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Blair KJ, Torres TS, Hoagland B, Bezerra DRB, Veloso VG, Grinsztejn B, Clark J, Luz PM. Moderating Effect of Pre-Exposure Prophylaxis Use on the Association Between Sexual Risk Behavior and Perceived Risk of HIV Among Brazilian Gay, Bisexual, and Other Men Who Have Sex With Men: Cross-Sectional Study. JMIR Public Health Surveill 2023; 9:e45134. [PMID: 37796573 PMCID: PMC10587815 DOI: 10.2196/45134] [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: 12/16/2022] [Revised: 07/14/2023] [Accepted: 07/31/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (MSM) with a higher perceived risk of HIV are more aware of and willing to use pre-exposure prophylaxis (PrEP). PrEP is an effective HIV prevention strategy, but there is a lack of data on how PrEP use might moderate the relationship between sexual risk behavior and perceived risk of HIV. Moreover, most studies measure perceived risk of HIV via a single question. OBJECTIVE We estimated the moderating effect of PrEP use on the association between sexual risk behavior and perceived risk of HIV, measured with the 8-item Perceived Risk of HIV Scale (PRHS), among Brazilian MSM. METHODS A cross-sectional, web-based survey was completed by Brazilian Hornet app users aged ≥18 years between February and March 2020. We included data from cisgender men who reported sex with men in the previous 6 months. We evaluated the moderating effect of current PrEP use on the association between sexual risk behavior, measured via the HIV Incidence Risk Index for MSM (HIRI-MSM), and perceived risk of HIV, measured by the PRHS. Higher HIRI-MSM (range 0-45) and PRHS (range 10-40) scores indicate greater sexual behavioral risk and perceived risk of HIV, respectively. Both were standardized to z scores for use in multivariable linear regression models. RESULTS Among 4344 cisgender MSM, 448 (10.3%) were currently taking PrEP. Current PrEP users had a higher mean HIRI-MSM score (mean 21.0, SD 9.4 vs mean 13.2, SD 8.1; P<.001) and a lower mean PRHS score (mean 24.6, SD 5.1 vs mean 25.9, SD 4.9; P<.001) compared to those not currently taking PrEP. In the multivariable model, greater HIRI-MSM scores significantly predicted increased PRHS scores (β=.26, 95% CI 0.22-0.29; P<.001). PrEP use moderated the association between HIRI-MSM and PRHS score (interaction term β=-.30, 95% CI -0.39 to -0.21; P<.001), such that higher HIRI-MSM score did not predict higher PRHS score among current PrEP users. CONCLUSIONS Our results suggest current PrEP users have confidence in PrEP's effectiveness as an HIV prevention strategy. PrEP's effectiveness, positive psychological impact, and the frequent HIV testing and interaction with health services required of PrEP users may jointly influence the relationship between sexual risk behavior and perceived risk of HIV among PrEP users.
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Affiliation(s)
- Kevin James Blair
- South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, CA, United States
- Department of Surgery, University of California Los Angeles, Los Angeles, CA, United States
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Daniel R B Bezerra
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jesse Clark
- South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Coukan F, Murray KK, Papageorgiou V, Lound A, Saunders J, Atchison C, Ward H. Barriers and facilitators to HIV Pre-Exposure Prophylaxis (PrEP) in Specialist Sexual Health Services in the United Kingdom: A systematic review using the PrEP Care Continuum. HIV Med 2023; 24:893-913. [PMID: 37078101 DOI: 10.1111/hiv.13492] [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: 08/24/2022] [Accepted: 03/20/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVES HIV pre-exposure prophylaxis (PrEP) delivery in the UK is inequitable; over 95% of PrEP users were men who have sex with men (MSM) despite making up less than 50% of new HIV diagnoses. We conducted a systematic review to identify modifiable barriers and facilitators to PrEP delivery in the UK among underserved populations. METHODS We searched bibliographic/conference databases using the terms HIV, PrEP, barriers, facilitators, underserved populations, and UK. Modifiable factors were mapped along the PrEP Care Continuum (PCC) to identify targets for interventions. RESULTS In total, 44 studies were eligible: 29 quantitative, 12 qualitative and three mixed-methods studies. Over half (n = 24 [54.5%]) exclusively recruited MSM, whereas 11 were in mixed populations (all included MSM as a sub-population) and the other nine were in other underserved populations (gender and ethnicity minorities, women, and people who inject drugs). Of the 15 modifiable factors identified, two-thirds were at the PrEP contemplation and PrEParation steps of the PCC. The most reported barriers were lack of PrEP awareness (n = 16), knowledge (n = 19), willingness (n = 16), and access to a PrEP provider (n = 16), whereas the more reported facilitators were prior HIV testing (n = 8), agency and self-care (n = 8). All but three identified factors were at the patient rather than provider or structural level. CONCLUSIONS This review highlights that the bulk of the scientific literature focuses on MSM and on patient-level factors. Future research needs to ensure underserved populations are included and prioritized (e.g. ethnicity and gender minorities, people who inject drugs) and provider and structural factors are investigated.
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Affiliation(s)
- Flavien Coukan
- National Institute for Health Research Applied Research Collaboration North West London, Chelsea and Westminster Hospital, London, UK
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
| | - Keitumetse-Kabelo Murray
- National Institute for Health Research Applied Research Collaboration North West London, Chelsea and Westminster Hospital, London, UK
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
| | - Vasiliki Papageorgiou
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
| | - Adam Lound
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
| | - John Saunders
- UCL Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK
| | - Christina Atchison
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
| | - Helen Ward
- National Institute for Health Research Applied Research Collaboration North West London, Chelsea and Westminster Hospital, London, UK
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
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Madhani A, Finlay KA. Using the COM-B model to characterize the barriers and facilitators of pre-exposure prophylaxis (PrEP) uptake in men who have sex with men. Br J Health Psychol 2022; 27:1330-1353. [PMID: 35698439 PMCID: PMC9796940 DOI: 10.1111/bjhp.12605] [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: 01/13/2021] [Revised: 04/14/2022] [Accepted: 05/16/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Using the COM-B model, this study aimed to characterize barriers and facilitators to pre-exposure prophylaxis (PrEP) uptake amongst men who have sex with men (MSM). DESIGN AND METHOD Semistructured interviews with 13 MSM who were non-PrEP users were conducted with a specific focus on barriers and facilitators to PrEP uptake. A 15-item interview schedule was created informed by the COM-B model. Transcripts were transcribed verbatim and inductively analysed using thematic analysis. To illustrate pathways for intervention design, inductive themes were then deductively mapped onto COM-B constructs. RESULTS Results demonstrated that barriers to PrEP uptake were closely aligned with five (of six) COM-B components: psychological capability, physical opportunity, social opportunity, reflective motivation and automatic motivation. These COM-B subcomponents reflected seven thematized barriers: (1) limited information about PrEP, (2) restricted access to PrEP, (3) gay identity and sexual stigmatization, (4) social and cultural stigmatization, (5) capabilities in treatment adherence, (6) optimistic bias about sexual behaviours and (7) calculating risk. No facilitators or physical capability concerns were demonstrated. CONCLUSION This study adopted a novel behaviour change-informed approach to understanding barriers and facilitators to PrEP uptake amongst MSM. Unrealistic optimism about self-protective individual behaviours, the physical accessibility of PrEP and (mis)information together interacted closely with perceptions of personal and social stigmatization to dynamically impact PrEP uptake decisions. Barriers to PrEP uptake mapped clearly to the COM-B; therefore, these results provide the foundation for Behaviour Change Wheel intervention development to improve rates of PrEP uptake and its acceptability for MSM.
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Affiliation(s)
- Adam Madhani
- School of PsychologyUniversity of BuckinghamBuckinghamUK
| | - Katherine A. Finlay
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
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Jaspal R, Lopes B. Psychological wellbeing facilitates accurate HIV risk appraisal in gay and bisexual men. Sex Health 2021; 17:288-295. [PMID: 32586413 DOI: 10.1071/sh19234] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 04/28/2020] [Indexed: 01/07/2023]
Abstract
Background Accurate HIV risk appraisal is key to effective HIV prevention. This study focuses on the role of psychological wellbeing in determining perceived HIV risk in a sample of gay and bisexual (GBM) in the UK. METHODS Overall, 191 HIV-negative GBM completed a cross-sectional survey, in which they provided demographic information and completed measures of engagement in actual sexual risk behaviours, diagnosis with a sexually transmissible infection in the past 12 months, frequency of HIV testing, use of post-exposure prophylaxis (PEP), perceived HIV risk, lesbian, gay, bisexual and transgender (LGBT) identity, sexual identity openness and psychological wellbeing. RESULTS Results showed that there was a correlation between engagement in actual HIV risk behaviours and perceived HIV risk, suggesting relatively accurate HIV risk appraisal in the participant sample. LGBT identity and sexual identity openness were associated with increased psychological wellbeing. Structural equation modelling showed that psychological wellbeing has an effect on perceived HIV risk through the mediator of LGBT identity. CONCLUSIONS It appears that a state of psychological wellbeing facilitates the construction of a strong and robust LGBT identity, which can be displayed to others, and that a strong LGBT identity in turn facilitates accurate HIV risk appraisal in GBM. In order to achieve our target of zero new HIV infections by 2030, it will be essential to focus on enhancing psychological wellbeing in people at risk of HIV.
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Affiliation(s)
- Rusi Jaspal
- Nottingham Trent University, School of Social Sciences, 58 Shakespeare Street, Nottingham, NG1-4FQ, UK; and Corresponding author.
| | - Barbara Lopes
- Universidade de Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculdade de Psicologia e de Ciências da Educação, Coimbra, 3000-115, Portugal
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Jaspal R, Breakwell GM. Social support, perceived risk and the likelihood of COVID-19 testing and vaccination: cross-sectional data from the United Kingdom. CURRENT PSYCHOLOGY 2021; 41:492-504. [PMID: 33846675 PMCID: PMC8026809 DOI: 10.1007/s12144-021-01681-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 01/21/2023]
Abstract
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.
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Affiliation(s)
- Rusi Jaspal
- Department of Psychology, Nottingham Trent University, Nottingham, NG1-4FQ UK
| | - Glynis M. Breakwell
- Department of Psychology, University of Bath, Bath, UK
- Institute of Global Health Innovation, Imperial College, London, UK
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Users' Concerns Related to Online HIV Counseling in South Korea: A Descriptive Qualitative Study. J Assoc Nurses AIDS Care 2020; 31:646-653. [PMID: 32675645 DOI: 10.1097/jnc.0000000000000193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This qualitative descriptive study was designed to identify HIV-related questions frequently asked by online counseling users seeking professional advice. Data were collected via a public online question/answer counseling website operated by the Gyeonggi-do branch of the Korean Association for AIDS Prevention. Data on users' questions regarding HIV were collected between January 1, 2017, and December 31, 2018. The online questions were then analyzed and divided into codes and categories. From the 559 questions submitted, content analysis identified four major categories related to HIV: (a) HIV testing, (b) self-perceived HIV risk and risky sexual behaviors, (c) positive and negative emotional states, and (d) treatment and prevention. This study indicates that online counseling can be used to provide tailored information related to HIV along with emotional and psychosocial support to reach different subgroups and to provide current information such as the use of pre-exposure prophylaxis for those seeking professional advice.
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Jolley D, Jaspal R. Discrimination, HIV conspiracy theories and pre-exposure prophylaxis acceptability in gay men. Sex Health 2020; 17:525-533. [PMID: 33341121 DOI: 10.1071/sh20154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/21/2020] [Indexed: 11/23/2022]
Abstract
Background Combination prevention, which includes pre-exposure prophylaxis (PrEP), is essential for achieving the zero HIV infections target in the UK by 2030. It is important to assess attitudes towards PrEP in at-risk populations. This study focuses on the effect of discrimination and HIV conspiracy theorising on attitudes towards PrEP in gay men in the UK. METHODS In total, 244 White British gay men completed a survey that included demographic questions and measures of sexual health screening, hypervigilance, sexual orientation discrimination, quality of contact with healthcare professionals, belief in conspiracy theories and attitudes towards PrEP. Data were analysed using multiple linear regression and mediation analysis. RESULTS Discrimination was positively correlated with HIV conspiracy beliefs and negatively correlated with PrEP acceptance. Mediation analyses demonstrated that the relationship between discrimination and attitudes towards PrEP was explained by HIV conspiracy theorising. Gay men who had attended a sexual health screening (vs never attended) reported higher belief in HIV conspiracy theories. A further mediation analysis showed that reported poor contact with a healthcare professional was associated with an increased belief in HIV conspiracy theories, which was associated with negative attitudes towards PrEP. Both perceived discrimination and poor contact with a healthcare professional were exacerbated by hypervigilance. CONCLUSIONS HIV conspiracy theorising is an important variable in understanding attitudes towards PrEP among gay men. Its roots are in adverse social experiences (e.g. discrimination, poor contact with healthcare professionals) and its consequences may be the rejection of PrEP. HIV prevention and PrEP campaigns must focus on prejudice reduction and on challenging conspiracy beliefs.
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Affiliation(s)
- Daniel Jolley
- Department of Psychology, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK; and Corresponding author.
| | - Rusi Jaspal
- School of Social Sciences, Nottingham Trent University, Nottingham, NG1 4FQ, UK
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Hibbert MP, Brett CE, Porcellato LA, Hope VD. Sexually transmitted infection diagnoses, sexualised drug use and associations with pre-exposure prophylaxis use among men who have sex with men in the UK. Int J STD AIDS 2020; 31:254-263. [PMID: 32036753 DOI: 10.1177/0956462419897222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Previous research has focused on acceptability of pre-exposure prophylaxis (PrEP) use, but few community-based studies have been conducted regarding actual use, and PrEP use in the context of sexualised drug use remains understudied. A national online cross-sectional study recruited men who have sex with men (MSM) via social media (April–June 2018). Multivariable logistic regression was used to investigate factors associated with PrEP use. Bivariate analyses compared engaging in condomless anal intercourse (CAI) under the influence of specific drugs and recent sexually transmitted infection (STI) diagnoses (past 12 months) between MSM taking PrEP and those not. Overall, 6% (99/1581) MSM reported current PrEP use. Factors associated with PrEP use were increasing age, recent genitourinary medicine (GUM) attendance (95% versus 45%, aOR = 6.25, 95%CI 2.05, 19.03), an HIV test in the past three months (89% versus 23%, aOR = 14.22, 95%CI 6.76, 29.90), and recent engagement in chemsex (21% versus 4%, aOR = 3.56, 95%CI 1.78, 7.11). MSM taking PrEP were more likely to have had an STI diagnosis (42% versus 8%), most commonly chlamydia (26% versus 3%) and gonorrhoea (25% versus 4%). Considering the elevated levels of self-reported STI diagnoses among those on PrEP, there was a high level of engagement with sexual health services, which may help reduce onward STI transmission.
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Affiliation(s)
- Matthew P Hibbert
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Caroline E Brett
- School of Natural Sciences and Psychology, Liverpool John Moores University, Liverpool, UK
| | - Lorna A Porcellato
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Vivian D Hope
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
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Carpi E, Pınar Şenoğuz H. Refugee Hospitality in Lebanon and Turkey. On Making ‘The Other’. INTERNATIONAL MIGRATION 2018. [DOI: 10.1111/imig.12471] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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