Attitudes toward HIV testing, awareness of HIV campaigns, and using social networking sites to deliver HIV testing messages in the age of social media: a qualitative study of young black men

A Qualitative Study of HIV Testing Experiences and HIV Self-Testing Perspectives among Men in Northern Nigeria

HIV self-testing (HIVST) holds promise for accessing hard-to-reach populations by overcoming sociocultural and structural barriers to awareness of HIV status. This phenomenological qualitative study explored the experiences and perspectives of married men in Kano, northern Nigeria, regarding HIV testing and counseling (HTC) and HIVST. Twenty married men from diverse socioeconomic backgrounds participated in in-depth interviews conducted in the local language. Thematic analysis was employed to analyze the data, yielding key themes related to prior test experiences, knowledge of self-testing, and perceived ease of use, in addition to motivation for self-testing and concerns about reliability and counseling support. The findings shed light on the impact of facility-based HIV testing experiences on the perspectives of participants. Concerns related to delays, overcrowding, discomfort, fear, and unsupportive attitudes from healthcare providers influenced their perceptions. Among persons with previous self-testing experience, initial uneasiness was overcome with repeated use, highlighting the ease of use associated with HIVST. Motivations for self-testing included privacy, convenience, personal empowerment, improved infection detection, and efficiency. Concerns were raised regarding the reliability of self-testing results compared to hospital-based testing, and the absence of counseling support during self-testing. Our findings underscore the need to address infrastructural limitations, enhance counseling support, and promote awareness and knowledge of HIVST.

'People listen more to what actors say': A qualitative study of tuberculosis-related knowledge, behaviours, stigma, and potential interventions in Puducherry, India

India has made substantial advancements in reducing the burden of tuberculosis (TB), but persons living with active TB (PLWATB) still face myriad challenges in seeking and receiving care, including TB-related stigma. To meet the END TB targets, it is critical that PLWATB engage in care and are able to adhere to treatment. This qualitative study aimed to understand TB-related stigma (perceived, enacted, and internalised) and possible interventions to reduce stigma in Puducherry and Tamil Nadu, India. We conducted 47 in-depth interviews with PLWATB and household members and eight focus group discussions: two each with PLWATB, their household members, healthcare workers, and key informants. We found varying TB-related knowledge: the vast majority of interview participants reported incorrect modes of transmission, although most were also aware that TB is curable. Participants reported high levels of perceived stigma, with nearly two-thirds of PLWATB choosing to hide their disease to avoid being stigmatised in their community. Participants supported interventions including celebrity advocacy and school-based programming to increase community knowledge and reduce enacted stigma as well as support groups and counselling to reduce internalised stigma in PLWATB. This study has the potential to inform future interventions to reduce TB-related stigma in India.

Nonuptake of HIV Testing Among Transgender Populations in the United States: Results from the 2015 U.S. Transgender Survey

Purpose

In this study, we examined the nonuptake of HIV testing and the main reasons for never testing among transgender populations.

Methods

Data on 26,927 respondents from the 2015 U.S. Transgender Survey were analyzed in this study. The main reasons for never testing were categorized as low risk perception; access related; fear or HIV-related stigma; and others. We performed weighted descriptive statistics and multivariable logistic regression analyses, controlling for sociodemographic characteristics and sexual orientation.

Results

Forty-five percent of the respondents had never tested for HIV. Trans women (adjusted odds ratio [aOR]=1.1, 95% confidence interval [CI]=1.07-1.25) and assigned female at birth genderqueer/nonbinary individuals (AFAB GQ/NB) (aOR=1.3, 95% CI=1.16-1.35) had significantly higher odds of reporting never testing for HIV compared with trans men. The most reported reason for never testing was low risk perception (87%). AFAB GQ/NB (aOR=1.4, 95% CI=1.22-1.66) had significantly higher odds of reporting low risk perception as the main reason for never testing for HIV relative to trans men. AFAB GQ/NB were less likely to report access related as the main reason for never testing (aOR=0.8, 95% CI=0.56-0.95). The odds of trans women and assigned male at birth GQ/NB individuals reporting fear or HIV-related stigma as the main reason for never testing were 1.7 (95% CI=1.13-2.55) and 2.8 (95% CI=1.69-4.70) times that of trans men. Both trans women (aOR=0.8, 95% CI=0.65-0.97) and AFAB GQ/NB (aOR=0.7, 95% CI=0.60-0.88) had lower odds of reporting others. The main reasons for never testing also varied by sociodemographic factors, including age, educational attainment, race/ethnicity, employment status, poverty, and sexual orientation.

Conclusions

HIV testing is suboptimal among transgender populations. Our findings also suggest that barriers to HIV testing vary by transgender populations, thus interventions for improved uptake should be population specific.

Factors Influencing Rapid Antiretroviral Therapy Initiation at Four eThekwini Clinics, KwaZulu-Natal, South Africa

Timely uptake of Antiretroviral therapy considerably improves the health of people living with the Human Immunodeficiency virus. We conducted a cross-sectional study of newly HIV diagnosed individuals in four clinics in eThekwini municipality, KwaZulu-Natal. Data was collected between June 2020 and December 2020. Participants completed an interviewer-administered questionnaire after HIV testing, on the day of HIV diagnosis. We evaluated factors influencing uptake of same-day ART initiation in eThekwini clinics, KwaZulu Natal, South Africa. Demographic information, health status, sexual behaviour, knowledge of universal test and treat (UTT), ART initiation uptake, and disclosure data was collected. Among the 403 participants, same-day initiation (SDI) was 69.2% (n = 279). We observed the number of sexual partners (aOR 0.35; 95% CI 0.15–0.81), HIV status of the partner (aOR 5.03; 95% CI 2.74–9.26) and knowledge of UTT (aOR 1.97; 95% CI 1.34–2.90) were identified as major factors influencing uptake of same-day ART initiation. More strategies are needed to achieve the SDI uptake within the framework of UTT.

Characterizing HIV discussions and engagement on Twitter

The novel settings provided by social media facilitate users to seek and share information on a wide array of subjects, including healthcare and wellness. Analyzing health-related opinions and discussions on these platforms complement traditional public health surveillance systems to support timely and effective interventions. This study aims to characterize the HIV-related conversations on Twitter by identifying the prevalent topics and the key events and actors involved in these discussions. Through Twitter API, we collected tweets containing the hashtag #HIV for a one-year period. After pre-processing the collected data, we conducted engagement analysis, temporal analysis, and topic modeling algorithm on the analytical sample (n = 122,807). Tweets by HIV/AIDS/LGBTQ activists and physicians received the highest level of engagement. An upsurge in tweet volume and engagement was observed during global and local events such as World Aids Day and HIV/AIDS awareness and testing days for trans-genders, blacks, women, and the aged population. Eight topics were identified that include “stigma”, “prevention”, “epidemic in the developing countries”, “World Aids Day”, “treatment”, “events”, “PrEP”, and “testing”. Social media discussions offer a nuanced understanding of public opinions, beliefs, and sentiments about numerous health-related issues. The current study reports various dimensions of HIV-related posts on Twitter. Based on the findings, public health agencies and pertinent entities need to proactively use Twitter and other social media by engaging the public through involving influencers. The undertaken methodological choices may be applied to further assess HIV discourse on other popular social media platforms.

Association Between HIV Testing and HIV-Related Risk Behaviors Among US and Non-US Born Black Individuals Living in the US: Results From the National Survey on HIV in the Black Community (NSHBC)

Despite improvements in HIV prevention and treatment, Black individuals continue to be disproportionately affected by the HIV epidemic in the US. Using data from the National Survey on HIV in the Black Community, we examined the differences in demographic characteristics, risk behaviors, and HIV testing between US and non-US born Black adults. 868 individuals completed the survey and provided baseline data on sexual risk. Participants were grouped as US-born (N = 763) and non-US born (N = 101) based on self-reported place of birth. Amongst US-born participants, males were less likely to test for HIV, whereas those who reported a lifetime history of anal sex and sexually transmitted infections (STIs) were more likely to test for HIV. Non-US born participants who reported a single marital status were less likely to test for HIV, whereas those who reported a lifetime history of STIs were more likely to test for HIV. Some differences in predictors of HIV testing exist by place of birth. Understanding these differences is needed to develop HIV/AIDS prevention and treatment programs for US and non-US born Black individuals.

Gay and Bisexual Men's Recommendations for Effective Digital Social Marketing Campaigns to Enhance HIV Prevention and Care Continuity

Because use of geosocial-networking smartphone applications ('apps') is ubiquitous among men who have sex with men (MSM), online-to-offline service models that include advertisements on these apps may improve engagement with effective HIV prevention and treatment services. Through our formative qualitative study, we conducted individual in-depth interviews (n = 30) and focus group discussions (n = 18) with MSM in Rhode Island to develop a digital social marketing campaign aimed at increasing HIV testing, including how best to reach men by advertising on apps. Qualitative data analysis revealed that participants were frequently exposed to pop-up advertisements on apps. These advertisements are viewed as invasive and, as such, many expressed a preference for other formats (e.g., direct messages, banner advertisements). Men expressed a preference for provocative images and phrases to catch their attention followed with fact-driven messaging to motivate them to engage with services offline. Findings from this study offer several practical recommendations for developing a social marketing campaign that uses advertisements on apps to increase HIV testing among MSM, including using formats other than pop-up advertisements and pairing fact-driven messaging with eye-catching images to direct them to trusted local clinical services.

Changes in Diagnoses of Heterosexually Acquired HIV Infection Among Black/African American Males and Females in Seven Southern United States, 2014-2018

Racial and geographical disparities exist in HIV infections in the USA. The highest burden of HIV diagnoses remains among Black/African American persons and is concentrated in the Southern region. This paper describes within-race changes in HIV diagnoses among heterosexually active Black/African American persons in seven states with the highest rates/100,000 population of HIV diagnoses in the South, during 2014-2018. The total number of diagnoses among Black males and females with infection attributed to heterosexual contact decreased in 2018 compared to 2014. Diagnoses decreased among Black males and females in Louisiana and among Black females in Texas. While the declines indicate progress, Black males and females in the South remain disproportionately affected by HIV. Results support a need for the development, implementation, and evaluation of evidence-based HIV prevention interventions and strategies for heterosexually active persons in jurisdictions that have not seen decreases in HIV diagnoses.

Social support, perceived risk and the likelihood of COVID-19 testing and vaccination: cross-sectional data from the United Kingdom

Two samples of 227 and 214 adults completed surveys of social support, perceived risk of COVID-19 and COVID-19 preventive activity - in Study 1 likelihood of testing was examined and in Study 2 likelihood of both testing and vaccination were examined during the COVID-19 pandemic in the United Kingdom. Path analysis showed, in Study 1, that access to help (as an indicator of social support) had a direct effect on likelihood of testing and indirect effects through self-efficacy, perceived risk and preventive behavior; and, in Study 2, that neighborhood identification (as an indicator of social support) had a direct effect on likelihood of testing and indirect effects on likelihood of both testing and vaccination through the mediators of strength of social network, loneliness, perceived risk of COVID-19, and preventive activity. Both studies suggest that level of social support (conceptualized in different ways) is an important determinant of COVID-19 testing and Study 2 shows it is also a determinant of likelihood of vaccination. As resurgences of COVID-19 occur, it will be necessary to monitor the likelihood of COVID-19 testing and vaccination behaviors and, especially, to promote confidence in the latter in individuals with decreased access to social support.

Digital health for sexually transmitted infection and HIV services: a global scoping review

PURPOSE OF REVIEW

The current study aimed to review how digital health has been used for sexually transmitted infection (STI)/HIV prevention, testing, and treatment.

RECENT FINDINGS

A scoping review was conducted by searching five databases for peer-reviewed literature published between March 2018 to August 2019. 23 out of 258 studies met the inclusion criteria and were assessed. Six studies used digital platform to enhance STI/HIV prevention messaging; four studies found that digital health can provide vivid promotional information and has been instrumental in increasing the accessibility and acceptability of STI/HIV testing; three studies reported digital health provides a channel to understand and interpret the discourses on preexposure prophylaxis (PrEP) and increase PrEP uptake; three studies focused on refining big data algorithms for surveillance; four studies reported on how digital interventions could be used to optimize clinical interventions; and four studies found digital interventions can be used to assist mental health services.

SUMMARY

Digital health is a powerful and versatile tool that can be utilized in the production of high-quality, innovative strategies on STIs and HIV services. Future studies should consider focusing on strategies and implementations that leverage digital platforms for network-based interventions, in addition to recognizing the norms of individual digital intervention platforms.

Utilizing Policy and Electronic Health Record (EHR) System Modifications to Implement and Sustain Routine Opt-Out HIV Screening and Linkage to Care During the COVID-19 Pandemic

The burden of HIV infection disproportionately impacts Black people across the United States. New York City (NYC) has taken substantial steps to End the HIV Epidemic, boasting reductions in new HIV infections by 40% since 2015; however, racial inequities persist. In 2019, Black people living in NYC accounted for 24% of the population, yet represented 46.1% of new HIV diagnoses and 48.7% of HIV deaths. To address the high incidence of HIV in a predominately Black community in Central Brooklyn, Brookdale Hospital Medical Center (BHMC) developed a multi-faceted approach to increase routine opt-out HIV screening and linkage. In order to integrate HIV testing into routine clinical care, BHMC leadership updated screening policies; developed an Electronic Health Record (EHR) algorithm to trigger HIV screening in five BHMC ambulatory clinics; and modified the EHR to transmit positive HIV screening results to patient navigators dedicated to linking patients to HIV care. During the height of the COVID-19 pandemic, between March and April 2020, HIV screening across all five ambulatory sites decreased by 87.3%. After activation of the EHR algorithm in three ambulatory sites in June 2020, HIV screening increased 216.3% from the prior month. By the time the final EHR algorithm launched in August 2020, HIV testing had fully rebounded to pre-pandemic levels. Policies supporting routine opt-out HIV screening coupled with EHR-prompted screening can improve and sustain HIV testing in a Black community with a high incidence and prevalence of HIV.

Comparing Web-Based Platforms for Promoting HIV Self-Testing and Pre-Exposure Prophylaxis Uptake in High-Risk Men Who Have Sex With Men: Protocol for a Longitudinal Cohort Study

BACKGROUND

The majority of those living with HIV in the United States are men who have sex with men (MSM), and young, minority MSM account for more new HIV infections than any other group. HIV transmission can be reduced through detection and early treatment initiation or by starting pre-exposure prophylaxis (PrEP), but rates of testing are lower than recommended among MSM, and PrEP uptake has been slow. Although promoting HIV testing and PrEP uptake by placing advertisements on web-based platforms - such as social media websites and dating apps - is a promising approach for promoting HIV testing and PrEP, the relative effectiveness of HIV prevention advertising on common web-based platforms is underexamined.

OBJECTIVE

This study aims to evaluate the relative effectiveness of advertisements placed on 3 types of web-based platforms (social media websites, dating apps, and informational websites) for promoting HIV self-testing and PrEP uptake.

METHODS

Advertisements will be placed on social media websites (Facebook, Instagram, and Twitter), dating apps (Grindr, Jack'd, and Hornet), and informational search websites (Google, Yahoo, and Bing) to recruit approximately 400 young (18-30 years old), minority (Black or Latino) MSM at elevated risk of HIV exposure. Recruitment will occur in 3 waves, with each wave running advertisements on 1 website from each type of platform. The number of participants per platform is not prespecified, and recruitment in each wave will occur until approximately 133 HIV self-tests are ordered. Participants will complete a baseline survey assessing risk behavior, substance use, psychological readiness to test, and attitudes and then receive an electronic code to order a free home-based HIV self-test kit. Two follow-ups are planned to assess HIV self-test results and PrEP uptake.

RESULTS

Recruitment was completed in July 2020.

CONCLUSIONS

Findings may improve our understanding of how the platform users' receptivity to test for HIV differs across web-based platforms and thus may assist in facilitating web-based HIV prevention campaigns.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04155502; https://clinicaltrials.gov/ct2/show/NCT04155502.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/20417.