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Thomas D, Nakabugo L, Nambi F, Kibuuka J, Muwonge TR, Feutz E, Thomas KK, Simoni JM, Montgomery ET, Ware N, Wyatt MA, Katz IT, Kadama H, Mujugira A, Heffron R. Intimate Partner Violence and Adherence to PrEP and ART Among Ugandan HIV Serodifferent Couples. J Acquir Immune Defic Syndr 2024; 95:347-354. [PMID: 38133584 PMCID: PMC10896193 DOI: 10.1097/qai.0000000000003368] [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: 05/31/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Intimate partner violence (IPV) is associated with increased risk of HIV acquisition and reduced engagement in HIV care. There is limited understanding of the ways in which IPV exposure and other maladaptive relationship dynamics may influence adherence to antiretroviral treatment (ART) and pre-exposure prophylaxis (PrEP) for individuals in committed, HIV serodifferent partnerships. METHODS We used binomial generalized linear mixed-effect regression models to evaluate the association between IPV exposure and ART/PrEP adherence among members of serodifferent couples in Uganda. Secondarily, we assessed the association between relationship powerlessness and ART/PrEP adherence. RESULTS We enrolled and followed both partners in 149 heterosexual serodifferent couples. The partner living with HIV was female in 64% of couples. IPV exposure was associated with low ART adherence (15% vs. 5% in quarters with no IPV, odds ratio: 4.78, 95% confidence interval: 1.48 to 15.42), but not low PrEP adherence (33% vs. 36%, P = 0.69). Among HIV-negative individuals, those reporting moderate relationship powerlessness were less likely to have poor PrEP adherence compared with those with low relationship powerlessness (20% vs. 30%, odds ratio: 0.57, 95% confidence interval: 0.36 to 0.90). We observed no association between relationship powerlessness and ART adherence. CONCLUSIONS We found that IPV exposure was associated with low adherence to ART and that relationship powerlessness was associated with good adherence to PrEP. These findings contribute to the evidence base outlining the influence of IPV and relationship power on ART/PrEP adherence for individuals in HIV serodifferent unions.
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Affiliation(s)
- Dorothy Thomas
- Department of Global Health, University of Washington, Seattle, WA
| | | | - Florence Nambi
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Joseph Kibuuka
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Erika Feutz
- Department of Global Health, University of Washington, Seattle, WA
| | | | - Jane M. Simoni
- Department of Global Health, University of Washington, Seattle, WA
- Department of Psychology, University of Washington, Seattle, WA
| | - Elizabeth T. Montgomery
- Women's Global Health Imperative, RTI International, Berkeley, CA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Norma Ware
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | - Monique A. Wyatt
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
- Harvard Global, Cambridge, MA
| | | | | | - Andrew Mujugira
- Department of Global Health, University of Washington, Seattle, WA
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Renee Heffron
- Department of Global Health, University of Washington, Seattle, WA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; and
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Keddem S, Frye V, Davis A, Koblin BA, Tieu HV, Lipsky RK, Nandi V, Teitelman AM. The Moderating Effects of HIV Relevant Factors on the Relationship Between Intimate Partner Violence and Intention to Start HIV Pre-exposure Prophylaxis (PrEP) Among Cisgender Women. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1531-1539. [PMID: 38366311 DOI: 10.1007/s10508-024-02812-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 12/19/2023] [Accepted: 01/10/2024] [Indexed: 02/18/2024]
Abstract
Intimate partner violence (IPV) and HIV are serious and related public health problems that detrimentally impact women's health. Because women who experience IPV are more likely to acquire HIV, it is critical to promote HIV prevention strategies, such as HIV pre-exposure prophylaxis (PrEP), that increase autonomy. This study of cisgender women eligible for HIV PrEP took place between 2017 and 2019 in Philadelphia and New York City. This study aimed to examine the relationship between four types of IPV (control, psychological, physical, sexual) and intention to start PrEP among PrEP-eligible cisgender women and assess the extent to which HIV relevant factors moderated the association between IPV experience and intention to start PrEP. In this sample of PrEP-eligible women (n = 214), 68.7% indicated intention to start PrEP in the next 3 months. Ethnicity was strongly associated with intention to start PrEP, with Hispanic women having the highest odds of intending to start PrEP in the next 3 months. Having a controlling partner significantly predicted intention to start PrEP. Women with more than one sex partner and a controlling partner had higher odds of intending to start PrEP as compared with those who had one or no partners and had no IPV control. These findings point to a need for patient-centered interventions that address the need for safety and autonomy among cisgender, PrEP-eligible women.
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Affiliation(s)
- Shimrit Keddem
- Center for Health Equity Research & Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, 19104, USA.
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Victoria Frye
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, USA
| | - Annet Davis
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
| | - Rachele K Lipsky
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- School of Nursing, Duke University, Durham, NC, USA
| | - Vijay Nandi
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
| | - Anne M Teitelman
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Thomas Jefferson University College of Nursing, Philadelphia, PA, USA
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3
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Zack JL, Hull SJ, Coleman ME, Ye PP, Lotke PS, Visconti A, Beverley J, Brant A, Moriarty P, Scott RK. Age-related factors associated with intention to initiate pre-exposure prophylaxis among cisgender women in Washington D.C. Ther Adv Infect Dis 2024; 11:20499361241252351. [PMID: 38751758 PMCID: PMC11095193 DOI: 10.1177/20499361241252351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) utilization among cisgender women (subsequently 'women') is low across age groups, relative to their risk of HIV acquisition. We hypothesize that age-related differences in psychosocial factors also influence women's intention to initiate oral PrEP in Washington, D.C. Methods A secondary analysis of a cross-sectional survey data was performed to evaluate factors influencing intention to initiate oral PrEP among women seen at a family planning and a sexual health clinic. A bivariate analysis was performed to identify differences by age group in demographic characteristics, indications for PrEP, and attitudes toward PrEP; we then performed additional bivariate analysis to assess these variables in relation to PrEP intention. Results Across age groups, perceived risk of HIV acquisition was not significantly different and was not associated with intention to initiate PrEP. Awareness of and attitude toward PrEP, injunctive norms, descriptive norms, and self-efficacy were not different across age, however there were significant age-associated differences in relation to PrEP intention. Specifically, among 18-24-year-olds, intention to start PrEP was associated with support from provider (p = 0.03), main sexual partner (p < 0.01), and peers (p < 0.01). For women 25-34 years old, having multiple sexual partners (p = 0.03) and support from casual sexual partners (p = 0.03) was also important. Among women 35-44 years old, prior awareness of PrEP (p = 0.02) and their children's support of PrEP uptake (p < 0.01) were associated with intention to initiate PrEP. Among 45-55 year-old women intention to initiate PrEP was positively associated with engaging in casual sex (p = 0.03) and negatively associated with stigma (p < 0.01). Conclusion Overall, there were more similarities than differences in factors influencing intention to initiate PrEP across age groups. Observed differences offer an opportunity to tailor PrEP delivery and HIV prevention interventions to increase awareness and uptake for cisgender women.
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Affiliation(s)
- Jennifer L. Zack
- Georgetown University School of Medicine, 3900 Reservoir Rd NW, Washington, DC 20007, USA
| | - Shawnika J. Hull
- Department of Communication, Rutgers University, New Brunswick, NJ, USA
| | - Megan E. Coleman
- Whitman-Walker Health, Department of Clinical Investigations, Washington, DC, USA
| | - Peggy Peng Ye
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Health, Washington, DC, USA
| | - Pamela S. Lotke
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Health, Washington, DC, USA
| | - Adam Visconti
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Georgetown University Hospital, Department of Family Medicine, Washington, DC, USA
| | - Jason Beverley
- DC Health, DC Department of Health: HIV/AIDS, Hepatitis, STD & TB Administration (HAHSTA), Washington, DC, USA
| | - Ashley Brant
- Cleveland Clinic Foundation, Women’s Health Institute, Cleveland, OH, USA
| | - Patricia Moriarty
- MedStar Health Research Institute, Clinical Research, Hyattsville, MD, USA
| | - Rachel K. Scott
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Health, Washington, DC, USA
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Sternberg CA, Daniel EV, Marcelin D, Chery MJ, Maddy K, Richard D, Thomas T, Ravix J, Warner J, Titus M, Francois A, Borick J, Feaster DJ, Doblecki-Lewis S, Jones DL, Alcaide ML, Dale SK. Bon Sante (Good Health): Factors Influencing PrEP Use Among Haitians/Haitian Americans. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01834-9. [PMID: 38019373 DOI: 10.1007/s40615-023-01834-9] [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: 06/02/2023] [Revised: 09/22/2023] [Accepted: 10/09/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND The HIV/AIDS epidemic has disproportionately affected Black individuals in the USA, and this health disparity has increased over time. Despite the effectiveness of pre-exposure prophylaxis (PrEP) as a prevention tool for HIV, there are disparities in its use, and uptake of this intervention remains low among racial and ethnic minorities, including Haitians/Haitian Americans. In this study, factors influencing PrEP use among Haitians/Haitian Americans in Miami, FL, are explored to provide necessary data to address disparities. METHODS The research team collaborated with local organizations to recruit 30 individuals (Haitians/Haitian Americans) between February 4 and October 1, 2021, and conducted semi-structured interviews. All interviews were audio-recorded and transcribed, and NVivo® was used to analyze the transcripts for emergent themes. RESULTS The study sample comprised 30 adults of Haitian descent in Miami, FL (50% female, approximately 67% with a high school education or more, mean age = 43.7 ± 13 years, and 74.2% born in Haiti). Four primary themes emerged from the analysis: (1) limited PrEP awareness, (2) underutilization of PrEP, (3) inadequate discussion of HIV prevention strategies, and (4) PrEP delivery encompassing barriers and facilitators for PrEP delivery and promotion strategies. CONCLUSION This study indicated that there is a critical need to increase Haitians/Haitian Americans' knowledge regarding PrEP. Health communication interventions tailored specifically for Haitians/Haitian Americans that target stigma, attitudes toward HIV, and risk perception may be significant in increasing PrEP in this population.
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Affiliation(s)
- Candice A Sternberg
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street #858, Miami, FL, 33136, USA.
| | - E Valerie Daniel
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Dora Marcelin
- Department of Obstetrics and Gynecology, University of Miami, Miami, FL, USA
| | - Maurice Junior Chery
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Krisna Maddy
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Danelle Richard
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tanya Thomas
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jovanka Ravix
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua Warner
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Micaelle Titus
- Community Health and Empowerment Network, Miami, FL, USA
| | | | - Joseph Borick
- Miami Veteran's Affairs Medical Center, Miami, FL, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Deborah L Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria L Alcaide
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Obstetrics and Gynecology, University of Miami, Miami, FL, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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Rugira E, Biracyaza E, Umubyeyi A. Uptake and Persistence on HIV Pre-Exposure Prophylaxis Among Female Sex Workers and Men Having Sex with Men in Kigali, Rwanda: A Retrospective Cross-Sectional Study Design. Patient Prefer Adherence 2023; 17:2353-2364. [PMID: 37790862 PMCID: PMC10542111 DOI: 10.2147/ppa.s427021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/15/2023] [Indexed: 10/05/2023] Open
Abstract
Background Although HIV pre-exposure prophylaxis (PrEP) is known for its effectiveness in preventing HIV transmission; there is a global rise in HIV infection rates, particularly prominent in sub-Saharan Africa. This health concern is mostly evident among high-risk groups, namely Female Sex Workers (FSWs) and Men who have Sex with Men (MSMs), both of whom are more susceptible to sexually transmissible infections. This research examined the persistence, uptake, and associated predictors of PrEP utilization within the FSW and MSM populations. Methods A cross-sectional study design was conducted involving 4872 individuals from the FSW and MSM groups who were enrolled in a PrEP program across 10 health centers participating in a pilot initiative. The study population was subject to a year-long follow-up period commencing on March 1st, 2019. To evaluate the determinants of PrEP utilization within FSW and MSM groups, bivariate logistic analyses and multivariate logistic regression models were employed. Results The findings revealed that the occurrence of PrEP uptake was 45.55% (n=2219) among FSWs and 35.42% (n=17 participants) among MSM. Regarding PrEP persistence, MSM (88.24%, n=15 participants) presented higher PrEP proportion than FSWs (78.5%, n=1742 women). Our findings disclosed that individuals aged 25-34 years (aOR=0.82; 95% CI=0.72-0.93, p=0.002), 35-44 years (aOR=0.83; 95% CI=0.71-0.97, p=0.017), and 55 years and older (OR=0.14; 95% CI=0.04-0.48, p=0.002) exhibited lower likelihoods of having low PrEP uptake than those aged 15-19 years. Moreover, individuals residing with their families (aOR=0.71; 95% CI=0.58-0.87, p<0.001), living with roommates (aOR=0.7; 95% CI=0.5-0.97, p=0.032) displayed lower odds for experiencing low PrEP uptake than their counterparts living alone. Conclusion This study highlighted the low uptake of PrEP among participants when compared to previous studies. These results revealed significant influences of age and living conditions on PrEP usage.
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Affiliation(s)
- Eugene Rugira
- Department of Epidemiologuy and Biostatistics, School of Public Health, University of Rwanda, Kigali, Rwanda
| | - Emmanuel Biracyaza
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), Montreal, Canada
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Aline Umubyeyi
- Department of Epidemiologuy and Biostatistics, School of Public Health, University of Rwanda, Kigali, Rwanda
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Scott RK, Hull SJ, Huang JC, Ye PP, Lotke P, Beverley J, Moriarty P, Balaji D, Ward A, Holiday J, Brant AR, Elion R, Visconti AJ, Coleman M. Intention to Initiate HIV Pre-exposure Prophylaxis Among Cisgender Women in a High HIV Prevalence U.S. City. Womens Health Issues 2023; 33:541-550. [PMID: 37479630 PMCID: PMC10552685 DOI: 10.1016/j.whi.2023.05.009] [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: 10/27/2022] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE Our objective was to identify the individual, interpersonal, community, health-system, and structural factors that influence HIV pre-exposure prophylaxis (PrEP) initiation among cisgender women seeking sexual and reproductive health care in a high HIV prevalence community to inform future clinic-based PrEP interventions. METHODS We collected anonymous, tablet-based questionnaires from a convenience sample of cisgender women in family planning and sexual health clinics in the District of Columbia. The survey used the lens of the socio-ecological model to measure individual, interpersonal, community, institutional, and structural factors surrounding intention to initiate PrEP. The survey queried demographics, behavioral exposure to HIV, perceived risk of HIV acquisition, a priori awareness of PrEP, intention to initiate PrEP, and factors influencing intention to initiate PrEP. RESULTS A total of 1437 cisgender women completed the survey. By socio-ecological level, intention to initiate PrEP was associated with positive attitudes toward PrEP (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.13-2.15) and higher self-efficacy (OR, 1.32; 95% CI, 1.02-1.72) on the individual level, perceived future utilization of PrEP among peers and low fear of shame/stigma (OR, 1.65; 95% CI, 1.33-2.04) on the community level, and having discussed PrEP with a provider (OR. 2.39; 95% CI, 1.20-4.75) on the institutional level. CONCLUSION Our findings highlight the importance of multilevel, clinic-based interventions for cisgender women, which promote sex-positive and preventive PrEP messaging, peer navigation to destigmatize PrEP, and education and support for women's health medical providers in the provision of PrEP services for cisgender women.
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Affiliation(s)
- Rachel K Scott
- MedStar Health Research Institute, Hyattsville, Maryland; MedStar Washington Hospital Center, Washington, District of Columbia.
| | - Shawnika J Hull
- Rutgers University, Department of Communications, New Brunswick, New Jersey
| | - Jim C Huang
- Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Peggy P Ye
- MedStar Washington Hospital Center, Washington, District of Columbia
| | - Pamela Lotke
- MedStar Washington Hospital Center, Washington, District of Columbia
| | | | | | | | - Allison Ward
- MedStar Health Research Institute, Hyattsville, Maryland; MedStar Washington Hospital Center, Washington, District of Columbia
| | | | - Ashley R Brant
- MedStar Health Research Institute, Hyattsville, Maryland
| | - Rick Elion
- DC Health, Washington, District of Columbia
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Scott RK, Deyarmond M, Marwitz S, Huang JC, Moriarty P, Visconti AJ, Beverley J, Elion R, Coleman M, Hull SJ. Implementation of an Educational Intervention to Improve HIV Pre-Exposure Prophylaxis Services for Women in an Urban Sexual Health Clinic. AIDS Patient Care STDS 2023; 37:447-457. [PMID: 37713289 PMCID: PMC10623070 DOI: 10.1089/apc.2023.0107] [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: 09/17/2023] Open
Abstract
To test the hypothesis that implementation of a multicomponent, educational HIV pre-exposure prophylaxis (PrEP) intervention to promote universal PrEP services for cisgender women (subsequently "women") in sexual and reproductive health centers would improve the proportion of women screened, offered, and prescribed PrEP, we implemented a multicomponent, educational intervention in a Washington D.C. Department of Health-sponsored sexual health clinic. The clinic serves a patient population with high-potential exposure to HIV. The intervention included clinic-wide PrEP trainings, an electronic health record prompt for PrEP counseling by providers, and educational videos in the waiting room. We collected preimplementation data from March 22, 2018 to July 4, 2018, including 331 clinical encounters for 329 women. Between July 5, 2018 and July 1, 2019, there were 1733 clinical encounters for 1720 HIV-negative women. We used mixed methods to systematically assess intervention implementation using the Reach Effectiveness Adoption Implementation Maintenance framework. Additionally, we assessed the interventions' acceptability and feasibility among providers through semistructured interviews. The proportion of women screened by providers for PrEP (5.6% preimplementation to a mean of 89.2% of women during the implementation period, p < 0.01), offered (6.2 to 69.8%, p < 0.01), and prescribed PrEP (2.6 to 8.1%, p < 0.01) by providers increased significantly in the implementation period. Providers and clinic staff found the intervention both highly feasible and acceptable and demonstrated increased knowledge of PrEP and HIV prevention associated with the clinic-wide trainings. Our results demonstrate the effectiveness of a low-cost educational intervention to increase provision of integrated PrEP services in an urban sexual health clinic serving women with high-potential exposure to HIV. ClinicalTrials.gov ID NCT03705663.
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Affiliation(s)
- Rachel K. Scott
- Department of Women's and Infants' Services, MedStar Washington Hospital Center, Division of Women's Health Research, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Megan Deyarmond
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Shannon Marwitz
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Jim C. Huang
- Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Patricia Moriarty
- Division of Women's Health Research, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Adam J. Visconti
- HIV/AIDS, Hepatitis, STD and TB Administration, DC Health, Washington, District of Columbia, USA
| | - Jason Beverley
- HIV/AIDS, Hepatitis, STD and TB Administration, DC Health, Washington, District of Columbia, USA
| | - Rick Elion
- HIV/AIDS, Hepatitis, STD and TB Administration, DC Health, Washington, District of Columbia, USA
| | - Megan Coleman
- Whitman Walker Health, Washington, District of Columbia, USA
| | - Shawnika J. Hull
- Department of Prevention and Community Medicine, George Washington University, Washington, District of Columbia, USA
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O'Malley TL, Krier SE, Bainbridge M, Hawk ME, Egan JE, Burke JG. Women's perspectives on barriers to potential PrEP uptake for HIV prevention: HIV risk assessment, relationship dynamics and stigma. CULTURE, HEALTH & SEXUALITY 2023; 25:776-790. [PMID: 35839305 DOI: 10.1080/13691058.2022.2099016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 07/04/2022] [Indexed: 06/02/2023]
Abstract
HIV remains a significant health issue for women, and multiple overlapping factors shape women's HIV-related risk. Pre-exposure prophylaxis (PrEP) offers critical advantages over other existing options, yet it remains significantly underused among women in the USA where limited work has explored women's opinions on barriers to potential PrEP use. Using open-ended text responses from a sample of women seeking care at a US urban family planning health centre, this study aimed to understand perceptions of factors affecting potential PrEP use. Three themes concerning key factors impacting potential PrEP use emerged: HIV risk assessment, relationship dynamics, and anticipated stigma. Women's assessment of HIV risk suggests that identifying women in clinical settings as having low self-perceived risk may overlook the complexity of how women determine HIV-related risk and prevention needs. Women frequently referenced relationship dynamics when considering PrEP and discussed anticipated partner reactions about use contributing to non-use. Fear or worry of stigma were expressed as motivations to not use PrEP. Study results highlight the importance of public health and health care professionals normalising PrEP as a strategy in women's HIV prevention and sexual health decision-making. Woman-centred PrEP education, screening and communication strategies reflective of their unique HIV-related risk context are needed.
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Affiliation(s)
- Teagen L O'Malley
- Department of Infectious Diseases and Microbiology, School of Public Heath, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah E Krier
- Department of Infectious Diseases and Microbiology, School of Public Heath, University of Pittsburgh, Pittsburgh, PA, USA
| | - Maura Bainbridge
- Department of Infectious Diseases and Microbiology, School of Public Heath, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary E Hawk
- Department of Behavioral and Community Health Sciences, School of Public Heath, University of Pittsburgh, Pittsburgh, PA, USA
| | - James E Egan
- Department of Behavioral and Community Health Sciences, School of Public Heath, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica G Burke
- Department of Behavioral and Community Health Sciences, School of Public Heath, University of Pittsburgh, Pittsburgh, PA, USA
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Ramraj T, Chirinda W, Jonas K, Govindasamy D, Jama N, McClinton Appollis T, Zani B, Mukumbang FC, Basera W, Hlongwa M, Turawa EB, Mathews C, Nicol E. Service delivery models that promote linkages to PrEP for adolescent girls and young women and men in sub-Saharan Africa: a scoping review. BMJ Open 2023; 13:e061503. [PMID: 36972966 PMCID: PMC10069497 DOI: 10.1136/bmjopen-2022-061503] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is an emerging biomedical prevention intervention. Documenting PrEP service delivery models (SDMs) that promote linkage to and continuation of PrEP will inform guidelines and maximise roll-out. OBJECTIVES To synthesise and appraise the effectiveness and feasibility of PrEP SDMs designed to promote linkage to PrEP care among adolescent girls and young women (AGYW) and men in sub-Saharan Africa (SSA). ELIGIBILITY CRITERIA Primary quantitative and qualitative studies published in English and conducted in SSA were included. No restrictions on the date of publication were applied. SOURCES OF EVIDENCE Methodology outlined in the Joanna Briggs Institute reviewers' manual was followed. PubMed, Cochrane library, Scopus, Web of Science and online-conference abstract archives were searched. CHARTING METHODS Data on article, population, intervention characteristics and key outcomes was charted in REDCap. RESULTS AND CONCLUSION Of the 1204 identified records, 37 (met the inclusion criteria. Health facility-based integrated models of PrEP delivery with family planning, maternal and child health or sexual and reproductive services to AGYW resulted in PrEP initiation of 16%-90%. Community-based drop-in centres (66%) was the preferred PrEP outlet for AGYW compared with public clinics (25%) and private clinics (9%). Most men preferred community-based delivery models. Among individuals who initiated PrEP, 50% were men, 62% were <35 years old and 97% were tested at health fairs compared with home testing. Integrated antiretroviral therapy (ART)-PrEP delivery was favoured among serodiscordant couples with 82.9% of couples using PrEP or ART with no HIV seroconversions. PrEP initiation within healthcare facilities was increased by perceived client-friendly services and non-judgemental healthcare workers. Barriers to PrEP initiation included distance to travel to and time spent at health facilities and perceived community stigma. PrEP SDMs for AGYW and men need to be tailored to the needs and preferences for each group. Programme implementers should promote community-based SDMs to increase PrEP initiation among AGYW and men.
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Affiliation(s)
- Trisha Ramraj
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Durban, KwaZulu-Natal, South Africa
| | - Witness Chirinda
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
| | - Kim Jonas
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
- Adolescent Health Research Unit, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Darshini Govindasamy
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
- Adolescent Health Research Unit, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Ngcwalisa Jama
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
| | - Tracy McClinton Appollis
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
- Adolescent Health Research Unit, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Babalwa Zani
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
| | - Ferdinand C Mukumbang
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
| | - Wisdom Basera
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
| | - Mbuzeleni Hlongwa
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
- College of Health Sciences, School of Nursing and Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Eunice B Turawa
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
- Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
- Adolescent Health Research Unit, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Edward Nicol
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
- Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa
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10
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Haider S, Friedman EE, Ott E, Moore A, Pandiani A, Desmarais C, Johnson AK. Knowledgeable, aware / interested: Young black women's perceptions of pre-exposure prophylaxis. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:671009. [PMID: 36303637 PMCID: PMC9580699 DOI: 10.3389/frph.2022.671009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose HIV in the United States disproportionately affects young Black women. Pre-exposure prophylaxis (PrEP) is an effective HIV prevention option that has the potential to reduce HIV incidence among HIV-vulnerable populations. However, data regarding women's awareness, interest in starting, and feelings of acceptability or stigma about PrEP remains limited, particularly among adolescent and young Black women. Materials and methods A cross-sectional survey was conducted with 100 sexually active young Black women ages 13–24 years attending women's health clinics in Chicago, IL. Descriptive statistics were used to characterize the sample and determine more about what the PrEP needs and barriers are in this community. Associations were modeled using logistic regression and 95% confidence intervals for both bivariate and multivariable models. Results In our survey (N = 100), half of study participants (50%) expressed interest in starting PrEP in the next three months and a majority (80%) of young women were confident they could obtain PrEP. Pregnant young women were significantly more interested in starting PrEP than non-pregnant women [OR 2.3 95% CI (1.0, 5.4)], p = 0.05), however, this association did not remain significant in adjusted models. Conclusions This study provides a more complete understanding of awareness, interest in, and acceptability of PrEP among adolescent and young Black women attending women's health clinics. Findings indicate sustained interest in starting PrEP, reduced stigma, and increased awareness of PrEP among young Black women. These findings suggest that integrating PrEP into women's health clinics is a promising strategy to increase awareness and utilization of PrEP and decrease HIV transmission among youth at highest risk.
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Affiliation(s)
- Sadia Haider
- Department of Obstetrics and Gynecology, Rush University Medical Center, Chicago, IL, United States
- Correspondence: Sadia Haider
| | - Eleanor E. Friedman
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States
| | - Emily Ott
- Department of Obstetrics and Gynecology, Rush University Medical Center, Chicago, IL, United States
| | - Amy Moore
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States
| | - Agustina Pandiani
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States
| | - Catherine Desmarais
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States
| | - Amy K. Johnson
- Division of Adolescent Medicine, Ann / Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
- Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, IL, United States
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11
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Kim H, Martin E. Barriers to accessing pre-exposure prophylaxis among women experiencing intimate partner violence in the United States: a systematic literature review. AIDS Care 2022; 35:509-523. [PMID: 36102031 DOI: 10.1080/09540121.2022.2121959] [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: 10/14/2022]
Abstract
Women experiencing intimate partner violence (IPV) are at increased risk of human immunodeficiency virus (HIV) infection but have limited uptake of pre-exposure prophylaxis (PrEP). We systematically reviewed the existing evidence for the association between IPV and PrEP use, and barriers to accessing PrEP among women with a history of IPV in the United States. A keyword search of PubMed, CINAHL, ScienceDirect, and Web of Science for relevant articles within the United States from 2012 to 2022 yielded 133 articles, of which 15 were ultimately included in the analysis. A qualitative synthesis of evidence suggests that the association between IPV and PrEP awareness, PrEP acceptability, PrEP use, and HIV risk perception was contingent on the mediating or moderating effects of women's relationship status, social network characteristics, and the timing and types of IPV. Controlling partners' reactions and a lack of independent decision-making in the abusive relationship were salient barriers. The methodological quality of qualitative studies was high; however, there were important risks of bias among quantitative and mixed-method studies. Additional studies are needed to understand barriers to PrEP use among women with IPV in more diverse settings and to provide rigorous evidence for developing targeted HIV prevention strategies for them.
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Affiliation(s)
- Heeun Kim
- Department of Public Administration and Policy, University at Albany, Albany, NY, USA
| | - Erika Martin
- Department of Public Administration and Policy, University at Albany, Albany, NY, USA.,Center for Collaborative HIV Research in Practice and Policy, University at Albany, Albany, NY, USA
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12
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Villalba K, Jean-Gilles M, Rosenberg R, Cook RL, Ichite A, Martin P, Dévieux JG. Understanding the Impact of Intimate Partner Violence Type and Timing on Pre-exposure Prophylaxis Knowledge, Acceptability, Sexual Behavior, and Gender Roles Among Women of Color. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP12998-NP13017. [PMID: 33752483 DOI: 10.1177/08862605211001468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Knowledge and acceptability are key factors for pre-exposure prophylaxis (PrEP) use among women with a history of intimate partner violence (IPV) and research suggests that different types of IPV affect PrEP uptake differently. Few studies have examined whether the type (i.e., physical, sexual, and psychological) and timing (i.e., lifetime, past year) of IPV experiences are related to PrEP knowledge and acceptability, or whether gender roles and sexual risk behaviors affect PrEP use. We aimed to examine the associations between lifetime and past-year physical, sexual, and psychological IPV experiences on PrEP-related outcomes (i.e., knowledge, acceptability, sexual behavior if on PrEP) and the association between gender roles and PrEP-related outcomes. A total of 186 women of color at risk for HIV participated in this study, of whom 54% had ever experienced partner violence. Results showed that lifetime psychological (OR 3.0, 95% CI 1.1-9.4) and lifetime physical IPV (OR 5.5, 95% CI 1.2-18.9) were significantly associated with increased PrEP knowledge. lifetime psychological (OR 6.3, 95% CI 1.0-13.6) and lifetime physical IPV (OR 4.3, 95% CI 4.3-11.5) were significantly associated with increased sexual behavior if on PrEP. Past year physical IPV was significantly associated with interest in using PrEP (OR 1.9, 95% CI 1.7-4.3) and with sexual behavior if on PrEP (OR 4.0, 95% CI 1.1-13.1). Being subordinate to others was also significantly associated with interest in using PrEP (OR 1.5, 95% CI 1.2-2.4) Self-silencing was significantly associated with increased sexual behavior if on PrEP (OR 1.2, 95% CI 1.0-1.5). Gender norms and IPV type and timing can influence whether a person is interested in PrEP use. Both lifetime and past-year IPV experiences need to be examined in the context of gender norms when prescribing PrEP to encourage uptake and continuation among vulnerable women at risk for HIV.
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13
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Scott RK, Hull SJ, Huang JC, Coleman M, Ye P, Lotke P, Beverley J, Moriarty P, Balaji D, Ward A, Holiday J, Brant AR, Cameron M, Elion R, Visconti A. Factors Associated with Intention to Initiate Pre-exposure Prophylaxis in Cisgender Women at High Behavioral Risk for HIV in Washington, D.C. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2613-2624. [PMID: 35622077 PMCID: PMC9308717 DOI: 10.1007/s10508-021-02274-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 06/15/2023]
Abstract
Pre-exposure prophylaxis (PrEP) for HIV prevention is underutilized by cisgender women at risk for HIV in the USA. Published research on PrEP initiation among cisgender women at risk for HIV focuses on identifying barriers and facilitators associated with intention to initiate, but few apply a behavioral theoretical lens to understand the relative importance of these diverse factors. This study provides a theoretically grounded view of the relative importance of factors associated with intention to initiate PrEP. We conducted an anonymous, cross-sectional survey of 1437 cisgender women seeking care at family planning and sexual health clinics to evaluate hypothesized barriers and facilitators of PrEP initiation. We categorized cisgender women with ≥ 3 behavioral risk-factors as "high-risk" for HIV acquisition; 26.9% (N = 387) met high-risk criterion. Among cisgender women in the high-risk sample, the majority were Black and single. Perceived risk of HIV acquisition was low and 13.7% reported intention to initiate PrEP. Positive attitudes toward PrEP, self-efficacy, perceived support from medical providers and social networks, and prior discussion about PrEP with medical providers were associated with intention to initiate PrEP; stigma was negatively associated. Background characteristics (other than age), risk factors for HIV acquisition, prior awareness of PrEP, and perceived risk of HIV were not associated with uptake intention. These findings support interventions that center on the role of providers in the provision of PrEP and on social networks in destigmatization of PrEP use.
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Affiliation(s)
- Rachel K Scott
- MedStar Health Research Institute, 6525 Belcrest Road, Hyattsville, MD, 20782, USA.
- MedStar Washington Hospital Center, Washington, DC, USA.
| | - Shawnika J Hull
- Department of Communication, Rutgers University, New Brunswick, NJ, USA
| | - Jim C Huang
- Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | | | - Peggy Ye
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Pam Lotke
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Patricia Moriarty
- MedStar Health Research Institute, 6525 Belcrest Road, Hyattsville, MD, 20782, USA
| | - Dhikshitha Balaji
- MedStar Health Research Institute, 6525 Belcrest Road, Hyattsville, MD, 20782, USA
| | - Allison Ward
- MedStar Health Research Institute, 6525 Belcrest Road, Hyattsville, MD, 20782, USA
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Jennifer Holiday
- MedStar Health Research Institute, 6525 Belcrest Road, Hyattsville, MD, 20782, USA
| | - Ashley R Brant
- Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Martha Cameron
- International Community of Women Living with HIV, Washington, DC, USA
| | | | - Adam Visconti
- MedStar Georgetown University, NW Washington, DC, USA
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Intimate Partner Violence and Preferences for Pre-exposure Prophylaxis (PrEP) Modes of Delivery Among A Sample of Gay, Bisexual, and Other Men Who Have Sex with Men. AIDS Behav 2022; 26:2425-2434. [PMID: 35076797 DOI: 10.1007/s10461-022-03587-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 11/01/2022]
Abstract
While there is strong evidence that the experience of intimate partner violence (IPV) shapes PrEP use among heterosexual women, evidence for similar relationships among gay, bisexual and other men who have sex with men (GBMSM) is scant. In this paper we analyze baseline data from a large randomized controlled trial (RCT) of an HIV prevention intervention for GBMSM recruited from three cities (Atlanta, Detroit and New York City) to examine how the recent experience of IPV shapes their rankings of PrEP delivery options. Men were asked to rank from 1 to 8 PrEP taken by daily pill, event-based pill, injection, anal suppository (before sex), suppository (after sex), gel (penile or rectal) (before sex), and gel (after sex) and condoms. The analysis sample is 694 HIV-negative, sexually active GBMSM. Analysis considers an ordinal outcome measuring participant's ranked preferences for their future use of eight HIV prevention options. Men who experienced physical IPV preferred PrEP in pill form, while men who experienced partners monitoring their behaviors (monitoring IPV) preferred PrEP by injection. Men who experienced emotional IPV ranked PrEP by pill lower than other methods. Sexual and controlling IPV were not significantly associated with PrEP modality ranking. As more modes of PrEP delivery become available, providers should be encouraged to screen GBMSM seeking PrEP for IPV, and to provide men with the necessary information to facilitate an informed choice when deciding on a PrEP modality that will work for them and their relationship context.
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15
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Elopre L, Boutwell A, Gordon B, Johnson B, Marrazzo J, Van Der Pol B, Mugavero MJ. PrEP service delivery preferences of black Cis-gender women living in the Southern United States. AIDS Behav 2022; 26:3469-3479. [PMID: 35445992 PMCID: PMC9022049 DOI: 10.1007/s10461-022-03691-9] [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] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
Abstract
To assess PrEP service delivery preferences among Black cis-gender women living in urban and rural settings in Alabama, we conducted a cross-sectional discrete choice experiment survey. Discrete choice experiments included five attributes. Hierarchical Bayes (HB) modeling and latent class analyses (LCA) were used to evaluate attribute preferences. Among 795 Black cis-gender HIV-negative women, almost two-thirds lived in urban settings and reported having at least some college; about a third reported a household income less than $25,000 annually; and reported willingness to use PrEP. Respondents placed the greatest importance on PrEP medication formulation and healthcare facility. LCA showed the group with the highest rural proportion preferred for on-line visits. Black women in the Deep South had distinct preferences regarding PrEP service delivery. These findings can inform tailored interventions to improve PrEP uptake among Black cis-gender women across diverse settings in the South.
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Affiliation(s)
- Latesha Elopre
- Department of Medicine, University of Alabama at Birmingham, Birmingham, United States.
| | - Alexander Boutwell
- Department of Medicine, University of Alabama at Birmingham, Birmingham, United States
| | - Bretia Gordon
- Medical Advocacy and Outreach, Birmingham, AL, United States
| | - Bernadette Johnson
- Department of Medicine, University of Alabama at Birmingham, Birmingham, United States
| | - Jeanne Marrazzo
- Department of Medicine, University of Alabama at Birmingham, Birmingham, United States
| | - Barbara Van Der Pol
- Department of Medicine, University of Alabama at Birmingham, Birmingham, United States
| | - Michael J Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, United States
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16
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Pre-exposure Prophylaxis (PrEP) Initiation Among Black and Latina Cisgender Women Receiving HIV Prevention Care Coordination Services in New York City. AIDS Behav 2022; 26:3174-3184. [PMID: 35362904 DOI: 10.1007/s10461-022-03661-1] [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: 03/18/2022] [Indexed: 11/01/2022]
Abstract
Black and Latina cisgender women are disproportionately impacted by HIV in the US. Although PrEP is effective at preventing HIV infection, uptake in this population remains low. The aim of the study was to examine sociodemographic, behavioral, clinical, and psychosocial factors associated with PrEP initiation (defined as receiving a PrEP prescription) among 565 cisgender women enrolled in an HIV prevention services coordination program in NYC from January 2017 to December 2019 who met HIV risk criteria for PrEP. Of these, 26% initiated PrEP. Latina women were significantly more likely than white women to have initiated PrEP (Latina: 29.7%; Black: 26.1%; White: 16.3%; Other: 7.4%). PrEP initiation was significantly associated with PrEP awareness, an annual income < $20,000, being unstably housed, receiving benefits navigation services, and reporting non-injection drug use and/or a recent sexual relationship with an HIV-positive partner. The relatively low rate of PrEP initiation we observed suggests the need to increase PrEP access and uptake among women, particularly Black and Latina women who continue to be disproportionately at risk for HIV.
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17
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Conley C, Johnson R, Bond K, Brem S, Salas J, Randolph S. US Black cisgender women and pre-exposure prophylaxis for human immunodeficiency virus prevention: A scoping review. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221103098. [PMID: 35699104 PMCID: PMC9201306 DOI: 10.1177/17455057221103098] [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] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/28/2022] [Accepted: 05/06/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Black cisgender women in the United States experience a disproportionate burden of human immunodeficiency virus acquisition. Pre-exposure prophylaxis is an effective oral daily medication that reduces the risk of human immunodeficiency virus through sex by 99% when taken as prescribed. However, less than 2% of eligible Black cisgender women take pre-exposure prophylaxis. The purpose of this scoping review was to describe the types of research studies done in this area, gaps in knowledge, and potential areas of research needed to increase pre-exposure prophylaxis use among Black cisgender women in the United States. METHODS We conducted our search in MEDLINE (PubMed), Embase (Elsevier), CINAHL (EBSCOhost), PsycINFO (EBSCOhost), and Scopus (Elsevier) using a combination of keywords and database-specific subject headings for the following concepts: pre-exposure prophylaxis, African American/Black or minority, and women. We used the Joanna Briggs Institute's Reviewers' Manual process for Scoping Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews to ensure comprehensive and standardized reporting of each part of the review. RESULTS Fifty-nine studies were included in the final review. Results of the study were classified according to the three phases of the Human Immunodeficiency Virus Prevention Cascade-demand side, supply side, and adherence and retention. The majority of studies (n = 24, 41%) were cross-sectional quantitative surveys and 43 (34%) focused on the demand-side phase of the Human Immunodeficiency Virus Prevention Cascade. Fifty-eight percent of studies either assessed women's pre-exposure prophylaxis knowledge, attitudes, and intentions to use, or assessed perceived barriers and facilitators. Seven studies (12%) tested pre-exposure prophylaxis uptake and adherence among Black cisgender women. CONCLUSION This review found multiple missed opportunities to increase women's demand for pre-exposure prophylaxis and health care provider screening and referral for pre-exposure prophylaxis. Additional studies are needed to effectively assess pre-exposure prophylaxis uptake and adherence among Black cisgender women.
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Affiliation(s)
| | | | - Keosha Bond
- City University of New York School of
Medicine, New York, NY, USA
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18
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Willie TC, Alexander KA, Kershaw T, Campbell JC, Stockman JK. No Longer the Exception, but the Standard: Integrating Trauma-Informed Policy and Pre-exposure Prophylaxis Implementation for Women. Womens Health Issues 2021; 31:415-419. [PMID: 34175198 PMCID: PMC8448947 DOI: 10.1016/j.whi.2021.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Tiara C Willie
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | | | - Trace Kershaw
- Department of Social and Behavioral Sciences, New Haven, Connecticut
| | | | - Jamila K Stockman
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, California
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19
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Lane J, Brezak A, Patel P, Verani AR, Benech I, Katz A. Policy considerations for scaling up access to HIV pre-exposure prophylaxis for adolescent girls and young women: Examples from Kenya, South Africa, and Uganda. Int J Health Plann Manage 2021; 36:1789-1808. [PMID: 34159630 DOI: 10.1002/hpm.3252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 10/09/2020] [Accepted: 05/10/2021] [Indexed: 11/06/2022] Open
Abstract
Adolescent girls and young women (aged 15-24 years; AGYW) continue to carry a disproportionate burden of HIV in sub-Saharan Africa. Pre-exposure prophylaxis (PrEP) helps reduce the risk of acquiring HIV for persons at substantial risk, including AGYW. As countries plan for the rollout of PrEP across sub-Saharan Africa, PrEP policies and programs could address the unique needs of AGYW. The purpose of this analysis was to identify policy considerations to improve AGYW access to PrEP. After reviewing the literature, we identified 13 policy considerations that policymakers and stakeholders could evaluate when developing or reviewing PrEP-related policies. We sorted these considerations into five categories, which together comprise an AGYW Access to PrEP Framework: AGYW-friendly delivery systems, clinical eligibility and adherence support, legal barriers and facilitators, affordability, and community and AGYW outreach. We also reviewed policies in three countries (Kenya, South Africa, and Uganda) to explore how PrEP-related policies addressed these considerations. Some of these policies addressed some of the 13 policy considerations, but none of the policies directly addressed the unique needs of AGYW for accessing PrEP. To improve access to PrEP for AGYW, country policies could include specific components that address these 13 considerations. To reach AGYW effectively, each country could use the 13 considerations we have identified to analyze current policies to identify existing programmatic barriers to AGYW accessing HIV services and address these barriers in PrEP-related policies.
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Affiliation(s)
- Jeff Lane
- University of Washington School of Public Health, Seattle, Washington, USA
| | - Audrey Brezak
- University of Washington School of Public Health, Seattle, Washington, USA
| | - Pragna Patel
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andre R Verani
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Irene Benech
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aaron Katz
- University of Washington School of Public Health, Seattle, Washington, USA
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20
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Leis M, McDermott M, Koziarz A, Szadkowski L, Kariri A, Beattie TS, Kaul R, Kimani J. Intimate partner and client-perpetrated violence are associated with reduced HIV pre-exposure prophylaxis (PrEP) uptake, depression and generalized anxiety in a cross-sectional study of female sex workers from Nairobi, Kenya. J Int AIDS Soc 2021; 24 Suppl 2:e25711. [PMID: 34164924 PMCID: PMC8222843 DOI: 10.1002/jia2.25711] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION UNAIDS has identified female sex workers (FSW) as a key HIV at-risk population. FSW disproportionately experience gender-based violence, which compounds their risk of HIV acquisition and may contribute to adverse mental health outcomes. Pre-exposure prophylaxis (PrEP) is a powerful but underused HIV prevention tool for these women. This study explored the associations between intimate partner violence (IPV) and client-perpetrated violence against FSW, mental health outcomes and PrEP use. METHODS An anonymous questionnaire was administered to a convenience sample of 220 Nairobi FSW attending dedicated clinics from June to July 2019, where PrEP was available free of charge. A modified version of the WHO Violence Against Women Instrument assessed IPV and client-perpetrated violence, and the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) assessed depressive and anxiety symptoms respectively. Multivariable logistic regressions evaluated predictors of depression, generalized anxiety and PrEP use. RESULTS Of the total 220 women (median [IQR] age 32 [27-39]), 56.8% (125/220) reported depression (PHQ-9 ≥ 10) and 39.1% (86/220) reported anxiety (GAD-7 ≥ 10). Only 41.4% (91/220) reported optimal use of PrEP (taken correctly six to seven days/week) despite the cohort pursuing sex work for a median of 7 (4 to 12) years. Most women reported experiencing any violence in the past 12 months (90%, 198/220). Any recent IPV was frequent (78.7%, 129/164), particularly emotional IPV (66.5%, 109/164), as was any client-perpetrated violence in the past 12 months (80.9%, 178/220). Regression analyses found that violence was independently associated with depression (adjusted OR [aOR] 9.39, 95% CI 2.90 to 30.42, p = 0.0002) and generalized anxiety (aOR 3.47, 95% CI 1.10 to 10.88, p = 0.03), with the strongest associations between emotional IPV and both depression and anxiety. Recent client-perpetrated emotional violence (aOR 0.23, 95% CI 0.07 to 0.71, p = 0.01) was associated with decreased PrEP use, whereas client-perpetrated physical violence was associated with increased PrEP use (aOR 3.01, 95% CI 1.16 to 7.81, p = 0.02). CONCLUSIONS There was a high prevalence of recent violence by different perpetrators as well as depression and anxiety among FSW from Nairobi. PrEP use was relatively infrequent, and recent client-perpetrated emotional violence was associated with PrEP non-use. Interventions to reduce gender-based violence may independently enhance HIV prevention and reduce the mental health burden in this community.
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Affiliation(s)
- Maria Leis
- Department of MedicineUniversity of TorontoTorontoCanada
| | | | - Alex Koziarz
- Department of MedicineUniversity of TorontoTorontoCanada
| | - Leah Szadkowski
- Biostatistics Research UnitUniversity Health NetworkTorontoCanada
| | - Antony Kariri
- Department of Medical MicrobiologyUniversity of NairobiNairobiKenya
| | - Tara S Beattie
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonEngland
| | - Rupert Kaul
- Department of MedicineUniversity of TorontoTorontoCanada
| | - Joshua Kimani
- Department of Medical MicrobiologyUniversity of NairobiNairobiKenya
- Department of Medical MicrobiologyUniversity of ManitobaManitobaCanada
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21
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Nydegger LA, Dickson-Gomez J, Ko TK. Structural and syndemic barriers to PrEP adoption among Black women at high risk for HIV: a qualitative exploration. CULTURE, HEALTH & SEXUALITY 2021; 23:659-673. [PMID: 32212993 PMCID: PMC7529643 DOI: 10.1080/13691058.2020.1720297] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
In the USA, Black women are at disproportionately higher risk for HIV compared to women of other races/ethnicities, which can be explained by the Substance Abuse, Violence and AIDS (SAVA) syndemic. Disparities in HIV, substance use and violence are driven by multiple influences, including structural factors (e.g. housing and poverty), which exacerbate social- and individual-level factors leading to more sex partners, engaging in unprotected sex, having sex for money, experiencing forced sex from an intimate partner or increased substance use, all of which increase HIV risk. Pre-exposure prophylaxis (PrEP), a pill that can prevent HIV, is a discreet and underutilised method that Black women experiencing syndemics can use to decrease their risk. This study explored Black women's interest in, and barriers to adopting PrEP over 6 months. Thirty Black women (age M = 32.2) who experienced multiple substance use, violence and HIV-related syndemic factors were interviewed four times over a 6-month period. Results demonstrated that experiencing intimate partner violence, substance use, community violence and other structural factors (poor access to social services, transport and childcare) all acted as barriers to PrEP adoption. Future research should consider multi-level interventions that include methods such as media campaigns, providing PrEP or referrals where women who experience syndemic and structural factors seek help, and implement a PrEP adherence programmes and interventions in support group settings.
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Affiliation(s)
- Liesl A. Nydegger
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, USA
- Corresponding Author: Liesl A. Nydegger
| | - Julia Dickson-Gomez
- Department of Epidemiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Thant Ko Ko
- Institute for Health Equity, Medical College of Wisconsin, Milwaukee, WI, USA
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22
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Baldwin A, Light B, Allison WE. Pre-Exposure Prophylaxis (PrEP) for HIV Infection in Cisgender and Transgender Women in the U.S.: A Narrative Review of the Literature. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1713-1728. [PMID: 34075504 PMCID: PMC8213571 DOI: 10.1007/s10508-020-01903-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/18/2020] [Accepted: 12/09/2020] [Indexed: 05/11/2023]
Abstract
Using a socioecological approach, this review describes the peer-reviewed literature on oral pre-exposure prophylaxis (PrEP) among both cisgender (cis women) and transgender women (trans women) in the U.S. A search of the PubMed database and HIV-related conference abstracts generated over 2,200 articles and abstracts. Of these, 103 fulfilled review inclusion criteria. Most of the existing research presents findings on individual-level factors associated with PrEP use such as willingness and perceived barriers. There was far less investigation of factors related to PrEP at more distal ecological levels. Though trans women are at greater risk of HIV infection than cisgender women, less is known about this population group with respect to PrEP despite their inclusion in many major clinical trials. Further, the literature is characterized by a persistent conflation of sex and gender which makes it difficult to accurately assess the reviewed research on HIV prevention and PrEP apart from risk group. Informed by these findings, we highlight specific opportunities to improve access to PrEP and reduce socioecological barriers to PrEP care engagement for cisgender and transgender women.
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Affiliation(s)
- Aleta Baldwin
- Department of Public Health, California State University, Sacramento, Solano Hall 3014, 6000 J Street, Sacramento, CA, 95819, USA.
| | - Brenda Light
- School of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Waridibo E Allison
- Division of Infectious Disease, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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23
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Teitelman AM, Koblin BA, Brawner BM, Davis A, Darlington C, Lipsky RK, Iwu E, Bond KT, Westover J, Fiore D, Tieu HV. Just4Us: Development of a Counselor-Navigator and Text Message Intervention to Promote PrEP Uptake Among Cisgender Women at Elevated Risk for HIV. J Assoc Nurses AIDS Care 2021; 32:188-204. [PMID: 33427767 PMCID: PMC10375596 DOI: 10.1097/jnc.0000000000000233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT In the United States, pre-exposure prophylaxis (PrEP) uptake among eligible cisgender women has been slow, despite the availability of oral PrEP since 2012. Although women make up nearly 20% of those living with HIV, there are currently few PrEP uptake interventions for cisgender women at elevated risk for acquiring HIV. Here we describe the process used to design and pre-pilot test Just4Us, a theory-based behavioral intervention to promote PrEP initiation and adherence among PrEP-eligible cisgender women. This work was part of a multiphase study conducted in New York City and Philadelphia, two locations with HIV rates higher than the national average. The counselor-navigator component of the intervention was designed to be delivered in a 60- to 90-min in-person session in the community, followed by several phone calls to support linkage to care. An automated text messaging program was also designed for adherence support. Just4Us addressed personal and structural barriers to PrEP uptake using an empowerment framework by building on women's insights and resources to overcome barriers along the PrEP cascade. Usability pre-pilot testing results were favorable and provided valuable feedback used to refine the intervention.
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Affiliation(s)
- Anne M Teitelman
- Anne M. Teitelman, PhD, FNP-BC, FAAN, FAANP, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Beryl A. Koblin, PhD, is an Independent Consultant, Metuchen, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Annet Davis, RN, MSW, CCRC, is a Coordinator of Community Engagement & Project Director for the Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Caroline Darlington, MSN, WHNP-BC, is a PhD Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Rachele K. Lipsky, PhD, CRNP, PMHNP-BC, is a Postdoctoral Scholar, National Clinical Scholars Program, Duke University, Durham, North Carolina, USA, and a Former Doctoral Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Emilia Iwu, PhD, RN, APNC, FWACN, is an Assistant Professor, Rutgers University School of Nursing, Division of Nursing Science and Center for Global Health, Newark, New Jersey, USA. Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Julie Westover, BS, is a Medical Student, University of California San Diego, School of Medicine, San Diego, California, USA, and a Former Innovation Technology Fellow, Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania, USA. Danielle Fiore, BS, is a Data Manager, Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Hong-Van Tieu, MD, MS, is Head of the Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Beryl A Koblin
- Anne M. Teitelman, PhD, FNP-BC, FAAN, FAANP, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Beryl A. Koblin, PhD, is an Independent Consultant, Metuchen, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Annet Davis, RN, MSW, CCRC, is a Coordinator of Community Engagement & Project Director for the Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Caroline Darlington, MSN, WHNP-BC, is a PhD Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Rachele K. Lipsky, PhD, CRNP, PMHNP-BC, is a Postdoctoral Scholar, National Clinical Scholars Program, Duke University, Durham, North Carolina, USA, and a Former Doctoral Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Emilia Iwu, PhD, RN, APNC, FWACN, is an Assistant Professor, Rutgers University School of Nursing, Division of Nursing Science and Center for Global Health, Newark, New Jersey, USA. Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Julie Westover, BS, is a Medical Student, University of California San Diego, School of Medicine, San Diego, California, USA, and a Former Innovation Technology Fellow, Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania, USA. Danielle Fiore, BS, is a Data Manager, Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Hong-Van Tieu, MD, MS, is Head of the Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Bridgette M Brawner
- Anne M. Teitelman, PhD, FNP-BC, FAAN, FAANP, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Beryl A. Koblin, PhD, is an Independent Consultant, Metuchen, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Annet Davis, RN, MSW, CCRC, is a Coordinator of Community Engagement & Project Director for the Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Caroline Darlington, MSN, WHNP-BC, is a PhD Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Rachele K. Lipsky, PhD, CRNP, PMHNP-BC, is a Postdoctoral Scholar, National Clinical Scholars Program, Duke University, Durham, North Carolina, USA, and a Former Doctoral Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Emilia Iwu, PhD, RN, APNC, FWACN, is an Assistant Professor, Rutgers University School of Nursing, Division of Nursing Science and Center for Global Health, Newark, New Jersey, USA. Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Julie Westover, BS, is a Medical Student, University of California San Diego, School of Medicine, San Diego, California, USA, and a Former Innovation Technology Fellow, Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania, USA. Danielle Fiore, BS, is a Data Manager, Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Hong-Van Tieu, MD, MS, is Head of the Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Annet Davis
- Anne M. Teitelman, PhD, FNP-BC, FAAN, FAANP, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Beryl A. Koblin, PhD, is an Independent Consultant, Metuchen, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Annet Davis, RN, MSW, CCRC, is a Coordinator of Community Engagement & Project Director for the Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Caroline Darlington, MSN, WHNP-BC, is a PhD Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Rachele K. Lipsky, PhD, CRNP, PMHNP-BC, is a Postdoctoral Scholar, National Clinical Scholars Program, Duke University, Durham, North Carolina, USA, and a Former Doctoral Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Emilia Iwu, PhD, RN, APNC, FWACN, is an Assistant Professor, Rutgers University School of Nursing, Division of Nursing Science and Center for Global Health, Newark, New Jersey, USA. Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Julie Westover, BS, is a Medical Student, University of California San Diego, School of Medicine, San Diego, California, USA, and a Former Innovation Technology Fellow, Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania, USA. Danielle Fiore, BS, is a Data Manager, Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Hong-Van Tieu, MD, MS, is Head of the Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Caroline Darlington
- Anne M. Teitelman, PhD, FNP-BC, FAAN, FAANP, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Beryl A. Koblin, PhD, is an Independent Consultant, Metuchen, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Annet Davis, RN, MSW, CCRC, is a Coordinator of Community Engagement & Project Director for the Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Caroline Darlington, MSN, WHNP-BC, is a PhD Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Rachele K. Lipsky, PhD, CRNP, PMHNP-BC, is a Postdoctoral Scholar, National Clinical Scholars Program, Duke University, Durham, North Carolina, USA, and a Former Doctoral Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Emilia Iwu, PhD, RN, APNC, FWACN, is an Assistant Professor, Rutgers University School of Nursing, Division of Nursing Science and Center for Global Health, Newark, New Jersey, USA. Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Julie Westover, BS, is a Medical Student, University of California San Diego, School of Medicine, San Diego, California, USA, and a Former Innovation Technology Fellow, Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania, USA. Danielle Fiore, BS, is a Data Manager, Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Hong-Van Tieu, MD, MS, is Head of the Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Rachele K Lipsky
- Anne M. Teitelman, PhD, FNP-BC, FAAN, FAANP, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Beryl A. Koblin, PhD, is an Independent Consultant, Metuchen, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Annet Davis, RN, MSW, CCRC, is a Coordinator of Community Engagement & Project Director for the Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Caroline Darlington, MSN, WHNP-BC, is a PhD Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Rachele K. Lipsky, PhD, CRNP, PMHNP-BC, is a Postdoctoral Scholar, National Clinical Scholars Program, Duke University, Durham, North Carolina, USA, and a Former Doctoral Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Emilia Iwu, PhD, RN, APNC, FWACN, is an Assistant Professor, Rutgers University School of Nursing, Division of Nursing Science and Center for Global Health, Newark, New Jersey, USA. Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Julie Westover, BS, is a Medical Student, University of California San Diego, School of Medicine, San Diego, California, USA, and a Former Innovation Technology Fellow, Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania, USA. Danielle Fiore, BS, is a Data Manager, Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Hong-Van Tieu, MD, MS, is Head of the Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Emilia Iwu
- Anne M. Teitelman, PhD, FNP-BC, FAAN, FAANP, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Beryl A. Koblin, PhD, is an Independent Consultant, Metuchen, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Annet Davis, RN, MSW, CCRC, is a Coordinator of Community Engagement & Project Director for the Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Caroline Darlington, MSN, WHNP-BC, is a PhD Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Rachele K. Lipsky, PhD, CRNP, PMHNP-BC, is a Postdoctoral Scholar, National Clinical Scholars Program, Duke University, Durham, North Carolina, USA, and a Former Doctoral Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Emilia Iwu, PhD, RN, APNC, FWACN, is an Assistant Professor, Rutgers University School of Nursing, Division of Nursing Science and Center for Global Health, Newark, New Jersey, USA. Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Julie Westover, BS, is a Medical Student, University of California San Diego, School of Medicine, San Diego, California, USA, and a Former Innovation Technology Fellow, Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania, USA. Danielle Fiore, BS, is a Data Manager, Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Hong-Van Tieu, MD, MS, is Head of the Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Keosha T Bond
- Anne M. Teitelman, PhD, FNP-BC, FAAN, FAANP, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Beryl A. Koblin, PhD, is an Independent Consultant, Metuchen, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Annet Davis, RN, MSW, CCRC, is a Coordinator of Community Engagement & Project Director for the Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Caroline Darlington, MSN, WHNP-BC, is a PhD Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Rachele K. Lipsky, PhD, CRNP, PMHNP-BC, is a Postdoctoral Scholar, National Clinical Scholars Program, Duke University, Durham, North Carolina, USA, and a Former Doctoral Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Emilia Iwu, PhD, RN, APNC, FWACN, is an Assistant Professor, Rutgers University School of Nursing, Division of Nursing Science and Center for Global Health, Newark, New Jersey, USA. Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Julie Westover, BS, is a Medical Student, University of California San Diego, School of Medicine, San Diego, California, USA, and a Former Innovation Technology Fellow, Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania, USA. Danielle Fiore, BS, is a Data Manager, Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Hong-Van Tieu, MD, MS, is Head of the Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Julie Westover
- Anne M. Teitelman, PhD, FNP-BC, FAAN, FAANP, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Beryl A. Koblin, PhD, is an Independent Consultant, Metuchen, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Annet Davis, RN, MSW, CCRC, is a Coordinator of Community Engagement & Project Director for the Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Caroline Darlington, MSN, WHNP-BC, is a PhD Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Rachele K. Lipsky, PhD, CRNP, PMHNP-BC, is a Postdoctoral Scholar, National Clinical Scholars Program, Duke University, Durham, North Carolina, USA, and a Former Doctoral Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Emilia Iwu, PhD, RN, APNC, FWACN, is an Assistant Professor, Rutgers University School of Nursing, Division of Nursing Science and Center for Global Health, Newark, New Jersey, USA. Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Julie Westover, BS, is a Medical Student, University of California San Diego, School of Medicine, San Diego, California, USA, and a Former Innovation Technology Fellow, Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania, USA. Danielle Fiore, BS, is a Data Manager, Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Hong-Van Tieu, MD, MS, is Head of the Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Danielle Fiore
- Anne M. Teitelman, PhD, FNP-BC, FAAN, FAANP, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Beryl A. Koblin, PhD, is an Independent Consultant, Metuchen, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Annet Davis, RN, MSW, CCRC, is a Coordinator of Community Engagement & Project Director for the Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Caroline Darlington, MSN, WHNP-BC, is a PhD Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Rachele K. Lipsky, PhD, CRNP, PMHNP-BC, is a Postdoctoral Scholar, National Clinical Scholars Program, Duke University, Durham, North Carolina, USA, and a Former Doctoral Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Emilia Iwu, PhD, RN, APNC, FWACN, is an Assistant Professor, Rutgers University School of Nursing, Division of Nursing Science and Center for Global Health, Newark, New Jersey, USA. Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Julie Westover, BS, is a Medical Student, University of California San Diego, School of Medicine, San Diego, California, USA, and a Former Innovation Technology Fellow, Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania, USA. Danielle Fiore, BS, is a Data Manager, Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Hong-Van Tieu, MD, MS, is Head of the Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Hong-Van Tieu
- Anne M. Teitelman, PhD, FNP-BC, FAAN, FAANP, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Beryl A. Koblin, PhD, is an Independent Consultant, Metuchen, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Annet Davis, RN, MSW, CCRC, is a Coordinator of Community Engagement & Project Director for the Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Caroline Darlington, MSN, WHNP-BC, is a PhD Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Rachele K. Lipsky, PhD, CRNP, PMHNP-BC, is a Postdoctoral Scholar, National Clinical Scholars Program, Duke University, Durham, North Carolina, USA, and a Former Doctoral Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Emilia Iwu, PhD, RN, APNC, FWACN, is an Assistant Professor, Rutgers University School of Nursing, Division of Nursing Science and Center for Global Health, Newark, New Jersey, USA. Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Julie Westover, BS, is a Medical Student, University of California San Diego, School of Medicine, San Diego, California, USA, and a Former Innovation Technology Fellow, Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania, USA. Danielle Fiore, BS, is a Data Manager, Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Hong-Van Tieu, MD, MS, is Head of the Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
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Intimate Partner Violence, HIV Pre-Exposure Prophylaxis (PrEP) Acceptability, and Attitudes About Use: Perspectives of Women Seeking Care at a Family Planning Clinic. AIDS Behav 2021; 25:427-437. [PMID: 32813087 DOI: 10.1007/s10461-020-03003-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pre-exposure prophylaxis (PrEP) presents an opportunity to expand prevention options for women at risk for HIV infection. Yet, women's PrEP use remains low and relatively little is known about PrEP acceptability and attitudes among a sub-population of women at risk for HIV-those experiencing intimate partner violence (IPV). A cross-sectional survey included closed and open-ended questions to assess IPV, PrEP acceptability, and attitudes about PrEP use among women seeking care at an urban family planning clinic in Pittsburgh, Pennsylvania (N = 145). Approximately 70% of women reported being willing to use PrEP with the key reasons for potential use including previous STI diagnosis, inconsistent condom use, and lack of or dishonest conversations with partners. Among women reporting recent IPV (41%), potential barriers to PrEP included concerns around drug effects, access/affordability, and adherence. Over half of women reporting recent IPV reported concerns around partner reaction impacting potential PrEP use. Results from this mixed-methods study highlight the need for a woman-centered PrEP intervention that uniquely includes awareness raising and understanding of PrEP for women, as well as reflects the context of IPV in decision-making and care.
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Nydegger LA, Dickson-Gomez J, Ko Ko T. A Longitudinal, Qualitative Exploration of Perceived HIV Risk, Healthcare Experiences, and Social Support as Facilitators and Barriers to PrEP Adoption Among Black Women. AIDS Behav 2021; 25:582-591. [PMID: 32886220 DOI: 10.1007/s10461-020-03015-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Black women contract HIV at much higher rates than White or Hispanic women. Pre-exposure prophylaxis (PrEP) is an underutilized prevention tool among this population. We sought to determine participants' interest in PrEP and facilitators and barriers to PrEP adoption. This longitudinal, qualitative study included 30 Black women (Mage = 32.2) interviewed 4 times over 6 months. Most participants had never heard of PrEP and a majority expressed initial interest. Barriers to PrEP initiation included low perceived HIV risk, medical mistrust, provider experiences and knowledge, negative reactions from family and friends, low perceived efficacy to adherence, and transportation. This study demonstrated actual, rather than hypothetical, PrEP interest and attitudes among Black women, and the barriers that arose over time during the study. PrEP awareness needs to be promoted among Black women and medical providers. Future research should address individual risk perception, medical mistrust, increasing social support, and decreasing transportation barriers.
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Allan-Blitz LT, Mena LA, Mayer KH. The ongoing HIV epidemic in American youth: challenges and opportunities. Mhealth 2021; 7:33. [PMID: 33898602 PMCID: PMC8063015 DOI: 10.21037/mhealth-20-42] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/05/2020] [Indexed: 01/05/2023] Open
Abstract
The incidence of human immunodeficiency virus (HIV) infection has been decreasing in the United States overall, except among youth, and in particular among Black and Latinx young men who have sex with men (MSM). In this review we summarize key drivers of the HIV epidemic among youth, as well as novel interventions geared specifically towards combating the epidemic among high-risk populations. Many factors driving the HIV epidemic among youth are related to systemic inequities, including lack of access to healthcare, inadequate education, and internalized and experience homophobia and racism. Developmentally, youth may feel that they are invulnerable and be willing to engage in risks. Moreover, HIV is often invisible for youth given advances in treatment and community stigma, limiting open discussion of risk and new preventive modalities. Outcomes from the HIV treatment cascade suggest that youth are less likely to be aware of their HIV infection status, less likely to link to and be engaged in care, and less likely to be virologically suppressed than older MSM and other populations of people living with HIV. Importantly, pre-exposure prophylaxis (PrEP) has been shown to be an effective tool for prevention of HIV infection that also appears to have disproportionately poor uptake among youth. Barriers to PrEP utilization appear to be quite heterogeneous, and include patient-, provider-, and structural-level barriers. Interventions important in improving HIV prevention will thus have to be multipronged and developed for culturally diverse populations. Cognitive behavioral therapy-based interventions are promising strategies as they are able to address a diverse array of barriers. New formulations of PrEP will also likely be instrumental in improving adherence. Since youth spend considerable amounts of time accessing digital media, the deployment of apps and other mobile phone-based interfaces offer unique opportunities to increase education and to facilitate HIV prevention for at risk youth. Multiple studies are underway to better inform the optimal delivery of treatment and prevention services for this complex and diverse population, and include novel sociobiological interventions and new modes of medication delivery that may lend themselves to overcoming obstacles specific to youth.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- Department of Medicine, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Leandro A. Mena
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kenneth H. Mayer
- Fenway Health, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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O'Malley TL, Egan JE, Hawk ME, Krier SE, Burke JG. Intersection of Intimate Partner Violence and Pre-Exposure Prophylaxis: Exploring HIV Worry and PrEP Acceptability Among Women. Violence Against Women 2020; 27:2600-2616. [PMID: 33211622 DOI: 10.1177/1077801220969874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article examines the prevalence of recent and lifetime intimate partner violence (IPV) and association with pre-exposure prophylaxis (PrEP) acceptability among women seeking care at an urban family planning clinic (N = 145). We found high prevalence of recent (40%) and lifetime IPV (71%). Almost a third of participants reported being worried about HIV risk, 70% were willing to take PrEP, and 71% of women who disclosed recent IPV were willing to take PrEP. Findings provide direction for research, practice, and policy attention needed around the context of IPV to focus development of a woman-centered PrEP intervention.
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Abstract
Intimate partner violence (IPV) significantly increases HIV risk among MSM. Pre-exposure prophylaxis (PrEP) may provide MSM experiencing IPV an option for self-protection from HIV without requiring condom negotiation or compromising safety. This study examined relationships among various forms of IPV (physical, emotional, monitoring, controlling, and forced sex) and PrEP use among 863 MSM participating in a cross-sectional, internet-based survey. Participants reported IPV rates during the prior 6 months that were consistent with prior research (physical violence, 23.3%; emotional violence, 36.3%; monitoring, 45.1%; controlling, 25.3%; forced sex, 20.0%). Forced sex and emotional IPV were negatively associated with PrEP use in our sample; in contrast, controlling was positively associated with PrEP use. We suggest clinical IPV screenings among MSM seeking PrEP, as well as PrEP-focused interventions that explicitly address IPV.
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Taggart T, Liang Y, Pina P, Albritton T. Awareness of and willingness to use PrEP among Black and Latinx adolescents residing in higher prevalence areas in the United States. PLoS One 2020; 15:e0234821. [PMID: 32628674 PMCID: PMC7337337 DOI: 10.1371/journal.pone.0234821] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/02/2020] [Indexed: 12/28/2022] Open
Abstract
This mixed-methods study examined awareness of and willingness to use pre-exposure prophylaxis (PrEP) among sexually active Black and Latinx adolescents (13–17 years) residing in five cities in the United States with some of the highest burden of HIV. Data are from adolescents who participated in a cross-sectional survey (n = 208) and one-on-one interviews and focus groups (n = 26) conducted from September 2017—August 2019. Approximately 50% of the sample were recruited through community efforts, and the other half through a panel. Logistic regression with covariates including sexual orientation, relationship status, socioeconomic status, and race/ethnicity were used to assess factors associated with PrEP awareness and willingness. For the qualitative data, thematic analysis was used to develop a codebook of a-priori and inductive codes while analytic memos were written to identify key themes. PrEP awareness was reported by 38% of the sample and was associated with Black race (AOR = 0.49; 95% CI = 0.27, 0.90) and prior HIV testing (AOR = 3.89, 95% CI = 1.25, 12.08). PrEP willingness (defined as “definitely would use PrEP”) was reported by 22% of the sample and was associated with higher age, more education, having had condomless sex in the past 6 months (AOR = 0.23; 95% CI = 0.10, 0.56), perceived likelihood of acquiring HIV (AOR = 3.59; 95% CI = 1.06, 12.21), and PrEP awareness (AOR = 0.41; 95% CI = 0.19, 0.89). Qualitative data showed that misconceptions about PrEP persist and PrEP stigma, fear of being punished, provider attitudes and recommendations, and empowerment were related to adolescents’ willingness to use PrEP. Study findings reveal important strategies for improving PrEP delivery and scale-up to Black and Latinx adolescents. These strategies include using sociodemographic and health behavior data to target adolescents who may be more or less willing to use PrEP, improving provider communication about PrEP, and creating culturally and developmentally appropriate PrEP education materials that address common misconceptions held by adolescents.
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Affiliation(s)
- Tamara Taggart
- Department of Prevention and Community Health, George Washington University, Milken Institute School of Public Health, Washington, DC, United States of America
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
- * E-mail:
| | - Yilin Liang
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, United States of America
| | - Paulo Pina
- Department of Pediatrics, New York University (NYU), Brooklyn, New York, United States of America
| | - Tashuna Albritton
- Department of Community Health and Social Medicine, City University of New York (CUNY) School of Medicine, New York, New York, United States of America
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Tsuyuki K, Stockman JK, Knauth D, J Catabay C, He F, Al-Alusi NA, Pilecco FB, Jain S, Barbosa RM. Typologies of violence against women in Brazil: A latent class analysis of how violence and HIV intersect. Glob Public Health 2020; 15:1639-1654. [PMID: 32515274 DOI: 10.1080/17441692.2020.1767675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We address the limited understanding around the overlap between violence and HIV in Brazil. Data was from two clinic-based samples of HIV-positive (n = 1534) and HIV-negative women (n = 1589) in São Paulo and Porto Alegre. We conducted latent class analysis and identified violence typologies by type of violence, life course timing, frequency, and perpetrator, stratified by city and HIV-status. Overall, HIV-positive women experienced more lifetime physical and sexual violence than HIV-negative women. Twelve unique violence latent classes were identified. In São Paulo, HIV-positive women were likely to have endured physical violence several times (Conditional Probability [CP]: 0.80) by an intimate partner (CP: 0.85), and sexual violence several times (CP: 0.46) by an intimate partner (CP: 0.62). In Porto Alegre, HIV-positive women endured physical violence several times (CP: 0.80) by an intimate partner (CP: 0.70) during childhood/adolescence (CP: 0.48), and sexual violence several times (CP: 0.54) by an intimate partner (CP: 0.60). Findings inform interventions to educate around gender equity, violence, and the health effects of violence including HIV, integrate HIV and violence services, and improve the provision of bio-medical HIV prevention among HIV-negative women who experience violence.
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Affiliation(s)
- Kiyomi Tsuyuki
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Jamila K Stockman
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Daniela Knauth
- Department of Social Medicine, University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Christina J Catabay
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Feng He
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Noor A Al-Alusi
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Flavia Bulegon Pilecco
- Department of Preventive and Social Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sonia Jain
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
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O'Malley TL, Hawk ME, Egan JE, Krier SE, Burke JG. Intimate Partner Violence and Pre-exposure Prophylaxis (PrEP): A Rapid Review of Current Evidence for Women's HIV Prevention. AIDS Behav 2020; 24:1342-1357. [PMID: 31776819 DOI: 10.1007/s10461-019-02743-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is a valued component of HIV prevention and increasing attention is focusing on women's PrEP use. Common HIV prevention options (e.g., condoms) remain underused and fail to consider the context of intimate partner violence (IPV). PrEP presents an opportunity to expand viable options for women. A systematic rapid review using key word searches of PubMed and proceedings from six national and international conferences related to HIV, women's health, or interpersonal violence identified nine studies which met set inclusion criteria. Studies were coded using a structured abstraction form and summarized according to relevant themes. IPV was found to have implications on women's interest and willingness to use PrEP, partner interference or interruptions in PrEP use, and adherence. Findings indicate a dearth of research on women's PrEP use and IPV and highlight the urgency for research, public heath practice, and policy attention around the HIV risk context and needs of women who experience IPV.
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Affiliation(s)
- Teagen L O'Malley
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 3520 Fifth Avenue, Suite 400, Pittsburgh, PA, 15213, USA.
| | - Mary E Hawk
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - James E Egan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah E Krier
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica G Burke
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Tolley EE, Li S, Zangeneh SZ, Atujuna M, Musara P, Justman J, Pathak S, Bekker L, Swaminathan S, Stanton J, Farrior J, Sista N. Acceptability of a long-acting injectable HIV prevention product among US and African women: findings from a phase 2 clinical Trial (HPTN 076). J Int AIDS Soc 2019; 22:e25408. [PMID: 31651098 PMCID: PMC6813716 DOI: 10.1002/jia2.25408] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 10/02/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION High HIV incidence and low adherence to daily oral PrEP among women underscore the need for more acceptable and easier to use HIV prevention products. Global demand for injectable contraception suggests that new, long-acting, injectable formulations could meet this need. We examine acceptability of a long-acting injectable PrEP among HIV-uninfected women in Zimbabwe, South Africa and two United States phase 2 trial sites. METHODS Quantitative surveys were administered at the first, fourth and sixth injection visits. Focus group discussions (FGD) were conducted after the sixth injection visit. We compared the acceptability of injectable product attributes, prevention preferences and future interest in injectable PrEP by site and arm and ran longitudinal ordinal logistic regression models to identify determinants of future interest in injectable PrEP. RESULTS Between April 2015 and February 2017, the trial enrolled 136 (100 African, 36 US) women with a median age of 31 years. Most participants (>75%) rated injectable attributes as very acceptable. While few reported rash or other side effects, 56% to 67% reported injection pain, with nonsignificant differences over time and between arms. During FGDs, participants described initial fear of the injectable and variable experiences with pain. Most US and African participants preferred injectable PrEP to daily oral pills (56% to 96% vs. 4% to 25%). Future interest in using injectable PrEP was associated with acceptability of product attributes and was higher in African than US sites. In FGDs, participants described multiple reasons for trial participation, including a combination of monetary, health-related and altruistic motivations. While associated with future interest in use in univariate models, neither altruistic nor personal motivations remained significant in the multivariate model. CONCLUSIONS This study found that long-acting injectable PrEP is acceptable among African and US women experiencing product use. Acceptability of product attributes better predicted future interest in injectable use than experience of pain. This is reassuring as a single-dose regimen of a different product has advanced to phase 3 trials. Finally, the study suggests that future demand for an injectable PrEP by women may be greater in African than US settings, where the risk of HIV is highest.
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Affiliation(s)
| | - Sue Li
- Vaccine and Infectious Disease DivisionFred HutchSeattleWAUSA
| | | | | | | | | | - Subash Pathak
- Vaccine and Infectious Disease DivisionFred HutchSeattleWAUSA
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Bradley E, Forsberg K, Betts JE, DeLuca JB, Kamitani E, Porter SE, Sipe TA, Hoover KW. Factors Affecting Pre-Exposure Prophylaxis Implementation for Women in the United States: A Systematic Review. J Womens Health (Larchmt) 2019; 28:1272-1285. [PMID: 31180253 DOI: 10.1089/jwh.2018.7353] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Oral HIV pre-exposure prophylaxis (PrEP) is a highly effective pill that HIV-negative individuals can take once daily to prevent HIV infection. Although PrEP is a private, user-controlled method that empowers women to protect themselves without relying on a partner's behavior, women's PrEP use has been extremely low. We systematically reviewed the literature to identify and summarize factors that may be affecting PrEP implementation for women in the United States. We conducted a search of the Centers for Disease Control and Prevention HIV/AIDS Prevention Research Synthesis Project database (MEDLINE, EMBASE, and CINAHL) and PubMed to identify peer-reviewed studies published between January 2000 and April 2018 that reported U.S. women's or health care providers' PrEP knowledge or awareness, willingness to use or prescribe, attitudes, barriers and facilitators to use or prescription, or PrEP adherence and discontinuation influences. Thirty-nine studies (26 women, 13 providers) met the eligibility criteria. In these studies, 0%-33% of women had heard of PrEP. Between 51% and 97% of women were willing to try PrEP, and 60%-92% of providers were willing to prescribe PrEP to women. Implementation barriers included access, cost, stigma, and medical distrust. Three studies addressed adherence or discontinuation. PrEP knowledge is low among women and providers. However, women and providers generally have positive views when aware of PrEP, including a willingness to use or prescribe PrEP to women. Most of the implementation barriers highlighted in studies were social or structural factors (e.g., access). Additional studies are needed to address research gaps, including studies of PrEP adherence and discontinuation.
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Affiliation(s)
- Erin Bradley
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kaitlin Forsberg
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Julia B DeLuca
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emiko Kamitani
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah E Porter
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Theresa Ann Sipe
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karen W Hoover
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Santa Maria D, Flash CA, Narendorf S, Barman-Adhikari A, Petering R, Hsu HT, Shelton J, Bender K, Ferguson K. Knowledge and Attitudes About Pre-Exposure Prophylaxis Among Young Adults Experiencing Homelessness in Seven U.S. Cities. J Adolesc Health 2019; 64:574-580. [PMID: 30254009 DOI: 10.1016/j.jadohealth.2018.06.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/21/2018] [Accepted: 06/22/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Evidence suggests that young adults experiencing homelessness (YEH) are at elevated risk of HIV compared to housed youth. Given the limited research on pre-exposure prophylaxis (PrEP) awareness among YEH, this study examined their PrEP knowledge and attitudes. METHODS Data from a cross-sectional survey among YEH (ages 18-26) (n = 1,427) in seven U.S. cities were used to assess their knowledge and attitudes regarding PrEP to inform HIV prevention efforts. RESULTS Participants were primarily male youth of color. The mean age was 20.9years. While 66% felt at risk for HIV, only 14% strongly agreed that they try to protect themselves from getting infected with HIV. Most (84%) were eligible for PrEP based on risk, yet only 29% had knowledge of PrEP. Despite this, 59% reported they were likely/extremely likely to take PrEP. Access to free PrEP (55%), HIV testing (72%), healthcare (68%), and one-on-one (62%), and text messaging support (57%) were rated as very/extremely important for PrEP uptake and adherence. CONCLUSIONS The results of this study suggest missed opportunities to prevent new HIV infections among YEH. Efforts to increase PrEP uptake among this population should consider provider- and system-level interventions to increase PrEP awareness, decrease PrEP-associated healthcare costs, improve access to PrEP providers, and provide in-person and text messaging support.
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Affiliation(s)
- Diane Santa Maria
- Department of Nursing Systems, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas.
| | - Charlene A Flash
- Department of Medicine, Division of Infectious Disease, Baylor College of Medicine and Legacy Community Health, Houston, Texas.
| | - Sarah Narendorf
- Graduate College of Social Work, University of Houston, Houston, Texas.
| | | | - Robin Petering
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California.
| | - Hsun-Ta Hsu
- School of Social Work, University of Missouri, Columbia, Missouri.
| | - Jama Shelton
- Silberman School of Social Work, at Hunter College, New York, New York.
| | - Kimberly Bender
- Graduate School of Social Work, University of Denver, Denver, Colorado.
| | - Kristin Ferguson
- School of Social Work, Arizona State University, Phoenix, Arizona.
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35
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Santa Maria D, Gallardo KR, Narendorf S, Petering R, Barman-Adhikari A, Flash C, Hsu HT, Shelton J, Ferguson K, Bender K. Implications for PrEP Uptake in Young Adults Experiencing Homelessness: A Mixed Methods Study. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:63-81. [PMID: 30742477 DOI: 10.1521/aeap.2019.31.1.63] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Youth experiencing homelessness (YEH) have a high risk of contracting HIV; however, they remain relatively unreached by pre-exposure prophylaxis (PrEP)-based HIV prevention initiatives. We used a cross-sectional mixed-methods study to explore PrEP knowledge, interest, facilitators, and barriers among YEH. Young adults were recruited from agencies serving YEH in Houston, TX (n = 30) and Los Angeles, CA (n = 15) to participate in an electronic self-report survey and a semistructured interview. Survey results indicate that 68.2% of YEH had low or no prior knowledge of PrEP, though 63.7% reported interest in taking PrEP. Qualitative results revealed facilitators of PrEP use, including high PrEP acceptability and awareness, and supportive social networks. Several barriers emerged, including medication-related barriers, adherence, cost, access barriers, low perceived HIV risk, perceived stigma of PrEP use, and low PrEP awareness. Despite high PrEP acceptability, PrEP use among YEH remains low partly due to low PrEP awareness, low perceived HIV risk, and medical mistrust.
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Affiliation(s)
- Diane Santa Maria
- Cizik School of Nursing, The University of Texas Health Science Center at Houston
| | - Kathryn R Gallardo
- School of Public Health, The University of Texas Health Science Center at Houston
| | | | | | | | - Charlene Flash
- Baylor College of Medicine and Legacy Community Health, Houston, Texas
| | - Hsun-Ta Hsu
- School of Social Work, University of Missouri, Columbia, Missouri
| | - Jama Shelton
- Silberman School of Social Work, Hunter College, New York City
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Ridgway J, Almirol E, Schmitt J, Bender A, Anderson G, Leroux I, McNulty M, Schneider J. Exploring Gender Differences in PrEP Interest Among Individuals Testing HIV Negative in an Urban Emergency Department. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:382-392. [PMID: 30332310 PMCID: PMC6517836 DOI: 10.1521/aeap.2018.30.5.382] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PrEP is greater than 90% effective at preventing HIV infection, but many people who are vulnerable to HIV choose not to take PrEP. Among women, men who have sex with women (MSW) and men who have sex with men (MSM) who tested HIV negative in our emergency department, we assessed behavioral risk factors, self-perception of HIV risk, and interest in PrEP linkage. Women had lower odds of perceiving any HIV risk versus no risk than MSM, while Whites had greater odds of perceiving themselves as high risk than Blacks. Age and self-perception of risk were not associated with PrEP interest, but patients who were objectively classified as "at risk" had greater odds of interest in PrEP than those not at risk (p < .01). Discordance between HIV risk self-perception and objective risk demonstrates the limitation of relying on patient self-referral for PrEP based on their own subjective risk perception.
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Affiliation(s)
- Jessica Ridgway
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Ellen Almirol
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Jessica Schmitt
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Alvie Bender
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Grace Anderson
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Ivan Leroux
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Moira McNulty
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - John Schneider
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
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Braksmajer A, Leblanc NM, El-Bassel N, Urban MA, McMahon JM. Feasibility and acceptability of pre-exposure prophylaxis use among women in violent relationships. AIDS Care 2018; 31:475-480. [PMID: 30045629 DOI: 10.1080/09540121.2018.1503634] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Intimate partner violence (IPV) is associated with a high risk of HIV acquisition. Pre-exposure prophylaxis (PrEP), which does not require partner knowledge or consent, is a promising HIV risk reduction option for women experiencing IPV. Drawing on semi-structured interviews with 26 women experiencing IPV within the last six months, this study explored the feasibility and acceptability of PrEP use in this population. Slightly more than half of the women in this study expressed interest in taking PrEP when in a relationship with an abusive partner. Potential barriers to PrEP, discussed regardless of women's expressed interest in PrEP, included fear of side effects and long-term health concerns, low risk perceptions, potential partner interference, and prioritizing coping with the relationship over HIV prevention. When offering PrEP counseling, providers should inquire about IPV, as women in violent relationships may require tailored counseling to address barriers and concerns specific to their situation.
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Affiliation(s)
- Amy Braksmajer
- a School of Nursing , University of Rochester , Rochester , NY , USA
| | - Natalie M Leblanc
- a School of Nursing , University of Rochester , Rochester , NY , USA
| | - Nabila El-Bassel
- b School of Social Work , Columbia University , New York , NY , USA
| | - Marguerite A Urban
- c Department of Medicine, School of Medicine and Dentistry , University of Rochester , Rochester , NY , USA
| | - James M McMahon
- a School of Nursing , University of Rochester , Rochester , NY , USA
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Willie TC, Stockman JK, Overstreet NM, Kershaw TS. Examining the Impact of Intimate Partner Violence Type and Timing on Pre-exposure Prophylaxis Awareness, Interest, and Coercion. AIDS Behav 2018; 22:1190-1200. [PMID: 28887703 DOI: 10.1007/s10461-017-1901-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Previous research suggests that intimate partner violence (IPV) is associated with acceptability of and adherence to pre-exposure prophylaxis (PrEP). However, very few studies have examined whether the type (i.e., physical, sexual, and psychological IPV) and timing (i.e., lifetime, past-year) of IPV experiences differentially relate to PrEP awareness, interest, and perceived PrEP coercion. Therefore, the objective of this study is to examine associations between lifetime and past-year physical, sexual, and psychological IPV experiences on PrEP awareness, interest, and perceived PrEP coercion. Data were collected from an online survey administered to 210 women and men. Past-year physical IPV experiences (AOR 4.53, 95% CI 1.85, 11.11) were significantly associated with being interested in using PrEP. Lifetime sexual (AOR 3.69, 95% CI 1.62, 8.40), psychological IPV (AOR 4.70, 95% CI 1.01, 21.89), and past-year sexual IPV experiences (AOR 3.01, 95% CI 1.10, 8.27) were also significantly associated with believing a recent partner would attempt to control the participant's use of PrEP, if she or he were currently using it. Understanding that engaging in PrEP care is influenced differently by the type and timing of IPV has potential implications for PrEP candidacy guidelines and interventions.
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Affiliation(s)
- Tiara C Willie
- School of Public Health, Yale University, 60 College Street, P.O. Box 208034, New Haven, CT, 06520, USA.
- Yale Center for Interdisciplinary Research on AIDS, 135 College Street, Suite 200, New Haven, CT, 06510-2483, USA.
| | - Jamila K Stockman
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Nicole M Overstreet
- Department of Psychology, Clark University, 950 Main Street, Worcester, MA, 01610, USA
| | - Trace S Kershaw
- School of Public Health, Yale University, 60 College Street, P.O. Box 208034, New Haven, CT, 06520, USA
- Yale Center for Interdisciplinary Research on AIDS, 135 College Street, Suite 200, New Haven, CT, 06510-2483, USA
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Machado DM, de Sant'Anna Carvalho AM, Riera R. Adolescent pre-exposure prophylaxis for HIV prevention: current perspectives. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2017; 8:137-148. [PMID: 29238237 PMCID: PMC5716324 DOI: 10.2147/ahmt.s112757] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Adolescents are a critical population that is disproportionately impacted by the HIV epidemic. More than 2 million adolescents between the age group of 10 and 19 years are living with HIV, and millions are at risk of infection. HIV risks are considerably higher among girls, especially in high-prevalence settings such as eastern and southern Africa. In addition to girls, there are other vulnerable adolescent subgroups, such as teenagers, who use intravenous (IV) drugs, gay and bisexual boys, transgender youth, male sex workers, and people who fall into more than one of these categories. Pre-exposure prophylaxis (PrEP) is a new intervention for people at high risk for acquiring HIV, with an estimated HIV incidence of >3%. Recent data from trials show evidence of the efficacy of PrEP as a powerful HIV prevention tool in high-risk populations, including men who have sex with men, HIV-1-serodiscordant heterosexual couples, and IV drug users. The reported efficacy in those trials of the daily use of oral tenofovir, alone or in combination with emtricitabine, to prevent HIV infection ranged from 44% to 75% and was heavily dependent on adherence. Despite the proven efficacy of PrEP in adult trials, concerns remain about its feasibility in real-life scenarios due to stigma, cost, and limited clinician experience with PrEP delivery. Recent studies are attempting to expand the inquiry into the efficacy of such HIV prophylaxis approaches in adolescent populations, but there are still many gaps in knowledge, and no country has yet approved it for use with adolescents. The aim of this review was to identify and summarize the evidence from studies on PrEP for adolescents. We have compiled and reviewed published studies focusing on safety, feasibility, adherence to therapeutics, self-perception, and legal issues related to PrEP in people aged between 10 and 24 years.
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Affiliation(s)
- Daisy Maria Machado
- Disciplina de Infectologia Pediátrica, Departamento de Pediatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo
| | | | - Rachel Riera
- Disciplina de Medicina Baseada em Evidências, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Hynes JS, Sales JM, Sheth AN, Lathrop E, Haddad LB. Interest in multipurpose prevention technologies to prevent HIV/STIs and unintended pregnancy among young women in the United States. Contraception 2017; 97:277-284. [PMID: 29055782 DOI: 10.1016/j.contraception.2017.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE High rates of sexually transmitted infections (STIs) and unintended pregnancy suggest a role for multipurpose prevention technologies (MPTs) designed to combine contraception and infection prophylaxis into one unified method. This study aims to determine factors associated with interest in MPTs among US women. STUDY DESIGN We administered a national cross-sectional survey via MTurk. Eligibility criteria included female gender, age 18-29 years, residence in the USA, and sexual activity with a male partner in the past three months. In total, 835 surveys were suitable for analysis. Bivariable and multivariable logistic regressions were performed to determine factors associated with interest in MPTs. RESULTS Eighty-three percent of women were interested in MPTs. Factors associated with interest included oral sex in the past three months (aOR 1.87, 95% CI 1.07, 3.53), recent use of oral contraceptive pills (OCPs; aOR 1.78, 95% CI 1.08, 2.93), HIV test within one year (aOR 2.10, 95% CI 1.29, 3.40), and increased STI worry score (aOR 1.98, 95% CI 1.36, 2.86). No use of contraception in the past three months was associated with decreased interest in MPTs (aOR 0.31, 95% CI 0.17, 0.58). HIV risk factors including race were not associated with MPT interest. CONCLUSION Our data show that young, sexually active, US women are interested in MPTs. Women who used contraception, specifically OCPs, or evidenced concern for infection were most likely to be interested in such a product. Women reporting unsafe sexual habits were less likely to be interested, highlighting the importance of HIV/STI prevention education. IMPLICATIONS Women in the USA are interested in multipurpose prevention technologies, particularly those women who currently use contraception or are concerned about their risk of infection. Our results emphasize the importance of moving forward with MPT development as well as continued HIV/STI prevention education.
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Affiliation(s)
- Jenna S Hynes
- Emory University School of Medicine, Department of Gynecology and Obstetrics, 49 Jesse Hill Jr. Drive, NE, Faculty Office Building, Atlanta, GA 30322, USA.
| | - Jessica M Sales
- Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Anandi N Sheth
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, 201 Dowman Drive, Atlanta, GA 30322, USA.
| | - Eva Lathrop
- Emory University School of Medicine, Department of Gynecology and Obstetrics, 49 Jesse Hill Jr. Drive, NE, Faculty Office Building, Atlanta, GA 30322, USA.
| | - Lisa B Haddad
- Emory University School of Medicine, Department of Gynecology and Obstetrics, 49 Jesse Hill Jr. Drive, NE, Faculty Office Building, Atlanta, GA 30322, USA.
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Goparaju L, Praschan NC, Warren-Jeanpiere L, Experton LS, Young MA, Kassaye S. Stigma, Partners, Providers and Costs: Potential Barriers to PrEP Uptake among US Women. ACTA ACUST UNITED AC 2017; 8. [PMID: 29201531 PMCID: PMC5708581 DOI: 10.4172/2155-6113.1000730] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Pre-Exposure Prophylaxis (PrEP) use has remained low among US women while significantly increasing among men who have sex with men. Besides lack of awareness, women face several social and structural barriers in gaining access to and using PrEP. Methods Four focus group discussions with 20 HIV-negative women who live in the Washington DC metropolitan area. Results The women expressed concerns about social and structural barriers to PrEP use. They were afraid that stigma related to using “HIV medicines” could affect PrEP use as well. They are worried that family and friends may question their reasons for taking anti-retrovirals and suspect that they were HIV-positive. They expected hostile reactions from male partners, including accusations of infidelity and introducing mistrust in their relationships. Communicating with health care providers about sexual matters in general and their need for PrEP in particular were identified as further barriers. Women reported that providers rarely ask about risk behaviors related to HIV acquisition; that short visits hinder establishing a trusting relationship to discuss sensitive matters. They were concerned that disclosure of risk behaviors may result in judgmental responses and harsh treatment from providers. Lastly, women were concerned that PrEP costs, including insurance coverage and copays, would keep PrEP out of their reach. While cognizant of the potential barriers, women were unwavering in their determination to find ways to circumvent challenges to PrEP access. Conclusion Social and structural barriers may impede women's access to PrEP despite their own reported interest. Continued efforts to reduce HIV stigma, improve patient-provider relationships and ensure affordability of PrEP may increase the likelihood that women will use this important prevention modality.
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Intimate Partner Violence and PrEP Acceptability Among Low-Income, Young Black Women: Exploring the Mediating Role of Reproductive Coercion. AIDS Behav 2017; 21:2261-2269. [PMID: 28409266 DOI: 10.1007/s10461-017-1767-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A few studies suggest that women who experience intimate partner violence (IPV) are willing to use pre-exposure prophylaxis (PrEP), but no research has examined mediators of this relationship. The current study used path analysis to examine a phenomenon closely associated with IPV: reproductive coercion, or explicit male behaviors to promote pregnancy of a female partner without her knowledge or against her will. Birth control sabotage and pregnancy coercion-two subtypes of reproductive coercion behaviors-were examined as mediators of the relationship between IPV and PrEP acceptability among a cohort of 147 Black women 18-25 years of age recruited from community-based organizations in an urban city. IPV experiences were indirectly related to PrEP acceptability through birth control sabotage (indirect effect = 0.08; p < 0.05), but not to pregnancy coercion. Findings illustrate the importance of identifying and addressing reproductive coercion when assessing whether PrEP is clinically appropriate and a viable option to prevent HIV among women who experience IPV.
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Garfinkel DB, Alexander KA, McDonald-Mosley R, Willie TC, Decker MR. Predictors of HIV-related risk perception and PrEP acceptability among young adult female family planning patients. AIDS Care 2017; 29:751-758. [PMID: 27680304 PMCID: PMC5553279 DOI: 10.1080/09540121.2016.1234679] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
HIV pre-exposure prophylaxis (PrEP) presents new opportunities for HIV prevention. While women comprise approximately 20% of new HIV infections in the US, significant questions remain about how to most effectively facilitate PrEP uptake for this population. Family planning clinics are a dominant source of health care for young women and support an estimated 4.5 million women annually. We explore characteristics associated with HIV risk perception and PrEP acceptability among young adult women seeking reproductive health services in a high-prevalence setting. A cross-sectional, clinic-based survey was conducted with women ages 18-35 (n = 146) seeking health care at two family planning clinics in the greater Baltimore, Maryland area, from January to April 2014. An estimated 22% of women reported being worried about HIV risk, and 60% reported they would consider taking a pill daily to prevent HIV. In adjusted models, HIV-related worry was associated with having no college education, being single or dating more than one person, practicing consistent condom use during vaginal sex, and having ever traded sex. PrEP acceptability was significantly associated with being Black (71% vs. 49%, AOR 2.23, CI: 1.89-2.64) and having ever traded sex (83% vs. 58%, AOR 4.94, CI: 2.00-12.22). For women with a history of intimate partner violence (IPV), PrEP acceptability was significantly lower (57% vs. 62%, AOR .71, CI: .59-.85) relative to their non-abused counterparts. Results suggest that family planning clinics may be a natural setting for PrEP discussion and roll-out. They should be considered in the context of integrating HIV prevention with reproductive health services. Women with a trauma history may need additional support for implementing HIV prevention in the form of PrEP.
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Flash CA, Dale SK, Krakower DS. Pre-exposure prophylaxis for HIV prevention in women: current perspectives. Int J Womens Health 2017; 9:391-401. [PMID: 28615975 PMCID: PMC5459979 DOI: 10.2147/ijwh.s113675] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
There are ~900,000 new HIV infections among women every year, representing nearly half of all new HIV infections globally. In the US, nearly one-fifth of all new HIV infections occur among women, and women from racial and ethnic minority communities experience disproportionately high rates of new HIV infections. Thus, there is a need to develop and implement effective HIV prevention strategies for women in the US and internationally, with a specific need to advance strategies in minority communities. Previous studies have demonstrated that oral HIV pre-exposure prophylaxis (PrEP), the use of antiretroviral medications by HIV-uninfected persons to prevent HIV acquisition, can reduce HIV incidence among women who are adherent to PrEP. However, to date, awareness and uptake of PrEP among women have been very limited, suggesting a need for innovative strategies to increase the knowledge of and access to PrEP among women in diverse settings. This narrative review summarizes the efficacy and safety data of PrEP in women, discusses considerations related to medication adherence for women who use PrEP, and highlights behavioral, social, and structural barriers to maximize the effectiveness of PrEP in women. It also reviews novel modalities for PrEP in women which are being developed and tested, including topical formulations and long-acting injectable agents that may offer advantages as compared to oral PrEP and proposes a community-oriented, social networking framework to increase awareness of PrEP among women. If women are provided with access to PrEP and support to overcome social and structural barriers to adhere to PrEP, this prevention strategy holds great promise to impact the HIV epidemic among women in the US and globally.
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Affiliation(s)
- Charlene A Flash
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Sannisha K Dale
- Massachusetts General Hospital.,Department of Psychiatry, Harvard Medical School, Boston, MA.,Department of Psychology, University of Miami, Coral Gables, FL
| | - Douglas S Krakower
- Department of Psychiatry, Harvard Medical School, Boston, MA.,Division of Infectious Diseases, Beth Israel Deaconess Medical Center.,The Fenway Institute, Boston, MA, USA
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Koechlin FM, Fonner VA, Dalglish SL, O'Reilly KR, Baggaley R, Grant RM, Rodolph M, Hodges-Mameletzis I, Kennedy CE. Values and Preferences on the Use of Oral Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Multiple Populations: A Systematic Review of the Literature. AIDS Behav 2017; 21:1325-1335. [PMID: 27900502 PMCID: PMC5378753 DOI: 10.1007/s10461-016-1627-z] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Daily oral pre-exposure prophylaxis (PrEP) is the use of antiretroviral drugs by HIV-negative people to prevent HIV infection. WHO released new guidelines in 2015 recommending PrEP for all populations at substantial risk of HIV infection. To prepare these guidelines, we conducted a systematic review of values and preferences among populations that might benefit from PrEP, women, heterosexual men, young women and adolescent girls, female sex workers, serodiscordant couples, transgender people and people who inject drugs, and among healthcare providers who may prescribe PrEP. A comprehensive search strategy reviewed three electronic databases of articles and HIV-related conference abstracts (January 1990-April 2015). Data abstraction used standardised forms to categorise by population groups and relevant themes. Of 3068 citations screened, 76 peer-reviewed articles and 28 conference abstracts were included. Geographic coverage was global. Most studies (N = 78) evaluated hypothetical use of PrEP, while 26 studies included individuals who actually took PrEP or placebo. Awareness of PrEP was low, but once participants were presented with information about PrEP, the majority said they would consider using it. Concerns about safety, side effects, cost and effectiveness were the most frequently cited barriers to use. There was little indication of risk compensation. Healthcare providers would consider prescribing PrEP, but need more information before doing so. Findings from a rapidly expanding evidence base suggest that the majority of populations most likely to benefit from PrEP feel positively towards it. These same populations would benefit from overcoming current implementation challenges with the shortest possible delay.
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Affiliation(s)
- Florence M Koechlin
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland.
| | - Virginia A Fonner
- Department of Psychiatry, Center for Global and Community Health, Medical University of South Carolina, 176 Croghan Spur Rd Suite 104, Charleston, SC, 29407, USA
| | - Sarah L Dalglish
- International Health and the Program is Social and Behavioral Interventions, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Kevin R O'Reilly
- Department of Psychiatry, Center for Global and Community Health, Medical University of South Carolina, 176 Croghan Spur Rd Suite 104, Charleston, SC, 29407, USA
| | - Rachel Baggaley
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Robert M Grant
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Michelle Rodolph
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Ioannis Hodges-Mameletzis
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Caitlin E Kennedy
- International Health and the Program is Social and Behavioral Interventions, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Braksmajer A, Senn TE, McMahon J. The Potential of Pre-Exposure Prophylaxis for Women in Violent Relationships. AIDS Patient Care STDS 2016; 30:274-81. [PMID: 27286296 PMCID: PMC4913495 DOI: 10.1089/apc.2016.0098] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
HIV and intimate partner violence (IPV) are significant intersecting threats to women's health. Women in violent relationships have few feasible HIV risk reduction options as traditional prevention methods are largely dependent on a partner's cooperation. The purpose of this review is to explore potential benefits and drawbacks of pre-exposure prophylaxis (PrEP) use among women in the United States experiencing IPV. Advantages of PrEP use in this population include the potential for covert or autonomous use, coital independence, dual protection against sexual and injection risk, and facilitated connections to social services. A number of barriers, however, may interfere with the effective use of PrEP, including partner resistance, cost, frequent medical visits, gendered norms regarding sexuality, and stigma. To realize its potential for women in violent relationships, it will be necessary to incorporate PrEP into behavioral and structural interventions that encourage uptake, facilitate adherence, ensure women's safety, and challenge existing gender norms.
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Affiliation(s)
- Amy Braksmajer
- University of Rochester School of Nursing , Rochester, New York
| | - Theresa E Senn
- University of Rochester School of Nursing , Rochester, New York
| | - James McMahon
- University of Rochester School of Nursing , Rochester, New York
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Castel AD, Magnus M, Greenberg AE. Pre-exposure prophylaxis for human immunodeficiency virus: the past, present, and future. Infect Dis Clin North Am 2014; 28:563-83. [PMID: 25455314 DOI: 10.1016/j.idc.2014.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This article presents an overview of pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) prevention. The authors describe the past animal and human research that has been conducted that informs our current understanding of PrEP; summarize ongoing research in the area, including describing new regimens and delivery mechanisms being studied for PrEP; and highlight key issues that must be addressed in order to implement and optimize the use of this HIV prevention tool.
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Affiliation(s)
- Amanda D Castel
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, Northwest, 5th Floor, Washington, DC 20052, USA.
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, Northwest, 5th Floor, Washington, DC 20052, USA
| | - Alan E Greenberg
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, Northwest, 5th Floor, Washington, DC 20052, USA
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McMahon JM, Myers JE, Kurth AE, Cohen SE, Mannheimer SB, Simmons J, Pouget ER, Trabold N, Haberer JE. Oral pre-exposure prophylaxis (PrEP) for prevention of HIV in serodiscordant heterosexual couples in the United States: opportunities and challenges. AIDS Patient Care STDS 2014; 28:462-74. [PMID: 25045996 PMCID: PMC4135325 DOI: 10.1089/apc.2013.0302] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Oral HIV pre-exposure prophylaxis (PrEP) is a promising new biomedical prevention approach in which HIV-negative individuals are provided with daily oral antiretroviral medication for the primary prevention of HIV-1. Several clinical trials have demonstrated efficacy of oral PrEP for HIV prevention among groups at high risk for HIV, with adherence closely associated with level of risk reduction. In the United States (US), three groups have been prioritized for initial implementation of PrEP-injection drug users, men who have sex with men at substantial risk for HIV, and HIV-negative partners within serodiscordant heterosexual couples. Numerous demonstration projects involving PrEP implementation among MSM are underway, but relatively little research has been devoted to study PrEP implementation in HIV-serodiscordant heterosexual couples in the US. Such couples face a unique set of challenges to PrEP implementation at the individual, couple, and provider level with regard to PrEP uptake and maintenance, adherence, safety and toxicity, clinical monitoring, and sexual risk behavior. Oral PrEP also provides new opportunities for serodiscordant couples and healthcare providers for primary prevention and reproductive health. This article provides a review of the critical issues, challenges, and opportunities involved in the implementation of oral PrEP among HIV-serodiscordant heterosexual couples in the US.
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Affiliation(s)
- James M. McMahon
- School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Julie E. Myers
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
- Division of Infectious Diseases, Department of Medicine, Columbia University, New York, New York
| | - Ann E. Kurth
- College of Nursing, New York University, New York, New York
| | - Stephanie E. Cohen
- San Francisco Department of Public Health, STD Prevention and Control, San Francisco, California
| | - Sharon B. Mannheimer
- Department of Medicine, Harlem Hospital, Columbia University College of Physicians and Surgeons, New York, New York
| | - Janie Simmons
- National Development and Research Institutes, New York, New York
| | | | - Nicole Trabold
- School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Jessica E. Haberer
- Massachusetts General Hospital Center for Global Health and Harvard Medical School, Boston, Massachusetts
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