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Tao J, Sosnowy C, Arnold T, Kapadia J, Parent H, Rogers BG, Almonte A, Chan PA. Perspectives of a peer-driven approach to improve pre-exposure prophylaxis and HIV prevention among Black/African American and Hispanic/Latino men who have sex with men. Sex Health 2023; 20:453-460. [PMID: 37532286 PMCID: PMC10902904 DOI: 10.1071/sh23072] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/11/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Black/African American (B/AA) and Hispanic/Latino (H/L) men who have sex with men (MSM) are significantly less likely than white MSM to initiate pre-exposure prophylaxis (PrEP). A peer-driven intervention (PDI) may be an effective approach to addressing this disparity. In this study, we explored community member perspectives of a PDI to promote PrEP uptake among B/AA and H/L MSM. METHODS We conducted semi-structured interviews with B/AA and H/L HIV-negative MSM between August 2018 and October 2019 in Rhode Island, USA. Participants reported their perspectives and recommendations for a PDI. Data from participant responses were thematically analysed. RESULTS Of 15 MSM, the median age was 25years (interquartile range: 22, 33). The majority identified as B/AA (53.3%), H/L (66.7%), and having a college education or above (53.3%). Most participants viewed a PDI positively and were willing to learn and promote PrEP among their peers. Participants identified and supported several potential intervention components, such as education about the benefit of PrEP, emphasising prevention-effective dosing, and clarifying no prevention effect towards other sexually transmitted infections. They preferred in-person meetings to electronic communication. Preferred characteristics of peer educators included compassion, good communication skills, and enthusiasm about PrEP. CONCLUSIONS This in-depth qualitative interview suggested that a PDI approach is promising in promoting PrEP uptake, as it could deliver culturally appropriate education and encourage PrEP uptake via peer influence among B/AA and H/L MSM.
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Affiliation(s)
- Jun Tao
- Infectious Diseases, Brown University Warren Alpert Medical School, 593 Eddy Street, Providence, RI 02903
- Division of Infectious Diseases, The Miriam Hospital, 11 4th Street, Providence, RI 02906, USA
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912
| | - Collette Sosnowy
- Infectious Diseases, Brown University Warren Alpert Medical School, 593 Eddy Street, Providence, RI 02903
- Division of Infectious Diseases, The Miriam Hospital, 11 4th Street, Providence, RI 02906, USA
| | - Trisha Arnold
- Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, 345 Blackstone Blvd. Providence, RI 02906
| | - Jhanavi Kapadia
- Infectious Diseases, Brown University Warren Alpert Medical School, 593 Eddy Street, Providence, RI 02903
| | - Hannah Parent
- Division of Infectious Diseases, The Miriam Hospital, 11 4th Street, Providence, RI 02906, USA
| | - Brooke G. Rogers
- Infectious Diseases, Brown University Warren Alpert Medical School, 593 Eddy Street, Providence, RI 02903
- Division of Infectious Diseases, The Miriam Hospital, 11 4th Street, Providence, RI 02906, USA
| | - Alexi Almonte
- Division of Infectious Diseases, The Miriam Hospital, 11 4th Street, Providence, RI 02906, USA
| | - Philip A. Chan
- Infectious Diseases, Brown University Warren Alpert Medical School, 593 Eddy Street, Providence, RI 02903
- Division of Infectious Diseases, The Miriam Hospital, 11 4th Street, Providence, RI 02906, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 8 floor, 121 South Main Street, Providence, RI, 02912
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Tansarli GS, Long DR, Waalkes A, Bourassa LA, Libby SJ, Penewit K, Almazan J, Matsumoto J, Bryson-Cahn C, Rietberg K, Dell BM, Hatley NV, Salipante SJ, Fang FC. Genomic reconstruction and directed interventions in a multidrug-resistant Shigellosis outbreak in Seattle, WA, USA: a genomic surveillance study. Lancet Infect Dis 2023; 23:740-750. [PMID: 36731480 PMCID: PMC10726761 DOI: 10.1016/s1473-3099(22)00879-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 10/07/2022] [Revised: 11/09/2022] [Accepted: 12/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Shigella spp have been associated with community-wide outbreaks in urban settings. We analysed a sustained shigellosis outbreak in Seattle, WA, USA, to understand its origins and mechanisms of antimicrobial resistance, define ongoing transmission patterns, and optimise strategies for treatment and infection control. METHODS We did a retrospective study of all Shigella isolates identified from stool samples at the clinical laboratories at Harborview Medical Center and University of Washington Medical Center (Seattle, WA, USA) from May 1, 2017, to Feb 28, 2022. We characterised isolates by species identification, phenotypic susceptibility testing, and whole-genome sequencing. Demographic characteristics and clinical outcomes of the patients were retrospectively examined. FINDINGS 171 cases of shigellosis were included. 78 (46%) patients were men who have sex with men (MSM), and 88 (52%) were people experiencing homelessness (PEH). Although 84 (51%) isolates were multidrug resistant, 100 (70%) of 143 patients with data on antimicrobial therapy received appropriate empirical therapy. Phylogenomic analysis identified sequential outbreaks of multiple distinct lineages of Shigella flexneri and Shigella sonnei. Discrete clonal lineages (ten in S flexneri and nine in S sonnei) and resistance traits were responsible for infection in different at-risk populations (ie, MSM, PEH), enabling development of effective guidelines for empirical treatment. The most prevalent lineage in Seattle was probably introduced to Washington State via international travel, with subsequent domestic transmission between at-risk groups. INTERPRETATION An outbreak in Seattle was driven by parallel emergence of multidrug-resistant strains involving international transmission networks and domestic transmission between at-risk populations. Genomic analysis elucidated not only outbreak origin, but directed optimal approaches to testing, treatment, and public health response. Rapid diagnostics combined with detailed knowledge of local epidemiology can enable high rates of appropriate empirical therapy even in multidrug-resistant infection. FUNDING None.
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Affiliation(s)
- Giannoula S Tansarli
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Dustin R Long
- Division of Critical Care Medicine, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Adam Waalkes
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Lori A Bourassa
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Stephen J Libby
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Kelsi Penewit
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Jared Almazan
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Jason Matsumoto
- Clinical Microbiology Laboratory, Harborview Medical Center, Seattle, WA, USA
| | - Chloe Bryson-Cahn
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA; Infection Prevention and Control, Harborview Medical Center, Seattle, WA, USA
| | - Krista Rietberg
- Infection Prevention and Control, Harborview Medical Center, Seattle, WA, USA
| | - BreeAnna M Dell
- Public Health-Seattle & King County, Communicable Diseases, Epidemiology, and Immunizations, Seattle, WA, USA
| | - Noël V Hatley
- Public Health-Seattle & King County, Communicable Diseases, Epidemiology, and Immunizations, Seattle, WA, USA
| | - Stephen J Salipante
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Ferric C Fang
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA; Department of Microbiology, University of Washington School of Medicine, Seattle, WA, USA; Clinical Microbiology Laboratory, Harborview Medical Center, Seattle, WA, USA.
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3
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Abstract
This article presents data on the external validity of an alcohol administration study of sexual decision-making in men who have sex with men (MSM) ages 21-50. Men (N = 135) randomized to alcohol (blood alcohol concentration [BAC] = .075%) or water control conditions reported intentions to engage in condomless anal intercourse (CAI) in response to video vignettes. Following the experiment participants provided 6 weeks of experience sampling method (ESM) data assessing intoxication, sexual arousal, partner relationship, and sexual behavior. Laboratory CAI intentions were hypothesized to predict future CAI behavior, and associations were hypothesized to be conditional upon sexual arousal and intoxication contextual factors as well as laboratory beverage condition. The hypotheses were partially supported. CAI intentions were correlated with subject proportions of days engaging in CAI (r = .29). A multilevel analysis indicated, on average, CAI intention predicted increased probability of CAI versus anal intercourse with a condom (relative risk ratio [RRR] = 1.43). There was mixed evidence of CAI intentions effects being conditional upon laboratory condition as well as arousal and intoxication contextual factors. Graphs of conditional marginal effects identified regions of significance. Effects of CAI intention for men in the alcohol condition on the CAI versus No Sex contrast were significant when sexual arousal was elevated. CAI intentions for men in the water control condition predicted a higher probability of CAI versus anal intercourse with a condom when intoxication was moderately elevated and/or arousal moderately low. The results support the external validity of alcohol administration experiments of sexual decision-making among MSM and, reciprocally, provide support for the validity of ESM assessment of sexual behavior. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Abstract
The human immunodeficiency virus (HIV) epidemic in the Philippines has been driven by sexual transmission among men who have sex with men (MSM) over the past 2 decades. As the incidence of HIV infection among MSM has not been extensively evaluated, this study aimed to determine the incidence of HIV infections and the associated risk factors among MSM in Metro Manila, Philippines. This prospective cohort study was conducted in 2 community centers in Metro Manila, the Philippines, between March 2014 and December 2018. MSM who had anal or oral sex in the past 12 months, aged ≥18 years, and confirmed HIV-negative status were enrolled. Participants were followed up every 3 months with repeat HIV testing and assessment of HIV-related practices. Of the 708 MSM included in this study, a total of 59 HIV seroconversions occurred during the follow-up, resulting in an incidence of 2.7 (95% confidence interval: 2.1-3.5) per 100 patient-years. Multivariate risk regression analysis indicated that age (P = .002) and anal sex with a consensual male partner in the past 3 months (P = .039) were significantly associated with HIV infection. Our study has shown high rates of incident HIV infection among Filipino MSM. This demonstrates the need for effective HIV prevention, surveillance, treatment, and intervention strategies targeting this population.
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Affiliation(s)
- Rossana Ditangco
- Department of Health, AIDS Research Group, Research Institute for Tropical Medicine, Manila, Philippines
- *Correspondence: Rossana Ditangco, Department of Health, AIDS Research Group, Research Institute for Tropical Medicine (RITM), Manila, Philippines (e-mail: )
| | - Mary Lorraine Mationg
- Department of Health, AIDS Research Group, Research Institute for Tropical Medicine, Manila, Philippines
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Abstract
Minimizing error in self-reported sexual behavior could reduce investigators' likelihood of rejecting truly successful interventions to decrease HIV and STI transmission risk. Sexual behavior assessments can elicit problematic data. This may manifest in the form of elevated levels of non-response, inaccurate point estimates, or misclassification errors resulting in inappropriately answering or, perhaps more importantly, skipping questions. We programed conversational interviewing elements into 20 sexual behavior questions in an exit survey of gay bathhouse patrons (N = 459) administered using ACASI. Those elements, called alternate pathways, included follow-up questions to responses to confirm that operational definitions were applied in the answer (with return to the initial question if confirmation failed), and assurances of confidentiality and requests for best guesses in reaction to non-response (including "don't know"). These elements were invoked in nearly 10% of participants, and approximately 74% of all invocations resulted in a usable numeric response, or 87% if the data need only estimate prevalence. Almost two-thirds of the problematic data issues occurred in answers to sexual contact questions, with others related to follow-up questions about specific sexual behavior. It is at this level of important filtering questions where the benefits of the approach are likely to be maximized.
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Affiliation(s)
- Lance M. Pollack
- Center for AIDS Prevention Studies, University of California San Francisco
| | - John A. Sauceda
- Center for AIDS Prevention Studies, University of California San Francisco
| | - Paul D. Cotten
- Center for AIDS Prevention Studies, University of California San Francisco
| | | | - William J. Woods
- Center for AIDS Prevention Studies, University of California San Francisco
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Abstract
ABSTRACT In this large online survey of primarily men who have sex with men, those who used preexposure prophylaxis reported greater sexual satisfaction than did nonusers, including sexual sensations, sexual presence/awareness, and sexual exchange. Person-centered care and messaging may require acknowledging that some people use preexposure prophylaxis for reasons beyond HIV prevention.
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Affiliation(s)
| | - Whitney C Sewell
- From the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute
| | - Victoria E Powell
- From the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute
| | - Aileen Ochoa
- From the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute
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Sewell WC, Powell VE, Ball-Burack M, Mayer KH, Ochoa A, Marcus JL, Krakower DS. Brief Report: "I Didn't Really Have a Primary Care Provider Until I Got PrEP": Patients' Perspectives on HIV Preexposure Prophylaxis as a Gateway to Health Care. J Acquir Immune Defic Syndr 2021; 88:31-35. [PMID: 34397743 PMCID: PMC8369038 DOI: 10.1097/qai.0000000000002719] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/26/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND HIV prevention is the primary goal of preexposure prophylaxis (PrEP); however, ancillary benefits may exist, including PrEP as an entry point to primary care. OBJECTIVE To explore PrEP users' perspectives on how PrEP use relates to broader engagement in health care. DESIGN In-depth qualitative interviews. PARTICIPANTS We recruited PrEP users aged 18 years or older from a social media group for people interested in PrEP information and a Boston community health center specializing in health care for sexual and gender minorities. APPROACH Inductive content analysis to identify emergent themes. KEY RESULTS All 25 participants were men who have sex with men, whose mean age was 34 years, and 84% were White. Three major themes emerged: (1) accessing PrEP was a strong motivator for initial and continued engagement in health care, which for some evolved over time into accessing comprehensive primary care; (2) provider awareness and attitudes about PrEP influenced participants' ongoing engagement in health care; and (3) PrEP engendered a positive sense of control over users' personal health, giving them agency in reducing their risk of HIV and engaging in other aspects of their health. Quarterly PrEP visits helped participants establish and maintain a relationship with a primary care provider, access non-HIV-related care services, and feel empowered to keep themselves healthy. CONCLUSIONS The benefits of PrEP extend beyond HIV prevention to broader engagement in health care, including new relationships with primary care providers and use of other preventive health care services. To maximize those benefits, efforts are needed to ensure that providers are aware, nonjudgmental, and supportive of PrEP use.
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Affiliation(s)
- Whitney C. Sewell
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Victoria E. Powell
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Maya Ball-Burack
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Kenneth H. Mayer
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Aileen Ochoa
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Julia L. Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Douglas S. Krakower
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
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8
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Dionne-Odom J, Van Der Pol B, Boutwell A, Biligowda N, Schmid D, Hook EW. Limited Utility of Reverse Algorithm Syphilis Testing in HIV Clinic Among Men Who Have Sex With Men. Sex Transm Dis 2021; 48:675-679. [PMID: 33534407 PMCID: PMC8711644 DOI: 10.1097/olq.0000000000001386] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The reverse algorithm for syphilis diagnosis consists of a treponemal antibody screening immunoassay followed by confirmatory nontreponemal antibody testing. It is increasingly used in the United States despite studies suggesting limited cost-effectiveness in high-prevalence groups. METHODS In this retrospective cross-sectional study, we included men who have sex with men tested with the reverse algorithm in an Alabama HIV clinic between March 2015 and February 2017. Trep-Sure enzyme immunoassay (EIA) was used for the initial screen, followed by reflex nontreponemal reactive rapid plasma reagin (RPR) testing of specimens with positive results. Sociodemographic and clinical data were extracted from the electronic medical record and stratified according to EIA screen positivity. Quantitative EIA antibody index values were collected to assess test performance at various thresholds. RESULTS Among 1693 men tested for syphilis with the reverse algorithm in HIV clinic, 808 (48%) had a positive initial EIA screen. A majority (53%) of men with subsequent RPR testing had a nonreactive RPR (EIA+/RPR-), and 19% (19/98) of these EIA+/RPR- samples tested had a negative confirmatory Treponema pallidum particle agglutination testing result. Analysis of quantitative EIA index values using a receiver operating characteristics curve suggested that a threshold >8 (rather the current threshold of antibody index 1.2) improved the performance of the test. CONCLUSIONS Among men who have sex with men tested in HIV clinic, the syphilis reverse algorithm was inefficient because of high rates of prior syphilis and false-positive EIA screening. Frequent syphilis screening in high-prevalence populations is an important part of the US epidemic response, and the traditional algorithm is preferred.
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Affiliation(s)
- Jodie Dionne-Odom
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Barbara Van Der Pol
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alex Boutwell
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Niranjan Biligowda
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Edward W. Hook
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Wigfall LT, Goodson P, Cunningham GB, Harvey IS, Gilreath TD, Adair M, Gaddist BW, Julious CH, Friedman DB. Understanding Community-based HIV/AIDS Service Organizations: An Invaluable Source of HPV-related Cancer Information for At-risk Populations. J Health Commun 2020; 25:23-32. [PMID: 31914359 PMCID: PMC7703688 DOI: 10.1080/10810730.2019.1697397] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
To describe non-clinical HIV service providers (NCHSPs) as surrogate seekers and health information mavens for people living with HIV (PLWH), men who have sex with men (MSM), and other vulnerable populations.In May/June 2016, we recruited 30 NCHSPs from three community-based HIV/AIDS service organizations. NCHSPs completed a 118-item self-administered, paper-and-pencil survey about HPV, cancer, and health communication. Data were analyzed using Stata/SE 14.1.Almost all (97%) NCHSPs were surrogate seekers and had looked for HIV/AIDS (97%), STD (97%), and cancer (93%) information. Most (60%) cancer information seekers had looked for information about HPV. The Internet (97%) and healthcare providers (97%) were health information sources almost all NCHSPs trusted. Nearly all NCHSPs (93%) were completely or very confident about their ability to find health information. The mean health information mavenism score (17.4 ± 2.1) was significantly higher than the scale's high-score cutoff (15.0) (p < 0 .001).NCHSPs look for and share health information with the vulnerable populations (e.g., PLWH, MSM) they serve. More research is needed to understand what NCHSPs' know and think about the health information they are sharing with vulnerable populations.
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Affiliation(s)
- Lisa T. Wigfall
- Texas A&M University, College of Education and Human Development, Department of Health and Kinesiology, Division of Health Education
- Texas A&M University, College of Education and Human Development, Department of Health and Kinesiology, Transdisciplinary Center for Health Equity Research
| | - Patricia Goodson
- Texas A&M University, College of Education and Human Development, Department of Health and Kinesiology, Division of Health Education
| | - George B. Cunningham
- Texas A&M University, College of Education and Human Development, Department of Health and Kinesiology, Division of Sport Management
| | - Idethia S. Harvey
- Texas A&M University, College of Education and Human Development, Department of Health and Kinesiology, Division of Health Education
- Texas A&M University, College of Education and Human Development, Department of Health and Kinesiology, Transdisciplinary Center for Health Equity Research
| | - Tamika D. Gilreath
- Texas A&M University, College of Education and Human Development, Department of Health and Kinesiology, Division of Health Education
- Texas A&M University, College of Education and Human Development, Department of Health and Kinesiology, Transdisciplinary Center for Health Equity Research
| | | | | | | | - Daniela B. Friedman
- University of South Carolina. Arnold School of Public Health, Department of Health Promotion, Education, and Behavior
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10
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Abstract
For the healthcare professional dealing with infections presents two main problems. First, managing detainees or police personnel who have contracted a disease and may be infectious or unwell, and second, handling complainants of assault, including police officers, who have potentially been exposed to an infectious disease. This chapter addresses some general principles of infection control and safety in the working environment and then goes on to discuss some infections that may be encountered in police custody and how they can best be managed.
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Affiliation(s)
- Margaret M. Stark
- Faculty of Forensic and Legal Medicine, Royal College of Physicians, London, UK
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11
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Vasilenko SA, Espinosa-Hernández G, Rice CE, Biello KB, Novak DS, Mayer KH, Mimiaga MJ, Rosenberger JG. Patterns of Sexual Behaviors in Young Men Who Have Sex With Men in Mexico. J Sex Res 2019; 56:1168-1178. [PMID: 30638395 PMCID: PMC6626694 DOI: 10.1080/00224499.2018.1563667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/09/2023]
Abstract
Recent research has documented the importance of understanding the multidimensional nature of sexual risk behavior. However, little is known about patterns of sexual behavior among men who have sex with men (MSM) in Mexico, men who are at greatest risk for HIV and sexually transmitted infections compared to other subpopulations in the country. This study applied latent class analysis to data from a large, HIV-negative sample of 18- to 25-year-old Mexican MSM recruited from a social and sexual networking website (N = 3,722) to uncover multidimensional patterns of sexual behaviors, partner factors, and protective behaviors, and examine how these were associated with health and well-being correlates. We selected a model with seven classes. The most common class included those who reported both insertive and receptive behaviors with more than one partner, but smaller groups of individuals were in classes marked by only insertive or receptive anal sex, romantic relationships, or sexual inactivity. Class membership differed by sexual orientation, age, depressive symptoms, alcohol problems, and self-acceptance, with individuals in a class marked by same-sex relationships generally reporting more positive outcomes. Findings suggest heterogeneity of behaviors among Mexican MSM and the possible efficacy of prevention messages tailored to individuals' specific patterns of sexual behavior.
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Affiliation(s)
- Sara A Vasilenko
- Department of Human Development and Family Science, Syracuse University
| | | | - Cara E Rice
- The Methodology Center, Pennsylvania State University
| | - Katie B Biello
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University, and The Fenway Institute
| | | | - Kenneth H Mayer
- The Fenway Institute and Department of Global Health and Population, Harvard University
| | - Matthew J Mimiaga
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University and The Fenway Institute
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12
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Wang R, Haberlen SA, Palella FJ Jr, Mugavero MJ, Margolick JB, Macatangay BJC, Martínez-Maza O, Jacobson LP, Abraham AG. Viremia copy-years and mortality among combination antiretroviral therapy-initiating HIV-positive individuals: how much viral load history is enough? AIDS 2018; 32:2547-56. [PMID: 30379686 DOI: 10.1097/QAD.0000000000001986] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Ongoing HIV replication while receiving combination antiretroviral therapy (cART) may reduce survival. Viremia copy-years (VCY) has shown improved mortality risk prediction over single time-point viral load measures. However, the timing of a patient's viral load history most associated with later mortality has not been studied. Here we determined the optimal duration and temporality of viral load history for predicting mortality. DESIGN Survival analysis among HIV-positive men who initiated cART in the Multicenter AIDS Cohort Study (1995-2015). METHODS VCY measures were derived from area-under-the-viral load-curve. The overall VCY based upon the complete post-cART viral load history was compared with 20 VCYs derived from viral loads assessed during different shorter time periods (the most recent 1-10 years and initial 1-10 years following cART initiation) for associations with mortality. RESULTS Each 10-fold increase in VCYs based on the most recent 3-8 years was significantly associated with 23-26% decrease in survival times, a magnitude of effect greater than that of the most recent viral load (16%). These associations were independent of CD4 cell count and single time-point viral loads. In addition, the degree of pre-cART immunodeficiency did not affect the mortality prognostic value of VCY based on viral loads in the most recent 3 years. Conversely, the overall VCY and VCYs based on viral loads immediately following cART initiation were not independent predictors of mortality. CONCLUSION Among cART-treated men, VCY based upon viral loads in the recent 3 years (six viral loads) has a mortality prognostic value greater than that of the overall VCY and single time-point viral loads, making the former a more feasible measure for use.
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13
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Chen YH, McFarland W, Raymond HF, Scott HM, Vittinghoff E, Porco TC. Distribution of Behavioral Patterns Before Infection Among San Francisco Men Who Have Sex With Men Newly Infected With HIV in 2014. J Acquir Immune Defic Syndr 2017; 75:528-534. [PMID: 28481784 PMCID: PMC5649625 DOI: 10.1097/qai.0000000000001439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite continued reductions in the number of HIV cases reported among San Francisco men who have sex with men (MSM) and the HIV-prevention potential offered by pharmaceutical tools such as pre-exposure prophylaxis (PrEP), there are uncertainties, particularly given reported decreases in consistent condom use. A key uncertainty is what groups of MSM should be targeted. This study estimates the distribution of behavioral patterns before infection among San Francisco MSM newly infected with HIV in 2014. METHODS We used a novel modeling approach. The approach uses estimates from the National HIV Behavioral Surveillance System for MSM, the Medical Monitoring Project, 2 trials of PrEP, and a meta-analysis of per-act risks of HIV infection. RESULTS The modeling study suggests that 76% of newly HIV-infected MSM in 2014 were individuals with no discernible strategy in the 6 months before infection: that is, they had condomless receptive anal intercourse with one or more partners not perceived to be HIV uninfected. An estimated 7% of newly infected MSM were serosorters before infection. CONCLUSIONS Prevention efforts in San Francisco must reach HIV-uninfected MSM with no discernible behavioral strategy, a group that constitutes 8% of HIV-uninfected MSM in the city. Our study suggests that if all HIV-uninfected, San Francisco MSM with no discernible strategy had been on PrEP in 2014, there would have been 70% fewer HIV infections among San Francisco MSM. Uncertainty analysis suggests that PrEP's impact may be maximized by encouraging PrEP persistence and concomitant reductions in sexual risk behaviors.
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Affiliation(s)
- Yea-Hung Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA
| | - Willi McFarland
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA
| | - H Fisher Raymond
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA
| | - Hyman M Scott
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Travis C Porco
- Department of Medicine, University of California, San Francisco, San Francisco, CA; and |Francis I Proctor Foundation for Research in Opthamology, University of California, San Francisco, San Francisco, CA
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14
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Moore DM, Cui Z, Lachowsky N, Raymond HF, Roth E, Rich A, Sereda P, Howard T, McFarland W, Lal A, Montaner J, Corneil T, Hogg RS. HIV Community Viral Load and Factors Associated With Elevated Viremia Among a Community-Based Sample of Men Who Have Sex With Men in Vancouver, Canada. J Acquir Immune Defic Syndr 2016; 72:87-95. [PMID: 26825177 PMCID: PMC4837069 DOI: 10.1097/qai.0000000000000934] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We developed estimates of community viral load (VL) and risk factors for unsuppressed VL from a cross-sectional study of men who have sex with men (MSM) in Vancouver, Canada. METHODS MSM were recruited from February 25, 2012 to February 28, 2014 using respondent-driven sampling (RDS). Participants completed a computer-assisted self-interview questionnaire and a nurse-administered point-of-care HIV test. For HIV-positive participants, we conducted VL and CD4 cell counts. We used RDS-weighted analysis to obtain population estimates of key variables and multivariable logistic regression to examine factors associated with having a VL of ≥200 copies per milliliter among HIV-positive participants. RESULTS We recruited 719 participants, of whom 119 (16.6%) were seeds. Our estimate of the population prevalence of HIV was 23.4% [95% confidence interval (CI): 15.8% to 31.0%] after RDS adjustments. We estimated that 18.6% (95% CI: 8.8% to 30.4%) of HIV-positive MSM in Vancouver had a VL of ≥200 copies per milliliter. Having an unsuppressed VL was associated with non-white ethnicity [adjusted odds ratio (AOR) = 4.34; 95% CI: 1.67 to 11.1], an annual income of <$15,000 CAD (AOR = 6.43; 95% CI: 2.08 to 19.9), using gamma-hydroxy butyrate in the previous 6 months (AOR = 4.85; 95% CI: 1.79 to 13.2), unprotected anal intercourse with a known HIV-negative or an unknown serostatus partner (AOR = 3.13; 95% CI: 1.10 to 8.90), and disclosing one's HIV serostatus ≥50% of the time (AOR = 7.04; 95% CI: 1.01 to 49.1). CONCLUSION Despite a high prevalence of HIV, we estimated that a small proportion of HIV-positive MSM have undiagnosed HIV and unsuppressed VL. Our results highlight the importance of continued work to address health inequities using a framework based on social determinants of health.
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Affiliation(s)
- David M. Moore
- Department of Medicine, University of British Columbia, Vancouver, Canada
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Zishan Cui
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Nathan Lachowsky
- Department of Medicine, University of British Columbia, Vancouver, Canada
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Henry F. Raymond
- University of California–San Francisco, San Francisco, United States
| | - Eric Roth
- University of Victoria, Victoria, Canada
| | - Ashleigh Rich
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Paul Sereda
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Terry Howard
- Positive Living Society of BC, Vancouver, Canada
| | - Willi McFarland
- University of California–San Francisco, San Francisco, United States
| | - Allan Lal
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Julio Montaner
- Department of Medicine, University of British Columbia, Vancouver, Canada
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | | | - Robert S. Hogg
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Simon Fraser University, Burnaby, Canada
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15
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Liu AY, Cohen SE, Vittinghoff E, Anderson PL, Doblecki-Lewis S, Bacon O, Chege W, Postle BS, Matheson T, Amico KR, Liegler T, Rawlings MK, Trainor N, Blue RW, Estrada Y, Coleman ME, Cardenas G, Feaster DJ, Grant R, Philip SS, Elion R, Buchbinder S, Kolber MA. Preexposure Prophylaxis for HIV Infection Integrated With Municipal- and Community-Based Sexual Health Services. JAMA Intern Med 2016; 176:75-84. [PMID: 26571482 PMCID: PMC5042323 DOI: 10.1001/jamainternmed.2015.4683] [Citation(s) in RCA: 476] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
IMPORTANCE Several randomized clinical trials have demonstrated the efficacy of preexposure prophylaxis (PrEP) in preventing human immunodeficiency virus (HIV) acquisition. Little is known about adherence to the regimen, sexual practices, and overall effectiveness when PrEP is implemented in clinics that treat sexually transmitted infections (STIs) and community-based clinics serving men who have sex with men (MSM). OBJECTIVE To assess PrEP adherence, sexual behaviors, and the incidence of STIs and HIV infection in a cohort of MSM and transgender women initiating PrEP in the United States. DESIGN, SETTING, AND PARTICIPANTS Demonstration project conducted from October 1, 2012, through February 10, 2015 (last date of follow-up), among 557 MSM and transgender women in 2 STI clinics in San Francisco, California, and Miami, Florida, and a community health center in Washington, DC. Data were analyzed from December 18, 2014, through August 8, 2015. INTERVENTIONS A combination of daily, oral tenofovir disoproxil fumarate and emtricitabine was provided free of charge for 48 weeks. All participants received HIV testing, brief client-centered counseling, and clinical monitoring. MAIN OUTCOMES AND MEASURES Concentrations of tenofovir diphosphate in dried blood spot samples, self-reported numbers of anal sex partners and episodes of condomless receptive anal sex, and incidence of STI and HIV acquisition. RESULTS Overall, 557 participants initiated PrEP, and 437 of these (78.5%) were retained through 48 weeks. Based on the findings from the 294 participants who underwent measurement of tenofovir diphosphate levels, 80.0% to 85.6% had protective levels (consistent with ≥4 doses/wk) at follow-up visits. African American participants (56.8% of visits; P = .003) and those from the Miami site (65.1% of visits; P < .001) were less likely to have protective levels, whereas those with stable housing (86.8%; P = .02) and those reporting at least 2 condomless anal sex partners in the past 3 months (88.6%; P = .01) were more likely to have protective levels. The mean number of anal sex partners declined during follow-up from 10.9 to 9.3, whereas the proportion engaging in condomless receptive anal sex remained stable at 65.5% to 65.6%. Overall STI incidence was high (90 per 100 person-years) but did not increase over time. Two individuals became HIV infected during follow-up (HIV incidence, 0.43 [95% CI, 0.05-1.54] infections per 100 person-years); both had tenofovir diphosphate levels consistent with fewer than 2 doses/wk at seroconversion. CONCLUSIONS AND RELEVANCE The incidence of HIV acquisition was extremely low despite a high incidence of STIs in a large US PrEP demonstration project. Adherence was higher among those participants who reported more risk behaviors. Interventions that address racial and geographic disparities and housing instability may increase the impact of PrEP.
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Affiliation(s)
- Albert Y. Liu
- San Francisco Department of Public Health, San Francisco, California
- University of California, San Francisco, San Francisco, California
| | - Stephanie E. Cohen
- San Francisco Department of Public Health, San Francisco, California
- University of California, San Francisco, San Francisco, California
| | - Eric Vittinghoff
- University of California, San Francisco, San Francisco, California
| | - Peter L. Anderson
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado
| | | | - Oliver Bacon
- San Francisco Department of Public Health, San Francisco, California
- University of California, San Francisco, San Francisco, California
| | - Wairimu Chege
- National Institutes of Health, Division of AIDS, Bethesda, Maryland
| | | | - Tim Matheson
- San Francisco Department of Public Health, San Francisco, California
| | | | - Teri Liegler
- University of California, San Francisco, San Francisco, California
| | | | - Nikole Trainor
- San Francisco Department of Public Health, San Francisco, California
| | | | - Yannine Estrada
- University of Miami, Miller School of Medicine, Miami, Florida
| | | | | | | | - Robert Grant
- Gladstone Institutes, San Francisco, California
- San Francisco AIDS Foundation, San Francisco, California
| | - Susan S. Philip
- San Francisco Department of Public Health, San Francisco, California
- University of California, San Francisco, San Francisco, California
| | - Richard Elion
- Whitman-Walker Health, Washington, DC
- George Washington University School of Medicine
| | - Susan Buchbinder
- San Francisco Department of Public Health, San Francisco, California
- University of California, San Francisco, San Francisco, California
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16
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Boroughs MS, Valentine SE, Ironson GH, Shipherd JC, Safren SA, Taylor SW, Dale SK, Baker JS, Wilner JG, O'Cleirigh C. Complexity of childhood sexual abuse: predictors of current post-traumatic stress disorder, mood disorders, substance use, and sexual risk behavior among adult men who have sex with men. Arch Sex Behav 2015; 44:1891-902. [PMID: 26159863 PMCID: PMC4853755 DOI: 10.1007/s10508-015-0546-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [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] [Received: 08/11/2014] [Revised: 04/07/2015] [Accepted: 04/10/2015] [Indexed: 05/16/2023]
Abstract
Men who have sex with men (MSM) are the group most at risk for HIV and represent the majority of new infections in the United States. Rates of childhood sexual abuse (CSA) among MSM have been estimated as high as 46 %. CSA is associated with increased risk of HIV and greater likelihood of HIV sexual risk behavior. The purpose of this study was to identify the relationships between CSA complexity indicators and mental health, substance use, sexually transmitted infections, and HIV sexual risk among MSM. MSM with CSA histories (n = 162) who were screened for an HIV prevention efficacy trial completed comprehensive psychosocial assessments. Five indicators of complex CSA experiences were created: CSA by family member, CSA with penetration, CSA with physical injury, CSA with intense fear, and first CSA in adolescence. Adjusted regression models were used to identify relationships between CSA complexity and outcomes. Participants reporting CSA by family member were at 2.6 odds of current alcohol use disorder (OR 2.64: CI 1.24-5.63), two times higher odds of substance use disorder (OR 2.1: CI 1.02-2.36), and 2.7 times higher odds of reporting an STI in the past year (OR 2.7: CI 1.04-7.1). CSA with penetration was associated with increased likelihood of current PTSD (OR 3.17: CI 1.56-6.43), recent HIV sexual risk behavior (OR 2.7: CI 1.16-6.36), and a greater number of casual sexual partners (p = 0.02). Both CSA with Physical Injury (OR 4.05: CI 1.9-8.7) and CSA with Intense Fear (OR 5.16: CI 2.5-10.7) were related to increased odds for current PTSD. First CSA in adolescence was related to increased odds of major depressive disorder. These findings suggest that CSA, with one or more complexities, creates patterns of vulnerabilities for MSM, including post-traumatic stress disorder, substance use, and sexual risk taking, and suggests the need for detailed assessment of CSA and the development of integrated HIV prevention programs that address mental health and substance use comorbidities.
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Affiliation(s)
- Michael S. Boroughs
- Department of Psychiatry, Massachusetts General Hospital
- Harvard Medical School
| | - Sarah E. Valentine
- Department of Psychiatry, Massachusetts General Hospital
- Harvard Medical School
| | | | - Jillian C. Shipherd
- VA Boston Healthcare System, National Center for PTSD – Women's Health Sciences Division and Boston University School of Medicine
| | - Steven A. Safren
- Department of Psychiatry, Massachusetts General Hospital
- Harvard Medical School
- The Fenway Institute, Fenway Health
| | | | - Sannisha K. Dale
- Department of Psychiatry, Massachusetts General Hospital
- Harvard Medical School
| | | | | | - Conall O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital
- Harvard Medical School
- The Fenway Institute, Fenway Health
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17
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Cohen SE, Vittinghoff E, Bacon O, Doblecki-Lewis S, Postle BS, Feaster DJ, Matheson T, Trainor N, Blue RW, Estrada Y, Coleman ME, Elion R, Castro JG, Chege W, Philip SS, Buchbinder S, Kolber MA, Liu AY. High interest in preexposure prophylaxis among men who have sex with men at risk for HIV infection: baseline data from the US PrEP demonstration project. J Acquir Immune Defic Syndr 2015; 68:439-48. [PMID: 25501614 PMCID: PMC4334721 DOI: 10.1097/qai.0000000000000479] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Preexposure prophylaxis (PrEP) is the first biomedical intervention with proven efficacy to reduce HIV acquisition in men who have sex with men (MSM) and transgender women. Little is known about levels of interest and characteristics of individuals who elect to take PrEP in real-world clinical settings. METHODS The US PrEP Demonstration Project is a prospective open-label cohort study assessing PrEP delivery in municipal sexually transmitted disease clinics in San Francisco and Miami and a community health center in Washington, DC. HIV-uninfected MSM and transgender women seeking sexual health services at participating clinics were assessed for eligibility and offered up to 48 weeks of emtricitabine/tenofovir for PrEP. Predictors of enrollment were assessed using a multivariable Poisson regression model, and characteristics of enrolled participants are described. RESULTS Of 1069 clients assessed for participation, 921 were potentially eligible and 557 (60.5%) enrolled. In multivariable analyses, participants from Miami (adjusted Relative Risk [aRR]: 1.53; 95% confidence interval [CI]: 1.33 to 1.75) or DC (aRR: 1.33; 95% CI: 1.2 to 1.47), those who were self-referred (aRR: 1.48; 95% CI: 1.32 to 1.66), those with previous PrEP awareness (aRR: 1.56; 95% CI: 1.05 to 2.33), and those reporting >1 episode of anal sex with an HIV-infected partner in the last 12 months (aRR: 1.20; 95% CI: 1.09 to 1.33) were more likely to enroll. Almost all (98%) enrolled participants were MSM, and at baseline, 63.5% reported condomless receptive anal sex in the previous 3 months. CONCLUSIONS Interest in PrEP is high among a diverse population of MSM at risk for HIV infection when offered in sexually transmitted disease and community health clinics.
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Affiliation(s)
- Stephanie E Cohen
- *San Francisco Department of Public Health, San Francisco, CA; †Department of Medicine, University of California-San Francisco, San Francisco, CA; ‡Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL; §DF/Net Research, Inc, Seattle, WA; ‖Whitman-Walker Health Center, Washington, DC; and ¶Division of AIDS, National Institutes of Health, Bethesda, MD
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18
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Khanna AS, Goodreau SM, Gorbach PM, Daar E, Little SJ. Modeling the impact of post-diagnosis behavior change on HIV prevalence in Southern California men who have sex with men (MSM). AIDS Behav 2014; 18:1523-31. [PMID: 24165985 PMCID: PMC4004722 DOI: 10.1007/s10461-013-0646-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Our objective here is to demonstrate the population-level effects of individual-level post-diagnosis behavior change (PDBC) in Southern Californian men who have sex with men (MSM), recently diagnosed with HIV. While PDBC has been empirically documented, the population-level effects of such behavior change are largely unknown. To examine these effects, we develop network models derived from the exponential random graph model family. We parameterize our models using behavioral data from the Southern California Acute Infection and Early Disease Research Program, and biological data from a number of published sources. Our models incorporate vital demographic processes, biology, treatment and behavior. We find that without PDBC, HIV prevalence among MSM would be significantly higher at any reasonable frequency of testing. We also demonstrate that higher levels of HIV risk behavior among HIV-positive men relative to HIV-negative men observed in some cross-sectional studies are consistent with individual-level PDBC.
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Affiliation(s)
- Aditya S Khanna
- International Clinical Research Center, Department of Global Health, University of Washington, P.O. Box 359927, 325 Ninth Avenue, Seattle, WA, 98104, USA,
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19
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Wagner GJ, Tohme J, Hoover M, Frost S, Ober A, Khouri D, Iguchi M, Mokhbat J. HIV prevalence and demographic determinants of unprotected anal sex and HIV testing among men who have sex with men in Beirut, Lebanon. Arch Sex Behav 2014; 43:779-788. [PMID: 24752791 PMCID: PMC4134874 DOI: 10.1007/s10508-014-0303-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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] [Received: 06/19/2013] [Revised: 11/18/2013] [Accepted: 12/01/2013] [Indexed: 06/01/2023]
Abstract
The limited epidemiological data in Lebanon suggest that HIV incident cases are predominantly among men who have sex with men (MSM). We assessed the prevalence of HIV and demographic correlates of condom use and HIV testing among MSM in Beirut. Respondent-driven sampling was used to recruit 213 participants for completion of a behavioral survey and an optional free rapid HIV test. Multivariate regression analysis was used to examine demographic correlates of unprotected anal sex and any history of HIV testing. Nearly half (47 %) were under age 25 years and 67 % self-identified as gay. Nearly two-thirds (64 %) reported any unprotected anal intercourse (UAI) with men in the prior 3 months, including 23 % who had unprotected anal intercourse with men whose HIV status was positive or unknown (UAIPU) to the participant. Three men (1.5 % of 198 participants tested) were HIV-positive; 62 % had any history of HIV testing prior to the study and testing was less common among those engaging in UAIPU compared to others (33 % vs. 71 %). In regression analysis, men in a relationship had higher odds of having UAI but lower odds of UAIPU and any university education was associated with having UAI; those with any prior history of HIV testing were more likely to be in a relationship and have any university education. HIV prevention efforts for MSM need to account for the influence of relationship dynamics and promotion of testing needs to target high-risk MSM.
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Affiliation(s)
- Glenn J Wagner
- RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA,
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20
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Nelson KM, Simoni JM, Morrison DM, George WH, Leickly E, Lengua LJ, Hawes SE. Sexually explicit online media and sexual risk among men who have sex with men in the United States. Arch Sex Behav 2014; 43:833-843. [PMID: 24464547 PMCID: PMC4011997 DOI: 10.1007/s10508-013-0238-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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] [Received: 05/29/2013] [Revised: 08/17/2013] [Accepted: 09/10/2013] [Indexed: 05/31/2023]
Abstract
This study aimed to describe sexually explicit online media (SEOM) consumption among men who have sex with men (MSM) in the United States and examine associations between exposure to unprotected anal intercourse (UAI) in SEOM and engagement in both UAI and serodiscordant UAI. MSM in the U.S. who accessed a men-seeking-men website in the past year (N = 1,170) were recruited online for a cross-sectional, Internet-based survey of sexual risk and SEOM consumption. In the 3 months prior to interview, more than half (57 %) of the men reported viewing SEOM one or more times per day and almost half (45 %) reported that at least half of the SEOM they viewed portrayed UAI. Compared to participants who reported that 0-24 % of the SEOM they viewed showed UAI, participants who reported that 25-49, 50-74, or 75-100 % of the SEOM they viewed portrayed UAI had progressively increasing odds of engaging in UAI and serodiscordant UAI in the past 3 months. As SEOM has become more ubiquitous and accessible, research should examine causal relations between SEOM consumption and sexual risk-taking among MSM as well as ways to use SEOM for HIV prevention.
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Affiliation(s)
- Kimberly M Nelson
- Department of Psychology, University of Washington, Box 351525, Seattle, WA, 98195-1525, USA,
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21
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Abstract
Seroadaptation describes a diverse set of potentially harm-reducing behaviors that use HIV status to inform sexual decision making. Men who have sex with men (MSM) in many settings adopt these practices, but their effectiveness at preventing HIV transmission is debated. Past modeling studies have demonstrated that serosorting is only effective at preventing HIV transmission when most men accurately know their HIV status, but additional modeling is needed to address the effectiveness of broader seroadaptive behaviors. The types of information withwhichMSMmake seroadaptive decisions is expanding to include viral load, treatment status, and HIV status based on home-use tests, and recent research has begun to examine the entire seroadaptive process, from an individual's intentions to seroadapt to their behaviors to their risk of acquiring or transmitting HIV and other STIs. More research is needed to craft clear public health messages about the risks and benefits of seroadaptive practices.
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22
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Deiss RG, Leon SR, Konda KA, Brown B, Segura ER, Galea JT, Caceres CF, Klausner JD. Characterizing the syphilis epidemic among men who have sex with men in Lima, Peru to identify new treatment and control strategies. BMC Infect Dis 2013; 13:426. [PMID: 24016185 PMCID: PMC3846360 DOI: 10.1186/1471-2334-13-426] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 09/02/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Syphilis is an important sexually transmitted infection (STI) with serious public health consequences. Among men who have sex with men (MSM) in Lima, the prevalence and incidence are extraordinarily high. Current syndromic approaches, however, fail to identify asymptomatic cases, and in settings where large proportions of individuals test positive again after treatment, it is frequently difficult to distinguish treatment failure from re-infection. Thus, new approaches are needed to improve treatment strategies and public health control efforts. METHODS/DESIGN Study participants will undergo baseline testing for syphilis infection along with a behavioral survey covering demographics, sexual behavior, drug and alcohol abuse and health-care seeking behavior. The cohort will be followed for 18 months at three-month intervals. Blood and earlobe scrapings will also be collected for T. pallidum DNA testing, to create molecular markers for subtyping. We will also perform cytokine testing on collected samples in order to create host immunologic profiles associated with recurrence, re-infection, treatment failure and success. DISCUSSION Advances in social epidemiology, molecular typing and characterization of host immune responses will offer promise in developing new understandings of syphilis management. We will share our findings with the Peruvian Ministry of Health and other public health organizations, to identify new approaches of case detection and successful treatment.
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Affiliation(s)
- Robert G Deiss
- Division of Infectious Diseases, Harbor-UCLA Medical Center, 1000 W. Carson Street, Box 466, Torrance, CA 90502, USA
| | - Segundo R Leon
- Unit of Health, Sexuality and Human Development, Cayetano Heredia University School of Public Health, Lima, Peru. Av. Armendariz 445 Lima 18, Peru
- Department of Global Health, University of Washington, Harborview Medical Center, 325 9th Avenue Box 359931, Seattle, WA 98104, USA
| | - Kelika A Konda
- Program in Global Health, Division of Infectious Diseases, David Geffen School of Medicine, University of California, 10833 Le Conte Ave. CHS 12-105, Los Angeles, CA 90095-1688, USA
| | - Brandon Brown
- Program in Public Health, Department of Population Health & Disease Prevention, University of California, Irvine, 653 E. Peltason Road Suite 2010, Irvine, CA 92697-3957, USA
| | - Eddy R Segura
- Program in Global Health, Division of Infectious Diseases, David Geffen School of Medicine, University of California, 10833 Le Conte Ave. CHS 12-105, Los Angeles, CA 90095-1688, USA
| | - Jerome T Galea
- Unit of Health, Sexuality and Human Development, Cayetano Heredia University School of Public Health, Lima, Peru. Av. Armendariz 445 Lima 18, Peru
- Centre for Sexual Health and HIV Research, Faculty of Population Health, University College London, Gower St, London, Greater London WC1E 6BT, UK
| | - Carlos F Caceres
- Unit of Health, Sexuality and Human Development, Cayetano Heredia University School of Public Health, Lima, Peru. Av. Armendariz 445 Lima 18, Peru
| | - Jeffrey D Klausner
- Program in Global Health, Division of Infectious Diseases, David Geffen School of Medicine, University of California, 10833 Le Conte Ave. CHS 12-105, Los Angeles, CA 90095-1688, USA
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23
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Castle PE, Follansbee S, Borgonovo S, Tokugawa D, Schwartz LM, Lorey TS, LaMere B, Gage JC, Fetterman B, Darragh TM, Rodriguez AC, Wentzensen N. A comparison of human papillomavirus genotype-specific DNA and E6/E7 mRNA detection to identify anal precancer among HIV-infected men who have sex with men. Cancer Epidemiol Biomarkers Prev 2013; 22:42-9. [PMID: 23155136 PMCID: PMC3538931 DOI: 10.1158/1055-9965.epi-12-0984] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) RNA detection is reportedly more specific for the detection of anogenital precancer than HPV DNA but it is unknown whether this is due to detection of RNA or due to HPV genotype restriction. METHODS A total of 363 human immunodeficiency virus (HIV)-positive men who have sex with men had two anal cytology samples taken and were evaluated using high-resolution anoscopy and biopsies of visible lesions. Anal specimens were tested for E6/E7 RNA for five carcinogenic HPV genotypes (HPV16, 18, 31, 33, and 45) and tested for the DNA of 13 carcinogenic HPV genotypes. RESULTS DNA testing was more likely to be positive than RNA testing (53% vs. 48%; P = 0.02) for the same five HPV genotypes in aggregate. When restricted to five HPV genotypes targeted by the RNA test, the sensitivity to detect anal precancer was the same for DNA and RNA (81%), whereas RNA was more specific than DNA (65% vs. 58%; P = 0.007). In comparison, DNA detection of all 13 carcinogenic HPV genotypes was more sensitive (96% vs. 81%; P = 0.001) but much less specific (65% vs. 33%; P < 0.001) as compared with RNA detection of the five HPV genotypes. CONCLUSION After controlling for HPV genotypes, RNA was only slightly more specific than DNA detection for anal precancer. IMPACT DNA or RNA testing for a subset of the most carcinogenic HPV genotypes may be useful for distinguishing between those HPV-positive men at higher and lower risk of anal precancer and cancer.
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Affiliation(s)
| | | | | | - Diane Tokugawa
- Kaiser Permanente TPMG Regional Laboratory, Berkeley, CA
| | - Lauren M. Schwartz
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | | | - Brandon LaMere
- Women’s Health Research Institute, Division of Research, Kaiser Permanente, Oakland, CA
| | - Julia C. Gage
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | | | | | - Ana Cecilia Rodriguez
- Albert Einstein College of Medicine, Bronx, NY
- Proyecto Epidemiológico Guanacaste, Fundación Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud, San José, Costa Rica
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
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Snyder H, Yeldandi VV, Kumar GP, Liao C, Lakshmi V, Gandham SR, Muppudi U, Oruganti G, Schneider JA. Field-based video pre-test counseling, oral testing, and telephonic post-test counseling: implementation of an HIV field testing package among high-risk Indian men. AIDS Educ Prev 2012; 24:309-326. [PMID: 22827901 PMCID: PMC3660959 DOI: 10.1521/aeap.2012.24.4.309] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 06/01/2023]
Abstract
In India, men who have sex with men (MSM) and truck drivers are high-risk groups that often do not access HIV testing due to stigma and high mobility. This study evaluated a field testing package (FTP) that identified HIV positive participants through video pre-test counseling, OraQuick oral fluid HIV testing, and telephonic post-test counseling and then connected them to government facilities. A total of 598 MSM and truck drivers participated in the FTP and completed surveys covering sociodemographics, HIV testing history, risk behaviors, and opinions on the FTP. MSM and truck drivers equally preferred video counseling, although MSM who had been previously tested preferred traditional methods. Nearly all participants preferred oral testing. Rates of counseling completion and linkage to government centers were low, with one-third of newly identified positives completing follow-up. With increased public-private coordination, this FTP could identify many hard-to-reach preliminary positive individuals and connect them to government testing and care.
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Affiliation(s)
- Hannah Snyder
- University of Chicago, Pritzker School of Medicine, Chicago, United States
| | | | | | - Chuanhong Liao
- University of Chicago, Department of Medicine, Chicago, United States
| | - Vemu Lakshmi
- Nizam’s Institute of Medical Sciences, Microbiology, Hyderabad, India
| | | | - Uma Muppudi
- California College for Health Sciences, Public Health, Salt Lake City, United State
| | | | - John A. Schneider
- University of Chicago, Department of Medicine, Chicago, United States
- University of Chicago, Department of Medicine and Health Studies, Chicago, United States
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25
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Stein DJ, Silvera RJ, Hagerty R, Marmor M. Viewing pornography depicting unprotected anal intercourse: are there implications for HIV prevention among men who have sex with men? Arch Sex Behav 2012; 41:411-9. [PMID: 21755381 PMCID: PMC3310969 DOI: 10.1007/s10508-011-9789-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [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] [Received: 06/03/2010] [Revised: 05/27/2011] [Accepted: 05/29/2011] [Indexed: 05/19/2023]
Abstract
We used an Internet-based questionnaire to investigate whether viewing pornography depicting unprotected anal intercourse (UAI) was associated with engaging in UAI in a sample of 821 non-monogamous men who have sex with men (MSM). In the 3 months prior to interview, 77.2% viewed pornography depicting UAI, 42.6% engaged in insertive UAI, and 38.9% engaged in receptive UAI. Polytomous logistic regression of the 751 subjects who provided data on pornography viewing showed significantly elevated odds ratios for having engaged in receptive UAI, insertive UAI, and both receptive and insertive UAI associated with increasing percentage of pornography viewed that depicted UAI. We also found independently significant associations of engaging in UAI with age, use of inhalant nitrites, and HIV status. Although the data cannot establish causality, our findings indicate that viewing pornography depicting UAI and engaging in UAI are correlated. Further research is needed to determine if this observation may have utility for HIV prevention.
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Affiliation(s)
- Dylan J Stein
- Department of Environmental Medicine, NYU School of Medicine, New York, NY
- Center for AIDS Research, NYU School of Medicine, New York, NY
| | - Richard J Silvera
- Department of Environmental Medicine, NYU School of Medicine, New York, NY
- Center for AIDS Research, NYU School of Medicine, New York, NY
| | - Robert Hagerty
- Department of Environmental Medicine, NYU School of Medicine, New York, NY
- Center for AIDS Research, NYU School of Medicine, New York, NY
| | - Michael Marmor
- Department of Environmental Medicine, NYU School of Medicine, New York, NY
- Center for AIDS Research, NYU School of Medicine, New York, NY
- Department of Medicine, NYU School of Medicine, New York, NY
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26
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Fields EL, Bogart LM, Smith KC, Malebranche DJ, Ellen J, Schuster MA. HIV risk and perceptions of masculinity among young black men who have sex with men. J Adolesc Health 2012; 50:296-303. [PMID: 22325136 PMCID: PMC3281559 DOI: 10.1016/j.jadohealth.2011.07.007] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 07/01/2011] [Accepted: 07/19/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE Young black men who have sex with men (YBMSM) are known to have the highest rates of HIV infection in the United States. Although reported rates of unprotected anal intercourse are similar to the rates of men who have sex with men of other racial/ethnic backgrounds, YBMSM aged 15-22 years are five times more likely to be HIV-infected than the comparably aged white men who have sex with men. We explored contextual social-environmental factors that may influence how YBMSM assess risk, choose partners, and make decisions about condom use. METHODS We analyzed semi-structured interviews with 35 YBMSM (age: 18-24 years) in New York City, Upstate New York, and Atlanta. We used structured analytic coding based on a theoretical scheme that emerged from the data. RESULTS Perception of masculinity was the primary contextual factor influencing partner selection, risk assessment, and decision-making with regard to condom usage. Four primary themes emerged: (1) greater preference for partners perceived as masculine; (2) discomfort with allowing men perceived as feminine to be the insertive partner in anal intercourse; (3) a power dynamic such that partners perceived as more masculine made condom-use decisions within the dyad; and (4) use of potential partners' perceived masculinity to assess HIV risk. CONCLUSIONS Perceived masculinity may play a significant role in HIV risk for YBMSM and may be an important concept to consider in prevention strategies directed toward this population.
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Affiliation(s)
- Errol L. Fields
- Boston Combined Residency in Pediatrics; Divisions of General Pediatrics and Adolescent/Young Adult Medicine, Department of Medicine, Children’s Hospital Boston; Department of Pediatrics, Boston Medical Center; Department of Pediatrics, Harvard Medical School; Department of Pediatrics, Boston University School of Medicine, Boston, MA
| | - Laura M. Bogart
- Division of General Pediatrics, Department of Medicine, Children’s Hospital Boston & Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Katherine C. Smith
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Jonathan Ellen
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Mark A. Schuster
- Division of General Pediatrics, Department of Medicine, Children’s Hospital Boston & Department of Pediatrics, Harvard Medical School, Boston, MA
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Abstract
This study examines the value of using syndemics theory as a model for understanding HIV risk taking in a population of men who are at great risk for acquiring and/or transmitting HIV. The principal aim is to provide an empirical test of the applicability of the theory to sexual risk behaviors in this particular research population. The study was based on a national random sample of 332 men who have sex with men, or MSM, who use the Internet to seek men with whom they can engage in unprotected sex. Data collection was conducted via telephone interviews between January 2008 and May 2009. As hypothesized in the syndemics theory model, attitudes toward condom use were central to understanding men's involvement in risky sex. As hypothesized, these attitudes depended on various demographic, psychological/psychosocial functioning, and sex-related preference measures. Also as hypothesized, psychological and psychosocial functioning were found to be very important to the overall model, and as expected, these factors were shaped greatly by factors such as demographic characteristics and childhood maltreatment experiences. The structural equation assessing the fit of the overall model indicated solid support for the syndemics theory approach. Overall, syndemics theory seems to apply fairly well to understanding the complexity of the factors that underlie men's risk-taking practices. The complicated interplay among factors such as attitudes toward condom use, childhood maltreatment experiences, psychological and psychosocial functioning, and substance use and abuse-all of which are central to a syndemics theory approach to studying risk-was demonstrated.
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Affiliation(s)
- Hugh Klein
- Kensington Research Institute, Silver Spring, MD 20910, USA.
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28
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Abstract
The Internet has become a venue for men who have sex with men to search for sexual partners. Some of these men intentionally seek unprotected anal intercourse with other men ('bareback' sex). This paper focuses on the creation, use, and content of Internet personal profiles of men who have sex with men in the greater New York City metropolitan area who use bareback sites for sexual networking. We used a mixed-methods approach to examine data from a cybercartography of Internet sites conducted during the first phase of the research (199 personal profiles) and from in-depth interviews conducted during its second phase (120 men who have sex with men who sought partners online for bareback sex). Results indicate that men generally followed offline stereotypical patterns in their online profiles. However, men who disclosed being HIV-positive were more likely to include face and head pictures. Overall, the images they used were heavily sexualised in accordance with group norms perceived and reinforced by the websites' design and imagery. Bottom-identified men tended to be more explicit in the exposition of their sexual and drug use interests online. This paper highlights how certain virtual and social performances play upon and reinforce other, in the flesh, performances.
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Affiliation(s)
- Nuno Nodin
- Instituto Superior de Psicologia Aplicada, Lisbon, Portugal.
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Colón-López V, Rodríguez-Díaz CE, Ortiz AP, Soto-Salgado M, Suárez E, Pérez CM. HIV-related risk behaviors among a sample of men who have sex with men in Puerto Rico: an overview of substance use and sexual practices. P R Health Sci J 2011; 30:65-68. [PMID: 21682148 PMCID: PMC3119669] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Despite the growing impact of the human immunodeficiency virus (HIV) epidemic in Puerto Rico (PR), limited epidemiological research on men who have sex with men (MSM) has been conducted. The aim of this study was to describe HIV-related risk behaviors in a sample of MSM in PR. METHODS A secondary data analysis of a household survey of the adult population of PR was performed in order to describe substance use and sexual practices related to HIV transmission and seropositivity for hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), HIV, and type 2 herpes simplex virus (HSV-2) in MSM. Data regarding substance use and sexual practices were collected using audio computer-assisted self-interviewing (A-CASI). Descriptive statistics were used to examine lifetime and recent (12 months) prevalence of substance use and sexual practices. RESULTS Of the 640 men interviewed, 41 (6.4%) reported having ever had sex with another man on at least one occasion. Approximately one-fourth of MSM reported having used marijuana (24.4%) and cocaine (24.4%) in the past 12 months. Nearly 42% of the MSM reported an early age of sexual initiation (< 15 years), and 61% reported having had at least 10 sexual partners in their lifetime. Seropositivity rates for HAV, HSV-2, HIV, HCV, and HBV were 43.3%, 32.4%, 7.3%, 4.9%, and 4.9%, respectively. CONCLUSION This is the first study to attempt to examine high-risk behaviors related to HIV in a population-based sample of MSM in PR. Concurrent efforts that will help to intensify research and prevention initiatives among MSM are necessary, especially those that will enhance awareness of screening for HIV, HCV, and other sexually transmitted infections, access to HAV and HBV vaccinations, substance use, and identification of social barriers.
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Affiliation(s)
- Vivian Colón-López
- Department of Health Services Administration, Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.
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30
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Abstract
HIV prevalence among men who have sex with men (MSM) has increased significantly in China since early 2000, with MSM accounting for 32.5% of the newly infected HIV cases in China in 2009. This study reviews a total of 33 studies published in English literature on MSM in China from 2000 to 2009. Existing studies indicated that frequently MSM in China were married (especially older MSM); a majority were migrants and self-identified as gay. A large and increasing proportion of MSM sought sexual partners online. Sexual risk behaviors among MSM were prevalent, including high rates of unprotected sex, concurrent sexual relationships with both men and women, and commercial sex. Illicit drug use, however, was relatively low among general Chinese MSM, but higher among those engaged in commercial sex with men. The existing literature suggests a lack of socio-behavioral studies, lack of intervention studies specifically targeting MSM, and lack of studies in smaller cities, towns, and rural areas. Future studies need to employ more rigorous research methodology, including longitudinal study design, multiple sampling methods, and common measurements of HIV-related risk behaviors.
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Affiliation(s)
- Yan Guo
- Prevention Research Center, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI 48201, USA.
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Mackesy-Amiti ME, Fendrich M, Johnson TP. Symptoms of substance dependence and risky sexual behavior in a probability sample of HIV-negative men who have sex with men in Chicago. Drug Alcohol Depend 2010; 110:38-43. [PMID: 20219291 PMCID: PMC2885520 DOI: 10.1016/j.drugalcdep.2010.01.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 01/27/2010] [Accepted: 01/29/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study examines the relationship between self-reported symptoms of substance dependence and risky sexual behavior among 187 HIV-negative men who have sex with men. METHOD In a supplement to a Chicago household survey, using random probability sampling, men who reported consensual sex with other men or who identified as gay or bisexual were selected for interviews. Participants reported on sexual behavior, substance use, and symptoms of substance dependence related to past year use of alcohol, marijuana, cocaine, and sedatives, tranquilizers or pain relievers. Risky sexual behavior was defined as unprotected insertive or receptive anal intercourse plus having multiple partners, casual partners, or a partner who was HIV positive or of unknown serostatus. RESULTS Risky sexual behavior in the past six months was significantly and positively associated with alcohol dependence symptoms, cocaine dependence symptoms (receptive only), and prescription drug dependence symptoms (insertive only). Confirmatory factor analyses revealed that dependence symptoms loaded on separate factors by substance, which in turn loaded on an overarching dependence symptoms factor. In structural equation models, individual substance factors were not significantly associated with sexual risk behavior, however the higher order dependence symptoms factor was significantly and positively associated with both receptive and insertive risk behavior. CONCLUSIONS MSM with symptoms of multiple substance use dependencies are more likely to be engaged in sexual behavior that places them at risk for acquiring HIV and other sexually transmitted infections. Alcohol and drug abuse treatment providers should be aware of the need for HIV testing and counseling in this population.
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Affiliation(s)
- Mary Ellen Mackesy-Amiti
- Community Outreach Intervention Projects, Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603W Taylor St., Chicago, IL 60612, United States.
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Grov C, Parsons JT, Bimbi DS. The association between penis size and sexual health among men who have sex with men. Arch Sex Behav 2010; 39:788-97. [PMID: 19139986 PMCID: PMC2874247 DOI: 10.1007/s10508-008-9439-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [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] [Received: 05/07/2008] [Revised: 10/09/2008] [Accepted: 10/11/2008] [Indexed: 05/11/2023]
Abstract
Larger penis size has been equated with a symbol of power, stamina, masculinity, and social status. Yet, there has been little research among men who have sex with men assessing the association between penis size and social-sexual health. Survey data from a diverse sample of 1,065 men who have sex with men were used to explore the association between perceived penis size and a variety of psychosocial outcomes. Seven percent of men felt their penis was "below average," 53.9% "average," and 35.5% "above average." Penis size was positively related to satisfaction with size and inversely related to lying about penis size (all ps < .01). Size was unrelated to condom use, frequency of sex partners, HIV status, or recent diagnoses of HBV, HCV, gonorrhea/Chlamydia/urinary tract infections, and syphilis. Men with above average penises were more likely to report HPV and HSV-2 (Fisher's exact p <or= .05). Men with below average penises were significantly more likely to identify as "bottoms" (anal receptive) and men with above average penises were significantly more likely to identify as "tops" (anal insertive). Finally, men with below average penises fared significantly worse than other men on three measures of psychosocial adjustment. Though most men felt their penis size was average, many fell outside this "norm." The disproportionate number of viral skin-to-skin STIs (HSV-2 and HPV) suggest size may play a role in condom slippage/breakage. Further, size played a significant role in sexual positioning and psychosocial adjustment. These data highlight the need to better understand the real individual-level consequences of living in a penis-centered society.
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Affiliation(s)
- Christian Grov
- Department of Health and Nutrition Sciences, Brooklyn College, City University of New York (CUNY)
- Center for HIV/AIDS Educational Studies and Training (CHEST)
| | - Jeffrey T. Parsons
- Center for HIV/AIDS Educational Studies and Training (CHEST)
- Department of Social & Personality Psychology, The Graduate Center of CUNY
- To whom correspondence should be addressed at Department of Psychology, Hunter College, CUNY, 695 Park Avenue, New York, NY. 10065. . 212-206-7919x226; 212-206-7994 (Fax)
| | - David S. Bimbi
- Center for HIV/AIDS Educational Studies and Training (CHEST)
- Department of Natural and Applied Sciences, LaGuardia Community College, CUNY
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Grov C, Bux D, Parsons JT, Morgenstern J. Recruiting hard-to-reach drug-using men who have sex with men into an intervention study: lessons learned and implications for applied research. Subst Use Misuse 2009; 44:1855-71. [PMID: 20001284 PMCID: PMC2874238 DOI: 10.3109/10826080802501570] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Drug (ab)use researchers and service providers across the globe have been challenged with locating target populations and subsequently enrolling participants into their programs. This study presents data from nearly 3 years (2004-2006) of recruiting "high-risk" drug-using gay and bisexual men into a clinical research trial based in New York City. During the enrollment period, two recruitment/marketing strategies were utilized: (1) marketing of the intervention research study itself to men who were in the early stages of identifying problems with their drug use and risky sexual behavior and (2) two-stage recruitment via a lower-threshold/commitment (i.e., brief survey) and subsequent offering/enrollment into the full trial upon completion of the initial visit (i.e., a foot-in-the-door). The second approach was substantially more effective in enrolling participants into the full trial (6.3 participants/month vs. 2.5 participants/month). Furthermore, recruitment costs for the foot-in-the-door approach were substantially reduced ($356.57 per participant vs. $497.03 per participant). Compared to the marketing of interventions themselves to target populations, a two-stage recruitment strategy incorporating lower-threshold interactions may be a more effective approach to recruit for interventions.
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Affiliation(s)
- Christian Grov
- Center for HIV/AIDS Educational Studies and Training, New York, NY
- National Development and Research Institutes, Inc. New York, NY
- Public Health Solutions, New York, NY
| | - Donald Bux
- Columbia University College of Physicians & Surgeons and the Research Foundation for Mental Hygiene, Inc
| | - Jeffrey T. Parsons
- Center for HIV/AIDS Educational Studies and Training, New York, NY
- Hunter College and the Graduate Center of the City University of New York, New York, NY
| | - Jon Morgenstern
- Columbia University College of Physicians & Surgeons and the Research Foundation for Mental Hygiene, Inc
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