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Nicholls EJ, Policek N, Volny-Anne A, Spire B, Burns F, Ruiz-Burga E, Tariq S. A systematic review of qualitative research on recently acquired HIV. AIDS 2023; 37:2199-2212. [PMID: 37650757 PMCID: PMC10621639 DOI: 10.1097/qad.0000000000003697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES Recently acquired HIV is a critical time when people may experience debilitating symptoms and is when they are most likely to pass HIV on. Qualitative research offers insights into lived experiences and a deeper understanding of the contextual factors underlying HIV acquisition. We aimed to synthesize qualitative literature on recently acquired HIV. DESIGN Systematic review and textual narrative synthesis. METHODS We searched MEDLINE, CINAHL Plus, PsycINFO and Sociology Database. Articles were screened, and two authors completed full text review and data extraction. Quality appraisal was conducted (Critical Appraisal Skills Programme Qualitative Studies Checklist) and certainty of findings graded (GRADE-CERQual). RESULTS We reviewed 1890 articles (1554 following de-duplication), excluding 1539. Fifteen articles were included and an additional article was included after updating the search. We identified 15 themes, three of which we have high confidence in: recent acquisition of HIV facilitates understanding of circumstances of HIV acquisition; indeterminate HIV tests generate uncertainty and anxiety; and people with recently acquired HIV are motivated to reduce risk of onward transmission. CONCLUSIONS Our findings highlight the importance of continued research into recently acquired HIV, as well as the need for support to manage the emotional impact of indeterminate test results and negotiate risk reduction. We found no studies exploring sexual risk in the context of recently acquired HIV, or use of pre-exposure prophylaxis or treatment as prevention. The literature is primarily focused on HIV acquisition from an individual and behavioural perspective, neglecting important aspects of lived experience such as immediate ART, stigma, and health and wellbeing.
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Affiliation(s)
| | | | | | - Bruno Spire
- Aix Marseille Univ., Inserm, IRD, SESSTIM, ISSPAM, Marseille, France
| | - Fiona Burns
- Institute for Global Health, University College London, London
- Royal Free London NHS Foundation Trust, London
| | | | - Shema Tariq
- Institute for Global Health, University College London, London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
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2
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Wells N, Murphy D, Ellard J, Howard C, Keen P, Fairley C, Donovan B, Prestage G. Requesting HIV Results Be Conveyed in-Person: Perspectives of Clinicians and People Recently Diagnosed with HIV. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2023:1-8. [PMID: 37363348 PMCID: PMC10257370 DOI: 10.1007/s13178-023-00827-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/28/2023]
Abstract
Introduction Guidelines recommend that, where possible, clinicians convey HIV-positive test results in person in Australia. However, HIV-negative and all other STI results are routinely delivered by phone or text message. Requesting individuals to obtain positive HIV test results in person could be a deviation from the standard delivery of healthcare and be interpreted as indicating a positive HIV diagnosis. Methods This paper is based on two related, ongoing qualitative studies conducted in Australia with HIV healthcare providers and people recently diagnosed with HIV. In study one, in-depth, semi-structured interviews were conducted with people who had recently received a positive HIV diagnosis. In study two, in-depth, semi-structured interviews were conducted with HIV healthcare and peer support providers. Interviews were analyzed thematically. Results While clinicians were willing to convey HIV-positive diagnoses by phone, most preferred in-person delivery. In-person delivery enabled clinicians to assess visual cues to better respond to the psychological and emotional needs of patients. For some participants living with HIV, however, the requirement to return to the clinic was interpreted as an unofficial HIV-positive diagnosis. This led to a period in which recently diagnosed participants believed they were HIV-positive without having received an explicit diagnosis. Conclusion Protocols for delivering HIV diagnoses by phone, followed by a face-to-face appointment, may reduce the period of anxiety for some patients and assist with an early connection to HIV care and support. Policy Implications In some instances, conveying HIV diagnoses by phone may be more appropriate than recalling individuals to the clinic to deliver a positive HIV diagnosis in person.
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Affiliation(s)
- Nathanael Wells
- Kirby Institute, University of NSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
| | - Dean Murphy
- Kirby Institute, University of NSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
| | - Jeanne Ellard
- Australian Research Centre for Sex, Health, and Society, Bundoora, Australia
| | - Chris Howard
- Queensland Positive People (QPP), Brisbane, Australia
- National Association for People With HIV Australia, Sydney, Australia
| | - Phillip Keen
- Kirby Institute, University of NSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
| | - Christopher Fairley
- Alfred Health, Melbourne Sexual Health Centre, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Basil Donovan
- Kirby Institute, University of NSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
| | - Garrett Prestage
- Kirby Institute, University of NSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
| | - on behalf of the RISE Study Team
- Kirby Institute, University of NSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
- Australian Research Centre for Sex, Health, and Society, Bundoora, Australia
- Queensland Positive People (QPP), Brisbane, Australia
- National Association for People With HIV Australia, Sydney, Australia
- Alfred Health, Melbourne Sexual Health Centre, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
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3
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Wells N, Murphy D, Ellard J, Philpot SP, Prestage G. HIV Diagnosis as Both Biographical Disruption and Biographical Reinforcement: Experiences of HIV Diagnoses Among Recently Diagnosed People Living With HIV. QUALITATIVE HEALTH RESEARCH 2023; 33:165-175. [PMID: 36633974 DOI: 10.1177/10497323221146467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Despite the potential for HIV treatments to transform the health needs of people living with HIV, receiving a positive HIV diagnosis can be a difficult experience and feelings of shock, distress and concerns for the future are commonly reported. Drawing on Michael Bury's conceptualisation of 'biographical disruption', we utilised semi-structured interviews to explore experiences of HIV diagnoses among 34 people diagnosed with HIV between 2016 and 2020 and living in Australia. Interviews were conducted between January 2018 and August 2021. Despite significant advances in biomedical HIV treatments and prevention, participants commonly experienced HIV diagnosis as emotionally challenging. For those with limited HIV awareness, HIV was commonly understood as a likely fatal condition. For some participants, receiving a positive diagnosis also engendered a degree of uncertainty as to their anticipated life trajectory, particularly its impact on future sexual and romantic relationships, options for starting a family and migration opportunities. For some gay and bisexual male participants, receiving a positive diagnosis almost confirmed a life trajectory that they had worked to avoid and their own sometimes-negative attitudes toward people living with HIV were internalised, making adjusting to diagnosis more complex. While all participants reported challenges in adjusting to an HIV diagnosis, some ultimately came to experience living with HIV as bringing about unexpected and welcome changes to their lives. Our findings highlight the complex and intersecting medical, social and emotional needs of people living with HIV when receiving and adjusting to a positive HIV diagnosis.
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Affiliation(s)
- Nathanael Wells
- HIV Epidemiology and Prevention Program, 2786Kirby Institute, University of NSW, Sydney, NSW, Australia
| | - Dean Murphy
- HIV Epidemiology and Prevention Program, 2786Kirby Institute, University of NSW, Sydney, NSW, Australia
| | - Jeanne Ellard
- 110434Australian Research Centre in Sex, Health, and Society, Melbourne, VIC, Australia
| | - Steven P Philpot
- HIV Epidemiology and Prevention Program, 2786Kirby Institute, University of NSW, Sydney, NSW, Australia
| | - Garrett Prestage
- HIV Epidemiology and Prevention Program, 2786Kirby Institute, University of NSW, Sydney, NSW, Australia
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4
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Jacobson D, Grace D, Boddy J, Einstein G. Reproductive health care appointments: How the institutional organization of obstetric/gynecological work shapes the experiences of women with female genital cutting in Toronto, Canada. PLoS One 2023; 18:e0279867. [PMID: 36656810 PMCID: PMC9851502 DOI: 10.1371/journal.pone.0279867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 12/15/2022] [Indexed: 01/20/2023] Open
Abstract
We investigated the social relations shaping the reproductive health care experiences of women with female genital cutting (FGC) in Toronto, Canada. Using Institutional Ethnography, we interviewed eight women with FGC and seven obstetrician/gynecologists (OB/GYN). We found a disjuncture between women's needs during appointments that extended beyond the reproductive body and range of care that doctors were able to provide. Women engaged in emotional healthwork during appointments by explaining FGC to doctors, reading doctors' body language, and getting through vulvar/vaginal examinations. Women reported that if they had emotional reactions during appointments, they were often referred to a mental health specialist, a referral on which they did not act. OB/GYNs described their specialty as "surgical"-training centered around treating reproductive abnormalities and not mental health issues. Therefore, the disjuncture between women's needs and OB/GYNs' institutional training highlights the difficulties inherent when bodies of "difference" encounter the reproductive health care system.
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Affiliation(s)
- Danielle Jacobson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- * E-mail:
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Janice Boddy
- Department of Anthropology, University of Toronto, Toronto, Canada
| | - Gillian Einstein
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Psychology, University of Toronto, Toronto, Canada
- Department of Gender Studies, Linköping University, Linköping, Sweden
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5
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Milwid RM, Xia Y, Doyle CM, Cox J, Lambert G, Thomas R, Mishra S, Grace D, Lachowsky NJ, Hart TA, Boily MC, Maheu-Giroux M. Past dynamics of HIV transmission among men who have sex with men in Montréal, Canada: a mathematical modeling study. BMC Infect Dis 2022; 22:233. [PMID: 35255860 PMCID: PMC8902714 DOI: 10.1186/s12879-022-07207-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/24/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (gbMSM) experience disproportionate risks of HIV acquisition and transmission. In 2017, Montréal became the first Canadian Fast-Track City, setting the 2030 goal of zero new HIV infections. To inform local elimination efforts, we estimate the evolving role of prevention and sexual behaviours on HIV transmission dynamics among gbMSM in Montréal between 1975 and 2019. METHODS Data from local bio-behavioural surveys were analyzed to develop, parameterize, and calibrate an agent-based model of sexual HIV transmission. Partnership dynamics, HIV's natural history, and treatment and prevention strategies were considered. The model simulations were analyzed to estimate the fraction of HIV acquisitions and transmissions attributable to specific groups, with a focus on age, sexual partnering level, and gaps in the HIV care-continuum. RESULTS The model-estimated HIV incidence peaked in 1985 (2.3 per 100 person years (PY); 90% CrI: 1.4-2.9 per 100 PY) and decreased to 0.1 per 100 PY (90% CrI: 0.04-0.3 per 100 PY) in 2019. Between 2000-2017, the majority of HIV acquisitions and transmissions occurred among men aged 25-44 years, and men aged 35-44 thereafter. The unmet prevention needs of men with > 10 annual anal sex partners contributed 90-93% of transmissions and 67-73% of acquisitions annually. The primary stage of HIV played an increasing role over time, contributing to 11-22% of annual transmissions over 2000-2019. In 2019, approximately 70% of transmission events occurred from men who had discontinued, or never initiated antiretroviral therapy. CONCLUSIONS The evolving HIV landscape has contributed to the declining HIV incidence among gbMSM in Montréal. The shifting dynamics identified in this study highlight the need for continued population-level surveillance to identify gaps in the HIV care continuum and core groups on which to prioritize elimination efforts.
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Affiliation(s)
- Rachael M. Milwid
- grid.14709.3b0000 0004 1936 8649Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC Canada
| | - Yiqing Xia
- grid.14709.3b0000 0004 1936 8649Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC Canada
| | - Carla M. Doyle
- grid.14709.3b0000 0004 1936 8649Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC Canada
| | - Joseph Cox
- grid.14709.3b0000 0004 1936 8649Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC Canada ,grid.459278.50000 0004 4910 4652Direction Régionale de Santé Publique de Montréal, Montréal, QC Canada
| | - Gilles Lambert
- grid.459278.50000 0004 4910 4652Direction Régionale de Santé Publique de Montréal, Montréal, QC Canada
| | | | - Sharmistha Mishra
- grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Canada
| | - Daniel Grace
- grid.17063.330000 0001 2157 2938Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Nathan J. Lachowsky
- grid.143640.40000 0004 1936 9465School of Public Health and Social Policy, University of Victoria, Victoria, BC Canada
| | - Trevor A. Hart
- grid.68312.3e0000 0004 1936 9422Department of Psychology, Ryerson University, Toronto, ON Canada
| | - Marie-Claude Boily
- grid.7445.20000 0001 2113 8111Department of Infectious Diseases, Imperial College London, London, UK
| | - Mathieu Maheu-Giroux
- grid.14709.3b0000 0004 1936 8649Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC Canada
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Gilbertson A, Tucker JD, Dubé K, Dijkstra M, Rennie S. Ethical considerations for HIV remission clinical research involving participants diagnosed during acute HIV infection. BMC Med Ethics 2021; 22:169. [PMID: 34961509 PMCID: PMC8714439 DOI: 10.1186/s12910-021-00716-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/20/2021] [Indexed: 11/16/2022] Open
Abstract
HIV remission clinical researchers are increasingly seeking study participants who are diagnosed and treated during acute HIV infection—the brief period between infection and the point when the body creates detectable HIV antibodies. This earliest stage of infection is often marked by flu-like illness and may be an especially tumultuous period of confusion, guilt, anger, and uncertainty. Such experiences may present added ethical challenges for HIV research recruitment, participation, and retention. The purpose of this paper is to identify potential ethical challenges associated with involving acutely diagnosed people living with HIV in remission research and considerations for how to mitigate them. We identify three domains of potential ethical concern for clinicians, researchers, and ethics committee members to consider: 1) Recruitment and informed consent; (2) Transmission risks and partner protection; and (3) Ancillary and continuing care. We discuss each of these domains with the aim of inspiring further work to advance the ethical conduct of HIV remission research. For example, experiences of confusion and uncertainty regarding illness and diagnosis during acute HIV infection may complicate informed consent procedures in studies that seek to recruit directly after diagnosis. To address this, it may be appropriate to use staged re-consent procedures or comprehension assessment. Responsible conduct of research requires a broad understanding of acute HIV infection that encompasses its biomedical, psychological, social, and behavioral dimensions. We argue that the lived experience of acute HIV infection may introduce ethical concerns that researchers and reviewers should address during study design and ethical approval.
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Affiliation(s)
- Adam Gilbertson
- Pacific Institute for Research and Evaluation, Chapel Hill Center, 101 Conner Drive, Suite 200, Chapel Hill, NC, 27514-7038, USA. .,UNC Center for Bioethics, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Joseph D Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WCE1, UK.,UNC Project-China, 2 Lujing Road, Guangzhou, China
| | - Karine Dubé
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maartje Dijkstra
- Department of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Stuart Rennie
- UNC Center for Bioethics, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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Pralat R, Anderson J, Burns F, Yarrow E, Barber TJ. Discussing parenthood with gay men diagnosed with HIV: a qualitative study of patient and healthcare practitioner perspectives. BMC Public Health 2021; 21:2300. [PMID: 34923967 PMCID: PMC8684690 DOI: 10.1186/s12889-021-12285-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 11/22/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Research on HIV and reproduction has focused largely on women and heterosexual men. This article examines whether it is relevant to address parenthood in HIV care with gay men and what ways of doing so are most appropriate. METHODS Qualitative interviews were conducted at four London clinics with 25 men living with HIV, aged 20-45, who did not have children, and 16 HIV clinicians. A thematic analysis identified potential reasons why parenthood was rarely discussed with gay men in HIV care. RESULTS Two sets of ideas contributed to a lack of conversations about parenthood: clinicians' ideas about what matters to gay men and men's ideas about what it means to be HIV-positive. Both sets of ideas largely excluded having children, with patients and practitioners similarly unlikely to raise the topic of parenthood in the clinic. Contrary to what clinician commonly assumed, many men expressed interest in receiving more information, highlighting the importance of reassuring people upon diagnosis that it is possible to become parents while living with HIV. CONCLUSIONS Parenting desires and intentions were rarely discussed with men in HIV care. Our findings illuminate the potentially beneficial effects of emphasising that having children is a possibility at diagnosis, regardless of patients' gender or sexuality. Conveying this information seems meaningful, not only to men who want to become parents in the future but also to others, as it appears to alleviate fears about mortality and ill health.
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Affiliation(s)
- Robert Pralat
- Department of Sociology, University of Cambridge, 16 Mill Lane, Cambridge, CB2 1SB, UK.
| | - Jane Anderson
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - Fiona Burns
- Institute for Global Health, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Elizabeth Yarrow
- Centre for Gender Studies, University of Cambridge, Cambridge, UK
| | - Tristan J Barber
- Institute for Global Health, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
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8
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Ngobi JB, Pottie K, Leonard L, Tugwell P, Hoffman SJ, Welch V. Human immunodeficiency virus testing and psychosocial outcomes: a scoping review protocol. ACTA ACUST UNITED AC 2020; 17:1616-1625. [PMID: 30864981 DOI: 10.11124/jbisrir-2017-003864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The proposed scoping review will identify psychosocial outcomes immediately following human immunodeficiency virus (HIV) testing and their measurements, specifically among individuals with a new negative or positive test result. INTRODUCTION No systematic study has described psychosocial outcomes and their measurements in persons immediately following HIV testing. Also, to our knowledge, there is no consensus on a core set of psychosocial outcomes and measurements following HIV diagnosis, which are essential for quality improvement. INCLUSION CRITERIA All study designs will be considered. Participants with a new positive or negative HIV test result, regardless of sex or age, in any setting will be included. Any measured beneficial or harmful outcomes in the mental and social domains following a new diagnosis will be included. Psychosocial outcomes of participants undergoing treatment and care will be excluded. METHODS The databases Ovid MEDLINE, Embase and PsycINFO will be searched, and published articles in English from 2007 to the present date will be included. The methods for scoping reviews outlined by the Joanna Briggs Institute will be followed. Data will be extracted from included studies by two reviewers. Any disagreements between the two reviewers will be solved through discussion in a team of five members. To define the specific concepts or outcome (sub)-domains and their measurements, the models proposed by the Outcome Measures in Rheumatology initiative and the Core Outcome Measures in Effectiveness Trials initiative, respectively, will be used. To analyze the data, this study will rely on a multi-level social-ecological model.
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Affiliation(s)
- John B Ngobi
- Population Health PhD Interdisciplinary Program, Faculty of Health Science, University of Ottawa, Ottawa, Canada
| | - Kevin Pottie
- Bruyère Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Lynne Leonard
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Peter Tugwell
- Bruyère Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Steven J Hoffman
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, Canada
| | - Vivian Welch
- Bruyère Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Pleasure and HIV biomedical discourse: The structuring of sexual and drug-related risks for gay and bisexual men who Party-n-Play. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:181-190. [PMID: 31627160 DOI: 10.1016/j.drugpo.2019.09.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/21/2019] [Accepted: 09/23/2019] [Indexed: 11/23/2022]
Abstract
Party-n-Play (PNP) is a social practice that refers to sex that occurs under the influence of drugs. This study critically examined the risk and pleasure discourses of gay and bisexual men who PNP to explore how epistemic shifts associated with advancements in HIV biomedical sciences influence gay and bisexual men's perceptions of HIV risks and their sexual and drug-related practices. This study also aims to provide a more nuanced understanding of how sexual and drug-related risk practices of gay and bisexual men are entangled with their search for pleasure. The study was framed within poststructural Critical Discourse Analysis (CDA) methodology. In-depth one-hour interviews were conducted with 44 self-identified gay, bisexual, queer, or Two-Spirit men, who lived in Toronto, and who reported using drugs before or during sex with another man. The findings from this study demonstrated the capacity of biomedical discourses to affect respondents' HIV risk perceptions and practices. The transition from condom-centered prevention to today's context where new highly effective biomedical tools for HIV prevention are available created possibilities for greater intimacy, increased pleasure, and less anxiety about HIV tranmission, while challenging many years of preventive socialization among gay and bisexual men. However, this new context also rekindled deep-seated fears about HIV risk and viral load verifiability, reinforced unequal forms of biomedical self-governance and citizenship, and reproduced practices of biopolitics. While discourses on risk and pleasure were interwoven within complex PNP assemblages, the notion of pleasure was mobilized as a discursive tactic of self-control, and the division between normative and non-normative pleasures highlighted the consequence of biopolitical forces governing the production of discourses on sex and drugs. Future HIV social science research needs to attend to the fluid nature of the discursive environments of HIV prevention science, and consider how both the material context of PNP and its social/discursive elements operate together.
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10
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Grace D, Gaspar M, Lessard D, Klassen B, Brennan DJ, Adam BD, Jollimore J, Lachowsky NJ, Hart TA. Gay and bisexual men's views on reforming blood donation policy in Canada: a qualitative study. BMC Public Health 2019; 19:772. [PMID: 31208391 PMCID: PMC6580549 DOI: 10.1186/s12889-019-7123-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/07/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Researchers and activists have long called for changes to blood donation policies to end what is frequently framed as unjustified bans or deferral periods for men who have sex with men (MSM). Since 2016, in Canada, a man had to be abstinent from all sexual contact (anal or oral sex) with other men for at least 12 months in order to be an eligible blood donor. As of June 3, 2019, this deferral period was reduced to 3 months. METHODS To better understand the acceptance of existing deferral policies and possible future policy, we conducted 47 in-depth interviews with a demographically diverse sample of gay, bisexual, queer, and other men who have sex with men (GBM) in Canada's three largest cities: Vancouver, (n = 17), Toronto (n = 15), and Montreal (n = 15). Interviews were coded in NVivo 11 following an inductive thematic analysis. We focus on men's preferred policy directions and their opinions about a policy change proposed by Canada's blood operators: a 3-month deferral for all sexual activity between men. We interviewed GBM approximately one-year before this new deferral policy was approved by Health Canada. RESULTS Most participants were opposed to any deferral period in relation to MSM-specific sexual activity. A fair and safe policy was one that was the "same for everyone" and included screening for several risk factors during the blood donation process with no categorical exclusion of all sexually active MSM. Participants believed that multiple "gender blind" and HIV testing-related strategies could be integrated into the blood donation process. These preferences for a move away from MSM-specific exclusions aligned with their opinions concerning the possible change to a 3-month MSM deferral, for which participants shared three overarching perspectives: (1) step in the right direction; (2) ambivalence and uncertainty; and (3) not an improvement. CONCLUSION A predominant assertion was that a change from a 12-month to a 3-month deferral period would not resolve the fundamental issues of fairness and equity affecting blood screening practices for GBM in Canada. Many participants believed that blood donation policy should be based on more up-to-date scientific evidence concerning risk factor assessment and HIV testing.
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Affiliation(s)
- Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 5th Floor, Room 556, Toronto, ON, M5T 3M7, Canada.
| | - Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 5th Floor, Room 510, Toronto, ON, M5T 3M7, Canada
| | - David Lessard
- Centre for Health Outcomes Research, McGill University Health Centre, 5252 de Maisonneuve West, Montréal, QC, H4A 3S5, Canada
| | - Benjamin Klassen
- Department of History, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - David J Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St W, Toronto, ON, M5S 1V4, Canada
| | - Barry D Adam
- Ontario HIV Treatment Network, 1300 Yonge Street #600, Toronto, ON, M4T 1X3, Canada
| | - Jody Jollimore
- Community-Based Research Centre, 1007-808 Nelson Street, Vancouver, BC, V6Z 2H2, Canada
| | - Nathan J Lachowsky
- School of Public Health & Social Policy, Faculty of Human & Social Development, University of Victoria, Michael Smith Foundation for Health Research Scholar, P.O. Box 1700, STN CSC, Victoria, BC, V8W 2Y2, Canada
| | - Trevor A Hart
- HIV Prevention Lab, Department of Psychology, Ryerson University, 350 Victoria St, Toronto, ON, M5B 2K3, Canada
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11
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Hollingdrake O, Lui CW, Mutch A, Dean J, Howard C, Fitzgerald L. Factors affecting the decision to initiate antiretroviral therapy in the era of treatment-as-prevention: synthesis of evidence from qualitative research in high-income settings. AIDS Care 2018; 31:397-402. [PMID: 30311499 DOI: 10.1080/09540121.2018.1533235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The emergence of treatment-as-prevention has made early initiation of antiretroviral treatment (ART) a "universal" policy. This review synthesizes qualitative research findings on barriers and facilitators of ART initiation in Organization for Economic Co-operation and Development (OECD) countries published since 2010. Ten articles describing seven research studies were included in the review. Findings confirmed ART initiation as a complicated process involving careful deliberation of the personal risks and benefits of treatment within the broader contexts of everyday life for people living with HIV (PLHIV). They also highlight interpersonal dynamics and concern for the public as increasingly important factors in shaping the decision to initiate treatment. The review provides valuable information for understanding treatment behaviour and maximizing treatment options brought forth by new biomedical advances.
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Affiliation(s)
| | - Chi-Wai Lui
- a School of Public Health , University of Queensland , Brisbane , Australia
| | - Allyson Mutch
- a School of Public Health , University of Queensland , Brisbane , Australia
| | - Judith Dean
- a School of Public Health , University of Queensland , Brisbane , Australia
| | - Chris Howard
- b Department of Life and Program , Queensland Positive People , Brisbane , Australia
| | - Lisa Fitzgerald
- a School of Public Health , University of Queensland , Brisbane , Australia
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12
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Gilbert M, Taylor D, Michelow W, Grace D, Balshaw R, Kwag M, Lim E, Fischer B, Patrick D, Ogilvie G, Coombs D, Steinberg M, Rekart M. Sustained Reduction in Sexual Behavior that May Pose a Risk of HIV Transmission Following Diagnosis During Early HIV Infection Among Gay Men in Vancouver, British Columbia. AIDS Behav 2018; 22:2068-2078. [PMID: 28168375 DOI: 10.1007/s10461-017-1702-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Increased viral load during early HIV infection (EHI) disproportionately contributes to HIV transmission among gay men. We examined changes in sexual behavior that may pose a risk of HIV transmission (condomless anal sex (AS) with a serodiscordant or unknown status partner, CAS-SDU) in a cohort of 25 gay men newly diagnosed during EHI who provided information on 241 sexual partners at six time points following diagnosis. Twenty-two (88%) participants reported ≥1 AS partner (median time to first AS 80 days) and 12 (55%) reported ≥1 partnership involving CAS-SDU (median 116 days). In hierarchical generalized linear mixed effects models, AS was significantly less likely in all time periods following diagnosis and more likely with serodiscordant partners. The likelihood of CAS-SDU decreased three months after diagnosis and was higher in recently versus acutely infected participants. Most men in our study abstained from sex immediately after diagnosis with sustained longer-term reduction in CAS-SDU, confirming the importance of timely diagnosis during EHI.
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13
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Wandell GM, Molina Y, Sánchez H, Greer AC, Ríos J, Bain C, Segura P, Lama JR, Sánchez J, Duerr A. Knowledge and preferences concerning acute HIV testing programs among both Peruvian men who have sex with men and transgender women. Int J STD AIDS 2017; 28:1010-1017. [PMID: 28056724 DOI: 10.1177/0956462416685674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Immediate antiretroviral therapy (ART) for acute HIV infection (AHI) may decrease HIV transmission in high-risk populations. This study evaluated knowledge of AHI and AHI testing program preferences in Lima, Peru through four semi-structured focus groups with high-risk men who have sex with men (MSM) ( n = 20) and transgender women (TW) ( n = 16). Using content analysis, emergent themes included knowledge of AHI symptoms, AHI transmission potential, and the HIV testing window period, and preferences concerning point of care results. Participants demonstrated low familiarity with the term AHI, but many correctly identified AHI symptoms. However, these symptoms may not motivate testing because they overlap with common viral illnesses and AIDS. Some were aware that infectiousness is highest during AHI, and believe this knowledge would facilitate HIV testing. The shortened window period with AHI testing would encourage testing following high-risk sex. Delayed result notification would not decrease AHI testing demand among MSM, although it might for some TW.
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Affiliation(s)
- Grace M Wandell
- 1 University of Washington School of Medicine, Seattle, WA, USA
| | - Yamile Molina
- 2 School of Public Health, University of Illinois, Chicago, IL, USA
| | | | - Anna C Greer
- 1 University of Washington School of Medicine, Seattle, WA, USA
| | - Jessica Ríos
- 4 Asociación Civil Impacta Salud y Educación, Lima, Perú
| | - Carolyn Bain
- 5 Vaccine and Infectious Disease & Public Health Science Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Javier R Lama
- 4 Asociación Civil Impacta Salud y Educación, Lima, Perú.,6 Department of Global Health, University of Washington School of Medicine, Seattle, WA, USA
| | - Jorge Sánchez
- 4 Asociación Civil Impacta Salud y Educación, Lima, Perú.,6 Department of Global Health, University of Washington School of Medicine, Seattle, WA, USA
| | - Ann Duerr
- 5 Vaccine and Infectious Disease & Public Health Science Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,6 Department of Global Health, University of Washington School of Medicine, Seattle, WA, USA
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14
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Grace D, Chown SA, Kwag M, Steinberg M, Lim E, Gilbert M. Becoming "Undetectable": Longitudinal Narratives of Gay Men's Sex Lives After a Recent HIV Diagnosis. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2015; 27:333-349. [PMID: 26241383 DOI: 10.1521/aeap.2015.27.4.333] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We explore gay men's sex life narratives following their diagnosis with an acute or recent HIV infection. All participants received an acute (n = 13) or recent (n = 12) HIV diagnosis and completed a series of self-administered questionnaires and in-depth qualitative interviews over a one-year period or longer. Over the course of four qualitative interviews, participants frequently spoke of the role of medications (e.g., decisions to start treatment) and changing viral loads (e.g., discourses of becoming "undetectable") in relation to their sex lives since being diagnosed with HIV. Many men talked about milestones relating to initiating medication and viral load as informing their shifting sexual behaviors and identities as HIV-positive--or "undetectable"--gay men. The narratives of our participants provide insight regarding complex negotiations and processes of decision-making over time related to sex, counseling needs, treatment initiation, viral load, and the significance of undetectability as an emergent identity.
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Affiliation(s)
- Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sarah A Chown
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Michael Kwag
- British Columbia Centre for Disease Control, Vancouver, Canada
| | | | - Elgin Lim
- Positive Living Society of British Columbia, Vancouver, Canada
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