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Guss CE, Pilcher S, Assefa I, Fitzgerald S, Stamoulis C, Woods ER. HIV/Pre-Exposure Prophylaxis Knowledge and Acceptability of Rapid HIV Testing Among Transgender Adolescents in a Multidisciplinary Gender Clinic. Transgend Health 2024; 9:128-135. [PMID: 38585242 PMCID: PMC10998023 DOI: 10.1089/trgh.2021.0163] [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: 12/13/2022] Open
Abstract
Purpose The objectives of this study were to assess the knowledge of HIV and pre-exposure prophylaxis (PrEP) in transgender adolescents and young adults (AYAs) and to test the acceptability of rapid HIV testing among transgender adolescents in a multidisciplinary gender clinic. Methods Participants enrolled on the same day as their mental health or medical appointment in a multidisciplinary gender clinic. They completed survey questions regarding HIV and PrEP knowledge and were also offered an optional same-day, rapid, fourth-generation HIV test. Participants who had an HIV test answered additional questions about their testing experience. Results We enrolled 61 participants; just over half (n=31) were assigned female at birth. Less than a third (n=20, 32.8%) scored 80% or above regarding HIV knowledge. Nearly half of the participants (n=29, 47.5%) were not interested in PrEP. Forty-one percent of participants chose to have a rapid HIV test; all were "satisfied" with the testing experience. There were no positive HIV results. Conclusions Transgender AYAs have gaps in their understanding of HIV acquisition and transmission. Rapid HIV testing in the setting of gender care is well received by those who desire testing and may be a way to increase knowledge of transgender AYA HIV status.
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Affiliation(s)
- Carly E. Guss
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah Pilcher
- Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ida Assefa
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Susan Fitzgerald
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Catherine Stamoulis
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth R. Woods
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Olakunde BO, Ujam C, Ndukwe CD, Falola-Anoemuah Y, Olaifa Y, Oladele TT, Yahaya HB, Ogundipe A. Barriers to the uptake of oral pre-exposure prophylaxis among young key populations in Nigeria. Int J STD AIDS 2024; 35:346-351. [PMID: 38105179 DOI: 10.1177/09564624231220099] [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: 12/19/2023]
Abstract
BACKGROUND Young key populations (YKP) contribute to the burden of HIV in Nigeria and are a priority population for oral pre-exposure prophylaxis (PrEP). However, their uptake of PrEP remains low. We assessed the main barriers to PrEP uptake and the variation among YKP (15-24 years) in Nigeria. METHODS This study was a secondary data analysis of the 2020 Integrated Biological & Behavioural Surveillance Survey conducted among key populations (KP), including female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and transgender people (TG), in 12 states in Nigeria. A closed-ended question asking the main reason for not taking PrEP among KP who had never taken PrEP was included in the surveillance questionnaire. We collapsed the responses into six barrier themes. Using multinomial logistic regression analysis, we examined the association between the barriers (dependent variable) and KP group (independent variable), controlling for age, educational attainment, religion, marital status, employment status, and geopolitical zone. RESULTS A total of 1776 YKP were included in this study. The most cited barriers by KP group were: lack of access (28.3%) and fear of side effects (28.3%) by FSW; lack of interest (37.1%) by MSM; low risk perception (65.5%) by PWID; and lack of access (34.4%) by TG. The odds of reporting fear of side effects, lack of access, lack of interest, and nonspecific/others reasons were significantly different by KP group. CONCLUSIONS The barriers limiting the uptake of PrEP among YKP vary by KP group. Our results highlight the need for KP-specific interventions to improve the uptake of PrEP among YKP in Nigeria.
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Affiliation(s)
- Babayemi O Olakunde
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Chukwugozie Ujam
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
| | - Chinwedu D Ndukwe
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
- African Institute of Health Policy and Health Systems, Abakaliki, Nigeria
| | - Yinka Falola-Anoemuah
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
| | - Yewande Olaifa
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
| | - Tolulope T Oladele
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
| | - Hidayat B Yahaya
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
| | - Alex Ogundipe
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
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D’Avanzo P, Shourya S, Brin M, Kaw S, Kay E, Batey DS, Radix A, Belkind U, Tanner M, Galindo C, Ferrara S, Ott C, Ramirez SO, Schnall R. Identifying Key Factors to PrEP Initiation and Persistence Among YMSM Through Focus Groups and Surveys in Two High-Priority Settings. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2024; 36:33-47. [PMID: 38349352 PMCID: PMC11034730 DOI: 10.1521/aeap.2024.36.1.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Cisgender men are diagnosed with HIV at a rate four times greater than cisgender women, with 71% of infections attributed to male-male sexual contact. Despite expanding accessibility, pre-exposure prophylaxis (PrEP) for HIV prevention is initiated by only 30% of people with PrEP indications. Five focus groups with 42 young men who have sex with men from New York and Alabama were conducted to identify key factors to PrEP initiation and persistence. Thirty focus group participants completed a survey on demographics, PrEP choices and health care attitudes. Findings suggest provider competency significantly influences PrEP use due to stigmatization in medical settings. Participants noted benefits of PrEP including HIV protection and sexual empowerment, yet barriers like cost and side effects were prevalent. Our findings outline barriers and facilitators to PrEP use among young men who have sex with men in two high priority settings that will inform PrEP care updates in participating clinics.
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Affiliation(s)
- Paul D’Avanzo
- Columbia University and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032
| | - Shivesh Shourya
- Columbia University School of Nursing, 516 W. 168 Street, New York, NY, 10032
| | - Maeve Brin
- Columbia University School of Nursing, 516 W. 168 Street, New York, NY, 10032
| | - Shivani Kaw
- Columbia University School of Nursing, 516 W. 168 Street, New York, NY, 10032
| | - Emma Kay
- Magic City Wellness Center, 3220 5 Avenue South, Suite 100, Birmingham, AL, 35222
| | - D. Scott Batey
- Tulane University School of Social Work, 127 Elk Place, New Orleans, LA, 70112
| | - Asa Radix
- Callen-Lorde, 356 W. 18 Street, New York, NY, 10011
| | - Uri Belkind
- Callen-Lorde, 356 W. 18 Street, New York, NY, 10011
| | - Mary Tanner
- Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, Georgia, 30329
| | - Carla Galindo
- Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, Georgia, 30329
| | - Stephen Ferrara
- Columbia University School of Nursing, 516 W. 168 Street, New York, NY, 10032
| | - Corilyn Ott
- University of Birmingham at Alabama, School of Nursing and School of Medicine, 1701 University Boulevard, Birmingham, Alabama 35294
| | | | - Rebecca Schnall
- Columbia University School of Nursing, 516 W. 168 Street, New York, NY, 10032
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4
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Labudde EJ, Gillespie S, Wood A, Middlebrooks L, Gooding HC, Morris CR, Camacho-Gonzalez A. HIV in youth prevention in the emergency department initiative: A survey of pediatric emergency medicine providers. Am J Emerg Med 2023; 72:164-169. [PMID: 37536088 DOI: 10.1016/j.ajem.2023.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/28/2023] [Accepted: 07/22/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND The incidence of HIV among adolescents remains high, and adolescents are known to participate in sexual behaviors that increase their risk for HIV, such as unprotected sex and sex with multiple partners. HIV pre-exposure prophylaxis (PrEP) has been shown to be effective at preventing HIV when taken daily and is approved by the FDA for use in adolescents. Efforts to screen patients in adult emergency departments and connect them with PrEP services have been validated. We surveyed pediatric emergency medicine (PEM) providers to determine their knowledge of PrEP, prescribing practices, willingness to prescribe, and barriers to a screening protocol in the pediatric emergency department (PED). METHODS We administered a survey to a multidisciplinary group of PEM providers to measure knowledge, use, willingness, and implementation barriers to PrEP as well as elements needed for a successful referral system. RESULTS A total of 87 responses were included for analysis. While 79.1% of all providers had heard of PrEP, only 14.8% of prescribing providers had ever discussed PrEP with a patient, and none had ever prescribed PrEP. Overall, 76.3% of all providers were knowledgeable about PrEP based on answers to true/false questions, with prescribing providers significantly more likely to be knowledgeable compared to nurses (p = 0.005). Knowledgeable providers had higher willingness scores to refer for PrEP compared to providers who were not knowledgeable. Ninety-two percent of providers felt a PrEP referral process from the PED would be feasible. Creation of an eligibility algorithm and educational materials were the most common efforts providers preferred to make them more likely to refer for PrEP. The most notable barriers perceived by providers included patient noncompliance with therapy (20.9%), acceptance of PrEP discussion among patients and parents (19.8%), and cost of therapy (15.1%). CONCLUSION PEM providers are knowledgeable about PrEP but have little experience with discussing or prescribing PrEP. Their willingness to refer for PrEP and anticipated feasibility of a PrEP referral system is encouraging. These results support the need for future educational efforts among PEM providers and creation of referral systems for PrEP services from the PED.
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Affiliation(s)
- Emily J Labudde
- Department of Pediatrics, Emory University, Atlanta, GA, United States of America.
| | - Scott Gillespie
- Department of Pediatrics, Emory University, Atlanta, GA, United States of America
| | - Anna Wood
- Department of Pediatrics, Emory University, Atlanta, GA, United States of America
| | - Lauren Middlebrooks
- Department of Pediatrics, Division of Emergency Medicine, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Holly C Gooding
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Claudia R Morris
- Department of Pediatrics, Division of Emergency Medicine, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Andres Camacho-Gonzalez
- Department of Pediatrics, Division of Infectious Disease, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, United States of America
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Yellin H, Levy ME, Magnus M, Kuo I, Siegel M. HIV Risk Perception, Willingness to Use PrEP, and PrEP Uptake Among Young Men who have Sex with Men in Washington, DC. AIDS Behav 2023; 27:2844-2854. [PMID: 36807246 PMCID: PMC10439971 DOI: 10.1007/s10461-023-04008-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 02/23/2023]
Abstract
Low HIV risk perception is a barrier to PrEP uptake, but few studies have examined risk perception and PrEP uptake among young men who have sex with men (YMSM). We performed a secondary analysis of data collected in 2016 from YMSM ages 16-25 in the Washington, DC metropolitan area who participated in a cross-sectional online survey that aimed to identify strategies for engaging YMSM in PrEP services. Of 188 participants, 115 (61%) were considered eligible for PrEP. Among PrEP-eligible participants who had never used PrEP, 53%, 71%, and 100% with low, moderate, and high risk perception, respectively, were willing to use PrEP (Fisher's exact test p = 0.01). Odds of PrEP willingness were greater among those with moderate/high versus low risk perception (adjusted odds ratio [OR] = 5.62, 95% CI = 1.73-18.34). HIV risk perception was not significantly associated with self-reported PrEP use. These findings suggest the importance of risk perception as a correlate of willingness to use PrEP, which is a key step in existing frameworks of PrEP uptake.
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Affiliation(s)
- Hannah Yellin
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave NW, 20037, Washington, DC, USA.
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA.
| | - Matthew E Levy
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave NW, 20037, Washington, DC, USA
| | - Manya Magnus
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave NW, 20037, Washington, DC, USA
| | - Irene Kuo
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave NW, 20037, Washington, DC, USA
| | - Marc Siegel
- Division of Infectious Disease, Department of Medicine, Medical Faculty Associates, George Washington University, Washington, DC, USA
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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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7
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Zhou L, Assanangkornchai S. Current Perspectives on the Determinants of Acceptability of Pre-Exposure Prophylaxis and Nonoccupational Post-Exposure Prophylaxis among People at Risk for HIV: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12605. [PMID: 36231904 PMCID: PMC9565962 DOI: 10.3390/ijerph191912605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Pre-exposure prophylaxis (PrEP) and nonoccupational post-exposure prophylaxis (nPEP) were found to be effective HIV biomedical interventions. However, several barriers to acceptance of these interventions were discovered among populations at risk for HIV, and the Coronavirus Disease 2019 (COVID-19) pandemic may also exacerbate these. The current scoping review aims to update information in regards to facilitators and barriers for PrEP and nPEP acceptability among key populations collected in the past two years and to identify any existing knowledge gaps during the time of the COVID-19 pandemic. Of 1453 studies retrieved, 16 met the final inclusion criteria. The review synthesized a range of individual, PrEP-specific, psychosocial, and health system factors that may affect the acceptability of PrEP or nPEP. The conclusion from this scoping review is that more research is needed to enable a comprehensive understanding of the determinants of acceptability of PrEP and nPEP in the context of COVID-19, particularly among PWID and FSWs.
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Affiliation(s)
- Lingmi Zhou
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
- Department of AIDS Control and Prevention, Guilin Center for Disease Control and Prevention, Guilin 541000, China
| | - Sawitri Assanangkornchai
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
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Gordián-Arroyo A, Schnall R, Garofalo R, Kuhns LM, Pearson C, Bruce J, Scott Batey D, Radix A, Belkind U, Hirshfield S, Hidalgo MA. Homonegative Victimization and Perceived Stress among Adolescent Sexual Minority Males: The Attenuating Role of Peer and Family Support. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2022; 34:691-701. [PMID: 36776753 PMCID: PMC9918044 DOI: 10.1080/19317611.2022.2124341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 07/23/2022] [Accepted: 07/29/2022] [Indexed: 06/18/2023]
Abstract
PURPOSE Research suggests social support may protect sexual minorities from the harmful effects of victimization that undermine mental and sexual health wellness; however, this relationship has been underexplored among a diverse youth population. We examined the association between lifetime homonegative victimization, perceived stress in the last month, and resilience factors among a diverse sample of adolescent sexual minority males. METHODS Data were collected between June 2018 and April 2020 as part of the MyPEEPS Mobile study, a multi-site randomized controlled trial evaluating the effectiveness of a mobile behavioral HIV prevention intervention for adolescents living in the U.S. We analyzed baseline survey data from 542 sexual minority males, aged 13-18 years. We used bivariate analyses to examine relationships among variables and multivariable linear regression models to determine if resilience factors attenuated the association between homonegative victimization and perceived stress. RESULTS Perceived stress was positively associated with younger age, internalized homophobia, experiencing verbal victimization, threats of being outed, and threats of physical violence. Relying on online friends for support and having good family relations both attenuated the relationship between verbal victimization and perceived stress. However, neither of these resilience factors significantly weakened the associations between perceived stress, threats of physical violence, and being outed. CONCLUSION Resilience factors, including peer and family support, may play an attenuating role in the relationship between homonegative victimization and perceived stress among adolescent sexual minority males.
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Affiliation(s)
- Alvin Gordián-Arroyo
- Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Rebecca Schnall
- School of Nursing, Columbia University, New York, New York, USA
- Mailman School of Public Health, Department of Population and Family Health, Columbia University, New York, New York, USA
| | - Robert Garofalo
- Department of Pediatrics, Northwestern University’s Feinberg School of Medicine, Chicago, Illinois, USA
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - Lisa M. Kuhns
- Department of Pediatrics, Northwestern University’s Feinberg School of Medicine, Chicago, Illinois, USA
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - Cynthia Pearson
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Josh Bruce
- Department of Education, Birmingham AIDS Outreach, Birmingham, Alabama, USA
| | - D. Scott Batey
- School of Social Work, University of Alabama, Birmingham, Alabama, USA
| | - Asa Radix
- Department of Medicine, Callen-Lorde Community Health Center, New York, New York, USA
| | - Uri Belkind
- Department of Medicine, Callen-Lorde Community Health Center, New York, New York, USA
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Marco A. Hidalgo
- Department of Medicine, Medicine-Pediatrics Section, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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9
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Bonett S, Dowshen N, Bauermeister J, Meanley S, Wirtz AL, Celentano DD, Galai N, Arrington-Sanders R. Characterizing the PrEP Continuum for Black and Latinx Sexual and Gender Minority Youth. AIDS Behav 2022; 26:1211-1221. [PMID: 34546472 DOI: 10.1007/s10461-021-03476-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 11/25/2022]
Abstract
Pre-exposure prophylaxis (PrEP) rollout efforts thus far have inadequately reached young people from underrepresented backgrounds. This study explores PrEP engagement among young Black and Latinx men who have sex with men, transgender women, and gender diverse individuals in three U.S. cities using an adapted PrEP continuum measure. We analyze data from the recruitment phase of an ongoing PrEP engagement intervention (n = 319) using partial proportional odds logistic regression. Participants reported high willingness and intention to use PrEP, yet most (82%) were not currently taking PrEP. Being insured (aOR = 2.95, 95%-CI = 1.60-5.49), having one or more PrEP users in one's sexual network (aOR = 4.19, 95%-CI = 2.61-6.79), and higher individual HIV risk scores (aOR = 1.62, 95%-CI = 1.34-1.97) were each associated with being further along the PrEP continuum. Strategies are needed to address barriers to healthcare access and leverage connections within social and sexual networks in order to bolster PrEP engagement among marginalized young people from diverse backgrounds.
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Affiliation(s)
- Stephen Bonett
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA.
| | - Nadia Dowshen
- Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, 3550 Market St, Philadelphia, PA, 19104, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - José Bauermeister
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Steven Meanley
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
- Department of Statistics, University of Haifa, Mt Carmel, Haifa, Israel
| | - Renata Arrington-Sanders
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, 200 N. Wolfe Street, Baltimore, MD, 21287, USA
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10
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Reddit on PrEP: Posts About Pre-exposure Prophylaxis for HIV from Reddit Users, 2014-2019. AIDS Behav 2022; 26:1084-1094. [PMID: 34536176 DOI: 10.1007/s10461-021-03463-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2021] [Indexed: 10/20/2022]
Abstract
Social media forums provide a window into how gay, bisexual, and other men who have sex with men talk about pre-exposure prophylaxis for HIV prevention (PrEP) outside of research contexts. To examine information exchange about this important pillar of HIV prevention, discussions around PrEP were collected from the r/askgaybros subreddit of the social media site Reddit (2014-2019). Post titles and asks were qualitatively coded to identify themes describing the primary purpose of the post. In all, 1163 PrEP posts were identified, and a 23.3-fold increase in post volume was seen from 2014 (n = 20) to 2019 (n = 466). The most common post type was a mention of PrEP in a post primarily discussing: an assessment of risk after a sexual encounter (19.2%); a sexual or romantic relationship (6.0%); or other (29.3%). Access challenges (19.1%), information seeking (17.5%), and the cultural effects of PrEP on the gay community (16.3%) were other common themes. Posts regarding the initiation of PrEP (11.8%) and PrEP side-effects (9.4%) were moderately represented. Posts addressing promotion, shade, stigma, and usage were infrequent (≤ 5.5% of posts, respectively). Over time, discussion of PrEP has increased exponentially on r/askgaybros, which may reflect the normalization of PrEP. Qualitative analysis of these posts can be a rich source of data for scientists, practitioners, and healthcare providers interested in increasing uptake of PrEP and decreasing barriers to its use.
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11
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Owens C, Moran K, Mongrella M, Moskowitz DA, Mustanski B, Macapagal K. "It's Very Inconvenient for Me": A Mixed-Method Study Assessing Barriers and Facilitators of Adolescent Sexual Minority Males Attending PrEP Follow-Up Appointments. AIDS Behav 2022; 26:21-34. [PMID: 34081237 DOI: 10.1007/s10461-021-03313-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 12/22/2022]
Abstract
Researching PrEP retention in adolescent sexual minority men (ASMM) is critical to increasing persistence of PrEP in this priority population, yet this research is lacking. ASMM (N = 1433) completed a baseline survey for an online HIV prevention program between 2018 and 2020. Open- and closed-ended survey items identified their beliefs about attending 3-month PrEP follow-up appointments and examined the association of Andersen's Behavioral Model factors (predisposing, enabling, and need) and confidence to attend these appointments. Qualitative and quantitative findings show that perceived parental support is a salient factor in ASMM attending PrEP follow-up appointments. Participants did not want to have to go to the doctor and get bloodwork done trimonthly, and qualitative findings elucidated rationales for this, such as perceptions that follow-ups might be time-consuming, costly, and could out their sexuality to their parents. This study suggests that parents are gatekeepers for ASMM to initiate and sustain the PrEP care continuum.
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Affiliation(s)
- Christopher Owens
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Suite 1400, Chicago, IL, 60611, USA.
| | - Kevin Moran
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Suite 1400, Chicago, IL, 60611, USA
| | - Melissa Mongrella
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Suite 1400, Chicago, IL, 60611, USA
| | - David A Moskowitz
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Suite 1400, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University, 633 N. Saint Clair St, 19th Floor , Chicago, IL, 60611, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Suite 1400, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University, 633 N. Saint Clair St, 19th Floor , Chicago, IL, 60611, USA
| | - Kathryn Macapagal
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Suite 1400, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University, 633 N. Saint Clair St, 19th Floor , Chicago, IL, 60611, USA
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Thepthien BO, Srivanichakorn S, Udomsubpayakul U, Sein Win ZZK, Zaw AMM. HIV risk behavior and testing among MS M in Bangkok 2015-2019: a short report. AIDS Care 2021; 34:869-877. [PMID: 34749547 DOI: 10.1080/09540121.2021.2001418] [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: 10/19/2022]
Abstract
Men who have sex with men (MSM) in Thailand have high HIV prevalence. This analysis used three years of data from the Behavioral Surveillance Survey (BSS) to examine the behaviors and biomedical interventions among MSM in Bangkok. Percent MSM with an HIV or STI test in the past 12 months decreased from 50.8% to 29.8%, and 42.2% to 33.0%, respectively. The frequency of HIV/STI testing was higher among those who had university-level education, as well as among those who reported higher AIDS knowledge, and had utilized prevention services. Additionally, awareness of PrEP peaked in 2017 (74.1%). The study found an increasing trend of men who had sex without a condom the last time they had anal sex with a man, and/or with multiple partners. Nearly two-thirds of the sample were reached by HIV prevention interventions. One-third had correct AIDS knowledge. These findings suggest that, after an increase of sex behavior risk, a decrease in PrEP awareness, and unknown HIV status, HIV prevalence among MSM in Bangkok may have begun to increase again. Intensified prevention interventions are urgently needed to reduce HIV behavioral risk for MSM since that is a major driver of the HIV epidemic in Thailand.
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Affiliation(s)
- Bang-On Thepthien
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand
| | | | - Umaporn Udomsubpayakul
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Nakhon Pathom, Thailand
| | - Zu Zu Kyaw Sein Win
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand
| | - Aye Myat Myat Zaw
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand
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13
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Franco Vega I, Eleftheriou A, Graham C. Using video games to improve the sexual health of young people aged 15-25 years: A rapid review (Preprint). JMIR Serious Games 2021; 10:e33207. [PMID: 35587873 PMCID: PMC9164099 DOI: 10.2196/33207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 03/19/2022] [Accepted: 04/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background Sexually transmitted infections and unintended pregnancies among young people remain public health concerns in many countries. To date, interventions that address these concerns have had limited success. Serious games are increasingly being used as educational tools in health and professional public education. Although acknowledged as having great potential, few studies have evaluated the use of serious games in sexual health education among young people, and to date, there have been no published reviews of these studies. Objective This study aims to assess the effects of video game–based sexual health interventions for risky sexual behavior in young people aged between 15 and 25 years. Methods A rapid review of randomized controlled trials and quasi–randomized controlled trials was performed. The search included the following bibliographic databases: Cochrane Central Register of Controlled Trials, Embase, MEDLINE, PsycINFO, and Scopus. A total of 2 reviewers independently screened 50% (35/70) of the retrieved articles during the full-text screening phase. Results From a total of 459 identified citations, after removing duplicates, 327 (71.2%) articles were deemed eligible for title and abstract screening. Of the 327 articles, 70 (21.4%) full texts were screened, from which 10 (3.1%) articles (evaluating 11 different games) were included in the review. The findings highlighted the considerable diversity in video game–based interventions and assessed sexual health outcomes. Although there were some promising findings in outcome studies using game-based interventions, the results across studies were mixed. Conclusions Although game interventions for sexual health have been in existence for almost three decades, relatively few studies have evaluated them, and the results of previous outcome studies have been mixed. Moreover, there is little clarity regarding which specific elements of a game facilitate positive outcomes. We provide recommendations for future researchers developing video game–based interventions to improve sexual health in young people.
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Affiliation(s)
- Ignacio Franco Vega
- Department of Social & Policy Sciences, University of Bath, Bath, United Kingdom
| | | | - Cynthia Graham
- Department of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
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Holloway IW, Krueger EA, Meyer IH, Lightfoot M, Frost DM, Hammack PL. Longitudinal trends in PrEP familiarity, attitudes, use and discontinuation among a national probability sample of gay and bisexual men, 2016-2018. PLoS One 2020; 15:e0244448. [PMID: 33382743 PMCID: PMC7775083 DOI: 10.1371/journal.pone.0244448] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022] Open
Abstract
This study explored familiarity with, attitudes toward, uptake and discontinuation of PrEP (Pre-exposure prophylaxis) among a national probability sample of gay and bisexual men. PrEP is one of the most effective biomedical HIV prevention strategies; however, use among gay and bisexual men remains low within the United States. This study used a national probability sample of gay and bisexual men from three age cohorts of men (18-25, 34-41, and 52-59 years at wave 1) who completed three annual surveys between March 2016 and March 2018 (N at wave 1 = 624). Recruitment occurred through a Gallup dual-frame sampling procedure; results for this study came from eligible individuals who consented to be part of the self-administered online or mailed survey questionnaire. We used descriptive data with sampling weights to understand trends in PrEP familiarity, PrEP attitudes and PrEP use across all three time points. Next, PrEP uptake and discontinuation were assessed among men completing all three surveys and who remained eligible for PrEP at all three time points (N = 181). PrEP familiarity increased considerably between 2016 and 2018 among those eligible for PrEP (from 59.8% from wave 1 to 92.0% at wave 3). Favorable attitudes toward PrEP increased more modestly (from 68.3% at wave 1 to 72.7% at wave 3). While PrEP use increased by 90% between the two time points (from 4.1% in 2016 to 7.8% in 2018), this represented a small percentage of overall uptake among eligible participants across time (6.6%). Among respondents who reported PrEP use at wave 1 or wave 2, 33.3% subsequently discontinued PrEP use at a later wave. Findings indicate modest increases in PrEP use between 2016 and 2018 in a national probability sample of sexually-active gay and bisexual men. PrEP discontinuation was high and suggests the need for further research into gay and bisexual men's PrEP discontinuation and persistence.
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Affiliation(s)
- Ian W. Holloway
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, California, United States of America
- Gay Sexuality and Social Policy Initiative, UCLA Luskin School of Public Affairs, Los Angeles, California, United States of America
- * E-mail:
| | - Evan A. Krueger
- Department of Preventive Medicine, USC Keck School of Medicine, Los Angeles, California, United States of America
| | - Ilan H. Meyer
- Williams Institute, UCLA School of Law, Los Angeles, California, United States of America
| | - Marguerita Lightfoot
- Department of Medicine, University of California, San Francisco, California, United States of America
| | - David M. Frost
- Department of Social Science, University College, London, United Kingdom
| | - Phillip L. Hammack
- Department of Psychology, University of California, Santa Cruz, California, United States of America
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Nelson LE. Awakening to an Intersectional Reality: Ending the HIV Epidemic in the USA Starts with Reducing Inequities among Black MSM. J Urban Health 2020; 97:589-591. [PMID: 33025307 PMCID: PMC7560685 DOI: 10.1007/s11524-020-00487-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 01/13/2023]
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