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Harris LM, Kerr JC, Skidmore BD, Ghare S, Reyes-Vega A, Remenik-Zarauz V, Samanapally H, Anwar RU, Rijal R, Bryant K, Hall MT, Barve S. A conceptual analysis of SBIRT implementation alongside the continuum of PrEP awareness: domains of fit and feasibility. Front Public Health 2024; 11:1310388. [PMID: 38259734 PMCID: PMC10801388 DOI: 10.3389/fpubh.2023.1310388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a supplementary intervention that can be incorporated into the Pre-Exposure Prophylaxis (PrEP) Care Continuum, complementing initiatives and endeavors focused on Human Immunodeficiency Virus (HIV) prevention in clinical care and community-based work. Referencing the Transtheoretical Model of Change and the PrEP Awareness Continuum, this conceptual analysis highlights how SBIRT amplifies ongoing HIV prevention initiatives and presents a distinct chance to address identified gaps. SBIRT's mechanisms show promise of fit and feasibility through (a) implementing universal Screening (S), (b) administering a Brief Intervention (BI) grounded in motivational interviewing aimed at assisting individuals in recognizing the significance of PrEP in their lives, (c) providing an affirming and supportive Referral to Treatment (RT) to access clinical PrEP care, and (d) employing client-centered and destigmatized approaches. SBIRT is uniquely positioned to help address the complex challenges facing PrEP awareness and initiation efforts. Adapting the SBIRT model to integrate and amplify HIV prevention efforts merits further examination.
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Affiliation(s)
- Lesley M. Harris
- Kent School of Social Work & Family Science, University of Louisville, Louisville, KY, United States
| | - Jelani C. Kerr
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, United States
| | - Blake D. Skidmore
- Kent School of Social Work & Family Science, University of Louisville, Louisville, KY, United States
| | - Smita Ghare
- School of Medicine, University of Louisville, Louisville, KY, United States
| | - Andrea Reyes-Vega
- School of Medicine, University of Louisville, Louisville, KY, United States
| | | | | | - Rana Usman Anwar
- School of Medicine, University of Louisville, Louisville, KY, United States
| | - Rishikesh Rijal
- School of Medicine, University of Louisville, Louisville, KY, United States
| | - Kendall Bryant
- HIV/AIDS Research, National Institute on Alcohol Abuse and Alcoholism (NIAAA), Bethesda, MD, United States
| | - Martin T. Hall
- Kent School of Social Work & Family Science, University of Louisville, Louisville, KY, United States
| | - Shirish Barve
- School of Medicine, University of Louisville, Louisville, KY, United States
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Sánchez-Mendoza V, Soriano-Ayala E, Vallejo-Medina P, Martínez O. A Scoping Review of Biobehavioural Interventions to Improve PrEP Continuum of Care in Latin America. ACTA COLOMBIANA DE PSICOLOGIA 2023; 26:141-154. [PMID: 38130977 PMCID: PMC10733975 DOI: 10.14718/acp.2023.26.2.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
According to the literature, biobehavioural interventions or combined strategies would reduce the risk of HIV infection by more than 7,000 new cases each day, which would contribute to the battle facing Latin America, where despite the high incidence and prevalence of HIV in the region, access to PrEP (pre-exposure prophylaxis) is very limited. The objective of this research was, consistent with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), to conduct a scoping review to assess the evidence of available outcome data on biobehavioural interventions and programs to address gaps in the PrEP continuum of care in Latin America. The search was conducted in the databases EBSCOhost, WoS, Scopus, and ProQuest, and include all studies published from 2010 to 2021. One hundred eighty-six studies were identified and evaluated according to the eligibility criteria in six stages starting with the elimination of duplicates until the selection of studies that met the previously mentioned criteria; at the end five studies were chosen which were submitted to the methodological quality assessment including compliance with ethical guidelines. Results show that biobehavioural interventions promoting PrEP in Latin America are effective in increasing condom use, decreasing HIV risk, and increasing PrEP awareness, uptake, adherence, and retention. The limited number of interventions in the PrEP continuum of care indicates a need for the uptake of dissemination and implementation science (D&I) frameworks. D&I could help facilitate the translation of evidence-based practices, interventions, and policies to address the HIV crisis in Latin America.
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Affiliation(s)
- Vanessa Sánchez-Mendoza
- Universidad de Almería, Almería, Spain, Fundación Universitaria Konrad Lorenz, Bogotá, Colombia
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Santos LAD, Unsain RF, Brasil SA, Silva LAVD, Duarte FM, Couto MT. PrEP perception and experiences of adolescent and young gay and bisexual men: an intersectional analysis. CAD SAUDE PUBLICA 2023; 39Suppl 1:e00134421. [PMID: 36995863 DOI: 10.1590/0102-311xen134421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/11/2021] [Indexed: 03/29/2023] Open
Abstract
Studies indicate gaps in knowledge about the barriers to access and adhere to HIV pre-exposure prophylaxis (PrEP) in adolescents. In this article, we explore the perceptions and experiences of young gay, bisexual, and other men who have sex with men (YGBMSM) of the search, use and adherence to PrEP, considering their positions according to social markers of difference such as race/skin color, gender, sexuality, and social status. Intersectionality provides theoretical and methodological tools to interpret how the interlinking of these social markers of difference constitutes barriers and facilitators in the PrEP care continuum. The analyzed material is part of the PrEP1519 study and is comprised of 35 semi-structured interviews with YGBMSM from two Brazilian capitals (Salvador and São Paulo). The analyses suggest connections between social markers of difference, sexual cultures, and the social meanings of PrEP. Subjective, relational and symbolic aspects permeate the awareness of PrEP in the range of prevention tools. Willingness to use and adhere to PrEP is part of a learning process, production of meaning, and negotiation in the face of getting HIV and other sexually transmittable infections and the possibilities of pleasure. Thus, accessing and using PrEP makes several adolescents more informed about their vulnerabilities, leading to more informed decision-making. Interlinking the PrEP continuum of care among YGBMSM with the intersections of the social markers of difference may provide a conceptual framework to problematize the conditions and effects of implementing this prevention strategy, which could bring advantages to HIV prevention programs.
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Murphy L, Bowra A, Adams E, Cabello R, Clark JL, Konda K, Perez-Brumer A. PrEP policy implementation gaps and opportunities in Latin America and the Caribbean: a scoping review. Ther Adv Infect Dis 2023; 10:20499361231164030. [PMID: 37114192 PMCID: PMC10126665 DOI: 10.1177/20499361231164030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/28/2023] [Indexed: 04/29/2023] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) is an important tool for HIV prevention in Latin America and the Caribbean (LAC). Yet, little is known about the PrEP policies landscape in the region. Addressing this gap, this scoping review assessed current PrEP policies throughout LAC to better understand existing PrEP implementation gaps and identify opportunities to improve access. Methods We conducted a scoping review, using a modified PRISMA extension, through 28 July 2022, to identify country-level PrEP policies. Data were collected in English, Spanish, French, and Portuguese utilizing online platforms for screening and data extraction (Google Forms, Zotero, and Excel). Extracted data were divided by data source, including country-level government policies, gray literature, and peer-reviewed literature, with at least one full-text reviewer and data extractor per publication. An iterative summative content analysis was performed to compare and interpret themes across phases and data sources. Results Of the 33 countries in LAC, 22 (67%) had policies approving daily oral PrEP for HIV prevention, which outlined specific key populations, including men who have sex with men, transgender women, sex workers, and serodiscordant couples. Generic tenofovir disoproxil fumarate/emtricitabine has been approved in 15 of the 33 countries, and 13 of the 33 countries have incorporated PrEP into their public health system. No countries were found to have approved cabotegravir. Costing data were reported by only one country, Ecuador, in its national health ministry guidelines. Findings also document a lag between the media/gray-literature announcement of PrEP and implementation of policies. Conclusion Findings underscore significant advances in PrEP policies in the region and signal opportunities for greater PrEP implementation. Since 2017, an increasing number of countries have begun to provide PrEP to communities at heightened need, although significant gaps remain. Policy approval is a key step to further increasing access to PrEP in LAC, necessary to reduce the burden of HIV in LAC, specifically among marginalized populations.
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Affiliation(s)
- Luke Murphy
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Andrea Bowra
- Division of Social and Behavioural Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ellithia Adams
- Division of Social and Behavioural Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Jesse L. Clark
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kelika Konda
- Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Amaya Perez-Brumer
- Division of Social and Behavioural Health, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, Canada, M5T 3M7
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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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Bracho-Sanchez E, Stonbraker S, Halpern M, Wood S, Lowenthal E. HIV pre-exposure prophylaxis: assessment of acceptability among members of HIV serodiscordant/serostatus unknown couples. Int J STD AIDS 2022; 33:687-693. [PMID: 35488451 DOI: 10.1177/09564624221097753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is effective in preventing HIV infection but is not yet widely available in resource-limited settings such as the Dominican Republic. We aimed to ascertain PrEP acceptability among people living with HIV in the Dominican Republic who are part of HIV serodiscordant partnerships and understand relationships between PrEP acceptability, HIV stigma, and intimate partner violence.Methods: A cross-sectional survey of people in care for HIV infection included acceptability-related questions and assessments of HIV stigma and intimate partner violence. We also explored the expected impact of PrEP on HIV disclosure rates and fertility intentions.Results: Of the 100 participants, 74% had been in their current partnership for >1 year; 38% had not disclosed to their partner; 29% reported condomless sex, and 23% reported sex with multiple partners. PrEP was highly acceptable with 84% of participants saying they were "very likely" to offer PrEP to their partner if available and 21% stating it would allow them to have more children. Of those who had not disclosed to their partner, 71% stated PrEP would help them do so. No relationship was found between PrEP acceptability, HIV stigma, and intimate partner violence. However, higher than expected rates of PrEP acceptability limited the power of these analyses.Conclusion: Pre-exposure prophylaxis was considered to be highly acceptable among people living with HIV in the Dominican Republic who are part of serodiscordant partnerships.
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Affiliation(s)
| | - Samantha Stonbraker
- 129263University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, CO, USA
| | - Mina Halpern
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | - Sarah Wood
- Department of Pediatrics, Global Health Center, 6567The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Elizabeth Lowenthal
- Department of Pediatrics, Global Health Center, 6567The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department Biostatistics, Epidemiology and Informatics, 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Baruch R, Cuadra SM, Arellano J, Sánchez D, Ortega DV, Arredondo A. Pre-exposure prophylaxis and its implications in Mexico: notions of men who have sex with men. Sex Health 2021; 17:22-28. [PMID: 31969247 DOI: 10.1071/sh18193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 07/02/2019] [Indexed: 01/10/2023]
Abstract
Background The aim of this study was to analyse ideas regarding pre-exposure prophylaxis (PrEP) for the prevention of HIV among groups of men who have sex with men in Mexico for future implementation in health services. METHODS During 2015, 54 people participated in four focus groups in three Mexican cities. Issues related to challenges for uses and limitations of PrEP were explored. RESULTS In contrast with other qualitative studies, which emphasised problems with relationships with other people for PrEP use or access to key populations, Mexican participants focused their concerns around the public health services organisation: PrEP is too expensive and the health services have no resources, which will affect services and result in discrimination. Participants identified possible stigmatisation related to prejudices of medical providers who do not approve the decreased use of condoms. As a potential solution, participants suggested that the Mexican Government could negotiate a lower cost for PrEP and public health services could provide the medication, with periodical review of the arrangements by civil organisations. CONCLUSION In the current context of the new Mexican government, it is necessary to propose public politics focused on negotiating with pharmaceutical companies on the costs of the PrEP, coordinating public services with groups within civil society and strengthening policies and actions to reduce stigma and discrimination.
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Affiliation(s)
- R Baruch
- Escuela de Salud Pública de México, Instituto Nacional de Salud Pública, Avenida Universidad 655, Colonia Santa María Ahuacatitlán, Cuernavaca, Morelos, CP 62100, México
| | - S M Cuadra
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública de México, Instituto Nacional de Salud Pública, Avenida Universidad 655, Colonia Santa María Ahuacatitlán, Cuernavaca, Morelos, CP 62100, México; and Corresponding author.
| | - J Arellano
- Programa Conjunto de las Naciones Unidas sobre el VIH/Sida, Coordinación en México, Homero 806, colonia Polanco IV sección, Delegación Benito Juárez, Ciudad de México 11550, México
| | - D Sánchez
- Dirección General para la Organización de las Naciones Unidas, Secretaría de Relaciones Exteriores, Avenida Juárez, Centro, Ciudad de México 06000, México
| | - D V Ortega
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública de México, Instituto Nacional de Salud Pública, Avenida Universidad 655, Colonia Santa María Ahuacatitlán, Cuernavaca, Morelos, CP 62100, México
| | - A Arredondo
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública de México, Instituto Nacional de Salud Pública, Avenida Universidad 655, Colonia Santa María Ahuacatitlán, Cuernavaca, Morelos, CP 62100, México
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Are men who have sex with men at higher risk for HIV in Latin America more aware of PrEP? PLoS One 2021; 16:e0255557. [PMID: 34388155 PMCID: PMC8362965 DOI: 10.1371/journal.pone.0255557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 07/14/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction PrEP awareness in Latin America has been poorly characterized, with studies in Brazil, Mexico, and Peru highlighting awareness of 65% among gay, bisexual and other men who have sex with men (MSM). We assessed the association between higher risk of HIV infection, indicative of PrEP eligibility, and PrEP awareness among MSM from these countries. Methods This was a secondary analysis of a web-based survey advertised on social media platforms from March-June 2018 in Brazil, Mexico and Peru. Eligible individuals were cisgender MSM, ≥18 years old, HIV negative or of unknown status, who lived in these countries, and provided informed consent. Higher risk of HIV infection was defined as having 10 or more points in the HIV Risk Index for MSM (HIRI-MSM). We used multivariable Poisson regression models to calculate adjusted prevalence ratios (aPR) testing the association between higher risk for HIV and PrEP awareness. Results After exclusions, 19,457 MSM were included in this analysis. In Brazil, 53.8% were classified as higher risk for HIV, 51.9% in Mexico, and 54.2% in Peru. Higher risk for HIV was minimally associated with PrEP awareness among those in Brazil (aPR 1.04, 95% CI 1.01, 1.06), but no such association was observed in Mexico or Peru. Having more than a high school education, high income, daily use of geosocial networking (GSN) applications, and substance use were associated with PrEP awareness. Conclusion Higher risk of HIV infection was associated with increased PrEP awareness in Brazil. However, this association was weak indicating that PrEP awareness could be strengthened with further prevention efforts. In the remaining countries, results were non-conclusive between risk and awareness. Interventions to increase PrEP awareness are paramount to increase PrEP willingness and uptake and in turn prevent new HIV infections. Social media platforms could play an important role to achieve this goal.
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Best A, Rambarran N. The demographic features and outcome indicators of the Barbados HIV Pre-exposure Prophylaxis Program, 2018-2019. Rev Panam Salud Publica 2021; 45:e51. [PMID: 33907558 PMCID: PMC8064290 DOI: 10.26633/rpsp.2021.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/26/2021] [Indexed: 12/17/2022] Open
Abstract
Objective. To assess the demographics, risk profiles and outcome indicators of one of the few government-supported programs on pre-exposure prophylaxis (PrEP) in the English-speaking Caribbean. Methods. Chart review of all persons enrolled into the national PrEP Program from its inception on March 1st 2018 to November 30th 2019, with a descriptive summary analysis of the data extracted. Results. Of the 134 persons enrolled into the program most identified as men who have sex with men (67.9%), followed by men who have sex with men and women (14.9%); there were 20 persons, mostly men (85%), in sero-discordant relationships. PrEP uptake was 96%; however, the continuation rate (continuing for three consecutive months after initiation) was 61.5%. Continuation status for many could not be ascertained due to loss-to-follow-up. PrEP-associated toxicity prevalence was 2.3%, although side-effects occurred in 52% (mostly gastrointestinal). HIV positivity during the study period was 1.5%. Conclusions. Uptake of Barbados’ national PrEP Program is excellent but fairly low continuation rates and the HIV positivity rate indicate the need for improved pre-ART initiation education and follow-up processes. Service utilisation is mainly by men who have sex with men, and provision expansion to other civil society partners and private practitioners, as well as increased public awareness could increase access by other high-risk groups.
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Affiliation(s)
- Anton Best
- Ministry of Health and Wellness Bridgetown Barbados Ministry of Health and Wellness, Bridgetown, Barbados
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Ganley KY, Wilson-Barthes M, Zullo AR, Sosa-Rubí SG, Conde-Glez CJ, García-Cisneros S, Lurie MN, Marshall BDL, Operario D, Mayer KH, Galárraga O. Incidence and time-varying predictors of HIV and sexually transmitted infections among male sex workers in Mexico City. Infect Dis Poverty 2021; 10:7. [PMID: 33461615 PMCID: PMC7814587 DOI: 10.1186/s40249-020-00792-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/28/2020] [Indexed: 11/21/2022] Open
Abstract
Background Male sex workers are at high-risk for acquisition of sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). We quantified incidence rates of STIs and identified their time-varying predictors among male sex workers in Mexico City. Methods From January 2012 to May 2014, male sex workers recruited from the largest HIV clinic and community sites in Mexico City were tested for chlamydia, gonorrhea, syphilis, hepatitis, and HIV at baseline, 6-months, and 12-months. Incidence rates with 95% bootstrapped confidence limits were calculated. We examined potential time-varying predictors using generalized estimating equations for a population averaged model. Results Among 227 male sex workers, median age was 24 and baseline HIV prevalence was 32%. Incidence rates (per 100 person-years) were as follows: HIV [5.23; 95% confidence interval (CI): 2.15–10.31], chlamydia (5.15; 95% CI: 2.58–9.34), gonorrhea (3.93; 95% CI: 1.88–7.83), syphilis (13.04; 95% CI: 8.24–19.94), hepatitis B (2.11; 95% CI: 0.53–4.89), hepatitis C (0.95; 95% CI: 0.00–3.16), any STI except HIV (30.99; 95% CI: 21.73–40.26), and any STI including HIV (50.08; 95% CI: 37.60–62.55). In the multivariable-adjusted model, incident STI (excluding HIV) were lower among those who reported consistently using condoms during anal and vaginal intercourse (odds ratio = 0.03, 95% CI: 0.00–0.68) compared to those who reported inconsistently using condoms during anal and vaginal intercourse. Conclusions Incidence of STIs is high among male sex workers in Mexico City. Consistent condom use is an important protective factor for STIs, and should be an important component of interventions to prevent incident infections. ![]()
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Affiliation(s)
- Karla Y Ganley
- Department of Narrative Medicine, Columbia University, New York, NY, USA
| | - Marta Wilson-Barthes
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, 121 South Main Street, Box G-121S-2, Providence, RI, 02912, USA
| | | | | | | | - Mark N Lurie
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Don Operario
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, RI, USA
| | | | - Omar Galárraga
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, 121 South Main Street, Box G-121S-2, Providence, RI, 02912, USA.
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Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems. BMC Med 2021; 19:4. [PMID: 33413343 PMCID: PMC7791645 DOI: 10.1186/s12916-020-01876-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/27/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. METHODS We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. RESULTS All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries-apart from Ecuador-across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups-the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. CONCLUSIONS Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths.
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Abstract
Purpose of review To describe how countries in Latin America and the Caribbean are (or are not) meeting 2016 WHO guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, that is, their progress on the adoption of ‘Treat All’ and of preexposure prophylaxis (PrEP) as an additional prevention tool for people at substantial risk of HIV infection. Recent findings The HIV epidemic in the region continues largely concentrated in vulnerable populations with MSM and transgender women (TGW) suffering the highest burden. On treatment, the challenges of late initiation as well as suboptimal adherence persist. On prevention, recent studies on PrEP willingness in key populations show promising results, meanwhile PrEP implementation projects as well as actual PrEP adoption by national health systems is expanding. A glimpse of real-world PrEP uptake is shown through Brazil's first-year experience of offering PrEP in multiple cities in all regions of the country. Summary In conclusion, accomplishments have been made though challenges for fully addressing the HIV epidemic persist. The impact of both treatment and PrEP will be limited by the availability and prompt use of all services, including HIV testing.
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Torres-Cruz C, Suárez-Díaz E. The stratified biomedicalization of HIV prevention in Mexico City. Glob Public Health 2019; 15:598-610. [PMID: 31630626 DOI: 10.1080/17441692.2019.1679217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In the late 1990s antiretroviral pharmaceuticals began to be used in the United States and Western Europe to prevent HIV infection in contexts of occupational exposure. One decade later, the application of Post Exposure Prophylaxis (PEP) and Pre-Exposure Prophylaxis (PrEP) had been extended to include cases of exposure to sexual assault, injection-drug use, and consensual sexual intercourse deemed at high risk. This article explores the implementation of biomedicalized HIV prevention protocols at a public healthcare clinic in Mexico City, building on sociological-feminist approaches in Science and Technology Studies (STS) and drawing on interviews with key actors, as well as digital ethnography. We emphasise the stratified biomedicalization or, said otherwise, the differences in PEP and PrEP accessibility and consumption among different populations and groups. We also describe the fragile grip of institutionalised biomedical solutions when alternative 'moral economies' intersect with them, particularly in contexts like Mexico, where governmental funding for experimental research on biomedical innovations has been limited. This text reveals both the existence of contrasting technoscientific interventions along class and gender differences, and the multiple and vivid ways by which individuals appropriate and interpret global biomedical practices.
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Affiliation(s)
- César Torres-Cruz
- Science and Technology Studies Group, School of Sciences, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Edna Suárez-Díaz
- Science and Technology Studies Group, School of Sciences, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
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14
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Identification of a Syndemic of Blood-Borne Disease Transmission and Injection Drug Use Initiation at the US-Mexico Border. J Acquir Immune Defic Syndr 2019; 79:559-565. [PMID: 30222661 DOI: 10.1097/qai.0000000000001858] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Efforts to prevent injection drug use (IDU) are increasingly focused on the role that people who inject drugs (PWID) play in the assistance with injection initiation. We studied the association between recent (ie, past 6 months) injection-related HIV risk behaviors and injection initiation assistance into IDU among PWID in the US-Mexico border region. SETTING Preventing Injecting by Modifying Existing Responses (PRIMER) is a multicohort study assessing social and structural factors related to injection initiation assistance. This analysis included data collected since 2014 from 2 participating cohorts in San Diego and Tijuana. METHODS Participants were 18 years and older and reported IDU within the month before study enrollment. Logistic regression analyses were conducted to assess the association between recent injection-related HIV risk behaviors (eg, distributive/receptive syringe sharing, dividing drugs in a syringe, and paraphernalia sharing) and recent injection initiation assistance. RESULTS Among 892 participants, 41 (4.6%) reported recently providing injection initiation assistance. In multivariable analysis adjusting for potential confounders, reporting a higher number of injection-related risk behaviors was associated with an increased odds of recently assisting others with injection initiation (adjusted odds ratio per risk behavior: 1.3; 95% confidence interval: 1.0 to 1.6, P = 0.04). CONCLUSIONS PWID who recently engaged in one or more injection-related HIV risk behavior were more likely to assist others in injection initiation. These results stress the syndemic of injection initiation and risk behaviors, which indicates that prevention of injection-related HIV risk behaviors might also reduce the incidence of injection initiation.
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15
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Longino A, Montano MA, Sanchez H, Bayer A, Sanchez J, Tossas-Milligan K, Duerr A, Molina Y. Increasing PrEP uptake and adherence among MSM and TW sex workers in Lima, Perú: what and whom do different patients trust? AIDS Care 2019; 32:255-260. [PMID: 31242753 DOI: 10.1080/09540121.2019.1634787] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In Perú, men who have sex with men (MSM) and transgender women (TW) suffer rates of HIV 50 times greater than the general population. MSM or TW sex workers (SWs) are at especially high risk. Daily oral pre-exposure prophylaxis (PrEP) effectively prevents HIV infection if patients adhere to a daily or on-demand regimen. Necessary levels of adoption and adherence require data-driven intervention strategies for these marginalized groups. We conducted qualitative content analysis of data obtained from focus groups (FGs) with MSM and TW SWs. Both groups expressed strong skepticism about the motives behind international drug trials, and the safety of participating in them. Important differences between MSM and TW groups' beliefs about trustworthy information as well as community and public institutions also emerged. MSM SWs were less trusting of information from other MSM SWs, and preferred to receive information from institutional medical sources, while TGW SWs preferred to receive information from other TGW SWs. Successful strategies to encourage PrEP uptake and adherence must address the distrust patients feel towards international and institutional actors by providing patients with tailored, reliable information from local and community sources that they trust.
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Affiliation(s)
- August Longino
- School of Medicine, University of Washington, Seattle, USA
| | | | | | - Angela Bayer
- Epidemiology, STI, and HIV Research Unit, School of Public Health and Administration, Universidad Perúana Cayetano Heredia, Lima, Perú.,David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jorge Sanchez
- Centro de Investigación Tecnologicas, Biomedicas y Medioambientales, Universidad Mayor de San Marcos, Lima, Perú
| | - Kathy Tossas-Milligan
- University of Illinois Cancer Center, Office of Global Assets and Innovative Solutions, Chicago, USA
| | - Ann Duerr
- School of Medicine, University of Washington, Seattle, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Yamilé Molina
- University of Illinois Cancer Center, Office of Global Assets and Innovative Solutions, Chicago, USA.,School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
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16
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Golub SA, Myers JE. Next-Wave HIV Pre-Exposure Prophylaxis Implementation for Gay and Bisexual Men. AIDS Patient Care STDS 2019; 33:253-261. [PMID: 31094576 DOI: 10.1089/apc.2018.0290] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Data indicate that diffusion of pre-exposure prophylaxis (PrEP) programs for HIV prevention is increasing in the United States; however, persistent disparities in PrEP access remain. Earlier waves of PrEP implementation focused on development (2012-2015) and diffusion (2016-2018). To reduce disparities, the next wave of PrEP implementation should focus on integration; that is, the assimilation of PrEP service as an integral part of HIV prevention, sexual health, and primary care. This review analyzes PrEP implementation literature in the context of three "next-wave" challenges: increasing patient demand, enhancing provider investment and competency, and improving health systems capacity. Our review revealed five activities we consider critical to successful next-wave PrEP implementation efforts: (1) redefining PrEP eligibility assessment, (2) de-emphasizing risk perception as a strategy to increase demand, (3) rejecting risk compensation arguments, (4) altering guidelines to make PrEP follow-up less onerous, and (5) focusing directly on strategies to reduce the cost of PrEP medication. This article ends with a case study of a research-practice partnership designed to instantiate new approaches to integrative implementation efforts.
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Affiliation(s)
- Sarit A. Golub
- Department of Psychology, Hunter College of the City University of New York, New York, New York
- Basic and Applied Social Psychology (BASP) PhD Program, Department of Psychology, Graduate Center of the City University of New York, New York, 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 Medical Center, New York, New York
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17
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Reisner SL, Perez-Brumer A, Oldenburg CE, Gamarel KE, Malone J, Leung K, Mimiaga MJ, Rosenberger JG, Biello KB. Characterizing HIV risk among cisgender men in Latin America who report transgender women as sexual partners: HIV risk in Latin America men. Int J STD AIDS 2019; 30:378-385. [PMID: 30537903 PMCID: PMC9897015 DOI: 10.1177/0956462418802687] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cisgender men (CM) who report transgender women (TW) as sexual partners are an understudied population in the HIV epidemic in Latin America. The current study sought to characterize this group in a 2012 cross-sectional online survey of Latin American CM who were members of a sexual networking website for men who have sex with men (N = 11,847). Multivariable logistic regression models were fit to estimate demographic, behavioral, and psychosocial correlates of having a TW sexual partner and engaging in condomless sex. Overall, 0.9% (n = 106) reported a TW sexual partner in the last 12 months; of these, 76.4% (n = 81) reported condomless sex in the last three months. Identifying as bisexual or heterosexual compared to gay, and specifying a versatile sexual role preference compared to insertive were associated with reporting a recent TW sex partner (all p < 0.05). HIV-negative serostatus, lifetime STI history, and alcohol dependence were associated with recent condomless sex (all p < 0.05). CM with TW sexual partners have distinct HIV-related vulnerabilities. Future research is needed to understand CM who report TW sexual partners, including their sexual preferences and practices, sexual networks, exposure to stigma, biomedical prevention interest and uptake, and acceptability of integrating alcohol abuse screening into sexual health services.
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Affiliation(s)
- Sari L Reisner
- Division of General Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore MD
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | | | - Kristi E Gamarel
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jowanna Malone
- Johns Hopkins Bloomberg School of Public Health, Baltimore MD
| | - Kingsley Leung
- Johns Hopkins Bloomberg School of Public Health, Baltimore MD
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Katie B. Biello
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
- Center for Health Equity Research, Brown University, Providence, RI
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18
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Edeza A, Galarraga O, Novak D, Mayer K, Rosenberger J, Mimiaga M, Biello K. The role of sexual risk behaviors on PrEP awareness and interest among men who have sex with men in Latin America. Int J STD AIDS 2019; 30:542-549. [PMID: 30722750 DOI: 10.1177/0956462419825944] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In Latin America, men who have sex with men (MSM) remain disproportionately impacted by HIV. Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool and has been FDA approved in the United States since 2012, but no Latin American state, with the recent exception of Brazil, has implemented PrEP guidelines. We carried out a multinational online survey of MSM in Latin America (n = 22698) in 2012 to assess whether MSM at highest risk of HIV acquisition (i.e., those engaging in condomless anal sex [CAS; n = 2606] and transactional sex [n = 1488]) had higher levels of awareness of PrEP, PrEP use and interest in participating in a PrEP trial. After adjusting for demographic and psychosocial characteristics including depressive symptoms, hazardous alcohol use, childhood sexual abuse, and sexual compulsivity, transactional sex and CAS were associated with increased PrEP awareness (aOR = 1.29, 95% CI: 1.05-1.59, p < .001 and aOR = 1.22, 95% CI: 1.11-1.34, p < .001, respectively) and PrEP trial interest (aOR = 1.45, 95% CI: 1.25-1.71, p < .001 and aOR = 1.74, 95% CI: 1.57-1.95, p < .001, respectively). Findings demonstrate substantial awareness of and interest in PrEP among MSM with behavioral risk factors for HIV in Latin America, suggesting that this region is primed for PrEP implementation, which has been slow.
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Affiliation(s)
- Alberto Edeza
- 1 Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Omar Galarraga
- 2 Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | - David Novak
- 3 OLB Research Institute, Cambridge, MA, USA
| | - Kenneth Mayer
- 4 The Fenway Institute, Boston, MA, USA.,5 Department of Infectious Disease, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Joshua Rosenberger
- 6 College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Matthew Mimiaga
- 1 Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA.,4 The Fenway Institute, Boston, MA, USA.,7 Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Katie Biello
- 1 Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA.,4 The Fenway Institute, Boston, MA, USA.,7 Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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19
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Garcia J, Perez-Brumer AG, Cabello R, Clark JL. "And Then Break the Cliché": Understanding and Addressing HIV Vulnerability Through Development of an HIV Prevention Telenovela with Men Who Have Sex with Men and Transwomen in Lima, Peru. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1995-2005. [PMID: 29464455 PMCID: PMC6082681 DOI: 10.1007/s10508-017-1119-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/07/2017] [Accepted: 11/14/2017] [Indexed: 06/08/2023]
Abstract
HIV and other sexually transmitted infections (STIs) continue to affect men who have sex with men (MSM) and transgender women (TW) in Peru at disproportionately high rates. The ineffectiveness of traditional prevention strategies may be due to the disconnect between health promotion messages and community-level understandings of sexual cultures. We conducted 15 workshops with MSM and TW to develop a community-based sexual health intervention. Intervention development consisted of focus groups and scenic improvisation to identify sexual scripts for an HIV prevention telenovela, or Spanish soap opera. Workshops were stratified by self-reported socioeconomic status, sexual orientation, and gender identity: (1) low-income MSM (n = 9); (2) middle/high-income MSM (n = 6); and (3) TW (n = 8). Employing a conceptual model based on sexual scripts and critical consciousness theories, this paper reports on three themes identified during the telenovela-development process as participants sought to "rescript" social and sexual stereotypes associated with HIV-related vulnerability: (1) management of MSM and TW social identities at the intersection of socioeconomic status, sexuality, and gender performance; (2) social constructions of gender and/or sexual role and perceived and actual HIV/STI risk(s) within sexual partnership interactions; and (3) idealized and actual sexual scripts in the negotiation of safer sex practices between MSM/TW and their partners. These findings are key to reframing existing prevention strategies that fail to effectively engage poorly defined "high-risk populations." Leveraging community-based expertise, the results provide an alternative to the static transfer of information through expert-patient interactions in didactic sessions commonly used in HIV prevention interventions among MSM and TW.
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Affiliation(s)
- Jonathan Garcia
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, 118C Milam Hall, Corvallis, OR, 97331, USA.
| | - Amaya G Perez-Brumer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Jesse L Clark
- Department of Medicine/Division of Infectious Diseases, UCLA Geffen School of Medicine, Los Angeles, CA, USA
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20
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Pines HA, Strathdee SA, Hendrix CW, Bristow CC, Harvey-Vera A, Magis-Rodríguez C, Martinez G, Semple SJ, Patterson TL. Oral and vaginal HIV pre-exposure prophylaxis product attribute preferences among female sex workers in the Mexico-US border region. Int J STD AIDS 2018; 30:45-55. [PMID: 30170533 DOI: 10.1177/0956462418793038] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
To assess the potential uptake of HIV pre-exposure prophylaxis (PrEP) products among female sex workers (FSWs) vulnerable to HIV infection, we examined the influence of product attributes on willingness to use products among 271 HIV-negative FSWs in Tijuana and Ciudad Juarez, Mexico (2016-2017). Via five-point Likert scale ratings, participants indicated their willingness to use hypothetical products with six attributes: formulation (pill, gel, liquid, or ring), frequency of use (daily, on-demand, or monthly), cost per use (10 or 200 pesos), effectiveness (40% or 80%), side effects (none or mild), and access point (healthcare clinic or non-governmental organization). Conjoint analysis was used to determine the impact of attributes on product ratings and identify preferred product attributes. Multinomial logistic regression was used to identify factors associated with formulation preferences. In both cities, formulation and frequency of use had the greatest impact on ratings. Participants in Ciudad Juarez indicated a strong preference for oral pills, whereas participants in Tijuana indicated roughly equal preferences for oral pills and vaginal gels. Monthly product use was preferred in both cities. Compared to preferring oral pills (38%), preferring vaginal gels (28%) was associated with practicing vaginal lubrication (adjusted odds ratio = 2.08; 95% confidence interval: 1.07-4.04). Oral PrEP may be acceptable to many FSWs in Tijuana and Ciudad Juarez; however, continued development of behaviorally-congruent vaginal PrEP products may also facilitate uptake and ensure sufficient coverage.
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Affiliation(s)
- H A Pines
- 1 Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - S A Strathdee
- 1 Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - C W Hendrix
- 2 Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - C C Bristow
- 1 Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - A Harvey-Vera
- 1 Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - C Magis-Rodríguez
- 3 Centro Nacional para la Prevención y Control del VIH/SIDA (CENSIDA; National Center for HIV/AIDS Prevention and Control), Ministry of Health, Mexico City, Mexico
| | - G Martinez
- 4 Federacion Mexicana de Asociaciones Privadas, Ciudad Juarez, Chihuahua, Mexico
| | - S J Semple
- 5 Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - T L Patterson
- 5 Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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21
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Zucchi EM, Grangeiro A, Ferraz D, Pinheiro TF, Alencar T, Ferguson L, Estevam DL, Munhoz R. [From evidence to action: challenges for the Brazilian Unified National Health System in offering pre-exposure prophylaxis (PrEP) for HIV to persons with the greatest vulnerability]. CAD SAUDE PUBLICA 2018; 34:e00206617. [PMID: 30043853 DOI: 10.1590/0102-311x00206617] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 05/02/2018] [Indexed: 12/12/2022] Open
Abstract
Pre-exposure prophylaxis (PrEP) has been considered a promising strategy for controlling the global HIV epidemic. However, it is necessary to translate the knowledge accumulated from clinical trials and demosntration studies to the reality of health services and the groups most vulnerable to infection in order to achieve broad coverage with PrEP. The article proposes a reflection on this challenge, focusing on three dimensions: users of prophylaxis, with an emphasis on the contexts of sexual practices and the potential exposures to HIV; the advantages of prophylaxis as compared to other methods and the challenges for protective and safe use; and health services, considering the organizational principles to ensure greater success in the supply and incorporation of PrEP as part of combination prevention strategies. The following principles were analyzed: uniqueness of care, freedom of choice and non-hierarchization of prevention methods, sexual risk management, scheduling flexibility, and complementary and multidisciplinary care. These principles can foster organization of the health service and care, facilitating linkage and retention in care. Some comments were offered on the relative incompatibility between the existing structure of services and the Brazilian Ministry of Health guidelines for offering PrEP. The conclusion was that the success of PrEP as a public health policy depends on two essential factors: ensuring that health services are culturally diverse settings, free of discrimination, and the intensification of community-based interventions, including social networks, in order to reduce inequalities in access to PrEP and health services as a whole.
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Affiliation(s)
- Eliana Miura Zucchi
- Programa de Pós-graduação em Saúde Coletiva, Universidade Católica de Santos, Santos, Brasil
| | | | - Dulce Ferraz
- Escola Fiocruz de Governo, Fundação Oswaldo Cruz, Brasília, Brasil
| | | | - Tatianna Alencar
- Departamento de Vigilância, Prevenção e Controle das Infecções Sexualmente Transmissíveis, do HIV/Aids e das Hepatites Virais, Ministério da Saúde, Brasília, Brasil
| | - Laura Ferguson
- Keck School of Medicine, University of Southern California, Los Angeles, U.S.A
| | - Denize Lotufo Estevam
- Centro de Referência e Treinamento em DST/AIDS-SP, Secretaria de Estado de Saúde de São Paulo, São Paulo, Brasil
| | - Rosemeire Munhoz
- Centro de Referência e Treinamento em DST/AIDS-SP, Secretaria de Estado de Saúde de São Paulo, São Paulo, Brasil
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Zablotska IB, O'Connor CC. Preexposure Prophylaxis of HIV Infection: the Role of Clinical Practices in Ending the HIV Epidemic. Curr HIV/AIDS Rep 2018; 14:201-210. [PMID: 29071519 DOI: 10.1007/s11904-017-0367-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW The aim of this study is to summarise the recent evidence from high-income settings about providers' ability to deliver on the UNAIDS goal of at least three million people at substantial risk of HIV infection with PrEP by 2020, including awareness and knowledge about PrEP, willingness to prescribe PrEP, current levels of prescribing and service delivery models and issues. RECENT FINDINGS Awareness about PrEP among health providers is growing, but at different pace depending on provider type. HIV and sexual health specialists are more likely to have knowledge about PrEP than generalists, and to be willing to prescribe it, mainly because of their closer contact with people at high risk for HIV and better risk assessment skills. There is still no consensus as to who should be responsible for providing PrEP, but clearly all hands on deck will be useful in delivering on the international target of three million people at substantial risk for HIV on PrEP by 2020. Only about 5% of the target has been reached so far. Local guidance and large-scale education and information programs for clinicians will be necessary to upskill health providers. High cost of PrEP is still a major barrier for its broad implementation, even in countries were PrEP roll-out has started. Health services are facing major structural challenges due to implementation of PrEP services to a substantial volume of patients. The early implementation experiences demonstrated that PrEP can be successfully delivered across a variety of settings, and a broad range of strategies and models of care can streamline PrEP delivery. Education of the providers and PrEP cost solutions will be essential for rapid roll-out of PrEP.
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Affiliation(s)
- Iryna B Zablotska
- The Kirby Institute, University of New South Wales Sydney, Sydney, 2052, Australia.
| | - Catherine C O'Connor
- The Kirby Institute, University of New South Wales Sydney, Sydney, 2052, Australia
- Sexual Health Service, Sydney Local Health District, Camperdown, 2050, Australia
- Central Clinical School, University of Sydney, Sydney, 2006, Australia
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23
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Galea JT, Baruch R, Brown B. ¡PrEP Ya! Latin America wants PrEP, and Brazil leads the way. Lancet HIV 2018; 5:e110-e112. [PMID: 29467099 DOI: 10.1016/s2352-3018(18)30011-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/15/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Jerome T Galea
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA.
| | | | - Brandon Brown
- Center for Healthy Communities, School of Medicine, University of California, Riverside, CA, USA
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Awareness and willingness to use HIV pre-exposure prophylaxis among men who have sex with men in low- and middle-income countries: a systematic review and meta-analysis. J Int AIDS Soc 2017; 20:21580. [PMID: 28691439 PMCID: PMC5515024 DOI: 10.7448/ias.20.1.21580] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction: To facilitate provision of pre-exposure prophylaxis (PrEP) in low- and middle-income countries (LMIC), a better understanding of potential demand and user preferences is required. This review assessed awareness and willingness to use oral PrEP among men who have sex with men (MSM) in LMIC. Methods: Electronic literature search of Cochrane library, Embase, PubMed, PsychINFO, CINHAL, Web of Science, and Google Scholar was conducted between July and September 2016. Reference lists of relevant studies were searched, and three authors contacted for additional data. Non-peer reviewed publications were excluded. Studies were screened for inclusion, and relevant data abstracted, assessed for bias, and synthesized. Results: In total, 2186 records were identified, of which 23 studies involving 14,040 MSM from LMIC were included. The proportion of MSM who were aware of PrEP was low at 29.7% (95% CI: 16.9–44.3). However, the proportion willing to use PrEP was higher, at 64.4% (95% CI: 53.3–74.8). Proportions of MSM aware of PrEP was <50% in 11 studies and 50–70% in 3 studies, while willingness to use PrEP was <50% in 6 studies, 50–70% in 9 studies, and over 80% in 5 studies. Several factors affected willingness to use PrEP. At the individual domain, poor knowledge of PrEP, doubts about its effectiveness, fear of side effects, low perception of HIV risk, and the need to adhere or take medicines frequently reduced willingness to use PrEP, while PrEP education and motivation to maintain good health were facilitators of potential use. Demographic factors (education, age, and migration) influenced both awareness and willingness to use PrEP, but their effects were not consistent across studies. At the social domain, anticipated stigma from peers, partners, and family members related to sexual orientation, PrEP, or HIV status were barriers to potential use of PrEP, while partner, peer, and family support were facilitators of potential use. At the structural domain, concerns regarding attitudes of healthcare providers, quality assurance, data protection, and cost were determinants of potential use. Conclusions: This review found that despite low levels of awareness of PrEP, MSM in LMIC are willing to use it if they are supported appropriately to deal with a range of individual, social, and structural barriers.
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No one left behind: how are we doing in the roll-out of PrEP as part of combination HIV prevention? J Int AIDS Soc 2016; 19:21364. [PMID: 27760690 PMCID: PMC5071753 DOI: 10.7448/ias.19.7.21364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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26
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Global implementation of PrEP as part of combination HIV prevention - Unsolved challenges. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.7.21479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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