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Brisson JB, Grace D, Perez-Brumer AG. Collective antiretroviral protection: new dimensions of community HIV prevention practices at the intersection of U=U and PrEP. Lancet HIV 2024; 11:e341-e344. [PMID: 38513674 DOI: 10.1016/s2352-3018(24)00034-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/23/2024] [Accepted: 02/08/2024] [Indexed: 03/23/2024]
Abstract
Collective antiretroviral protection is an evolving sexual health strategy in HIV prevention, used in particular by gay, bisexual, and other men who have sex with men. The strategy involves HIV-negative individuals who engage in condomless sexual activities but, instead of using pre-exposure prophylaxis (PrEP) themselves, choose partners who either have undetectable viral loads or are on PrEP. This biomedical-sorting practice, rooted in the scientific principles of undetectable equals untransmittable (U=U) and PrEP, relies on an indirect protection strategy. Collective antiretroviral protection allows for HIV-negative individuals not on PrEP to benefit from their partner's antiretroviral use, without directly consuming antiretrovirals themselves for HIV prevention, during condomless sex. Empirical research is needed to evaluate the public health implications of this emerging sexual health approach. Research and public health initiatives should adopt a non-stigmatising approach to individuals engaging in collective antiretroviral protection and look beyond individual behaviour to understand the broader community-level effects of this innovative HIV prevention strategy.
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Affiliation(s)
- Julien B Brisson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Padilla M, Gutierrez M, Basu M, Fagan J. Attitudes and Beliefs About HIV Treatment as Prevention Among People Who are Not Engaged in HIV Care, 2018-2019. AIDS Behav 2023; 27:3122-3132. [PMID: 36862279 PMCID: PMC10474239 DOI: 10.1007/s10461-023-04032-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/03/2023]
Abstract
Treatment as prevention (TasP) is an effective HIV prevention strategy. Our objectives were to explore TasP attitudes and beliefs among people with HIV (PWH) who are not engaged in care and to examine attitudes and beliefs by selected characteristics. We sampled PWH who had participated in the Medical Monitoring Project (MMP), a structured interview survey, from June 2018-May 2019 to participate in 60-minute semi-structured telephone interviews. We obtained sociodemographic and behavioral quantitative data from the MMP structured interview. We used applied thematic analysis to analyze the qualitative data and integrated the qualitative and quantitative data during analysis. Negative attitudes and beliefs, especially skepticism and mistrust, about TasP were pervasive. Only one participant who identified as female, was not sexually active, and had not heard of TasP held positive attitudes and beliefs about TasP. TasP messages should use clear and unambiguous language, address mistrust, and reach people who are not engaged in medical care.
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Affiliation(s)
- Mabel Padilla
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- DHAP/NCHHSTP/CDC, 1600 Clifton Road NE MS E-46, 30333, Atlanta, GA, USA.
| | - Mariana Gutierrez
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mohua Basu
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer Fagan
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Ye ZH, Liu F, Chu ZX, Duan JY, Yang J, Zheng JX, Bi XY, Ding HB, Jiang YJ, Xu JJ, Hu QH, Shang H. Effectiveness and safety of community-led assisted partner service among HIV-diagnosed men who have sex with men: a multicentre, randomized controlled trial in China. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 36:100772. [PMID: 37547042 PMCID: PMC10398600 DOI: 10.1016/j.lanwpc.2023.100772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/02/2023] [Accepted: 04/11/2023] [Indexed: 08/08/2023]
Abstract
Background No randomized controlled trials have involved established HIV-diagnosed men who have sex with men (MSM) diagnosed for more than 6 months into the assisted partner service (aPS). We compared voluntary aPS involving community-based organizations (CBOs) and HIV self-testing (aPSST) with regular partner service (rPS) in HIV-diagnosed MSM irrespective of diagnosis time. Methods In this unblinded, multicentre trial, we enrolled HIV-diagnosed MSM irrespective of diagnosis time in three cities in northern China. Index patients were randomly assigned to aPSST or rPS. Index patients in the aPSST group were additionally provided a comprehensive intervention package including HIV self-testing and CBO-based aPS compared with rPS group. The primary outcome was the number of index patients whose any sexual partner tested for HIV during the 6-month study. Completion of HIV testing was defined as sexual partners taking a clinic-based HIV test or HIV self-testing. Safety was assessed preliminary at the end of the 6-month follow-up. This study has been registered at chictr.org.cn (ChiCTR2000038784). Findings From March to December 2021, 325 of HIV-diagnosed MSM were enrolled (90⋅2% were established HIV-diagnosed MSM) and randomly assigned to receive aPSST (n = 167) or rPS (n = 158). At 6 months, 110 (65⋅9%) index patients in the aPSST group had at least one sexual partner tested for HIV compared with 50 (31⋅6%) in the rPS group (hazard ratio 2⋅86; 95% confidence interval 2⋅03-4⋅03; p < 0⋅001). No significant difference was observed in effects of aPSST on HIV testing promotion between established and newly HIV-diagnosed MSM. Self-reported harms were infrequently observed in both groups (approximately 2⋅0%). Interpretation Among HIV-diagnosed MSM regardless of diagnosis time, voluntary aPS involving CBOs and HIV self-testing was effective and safe for promoting partner HIV testing. Funding This work was supported by the Mega-Projects of National Science Research, the National Natural Science Foundation of China and the Liaoning Revitalization Talents Program, China.
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Affiliation(s)
- Ze-Hao Ye
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Centre for Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
- Ningbo Municipal Centre for Disease Control and Prevention, Ningbo, 315010, China
| | - Fan Liu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Centre for Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Zhen-Xing Chu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Centre for Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Jun-Yi Duan
- Tian Yuan Studio, Beijing You'an Hospital, Beijing, 100069, China
| | - Jie Yang
- Shenlan Public Health Advisory Service Centre, Tianjin, 300122, China
| | - Jia-Xin Zheng
- Yikang Social Work Service Centre, Shenbei New District, Shenyang, 110001, China
| | - Xiao-Yan Bi
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Centre for Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hai-Bo Ding
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Centre for Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yong-Jun Jiang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Centre for Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Jun-Jie Xu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Centre for Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Qing-Hai Hu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Centre for Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hong Shang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Centre for Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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Jackman KMP, Tilchin C, Wagner J, Flinn RE, Trent M, Latkin C, Ruhs S, Fields EL, Hamill MM, Mahaffey C, Greenbaum A, Jennings JM. Desires for Individual- and Interpersonal-Level Patient Portal Use for HIV Prevention Among Urban Sexual Minority Men: Cross-sectional Study. JMIR Form Res 2023; 7:e43550. [PMID: 36826983 PMCID: PMC9994643 DOI: 10.2196/43550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Gay, bisexual, and other sexual minority men have expressed the acceptability of patient portals as tools for supporting HIV prevention behaviors, including facilitating disclosure of HIV and other sexually transmitted infection (STI/HIV) laboratory test results to sex partners. However, these studies, in which Black or African American sexual minority men were undersampled, failed to determine the relationship of reported history of discussing HIV results with sex partners and anticipated willingness to disclose web-based STI/HIV test results using a patient portal. OBJECTIVE Among a sample of predominantly Black sexual minority men, this study aimed to (1) determine preferences for patient portal use for HIV prevention and (2) test the associations between reported history of discussing HIV results and anticipated willingness to disclose web-based STI/HIV test results with most recent main and nonmain partners using patient portals. METHODS Data come from audio-computer self-assisted interview survey data collected during the 3-month visit of a longitudinal cohort study. Univariate analysis assessed patient portal preferences by measuring the valuation rankings of several portal features. Multiple Poisson regression models with robust error variance determined the associations between history of discussing HIV results and willingness to disclose those results using web-based portals by partner type, and to examine criterion validity of the enhancing dyadic communication (EDC) scale to anticipated willingness. RESULTS Of the 245 participants, 71% (n=174) were Black and 22% (n=53) were White. Most participants indicated a willingness to share web-based STI/HIV test results with their most recent main partner. Slightly fewer, nonetheless a majority, indicated a willingness to share web-based test results with their most recent nonmain partner. All but 2 patient portal features were valued as high or moderately high priority by >80% of participants. Specifically, tools to help manage HIV (n=183, 75%) and information about pre- and postexposure prophylaxis (both 71%, n=173 and n=175, respectively) were the top-valuated features to include in patient portals for HIV prevention. Discussing HIV test results was significantly associated with increased prevalence of willingness to disclose web-based test results with main (adjusted prevalence ratio [aPR] 1.46, 95% CI 1.21-1.75) and nonmain partners (aPR 1.54, 95% CI 1.23-1.93). CONCLUSIONS Our findings indicate what features Black sexual minority men envision may be included in the patient portal's design to optimize HIV prevention, further supporting the criterion validity of the EDC scale. Efforts should be made to support Black sexual minority men's willingness to disclose STI/HIV testing history and status with partners overall as it is associated significantly with a willingness to disclose testing results digitally via patient portals. Future studies should consider discussion behaviors regarding past HIV test results with partners when tailoring interventions that leverage patient portals in disclosure events.
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Affiliation(s)
- Kevon-Mark P Jackman
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Carla Tilchin
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, United States.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jessica Wagner
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Ryan E Flinn
- Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Maria Trent
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Carl Latkin
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Sebastian Ruhs
- Chase Brexton Health Services, Baltimore, MD, United States
| | - Errol L Fields
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Matthew M Hamill
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, United States.,STI/HIV Program, Baltimore City Health Department, Baltimore, MD, United States
| | - Carlos Mahaffey
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, United States
| | - Adena Greenbaum
- STI/HIV Program, Baltimore City Health Department, Baltimore, MD, United States
| | - Jacky M Jennings
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, United States.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Patterns of sexual and HIV-related stigma among men who have sex with men and women living with HIV in Haiti. Sci Rep 2022; 12:7511. [PMID: 35525876 PMCID: PMC9079062 DOI: 10.1038/s41598-022-11647-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/27/2022] [Indexed: 02/04/2023] Open
Abstract
Vulnerability to contracting HIV among Men who have Sex with Men and Women (MSMW) was recognized early in the epidemic. However, while global HIV efforts have made tremendous progress for the heterosexually-identified population, the specific needs of MSMW were not directly addressed with tailored and context-adapted interventions. The purpose of this study was to inform this area of research by exploring patterns of stigma through sexual identity developmental history as well as coping mechanisms among MSMW living with HIV in Haiti. A qualitative descriptive study comprised of in-depth interviews with 32 MSMW living with HIV was carried out. Participants were recruited using snowball techniques. An inductive thematic analysis was conducted in NVivo, contextualized by the socio-ecological context of Haiti. MSMW reported struggling with their sexuality since their adolescence, often because of enacted stigma from family members, the community, and cultural conflicts. Most participants described experiencing anxiety, psychological distress, depression, social isolation, suicidal ideation and suicide attempts. Mechanisms for coping with stigma included self-acceptance, social support, hiding their sexual orientation, and tolerance of the voodoo religion. To combat stigma, and improve HIV treatment adherence and retention among MSMW, culturally-tailored multilevel initiatives should be implemented.
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