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Bragard E, Fisher CB. Parental Sexual Socialization, Sexual Subjectivity, and Emotional Responses to Sexual Experiences among Adolescent Girls. ARCHIVES OF SEXUAL BEHAVIOR 2024:10.1007/s10508-024-02990-7. [PMID: 39225845 DOI: 10.1007/s10508-024-02990-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 08/15/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024]
Abstract
This study explored girls' sexual subjectivity as a pathway through which parental socialization influenced their emotions about past sexual experiences. A national online survey of 397 adolescent girls (Mage = 16.8 years) from diverse racial/ethnic backgrounds (33.0% Black, 25.7% Latina, 28.0% non-Hispanic White) assessed (1) parental messaging emphasizing relational, sex-positive, gendered sex role, abstinence-only, and sex-is-taboo discourses; (2) girls' sexual subjectivity including sexual body esteem, entitlement to sexual pleasure, and perceived sexual control; and (3) positive and negative emotional reactions to sexual experiences. Sexual subjectivity fully mediated the positive effect of relational messaging on positive emotional reactions and the negative effect on negative emotional reactions. Additionally, sexual subjectivity partially mediated the positive effect of gendered sex role messaging on negative emotional reactions. This study draws critical attention to placing the psychological aspects of girls' sense of their own sexuality and the emotional components of their sexual experience at the forefront of understanding the influence of parental sexual socialization on the sexual experiences of adolescent girls.
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Affiliation(s)
- Elise Bragard
- Department of Public Health Sciences, Alcohol Research Center, University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT, 06030, USA.
- Department of Psychology and Center for Ethics Education, Fordham University, Bronx, NY, USA.
| | - Celia B Fisher
- Department of Psychology and Center for Ethics Education, Fordham University, Bronx, NY, USA
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Day S, Tahlil KM, Shah SJ, Fidelak L, Wilson EC, Shah SK, Nwaozuru U, Chima K, Obiezu-Umeh C, Chikwari CD, Mwaturura T, Phiri N, Babatunde AO, Gbajabiamila T, Rennie S, Iwelunmor J, Ezechi O, Tucker JD. The HI V O pen Call on I nformed C onsent and E thics in Research (VOICE) for Adolescents and Young Adults: A Digital Crowdsourcing Open Call in Low- and Middle-Income Countries. Sex Transm Dis 2024; 51:359-366. [PMID: 38346417 PMCID: PMC11018461 DOI: 10.1097/olq.0000000000001949] [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] [Indexed: 02/22/2024]
Abstract
BACKGROUND Many adolescents and young adults (AYAs; 10-24 years old) are excluded from HIV research because of social, ethical, and legal challenges with informed consent, resulting in limited AYA-focused data. We use a participatory approach to identify strategies for improving AYA consent processes in HIV research in low- and middle-income countries (LMICs). METHODS We conducted a digital crowdsourcing open call for ideas to improve AYA consent to HIV research in LMICs. Crowdsourcing involves engaging a group of people in problem-solving, then sharing emergent solutions. Submissions were evaluated by 3 independent judges using predefined criteria, with exceptional strategies receiving prizes. Demographic data were collected, and textual data were qualitatively analyzed for emergent themes in barriers and facilitators for improving AYA consent in HIV research, guided by a socioecological model. RESULTS We received 110 strategies total; 65 were eligible for evaluation, 25 of which were identified as finalists. Fifty-eight participants from 10 LMICs submitted the 65 eligible submissions, of which 30 (52%) were 18 to 24 years old. Thematic analysis identified 10 barriers to AYA consent, including HIV stigma, limited education, and legal/regulatory barriers. Strategies for improving AYA consent processes revealed 7 potential facilitators: enhancing AYA engagement in research, involving parents/guardians, improving education/awareness, improving institutional practices/policy, making research participation more AYA-friendly, enhancing engagement of other key communities of interest, and empowering AYA. CONCLUSIONS Diverse communities of interest in LMICs developed compelling strategies to enhance informed consent that may improve AYA inclusion in HIV research. These data will be used to develop practical guidance on improving AYA consent processes.
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Affiliation(s)
- Suzanne Day
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kadija M. Tahlil
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sonam J. Shah
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lauren Fidelak
- Current undergraduate student (degree not yet granted) in the Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Erin C. Wilson
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Seema K. Shah
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Ucheoma Nwaozuru
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kelechi Chima
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Chisom Obiezu-Umeh
- Department of Behavioral Science & Health Education, College for Public Health and Social Justice, St. Louis University, St. Louis, Missouri, USA
| | - Chido Dziva Chikwari
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Nomsa Phiri
- Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | | | - Titilola Gbajabiamila
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
- Department of Behavioral Science & Health Education, College for Public Health and Social Justice, St. Louis University, St. Louis, Missouri, USA
| | - Stuart Rennie
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- UNC Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Juliet Iwelunmor
- Department of Behavioral Science & Health Education, College for Public Health and Social Justice, St. Louis University, St. Louis, Missouri, USA
| | - Oliver Ezechi
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Joseph D. Tucker
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Servais J, Vanhoutte B, Maddy H, Godin I. Ethical and methodological challenges conducting participative research with transgender and gender-diverse young people: a systematic review. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2024; 25:419-438. [PMID: 39055638 PMCID: PMC11268261 DOI: 10.1080/26895269.2024.2323524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Introduction Research with transgender and gender-diverse (TGD) young people is essential to understand their experiences and to be able to propose, implement and adapt 'services' in the broadest sense to meet their needs. However, research outside clinical settings on current experiences and needs of youth under the age of 18 is limited which hinders the development of knowledge on TGD, as well as the development of research informed support practices. Acquiring parental consent for participatory research may present ethical and logistical difficulties, as it could jeopardize the safety, well-being, or confidentiality of adolescent participants. This creates a tension between the adolescent's right to autonomy, privacy, freedom, and all aspects related to the consent of the underage on the one hand, and the parents' right to protect their child on the other hand. This review aims to identify the methodological and ethical challenges associated with participatory research with transgender and gender-diverse young people. Methods We systematically searched bibliometric databases for studies published between 2006 and 2022 and included 4 main conceptual groups: transgender and gender non-conforming, adolescence, qualitative research (including participatory research) and consent. This review was registered in PROSPERO (CRD42022368360) in November 2022. Results Of the 3,794 articles initially identified, 291 met the inclusion criteria and 48 were examined. The selected studies were analyzed in the light of four main ethical tensions: involving parents or a trusted person in the consent gathering process, ensuring the protection and safety of young people while respecting confidentiality, and ensuring that spaces are created for transgender and gender-diverse young people to express themselves freely as part of an empowering research process. At the same time, several methodological challenges concerning public and stakeholder participation and recruitment, data collection and analysis as well as research integrity emerged from the selected studies. Conclusion & implications The existing literature of participatory research involving young transgender and gender-diverse individuals underscores the intricate and conflicting aspects, especially concerning power dynamics, empowerment, and the researcher's role. The relevance of these findings extends across various legal frameworks and is applicable to multiple contexts and countries.
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Affiliation(s)
- Julie Servais
- School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Bram Vanhoutte
- School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Herby Maddy
- Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Godin
- School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
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Zucchi EM, Ferguson L, Magno L, Dourado I, Greco D, Ferraz D, Tupinambas U, Grangeiro A. When Ethics and the Law Collide: A Multicenter Demonstration Cohort Study of Pre-Exposure Prophylaxis Provision to Adolescent Men Who Have Sex With Men and Transgender Women in Brazil. J Adolesc Health 2023; 73:S11-S18. [PMID: 37953003 DOI: 10.1016/j.jadohealth.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 06/16/2023] [Accepted: 08/04/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE To explore legal and ethical challenges related to adolescents' participation in human immunodeficiency virus (HIV) research that may affect their best interests. METHODS We analyzed the ethical principles and legal aspects of the participation of 15-17-year-old men who have sex with men and transgender women in the pre-exposure prophylaxis (PrEP) 1519 study, a PrEP demonstration cohort study in three Brazilian cities. The analyses of ethics review committees' (ERCs) evaluations and court decisions followed ethical and human rights principles. An HIV vulnerability score was created, and descriptive statistics and multivariate logistic regression were performed using data from 347 participants. RESULTS The ERCs evaluated the benefits and risks of research participation, all finding that the benefits outweighed the risks. ERCs deferred responsibility for decisions about waiving parental consent to the judiciary. State courts reached different decisions about waiving parental consent, reflecting variation in recognition of adolescents' evolving capacities and the adolescent as a subject of sexual rights and the primary agent capable of deciding on their health and best interests. The most vulnerable adolescent participants were found in sites where the blanket waiver was in place. DISCUSSION Judicializing the ethical review process is detrimental to fulfilling the ethical principle of justice and vulnerable adolescents' access to health research. ERCs must be sufficiently independent and autonomous and have the capacity to respect, protect, and help fulfill the rights of participants while ensuring the generation of adequate evidence to inform public health practice.
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Affiliation(s)
- Eliana Miura Zucchi
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Católica de Santos, Santos, São Paulo, Brazil.
| | - Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California
| | - Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Bahia, Brazil
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Dirceu Greco
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Dulce Ferraz
- Fundação Oswaldo Cruz (Fiocruz), Diretoria Regional de Brasília, Brasília, Brazil; UMR Inserm 1296 - Radiations: Défense Santé Environnement, Université Lumière Lyon 2, Lyon, France
| | - Unai Tupinambas
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Alexandre Grangeiro
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
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MacDonald KR, Enane LA, McHenry MS, Davis NL, Whipple EC, Ott MA. Ethical Aspects of Involving Adolescents in HIV Research: A Systematic Review of the Empiric Literature. J Pediatr 2023; 262:113589. [PMID: 37399918 PMCID: PMC11119419 DOI: 10.1016/j.jpeds.2023.113589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To evaluate the ethics of involving adolescents in HIV research, we conducted a systematic review of the empiric literature. METHODS Electronic databases Ovid Medline, Embase, and CINAHL were systematically searched using controlled vocabulary terms related to ethics, HIV, specified age groups, and empiric research studies. We reviewed titles and abstracts, including studies that collected qualitative or quantitative data, evaluated ethical issues in HIV research, and included adolescents. Studies were appraised for quality, data were extracted, and studies were analyzed using narrative synthesis. RESULTS We included 41 studies: 24 qualitative, 11 quantitative, 6 mixed methods; 22 from high-income countries (HIC), 18 from low- or middle-income countries (LMIC), and 1 from both HIC and LMIC. Adolescent, parent, and community perspectives assert the benefits of involving minors in HIV research. Participants in LMIC expressed mixed views regarding parental consent requirements and confidentiality, given adolescents' both increasing autonomy and continued need for adult support. In studies in HIC, sexual or gender minority youth would not participate in research if parental consent were required or if there were confidentiality concerns. There was variation in the comprehension of research concepts, but adolescents generally demonstrated good comprehension of informed consent. Informed consent processes can be improved to increase comprehension and study accessibility. Vulnerable participants face complex social barriers that should be considered in study design. CONCLUSIONS Data support the inclusion of adolescents in HIV research. Empiric research can inform consent processes and procedural safeguards to ensure appropriate access.
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Affiliation(s)
- Katherine R MacDonald
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Leslie A Enane
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN
| | - Megan S McHenry
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN
| | - Neilkant L Davis
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Elizabeth C Whipple
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN
| | - Mary A Ott
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN
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Neelakantan L, Fry D, Florian L, Meinck F. Adolescents' Experiences of Participating in Sensitive Research: A Scoping Review of Qualitative Studies. TRAUMA, VIOLENCE & ABUSE 2023; 24:1405-1426. [PMID: 35044869 DOI: 10.1177/15248380211069072] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Despite an increasing emphasis on adolescents' participation rights, there are concerns about their participation in research on sensitive topics, such as trauma and violence. This review reports findings of a scoping review that examined the nature and extent of qualitative studies conducted with adolescents about their experiences of participating in research on sensitive topics. Studies were identified by searching electronic databases and grey literature and reported on qualitative and mixed-methods studies eliciting adolescents' experiences of participating in research on sensitive topics. Seventeen (17) studies were included after screening 4426 records. The scoping review revealed significant adolescent benefits from participation, relating to positive emotions, skill acquisition and enhanced self-efficacy and interpersonal relationships. To a lesser extent, participants also experienced burdens relating to negative emotions, concerns about confidentiality and privacy and inconvenience of participation, which were mitigated by careful attention to research design and researcher engagement and training. Participants shared insights into their motivation to participate, and factors that impacted their experiences of research, such as ethical considerations, including consent procedures, safety and connection in research, study procedures and documentation and researcher characteristics. There were tangible benefits and some burdens involved in adolescents' participation in sensitive research. This review considers implications for research and practice, such as the need to regularly publish findings of consultations, assessing caregiver consent requirements, obtaining adolescent views on study documents and measures and building on existing research, differentiated by age, gender and dis/ability status, especially in diverse and under-represented regions.
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Affiliation(s)
| | - Deborah Fry
- Moray House School of Education and Sport, The University of Edinburgh, Edinburgh, UK
| | - Lani Florian
- Moray House School of Education and Sport, The University of Edinburgh, Edinburgh, UK
| | - Franziska Meinck
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
- OPTENTIA, Faculty of Health Sciences, North-West University, Vanderbijlpark, South Africa
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Kreniske P, Hoffman S, Ddaaki W, Nakyanjo N, Spindler E, Ssekyewa C, Isabirye D, Nakubulwa R, Proscovia N, Daniel L, Haba N, Maru M, Thompson J, Chen IS, Nalugoda F, Ssekubugu R, Lutalo T, Ott MA, Santelli JS. Capacity to Consent to Research Among Adolescent-Parent Dyads in Rakai, Uganda. J Pediatr 2023; 257:113271. [PMID: 36402433 PMCID: PMC10202026 DOI: 10.1016/j.jpeds.2022.11.012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/11/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To assess the cognitive capacity of early, middle, and late adolescents and their parents or guardians to provide informed consent to a population-based cohort study. STUDY DESIGN Adolescent-parent/guardian dyads including 40 early (n = 80; 10-14 years), 20 middle (15-17 years), and 20 late (18-19 years) adolescents were recruited from the Rakai Community Cohort Study, an open demographic cohort in Uganda. Participants were administered the MacArthur Competence Assessment Tool for Clinical Research, a structured open-ended assessment; interviews were recorded and transcribed. Twenty transcripts were scored independently by two coders; the intraclass correlation coefficient was 0.89. The remaining interviews were scored individually. We compared mean scores for early and middle/late adolescents using a one-sided t test and score differences between parent/guardian and adolescent dyads using two-sided paired t tests. RESULTS Early adolescents (mean score, 28.8; 95% CI, 27.1-30.5) scored significantly lower (P < .01) than middle/late adolescents (32.4; 31.6-33.1). In paired dyad comparisons, we observed no statistically significant difference in scores between parents/guardians and middle/late adolescents (difference, -0.2; 95% CI, -1.0-0.6). We found a statistically significant difference in scores between parents/guardians and early adolescents (difference, 3.0; 95% CI, 1.2-4.8). CONCLUSIONS The capacity of adolescents-of different ages and in diverse settings-to comprehend risks, benefits, and other elements of informed consent is a critical but understudied area in research ethics. Our findings support the practice of having middle and late adolescents provide independent informed consent for sexual and reproductive health studies. Early adolescents may benefit from supported decision-making approaches.
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Affiliation(s)
- Philip Kreniske
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY.
| | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | | | | | - Esther Spindler
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY
| | | | | | | | | | - Lee Daniel
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY
| | - Nao Haba
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY
| | - Mahlet Maru
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY
| | - Julia Thompson
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY
| | - Ivy S Chen
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY
| | | | | | - Tom Lutalo
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - Mary A Ott
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - John S Santelli
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY
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Polfuss M, Mooney-Doyle K, Keller M, Gralton KS, Giambra B, Vance A. Developing a Family Resource: Considerations for Family Member Research Participation. JOURNAL OF FAMILY NURSING 2023; 29:202-222. [PMID: 36935575 DOI: 10.1177/10748407231157433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
When individuals participate in health care research, the choice often affects the entire family. Researchers are responsible for protecting participants and minimizing any burdens the research may place on them. Resources to educate potential study participants about these issues from a family perspective are lacking. A family-focused, evidence-based resource was created for individuals and families to prompt discussion prior to their consenting to enrollment in research. The resource includes key relevant questions to consider related to their study participation and was revised based on input from family nurse scientists and a hospital-based family advisory group. This resource raises awareness of the importance of employing a family lens when designing research and during the recruitment and enrollment of participants. Adopting a family lens in health care research will support the participant's ability to make an informed choice regarding participation and may ultimately enhance the experience of participants and their families and study outcomes.
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Affiliation(s)
- Michele Polfuss
- University of Wisconsin - Milwaukee, Milwaukee, WI, USA
- Children's Wisconsin, Milwaukee, WI, USA
| | | | | | | | - Barbara Giambra
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati, Cincinnati, OH, USA
| | - Ashlee Vance
- Michigan State University, Detroit, USA
- Michigan State University, East Lansing, MI, USA
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Pacheco M, Warfield SK, Hatzistavrakis P, Mochida-Meek S, Moskowitz D, Matson M, Mustanski B. "I don't see myself represented:" Strategies and considerations for engaging gay male Native Hawaiian and Other Pacific Islander teens in research and HIV prevention services. AIDS Behav 2023; 27:1055-1067. [PMID: 36097088 PMCID: PMC9466349 DOI: 10.1007/s10461-022-03843-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 12/02/2022]
Abstract
Significant efforts have been applied to the development of sexual health programs for minority young gay males. Given the absence of research with Native Hawaiian and other Pacific Islander (NHOPI) gay teen males, this study was done to assess how to reach them. Interviews were conducted with 20 NHOPI gay males ages 19-24 as near peers that can inform reaching teens. Data was analyzed using the Reflexive Thematic Analysis method. Three themes were identified: (1) Culture is a crucial factor for recruitment and engagement-whether participants realized it or not; (2) Confidentiality is key in recruitment to provide a safe space for NHOPI gay teen male research participation; and (3) NHOPI gay teen males experience multiple identity conflicts that must be considered for recruitment and engagement initiatives. Online recruitment efforts are optimal and should reflect distinct NHOPI cultures. More research is needed when it comes to understanding the cultural acceptance and understanding of homosexuality in NHOPI communities and how to integrate cultural education into recruitment methods and interventions.
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Affiliation(s)
- Misty Pacheco
- Department of Kinesiology and Exercise Sciences, University of Hawai'i at Hilo, 200 W Kawili Street, 96720, Hilo, HI, USA.
| | | | - Patti Hatzistavrakis
- Department of Kinesiology and Exercise Sciences, University of Hawai'i at Hilo, 200 W Kawili Street, 96720, Hilo, HI, USA
| | - Summer Mochida-Meek
- Department of Kinesiology and Exercise Sciences, University of Hawai'i at Hilo, 200 W Kawili Street, 96720, Hilo, HI, USA
| | - David Moskowitz
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | - Margaret Matson
- Department of Medical Social Sciences, Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL, USA
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10
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Tailor J, Rodrigues J, Meade J, Segal K, Benjamin Mwakyosi L. Correlations between oral Pre-Exposure Prophylaxis (PrEP) initiations and policies that enable the use of PrEP to address HIV globally. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001202. [PMID: 36962791 PMCID: PMC10021197 DOI: 10.1371/journal.pgph.0001202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/31/2022] [Indexed: 12/12/2022]
Abstract
Policies facilitating access to HIV prevention services, specifically for pre-exposure prophylaxis (PrEP), can foster enabling environments for service uptake. This analysis aims to establish whether policies enabling broad PrEP eligibility, HIV self-testing, and lowered age of consent to HIV testing and treatment services are correlated with PrEP uptake. Ages of consent vary by country, therefore this analysis focused on how age of consent policies, in general, affect adolescent PrEP uptake. Data was collected from the HIV Policy Lab and AVAC's Global PrEP Tracker, a database of approximately 334 PrEP projects operating across 95 countries, and linear regression and correlation analyses were conducted via STATA to examine relationships amongst national oral PrEP eligibility, HIV self-testing, lowered age of consent, and national cumulative oral PrEP initiations, as of December 2021. Of all 194 countries tracked by the HIV Policy Lab, only about 7% have adopted all three policies (HIV self-testing, lowered age of consent, and PrEP eligibility policies). Less than 50% have adopted have adopted at least one of these policies. Of the 54 countries that have fully adopted PrEP eligibility policies, less than 30% have co-adopted HIV self-testing or lowered age of consent policies. About 30% of these 194 countries have yet to adopt any of these policies, of which about 14% have indicated information is "unavailable" for at least one of the policies. Analyses conducted for the 91 countries tracked by both the HIV Policy Lab and the Global PrEP Tracker revealed a significant and positive relationship between cumulative individuals initiated on oral PrEP and adoption of HIV self-testing policies (p = 0.01, r = 0.26), lowered age of consent policies (p = 0.01, r = 0.25), and PrEP eligibility policies (p = 0.01, r = 0.26). Stronger advocacy efforts towards approving public health policies, such as those outlined in our analysis, that enshrine and enable access to HIV prevention are necessary.
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Affiliation(s)
- Janki Tailor
- AVAC, New York, New York, United States of America
| | | | - John Meade
- AVAC, New York, New York, United States of America
| | - Kate Segal
- AVAC, New York, New York, United States of America
| | - Lilian Benjamin Mwakyosi
- COMPASS-Africa, Dar es Salaam, United Republic of Tanzania
- DARE Organization, Dar es Salaam, United Republic of Tanzania
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11
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Tao X, Fisher CB. Exposure to Social Media Racial Discrimination and Mental Health among Adolescents of Color. J Youth Adolesc 2022; 51:30-44. [PMID: 34686952 PMCID: PMC8535107 DOI: 10.1007/s10964-021-01514-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/28/2021] [Indexed: 01/03/2023]
Abstract
Offline and online racial discrimination has been associated with mental health problems among adolescents of color. Pandemic shelter-at-home policies and the reignited racial justice movement increased the use of social media among youth of color, potentially exposing them to social media racial discrimination. Yet, it is unclear which aspects of social media significantly contributed to youth exposure to racial discrimination and associated mental health issues during this period. This study assessed the relationships among social media use (hours, racial intergroup contact, and racial justice civic engagement), individual and vicarious social media discrimination (defined as personally directed versus observing discrimination directed at others), and mental health among 115 black, 112 East/Southeast Asian, 79 Indigenous, and 101 Latinx adolescents (N = 407, 82.31% female, aged 15-18 years, M = 16.47, SD = 0.93). Structural equation modeling (SEM) analyses indicate that hours of use and racial justice civic engagement were associated with increased social media racial discrimination, depressive symptoms, anxiety, alcohol use disorder, and drug use problems. Furthermore, individual social media racial discrimination fully mediated the relationship between racial justice civic publication and depressive and alcohol use disorder. Vicarious social media racial discrimination fully mediated the relationship between racial justice activity coordination with depressive symptoms, anxiety, and alcohol use disorder. Alternative SEM models indicate that exposure to individual and vicarious social media racial discrimination increased depressive symptoms and drug use problems among youth of color, further increasing their social media use frequency and racial justice civic publication. The findings call for strategies to mitigate the effects of social media racial discrimination in ways that support adolescents' racial justice civic engagement and mental health.
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Affiliation(s)
- Xiangyu Tao
- Department of Psychology, Fordham University, 441 East Fordham Road, Dealy Hall, Bronx, NY, 10458, US.
| | - Celia B Fisher
- Department of Psychology, Fordham University, 441 East Fordham Road, Dealy Hall, Bronx, NY, 10458, US
- Center for Ethics Education, Fordham University, 441 East Fordham Road, Dealy Hall, Bronx, NY, 10458, US
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12
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Philbin MM, Guta A, Wurtz H, Bradley-Perrin I, Kinnard EN, Goldsamt L. How Black and Latino young men who have sex with men in the United States experience and engage with eligibility criteria and recruitment practices: implications for the sustainability of community-based research. CRITICAL PUBLIC HEALTH 2022; 32:677-688. [PMID: 36439240 PMCID: PMC9697991 DOI: 10.1080/09581596.2021.1918329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Research recruitment, eligibility, and who chooses to participate shape the resulting data and knowledge, which together inform interventions, treatment, and programming. Patterns of research participation are particularly salient at this moment given emerging biomedical prevention paradigms. This paper explores the perspectives of Black and Latino young men who have sex with men (BL-YMSM) regarding research recruitment and eligibility criteria, how their experiences influence willingness to enroll in a given study, and implications for the veracity and representativeness of resulting data. We examine inclusion and recruitment as a complex assemblage, which should not be reduced to its parts. From April-July 2018, we conducted in-depth interviews with 30 BL-YMSM, ages 18-29, in New York City. Interviews were recorded, transcribed, and analyzed using the constant comparative method. Black and Latino YMSM's responses unveiled tensions between researchers', recruiters', and participants' expectations, particularly regarding eligibility criteria (e.g., age, sex frequency), assumptions about 'risky behaviors,' and the 'target' community. Men preferred peer-to-peer recruitment, noting that most approaches miss key population segments. Findings highlight the need to critically examine the selected 'target' community, who sees themselves as participants, and implications for data comprehensiveness and veracity. Study eligibility criteria and recruitment approaches are methodological issues that shape knowledge production and the policies and programs deployed into communities. These findings can inform how future research studies frame recruitment and eligibility in order to better meet the needs of participants and ensure future engagement.
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Affiliation(s)
- Morgan M. Philbin
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY
| | - Adrian Guta
- School of Social Work, University of Windsor, 167 Ferry Street, Windsor, ON N9A0C5
| | - Heather Wurtz
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY
| | - Ian Bradley-Perrin
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY
| | - Elizabeth N. Kinnard
- Division of Epidemiology, University of California at Berkeley School of Public Health, 2121 Berkeley Way, Berkeley, CA 94720
| | - Lloyd Goldsamt
- College of Nursing, New York University, 433 First Avenue, 7th floor New York, NY
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Bonner CP, Fisher CB, Carney T, Browne FA, Gichane MW, Howard BN, Turner L, Wechsberg WM. "Because all mothers is not the same": The development and implementation of an in loco parentis informed consent procedure to enroll adolescent girls and young women to participate in HIV research. J Adolesc 2021; 93:234-244. [PMID: 34896961 PMCID: PMC10916742 DOI: 10.1016/j.adolescence.2021.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/12/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION South Africa has one of the highest incidences of HIV among adolescent girls and young women (AGW), ages 15-24, and recent research has focused on developing interventions for HIV prevention. However, the South African National Health Act requires those under 18 years of age to obtain a guardian's permission to participate in research. Limiting research enrolment to AGYW who can obtain guardian consent may lead to non-representative findings. Therefore, innovative, inclusive consent approaches that protect AGYW from the risks of research are needed. METHODS This report details the development and implementation of an approach called the in loco parentis (in place of parent) consent procedure. In loco parentis consent provides a vehicle for adolescent participation that protects adolescents from potential social harms. The in loco parentis consent procedure does not seek to obtain independent minor consent but seeks to obtain permission for the minor to participate in research from a trusted adult who is not a minor's parent or legal guardian. This report also qualitatively explores the experiences of 31 AGYW who were recruited into a behavioral HIV prevention study using this method. RESULTS Findings suggest that the in loco parentis consent procedure is a feasible and acceptable method to inclusively AGYW in HIV research. CONCLUSIONS The in loco parentis procedure may provide a more inclusive strategy to recruit AGYW for HIV research to increase the generalizability of findings.
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Affiliation(s)
- Courtney Peasant Bonner
- Substance Use, Gender, and Applied Research Program, RTI International, Atlanta, GA, USA; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
| | | | - Tara Carney
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Felicia A Browne
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC, USA
| | - Margaret W Gichane
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC, USA
| | - Brittni N Howard
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC, USA
| | - Leslie Turner
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC, USA
| | - Wendee M Wechsberg
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC, USA; Department of Psychology, North Carolina State University, Raleigh, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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14
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Asquith A, Sava L, Harris AB, Radix AE, Pardee DJ, Reisner SL. Patient-centered practices for engaging transgender and gender diverse patients in clinical research studies. BMC Med Res Methodol 2021; 21:202. [PMID: 34598674 PMCID: PMC8487157 DOI: 10.1186/s12874-021-01328-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this formative study was to assess barriers and facilitators to participation of transgender and gender diverse (TGD) patients in clinical research to solicit specific feedback on perceived acceptability and feasibility of research methods to inform creation of a multisite longitudinal cohort of primary care patients engaged in care at two community health centers. METHOD Between September-November 2018, four focus groups (FGs) were convened at two community health centers in Boston, MA and New York, NY (N = 28 participants across all 4 groups; 11 in Boston and 17 in New York). FG guides asked about patient outreach, acceptability of study methods and measures, and ideas for study retention. FGs were facilitated by TGD study staff, lasted approximately 90 min in duration, were audio recorded, and then transcribed verbatim by a professional transcription service. Thematic analyses were conducted by two independent analysts applying a constant comparison method. Consistency and consensus were achieved across code creation and application aided by Dedoose software. RESULTS Participants were a mean age of 33.9 years (SD 12.3; Range 18-66). Participants varied in gender identity with 4 (14.3%) men, 3 (10.7%) women, 8 (28.6%) transgender men, 10 (35.7%) transgender women, and 3 (10.7%) nonbinary. Eight (26.6%) were Latinx, 5 (17.9%) Black, 3 (10.7%) Asian, 3 (10.7%) another race, and 5 (17.9%) multiracial. Motivators and facilitators to participation were: research creating community, research led by TGD staff, compensation, research integrated into healthcare, research applicable to TGD and non-TGD people, and research helping TGD communities. Barriers were: being research/healthcare averse, not identifying as TGD, overlooking questioning individuals, research coming from a 'cisgender lens", distrust of how the research will be used, research not being accessible to TGD people, and research being exploitative. CONCLUSION Though similarities emerged between the perspectives of TGD people and research citing perspectives of other underserved populations, there are barriers and facilitators to research which are unique to TGD populations. It is important for TGD people to be involved as collaborators in all aspects of research that concerns them.
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Affiliation(s)
- Andrew Asquith
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA, 02215, USA
| | - Lauren Sava
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA, 02215, USA
| | | | - Asa E Radix
- Callen-Lorde Community Health Center, New York City, NY, USA
| | - Dana J Pardee
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA, 02215, USA
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA, 02215, USA. .,Division of Endocrinology, Brigham and Women's Hospital, Diabetes & Hypertension, Boston, MA, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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15
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Tao X, Bragard E, Fisher CB. Risks and Benefits of Adolescent Girls' Participation in Online Sexting Survey Research. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2335-2346. [PMID: 34374874 DOI: 10.1007/s10508-021-02003-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 06/13/2023]
Abstract
The increasingly ubiquitous use of sexting among adolescent girls underscores the importance of empirical data on their sexting behaviors, motivations, and outcomes. To date, the majority of sexting studies have been conducted online; however, little is known about the extent to which responding to such socially sensitive questions may cause participant discomfort or distress. Research on this question is critical since in the absence of empirical data, institutional review boards (IRBs) may permit or place restrictions on online sexting studies based on an under- or overestimation of adolescent participation risk. The current online study asked 210 girls (aged 14-18 years, 55% non-Hispanic White, with sexting experience in the past 12 months) who previously registered to take online surveys on (1) their anticipated comfort in responding to a sexting survey include items on sexting motivations, positive and negative sexting consequences, and related sexual behaviors; (2) their perceptions of sexting research benefits/harms; and (3) comfort discussing similar topics in everyday life and with health professionals. Overall, participants were comfortable responding to sexting survey questions, rated sexting research as high benefits and low risks, and felt about the same as or more comfortable completing a sexting survey than discussing similar topics with peers, parents, or healthcare professionals. Findings suggest that anonymous online sexting studies can be classified as minimal risk research for adolescent girls and provide empirical support for IRB decisions to waive guardian permission for participation in such studies.
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Affiliation(s)
- Xiangyu Tao
- Department of Psychology, Fordham University, 226 Dealy Hall, Rose Hill Campus, 441 E. Fordham Road, Bronx, NY, 10458, USA.
| | - Elise Bragard
- Department of Psychology, Fordham University, 226 Dealy Hall, Rose Hill Campus, 441 E. Fordham Road, Bronx, NY, 10458, USA
| | - Celia B Fisher
- Department of Psychology, Fordham University, 226 Dealy Hall, Rose Hill Campus, 441 E. Fordham Road, Bronx, NY, 10458, USA
- Center for Ethics Education, Fordham University, Bronx, NY, USA
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16
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Lane J, Brezak A, Patel P, Verani AR, Benech I, Katz A. Policy considerations for scaling up access to HIV pre-exposure prophylaxis for adolescent girls and young women: Examples from Kenya, South Africa, and Uganda. Int J Health Plann Manage 2021; 36:1789-1808. [PMID: 34159630 DOI: 10.1002/hpm.3252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 10/09/2020] [Accepted: 05/10/2021] [Indexed: 11/06/2022] Open
Abstract
Adolescent girls and young women (aged 15-24 years; AGYW) continue to carry a disproportionate burden of HIV in sub-Saharan Africa. Pre-exposure prophylaxis (PrEP) helps reduce the risk of acquiring HIV for persons at substantial risk, including AGYW. As countries plan for the rollout of PrEP across sub-Saharan Africa, PrEP policies and programs could address the unique needs of AGYW. The purpose of this analysis was to identify policy considerations to improve AGYW access to PrEP. After reviewing the literature, we identified 13 policy considerations that policymakers and stakeholders could evaluate when developing or reviewing PrEP-related policies. We sorted these considerations into five categories, which together comprise an AGYW Access to PrEP Framework: AGYW-friendly delivery systems, clinical eligibility and adherence support, legal barriers and facilitators, affordability, and community and AGYW outreach. We also reviewed policies in three countries (Kenya, South Africa, and Uganda) to explore how PrEP-related policies addressed these considerations. Some of these policies addressed some of the 13 policy considerations, but none of the policies directly addressed the unique needs of AGYW for accessing PrEP. To improve access to PrEP for AGYW, country policies could include specific components that address these 13 considerations. To reach AGYW effectively, each country could use the 13 considerations we have identified to analyze current policies to identify existing programmatic barriers to AGYW accessing HIV services and address these barriers in PrEP-related policies.
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Affiliation(s)
- Jeff Lane
- University of Washington School of Public Health, Seattle, Washington, USA
| | - Audrey Brezak
- University of Washington School of Public Health, Seattle, Washington, USA
| | - Pragna Patel
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andre R Verani
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Irene Benech
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aaron Katz
- University of Washington School of Public Health, Seattle, Washington, USA
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Hubach RD, O'Neil A, Stowe M, Giano Z, Curtis B, Fisher CB. Perceived Confidentiality Risks of Mobile Technology-Based Ecologic Momentary Assessment to Assess High-Risk Behaviors Among Rural Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1641-1650. [PMID: 32078710 PMCID: PMC7438245 DOI: 10.1007/s10508-019-01612-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 06/10/2023]
Abstract
Although men who have sex with men (MSM) within rural communities are disproportionately impacted by HIV, limited HIV research and programmatic resources are directed to these communities within the U.S. There is a need for improved behavioral data collection methods to obtain more detailed information on the relationship between rural environments, sexual behavior, and substance use. Utilization of mobile health (mHealth) technologies, such as ecologic momentary assessment (EMA), has been advocated for; however, limited research has evaluated its utility among rural MSM. Forty MSM residing in rural Oklahoma were recruited to complete in-depth interviews related to participating online/mobile-based HIV prevention research. Men described a willingness to participate in HIV and substance use studies that use EMA methodologies for data collection; however, they raised various research-related concerns. In particular, participants indicated potential privacy and confidentiality concerns related to the use of the mobile technology-based EMA in public and the storage of data by researchers. Given the varying degree of sexual orientation and substance use disclosure by participants, rural MSM were largely concerned with being inadvertently "outed" within their communities. Men described the various strategies they could employ to protect private information and methods to minimize research risk. Study findings suggest that EMA is an acceptable research methodology for use among rural MSM in the context of HIV and sexual health information, when privacy and confidentiality concerns are adequately addressed. Input from community members and stakeholders is necessary to identify potential areas of concerns for participants prior to data collection.
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Affiliation(s)
- Randolph D Hubach
- Sexual Health Research Lab, Center for Rural Health, Oklahoma State University-Center for Health Sciences, 1111 W 17th Street, Tulsa, OK, 74107, USA.
| | - Andrew O'Neil
- Sexual Health Research Lab, Center for Rural Health, Oklahoma State University-Center for Health Sciences, 1111 W 17th Street, Tulsa, OK, 74107, USA
| | - Mollie Stowe
- Sexual Health Research Lab, Center for Rural Health, Oklahoma State University-Center for Health Sciences, 1111 W 17th Street, Tulsa, OK, 74107, USA
| | - Zachary Giano
- Sexual Health Research Lab, Center for Rural Health, Oklahoma State University-Center for Health Sciences, 1111 W 17th Street, Tulsa, OK, 74107, USA
| | - Brenda Curtis
- National Institute on Drug Abuse, Baltimore, MD, USA
| | - Celia B Fisher
- Center for Ethics Education and Department of Psychology, Fordham University, Bronx, NY, USA
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Fisher CB, Puri LI, Macapagal K, Feuerstahler L, Ahn JR, Mustanski B. Competence to Consent to Oral and Injectable PrEP Trials Among Adolescent Males Who Have Sex with Males. AIDS Behav 2021; 25:1606-1618. [PMID: 33247336 PMCID: PMC8052255 DOI: 10.1007/s10461-020-03077-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 01/16/2023]
Abstract
Adherence to oral pre-exposure prophylaxis (PrEP) is challenging for adolescent males who have sex with males (AMSM). Once adult trials comparing oral to longer lasting injectable PrEP are completed, there will be a need for adolescent studies. However, lack of data on adolescent consent capacity may sustain guardian permission requirements identified as a barrier to AMSM participation in prior PrEP trials. This online study assessed AMSM's (14-17 years) consent capacity for these trials, comparing performance to MSM (18-19 years) for whom guardian permission is not required. Applying the MacCAT-CR, participants (N = 214) viewed a video and mock consent form followed by open-ended and yes/no items. Cognitive diagnostic models and means testing analyses supported AMSM capacity to consent to these trials: 16-17 and most 14-15 year-olds, demonstrated consent understanding, appreciation and reasoning at 18-19 year-old levels. Data also identified vulnerabilities requiring attention during informed consent.
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Affiliation(s)
- Celia B Fisher
- Center for Ethics Education, HIV/Drug Abuse Prevention Research Ethics Institute, and Department of Psychology, Fordham University, Dealy Hall, Bronx, NY, 10458, USA.
| | | | - Kathryn Macapagal
- Institute for Sexual and Gender Minority Health and Wellbeing & Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | | | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing & Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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19
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Baldwin A, Light B, Allison WE. Pre-Exposure Prophylaxis (PrEP) for HIV Infection in Cisgender and Transgender Women in the U.S.: A Narrative Review of the Literature. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1713-1728. [PMID: 34075504 PMCID: PMC8213571 DOI: 10.1007/s10508-020-01903-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/18/2020] [Accepted: 12/09/2020] [Indexed: 05/11/2023]
Abstract
Using a socioecological approach, this review describes the peer-reviewed literature on oral pre-exposure prophylaxis (PrEP) among both cisgender (cis women) and transgender women (trans women) in the U.S. A search of the PubMed database and HIV-related conference abstracts generated over 2,200 articles and abstracts. Of these, 103 fulfilled review inclusion criteria. Most of the existing research presents findings on individual-level factors associated with PrEP use such as willingness and perceived barriers. There was far less investigation of factors related to PrEP at more distal ecological levels. Though trans women are at greater risk of HIV infection than cisgender women, less is known about this population group with respect to PrEP despite their inclusion in many major clinical trials. Further, the literature is characterized by a persistent conflation of sex and gender which makes it difficult to accurately assess the reviewed research on HIV prevention and PrEP apart from risk group. Informed by these findings, we highlight specific opportunities to improve access to PrEP and reduce socioecological barriers to PrEP care engagement for cisgender and transgender women.
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Affiliation(s)
- Aleta Baldwin
- Department of Public Health, California State University, Sacramento, Solano Hall 3014, 6000 J Street, Sacramento, CA, 95819, USA.
| | - Brenda Light
- School of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Waridibo E Allison
- Division of Infectious Disease, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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20
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Macapagal K, Nery-Hurwit M, Matson M, Crosby S, Greene GJ. Perspectives on and preferences for on-demand and long-acting PrEP among sexual and gender minority adolescents assigned male at birth. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2021; 18:39-53. [PMID: 33456624 PMCID: PMC7810244 DOI: 10.1007/s13178-020-00441-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Sexual and gender minority (SGM) adolescents assigned male at birth who have sex with male partners are at increased risk for HIV. Daily oral pre-exposure prophylaxis (PrEP) is available for minor adolescents in the United States, who may have difficulty with adherence. Adolescents' perspectives toward emerging PrEP delivery methods that would not require daily pill-taking have not been well-explored. METHODS We conducted online surveys and focus groups in November 2018-February 2019 with 59 SGM adolescents assigned male at birth who reported sex with or attraction to male partners. Questions assessed their perspectives on and preferences for biomedical (on-demand, injection, implant) and non-biomedical HIV prevention options (condoms). Data were analyzed thematically. RESULTS Of all prevention options, the implant and condoms were rated highest, and participants preferred the implant over other biomedical options. Convenience, duration, and ease of access played important roles in adolescents' preferences. Parents were viewed as a barrier to taking PrEP regardless of delivery method due to their role in adolescents' ability to access healthcare. CONCLUSIONS SGM adolescents are interested in long-acting PrEP, yet also perceive substantial obstacles to using biomedical prevention that reflect adolescents' developmental contexts. POLICY IMPLICATIONS State laws expanding adolescents' access to HIV preventive services, sex education inclusive of PrEP information, and parent- and provider-initiated PrEP conversations can reduce barriers regardless of PrEP delivery method. Research to accelerate the availability of long-acting implants for adolescents is needed.
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Affiliation(s)
- Kathryn Macapagal
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University; 625 N. Michigan Avenue, Chicago, IL 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University; 625 N. Michigan Avenue, Chicago, IL 60611, USA
| | - Mara Nery-Hurwit
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University; 625 N. Michigan Avenue, Chicago, IL 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University; 625 N. Michigan Avenue, Chicago, IL 60611, USA
| | - Margaret Matson
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University; 625 N. Michigan Avenue, Chicago, IL 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University; 625 N. Michigan Avenue, Chicago, IL 60611, USA
| | - Shariell Crosby
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University; 625 N. Michigan Avenue, Chicago, IL 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University; 625 N. Michigan Avenue, Chicago, IL 60611, USA
| | - George J. Greene
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University; 625 N. Michigan Avenue, Chicago, IL 60611, USA
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Fields EL, Hussen SA, Malebranche DJ. Mind the Gap: HIV Prevention Among Young Black Men Who Have Sex with Men. Curr HIV/AIDS Rep 2021; 17:632-642. [PMID: 32914329 PMCID: PMC7483045 DOI: 10.1007/s11904-020-00532-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Young Black men who have sex with men (YBMSM) suffer profound health inequities in new HIV diagnoses and clinical outcomes. While the evolution of HIV prevention options has become increasingly biomedical, inequities in access and uptake of these modalities persist. RECENT FINDINGS Studies suggest that while YBMSM display interest and acceptability of varied HIV prevention options, uptake lags due to the lingering effects of intersectional oppression from racism and sexual prejudice, HIV stigma, institutional and provider bias, and unresolved health policy barriers. Promising avenues to address these barriers have yet to be fully explored. We have the tools to effectively prevent HIV transmission and acquisition among YBMSM, but we have not yet effectively implemented these tools for this priority population. To end the epidemic, we must tailor and adapt HIV prevention strategies to meet the unique intersecting needs, identities, and social contexts of YBMSM.
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Affiliation(s)
- Errol L Fields
- Division of Adolescent/Young Adult Medicine, Johns Hopkins School of Medicine, 200 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Sophia A Hussen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - David J Malebranche
- Department of General Medicine, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA.
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22
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Allan-Blitz LT, Mena LA, Mayer KH. The ongoing HIV epidemic in American youth: challenges and opportunities. Mhealth 2021; 7:33. [PMID: 33898602 PMCID: PMC8063015 DOI: 10.21037/mhealth-20-42] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/05/2020] [Indexed: 01/05/2023] Open
Abstract
The incidence of human immunodeficiency virus (HIV) infection has been decreasing in the United States overall, except among youth, and in particular among Black and Latinx young men who have sex with men (MSM). In this review we summarize key drivers of the HIV epidemic among youth, as well as novel interventions geared specifically towards combating the epidemic among high-risk populations. Many factors driving the HIV epidemic among youth are related to systemic inequities, including lack of access to healthcare, inadequate education, and internalized and experience homophobia and racism. Developmentally, youth may feel that they are invulnerable and be willing to engage in risks. Moreover, HIV is often invisible for youth given advances in treatment and community stigma, limiting open discussion of risk and new preventive modalities. Outcomes from the HIV treatment cascade suggest that youth are less likely to be aware of their HIV infection status, less likely to link to and be engaged in care, and less likely to be virologically suppressed than older MSM and other populations of people living with HIV. Importantly, pre-exposure prophylaxis (PrEP) has been shown to be an effective tool for prevention of HIV infection that also appears to have disproportionately poor uptake among youth. Barriers to PrEP utilization appear to be quite heterogeneous, and include patient-, provider-, and structural-level barriers. Interventions important in improving HIV prevention will thus have to be multipronged and developed for culturally diverse populations. Cognitive behavioral therapy-based interventions are promising strategies as they are able to address a diverse array of barriers. New formulations of PrEP will also likely be instrumental in improving adherence. Since youth spend considerable amounts of time accessing digital media, the deployment of apps and other mobile phone-based interfaces offer unique opportunities to increase education and to facilitate HIV prevention for at risk youth. Multiple studies are underway to better inform the optimal delivery of treatment and prevention services for this complex and diverse population, and include novel sociobiological interventions and new modes of medication delivery that may lend themselves to overcoming obstacles specific to youth.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- Department of Medicine, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Leandro A. Mena
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kenneth H. Mayer
- Fenway Health, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Gordon AR, Calzo JP, Eiduson R, Sharp K, Silverstein S, Lopez E, Thomson K, Reisner SL. Asynchronous Online Focus Groups for Health Research: Case Study and Lessons Learned. INTERNATIONAL JOURNAL OF QUALITATIVE METHODS 2021; 20:10.1177/1609406921990489. [PMID: 35185443 PMCID: PMC8856649 DOI: 10.1177/1609406921990489] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Increasingly, social life-and accordingly, social research-is conducted in online environments. Asynchronous online focus groups (AOFGs) have emerged as an important tool to conduct remote research with geographically diverse populations. However, there remain few systematic accounts of AOFG methods to guide researchers' decision-making in designing and implementing studies. This paper seeks to address this gap by describing a recent study on body image and health among transgender and gender diverse (TGD) young adults. In this study, eight AOFGs were conducted in August-October 2019 with 66 TGD young adults residing in 25 U.S. states. Each AOFG lasted four consecutive days with two prompts posted by moderators per day. Overall, participant satisfaction with AOFGs was high: 98% reported their experience was excellent, very good, or good and 95% would be somewhat or very likely to sign up for another AOFG. This example is used to illustrate key methodological decision-points, acceptability of the method to participants, and lessons learned. The goal of this paper is to encourage other researchers, particularly health researchers, to consider using AOFGs and to engage with the method's strengths and limitations in order to develop new opportunities for online technologies to enrich the field of qualitative health research.
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Affiliation(s)
- Allegra R Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Division of Adolescent/Young Adults Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jerel P Calzo
- Division of Health Promotion and Behavioral Science, San Diego State University, San Diego, CA, USA
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, CA, USA
| | - Rose Eiduson
- Division of Adolescent/Young Adults Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Kendall Sharp
- Division of Adolescent/Young Adults Medicine, Boston Children's Hospital, Boston, MA, USA
| | | | | | - Katharine Thomson
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Sari L Reisner
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Sims JP, Nolen C. “I Wouldn’t Trust the Parents To ‘Do No Harm’ To a Queer Kid”: Rethinking Parental Permission Requirements for Youth Participation in Social Science Research. J Empir Res Hum Res Ethics 2020; 16:35-45. [DOI: 10.1177/1556264620983134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Obtaining parental consent for youth to participate in research is a standard requirement in the United States. However, the assumption that involving parents is the best way to protect youth research participants is untenable for some populations. This study draws on interviews with 19 LGBTQ+ mixed-race participants to examine lay views of parental consent requirements for LGBTQ+ youth research participants. Qualitative data analysis found concerns about potentially outing LGBTQ+ youth to intolerant parents. Interviewees also asserted that adolescents aged 16 and older are competent enough and should have the autonomy to consent themselves. Finally, interviewees raised several methodological concerns regarding the biased research that may result from parental consent requirements. We agree with others that U.S. Institutional Review Boards should end uncritical requirements for parental consent for older adolescents and should routinize the use and study of alternative protective measures.
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Day S, Kapogiannis BG, Shah SK, Wilson EC, Ruel TD, Conserve DF, Strode A, Donenberg GR, Kohler P, Slack C, Ezechi O, Tucker JD. Adolescent participation in HIV research: consortium experience in low and middle-income countries and scoping review. Lancet HIV 2020; 7:e844-e852. [PMID: 33275917 PMCID: PMC8491773 DOI: 10.1016/s2352-3018(20)30269-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/10/2020] [Accepted: 09/07/2020] [Indexed: 01/09/2023]
Abstract
Adolescents in low and middle-income countries (LMICs) have a high prevalence of HIV, therefore, it is important that they are included in HIV research. However, ethical challenges regarding consent can hinder adolescent research participation. We examined examples from the Prevention and Treatment Through a Comprehensive Care Continuum for HIV-affected Adolescents in Resource Constrained Settings (PATC3H) research consortium, which investigates adolescent HIV prevention and treatment in seven LMICs: Brazil, Kenya, Mozambique, Nigeria, South Africa, Uganda, and Zambia. PATC3H researchers were asked to identify ethical and practical challenges of adolescent consent to research participation in these countries. We also did a scoping review of strategies that could improve adolescent participation in LMIC HIV studies. Examples from PATC3H research highlighted many ethical challenges that affect adolescent participation, including inconsistent or absent consent guidance, guidelines that fail to account for the full array of adolescents' lives, and variation in how ethical review committees assess adolescent studies. Our scoping review identified three consent-related strategies to expand adolescent inclusion: waiving parental consent requirements, allowing adolescents to independently consent, and implementing surrogate decision making. Our analyses suggest that these strategies should be further explored and incorporated into ethical and legal research guidance to increase adolescent inclusion in LMIC HIV research.
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Affiliation(s)
- Suzanne Day
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Bill G Kapogiannis
- Maternal and Pediatric Infectious Diseases Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Seema K Shah
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Mary Ann and J Milburn Smith Child Health Research, Outreach, and Advocacy Center, Stanley Manne Children's Research Institute, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Erin C Wilson
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Theodore D Ruel
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Donaldson F Conserve
- Department of Prevention and Community Health, The George Washington University, Washington, DC, USA
| | - Ann Strode
- School of Law, University of KwaZulu-Natal, University Road, Durban, South Africa
| | - Geri R Donenberg
- Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Pamela Kohler
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, USA
| | - Catherine Slack
- HIV AIDS Vaccines Ethics Group, School of Applied Human Sciences, University of KwaZulu-Natal, Scottsville, Pietermaritzburg, South Africa
| | - Oliver Ezechi
- Nigerian Institute of Medical Research, Medical Compound, Yaba, Lagos, Nigeria
| | - Joseph D Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Faculty of Infectious Diseases, London School of Hygiene & Tropical Medicine
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Bragard E, Fisher CB, Curtis BL. "They know what they are getting into:" Researchers confront the benefits and challenges of online recruitment for HIV research. ETHICS & BEHAVIOR 2020; 30:481-495. [PMID: 33041608 DOI: 10.1080/10508422.2019.1692663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Online research has become a critical recruitment modality for understanding and reducing health disparities among hidden populations most at risk for HIV infection. There is a lack of consensus and guidelines for the responsible conduct of online recruitment for HIV risk populations. Using semi-structured phone interviews, this study drew on the experiences of principal investigators (PIs) engaged in online HIV research to illuminate scientific and ethical benefits and challenges of social media recruitment. Using Thematic Analysis five major themes emerged: sampling advantages and disadvantages; challenges of data integrity; control of privacy protections; researcher competence and responsibility; and resources.
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Affiliation(s)
- Elise Bragard
- Department of Psychology, Fordham University, Bronx, NY
| | - Celia B Fisher
- Center for Ethics Education and Department of Psychology, Fordham University, Bronx, NY
| | - Brenda L Curtis
- Technology and Translational Research Unit, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD
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Shah SK, Essack Z, Byron K, Slack C, Reirden D, van Rooyen H, Jones NR, Wendler DS. Adolescent Barriers to HIV Prevention Research: Are Parental Consent Requirements the Biggest Obstacle? J Adolesc Health 2020; 67:495-501. [PMID: 32636140 PMCID: PMC7508889 DOI: 10.1016/j.jadohealth.2020.05.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 04/17/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE One third of people newly living with HIV/AIDS are adolescents. Research on adolescent HIV prevention is critical owing to differences between adolescents and adults. Parental permission requirements are often considered a barrier to adolescent enrollment in research, but whether adolescents view this barrier as the most important one is unclear. METHODS Adolescents were approached in schools in KwaZulu-Natal, South Africa, and at a sexually transmitted infection clinic at the Children's Hospital of Aurora, Colorado. Surveys with a hypothetical vignette about participation in a pre-exposure prophylaxis trial were conducted on smartphones or tablets with 75 adolescents at each site. We calculated descriptive statistics for all variables, using 2-sample tests for equality of proportions with continuity correction. Statistical significance was calculated at p < 0.05. Multivariate analyses were also conducted. RESULTS Most adolescents thought side effects (77%) and parental consent requirements (69%) were very important barriers to research participation. When asked to rank barriers, adolescents did not agree on a single barrier as most important, but the largest group of adolescents ranked parental consent requirements as most important (29.5%). Parental consent was seen as more of a barrier for adolescents in South Africa than in the United States. Concerns about being experimented on or researchers' mandatory reporting to authorities were ranked much lower. Finally, most (71%, n = 106) adolescents said they would want to extra support from another adult if parental permission was not required. CONCLUSION Adolescents consider both parental permission requirements and side effects important barriers to their enrollment in HIV prevention research. Legal reform and better communication strategies may help address these barriers.
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Affiliation(s)
- Seema K Shah
- Division of AIDS, Department of Bioethics, NIH Clinical Center, Bethesda, Maryland; Department of Pediatrics, Smith Child Health Research, Outreach, and Advocacy Center, Lurie Children's Hospital, Northwestern University Medical School, Chicago, Illinois.
| | - Zaynab Essack
- Centre for Community-Based Research, Human Sciences Research Council (HSRC), Sweetwaters, KwaZulu-Natal, South Africa; HIV AIDS Vaccines Ethics Group (HAVEG), School of Applied Human Sciences, College of Humanities, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Katherine Byron
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland
| | - Catherine Slack
- HIV AIDS Vaccines Ethics Group (HAVEG), School of Applied Human Sciences, College of Humanities, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Daniel Reirden
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Heidi van Rooyen
- Centre for Community-Based Research, Human Sciences Research Council (HSRC), Sweetwaters, KwaZulu-Natal, South Africa; Faculty of Health Sciences, School of Clincial Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Nathan R Jones
- University of Wisconsin Survey Center, Madison, Wisconsin
| | - David S Wendler
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland
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Moskowitz DA, Macapagal K, Mongrella M, Pérez-Cardona L, Newcomb ME, Mustanski B. What If My Dad Finds Out!?: Assessing Adolescent Men Who Have Sex with Men's Perceptions About Parents as Barriers to PrEP Uptake. AIDS Behav 2020; 24:2703-2719. [PMID: 32157491 PMCID: PMC7462124 DOI: 10.1007/s10461-020-02827-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy for high-risk adults and recently was given US FDA approval for use among adolescents. Yet, the barriers to medication uptake for this population are unique when compared to adult populations, as parents may be just as likely as prescribers to be gatekeepers to access. To better understand the role of parents in adolescents' attitudes towards PrEP, we surveyed 491 adolescent men who have sex with men (AMSM) ages 13-18, using forced choice and open-ended response questions. We measured perceived parent-PrEP supportiveness, hypothetical parent reactions to a request to initiate PrEP, and perceived positive and negative aspects of taking PrEP without parents knowing. A mixed-methods approach was employed. Results indicated a majority of AMSM had heard of PrEP and most reported their parents would be unsupportive of their taking PrEP. Teens perceived their parents would likely be angry, accusatory, and punitive if PrEP use was discovered, and that accessing PrEP independent of parents might increase their health autonomy, agency, and prevent awkward conversations about sex. Furthermore, a path model revealed that fears of parental reaction and poor self-efficacy to communicate with parents about PrEP significantly contributed to participants feeling PrEP was not "right" for them, and as a corollary, less interest in starting PrEP. The study suggests that improving parental knowledge of PrEP and encouraging parents to begin the conversation about PrEP could help increase uptake in AMSM.
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Affiliation(s)
- David A Moskowitz
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL, 60611, USA
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kathryn Macapagal
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL, 60611, USA
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Melissa Mongrella
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL, 60611, USA
| | - Leishla Pérez-Cardona
- Mary Ann & J. Milburn Smith Child Health Research, Outreach and Advocacy Center, Chicago, IL, USA
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Michael E Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL, 60611, USA
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL, 60611, USA.
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Landers SE, Francis JKR, Morris MC, Mauro C, Rosenthal SL. Adolescent and Parent Perceptions about Participation in Biomedical Sexual Health Trials. Ethics Hum Res 2020; 42:2-11. [PMID: 32421948 DOI: 10.1002/eahr.500048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Given the burden of HIV and other sexually transmitted infections among adolescents who are legal minors, it is critical that they be included in biomedical sexual health trials to ensure that new prevention and treatment interventions are safe, effective, and acceptable for their use. However, adolescents are often not well represented in clinical trials. We provide an overview of the available evidence regarding adolescent and parent willingness for adolescents to participate in biomedical sexual health trials, parental involvement in the permission-consent process, management of differences and discord among adolescents and parents, and parental involvement throughout the study period. We also outline recommendations for current practice and areas for future research.
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Affiliation(s)
- Sara E Landers
- Research coordinator in the Department of Pediatrics at Vagelos College of Physicians and Surgeons at Columbia University Irving Medical Center
| | - Jenny K R Francis
- Assistant professor in the Department of Pediatrics at the University of Texas Southwestern Medical Center
| | - Marilyn C Morris
- Associate professor in the Department of Pediatrics at Vagelos College of Physicians and Surgeons at Columbia University Irving Medical Center
| | - Christine Mauro
- Assistant professor in the Department of Biostatistics at the Mailman School of Public Health at Columbia University Irving Medical Center
| | - Susan L Rosenthal
- Professor of medical psychology in the Departments of Pediatrics and Psychiatry at Vagelos College of Physicians and Surgeons at Columbia University Irving Medical Center
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Knopf A, Ott MA, Draucker CB, Fortenberry JD, Reirden DH, Arrington-Sanders R, Schneider J, Straub D, Baker R, Bakoyannis G, Zimet GD. Innovative Approaches to Obtain Minors' Consent for Biomedical HIV Prevention Trials: Multi-Site Quasi-Experimental Study of Adolescent and Parent Perspectives. JMIR Res Protoc 2020; 9:e16509. [PMID: 32224493 PMCID: PMC7154935 DOI: 10.2196/16509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite the high burden of new HIV infections in minor adolescents, they are often excluded from biomedical HIV prevention trials, largely owing to the ethical complexities of obtaining consent for enrollment. Researchers and ethics regulators have a duty to protect adolescents-as a special category of human subjects, they must have protection that extends beyond those afforded to all human subjects. Typically, additional protection includes parental consent for enrollment. However, parental consent can present a risk of harm for minor adolescents. Research involving minor adolescents indicate that they are unwilling to join biomedical trials for stigmatized health problems, such as HIV, when parental consent is required. This presents a significant barrier to progress in adolescent HIV prevention by creating delays in research and the translation of new scientific evidence generated in biomedical trials in adult populations. OBJECTIVE This protocol aims to examine how parental involvement in the consent process affects the acceptability of hypothetical participation in biomedical HIV prevention trials from the perspectives of minor adolescents and parents of minor adolescents. METHODS In this protocol, we use a quasi-experimental design that involves a simulated consent process for 2 different HIV prevention trials. The first trial is modeled after an open-label study of the use of tenofovir disoproxil fumarate and emtricitabine as preexposure prophylaxis for HIV. The second trial is modeled after a phase IIa trial of an injectable HIV integrase inhibitor. There are 2 groups in the study-minor adolescents aged 14 to 17 years, inclusive, and parents of minor adolescents in the same age range. The adolescent participants are randomized to 1 of 3 consent conditions with varying degrees of parental involvement. After undergoing a simulated consent process, they rate their willingness to participate (WTP) in each of the 2 trials if offered the opportunity. The primary outcome is WTP, given the consent condition. Parents undergo a similar process but are asked to rate the acceptability of each of the 3 consent conditions. The primary outcome is acceptability of the consent method for enrollment. The secondary outcomes include the following: capacity to consent among both participant groups, the prevalence of medical mistrust, and the effects of the study phase (eg, phase IIa vs the open-label study) and drug administration route (eg, oral vs injection) on WTP (adolescents) and acceptability (parents) of the consent method. RESULTS Enrollment began in April 2018 and ended mid-September 2019. Data are being analyzed and dissemination is expected in April 2020. CONCLUSIONS The study will provide the needed empirical data about minor adolescents' and parents' perspectives on consent methods for minors. The evidence generated can be used to guide investigators and ethics regulators in the design of consent processes for biomedical HIV prevention trials. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16509.
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Affiliation(s)
- Amelia Knopf
- Department of Community & Health Services, School of Nursing, Indiana University, Indianapolis, IN, United States
| | - Mary A Ott
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Claire Burke Draucker
- Department of Community & Health Services, School of Nursing, Indiana University, Indianapolis, IN, United States
| | - J Dennis Fortenberry
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Daniel H Reirden
- Children's Hospital Colorado, School of Medicine, The University of Colorado, Aurora, CO, United States
| | - Renata Arrington-Sanders
- Division of General Pediatrics & Adolescent Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - John Schneider
- Department of Medicine, The University of Chicago, Chicago, IL, United States
| | - Diane Straub
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Rebecca Baker
- Department of Community & Health Services, School of Nursing, Indiana University, Indianapolis, IN, United States
| | - Giorgos Bakoyannis
- Department of Biostatistics, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Gregory D Zimet
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, United States
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Bauman LJ, Mellins CA, Klitzman R. Whether to Waive Parental Permission in HIV Prevention Research Among Adolescents: Ethical and Legal Considerations. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2020; 48:188-201. [PMID: 32342775 PMCID: PMC8367279 DOI: 10.1177/1073110520917010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Critical ethical questions arise concerning whether studies among adolescents of new behavioral and biomedical HIV preventive interventions such as Pre-Exposure Prophylaxis (PrEP) should obtain parental permission. This paper examines the relevant regulations and ethical guidance concerning waivers of parental permission, and arguments for and against such waivers. Opponents of such waivers may argue that adolescent decision-making is "too immature" and that parents always have rights to decide how to protect their children. Yet requiring parental permission may put adolescents at risk, and/or limit adolescent participation, jeopardizing study findings' validity. This paper presents recommendations on when researchers and Institutional Review Boards (IRB) should waive parental permission, and what special protections should be adopted for adolescents who consent for themselves, e.g., assuring adolescent privacy and confidentiality, screening for capacity to consent, and identifying adolescents who are at elevated risk from study participation. We also present a series of specific areas for future research to design tools to help make these assessments, and to inform researcher and IRB decisions. These recommendations can help ensure that research is conducted that can aid adolescents at risk for HIV, while minimizing risks and protecting these individuals' rights as much as possible.
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Affiliation(s)
- Laurie J Bauman
- Laurie J. Bauman, Ph.D., is Professor of Pediatrics and Psychiatry and Behavioral Sciences at the Albert Einstein College of Medicine, where she also serves as Director of the Preventive Intervention Research Center and of the Behavioral Science Core of the Einstein-Rockefeller-CUNY Center for AIDS Research. She is also Director of the Bio-Behavioral Core of the HIV Center for Clinical and Behavioral Studies. Her research addresses HIV prevention among adolescents, including behavioral interventions and adoption of PrEP. Claude Ann Mellins, Ph.D., is a clinical psychologist and Professor of Medical Psychology in Psychiatry and Sociomedical Sciences at the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University. She is the co-director of the HIV Center with 28 years of clinical and research experience working globally with youth and families affected by HIV. Robert Klitzman, M.D., is a professor of psychiatry at the Vagelos College of Physicians and Surgeons and the Mailman School of Public Health, and the Director of the online and in-person Bioethics Masters and Certificate Programs at Columbia University. He has published over 150 scientific journal articles and nine books on ethical issues concerning HIV, genetics, research, and other areas
| | - Claude Ann Mellins
- Laurie J. Bauman, Ph.D., is Professor of Pediatrics and Psychiatry and Behavioral Sciences at the Albert Einstein College of Medicine, where she also serves as Director of the Preventive Intervention Research Center and of the Behavioral Science Core of the Einstein-Rockefeller-CUNY Center for AIDS Research. She is also Director of the Bio-Behavioral Core of the HIV Center for Clinical and Behavioral Studies. Her research addresses HIV prevention among adolescents, including behavioral interventions and adoption of PrEP. Claude Ann Mellins, Ph.D., is a clinical psychologist and Professor of Medical Psychology in Psychiatry and Sociomedical Sciences at the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University. She is the co-director of the HIV Center with 28 years of clinical and research experience working globally with youth and families affected by HIV. Robert Klitzman, M.D., is a professor of psychiatry at the Vagelos College of Physicians and Surgeons and the Mailman School of Public Health, and the Director of the online and in-person Bioethics Masters and Certificate Programs at Columbia University. He has published over 150 scientific journal articles and nine books on ethical issues concerning HIV, genetics, research, and other areas
| | - Robert Klitzman
- Laurie J. Bauman, Ph.D., is Professor of Pediatrics and Psychiatry and Behavioral Sciences at the Albert Einstein College of Medicine, where she also serves as Director of the Preventive Intervention Research Center and of the Behavioral Science Core of the Einstein-Rockefeller-CUNY Center for AIDS Research. She is also Director of the Bio-Behavioral Core of the HIV Center for Clinical and Behavioral Studies. Her research addresses HIV prevention among adolescents, including behavioral interventions and adoption of PrEP. Claude Ann Mellins, Ph.D., is a clinical psychologist and Professor of Medical Psychology in Psychiatry and Sociomedical Sciences at the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University. She is the co-director of the HIV Center with 28 years of clinical and research experience working globally with youth and families affected by HIV. Robert Klitzman, M.D., is a professor of psychiatry at the Vagelos College of Physicians and Surgeons and the Mailman School of Public Health, and the Director of the online and in-person Bioethics Masters and Certificate Programs at Columbia University. He has published over 150 scientific journal articles and nine books on ethical issues concerning HIV, genetics, research, and other areas
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Macapagal K, Kraus A, Korpak AK, Jozsa K, Moskowitz DA. PrEP Awareness, Uptake, Barriers, and Correlates Among Adolescents Assigned Male at Birth Who Have Sex with Males in the U.S. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:113-124. [PMID: 31602584 PMCID: PMC7263631 DOI: 10.1007/s10508-019-1429-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 05/26/2023]
Abstract
In May 2018, the US Food and Drug Administration approved daily oral pre-exposure prophylaxis (PrEP) for adolescents under age 18. Although this is an important step toward HIV prevention for adolescents assigned male at birth who have sex with males (AMSM), limited research exists to gauge their awareness of PrEP as a prevention option. Additionally, the attitudes and perceived barriers regarding PrEP among this population have not been well studied. We conducted an online survey from February to April 2018, in which 219 AMSM age 15-17 read a description of PrEP, and then answered questions about PrEP awareness, perceived barriers, and demographic and behavioral correlates. A slight majority (54.8%) had heard of PrEP before, and 56.1% did not know how they would access PrEP. Of those who had heard of PrEP, 2.5% had ever used it. Most had first learned about PrEP online, through media or geosocial networking (GSN) applications to meet male partners. Those who had heard of PrEP were more likely to be older, to have used GSN applications, and to have greater HIV knowledge. Not knowing how to access PrEP was predicted by having had more partners, lower HIV knowledge, and never having talked to a provider about PrEP. Believing that one could not afford PrEP was predicted by greater perceived risk of HIV. Findings suggest moderate awareness of PrEP among AMSM, that youth at greater risk of HIV may perceive greater barriers, and that online spaces can play a significant role in increasing PrEP knowledge and reducing implementation barriers.
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Affiliation(s)
- Kathryn Macapagal
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 1400, Chicago, IL, 60611, USA.
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA.
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Ashley Kraus
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 1400, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Aaron K Korpak
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 1400, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Kyle Jozsa
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 1400, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David A Moskowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 1400, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
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Gray A, Macapagal K, Mustanski B, Fisher CB. Surveillance studies involving HIV testing are needed: Will at-risk youth participate? Health Psychol 2019; 39:21-28. [PMID: 31512922 DOI: 10.1037/hea0000804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Adolescent males who have sex with males (AMSMs) account for high numbers of new HIV diagnoses. To date, surveillance data have been limited to diagnosed cases of HIV, resulting in an underestimation of risk and burden among AMSMs unwilling or unable to access HIV testing. This study identified facilitators and barriers to AMSMs' participation in future surveillance studies involving HIV testing. METHOD AMSMs (n = 198) aged 14 to 17 years participated. The majority identified as non-Hispanic White or Latinx, had a least 1 male sex partner, and self-reported HIV negative. Participants read an online survey beginning with a vignette describing a hypothetical HIV surveillance study requiring HIV testing. They then completed questions assessing likelihood to participate, perceived research benefits and risks, attitudes toward HIV risk, prior HIV health services, and parental awareness of sexual orientation. RESULTS Approximately 40% indicated strong willingness to participate. Willingness was positively related to perceived HIV risk, free access to HIV testing, counseling and referral if testing positive, confidentiality protections, and lack of access to a trusted physician. Having to tell others if one tested positive for HIV and requirements for guardian permission were significant participation barriers. CONCLUSIONS Inclusion of HIV testing in surveillance studies is essential for accurate estimation of HIV incidence and prevalence among AMSMs. Successful recruitment of sexual minority youth into sexual health surveillance research will require procedures tailored to youth's health care needs and concerns, including adequate HIV counseling, referral to treatment if seropositive, and attention to concerns regarding guardian permission. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Abstract
The Society for Adolescent Health and Medicine emphasizes the need for research to focus on the health outcomes of sexual minority youth (i.e., lesbian, gay, bisexual, transgender, queer). However, sexual minority youth (SMY) are often less willing to participate in research studies where parental consent is required due to potential victimization and discrimination. This is a major concern given that more research is needed to understand the health needs of this population, especially in terms of suicide, substance use, and HIV prevention. The National Suicide Prevention Strategy classifies SMY as a high-risk group, emphasizing the need to explore suicide risks (along with other health outcomes) among this group. However, this high-risk classification also increases the safeguards necessary to conduct research with this population. Many researchers have argued for waivers of parental consent, but such waivers present with several ethical implications. This article discusses ethical principles, risks, benefits, safeguards, and potential alternative approaches to waivers of parental consent for SMY. We conclude by emphasizing the need for policy changes to allow parental consent waivers for research targeting SMY.
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Affiliation(s)
- Ariel U Smith
- School of Nursing & Health Studies, University of Miami , Coral Gables , FL , USA
| | - Seth J Schwartz
- Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami , Coral Gables , FL , USA
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Schrager SM, Steiner RJ, Bouris AM, Macapagal K, Brown CH. Methodological Considerations for Advancing Research on the Health and Wellbeing of Sexual and Gender Minority Youth. LGBT Health 2019; 6:156-165. [PMID: 31145662 PMCID: PMC6551986 DOI: 10.1089/lgbt.2018.0141] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Continued research with sexual and gender minority (SGM) youth is essential both to understand health disparities and to develop interventions targeting those disparities, but conducting rigorous, ethical research with these populations remains a substantial challenge. In addition to considerations for research with adolescents in general, such as utilizing developmentally appropriate measures and obtaining parental permission, factors unique to SGM youth must be addressed at every step of the research process. Defining the study population is complex, as is recruiting a sample once it is defined. Measurement is another challenge, given the paucity of measures developed for or validated with SGM samples. Key constructs, such as sexual orientation, gender identity, and family acceptance, are not amenable to randomization and involving minor participants' parents poses ethical concerns given the precarious home and safety situations that can arise from employing typical study procedures with youth who have a stigmatized identity. In this article, we examine some of these unique methodological challenges. Informed by theoretical and empirical literature, practical experience, and an ongoing dialogue with SGM youth themselves, we present a guide to best practices for ethical, productive research with SGM youth. By discussing existing approaches to studying SGM youth and suggesting innovative ways to approach the questions that remain, we hope to assist the research community in addressing methodological gaps to advance research on SGM youth in relation to families and schools.
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Affiliation(s)
- Sheree M Schrager
- 1 Department of Research and Sponsored Programs, California State University, Northridge, Northridge, California
- 2 Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Riley J Steiner
- 3 Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alida M Bouris
- 4 School of Social Service Administration, University of Chicago, Chicago, Illinois
- 5 Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois
| | - Kathryn Macapagal
- 6 Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- 7 Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois
| | - C Hendricks Brown
- 6 Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- 7 Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois
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Nelson KM, Carey MP, Fisher CB. Is Guardian Permission a Barrier to Online Sexual Health Research Among Adolescent Males Interested in Sex With Males? JOURNAL OF SEX RESEARCH 2019; 56:593-603. [PMID: 29952665 PMCID: PMC6310663 DOI: 10.1080/00224499.2018.1481920] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Institutional review boards (IRBs) that refuse to grant waivers of guardian permission may hinder research to inform needed online sexual health interventions for adolescent males interested in sex with males (AMSM). Information on the challenges of obtaining (or waiving) guardian permission is imperative. In June and July 2017, AMSM (N = 206; ages 14 to 17) in the United States completed an online survey on sexual behaviors, sexually explicit media use, and sexual education exposure/needs. A mixed-methods approach assessed attitudes toward guardian permission for the current survey and future online sexual health intervention research. Logistic regression models assessed differences by "outness" to a guardian. A framework matrix analysis was conducted to summarize, then aggregate, qualitative responses. Findings indicated that most AMSM would not participate if guardian permission was required (current: 83%; future: 87%). Youth who were not out were more likely to say they would not participate (current: adjusted odds ratio [AOR] = 2.8, 95% confidence interval [CI]: 1.2 to 6.8); future: AOR = 4.7, 95% CI: 1.6 to 13.5). Participants reported that guardian permission would be an invasion of their privacy, lead to involuntary outing, and endanger participants. Overall, guardian permission appears to be a barrier to AMSM participation in online sexual health research. Investigators and IRBs should consider alternative practices and policies to facilitate such research.
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Affiliation(s)
- Kimberly M Nelson
- a Centers for Behavioral and Preventive Medicine , The Miriam Hospital
- b Department of Psychiatry and Human Behavior , Brown University
- c Department of Behavioral and Social Sciences , Brown University
| | - Michael P Carey
- a Centers for Behavioral and Preventive Medicine , The Miriam Hospital
- b Department of Psychiatry and Human Behavior , Brown University
- c Department of Behavioral and Social Sciences , Brown University
| | - Celia B Fisher
- d Department of Psychology , Center for Ethics Education, Fordham University
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Macapagal K, Bettin E, Matson M, Kraus A, Fisher CB, Mustanski B. Measuring Discomfort in Health Research Relative to Everyday Events and Routine Care: An Application to Sexual and Gender Minority Youth. J Adolesc Health 2019; 64:594-601. [PMID: 30612810 PMCID: PMC6478526 DOI: 10.1016/j.jadohealth.2018.10.293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/19/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Understanding how sexual and gender minority (SGM) youth's comfort with research procedures compares to their comfort with everyday experiences and routine health care can help calibrate decisions about whether a study meets minimal risk criteria. We sought to quantify SGM adolescents' comfort with sexual health research relative to everyday events and activities often cited as benchmarks of minimal risk. METHODS A total of 616 SGM adolescents in the United States (mean age = 15.7 years, 41.7% racial/ethnic minority) completed online survey questions assessing sexual behavior, SGM identity, and a 53-item Measure of Adolescent Comfort with Clinical, Research, and Everyday Events that assessed comfort on a 7-point scale (1 = extremely uncomfortable and 7 = extremely comfortable). RESULTS The Everyday Events for Adolescents domain had the lowest mean comfort score (M = 3.49, standard deviation [SD] = .58) and was significantly lower than the Routine Medical and Psychological Tests domain (M = 4.43, SD = .92) and the HIV/Sexual Health Research Procedures domain (M = 4.19, SD = .94). Eleven of 17 items on the HIV/Sexual Health Research Procedures domain were ranked as more comfortable than a neutral rating of "neither comfortable nor uncomfortable." Higher levels of parental acceptance predicted greater levels of comfort across all four domains of the Measure of Adolescent Comfort with Clinical, Research, and Everyday Events. Participants who were out to their parents expressed greater comfort with both SGM Identity and Sexual Health-related procedures and events as well as HIV/Sexual Health Research Procedures. CONCLUSIONS Overall participants expressed equal or more comfort with research procedures than with everyday life experiences. These findings indicate that common sexual health research procedures may meet minimal risk criteria among SGM adolescent populations.
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Affiliation(s)
- Kathryn Macapagal
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois.
| | - Emily Bettin
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, USA,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, USA
| | - Margaret Matson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, USA,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, USA
| | - Ashley Kraus
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, USA,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, USA
| | - Celia B. Fisher
- Center for Ethics Education & Department of Psychology, Fordham University, 441 E. Dealy Road, Dealy 226, Bronx, NY 10458, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, USA,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, USA
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Matson M, Macapagal K, Kraus A, Coventry R, Bettin E, Fisher CB, Mustanski B. Sexual and gender minority youth's perspectives on sharing de-identified data in sexual health and HIV prevention research. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2019; 16:1-11. [PMID: 31890053 PMCID: PMC6936765 DOI: 10.1007/s13178-018-0372-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Funding agencies encourage and sometimes require data sharing. However, there is limited empirical research on participant perspectives on sharing de-identified data from research on sensitive topics (e.g., HIV, sexual health) with other researchers, and virtually none from adolescents or sexual and gender minority (SGM) participants. SGM teens (N = 197) ages 14-17 completed an online survey with multiple choice and open-ended items assessing perspectives toward sharing survey responses and blood samples from sexual health and HIV testing studies with other researchers. SGM youth were willing to share data but frequently cited confidentiality and privacy concerns, including fears about parents finding out about their identities even after de-identification was explained. Researchers need to ensure youth understand explanations of data security protections in order to make well-informed decisions about participating in research.
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Affiliation(s)
- Margaret Matson
- Department of Medical Social Sciences & Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine (Chicago, IL)
| | - Kathryn Macapagal
- Department of Medical Social Sciences & Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine (Chicago, IL)
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine (Chicago, IL)
| | - Ashley Kraus
- Department of Medical Social Sciences & Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine (Chicago, IL)
| | - Ryan Coventry
- Department of Medical Social Sciences & Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine (Chicago, IL)
| | - Emily Bettin
- Department of Medical Social Sciences & Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine (Chicago, IL)
| | - Celia B. Fisher
- Center for Ethics Education & Department of Psychology, Fordham University (Bronx, NY)
| | - Brian Mustanski
- Department of Medical Social Sciences & Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine (Chicago, IL)
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine (Chicago, IL)
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Groves AK, Hallfors DD, Iritani BJ, Rennie S, Odongo FS, Kwaro D, Amek N, Luseno WK. "I think the parent should be there because no one was born alone": Kenyan adolescents' perspectives on parental involvement in HIV research. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2018; 17:227-239. [PMID: 30319046 DOI: 10.2989/16085906.2018.1504805] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Despite a pressing need for adolescent HIV research in sub-Saharan Africa, ethical guidance for conducting research among minor adolescents is lacking. One ethical issue is the degree to which parents should be involved in the research process. The existing discourse is predominantly speculative and focuses on negative consequences of parental involvement. We use empirical data to describe the perspectives of Kenyan adolescents on parental involvement in consent and disclosure of HIV test results within a research study context. We conducted two rounds of focus group discussions with 40 adolescents in western Kenya to ask about minor adolescent participation in HIV research. We analysed data using codes and matrices. Kenyan adolescents were largely in favour of parental involvement during the research process. Half felt adolescent minors should solicit parental consent to participate, and nearly all said parents should learn the HIV test results of adolescent minors in order to provide necessary support. From their perspective, involvement of parents in research extends beyond obtaining their consent to providing essential support for youth, regardless of HIV status, both during and beyond the research study. Ethical guidelines that prioritise adolescent autonomy in research must consider reasons to involve parents considered important by adolescents themselves, particularly in low-resource settings.
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Affiliation(s)
- Allison K Groves
- a Department of Community Health and Prevention , Drexel University , Philadelphia , USA
| | | | - Bonita J Iritani
- b Pacific Institute for Research and Evaluation , Chapel Hill , USA
| | - Stuart Rennie
- c Department of Social Medicine , University of North Carolina , Chapel Hill , USA
| | - Fredrick S Odongo
- d Kenya Medical Research Institute , Centre for Global Health Research , Kisumu , Kenya
| | - Daniel Kwaro
- d Kenya Medical Research Institute , Centre for Global Health Research , Kisumu , Kenya
| | - Nyaguara Amek
- d Kenya Medical Research Institute , Centre for Global Health Research , Kisumu , Kenya
| | - Winnie K Luseno
- b Pacific Institute for Research and Evaluation , Chapel Hill , USA
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Mustanski B, Macapagal K, Thomann M, Feinstein BA, Newcomb ME, Motley D, Fisher CB. Parents' Perspectives About Adolescent Boys' Involvement in Biomedical HIV Prevention Research. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1923-1935. [PMID: 28875351 PMCID: PMC5837896 DOI: 10.1007/s10508-017-1035-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/27/2017] [Accepted: 07/06/2017] [Indexed: 05/12/2023]
Abstract
Research on the use of pre-exposure prophylaxis (PrEP) among adolescents at high risk for HIV is urgently needed, and parents' perspectives on these studies are essential for guiding the responsible conduct of adolescent PrEP research. We conducted interviews with 30 parents of adolescent boys (50% known/presumed heterosexual; 50% sexual minority) to understand their views of research risks and benefits and parental permission regarding their son's involvement in a hypothetical PrEP adherence trial. Parents identified several health and educational benefits of the study and expressed that waiving parental permission would overcome barriers to accessing PrEP, particularly for youth who may benefit most. Among their concerns were medication non-adherence and risk compensation. Parents provided suggestions to facilitate informed, rational, and voluntary participation decisions and protect youth's safety if parental permission was waived. These findings can inform ways to increase parental trust in PrEP research and create adequate protections for adolescent participants.
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Affiliation(s)
- Brian Mustanski
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 2700, Chicago, IL, 60611, USA.
| | - Kathryn Macapagal
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 2700, Chicago, IL, 60611, USA
| | - Matthew Thomann
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 2700, Chicago, IL, 60611, USA
- Department of Anthropology and Sociology, Kalamazoo College, Kalamazoo, MI, USA
| | - Brian A Feinstein
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 2700, Chicago, IL, 60611, USA
| | - Michael E Newcomb
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 2700, Chicago, IL, 60611, USA
| | - Darnell Motley
- Psychology Service, Edward Hines, Jr. VA Medical Center, Hines, IL, USA
| | - Celia B Fisher
- Department of Psychology, Center for Ethics Education, Fordham University, Bronx, NY, USA
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Fisher CB, Fried AL, Macapagal K, Mustanski B. Patient-Provider Communication Barriers and Facilitators to HIV and STI Preventive Services for Adolescent MSM. AIDS Behav 2018; 22:3417-3428. [PMID: 29546468 DOI: 10.1007/s10461-018-2081-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Adolescent males who have sex with males (AMSM) are at increased risk of contracting HIV/AIDS and other sexually transmitted infections (STIs). Healthcare providers are a critical source of HIV/STI prevention, yet little is known about AMSM patient-provider sexual health communications and services. To explore this issue, we surveyed a national sample of 198 AMSM 14-17 years. Four online psychometrically validated scales indicated over half the youth avoided communicating their sexual orientation and sexual health concerns to providers due to fear of heterosexist bias, concern their sexual health information would be disclosed to parents, and a general belief that sexual minority youth do not receive equitable treatment in health care settings. Youth who reported their physicians had initiated discussion about their sexual orientation were significantly more likely to have received HIV/STI preventive services and testing. Discussion includes the importance of medical training that meets the unique sexual health needs of AMSM.
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Affiliation(s)
- Celia B Fisher
- Center for Ethics Education and Department of Psychology, Fordham University, Bronx, NY, 10458, USA.
| | - Adam L Fried
- Clinical Psychology Program, Midwestern University, Glendale, AZ, USA
| | - Kathryn Macapagal
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Overstreet NM, Okuyan M, Fisher CB. Perceived Risks and Benefits in IPV and HIV Research: Listening to the Voices of HIV-Positive African American Women. J Empir Res Hum Res Ethics 2018; 13:511-524. [PMID: 30183457 DOI: 10.1177/1556264618797557] [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: 11/16/2022]
Abstract
African American women living with HIV were asked to reflect on the perceived risks and benefits of research participation after completing a study examining socially sensitive issues in their lives, including intimate partner violence (IPV) and HIV. Administration of standardized quantitative instruments yielded positive responses to the research experience. However, qualitative assessments of perceived risks and benefits revealed more nuanced responses. For example, confidentiality concerns were more prominent in open-ended responses as was participants' positive attitudes toward monetary compensation. In addition, some women reported that study participation provided them with new insights about their experiences with IPV. Findings suggest that empirical studies on research protections involving potentially distressing and socially sensitive experiences with vulnerable populations require both quantitative and qualitative assessments of perceived risks and benefits. We discuss implications of our findings for ethics practices in trauma-related research among populations with multiple social vulnerabilities.
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Fisher CB, Fried AL, Ibrahim Puri L, Macapagal K, Mustanski B. "Free Testing and PrEP without Outing Myself to Parents:" Motivation to participate in oral and injectable PrEP clinical trials among adolescent men who have sex with men. PLoS One 2018; 13:e0200560. [PMID: 30044845 PMCID: PMC6059443 DOI: 10.1371/journal.pone.0200560] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/28/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Adolescent men who have sex with men (AMSM) account for disproportionately high numbers of new HIV diagnoses. Non-adherence to daily use limiting the effectiveness of oral PrEP (Truvada) has led to current trials with adult MSM testing Cabotegravir, a long-term injectable medication. Once comparative studies with young adult MSM have established relative safety and efficacy of these medications, there will be a need for such comparative trials involving adolescents. Trends in state laws and IRB protocol review indicate that many of these studies will permit youth to provide independent consent for participation. Understanding the motivations of AMSM to participate in HIV biomedical prevention studies is important to ensure their agreement is voluntary without misunderstanding and undue influence. This study examined AMSM attitudes toward participation in oral/injectable PrEP RCTs to inform protections of youth's rights and welfare in future studies. METHODS We administered to 198 ethnically diverse U.S. AMSM, 14-17 years, a web-based survey including demographic and sexual health questions, description of a year-long oral versus injectable PrEP RCT and 26 Likert-type and one open-ended item assessing motivations for and against participation including: perceived benefits and risks of PrEP; free HIV/STI testing and counseling; confidentiality concerns; random assignment; and benefit to others. RESULTS Sixty-two percent indicated they were likely to participate in the study. The majority endorsed daily HIV protection, free HIV/STI testing, sexual health counseling, not having to rely on partner's condom use, and altruism as reasons to participate. Reasons against participation included medication side effects, concern taking the pill daily and clinic visits would reveal their sexual orientation and behaviors to parents. Over half erroneously assumed they would be assigned to the condition best for them and 39% indicated free access to services would lead them to participate even if they did not want to. Multiple regression indicated these factors accounted for 55% of the variance in participation choice. Nether age or ethnicity yielded significance. CONCLUSIONS Results suggest future biomedical HIV prevention research will need to develop procedures to address AMSM's confidentiality concerns, enhance youth's understanding of random assignment, the continued importance of medication adherence and partner condom use during trial participation, and availability of alternative sexual health services to avoid the potentially undue influence of access to free sexual health services.
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Affiliation(s)
- Celia B. Fisher
- Center for Ethics Education, Fordham University, New York, New York, United States of America
| | - Adam L. Fried
- Clinical Psychology Department, Midwestern University, Glendale, Arizona, United States of America
| | - Leah Ibrahim Puri
- Center for Ethics Education, Fordham University, New York, New York, United States of America
| | - Kathryn Macapagal
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Brian Mustanski
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
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Shah SK, Allison SM, Kapogiannis BG, Black R, Dawson L, Erbelding E. Advancing independent adolescent consent for participation in HIV prevention research. JOURNAL OF MEDICAL ETHICS 2018; 44:431-433. [PMID: 29895555 DOI: 10.1136/medethics-2018-104959] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Seema K Shah
- University of Washington Medical School Department of Pediatrics, Division of Bioethics, Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, University of Washington, Seattle, Washington, USA
| | - Susannah M Allison
- Division of AIDS Research, National Institute of Mental Health, NIH, Bethesda, Maryland, USA
| | - Bill G Kapogiannis
- Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Roberta Black
- Division of AIDS, National Institute of Allergy & Infectious Diseases, Bethesda, Maryland, USA
| | - Liza Dawson
- Division of AIDS, National Institute of Allergy & Infectious Diseases, Bethesda, Maryland, USA
| | - Emily Erbelding
- Division of Microbiology and Infectious Diseases, National Institute of Allergy & Infectious Diseases, Bethesda, Maryland, USA
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Chen D, Matson M, Macapagal K, Johnson EK, Rosoklija I, Finlayson C, Fisher CB, Mustanski B. Attitudes Toward Fertility and Reproductive Health Among Transgender and Gender-Nonconforming Adolescents. J Adolesc Health 2018; 63:62-68. [PMID: 29503031 PMCID: PMC6067953 DOI: 10.1016/j.jadohealth.2017.11.306] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Little is known about the reproductive desires of transgender and gender-nonconforming (TGNC) adolescents who may seek gender-affirming medical care that leads to infertility. The current study addressed this gap by examining attitudes toward fertility and family formation in a diverse sample of TGNC youth. METHOD An online survey about sexual/reproductive health in sexual and gender minority (SGM) adolescents ages 14-17 years was conducted from September to October 2016. RESULTS A total of 156 TGNC adolescents (Mage = 16.1 years; 83.3% assigned female at birth; 58.3% youth of color) responded. Overall, 70.5% of TGNC adolescents were interested in adoption and 35.9% in biological parenthood; more gender-nonconforming youth (43.8%) than transgender youth (25.8%) expressed interest in biological fertility. Discussions with health-care providers about fertility and reproductive health were uncommon-only 20.5% of youth had discussed fertility in general and only 13.5% had discussed effects of hormones on fertility. However, 60.9% of respondents were interested in learning more about their fertility and family building options. Key themes emerging from qualitative comments included concerns related to fertility/reproductive health (e.g., stigma of SGM parenthood, effect of gender-affirming treatments on fertility), and the need for additional reproductive health information both tailored to their individual experience and for SGM individuals more generally. DISCUSSION TGNC adolescents expressed interest in multiple family building options, including adoption and biological parenthood, and identified a need for more information about these options. Thus, clinicians working with adolescents should be aware of the unique fertility and reproductive health needs of TGNC youth.
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Affiliation(s)
- Diane Chen
- Division of Adolescent Medicine & Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Margaret Matson
- Department of Medical Social Sciences & Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kathryn Macapagal
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL,Department of Medical Social Sciences & Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Emilie K. Johnson
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL,Department of Urology & Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ilina Rosoklija
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Courtney Finlayson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL,Division of Endocrinology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Celia B. Fisher
- Center for Ethics Education & Department of Psychology, Fordham University
| | - Brian Mustanski
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL,Department of Medical Social Sciences & Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, IL
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Hookup App Use, Sexual Behavior, and Sexual Health Among Adolescent Men Who Have Sex With Men in the United States. J Adolesc Health 2018; 62:708-715. [PMID: 29784114 PMCID: PMC5967650 DOI: 10.1016/j.jadohealth.2018.01.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/02/2018] [Accepted: 01/02/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE Geosocial networking applications (e.g., "hookup apps") are widely used among adult men who have sex with men (MSM). Little is known about adolescent MSM's (AMSM) use of these apps. Exploratory research is needed as AMSM's app use poses various ethical, legal, and sexual health concerns. This article examined AMSM's app use patterns and its associations with their sexual health and behavior. METHODS Two hundred sexually experienced AMSM in the United States (M age = 16.6, 49% racial/ethnic minority) completed online survey questions assessing their use of apps specific to MSM and not specific to MSM to meet partners for dating and sex, as well as their sexual behavior and HIV risk. RESULTS Overall, 52.5% of participants (n = 105) reported using MSM-specific apps to meet partners for sex. Of these, most participants reported having oral (75.7%, n = 78) and anal sex (62.1%, n = 64) with those partners. Of those who reported having anal sex, 78.1% (n = 50) had sex with those partners more than once, and only 25.0% (n = 16) always used condoms with those partners. Relative to those who used only non-MSM-specific apps, MSM-specific app users reported more sex partners and condomless anal sex partners, greater perceived risk of HIV, more engagement in sexual health services, and greater odds of HIV testing. CONCLUSIONS Use of MSM-specific apps was not uncommon among this sample of AMSM. Patterns of risk behavior and HIV testing were similar to samples of adult MSM app users. Further research should investigate AMSM's app-related sexual and HIV/sexually transmitted infection prevention decision-making to guide sexual health education efforts for AMSM.
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Flores D, McKinney R, Arscott J, Barroso J. Obtaining waivers of parental consent: A strategy endorsed by gay, bisexual, and queer adolescent males for health prevention research. Nurs Outlook 2018; 66:138-148. [PMID: 28993074 PMCID: PMC5857413 DOI: 10.1016/j.outlook.2017.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/05/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Requiring parental consent in studies with sexual minority youth (SMY) can sometimes be problematic as participants may have yet to disclose their sexual orientation, may not feel comfortable asking parents' permission, and may promote a self-selection bias. PURPOSE We discuss rationale for waiving parental consent, strategies to secure waivers from review boards, and present participants' feedback on research without parents' permission. METHODS We share our institutional review board proposal in which we made a case that excluding SMY from research violates ethical research principles, does not recognize their autonomy, and limits collection of sexuality data. DISCUSSION Standard consent policies may inadvertently exclude youth who are at high risk for negative health outcomes or may potentially put them at risk because of forced disclosure of sexual orientation. Securing a waiver addresses these concerns and allows for rich data, which is critical for providers to have a deeper understanding of their unique sexual health needs. CONCLUSION To properly safeguard and encourage research informed by SMY, parental consent waivers may be necessary.
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Affiliation(s)
| | - Ross McKinney
- Association of American Medical Colleges, Washington, DC
| | | | - Julie Barroso
- Medical University of South Carolina School of Nursing, Charleston, SC
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Fletcher FE, Fisher C, Buchberg MK, Floyd B, Hotton A, Ehioba A, Donenberg G. "Where Did This [PrEP] Come From?" African American Mother/Daughter Perceptions Related to Adolescent Preexposure Prophylaxis (PrEP) Utilization and Clinical Trial Participation. J Empir Res Hum Res Ethics 2018; 13:173-184. [PMID: 29471706 DOI: 10.1177/1556264618755919] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the demonstrated effectiveness of preexposure prophylaxis (PrEP) to reduce incident HIV infections, PrEP's potential as an HIV prevention strategy for adolescent populations is unknown. This study assessed perceptions of adolescent PrEP use and clinical trial participation among African American women and their adolescent daughters. We conducted focus group discussions with 15 African American mother/daughter pairs ( N = 30). Findings suggest a general lack of PrEP awareness, favorable attitudes toward adolescent PrEP use, altruistic attitudes regarding research participation among daughters, and less favorable attitudes toward adolescent clinical trial participation among mothers. Study findings have the potential to inform strategies that provide equitable access to HIV scientific advances among African American women and girls and promote informed parent-child research decision making.
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Knopf AS, Ott MA, Liu N, Kapogiannis BG, Zimet GD, Fortenberry JD, Hosek SG. Minors' and Young Adults' Experiences of the Research Consent Process in a Phase II Safety Study of Pre-exposure Prophylaxis for HIV. J Adolesc Health 2017; 61:747-754. [PMID: 28967541 PMCID: PMC5701834 DOI: 10.1016/j.jadohealth.2017.06.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/05/2017] [Accepted: 06/19/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE There is a persistent HIV epidemic among sexual and gender minority adolescents in the U.S. Oral pre-exposure prophylaxis (PrEP) is an efficacious prevention strategy, but not yet approved for minors. Minors' access to biomedical HIV prevention technologies is impeded by the ethical and legal complexities of consent to research participation. We explore autonomous consent and study experiences among minor and adult participants in Project PrEPare, a Phase II safety study of PrEP for HIV prevention. METHODS Data for this mixed-methods descriptive study were collected via self-administered web-survey and in-depth telephone interviews in early 2016. Eligible participants were previously enrolled in Project PrEPare. We attempted to contact 191 participants; 74 were reached and expressed interest in participating and 58 enrolled. RESULTS Participants nearly universally felt well informed, understood the study, and freely volunteered with the clear understanding they could withdraw any time. All felt supported by study staff, but a small minority wished for more support during enrollment. Minors were more likely than adults to indicate a wish for more support in decision-making, and adults expressed higher satisfaction with their decision compared to minors. There was no association between elements of consent and Project PrEPare study outcomes. CONCLUSIONS Participants had an overwhelmingly positive experience in a Phase II safety study of PrEP for HIV prevention. Some minors wished for more support during the decision-making process, but none consulted their parents about the decision. Our results support the inclusion of decisional supports in consent processes for adolescents, while also protecting their privacy.
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Affiliation(s)
- Amelia S. Knopf
- Indiana University School of Nursing, 600 Barnhill Drive, W425, Indianapolis, IN 46202
| | - Mary A. Ott
- Adolescent Medicine; Indiana University School of Medicine, Department of Pediatrics; 410 West 10th Street, Suite 1001; Indianapolis, IN 46202
| | - Nancy Liu
- Westat, 1 600 Research Blvd. Rockville, MD 20850-3129
| | - Bill G. Kapogiannis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services; 6100 Executive Boulevard, Room 4B11J; Bethesda, MD 20892
| | - Gregory D. Zimet
- Adolescent Medicine; Indiana University School of Medicine, Department of Pediatrics; 410 West 10th Street, Suite 1001; Indianapolis, IN 46202
| | - J. Dennis Fortenberry
- Adolescent Medicine; Indiana University School of Medicine, Department of Pediatrics; 410 West 10th Street, Suite 1001; Indianapolis, IN 46202
| | - Sybil G. Hosek
- Stroger Hospital of Cook County, Department of Psychiatry; 1900 Polk Street, #854; Chicago, IL 60612
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Machado DM, de Sant'Anna Carvalho AM, Riera R. Adolescent pre-exposure prophylaxis for HIV prevention: current perspectives. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2017; 8:137-148. [PMID: 29238237 PMCID: PMC5716324 DOI: 10.2147/ahmt.s112757] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Adolescents are a critical population that is disproportionately impacted by the HIV epidemic. More than 2 million adolescents between the age group of 10 and 19 years are living with HIV, and millions are at risk of infection. HIV risks are considerably higher among girls, especially in high-prevalence settings such as eastern and southern Africa. In addition to girls, there are other vulnerable adolescent subgroups, such as teenagers, who use intravenous (IV) drugs, gay and bisexual boys, transgender youth, male sex workers, and people who fall into more than one of these categories. Pre-exposure prophylaxis (PrEP) is a new intervention for people at high risk for acquiring HIV, with an estimated HIV incidence of >3%. Recent data from trials show evidence of the efficacy of PrEP as a powerful HIV prevention tool in high-risk populations, including men who have sex with men, HIV-1-serodiscordant heterosexual couples, and IV drug users. The reported efficacy in those trials of the daily use of oral tenofovir, alone or in combination with emtricitabine, to prevent HIV infection ranged from 44% to 75% and was heavily dependent on adherence. Despite the proven efficacy of PrEP in adult trials, concerns remain about its feasibility in real-life scenarios due to stigma, cost, and limited clinician experience with PrEP delivery. Recent studies are attempting to expand the inquiry into the efficacy of such HIV prophylaxis approaches in adolescent populations, but there are still many gaps in knowledge, and no country has yet approved it for use with adolescents. The aim of this review was to identify and summarize the evidence from studies on PrEP for adolescents. We have compiled and reviewed published studies focusing on safety, feasibility, adherence to therapeutics, self-perception, and legal issues related to PrEP in people aged between 10 and 24 years.
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Affiliation(s)
- Daisy Maria Machado
- Disciplina de Infectologia Pediátrica, Departamento de Pediatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo
| | | | - Rachel Riera
- Disciplina de Medicina Baseada em Evidências, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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