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Mathias A, Santos LAD, Grangeiro A, Couto MT. HIV risk perceptions and post-exposure prophylaxis among men who have sex with men in five Brazilian cities. CIENCIA & SAUDE COLETIVA 2021; 26:5739-5749. [PMID: 34852105 DOI: 10.1590/1413-812320212611.29042020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/10/2020] [Indexed: 05/31/2023] Open
Abstract
In the current context of the HIV epidemic, multiple prevention strategies including biomedical interventions have been presented as alternatives for vulnerable groups. This study investigated homosexuals' and bisexuals' perceptions of the risk of HIV infection and their experiences of using HIV post-exposure prophylaxis (PEP). We conducted a qualitative study with 25 men who have sex with men (MSM) in five Brazilian cities using semi-structured interviews. The results showed that the use of condoms was the main HIV prevention strategy employed by the respondents. In addition, condom failure, inconsistent condom use and intentional non-use are the main prompters of risk perception and the consequent decision to seek PEP. The respondent's perceptions and meanings of the use of PEP were mediated by prior knowledge of PEP. This work broadens the debate on the more subjective aspects of HIV prevention among MSM, especially those related to risk perception and the decision to use PEP in the context of combined prevention.
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Affiliation(s)
- Augusto Mathias
- Programa de Pós-Graduação em Saúde Coletiva, Faculdade de Medicina, Universidade de São Paulo (USP). Av. Dr. Arnaldo 455, Sala 2165, Cerqueira César. 01246-903 São Paulo SP Brasil.
| | - Lorruan Alves Dos Santos
- Programa de Pós-Graduação em Saúde Coletiva, Faculdade de Medicina, Universidade de São Paulo (USP). Av. Dr. Arnaldo 455, Sala 2165, Cerqueira César. 01246-903 São Paulo SP Brasil.
| | - Alexandre Grangeiro
- Departamento de Medicina Preventiva, Faculdade de Medicina, USP. São Paulo SP Brasil
| | - Marcia Thereza Couto
- Departamento de Medicina Preventiva, Faculdade de Medicina, USP. São Paulo SP Brasil
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2
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Bosco SC, Pawson M, Parsons JT, Starks TJ. Biomedical HIV Prevention among Gay Male Couples: A Qualitative Study of Motivations and Concerns. JOURNAL OF HOMOSEXUALITY 2021; 68:1353-1370. [PMID: 31809246 PMCID: PMC7274863 DOI: 10.1080/00918369.2019.1696105] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are highly efficacious biomedical prevention strategies, which significantly reduce the risk of HIV transmission. Yet, partnered sexual minority men (SMM) continue to exhibit poorer uptake rates especially those in a non-monogamous or serodiscordant relationship for whom PrEP is recommended. The purpose of the study was to identify factors that may facilitate or impede the uptake of PrEP or PEP among partnered SMM. This qualitative study conducted semi-structured interviews with 10 sexual minority male couples recruited from the New York City metropolitan area. Thematic analysis identified relationship-specific and structural-level factors, which influence motivation and willingness for biomedical prevention uptake. Specifically, results highlighted the tension between relationship functioning and HIV prevention. In addition, stigma and access to knowledgeable health care providers diminished interest in biomedical prevention. Findings suggest a need for interventions that frame biomedical prevention in ways that minimize social perceptions of mistrust between partners and improve access.
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Affiliation(s)
- Stephen C. Bosco
- Doctoral Program in Health Psychology and Clinical Science,
The Graduate Center of CUNY, 365 5th Ave, New York, NY 10034, USA
| | - Mark Pawson
- Department of Psychology, Hunter College of the City
University of New York (CUNY), 695 Park Ave, New York, NY 10065, USA
| | - Jeffrey T. Parsons
- Department of Psychology, Hunter College of the City
University of New York (CUNY), 695 Park Ave, New York, NY 10065, USA
| | - Tyrel J. Starks
- Department of Psychology, Hunter College of the City
University of New York (CUNY), 695 Park Ave, New York, NY 10065, USA
- Doctoral Program in Health Psychology and Clinical Science,
The Graduate Center of CUNY, 365 5th Ave, New York, NY 10034, USA
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3
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Wang Z, Yuan T, Fan S, Qian HZ, Li P, Zhan Y, Li H, Zou H. HIV Nonoccupational Postexposure Prophylaxis Among Men Who Have Sex with Men: A Systematic Review and Meta-Analysis of Global Data. AIDS Patient Care STDS 2020; 34:193-204. [PMID: 32396477 DOI: 10.1089/apc.2019.0313] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
HIV nonoccupational postexposure prophylaxis (nPEP) has been prescribed to men who have sex with men (MSM) for decades, but the global situation of nPEP implementation among this population remains unclear. To understand nPEP awareness, uptake, and factors associated with uptake among MSM, we searched PubMed, Scopus, Embase, the Cochrane Library, and Web of Science for studies reporting nPEP implementation among MSM published before May 19, 2019. We estimated pooled rates and their 95% confidence intervals (CIs) of awareness, uptake using a random-effects model. We identified 74 studies: 3 studies (4.1%) from upper-middle-income regions and 71 (95.9%) from high-income regions. The pooled rate of nPEP awareness and uptake was 51.6% (95% CI 40.6-62.5%) and 6.0% (5.0-7.1%), respectively. Pooled uptake rate was higher in upper-middle-income regions [8.9% (7.8-10.0%)] than in high-income regions [5.8% (4.8-6.9%)]. Unprotected anal sex was the most common exposure (range: 55.0-98.6%, median: 62.9%). Pooled completion of nPEP was 86.9% (79.5-92.8%). Of 19,546 MSM prescribed nPEP, 500 HIV seroconversions (2.6%) were observed. Having risky sexual behaviors and history of sexually transmitted infections were associated with higher nPEP uptake, whereas insufficient knowledge, underestimated risk of exposure to HIV, lack of accessibility, and social stigma might hinder nPEP uptake. Awareness and uptake of nPEP among MSM worldwide are low. Further efforts are needed to combat barriers to access nPEP, including improving accessibility and reducing stigma. Seroconversions post-nPEP uptake suggest that joint prevention precautions aside from nPEP are needed for high-risk MSM. More evidence from low-income and middle-income regions is needed.
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Affiliation(s)
- Zhenyu Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Tanwei Yuan
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Song Fan
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Han-zhu Qian
- School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Peiyang Li
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yuewei Zhan
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Hui Li
- Shizhong District Center for Disease Control and Prevention, Jinan, China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
- Kirby Institute, University of New South Wales, Sydney, Australia
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4
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Kauss B, Fachel Leal A, Grangeiro A, Couto MT. 'Repeat offenders' in care, but with no right to prevention: An analysis of the availability of post-exposure prophylaxis for HIV in Porto Alegre, Brazil. Salud Colect 2020; 16:e2463. [PMID: 32222144 DOI: 10.18294/sc.2020.2463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 03/06/2020] [Indexed: 11/24/2022] Open
Abstract
This study seeks to identify challenges in the implementation of post-exposure prophylaxis for HIV, based on an analysis of actions taken by healthcare professionals in the state-run health sector in Porto Alegre, Brazil. Based on a qualitative approach that included ethnographic observations and in-depth interviews, we found that contextual, institutional, and individual factors represented challenges to the implementation of post-exposure prophylaxis for HIV. Barriers to implementation included the historical context structuring healthcare services and practices, the lack of training and/or continued education in health, and certain attitudes on the part of healthcare professionals (ideas regarding both the strategy itself as well as the individuals that seek PEP). We conclude that there is a need for greater attention to specialized services for STI/HIV/AIDS as well as the professionals that provide these services, in order to guarantee greater effective access to this strategy at the local level.
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Affiliation(s)
- Bruno Kauss
- Magíster en Políticas Públicas. Investigador, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil.
| | - Andréa Fachel Leal
- Doctora en Antropología Social. Profesora Asociada IV, Instituto de Filosofía y Ciencias Humanas, Universidade Federal del Rio Grande del Sul, Porto Alegre, Brasil.
| | - Alexandre Grangeiro
- Licenciado en Ciencias Sociales. Investigador, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil.
| | - Marcia Thereza Couto
- Doctora en Sociología. Profesora Asociada, Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil.
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5
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Mathias A, Alves Dos Santos L, Grangeiro A, Couto MT. Thematic synthesis HIV prevention qualitative studies in men who have sex with men (MSM). Colomb Med (Cali) 2019; 50:201-214. [PMID: 32284665 PMCID: PMC7141148 DOI: 10.25100/cm.v50i3.4078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Qualitative studies on HIV prevention strategies and methods among men who have sex with men (MSM) allow identify knowledge gaps and improve preventive actions. Objective: To make a thematic synthesis of the scientific productions that use the qualitative methodology in the strategies and methods of HIV prevention area among MSM. Methods: We conducted a literature review following the guidelines of the ENTREQ protocol. The analysis included 48 empirical studies published in Portuguese, English and Spanish between 2001 and 2018 available in the Medline, Embase, Scielo, Scopus, Bireme and Web of Science databases. Results: Where an increased production in the last six years and concentration in northern countries. Seven prevention methods were part of the study, with emphasis on pre-exposure prophylaxis, testing, condoms and behavioral strategies. The main topics discussed were stigma and support and care networks. Conclusion: we notice that an increasing production on prevention in the men who have sex with men segment results from the emergence of multiple preventive methods and strategies and their combined actions beyond the star role of condoms.
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Affiliation(s)
- Augusto Mathias
- Universidade de São Paulo, Facultad de Medicina, Departamento de Medicina Preventiva, Programa de Salud Colectiva, São Paulo, Brasil
| | - Lorruan Alves Dos Santos
- Universidade de São Paulo, Facultad de Medicina, Departamento de Medicina Preventiva, Programa de Salud Colectiva, São Paulo, Brasil
| | - Alexandre Grangeiro
- Universidade de São Paulo, Facultad de Medicina, Departamento de Medicina Preventiva, São Paulo, Brasil
| | - Marcia Thereza Couto
- Universidade de São Paulo, Facultad de Medicina, Departamento de Medicina Preventiva, São Paulo, Brasil
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6
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Klassen BJ, Fulcher K, Chown SA, Armstrong HL, Hogg RS, Moore DM, Roth EA, Lachowsky NJ. "Condoms are … like public transit. It's something you want everyone else to take": Perceptions and use of condoms among HIV negative gay men in Vancouver, Canada in the era of biomedical and seroadaptive prevention. BMC Public Health 2019; 19:120. [PMID: 30691426 PMCID: PMC6350294 DOI: 10.1186/s12889-019-6452-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The emergence of biomedical and seroadaptive HIV prevention strategies has coincided with a decline in condom use among gay men. METHODS We undertook a social ecological analysis of condom use and perceptions using nineteen semi-structured interviews with HIV negative gay men in Vancouver, Canada who used HAART-based prevention strategies. RESULTS Contributors to inconsistent condom use were found at various levels of the social ecological model. Ongoing concern regarding HIV transmission and belief in the proven efficacy of condoms motivated contextual use. When condoms were not used, participants utilized seroadaptive and biomedical prevention strategies to mitigate risk. CONCLUSIONS These findings indicate that notions of "safety" and "risk" based on consistent condom use are eroding as other modes of prevention gain visibility. Community-based and public health interventions will need to shift prevention messaging from advocacy for universal condom use toward combination prevention in order to meet gay men's current prevention needs. Interventions should advance gay men's communication and self-advocacy skills in order to optimize these strategies.
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Affiliation(s)
- Benjamin J Klassen
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of History, Simon Fraser University, Burnaby, BC, Canada
| | - Karyn Fulcher
- School of Public Health & Social Policy, University of Victoria, room B202, HSD Building, 3800 Finnerty Rd, Victoria, BC, V8P 5C2, Canada
| | | | - Heather L Armstrong
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Robert S Hogg
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - David M Moore
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Eric A Roth
- Department of Anthropology, University of Victoria, Victoria, BC, Canada.,Centre for Addictions Research of British Columbia, Victoria, BC, Canada
| | - Nathan J Lachowsky
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada. .,School of Public Health & Social Policy, University of Victoria, room B202, HSD Building, 3800 Finnerty Rd, Victoria, BC, V8P 5C2, Canada.
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7
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Zucchi EM, Grangeiro A, Ferraz D, Pinheiro TF, Alencar T, Ferguson L, Estevam DL, Munhoz R. [From evidence to action: challenges for the Brazilian Unified National Health System in offering pre-exposure prophylaxis (PrEP) for HIV to persons with the greatest vulnerability]. CAD SAUDE PUBLICA 2018; 34:e00206617. [PMID: 30043853 DOI: 10.1590/0102-311x00206617] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 05/02/2018] [Indexed: 12/12/2022] Open
Abstract
Pre-exposure prophylaxis (PrEP) has been considered a promising strategy for controlling the global HIV epidemic. However, it is necessary to translate the knowledge accumulated from clinical trials and demosntration studies to the reality of health services and the groups most vulnerable to infection in order to achieve broad coverage with PrEP. The article proposes a reflection on this challenge, focusing on three dimensions: users of prophylaxis, with an emphasis on the contexts of sexual practices and the potential exposures to HIV; the advantages of prophylaxis as compared to other methods and the challenges for protective and safe use; and health services, considering the organizational principles to ensure greater success in the supply and incorporation of PrEP as part of combination prevention strategies. The following principles were analyzed: uniqueness of care, freedom of choice and non-hierarchization of prevention methods, sexual risk management, scheduling flexibility, and complementary and multidisciplinary care. These principles can foster organization of the health service and care, facilitating linkage and retention in care. Some comments were offered on the relative incompatibility between the existing structure of services and the Brazilian Ministry of Health guidelines for offering PrEP. The conclusion was that the success of PrEP as a public health policy depends on two essential factors: ensuring that health services are culturally diverse settings, free of discrimination, and the intensification of community-based interventions, including social networks, in order to reduce inequalities in access to PrEP and health services as a whole.
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Affiliation(s)
- Eliana Miura Zucchi
- Programa de Pós-graduação em Saúde Coletiva, Universidade Católica de Santos, Santos, Brasil
| | | | - Dulce Ferraz
- Escola Fiocruz de Governo, Fundação Oswaldo Cruz, Brasília, Brasil
| | | | - Tatianna Alencar
- Departamento de Vigilância, Prevenção e Controle das Infecções Sexualmente Transmissíveis, do HIV/Aids e das Hepatites Virais, Ministério da Saúde, Brasília, Brasil
| | - Laura Ferguson
- Keck School of Medicine, University of Southern California, Los Angeles, U.S.A
| | - Denize Lotufo Estevam
- Centro de Referência e Treinamento em DST/AIDS-SP, Secretaria de Estado de Saúde de São Paulo, São Paulo, Brasil
| | - Rosemeire Munhoz
- Centro de Referência e Treinamento em DST/AIDS-SP, Secretaria de Estado de Saúde de São Paulo, São Paulo, Brasil
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8
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Ferraz D, Paiva V. Sex, human rights and AIDS: an analysis of new technologies for HIV prevention in the Brazilian context. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 18 Suppl 1:89-103. [PMID: 26630300 DOI: 10.1590/1809-4503201500050007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 01/22/2015] [Indexed: 11/22/2022] Open
Abstract
Worldwide, HIV prevention is challenged to change because clinical trials show the protective effect of technologies such as circumcision, preexposure prophylaxis, and the suppression of viral load through antiretroviral treatment. In the face of demands for their implementation on population levels, the fear of stimulating risk compensation processes and of increasing riskier sexual practices has retarded their integration into prevention programs. In this article, following a narrative review of the literature on risk compensation using the PubMed database, we offer a critical reflection on the theme using a constructionist approach of social psychology integrated to the theoretical framework of vulnerability and human rights. The use of biomedical technologies for prevention does not consistently induce its users to the increase of riskier practices, and variations on the specificity of each method need to be carefully considered. Alternatives to the theories of sociocognitive studies, such as social constructionist approaches developed in the social sciences and humanities fields, indicate more comprehensive interpretations, valuing the notions of agency and rights. The critical analysis suggests priority actions to be taken in the implementation process: development of comprehensive programs, monitoring and fostering dialog on sexuality, and technical information. We highlight the need to implement a human rights-based approach and to prioritize dialog, stressing how complementary these technologies can be to meet different population needs. We conclude by stressing the need to prioritize sociopolitical changes to restore participation, dialog about sexuality, and emphasis on human rights such as core elements of the Brazilian AIDS policy.
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Affiliation(s)
- Dulce Ferraz
- Escola FIOCRUZ de Governo, Diretoria Regional de Brasília da Fundação Oswaldo Cruz, Brasília, DF, Brazil
| | - Vera Paiva
- Study Group for the Prevention of AIDS, Universidade de São Paulo, São Paulo, SP, Brazil
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9
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Grangeiro A, Ferraz D, Calazans G, Zucchi EM, Díaz-Bermúdez XP. The effect of prevention methods on reducing sexual risk for HIV and their potential impact on a large-scale: a literature review. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 18 Suppl 1:43-62. [PMID: 26630298 DOI: 10.1590/1809-4503201500050005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 06/15/2015] [Indexed: 12/23/2022] Open
Abstract
A spectrum of diverse prevention methods that offer high protection against HIV has posed the following challenge: how can national AIDS policies with high coverage for prevention and treatment make the best use of new methods so as to reverse the current high, and even rising, incidence rates among specific social groups? We conducted a narrative review of the literature to examine the prevention methods and the structural interventions that can have a higher impact on incidence rates in the context of socially and geographically concentrated epidemics. Evidence on the protective effect of the methods against sexual exposure to HIV, as well as their limits and potential, is discussed. The availability and effectiveness of prevention methods have been hindered by structural and psychosocial barriers such as obstacles to adherence, inconsistent use over time, or only when individuals perceive themselves at higher risk. The most affected individuals and social groups have presented limited or absence of use of methods as this is moderated by values, prevention needs, and life circumstances. As a result, a substantial impact on the epidemic cannot be achieved by one method alone. Programs based on the complementarity of methods, the psychosocial aspects affecting their use and the mitigation of structural barriers may have the highest impact on incidence rates, especially if participation and community mobilization are part of their planning and implementation.
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Affiliation(s)
- Alexandre Grangeiro
- Department of Preventive Medicine, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Dulce Ferraz
- Department of Preventive Medicine, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Gabriela Calazans
- Department of Preventive Medicine, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Eliana Miura Zucchi
- Study Group for AIDS prevention, Universidade de São Paulo, São Paulo, SP, Brazil
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10
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Palich R, Martin-Blondel G, Cuzin L, Le Talec JY, Boyer P, Massip P, Delobel P. Experiences of HIV postexposure prophylaxis (PEP) among highly exposed men who have sex with men (MSM). Sex Transm Infect 2017; 93:493-498. [PMID: 28739808 DOI: 10.1136/sextrans-2016-052901] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 06/11/2017] [Accepted: 06/23/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES HIV postexposure prophylaxis (PEP) is indicated after sexual exposure with high risk of transmission. Men who have sex with men (MSM) are the main target of PEP. The aim of our study was to investigate the experience and shortcomings of PEP among people with a high risk of HIV exposure. DESIGN AND METHODS Subjects with ongoing follow-up for HIV infection and PEP history were selected for the qualitative study. Semistructured interviews were conducted at the patients' homes. They were audio-recorded, transcribed and deidentified before data analysis, double coding and thematic analysis with an inductive approach. RESULTS Twenty-three patients were eligible for the qualitative study. Thirteen interviews were carried out. All patients were 20-60-year-old MSM. The median time between PEP and HIV diagnosis was 3.3 years (interquartile range (IQR)25-75=0.9-4.9). Many participants reported negative PEP experiences: awkward access to the PEP clinic, uneasiness and shame in the hospital setting, unpleasant interaction and moral disapprobation from the medical staff, treatment intolerance and prevention messages that were 'inconsistent with real life' CONCLUSION: Our data highlight PEP management failures among its target population that may have compromised any subsequent attempts to seek out PEP. Practitioners should be more aware of MSM sexual contexts and practices. PEP consultations should provide the opportunity to discuss prevention strategies with highly exposed HIV-negative subjects, which may include pre-exposure prophylaxis.
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Affiliation(s)
- Romain Palich
- Service des Maladies Infectieuses et Tropicales, CHU Toulouse-Purpan, Toulouse, France.,Departement de Medecine Generale, Faculte de Medecine Toulouse-Rangueuil, Toulouse, France
| | - Guillaume Martin-Blondel
- Service des Maladies Infectieuses et Tropicales, CHU Toulouse-Purpan, Toulouse, France.,INSERM U1043 - CNRS UMR 5282, Centre de Physiopathologie Toulouse-Purpan, Toulouse, France
| | - Lise Cuzin
- Universite de Toulouse III, Toulouse, France.,COREVIH de Toulouse, CHU Toulouse-Purpan, Toulouse, France.,INSERM UMR 1027, Toulouse, France
| | - Jean-Yves Le Talec
- CERTOP UMR 5044, CNRS et Universite Toulouse Jean Jaures, Toulouse, France
| | - Pierre Boyer
- Departement de Medecine Generale, Faculte de Medecine Toulouse-Rangueuil, Toulouse, France
| | - Patrice Massip
- Service des Maladies Infectieuses et Tropicales, CHU Toulouse-Purpan, Toulouse, France
| | - Pierre Delobel
- Service des Maladies Infectieuses et Tropicales, CHU Toulouse-Purpan, Toulouse, France.,INSERM U1043 - CNRS UMR 5282, Centre de Physiopathologie Toulouse-Purpan, Toulouse, France
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11
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Mey A, Plummer D, Dukie S, Rogers GD, O'Sullivan M, Domberelli A. Motivations and Barriers to Treatment Uptake and Adherence Among People Living with HIV in Australia: A Mixed-Methods Systematic Review. AIDS Behav 2017; 21:352-385. [PMID: 27826734 DOI: 10.1007/s10461-016-1598-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In Australia, approximately 30% of people diagnosed with HIV are not accessing treatment and 8% of those receiving treatment fail to achieve viral suppression. Barriers limiting effective care warrant further examination. This mixed-methods systematic review accessed health and social sector research databases between November and December 2015 to identify studies that explored the perspective of people living with HIV in Australia. Articles were included for analysis if they described the experiences, knowledge, attitudes and beliefs, in relation to treatment uptake and adherence, published between January 2000 and December 2015. Quality appraisal utilised the Mixed Methods Appraisal Tool Version 2011. Seventy-two studies that met the inclusion criteria were reviewed. The interplay of lack of knowledge, fear, stigma, physical, emotional and social issues were found to negatively impact treatment uptake and adherence. Strategies targeting both the individual and the wider community are needed to address these barriers.
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Affiliation(s)
- Amary Mey
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia.
| | - David Plummer
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| | - Shailendra Dukie
- School of Pharmacy, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| | - Gary D Rogers
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| | - Maree O'Sullivan
- Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Amber Domberelli
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia
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12
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Beanland RL, Irvine CM, Green K. End Users' Views and Preferences on Prescribing and Taking Postexposure Prophylaxis for Prevention of HIV: Methods to Support World Health Organization Guideline Development. Clin Infect Dis 2016; 60 Suppl 3:S191-5. [PMID: 25972503 DOI: 10.1093/cid/civ070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The 2014 World Health Organization guidelines for human immunodeficiency virus postexposure prophylaxis (PEP) are the first to combine recommendations for all populations and exposures. To inform the development of these guidelines, we gathered views of end users on key aspects of PEP provision. A mixed-methods approach was used to gather views from the populations for whom the guideline will be of relevance. Data gathered from an online survey, focus group discussions, and previously collected data from in-depth interviews with key populations were used to inform the development of recommendations, in particular where there is a paucity of evidence to assess the benefits and harms of an intervention. This was a successful method to gather end users' views and preferences; however, limitations exist in the generalizability and reliability of the evidence. Future guideline development processes should consider methods to include the views of end users to guide the decision-making process.
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Affiliation(s)
- Rachel L Beanland
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Cadi M Irvine
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
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Grangeiro A, Couto MT, Peres MF, Luiz O, Zucchi EM, de Castilho EA, Estevam DL, Alencar R, Wolffenbüttel K, Escuder MM, Calazans G, Ferraz D, Arruda É, Corrêa MDG, Amaral FR, Santos JCV, Alvarez VS, Kietzmann T. Pre-exposure and postexposure prophylaxes and the combination HIV prevention methods (The Combine! Study): protocol for a pragmatic clinical trial at public healthcare clinics in Brazil. BMJ Open 2015; 5:e009021. [PMID: 26307622 PMCID: PMC4550731 DOI: 10.1136/bmjopen-2015-009021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Few results from programmes based on combination prevention methods are available. We propose to analyse the degree of protection provided by postexposure prophylaxis (PEP) for consensual sexual activity at healthcare clinics, its compensatory effects on sexual behaviour; and the effectiveness of combination prevention methods and pre-exposure prophylaxis (PrEP), compared with exclusively using traditional methods. METHODS AND ANALYSIS A total of 3200 individuals aged 16 years or older presenting for PEP at 5 sexually transmitted disease (STD)/HIV clinics in 3 regions of Brazil will be allocated to one of two groups: the PEP group-individuals who come to the clinic within 72 h after a sexual exposure and start PEP; and the non-PEP group-individuals who come after 72 h but within 30 days of exposure and do not start PEP. Clinical follow-up will be conducted initially for 6 months and comprise educational interventions based on information and counselling for using prevention methods, including PrEP. In the second study phase, individuals who remain HIV negative will be regrouped according to the reported use of prevention methods and observed for 18 months: only traditional methods; combined methods; and PrEP. Effectiveness will be analysed according to the incidence of HIV, syphilis and hepatitis B and C and protected sexual behaviour. A structured questionnaire will be administered to participants at baseline and every 6 months thereafter. Qualitative methods will be employed to provide a comprehensive understanding of PEP-seeking behaviour, preventive choices and exposure to HIV. ETHICS AND DISSEMINATION This study will be conducted in accordance with the resolution of the School of Medicine Research Ethics Commission of Universidade de São Paulo (protocol no. 251/14). The databases will be available for specific studies, after management committee approval. Findings will be presented to researchers, health managers and civil society members by means of newspapers, electronic media and scientific journals and meetings.
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Affiliation(s)
- Alexandre Grangeiro
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Márcia Thereza Couto
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Maria Fernanda Peres
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Olinda Luiz
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Eliana Miura Zucchi
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Católica de Santos, São Paulo, Brazil
| | - Euclides Ayres de Castilho
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Denize Lotufo Estevam
- Centro de Referência e Treinamento em DST/Aids, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil
| | - Rosa Alencar
- Centro de Referência e Treinamento em DST/Aids, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil
| | - Karina Wolffenbüttel
- Centro de Referência e Treinamento em DST/Aids, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil
| | | | - Gabriela Calazans
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Dulce Ferraz
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Escola FIOCRUZ de Governo, Diretoria Regional de Brasília, Fundação Oswaldo Cruz, Brasília, Brazil
| | - Érico Arruda
- Hospital São José, Secretaria de Estado da Saúde do Ceará, Fortaleza, Ceará, Brazil
| | - Maria da Gloria Corrêa
- Serviço de Atendimento Especializado de Doenças Sexualmente Transmissíveis e Aids da Vila dos Comerciários, Secretaria Municipal de Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fabiana Rezende Amaral
- Centro de Referência em Especialidades Central, Secretaria Municipal de Saúde de Ribeirão Preto, São Paulo, Ribeirão Preto, Brazil
| | | | - Vivian Salles Alvarez
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Tiago Kietzmann
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Effects of messaging about multiple biomedical and behavioral HIV prevention methods on intentions to use among US MSM: results of an experimental messaging study. AIDS Behav 2014; 18:1651-60. [PMID: 24907778 DOI: 10.1007/s10461-014-0811-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Combining multiple biomedical and behavioral HIV prevention approaches is a priority for at-risk populations such as men who have sex with men (MSM), and it is essential to understand how receiving messages about multiple approaches impacts attitudes and intentions for their use. We examined whether receiving combinations of different HIV prevention messages produced differences in perceived benefits and costs of condom use, and in intentions to use condoms and biomedical prevention approaches. MSM (N = 803) were recruited online and were randomly assigned to view informational messages about one, two, or four of the following prevention options: pre-exposure prophylaxis (PrEP), non-occupational post-exposure prophylaxis (nPEP), rectal microbicides, and condoms. The number of HIV prevention messages did not produce differential attitudes and intentions regarding condoms, nor did it produce changes in attitudes towards unprotected sex. Receiving multiple messages was associated with greater intentions to use PrEP and nPEP, but not rectal microbicides.
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Macphail CL, Sayles JN, Cunningham W, Newman PA. Perceptions of sexual risk compensation following posttrial HIV vaccine uptake among young South Africans. QUALITATIVE HEALTH RESEARCH 2012; 22:668-678. [PMID: 22218269 PMCID: PMC3735355 DOI: 10.1177/1049732311431944] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Concerns about the impact of risk compensation on advances in biomedical human immunodeficiency virus (HIV) prevention technologies have been documented. We conducted an exploratory qualitative study using focus group discussions with young South African men and women (aged 18 to 24 years) to explore perceptions of risk compensation with regard to a hypothetical posttrial HIV vaccine. During the discussions, participants expressed their disquiet about the potential for risk compensation and the manner in which this might manifest among young people. Discussions specifically focused on reductions in condom use, an increase in multiple partners, and increased frequency of sex. The discussions also revealed contradictory feelings about HIV vaccines: appreciation for their development tempered by concerns about loss of control and undermining morality. Women were particularly concerned with the possibility of increased partner concurrency and infidelity. We suggest that concerns in HIV vaccine target populations about the impact of possible risk compensation be incorporated into strategies for vaccine introduction once vaccines move from the hypothetical to reality.
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Affiliation(s)
- Catherine L Macphail
- Wits Reproductive Health and HIV Institute, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Australian gay men who have taken nonoccupational postexposure prophylaxis for HIV are in need of effective HIV prevention methods. J Acquir Immune Defic Syndr 2011; 58:424-8. [PMID: 21857349 DOI: 10.1097/qai.0b013e318230e885] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Gay men who request nonoccupational postexposure prophylaxis (PEP) may seek preexposure prophylaxis (PrEP) should this become available. We explored trends and predictors of PEP use among Australian gay men to inform future biomedical prevention programs. METHODS We used 2001-2010 data from Gay Community Periodic Surveys in 3 Eastern Australian states and assessed PEP awareness and use in the 6 months before each survey, and among HIV-uninfected men in all surveys predictors of PEP use. Analytical methods included chi-square test for trend and multivariate log-binomial estimation of associations. RESULTS The awareness of PEP significantly increased from 23% in 2001 to 64% in 2010. PEP use also increased from 2.3% to 3.9%, respectively. PEP use was significantly associated with being in a regular relationship with an HIV-serodiscordant partner, higher number of sex partners, engaging in anal intercourse with casual partners, and regularly testing for HIV/sexually transmitted infections. However, fewer than 8% of men who engaged in these practices reported PEP use. CONCLUSIONS Our findings highlight the profiles of current PEP users: men in HIV-serodiscordant relationships, and men having high numbers of casual partners and unprotected anal intercourse with them. These men are in need of effective HIV prevention strategies and may be receptive to preexposure prophylaxis in the future. Presently, targeted HIV education to improve risk assessment skills may prevent some seroconversions through the appropriate use of PEP.
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Roland ME, Neilands TB, Krone MR, Coates TJ, Franses K, Chesney MA, Kahn JS, Martin JN. A randomized noninferiority trial of standard versus enhanced risk reduction and adherence counseling for individuals receiving post-exposure prophylaxis following sexual exposures to HIV. Clin Infect Dis 2011; 53:76-83. [PMID: 21653307 DOI: 10.1093/cid/cir333] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The National HIV/AIDS Strategy proposes to scale-up post-exposure prophylaxis (PEP). Intensive risk reduction and adherence counseling appear to be effective but are resource intensive. Identifying simpler interventions that maximize the HIV prevention potential of PEP is critical. METHODS A randomized noninferiority study comparing 2 (standard) or 5 (enhanced) risk reduction counseling sessions was performed. Adherence counseling was provided in the enhanced arm. We measured changes in unprotected sexual intercourse acts at 12 months, compared with baseline; HIV acquisition; and PEP adherence. Outcomes were stratified by degree of baseline risk. RESULTS We enrolled 457 individuals reporting unprotected intercourse within 72 h with an HIV-infected or at-risk partner. Participants were 96% male and 71% white. There were 1.8 and 2.3 fewer unprotected sex acts in the standard and enhanced groups. The maximum potential risk difference, reflected by the upper bound of the 95% confidence interval, was 3.9 acts. The difference in the riskier subset may have been as many as 19.6 acts. The incidence of HIV seroconversion was 2.9% and 2.6% among persons randomized to standard and enhanced counseling, respectively, with a maximum potential difference of 3.4%. The absolute and maximal HIV seroconversion incidence was 9.9% and 20.4% greater in the riskier group randomized to standard, compared with enhanced, counseling. Adherence outcomes were similar, with noninferiority in the lower risk group and concerning differences among the higher-risk group. CONCLUSIONS Risk assessment is critical at PEP initiation. Standard counseling is only noninferior for individuals with lower baseline risk; thus, enhanced counseling should be targeted to individuals at higher risk.
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Affiliation(s)
- Michelle E Roland
- Positive Health Program, Department of Internal Medicine, San Francisco General Hospital, San Francisco, California, USA.
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Wilkerson JM, Danilenko GP, Smolenski DJ, Myer BB, Rosser BRS. The role of critical self-reflection of assumptions in an online HIV intervention for men who have sex with men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2011; 23:13-24. [PMID: 21341957 PMCID: PMC3423317 DOI: 10.1521/aeap.2011.23.1.13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The Men's INTernet Study II included a randomized controlled trial to develop and test an Internet-based HIV prevention intervention for U.S men who use the Internet to seek sex with men. In 2008, participants (n = 560) were randomized to an online, interactive, sexual risk-reduction intervention or to a wait list null control. After 3 months, participants in both conditions reported varying degrees of change in sexual beliefs or behaviors. Using content analysis and logistic regression, this mixed-methods study sought to understand why these changes occurred. Level of critical self-reflection of assumptions appeared to facilitate the labeling of sexual beliefs and behaviors as risky, which in turn encouraged men to commit to and enact change. New HIV prevention interventions should include activities in their curriculum that foster critical self-reflection on assumptions.
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Affiliation(s)
- J Michael Wilkerson
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis 55416, USA.
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Risk compensation in HIV prevention: implications for vaccines, microbicides, and other biomedical HIV prevention technologies. Curr HIV/AIDS Rep 2008; 4:165-72. [PMID: 18366947 DOI: 10.1007/s11904-007-0024-7] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Studies investigating the effects of biologic HIV prevention technologies have been reported with promising results for slowing the spread of the disease. Although they can reduce the rate of HIV transmission at varying levels of efficaciousness, it is vital to anticipate their impact on subsequent sexual behaviors. Risk homeostasis theory posits that decreases in perceived risk, which will occur with access to HIV prevention technologies, will correspond with increases in risk-taking behavior. Here we review the literature on risk compensation in response to HIV vaccines, topical microbicides, antiretroviral medications, and male circumcision. Behavioral risk compensation is evident in response to prevention technologies that are used in advance of HIV exposure and at minimal personal cost. We conclude that behavioral risk compensation should be addressed by implementing adjunct behavioral risk-reduction interventions to avoid negating the preventive benefits of biomedical HIV prevention technologies.
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