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Sandfort TGM, Szydlo D, Fogel JM, Chimwaza Y, Rinnooy Kan CE, Hamilton EL, Mudhune V, Panchia R, Reynolds D. Gaps in HIV Treatment and Care Cascade Among Men and Transfeminine Persons Who Have Sex with Men in Kenya, Malawi, and South Africa: Findings from the HIV Prevention Trials Network 075 Study (2015-2017). AIDS Patient Care STDS 2025. [PMID: 40195948 DOI: 10.1089/apc.2025.0028] [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: 04/09/2025] Open
Abstract
Improving HIV outcomes for men who have sex with men (MSM) in sub-Saharan Africa requires addressing gaps in the HIV treatment cascade. This study examined these gaps among 71 treatment-naive MSM with HIV in the HIV Prevention Trials Network 075, a 1-year prospective biobehavioral cohort study (2015-2017) across four sub-Saharan African sites. Following a positive diagnosis, 86% of participants sought HIV care. Reasons for not having sought care or delays included a lack of perceived health issues and practical challenges. Most participants (80%) who engaged in care were prescribed antiretroviral therapy (ART). Although self-reported adherence was high, over one-third of those prescribed ART had no detectable antiretroviral drugs (ARVs) at the study's conclusion. ARV detection was significantly associated with study site, higher income, and experienced homophobia. The highest adherence rates were observed at the site offering direct, integrated treatment, underscoring the potential of "one-stop shop" services to mitigate intra-, interpersonal, and structural barriers. Despite a supportive study environment, gaps remain in linking MSM and transfeminine individuals to sustained HIV care and ART adherence. Given the urgency of addressing HIV among these populations, targeted interventions that promote engagement in care and adherence to treatment are critical.
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Affiliation(s)
- Theo G M Sandfort
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Daniel Szydlo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jessica M Fogel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yamikani Chimwaza
- Kamuzu University of Health Sciences-Johns Hopkins Research Project, Blantyre, Malawi
| | - Charlotte E Rinnooy Kan
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Erica L Hamilton
- Network and Collaborative Research Division, Durham, North Carolina, USA
| | - Victor Mudhune
- Kenya Medical Research Institute, Kisumu Clinical Research Site, Kisumu, Kenya
| | - Ravindre Panchia
- Perinatal HIV Research Unit, Univ. of the Witwatersrand, Soweto HPTN CRS, Soweto, South Africa
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Kelley CF, Acevedo-Quiñones M, Agwu AL, Avihingsanon A, Benson P, Blumenthal J, Brinson C, Brites C, Cahn P, Cantos VD, Clark J, Clement M, Creticos C, Crofoot G, Diaz RS, Doblecki-Lewis S, Gallardo-Cartagena JA, Gaur A, Grinsztejn B, Hassler S, Hinojosa JC, Hodge T, Kaplan R, Lacerda M, LaMarca A, Losso MH, Valdez Madruga J, Mayer KH, Mills A, Mounzer K, Ndlovu N, Novak RM, Perez Rios A, Phanuphak N, Ramgopal M, Ruane PJ, Sánchez J, Santos B, Schine P, Schreibman T, Spencer LY, Van Gerwen OT, Vasconcelos R, Vasquez JG, Zwane Z, Cox S, Deaton C, Ebrahimi R, Wong P, Singh R, Brown LB, Carter CC, Das M, Baeten JM, Ogbuagu O. Twice-Yearly Lenacapavir for HIV Prevention in Men and Gender-Diverse Persons. N Engl J Med 2025; 392:1261-1276. [PMID: 39602624 DOI: 10.1056/nejmoa2411858] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2024]
Abstract
BACKGROUND Twice-yearly subcutaneous lenacapavir has been shown to be efficacious for prevention of human immunodeficiency virus (HIV) infection in cisgender women. The efficacy of lenacapavir for preexposure prophylaxis (PrEP) in cisgender men, transgender women, transgender men, and gender-nonbinary persons is unclear. METHODS In this phase 3, double-blind, randomized, active-controlled trial, we randomly assigned participants in a 2:1 ratio to receive subcutaneous lenacapavir every 26 weeks or daily oral emtricitabine-tenofovir disoproxil fumarate (F/TDF). The primary efficacy analysis compared the incidence of HIV infection in the lenacapavir group with the background HIV incidence in the screened population. The secondary efficacy analysis compared the incidence of HIV infection in the lenacapavir group with that in the F/TDF group. RESULTS Among 3265 participants who were included in the modified intention-to-treat analysis, HIV infections occurred in 2 participants in the lenacapavir group (0.10 per 100 person-years; 95% confidence interval [CI], 0.01 to 0.37) and in 9 participants in the F/TDF group (0.93 per 100 person-years; 95% CI, 0.43 to 1.77). The background HIV incidence in the screened population (4634 participants) was 2.37 per 100 person-years (95% CI, 1.65 to 3.42). The incidence of HIV infection in the lenacapavir group was significantly lower than both the background incidence (incidence rate ratio, 0.04; 95% CI, 0.01 to 0.18; P<0.001) and the incidence in the F/TDF group (incidence rate ratio, 0.11; 95% CI, 0.02 to 0.51; P = 0.002). No safety concerns were identified. A total of 26 of 2183 participants (1.2%) in the lenacapavir group and 3 of 1088 (0.3%) in the F/TDF group discontinued the trial regimen because of injection-site reactions. CONCLUSIONS The HIV incidence with twice-yearly lenacapavir was significantly lower than the background incidence and the incidence with F/TDF. (Funded by Gilead Sciences; PURPOSE 2 ClinicalTrials.gov number, NCT04925752.).
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Affiliation(s)
- Colleen F Kelley
- Hope Clinic of Emory University School of Medicine, Decatur, GA
- Grady Health System, Atlanta
| | | | - Allison L Agwu
- Divisions of Pediatric and Adult Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore
| | - Anchalee Avihingsanon
- HIV Netherlands Australia Thailand Research Collaboration, Thai Red Cross AIDS Research Centre and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Jill Blumenthal
- Department of Medicine, University of California San Diego, San Diego
| | | | - Carlos Brites
- Complexo Hospitalar Universitário Professor Edgard Santos, Salvador, Brazil
| | | | - Valeria D Cantos
- Division of Infectious Diseases, Emory University-Ponce de Leon Center Clinical Research Site, HIV/AIDS Clinical Trials Unit, Atlanta
| | - Jesse Clark
- Department of Medicine, University of California, Los Angeles
| | - Meredith Clement
- Department of Infectious Diseases, Louisiana State University Health Sciences Center-New Orleans, New Orleans
| | | | | | | | | | - Jorge A Gallardo-Cartagena
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Aditya Gaur
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN
| | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz-Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro
| | | | | | - Theo Hodge
- Washington Health Institute, Washington, DC
| | | | - Marcus Lacerda
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | | | - Marcelo H Losso
- Hospital General de Agudos José María Ramos Mejía, Buenos Aires
| | | | | | | | - Karam Mounzer
- Philadelphia FIGHT Community Health Centers-Jonathan Lax Treatment Center, Philadelphia
| | - Nkosiphile Ndlovu
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg
| | - Richard M Novak
- Division of Infectious Diseases, University of Illinois Health Sciences, Chicago
| | - Alma Perez Rios
- Centro de Investigacion Farmaceutica Especializada de Occidente, Guadalajara, Mexico
| | - Nittaya Phanuphak
- Institute of HIV Research and Innovation-Pribta Tangerine Clinic, Bangkok, Thailand
| | - Moti Ramgopal
- Midway Immunology and Research Center, Fort Pierce, FL
| | | | - Jorge Sánchez
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Breno Santos
- Infectious Diseases Service, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | | | | | - LaShonda Y Spencer
- Drew Center for AIDS Research, Education, and Services, Charles R. Drew University, Los Angeles
| | - Olivia T Van Gerwen
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham
| | - Ricardo Vasconcelos
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo
| | | | - Zwelethu Zwane
- Aurum Institute-Pretoria Clinical Research Site, Pretoria, South Africa
| | | | | | | | | | | | | | | | | | | | - Onyema Ogbuagu
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT
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Macicame I, Bhatt N, Viegas E, Yates A, Nwoga C, Chissumba RM, Monteiro V, Imbach M, Milazzo M, Li Q, Schech S, Mebrahtu T, Eller LA, Swann E, Michael NL, Robb ML, Crowell TA, Polyak CS, Jani I. HIV incidence and its associated factors among young adults with multiple sexual partners in Maputo, Mozambique: a vaccine preparedness study. BMC Public Health 2024; 24:2692. [PMID: 39358725 PMCID: PMC11446008 DOI: 10.1186/s12889-024-20032-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 09/10/2024] [Indexed: 10/04/2024] Open
Abstract
INTRODUCTION Sub-Saharan Africa has a high burden of HIV, particularly among female sex workers (FSW) and men who have sex with men (MSM). Future clinical trials to evaluate vaccines and other interventions to prevent HIV will need to enroll populations with high HIV incidence. We conducted an observational study of HIV incidence among men and women with multiple sexual partners-including MSM and FSW-in Maputo, Mozambique, in order to prepare the country to conduct future efficacy trials of candidate HIV vaccines and other HIV prevention products. METHODS We conducted a prospective observational HIV incidence study in Maputo, Mozambique, that enrolled adults aged 18-35 years, without HIV, who had two or more sexual partners in the preceding three months. Recruitment strategies prioritized participation of MSM and FSW. Participants were followed for 24 months with HIV-1 testing every 3 months and staff-administered behavioral questionnaires every 6 months. Cox proportional hazard modeling was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for factors potentially associated with HIV acquisition. RESULTS From January 2014 to October 2017, 505 adults without HIV were enrolled with median age of 21 years (interquartile range:19-24); 41% were female and 82% were single. There were 19 HIV seroconversions (10 female and 9 male) during 943 person-years (PY) of observation (overall HIV incidence 2.02/100PY; 95%CI 1.21-3.15). The highest HIV incidence was observed among sex workers (2.08/100PY; 95%CI 0.25-7.52) and MSM (19.18/100PY; 95%CI 3.96-56.06). Increased hazard of incident HIV was observed among participants who were MSM (HR = 27.95, 95%CI 4.39-117.94), p = 0.0004), reported three or more sexual partners at enrollment (HR = 7.39, 95%CI 1.64-33.25, p = 0.009), and indicated ever having a sexual partner living with HIV (HR = 9.64, 95%CI 2.23-41.71, p = 0.002). CONCLUSION Our findings may inform inclusion criteria for upcoming clinical trials of HIV prevention interventions, including vaccine candidates, which may prioritize enrollment of MSM, people with more than three sexual partners, and people with sexual partners who are living with HIV. These same populations are in need of further intervention to reduce HIV incidence.
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Affiliation(s)
- Ivalda Macicame
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Nilesh Bhatt
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Edna Viegas
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Adam Yates
- U.S. Military HIV Research Program, CIDR, Walter Reed Army Institute of Research, 6720A Rockledge Drive, Suite 400 Silver Spring, Bethesda, MD, 20817, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA
| | - Chiaka Nwoga
- U.S. Military HIV Research Program, CIDR, Walter Reed Army Institute of Research, 6720A Rockledge Drive, Suite 400 Silver Spring, Bethesda, MD, 20817, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA
| | | | - Vanessa Monteiro
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Michelle Imbach
- U.S. Military HIV Research Program, CIDR, Walter Reed Army Institute of Research, 6720A Rockledge Drive, Suite 400 Silver Spring, Bethesda, MD, 20817, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA
| | - Mark Milazzo
- U.S. Military HIV Research Program, CIDR, Walter Reed Army Institute of Research, 6720A Rockledge Drive, Suite 400 Silver Spring, Bethesda, MD, 20817, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA
| | - Qun Li
- U.S. Military HIV Research Program, CIDR, Walter Reed Army Institute of Research, 6720A Rockledge Drive, Suite 400 Silver Spring, Bethesda, MD, 20817, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA
| | - Steven Schech
- U.S. Military HIV Research Program, CIDR, Walter Reed Army Institute of Research, 6720A Rockledge Drive, Suite 400 Silver Spring, Bethesda, MD, 20817, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA
| | - Tsedal Mebrahtu
- U.S. Military HIV Research Program, CIDR, Walter Reed Army Institute of Research, 6720A Rockledge Drive, Suite 400 Silver Spring, Bethesda, MD, 20817, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA
| | - Leigh Anne Eller
- U.S. Military HIV Research Program, CIDR, Walter Reed Army Institute of Research, 6720A Rockledge Drive, Suite 400 Silver Spring, Bethesda, MD, 20817, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA
| | - Edith Swann
- Division of AIDS, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA
| | - Nelson L Michael
- U.S. Military HIV Research Program, CIDR, Walter Reed Army Institute of Research, 6720A Rockledge Drive, Suite 400 Silver Spring, Bethesda, MD, 20817, USA
| | - Merlin L Robb
- U.S. Military HIV Research Program, CIDR, Walter Reed Army Institute of Research, 6720A Rockledge Drive, Suite 400 Silver Spring, Bethesda, MD, 20817, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA
| | - Trevor A Crowell
- U.S. Military HIV Research Program, CIDR, Walter Reed Army Institute of Research, 6720A Rockledge Drive, Suite 400 Silver Spring, Bethesda, MD, 20817, USA.
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA.
| | - Christina S Polyak
- U.S. Military HIV Research Program, CIDR, Walter Reed Army Institute of Research, 6720A Rockledge Drive, Suite 400 Silver Spring, Bethesda, MD, 20817, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA
| | - Ilesh Jani
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
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Sandfort TGM, Kreniske P, Mbeda C, Reynolds D, Tshabalala G, Madiwati B, Ogendo A, Dominquez K, Panchia R, Gondwe D, Hamilton EL, Guo X, Cummings V. Interest in I-PrEP and Willingness to Participate in Clinical Trials Among Men and Transfeminine Persons Who have Sex with Men in Sub-Saharan Africa: Quantitative and Qualitative Findings from HPTN 075. AIDS Behav 2024; 28:2361-2377. [PMID: 38761334 PMCID: PMC11199096 DOI: 10.1007/s10461-024-04334-x] [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] [Accepted: 03/27/2024] [Indexed: 05/20/2024]
Abstract
This study explored interest in injectable PrEP (I-PrEP) and willingness to participate in clinical trials testing new biomedical HIV prevention strategies among men and transfeminine persons who have sex with men (MSM & TGP), using data collected in the HIV Prevention Trials Network (HPTN) 075 study, which took place at sites in Kenya, Malawi, and South Africa. Data result from a survey among 267 18-44 years old HIV negative participants, complemented with semi-structured interviews with 80 purposively recruited persons. Correlations coefficients were calculated to identify demographic and psychosocial factors associated with interest in I-PrEP. Qualitative interviews were analyzed using concept-driven and subsequent data-driven coding. Most surveyed participants expressed an interest in I-PrEP. Quantitatively, only being interested in other HIV prevention measures was associated with interest in I-PrEP. Qualitatively, most participants preferred I-PrEP to O-PrEP and remained interested in I-PrEP despite barriers such as the somewhat invasive nature of the procedure and potential side effects of I-PrEP. Interest in I-PrEP was driven by the possibility of avoiding sexual or HIV stigma. Access to healthcare and altruism-such as assisting in the development of new HIV prevention methods-positively impacted willingness to participate in clinical trials. With I-PrEP favored by most participants, it is potentially a critical tool to prevent HIV infection among MSM & TGP in sub-Saharan Africa, with the mitigation of stigma as a major advance. Recruitment of MSM & TGP in biobehavioral clinical trials seems feasible, with altruistic reasons and receiving I-PrEP and free medical care as major motivators.
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Affiliation(s)
- Theodorus G M Sandfort
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
| | - Philip Kreniske
- Community Health and Social Sciences Department, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, USA
| | - Calvin Mbeda
- Kenya Medical Research Institute (KEMRI) CDC, Kisumu, Kenya
| | | | - Gugulethu Tshabalala
- Perinatal HIV Research Unit, University of the Witwatersrand, Soweto, South Africa
| | | | - Arthur Ogendo
- Kenya Medical Research Institute (KEMRI) CDC, Kisumu, Kenya
| | | | - Ravindre Panchia
- Perinatal HIV Research Unit, University of the Witwatersrand, Soweto, South Africa
| | - Daniel Gondwe
- College of Medicine-Johns Hopkins Research Project, Blantyre, Malawi
| | | | - Xu Guo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Vanessa Cummings
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Pulerwitz J, Gottert A, Tun W, Eromhonsele AF, Oladimeji PL, Shoyemi E, Akoro M, Ndeloa C, Adedimeji A. Reducing stigma and promoting HIV wellness/mental health of sexual and gender minorities: RCT results from a group-based programme in Nigeria. J Int AIDS Soc 2024; 27:e26256. [PMID: 38837614 PMCID: PMC11151009 DOI: 10.1002/jia2.26256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 04/15/2024] [Indexed: 06/07/2024] Open
Abstract
INTRODUCTION High levels of HIV stigma as well as stigma directed towards sexual and/or gender minorities (SGMs) are well documented in the African setting. These intersecting stigmas impede psychosocial wellbeing and HIV prevention and care. Yet, there are few if any evidence-based interventions that focus on reducing internalized stigma and promoting mental health and HIV wellness for SGMs in Africa. We developed and evaluated a group-based intervention drawing on cognitive behavioural therapy (CBT) strategies for men who have sex with men (MSM) and transgender women (TGW) at risk for or living with HIV in Lagos, Nigeria. METHODS The intervention comprised four weekly in-person group sessions facilitated by community health workers. We conducted a delayed intervention group randomized controlled trial (April-September 2022), with pre-post surveys plus 3-month follow-up (immediate group only), as well as qualitative research with participants and programme staff. Outcomes included internalized stigma related to SGM and HIV status, depression, resiliency/coping and pre-exposure prophylaxis (PrEP)/HIV treatment use. RESULTS Mean age of the 240 participants was 26 years (range 18-42). Seventy-seven percent self-identified as MSM and 23% TGW; 27% were people with HIV. Most (88%) participants attended all four sessions, and 98% expressed high intervention satisfaction. There was significant pre-post improvement in each psychosocial outcome, in both the immediate and delayed arms. There were further positive changes for the immediate intervention group by 3-month follow-up (e.g. in intersectional internalized stigma, depression). While baseline levels of ever-PrEP use were the same, 75% of immediate-group participants reported currently using PrEP at 3 months post-intervention versus 53% of delayed-group participants right after the intervention (p<0.01). Participants post-intervention described (in qualitative interviews) less self-blame, and enhanced social support and resilience when facing stigma, as well as motivation to use PrEP, and indicated that positive pre-intervention changes in psychosocial factors found in the delayed group mainly reflected perceived support from the study interviewers. CONCLUSIONS This study demonstrated the feasibility and acceptability of a group-based CBT model for MSM and TGW in Nigeria. There were also some indications of positive shifts related to stigma, mental health and PrEP, despite issues with maintaining the randomized design in this challenging environment.
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Affiliation(s)
- Julie Pulerwitz
- Social and Behavioural Science Research DivisionPopulation CouncilWashingtonDCUSA
| | - Ann Gottert
- Social and Behavioural Science Research DivisionPopulation CouncilWashingtonDCUSA
| | - Waimar Tun
- Social and Behavioural Science Research DivisionPopulation CouncilWashingtonDCUSA
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Badejo O, Wouters E, Van Belle S, Buve A, Smekens T, Jwanle P, Laga M, Nöstlinger C. Latent class analysis of barriers to HIV testing services and associations with sexual behaviour and HIV status among adolescents and young adults in Nigeria. PLoS One 2024; 19:e0300220. [PMID: 38635546 PMCID: PMC11025812 DOI: 10.1371/journal.pone.0300220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 02/25/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION Adolescents and young adults (AYA) face multiple barriers to accessing healthcare services, which can interact, creating complex needs that often impact health behaviours, leading to increased vulnerability to HIV. We aimed to identify distinct AYA subgroups based on patterns of barriers to HIV testing services and assess the association between these barrier patterns and sexual behaviour, socio-demographics, and HIV status. METHODS Data were from Nigeria's AIDS Indicator and Impact Survey (NAIIS, 2018) and included 18,612 sexually active AYA aged 15-24 years who had never been tested for HIV and reported barriers to accessing HIV testing services. A Latent class analysis (LCA) model was built from 12 self-reported barrier types to identify distinct subgroups of AYA based on barrier patterns. Latent class regressions (LCR) were conducted to compare the socio-demographics, sexual behaviour, and HIV status across identified AYA subgroups. Sex behaviour characteristics include intergenerational sex, transactional sex, multiple sex partners, condom use, and knowledge of partner's HIV status. RESULTS Our LCA model identified four distinct AYA subgroups termed 'low-risk perception' (n = 7,361; 39.5%), 'consent and proximity' (n = 5,163; 27.74%), 'testing site' (n = 4,996; 26.84%), and 'cost and logistics' (n = 1,092; 5.87%). Compared to adolescents and young adults (AYA) in the low-risk perception class, those in the consent and proximity class were more likely to report engaging in intergenerational sex (aOR 1.17, 95% CI 1.02-1.35), transactional sex (aOR 1.50, 95% CI 1.23-1.84), and have multiple sex partners (aOR 1.75, 95% CI 1.39-2.20), while being less likely to report condom use (aOR 0.79, 95% CI 0.63-0.99). AYA in the testing site class were more likely to report intergenerational sex (aOR 1.21, 95% CI 1.04-1.39) and transactional sex (aOR 1.53, 95% CI 1.26-1.85). AYA in the cost and logistics class were more likely to engage in transactional sex (aOR 2.12, 95% CI 1.58-2.84) and less likely to report condom use (aOR 0.58, 95% CI 0.34-0.98). There was no significant relationship between barrier subgroup membership and HIV status. However, being female, aged 15-24 years, married or cohabiting, residing in the Southsouth zone, and of Christian religion increased the likelihood of being HIV infected. CONCLUSIONS Patterns of barriers to HIV testing are linked with differences in sexual behaviour and sociodemographic profiles among AYA, with the latter driving differences in HIV status. Findings can improve combination healthcare packages aimed at simultaneously addressing multiple barriers and determinants of vulnerability to HIV among AYA.
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Affiliation(s)
- Okikiolu Badejo
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Sociology, University of Antwerp, Antwerp, Belgium
- APIN Public Health Institute, Abuja, Nigeria
| | - Edwin Wouters
- Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Anne Buve
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Tom Smekens
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Marie Laga
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Dias BDC, Sekgele W, Nhlapo D, Mahlangu MP, Venter JME, Maseko DV, Müller EE, Greeves M, Botha P, Radebe F, Kufa T, Kularatne RS. Extragenital Sexually Transmitted Infections Among High-Risk Men Who Have Sex With Men in Johannesburg, South Africa. Sex Transm Dis 2024; 51:245-250. [PMID: 38534082 DOI: 10.1097/olq.0000000000001927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND In South Africa, extragenital etiological sexually transmitted infection (STI) screening among men who have sex with men (MSM) is not routinely available. We aimed to determine the prevalence of STI pathogens at rectal and pharyngeal sites, syphilis seroprevalence, and associated risk factors among a selection of high-risk MSM without symptomatic urethritis attending a men's health clinic in Johannesburg, South Africa. METHODS A cross-sectional study was conducted in 2022. Enrolled clients self-reported demographic, sexual behavioral risks, and clinical information. Client or clinician-collected rectal and pharyngeal swabs were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis. C. trachomatis-positive rectal samples were reflex tested for lymphogranuloma venereum. Blood specimens were screened for syphilis. Univariate and multivariate regression models were used to determine factors independently associated with the presence of an extragenital STI or syphilis. RESULTS Among the 97 participants (median age, 29 years), 24.7% had an extragenital STI and 9.4% had high nontreponemal antibody titers (rapid plasma reagin ≥1:16). Rectal STIs were detected in 26.4% participants: N. gonorrhoeae (14.3%), C. trachomatis (9.9%), and M. genitalium (5.5%). Pharyngeal STIs were less prevalent (4.1%). Overall, the prevalence of any STI was 41%. Sex under the influence of drugs (adjusted odds ratio, 4.94; 95% confidence interval, 1.56-15.69) and engaging in condomless receptive anal intercourse with a casual partner (adjusted odds ratio, 8.36; 95% confidence interval, 1.73-40.28) were independent risk factors for having an extragenital STI. CONCLUSIONS The high burden of extragenital STIs and active syphilis in asymptomatic MSM underscores the importance of routine etiological screening in this key population, as the syndromic approach would not enable detection or treatment of these infections.
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Affiliation(s)
| | - Windy Sekgele
- South African Field Epidemiology Training Programme (SAFETP), National Institute for Communicable Diseases
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Scheim AI, Rich AJ, Zubizarreta D, Malik M, Baker KE, Restar AJ, van der Merwe LA, Wang J, Beebe B, Ridgeway K, Baral SD, Poteat T, Reisner SL. Health status of transgender people globally: A systematic review of research on disease burden and correlates. PLoS One 2024; 19:e0299373. [PMID: 38466747 PMCID: PMC10927095 DOI: 10.1371/journal.pone.0299373] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 02/08/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Transgender and gender diverse (trans) health research has grown rapidly, highlighting the need to characterize the scientific evidence base. We conducted a systematic review of peer-reviewed research on disease burden and correlates in trans adolescents and adults over a 20-month period to identify knowledge gaps and assess methodological characteristics including measurement of gender identity, community engagement, and study quality. DATA SOURCES, ELIGIBILITY CRITERIA, AND SYNTHESIS METHODS We searched seven databases using terms related to (a) transgender populations and (b) health or disease. Eligible studies were in English, French, or Spanish and reported original quantitative data on mental health or substance use conditions, infectious diseases, or non-communicable conditions in at least 25 trans individuals aged 15+. Quality assessment was performed in duplicate on a 10% sample of articles and findings were summarized using narrative synthesis. RESULTS The 328 included studies were conducted in 45 countries, with most from North America (54%) and limited research from South Asia (3%), Sub-Saharan Africa (3%), and the Middle East and North Africa (2%). Most studies used cross-sectional designs (73%) and convenience sampling (65%). Only 30% of studies reported any form of community engagement. Mental health and substance use disorders were the most studied area (77% of studies) and non-communicable conditions the least (16%). Available data indicated that trans populations experience high disease burden with considerable heterogeneity within and across settings. Of 39 articles assessed for quality, 80% were rated as fair, 18% as poor, and 3% as good quality. CONCLUSIONS AND IMPLICATIONS Geographic, gender-specific, and topical gaps remain in trans health, but we found more research from African countries, with transmasculine people, and on non-communicable conditions than previous syntheses. Areas for growth in trans health research include community engagement, non-binary health, chronic and age-related conditions, and health determinants. REGISTRATION PROSPERO CRD42021234043.
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Affiliation(s)
- Ayden I. Scheim
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, United States of America
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ashleigh J. Rich
- Department of Social Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Dougie Zubizarreta
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Mannat Malik
- Department of Health Behaviour, Gillings School of Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Kellan E. Baker
- Whitman-Walker Institute, Washington, District of Columbia, United States of America
| | - Arjee J. Restar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Leigh Ann van der Merwe
- Social, Health and Empowerment Feminist Collective of Transgender Women of Africa (S.H.E.), East London, South Africa
| | - June Wang
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Bianca Beebe
- School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Kathleen Ridgeway
- School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Stefan D. Baral
- Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Sari L. Reisner
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
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Munyaneza A, Patel VV, Gutierrez NR, Shi Q, Muhoza B, Kubwimana G, Ross J, Nsereko E, Murenzi G, Nyirazinyoye L, Mutesa L, Anastos K, Adedimeji A. Awareness and willingness to use pre-exposure prophylaxis for HIV prevention among men who have sex with men in Rwanda: findings from a web-based survey. Front Public Health 2024; 12:1325029. [PMID: 38496393 PMCID: PMC10940510 DOI: 10.3389/fpubh.2024.1325029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/07/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction Pre-exposure Prophylaxis (PrEP) is a daily pill aimed at reducing HIV transmission risk when taken as prescribed. It's highly recommended for high-risk Men who have sex with Men (MSM). This study aimed to assess PrEP awareness and willingness to use it among Rwandan MSM, a critical aspect given PrEP's proven effectiveness. The findings are expected to inform policy decisions and further advance the implementation of PrEP strategies. Methods This is a cross-sectional study design that utilized a web-based survey conducted between April and June 2019 to assess awareness and willingness to use PrEP among sexually active MSM in Rwanda. A snowball sampling technique was used to recruit participants via social media such as WhatsApp and e-mail. Eligibility criteria included being sexually active, aged ≥18 years, self-identifying as MSM, residing in Rwanda, self-reported engagement in receptive or insertive anal sex in the last 12 months, and self-reported HIV-negative serostatus. We assessed two primary outcomes: PrEP awareness (having ever heard of PrEP) and willingness to use PrEP within one month of completing the survey. Multivariable logistic regression was performed to identify participant characteristics associated with PrEP awareness and willingness to use it. Results Out of 521 participants, the majority (73%) demonstrated awareness of PrEP. Factors linked to PrEP awareness included residing outside the capital, Kigali, being in the 18-29 age group, having higher education levels, perceiving a benefit from PrEP, and engaging in vaginal sex with a woman while using a condom in the last year. Additionally, 96% of participants expressed a strong willingness to use PrEP. Conclusion Rwandan MSM exhibits a high level of PrEP awareness, notably associated with factors like location, age, education, perceived benefits, and condom use. The study also revealed a strong willingness to use PrEP, indicating promising prospects for its adoption among this group. These findings highlight the need for targeted awareness campaigns, personalized interventions, and comprehensive sexual health education to promote PrEP adoption and strengthen HIV prevention efforts among Rwandan MSM.
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Affiliation(s)
- Athanase Munyaneza
- Research for Development (RD Rwanda), Kigali, Rwanda
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Viraj V. Patel
- Division of General Internal Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Nataly Rios Gutierrez
- Division of General Internal Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Qiuhu Shi
- New York Medical College, Valhalla, NY, United States
| | | | | | - Jonathan Ross
- Division of General Internal Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Etienne Nsereko
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Gad Murenzi
- Research for Development (RD Rwanda), Kigali, Rwanda
| | - Laetitia Nyirazinyoye
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Leon Mutesa
- Research for Development (RD Rwanda), Kigali, Rwanda
- Center for Human Genetics, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Kathryn Anastos
- Division of General Internal Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
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10
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Stevens O, Anderson R, Stover J, Teng Y, Stannah J, Silhol R, Jones H, Booton RD, Martin-Hughes R, Johnson L, Maheu-Giroux M, Mishra S, Stone J, Bershteyn A, Kim HY, Sabin K, Mitchell KM, Dimitrov D, Baral S, Donnell D, Korenromp E, Rice B, Hargreaves JR, Vickerman P, Boily MC, Imai-Eaton JW. Comparison of Empirically Derived and Model-Based Estimates of Key Population HIV Incidence and the Distribution of New Infections by Population Group in Sub-Saharan Africa. J Acquir Immune Defic Syndr 2024; 95:e46-e58. [PMID: 38180738 PMCID: PMC10769165 DOI: 10.1097/qai.0000000000003321] [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: 01/06/2024]
Abstract
BACKGROUND The distribution of new HIV infections among key populations, including female sex workers (FSWs), gay men and other men who have sex with men (MSM), and people who inject drugs (PWID) are essential information to guide an HIV response, but data are limited in sub-Saharan Africa (SSA). We analyzed empirically derived and mathematical model-based estimates of HIV incidence among key populations and compared with the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates. METHODS We estimated HIV incidence among FSW and MSM in SSA by combining meta-analyses of empirical key population HIV incidence relative to the total population incidence with key population size estimates (KPSE) and HIV prevalence. Dynamic HIV transmission model estimates of HIV incidence and percentage of new infections among key populations were extracted from 94 country applications of 9 mathematical models. We compared these with UNAIDS-reported distribution of new infections, implied key population HIV incidence and incidence-to-prevalence ratios. RESULTS Across SSA, empirical FSW HIV incidence was 8.6-fold (95% confidence interval: 5.7 to 12.9) higher than total population female 15-39 year incidence, and MSM HIV incidence was 41.8-fold (95% confidence interval: 21.9 to 79.6) male 15-29 year incidence. Combined with KPSE, these implied 12% of new HIV infections in 2021 were among FSW and MSM (5% and 7% respectively). In sensitivity analysis varying KPSE proportions within 95% uncertainty range, the proportion of new infections among FSW and MSM was between 9% and 19%. Insufficient data were available to estimate PWID incidence rate ratios. Across 94 models, median proportion of new infections among FSW, MSM, and PWID was 6.4% (interquartile range 3.2%-11.7%), both much lower than the 25% reported by UNAIDS. CONCLUSION Empirically derived and model-based estimates of HIV incidence confirm dramatically higher HIV risk among key populations in SSA. Estimated proportions of new infections among key populations in 2021 were sensitive to population size assumptions and were substantially lower than estimates reported by UNAIDS.
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Affiliation(s)
- Oliver Stevens
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Rebecca Anderson
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - John Stover
- Center for Modeling, Planning and Policy Analysis, Avenir Health, Glastonbury, CT
| | - Yu Teng
- Center for Modeling, Planning and Policy Analysis, Avenir Health, Glastonbury, CT
| | - James Stannah
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, Canada
| | - Romain Silhol
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- HIV Prevention Trials Network Modelling Centre, Imperial College London, London, United Kingdom
| | - Harriet Jones
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ross D. Booton
- United Kingdom Heath Security Agency, London, United Kingdom
| | - Rowan Martin-Hughes
- Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Australia
| | - Leigh Johnson
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, Canada
| | - Sharmistha Mishra
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | - Jack Stone
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Anna Bershteyn
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Hae-Young Kim
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Keith Sabin
- Data for Impact, The Joint United Nations Program on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - Kate M. Mitchell
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- Department of Nursing and Community Health, Glasgow Caledonian University London, London, United Kingdom
| | - Dobromir Dimitrov
- HIV Prevention Trials Network Modelling Centre, Imperial College London, London, United Kingdom
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Deborah Donnell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Eline Korenromp
- Data for Impact, The Joint United Nations Program on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - Brian Rice
- School of Health and Related Research (SchARR), University of Sheffield, Sheffield, United Kingdom; and
| | - James R. Hargreaves
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Marie-Claude Boily
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- HIV Prevention Trials Network Modelling Centre, Imperial College London, London, United Kingdom
| | - Jeffrey W. Imai-Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
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11
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Munyaneza A, Patel VV, Gutierrez NR, Shi Q, Muhoza B, Kubwimana G, Ross J, Nsereko E, Murenzi G, Nyirazinyoye L, Mutesa L, Anastos K, Adedimeji A. Awareness and Willingness to Use HIV Infection Pre-Exposure Prophylaxis among Rwandan Men Who Have Sex with Men: Findings from a Web-based Survey. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.01.23297747. [PMID: 37961327 PMCID: PMC10635244 DOI: 10.1101/2023.11.01.23297747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Introduction Pre-exposure Prophylaxis (PrEP) is a daily pill intended to reduce the risk of acquiring Human Immunodeficiency Virus (HIV) when taken as prescribed. It is strongly recommended for Men who have sex with Men (MSM) at high risk of HIV transmission to minimize infection risk. Despite its proven effectiveness, there is a lack of information about awareness and willingness to use PrEP among Rwandan MSM. In the context of HIV acquisition, the purpose of this study was to ascertain the awareness and willingness to use PrEP among high-risk Rwandan MSM. The findings of this research will provide valuable perspectives to mold policy and direct the effective execution of PrEP within the country. Method This is a cross-sectional study design that utilized a web-based survey conducted between April and June 2019 to assess awareness and willingness to use PrEP among sexually active MSM in Rwanda. A snowball sampling technique was used to recruit participants who were contacted via social medial such as WhatsApp and e-mail. To be eligible, participants were supposed to be sexually active, aged ≥18 years, self-identify as MSM, residence in Rwanda, self-reported engagement in receptive or insertive anal sex in the last 12 months, and self-reported HIV-negative sero-status. We assessed two primary outcomes: PrEP awareness (having ever heard of PrEP) and willingness to use PrEP within one month of completing the survey. Multivariable logistic regression was performed to identify participant characteristics associated with PrEP awareness and willingness to use it. Results Among the 521 participants included in the analysis, 63% were aged below 24 years. The majority (73%) demonstrated awareness of PrEP. Factors associated with PrEP awareness included residing outside of the capital, Kigali, as opposed to living in Kigali (adjusted odds ratio [aOR] 2.35, 95% confidence interval [CI] 1.40-3.97), being in the age groups 18-24 years (aOR 2.28, 95% CI: 1.03-5.01) or 25-29 years (aOR 3.06, 95% CI 1.35-6.93) compared to those aged 30 or older, having higher education levels, such as completing secondary education (aOR 1.76, 95% CI 1.01-3.06) or university education (aOR 2.65, 95% CI 1.18-5.96) in contrast to having no education. Lastly, perceiving a benefit from PrEP (aOR 9.52, 95% CI 4.27-21.22), and engaging in vaginal sex with a woman using a condom in the last 12 months (aOR 1.82, 95% CI 1.14-2.91) versus not. Impressively, 96% of participants expressed a strong willingness to use PrEP. Conclusion Among Rwandan MSM, there is a high level of awareness of PrEP, notably associated with factors such as residing outside Kigali, younger age, higher education, perceived benefits of PrEP and condom use during vaginal sex in the past year. Furthermore, a significant portion of participants demonstrated an intense desire to use PrEP, suggesting promising possibilities for its extensive implementation among this group of people. The findings from this study emphasize the importance of implementing highly focused awareness campaigns, personalized intervention, and comprehensive sexual health education programs in order to enhance the adoption of PrEP and bolster HIV prevention initiatives among the Rwandan population of MSM.
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Affiliation(s)
- Athanase Munyaneza
- Einstein-Rwanda Research and, Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Viraj V. Patel
- Division of General Internal Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Nataly Rios Gutierrez
- Division of General Internal Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Qiuhu Shi
- New York Medical College, Valhalla, New York, USA
| | - Benjamin Muhoza
- Einstein-Rwanda Research and, Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | - Gallican Kubwimana
- Einstein-Rwanda Research and, Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | - Jonathan Ross
- Division of General Internal Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Etienne Nsereko
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Gad Murenzi
- Einstein-Rwanda Research and, Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | - Laetitia Nyirazinyoye
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Leon Mutesa
- Einstein-Rwanda Research and, Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
- Center for Human Genetics, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Kathryn Anastos
- Division of General Internal Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
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12
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Knox J, Shiau S, Kutner B, Reddy V, Dolezal C, Sandfort TGM. Information, Motivation and Behavioral Skills as Mediators Between Sexual Minority Stigma and Condomless anal Sex Among Black South African Men Who have Sex with Men. AIDS Behav 2022; 27:1587-1599. [PMID: 36318425 PMCID: PMC10149565 DOI: 10.1007/s10461-022-03892-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
We assessed pathways between sexual minority stigma and condomless anal intercourse (CAI) among two samples of Black South African men who have sex with other men (MSM). Two cross-sectional surveys were conducted in Tshwane, South Africa; one among 199 Black MSM and another among 480 Black MSM. Men reported on external and internalized experiences of sexual minority stigma, mental health, alcohol use, information-motivation-behavioral skills (IMB) model constructs, and CAI. Structural equation modeling was used to test whether external and internalized stigma were directly and indirectly associated with CAI. In both studies, external stigma and internalized stigma were associated with CAI through IMB model constructs. These results suggest a pathway through which stigma contributes to HIV risk. For HIV prevention efforts to be effective, strengthening safer sex motivation and thus decreasing sexual risk behavior likely requires reducing sexual minority stigma that MSM experience and internalize.
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Affiliation(s)
- Justin Knox
- Department of Psychiatry, Columbia University, New York, US. .,HIV Center for Behavioral Studies, New York State Psychiatric Institute, New York, US. .,Department of Sociomedical Sciences, Columbia University, New York, US. .,, 722 West 168th street, 10032, New York, US.
| | - Stephanie Shiau
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Bryan Kutner
- Department of Psychiatry, Columbia University, New York, US.,HIV Center for Behavioral Studies, New York State Psychiatric Institute, New York, US
| | - Vasu Reddy
- Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Curtis Dolezal
- HIV Center for Behavioral Studies, New York State Psychiatric Institute, New York, US
| | - Theo G M Sandfort
- Department of Psychiatry, Columbia University, New York, US.,HIV Center for Behavioral Studies, New York State Psychiatric Institute, New York, US.,Department of Sociomedical Sciences, Columbia University, New York, US.,Faculty of Humanities, University of Pretoria, Pretoria, South Africa
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13
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Crandall A, Phaleng H, Dacus JD, Bista O, Brouard P, Nel D, Reddy V, Sandfort T, Knox J. The social and sexual lives of Black sexual minority men 30 years of age and older in South Africa. BMC Public Health 2022; 22:1923. [PMID: 36243701 PMCID: PMC9569126 DOI: 10.1186/s12889-022-14303-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background Black sexual minority men (SMM) ages 30 and older are under-represented in HIV studies in sub-Saharan Africa, despite being at increased risk of HIV infection and contributing to potential onward HIV transmission. To better understand the social and sexual lives of older Black South African SMM, we conducted in-depth interviews with SMM who were > 30 years old. Methods From March–September 2016, we recruited a convenience sample of 37 SMM ages 30 and older by partnering with an LGBTQ+ organization in Tshwane, Pretoria. Men were interviewed about various aspects of their lives, including their sexual orientation, social connectedness, experiences with stigma and perspectives on participating in research. Results Participants described their experiences with their sexual identities, cultural and social implications of disclosure, and their perspective on South Africa’s political perspectives on the LGBTQ+ community. Men described how these experiences influence their trust in research and comfort participating in studies. Conclusions Inferences drawn from these findings provide direction on how to improve middle-aged SMM’s representation in research, such as recruiting a higher proportion of older and middle-aged SMM to serve as seed participants and building stronger community partnerships to disseminate study findings to settings where data collection is conducted. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14303-5.
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Affiliation(s)
- Amy Crandall
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, NY, USA.
| | | | - Jagadīśa-Devaśrī Dacus
- Institute for Sexual and Gender Minority Health and Wellbeing at Northwestern University, Chicago, IL, USA
| | - Oshin Bista
- New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, New York, NY, USA
| | - Pierre Brouard
- Department of Sociology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Dawie Nel
- OUT LGBT Well-Being, Pretoria, South Africa
| | - Vasu Reddy
- Department of Sociology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Theo Sandfort
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, NY, USA.,New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, New York, NY, USA.,Department of Psychology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Justin Knox
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, NY, USA.,New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, New York, NY, USA.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
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14
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Tun W, Pulerwitz J, Shoyemi E, Fernandez A, Adeniran A, Ejiogu F, Sangowawa O, Granger K, Dirisu O, Adedimeji AA. A qualitative study of how stigma influences HIV services for transgender men and women in Nigeria. J Int AIDS Soc 2022; 25 Suppl 1:e25933. [PMID: 35818868 PMCID: PMC9274359 DOI: 10.1002/jia2.25933] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 05/05/2022] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Transgender men and women in Nigeria experience many barriers in accessing HIV prevention and treatment services, particularly given the environment of transphobia (including harassment, violence and discrimination) and punitive laws in the country. HIV epidemic control in Nigeria requires improving access to and quality of HIV services for key populations at high risk, including transgender men and women. We assessed how stigma influences HIV services for transgender people in Lagos, Nigeria. METHODS In-depth interviews (IDIs) and focus group discussions were conducted with transgender men (n = 13) and transgender women (n = 25); IDIs were conducted with community service organization (CSO) staff (n = 8) and healthcare providers from CSO clinics and public health facilities (n = 10) working with the transgender population in March 2021 in Lagos. Content analysis was used to identify how stigma influences transgender people's experiences with HIV services. RESULTS AND DISCUSSION Three main findings emerged. First, gender identity disclosure is challenging due to anticipated stigma experienced by transgender persons and fear of legal repercussions. Fear of being turned in to authorities was a major barrier to disclose to providers in facilities not affiliated with a transgender-inclusive clinic. Providers also reported difficulty in eliciting information about the client's gender identity. Second, respondents reported lack of sensitivity among providers about gender identity and conflation of transgender men with lesbian women and transgender women with being gay or men who have sex with men, the latter being more of a common occurrence. Transgender participants also reported feeling disrespected when providers were not sensitive to their pronoun of preference. Third, HIV services that are not transgender-inclusive and gender-affirming can reinforce stigma. Both transgender men and women spoke about experiencing stigma and being refused HIV services, especially in mainstream public health facilities, as opposed to transgender-inclusive CSO clinics. CONCLUSIONS This study highlights how stigma impedes access to appropriate HIV services for transgender men and women, which can have a negative impact along the HIV care continuum. There is a need for transgender-inclusive HIV services and competency trainings for healthcare providers so that transgender clients can receive appropriate and gender-affirming HIV services.
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Affiliation(s)
- Waimar Tun
- Social and Behavioral Science Research, Population Council, Washington, DC, USA
| | - Julie Pulerwitz
- Social and Behavioral Science Research, Population Council, Washington, DC, USA
| | | | | | | | | | | | - Krista Granger
- Social and Behavioral Science Research, Population Council, Washington, DC, USA
| | - Osasuyi Dirisu
- Policy Innovation Unit, Nigerian Economic Summit Group, Lagos, Nigeria
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15
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Dukers-Muijrers NHTM, Evers YJ, Hoebe CJPA, Wolffs PFG, de Vries HJC, Hoenderboom B, van der Sande MAB, Heijne J, Klausner JD, Hocking JS, van Bergen J. Controversies and evidence on Chlamydia testing and treatment in asymptomatic women and men who have sex with men: a narrative review. BMC Infect Dis 2022; 22:255. [PMID: 35287617 PMCID: PMC8922931 DOI: 10.1186/s12879-022-07171-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/03/2022] [Indexed: 11/19/2022] Open
Abstract
Background Chlamydia trachomatis (CT) is the most common bacterial sexually transmitted infection (STI) worldwide. CT is mainly asymptomatic. Test-and-treat strategies are widely implemented to prevent transmission and complications. Strategies are not without controversy in asymptomatic women and men who have sex with men (MSM). Concerns are emerging to test and treat asymptomatic persons for urogenital CT (‘Controversy 1’) and pharyngeal or rectal CT (‘Controversy 2’), whereby testing symptomatic persons is not under debate. Opposed views in CT treatment involve using azithromycin versus doxycycline (‘Controversy 3’). The objective of this review is to provide coverage of these public health and clinical controversies by reviewing the current scientific evidence. Methods A literature search was performed using PubMed for relevant publications between 2018 and September 2021, and iterative retrieval of additional relevant publications. Results Controversy 1. In women, the majority of asymptomatic CT are at the urogenital site, and detections mostly include viable CT. CT easily transmits to a partner and potentially also between the vaginal and rectal areas; the clinical impact of urogenital CT is established, although risks for adverse outcomes are uncertain. Wide-scale testing in asymptomatic women has not resulted in reduced prevalence. In MSM, evidence for the clinical impact of asymptomatic urogenital CT is lacking. Controversy 2. Rectal CT is common in women diagnosed with urogenital CT, but the clinical impact of asymptomatic rectal CT is uncertain. In MSM, rectal CT is common, and most CT infections are at the rectal site, yet the risk of longer term complications is unknown. In both sexes, pharyngeal CT is uncommon and has no documented clinical impact. Controversy 3. In the treatment of rectal CT, doxycycline has superior effectiveness to azithromycin. Evidence has also accumulated on the harms of test-and-treat strategies. Conclusions Current practices vary widely, from widescale test-and-treat approaches to more individual patient- and partner-level case management. Choosing which asymptomatic people to test at what anatomic site, and whether to test or not, requires an urgent (re-)definition of the goals of testing and treating asymptomatic persons. Treatment guidelines are shifting toward universal doxycycline use, and clinical practice now faces the challenge of implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07171-2. Test-and-treat is a key strategy in the control of Chlamydia trachomatis (CT). We discuss recent controversies and present scientific evidence regarding urogenital, rectal, and pharyngeal CT test-and-treat strategies in women and in men who have sex with men (MSM). This should inform best practices for the prevention and management of the most common bacterial sexually transmitted infection (STI) worldwide.
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Affiliation(s)
- Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, PO Box 33, 6400 AA, Heerlen, The Netherlands. .,Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
| | - Ymke J Evers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, PO Box 33, 6400 AA, Heerlen, The Netherlands.,Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, PO Box 33, 6400 AA, Heerlen, The Netherlands.,Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Petra F G Wolffs
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Henry J C de Vries
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Department of Infectious Diseases, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands.,Department of Dermatology, Amsterdam Infection & Immunity Institute (AII), Amsterdam University Medical Center (UMC), Amsterdam, The Netherlands
| | - Bernice Hoenderboom
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Institute for Public Health Genomics, Genetics & Cell Biology, Maastricht University, Faculty of Health and Medicine and Life Sciences, Maastricht, The Netherlands
| | - Marianne A B van der Sande
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Global Health, Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Janneke Heijne
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jeffrey D Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Jan van Bergen
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,STI AIDS Netherlands, Amsterdam, The Netherlands
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Sexual Prejudice and Comfort to Provide Services to Men Who Have Sex with Men Among HIV Healthcare Workers in Western Kenya: Role of Interpersonal Contact. AIDS Behav 2022; 26:805-813. [PMID: 34406550 DOI: 10.1007/s10461-021-03440-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
Sexual minority men living in Africa, where many countries criminalize same-sex behavior, are vulnerable to HIV and experience significant barriers to HIV care. Sexual prejudice in healthcare settings is a key contributor to these barriers. Building on social psychological models of prejudice and interpersonal contact at the clinic, we examined the associations between healthcare workers' sexual prejudice and their comfort to provide care to MSM, and assessed the moderating role of workers' prior interpersonal contact with MSM. A cross-sectional survey of 147 healthcare workers varying in level of training and expertise working in HIV care organizations was conducted in western Kenya. Sexual prejudice was negatively associated with comfort to provide care to MSM. Prior interpersonal contact with MSM moderated the association between sexual prejudice and comfort to provide care to MSM among nurses/counselors, such that those with low prior contact and high sexual prejudice were the most uncomfortable providing care to MSM. Interventions are needed to address sexual prejudice and encourage positive forms of interpersonal contact with MSM, especially with nurses and counselors who might have more and varied patient interactions, to improve access to the continuum of HIV prevention and care for MSM in Kenya.
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Siamisang K, Nkomo B, Kusi K, Kanyenvu D, Molefi M. High-risk behaviors and factors for HIV and sexually transmitted infections among transgender people in Gaborone, Botswana: results from a national survey. Pan Afr Med J 2022; 41:128. [PMID: 35480404 PMCID: PMC9011908 DOI: 10.11604/pamj.2022.41.128.32430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/25/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction key populations and transgender people in particular are at a high risk of HIV infection. However, very little is known about risk behaviors of transgender people in Botswana. The aim of this study was to determine the prevalence of high-risk behaviors for HIV and sexually transmitted infections (STIs) among transgender people in Botswana. Methods data from the Botswana 2017 Biological and Behavioral Surveillance Survey of HIV/STIs among select key populations (BBSS-2) was used. The cross sectional survey documented behavioral risk factors for these infections. This paper only focused on the analysis of the transgender data. Descriptive analysis was done with IBM Statistical Software for the Social Sciences (SPSS) version 24. Results there were 56 transgender people identified of which 12 (21.4%) were transgender women. The median age was 24 (interquartile range (IQR) 22-28). Among transgender women, 2 (16.7%) reported concurrent sexual partners and 9 (75%) reported condom use at last intercourse. However, only 7 (58.3%) reported consistent lubricant use. About 45% of the respondents did not know the HIV status of their last male partner. Only one of the transgender women reported intercourse with at least 1 female in the last month. About a third reported that they had STI symptoms in the past year. Alcohol use was reported in 50% of respondents while 83% had disclosed gender identity and had been accepted by their families. However, 25% reported discrimination by a healthcare worker. Conclusion the high-risk behaviors were frequent among transgender women. This study underlines the need for sustained efforts to reach this key population.
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Affiliation(s)
- Keatlaretse Siamisang
- Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana
- Department of Health Services Management, Ministry of Health and Wellness, Gaborone, Botswana
| | - Bornapate Nkomo
- Department of Health Services Management, Ministry of Health and Wellness, Gaborone, Botswana
| | - Kemmonye Kusi
- Department of Health Services Management, Ministry of Health and Wellness, Gaborone, Botswana
| | - Dorcus Kanyenvu
- Department of Health Services Management, Ministry of Health and Wellness, Gaborone, Botswana
| | - Mooketsi Molefi
- Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana
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Correction: HIV incidence in a multinational cohort of men and transgender women who have sex with men in sub-Saharan Africa: Findings from HPTN 075. PLoS One 2021; 16:e0249331. [PMID: 33760892 PMCID: PMC7990216 DOI: 10.1371/journal.pone.0249331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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