1
|
Seyedroudbari S, Ghadimi F, Grady G, Uzosike O, Nkwihoreze H, Jemmott JB, Momplaisir F. Assessing Structural Racism and Discrimination Along the Pre-exposure Prophylaxis Continuum: A Systematic Review. AIDS Behav 2024:10.1007/s10461-024-04387-y. [PMID: 38851649 DOI: 10.1007/s10461-024-04387-y] [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] [Accepted: 05/16/2024] [Indexed: 06/10/2024]
Abstract
Structural racism and discrimination (SRD) is deeply embedded across U.S. healthcare institutions, but its impact on health outcomes is challenging to assess. The purpose of this systematic literature review is to understand the impact of SRD on pre-exposure prophylaxis (PrEP) care continuum outcomes across U.S. populations who could benefit from HIV prevention. Guided by PRISMA guidelines, we conducted a systematic review of the published literature up to September 2023 using PubMed and PsycInfo and included peer-reviewed articles meeting inclusion criteria. At least two authors independently screened studies, performed quality assessments, and abstracted data relevant to the topic. Exposure variables included race/ethnicity and any level of SRD (interpersonal, intra- and extra-organizational SRD). Outcomes consisted of any steps of the PrEP care continuum. A total of 66 studies met inclusion criteria and demonstrated the negative impact of SRD on the PrEP care continuum. At the interpersonal level, medical mistrust (i.e., lack of trust in medical organizations and professionals rooted from current or historical practices of discrimination) was negatively associated with almost all the steps across the PrEP care continuum: individuals with medical mistrust were less likely to have PrEP knowledge, adhere to PrEP care, and be retained in care. At the intra-organizational level, PrEP prescription was lower for Black patients due to healthcare provider perception of higher sex-risk behaviors. At the extra-organizational level, factors such as homelessness, low socioeconomic status, and incarceration were associated with decreased PrEP uptake. On the other hand, healthcare provider trust, higher patient education, and access to health insurance were associated with increased PrEP use and retention in care. In addition, analyses using race/ethnicity as an exposure did not consistently show associations with PrEP continuum outcomes. We found that SRD has a negative impact at all steps of the PrEP care continuum. Our results suggest that when assessing the effects of race/ethnicity without the context of SRD, certain relationships and associations are missed. Addressing multi-level barriers related to SRD are needed to reduce HIV transmission and promote health equity.
Collapse
Affiliation(s)
| | - Fatemeh Ghadimi
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Hervette Nkwihoreze
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John B Jemmott
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Florence Momplaisir
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
2
|
Hill M, Truszczynski N, Newbold J, Coffman R, King A, Brown MJ, Radix A, Kershaw T, Kirklewski S, Sikkema K, Haider MR, Wilson P, Hansen N. The mediating role of social support between HIV stigma and sexual orientation-based medical mistrust among newly HIV-diagnosed gay, bisexual, and other men who have sex with men. AIDS Care 2023; 35:696-704. [PMID: 36205058 PMCID: PMC10079779 DOI: 10.1080/09540121.2022.2119472] [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: 10/25/2021] [Accepted: 08/25/2022] [Indexed: 10/10/2022]
Abstract
HIV-related stigma and medical mistrust are significant challenges to addressing HIV inequities among gay, bisexual, and other men who have sex with men (MSM). HIV-related stigma is associated with high levels of medical mistrust, but there is limited knowledge regarding the mechanisms that link these variables. We examined the potential mediating roles of social support and coping in the relationship between perceived HIV stigma and sexual orientation based-medical mistrust among newly HIV-diagnosed MSM. We hypothesized that HIV-related stigma would be associated with mistrust and that social support, and coping would mediate this relationship. Data were obtained from 202 newly HIV-diagnosed (<1 year) MSM receiving care at community HIV clinics in New York. A path model indicated that HIV stigma was directly related to greater sexual orientation based medical mistrust, and that this relationship was mediated by social support. However, coping did not mediate the relationship between HIV stigma and mistrust. Efforts to increase social support and decrease stigma are critical for strengthening relationships between MSM and HIV care networks. Future research should assess the feasibility of designing and implementing interventions focused on increasing social network support and improving trust in the medical community among newly HIV-diagnosed MSM.
Collapse
Affiliation(s)
- Miranda Hill
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA
| | | | | | - Robert Coffman
- Department of Health Promotion & Behavior, College of Public Health, University of Georgia, Athens, Georgia
| | - Aisha King
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Monique J Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, NY, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Sally Kirklewski
- Department of Health Promotion & Behavior, College of Public Health, University of Georgia, Athens, Georgia
| | - Kathleen Sikkema
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mohammad Rifat Haider
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia
| | - Patrick Wilson
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Nathan Hansen
- Department of Health Promotion & Behavior, College of Public Health, University of Georgia, Athens, Georgia
| |
Collapse
|
3
|
Rivlin K, Brenner-Levoy J, Odum T, Muzyczka Z, Norris A, Norris Turner A, Bessett D. Provider Mistrust and Telemedicine Abortion Care Preferences Among Patients in Ohio, West Virginia, and Kentucky. Telemed J E Health 2023; 29:414-424. [PMID: 35856859 PMCID: PMC10081726 DOI: 10.1089/tmj.2022.0101] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/29/2022] [Accepted: 05/07/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: The convenience and privacy provided by telemedicine medication abortion may make this service preferable to patients who mistrust their abortion provider. We assessed associations between mistrust in the abortion provider and preferences for telemedicine abortion. Study Design: From April 2020 to April 2021, we surveyed patients seeking abortion in Ohio, West Virginia, and Kentucky. Using unconditional logistic regression models, we examined unadjusted and adjusted associations between mistrust in the abortion provider and preferences for telemedicine abortion among all participants, and among only participants undergoing medication abortion. Results: Of 1,218 patients who met inclusion criteria, 546 used medication abortion services. Just more than half (56%) of all participants and many (64%) of medication abortion participants preferred telemedicine services. Only 6% of medication abortion participants received telemedicine medication dispensing services. Only 1.4% of all participants and 1% of medication abortion participants mistrusted the abortion provider. Participants who mistrusted the abortion provider were somewhat more likely to prefer telemedicine abortion (unadjusted odds ratio [OR]: 2.5, 95% CI: 0.8-7.9; adjusted OR: 2.9, 95% CI: 0.9-9), and medication abortion participants who mistrusted the abortion provider were also somewhat more likely to prefer telemedicine abortion (unadjusted OR: 3.5, 95% CI: 0.4-28.9; adjusted OR: 5.0, 95% CI: 0.6-43), although these associations were not statistically significant. Conclusions: In three abortion-restrictive states, most patients expressed preferences for telemedicine abortion, but few accessed them. Provider mistrust was rare, but those experiencing mistrust trended toward preferring telemedicine services. Telemedicine may improve access to abortion services for patients experiencing medical mistrust.
Collapse
Affiliation(s)
- Katherine Rivlin
- Department of Obstetrics and Gynecology, The College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | | | - Tamika Odum
- Behavioral Science Department, Blue Ash College, University of Cincinnati, Cincinnati, Ohio, USA
| | - Zoe Muzyczka
- Department of Sociology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alison Norris
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Abigail Norris Turner
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Danielle Bessett
- Department of Sociology, University of Cincinnati, Cincinnati, Ohio, USA
| |
Collapse
|
4
|
Clement ME, Lovett A, Caldwell S, Beckford J, Hilgart M, Corneli A, Flickinger T, Dillingham R, Ingersoll K. Development of an mHealth App to Support the Prevention of Sexually Transmitted Infections Among Black Men Who Have Sex With Men Engaged in Pre-exposure Prophylaxis Care in New Orleans, Louisiana: Qualitative User-Centered Design Study. JMIR Form Res 2023; 7:e43019. [PMID: 36848209 PMCID: PMC10011974 DOI: 10.2196/43019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Sexual health disparities exist for Black men who have sex with men (BMSM) in New Orleans, Louisiana. Rates of sexually transmitted infections (STIs) are high for both BMSM and those taking HIV pre-exposure prophylaxis (PrEP). OBJECTIVE In this study, we introduced an existing PrEP adherence app to new potential users-BMSM engaged in PrEP care in New Orleans-to guide app adaptation with STI prevention features and tailoring for the local context. METHODS Using a user-centered design, we conducted 4 focus group discussions (FGDs), with interim app adaptations from December 2020 to March 2021. During the FGDs, a video of the app, app website, and mock-ups were shown to participants. We asked about facilitators of and barriers to STI prevention in general, current app use, impressions of the existing app, new app features to potentially facilitate STI prevention, and how the app should be tailored for BMSM. We used applied qualitative thematic analysis to identify themes and needs of the population. RESULTS Overall, 4 FGDs were conducted with 24 BMSM taking PrEP. We grouped themes into 4 categories: STI prevention, current app use and preferences, preexisting features and impressions of the prep'd app, and new features and modifications for BMSM. Participants noted concern about STIs and shared that anxiety about some STIs was higher than that for others; some participants shared that since the emergence of PrEP, little thought is given to STIs. However, participants desired STI prevention strategies and suggested prevention methods to implement through the app, including access to resources, educational content, and sex diaries to follow their sexual activity. When discussing app preferences, they emphasized the need for an app to offer relevant features and be easy to use and expressed that some notifications were important to keep users engaged but that they should be limited to avoid notification fatigue. Participants thought that the current app was useful and generally liked the existing features, including the ability to communicate with providers, staff, and each other through the community forum. They had suggestions for modifications for STI prevention, such as the ability to comment on sexual encounters, and for tailoring to the local context, such as depictions of iconic sights from the area. Mental health emerged as an important need to be addressed through the app during discussion of almost all features. Participants also stressed the importance of ensuring privacy and reducing stigma through the app. CONCLUSIONS A PrEP adherence app was iteratively adapted with feedback from BMSM, resulting in a new app modified for the New Orleans context and with STI prevention features. Participants gave the app a new name, PCheck, to be more discreet. Next steps will assess PCheck use and STI prevention outcomes.
Collapse
Affiliation(s)
- Meredith Edwards Clement
- Division of Infectious Diseases, Louisiana State University Health Sciences Center- New Orleans, New Orleans, LA, United States
| | - Aish Lovett
- Division of Infectious Diseases, Louisiana State University Health Sciences Center- New Orleans, New Orleans, LA, United States
| | - Sylvia Caldwell
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health, Charlottesville, VA, United States
| | - Jeremy Beckford
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Michelle Hilgart
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health, Charlottesville, VA, United States
| | - Amy Corneli
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
- Duke Clinical Research Institute, Durham, NC, United States
| | - Tabor Flickinger
- Division of General, Geriatric, Palliative, and Hospital Medicine, University of Virginia, Charlottesville, VA, United States
| | - Rebecca Dillingham
- Division of Infectious Disease and International Health, University of Virginia, Charlottesville, VA, United States
| | - Karen Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health, Charlottesville, VA, United States
| |
Collapse
|
5
|
Chai P, De D, Albrechta H, Goodman GR, Takabatake K, Ben-Arieh A, Lee JS, Glynn TR, Mayer K, O'Cleirigh C, Fisher C. Attitudes towards participating in research involving digital pill systems to measure oral HIV pre-exposure chemoprophylaxis: a cross-sectional study among men who have sex with men with substance use in the USA. BMJ Open 2023; 13:e067549. [PMID: 36717151 PMCID: PMC9887701 DOI: 10.1136/bmjopen-2022-067549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/19/2023] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES This quantitative survey sought to understand, among men who have sex with men (MSM) with potentially problematic substance use, the attitudes towards participation in research involving digital pill systems (DPS) for HIV pre-exposure prophylaxis (PrEP) adherence measurement, and the barriers and facilitators to research participation. DESIGN One-time, cross-sectional, online sampling-based survey. SETTING US social networking app predominantly focused on MSM. PARTICIPANTS MSM without HIV who reported current use of oral PrEP, potentially problematic substance use and sexual activity in the past 3 months. A total of 157 participants were eligible, passed validity checks and enrolled. OUTCOME MEASURES Perceptions of DPS usefulness, accuracy and usability (System Usability Scale (SUS)); willingness and motivations to participate in DPS research; preferences for access to and feedback on DPS adherence data; data sharing considerations; and medical mistrust (Group-Based Medical Mistrust Scale (GBMMS)). RESULTS Most of the sample (N=157) was white (n=119, 75.8%), gay (n=124, 79.0%) and cisgender (n=150, 95.5%). The median age was 33 years (IQR: 14). The mean GBMMS score was 13.5 (SD=5.2), and the median SUS score was 70 (IQR: 27.5). In the past 3 months, 36.3% (n=57) reported frequent use of substances before or during sex, and 62.4% (n=98) engaged in condomless sex. While most were adherent to PrEP, approximately 34.4% (n=54) expressed significant worry about daily adherence. Participants wished to monitor their PrEP adherence daily (n=66, 42.0%) and 52% (n=82) were very willing to participate in DPS-based research. The majority were minimally concerned about sharing DPS-detected adherence data with research teams (n=126, 80.3%), and were extremely willing to share these data with healthcare providers (n=109, 69.4%). CONCLUSIONS In this sample, MSM without HIV who use substances reported willingness to use DPS to measure PrEP adherence in a research context, and identified benefits to accessing real-time, DPS-detected adherence data.
Collapse
Affiliation(s)
- Peter Chai
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Fenway Institute, Boston, Massachusetts, USA
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA
| | - Dikha De
- Fenway Institute, Boston, Massachusetts, USA
- Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Georgia R Goodman
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Fenway Institute, Boston, Massachusetts, USA
| | - Koki Takabatake
- Fenway Institute, Boston, Massachusetts, USA
- Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Jasper S Lee
- Fenway Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tiffany R Glynn
- Fenway Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kenneth Mayer
- Fenway Institute, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Conall O'Cleirigh
- Fenway Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Celia Fisher
- Center for Ethics Education, Fordham University, New York, New York, USA
| |
Collapse
|
6
|
Celia G, Lausi G, Girelli L, Cavicchiolo E, Limone P, Giannini AM, Cozzolino M. COVID-19 related conspiracy beliefs and their relationship with defense strategies, emotions, powerlessness, attitudes, and time perspective. Front Psychol 2022; 13:939615. [PMID: 36304882 PMCID: PMC9592837 DOI: 10.3389/fpsyg.2022.939615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/05/2022] [Indexed: 11/18/2022] Open
Abstract
The COVID-19 pandemic has greatly impacted individual's life and society, and such an emergency has increased the likelihood of recurring conspiratorial thinking. There is much research on broader conspiratorial thinking and studies on COVID-19-related conspiratorial thinking has been growing worldwide, moreover, the negative consequences of COVID-19 specific conspiratorial beliefs for people's health are clear. However, person-centered research aiming at identify groups of individuals who share patterns of relations between COVID-19 specific conspiratorial beliefs and other psychological features is still scarce. A sample of 1.002 people (18-40 years old, M = 23; SD = 5.19) responded to a questionnaire administered online. The aim was to identify groups of individuals based on their beliefs about COVID-19 conspiracy theories and to compare the groups identified in terms of psychological characteristics associated such as automatic defense mechanisms, coping strategies, powerlessness, emotions, emotional regulation, attitudes toward the COVID-19, social distancing discontent, perceptions of COVID-19 severity and temporal perspective. A k-mean cluster analysis identified the groups of Believers (22.26%), Ambivalent believers (34.3%), and Non-believers (43.21%). The three groups differ particularly in terms of defense mechanisms, and time perspective. Results suggested the need to tailor interventions for individuals believing in COVID-19 conspiratorial theories based on differences in the psychological characteristics among the three groups.
Collapse
Affiliation(s)
- Giovanna Celia
- Department of Humanities, Literature, Cultural Heritage, Education Sciences, University of Foggia, Foggia, Italy
| | - Giulia Lausi
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Laura Girelli
- Department of Human, Philosophical and Educational Sciences, University of Salerno, Fisciano, Italy
| | - Elisa Cavicchiolo
- Department of Human, Philosophical and Educational Sciences, University of Salerno, Fisciano, Italy
| | - Pierpaolo Limone
- Department of Humanities, Literature, Cultural Heritage, Education Sciences, University of Foggia, Foggia, Italy
| | | | - Mauro Cozzolino
- Department of Human, Philosophical and Educational Sciences, University of Salerno, Fisciano, Italy
| |
Collapse
|
7
|
Gkinopoulos T, Mari S. How exposure to real conspiracy theories motivates collective action and political engagement? Τhe moderating role of primed victimhood and underlying emotional mechanisms in the case of 2018 bushfire in Attica. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2022. [DOI: 10.1111/jasp.12923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Silvia Mari
- Department of Psychology Università degli Studi di Milano‐Bicocca Milan Italy
| |
Collapse
|
8
|
Mikkilineni P, Simon R, Bhan A, Rao SD. Patient Perspectives on the COVID-19 Vaccine: A Pilot Survey Study of Patients in Endocrinology Clinics. Endocr Pract 2022; 28:897-900. [PMID: 35787467 PMCID: PMC9250825 DOI: 10.1016/j.eprac.2022.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/11/2022] [Accepted: 06/24/2022] [Indexed: 11/25/2022]
Abstract
Objective Vaccine hesitancy is an impediment to fighting the COVID-19 pandemic. Endocrinology clinics routinely see patients who are at high risk of a more aggressive form of COVID-19, including patients with diabetes, obesity, and hypertension. As patients with endocrine-related conditions often require multiple visits each year, endocrinology clinics provide a significant opportunity for vaccine education. The aim of our study was to evaluate patient perspectives about COVID-19 vaccination in outpatient endocrinology clinics. Methods A pilot survey study of patients who visited 3 endocrinology clinics between May 31, 2021, and June 18, 2021. A 7-item questionnaire explored the patients’ perspectives and behaviors regarding COVID-19 vaccination. Data were analyzed with descriptive statistics. Results A total of 446 patients from 3 clinic locations (1 urban and 2 suburbans) completed our survey. There were 361 (81%) patients who indicated that they were planning to or had already received the COVID-19 vaccination, 56 (13%) reported no intent for vaccination, and 29 (7%) were unsure. Of the 85 patients who were unsure or did not intend to be vaccinated, 43 (51%) were Black, 30 (35%) were White, and 4 (5%) had other racial/ethnic identities. When asked about vaccine hesitancy, 25 (29%) wanted to wait and see how the others responded to the vaccine, 20 (24%) had concerns about the side effects, 12 (14%) did not believe in vaccines, and 11 (13%) felt that COVID-19 was not as bad as the media had portrayed it. Significantly more Black patients had vaccine hesitancy than White patients (P = .035). Conclusion Although most endocrinology patients were amenable to COVID-19 vaccination, a subpopulation still expressed vaccine hesitancy, indicating that endocrinology clinics may be an ideal place for targeted vaccine education.
Collapse
Affiliation(s)
| | - Rebecca Simon
- Henry Ford Hospital, 3031 W Grand Blvd, Detroit, MI 48202
| | - Arti Bhan
- Henry Ford Hospital, 3031 W Grand Blvd, Detroit, MI 48202
| | - Sudhaker D Rao
- Henry Ford Hospital, 3031 W Grand Blvd, Detroit, MI 48202
| |
Collapse
|
9
|
Gebru NM, Benvenuti MC, Rowland BHP, Kalkat M, Chauca PG, Leeman RF. Relationships among Substance Use, Sociodemographics, Pre-Exposure Prophylaxis (PrEP) Awareness and Related Attitudes among Young Adult Men Who Have Sex with Men. Subst Use Misuse 2022; 57:786-798. [PMID: 35188880 PMCID: PMC9082761 DOI: 10.1080/10826084.2022.2040030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Men who have sex with men (MSM) account for two-thirds of new HIV diagnoses. Pre-exposure prophylaxis (PrEP), a highly efficacious HIV preventive medication, is underutilized. Identifying correlates of PrEP awareness and attitudes may help increase PrEP use. Thus, we evaluated (1) PrEP awareness; (2) differences in awareness related to substance use and sociodemographics; (3) initial PrEP information sources; and (4) possible associations between information sources and PrEP-related attitudes. Young adult (ages 18-30) HIV-negative MSM from Southern U.S. undertook a web survey including questions about substance use, sexual behaviors, perceived HIV risk, and PrEP. Participants were recruited using in-person and online approaches between January 2018-January 2020. Of 506 participants, 89% were aware of PrEP. Participants with high alcohol consumption and greater perceived HIV risk had higher odds of PrEP unawareness with a trend for minority race/ethnicity. PrEP-aware participants reported high overall perceived safety, confidence in PrEP's efficacy, and low perceived difficulties with adherence though those with higher perceived HIV risk and individuals who used tobacco had less favorable attitudes. Most participants first heard about PrEP from the internet. There were no statistically significant differences in PrEP-related attitudes across initial information sources. Associations between substance use and racial/ethnic minority status and lack of PrEP awareness suggest priority subgroups for educational campaigns. Future campaigns may tailor outreach materials to the respective audience (e.g., Spanish materials for Hispanic people) and disseminate where individuals who use substances may be more likely to see them (e.g., liquor and convenience stores). Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2022.2040030 .
Collapse
Affiliation(s)
- Nioud Mulugeta Gebru
- Department of Health Education & Behavior, College of Health & Human Performance; Center for Addiction Research and Education, University of Florida, Gainesville, FL, USA
- Southern HIV and Alcohol Research Consortium, University of Florida, Gainesville, FL, USA
| | - Maria Costanza Benvenuti
- Department of Health Education & Behavior, College of Health & Human Performance; Center for Addiction Research and Education, University of Florida, Gainesville, FL, USA
- Southern HIV and Alcohol Research Consortium, University of Florida, Gainesville, FL, USA
| | - Bonnie H. P. Rowland
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Meher Kalkat
- Department of Health Education & Behavior, College of Health & Human Performance; Center for Addiction Research and Education, University of Florida, Gainesville, FL, USA
| | - Patricia G. Chauca
- Department of Health Education & Behavior, College of Health & Human Performance; Center for Addiction Research and Education, University of Florida, Gainesville, FL, USA
- Southern HIV and Alcohol Research Consortium, University of Florida, Gainesville, FL, USA
| | - Robert F. Leeman
- Department of Health Education & Behavior, College of Health & Human Performance; Center for Addiction Research and Education, University of Florida, Gainesville, FL, USA
- Southern HIV and Alcohol Research Consortium, University of Florida, Gainesville, FL, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
10
|
Contessa G. It Takes a Village to Trust Science: Towards a (Thoroughly) Social Approach to Public Trust in Science. ERKENNTNIS 2022; 88:1-26. [PMID: 35194273 PMCID: PMC8852979 DOI: 10.1007/s10670-021-00485-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/17/2021] [Indexed: 05/05/2023]
Abstract
In this paper, I distinguish three general approaches to public trust in science, which I call the individual approach, the semi-social approach, and the social approach, and critically examine their proposed solutions to what I call the problem of harmful distrust. I argue that, despite their differences, the individual and the semi-social approaches see the solution to the problem of harmful distrust as consisting primarily in trying to persuade individual citizens to trust science and that both approaches face two general problems, which I call the problem of overidealizing science and the problem of overburdening citizens. I then argue that in order to avoid these problems we need to embrace a (thoroughly) social approach to public trust in science, which emphasizes the social dimensions of the reception, transmission, and uptake of scientific knowledge in society and the ways in which social forces influence both positively and negatively the trustworthiness of science.
Collapse
Affiliation(s)
- Gabriele Contessa
- Philosophy Department, Carleton University, Patterson 3A46, 1125 Colonel By Drive, Ottawa, ON Canada
| |
Collapse
|
11
|
Stigma, HIV Risk, and Access to HIV Prevention and Treatment Services Among Men Who have Sex with Men (MSM) in the United States: A Scoping Review. AIDS Behav 2021; 25:3574-3604. [PMID: 33866444 PMCID: PMC8053369 DOI: 10.1007/s10461-021-03262-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 12/11/2022]
Abstract
In light of recent advances in HIV prevention and treatment, we reviewed the literature to understand how different types of stigma impact HIV risk; access to HIV prevention, care, and treatment services; and related health outcomes among men who have sex with men (MSM) in the US. We conducted a scoping literature review of observational and qualitative studies that examined stigma and HIV-related outcomes among MSM. Our search identified 5794 studies, of which 47 met the eligibility criteria and were included in the final analysis. The review suggests that stigma remains a formidable barrier to engaging in HIV prevention and treatment among both HIV-negative and HIV-positive MSM. Among the studies of HIV-positive MSM, internalized stigma was related to lower levels of treatment engagement. HIV-positive MSM in the Southern part of the US were also more likely to engage in risky sexual behavior. Perceived health care discrimination was negatively associated with PrEP awareness, particularly among HIV-negative Black MSM. Among young MSM of color, intersectional stigma compounded the social structural barriers to PrEP adherence. Findings indicate that stigma reduction interventions should be implemented in diverse MSM communities to address the disproportionate burden of HIV along with critical gap in the care continuum. Further research should examine how individual types of stigma, including intersectional stigma, affect viral suppression and PrEP uptake and adherence, especially among MSM of color.
Collapse
|
12
|
Heads AM, Hill MJ, Suchting R, Yammine L, Gilmore-Thomas A. Predictors of Anticipated PrEP Stigma among Women with Self-Reported Problematic Substance Use: Implications for Engaging Women in the PrEP Care Continuum. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2955-2964. [PMID: 34561793 DOI: 10.1007/s10508-021-02031-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 04/21/2021] [Accepted: 04/27/2021] [Indexed: 06/13/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is an effective HIV prevention method, but it has been underutilized by women. Anticipated stigma regarding use of PrEP is a contributing factor in the underutilization of this prevention strategy. The current study explored the relationships among PrEP stigma, sex risk (i.e., inconsistent condom use, condomless sex with persons of unknown serostatus, or sex in exchange for money or drugs), substance use, attitudes toward HIV testing, and medical mistrust. Participants were 106 primarily ethnic-minority women who reported recent substance use and agreed to participate in a study exploring HIV prevention attitudes. Within this sample, the majority of participants had one or more CDC-defined PrEP indications. Findings indicate that medical mistrust was associated with perceived PrEP stereotypes and HIV testing attitudes. These results provide some insight into reasons for low PrEP uptake among women at risk for HIV. Implications for HIV prevention with women are discussed.
Collapse
Affiliation(s)
- Angela M Heads
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center At Houston, 1941 East Road, BBSB Suite 1238, Houston, TX, 77054, USA.
| | - Mandy J Hill
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health, Science Center at Houston, Houston, TX, USA
| | - Robert Suchting
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center At Houston, 1941 East Road, BBSB Suite 1238, Houston, TX, 77054, USA
| | - Luba Yammine
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center At Houston, 1941 East Road, BBSB Suite 1238, Houston, TX, 77054, USA
| | - Adrienne Gilmore-Thomas
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center At Houston, 1941 East Road, BBSB Suite 1238, Houston, TX, 77054, USA
| |
Collapse
|
13
|
Cook SH, Wood EP, Jaiswal J, Castro R, Calderon L, Qi Y, Llaneza A. Assessing Perceptions of Broad Consent Concerning Biological Specimen Collection in a Cohort of Young Sexual Minority Men. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3313-3321. [PMID: 34617188 PMCID: PMC8493942 DOI: 10.1007/s10508-021-01964-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 06/13/2023]
Abstract
The use of broad consent to store human biospecimens to be used in future research studies has increased over the years. However, it is currently unknown how young sexual minority men (YSMM) perceive broad consent in these specific types of studies. Therefore, in this study we aimed to determine the extent to which YSMM are comfortable with providing broad consent concerning their identifiable biological specimens to a variety of entities, including external researchers and pharmaceutical companies and to examine the relationship between mistrust based on racial/ethnic identity or sexual orientation and attitudes toward broad consent. YSMM (N = 239) ages 24-27 years were recruited from a prospective cohort study in New York City in 2018 to complete a survey assessing attitudes about the use of broad consent concerning biospecimens for secondary research. We found that YSMM were most willing to provide broad consent to the researcher from the study they were enrolled in (85.3%), other researchers within the same university (82.4%), and researchers at other universities (74.5%). Participants were least willing to provide broad consent to government organizations (64.4%) and pharmaceutical companies (53.8%). Further, we found that medical mistrust based on racial/ethnic identity or sexual orientation was associated with attitudes toward the use of broad consent. Research institutions should consider modifying consent procedures around the use of broad consent in order to maximize recruitment and retention, especially among minority populations.
Collapse
Affiliation(s)
- Stephanie H Cook
- Department of Biostatistics, School of Global Public Health, New York University, 715 Broadway, Room 1014, New York, NY, 10012, USA.
- Department of Social Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA.
- Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, New Brunswick, NJ, USA.
| | - Erica P Wood
- Department of Biostatistics, School of Global Public Health, New York University, 715 Broadway, Room 1014, New York, NY, 10012, USA
- Department of Social Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Jessica Jaiswal
- Rory Meyers School of Nursing, New York University, New York, NY, USA
- Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, New Brunswick, NJ, USA
| | - Robert Castro
- Department of Biostatistics, School of Global Public Health, New York University, 715 Broadway, Room 1014, New York, NY, 10012, USA
- Department of Social Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Liz Calderon
- Department of Biostatistics, School of Global Public Health, New York University, 715 Broadway, Room 1014, New York, NY, 10012, USA
- Department of Social Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Ying Qi
- Department of Biostatistics, School of Global Public Health, New York University, 715 Broadway, Room 1014, New York, NY, 10012, USA
- Department of Social Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Amanda Llaneza
- Department of Biostatistics, School of Global Public Health, New York University, 715 Broadway, Room 1014, New York, NY, 10012, USA
- Department of Social Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| |
Collapse
|
14
|
Harkness A, Rogers BG, Balise R, Mayo D, Weinstein ER, Safren SA, Pachankis JE. Who Aren't We Reaching? Young Sexual Minority Men's Non-participation in an HIV-Prevention and Mental Health Clinical Trial. AIDS Behav 2021; 25:2195-2209. [PMID: 33483898 PMCID: PMC8169533 DOI: 10.1007/s10461-020-03148-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 11/29/2022]
Abstract
Despite many successful clinical trials to test HIV-prevention interventions for sexual minority men (SMM), not all SMM are reached by these trials. Identifying factors associated with non-participation in these trials could help to ensure the benefits of research extend to all SMM. Prospective participants in New York City and Miami were screened to determine eligibility for a baseline assessment for a mental health/HIV-prevention trial (N = 633 eligible on screen). Logistic regression and classification and regression tree (CART) analysis identified predictors of non-participation in the baseline, among those who were screened as eligible and invited to participate. Individuals who reported unknown HIV status were more likely to be non-participators than those who reported being HIV-negative (OR = 2.39; 95% CI 1.41, 4.04). In New York City, Latinx SMM were more likely to be non-participators than non-Latinx white SMM (OR = 1.81; 95% CI, 1.09, 2.98). A CART model pruned two predictors of non-participation: knowledge of HIV status and age, such that SMM with unknown HIV status and SMM ages 18-19 were less likely to participate. Young SMM who did not know their HIV status, and thus are more likely to acquire and transmit HIV, were less likely to participate. Additionally, younger SMM (18-19 years) and Latinx SMM in New York City were less likely to participate. The findings suggest the importance of tailored recruitment to ensure HIV-prevention/mental health trials reach all SMM.
Collapse
Affiliation(s)
- Audrey Harkness
- Department of Public Health Sciences, University of Miami, Clinical Research Building, 1120 NW 14th Street, Suite 1008, Miami, FL, 33136, USA.
| | - Brooke G Rogers
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Raymond Balise
- Department of Public Health Sciences, University of Miami, Clinical Research Building, 1120 NW 14th Street, Suite 1008, Miami, FL, 33136, USA
| | - Daniel Mayo
- Department of Psychology, University of Miami, Miami, FL, USA
| | | | - Steven A Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | - John E Pachankis
- Department of Chronic Disease Epidemiology, Social and Behavioral Sciences Division, Yale School of Public Health, Yale University, New Haven, CT, USA
| |
Collapse
|
15
|
Behavioral and social science research to support accelerated and equitable implementation of long-acting preexposure prophylaxis. Curr Opin HIV AIDS 2021; 15:66-72. [PMID: 31644482 DOI: 10.1097/coh.0000000000000596] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The sociobehavioral research agenda for HIV prevention urgently needs to progress beyond research on end user preferences to examine how to best support patient access, engagement, and choice in the rollout of long-acting modalities. We outline critical challenges for an era of choice in biomedical prevention that could benefit from the rigorous application of sociobehavioral research methods. RECENT FINDINGS Research in three areas could accelerate implementation of long-acting antiretrovirals for prevention: integrating dual process models into research on patient decision-making and behavior; identifying strategies that mitigate against unconscious and implicit biases in provider decision-making and behavior; and developing tools to support patient-centered communication that incorporate research in both of the first two areas. SUMMARY We encourage the development of dual process models and measures to better understand patient behavior, including behavior related to initiating biomedical prevention, choice of prevention strategy, switching among strategies, and discontinuation. Second, there is the need to develop intervention research that targets provider behavior. Finally, we call for research to inform patient-centered communication tools that integrate an understanding of affective drivers of preexposure prophylaxis (PrEP) decision-making and protect against implicit bias in provider recommendations related to PrEP.
Collapse
|
16
|
Jones DL, Salazar AS, Rodriguez VJ, Balise RR, Starita CU, Morgan K, Raccamarich PD, Montgomerie E, Nogueira NF, Barreto Ojeda I, Maddalon M, Rodriguez NLY, Brophy T, Martinez T, Alcaide ML. Severe Acute Respiratory Syndrome Coronavirus 2: Vaccine Hesitancy Among Underrepresented Racial and Ethnic Groups With HIV in Miami, Florida. Open Forum Infect Dis 2021; 8:ofab154. [PMID: 34621912 PMCID: PMC8083672 DOI: 10.1093/ofid/ofab154] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and human immunodeficiency virus (HIV) disproportionally affect underrepresented ethnoracial groups in the United States. Medical mistrust and vaccine hesitancy will likely impact acceptability of SARS-CoV-2 vaccines. This study examined SARS-CoV-2 vaccine hesitancy among underrepresented ethnoracial groups with HIV and identified factors that may reduce vaccine uptake. METHODS We conducted a cross-sectional study of adults ≥18 years of age with HIV residing in Miami, Florida. Participants were invited to participate in the ACTION (A Comprehensive Translational Initiative on Novel Coronavirus) cohort study. A baseline survey was administered from April to August 2020 and followed by a coronavirus disease 2019 (COVID-19) vaccine hesitancy survey from August to November 2020. The COVID-19 vaccine hesitancy survey was adapted from the Strategic Advisory Group of Experts survey. Comparisons by race and ethnicity were performed using the Freedman-Haltmann extension of the Fisher exact test. RESULTS A total of 94 participants were enrolled; mean age was 54.4 years, 52% were female, 60% were Black non-Latinx, and 40% were non-Black Latinx. Black non-Latinx participants were less likely to agree that vaccinations are important for health when compared to non-Black Latinx (67.8% vs 92.1%, P = .009), less likely to agree that vaccines are effective in preventing disease (67.8% vs 84.2%, P = .029), less likely to believe that vaccine information is reliable and trustworthy (35.7% vs 71.1%, P = .002), and less likely to believe vaccines were unnecessary because COVID-19 would disappear soon (11% vs 21%, P = .049). CONCLUSIONS Medical mistrust, vaccine hesitancy, and negative sentiments about SARS-CoV-2 vaccines are prevalent among underrepresented ethnoracial groups with HIV, particularly Black non-Latinx. Targeted strategies to increase vaccine uptake in this population are warranted.
Collapse
Affiliation(s)
- Deborah L Jones
- Department of Psychiatry and Behavioral Sciences,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| | - Ana S Salazar
- Division of Infectious Diseases, Department of Medicine,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| | | | - Raymond R Balise
- Division of Biostatistics, Department of Public Health
Sciences, University of Miami Miller School of Medicine,
Miami, Florida, USA
| | - Claudia Uribe Starita
- Division of Infectious Diseases, Department of Medicine,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| | - Kristiana Morgan
- Division of Biostatistics, Department of Public Health
Sciences, University of Miami Miller School of Medicine,
Miami, Florida, USA
- University of Miami Miller School of
Medicine, Miami, Florida, USA
| | - Patricia D Raccamarich
- Division of Infectious Diseases, Department of Medicine,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| | - Emily Montgomerie
- Division of Infectious Diseases, Department of Medicine,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| | - Nicholas Fonseca Nogueira
- Division of Infectious Diseases, Department of Medicine,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| | - Irma Barreto Ojeda
- Division of Infectious Diseases, Department of Medicine,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| | - Marissa Maddalon
- University of Miami School of Nursing and Health
Studies, Miami, Florida, USA
| | - Nicolle L Yanes Rodriguez
- Department of Psychiatry and Behavioral Sciences,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| | - Theodora Brophy
- University of Miami Miller School of
Medicine, Miami, Florida, USA
| | - Thais Martinez
- University of Miami Miller School of
Medicine, Miami, Florida, USA
| | - Maria L Alcaide
- Division of Infectious Diseases, Department of Medicine,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| |
Collapse
|
17
|
Mistler CB, Sullivan MC, Copenhaver MM, Meyer JP, Roth AM, Shenoi SV, Edelman EJ, Wickersham JA, Shrestha R. Differential impacts of COVID-19 across racial-ethnic identities in persons with opioid use disorder. J Subst Abuse Treat 2021; 129:108387. [PMID: 34080555 PMCID: PMC8380664 DOI: 10.1016/j.jsat.2021.108387] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/27/2021] [Accepted: 03/18/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has exacerbated health disparities, particularly among at-risk people with opioid use disorder (OUD). We sought to characterize the direct and indirect impacts of COVID-19 on this group to understand how the pandemic has affected this group, this group's public health response to COVID-19, and whether there were differences by race/ethnicity. METHODS This study recruited its sample from a drug treatment setting in the northeast region of the United States. We surveyed 110 individuals on methadone as treatment for OUD and assessed COVID-19-related impacts on their health behaviors and other indices of social, physical, and mental well-being, including sexual health behaviors, substance use, mental health status, health care access, income, and employment. RESULTS Our findings highlight overall increases in depression, anxiety, loneliness, and frustration among the sample of people with OUD; the study also observed decreases in financial stability. Significant differences between groups indicated a greater financial burden among racial-ethnic minorities; this subgroup also reported greater direct adverse effects of COVID-19, including being more concerned about contracting COVID-19, not being able to get a COVID-19 test, and knowing someone who had died from COVID-19. A greater proportion of Whites indicated increases in alcohol consumption and non-prescription drug use than did racial-ethnic minorities. CONCLUSIONS Treatment providers must be vigilant in managing direct and indirect outcomes of COVID-19 among people with OUD. Findings highlight the need to develop culturally competent, differentiated interventions in partnership with community-based organizations to meet the unique challenges that the COVID-19 pandemic presents for people in treatment for OUD.
Collapse
Affiliation(s)
- Colleen B Mistler
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA; Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA.
| | - Matthew C Sullivan
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA; Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Michael M Copenhaver
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA; Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Jaimie P Meyer
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, CT, USA
| | - Alexis M Roth
- Department of Community Health Prevention, Drexel University, Philadelphia, PA, USA
| | - Sheela V Shenoi
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - E Jennifer Edelman
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA; Department of Internal Medicine, Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jeffrey A Wickersham
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA; Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, CT, USA
| | - Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA; Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| |
Collapse
|
18
|
Bogart LM, Ojikutu BO, Tyagi K, Klein DJ, Mutchler MG, Dong L, Lawrence SJ, Thomas DR, Kellman S. COVID-19 Related Medical Mistrust, Health Impacts, and Potential Vaccine Hesitancy Among Black Americans Living With HIV. J Acquir Immune Defic Syndr 2021. [DOI: https://doi.org.10.1097/qai.0000000000002570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
19
|
Bogart LM, Ojikutu BO, Tyagi K, Klein DJ, Mutchler MG, Dong L, Lawrence SJ, Thomas DR, Kellman S. COVID-19 Related Medical Mistrust, Health Impacts, and Potential Vaccine Hesitancy Among Black Americans Living With HIV. J Acquir Immune Defic Syndr 2021; 86:200-207. [PMID: 33196555 PMCID: PMC7808278 DOI: 10.1097/qai.0000000000002570] [Citation(s) in RCA: 278] [Impact Index Per Article: 92.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/28/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Medical mistrust, a result of systemic racism, is prevalent among Black Americans and may play a role in COVID-19 inequities. In a convenience sample of HIV-positive Black Americans, we examined associations of COVID-19-related medical mistrust with COVID-19 vaccine and COVID-19 treatment hesitancy and negative impacts of COVID-19 on antiretroviral therapy (ART) adherence. METHODS Participants were 101 HIV-positive Black Americans (age: M = 50.3 years; SD = 11.5; 86% cisgender men; 77% sexual minority) enrolled in a randomized controlled trial of a community-based ART adherence intervention in Los Angeles County, CA. From May to July 2020, participants completed telephone interviews on negative COVID-19 impacts, general COVID-19 mistrust (eg, about the government withholding information), COVID-19 vaccine and treatment hesitancy, and trust in COVID-19 information sources. Adherence was monitored electronically with the Medication Event Monitoring System. RESULTS Nearly all participants (97%) endorsed at least one general COVID-19 mistrust belief, and more than half endorsed at least one COVID-19 vaccine or treatment hesitancy belief. Social service and health care providers were the most trusted sources. Greater COVID-19 mistrust was related to greater vaccine and treatment hesitancy [b (SE) = 0.85 (0.14), P < 0.0001 and b (SE) = 0.88 (0.14), P < 0.0001, respectively]. Participants experiencing more negative COVID-19 impacts showed lower ART adherence, assessed among a subset of 49 participants [b (SE) = -5.19 (2.08), P = 0.02]. DISCUSSION To prevent widening health inequities, health care providers should engage with communities to tailor strategies to overcome mistrust and deliver evidence-based information, to encourage COVID-19 vaccine and treatment uptake.
Collapse
Affiliation(s)
| | - Bisola O. Ojikutu
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
- Infectious Disease Division, Massachusetts General Hospital, Boston, MA
- Division of Global Health Equity, Harvard Medical School, Boston, MA
| | - Keshav Tyagi
- Community-Based Research, APLA Health & Wellness; and
| | | | - Matt G. Mutchler
- Community-Based Research, APLA Health & Wellness; and
- Department of Health Science, California State University, Dominguez Hills
| | | | | | | | - Sarah Kellman
- Community-Based Research, APLA Health & Wellness; and
| |
Collapse
|
20
|
Gessner M, Bishop MD, Martos A, Wilson BDM, Russell ST. Sexual Minority People's Perspectives of Sexual Health Care: Understanding Minority Stress in Sexual Health Settings. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2020; 17:607-618. [PMID: 33737988 PMCID: PMC7962798 DOI: 10.1007/s13178-019-00418-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Sexual minority individuals (e.g., lesbian, gay, bisexual people) face sexual health inequalities related to their experiences with providers in sexual health care settings, yet few prior studies have focused on these experiences. In the current study, we analyzed qualitative interviews with a diverse sample of 58 sexual minority individuals from three age cohorts in the United States to explore sexual minority people's perspectives of sexual health care. Thematic content analysis revealed four key themes: erasure, enacted stigma, felt stigma, and affirmative care. Subgroup differences in themes across gender, sexual identity, race/ethnicity, and age cohort were also assessed. Women and genderqueer participants reported erasure in the context of identity dismissal in family planning conversations, and men reported felt stigma in the context of hyperawareness of sexual minority identity. Some sexual minority people of color also reported intersectional felt stigma as a result of multiple marginalized identities. Additionally, fewer men reported erasure compared to women or genderqueer people and fewer gay and lesbian participants reported erasure than bisexual or queer people. Implications of these findings include the need for more sexual minority health care initiatives and training and the development of affirmative care practices for sexual minority populations, including those with multiple marginalized identities.
Collapse
Affiliation(s)
- McKenna Gessner
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, TX, USA
| | - Meg D. Bishop
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, TX, USA
| | - Alexander Martos
- The Williams Institute, University of California Los Angeles School of Law, Los Angeles, CA, USA
| | - Bianca D. M. Wilson
- The Williams Institute, University of California Los Angeles School of Law, Los Angeles, CA, USA
| | - Stephen T. Russell
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, TX, USA
| |
Collapse
|
21
|
Ojikutu BO, Amutah-Onukagha N, Mahoney TF, Tibbitt C, Dale SD, Mayer KH, Bogart LM. HIV-Related Mistrust (or HIV Conspiracy Theories) and Willingness to Use PrEP Among Black Women in the United States. AIDS Behav 2020; 24:2927-2934. [PMID: 32239358 DOI: 10.1007/s10461-020-02843-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Uptake of pre-exposure prophylaxis (PrEP) among Black women living in the US is suboptimal. We sought to determine the association between HIV-related medical mistrust (or belief in HIV conspiracy theories) and willingness to use PrEP among Black women. We analyzed data from the 2016 National Survey on HIV in the Black Community (NSHBC), a nationally representative cross-sectional survey. Among NSHBC participants, 522 were women and 347 (69.0%) reported HIV risk factors. Only 14.1% were aware that PrEP exists; 30.8% reported willingness to use PrEP. HIV-related medical mistrust was reported by 60.4% of women. In multivariable analysis, controlling for income, education, marital status and health care engagement, belief in conspiracy theories was significantly associated with higher willingness to use PrEP. The HIV-Related Medical Mistrust Scale item: "there is a cure for HIV, but the government is withholding it from the poor" was independently associated with higher PrEP willingness. This finding speaks to the need for an improved understanding of the role of HIV-related medical mistrust among Black women to improve uptake of biomedical HIV prevention.
Collapse
Affiliation(s)
- B O Ojikutu
- Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
- Harvard School of Medicine, Boston, MA, USA.
| | | | - T F Mahoney
- School of Public Health, Boston University, Boston, MA, USA
| | - C Tibbitt
- Tufts University School of Medicine, Boston, MA, USA
| | - S D Dale
- University of Miami Medical Center, Miami, FL, USA
| | - K H Mayer
- The Fenway Institute, Boston, MA, USA
- Beth Israel Lahey Medical Center, Boston, MA, USA
| | | |
Collapse
|
22
|
Olansky E, Mansergh G, Pitts N, Mimiaga MJ, Denson DJ, Landers S, Holman J, Herbst JH. PrEP Awareness in the Context of HIV/AIDS Conspiracy Beliefs Among Black/African American and Hispanic/Latino MSM in Three Urban US Cities. JOURNAL OF HOMOSEXUALITY 2020; 67:833-843. [PMID: 30633661 DOI: 10.1080/00918369.2018.1557953] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We examined HIV conspiracy beliefs and PrEP awareness in a convenience sample of minority MSM. Participants in three cities completed a behavioral self-assessment on sociodemographics, PrEP awareness, and HIV/AIDS conspiracy beliefs. HIV/AIDS conspiracy beliefs were more common among Black than Latino MSM (58% vs. 42%, p < .05), and among younger men than older men (age 18-29 (50%), 30-39 (22%), 40+ (28%); p < .05). PrEP awareness co-occurred with conspiracy belief less (37%) than with non-belief (63%, p < .05), persisting in multivariable regression (aOR = 0.52, 95% CI = 0.38-0.71). This relationship suggests that current HIV care and prevention messaging is either inaccessible or not credible to some minority subpopulations.
Collapse
Affiliation(s)
| | | | | | - Matthew J Mimiaga
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | | | | | - Jeremy Holman
- Health Resources in Action, Boston, Massachusetts, USA
| | | |
Collapse
|
23
|
Underhill K. Perceptions of Protection under Nondiscrimination Law. AMERICAN JOURNAL OF LAW & MEDICINE 2020; 46:21-54. [PMID: 32460651 DOI: 10.1177/0098858820919551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Nondiscrimination rules-statutes, regulations, and soft law protections-are critical for reducing health and health care disparities. Although scholarship has interrogated how nondiscrimination rules affect behavior by discriminators, comparatively little has considered how protections can affect choices made by members of protected groups. A number of states and some interpretations of federal law protect people from discrimination on the basis of sexual orientation. This Article seeks to identify relationships between actual state law, perceived state law, and experiences of discrimination and medical mistrust. This Article reports the results of a national cross-sectional survey of over 3,000 men using Grindr to meet male partners. Participants scored comparable to chance in knowledge about state nondiscrimination protections, with "optimistic errors" (erroneous beliefs that one was protected) significantly more common than pessimistic errors. Perceptions of protection were significantly correlated with lower medical mistrust and greater uptake of care, as well as lower perceived barriers to disclosure and care-seeking. Actual state law protections, however, were significant predictors of having had discussions with providers that depended on disclosure of sexual behavior or orientation. Building on these results, this Article considers pathways by which nondiscrimination law may exert welcome mat (and "unwelcome mat") effects.
Collapse
Affiliation(s)
- Kristen Underhill
- Associate Professor of Law, Columbia Law School. Associate Professor of Population & Family Health, Mailman School of Public Health, Columbia University. J.D., Yale Law School; D.Phil., University of Oxford. This research was funded by K01-MH093273 from the National Institute of Mental Health. I am grateful to the study participants for sharing their thoughts and experiences. I am also grateful to the peer reviewers and commentators at the American Society of Law, Medicine & Ethics Health Law Professors Conference; the Behavioral Law and Economics conference; the Columbia Faculty Workshop; the Harvard Health Law Workshop; the Mailman School Department of Population & Family Health; the Penn State Health Services Research Colloquium; and the Regional Health Law Works-in-Progress Retreat for valuable feedback on this work. I thank Leo Beletsky, I. Glenn Cohen, Carl Coleman, Mark Hatzenuehler, Suzanne Goldberg, Bert Huang, Craig Konnoth, Terry McGovern, Adam Muchmore, Govind Persad, and Brian Sheppard for helpful comments and discussion. I am grateful to Kenneth H. Mayer, Don Operario, Kate Guthrie, Peter Salovey, Christopher Kahler, and Sarah K. Calabrese for guidance and collaboration on the K01 study that included this survey. All errors herein are my own
| |
Collapse
|
24
|
Gray A, Macapagal K, Mustanski B, Fisher CB. Surveillance studies involving HIV testing are needed: Will at-risk youth participate? Health Psychol 2019; 39:21-28. [PMID: 31512922 DOI: 10.1037/hea0000804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Adolescent males who have sex with males (AMSMs) account for high numbers of new HIV diagnoses. To date, surveillance data have been limited to diagnosed cases of HIV, resulting in an underestimation of risk and burden among AMSMs unwilling or unable to access HIV testing. This study identified facilitators and barriers to AMSMs' participation in future surveillance studies involving HIV testing. METHOD AMSMs (n = 198) aged 14 to 17 years participated. The majority identified as non-Hispanic White or Latinx, had a least 1 male sex partner, and self-reported HIV negative. Participants read an online survey beginning with a vignette describing a hypothetical HIV surveillance study requiring HIV testing. They then completed questions assessing likelihood to participate, perceived research benefits and risks, attitudes toward HIV risk, prior HIV health services, and parental awareness of sexual orientation. RESULTS Approximately 40% indicated strong willingness to participate. Willingness was positively related to perceived HIV risk, free access to HIV testing, counseling and referral if testing positive, confidentiality protections, and lack of access to a trusted physician. Having to tell others if one tested positive for HIV and requirements for guardian permission were significant participation barriers. CONCLUSIONS Inclusion of HIV testing in surveillance studies is essential for accurate estimation of HIV incidence and prevalence among AMSMs. Successful recruitment of sexual minority youth into sexual health surveillance research will require procedures tailored to youth's health care needs and concerns, including adequate HIV counseling, referral to treatment if seropositive, and attention to concerns regarding guardian permission. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
|
25
|
Tekeste M, Hull S, Dovidio JF, Safon CB, Blackstock O, Taggart T, Kershaw TS, Kaplan C, Caldwell A, Lane SB, Calabrese SK. Differences in Medical Mistrust Between Black and White Women: Implications for Patient-Provider Communication About PrEP. AIDS Behav 2019; 23:1737-1748. [PMID: 30264207 DOI: 10.1007/s10461-018-2283-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention method. PrEP uptake has been persistently low among US women, particularly Black women, who account for 61% of new HIV diagnoses among women. Further understanding of barriers to Black women accessing PrEP is needed. This 2017 cross-sectional survey study explored race-based differences in PrEP interest and intention among women and the indirect association between race and comfort discussing PrEP with a healthcare provider through medical mistrust. The sample consisted of 501 adult women (241 Black; 260 White) who were HIV-negative, PrEP-inexperienced, and heterosexually active. Black women reported greater PrEP interest and intention than White women. However, Black women expressed higher levels of medical mistrust, which, in turn, was associated with lower comfort discussing PrEP with a provider. Medical mistrust may operate as a unique barrier to PrEP access among Black women who are interested in and could benefit from PrEP.
Collapse
Affiliation(s)
- Mehrit Tekeste
- Department of Psychology, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA.
| | - Shawnika Hull
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - John F Dovidio
- Department of Psychology, Yale University, New Haven, CT, USA
- Yale School of Public Health, Yale University, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Cara B Safon
- Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Oni Blackstock
- New York City Department of Health & Mental Hygiene, New York, NY, USA
| | - Tamara Taggart
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- Yale School of Public Health, Yale University, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Trace S Kershaw
- Yale School of Public Health, Yale University, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Clair Kaplan
- Planned Parenthood of Southern New England, New Haven, CT, USA
| | | | - Susan B Lane
- Planned Parenthood of Southern New England, New Haven, CT, USA
| | - Sarah K Calabrese
- Department of Psychology, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
- Yale School of Public Health, Yale University, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| |
Collapse
|
26
|
Longino A, Montano MA, Sanchez H, Bayer A, Sanchez J, Tossas-Milligan K, Duerr A, Molina Y. Increasing PrEP uptake and adherence among MSM and TW sex workers in Lima, Perú: what and whom do different patients trust? AIDS Care 2019; 32:255-260. [PMID: 31242753 DOI: 10.1080/09540121.2019.1634787] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In Perú, men who have sex with men (MSM) and transgender women (TW) suffer rates of HIV 50 times greater than the general population. MSM or TW sex workers (SWs) are at especially high risk. Daily oral pre-exposure prophylaxis (PrEP) effectively prevents HIV infection if patients adhere to a daily or on-demand regimen. Necessary levels of adoption and adherence require data-driven intervention strategies for these marginalized groups. We conducted qualitative content analysis of data obtained from focus groups (FGs) with MSM and TW SWs. Both groups expressed strong skepticism about the motives behind international drug trials, and the safety of participating in them. Important differences between MSM and TW groups' beliefs about trustworthy information as well as community and public institutions also emerged. MSM SWs were less trusting of information from other MSM SWs, and preferred to receive information from institutional medical sources, while TGW SWs preferred to receive information from other TGW SWs. Successful strategies to encourage PrEP uptake and adherence must address the distrust patients feel towards international and institutional actors by providing patients with tailored, reliable information from local and community sources that they trust.
Collapse
Affiliation(s)
- August Longino
- School of Medicine, University of Washington, Seattle, USA
| | | | | | - Angela Bayer
- Epidemiology, STI, and HIV Research Unit, School of Public Health and Administration, Universidad Perúana Cayetano Heredia, Lima, Perú.,David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jorge Sanchez
- Centro de Investigación Tecnologicas, Biomedicas y Medioambientales, Universidad Mayor de San Marcos, Lima, Perú
| | - Kathy Tossas-Milligan
- University of Illinois Cancer Center, Office of Global Assets and Innovative Solutions, Chicago, USA
| | - Ann Duerr
- School of Medicine, University of Washington, Seattle, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Yamilé Molina
- University of Illinois Cancer Center, Office of Global Assets and Innovative Solutions, Chicago, USA.,School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
27
|
James AJ, Marable D, Cubbison CV, Tarbox AA, Mejia DL, Oo SA, Freedberg KA, Levison JH. HIV testing in a large community health center serving a multi-cultural patient population: A qualitative study of providers. AIDS Care 2019; 31:1585-1592. [PMID: 31131623 DOI: 10.1080/09540121.2019.1612016] [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: 10/26/2022]
Abstract
In the United States, 15% of HIV-positive individuals do not know their HIV serostatus. While CDC guidelines recommend HIV testing for individuals age 13-64 years, racial and ethnic minorities continue to experience delays in HIV diagnosis. We assessed providers' perspectives on HIV testing at an urban community health center serving racial/ethnic minority populations of low socioeconomic status. We conducted five focus groups from January 2017 to November 2017 with 74 health center staff: 20 adult medicine/primary care providers, 34 community health workers (CHWs) and community health administrators, six urgent care physicians, and fourteen behavioral health providers. Study staff analyzed transcripts using a grounded theory approach and used open coding to develop themes. We identified five themes affecting HIV testing: 1) provider perception of patients' preferences for HIV testing; 2) competing medical and social issues; 3) inter-professional communication; 4) knowledge of clinical indicators for HIV testing; and 5) knowledge of frequency of HIV testing. Primary care physicians desired mechanisms to easily identify patients for HIV testing and assistance with testing for non-English speakers. Training to improve comfort with HIV testing, integrating CHWs into routine practice, and focusing on patients' cultural beliefs may increase HIV testing in diverse community health centers..
Collapse
Affiliation(s)
- Anthony J James
- From the Divisions of General Internal Medicine, Massachusetts General Hospital , Boston , MA , USA
| | - Danelle Marable
- Center for Community Health Improvement, Massachusetts General Hospital , Boston , MA , USA
| | - Caroline V Cubbison
- From the Divisions of General Internal Medicine, Massachusetts General Hospital , Boston , MA , USA
| | - Andrew A Tarbox
- From the Divisions of General Internal Medicine, Massachusetts General Hospital , Boston , MA , USA
| | - Dianna L Mejia
- From the Divisions of General Internal Medicine, Massachusetts General Hospital , Boston , MA , USA
| | - Sarah A Oo
- Center for Community Health Improvement, Massachusetts General Hospital , Boston , MA , USA
| | - Kenneth A Freedberg
- From the Divisions of General Internal Medicine, Massachusetts General Hospital , Boston , MA , USA.,Infectious Diseases, Massachusetts General Hospital , Boston , MA , USA.,The Medical Practice Evaluation Center, Massachusetts General Hospital , Boston , MA , USA.,Harvard Medical School , Boston , MA , USA
| | - Julie H Levison
- From the Divisions of General Internal Medicine, Massachusetts General Hospital , Boston , MA , USA.,Harvard Medical School , Boston , MA , USA
| |
Collapse
|
28
|
Ramos SR, Warren R, Shedlin M, Melkus G, Kershaw T, Vorderstrasse A. A Framework for Using eHealth Interventions to Overcome Medical Mistrust Among Sexual Minority Men of Color Living with Chronic Conditions. Behav Med 2019; 45:166-176. [PMID: 31343963 PMCID: PMC6793989 DOI: 10.1080/08964289.2019.1570074] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 10/26/2022]
Abstract
The purpose of this paper is to present a stepwise, multi-construct, innovative framework that supports the use of eHealth technology to reach sexual minority populations of color to establish trustworthiness and build trust. The salience of eHealth interventions can be leveraged to minimize the existing paradigm of medical mistrust among sexual minority populations of color living with chronic illnesses. These interventions include virtual environments and avatar-led eHealth videos, which address psychosocial and structural-level challenges related to mistrust. Our proposed framework addresses how eHealth interventions enable technology adoption and usage, anonymity, co-presence, self-disclosure, and social support and establish trustworthiness and build trust.
Collapse
Affiliation(s)
| | - Rueben Warren
- b Tuskegee University National Center for Bioethics in Research and Health Care
| | | | - Gail Melkus
- a New York University Rory Meyers College of Nursing
| | | | | |
Collapse
|
29
|
Jolley D, Meleady R, Douglas KM. Exposure to intergroup conspiracy theories promotes prejudice which spreads across groups. Br J Psychol 2019; 111:17-35. [PMID: 30868563 PMCID: PMC7004178 DOI: 10.1111/bjop.12385] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 01/11/2019] [Indexed: 11/27/2022]
Abstract
This research experimentally examined the effects of exposure to intergroup conspiracy theories on prejudice and discrimination. Study 1 (N = 166) demonstrated that exposure to conspiracy theories concerning immigrants to Britain from the European Union (vs. anti‐conspiracy material or a control) exacerbated prejudice towards this group. Study 2 (N = 173) found the same effect in a different intergroup context – exposure to conspiracy theories about Jewish people (vs. anti‐conspiracy material or a control) increased prejudice towards this group and reduced participants’ willingness to vote for a Jewish political candidate. Finally, Study 3 (N = 114) demonstrated that exposure to conspiracy theories about Jewish people not only increased prejudice towards this group but was indirectly associated with increased prejudice towards a number of secondary outgroups (e.g., Asians, Arabs, Americans, Irish, Australians). The current research suggests that conspiracy theories may have potentially damaging and widespread consequences for intergroup relations.
Collapse
|
30
|
Matson M, Macapagal K, Kraus A, Coventry R, Bettin E, Fisher CB, Mustanski B. Sexual and gender minority youth's perspectives on sharing de-identified data in sexual health and HIV prevention research. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2019; 16:1-11. [PMID: 31890053 PMCID: PMC6936765 DOI: 10.1007/s13178-018-0372-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Funding agencies encourage and sometimes require data sharing. However, there is limited empirical research on participant perspectives on sharing de-identified data from research on sensitive topics (e.g., HIV, sexual health) with other researchers, and virtually none from adolescents or sexual and gender minority (SGM) participants. SGM teens (N = 197) ages 14-17 completed an online survey with multiple choice and open-ended items assessing perspectives toward sharing survey responses and blood samples from sexual health and HIV testing studies with other researchers. SGM youth were willing to share data but frequently cited confidentiality and privacy concerns, including fears about parents finding out about their identities even after de-identification was explained. Researchers need to ensure youth understand explanations of data security protections in order to make well-informed decisions about participating in research.
Collapse
Affiliation(s)
- Margaret Matson
- Department of Medical Social Sciences & Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine (Chicago, IL)
| | - Kathryn Macapagal
- Department of Medical Social Sciences & Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine (Chicago, IL)
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine (Chicago, IL)
| | - Ashley Kraus
- Department of Medical Social Sciences & Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine (Chicago, IL)
| | - Ryan Coventry
- Department of Medical Social Sciences & Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine (Chicago, IL)
| | - Emily Bettin
- Department of Medical Social Sciences & Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine (Chicago, IL)
| | - Celia B. Fisher
- Center for Ethics Education & Department of Psychology, Fordham University (Bronx, NY)
| | - Brian Mustanski
- Department of Medical Social Sciences & Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine (Chicago, IL)
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine (Chicago, IL)
| |
Collapse
|
31
|
Jaiswal J. Whose Responsibility Is It to Dismantle Medical Mistrust? Future Directions for Researchers and Health Care Providers. Behav Med 2019; 45:188-196. [PMID: 31343959 PMCID: PMC7808309 DOI: 10.1080/08964289.2019.1630357] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Medical mistrust persists and appears to be growing. The public health literature on medical mistrust has largely focused on mistrust among Black and African American populations due to legacies of abuse and mistreatment, such as the infamous Tuskegee Syphilis Study. However, research is now emerging that explores mistrust among various populations and in varying contexts, and the literature now largely emphasizes the role of ongoing, present-day social and economic inequalities in shaping and sustaining mistrust, particularly among populations who experience staggering health disparities. This special issue showcased nine articles exploring medical mistrust among diverse populations, exploring a wide array of topics and spanning myriad methodologies. In addition to a rigorous systematic review of the literature, this issue covers several critical subareas of the health disparities literature, including preventative health screenings among Black men, discrimination and cultural factors among rural Latinx communities, health care satisfaction among Latina immigrant women, the complex relationship between HIV testing and "conspiracy beliefs" among Black populations, pre-exposure prophylaxis use among transgender women, the impacts of mass incarceration on HIV care, eHealth interventions to address chronic diseases among sexual minority men of color, and participatory research to engage underserved populations as co-researchers. The purpose of this article is to provide a brief summary of the nine manuscripts in this special issue and to outline some recommendations and future directions for research on medical mistrust.
Collapse
Affiliation(s)
- Jessica Jaiswal
- Department of Health Science, University of Alabama,Center for Health, Behavior and Prevention Studies, Rutgers University,Center for Drug Use and HIV/HCV Research, New York University,Center for Interdisciplinary Research on AIDS, Yale University
| |
Collapse
|
32
|
Fisher CB, Fried AL, Macapagal K, Mustanski B. Patient-Provider Communication Barriers and Facilitators to HIV and STI Preventive Services for Adolescent MSM. AIDS Behav 2018; 22:3417-3428. [PMID: 29546468 DOI: 10.1007/s10461-018-2081-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Adolescent males who have sex with males (AMSM) are at increased risk of contracting HIV/AIDS and other sexually transmitted infections (STIs). Healthcare providers are a critical source of HIV/STI prevention, yet little is known about AMSM patient-provider sexual health communications and services. To explore this issue, we surveyed a national sample of 198 AMSM 14-17 years. Four online psychometrically validated scales indicated over half the youth avoided communicating their sexual orientation and sexual health concerns to providers due to fear of heterosexist bias, concern their sexual health information would be disclosed to parents, and a general belief that sexual minority youth do not receive equitable treatment in health care settings. Youth who reported their physicians had initiated discussion about their sexual orientation were significantly more likely to have received HIV/STI preventive services and testing. Discussion includes the importance of medical training that meets the unique sexual health needs of AMSM.
Collapse
Affiliation(s)
- Celia B Fisher
- Center for Ethics Education and Department of Psychology, Fordham University, Bronx, NY, 10458, USA.
| | - Adam L Fried
- Clinical Psychology Program, Midwestern University, Glendale, AZ, USA
| | - Kathryn Macapagal
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
33
|
Thomann M, Zapata R, Grosso A, Chiasson MA. 'WTF is PrEP?': attitudes towards pre-exposure prophylaxis among men who have sex with men and transgender women in New York City. CULTURE, HEALTH & SEXUALITY 2018; 20:772-786. [PMID: 28982311 PMCID: PMC6217837 DOI: 10.1080/13691058.2017.1380230] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
In the USA, gay and other men who have sex with men and transgender women are disproportionately affected by HIV. Uptake of pre-exposure prophylaxis (PrEP), anti-retroviral therapy to prevent HIV-negative individuals from seroconverting if exposed to HIV, by members of this population remains low, particularly among African-Americans. We conducted two focus groups to assess responses to an online social media campaign focusing on PrEP use in New York City. We designed, produced and disseminated the campaign to address knowledge of PrEP; its physical and psychological side effects; and psychosocial barriers related to PrEP adherence and sex shaming. Focus group participants demonstrated a relatively high knowledge of PrEP, although considerable concern remained about side effects, particularly among Black participants. Participants suggested that stigma against PrEP users was declining as PrEP use became more common, but stigma remained, particularly for those not using condoms. Many focus group participants reported distrust of medical providers and were critical of the commodification of HIV prevention by the pharmaceutical industry. Participants reported that those in romantic relationships confronted unique issues regarding PrEP, namely suspicions of infidelity. Finally, Black participants spoke of the need for more tailored and sensitive representations of Black gay men in future programmes and interventions.
Collapse
Affiliation(s)
- Matthew Thomann
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Richard Zapata
- CUNY School of Public Health, Hunter College, New York, NY, USA
| | - Ashley Grosso
- Research and Evaluation Unit, Public Health Solutions, New York, NY, USA
| | - Mary Ann Chiasson
- Mailman School of Public Health, Columbia University, New York, NY, USA
- Research and Evaluation Unit, Public Health Solutions, New York, NY, USA
| |
Collapse
|
34
|
Quinn KG, Kelly JA, DiFranceisco WJ, Tarima SS, Petroll AE, Sanders C, Lawrence JSS, Amirkhanian YA. The Health and Sociocultural Correlates of AIDS Genocidal Beliefs and Medical Mistrust Among African American MSM. AIDS Behav 2018; 22:1814-1825. [PMID: 28013400 DOI: 10.1007/s10461-016-1657-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examined social and health-related correlates of AIDS conspiracy theories among 464 African American men who have sex with men (MSM). Exploratory factor analysis revealed two subscales within the AIDS conspiracy beliefs scale: medical mistrust and AIDS genocidal beliefs. Multiple regression analyses revealed medical mistrust and AIDS genocidal beliefs were both associated negative condom use attitudes and higher levels of internalized homonegativity. Medical mistrust was also associated with lower knowledge of HIV risk reduction strategies. Finally, we conducted bivariate regressions to examine the subsample of participants who reported being HIV-positive and currently taking HIV antiretroviral therapy (ART) to test associations between sexual behavior and HIV treatment and AIDS conspiracy theories. Among this subsample, medical mistrust was associated with having a detectable viral load and not disclosing HIV-status to all partners in the previous 3 months. Collectively, these findings have implications for HIV prevention and treatment for African American MSM.
Collapse
Affiliation(s)
- Katherine G Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit, Milwaukee, WI, 53202, USA.
| | - Jeffrey A Kelly
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit, Milwaukee, WI, 53202, USA
| | - Wayne J DiFranceisco
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit, Milwaukee, WI, 53202, USA
| | - Sergey S Tarima
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit, Milwaukee, WI, 53202, USA
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew E Petroll
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit, Milwaukee, WI, 53202, USA
- Division of Infectious Disease, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Chris Sanders
- Department of Sociology, Lakehead University, Thunder Bay, ON, Canada
| | | | - Yuri A Amirkhanian
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit, Milwaukee, WI, 53202, USA
| |
Collapse
|
35
|
Pham MD, Aung PP, Paing AK, Pasricha N, Agius PA, Tun W, Bajracharya A, Luchters S. Factors associated with HIV testing among young men who have sex with men in Myanmar: a cross-sectional study. J Int AIDS Soc 2018; 20. [PMID: 29105323 PMCID: PMC5810319 DOI: 10.1002/jia2.25026] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 10/12/2017] [Indexed: 01/10/2023] Open
Abstract
Introduction In Myanmar, men who have sex with men (MSM) experience high risk of HIV infection. However, access to HIV testing and prevention services remains a challenge among this marginalized population. The objective of this study was to estimate population prevalence and correlates of prior HIV testing among young MSM (YMSM) and informs the development of HIV testing and intervention programmes that respond to the specific needs of this population. Methods Five hundred and eighty‐five YMSM aged 18 to 24 years were recruited using respondent‐driven sampling (RDS) in a cross‐sectional survey conducted in six townships of Myanmar. RDS‐adjusted population estimates were calculated to estimate prevalence of HIV testing; RDS‐weighted logistic regression was used to examine correlates of HIV testing in the past 6 months and in a lifetime. Results There were 12 participants who reported receiving a HIV‐positive test; of those, five were tested in the past 6 months. The RDS‐weighted prevalence estimates of lifetime (any prior) HIV testing was 60.6% (95% CI: 53.3% to 66.4%) and of recent (≤ 6 months) HIV testing was 50.1% (95% CI: 44.1% to 55.5%). In multivariable analysis, sexual identity was associated with lifetime but not recent HIV testing. Lifetime and recent HIV testing were associated with having three or more male sexual partners in the past 12 months (adjusted ORs (aORs) = 2.28, 95% CIs: 1.21 to 4.32 and 2.69, 95% CI: 1.59 to 4.56), having good HIV‐related knowledge (aORs = 1.96, 95% CIs: 1.11 to 3.44 and 1.77, 95% CI: 1.08 to 2.89), reporting high HIV testing self‐efficacy (aORs = 13.5, 95% CIs: 6.0 to 30.1 and 9.81, 95% CI: 4.27 to 22.6) and having access to and use of non‐HIV health‐related services in the past 12 months (aORs = 13.2, 95% CIs: 6.85 to 25.6 and 7.15, 95% CI: 4.08 to 12.5) respectively. Conclusions HIV testing coverage among YMSM aged 18 to 24 years old in Myanmar is still suboptimal. Integrated HIV testing and prevention services in existing health service provision systems with tailored HIV information and education programmes targeting YMSM to improve HIV‐related knowledge and self‐efficacy may help to promote regular HIV testing behaviour and contribute to sustainable control of the HIV epidemic among this marginalized population in Myanmar.
Collapse
Affiliation(s)
- Minh D Pham
- Burnet Institute, Melbourne, Vic., Australia.,Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Poe Poe Aung
- Institute for Global Health, Yangon, Myanmar.,University of Maryland, Baltimore, MD, USA.,Burnet Institute, Yangon, Myanmar
| | | | | | | | | | | | - Stanley Luchters
- Burnet Institute, Melbourne, Vic., Australia.,Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia.,International Centre for Reproductive Health, Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
36
|
Hill BS, Patel VV, Haughton LJ, Blackstock OJ. Leveraging Social Media to Explore Black Women's Perspectives on HIV Pre-exposure Prophylaxis. J Assoc Nurses AIDS Care 2017; 29:107-114. [PMID: 28709753 DOI: 10.1016/j.jana.2017.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/15/2017] [Indexed: 11/26/2022]
|
37
|
Evangeli M, Pady K, Wroe AL. Which Psychological Factors are Related to HIV Testing? A Quantitative Systematic Review of Global Studies. AIDS Behav 2016; 20:880-918. [PMID: 26566783 PMCID: PMC4799267 DOI: 10.1007/s10461-015-1246-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Deciding to test for HIV is necessary for receiving HIV treatment and care among those who are HIV-positive. This article presents a systematic review of quantitative studies on relationships between psychological (cognitive and affective) variables and HIV testing. Sixty two studies were included (fifty six cross sectional). Most measured lifetime testing. HIV knowledge, risk perception and stigma were the most commonly measured psychological variables. Meta-analysis was carried out on the relationships between HIV knowledge and testing, and HIV risk perception and testing. Both relationships were positive and significant, representing small effects (HIV knowledge, d = 0.22, 95 % CI 0.14-0.31, p < 0.001; HIV risk perception, OR 1.47, 95 % CI 1.26-1.67, p < 0.001). Other variables with a majority of studies showing a relationship with HIV testing included: perceived testing benefits, testing fear, perceived behavioural control/self-efficacy, knowledge of testing sites, prejudiced attitudes towards people living with HIV, and knowing someone with HIV. Research and practice implications are outlined.
Collapse
Affiliation(s)
- Michael Evangeli
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK.
| | - Kirsten Pady
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK
| | - Abigail L Wroe
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK
| |
Collapse
|
38
|
Duncan DT, Kapadia F, Regan SD, Goedel WC, Levy MD, Barton SC, Friedman SR, Halkitis PN. Feasibility and Acceptability of Global Positioning System (GPS) Methods to Study the Spatial Contexts of Substance Use and Sexual Risk Behaviors among Young Men Who Have Sex with Men in New York City: A P18 Cohort Sub-Study. PLoS One 2016; 11:e0147520. [PMID: 26918766 PMCID: PMC4769145 DOI: 10.1371/journal.pone.0147520] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 01/05/2016] [Indexed: 01/26/2023] Open
Abstract
Background No global positioning system (GPS) technology study has been conducted among a sample of young gay, bisexual, and other men who have sex with men (YMSM). As such, the purpose of this study was to evaluate the feasibility and acceptability of using GPS methods to understand the spatial context of substance use and sexual risk behaviors among a sample of YMSM in New York City, a high-risk population. Methods Data came from a subsample of the ongoing P18 Cohort Study (n = 75). GPS feasibility and acceptability among participants was measured with: 1) a pre- and post-survey and 2) adherence to the GPS protocol which included returning the GPS device, self-report of charging and carrying the GPS device as well as objective data analyzed from the GPS devices. Analyses of the feasibility surveys were treated as repeated measures as each participant had a pre- and post-feasibility survey. When comparing the similar GPS survey items asked at baseline and at follow-up, we present percentages and associated p-values based on chi-square statistics. Results Participants reported high ratings of pre-GPS acceptability, ease of use, and low levels of wear-related concerns in addition to few concerns related to safety, loss, or appearance, which were maintained after baseline GPS feasibility data collection. The GPS return rate was 100%. Most participants charged and carried the GPS device on most days. Of the total of 75 participants with GPS data, 75 (100%) have at least one hour of GPS data for one day and 63 (84%) had at least one hour on all 7 days. Conclusions Results from this pilot study demonstrate that utilizing GPS methods among YMSM is feasible and acceptable. GPS devices may be used in spatial epidemiology research in YMSM populations to understand place-based determinants of health such as substance use and sexual risk behaviors.
Collapse
Affiliation(s)
- Dustin T. Duncan
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
- College of Global Public Health, New York University, New York, NY, United States of America
- Population Center, New York University, New York, NY, United States of America
- Center for Health, Identity, Behavior and Prevention Studies, New York University, New York, NY, United States of America
- Center for Drug Use and HIV Research, New York University College of Nursing, New York, NY, United States of America
- Center for Data Science, New York University, New York, NY, United States of America
- * E-mail:
| | - Farzana Kapadia
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
- College of Global Public Health, New York University, New York, NY, United States of America
- Population Center, New York University, New York, NY, United States of America
- Center for Health, Identity, Behavior and Prevention Studies, New York University, New York, NY, United States of America
- Center for Drug Use and HIV Research, New York University College of Nursing, New York, NY, United States of America
| | - Seann D. Regan
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
| | - William C. Goedel
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
- College of Global Public Health, New York University, New York, NY, United States of America
| | - Michael D. Levy
- Center for Health, Identity, Behavior and Prevention Studies, New York University, New York, NY, United States of America
| | - Staci C. Barton
- Center for Health, Identity, Behavior and Prevention Studies, New York University, New York, NY, United States of America
| | - Samuel R. Friedman
- Center for Drug Use and HIV Research, New York University College of Nursing, New York, NY, United States of America
- Institute of Infectious Disease Research, National Development and Research Institutes, Inc., New York, NY, United States of America
| | - Perry N. Halkitis
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
- College of Global Public Health, New York University, New York, NY, United States of America
- Population Center, New York University, New York, NY, United States of America
- Center for Health, Identity, Behavior and Prevention Studies, New York University, New York, NY, United States of America
- Center for Drug Use and HIV Research, New York University College of Nursing, New York, NY, United States of America
| |
Collapse
|
39
|
Kelly JA, St Lawrence JS, Tarima SS, DiFranceisco WJ, Amirkhanian YA. Correlates of Sexual HIV Risk Among African American Men Who Have Sex With Men. Am J Public Health 2015; 106:96-102. [PMID: 26562130 DOI: 10.2105/ajph.2015.302945] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES We examined correlates of condomless anal intercourse with nonmain sexual partners among African American men who have sex with men (MSM). METHODS We recruited social networks composed of 445 Black MSM from 2012 to 2014 in Milwaukee, Wisconsin; Cleveland, Ohio; and Miami Beach, Florida. Participants reported past-3-month sexual behavior, substance use, and background, psychosocial, and HIV-related characteristics. RESULTS Condomless anal intercourse outside main concordant partnerships, reported by 34.4% of MSM, was less likely in the case of no alcohol and marijuana use in the past 30 days, and higher risk-reduction behavioral intentions. High frequency of condomless anal intercourse acts with nonmain partners was associated with high gay community participation, weak risk-reduction intentions, safer sex not being perceived as a peer norm, low condom-use self-efficacy, and longer time since most recent HIV testing. CONCLUSIONS Condomless anal intercourse with nonmain partners among Black MSM was primarily associated with gay community participation, alcohol and marijuana use, and risk-reduction behavioral intentions.
Collapse
Affiliation(s)
- Jeffrey A Kelly
- Jeffrey A. Kelly, Sergey S. Tarima, Wayne J. DiFranceisco, and Yuri A. Amirkhanian are with Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Janet S. St Lawrence was with the College of Arts and Sciences, Mississippi State University, Meridian, when the study was conducted
| | - Janet S St Lawrence
- Jeffrey A. Kelly, Sergey S. Tarima, Wayne J. DiFranceisco, and Yuri A. Amirkhanian are with Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Janet S. St Lawrence was with the College of Arts and Sciences, Mississippi State University, Meridian, when the study was conducted
| | - Sergey S Tarima
- Jeffrey A. Kelly, Sergey S. Tarima, Wayne J. DiFranceisco, and Yuri A. Amirkhanian are with Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Janet S. St Lawrence was with the College of Arts and Sciences, Mississippi State University, Meridian, when the study was conducted
| | - Wayne J DiFranceisco
- Jeffrey A. Kelly, Sergey S. Tarima, Wayne J. DiFranceisco, and Yuri A. Amirkhanian are with Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Janet S. St Lawrence was with the College of Arts and Sciences, Mississippi State University, Meridian, when the study was conducted
| | - Yuri A Amirkhanian
- Jeffrey A. Kelly, Sergey S. Tarima, Wayne J. DiFranceisco, and Yuri A. Amirkhanian are with Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Janet S. St Lawrence was with the College of Arts and Sciences, Mississippi State University, Meridian, when the study was conducted
| |
Collapse
|
40
|
A Qualitative Study of Medical Mistrust, Perceived Discrimination, and Risk Behavior Disclosure to Clinicians by U.S. Male Sex Workers and Other Men Who Have Sex with Men: Implications for Biomedical HIV Prevention. J Urban Health 2015; 92:667-86. [PMID: 25930083 PMCID: PMC4524849 DOI: 10.1007/s11524-015-9961-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Access to biomedical HIV prevention technologies such as pre-exposure prophylaxis (PrEP) requires individuals to disclose risk behavior to clinicians, but experiences of discrimination and medical mistrust may limit disclosure among male sex workers and other MSM. We explored experiences of perceived discrimination, medical mistrust, and behavior disclosure among male sex workers compared to other men who have sex with men (MSM). We conducted 56 interviews with MSM and compared findings about medical mistrust, discrimination, and disclosure for 31 men who engaged in sex work vs. 25 men who did not. MSM who engaged in sex work reported more medical mistrust and healthcare discrimination due to issues beyond MSM behavior/identity (e.g., homelessness, substance use, poverty). MSM who did not report sex work described disclosing sex with men to clinicians more often. Both subgroups reported low PrEP awareness, but willingness to disclose behavior to obtain PrEP. Medical mistrust and perceived discrimination create barriers for sexual behavior disclosure to clinicians, potentially impeding access to PrEP and other forms of biomedical HIV prevention. These barriers may be higher among male sex workers compared to other MSM, given overlapping stigmas including sex work, substance use, homelessness, and poverty. An intersectionality framework for understanding multiple stigmas can help to identify how these dynamics may limit access to biomedical HIV prevention among male sex workers, as well as suggesting strategies for addressing stigmas to improve the delivery of PrEP and other HIV prevention approaches in this population.
Collapse
|
41
|
St. Lawrence JS, Kelly JA, Dickson-Gomez J, Owczarzak J, Amirkhanian YA, Sitzler C. Attitudes Toward HIV Voluntary Counseling and Testing (VCT) Among African American Men Who Have Sex With Men: Concerns Underlying Reluctance to Test. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2015; 27:195-211. [PMID: 26010312 PMCID: PMC4547358 DOI: 10.1521/aeap.2015.27.3.195] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Contemporary antiretroviral therapy (ART) can produce viral suppression of HIV, maintain health, and prevent onward HIV transmission from infected persons to their sexual partners, giving rise to the concept of treatment as prevention. Successful implementation of test-and-treat strategies rests on the early detection of HIV infection through voluntary counseling and testing (VCT) followed by entry and retention in care, ART initiation and adherence, and subsequent viral suppression. In the United States, African American men who have sex with men (MSM) bear a disproportionate burden of HIV and have high rates of undetected and untreated HIV infection. However, little research has examined racial minority MSM's views about HIV testing. In this study, in-depth interviews were conducted with 96 key informants knowledgeable about racial minority MSM as well as 100 African American MSM community members in Milwaukee, Cleveland, and Miami. Most men in the sample were aware of the availability of testing and knew testing locations, but many voiced great personal ambivalence about being tested, feared knowing their HIV status, expressed concern about stigma and loss of confidentiality, and held beliefs indicative of medical mistrust. Participants did not spontaneously cite benefits of being tested, risk reduction behavior changes made as a consequence of testing, nor the benefits of testing to get early medical care for HIV infection. There is a gap between the public health field's perception of testing benefits and the beliefs about testing held by racial minority MSM in this sample. To increase the desired outcomes from VCT for minority MSM, VCT promotion should address the concerns of African American MSM and underscore the benefits of early entry into medical care.
Collapse
Affiliation(s)
| | - Jeffrey A. Kelly
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI
| | - Julia Dickson-Gomez
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI
- Johns Hopkins University School of Public Health, Baltimore, MD
| | - Jill Owczarzak
- Johns Hopkins University School of Public Health, Baltimore, MD
| | - Yuri A. Amirkhanian
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI
| | - Cheryl Sitzler
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
42
|
Jolley D, Douglas KM. The effects of anti-vaccine conspiracy theories on vaccination intentions. PLoS One 2014; 9:e89177. [PMID: 24586574 PMCID: PMC3930676 DOI: 10.1371/journal.pone.0089177] [Citation(s) in RCA: 509] [Impact Index Per Article: 50.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 12/20/2013] [Indexed: 11/18/2022] Open
Abstract
The current studies investigated the potential impact of anti-vaccine conspiracy beliefs, and exposure to anti-vaccine conspiracy theories, on vaccination intentions. In Study 1, British parents completed a questionnaire measuring beliefs in anti-vaccine conspiracy theories and the likelihood that they would have a fictitious child vaccinated. Results revealed a significant negative relationship between anti-vaccine conspiracy beliefs and vaccination intentions. This effect was mediated by the perceived dangers of vaccines, and feelings of powerlessness, disillusionment and mistrust in authorities. In Study 2, participants were exposed to information that either supported or refuted anti-vaccine conspiracy theories, or a control condition. Results revealed that participants who had been exposed to material supporting anti-vaccine conspiracy theories showed less intention to vaccinate than those in the anti-conspiracy condition or controls. This effect was mediated by the same variables as in Study 1. These findings point to the potentially detrimental consequences of anti-vaccine conspiracy theories, and highlight their potential role in shaping health-related behaviors.
Collapse
Affiliation(s)
- Daniel Jolley
- School of Psychology, University of Kent, Canterbury, United Kingdom
- * E-mail: (DJ); (KMD)
| | - Karen M. Douglas
- School of Psychology, University of Kent, Canterbury, United Kingdom
- * E-mail: (DJ); (KMD)
| |
Collapse
|
43
|
Golub SA, Gamarel KE, Rendina HJ, Surace A, Lelutiu-Weinberger CL. From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City. AIDS Patient Care STDS 2013; 27:248-54. [PMID: 23565928 DOI: 10.1089/apc.2012.0419] [Citation(s) in RCA: 261] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study examined potential facilitators and barriers to pre-exposure prophylaxis (PrEP) use and their association with PrEP acceptability and motivations for adherence among 184 MSM and transgender women living in New York City. Participants were presented with educational information about PrEP and completed a computerized survey. Overall, 55.4% of participants reported willingness to take PrEP. The most highly endorsed barriers to PrEP use were health concerns, including both long-term impacts and short-term side effects, questions about PrEP's impact on future drug resistance, and concerns that PrEP does not provide complete protection against HIV. The most highly endorsed facilitator was free access to PrEP, followed by access to support services such as regular HIV testing, sexual health care/monitoring, and access to one-on-one counseling. Participants of color rated both barriers and facilitators as more important than their White counterparts. In multivariate models, barrier and facilitator scores significantly predicted not only PrEP acceptability, but also motivation for PrEP adherence among those who were likely to use PrEP. PrEP implementation programs should consider addressing these barriers and facilitators in protocol and policy development. Findings underscore the importance of support services, such as sexual health counseling, to the success of PrEP as a prevention strategy.
Collapse
Affiliation(s)
- Sarit A. Golub
- Department of Psychology, Hunter College, The Graduate Center of the City University of New York (CUNY), New York, New York
- Doctoral Program in Psychology, The Graduate Center of the City University of New York (CUNY), New York, New York
| | - Kristi E. Gamarel
- Department of Psychology, Hunter College, The Graduate Center of the City University of New York (CUNY), New York, New York
- Doctoral Program in Psychology, The Graduate Center of the City University of New York (CUNY), New York, New York
| | - H. Jonathon Rendina
- Doctoral Program in Psychology, The Graduate Center of the City University of New York (CUNY), New York, New York
| | - Anthony Surace
- Department of Psychology, Hunter College, The Graduate Center of the City University of New York (CUNY), New York, New York
| | - Corina L. Lelutiu-Weinberger
- Department of Psychology, Hunter College, The Graduate Center of the City University of New York (CUNY), New York, New York
| |
Collapse
|