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Toledo LDSG, Almeida AIS, Bastos FI. Mapping projects for expanding rapid HIV testing in key populations, Brazil, 2004-2021. CAD SAUDE PUBLICA 2024; 40:e00182323. [PMID: 38775573 PMCID: PMC11105351 DOI: 10.1590/0102-311xen182323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 05/25/2024] Open
Abstract
The HIV/AIDS epidemic remains a persistent and real issue, especially in key populations such as men who have sex with men (MSM), travestis and transgender persons. Projects for expanding rapid HIV testing are strategic initiatives aimed at the earliest possible identification of individuals' serological status and thus early treatment, screening of sex partners, and upscaling of preventive actions to interrupt the transmission chain. This study thus maps, describes, and systematizes the projects for expanding rapid HIV testing implemented from 2004 to 2021 in Brazil, highlighting the on-going contribution of civil society organizations and discussing the interoperability and cooperation resulting from public governance processes. We selected 67 documents for analysis, including 30 scientific publications retrieved from electronic databases and 37 documents produced by government institutions and nongovernmental organizations (NGOs). Find Out (Fique Sabendo), I Want to Get Tested (Quero Fazer), The Time is Now (A Hora É Agora), Live Better Knowing (Viva Melhor Sabendo), and Live Better Knowing Young (Viva Melhor Sabendo Jovem) were the projects mapped. Results show that the projects have used strategies adapted to the key population, such as mobile testing units, peer education, and innovative community engagement approaches. Such actions were enabled by effective cooperation and interoperability between participating stakeholders, especially NGOs.
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Affiliation(s)
| | | | - Francisco Inácio Bastos
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Wong HY, Rajasuriar R, Wong PL, Lee YK. "I suppose in our culture, old means no sex": PLWH and healthcare provider views on factors influencing late HIV testing and diagnosis among older adults in Malaysia. AIDS Care 2024:1-15. [PMID: 38526987 DOI: 10.1080/09540121.2024.2331220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/08/2024] [Indexed: 03/27/2024]
Abstract
The proportion of new HIV diagnoses among older adults aged ≥50 years continues to rise. Older adults are at higher risk of late diagnosis which is associated with higher treatment complexity and poorer health outcomes. Few studies in the Asia-Pacific region have explored factors contributing to late presentation and diagnosis in this population. Thus, our study aimed to explore factors influencing late HIV diagnosis among older adults ≥50 years in Malaysia. We conducted in-depth interviews with 16 older adults newly diagnosed with HIV (OPLWH) and focus group discussions with seven healthcare providers (HCPs) from different specialties in an academic tertiary hospital in Malaysia. All sessions were audio-recorded, transcribed verbatim and analysed thematically. Three main themes related to late diagnosis among OPLWH emerged: (1) challenge in recognizing HIV symptoms among older persons, (2) older persons and HCPs having low index of suspicion of HIV and (3) poor acceptance of HIV testing among older persons due to perceived personal and social identities. HCPs often missed HIV symptoms and these collectively culminated in OPLWH experiencing complex diagnostic journeys resulting in late HIV diagnosis. To reduce delays in HIV diagnosis, strategies are needed to improve HIV knowledge and risk perception among both older adults and HCPs.
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Affiliation(s)
- Hoi Yee Wong
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Reena Rajasuriar
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Pui Li Wong
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yew Kong Lee
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Campbell GE, Johnson LW. Decision-Making for HIV AIDS Prevention: Altruism and the Moral Norm. JOURNAL OF HOMOSEXUALITY 2024; 71:1099-1135. [PMID: 36625553 DOI: 10.1080/00918369.2022.2161084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The purpose of this enquiry was to understand how gay men form and maintain their attitudes toward HIV transmission preventative behaviors. Autobiographical life histories of sixteen gay men showed that once they acquired knowledge of preventative behavior they consistently adhered to that behavior. They adhered because of fear of HIV infection and because they held a moral norm that obligated them to behave altruistically (Schwartz, 1977) to protect not only themselves, but also their sex partners, loved ones, and their positive self-evaluation. They saw their HIV negative status, and their adherence, as pre-requisite and enabler for achieving their goals in life. Dick and Basu's (1994) Framework for Customer Loyalty, a commercial marketing communications theoretical framework, explains development and maintenance of these men's loyalty (their consistent adherence). This understanding, within a marketing communications framework, will inform development of social marketing communications aiming to increase adherence to behaviors that prevent HIV transmission.
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Affiliation(s)
- Gordon E Campbell
- Swinburne Business School, Swinburne University of Technology, Hawthorn, Australia
| | - Lester W Johnson
- Swinburne Business School, Swinburne University of Technology, Hawthorn, Australia
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Siegel K, Cabán M, Brown-Bradley CJ, Schrimshaw EW. Condomless Anal Sex Between Male Sex Workers and Clients in the Age of Hookup Apps. AIDS Behav 2024; 28:1077-1092. [PMID: 38036795 PMCID: PMC11336491 DOI: 10.1007/s10461-023-04216-8] [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: 10/14/2023] [Indexed: 12/02/2023]
Abstract
Among men who have sex with men (MSM), those who also engage in the exchange of sex for money, drugs, shelter or other material goods (i.e., male sex workers-MSWs) have been found to have higher rates of condomless anal sex (CAS), HIV, and STIs than MSM who do not engage in exchange sex. To gain a better understanding of the factors that influence MSWs' engagement in CAS with male clients, we analyzed qualitative interview data from a diverse sample of 141 MSWs from 8 U.S. cities who met clients primarily through hookup or dating apps/websites and who reported having condomless anal sex with at least one of their exchange sex partners in the prior three months. While high client demand and financial incentives were the most frequently mentioned reasons for engaging in CAS with clients, other factors including drug and alcohol use, attraction to the client, the heat of the moment, concerns about sexual performance, and reliance on pre-exposure prophylaxis (PrEP) were also important. Participants who engaged in CAS generally felt that due to client characteristics or mitigating steps they had taken themselves, their chance of acquiring HIV/STIs was acceptably low. Hookup or dating apps/websites have provided an additional and increasingly popular venue for exchange sex to be arranged. These platforms also offer an opportunity for HIV/STI prevention through interventions and tailored messages delivered through these venues that address the motivations, misconceptions and/or situational factors that may lead to CAS.
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Affiliation(s)
- Karolynn Siegel
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - María Cabán
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Courtney J Brown-Bradley
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Eric W Schrimshaw
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL, USA
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5
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Hart TA, Noor SW, Tavangar F, Zahran A, Skakoon-Sparling S, Tan DHS, Lambert G, Grace D, Lachowsky N, Sang JM, Palma PA, Zhang T, Dvorakova M, Cox J, Moore DM. Human Immunodeficiency Virus Treatment Attitudes and Bacterial Sexually Transmitted Infections Among Gay and Bisexual Men. Sex Transm Dis 2024; 51:178-185. [PMID: 38412464 DOI: 10.1097/olq.0000000000001915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUNDS Positive attitudes toward human immunodeficiency virus (HIV) treatment, such as reduced concern about HIV transmissibility, are associated with sexual behaviors that may increase the risk of bacterial sexually transmitted infections (STIs) among gay, bisexual, and other men who have sex with men (GBM). We examined associations between HIV treatment attitudes and bacterial STI diagnoses among GBM in Canada's three largest cities. METHODS We fit a structural equation model between HIV treatment attitudes and bacterial STI diagnoses via sexual behaviors in the Engage study's baseline data. We estimated direct and indirect paths between scores on HIV treatment attitudes and STIs via number of male anal sex partners, condomless anal sex, and oral sex. We conducted sub-analyses with participants stratified by HIV serostatus. RESULTS Among 2449 GBM recruited in 2017 to 2019, there was a direct association between HIV treatment attitudes and current STI diagnoses (β = 0.13; 95% CI, 0.07-0.19; P < 0.001). The mediated model revealed a positive total indirect effect through 2 pathways: (1) engaging in condomless anal sex and (2) number of male anal sex partners and condomless anal sex. These 2 indirect pathways remained in the stratified mediation models for both HIV negative GBM and for GBM living with HIV. CONCLUSIONS The association between HIV treatment attitudes and diagnosed STIs is mediated through a higher number of male anal sex partners and condomless anal sex. The results highlight the importance of providers educating patients when providing effective STI counseling, testing, and prevention for GBM about how accurate HIV treatment attitudes may inadvertently be associated with the bacterial STI epidemic.
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Affiliation(s)
| | | | | | - Adhm Zahran
- From the Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | | | | | | | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Jordan M Sang
- Community-Based Research Centre, Vancouver, BC, Canada
| | - Paolo A Palma
- From the Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Terri Zhang
- From the Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Milada Dvorakova
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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Zhao X, Kadono M, Kranzler EC, Pavisic I, Miles S, Maher M, Strausser L, Cai X, Hoffman L. Message Fatigue and COVID-19 Vaccine Booster Uptake in the United States. JOURNAL OF HEALTH COMMUNICATION 2024; 29:61-71. [PMID: 37962284 DOI: 10.1080/10810730.2023.2282036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Dissemination of public health information plays an essential role in communicable disease control and prevention. However, widespread and repeated messaging could become counterproductive if it leads to avoidance and disengagement due to message fatigue. Americans have been inundated with accurate and inaccurate COVID-19 information from myriad sources since the start of the pandemic. Using the health belief model (HBM) as a guiding framework, this study examines COVID-19-related message fatigue among adults in the United States who have gotten at least one dose of a COVID-19 vaccine and the association between message fatigue and COVID-19 booster uptake and intentions. A special survey module of The COVID States Project was fielded between August and September 2022 (n = 16,546). Results showed moderately high levels of message fatigue among vaccinated individuals. Message fatigue was negatively associated with the likelihood of having gotten a COVID-19 booster and intentions to do so among those who had not yet received a booster, above and beyond variance explained by the HBM constructs. These findings underscore the importance of monitoring and mitigating COVID-19-related message fatigue in encouraging the public to stay up to date with COVID-19 vaccination.
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Affiliation(s)
- Xiaoquan Zhao
- Department of Communication, George Mason University, Fairfax, Virginia, USA
| | - Mika Kadono
- Communication Campaign Research & Evaluation, Fors Marsh, Arlington, Virginia, USA
| | - Elissa C Kranzler
- Communication Campaign Research & Evaluation, Fors Marsh, Arlington, Virginia, USA
| | - Ivica Pavisic
- Communication Campaign Research & Evaluation, Fors Marsh, Arlington, Virginia, USA
| | - Stephanie Miles
- Communication Campaign Research & Evaluation, Fors Marsh, Arlington, Virginia, USA
| | - Marcus Maher
- Advanced Analytics, Fors Marsh, Arlington, Virginia, USA
| | - Lindsey Strausser
- Communication Campaign Research & Evaluation, Fors Marsh, Arlington, Virginia, USA
| | - Xiaomei Cai
- Department of Communication, George Mason University, Fairfax, Virginia, USA
| | - Leah Hoffman
- Communication Campaign Research & Evaluation, Fors Marsh, Arlington, Virginia, USA
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Troutman J, Robillard A, Ingram LA, Qiao S, Gaddist B, Segosebe K. Individual, Social, and Structural Vulnerability for Black Women in the South: Implications for PrEP. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:290-308. [PMID: 37535327 DOI: 10.1521/aeap.2023.35.4.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention option, yet adoption among Black women, who are disproportionately impacted by HIV, is low. A nuanced understanding of the multi-level factors that contribute to elevated risk is necessary to better contextualize PrEP uptake. Qualitative data from Black women residing in the Southern U.S. who self-screened as HIV-negative, were collected via four focus groups (N = 27) to understand influences on HIV vulnerability and the potential role of PrEP in mitigating risk. Content analysis of transcribed data yielded multiple themes addressing: the pervasiveness of sexual partner sharing; lack of transparency regarding HIV status, disclosure, and testing; and social/cultural influences on HIV risk. Experiences with the health care system and providers were of particular concern. Findings demonstrate support for PrEP in this population and contribute to our understanding of individual, social, and structural factors to better inform PrEP promotion.
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Affiliation(s)
- Jamie Troutman
- Quality Comprehensive Health Center, Charlotte, North Carolina
| | - Alyssa Robillard
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Lucy Annang Ingram
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Shan Qiao
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | | | - Kebafe Segosebe
- Edson College of Nursing and Health Innovation, Arizona State University
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Yu Z, Zhang TT, Wang X, Chang Q, Huang H, Zhang H, Song D, Yu M, Yang J, Liu Y, Li C, Cui Z, Ma J. Sexual behaviour changes and HIV infection among men who have sex with men: evidence from an open cohort in China. BMJ Open 2022; 12:e055046. [PMID: 36171031 PMCID: PMC9528664 DOI: 10.1136/bmjopen-2021-055046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The HIV epidemic in key populations such as men who have sex with men (MSM) is a public health issue of worldwide concern. China has seen an increase in newly diagnosed HIV infections through male-male sexual contact in the past decade. In a long-term cohort, how the complex behaviour pattern of MSM changed and the association with the HIV risk are unclear at present. METHODS This study was conducted from October 2011 to December 2019 in Tianjin. MSM were recruited by snowball sampling through online and offline ways. Demographic and sexual behavioural data were collected for analysis. Three indicators (condom use in last anal sex, frequency of condom use during anal sex and the number of sexual partners) were used to define the behaviour change. Participants with zero, one, and two or three risk indicators were categorised into behaviour types of 'protective', 'moderate', and 'fragile', respectively. Change in behaviour type between baseline and each visit was considered. Time-varying Cox models were performed to evaluate HIV infection risk. RESULTS Of 2029 MSM included in the study, 127 were new HIV diagnoses. The overall incidence rate was 3.36 per 100 person-years. The percentage of 'protective' and 'moderate' behaviour types had a conspicuous growth trend as the follow-up. Furthermore, the HIV incidence rate in each visit among different behaviour transition types showed a general downward trend as the number of total follow-up times increased. Individuals who remained in 'fragile' (adjusted HR (aHR): 25.86, 95% CI: 6.92 to 96.57) or changed from 'protective' to 'moderate' (aHR: 4.79, 95% CI: 1.18 to 19.47), 'protective' to 'fragile' (aHR: 23.03, 95% CI: 6.02 to 88.13), and 'moderate' to 'fragile' (aHR: 25.48, 95% CI: 6.79 to 95.40) between baseline and the last follow-up had a higher HIV risk. Gained risk indicators were associated with the increase of HIV risk (gained one indicator, aHR: 2.67, 95% CI: 1.68 to 4.24; gained two or three indicators, aHR: 4.99, 95% CI: 3.00 to 8.31) while losing just one risk indicator could halve the risk (aHR: 0.43, 95% CI: 0.21 to 0.90). CONCLUSIONS Among MSM in Tianjin, it is necessary to get timely behaviour change for those with high-incidence behaviour patterns while sustaining for those with low-incidence patterns. TRIAL REGISTRATION NUMBER Chinese Clinical Trials Registry (ChiCTR2000039500).
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Affiliation(s)
- Zeyang Yu
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Tian-Tian Zhang
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Xiaomeng Wang
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Qinxue Chang
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Huijie Huang
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Honglu Zhang
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Desheng Song
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Maohe Yu
- STD & AIDS Control and Prevention Section, Tianjin Centers for Disease Control and Prevention, No. 6 Huayue Road, Hedong District, Tianjin, China
| | - Jie Yang
- Tianjin Shenlan Community-Based Organization, No. 43, Shuimu Tiancheng Tuanjie Ring Road, Hongqiao District, Tianjin, China
| | - Yuanyuan Liu
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Changping Li
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Zhuang Cui
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Jun Ma
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
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Liu Y, Fu G, Chen Y, Wu L, Pan M, Yang Y, Chen Z, Cao Y, Li Y, Wang H, Wang B, Lv C, Du R, Xiong Y, Liu W, Xu N, Xia X, Li Q, Ruan F, Wang J. Discordance between perceived risk and actual risky sexual behaviors among undergraduate university students in mainland China: a cross-sectional study. BMC Public Health 2022; 22:729. [PMID: 35413860 PMCID: PMC9006618 DOI: 10.1186/s12889-022-13132-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV prevention, diagnosis, treatment and care services might be hampered by inaccurate risk assessment. This study aimed to investigate the extent of and factors associated with the discordance between perceived risk and actual risky sexual behaviors among undergraduates in mainland China, guided by the Anderson's behavioral model. METHODS This study involved a secondary analysis of cross-sectional data collected during the fall semester of 2018-2019 academic year. The present analysis was restricted to 8808 undergraduates with low risk perception. Those who had low perceived risk but actually engaged in risky sexual behaviors were categorized as risk discordance (RD). Univariate and multivariate Logistic regression analyses were conducted to identify factors associated with RD. RESULTS Overall, the discordance rate between perceived and actual risk was 8.5% (95% CI: 7.9%-9.1%). Multivariate Logistic regression analysis indicated that non-heterosexual women (AOR = 0.41, 95% CI:0.27-0.60), heterosexual men (AOR = 0.45, 95% CI:0.33-0.61) and women (AOR = 0.26, 95% CI:0.19-0.35) were less likely to exhibit RD, when compared with non- heterosexual men. Furthermore, non-freshmen (AOR = 1.57, 95% CI:1.30-1.90), early initiators of sexual intercourse (AOR = 5.82, 95% CI:4.10-8.26), and those who had lower levels of HIV knowledge (AOR = 1.28, 95% CI:1.08-1.51), displayed higher levels of stigma against PLHIV (AOR = 1.50, 95% CI:1.26-1.77) and had ever been tested for HIV (AOR = 1.36, 95% CI:1.04-1.77) were more prone to reporting RD. Those with more enabling resources [i.e., displaying high levels of condom use self-efficacy (AOR = 0.70, 95% CI:0.59-0.84) and being knowledge of local testing center (AOR = 0.71, 95% CI:0.60-0.83)] were less likely to report RD. However, spending more than 2000 Yuan a month on basic needs (AOR = 2.55, 95% CI:2.07-3.14), residing in urban areas (AOR = 1.35, 95% CI:1.15-1.59) and being knowledgeable of the national AIDS policy (AOR = 1.40,95% CI:1.18-1.66) increased the chance of exhibiting RD. CONCLUSIONS Comprehensive interventions, including targeting students with high-risk characteristics, improving the acceptability of PrEP and PEP, conducting health education, enhancing self-efficacy for using condoms and making opt-out HIV testing routine in college campus, should be taken to reduce the discordance between perceived and actual HIV risk and finally to reach the goal of Zero AIDS.
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Affiliation(s)
- Yusi Liu
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Guochen Fu
- National Demonstration Center for Experimental General Medicine Education of Hubei University of Science and Technology, Xianning City, China
| | - Yifan Chen
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Lei Wu
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Mingliang Pan
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Yuli Yang
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Zhuo Chen
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Yu Cao
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Yong Li
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Hao Wang
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Bixiang Wang
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Chengcheng Lv
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Ruyi Du
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Yanting Xiong
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Wei Liu
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Nuo Xu
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Xiaobao Xia
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Qianqian Li
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Fang Ruan
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Junfang Wang
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China.
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Villa-Rueda AA, Onofre-Rodríguez DJ, Colina JADDL, Churchill S, Mendoza-Catalán G. “¿Por qué pasa esto? Porque vivimos en una sociedad que constantemente te dice que no eres mujer”: género y riesgo del VIH en mujeres trans del noreste mexicano. CAD SAUDE PUBLICA 2022. [DOI: 10.1590/0102-311x00266920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Las mujeres trans enfrentan un riesgo desproporcionado de adquirir el VIH. Este estudio analiza cualitativamente el riesgo del VIH en mujeres trans mexicanas desde el género como estructura social. Se trata de un estudio cualitativo realizado en el noreste de México. Se hicieron 15 entrevistas a mujeres trans de entre 22 y 69 años y se realizó un análisis temático. El análisis de las entrevistas reveló tres categorías temáticas: construcciones sociales del VIH y estigma, el género y el VIH en las relaciones interpersonales, y el género y el VIH en las instituciones y la política. Los resultados muestran que las construcciones sociales del VIH se tejen en el colectivo, a partir de la interacción con otras mujeres trans. El VIH es un fenómeno atravesado por la temporalidad sociohistórica y, en ese sentido, se generan las percepciones de riesgo frente a él. El género como estructura de opresión se vincula con las experiencias de estigma y discriminación, así como la búsqueda de la legitimación del género a través de las relaciones con parejas sexuales. Las instituciones y la política pública se relacionan con el acceso a los servicios de salud, además se identifican y analizan las barreras institucionales, personales y colectivas a partir de la identidad de género. La política sostiene y refuerza la marginalización de las mujeres trans impactando en el riesgo del VIH. Los resultados muestran que el riesgo del VIH es un fenómeno multicausal basado en el género como estructura de opresión con implicaciones sistémicas.
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Dennermalm N, Persson KI, Thomsen S, Forsberg BC, Alvesson HM. Conceptualizing safer sex in a new era: Risk perception and decision-making process among highly sexually active men who have sex with men. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000159. [PMID: 36962224 PMCID: PMC10022342 DOI: 10.1371/journal.pgph.0000159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 04/06/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) are at the epicenter of the HIV epidemic. Efforts to prevent sexually transmitted infections (STIs) and HIV transmission have traditionally focused on condoms and abstinence from high risk sexual practices. Recently, additional methods such as pre-exposure prophylaxis (PrEP) and viral load sorting have been introduced. The aim of this study was to gain understanding about risk management and risk perception strategies for HIV among highly sexually active Swedish MSM with men in Berlin. METHODS Eighteen sexually active Swedish MSM who travelled to or lived in Berlin were recruited and interviewed in this study. The data were analyzed using content analysis. RESULTS AND DISCUSSION These men represent a group of knowledgeable MSM in terms of HIV. They acknowledged that having sex with men in Berlin was linked to high sexual risk taking due to the higher prevalence of HIV/STIs than in Sweden, but reported that they nevertheless did not alter their risk management strategies. The analysis resulted in a conceptual model of risk assessment that allows for a deeper understanding of the complexity of the risk reduction decision-making process. Three ontological perceptions of risk were identified: accepting, minimizing and rejecting risk. Seven practiced risk reduction methods were described. Some informants applied their preferred method or set of methods to all settings and partners, while others faced complex decision-making processes. CONCLUSION HIV is integrated into the core of MSM's sexuality, independently of how they ontologically related to the idea of risk. A constant navigation between pleasure, risk and safety, alongside having to relate to risk created a complex process. Efforts were made to remove HIV from their lives by rejecting the idea of risk, and thereby reject the idea of the homosexual body being a possible vessel for a virus and an epidemic.
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Affiliation(s)
- Nicklas Dennermalm
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | | | - Sarah Thomsen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Birger C Forsberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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12
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Eaton LA, Watson RJ, Maksut JL, Rucinski KB, Earnshaw VA, Berman M. Elevated Perceived Risk for HIV as a Barrier to Accessing Health Care Among Black Men Who Have Sex with Men. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 21:917-925. [PMID: 32504393 DOI: 10.1007/s11121-020-01135-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We sought to examine how self-perception of risk for HIV and HIV status information avoidance are related to HIV testing uptake and engagement in routine health care among Black men who have sex with men (BMSM)-the group at highest risk for HIV in the USA. To do so, we used generalized linear modeling and serial mediation modeling to assess data from 342 HIV-negative BMSM collected from 2017 to 2019 in Atlanta, GA, USA. Participants reported considerable concern for testing HIV-positive; 40% reported believing they would test positive for HIV; 27% reported being "extremely concerned about getting HIV"; and 17% reported worrying about HIV "all the time". Mediation analyses demonstrated that greater concern for HIV was associated with longer intervals since the last HIV test and the last health-care appointment. BMSM perceived themselves to be at considerable risk for HIV, but critically, this outlook did not yield improved health-care behaviors. Findings highlight the need to reconceptualize our public health approach to reaching BMSM. Emphasizing risk behavior and targeting efforts toward BMSM may have unintended consequences and need to be reevaluated. Despite continued efforts to improve HIV-related outcomes, we are failing to meet the needs of BMSM.
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Affiliation(s)
- Lisa A Eaton
- Institute for Collaboration on Health, Intervention, and Policy University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06269-1248, USA
| | - Ryan J Watson
- Institute for Collaboration on Health, Intervention, and Policy University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06269-1248, USA.
| | - Jessica L Maksut
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Katherine B Rucinski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Valerie A Earnshaw
- Human Development and Family Sciences, University of Delaware, 240 Academy St, Newark, DE, 19716, USA
| | - Marcie Berman
- Institute for Collaboration on Health, Intervention, and Policy University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06269-1248, USA
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13
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Robles G, Sauermilch D, Gandhi M, Starks TJ. PrEP Demonstration Project Showed Superior Adherence with Tenofovir Alafenamide/Emtricitabine Compared to Tenofovir Disoproxil Fumarate/Emtricitabine in a Sample of Partnered Sexual Minority Men. AIDS Behav 2021; 25:1299-1305. [PMID: 33206262 PMCID: PMC7979438 DOI: 10.1007/s10461-020-03095-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 01/17/2023]
Abstract
Sexual minority men (SMM) remain at high risk of HIV infection in the United States, and for those in relationships, dyadic functioning may contextualize prevention decisions. Pre-exposure prophylaxis (PrEP) for HIV prevention was previously limited to tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) until the FDA approved tenofovir alafenamide/FTC (TAF/FTC) for PrEP in 2019. Data regarding substance use, sexual behavior, holding an active PrEP prescription, and type of PrEP regimen (TDF/FTC versus TAF/FTC) were analyzed from a sample of 421 partnered SMM. The majority of the sample on PrEP reported a TDF/FTC prescription as opposed to TAF/FTC. However, SMM reported significantly better adherence to TAF/FTC than TDF/FTC in multivariable models. Novelty of TAF/FTC, treatment fatigue with TDF/FTC, and/or a belief in TAF/FTC's superior efficacy and mitigated side effects may be plausible contributing factors. More studies using objective adherence metrics and surveys are needed.
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14
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Resnick D, Morales K, Gross R, Petsis D, Fiore D, Davis-Vogel A, Metzger D, Frank I, Wood S. Prior Sexually Transmitted Infection and Human Immunodeficiency Virus Risk Perception in a Diverse At-Risk Population of Men Who Have Sex with Men and Transgender Individuals. AIDS Patient Care STDS 2021; 35:15-22. [PMID: 33400589 DOI: 10.1089/apc.2020.0179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Prior sexually transmitted infections (STIs) are associated with higher rates of subsequent human immunodeficiency virus (HIV) infection, but the influence of prior STIs on perceived vulnerability to HIV remains unclear. We aimed to assess this relationship, hypothesizing that a prior STI diagnosis is associated with higher self-assessed vulnerability to HIV. We performed a cross-sectional study of men and transgender individuals who have sex with men screening for HIV prevention trials in Philadelphia. An unadjusted regression analysis found no significant association between prior STI and HIV risk perception (p = 0.71) or HIV anxiety (p = 0.32). Multivariate logistic regression models that controlled for predetermined potential cofounders known to impact HIV risk-such as condom use, preexposure prophylaxis use, and demographics-also failed to show statistically significant associations between prior STI and HIV risk perception (p = 0.87) or HIV anxiety (p = 0.10). Furthermore, there was no effect modification by HIV preventive behaviors on the relationship between prior STI and HIV vulnerability. These data suggest that a gap exists between how clinicians may attribute individual HIV risk and how individuals view their own vulnerability at a given moment in time. Future research should focus on the dynamic relationship between perceived HIV vulnerability, STI diagnosis, and adoption of preventive behavior to determine better, individualized targets for HIV prevention interventions.
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Affiliation(s)
- Daniel Resnick
- HIV Research Prevention Division, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Knashawn Morales
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Robert Gross
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Danielle Petsis
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Danielle Fiore
- HIV Research Prevention Division, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Annet Davis-Vogel
- HIV Research Prevention Division, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - David Metzger
- HIV Research Prevention Division, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ian Frank
- HIV Research Prevention Division, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sarah Wood
- HIV Research Prevention Division, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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15
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Fujimoto K, Wang P, Li DH, Kuhns LM, Amith M, Schneider JA. Collective Avoidance of Social and Health Venues and HIV Racial Inequities: Network Modeling of Venue Avoidance on Venue Affiliation, Social Networks, and HIV Risk. HEALTH EDUCATION & BEHAVIOR 2020; 47:202-212. [PMID: 32090656 DOI: 10.1177/1090198119876240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many younger Black men who have sex with men (YBMSM) are exposed to homonegativity, societal stigma, and racial discrimination in their social environment. This study uses a social network modeling methodology to identify aspects of the social environment that are not often described, that is, the places and spaces or "venues" where YBMSM socialize or where they receive HIV prevention services. In particular, we identify the structural features of avoidance of these venues as an indicator of negative experiences, using bipartite exponential random graph models. Our study theorizes that YBMSM avoid certain venues en masse through information diffusion among social network members. We specify two social mechanisms of collective venue avoidance-(1) homophily (i.e., ego-alter similarity in venue avoidance) and (2) popular opinion leaders (as early adopters)-and test the corresponding hypotheses that (Hypothesis 1) socially connected individuals avoid venues together and that (Hypothesis 2) popular individuals would be more likely to avoid venues. Based on data collected from YBMSM aged 16 to 29 years between 2014 and 2016 in Houston, Texas (N = 227) and Chicago, Illinois (N = 241), results indicate that Hypothesis 1 was supported in both cities but that Hypothesis 2 was supported only in Chicago. The findings suggest that the structural patterns of venue avoidance are different between cities and may inform dissemination of prevention messages and delivery of venue- and social influence-based HIV interventions.
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Affiliation(s)
- Kayo Fujimoto
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Peng Wang
- Swinburne University of Technology, Hawthorn, Victoria, Australia
| | | | - Lisa M Kuhns
- Northwestern University, Chicago, IL, USA.,Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Muhammad Amith
- The University of Texas Health Science Center at Houston, Houston, TX, USA
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16
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Li DH, Newcomb M, Macapagal K, Remble T, Mustanski B. Condom-Associated Erectile Function, But Not Other Domains of Sexual Functioning, Predicts Condomless Insertive Anal Sex Among Young Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:161-174. [PMID: 31980999 PMCID: PMC7018619 DOI: 10.1007/s10508-020-01642-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/10/2020] [Accepted: 01/11/2020] [Indexed: 05/09/2023]
Abstract
Condoms effectively prevent against HIV, especially when used in conjunction with biomedical strategies such as PrEP and viral suppression. However, consistent use of condoms in the real world has been a continual health promotion challenge, even among populations at highest risk, such as young men who have sex with men (YMSM). Inconsistent condom use may be related to poor sexual functioning, but limited research exists. The analytic sample comprised 688 racially diverse YMSM aged 16-29 (M = 22.9 years) living in Chicago, IL (19.2% living with HIV). Using multivariable logistic regression, we examined longitudinal associations between condom-associated sexual functioning (erectile function, orgasm satisfaction, global satisfaction, and anal discomfort) and condomless insertive anal sex (CIAS) and condomless receptive anal sex (CRAS) 6 months later. CIAS at Time 2 was associated with condom-associated erectile function at the bivariate and multivariable levels, even after controlling for CIAS at Time 1 (p < .05). Condom-associated erectile function, orgasm satisfaction, and global satisfaction predicted Time 2 CRAS in bivariate models, but none remained significant in the multivariable models. Age, having had a serious partner in the past 6 months, and HIV/PrEP status at Time 2 were significant predictors of CIAS/CRAS in some but not all models. Future interventions to improve consistent condom use should specifically highlight information and skills on how to use condoms within real-world contexts rather than from a clinical perspective. Our results also support the importance of biomedical strategies for those who have continued problems with sexual functioning when using condoms.
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Affiliation(s)
- Dennis H Li
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., Suite 1400, Chicago, IL, 60611, USA.
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Michael Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kathryn Macapagal
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Thomas Remble
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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17
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Kahle EM, Suarez N, Sharma A, Sullivan S, Stephenson R. Threat and impact of HIV compared to other health conditions among an online sample of gay, bisexual and other men who have sex with men in the U.S. AIDS Care 2019; 32:608-615. [PMID: 31167542 DOI: 10.1080/09540121.2019.1626341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Gay, bisexual and other men who have sex with men (GBMSM) experience greater health disparities, and concern about other health conditions may decrease engagement in HIV prevention. This study assessed perceived threat and impact of HIV relative to other health concerns among GBMSM. Data were from a national online survey of GBMSM conducted between August and September 2015. Participants ranked concern about contracting HIV and impact of HIV on their health compared with other health conditions. The association of HIV threat and impact with recent condomless anal sex (CAS) and HIV testing were assessed using regression models. Among 466 participants, threat and impact of HIV were ranked lower compared to cancer, Alzheimer's and heart disease. Concern about getting HIV was associated with greater odds of recent HIV testing (adjOR 1.1, 95%CI 1.02-1.18) and lower CAS (adjOR 0.86, 95%CI 0.78-0.94). Among GBMSM, other health conditions may be perceived as a greater threat and higher impact on health compared with HIV. Integrating complex health care concerns with HIV prevention strategies may increase engagement in prevention.
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Affiliation(s)
- Erin M Kahle
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas Suarez
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Akshay Sharma
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Stephen Sullivan
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
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18
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Beach LB, Greene GJ, Lindeman P, Johnson AK, Adames CN, Thomann M, Washington PC, Phillips G. Barriers and Facilitators to Seeking HIV Services in Chicago Among Young Men Who Have Sex with Men: Perspectives of HIV Service Providers. AIDS Patient Care STDS 2018; 32:468-476. [PMID: 30398956 DOI: 10.1089/apc.2018.0094] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Young men who have sex with men (YMSM) are disproportionally impacted by HIV, and continue to lag behind other age groups in the receipt of HIV prevention and care services. To inform the development of interventions to improve pre-exposure prophylaxis and HIV care engagement outcomes among YMSM, a growing number of studies have reported the barriers and facilitators YMSM encounter when accessing HIV services. Few studies, however, have assessed how HIV service providers perceive these facilitators and barriers. In total, 21 interviews were conducted with HIV service providers in Chicago about barriers and facilitators they perceived affected YMSM's engagement in HIV services. Barriers included lack of comprehensive wraparound services, lack of trust of providers, unfamiliarity with seeking HIV services, feelings of invincibility, lack of knowledge of HIV service providers, intersectional and structural concerns (e.g., not thinking the site's services were for YMSM), geography and distance to clinic, and HIV stigma. Facilitators included presence of comprehensive wraparound services, high trust in providers, a clinic's willingness to serve uninsured patients, community engagement, word-of-mouth recommendations from lesbian, gay, bisexual, and transgender (LGBT) friends, intersectionality (e.g., offering LGBT-tailored services), geography and distance, lack of HIV stigma. Axial coding revealed that five conceptual themes cut across multiple barriers and facilitators, including health system characteristics, intersectionality, geography and transportation, community outreach, and stigma. These conceptual themes map closely onto Bronfenbrenner's ecological model. Overall, these findings highlight the importance of a multi-level approach to future intervention development to increase engagement in HIV services among YMSM.
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Affiliation(s)
- Lauren B. Beach
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Evaluation, Data Integration, and Technical (EDIT) Assistance Program, Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, Illinois
| | - George J. Greene
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Evaluation, Data Integration, and Technical (EDIT) Assistance Program, Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, Illinois
| | - Peter Lindeman
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Evaluation, Data Integration, and Technical (EDIT) Assistance Program, Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, Illinois
| | - Amy K. Johnson
- Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
- AIDS Foundation of Chicago, Chicago, Illinois
| | - Christian N. Adames
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Evaluation, Data Integration, and Technical (EDIT) Assistance Program, Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, Illinois
| | - Matthew Thomann
- Department of Anthropology and Sociology, Kalamazoo College, Kalamazoo, Michigan
| | - Patrick C.T. Washington
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Sociology, University of Illinois at Chicago, Chicago, Illinois
| | - Gregory Phillips
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Evaluation, Data Integration, and Technical (EDIT) Assistance Program, Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, Illinois
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19
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Discordance of Self-report and Laboratory Measures of HIV Viral Load Among Young Men Who Have Sex with Men and Transgender Women in Chicago: Implications for Epidemiology, Care, and Prevention. AIDS Behav 2018; 22:2360-2367. [PMID: 29637386 DOI: 10.1007/s10461-018-2112-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Suppressing HIV viral load through daily antiretroviral therapy (ART) substantially reduces the risk of HIV transmission, however, the potential population impact of treatment as prevention (TasP) is mitigated due to challenges with sustained care engagement and ART adherence. For an undetectable viral load (VL) to inform decision making about transmission risk, individuals must be able to accurately classify their VL as detectable or undetectable. Participants were 205 HIV-infected young men who have sex with men (YMSM) and transgender women (TGW) from a large cohort study in the Chicago area. Analyses examined correspondence among self-reported undetectable VL, study-specific VL, and most recent medical record VL. Among HIV-positive YMSM/TGW, 54% had an undetectable VL (< 200 copies/mL) via study-specific laboratory testing. Concordance between self-report and medical record VL values was 80% and between self-report and study-specific laboratory testing was 73%; 34% of participants with a detectable study-specific VL self-reported an undetectable VL at last medical visit, and another 28% reported not knowing their VL status. Periods of lapsed viral suppression between medical visits may represent a particular risk for the TasP strategy among YMSM/TGW. Strategies for frequent viral load monitoring, that are not burdensome to patients, may be necessary to optimize TasP.
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20
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Colyer SP, Lachowsky NJ, Cui Z, Zhu J, Armstrong HL, Taylor M, Edward J, Olarewaju G, Hogg RS, Roth EA, Moore DM. HIV treatment optimism and crystal methamphetamine use and initiation among HIV-negative men who have sex with men in Vancouver, Canada: A longitudinal analysis. Drug Alcohol Depend 2018; 185:67-74. [PMID: 29427917 PMCID: PMC5889742 DOI: 10.1016/j.drugalcdep.2017.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 12/15/2017] [Accepted: 12/19/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Treatment as Prevention (TasP) leading to increased HIV treatment optimism among men who have sex with men (MSM) has been previously associated with behavioural risk compensation, though not yet via crystal methamphetamine (CM) use. Among HIV-negative MSM in a TasP environment, this study aimed to investigate the prevalence of recent CM use over time, examine the association between HIV treatment optimism and CM use and initiation, and identify correlates of recent CM use and predictors of CM initiation. METHODS Using data from a prospective behavioural cohort study of sexually active MSM in the Vancouver area, we used multi-level generalized mixed effect models to evaluate temporal trends in CM use, univariable and multivariable logistic regression to identify covariates of recent CM use, and univariable and multivariable survival analysis to identify predictors of CM initiation. RESULTS Of 497 HIV-negative cohort participants, 10.3% reported any recent CM use at enrollment. From 2012-2016, there were no statistically significant temporal trends in overall CM use or with routes of administration. In multivariable logistic regression analyses, HIV treatment optimism was not associated with recent CM use (not retained in final model) or CM initiation (aHR = 1.06, 95% CI:0.98-1.15). Significant correlates of CM use include recent gamma-hydroxybutyrate (GHB) and ecstasy use, and having received/given drugs for sex. CONCLUSIONS Among HIV-negative MSM in Vancouver, HIV treatment optimism does not appear to be independently associated with CM use or initiation of use, though use of CM was both prevalent and stable over time.
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Affiliation(s)
- Sean P. Colyer
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Nathan J. Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada,School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Zishan Cui
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Julia Zhu
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Heather L. Armstrong
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | | | | | | | - Robert S. Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada,Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Eric A. Roth
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - David M. Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
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21
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Zhou N, Bauermeister J, Guo W, Yu M, Yang J, Zheng M, Guo Y, Gong H, Gao Y, Jiang G. Condomless Anal Intercourse by Partner Type Among Chinese Men Who Have Sex With Men in Tianjin. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:63-71. [PMID: 29481303 DOI: 10.1521/aeap.2018.30.1.63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
HIV prevalence and incidence is high among men who have sex with men (MSM) in China, underscoring the need to support and optimize HIV risk reduction strategies for this population. We sought to estimate the prevalence of condomless anal sex among MSM living in Tianjin, China. We recruited 595 HIV-negative MSM living in Tianjin to participate in a HIV study between 2013 and 2014. Data were collected after a voluntary counseling and testing session through a face-to-face survey. We used multivariable logistic regressions to examine the association between sociodemographic characteristics and HIV risk correlates and MSM's likelihood of engaging in condomless anal intercourse with main and casual partners in the prior 6 months. Results are presented. HIV risk reduction efforts should be developed to be sensitive and responsive to the unique experiences of Chinese MSM. We discuss opportunities for future work, including the development HIV risk reduction interventions.
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Affiliation(s)
- Ning Zhou
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | | | - Wei Guo
- National Centre for AIDS/STD Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Maohe Yu
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Jie Yang
- Tianjin Dark Blue Working Group, Tianjin, China
| | - Minna Zheng
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Yan Guo
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Hui Gong
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Yongjun Gao
- Tianjin Hongqiao District Center for Disease Control and Prevention, Tianjin, China
| | - Gueohong Jiang
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
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