | | | | | | | | - Cathy J. Reback
- Center for HIV Identification, Prevention and Treatment Services, Department of Family Medicine, University of California Los Angeles
- Friends Research Institute
| | - Jill Blumenthal
- AntiViral Research Center, University of California, San Diego School of Medicine
| | - David J. Moore
- AntiViral Research Center, University of California, San Diego School of Medicine
| | | | - Sheldon Morris
- AntiViral Research Center, University of California, San Diego School of Medicine
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Agwang W, Nangendo J, Nabikande S, Okello T, Tusabe J, Semitala FC, Kasasa S, Matovu JKB. Factors associated with willingness to take Pre-Exposure Prophylaxis (PrEP) among high-risk adolescent boys and young men in Masese fishing community, Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001191. [PMID: 37289700 DOI: 10.1371/journal.pgph.0001191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 05/15/2023] [Indexed: 06/10/2023]
Abstract
Pre-Exposure Prophylaxis (PrEP) is a known HIV prevention strategy for high-risk populations however, some high-risk communities have not yet fully embraced it. We sought to determine willingness to take PrEP and the associated factors among high-risk adolescent boys and young men (ABYM) in Masese fishing community, Jinja district, Eastern Uganda. We conducted a cross-sectional study, between October and November 2020, using a semi-structured questionnaire among ABYM aged 10-24 years in Masese fishing community, Eastern Uganda. We surveyed 479 participants, who had two or more sexual partners with inconsistent or no condom use. We carried out modified Poisson regression analysis to determine factors associated with willingness to take PrEP.Of 479 high-risk ABYM, 86.4% (n = 414) were willing to take PrEP. Confidence in PrEP safety (adj.PR = 1.56; 95%CI: 1.55, 2.24), availability of PrEP in areas easily accessible by ABYM (adj.PR = 1.40; 95%CI: 1.25, 1.57), and perceiving oneself as being at a very high risk of HIV infection (adj.PR = 1.11; 95%CI: 1.03, 1.20) were positively associated with willingness to take PrEP. On the other hand, being unmarried (adj.PR = 0.92; 95%CI: 0.87, 0.98) and earning more than USD 27 a month (adj.PR = 0.92; 95%CI: 0.87, 0.97) were negatively associated with willingness to take PrEP. There was high willingness to take PrEP among adolescent boys and young men in Masese fishing community. Confidence in PrEP safety, access to PrEP in their community and self-perception to be at high risk for HIV acquisition had a positive bearing on willingness to take PrEP while being unmarried and earning more than USD27 had a negative bearing on willingness to take PrEP. These findings suggest a need for target-specific interventions for unmarried men and those earning >USD27.
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Affiliation(s)
- Winnie Agwang
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joanita Nangendo
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sherifah Nabikande
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Tom Okello
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joan Tusabe
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fred C Semitala
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Makerere University Joint AIDS Program, Kampala, Uganda
| | - Simon Kasasa
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joseph K B Matovu
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
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Restar AJ, Quilantang MI, Wickersham J, Adia A, Guigayoma J, Bermudez AN, Galárraga O, Flores DD, Cu‐Uvin S, Nazareno J, Operario D, Sison O. Predictors of PrEP awareness, PrEP discussion and interest in long-acting injectable PrEP among Filipina transfeminine adults. J Int AIDS Soc 2023; 26:e26080. [PMID: 37306123 PMCID: PMC10258862 DOI: 10.1002/jia2.26080] [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: 10/17/2022] [Accepted: 03/08/2023] [Indexed: 06/13/2023] Open
Abstract
INTRODUCTION Transfeminine adults are impacted by the HIV epidemic in the Philippines, and newly approved modalities of pre-exposure prophylaxis (PrEP), including long-acting injectable (LAI-PrEP), could be beneficial for this group. To inform implementation, we analysed PrEP awareness, discussion and interest in taking LAI-PrEP among Filipina transfeminine adults. METHODS We utilized secondary data from the #ParaSaAtin survey that sampled Filipina transfeminine adults (n = 139) and conducted a series of multivariable logistic regressions with lasso selection to explore factors independently associated with PrEP outcomes, including awareness, discussion with trans friends and interest in LAI-PrEP. RESULTS Overall, 53% of Filipina transfeminine respondents were aware of PrEP, 39% had discussed PrEP with their trans friends and 73% were interested in LAI-PrEP. PrEP awareness was associated with being non-Catholic (p = 0.017), having previously been HIV tested (p = 0.023), discussing HIV services with a provider (p<0.001) and having high HIV knowledge (p = 0.021). Discussing PrEP with friends was associated with older age (p = 0.040), having experienced healthcare discrimination due to transgender identity (p = 0.044), having HIV tested (p = 0.001) and having discussed HIV services with a provider (p < 0.001). Very interested in LAI-PrEP was associated with living in Central Visayas (p = 0.045), having discussed HIV services with a provider (p = 0.001) and having discussed HIV services with a sexual partner (p = 0.008). CONCLUSIONS Implementing LAI-PrEP in the Philippines requires addressing systemic improvements across personal, interpersonal, social and structural levels in healthcare access, including efforts to create healthcare settings and environments with providers who are trained and competent in transgender health and can address the social and structural drivers of trans health inequities, including HIV and barriers to LAI-PrEP.
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Affiliation(s)
- Arjee Javellana Restar
- Department of EpidemiologyUniversity of Washington School of Public HealthSeattleWashingtonUSA
- Department of Behavioral and Social Sciences, Research Education Institute for Diverse Scholars (REIDS)Yale University School of Public HealthNew HavenConnecticutUSA
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Ma Irene Quilantang
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRhode IslandUSA
- Department of Behavioral SciencesUniversity of Philippines‐ManilaManilaPhilippines
| | - Jeffrey Wickersham
- Department of Behavioral and Social Sciences, Research Education Institute for Diverse Scholars (REIDS)Yale University School of Public HealthNew HavenConnecticutUSA
- Department of Internal MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - Alex Adia
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
- Division of Health Policy and ManagementUniversity of California – Berkeley School of Public HealthBerkeleyCaliforniaUSA
| | - John Guigayoma
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Amiel Nazer Bermudez
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
- Department of EpidemiologyBrown University School of Public HealthProvidenceRhode IslandUSA
- Department of Epidemiology and BiostatisticsUniversity of Philippines‐ManilaManilaPhilippines
| | - Omar Galárraga
- Department of Health Services, Policy, and PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Dalmacio Dennis Flores
- Department of Behavioral and Social Sciences, Research Education Institute for Diverse Scholars (REIDS)Yale University School of Public HealthNew HavenConnecticutUSA
- Department of Family and Community HealthUniversity of Pennsylvania School of NursingPhiladelphiaPennsylvaniaUSA
| | - Susan Cu‐Uvin
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Jennifer Nazareno
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Don Operario
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
- Department of Behavioral, Social, and Health Education SciencesEmory University Rollins School of Public HealthAtlantaGeorgiaUSA
| | - Olivia Sison
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
- Department of EpidemiologyBrown University School of Public HealthProvidenceRhode IslandUSA
- Institute of Clinical Epidemiology, National Institutes of HealthUniversity of Philippines‐ManilaManilaPhilippines
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HIV Risk Perception and Pre-Exposure Prophylaxis (PrEP) Awareness Among Transgender Women from Mexico. AIDS Behav 2023; 27:992-1002. [PMID: 36121550 DOI: 10.1007/s10461-022-03836-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/01/2022]
Abstract
This study aimed to identify factors associated with HIV risk perception among Mexican transgender women (TGW). This cross-sectional survey was conducted online and at a public HIV clinic in Mexico City. Participants were ≥ 18 years old, self-identified as TGW, and reported not living with HIV. They answered questions on sexual behavior, HIV risk perception, and pre-exposure prophylaxis (PrEP) awareness. We performed a multivariate logistic regression to accomplish the study's objective. One hundred ninety-one TGW completed the survey. High HIV risk perception was associated with > 5 sexual partners, condomless receptive anal sex, sex with a male partner(s) of unknown HIV status, and PrEP awareness. Although most TGW reported low HIV risk perception, over half had risk sexual behavior, reflecting inaccurate risk assessment. Future interventions to improve accurate risk perception among TGW should promote HIV transmission and prevention knowledge and increase PrEP awareness and uptake.
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Wagner GA, Wu KS, Anderson C, Burgi A, Little SJ. Predictors of Human Immunodeficiency Virus Pre-Exposure Prophylaxis (PrEP) Uptake in a Sexual Health Clinic With Rapid PrEP Initiation. Open Forum Infect Dis 2023; 10:ofad060. [PMID: 36968957 PMCID: PMC10034584 DOI: 10.1093/ofid/ofad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
Background Improved pre-exposure prophylaxis (PrEP) uptake is essential for human immunodeficiency virus (HIV) prevention initiatives. Offering PrEP at the time of HIV and sexually transmitted infection (STI) testing can improve uptake. We offered rapid PrEP initiation in a sexual health clinic and assessed predictors of PrEP interest, initiation, linkage, and retention. Methods Between November 2018 and February 2020, PrEP-eligible individuals who presented to a sexual health clinic were offered a free 30-day supply of PrEP plus linkage to continued PrEP care. Univariable and multivariable analyses of demographic and HIV risk data were conducted to determine predictors of PrEP uptake. Results Of 1259 adults who were eligible for PrEP (99.7% male, 42.7% White, 36.2% Hispanic), 456 were interested in PrEP, 249 initiated PrEP, 209 were linked, and 67 were retained in care. Predictors of PrEP interest included younger age (P < .01), lower monthly income (P = .01), recreational drug use (P = .02), and a greater number of sexual partners (P < .01). Negative predictors of PrEP initiation included lower monthly income (P = .04), testing positive for chlamydia (P = .04), and exchanging money for sex (P = .01). Negative predictors of linkage included self-identifying as Black (P = .03) and testing positive for an STI (P < .01). Having health insurance positively predicted both linkage (P < .01) and retention (P < .03). Conclusions A minority of PrEP-eligible HIV and STI testers initiated PrEP when offered, suggesting that easy PrEP access in sexual health clinics alone may not improve uptake. Predictors of uptake included established HIV risk factors and markers of higher socioeconomic status, suggesting that those aware of their risk and with the means to utilize health services engaged best with this model.
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Affiliation(s)
- Gabriel A Wagner
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Kuan-Sheng Wu
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego, San Diego, California, USA
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Christy Anderson
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Alina Burgi
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Susan J Little
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego, San Diego, California, USA
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Awareness and use of HIV pre-exposure prophylaxis and factors associated with awareness among MSM in Beijing, China. Sci Rep 2023; 13:554. [PMID: 36631515 PMCID: PMC9834337 DOI: 10.1038/s41598-023-27485-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023] Open
Abstract
Human immunodeficiency virus (HIV) sexual transmission among men who have sex with men (MSM) has increased markedly in Beijing, China in the past decade. Pre-exposure prophylaxis (PrEP) is a highly efficacious biomedical prevention strategy that remarkably reduces HIV-transmission risk. This study examined PrEP awareness among MSM and the factors influencing it. From April to July 2021, respondent-driven sampling was used to conduct a cross-sectional survey among MSM in Beijing, China. Demographic, behavior, and awareness data regarding PrEP were collected. The factors influencing PrEP awareness were assessed using univariate and multivariable logistic regression. In total, 608 eligible responders were included in the study. Among the respondents, 27.9% had PrEP awareness, 3.3% had taken PrEP, and 57.9% expressed interest in receiving PrEP, if required. Greater odds of PrEP awareness were associated with higher education level (adjusted odds ratio [aOR] 3.525, 95% confidence interval [CI] 2.013-6.173, P < 0.0001), greater HIV-related knowledge (aOR 3.605, 95% CI 2.229-5.829, P < 0.0001), HIV testing (aOR 2.647, 95% CI 1.463-4.788, P = 0.0013), and sexually transmitted infections (aOR 2.064, 95% CI 1.189-3.584, P = 0.0101). Lower odds of PrEP awareness were associated with higher stigma score (aOR 0.729, 95% CI 0.591-0.897, P = 0.0029). The findings indicate sub-optimal awareness and low utilization of PrEP in Beijing and highlight PrEP inequities among MSM with stigma. Strengthening the training of peer educators in disseminating PrEP knowledge and reducing stigma are critical for improving PrEP awareness.
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Shen Y, Zhang C, Valimaki MA, Qian H, Mohammadi L, Chi Y, Li X. Why do men who have sex with men practice condomless sex? A systematic review and meta-synthesis. BMC Infect Dis 2022; 22:850. [PMCID: PMC9661788 DOI: 10.1186/s12879-022-07843-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Despite a large amount of behavioral interventions to reduce human immunodeficiency virus (HIV)-related high-risk sexual behaviors, consistent condom use remains suboptimal among men who have sex with men (MSM). However, current databases are lack of synthesized evidence to explain why MSM practiced condomless sex.
Objective
Our study aims to conduct a systematic review and meta-synthesis of 39 eligible qualitative studies to explore the barriers to condom use among MSM.
Methods
A systematic review and meta-synthesis of qualitative studies (1994–2021). On March 4, 2021, a comprehensive search was conducted in 14 electronic databases. The study was conducted based on the Joanna Briggs Institute’s recommendations.
Results
Thematic analysis produced six synthesized themes, which were classified into three levels according to the Social-ecology Model. Individual level barriers to condom use included physical discomfort, lack of HIV/STI-related knowledge and substance use; interpersonal-level barrier was mainly the condom stigma, namely regarding using condom as symbols of distrust or HIV/sexually transmitted infections (STIs) prevention, or as violating traditional cognition of sex, or as an embarrassing topic; environmental/structural-level barriers included situational unavailability, unaffordability of condoms and power imbalance in the sexual relationship.
Conclusion
This meta-synthesis offered in-depth understanding of condom use barriers for MSM and could guide the development of multifactorial interventions according to the identified barriers, especially targeting to reduce condom stigma, which has not been focused and intervened previously.
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High Rates of Sexualized Drug Use or Chemsex among Brazilian Transgender Women and Young Sexual and Gender Minorities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031704. [PMID: 35162728 PMCID: PMC8835457 DOI: 10.3390/ijerph19031704] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/17/2022]
Abstract
(1) Background: We aimed to estimate sexualized drug use (SDU) prevalence and its predictors among sexual and gender minorities. (2) Methods: We used an online and on-site survey to enroll sexual/gender minorities people between October-December/2020, and multivariate logistic regression to obtain SDU correlates. (3) Results: We enrolled 3924 individuals (280 transgender women [TGW], 3553 men who have sex with men [MSM], and 91 non-binary), 29.0% currently on pre-exposure prophylaxis (PrEP). SDU prevalence was 28.8% (95% confidence interval [CI] 27.4-30.2). TGW had 2.44-times increased odds (95%CI 1.75-3.39) of engaging in SDU compared to MSM, regardless of PrEP use. PrEP use (aOR 1.19, 95%CI 1.00-1.41), South/Southeast region (aOR 1.26, 95%CI 1.04-1.53), younger age (18-24 years: aOR 1.41, 95%CI 1.10-1.81; 25-35 years: aOR 1.24, 95%CI 1.04-1.53), white race/color (aOR 1.21, 95%CI 1.02-1.42), high income (aOR 1.32, 95%CI 1.05-1.67), binge drinking (aOR 2.66, 95%CI 2.25-3.14), >5 sexual partners (aOR 1.88, 95%CI 1.61-2.21), condomless anal sex (aOR 1.49, 95%CI 1.25-1.79), self-reported sexually transmitted infection (aOR 1.40, 95%CI 1.14-1.71), and higher perceived HIV-risk (aOR 1.37, 95%CI 1.14-1.64) were associated with SDU. (4) Conclusions: TGW had the highest SDU odds. SDU may impact HIV vulnerability among key populations and should be addressed in HIV prevention approaches.
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Blair KJ, Torres TS, Hoagland B, Bezerra DR, Veloso VG, Grinsztejn B, Clark J, Luz PM. Pre-exposure prophylaxis use, HIV knowledge, and internalized homonegativity among men who have sex with men in Brazil: A cross-sectional study. LANCET REGIONAL HEALTH. AMERICAS 2022; 6:100152. [PMID: 35291206 PMCID: PMC8920052 DOI: 10.1016/j.lana.2021.100152] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Pre-exposure prophylaxis (PrEP) use in Brazil remains low despite free national access. We explored associations of HIV knowledge and internalized homonegativity with PrEP use among PrEP-eligible men who have sex with men (MSM). Methods Brazilian Hornet users completed an online, cross-sectional survey in February-March 2020. We included cis-men ≥18 years old who reported recent sex with men and were PrEP-eligible per the following: condomless anal intercourse, partner(s) living with HIV, transactional sex, and/or sexually transmitted infection. Our outcome was current PrEP use, defined by the response, "I am currently taking PrEP." Key predictors included the HIV/AIDS Knowledge Assessment (HIV-KA) and Reactions to Homosexuality Scale (RHS); higher scores indicate greater knowledge and greater internalized homonegativity, respectively. Scales were standardized for analysis. Associations with current PrEP use were estimated using adjusted odds ratios (aOR) with 95% confidence intervals (95%CI). Findings Among 2398 PrEP-eligible MSM, n = 370 (15·4%) reported current PrEP use. Increasing HIV-KA scores were associated with greater odds of PrEP use (aOR 1·70 [95%CI 1·41-2·04], p < 0·001), and increasing RHS scores with lower odds of PrEP use (aOR 0·83 [95%CI 0·73-0·96], p = 0·010). PrEP use was lower among 18-24 versus 40+-years-old MSM (aOR 0·43 [95%CI 0·27-0·69], p = 0·005), and in Black versus White/Asian respondents (aOR 0·51 [95%CI 0·31-0·85], p = 0·040). Interpretation Among PrEP-eligible Brazilian MSM, HIV knowledge was associated with increased PrEP use and internalized homonegativity with decreased use. Wider dissemination of HIV prevention knowledge and addressing stigma experienced by MSM could promote increased PrEP use. Funding National Institute of Mental Health, Fiocruz, Conselho Nacional de Desenvolvimento Científico e Tecnológico.
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Affiliation(s)
- Kevin J. Blair
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
- Department of Surgery, UCLA, 10833 Le Conte Ave, 72-227 CHS, Los Angeles, CA 90095, USA
| | - Thiago S. Torres
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Brenda Hoagland
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Daniel R.B. Bezerra
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Valdilea G. Veloso
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Jesse Clark
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Paula M. Luz
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
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Mora C, Nelvo R, Monteiro S. Government communication pieces on HIV pre-exposure (PrEP) and post-exposure (PEP) prophylaxis (2016-2019): analysis of their content and circulation among gay men, trans women/travestis, and sex workers. SAUDE E SOCIEDADE 2022. [DOI: 10.1590/s0104-12902022210855en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract This article analyzes the advertisement of pre-exposure (PrEP) and post-exposure (PEP) prophylaxis treatment for HIV considering the historical role of AIDS prevention campaigns in Brazil. A total of 24 pieces of communication on PrEP, PEP, and CP (Combined Prevention), produced from 2016 to 2019 and published on the website and social media of the Brazilian Ministry of Health were analyzed in addition to the testimony of 30 users of prophylaxis - including gays, trans women/travestis, and sex workers - in the metropolitan region of Rio de Janeiro. The materials were classified according to type, year, audience, and access information, and the results were interpreted from four axes: contextualization of the communication pieces and the experience of the interlocutors with the information; sexuality and risk; gender, emotions, and moralities; and condom displacements. The analysis indicated the erasure of expressions of sexuality and the predominance of an abstract and structured language, presupposing a rational and individualistic public, with condoms associated with “sexual risk.” Users’ reports regarding the advertisement of information on these prophylaxis reveals its insufficiency. We conclude that the potential of information and communication campaigns, guided by the sociocultural reality of social segments, has been little explored, compromising access to prophylaxis. Thus, the biomedicalization of prevention and the advance of conservatism in Brazil hinder the Brazilian response to AIDS.
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Affiliation(s)
- Claudia Mora
- Universidade do Estado do Rio de Janeiro, Brasil
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Mora C, Nelvo R, Monteiro S. Peças de comunicação governamentais sobre as profilaxias pré (PrEP) e pós-exposição (PEP) ao HIV (2016-2019): análise de seus conteúdos e circulação entre gays, mulheres trans/travestis e trabalhadoras sexuais. SAUDE E SOCIEDADE 2022. [DOI: 10.1590/s0104-12902022210855pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Resumo Este artigo analisa a divulgação das profilaxias pré (PrEP) e pós-exposição (PEP) ao HIV, considerando o papel histórico das campanhas de prevenção à aids. São utilizadas 24 peças de comunicação sobre PrEP, PEP e PC (Prevenção Combinada), produzidas entre 2016 e 2019 e publicadas no site e mídias sociais do Ministério da Saúde, e o depoimento de 30 usuários(as) das profilaxias - que incluem gays, mulheres trans/travestis e profissionais do sexo - na região metropolitana do Rio de Janeiro. As peças foram classificadas quanto ao tipo, ano, público e informação de acesso, e os resultados foram interpretados a partir de três eixos: sexualidade e risco; gênero, emoções e moralidades; deslocamentos do preservativo. A análise indicou o apagamento das expressões de sexualidade e o predomínio de uma linguagem abstrata e esquemática, pressupondo um público racional e individualista, com o preservativo associado à ideia de “risco sexual”. Os relatos dos(as) usuários(as) quanto à divulgação de informações sobre essas profilaxias evidenciaram sua insuficiência. Concluímos que ocorre uma baixa exploração do potencial das campanhas de comunicação, orientadas pela realidade sociocultural dos segmentos sociais, comprometendo o acesso às profilaxias. Assim, a biomedicalização da prevenção e o avanço do conservadorismo prejudicam a resposta brasileira à aids.
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Affiliation(s)
- Claudia Mora
- Universidade do Estado do Rio de Janeiro, Brasil
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12
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Elorreaga OA, Torres TS, Vega-Ramirez EH, Konda KA, Hoagland B, Benedetti M, Pimenta C, Diaz-Sosa D, Robles-Garcia R, Grinsztejn B, Caceres CF, Veloso VG. Awareness, willingness and barriers to HIV Self-testing (HIVST) among Men who Have Sex with Men (MSM) in Brazil, Mexico, and Peru: A web-based cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000678. [PMID: 36962436 PMCID: PMC10021908 DOI: 10.1371/journal.pgph.0000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/30/2022] [Indexed: 11/18/2022]
Abstract
HIV self-testing (HIVST) is an essential tool within the combined HIV prevention package and has been available in Latin America since 2015. However, HIVST use among key populations remains low. This study describes awareness, willingness, and barriers to HIVST among MSM in Brazil, Mexico, and Peru. A cross-sectional web-based survey was advertised in two geosocial networking apps (Grindr and Hornet) and Facebook in 2018. We included cisgender men ≥18 years old who self-reported HIV-negative status. We used multivariable Poisson regression models to calculate adjusted prevalence ratios (aPR) to assess the factors associated with willingness to use HIVST for each country. A total of 18,916 completed the survey, 59% from Brazil, 30% from Mexico, and 11% from Peru. Overall, 20% of MSM had never tested for HIV. Awareness and willingness to use HIVST were higher in Brazil than in Peru and Mexico (p < .001). Across the countries, the patterns of association of willingness with HIVST barriers were similar. Most participants think post-test counseling is essential and that dealing with a positive result would be difficult (aPR 1.13 to 1.37, range of aPRs across the three countries). Having the knowledge to deal with a positive HIVST resulted in increased willingness to use HIVST (aPR range: 1.11 to 1.22), while a lack of trust in HIVST compared to HIV testing in clinics was inversely associated (aPR range: 0.80 to 0.90). In general, willingness to use HIVST was associated with higher income (aPR range: 1.49 to 1.97), higher education (aPR range: 1.13 to 1.42), and willingness to use PrEP (aPR range: 1.19 to 1.72). Efforts to increase HIVST knowledge and resolve perceived barriers are warranted, especially among MSM with lower income and education from Brazil, Mexico, and Peru. Personalized virtual counseling could be crucial among this population. In addition, those willing to use HIVST are also willing to use PrEP. It indicates that HIVST delivery could be incorporated into PrEP programs within the Brazilian Public Health System and eventually in Mexico and Peru.
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Affiliation(s)
- Oliver A Elorreaga
- Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | | | - Kelika A Konda
- Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Marcos Benedetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Cristina Pimenta
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Dulce Diaz-Sosa
- National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico DF, Mexico
| | | | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Carlos F Caceres
- Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
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Costa AB, Rosa LDO, Fontanari AMV. Sampling bias in Brazilian studies on transgender and gender diverse populations: the two-step measure for assessing gender identity in surveys. CAD SAUDE PUBLICA 2022; 38:e00180420. [DOI: 10.1590/0102-311x00180420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/29/2021] [Indexed: 11/22/2022] Open
Abstract
Abstract: Correctly recognizing gender identity in population-based surveys is essential to develop effective public health strategies to improve the living conditions of transgender and gender-diverse populations, as well as to adequately collect data on cisgender individuals. This study aims to present the two-step measure as the best strategy for assessing gender identity in Brazilian surveys, thus we performed two separate analyses. Firstly, we conducted a systematic review concerning HIV-related care among Brazilian transgender and gender-diverse populations to assess the strategy used to identify participants’ gender identity. Secondly, we re-analyzed data from a recent survey that included Brazilian transgender populations, comparing characteristics and health outcomes from the sample identified by single-item and by the two-step measure. Concerning the systematic review, from 6,585 references, Brazilian research teams published seven articles, and only one study used the two-step measure. Regarding this survey, the two-step measure recognized 567 cisgender and 773 transgender and gender diverse participants among the 1,340 participants who answered the questionnaire, whereas the single-item measure was able to recognize only 540 transgender and gender diverse people. Furthermore, 31 transgender women self-identified as “transgender men” on the single-item measure. Therefore, although scarcely used in Brazil, the two-step measure is a more accurate strategy to recognize gender identity.
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Scales to Assess Knowledge, Motivation, and Self-Efficacy for HIV PrEP in Colombian MSM: PrEP-COL Study. AIDS Res Treat 2021; 2021:4789971. [PMID: 34540289 PMCID: PMC8443363 DOI: 10.1155/2021/4789971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/19/2021] [Accepted: 08/06/2021] [Indexed: 12/18/2022] Open
Abstract
Objective We evaluated the construct validity Spanish version of knowledge, stigma, norms, and self-efficacy scales regarding PrEP in MSM. Methods Sample of 287 MSM. Exploratory confirmatory factor analysis and item response theory were used to validate the constructs. Correlations and confidence interval-based estimation of relevance analyses were conducted to correlate the scales with willingness and intention to use PrEP. Results Attitude, stigma, and descriptive and subjective norms scales showed good construct validity and were related to intention and willingness to use PrEP. However, the knowledge scale and self-efficacy scales require further refinement. Conclusions The study provides useful information for assessing information, motivation, and self-efficacy related to PrEP use. Our results could be used to test the scales and the theoretical model in other contexts to confirm their usefulness.
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Grov C, Westmoreland DA, D’Angelo AB, Pantalone DW. How Has HIV Pre-Exposure Prophylaxis (PrEP) Changed Sex? A Review of Research in a New Era of Bio-behavioral HIV Prevention. JOURNAL OF SEX RESEARCH 2021; 58:891-913. [PMID: 34180743 PMCID: PMC9729849 DOI: 10.1080/00224499.2021.1936440] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
In 2012, the U.S. FDA approved the first drug for use as HIV Pre-Exposure Prophylaxis (PrEP), which is nearly 99% effective when taken as prescribed. Although the manifest function of PrEP is to prevent HIV infection in the event of exposure, the drug has also had a significant impact on various facets of sexuality. In this review, we focus on research that emerged in the near decade since PrEP's approval, with a specific focus on the ways in which different elements of sex and sexuality have been impacted by gay, bisexual, and other men who have sex with men (GBMSM), cisgender women, and transgender individuals. We highlight evidence showing how PrEP has enhanced sexual self-esteem, improved sexual pleasure, reduced sexual anxiety, and has increased sexual agency for those taking it. For many, PrEP also serves as a gateway to improve routine health and increase sexual health-care utilization. Additionally, we review the question of whether PrEP is associated with increased sexual risk taking (i.e. risk compensation), and note that, although some data are mixed, PrEP is not intended as an intervention to reduce condomless anal sex or STIs: it aims to prevent HIV. Finally, our review highlights that, although the volume of research on PrEP among GBMSM is robust, it is underdeveloped for cisgender women and transgender populations and insufficient for inclusion in such a review for cisgender heterosexual men was. PrEP research with these populations is an important direction for future research. Finally, from 2012 to 2019, a single PrEP formulation and delivery method was FDA approved (oral emtricitabine/tenofovir disoproxil fumarate). As additional drug formulations (ie.g., emtricitabine/tenofovir alafenamide) and delivery methods (e.g., microbiocides, vaginal ring, injectable) come to market, it will be important to examine how these, too, impact the spectrum of sexuality.
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Affiliation(s)
- Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY
- CUNY Institute for Implementation Science in Population Health, New York, NY
| | | | - Alexa B. D’Angelo
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY
- CUNY Institute for Implementation Science in Population Health, New York, NY
| | - David W. Pantalone
- Department of Psychology, University of Massachusetts Boston
- The Fenway Institute, Fenway Health, Boston, MA
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Blair KJ, Segura ER, Garner A, Lai J, Ritterbusch A, Leon-Giraldo S, Guilamo-Ramos V, Lake JE, Clark J, Holloway IW. PrEP Awareness, Use, Intention to Use, and Information Source Among Geosocial Networking Application Users in Mexico in 2018-2019. AIDS Behav 2021; 25:2743-2754. [PMID: 33646443 DOI: 10.1007/s10461-021-03184-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2021] [Indexed: 02/07/2023]
Abstract
Pre-exposure prophylaxis (PrEP) has limited availability across Latin America, though access is increasing. We explored PrEP uptake in Mexico via an online survey completed by Spanish-speaking, Hornet geosocial networking application (GSN app) users without HIV (n = 2020). Most (81.3%) had heard of PrEP, 3.5% were current users, and 34.2% intended to take PrEP within six months. Current PrEP use was associated with PrEP eligibility (aOR 26.07 [95%CI 13.05-52.09], p < 0.001), recent STI testing (aOR 3.79 [95%CI 1.10-13.11], p = 0.035), and recent chemsex (aOR 3.02 [95%CI 1.02-8.93], p = 0.046). Recent STI testing was associated with hearing about PrEP from a doctor (aOR 3.26 [95%CI 1.98-5.36], p < 0.001), and those who lived in large cities were less likely to have learned about PrEP via Hornet (aOR 0.52 [95%CI 0.32-0.85], p = 0.009). Interventions to increase PrEP uptake in Mexico should build upon existing health networks and utilize GSN apps for PrEP information dissemination, particularly in less populated areas.
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Affiliation(s)
- Kevin J Blair
- Department of Surgery, University of California, Los Angeles (UCLA), 10833 Le Conte Ave, 72-227 CHS, Los Angeles, CA, 90095, USA.
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, UCLA, Los Angeles, CA, USA.
| | - Eddy R Segura
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, UCLA, Los Angeles, CA, USA
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Alex Garner
- Hornet Gay Social Network, Los Angeles, CA, USA
- Gay Sexuality and Social Policy Initiative, Luskin School of Public Affairs, UCLA, Los Angeles, CA, USA
| | - Jianchao Lai
- Gay Sexuality and Social Policy Initiative, Luskin School of Public Affairs, UCLA, Los Angeles, CA, USA
| | - Amy Ritterbusch
- Gay Sexuality and Social Policy Initiative, Luskin School of Public Affairs, UCLA, Los Angeles, CA, USA
| | | | | | - Jordan E Lake
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, UCLA, Los Angeles, CA, USA
- McGovern Medical School, The University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Jesse Clark
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, UCLA, Los Angeles, CA, USA
| | - Ian W Holloway
- Gay Sexuality and Social Policy Initiative, Luskin School of Public Affairs, UCLA, Los Angeles, CA, USA
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Chakrapani V, Shaikh S, Arumugam V, Chawla U, Mehta S. Factors Influencing Willingness to Use Human Immunodeficiency Virus Preexposure Prophylaxis Among Transgender Women in India. Transgend Health 2021; 6:64-73. [PMID: 34414264 DOI: 10.1089/trgh.2019.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: High levels of human immunodeficiency virus (HIV) prevalence and inconsistent condom use among transgender women in India highlight the need for additional effective HIV prevention methods like preexposure prophylaxis (PrEP). We examined the extent of and factors influencing willingness to use PrEP among trans women in India. Methods: Between June and August 2017, we conducted a cross-sectional survey among 360 trans women recruited through community-based organizations in six cities. We assessed PrEP knowledge, condom use, attitudes toward PrEP (after providing information on PrEP), preferences in PrEP pricing and access venues, discrimination experiences, and the likelihood of using PrEP. Logistic regression analyses were conducted. Results: Participants' median age was 26 years; 50.7% had not completed high school, and 24.8% engaged in sex work. Only 17.1% reported having heard of PrEP before the survey, and 80.6% reported that they would definitely use PrEP. Trans women in sex work had 28 times higher odds of reporting willingness to use PrEP than those not in sex work (adjusted odds ratio [aOR]=28.9, 95% confidence interval [CI]=8.79-95.16, p<0.001). When compared with trans women who did not experience discrimination, the odds of reporting willingness to use PrEP was lower among trans women who had experienced discrimination from health care providers (aOR=0.25, 95% CI=0.06-0.97, p=0.04) and family members (aOR=0.08, 95% CI=0.05-0.14, p<0.001). Conclusion: Willingness to use PrEP was high among trans women, especially those in sex work, despite identified barriers (e.g., discrimination experiences). To promote PrEP uptake among at-risk trans women, the steps needed are as follows: increasing awareness about PrEP; providing easy-to-understand information on PrEP's effectiveness, side effects and interactions between PrEP and hormones; training health care providers on PrEP and cultural competency; and reducing stigmas related to PrEP use and HIV. PrEP implementation research projects to identify effective PrEP delivery strategies are urgently needed to reduce the disproportionate HIV burden among trans women in India.
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Are men who have sex with men at higher risk for HIV in Latin America more aware of PrEP? PLoS One 2021; 16:e0255557. [PMID: 34388155 PMCID: PMC8362965 DOI: 10.1371/journal.pone.0255557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 07/14/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction PrEP awareness in Latin America has been poorly characterized, with studies in Brazil, Mexico, and Peru highlighting awareness of 65% among gay, bisexual and other men who have sex with men (MSM). We assessed the association between higher risk of HIV infection, indicative of PrEP eligibility, and PrEP awareness among MSM from these countries. Methods This was a secondary analysis of a web-based survey advertised on social media platforms from March-June 2018 in Brazil, Mexico and Peru. Eligible individuals were cisgender MSM, ≥18 years old, HIV negative or of unknown status, who lived in these countries, and provided informed consent. Higher risk of HIV infection was defined as having 10 or more points in the HIV Risk Index for MSM (HIRI-MSM). We used multivariable Poisson regression models to calculate adjusted prevalence ratios (aPR) testing the association between higher risk for HIV and PrEP awareness. Results After exclusions, 19,457 MSM were included in this analysis. In Brazil, 53.8% were classified as higher risk for HIV, 51.9% in Mexico, and 54.2% in Peru. Higher risk for HIV was minimally associated with PrEP awareness among those in Brazil (aPR 1.04, 95% CI 1.01, 1.06), but no such association was observed in Mexico or Peru. Having more than a high school education, high income, daily use of geosocial networking (GSN) applications, and substance use were associated with PrEP awareness. Conclusion Higher risk of HIV infection was associated with increased PrEP awareness in Brazil. However, this association was weak indicating that PrEP awareness could be strengthened with further prevention efforts. In the remaining countries, results were non-conclusive between risk and awareness. Interventions to increase PrEP awareness are paramount to increase PrEP willingness and uptake and in turn prevent new HIV infections. Social media platforms could play an important role to achieve this goal.
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Blair KJ, Segura ER, Garner A, Lai J, Ritterbusch A, Leon-Giraldo S, Guilamo-Ramos V, Lake JE, Clark JL, Holloway IW. Pre-exposure prophylaxis awareness, use, and intention to use in a regional sample of Latin American geosocial networking application users in 2018-2019. Int J STD AIDS 2021; 32:1261-1267. [PMID: 34340629 DOI: 10.1177/09564624211034618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pre-exposure prophylaxis (PrEP) access is increasing in Latin America. We explored PrEP use among Spanish-speaking, Hornet geosocial networking application users from Latin American countries with limited PrEP data via an online survey completed between December 2018 and February 2019. A total of 718 Hornet users from 10 countries were included, of whom 72.1% reported PrEP awareness. Few (5.6%) were currently taking PrEP, though 32.1% intended to take PrEP in the subsequent 6 months. PrEP awareness was lower in 18-25 year olds compared to 26+ (62.4% vs. 75.6%, aOR 0.67, [95% CI 0.46-0.97]), and higher among those living in larger versus smaller cities (74.4% vs. 58.8%, aOR 1.96, [95% CI 1.25-3.07]) or countries with at least partial versus no PrEP policy adoption (79.1% vs. 60.8%, aOR 2.20, [95% CI 1.56-3.12]). Intention to use PrEP was higher among PrEP-eligible respondents (51.8% vs. 29.6%, aOR 2.26, [95% CI 1.26-4.07]) and those recently tested for a sexually transmitted infection (35.4% vs. 25.5%, aOR 1.58, [95% CI 1.01-2.48]). Efforts to expand PrEP use in Latin America should focus on national PrEP policy adoption, and research should explore barriers to awareness and use among young men who have sex with men.
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Affiliation(s)
- Kevin J Blair
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, 8783University of California Los Angeles, Los Angeles, CA, USA.,Department of Surgery, 8783University of California Los Angeles, Los Angeles, CA, USA
| | - Eddy R Segura
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, 8783University of California Los Angeles, Los Angeles, CA, USA.,Escuela de Medicina, 33217Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Alex Garner
- Hornet Gay Social Network, Los Angeles, CA, USA.,Gay Sexuality and Social Policy Initiative, Luskin School of Public Affairs, 8783University of California Los Angeles, Los Angeles, CA, USA
| | - Jianchao Lai
- Gay Sexuality and Social Policy Initiative, Luskin School of Public Affairs, 8783University of California Los Angeles, Los Angeles, CA, USA
| | - Amy Ritterbusch
- Gay Sexuality and Social Policy Initiative, Luskin School of Public Affairs, 8783University of California Los Angeles, Los Angeles, CA, USA
| | - Sebastian Leon-Giraldo
- Escuela de Gobierno Alberto Lleras Camargo, 27991Universidad de Los Andes, Bogotá, Colombia
| | | | - Jordan E Lake
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, 8783University of California Los Angeles, Los Angeles, CA, USA.,McGovern Medical School, 12339The University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Jesse L Clark
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, 8783University of California Los Angeles, Los Angeles, CA, USA
| | - Ian W Holloway
- Gay Sexuality and Social Policy Initiative, Luskin School of Public Affairs, 8783University of California Los Angeles, Los Angeles, CA, USA
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20
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Willingness to use HIV pre-exposure prophylaxis and associated factors among men who have sex with men in Liuzhou, China. AIDS Res Ther 2021; 18:46. [PMID: 34330300 PMCID: PMC8325278 DOI: 10.1186/s12981-021-00374-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND HIV pre-exposure prophylaxis (PrEP) is a key component of HIV combination prevention strategies and has the potential to decrease the incidence of HIV in men who have sex with men (MSM). This study aimed to evaluate levels of PrEP acceptability and explore factors associated with willingness to use PrEP among MSM in Liuzhou, China. METHODS Between November 2017 and May 2019, a cross-sectional survey was conducted among 829 MSM. The study participants were recruited through a nonprobability sampling method. The participants' demographics, HIV/AIDS knowledge, sexual behaviors, drug use and HIV test history were collected. Multivariate logistic regression was performed to identify factors associated with willingness to use PrEP. RESULTS A total of 829 MSM completed the survey, and 30.28% (95% CI 27.3-33.4) were willing to use PrEP. In multivariate logistic regression, factors associated with a higher willingness to use PrEP included Zhuang or Han ethnic origin, recruitment through peer introduction or gay venues, pursuit of a higher education level, previous HIV testing and oral sex with a man. Conversely, having casual sex in the past 6 months was associated with a lower willingness to use PrEP. CONCLUSIONS MSM in Liuzhou reported a relatively low level of willingness to use PrEP. The results indicate the need for effective education, targeted intervention, and implementation strategies to promote PrEP acceptance among MSM.
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Multilevel Barriers to HIV PrEP Uptake and Adherence Among Black and Hispanic/Latinx Transgender Women in Southern California. AIDS Behav 2021; 25:2301-2315. [PMID: 33515132 PMCID: PMC7845787 DOI: 10.1007/s10461-021-03159-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 02/02/2023]
Abstract
Black and Hispanic/Latinx transgender women in the United States (U.S.) are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) reduces risk of HIV infection but PrEP uptake remains low among Black and Hispanic/Latinx transgender women. Between July 2018 and August 2019, we conducted individual interviews with 30 Black and Hispanic/Latinx transgender women who were prescribed PrEP through a PrEP demonstration project and 10 healthcare providers who provide PrEP services to transgender women in Los Angeles and San Diego, California. The interviews assessed general attitudes, experiences, and beliefs about PrEP as well as individual-, interpersonal-, community-, and structural-level barriers to PrEP uptake and adherence. PrEP adherence was assessed by collecting quantitative intracellular tenofovir-diphosphate (TFV-DP) levels in retrospect on batched, banked dried blood spot (DBS) samples. We utilized qualitative content analysis to identify themes from the interviews. Findings indicated the presence of individual-level barriers including cost concerns, mental health issues, substance use, and concerns about PrEP side effects including hormone interaction. Interpersonal-level barriers included the influence of intimate/romantic partners and the impact of patient-provider communication. Community-level barriers consisted of experiencing stigma and negative community opinions about PrEP use as well as having negative experiences in healthcare settings. Structural-level barriers included unreliable transportation, employment, and housing insecurity. Interventions aiming to increase PrEP uptake and adherence among Black and Hispanic/Latinx transgender women in the U.S. should employ a multilevel approach to addressing the needs of transgender women, especially the structural barriers that have greatly limited the use of PrEP.
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Ogunbajo A, Storholm ED, Ober AJ, Bogart LM, Reback CJ, Flynn R, Lyman P, Morris S. Multilevel Barriers to HIV PrEP Uptake and Adherence Among Black and Hispanic/Latinx Transgender Women in Southern California. AIDS Behav 2021. [PMID: 33515132 DOI: 10.1007/s10461-021-03159-2]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Black and Hispanic/Latinx transgender women in the United States (U.S.) are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) reduces risk of HIV infection but PrEP uptake remains low among Black and Hispanic/Latinx transgender women. Between July 2018 and August 2019, we conducted individual interviews with 30 Black and Hispanic/Latinx transgender women who were prescribed PrEP through a PrEP demonstration project and 10 healthcare providers who provide PrEP services to transgender women in Los Angeles and San Diego, California. The interviews assessed general attitudes, experiences, and beliefs about PrEP as well as individual-, interpersonal-, community-, and structural-level barriers to PrEP uptake and adherence. PrEP adherence was assessed by collecting quantitative intracellular tenofovir-diphosphate (TFV-DP) levels in retrospect on batched, banked dried blood spot (DBS) samples. We utilized qualitative content analysis to identify themes from the interviews. Findings indicated the presence of individual-level barriers including cost concerns, mental health issues, substance use, and concerns about PrEP side effects including hormone interaction. Interpersonal-level barriers included the influence of intimate/romantic partners and the impact of patient-provider communication. Community-level barriers consisted of experiencing stigma and negative community opinions about PrEP use as well as having negative experiences in healthcare settings. Structural-level barriers included unreliable transportation, employment, and housing insecurity. Interventions aiming to increase PrEP uptake and adherence among Black and Hispanic/Latinx transgender women in the U.S. should employ a multilevel approach to addressing the needs of transgender women, especially the structural barriers that have greatly limited the use of PrEP.
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Affiliation(s)
- Adedotun Ogunbajo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Erik D Storholm
- School of Public Health, San Diego State University, San Diego, CA, USA
- RAND Corporation, Santa Monica, CA, USA
- Department of Family Medicine, Center for HIV Identification, Prevention and Treatment Services, University of California Los Angeles, Los Angeles, CA, USA
| | - Allison J Ober
- RAND Corporation, Santa Monica, CA, USA
- Department of Family Medicine, Center for HIV Identification, Prevention and Treatment Services, University of California Los Angeles, Los Angeles, CA, USA
| | - Laura M Bogart
- RAND Corporation, Santa Monica, CA, USA
- Department of Family Medicine, Center for HIV Identification, Prevention and Treatment Services, University of California Los Angeles, Los Angeles, CA, USA
| | - Cathy J Reback
- Department of Family Medicine, Center for HIV Identification, Prevention and Treatment Services, University of California Los Angeles, Los Angeles, CA, USA
- Friends Research Institute, Los Angeles, CA, USA
| | - Risa Flynn
- Los Angeles LGBT Center, Los Angeles, CA, USA
| | | | - Sheldon Morris
- AntiViral Research Center, San Diego School of Medicine, University of California, San Diego, CA, USA
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23
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Zucchi EM, Couto MT, Castellanos M, Dumont-Pena É, Ferraz D, Félix Pinheiro T, Grangeiro A, da Silva LAV, Dourado I, Pedrana L, Santos FSDR, Magno L. Acceptability of daily pre-exposure prophylaxis among adolescent men who have sex with men, travestis and transgender women in Brazil: A qualitative study. PLoS One 2021; 16:e0249293. [PMID: 33945527 PMCID: PMC8096080 DOI: 10.1371/journal.pone.0249293] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 03/15/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Adolescents face socio-structural, personal and programmatic barriers to HIV prevention services, highlighting the importance of understanding knowledge and acceptability as essential aspects to promote their broader access to pre-exposure prophylaxis (PrEP). We analyzed the acceptability of PrEP among adolescent men who have sex with men (MSM), travestis and transgender women (TGW). METHODS A qualitative investigation was conducted as part of the formative research of the PrEP15-19 study, an ongoing demonstration study that analyzes the effectiveness of daily PrEP among adolescent MSM, travestis and TGW aged 15-19 in three Brazilian cities. A total of 37 semi-structured interviews and 6 focus groups were conducted. Building from thematic analysis focusing on participants' sexual encounters, perceptions about PrEP efficacy, and vulnerability contexts, we analyzed prospective acceptability of PrEP. FINDINGS Knowledge about PrEP was incipient and characterized by adolescents' frequent doubts about its prescription and efficacy. The 'ideal' use of PrEP appeared together with consistent condom use, especially in casual sex. PrEP use was also mentioned as depending on increased learning about prevention management over time. Main barriers to PrEP use included the incorporation of a daily medication into participants' routine and its impact on their social lives, especially related to stigma. Concerns over short- and long-term side effects were also reported as barriers to PrEP use. TGW and travestis contrasted using PrEP with the precarity of their life conditions, and some expressed a critical vision about PrEP by associating it with pharmaceuticalization and trans necropolitics. CONCLUSIONS Participants' low knowledge and acceptability of PrEP are circumscribed by a rigid perception of condom as the ideal prevention method and the context of their sexual relations. Prospective acceptability highlights that the successful uptake of PrEP depends on overcoming barriers of access to health services and confronting transphobia and homophobia as part of care.
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Affiliation(s)
- Eliana Miura Zucchi
- Programa de Pós-Graduação em Saúde Coletiva, Mestrado Profissional em Psicologia e Políticas Públicas, Universidade Católica de Santos, São Paulo, Santos, Brazil
| | | | - Marcelo Castellanos
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Érica Dumont-Pena
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Dulce Ferraz
- Escola FIOCRUZ de Governo, Fundação Oswaldo Cruz, Brasília, Distrito Federal, Brazil
| | | | - Alexandre Grangeiro
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Leo Pedrana
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | | | - Laio Magno
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Bahia, Brazil
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Torres TS, Luz PM, Marins LMS, Bezerra DRB, Almeida-Brasil CC, Veloso VG, Grinsztejn B, Harel D, Thombs BD. Cross-cultural adaptation of the Perceived Risk of HIV Scale in Brazilian Portuguese. Health Qual Life Outcomes 2021; 19:117. [PMID: 33836775 PMCID: PMC8033701 DOI: 10.1186/s12955-021-01760-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Valid and reliable instruments are needed to measure the multiple dimensions of perceived risk. The Perceived Risk of HIV Scale is an 8-item measure that assesses how people think and feel about their risk of infection. We set out to perform a cross-cultural adaptation of the scale to Brazilian Portuguese among key populations (gay, bisexual and other men who have sex with men and transgender/non-binary) and other populations (cisgender heterosexual men and cisgender women). METHODS Methodological study with cross-sectional design conducted online during October/2019 (key populations [sample 1] and other populations) and February-March/2020 (key populations not on pre-exposure prophylaxis [sample 2]). Cross-cultural adaptation of the Perceived Risk of HIV Scale followed Beaton et al. 2000 guidelines and included confirmatory factor analysis, differential item functioning (DIF) using the Multiple-Indicator Multiple-Cause model, and concurrent validity to verify if younger individuals, those ever testing for HIV, and engaging in high-risk behaviors had higher scores on the scale. RESULTS 4342 participants from key populations (sample 1 = 235; sample 2 = 4107) and 155 participants from other populations completed the measure. We confirmed the single-factor structure of the original measure (fit indices for sample 1 plus other populations: CFI = 0.98, TLI = 0.98, RMSEA = 0.07; sample 2 plus other populations: CFI = 0.97, TLI = 0.95, RMSEA = 0.09). For the comparisons between key populations and other populations, three items (item 2: "I worry about getting infected with HIV", item 4: "I am sure I will not get infected with HIV", and item 8: "Getting HIV is something I have") exhibited statistically significant DIF. Items 2 and 8 were endorsed at higher levels by key populations and item 4 by other populations. However, the effect of DIF on overall scores was negligible (0.10 and 0.02 standard deviations for the models with other populations plus sample 1 and 2, respectively). Those ever testing for HIV scored higher than those who never tested (p < .001); among key populations, those engaging in high-risk behaviors scored higher than those reporting low-risk. CONCLUSION The Perceived Risk of HIV Scale can be used among key populations and other populations from Brazil.
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Affiliation(s)
- Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil.
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Luana M S Marins
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Daniel R B Bezerra
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | | | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Daphna Harel
- Department of Applied Statistics, Social Science, and Humanities, New York University, New York, NY, USA
- Center for Practice and Research and the Intersection of Information, Society, and Methodology, New York University, New York, NY, USA
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Departments of Psychiatry; Epidemiology, Biostatistics and Occupational Health; Medicine; Psychology; Educational and Counselling Psychology, and Biomedical Ethics Unit, McGill University, Montréal, Québec, Canada
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25
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Chen W, Ding Y, Chen J, Zhao P, Wang Z, Meng X, Jia T, Zheng H, Yang B, Luo Z, Zou H. Awareness of and Preferences for Preexposure Prophylaxis (PrEP) among MSM at High Risk of HIV Infection in Southern China: Findings from the T2T Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6682932. [PMID: 33869634 PMCID: PMC8035020 DOI: 10.1155/2021/6682932] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 03/03/2021] [Accepted: 03/17/2021] [Indexed: 12/15/2022]
Abstract
This study is aimed at investigating the awareness of and preferences for oral and long-acting injectable HIV preexposure prophylaxis (PrEP) and their associated factors among men who have sex with men (MSM) at high risk of HIV infection in southern China. A cross-sectional survey was conducted among 603 MSM who were recruited through a cohort study called the T2T Study at three sexual health clinics in Guangzhou, Shenzhen, and Wuxi, China, from 2017 to 2018. We collected information on HIV-negative participants' awareness of and willingness to use PrEP and its potential correlations. Univariate and multivariate logistic regressions were used for data analyses. A total of 550 HIV-negative MSM were enrolled in the study. Less than half of at-risk MSM (43.1%) had heard of PrEP before, and the rate of overall willingness to use PrEP was 65.8%, while MSM were more willing to use daily oral PrEP than long-acting injectable- (LAI-) PrEP (62.2% vs. 38.5%). MSM who had university degrees or above (aOR = 1.55, 95% CI: 1.01-2.37), used condoms during last anal sex (1.52, 1.01-2.29), and tested 3 times or more for HIV (2.45, 1.10-5.47) were more likely to be aware of PrEP. MSM who had use of gay dating apps (1.51, 1.02-2.23), ever participated in HIV- or sexually transmitted disease (STD-) related studies (1.91, 1.24-2.94), and had heard of PrEP (3.06, 2.06-4.54) were more willing to use any regimen of PrEP. MSM at high risk of HIV infection had low awareness of PrEP and moderate willingness to use PrEP. Further studies of the implementation and promotion of PrEP targeting at-risk MSM should be performed.
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Affiliation(s)
- Weiying Chen
- Department of Dermatology and Venereology, Nanshan Center for Chronic Disease Control, Shenzhen 518054, China
| | - Yi Ding
- Department of Dermatology and Venereology, Nanshan Center for Chronic Disease Control, Shenzhen 518054, China
| | - Jianghao Chen
- Department of Dermatology and Venereology, Nanshan Center for Chronic Disease Control, Shenzhen 518054, China
| | - Peipei Zhao
- Department of Dermatology and Venereology, Nanshan Center for Chronic Disease Control, Shenzhen 518054, China
- Jane Addams College of Social Work, University of Illinois at Chicago, Chicago IL 60601, USA
| | - Zhenyu Wang
- Department of Medical Statistics, School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 510080, China
| | - Xiaojun Meng
- Department of AIDS/STD Control and Prevention, Wuxi Center for Disease Control and Prevention, Wuxi 214000, China
| | - Tianjian Jia
- Department of AIDS/STD Control and Prevention, Wuxi Center for Disease Control and Prevention, Wuxi 214000, China
| | - Heping Zheng
- Dermatology Hospital, Southern Medical University, Guangzhou 510080, China
| | - Bin Yang
- Dermatology Hospital, Southern Medical University, Guangzhou 510080, China
| | - Zhenzhou Luo
- Department of Dermatology and Venereology, Nanshan Center for Chronic Disease Control, Shenzhen 518054, China
| | - Huachun Zou
- Department of Medical Statistics, School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 510080, China
- Kirby Institute, University of New South Wales, Sydney 1466, Australia
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26
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Villela LM, Veloso VG, Hoagland B, Fernandes NM, Kallas EG, Madruga JV, Moreira RI, Grinsztejn B, De Boni RB. Possible risk compensation, attitudes, and beliefs among Brazilian individuals potentially eligible for pre-exposure prophylaxis. Int J STD AIDS 2021; 32:806-815. [PMID: 33615909 DOI: 10.1177/0956462421992157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pre-exposure prophylaxis (PrEP) prevents HIV infection among men who have sex with men (MSM) and transgender women (TGW) who are the groups that presents the high incidence risk in Brazil. This cross-sectional secondary analysis describes possible risk compensation, attitudes, and beliefs regarding the use of PrEP among 723 MSM and TGW evaluated in the PrEP Brazil study pre-screening phase. Possible risk compensation was reported by 31.6% individuals. In the multivariate model, factors that increased the likelihood of possible risk compensation were: self-referring as white vs. Black (AOR 2.05; CI 1.09, 3.85), perceiving high likelihood of getting HIV in next 12 months (AOR 1.78; CI 1.23, 2.56), being less afraid of HIV infection if using PrEP (AOR 1.93; CI 1.19, 3.14), feeling liberated to have more partners if using PrEP (AOR 2.93; CI 1.92, 4.49), and believing closest friends would use PrEP (AOR 2.51; CI 1.1, 5.71). We found that possible risk compensation was more common among individuals who presented high-risk perception for HIV infection, probably reflecting they feel at risk and could benefit from PrEP use.
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Affiliation(s)
- Larissa M Villela
- 37903Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/FIOCRUZ), Rio de Janeiro, Brazil
| | - Valdiléa G Veloso
- 37903Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/FIOCRUZ), Rio de Janeiro, Brazil
| | - Brenda Hoagland
- 37903Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/FIOCRUZ), Rio de Janeiro, Brazil
| | - Nilo M Fernandes
- 37903Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/FIOCRUZ), Rio de Janeiro, Brazil
| | - Esper G Kallas
- Centro de Referência e Treinamento em DST/AIDS, São Paulo, Brazil
| | | | - Ronaldo I Moreira
- 37903Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/FIOCRUZ), Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- 37903Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/FIOCRUZ), Rio de Janeiro, Brazil
| | - Raquel B De Boni
- 37903Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/FIOCRUZ), Rio de Janeiro, Brazil
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27
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Delabre RM, Bernier A, Sánchez F, Vilotitch A, Chanos S, Cosmaro ML, Langanke H, Mey C, James C, Duken SB, Schlegel V, Stranz R, Jonas KJ, Spire B, Rojas Castro D. "Yes, I'm interested in taking PrEP!": PrEP interest among women respondents to the European community-based survey "Flash! PrEP in Europe". PLoS One 2021; 16:e0246037. [PMID: 33596225 PMCID: PMC7888674 DOI: 10.1371/journal.pone.0246037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/12/2021] [Indexed: 01/29/2023] Open
Abstract
The World Health Organization recommends pre-exposure prophylaxis (PrEP) for all populations at substantial risk of HIV infection, including women. However, data regarding PrEP interest among women is lacking, particularly in Europe. Factors associated with interest in using PrEP were assessed among women respondents to the Flash! PrEP in Europe (FPIE) survey. This community-based cross-sectional study, conducted in 12 European countries, aimed to assess PrEP knowledge and interest. “High objective risk” (HOR) was assessed using established risk criteria following EACS and CDC guidelines. Factors associated with interest in using PrEP were assessed in univariable and multivariable logistic regression models. Among 678 women, 12.5% (n = 85) were considered at HOR, 46.8% (n = 317) indicated prior PrEP knowledge and 18.0% (n = 122) reported interest in using PrEP. Among women at HOR, 40.0% (n = 34) were interested in PrEP. Factors significantly associated with PrEP interest in the final multivariable model were: younger age (18–29 years) (aOR 1.91[95CI: 1.07; 3.41]), bad self-perceived financial status (1.84[1.09; 3.11]), migrant status (south to north) (2.87[1.05; 7.89]), single or dating relationship status (1.93[1.23; 3.03]), sexual abuse history (1.86[1.17; 2.97]), “rather high”/ “high” self-perceived HIV risk (3.21[1.32; 7.81]), and HOR (2.49[1.42; 4.35]). These results show that women at HOR and those who perceived themselves to be at high risk are interested in using PrEP. There is a critical need for targeted information and improved access to PrEP to increase uptake of this HIV prevention tool to meet PrEP interest among women.
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Affiliation(s)
- Rosemary M. Delabre
- Coalition PLUS, Community-Based Research Laboratory, Pantin, France
- * E-mail:
| | - Adeline Bernier
- Coalition PLUS, Community-Based Research Laboratory, Pantin, France
| | - Flor Sánchez
- Department of Social Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Antoine Vilotitch
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | | | | | - Harriet Langanke
- GSSG–Gemeinnützige Stiftung Sexualität und Gesundheit, Cologne, Germany
| | | | - Cary James
- Terrence Higgins Trust, London, United Kingdom
| | | | | | | | - Kai J. Jonas
- Maastricht University, Maastricht, The Netherlands
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- AIDES, Pantin, France
| | - Daniela Rojas Castro
- Coalition PLUS, Community-Based Research Laboratory, Pantin, France
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
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28
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Impact of COVID-19 Pandemic on Sexual Minority Populations in Brazil: An Analysis of Social/Racial Disparities in Maintaining Social Distancing and a Description of Sexual Behavior. AIDS Behav 2021; 25:73-84. [PMID: 32737817 PMCID: PMC7394046 DOI: 10.1007/s10461-020-02984-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We conducted a web-based survey to understand the impact of social distancing measures on Brazilian MSM and transgender/non-binary lives. A total of 3486 respondents were included in this analysis and the great majority were cismen (98%). The median age was 32 years (IQR: 27-40), 44% non-white, 36% low schooling and 38% low income. Most of participants reported HIV negative/unknown status (77%). Participants on-PrEP reported more condomless anal sex than those off-PrEP. Conversely, 24% off-PrEP were at substantial HIV-risk. PrEP/ART continuation were reported by the majority, despite reports of impediments to medication refill. Transgender/non-binary reported more mental health problems and challenges to access health care. Social and racial disparities were associated with unattainability of maintaining social distancing. Tailored social and economic support policies during COVID-19 pandemic should be made available to these populations. Challenges for PrEP/ART access will demand the implementation of innovative solutions to avoid the expansion of the HIV epidemic.
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Ahouada C, Diabaté S, Mondor M, Hessou S, Guédou FA, Béhanzin L, Batona G, Gning NN, Zannou DM, Alary M. Acceptability of pre-exposure prophylaxis for HIV prevention: facilitators, barriers and impact on sexual risk behaviors among men who have sex with men in Benin. BMC Public Health 2020; 20:1267. [PMID: 32819335 PMCID: PMC7441559 DOI: 10.1186/s12889-020-09363-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 08/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Benin, men who have sex with men (MSM) do not always use condoms during anal sex. Pre-exposure prophylaxis (PrEP) using Truvada® (tenofovir disoproxil fumarate / emtricitabine) may be a complementary HIV prevention measure for MSM. This study aimed at identifying the potential facilitators and barriers to the use of PrEP. METHODS This was a cross-sectional study conducted in 2018 among male-born MSM aged 18 years or older who reported being HIV-negative or unaware of their HIV status. The participants were recruited by the RDS technique (respondent driven sampling) in six cities of Benin. Logistic regression analyses, adapted to RDS statistical requirements, were performed to identify the factors associated with PrEP acceptability. RESULTS Mean age of the 400 MSM recruited was 26.2 ± 5.0 years. PrEP was known by 50.7% of respondents. The intention to use PrEP was expressed by 90% of MSM. If PrEP effectiveness were 90% or more, 87.8% of the respondents thought they would decrease condom use. In multivariate analysis, the facilitators associated with PrEP acceptability were: not having to pay for PrEP (odds ratio (OR) = 2.39, 95% CI: 1.50-4.46) and its accessibility within MSM networks (OR = 9.82, 95% CI: 3.50-27.52). Only one barrier was significant: the concern that taking PrEP be perceived as marker of adopting HIV risky behaviors (OR = 0.11, 95% CI: 0.04-0.30). CONCLUSION In Benin, not all MSM know about PrEP. But once well informed, the majority seems willing to use it if made available. The free availability of the drug and its accessibility in the MSM networks are important facilitators. The possibility of decrease in condom use should not be a barrier to the prescription of PrEP if made available.
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Affiliation(s)
- Carin Ahouada
- Hopital de Zone Allada, Allada, Benin.,Centre de recherche du CHU de Québec, Université Laval, Québec, Québec, Canada.,Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada
| | - Souleymane Diabaté
- Centre de recherche du CHU de Québec, Université Laval, Québec, Québec, Canada.,Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada.,Université Alassane Ouattara, Bouaké, Côte d'Ivoire
| | - Myrto Mondor
- Centre de recherche du CHU de Québec, Université Laval, Québec, Québec, Canada
| | - Septime Hessou
- Centre Interfacultaire de Formation et de Recherche en Environnement pour le Développement Durable (CIFRED/UAC), Abomey-Calavi, Bénin
| | | | - Luc Béhanzin
- Dispensaire des IST, Centre de Santé Cotonou I, Cotonou, Bénin.,École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Épidémiologique, Université de Parakou, Parakou, Bénin
| | - Georges Batona
- Dispensaire des IST, Centre de Santé Cotonou I, Cotonou, Bénin
| | - Ndeye Ndiagna Gning
- Centre de recherche du CHU de Québec, Université Laval, Québec, Québec, Canada.,Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada
| | - D Marcel Zannou
- Centre National Hospitalier et Universitaire Hubert Koutoukou Maga de Cotonou, Cotonou, Benin.,Faculté des Sciences de la Santé, Cotonou, Bénin
| | - Michel Alary
- Centre de recherche du CHU de Québec, Université Laval, Québec, Québec, Canada. .,Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada. .,Institut national de santé publique, Québec, Québec, Canada. .,Hôpital du Saint-Sacrement 1050 chemin Ste-Foy Québec, Québec, QC, G1S 4L8, Canada.
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30
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Herder T, Agardh A, Björkman P, Månsson F. Interest in Taking HIV Pre-exposure Prophylaxis Is Associated with Behavioral Risk Indicators and Self-Perceived HIV Risk Among Men Who Have Sex with Men Attending HIV Testing Venues in Sweden. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2165-2177. [PMID: 32495243 PMCID: PMC7316853 DOI: 10.1007/s10508-020-01740-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/01/2020] [Accepted: 05/05/2020] [Indexed: 05/29/2023]
Abstract
This study explored factors associated with interest in taking PrEP among men who have sex with men (MSM) attending HIV testing venues in Sweden. Data from 658 HIV-negative respondents, surveyed by a questionnaire at six sites, were analyzed descriptively and by univariable and multivariable logistic regression. A total of 453 (68.8%) of the respondents expressed interest in taking PrEP. Reporting self-perceived risk of HIV acquisition as moderate or high, reporting ≥ 5 partners for condomless anal intercourse during the past year, and reporting hard drug use during the past year were independently associated with interest in taking PrEP. However, an aggregated variable of self-reported rectal gonorrhea, rectal chlamydia, or syphilis infection during the past year was not associated with interest in taking PrEP. Overall, Swedish MSM were well-informed regarding PrEP, and interest in taking PrEP was positively associated with sexual risk indicators.
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Affiliation(s)
- Tobias Herder
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Malmö, Lund University, Jan Waldenströms gata 35, 214 28, Malmö, Sweden.
| | - Anette Agardh
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Malmö, Lund University, Jan Waldenströms gata 35, 214 28, Malmö, Sweden
| | - Per Björkman
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Fredrik Månsson
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
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31
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Poteat T, Malik M, van der Merwe LLA, Cloete A, Adams D, Nonyane BAS, Wirtz AL. PrEP awareness and engagement among transgender women in South Africa: a cross-sectional, mixed methods study. Lancet HIV 2020; 7:e825-e834. [PMID: 32622370 DOI: 10.1016/s2352-3018(20)30119-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/14/2020] [Accepted: 04/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The South African national HIV plan recommends pre-exposure prophylaxis (PrEP) for transgender women, whose HIV prevalence estimates are as high as 25% in sub-Saharan Africa. The aim of this study was to explore PrEP awareness, uptake, and willingness, as well as associated barriers and facilitators, in order to inform PrEP implementation efforts with transgender women in South Africa. METHODS Using a community-engaged, convergent parallel mixed methods design, trained local transgender women data collectors recruited 213 transgender women participants (aged >18 years, assigned male sex at birth, and identifying as a gender different from male), via network referral and word-of-mouth in Cape Town, East London, and Johannesburg. A subset of 36 transgender women also participated in qualitative in-depth interviews. Quantitative analyses included descriptive statistics and negative binomial regression models to assess correlates of PrEP willingness. Qualitative interviews were audio-recorded, transcribed verbatim, and coded. Thematic content analysis was used to identify key themes. Quantitative and qualitative data were integrated for interpretation. FINDINGS Participants were recruited between June 1 and Nov 30, 2018. 57 (45%) of 127 HIV-negative participants were PrEP-aware and only 14 (11%) of 129 were currently taking PrEP. HIV-negative participants experiencing social (eg, violence, poverty) and interpersonal (eg, discrimination, low transgender women community connectedness) hardship reported PrEP awareness more frequently than HIV-negative transgender women who did not. Willingness to take PrEP was low, at 56 (55%) of 102, among HIV-negative participants who were not currently taking PrEP, and negatively associated with transgender women community connectedness (multivariable prevalence ratio 0·87; 95% CI 0·77-0·99). Barriers to PrEP included taking a daily pill, side-effects, and cost. Participants urged greater education and engagement of transgender women in PrEP implementation. INTERPRETATION South Africa is poised to scale up PrEP services for transgender women. Dedicated transgender clinics are planned to provide comprehensive care, including PrEP, for transgender women. It is critical to ensure transgender women are aware of and have accurate information about PrEP, and that health-care sites are prepared to provide quality care for transgender women. FUNDING Gilead Sciences.
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Affiliation(s)
- Tonia Poteat
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Mannat Malik
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - L Leigh Ann van der Merwe
- Social Health Empowerment Feminist Collective of Transgender Women of Africa, East London, South Africa
| | | | - Dee Adams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bareng A S Nonyane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Restar AJ, Adia A, Cu-Uvin S, Operario D. Characterizing PrEP Awareness and Interest Among Filipina Transgender Women. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:212-228. [PMID: 32749880 PMCID: PMC10442845 DOI: 10.1521/aeap.2020.32.3.212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Pre-exposure prophylaxis (PrEP) can efficaciously avert HIV acquisition for individuals at risk, including transgender individuals (trans) in the Philippines. We conducted multivariate logistic regression procedures in an online sample of Filipina trans women (n = 139) to examine associations of PrEP awareness. In this sample, 53% of Filipina trans women were unaware of PrEP, but almost all (93%) expressed interest in taking PrEP once learning about it. Greater odds of PrEP awareness was associated with discussion of HIV services with their health care providers, higher HIV knowledge, and discussion of PrEP among trans friends. Lower odds of PrEP awareness was associated with reporting being currently unemployed. The findings underscore a subset of trans women who might be early adopters of PrEP, and highlight PrEP inequities among trans women most marginalized, including those who are unemployed and have engaged in sex work.
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Affiliation(s)
- Arjee J Restar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island
- amfAR, The Foundation of AIDS Research, Washington, DC
| | - Alexander Adia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island
| | - Susan Cu-Uvin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island
- Providence-Boston Center for AIDS Research and Miriam Hospital, Department of Medicine, Providence, Rhode Island
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island
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Yager JL, Anderson PL. Pharmacology and drug interactions with HIV PrEP in transgender persons receiving gender affirming hormone therapy. Expert Opin Drug Metab Toxicol 2020; 16:463-474. [DOI: 10.1080/17425255.2020.1752662] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Jenna L. Yager
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Peter L. Anderson
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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A Gap Between Willingness and Uptake: Findings From Mixed Methods Research on HIV Prevention Among Black and Latina Transgender Women. J Acquir Immune Defic Syndr 2020; 82:131-140. [PMID: 31180995 DOI: 10.1097/qai.0000000000002112] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Black and Latina transgender women (BLTW) face significant HIV disparities with estimated HIV prevalence up to 50% and annual incidence rates as high as 2.8 per 100 person-years. However, few studies have evaluated the acceptability and uptake of high-impact HIV prevention interventions among BLTW. SETTING Data collection took place in Baltimore, MD and Washington, DC from May 2015 to May 2017. METHODS This mixed methods study included quantitative interviewer-administered surveys, key informant interviews, and focus group discussions. Rapid HIV testing followed each survey. Logistic regression models tested associations between legal gender affirmation (ie, desired name and gender marker on identity documents), transgender pride, history of exchange sex, HIV risk perception, and willingness to take pre-exposure prophylaxis (PrEP). Transcripts of qualitative data were coded to identify common themes related to engagement in HIV prevention. RESULTS Among 201 BLTW, 56% tested HIV-positive and 87% had heard of PrEP. Only 18% who had heard of PrEP had ever taken it. Of the 72 self-reported HIV-negative or status-unknown BLTW who had never taken PrEP, 75% were willing to take it. In multivariable analyses, history of exchange sex was associated with willingness to take PrEP, whereas greater HIV knowledge and transgender pride were associated with lower likelihood of willingness to take PrEP. Concern about drug interactions with hormone therapy was the most frequently reported barrier to PrEP uptake. CONCLUSIONS Noting the disconnect between PrEP willingness and uptake among BLTW, HIV prevention programs could bridge this gap by responding to identified access barriers and incorporating community-derived strategies.
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Torres TS, Bastos LS, Kamel L, Bezerra DRB, Fernandes NM, Moreira RI, Garner A, Veloso VG, Grinsztejn B, De Boni RB. Do men who have sex with men who report alcohol and illicit drug use before/during sex (chemsex) present moderate/high risk for substance use disorders? Drug Alcohol Depend 2020; 209:107908. [PMID: 32078972 DOI: 10.1016/j.drugalcdep.2020.107908] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 02/08/2020] [Accepted: 02/10/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND We evaluated the prevalence of sexualized drug use (Chemsex) and its association with moderate/high risk for substance use disorders and HIV sexual risk behavior among men who have sex with men (MSM). METHODS We conducted a cross-sectional web-based survey among MSM from Rio de Janeiro (Brazil). The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was used to screen people at moderate/high-risk for substance use disorders. Individuals found to be using substances in the prior three months were asked if they used before/during sex. Sexualized drug use was classified into: no sexualized drug use, sex using only alcohol (alcohol-sex), sex using only illicit drugs (drug-sex) and sex using alcohol and illicit drugs (alcohol-drug-sex). The questionnaire included questions about sociodemographic, HIV status/prevention and risk behavior. A multinomial regression model was performed to assess the factors associated with sexualized drug use. RESULTS Overall, 1048 MSM completed the questionnaire; median age was 29 years. Prevalence of alcohol and illicit drug use in previous 3 months was 89 % and 49 %, respectively. Most MSM (64 %) reported sexualized drug use: 28 % alcohol-sex, 9 % drug-sex and 27 % alcohol-drug-sex. Median ASSIST scores were higher among those reporting sexualized drug use compared to no use. All HIV sexual risk behavior variables presented increasing prevalence across the outcome categories. In the adjusted multivariate model, having moderate/high-risk for substance use disorders were associated with sexualized drug use. CONCLUSIONS MSM reporting sexualized drug use should receive brief intervention for substance use disorders and be evaluated for combination HIV prevention strategies including PrEP.
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Affiliation(s)
- Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil.
| | - Leonardo S Bastos
- Programa de Computação Cientifica, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Luciana Kamel
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil
| | - Daniel R B Bezerra
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil
| | - Nilo M Fernandes
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil
| | - Ronaldo I Moreira
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil
| | - Alex Garner
- Hornet INC, 3962 Ince Blvd, Culver City, CA 90232, United States
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil
| | - Raquel B De Boni
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil
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Cao W, Sun S, Peng L, Gu J, Hao C, Li J, Wei D, Gilmour S, Li J. Low willingness to pay for pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in China. BMC Public Health 2020; 20:337. [PMID: 32178657 PMCID: PMC7077166 DOI: 10.1186/s12889-020-08488-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 03/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) is recommended as an HIV prevention strategy for key populations, in particular men who have sex with men (MSM). However, the willingness to pay market rate for PrEP is largely unknown. This study aimed to investigate the willingness to pay for PrEP and its associated factors among MSM living in Mainland China. Methods A cross-sectional survey was conducted among 689 MSM who were recruited through a gay-friendly health consulting service center in Chengdu, China during 2018–2019. We collected information on participants’ willingness to pay for PrEP and its potential correlates (e.g., PrEP awareness and acceptability, perceived risk of HIV infection) using a structured questionnaire. Univariate and multivariate logistic regression were used for data analyses. Results Only 14.1% of respondents indicated they would not pay any money for PrEP, around half (49.3%) would like to pay $14–84 per month, and very few (6.8%) would like to pay ≥283 per month (market rate). We found that PrEP awareness (unadjusted odds ratio (ORu) = 1.41; 95% CI: 1.01–1.97), acceptability (ORu =1.20; 95% CI: 1.07–1.34), perceived PrEP adherence (ORu =1.23; 95% CI: 1.08–1.41), and perceived PrEP benefit in reducing condom use (ORu =1.29; 95% CI: 1.07–1.55) were all associated with participants’ willingness to pay the market rate for PrEP. Other facilitators of PrEP pay willingness included full disclosure of sexual orientation to health professionals, high HIV literacy, and a high degree of HIV disclosure with sex partners. Conclusions The overall willingness to pay for the market rate of PrEP was low among this urban sample of Chinese MSM. Programs aiming to promote PrEP pay willingness should provide enhanced counseling to improve PrEP-related cognition, deliver accurate HIV/PrEP information to increase health literacy, and decrease stigma towards sexual minorities to develop trust with health professionals.
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Affiliation(s)
- Wangnan Cao
- School of Public Health, Brown University, Providence, RI, USA
| | - Shengzhi Sun
- School of Public Health, Brown University, Providence, RI, USA
| | - Liping Peng
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jing Gu
- School of Public Health, Sun Yat-sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Chun Hao
- School of Public Health, Sun Yat-sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Jibin Li
- Department of Clinical Research, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Dannuo Wei
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Stuart Gilmour
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Jinghua Li
- School of Public Health, Sun Yat-sen University, Guangzhou, China. .,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China.
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37
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HIV Prevention Method Preferences Within Sexual Partnerships Reported by HIV-Negative MSM and TW in Tijuana, Mexico. AIDS Behav 2020; 24:839-846. [PMID: 30945030 DOI: 10.1007/s10461-019-02492-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To assess the potential for decreased condom use as pre-exposure prophylaxis (PrEP) is scaled-up in Latin America, we examined HIV prevention method preferences (neither PrEP nor condoms, condoms only, PrEP only, or PrEP with condoms) within 1302 sexual partnerships reported by 397 HIV-negative men who have sex with men (MSM) and transgender women (TW) in Tijuana, Mexico. Using PrEP with condoms (56%) was preferred to using condoms only (24%), using PrEP only (17%), and using neither PrEP nor condoms (3%). Compared to using condoms only, using PrEP only was preferred within primary (adjusted odds ratio [AOR] = 4.13, 95% confidence interval [CI] 1.92, 8.90) and condomless sex practicing (AOR = 6.97, 95% CI 3.92, 12.40) partnerships, suggesting PrEP use may not displace condom use among MSM and TW in Tijuana and other similar settings.
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Clark JL, Perez-Brumer AG, Reisner SL, Salazar X, McLean S, Huerta L, Silva-Santisteban A, Moriarty KM, Mimiaga MJ, Sanchez J, Mayer KH, Lama JR. Social Network Organization, Structure, and Patterns of Influence Within a Community of Transgender Women in Lima, Peru: Implications for Biomedical HIV Prevention. AIDS Behav 2020; 24:233-245. [PMID: 30989553 PMCID: PMC6801001 DOI: 10.1007/s10461-019-02506-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Understanding social network structures can contribute to the introduction of new HIV prevention strategies with socially marginalized populations like transgender women (TW). We conducted 20 semi-structured interviews and four focus groups (n = 32) with TW from selected social networks in Lima, Peru between May and July, 2015. Participants described layers of social influence from diverse actors in their social networks. The majority identified a close relative as their primary social support, with whom they confided secrets but avoided issues of transgender identity, sexuality, and sex work. Participants described close circles of TW friends with whom they shared information about gender identity, body modification, and sexual partners, but avoided issues like HIV. Community leadership included political leaders (who advocated for transgender rights) as well as social leaders (who introduced TW to hormone therapy, body modification, and commercial sex). Detailed analysis of TW social networks can contribute to implementation and acceptability of new HIV prevention technologies.
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Affiliation(s)
- J L Clark
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.
| | - A G Perez-Brumer
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - S L Reisner
- Department of Pediatrics, Harvard Medical School and Boston Children's Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - X Salazar
- Instituto de Estudios de Sexualidad y Derechos Humanos, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - S McLean
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - L Huerta
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| | - A Silva-Santisteban
- Instituto de Estudios de Sexualidad y Derechos Humanos, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - K M Moriarty
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA
- Brown University Alpert School of Medicine, Providence, RI, USA
| | - M J Mimiaga
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert School of Medicine, Providence, RI, USA
| | - J Sanchez
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
- CITBM, Universidad Nacional Mayor San Marcos, Lima, Peru
- Department of Global Health, University of Washington School of Medicine, Seattle, WA, USA
| | - K H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - J R Lama
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
- Department of Global Health, University of Washington School of Medicine, Seattle, WA, USA
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Torres TS, Marins LMS, Veloso VG, Grinsztejn B, Luz PM. How heterogeneous are MSM from Brazilian cities? An analysis of sexual behavior and perceived risk and a description of trends in awareness and willingness to use pre-exposure prophylaxis. BMC Infect Dis 2019; 19:1067. [PMID: 31856746 PMCID: PMC6923868 DOI: 10.1186/s12879-019-4704-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/12/2019] [Indexed: 12/22/2022] Open
Abstract
Background Brazil has the largest population of individuals living with HIV/AIDS in Latin America, with a disproportional prevalence of infection among gays, bisexuals and other men who have sex with men (MSM). Of relevance to prevention and treatment efforts, Brazilian MSM from different regions may differ in behaviors and risk perception related to HIV. Methods We report on MSM living in 29 different cities: 26 Brazilian state capitals, the Federal District and two large cities in São Paulo state assessed in three web-based surveys (2016–2018) advertised on Grindr, Hornet and Facebook. Using logistic regression models, we assessed the association of risk behavior with HIV perceived risk as well as factors associated with high-risk behavior. Results A total of 16,667 MSM completed the survey. Overall, MSM from the North and Northeast were younger, more black/mixed-black, of lower income and lower education compared to MSM from the South, Southeast and Central-west. Though 17% had never tested for HIV (with higher percentages in the North and Northeast), condomless receptive anal sex (previous 6 months) and high-risk behavior as per HIV Incidence Risk scale for MSM were observed for 41 and 64%, respectively. Sexual behavior and HIV perceived risk had low variability by city and high-risk behavior was strongly associated with high HIV perceived risk. Younger age, being gay/homosexual, having a steady partner, binge drinking, report of sexually transmitted infection (STI) and ever testing for HIV were associated with increased odds of high-risk behavior. Awareness and willingness to use PrEP increased from 2016 to 2018 in most cities. Conclusions Overall, MSM socio-demographic characteristics were heterogeneous among Brazilian cities, but similarities were noted among the cities from the same administrative region with a marked exception of the Federal District not following the patterns for the Central-West. Combination HIV prevention is most needed among young men who self-identify as gay/homosexual, report binge drinking or prior STI.
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Affiliation(s)
- Thiago S Torres
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil.
| | - Luana M S Marins
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Valdilea G Veloso
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Paula M Luz
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
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Huang W, Wu D, Ong JJ, Smith MK, Yang F, Fu H, Tang W, Tucker JD. Prepared for PrEP: preferences for HIV pre-exposure prophylaxis among Chinese men who have sex with men in an online national survey. BMC Infect Dis 2019; 19:1057. [PMID: 31842772 PMCID: PMC6916236 DOI: 10.1186/s12879-019-4692-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 12/09/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is not widely available in China. Previous studies reported low awareness and inconclusive findings on the acceptability of PrEP among Chinese men who have sex with men (MSM). METHODS We conducted a secondary analysis of an online national survey comparing preferences for oral and long-acting injectable PrEP among MSM and identifying correlates of preferences. The study did not collect detailed information about partner types that may influence negotiated safety and PrEP uptake. RESULTS Nine-hundred and seventy-nine men from the larger sample of 1045 men responded to the PrEP survey questions. Most men (81.9%) had never heard of PrEP, but reported interest in using PrEP. More participants chose injectable PrEP (36.3%) as their preferred formulation than oral PrEP (24.6%). Men who had at least two HIV tests (adjusted OR = 1.36, 95%CI 1.04, 1.78) more commonly preferred injectable PrEP. CONCLUSION Our findings may help inform PrEP messaging in areas where PrEP has yet to be scaled up.
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Affiliation(s)
- Wenting Huang
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Dan Wu
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Jason J. Ong
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - M. Kumi Smith
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Twin Cities, USA
| | - Fan Yang
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Hongyun Fu
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Eastern Virginia Medical School, Norfolk, USA
| | - Weiming Tang
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Joseph D. Tucker
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- London School of Hygiene and Tropical Medicine, London, UK
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
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Torres-Cruz C, Suárez-Díaz E. The stratified biomedicalization of HIV prevention in Mexico City. Glob Public Health 2019; 15:598-610. [PMID: 31630626 DOI: 10.1080/17441692.2019.1679217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In the late 1990s antiretroviral pharmaceuticals began to be used in the United States and Western Europe to prevent HIV infection in contexts of occupational exposure. One decade later, the application of Post Exposure Prophylaxis (PEP) and Pre-Exposure Prophylaxis (PrEP) had been extended to include cases of exposure to sexual assault, injection-drug use, and consensual sexual intercourse deemed at high risk. This article explores the implementation of biomedicalized HIV prevention protocols at a public healthcare clinic in Mexico City, building on sociological-feminist approaches in Science and Technology Studies (STS) and drawing on interviews with key actors, as well as digital ethnography. We emphasise the stratified biomedicalization or, said otherwise, the differences in PEP and PrEP accessibility and consumption among different populations and groups. We also describe the fragile grip of institutionalised biomedical solutions when alternative 'moral economies' intersect with them, particularly in contexts like Mexico, where governmental funding for experimental research on biomedical innovations has been limited. This text reveals both the existence of contrasting technoscientific interventions along class and gender differences, and the multiple and vivid ways by which individuals appropriate and interpret global biomedical practices.
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Affiliation(s)
- César Torres-Cruz
- Science and Technology Studies Group, School of Sciences, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Edna Suárez-Díaz
- Science and Technology Studies Group, School of Sciences, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
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Xie L, Wu Y, Meng S, Hou J, Fu R, Zheng H, He N, Wang M, Meyers K. Risk Behavior Not Associated with Self-Perception of PrEP Candidacy: Implications for Designing PrEP Services. AIDS Behav 2019; 23:2784-2794. [PMID: 31280397 PMCID: PMC7232689 DOI: 10.1007/s10461-019-02587-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In a study of sexually-active HIV-negative men who have sex with men (MSM) in China, we compared behavioral indication for pre-exposure prophylaxis (PrEP) based on risk criteria to self-perception of PrEP candidacy (SPC) and explored factors associated with SPC. Of 708 MSM surveyed, 323 (45.6%) were behaviorally-indicated for PrEP, among whom 42.1% self-perceived as appropriate PrEP candidates. In a multivariable model we found no association between sexual behavior nor HIV risk perception and SPC but found that higher perceived benefits of PrEP, increased frequency of HIV testing, and low condom use self-efficacy were positively-associated with SPC. In a sub-analysis restricted to MSM behaviorally-indicated for PrEP, relationship-factors were also significant. Our findings suggest that PrEP implementers should look beyond risk criteria to consider shared decision-making tools that support individuals to assess whether they are appropriate PrEP candidates based on their existing HIV prevention strategies, sexual health goals, and relationship dynamics.
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Affiliation(s)
- Lu Xie
- Institute of HIV/AIDS, The First Hospital of Changsha, Changsha, Hunan, China
| | - Yumeng Wu
- Aaron Diamond AIDS Research Center, The Rockefeller University, 455 First Avenue, Floor 7, New York, NY, 10016, USA
| | - Siyan Meng
- School of Public Health, Fudan University, Shanghai, China
| | - Jianhua Hou
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Rong Fu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | | | - Na He
- School of Public Health, Fudan University, Shanghai, China
| | - Min Wang
- Institute of HIV/AIDS, The First Hospital of Changsha, Changsha, Hunan, China
| | - Kathrine Meyers
- Aaron Diamond AIDS Research Center, The Rockefeller University, 455 First Avenue, Floor 7, New York, NY, 10016, USA.
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Soares F, MacCarthy S, Magno L, da Silva LAV, Amorim L, Nunn A, Oldenburg CE, Dourado I. Factors Associated with PrEP Refusal Among Transgender Women in Northeastern Brazil. AIDS Behav 2019; 23:2710-2718. [PMID: 30972620 PMCID: PMC9982655 DOI: 10.1007/s10461-019-02501-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Brazil has recently integrated HIV Pre-exposure Prophylaxis (PrEP) into its public health system and offered to key populations such as transgender women (TGW). This study investigates factors associated with PrEP refusal among TGW living in one of the largest and poorest cities of Brazil. We recruited 127 TGW using Respondent Driven Sampling (RDS) in Salvador, Brazil. Latent class analysis (LCA) was used to define acceptability of PrEP. Two latent classes were identified: "high acceptability of PrEP" (91.3%) and "PrEP refusal" (8.7%). PrEP was less acceptable among white TGW and among those age 25 or older, with income above minimum wage (≥ US$252.87), and reporting unprotected receptive anal intercourse with (URAI) causal partners. The findings highlight how nuanced strategies that takes into consideration unique characteristics are needed to effectively address the acceptability of PrEP.
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Affiliation(s)
- Fabiane Soares
- Institute of Collective Health, Federal University of Bahia (Universidade Federal da Bahia/Instituto de Saúde Coletiva), Rua Basílio da Gama, s/n, Campos Universitário do Canela, Salvador, Bahia, CEP: 40.110-040, Brazil.
| | | | - Laio Magno
- Institute of Collective Health, Federal University of Bahia (Universidade Federal da Bahia/Instituto de Saúde Coletiva), Rua Basílio da Gama, s/n, Campos Universitário do Canela, Salvador, Bahia CEP: 40.110-040, Brazil,Department of Life Science, State University of Bahia (Universidade do Estado da Bahia/Departamento de Ciências da Vida), Salvador, BA, Brazil
| | - Luís Augusto Vasconcelos da Silva
- Institute of Collective Health, Federal University of Bahia (Universidade Federal da Bahia/Instituto de Saúde Coletiva), Rua Basílio da Gama, s/n, Campos Universitário do Canela, Salvador, Bahia CEP: 40.110-040, Brazil,Institute of Humanities, Arts and Sciences Professor Milton Santos, Federal University of Bahia (Universidade Federal da Bahia/Instituto de Humanidades, Artes e Ciências Professor Milton Santos), Salvador, BA, Brazil
| | - Leila Amorim
- Institute of Collective Health, Federal University of Bahia (Universidade Federal da Bahia/Instituto de Saúde Coletiva), Rua Basílio da Gama, s/n, Campos Universitário do Canela, Salvador, Bahia CEP: 40.110-040, Brazil,Institute of Mathematics and Statistics, Federal University of Bahia (Universidade Federal da Bahia/Instituto de Matemática e Estatística), Salvador, BA, Brazil
| | - Amy Nunn
- School of Public Health, Brown University, Providence, RI, USA
| | - Catherine E. Oldenburg
- Francis I. Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia (Universidade Federal da Bahia/Instituto de Saúde Coletiva), Rua Basílio da Gama, s/n, Campos Universitário do Canela, Salvador, Bahia CEP: 40.110-040, Brazil
| | - The PopTrans Group
- Institute of Collective Health, Federal University of Bahia (Universidade Federal da Bahia/Instituto de Saúde Coletiva), Rua Basílio da Gama, s/n, Campos Universitário do Canela, Salvador, Bahia CEP: 40.110-040, Brazil
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Ajayi AI, Mudefi E, Yusuf MS, Adeniyi OV, Rala N, Goon DT. Low awareness and use of pre-exposure prophylaxis among adolescents and young adults in high HIV and sexual violence prevalence settings. Medicine (Baltimore) 2019; 98:e17716. [PMID: 31651904 PMCID: PMC6824740 DOI: 10.1097/md.0000000000017716] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
South Africa has adopted pre-exposure prophylaxis (PrEP) as a preventive strategy for populations at-risk for HIV, though uptake is low among adolescents and young adults. We examined the awareness and use of PrEP among adolescents and young adults in the Eastern Cape, South Africa.This cross-sectional study was conducted between June and November 2018 among 772 adolescents and young adults (aged 16-24 years) selected using stratified random sampling in a South African university. An electronic self-administered questionnaire was used to elicit demographic information, behavioral, family-related characteristics, awareness and use of PrEP. Adjusted and unadjusted logistic regression models were used to examine the predictors of PrEP awareness.The overall level of PrEP awareness was 18.8%; however, only 1.7% of participants had used PrEP, 7.5% of had seen it, 4.8% knew how much it cost, and 14.8% knew where and how to get it. In the adjusted regression analysis, only adequate family support (AOR: 2.11; CI: 1.47-3.04) and discussions of HIV and sexually transmitted infections with sexual partners (AOR: 1.78; CI: 1.19-2.67) were associated with a higher likelihood of being aware of PrEP.The level of awareness and use of PrEP is still very low among adolescents and young adults who may need it to prevent HIV infection. Poor awareness of PrEP among adolescents and young adults in high HIV risk settings may limit its use. Thus, concerted efforts are needed to promote awareness and access to PrEP among young South African adults.
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Affiliation(s)
- Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Centre, APHRC Campus, Manga Close, Nairobi, Kenya
| | - Elmon Mudefi
- Department of Sociology, University of Fort Hare, 50 Church Street, East London
| | | | - Oladele Vincent Adeniyi
- Department of Family Medicine & Rural Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha/East London Hospital Complex, Cecilia Makiwane Hospital
| | - Ntombana Rala
- Nursing Department, University of Fort Hare, 50 Church Street, East London, South Africa
| | - Daniel Ter Goon
- Nursing Department, University of Fort Hare, 50 Church Street, East London, South Africa
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Holder CL, Perez-Gilbe HR, Fajardo FJ, Garcia S, Cyrus E. Disparities of HIV risk and PrEP use among transgender women of color in South Florida. J Natl Med Assoc 2019; 111:625-632. [PMID: 31526532 DOI: 10.1016/j.jnma.2019.08.001] [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] [Received: 10/12/2018] [Revised: 06/03/2019] [Accepted: 08/10/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The majority of the transgender female population in South Florida are Latina and Black, and are at greatest risk for acquiring HIV, yet there is limited research focused on South Florida transgender women of color. The study objective was to describe the disparities among racial/ethnic minority transgender women regarding HIV screening, pre exposure prophylaxis (PrEP) knowledge and PrEP utilization. METHODS Sixty transgender women, recruited from South Florida community-based organizations, completed a questionnaire on HIV prevention and PrEP awareness and use. Univariate statistics were generated to describe sexual risk behavior, PrEP awareness and use, and HIV screening by race/ethnicity. RESULTS Of the 60 participants, 50.0% were Latina, 35.0% African American/non-Hispanic Black (AA/NHB), 11.7% white and 3.3% other race/ethnicity. 75.0% reported being screened for HIV in the last 12 months, 15.3% of the participants reported living with HIV (PLWH), while 18.6% reported an unknown status. Compared to Latinas, AA/NHB demonstrated more risk (≥2 sexual partners: 76.2% vs 53.3%; transactional sex: 47.6% vs. 26.7%; unprotected receptive anal sex: 42.9% v. 26.7%), and more engagement in routine care (81.0% vs. 76.7%) at least once a year. PrEP knowledge was 76.7% among Latinas, 71.4% among whites, 47.6% among Blacks, and 50.0% among other race/ethnicity. 65.0% of participants knew about PrEP. Of the 8.2% with current or previous PrEP use, none were AA/NHB. CONCLUSION Findings suggest that education and public health campaigns in South Florida that promote HIV prevention should focus on increasing awareness and utilization of PrEP among racial/ethnic minority transgender, particularly among AA/NHB transgender women who are most at risk and had the lowest knowledge and use of PrEP.
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Affiliation(s)
- Cheryl L Holder
- Florida International University HWCOM Department of Humanities, Health and Society, Miami, FL 33199, USA.
| | - Hector R Perez-Gilbe
- Research Librarian for the Health Sciences UCI Libraries, University of California-Irvine, Irvine, CA 92623, USA.
| | - Francisco J Fajardo
- Instruction and Information Services Librarian, Florida International University HWCOM Department of Humanities, Health and Society, Miami, FL 33199, USA
| | - Stephanie Garcia
- Research Scientist and Project Coordinator for the Integrated Biostatistics and Data Management Center, Florida International University Department of Biostatistics, Miami, FL 33199, USA
| | - Elena Cyrus
- Florida International University, Robert Stempel College of Public Health & Social Work, Department of Epidemiology, Miami, FL 33199, USA
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De Boni RB, Veloso VG, Fernandes NM, Lessa F, Corrêa RG, Lima RDS, Cruz M, Oliveira J, Nogueira SM, de Jesus B, Reis T, Lentini N, Miranda RL, Bingham T, Johnson CC, Barbosa Junior A, Grinsztejn B. An Internet-Based HIV Self-Testing Program to Increase HIV Testing Uptake Among Men Who Have Sex With Men in Brazil: Descriptive Cross-Sectional Analysis. J Med Internet Res 2019; 21:e14145. [PMID: 31373276 PMCID: PMC6694730 DOI: 10.2196/14145] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 12/31/2022] Open
Abstract
Background Approximately 30% of people living with HIV worldwide are estimated to be unaware of their infection. HIV self-testing (HIVST) is a strategy recommended by the World Health Organization to increase access to and uptake of testing among key populations who are at high risk for HIV infection. Objective This study aimed to describe the development and feasibility of a free, anonymous, internet-based HIVST strategy designed for men who have sex with men in Curitiba, Brazil (electronic testing [e-testing]). Methods The project was developed under the scope of the “A Hora é Agora” (The Time is Now) program. Individuals aiming to request an HIVST package (two tests each) answered an anonymous 5-minute questionnaire regarding inclusion criteria and sexual risk behavior. Eligible individuals could receive one package every 6 months for free. Website analytics, response to online questionnaires, package distribution, and return of test results were monitored via a platform-integrated system. Results Between February 2015 and January 2016, the website documented 17,786 unique visitors and 3218 completed online questionnaires. Most individuals self-reported being white (77.0%), young (median age: 25 years, interquartile range: 22-31 years), educated (87.3% completed secondary education or more), and previously tested for HIV (62.5%). Overall, 2526 HIVST packages were delivered; of those, 542 (21.4%) reported a result online or by mail (23 reactive and 11 invalid). During the study period, 37 individuals who reported using e-testing visited the prespecified health facility for confirmatory testing (30 positive, 7 negative). Conclusions E-testing proved highly feasible and acceptable in this study, thus supporting scale-up to additional centers for men who have sex with men in Brazil.
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Affiliation(s)
- Raquel Brandini De Boni
- Instituto Nacional de Infectologia Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Nilo Martinez Fernandes
- Instituto Nacional de Infectologia Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Flavia Lessa
- Instituto Nacional de Infectologia Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Renato Girade Corrêa
- National Department of STI, AIDS, and Viral Hepatitis, Ministry of Health, Brailia, Brazil
| | - Renato De Souza Lima
- National Department of STI, AIDS, and Viral Hepatitis, Ministry of Health, Brailia, Brazil
| | - Marly Cruz
- Escola Nacional de Saúde Pública, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | | | - Beto de Jesus
- Escola Nacional de Saúde Pública, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Nena Lentini
- Centers for Disease Control and Prevention-Brazil, Brasilia, Brazil
| | | | - Trista Bingham
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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47
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Kwan TH, Lee SS. Bridging Awareness and Acceptance of Pre-Exposure Prophylaxis Among Men Who Have Sex With Men and the Need for Targeting Chemsex and HIV Testing: Cross-Sectional Survey. JMIR Public Health Surveill 2019; 5:e13083. [PMID: 31271148 PMCID: PMC6636239 DOI: 10.2196/13083] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 05/02/2019] [Accepted: 06/03/2019] [Indexed: 11/23/2022] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) is currently an important tool for HIV prevention, especially in communities with higher risk of infection, notably men who have sex with men (MSM). To date, PrEP has remained generally unavailable in many cities around the world. In the planning of strategies for PrEP targeting MSM, community assessment is crucial to understand members’ responses to the new intervention. Objective Awareness and acceptance are 2 different but intricately linked contexts of PrEP. The aim of this study was to identify the determinants of awareness and acceptance of PrEP among MSM and to delineate their interrelationships in Hong Kong where PrEP services have not been developed. Methods A Web-based questionnaire survey was administered in light of the popularity of the internet as a platform for information and networking in the MSM community. Factors associated with PrEP acceptance and awareness were separately analyzed, and their predictors were subsequently tested by multivariate logistic regression. Associations between acceptance and awareness of PrEP were examined by factor network analysis. Results Between August and September 2016, results from a total of 453 HIV-negative MSM were analyzed. Half (49.7%, 225/453) of the respondents were aware of PrEP, and 78.3% (355/453) would consider using PrEP when it becomes available. Awareness of PrEP was associated with recent (P=.01) and ongoing (P=.04) use of psychotropic drugs for sex (chemsex). MSM who used online forums to seek sex partners had lower awareness (P=.04) than those visiting physical venues for sex networking. MSM who accepted PrEP were more likely users of internet channels for sex networking (P=.049), especially location-based social network apps (P=.04). MSM accepting PrEP were more concerned about their partners’ HIV status (P=.002), history of sexually transmitted infections (P=.01), condom use (P=.02), and HIV testing behavior (P=.02). Multivariate logistic regressions revealed that PrEP awareness was related to one’s networking pattern, whereas its acceptance was associated with inclination to self-protect from HIV. Factor network analysis highlighted the importance of chemsex, which was linked by over half of the edges, whereas the rest were contributed by HIV testing behaviors. Conclusions In Hong Kong, the overall awareness among MSM toward PrEP was only moderate but their acceptance was higher. Targeting MSM with chemsex behaviors through Web-based platforms and parallel development of tailored HIV testing services are important when introducing PrEP in the community.
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Affiliation(s)
- Tsz Ho Kwan
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, China (Hong Kong)
| | - Shui Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, China (Hong Kong)
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48
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Torres TS, Konda KA, Vega-Ramirez EH, Elorreaga OA, Diaz-Sosa D, Hoagland B, Diaz S, Pimenta C, Bennedeti M, Lopez-Gatell H, Robles-Garcia R, Grinsztejn B, Caceres C, Veloso VG. Factors Associated With Willingness to Use Pre-Exposure Prophylaxis in Brazil, Mexico, and Peru: Web-Based Survey Among Men Who Have Sex With Men. JMIR Public Health Surveill 2019; 5:e13771. [PMID: 31210143 PMCID: PMC6601256 DOI: 10.2196/13771] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 12/23/2022] Open
Abstract
Background HIV disproportionally affects key populations including men who have sex with men (MSM). HIV prevalence among MSM varies from 17% in Brazil and Mexico to 13% in Peru, whereas it is below 0.5% for the general population in each country. Pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir is being implemented in the context of combination HIV prevention. Reports on willingness to use PrEP among MSM have started to emerge over the last few years. Previously reported factors associated with willingness to use PrEP include awareness, higher sexual risk behavior, and previous sexually transmitted infection. Objective This study aimed to evaluate the factors associated with willingness to use daily oral PrEP among MSM in 3 Latin American, middle-income countries (Brazil, Mexico, and Peru). Methods This Web-based, cross-sectional survey was advertised in 2 gay social network apps (Grindr and Hornet) used by MSM to find sexual partners and on Facebook during 2 months in 2018. Inclusion criteria were being 18 years or older, cisgender men, and HIV-negative by self-report. Eligible individuals answered questions on demographics, behavior, and PrEP (awareness, willingness to use, barriers, and facilitators). Multivariable logistic regression modeling was performed to assess the factors associated with willingness to use daily oral PrEP in each country. Results From a total sample of 43,687 individuals, 44.54% of MSM (19,457/43,687) were eligible and completed the Web-based survey—Brazil: 58.42% (11,367/19,457), Mexico: 30.50% (5934/19,457), and Peru: 11.08% (2156/19,457); median age was 28 years (interquartile range: 24-34), and almost half lived in large urban cities. Most participants were recruited on Grindr (69%, 13,349/19,457). Almost 20% (3862/19,352) had never tested for HIV, and condomless receptive anal sex was reported by 40% (7755/19,326) in the previous 6 months. Whereas 67.51% (13,110/19,376) would be eligible for PrEP, only 9.80% (1858/18,959) of participants had high HIV risk perception. PrEP awareness was reported by 64.92% (12,592/19,396); this was lower in Peru (46.60%, 1002/2156). Overall, willingness to use PrEP was reported by 64.23% (12,498/19,457); it was highest in Mexico (70%, 4158/5934) and lowest in Peru (58%, 1241/2156). In multivariate regression models adjusted for age, schooling, and income in each country, willingness to use PrEP was positively associated with PrEP awareness and PrEP facilitators (eg, free PrEP and HIV testing) and negatively associated with behavioral (eg, concerned by daily pill regimen) and belief barriers (eg, sexual partners may expect condomless sex). Conclusions In this first cross-country, Web-based survey in Latin America, willingness to use PrEP was found to be high and directly related to PrEP awareness. Interventions to increase awareness and PrEP knowledge about safety and efficacy are crucial to increase PrEP demand. This study provides important information to support the implementation of PrEP in Brazil, Mexico, and Peru.
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Affiliation(s)
- Thiago Silva Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/Fiocruz), Rio de Janeiro, Brazil
| | - Kelika A Konda
- Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru
| | - E Hamid Vega-Ramirez
- Condesa & Condesa-Iztapalapa Specialized Clinics, Mexico City, Mexico.,National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Oliver A Elorreaga
- Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru
| | - Dulce Diaz-Sosa
- Condesa & Condesa-Iztapalapa Specialized Clinics, Mexico City, Mexico.,National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/Fiocruz), Rio de Janeiro, Brazil
| | - Steven Diaz
- Center for Prevention and Comprehensive Healthcare for HIV/AIDS of Mexico City, Mexico City, Mexico
| | | | - Marcos Bennedeti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/Fiocruz), Rio de Janeiro, Brazil
| | | | | | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/Fiocruz), Rio de Janeiro, Brazil
| | - Carlos Caceres
- Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/Fiocruz), Rio de Janeiro, Brazil
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- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/Fiocruz), Rio de Janeiro, Brazil.,Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru.,Condesa & Condesa-Iztapalapa Specialized Clinics, Mexico City, Mexico
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49
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Luz PM, Osher B, Grinsztejn B, Maclean RL, Losina E, Stern ME, Struchiner CJ, Parker RA, Freedberg KA, Mesquita F, Walensky RP, Veloso VG, Paltiel AD. The cost-effectiveness of HIV pre-exposure prophylaxis in men who have sex with men and transgender women at high risk of HIV infection in Brazil. J Int AIDS Soc 2019; 21:e25096. [PMID: 29603888 PMCID: PMC5878414 DOI: 10.1002/jia2.25096] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 03/01/2018] [Indexed: 12/22/2022] Open
Abstract
Introduction Men who have sex with men (MSM) and transgender women (TGW) in Brazil experience high rates of HIV infection. We examined the clinical and economic outcomes of implementing a pre‐exposure prophylaxis (PrEP) programme in these populations. Methods We used the Cost‐Effectiveness of Preventing AIDS Complications (CEPAC)‐International model of HIV prevention and treatment to evaluate two strategies: the current standard of care (SOC) in Brazil, including universal ART access (No PrEP strategy); and the current SOC plus daily tenofovir/emtracitabine PrEP (PrEP strategy) until age 50. Mean age (31 years, SD 8.4 years), age‐stratified annual HIV incidence (age ≤ 40 years: 4.3/100 PY; age > 40 years: 1.0/100 PY), PrEP effectiveness (43% HIV incidence reduction) and PrEP drug costs ($23/month) were from Brazil‐based sources. The analysis focused on direct medical costs of HIV care. We measured the comparative value of PrEP in 2015 United States dollars (USD) per year of life saved (YLS). Willingness‐to‐pay threshold was based on Brazil's annual per capita gross domestic product (GDP; 2015: $8540 USD). Results Lifetime HIV infection risk among high‐risk MSM and TGW was 50.5% with No PrEP and decreased to 40.1% with PrEP. PrEP increased per‐person undiscounted (discounted) life expectancy from 36.8 (20.7) years to 41.0 (22.4) years and lifetime discounted HIV‐related medical costs from $4100 to $8420, which led to an incremental cost‐effectiveness ratio (ICER) of $2530/YLS. PrEP remained cost‐effective (<1x GDP) under plausible variation in key parameters, including PrEP effectiveness and cost, initial cohort age and HIV testing frequency on/off PrEP. Conclusion Daily tenofovir/emtracitabine PrEP among MSM and TGW at high risk of HIV infection in Brazil would increase life expectancy and be highly cost‐effective.
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Affiliation(s)
- Paula M Luz
- The Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Benjamin Osher
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Beatriz Grinsztejn
- The Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Rachel L Maclean
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Elena Losina
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.,Harvard University Center for AIDS Research, Harvard Medical School, Boston, MA, USA.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Madeline E Stern
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Claudio J Struchiner
- The Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Robert A Parker
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.,Harvard University Center for AIDS Research, Harvard Medical School, Boston, MA, USA.,Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Kenneth A Freedberg
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard University Center for AIDS Research, Harvard Medical School, Boston, MA, USA.,Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA
| | - Fabio Mesquita
- The Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Rochelle P Walensky
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard University Center for AIDS Research, Harvard Medical School, Boston, MA, USA.,Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA.,Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA, USA
| | - Valdilea G Veloso
- The Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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50
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Torres TS, Luz PM, De Boni RB, de Vasconcellos MTL, Hoagland B, Garner A, Moreira RI, Veloso VG, Grinsztejn B. Factors associated with PrEP awareness according to age and willingness to use HIV prevention technologies: the 2017 online survey among MSM in Brazil .. AIDS Care 2019; 31:1193-1202. [PMID: 31122033 DOI: 10.1080/09540121.2019.1619665] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Brazil has the largest population of individuals living with HIV/AIDS in Latin America with a disproportional prevalence of infection among men who have sex with men (MSM). This study evaluated PrEP awareness by age (18-24, 25-35, ≥36 years), its associated factors and the willingness to use HIV prevention technologies among MSM using a GSN app in Brazil. Inclusion criteria were ≥18 years-old, cisgender men and HIV-negative serostatus. Of 7242 individuals, 4136 (57%) completed the questionnaire. PrEP awareness was reported by 51% (though lower among MSM aged 18-24 and ≥36 years) and its associated factors were higher family income, most friends with the same sexual orientation, high number of male sexual partners and marijuana use. HIV testing (never vs. at least once) lead to an almost 3-fold increase in the odds of PrEP awareness. High HIV risk perception led to increased PrEP awareness only among MSM aged 18-24 years. A total of 2335 (56%) was willing to use daily oral PrEP. PrEP awareness remains low in Brazil and mobile tools are key strategies to reach MSM and increase awareness of prevention technologies. Community-based interventions could add to online campaigns to reach the most vulnerable, which include young, non-white and lower-income MSM.
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Affiliation(s)
- Thiago S Torres
- a Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas , Rio de Janeiro , Brazil
| | - Paula M Luz
- a Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas , Rio de Janeiro , Brazil
| | - Raquel B De Boni
- a Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas , Rio de Janeiro , Brazil
| | | | - Brenda Hoagland
- a Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas , Rio de Janeiro , Brazil
| | | | - Ronaldo I Moreira
- a Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas , Rio de Janeiro , Brazil
| | - Valdilea G Veloso
- a Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas , Rio de Janeiro , Brazil
| | - Beatriz Grinsztejn
- a Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas , Rio de Janeiro , Brazil
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