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Matos LA, Janek SE, Salas J, Munoz C, Relf MV, Gonzalez-Guarda R. Understanding sociocultural influences in sexual health promotion and HIV protection among Latinx sexually minoritized men: A qualitative study. PLoS One 2025; 20:e0318096. [PMID: 40267115 PMCID: PMC12017495 DOI: 10.1371/journal.pone.0318096] [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: 09/30/2024] [Accepted: 01/07/2025] [Indexed: 04/25/2025] Open
Abstract
In the United States, Latinx individuals account for 18% of the overall population, yet sexual minoritized men (SMM) within this demographic disproportionately represent 30% of new HIV diagnoses among all SMM. Despite the availability of highly effective HIV prevention strategies such as Pre- exposure Prophylaxis (PrEP), there are marked inequities in access and utilization of these strategies among Latinx SMM. Sociocultural factors and the experiences of Latinx SMM shape beliefs about sexual health promotion and influence HIV self-protective behavior (e.g., the correct and consistent use of condoms, regular engagement in HIV testing, and PrEP use) in this group. A descriptive, qualitative study, using thematic analysis, was designed to describe the sociocultural barriers and facilitators that influence sexual health promotion and HIV self-protection among Latinx SMM. A convenience sample of 15 Latinx SMM was recruited from an ongoing longitudinal study and online for individual interview, which were conducted virtually between October 2020 and October 2021. Five themes emerged from the data: 1) prevention is better than to cure; 2) cultural and religious norms create a culture of silence around sexual health; 3) lack of information and misinformation leading to self-reliance for sexual health protection; 4) growing wiser: maturity's impact on sexual health and relationships; and 5) unjust and dehumanizing sexual health care. The findings from this study highlighted that stigma and structural factors shape the opportunities of Latinx SMM to engage in sexual health promotion and HIV self-protection. These findings emphasize the need for focus on addressing structural barriers such as sexual health education, access to care, and healthcare provider bias to improve sexual health outcomes among Latinx SMM.
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Affiliation(s)
- Lisvel A. Matos
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Sarah E. Janek
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Jasmine Salas
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Caroline Munoz
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Michael V. Relf
- School of Nursing, Duke University, Durham, North Carolina, United States of America
- Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Rosa Gonzalez-Guarda
- School of Nursing, Duke University, Durham, North Carolina, United States of America
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Freestone J, Xiao BJ, Siefried KJ, Bourne A, Ezard N, Maher L, Stirling R, Degenhardt L, Varma R, Prestage G, Hammoud M. Exploring experiences of talk therapies among gay and bisexual men seeking to reduce or abstain from using crystal methamphetamine in the context of chemsex. Drug Alcohol Rev 2025; 44:711-722. [PMID: 39887811 PMCID: PMC11886541 DOI: 10.1111/dar.13999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 12/19/2024] [Accepted: 01/03/2025] [Indexed: 02/01/2025]
Abstract
INTRODUCTION Some gay and bisexual men who have sex with men (GBMSM) who use drugs to enhance sex (chemsex/party and play) may experience harms and seek talk therapies. GBMSM who practice chemsex may not access drug services because of anticipated stigma and the perception that these services lack chemsex expertise. Barriers to services are documented, however, little is known about the service experiences of chemsex engaged GBMSM. METHODS Semi-structured interviews were conducted with 24 participants reporting current practice of sexualised use of methamphetamine and/or gamma hydroxybutyrate. Interviews explored experiences of counselling and psychology services, participant's treatment goals and challenges. Data were transcribed verbatim and analysed in NVIVO14 with a qualitative description methodology. RESULTS Most in our study sought to reduce the frequency of methamphetamine use and used methamphetamine only in sexual contexts. When engaging with counsellors and psychologists in alcohol and other drug or mental health services for the general adult population, most censored the sexual drivers and types of sexual behaviours incumbent in their methamphetamine use. Participants' reliance on drugs for sex was spoken about as a major barrier to reducing methamphetamine. Sexual self-censorship within services inhibited participants' abilities to access meaningful support and achieve treatment goals. DISCUSSION AND CONCLUSIONS Counsellor and psychologists working with GBMSM around drug use, must ask about context of drug use and sex. Training and supervision around sexual therapies for those working alongside GBMSM who practice chemsex may be beneficial. Research on treatment approaches to support the sexual wellbeing of people who practice chemsex is required.
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Affiliation(s)
- Jack Freestone
- The Kirby InstituteUNSW SydneySydneyAustralia
- ACONSydneyAustralia
- National Centre for Clinical Research on Emerging DrugsSydneyAustralia
| | | | - Krista J. Siefried
- National Centre for Clinical Research on Emerging DrugsSydneyAustralia
- Alcohol and Drug Service, St Vincent's Hospital SydneySydneyAustralia
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
| | - Adam Bourne
- The Kirby InstituteUNSW SydneySydneyAustralia
- Australian Research Centre for Sex Health and Society, La TrobeMelbourneAustralia
| | - Nadine Ezard
- National Centre for Clinical Research on Emerging DrugsSydneyAustralia
- Alcohol and Drug Service, St Vincent's Hospital SydneySydneyAustralia
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
| | - Lisa Maher
- The Kirby InstituteUNSW SydneySydneyAustralia
- Burnett InstituteMelbourneAustralia
| | - Robert Stirling
- Network of Alcohol and Other Drug AgenciesSydneyAustralia
- Drug Policy Modelling ProgramUNSW SydneySydneyAustralia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
| | - Rick Varma
- The Kirby InstituteUNSW SydneySydneyAustralia
- Sydney Sexual Health CentreSydneyAustralia
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Jaramillo J, Chavez JV, Larson ME, Harkness A. Peer-Led Adjunctive Interventions for Increasing the Reach of HIV Prevention and Care Interventions to Latino/x/e Men Who Have Sex with Men: a Scoping Review. Curr HIV/AIDS Rep 2025; 22:12. [PMID: 39762489 PMCID: PMC11703934 DOI: 10.1007/s11904-024-00719-8] [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] [Accepted: 12/03/2024] [Indexed: 01/11/2025]
Abstract
PURPOSE OF REVIEW Latino/x/e men who have sex with men (LMSM) in the United States are disproportionately affected by HIV. Peer-led adjunctive interventions show promise for enhancing engagement in HIV prevention and care among LMSM, but their effectiveness and implementation remain underexplored. This scoping review aimed to map existing evidence on peer-led interventions, identify gaps, and inform future research for enhancing HIV prevention and care among LMSM. RECENT FINDINGS We followed PRISMA-ScR guidelines, covering literature from 2011 to 2022, using Covidence for systematic screening and data extraction. Articles were categorized by intervention aspects like delivery methods, outcomes, translational phases, theory-informed approaches, and cultural adaptation levels. The search yielded 613 records, with 22 meeting eligibility criteria, including 17 unique interventions. Interventions were delivered individually (57%), in groups (30%), to couples (4%), and via public campaigns (4%). Outcomes included HIV testing uptake (74%), treatment linkage (39%), PrEP uptake (22%), and PEP uptake (4%). Translational phases included formative (22%), pilot (26%), efficacy (22%), and effectiveness (22%). Cultural adaptations were surface (22%) and deep (13%). Findings indicate diverse peer-led interventions for LMSM, though many are in early stages of development. Further research is needed to move these interventions along the translational pathway to enhance their public health impact.
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Affiliation(s)
- Jahn Jaramillo
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jennifer V Chavez
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Michaela E Larson
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Audrey Harkness
- School of Nursing and Health Studies, University of Miami, 5030 Brunson Dr, Coral Gables, Miami, FL, 33146, USA.
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Jaramillo J, Maya DH, Safren SA, Harkness A. What makes peers credible? A qualitative analysis to operationalize peer credibility in HIV-prevention and treatment programs for Latino MSM. AIDS Care 2025; 37:132-140. [PMID: 39636786 PMCID: PMC11831892 DOI: 10.1080/09540121.2024.2437078] [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: 04/06/2024] [Accepted: 11/25/2024] [Indexed: 12/07/2024]
Abstract
The potential of peers to be effective in delivering HIV interventions is linked at least in part to the degree to which they are perceived as credible sources of HIV-related information. This study aimed to operationalize qualities that would make a LMSM peer implementer credible. We conducted a qualitative analysis of semi-structured interviews with 20 LMSM and focus groups with 11 HIV service implementers. The parent study collected formative data to inform the design of a strategy to enhance the reach of HIV prevention and treatment services to LMSM. The present study examined participant views on qualities necessary for peer implementers to establish credibility among LMSM. We identified five themes regarding peer credibility, including (1) Peers must be trained in HIV prevention and care, (2) Peers should be verified and have a special designation indicating their knowledge and trustworthiness, (3) Peers should convey accurate information and not spread misinformation, (4) Peers should be relatable and interpersonally skilled, and (5) Peers should be engaged with the general LGBTQ + community to generate trust and credibility. Findings can inform the development of acceptable peer strategies for LMSM, peer recruitment, training, and peer supervision.
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Affiliation(s)
- Jahn Jaramillo
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel H.A. Maya
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Audrey Harkness
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
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Jaramillo J, Reyes N, Atuluru P, Payen N, Taylor K, Safren SA, Saber R, Harkness A. Peer ambassador stories: formative qualitative research to enhance the reach of PrEP, HIV testing, and behavioral health treatments to LMSM in South Florida. AIDS Care 2024; 36:569-579. [PMID: 38157344 PMCID: PMC10932813 DOI: 10.1080/09540121.2023.2287736] [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: 03/31/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
Existing HIV prevention interventions, such as pre-exposure prophylaxis (PrEP), and behavioral health treatments inadequately reach Latino men who have sex with men (LMSM) in the US. This study involved formative research to inform the content, design, and implementation of a scalable, low resource implementation strategy - peer ambassador stories - stories from peers to normalize using PrEP, HIV testing, and behavioral health treatment. We conducted semi-structured interviews with 20 LMSM to elucidate their content, design, and implementation preferences for peer ambassador stories. Men were asked about story prompts, story contributor characteristics, story platform features, design preferences, and recommendations for enhancing the adoption and use of the peer ambassador technology platform among LMSM. Interviews were transcribed and analyzed via rapid qualitative analysis. Qualitative analyses identified 14 themes within 4 pre-specified domains. Collectively, the themes unified around the central concept that technology-delivered peer ambassador stories require a personalized, relational, culturally relevant touch to be acceptable and appropriate for LMSM. This study suggests that disseminating peer ambassador stories using electronic platforms and audio/video formats may enhance the reach of services and if they are personalized, relational, and culturally relevant. Findings have broad implications for informing other peer-based strategies to mitigate HIV disparities among LMSM.
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Affiliation(s)
- Jahn Jaramillo
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nequiel Reyes
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Pranusha Atuluru
- Department of Medicine, University of Miami, Miller School of Medicine, FL, USA
| | - Naomie Payen
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
| | - Kayla Taylor
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
| | | | - Rana Saber
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Audrey Harkness
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
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Noor MN, Shaw SY, Linton J, Lorway R. Research on the barriers to accessing sexual healthcare for sexually diverse Muslim men: protocol for a scoping review. BMJ Open 2024; 14:e077955. [PMID: 38326243 PMCID: PMC10860077 DOI: 10.1136/bmjopen-2023-077955] [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: 07/19/2023] [Accepted: 01/09/2024] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION Sexually diverse Muslim men are seen to be at a higher risk for HIV and other sexually transmitted infections due to their limited access to sexual healthcare services. We outline a protocol to conduct a scoping review of research on the barriers that may impede these men's access to sexual healthcare. METHODS AND ANALYSIS To conduct this scoping review, we will follow the methodological framework developed by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses' extension for scoping reviews. To classify the barriers to sexual healthcare, we will employ Bronfenbrenner's socioecological model as a conceptual framework. We will conduct a literature search via Medline, Embase and Global Health (OVID); Scopus; CINAHL on EBSCOhost along with several other EBSCOhost databases (Academic Search Complete, Canadian Reference Centre, Alternative Press Index, Family & Society Studies Worldwide, Social Work Abstracts) and Google Scholar, published until November 2023. Journal articles, published in the English language, describing quantitative and qualitative research on sexual healthcare access barriers for sexually diverse Muslim men will be included in the review. Commentaries and correspondences, along with grey literature including research reports and conference abstracts, as well as studies that do not include men with the Muslim faith, will be considered ineligible. Following screening of titles and abstracts, we will conduct a full-text screening to determine the final number of studies to be included in the review. A Microsoft Excel spreadsheet will be used to extract study characteristics, and information on sexual healthcare access barriers will be classified according to the socioecological model's core concepts. ETHICS AND DISSEMINATION Our review does not require ethics approval. We will disseminate the review findings through peer-reviewed academic journals, seminars and conference presentations.
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Affiliation(s)
| | - Souradet Y Shaw
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Janice Linton
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert Lorway
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Norman T, Power J, Clifton B, Murray J, Bourne A. People living with HIV who inject or have injected non-prescription drugs: Evidence of substantial differences in health inequalities and experiences of clinical care. Drug Alcohol Rev 2023; 42:1517-1528. [PMID: 37171154 DOI: 10.1111/dar.13681] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION This study investigates differences in health and well-being associated with current, past or no injecting drug use (IDU) among people living with HIV (PLHIV) in Australia, identifying key health care considerations between injecting experiences. METHODS Data were extracted from the HIV Futures 9 study; a survey of PLHIV conducted in 2018-2019. Chi-square and analysis of variance analyses compared clinical and treatment characteristics, major physical and mental comorbidities, sexually transmitted infection diagnoses, and quality of life for those who reported current (last 12 months), past (12+ months ago) or no IDU. RESULTS Current IDU (n = 106) was associated with higher rates of sexually transmitted infection testing and diagnoses, higher frequency of self-reported antiretroviral therapy non-adherence due to drug use and greater social quality of life than past (n = 126) or no IDU (n = 508; total N = 740). Past and current IDUs were associated with more mental illness diagnoses and self-reported concern about drug use. Past IDU was associated with more physical comorbidities, lower satisfaction with clinical care and greater difficulty in affording health care than current or no IDU. DISCUSSION AND CONCLUSIONS Past and current IDUs are associated with unique health concerns. However, past IDU appears to be related to greater dissatisfaction in navigating health care than individuals with current IDU experience. Higher social connection and the types of services being accessed by individuals who currently inject may play a role in shaping service satisfaction. Peer-based interventions to help support individuals in accessing services that are affirming of their needs is an ongoing priority.
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Affiliation(s)
- Thomas Norman
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Jennifer Power
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Brent Clifton
- National Association of People with HIV Australia, Sydney, Australia
| | - Joel Murray
- National Association of People with HIV Australia, Sydney, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- Kirby Institute, UNSW Sydney, Sydney, Australia
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