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Takenaka BP, Barbour R, Kirklewski SJ, Nicholson E, Tengatenga C, Hansen NB, Kershaw T. Activity Space Mapping and Pre-Exposure Prophylaxis Uptake Among Gay, Bisexual, and Other Sexual Minority Men in Small Cities and Towns in the United States. AIDS Behav 2025; 29:1266-1280. [PMID: 39745597 DOI: 10.1007/s10461-024-04601-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2024] [Indexed: 04/11/2025]
Abstract
In the US, gay, bisexual, and other sexual minoritized men (GBSMM) remain disproportionately impacted by HIV, and continue to experience unmet needs for pre-exposure prophylaxis (PrEP). A growing body of literature has underscored the need to consider the geographic factors of HIV prevention, particularly beyond administrative boundaries and towards localized spaces that influence the accessibility and utilization of health-promoting resources. Therefore, the purpose of this study is to examine the associations of driving times from activity spaces to PrEP offering facilities and individual PrEP uptake. A total of 218 GBSMM (ages 18-34) from Connecticut and Georgia were sampled from a longitudinal cohort study. We used the getis-ord-gi statistic to examine the spatial clustering of PrEP offering facilities, and generalized estimating equations (GEE) and post-hoc moderation analyses to explore the state interactions on driving time and PrEP uptake. Our main findings suggest that for participants in Connecticut, state of residence was a significant moderator on driving time and ever hearing of PrEP and ever taking PrEP. Whereas for participants in Georgia, state of residence moderated the likelihood of returning to activity spaces of participants in both Connecticut and Georgia on PrEP uptake. These findings provide important direction for geographic inequities on PrEP use, but also a pragmatic method for co-creating and re-imagining place-health research. These results also offer an avenue to leverage the dynamic nuance of activity spaces as indicators to inform structural interventions for PrEP that are more equitable for GBSMM in small cities and towns in the U.S.
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Affiliation(s)
- Bryce Puesta Takenaka
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA.
| | - Russell Barbour
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA
| | - Sally J Kirklewski
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA
| | - Erin Nicholson
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA
| | - Cecil Tengatenga
- School of Medicine, University of Connecticut, 200 Academic Wy, Farmington, CT, 06032, USA
| | - Nathan B Hansen
- Department of Health Promotion and Behavior, University of Georgia College of Public Health, 100 Foster Road, Athens, GA, 30606, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA
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2
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Georgiadis N, Papamichail D, Lytras T, Halkitis PN, Tzanakaki G, Kornarou E, Vassilakou NT, Sergentanis TN. The impact of HIV preexposure prophylaxis on bacterial sexually transmitted infection occurrence in MSM: a systematic review and meta-analysis. AIDS 2024; 38:1033-1045. [PMID: 38669203 DOI: 10.1097/qad.0000000000003837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
OBJECTIVE To evaluate the effect of preexposure prophylaxis (PrEP) initiation on bacterial sexually transmitted infection (STI) occurrence (overall; chlamydia; gonorrhea; syphilis), in MSM. DESIGN Systematic review and meta-analysis. METHODS Systematic searches were performed in PubMed, Embase, and Scopus without language restrictions until 1 February 2023. We sought studies reporting data for the estimation of incidence rate ratios (IRR), prevalence ratios or cumulative incidence ratios (the latter in equal time periods before and after PrEP initiation) regarding bacterial STI occurrence. Separate analyses were performed overall for any STI, syphilis, chlamydia and gonorrhea (overall; rectal; urethral; pharyngeal for the two latter conditions); ratios greater than unity denoted increase in STI occurrence after PrEP initiation. RESULTS Twenty-three eligible studies with 11 776 participants (age range: 18-71 years) with a median follow-up of 12 months were included. Overall, PrEP initiation was associated with a significant increase in the occurrence of any STI (pooled effect size: 1.15, 95% confidence interval (CI): 1.04-1.26), any gonorrhea (pooled effect size: 1.17, 95% CI: 1.02-1.34), any chlamydia (pooled effect size: 1.31, 95% CI: 1.09-1.58) and rectal chlamydia (pooled effect size: 1.31, 95% CI: 1.05-1.64), whereas a borderline increase was found in urethral chlamydia (pooled effect size: 1.25, 95% CI: 0.99-1.60, P = 0.064). Changes in pharyngeal chlamydia and site-specific gonorrhea occurrence did not reach statistical significance. Syphilis showed virtually no change after PrEP initiation (pooled effect size: 0.99, 95% CI: 0.72-1.37). CONCLUSION These results highlight the need for more comprehensive, accessible STI testing to tackle bacterial STI infections in PrEP users.
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Affiliation(s)
- Nikolaos Georgiadis
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Dimitrios Papamichail
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Theodore Lytras
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Perry N Halkitis
- Department of Biostatistics & Epidemiology and Center for Health Identity, Behavior & Prevention Studies, School of Public Health, Rutgers University, Newark and New Brunswick, NJ, USA
| | - Georgina Tzanakaki
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Eleni Kornarou
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Nair-Tonia Vassilakou
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Theodoros N Sergentanis
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
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3
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Owens C, Brandenburg D, Grant MJ, Carter K, Hoffman M, Hubach RD. Parental Concerns of Their Sexual and Gender Minority Adolescents Using HIV Pre-Exposure Prophylaxis. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:85-99. [PMID: 36735230 DOI: 10.1521/aeap.2023.35.1.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Although parents of sexual and gender minority (SGM) adolescents are key stakeholders in SGM adolescents using HIV pre-exposure prophylaxis (PrEP), there is limited understanding of parental concerns and attitudes about their SGM adolescents taking PrEP. Fifty-four parents in the West South Central region of the U.S. completed an online, mixed-method, cross-sectional questionnaire to explore their concerns and questions about PrEP. Quantitative and qualitative results show that participants were more concerned about side effects, drug interactions, (non)adherence, and eligibility and duration of PrEP. Parents are less worried about picking PrEP from a pharmacy or returning to follow-up lab testing every three months. Most parents reported receiving medication information their adolescent takes from a medical provider and the media. Findings from this study can inform the development of parent-based PrEP interventions. Without further parent-based research and programming, SGM adolescents may continue to be disproportionately affected by HIV.
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Affiliation(s)
- Christopher Owens
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas
- Center for Health Equity and Evaluation Research, School of Public Health, Texas A&M University
| | - Dakota Brandenburg
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana
| | - Morgan J Grant
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas
- Center for Health Equity and Evaluation Research, School of Public Health, Texas A&M University
| | - Kaileigh Carter
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas
| | | | - Randolph D Hubach
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana
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4
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Lin B, Liu J, Zhong X. PrEP risk perception and adherence among men who have sex with men: a prospective cohort study based on growth mixture model. BMC Infect Dis 2022; 22:969. [PMID: 36585642 PMCID: PMC9805001 DOI: 10.1186/s12879-022-07966-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND It can be considered that pre-exposure prophylaxis (PrEP) risk perception is the negative experiences or concerns about taking PrEP. The aim of this study is to explore the longitudinal trajectory of PrEP risk perception among men who have sex with men (MSM) and its impact on adherence. METHODS Data related to PrEP risk perception and adherence were derived from a prospective cohort study in Western China from 2013 to 2015. Subjects were categorized into the time-driven, event-driven and blank control groups. Tenofovir disoproxil fumarate (TDF) was administered to subjects in the time-driven and event-driven groups, and all subjects were followed up every 12 weeks. The PrEP risk perception scale was constructed, and the growth mixture model (GMM) was used to classify longitudinal PrEP risk perception. The effect of different levels of PrEP risk perception on drug adherence was explored using generalized estimating equations (GEE) with relative risk (RR) and 95% confidence interval (CI). RESULTS The PrEP risk perception scale consists of 4 dimensions and 16 items with Cronbach's alpha = 0.828 and a good model fit. According to the GMM analysis, the subjects' PrEP risk perceptions were separated into two groups: a "high-risk perception group" (n = 133) and a "low-risk perception group" (n = 493), where the proportion of high levels of drug adherence were 57.89% and 68.35%, respectively (p = 0.024). High levels of PrEP risk perception in the MSM population hinder drug adherence (RR = 0.71, 95% CI 0.50 to 0.99, p = 0.046). The results of this study were validated in the subsequent PrEP projects conducted in 2019 to 2021. CONCLUSION This study demonstrates that high levels of PrEP risk perception in the MSM population are an obstacle to drug adherence, emphasizing the necessity of focusing on PrEP risk perception in this population and the value of its application in the current context.
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Affiliation(s)
- Bing Lin
- School of Public Health, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Number One Medical College Road, Yuzhong District, Chongqing, 400010 China
| | - Jiaxiu Liu
- School of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Xiaoni Zhong
- School of Public Health, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Number One Medical College Road, Yuzhong District, Chongqing, 400010 China
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Stults CB, Brandt SA, Hale JF, Rogers N, Kreienberg AE, Griffin M. A Qualitative Study of Intimate Partner Violence Among Young Gay and Bisexual Men. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP2251-NP2287. [PMID: 32618219 DOI: 10.1177/0886260520936365] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Intimate partner violence (IPV) is prevalent among young gay and bisexual men (YGBM) and is associated with physical and mental health problems, as well as deleterious psychosocial conditions. Most previous studies of IPV among YGBM have been quantitative in nature and have not examined the numerous subtypes of IPV, the chronicity of IPV experiences, and how is IPV manifested in the context of these same-sex relationships. Thus, a qualitative approach may be useful in exploring these multidimensional and understudied experiences. The present qualitative study sought to (a) explore dimensions of IPV victimization, perpetration, and bidirectional IPV among a sample of (n = 26) YGBM living in New York City and (b) explore the chronicity of IPV experiences among these YGBM. Participants were recruited from an ongoing cohort study of YGBM. Participants completed semistructured interviews that included questions about IPV victimization, perpetration, and bidirectional IPV. A modified version of the consensual qualitative research method was used to analyze the data. The YGBM in this study reported numerous forms of physical, psychological, sexual, and financial IPV victimization and perpetration. Bidirectional experiences of IPV were common. The various subtypes of IPV victimization and perpetration are explored in detail in this manuscript. In addition, many participants reported multiple experiences of abuse within the same relationship, and some participants experienced a pattern of abusive relationships over time. This study corroborates findings from quantitative studies, which indicate that IPV is a prevalent and significant health problem among YGBM, and one that warrants additional attention from researchers, practitioners, and policy-makers. Furthermore, this study adds rich qualitative data to the existing literature-data that can be used to help develop and refine future measures of IPV that are tailored for use with YGBM.
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Affiliation(s)
| | - Stephan A Brandt
- Brooklyn College, The City University of New York, New York City, USA
| | - Jonathan F Hale
- Baruch College, The City University of New York, New York City, USA
| | - Nicholas Rogers
- Baruch College, The City University of New York, New York City, USA
| | | | - Marybec Griffin
- School of Public Health, Rutgers University, New Brunswick, NJ, USA
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6
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Geographic Density and Uptake of Pre-exposure Prophylaxis (PrEP) Among Young Gay, Bisexual and Other Sexual Minority Men: A Global Positioning System (GPS) Study. AIDS Behav 2021; 25:155-164. [PMID: 33818642 PMCID: PMC8541942 DOI: 10.1007/s10461-021-03249-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 11/23/2022]
Abstract
The geographic availability of pre-exposure prophylaxis (PrEP) providers is one important factor that significantly affects PrEP uptake. While most previous studies have employed spatial accessibility in static residential neighborhood definitions or self-reported healthcare accessibility, we examined the associations of the objectively measured geographic density of PrEP services with current PrEP use, using global positioning system (GPS) among sexual minority men (SMM) in New York City. 250 HIV-negative SMM participated in a 2-week GPS monitoring (January 2017–January 2018). Geographic PrEP density was measured as total numbers of PrEP providers in (1) individual activity space defined as daily path area of GPS points, (2) residential street network buffers and (3) census tract and ZIP code of residential locations. Geographic PrEP density within GPS-based activity space was positively associated with current PrEP use (prevalence ratio for 50-m activity space = 1.10, 95% confidence interval: [1.02, 1.18]). PrEP provider counts in residential buffer areas and administrative neighborhoods were not associated with PrEP use. Although it is not generalizable beyond New York City, our finding suggests the importance of daily mobility pattern in HIV prevention and PrEP implementation strategies.
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7
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Jaiswal J, LoSchiavo C, Meanley S, Hascher K, Cox AB, Dunlap KB, Singer SN, Halkitis PN. Correlates of PrEP Uptake Among Young Sexual Minority Men and Transgender Women in New York City: The Need to Reframe "Risk" Messaging and Normalize Preventative Health. AIDS Behav 2021; 25:3057-3073. [PMID: 33830327 PMCID: PMC8419019 DOI: 10.1007/s10461-021-03254-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/26/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is an effective form of HIV prevention, but young sexual minority men face myriad barriers to PrEP uptake. Participants (n = 202) completed a survey on healthcare experiences and beliefs about HIV and PrEP. While 98% of the sample knew about PrEP, only 23.2% reported currently taking PrEP. Participants were more likely to be taking PrEP if they received PrEP information from a healthcare provider and endorsed STI-related risk compensation. Conversely, PrEP uptake was less likely among those with concerns about medication use and adherence. While there were no racial/ethnic differences in PrEP uptake, there were differences in correlates of PrEP use for White participants and participants of color. To facilitate PrEP uptake, clinicians should provide PrEP education and screen all patients for PrEP candidacy. Additionally, public health messaging must reframe HIV "risk", highlight benefits of STI testing, and emphasize the importance of preventive healthcare for SMM.
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Affiliation(s)
- J Jaiswal
- Department of Health Science, University of Alabama, 115 Russell Hall, 504 University Blvd, Tuscaloosa, AL, 35401, USA.
- Center for Interdisciplinary Research On AIDS, Yale University School of Public Health, New Haven, CT, 06510, USA.
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA.
| | - C LoSchiavo
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA
- School of Public Health, Rutgers University, Piscataway, NJ, 08854, USA
| | - S Meanley
- Center for Interdisciplinary Research On AIDS, Yale University School of Public Health, New Haven, CT, 06510, USA
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, 19104, USA
| | - K Hascher
- Department of Health Science, University of Alabama, 115 Russell Hall, 504 University Blvd, Tuscaloosa, AL, 35401, USA
| | - A B Cox
- Department of Health Science, University of Alabama, 115 Russell Hall, 504 University Blvd, Tuscaloosa, AL, 35401, USA
| | - K B Dunlap
- Department of Health Science, University of Alabama, 115 Russell Hall, 504 University Blvd, Tuscaloosa, AL, 35401, USA
| | - S N Singer
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA
- Graduate School of Applied & Professional Psychology, Rutgers University, 152 Frelinghuysen Road, Busch Campus, Piscataway, NJ, 08854, USA
| | - P N Halkitis
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA
- School of Public Health, Rutgers University, Piscataway, NJ, 08854, USA
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8
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Schuyler A, Alidina Z, Dolcini MM, Harper G, Fortenberry JD, Singh R, Jamil O, Pollack L, Catania J. Pre-Exposure Prophylaxis (PrEP) Dissemination: Adapting Diffusion Theory to Examine PrEP Adoption. AIDS Behav 2021; 25:3145-3158. [PMID: 34152531 PMCID: PMC11298242 DOI: 10.1007/s10461-021-03345-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/24/2022]
Abstract
PrEP adoption among African-American men-who-have-sex-with-men (AAMSM) remains low. We applied Diffusion-of-Innovations (DOI) theory to understand PrEP adoption processes among young HIV-negative/status unknown AAMSM (AAYMSM; N = 181; 17-24 years). Quantitative and qualitative analyses were used to examine predictors of PrEP diffusion stages. Most AAYMSM were in the persuasion stage (PrEP-aware, hadn't adopted; 72.4%). Our results suggest that model antecedents are DOI stage-specific. PrEP awareness (knowledge stage) was associated with lower levels of social stigma (p < .03) and greater health literacy (p < .05), while sexual risk (p < .03) and education (p < .03) predicted PrEP adoption (12.2%). PrEP efficacy and side effects were primary innovation characteristics influencing adoption receptivity in the persuasion stage. Interventions to improve PrEP diffusion should be tailored to stage-specific antecedents depending on how a community is stratified across the DOI stages.
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Affiliation(s)
- Ashley Schuyler
- School of Social and Behavioral Health Sciences, Hallie E Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, 410 Waldo Hall, Corvallis, OR, 97331, USA.
| | - Zainab Alidina
- School of Social and Behavioral Health Sciences, Hallie E Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, 410 Waldo Hall, Corvallis, OR, 97331, USA
| | - M Margaret Dolcini
- School of Social and Behavioral Health Sciences, Hallie E Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, 410 Waldo Hall, Corvallis, OR, 97331, USA
| | - Gary Harper
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Ryan Singh
- Oregon Social Learning Center, Eugene, OR, USA
| | - Omar Jamil
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Lance Pollack
- University of California, San Francisco, San Francisco, CA, USA
| | - Joseph Catania
- School of Social and Behavioral Health Sciences, Hallie E Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, 410 Waldo Hall, Corvallis, OR, 97331, USA
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9
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Kecojevic A, Meleo-Erwin ZC, Basch CH, Hammouda M. A Thematic Analysis of Pre-Exposure Prophylaxis (PrEP) YouTube Videos. JOURNAL OF HOMOSEXUALITY 2021; 68:1877-1898. [PMID: 31939710 DOI: 10.1080/00918369.2020.1712142] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is an encouraging approach to HIV prevention, yet there is a paucity of research aimed at understanding individual PrEP experiences. The current study aims to examine first-hand narratives of individuals detailing their PrEP experiences via the YouTube platform. We searched YouTube.com using the keywords, "pre-exposure prophylaxis" and "Truvada". Search results were limited to the 15 most-viewed videos. Informed by a thematic/content analysis approach, we conducted an iterative analysis of video transcripts. Narratives covered a wide range of topics including the reasons to start PrEP, interaction with providers, side effects, insurance coverage, and stigma. By and large, the videos encouraged those at risk for HIV to consider PrEP. Narratives were often characterized by emotional engagement. Given that YouTube videos are used to share individual PrEP experiences with a wider audience, our analysis may inform the development of strategies aimed at utilizing YouTube for increasing uptake of PrEP.
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Affiliation(s)
- Aleksandar Kecojevic
- Department of Public Health, William Paterson University, College of Science and Health, Wayne, New Jersey, USA
| | - Zoe C Meleo-Erwin
- Department of Public Health, William Paterson University, College of Science and Health, Wayne, New Jersey, USA
| | - Corey H Basch
- Department of Public Health, William Paterson University, College of Science and Health, Wayne, New Jersey, USA
| | - Mariam Hammouda
- Department of Public Health, William Paterson University, College of Science and Health, Wayne, New Jersey, USA
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10
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Khan MR, Kapadia F, Geller A, Mazumdar M, Scheidell JD, Krause KD, Martino RJ, Cleland CM, Dyer TV, Ompad DC, Halkitis PN. Racial and ethnic disparities in "stop-and-frisk" experience among young sexual minority men in New York City. PLoS One 2021; 16:e0256201. [PMID: 34437565 PMCID: PMC8389488 DOI: 10.1371/journal.pone.0256201] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 08/02/2021] [Indexed: 11/19/2022] Open
Abstract
Although racial/ethnic disparities in police contact are well documented, less is known about other dimensions of inequity in policing. Sexual minority groups may face disproportionate police contact. We used data from the P18 Cohort Study (Version 2), a study conducted to measure determinants of inequity in STI/HIV risk among young sexual minority men (YSMM) in New York City, to measure across-time trends, racial/ethnic disparities, and correlates of self-reported stop-and-frisk experience over the cohort follow-up (2014-2019). Over the study period, 43% reported stop-and-frisk with higher levels reported among Black (47%) and Hispanic/Latinx (45%) than White (38%) participants. Stop-and-frisk levels declined over follow-up for each racial/ethnic group. The per capita rates among P18 participants calculated based on self-reported stop-and-frisk were much higher than rates calculated based on New York City Police Department official counts. We stratified respondents' ZIP codes of residence into tertiles of per capita stop rates and observed pronounced disparities in Black versus White stop-and-frisk rates, particularly in neighborhoods with low or moderate levels of stop-and-frisk activity. YSMM facing the greatest economic vulnerability and mental disorder symptoms were most likely to report stop-and-frisk. Among White respondents levels of past year stop-and-frisk were markedly higher among those who reported past 30 day marijuana use (41%) versus those reporting no use (17%) while among Black and Hispanic/Latinx respondents stop-and-frisk levels were comparable among those reporting marijuana use (38%) versus those reporting no use (31%). These findings suggest inequity in policing is observed not only among racial/ethnic but also sexual minority groups and that racial/ethnic YSMM, who are at the intersection of multiple minority statuses, face disproportionate risk. Because the most socially vulnerable experience disproportionate stop-and-frisk risk, we need to reach YSMM with community resources to promote health and wellbeing as an alternative to targeting this group with stressful and stigmatizing police exposure.
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Affiliation(s)
- Maria R. Khan
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
- Center for Drug Use and HIV Research, New York University, New York, New York, United States of America
| | - Farzana Kapadia
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
- Department of Epidemiology, New York University, New York, New York, United States of America
| | - Amanda Geller
- Department of Criminology, Law and Society, University of California - Irvine, Irvine, California, United States of America
| | - Medha Mazumdar
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Joy D. Scheidell
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
- Center for Drug Use and HIV Research, New York University, New York, New York, United States of America
| | - Kristen D. Krause
- Center for Health, Identity, Behavior & Prevention Studies, Rutgers University, Piscataway, New Jersey, United States of America
| | - Richard J. Martino
- Center for Health, Identity, Behavior & Prevention Studies, Rutgers University, Piscataway, New Jersey, United States of America
| | - Charles M. Cleland
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
- Center for Drug Use and HIV Research, New York University, New York, New York, United States of America
| | - Typhanye V. Dyer
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, United States of America
| | - Danielle C. Ompad
- Center for Drug Use and HIV Research, New York University, New York, New York, United States of America
- Department of Epidemiology, New York University, New York, New York, United States of America
| | - Perry N. Halkitis
- Center for Health, Identity, Behavior & Prevention Studies, Rutgers University, Piscataway, New Jersey, United States of America
- Departments of Biostatistics and Epidemiology and Urban-Global Health, Rutgers University, Piscataway, New Jersey, United States of America
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11
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A Tale of Two Cities: Exploring the Role of Race/Ethnicity and Geographic Setting on PrEP Use Among Adolescent Cisgender MSM. AIDS Behav 2021; 25:139-147. [PMID: 32588260 DOI: 10.1007/s10461-020-02951-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although pre-exposure prophylaxis (PrEP) could substantially reduce the risk of HIV acquisition among adolescent cisgender men who have sex with men (cisMSM), various barriers faced by people of color, particularly within the southern region of the U.S., may lead to racial disparities in the utilization of PrEP. Few studies, however, have explored racial/ethnic differences in PrEP use by geographic setting among adolescent cisMSM. We conducted a cross-sectional analysis examining racial disparities in PrEP use among cisMSM ages 15-24 years in New Orleans, Louisiana, and Los Angeles, California recruited between May, 2017 and September, 2019. The odds of PrEP use among AA adolescents were considerably lower than White adolescents in New Orleans (OR (95% CI): 0.24 (0.10, 0.53)), although we did not find evidence of differences in Los Angeles. Our findings underscore the need for targeted interventions to promote PrEP use among adolescent MSM, particularly among AA adolescent cisMSM living in the southern region of U.S.
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Managing the COVID-19 Pandemic: Biopsychosocial Lessons Gleaned From the AIDS Epidemic. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 27 Suppl 1, COVID-19 and Public Health: Looking Back, Moving Forward:S39-S42. [PMID: 33239562 DOI: 10.1097/phh.0000000000001267] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Abstract
While pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy, its uptake is limited. To address barriers, we piloted a nurse-led PrEP clinic in an STI clinic and had public health nurses refer patients during STI follow-up. We recorded the number of PrEP offers and declines and clinic uptake. We conducted a thematic analysis of patients’ responses from nursing notes written at the time patients declined PrEP. From August 6, 2018 to August 5, 2019, nurses offered a PrEP referral to 261 patients who met our criteria; only 47.5% accepted. Qualitative analysis identified four themes: (1) perceptions of risk, (2) lack of interest, (3) inability to manage, and (4) concerns about PrEP. Our patients did not feel sufficiently at-risk for HIV to use PrEP and maintained that PrEP was for a reckless “other”. This analysis sheds light on how assumptions about risk affect PrEP uptake, particularly among those at-risk for HIV.
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Chu BA, Castellanos ER, Gonzales MM, Gaither TW. Social determinants of self-reported pre-exposure prophylaxis use among a national sample of US men who have sex with men. Sex Transm Infect 2019; 96:368-374. [PMID: 31601642 DOI: 10.1136/sextrans-2019-054177] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/01/2019] [Accepted: 09/23/2019] [Indexed: 11/03/2022] Open
Abstract
PURPOSE Various disparities exist in HIV transmission among men who have sex with men (MSM). Pre-exposure prophylaxis (PrEP) has been shown to decrease the acquisition of HIV, but there is variation in uptake within the MSM population. We aim to characterise PrEP use and correlates of self-reported PrEP use in a large national sample of urban MSM in the USA. METHODS Using data from a geosocial-networking application, a national sample (n=3744) from the largest 50 metropolitan centres in the USA was obtained. RESULTS We found 18.1% (95% CI 16.8 to 19.3) of profiles reported using PrEP, with decreased reported PrEP use in younger MSM aged 18-24 years (adjusted OR (aOR)=0.5, 95% CI 0.3 to 0.7), obese MSM (aOR=0.5, 95% CI 0.3 to 0.9), black MSM (aOR=0.6, 95% CI 0.4 to 0.9) and MSM in the South (aOR=0.7, 95% CI 0.5 to 0.9). CONCLUSION Significant disparities exist in PrEP reporting by age and among black, Southern US and obese MSM. More research is needed to better understand these disparities.
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Affiliation(s)
- Brian A Chu
- David Geffen School of Medicine, Los Angeles, California, USA
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Wu Y, Xie L, Meng S, Hou J, Fu R, Zheng H, He N, Meyers K. Mapping Potential Pre-Exposure Prophylaxis Users onto a Motivational Cascade: Identifying Targets to Prepare for Implementation in China. LGBT Health 2019; 6:250-260. [PMID: 31170020 DOI: 10.1089/lgbt.2018.0256] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose: China recently commenced several pre-exposure prophylaxis (PrEP) projects, but little work has characterized potential users. This study describes awareness of, intention to use, and uptake of PrEP in a sample of men who have sex with men (MSM), a key population experiencing high rates of HIV in China. Methods: Through a cross-sectional survey administered to 708 MSM in four cities, we mapped respondents onto a Motivational PrEP Cascade. We conducted bivariable and multivariable analysis to examine factors associated with progression through the Cascade. Results: Among 45.6% of MSM who were PrEP eligible, 36% were in Contemplation, 9% were in PrEParation, 2% were in PrEP Action and Initiation, and none reached Maintenance and Adherence. We found no association between individual risk factors and progression through the Cascade. In multivariable analysis, friends' positive attitudes toward PrEP, more frequent sexually transmitted infection testing, and higher scores on the perceived PrEP benefits scale were positively associated with entering PrEP Contemplation. Having higher condom use self-efficacy was associated with decreased odds of entering PrEP Contemplation. Having sex with men and women in the past 6 months, having heard of PrEP from medical providers, and knowing a PrEP user were positively associated with entering PrEParation. Conclusion: We found a high proportion of MSM who were PrEP eligible and identified several intervention targets to prepare for PrEP introduction in China: community education to increase accurate knowledge, gain-framed messaging for PrEP and sexual health, and provider trainings to build MSM-competent services that can support shared decision-making for PrEP initiation.
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Affiliation(s)
- Yumeng Wu
- 1 Aaron Diamond AIDS Research Center, The Rockefeller University, New York, New York
| | - Lu Xie
- 2 Institute of HIV/AIDS, The First Hospital of Changsha, Changsha, China
| | - Siyan Meng
- 3 School of Public Health, Fudan University, Shanghai, China
| | - Jianhua Hou
- 4 Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Rong Fu
- 5 Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Huang Zheng
- 6 Shanghai CSW & MSM Center, Shanghai, China
| | - Na He
- 3 School of Public Health, Fudan University, Shanghai, China
| | - Kathrine Meyers
- 1 Aaron Diamond AIDS Research Center, The Rockefeller University, New York, New York
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D’Avanzo PA, Bass SB, Brajuha J, Gutierrez-Mock L, Ventriglia N, Wellington C, Sevelius J. Medical Mistrust and PrEP Perceptions Among Transgender Women: A Cluster Analysis. Behav Med 2019; 45:143-152. [PMID: 31343968 PMCID: PMC6943929 DOI: 10.1080/08964289.2019.1585325] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/06/2019] [Accepted: 02/16/2019] [Indexed: 02/06/2023]
Abstract
Transgender (trans) women experience unique barriers in accessing preventative health services such as HIV preexposure prophylaxis (PrEP). These barriers may be exacerbated by past real or anticipated mistreatment in health care settings, but little is known about the relationship between medical mistrust and poor PrEP uptake and knowledge. Using a multistep approach, this study used a novel survey instrument administered to a pilot sample of 78 trans women. Item responses on a 0-10 scale were subjected to a TwoStep cluster analysis to explore how perceptions of PrEP and experiences with health care vary among trans women. Two distinct clusters (C1,C2) were defined on the basis of race (C1: 82% White, C2: 69% Black) and highest level of education completed (C1: 53% college or above, C2: 42% high school diploma or GED). Analyses suggest that varying levels of medical mistrust exist between clusters. Higher mean scores on medical mistrust items were reported in C1. A similar relationship was found on attitudes toward PrEP. Differences in intention to use PrEP and differences in past PrEP use were not significant; however, C2 members were more likely to have heard of PrEP from a doctor. Results suggest that levels of medical mistrust and PrEP perceptions vary among distinct subpopulations in this community, which may affect willingness to use PrEP. Interventions aimed at addressing unique perceptions in subpopulations could move trans women from intention to PrEP use.
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Affiliation(s)
- Paul A. D’Avanzo
- Department of Social and Behavioral Sciences, Temple University College of Public Health
- Risk Communication Laboratory, Temple University College of Public Health
| | - Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, Temple University College of Public Health
- Risk Communication Laboratory, Temple University College of Public Health
| | - Jesse Brajuha
- Risk Communication Laboratory, Temple University College of Public Health
| | - Luis Gutierrez-Mock
- Center of Excellence for Transgender Health, University of California, San Francisco
| | - Nicole Ventriglia
- Risk Communication Laboratory, Temple University College of Public Health
| | - Carine Wellington
- Risk Communication Laboratory, Temple University College of Public Health
| | - Jae Sevelius
- Center of Excellence for Transgender Health, University of California, San Francisco
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco
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Felsher M, Szep Z, Krakower D, Martinez-Donate A, Tran N, Roth AM. "I Don't Need PrEP Right Now": A Qualitative Exploration of the Barriers to PrEP Care Engagement Through the Application of the Health Belief Model. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:369-381. [PMID: 30332306 PMCID: PMC8558876 DOI: 10.1521/aeap.2018.30.5.369] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The Health Belief Model has been useful for studying uptake of HIV prevention behaviors and has had limited application to understanding utilization of pre-exposure prophylaxis (PrEP), a biomedical strategy to reduce HIV acquisition. We recruited 90 persons undergoing HIV screening and educated them about PrEP. We followed up with 35 participants approximately 3 weeks later and quantitatively assessed PrEP uptake. No participant had initiated PrEP. We conducted in-depth interviews with 15 participants to explore situational factors impacting this decision. In this paper we provide an overview of PrEP-related engagement using qualitative data to contextualize (in)action. While participants perceived PrEP as beneficial, perceived benefits did not outweigh real- and perceived barriers, such as financial and time-related constraints. In order to promote PrEP uptake, cues to action that increase the benefits of PrEP during seasons of risk, and interventions that reduce real and perceived barriers are needed.
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Affiliation(s)
- Marisa Felsher
- Drexel University, Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Zsofia Szep
- Drexel University College of Medicine, Division of Infectious Diseases and HIV Medicine, Philadelphia
| | - Douglas Krakower
- Beth Israel Deaconess Medical Center, Infectious Diseases/Department of Medicine, Boston, Massachusetts
| | - Ana Martinez-Donate
- Drexel University, Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Nguyen Tran
- Drexel University, Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Alexis M Roth
- Drexel University, Dornsife School of Public Health, Philadelphia, Pennsylvania
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