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Mosnier E, Hoyer M, Artigas F, Regnault H, Richard E, Michels D, Mosnier M, Inegbeze G, Robledo MS, Spire B, Vandentorren S, Lescaudron M, Eldin C, Roux P. Enhancing sexual health and empowerment among migrant women sex workers: a community health worker-led intervention in Marseille, France. Front Public Health 2024; 12:1359363. [PMID: 38601503 PMCID: PMC11005911 DOI: 10.3389/fpubh.2024.1359363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/21/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction Given the high infection rate of sexually transmitted infections (STI) among migrant women sex workers (WSWs), it is necessary to understand how to improve prevention, information and care for this vulnerable population. Community health workers (CHWs), by linking community to health services, are positioned to improve health outcomes in migrant communities. This article aims to describe a pilot innovative intervention performed by CHWs to improve sexual health in migrant WSWs. Methods This one-year intervention study used a respondent-driven sampling (RDS) to recruit a representative cohort of migrant WSWs in Marseille, France. Four CHWs were recruited from different communities and participated in all stages of the research. They performed individual and group interventions of prevention, support in care and empowerment. Data on participant characteristics, type of intervention and adherence to the intervention were reported via questionnaires given to participants. Simultaneously, semi-structured interviews and informal interviews of migrant WSW, CHWs and care providers were carried out. Results A total of 132 migrant WSWs were included in the cohort. Very few of them knew about PrEP (12%) or already used HIV post-exposure treatment (9%). Migrant WSWs were often victims of rape or racism, 15 and 21%, respectively. In two-thirds of cases the level of health literacy was low. Participants suffered from a combination of vulnerability factors: difficulties with access to social rights, food or housing. Only 13% reported having benefited from medical follow-up or assistance by an NGO in the 3 months prior to the program. By 3 months, more than one third of the participants had been tested for HIV (35%) and 63% knew about PrEP. A total retention rate of 70% was reported in the cohort after 6 months. Conclusion CHWs enabled to improve care access for migrant WSWs by improving the collaboration between care and social actors at a local level. Through these "bring-back-to" interventions for this hard-to-reach population, CHWs enabled an optimization of the care pathway. Our results also highlight the importance of a population-based approach for individual and group support of empowerment interventions in order to strengthen their capacity for action.
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Affiliation(s)
- Emilie Mosnier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l’Information Médicale, Aix Marseille Institute of Public Health ISSPAM, Marseille, France
- ANRS-MIE, University of Health Sciences, Phnom Penh, Cambodia
| | - Maxime Hoyer
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l’Information Médicale, Aix Marseille Institute of Public Health ISSPAM, Marseille, France
| | | | - Hippolyte Regnault
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l’Information Médicale, Aix Marseille Institute of Public Health ISSPAM, Marseille, France
| | - Elodie Richard
- PHAReS, Centre INSERM U1218, Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
| | - David Michels
- Association AIDES, Pantin, France
- Laboratoire de Recherche Communautaire, Coalition PLUS, Pantin, France
| | | | | | | | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l’Information Médicale, Aix Marseille Institute of Public Health ISSPAM, Marseille, France
- Association AIDES, Pantin, France
| | - Stéphanie Vandentorren
- PHAReS, Centre INSERM U1218, Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
| | | | - Carole Eldin
- Unité des Virus Emergents (UVE), Aix-Marseille Université, IRD 190 INSERM 1207 EFS-IRBA, Marseille, France
| | - Perrine Roux
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l’Information Médicale, Aix Marseille Institute of Public Health ISSPAM, Marseille, France
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Howell J, Deane-King J, Maguire R. Factors Associated with PrEP Stigma Among Gay, Bisexual, and Other Men Who Have Sex with Men (gbMSM): A Systematic Review. J Homosex 2024:1-30. [PMID: 38511847 DOI: 10.1080/00918369.2024.2326891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Gay, bisexual, and other men who have sex with men (gbMSM) are disproportionately affected by HIV. While pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV acquisition, uptake of PrEP among gbMSM is low, which may in part be due to stigma associated with PrEP use. This systematic review aimed to explore experiences of PrEP stigma and to identify factors associated with this. Four databases were searched for papers including terms relating to (i) gbMSM, (ii) PrEP, and (iii) stigma, with narrative synthesis used to analyze results. After screening, 70 studies were included in the final analysis. Experiences of PrEP stigma were found to be characterized by a number of stereotypes and came from a range of sources. Five categories of factors were associated with stigma: (i) healthcare-related factors, (ii) cultural and contextual factors, (iii) sociodemographic factors, (iv) peer-discussion, and (v) psychosocial factors. These findings suggest that stigma can be a common experience for gbMSM. However, some are more at risk than others. Interventions aimed at reducing PrEP stigma may be useful in increasing uptake.
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Affiliation(s)
- Jamie Howell
- Department of Psychology, Maynooth University, Maynooth, Ireland
| | | | - Rebecca Maguire
- Department of Psychology, Maynooth University, Maynooth, Ireland
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Yeo TED. Reconciling intimacy and safety: a qualitative systematic review of HIV pre-exposure prophylaxis implementation among gay and bisexual men. Cult Health Sex 2023:1-16. [PMID: 37860979 DOI: 10.1080/13691058.2023.2270004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
This review synthesises qualitative research on pre-exposure prophylaxis (PrEP) uptake by sexual minority men to provide an overarching conceptualisation of the implementation processes involved. Twenty-four studies-comprising 734 participants from USA, UK, France, Canada, and Taiwan-were synthesised using thematic synthesis. The synthesis elucidates the dual significance of PrEP uptake: (1) risk management: reinforcing relational circumstances, and rebalancing safety and risk; and (2) sexual empowerment: reclaiming health and sexuality and refocusing on sexual fulfillment and intimacy. Overall, the findings show how gay and bisexual men use PrEP to reconcile their antagonistic desires for intimacy and safety by recalibrating protection and reimagining intimacy. This review conceptualises the essence of users' experiences of PrEP implementation as reconciliation work-the labour and agency in making and remaking practices to manage discontinuities and incongruities-about the new HIV prevention modality. The concept of reconciliation work illustrates how using PrEP influences users' practices, which in turn, shape the meanings of PrEP use within the community. This work engenders contingent transformations and outcomes beyond HIV protection, encompassing the broader aspects of health and sexuality. Findings support the adoption of more holistic and empowering approaches to sexual health promotion and intervention.
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Affiliation(s)
- Tien Ee Dominic Yeo
- Department of Communication Studies, Hong Kong Baptist University, Hong Kong, China
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Lisboa C, Stuardo V, Folch C. Sexualized drug use among gay men and other men who have sex with men in Latin America: A description of the phenomenon based on the results of LAMIS-2018. PLoS One 2023; 18:e0287683. [PMID: 37856552 PMCID: PMC10586662 DOI: 10.1371/journal.pone.0287683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/08/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Sexualized drug use (SDU) to enhance and extend sexual relations may involve risks of substances abuse (intoxication, interactions and overdose) and higher exposure to HIV and other sexually transmitted infections. There are inconsistencies in the methodology and findings of previous research on SDU in Latin America (LA), and more studies are required. The purpose of this research was to characterize SDU in gay men and other men who have sex with men from 18 LA countries, and describe the aspects by comparing people who practice and do not practice SDU, at the general and country levels. MATERIAL AND METHODS Cross-sectional study based on the data collected by LAMIS-2018. Dependent variable was SDU (last 12 months), and the independent variables were: drug use (in any context/in sexual context), sociodemographic, socioepidemiological, and psychosocial aspects. A descriptive analysis was carried out, comparing those who practiced and did not practice SDU. RESULTS LAMIS-2018 included 64,655 participants, averaging 30 years of age. 13.6% declared having practiced SDU (6.6% with multiple partners). In the last sexual encounter the most commonly used drugs were cannabis (9.3%), poppers (6%), and Viagra (5.4%), and in the last encounter with multiple partners, poppers (19.7%), cannabis (17%), and Viagra (13.2%). HIV diagnosis was reported by 27% of people practicing SDU, vs. 14.3% in the other group. Severe anxiety-depression symptoms were more common among people practicing SDU (9.2% vs. 7%), as were the episodes of homophobic intimidation (52.6% vs. 48.2%), insults (34.4% vs. 28.6%), and aggression (4.1% vs. 3.0%). CONCLUSIONS SDU was reported by a high percentage of people, with a predominance of the use of drugs related to sexual practice, and others for recreational use. Aspects described as the higher proportion of self-reported HIV diagnosis and severe symptoms of anxiety-depression among those who practiced SDU, show that is necessary to implement preventive strategies to reduce the harmful impacts that can sometimes result from this practice, including harm reduction policies, promote access to mental health services and support in situations of homophobia and stigma.
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Affiliation(s)
- Cristian Lisboa
- Escuela de Salud Pública, Universidad de Chile, Santiago, Chile
| | - Valeria Stuardo
- Instituto de Salud Pública, Universidad Andrés Bello, Santiago, Chile
| | - Cinta Folch
- Centro de Estudios Epidemiológicos sobre las Infecciones de Transmisión Sexual y SIDA de Cataluña (CEEISCAT), Cataluña, España
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
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Protiere C, Sagaon-Teyssier L, Donadille C, Sow A, Gaubert G, Girard G, Mora M, Assoumou L, Beniguel L, Michels D, Ghosn J, Costagliola D, Rojas Castro D, Molina JM, Spire B. Perception of PrEP-related stigma in PrEP users: Results from the ANRS-PREVENIR cohort. HIV Med 2023; 24:938-945. [PMID: 37046178 DOI: 10.1111/hiv.13491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/20/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Since the advent of HIV pre-exposure prophylaxis (PrEP), stigma has been shown to be a major barrier to its uptake and adherence. It is therefore essential to define the proportion of users who consider that PrEP can negatively impact their image and the factors associated with this perception. METHOD We performed a multivariable logistic regression on data from the 2567 participants in the ANRS-PREVENIR study who answered the outcome question. RESULTS Almost one-third of the sample (comprising mostly cisgender men who have sex with men [94.3%]) considered that taking PrEP could give others a negative image of them. Younger participants (adjusted odds ratio [aOR] 0.98; 95% confidence interval [CI] 0.97-0.99) and more psychologically vulnerable participants (i.e., lower self-esteem score [aOR 0.98; 95% CI 0.96-0.99] and higher depression score [aOR 1.02; 95% CI 1.00-1.03]) were also more likely to have this perception. In contrast, participants encouraged to take PrEP by their main partner (aOR 0.67; 95% CI 0.51-0.88) and friends (aOR 0.79; 95% CI 0.66-0.95), and those who protected themselves more because they had knowledge of their most recent sexual partner's HIV status (aOR 0.83; 95% CI 0.69-0.99) and systematic use of PrEP and/or condoms during intercourse in the previous 3 months (aOR 0.80; 95% CI 0.67-0.96) were less likely to have this perception. DISCUSSION Given the strong interrelation between stigmatization (real or perceived), risky behaviours and adherence, our results emphasize the need for HIV prevention campaigns to promote a positive image of PrEP users. They also show that stigmatization and its effects need to be fully considered to improve HIV prevention offers to current and potential PrEP users who are most likely to be psychologically vulnerable.
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Affiliation(s)
- C Protiere
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Marseille, France
| | | | - C Donadille
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Marseille, France
| | - A Sow
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Marseille, France
| | - G Gaubert
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Marseille, France
| | - G Girard
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Marseille, France
| | - M Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Marseille, France
| | - L Assoumou
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, Paris, France
| | - L Beniguel
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, Paris, France
| | - D Michels
- AIDES, Paris, France
- Coalition PLUS, Community-based Research Laboratory, Paris, France
| | - J Ghosn
- University Paris Diderot, Sorbonne Paris Cité, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - D Costagliola
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, Paris, France
| | - D Rojas Castro
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Marseille, France
- AIDES, Paris, France
- Coalition PLUS, Community-based Research Laboratory, Paris, France
| | - J-M Molina
- Hospital Saint-Louis, Assistance Publique Hôpitaux de Paris, Department of Infectious diseases, Paris, France
| | - B Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Marseille, France
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Simon KA, Hanna-Walker V, Clark AN, Driver R, Kalinowski J, Watson RJ, Eaton LA. "This Is To Help Me Move Forward": The Role of PrEp in Harnessing Sex Positivity and Empowerment Among Black Sexual Minority Men in the Southern United States. J Sex Res 2023; 60:741-751. [PMID: 36239604 PMCID: PMC10102248 DOI: 10.1080/00224499.2022.2131704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
In the United States (U.S.), Black sexual minority men (BSMM) are disproportionately burdened by HIV. Prevention advances, such as HIV pre-exposure prophylaxis (PrEP), play a key role in reducing HIV transmission and improving our understanding of sexual expression and health. Despite these advances, little is known regarding the potential link between PrEP use and positive sexuality, including the benefits that BSMM see in accessing PrEP. We conducted a thematic analysis of 32 interviews with BSMM in the Southern U.S. regarding their PrEP beliefs. We developed five themes: (1) Sexual freedom, (2) Agency and empowerment, (3) Making PrEP normative, (4) Behavioral health practices, and (5) Committed relationship tensions. Our findings suggest that BSMM are increasingly concerned about freedom of choice and invested in sexual empowerment as related to their PrEP use. Further, unanticipated benefits, community support, and relationship tensions are salient factors in considerations of PrEP use among BSMM. These findings have implications for how we might understand a broader movement toward sexual empowerment and positivity, and the pivotal role that PrEP serves in this movement.
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Affiliation(s)
- Kay A. Simon
- Department of Family Social Science, University of Minnesota, St. Paul, MN, USA
| | - Veronica Hanna-Walker
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Alyssa N. Clark
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Redd Driver
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Jolaade Kalinowski
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Ryan J. Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Lisa A. Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
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Santos LAD, Grangeiro A, Couto MT. HIV Pre-Exposure Prophylaxis (PrEP) among men who have sex with men: peer communication, engagement and social networks. Ciênc saúde coletiva 2022. [DOI: 10.1590/1413-812320222710.06542022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract HIV Pre-Exposure Prophylaxis (PrEP) has renewed optimism in controlling the HIV epidemic, despite its continued growth among men who have sex with men (MSM). The popularity of dating-sexual dating apps and digital media platforms in exchanging information and experiences about PrEP on peer social networks is recognized. However, studies on contexts, motivations, and scope in HIV prevention are scarce. The article aims to understand the dynamics of virtual and face-to-face peer networks among MSM for the decision to use PrEP, its disclosure, and publicity. Qualitative study using semi-structured interviews with 48 PrEP users from five Brazilian cities. Most interviewees share information and experiences about PrEP in peer social networks. However, its publication reveals tensions arising from the permanence of stigmas associated with homosexuality and HIV. The protagonism in exposing the use of PrEP expresses commitment to attracting new users. The relevance of peer social networks in sharing experiences and information about PrEP has the potential to diversify the target audience and expand and democratize PrEP coverage in the country.
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Santos LAD, Grangeiro A, Couto MT. HIV Pre-Exposure Prophylaxis (PrEP) among men who have sex with men: peer communication, engagement and social networks. Cien Saude Colet 2022; 27:3923-3937. [PMID: 36134798 DOI: 10.1590/1413-812320222710.06542022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/22/2022] Open
Abstract
HIV Pre-Exposure Prophylaxis (PrEP) has renewed optimism in controlling the HIV epidemic, despite its continued growth among men who have sex with men (MSM). The popularity of dating-sexual dating apps and digital media platforms in exchanging information and experiences about PrEP on peer social networks is recognized. However, studies on contexts, motivations, and scope in HIV prevention are scarce. The article aims to understand the dynamics of virtual and face-to-face peer networks among MSM for the decision to use PrEP, its disclosure, and publicity. Qualitative study using semi-structured interviews with 48 PrEP users from five Brazilian cities. Most interviewees share information and experiences about PrEP in peer social networks. However, its publication reveals tensions arising from the permanence of stigmas associated with homosexuality and HIV. The protagonism in exposing the use of PrEP expresses commitment to attracting new users. The relevance of peer social networks in sharing experiences and information about PrEP has the potential to diversify the target audience and expand and democratize PrEP coverage in the country.
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Affiliation(s)
- Lorruan Alves Dos Santos
- Programa de Pós-Graduação em Saúde Coletiva, Faculdade de Medicina, Universidade de São Paulo (USP). Av. Dr. Arnaldo 455, Cerqueira César. 01246-903 São Paulo SP Brasil.
| | - Alexandre Grangeiro
- Departamento de Medicina Preventiva, Faculdade de Medicina, USP. São Paulo SP Brasil
| | - Marcia Thereza Couto
- Departamento de Medicina Preventiva, Faculdade de Medicina, USP. São Paulo SP Brasil
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Knox DC, Pilarski R, Dhunna HS, Kaushal A, Adachi JD. Clinical Considerations in the Selection of Preexposure Prophylaxis for HIV Prevention in Canada. Canadian Journal of Infectious Diseases and Medical Microbiology 2022; 2022:1-14. [PMID: 36081603 PMCID: PMC9448580 DOI: 10.1155/2022/3913439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022]
Abstract
According to the Public Health Agency of Canada, approximately 62,050 people were living with HIV in Canada in 2018, and of those, 13% were undiagnosed. Currently, no single strategy provides complete protection or is universally effective across all demographic groups at risk for HIV. However, HIV preexposure prophylaxis (PrEP) is the newest HIV prevention strategy that shows promise. To date, two products have received an indication for PrEP by Health Canada: emtricitabine/tenofovir disoproxil fumarate (Truvada®; FTC/TDF) and emtricitabine/tenofovir alafenamide (Descovy®; FTC/TAF). Despite the high efficacy of these PrEP intervention methods, access to PrEP in Canada remains low. Identifying and addressing barriers to PrEP access, especially in high-risk groups, are necessary to reduce HIV transmission in Canada. While guidelines published by the Center for Disease Control and Prevention (CDC) include FTC/TAF information, the efficacy of FTC/TAF for PrEP has not yet been considered in Canada's clinical practice guidelines. Thus, the current paper reviews data regarding the use of FTC/TDF and FTC/TAF for PrEP, which may be useful for Canadian healthcare providers when counseling and implementing HIV prevention methods. The authors highlight these data in relation to various at-risk populations and review ongoing clinical trials investigating novel PrEP agents. Overall, FTC/TDF PrEP is effective for many populations, including men who have sex with men, transgender women, heterosexuals with partners living with HIV, and people who use drugs. While there is fewer data reported on the efficacy of FTC/TAF to date, recent clinical trials have demonstrated noninferiority of FTC/TAF in comparison to FTC/TDF. Notably, as studies have shown that FTC/TAF maintains renal function and bone mineral density to a greater extent than FTC/TDF, FTC/TAF may be a safer option for patients experiencing renal and/or bone dysfunction, for those at risk of renal and bone complications, and for those who develop FTC/TDF-related adverse events.
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Aguayo GA, Goetzinger C, Scibilia R, Fischer A, Seuring T, Tran VT, Ravaud P, Bereczky T, Huiart L, Fagherazzi G. Methods to Generate Innovative Research Ideas and Improve Patient and Public Involvement in Modern Epidemiological Research: Review, Patient Viewpoint, and Guidelines for Implementation of a Digital Cohort Study. J Med Internet Res 2021; 23:e25743. [PMID: 34941554 PMCID: PMC8738987 DOI: 10.2196/25743] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/16/2021] [Accepted: 10/08/2021] [Indexed: 01/20/2023] Open
Abstract
Background Patient and public involvement (PPI) in research aims to increase the quality and relevance of research by incorporating the perspective of those ultimately affected by the research. Despite these potential benefits, PPI is rarely included in epidemiology protocols. Objective The aim of this study is to provide an overview of methods used for PPI and offer practical recommendations for its efficient implementation in epidemiological research. Methods We conducted a review on PPI methods. We mirrored it with a patient advocate’s viewpoint about PPI. We then identified key steps to optimize PPI in epidemiological research based on our review and the viewpoint of the patient advocate, taking into account the identification of barriers to, and facilitators of, PPI. From these, we provided practical recommendations to launch a patient-centered cohort study. We used the implementation of a new digital cohort study as an exemplary use case. Results We analyzed data from 97 studies, of which 58 (60%) were performed in the United Kingdom. The most common methods were workshops (47/97, 48%); surveys (33/97, 34%); meetings, events, or conferences (28/97, 29%); focus groups (25/97, 26%); interviews (23/97, 24%); consensus techniques (8/97, 8%); James Lind Alliance consensus technique (7/97, 7%); social media analysis (6/97, 6%); and experience-based co-design (3/97, 3%). The viewpoint of a patient advocate showed a strong interest in participating in research. The most usual PPI modalities were research ideas (60/97, 62%), co-design (42/97, 43%), defining priorities (31/97, 32%), and participation in data analysis (25/97, 26%). We identified 9 general recommendations and 32 key PPI-related steps that can serve as guidelines to increase the relevance of epidemiological studies. Conclusions PPI is a project within a project that contributes to improving knowledge and increasing the relevance of research. PPI methods are mainly used for idea generation. On the basis of our review and case study, we recommend that PPI be included at an early stage and throughout the research cycle and that methods be combined for generation of new ideas. For e-cohorts, the use of digital tools is essential to scale up PPI. We encourage investigators to rely on our practical recommendations to extend PPI in future epidemiological studies.
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Affiliation(s)
- Gloria A Aguayo
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Catherine Goetzinger
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Renza Scibilia
- Diabetes Australia, Melbourne, Australia.,Diabetogenic, Melbourne, Australia
| | - Aurélie Fischer
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Till Seuring
- Luxembourg Institute of Socio-Economic Research, Esch/Alzette, Luxembourg
| | - Viet-Thi Tran
- Centre of Research in Epidemiology and Statistic Sorbonne Paris Cité, National Institute of Health and Medical Research (INSERM), French National Institute for Agricultural Research (INRA), Université de Paris, Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Ravaud
- Centre of Research in Epidemiology and Statistic Sorbonne Paris Cité, National Institute of Health and Medical Research (INSERM), French National Institute for Agricultural Research (INRA), Université de Paris, Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Tamás Bereczky
- European Patients' Academy on Therapeutic Innovation, Brussels, Belgium
| | - Laetitia Huiart
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Guy Fagherazzi
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
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Reyniers T, Zimmermann HML, Davidovich U, Vuylsteke B, Laga M, Hoornenborg E, Prins M, De Vries HJC, Nöstlinger C. The social meanings of PrEP use - A mixed-method study of PrEP use disclosure in Antwerp and Amsterdam. Sociol Health Illn 2021; 43:1311-1327. [PMID: 33997998 DOI: 10.1111/1467-9566.13283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 03/31/2021] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
Pre-Exposure Prophylaxis (PrEP) is a novel HIV prevention tool. PrEP stigma is a frequently reported barrier, while social disclosure of PrEP use may be an important facilitator. We explored how PrEP users managed PrEP use disclosure using a symbolic interactionist approach. We interviewed 32 participants from two PrEP demonstration projects (Be-PrEP-ared, Antwerp; AMPrEP, Amsterdam). We validated qualitative findings through Be-PrEP-ared questionnaire data. A minority of participants had received negative reactions on PrEP. The way PrEP use was disclosed was highly dependent on the social situation. In a sexual context among MSM, PrEP use was associated with condomless sex. Friends endorsed PrEP use as a healthy choice, but also related it to carelessness and promiscuity. It was seldom disclosed to colleagues and family, which is mostly related to social norms dictating when it is acceptable to talk about sex. The study findings reveal that PrEP stigma experiences were not frequent in this population, and that PrEP users actively manage disclosure of their PrEP user status. Frequent disclosure and increased use may have helped PrEP becoming normalised in these MSM communities. To increase uptake, peer communication, community activism and framing PrEP as health promotion rather than a risk-reduction intervention may be crucial.
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Affiliation(s)
- Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Hanne M L Zimmermann
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Social Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marie Laga
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Amsterdam UMC, Amsterdam Institute for Infection and Immunity (AI&II), University of Amsterdam, Amsterdam, The Netherlands
| | - Henry J C De Vries
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Dermatology, Amsterdam UMC, Amsterdam Institute for Infection and Immunity (AI&II), University of Amsterdam, Amsterdam, The Netherlands
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Bauquier C, Préau M. Contribution of HIV/AIDS-Related Human and Social Sciences Research to a Better Understanding of the Challenges of Hepatitis B Prevention, Diagnosis and Care. Microorganisms 2021; 9:microorganisms9061166. [PMID: 34071536 PMCID: PMC8230355 DOI: 10.3390/microorganisms9061166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 01/05/2023] Open
Abstract
Recent scientific advances in hepatitis B virus research hint at the possibility of finding a cure in the medium term. In this context, the characterization of infected persons constitutes a major public health issue in terms of implementing adapted screening and prevention strategies. Overcoming the current challenges national health systems face in hepatitis B diagnosis is essential if the World Health Organization’s target of treating 80% of infected patients by 2030 is to be reached. These challenges reflect those previously faced in the fight against HIV/AIDS. Using the knowledge produced to date in Human and Social Sciences research in the fight against HIV/AIDS, we propose avenues of reflection to support and guide the development of research in the diagnosis of hepatitis B infection. More specifically, we present theoretical, methodological and epistemological considerations for how HSS research can be optimized in the following three HBV diagnosis-related areas: (i) access to screening; (ii) retention in care; and (iii) the integration of quality of life measurement in clinical trials.
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van Dijk M, de Wit JBF, Kamps R, Guadamuz TE, Martinez JE, Jonas KJ. Socio-Sexual Experiences and Access to Healthcare Among Informal PrEP Users in the Netherlands. AIDS Behav 2021; 25:1236-46. [PMID: 33196938 DOI: 10.1007/s10461-020-03085-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 10/25/2022]
Abstract
The aim of this qualitative study was to explore the experiences of informal PrEP users regarding access to PrEP and PrEP-related healthcare, community responses, sexual behavior and well-being. We interviewed 30 men who have sex with men (MSM) in semi-structured online interviews between March and August 2018. Interviews were analyzed using interpretive description. Informal PrEP users were well informed about the use of PrEP, but sometimes did not make use of renal testing. Participants reported a lack of PrEP knowledge among healthcare providers, which limited their access to PrEP and put them at risk, as they received incorrect information. Although some participants reported negative reactions from potential sex partners, most received positive reactions and were sometimes seen as more desirable sex partners. PrEP healthcare services should not only be accessible to formal PrEP users, but also to PrEP users who procure PrEP informally.
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14
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Abstract
PURPOSE OF REVIEW HIV pre-exposure prophylaxis (PrEP) is a safe and effective preventive intervention that could play a central role in ending the HIV epidemic. However, low uptake in general, and among certain social groups in particular, underscores the need to identify and address barriers to PrEP use. PrEP stigma has emerged as a key factor interfering with PrEP interest, uptake, and continuation. The purpose of this article is to describe and contextualize PrEP stigma and to offer recommendations on how to address it in future PrEP implementation initiatives. RECENT FINDINGS PrEP users are commonly stereotyped as sexually irresponsible, promiscuous, and immoral. These stereotypes and associated prejudice manifest at multiple levels and discourage PrEP interest and uptake, disrupt PrEP adherence, and motivate PrEP discontinuation. Intersecting forms of stigma may influence the nature, magnitude, and impact of PrEP stigma across social groups and otherwise hinder PrEP use. Current PrEP implementation strategies that narrowly focus on risk and target stigmatized groups with disproportionately high HIV incidence have yielded limited success and are counterproductive to the extent that they perpetuate stigma. Implementation strategies involving more inclusive messaging and further integration of PrEP within healthcare may help to reduce PrEP stigma and mitigate its impact, ultimately increasing PrEP use. PrEP stigma is a barrier to PrEP interest, uptake, and continuation that manifests at multiple levels. Understanding and addressing PrEP stigma requires consideration of its origins and intersections. Targeted, risk-focused implementation strategies perpetuate stigma and undermine use.
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Affiliation(s)
- Sarah K Calabrese
- Department of Psychological and Brain Sciences, The George Washington University, 2125 G Street NW, Washington, DC, 20052, USA. .,Department of Prevention and Community Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, DC, 20052, USA.
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Sherr L, Harding R, Davidovich U, Cluver L, Spire B, Prince B, Hedge B, Catalan J. AIDSImpact 2019 special issue - Promises to keep and miles to go … . AIDS Care 2020; 32:1-4. [PMID: 32297557 DOI: 10.1080/09540121.2020.1744508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Lorraine Sherr
- International AIDSImpact Board.,Institute for Global Health, University College London, London, UK
| | - Richard Harding
- International AIDSImpact Board.,Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Kings College London, London, UK
| | - Udi Davidovich
- International AIDSImpact Board.,Department of Research, Amsterdam Public Health Service, Amsterdam, Netherlands.,Department of Social Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Lucie Cluver
- International AIDSImpact Board.,Department of Social Policy & Social Intervention, University of Oxford, Oxford, UK.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Bruno Spire
- International AIDSImpact Board.,Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Bridgette Prince
- International AIDSImpact Board.,Human Sciences Research Council (HSRC), Cape Town, South Africa
| | | | - Jose Catalan
- International AIDSImpact Board.,CNWL NHS Foundation Trust, London, UK
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