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Harris CL, Blair CS, Segura ER, Gutiérrez J, Lake JE, Cabello R, Clark JL. Sexual network characteristics, condomless anal intercourse, and the HIV care cascade among MSM living with controlled versus uncontrolled HIV infection in Lima, Peru: a population-based cross-sectional analysis. Lancet Reg Health Am 2024; 32:100722. [PMID: 38629029 PMCID: PMC11019357 DOI: 10.1016/j.lana.2024.100722] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 04/19/2024]
Abstract
Background Despite high rates of HIV transmission among men who have sex with men (MSM) in Lima, Peru, limited data exist on the sexual network characteristics or risk factors for secondary HIV transmission among MSM with uncontrolled HIV infection. We report the frequency of serodiscordant, condomless anal intercourse (CAI) and associated sexual network characteristics among MSM in Lima with detectable HIV viremia and compare to those with undetectable viremia. Methods This cross-sectional analysis includes MSM who tested positive for HIV-1 during screening for a trial of partner management and STI control (June 2022-January 2023). Participants were tested for HIV, gonorrhoea, chlamydia, and syphilis, and completed questionnaires on their demographic characteristics, sexual identity and behaviour, sexual network structures and engagement in HIV care. Findings Of 665 MSM, 153 (23%) had detectable (>200 copies/mL) viremia. 75% (499/662) of men living with HIV were previously diagnosed, with 94% (n = 469/499) reporting that they were on ART, and 93% (n = 436/469) virally suppressed. 96% (n = 147/153) of men with detectable viremia reported serodiscordant CAI with at least one of their last three sexual partners, and 74% (n = 106/144) reported the same with all three of their recent partners. In contrast, 62% (n = 302/489) of men with undetectable viral load reported serodiscordant CAI with all of their last three partners (p < 0.01). Interpretation 23% of men living with HIV in Peru had detectable viremia, of whom almost all (96%) reported recent serodiscordant CAI. The primary gap in the HIV care cascade lies in awareness of HIV serostatus, suggesting that improved access to HIV testing could be a key prevention strategy in Peru. Funding Funding for this study was provided by NIH/NIMH grants R01 MH118973 (PI: Clark) and R25 MH087222 (PI: Clark).
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Affiliation(s)
- Carlyn L. Harris
- Emory University School of Medicine, Atlanta, GA, USA
- South American Program in HIV Prevention Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Cherie S. Blair
- Department of Medicine, David Geffen School of Medicine at UCLA, Division of Infectious Diseases, Los Angeles, CA, USA
| | - Eddy R. Segura
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | | | | | - Jesse L. Clark
- Department of Medicine, David Geffen School of Medicine at UCLA, Division of Infectious Diseases, Los Angeles, CA, USA
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Clark JL, Oldenburg CE, Passaro RC, Segura ER, Godwin W, Fulcher JA, Cabello R. Changes in Inflammatory Cytokine Levels in Rectal Mucosa Associated With Neisseria gonorrheae and/or Chlamydia trachomatis Infection and Treatment Among Men Who Have Sex With Men in Lima, Peru. J Infect Dis 2024; 229:845-854. [PMID: 37584273 PMCID: PMC10938210 DOI: 10.1093/infdis/jiad349] [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: 04/02/2023] [Revised: 07/04/2023] [Accepted: 08/14/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Neisseria gonorrheae and Chlamydia trachomatis are associated with mucosal inflammation and human immunodeficiency virus 1 (HIV-1) transmission. We assessed levels of inflammatory cytokines in men who have sex with men (MSM) with and without rectal gonorrhea and/or chlamydia in Lima, Peru. METHODS We screened 605 MSM reporting condomless receptive anal intercourse for rectal N. gonorrheae/C. trachomatis using nucleic acid testing. We identified 101 cases of gonorrhea and/or chlamydia and randomly selected 50 N. gonorrheae/C. trachomatis positive cases and matched 52 negative controls. We measured levels of IL-1β, IL-6, IL-8, and TNF-α in rectal secretions. Tests for HIV-1, rectal N. gonorrheae/C. trachomatis, and mucosal cytokines were repeated after 3 and 6 months. Cytokine levels in cases and uninfected controls were compared using Wilcoxon rank-sum tests and linear regression. RESULTS MSM with gonorrhea/chlamydia had elevated levels of all cytokines in rectal mucosa compared with matched controls (all P values <.001). Following antibiotic treatment there were no significant differences in cytokine levels at 3- or 6-month follow-up evaluations (all P values >.05). DISCUSSION Rectal gonorrhea/chlamydia infection is associated with transient mucosal inflammation and cytokine recruitment. Our data provide proof of concept for rectal sexually transmitted infection screening as an HIV prevention strategy for MSM. Clinical Trials Registration. NCT03010020.
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Affiliation(s)
- Jesse L Clark
- David Geffen School of Medicine, Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, California, USA
| | - Catherine E Oldenburg
- Proctor Foundation for Research in Ophthalmology, University of California, San Francisco, San Francisco, California, USA
| | - Ryan C Passaro
- Department of Emergency Medicine, University of Southern California, Los Angeles County Hospital, Los Angeles, California, USA
| | - Eddy R Segura
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - William Godwin
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Jennifer A Fulcher
- David Geffen School of Medicine, Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, California, USA
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Freese J, Segura ER, Gutierrez J, Lake JE, Cabello R, Clark JL, Blair C. Sexual network characteristics and partnership types among men who have sex with men diagnosed with syphilis, gonorrhoea and/or chlamydia in Lima, Peru. Sex Transm Infect 2024; 100:84-90. [PMID: 38124224 PMCID: PMC10922481 DOI: 10.1136/sextrans-2023-055910] [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: 06/26/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES Sexual networks are known to structure sexually transmitted infection (STI) transmission among men who have sex with men (MSM). We sought to estimate the risks of STI diagnosis for various partnership types within these networks. METHODS Our cross-sectional survey analysed data from 1376 MSM screened for a partner management intervention in Lima, Peru. Participants were tested for HIV, syphilis, gonorrhoea (NG) and chlamydia (CT) and completed surveys on their demographics, sexual identity/role, HIV status, partnership types and sexual network from the prior 90 days. χ2 and Wilcoxon rank-sum tests compared participants without an STI to those diagnosed with (1) syphilis, (2) NG and/or CT (NG/CT) and (3) syphilis and NG/CT coinfection (coinfection). RESULTS 40.8% (n=561/1376) of participants were diagnosed with an STI (syphilis: 14.9%, NG/CT: 16.4%, coinfection: 9.5%). 47.9% of all participants were living with HIV and 8.9% were newly diagnosed. A greater proportion of participants with syphilis and coinfection were living with HIV (73.5%, p<0.001; 71.0%, p<0.001) compared with those with NG/CT (47.8%) or no STI (37.8%). Participants with syphilis more often reported sex-on-premises venues (SOPVs) as the location of their last sexual encounter (51.7%, p=0.038) while those with NG/CT tended to meet their last sexual partner online (72.8%, p=0.031). Respondents with coinfection were the only STI group more likely to report transactional sex than participants without an STI (31.3%, p=0.039). CONCLUSIONS Sexual networks and partnership types of Peruvian MSM are associated with differential risks for STIs. Participants diagnosed with syphilis tended to meet single-encounter casual partners at SOPV, while MSM with NG/CT were younger and often contacted casual partners online. Coinfection had higher frequency of transactional sex. These findings suggest the potential importance of public health interventions through combined syphilis/HIV screening at SOPV, syphilis screening at routine clinic appointments for MSM living with HIV and directed advertisements and/or access to NG/CT testing through online platforms.
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Affiliation(s)
- Jonathan Freese
- University of Nebraska Medical Center, Omaha, Nebraska, USA
- Department of Medicine, Division of Infectious Diseases, South American Program in HIV Prevention Research, Los Angeles, California, USA
| | - Eddy R Segura
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | | | | | - Jesse L Clark
- Department of Medicine, Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, Los Angeles, California, USA
| | - Cherie Blair
- Department of Medicine, Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, Los Angeles, California, USA
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Temelkovska T, Moriarty K, Huerta L, Perez-Brumer AG, Segura ER, Passaro RC, Lake JE, Clark JL, Blair CS. Both/And: Mixed methods analysis of network composition, communication patterns, and socio-economic support within social networks of transgender women involved in sex work in Lima, Peru. BMC Public Health 2023; 23:2385. [PMID: 38041045 PMCID: PMC10690964 DOI: 10.1186/s12889-023-17278-z] [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: 07/07/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023] Open
Abstract
INTRODUCTION Social networks contribute to normative reinforcement of HIV prevention strategies, knowledge sharing, and social capital, but little research has characterized the social networks of transgender women (TW) in Latin America. We conducted a mixed methods analysis of three network clusters of TW in Lima, Peru, to evaluate network composition, types of support exchanged, and patterns of communication. METHODS We recruited TW residing in or affiliated with three "casas trans" (houses shared among TW) in Lima between April-May 2018. Eligible participants were 18 or older, self-reported HIV-negative, and reported recent intercourse with a cis-male partner. Participants completed demographic questionnaires, social network interviews, and semi-structured interviews to assess egocentric network structures, support exchanged, and communication patterns. Quantitative and qualitative data were analyzed using Stata v14.1 and Atlas.ti, respectively. RESULTS Of 20 TW, median age was 26 years and 100% reported involvement in commercial sex work. Respondents identified 161 individuals they interacted with in the past month (alters), of whom 33% were TW and 52% family members. 70% of respondents reported receiving emotional support from family, while 30% received financial support and instrumental support from family. Of the 13 (65%) respondents who nominated someone as a source of HIV prevention support (HPS), the majority (69%) nominated other TW. In a GEE regression analysis adjusted for respondent education and region of birth, being a family member was associated with lower likelihood of providing financial support (aOR 0.21, CI 0.08-0.54), instrumental support (aOR 0.16, CI 0.06-0.39), and HPS (aOR 0.18, CI 0.05-0.64). In qualitative interviews, most respondents identified a cis-female family member as their most trusted and closest network member, but other TW were more often considered sources of day-to-day support, including HPS. CONCLUSION TW have diverse social networks where other TW are key sources of knowledge sharing and support, and family members may also represent important and influential components. Within these complex networks, TW may selectively solicit and provide support from different network alters according to specific contexts and needs. HIV prevention messaging could consider incorporating network-based interventions with TW community input and outreach efforts for supportive family members.
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Affiliation(s)
- Tijana Temelkovska
- Department of Obstetrics and Gynecology, University of Colorado, 12631 East 17th Avenue, AO1, 4th Floor, Aurora, CO, 80045, USA.
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, UCLA, 911 Broxton Ave, Suite 301, Los Angeles, CA, 90024, USA.
| | - Kathleen Moriarty
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC, 20007, USA
| | - Leyla Huerta
- Feminas, Jiron Carlos de los Heros 265, Cercado de Lima 15084, Lima, Peru
| | - Amaya G Perez-Brumer
- Division of Social and Behavioral Health Sciences, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 5th Floor, Room 554, Toronto, ON, Canada
| | - Eddy R Segura
- Facultad de Ciencias de la Salud, Universidad de Huánuco, Jirón Hermilio, Valdizan, Huánuco, 859-885, 10001, Peru
| | - Ryan Colby Passaro
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, 1200 N State Street, Los Angeles, CA, 90033, USA
| | - Jordan E Lake
- Department of Internal Medicine, McGovern Medical School at UTHealth, MSB 1.150, Houston, Fannin, Houston, Texas, 6431, 77030, USA
| | - Jesse L Clark
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, UCLA, 911 Broxton Ave, Suite 301, Los Angeles, CA, 90024, USA
| | - Cheríe S Blair
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, UCLA, 911 Broxton Ave, Suite 301, Los Angeles, CA, 90024, USA
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Lake JE, Miao H, Bowman ER, Clark JL, Hyatt AN, Kettelhut A, Lama JR, Reisner SL, Mayer KH, Perez-Brumer A, Funderburg N. Gender-affirming hormone therapy decreases d-dimer but worsens insulin sensitivity in transgender women. HIV Med 2023; 24:1144-1149. [PMID: 37386803 PMCID: PMC10755063 DOI: 10.1111/hiv.13522] [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: 04/21/2023] [Accepted: 06/12/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVES Gender-affirming hormonal therapies (GAHT) and HIV increase cardiovascular risk for transgender women (TW), yet there is a paucity of data quantifying cardiometabolic changes following GAHT initiation, particularly among TW with HIV. METHODS The Féminas study enrolled TW from October 2016 to March 2017 in Lima, Peru. Participants reported sexual activity that was high risk for HIV acquisition or transmission. All were tested for HIV/ sexually transmitted infection and were given access to GAHT (oestradiol valerate and spironolactone), HIV pre-exposure prophylaxis (PrEP) or antiretroviral therapy (ART) for 12 months. Biomarker measurement was done on stored serum, whereas fasting glucose and lipids were measured in real time. RESULTS In all, 170 TW (32 with HIV, 138 without HIV) had median age 27 years and 70% prior GAHT use. At baseline, PCSK9, sCD14, sCD163, IL-6, sTNFRI/II, CRP and EN-RAGE levels were significantly higher in TW with HIV than in TW without HIV. High-density lipoprotein and total cholesterol were lower and insulin and glucose parameters were similar. All TW with HIV started ART, but only five achieved virological suppression at any time. No TW without HIV initiated PrEP. Over 6 months, all participants initiated GAHT and had worsening insulin, glucose and HOMA-IR. Large d-dimer decreases also occurred. Similar changes occurred in TW with and without HIV. CONCLUSIONS In this unique cohort of TW, GAHT decreased d-dimer but worsened insulin sensitivity. Because PrEP uptake and ART adherence were very low, observed effects are primarily attributed to GAHT use. Further study is needed to better understand cardiometabolic changes in TW by HIV serostatus.
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Affiliation(s)
- Jordan E. Lake
- University of Texas Health Science Center at Houston, 6431 Fannin St. MSB 2.112, Houston, TX 77030, USA
| | - Hongyu Miao
- Florida State University, 600 W College Ave, Tallahassee, FL 32306, USA
| | - Emily R. Bowman
- The Ohio State University, 453 West 10 Ave, Columbus, OH 43210, USA
| | - Jesse L. Clark
- University of California, Los Angeles, 405 Hilgard Ave., Los Angeles 90095, CA, USA
| | - Ana N. Hyatt
- University of Texas Health Science Center at Houston, 6431 Fannin St. MSB 2.112, Houston, TX 77030, USA
| | - Aaren Kettelhut
- The Ohio State University, 453 West 10 Ave, Columbus, OH 43210, USA
| | - Javier R. Lama
- Asociación Civil Impacta Salud y Educación, Av. Almte. Miguel Grau 1010, Lima 15063, Peru
| | - Sari L. Reisner
- Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
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Bocage AE, Coelho LE, Lake JE, Clark JL, Torres TS, Jalil EM, Cardoso SW, Moreira RI, Veloso VG, Grinsztejn B, Luz PM. The Impact of COVID-19 on HIV Care in Rio de Janeiro, Brazil 2019-2021: Disparities by Age and Gender. AIDS Behav 2023; 27:2629-2641. [PMID: 36715887 PMCID: PMC9885404 DOI: 10.1007/s10461-023-03988-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 01/31/2023]
Abstract
We evaluated COVID-19's impact on HIV care indicators among INI/FIOCRUZ's HIV Clinical Cohort in Rio de Janeiro, Brazil: (1) Adequate care visits: two visits ≥ 90 days apart; (2) Adequate viral load monitoring: ≥ 2 viral load results ≥ 90 days apart; (3) Consistent viral suppression: all viral loads < 40 copies/mL; and (4) ART medication possession ratio (MPR) ≥ 95%. Chi-square tests compared the fraction of participants meeting each indicator per period: pre-pandemic (3/1/2019-2/29/2020) and post-pandemic (3/1/2020-2/28/2021). Logistic regression models were used to assess disparities in adequate care visits. Among 906 participants, care visits and viral load monitoring decreased pre-pandemic to post-pandemic: 77.0-55.1% and 36.6-11.6% (both p < 0.001), respectively. The optimal MPR rate improved from 25.5 to 40.0% (p < 0.001). Post-pandemic period (aOR 0.33, CI 0.28-0.40), transgender women (aOR 0.34, CI 0.22-0.53), and those aged 18-24 years (aOR 0.67, CI 0.45-0.97) had lower odds of adequate care visits. COVID-19 disrupted care access disproportionately for transgender women and younger participants.
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Affiliation(s)
- Anne E Bocage
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
- The Warren Alpert Medical School of Brown University, 222 Richmond St, Box G-M117, Providence, RI, 02912, USA.
| | - Lara E Coelho
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Jordan E Lake
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- UTHealth Houston, Houston, TX, USA
| | - Jesse L Clark
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Center for HIV Identification, Prevention, and Treatment Services, Department of Family Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Thiago S Torres
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Emília M Jalil
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Sandra W Cardoso
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ronaldo I Moreira
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Valdilea G Veloso
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Paula M Luz
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Temelkovska T, Moriarty K, Huerta L, Perez-Brumer AG, Segura ER, Passaro RC, Lake JE, Clark JL, Blair CS. Both/And: Mixed methods analysis of network composition, communication patterns, and socio-economic support within social networks of transgender women in Lima, Peru. Res Sq 2023:rs.3.rs-3150364. [PMID: 37577472 PMCID: PMC10418543 DOI: 10.21203/rs.3.rs-3150364/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Introduction Social networks contribute to normative reinforcement of HIV prevention strategies, knowledge sharing, and social capital, but little research has characterized the social networks of transgender women (TW) in Latin America. We conducted a mixed methods analysis of three network clusters of TW in Lima, Peru, to evaluate network composition, types of support exchanged, and patterns of communication. Methods We recruited TW residing in or affiliated with three "casas trans" (houses shared among TW) in Lima between April-May 2018. Eligible participants were 18 or older, self-reported HIV-negative, and reported recent intercourse with a cis-male partner. Participants completed demographic questionnaires, social network interviews, and semi-structured interviews to assess egocentric network structures, support exchanged, and communication patterns. Quantitative and qualitative data were analyzed using Stata v14.1 and Atlas.ti, respectively. Results Of 20 TW, median age was 26 years and 100% reported involvement in commercial sex work. Respondents identified 161 individuals they interacted with in the past month (alters), of whom 33% were TW and 52% family members. 70% of respondents reported receiving emotional support from family, while 30% received financial support and instrumental support from family. Of the 13 (65%) respondents who nominated someone as a source of HIV prevention support (HPS), the majority (69%) nominated other TW. In a GEE regression analysis adjusted for respondent education and region of birth, being a family member was associated with lower likelihood of providing financial support (aOR 0.21, CI 0.08-0.54), instrumental support (aOR 0.16, CI 0.06-0.39), and HPS (aOR 0.18, CI 0.05-0.64). In qualitative interviews, most respondents identified a cis-female family member as their most trusted and closest network member, but other TW were more often considered sources of day-to-day support, including HPS. Conclusion TW have diverse social networks where other TW are key sources of knowledge sharing and support, and family members may also represent important and influential components. Within these complex networks, TW may selectively solicit and provide support from different network alters according to specific contexts and needs. HIV prevention messaging could consider incorporating network-based interventions with TW community input and outreach efforts for supportive family members.
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Zachek CM, Coelho LE, Clark JL, Domingues RMSM, Luz PM, Friedman RK, de Andrade ÂCV, Veloso VG, Lake JE, Grinsztejn B, De Boni RB. Reproductive health syndemics impact retention in care among women living with HIV in Rio de Janeiro, Brazil. Braz J Infect Dis 2023; 27:102779. [PMID: 37230150 PMCID: PMC10245108 DOI: 10.1016/j.bjid.2023.102779] [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: 01/23/2023] [Revised: 04/29/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023] Open
Abstract
Syndemic psychosocial and reproductive factors affecting women's retention in HIV care remain understudied. We analyzed correlates of non-retention in a cohort of women with HIV in Brazil from 2000‒2015. Participants self-reported exposure to physical/sexual violence, illicit drug use, adolescent pregnancy, or induced abortion. Lifetime history of these psychosocial stressors were used to create a syndemic score based on the presence or absence of these conditions. All dichotomous variables were summed (range 0 to 4), with greater scores indicating more syndemic factors experienced. Logistic regression models identified predictors of non-retention, defined as < 2 HIV viral load or CD4 results within the first year of enrollment. Of 915 women, non-retention was observed for 18%. Prevalence of syndemic factors was adolescent pregnancy (53.2%), physical/sexual violence (38.3%), induced abortion (27.3%), and illicit drug use (17.2%); 41.2% experienced ≥ 2 syndemic conditions. Syndemic scores of 2 and 3 were associated with non-retention, as well as low education, years with HIV and seroprevalent syphilis. Psychosocial and reproductive syndemics can limit women's retention in HIV care. Syphilis infection predicted non-retention and could be explored as a syndemic factor in future studies.
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Affiliation(s)
- Christine M Zachek
- University of California San Francisco, School of Medicine, San Francisco, CA, USA.
| | - Lara E Coelho
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Jesse L Clark
- University of California Los Angeles David Geffen School of Medicine, Department of Medicine, Los Angeles, CA, USA
| | - Rosa M S M Domingues
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Paula M Luz
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Ruth K Friedman
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | | | - Valdilea G Veloso
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Jordan E Lake
- The University of Texas Health Science Center at Houston (UTHealth), Department of Medicine, Houston, TX, USA
| | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Raquel B De Boni
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
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Blair CS, Gandhi M, Shoptaw S, Blades C, Clark JL. Contingency Management for Integrated Harm Reduction Among Men Who Have Sex with Men Who Use Methamphetamine in Los Angeles: A Pilot Assessment. AIDS Behav 2023; 27:1962-1971. [PMID: 36414775 PMCID: PMC10152513 DOI: 10.1007/s10461-022-03929-6] [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] [Accepted: 11/06/2022] [Indexed: 11/24/2022]
Abstract
Methamphetamine (MA) use is associated with HIV transmission among men who have sex with men (MSM) and lapses in medication adherence. Contingency Management (CM) is effective in reducing MA use, but studies of CM to support adherence to HIV prevention or treatment are limited. We conducted a pilot trial of a CM intervention to reduce MA use and improve PrEP/ART adherence among MSM prescribed a tenofovir (TFV)-based regimen for HIV prevention or treatment. Participants were randomly assigned to receive escalating incentives for either MA abstinence or TFV adherence (based on point-of-care urine testing), and to a monitoring schedule of either 2 or 3 visits/week for 4 weeks. 19 MSM were randomized to either CM for MA use or CM for PrEP/ART adherence (median age: 38; IQR: 28-46) and 15 were living with HIV. Participants attended 95.7% (67/70) of scheduled visits in the 2x/week arm and 74.8% (74/99) in the 3x/week arm. TFV adherence was higher among participants in the TFV adherence arm with 93.5% (n = 72/77) of urine samples positive for TFV, compared to 76.6% (n = 49/64) in the MA abstinence arm (p = 0.007). Participants in the MA abstinence arm had more urine samples negative for MA metabolites (20.3%, n = 13/64) than those receiving CM for TFV adherence (6.5%, n = 5/77; p = 0.021). A CM model for MA abstinence and PrEP/ART adherence using twice-weekly visits and urine testing for MA and TFV for MSM who use MA is feasible and potentially effective as an integrated harm reduction strategy.
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Affiliation(s)
- Cheríe S Blair
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 LeConte Avenue, CHS 52-215, 90095, Los Angeles, CA, USA.
| | - Monica Gandhi
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA, USA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Christopher Blades
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jesse L Clark
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 LeConte Avenue, CHS 52-215, 90095, Los Angeles, CA, USA
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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10
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Blair CS, Fulcher JA, Cho GD, Gorbach PM, Shoptaw S, Clark JL. Brief Report: Impact of Methamphetamine Use and Rectal STIs on Systemic and Rectal Mucosal Inflammation. J Acquir Immune Defic Syndr 2023; 92:281-285. [PMID: 36515912 PMCID: PMC9974870 DOI: 10.1097/qai.0000000000003143] [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: 08/26/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Methamphetamine (MA) use is associated with sexual risk behavior as well as systemic and mucosal inflammation, suggesting parallel biological and behavioral mechanisms of HIV transmission among men who have sex with men (MSM) who use MA. Data evaluating the combined biological effects of MA use with concomitant rectal gonococcal and/or chlamydial (GC/CT) infection on inflammation are limited. SETTING Secondary analysis of stored rectal and plasma specimens from 100 MSM participating in an NIDA-funded longitudinal cohort in Los Angeles, CA. METHODS This cross-sectional analysis evaluated systemic and rectal inflammatory markers under 2 conditions: (1) recent MA use (by urine drug screen) and (2) rectal GC/CT infection. We evaluated 50 participants with recent MA use (25 with and 25 without rectal GC/CT) and 50 MSM without MA use (25 with and 25 without rectal GC/CT). Log-transformed plasma and rectal immune markers were regressed on MA exposure and rectal GC/CT, controlling for HIV status and age. RESULTS Median age was 32 (range 19-45) years, and 58% of participants were living with HIV. Plasma tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-8, IL-1ß, and rectal IL-6 were associated with rectal GC/CT and MA use, independent of HIV status. Higher levels of rectal TNF-α, IL-1ß, and IL-17a were associated with rectal GC/CT. CONCLUSIONS Systemic and rectal inflammation was positively associated with rectal GC/CT and MA use. Condomless sex in the setting of GC/CT- and MA-induced immune activation may provide a basis for synergistic biobehavioral mechanisms that promote HIV/STI transmission among MSM who use MA.
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Affiliation(s)
- Cheríe S Blair
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jennifer A Fulcher
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Grace D Cho
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Pamina M Gorbach
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Department of Epidemiology, Fielding School of Public Health at UCLA, Los Angeles, CA
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA; and
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jesse L Clark
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA; and
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11
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Murphy L, Bowra A, Adams E, Cabello R, Clark JL, Konda K, Perez-Brumer A. PrEP policy implementation gaps and opportunities in Latin America and the Caribbean: a scoping review. Ther Adv Infect Dis 2023; 10:20499361231164030. [PMID: 37114192 PMCID: PMC10126665 DOI: 10.1177/20499361231164030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/28/2023] [Indexed: 04/29/2023] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) is an important tool for HIV prevention in Latin America and the Caribbean (LAC). Yet, little is known about the PrEP policies landscape in the region. Addressing this gap, this scoping review assessed current PrEP policies throughout LAC to better understand existing PrEP implementation gaps and identify opportunities to improve access. Methods We conducted a scoping review, using a modified PRISMA extension, through 28 July 2022, to identify country-level PrEP policies. Data were collected in English, Spanish, French, and Portuguese utilizing online platforms for screening and data extraction (Google Forms, Zotero, and Excel). Extracted data were divided by data source, including country-level government policies, gray literature, and peer-reviewed literature, with at least one full-text reviewer and data extractor per publication. An iterative summative content analysis was performed to compare and interpret themes across phases and data sources. Results Of the 33 countries in LAC, 22 (67%) had policies approving daily oral PrEP for HIV prevention, which outlined specific key populations, including men who have sex with men, transgender women, sex workers, and serodiscordant couples. Generic tenofovir disoproxil fumarate/emtricitabine has been approved in 15 of the 33 countries, and 13 of the 33 countries have incorporated PrEP into their public health system. No countries were found to have approved cabotegravir. Costing data were reported by only one country, Ecuador, in its national health ministry guidelines. Findings also document a lag between the media/gray-literature announcement of PrEP and implementation of policies. Conclusion Findings underscore significant advances in PrEP policies in the region and signal opportunities for greater PrEP implementation. Since 2017, an increasing number of countries have begun to provide PrEP to communities at heightened need, although significant gaps remain. Policy approval is a key step to further increasing access to PrEP in LAC, necessary to reduce the burden of HIV in LAC, specifically among marginalized populations.
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Affiliation(s)
- Luke Murphy
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Andrea Bowra
- Division of Social and Behavioural Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ellithia Adams
- Division of Social and Behavioural Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Jesse L. Clark
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kelika Konda
- Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Amaya Perez-Brumer
- Division of Social and Behavioural Health, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, Canada, M5T 3M7
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12
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Fulcher JA, Li F, Tobin NH, Zabih S, Elliott J, Clark JL, D'Aquila R, Mustanski B, Kipke MD, Shoptaw S, Gorbach PM, Aldrovandi GM. Gut dysbiosis and inflammatory blood markers precede HIV with limited changes after early seroconversion. EBioMedicine 2022; 84:104286. [PMID: 36179550 PMCID: PMC9520213 DOI: 10.1016/j.ebiom.2022.104286] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Alterations in the gut microbiome have been associated with HIV infection, but the relative impact of HIV versus other factors on the gut microbiome has been difficult to determine in cross-sectional studies. METHODS To address this, we examined the gut microbiome, serum metabolome, and cytokines longitudinally within 27 individuals before and during acute HIV using samples collected from several ongoing cohort studies. Matched control participants (n=28) from the same cohort studies without HIV but at similar behavioral risk were used for comparison. FINDINGS We identified few changes in the microbiome during acute HIV infection, but did find alterations in serum metabolites involving secondary bile acid (lithocholate sulfate, glycocholenate sulfate) and amino acid metabolism (3-methyl-2-oxovalerate, serine, cysteine, N-acetylputrescine). Greater microbiome differences, including decreased Bacteroides spp and increased Megasphaera elsdenii, were seen when comparing pre-HIV infection visits to matched at-risk controls. Those who acquired HIV also had elevated inflammatory cytokines (TNF-α, B cell activating factor, IL-8) and bioactive lipids (palmitoyl-sphingosine-phosphoethanolamide and glycerophosphoinositol) prior to HIV acquisition compared to matched controls. INTERPRETATION Longitudinal sampling identified pre-existing microbiome differences in participants with acute HIV compared to matched control participants observed over the same period. These data highlight the importance of increasing understanding of the role of the microbiome in HIV susceptibility. FUNDING This work was supported by NIH/NIAID (K08AI124979; P30AI117943), NIH/NIDA (U01DA036267; U01DA036939; U01DA036926; U24DA044554), and NIH/NIMH (P30MH058107; R34MH105272).
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Affiliation(s)
- Jennifer A Fulcher
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA; VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA.
| | - Fan Li
- Division of Infectious Diseases, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Nicole H Tobin
- Division of Infectious Diseases, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Sara Zabih
- Division of Infectious Diseases, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Julie Elliott
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Jesse L Clark
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Richard D'Aquila
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL 60611, USA
| | - Michele D Kipke
- Children's Hospital Los Angeles, Los Angeles, CA 90027, USA; Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, CA 90027, USA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Grace M Aldrovandi
- Division of Infectious Diseases, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
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13
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Vargas N, Clark JL, Estrada IA, De La Torre C, Yosha N, Magaña Alvarez M, Parker RG, Garcia J. Critical Consciousness for Connectivity: Decoding Social Isolation Experienced by Latinx and LGBTQ+ Youth Using a Multi-Stakeholder Approach to Health Equity. Int J Environ Res Public Health 2022; 19:11080. [PMID: 36078799 PMCID: PMC9518045 DOI: 10.3390/ijerph191711080] [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] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 06/15/2023]
Abstract
Systemic oppression creates a context in which Latinx LGBTQ+ youth experience social isolation. Social isolation has been associated with mental and physical health disparities, including disproportionate levels of depression, substance use, self-harm, and attempted suicide. These disparities are often magnified in rural and suburban areas with fewer identity-affirming spaces. This community-engaged study reports on the formative process of developing a Latinx LGBTQ+ telenovela (soap opera) allyship intervention based on critical consciousness theory. We conducted eight focus groups with community advisory boards, which included Latinx LGBTQ+ youth (n = 12), health and social service providers serving LGBTQ+ youth (n = 10), 4-H Latinx alumni youth (n = 12), and 4-H Latinx parents (n = 8). We interviewed nine Latinx LGBTQ+ youth enrolled in a film-making workshop. As a result of our multi-stakeholder approach, we: (1) described how stakeholders reflected on and decoded intersectional isolation on the individual, community, and structural levels; and (2) identified ways that stakeholders suggested taking action by improving access to resources to address social isolation, provide culturally competent healthcare, and co-create an enabling social environment. Our study indicated the importance of tapping into core values and intersectional identities to build solidarity among and within marginalized groups to dismantle oppressive systems.
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Affiliation(s)
- Nancy Vargas
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA
| | - Jesse L. Clark
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Ivan A. Estrada
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA
| | | | - Nili Yosha
- Outside the Frame, Portland, OR 97209, USA
| | - Mario Magaña Alvarez
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA
| | - Richard G. Parker
- Associação Brasileira Interdisciplinar de AIDS, Rio de Janeiro 20071-907, Brazil
| | - Jonathan Garcia
- Hallie E. Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA
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14
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Wolfe CR, Tomashek KM, Patterson TF, Gomez CA, Marconi VC, Jain MK, Yang OO, Paules CI, Palacios GMR, Grossberg R, Harkins MS, Mularski RA, Erdmann N, Sandkovsky U, Almasri E, Pineda JR, Dretler AW, de Castilla DL, Branche AR, Park PK, Mehta AK, Short WR, McLellan SLF, Kline S, Iovine NM, El Sahly HM, Doernberg SB, Oh MD, Huprikar N, Hohmann E, Kelley CF, Holodniy M, Kim ES, Sweeney DA, Finberg RW, Grimes KA, Maves RC, Ko ER, Engemann JJ, Taylor BS, Ponce PO, Larson L, Melendez DP, Seibert AM, Rouphael NG, Strebe J, Clark JL, Julian KG, de Leon AP, Cardoso A, de Bono S, Atmar RL, Ganesan A, Ferreira JL, Green M, Makowski M, Bonnett T, Beresnev T, Ghazaryan V, Dempsey W, Nayak SU, Dodd LE, Beigel JH, Kalil AC. Baricitinib versus dexamethasone for adults hospitalised with COVID-19 (ACTT-4): a randomised, double-blind, double placebo-controlled trial. Lancet Respir Med 2022; 10:888-899. [PMID: 35617986 PMCID: PMC9126560 DOI: 10.1016/s2213-2600(22)00088-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Baricitinib and dexamethasone have randomised trials supporting their use for the treatment of patients with COVID-19. We assessed the combination of baricitinib plus remdesivir versus dexamethasone plus remdesivir in preventing progression to mechanical ventilation or death in hospitalised patients with COVID-19. METHODS In this randomised, double-blind, double placebo-controlled trial, patients were enrolled at 67 trial sites in the USA (60 sites), South Korea (two sites), Mexico (two sites), Singapore (two sites), and Japan (one site). Hospitalised adults (≥18 years) with COVID-19 who required supplemental oxygen administered by low-flow (≤15 L/min), high-flow (>15 L/min), or non-invasive mechanical ventilation modalities who met the study eligibility criteria (male or non-pregnant female adults ≥18 years old with laboratory-confirmed SARS-CoV-2 infection) were enrolled in the study. Patients were randomly assigned (1:1) to receive either baricitinib, remdesivir, and placebo, or dexamethasone, remdesivir, and placebo using a permuted block design. Randomisation was stratified by study site and baseline ordinal score at enrolment. All patients received remdesivir (≤10 days) and either baricitinib (or matching oral placebo) for a maximum of 14 days or dexamethasone (or matching intravenous placebo) for a maximum of 10 days. The primary outcome was the difference in mechanical ventilation-free survival by day 29 between the two treatment groups in the modified intention-to-treat population. Safety analyses were done in the as-treated population, comprising all participants who received one dose of the study drug. The trial is registered with ClinicalTrials.gov, NCT04640168. FINDINGS Between Dec 1, 2020, and April 13, 2021, 1047 patients were assessed for eligibility. 1010 patients were enrolled and randomly assigned, 516 (51%) to baricitinib plus remdesivir plus placebo and 494 (49%) to dexamethasone plus remdesivir plus placebo. The mean age of the patients was 58·3 years (SD 14·0) and 590 (58%) of 1010 patients were male. 588 (58%) of 1010 patients were White, 188 (19%) were Black, 70 (7%) were Asian, and 18 (2%) were American Indian or Alaska Native. 347 (34%) of 1010 patients were Hispanic or Latino. Mechanical ventilation-free survival by day 29 was similar between the study groups (Kaplan-Meier estimates of 87·0% [95% CI 83·7 to 89·6] in the baricitinib plus remdesivir plus placebo group and 87·6% [84·2 to 90·3] in the dexamethasone plus remdesivir plus placebo group; risk difference 0·6 [95% CI -3·6 to 4·8]; p=0·91). The odds ratio for improved status in the dexamethasone plus remdesivir plus placebo group compared with the baricitinib plus remdesivir plus placebo group was 1·01 (95% CI 0·80 to 1·27). At least one adverse event occurred in 149 (30%) of 503 patients in the baricitinib plus remdesivir plus placebo group and 179 (37%) of 482 patients in the dexamethasone plus remdesivir plus placebo group (risk difference 7·5% [1·6 to 13·3]; p=0·014). 21 (4%) of 503 patients in the baricitinib plus remdesivir plus placebo group had at least one treatment-related adverse event versus 49 (10%) of 482 patients in the dexamethasone plus remdesivir plus placebo group (risk difference 6·0% [2·8 to 9·3]; p=0·00041). Severe or life-threatening grade 3 or 4 adverse events occurred in 143 (28%) of 503 patients in the baricitinib plus remdesivir plus placebo group and 174 (36%) of 482 patients in the dexamethasone plus remdesivir plus placebo group (risk difference 7·7% [1·8 to 13·4]; p=0·012). INTERPRETATION In hospitalised patients with COVID-19 requiring supplemental oxygen by low-flow, high-flow, or non-invasive ventilation, baricitinib plus remdesivir and dexamethasone plus remdesivir resulted in similar mechanical ventilation-free survival by day 29, but dexamethasone was associated with significantly more adverse events, treatment-related adverse events, and severe or life-threatening adverse events. A more individually tailored choice of immunomodulation now appears possible, where side-effect profile, ease of administration, cost, and patient comorbidities can all be considered. FUNDING National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
| | - Kay M Tomashek
- The National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Thomas F Patterson
- University of Texas Health San Antonio, University Health, and the South Texas Veterans Health Care System, San Antonio, TX, USA
| | | | | | - Mamta K Jain
- University of Texas Southwestern and Parkland Health and Hospital System, Dallas, TX, USA
| | - Otto O Yang
- University of California, Los Angeles, CA, USA
| | - Catharine I Paules
- Pennsylvania State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | | | - Robert Grossberg
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | | | | | - Eyad Almasri
- University of California, San Francisco, CA, USA
| | | | - Alexandra W Dretler
- Infectious Disease Specialists of Atlanta and Emory Decatur Hospital, Decatur, GA, USA
| | | | | | | | | | | | | | - Susan Kline
- The University of Minnesota Medical School, Minneapolis, MN, USA
| | - Nicole M Iovine
- University of Florida Health, Shands Hospital, Gainesville, FL, USA
| | | | | | - Myoung-Don Oh
- Seoul National University Hospital, Seoul, South Korea
| | - Nikhil Huprikar
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | | | | | | | - Eu Suk Kim
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | | | | | | | | | | | | | - Barbara S Taylor
- University of Texas Health San Antonio, University Health, and the South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Philip O Ponce
- University of Texas Health San Antonio, University Health, and the South Texas Veterans Health Care System, San Antonio, TX, USA
| | - LuAnn Larson
- University of Nebraska Medical Center, Omaha, NE, USA
| | | | | | | | - Joslyn Strebe
- University of Texas Southwestern and Parkland Health and Hospital System, Dallas, TX, USA
| | | | - Kathleen G Julian
- Pennsylvania State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Alfredo Ponce de Leon
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | | | | | - Tyler Bonnett
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory, Frederick, MD, USA
| | - Tatiana Beresnev
- The National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Varduhi Ghazaryan
- The National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Walla Dempsey
- The National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Seema U Nayak
- The National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Lori E Dodd
- The National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - John H Beigel
- The National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Andre C Kalil
- University of Nebraska Medical Center, Omaha, NE, USA.
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15
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Satcher MF, Segura ER, Silva-Santisteban A, Reisner SL, Perez-Brumer A, Lama JR, Operario D, Clark JL. Exploring Contextual Differences for Sexual Role Strain Among Transgender Women and Men Who Have Sex with Men in Lima, Peru. Arch Sex Behav 2022; 51:1977-1991. [PMID: 35290540 PMCID: PMC9387938 DOI: 10.1007/s10508-021-02181-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/10/2021] [Revised: 07/21/2021] [Accepted: 10/09/2021] [Indexed: 05/03/2023]
Abstract
Sexual and gender politics inform relational expectations surrounding sexual experiences of Peruvian transgender women (TW) and men who have sex with men (MSM). We used the framework of sexual role strain, or incongruence between preferred sexual role and actual sexual practices, to explore potential conflicts between personally articulated identities and externally defined norms of gender and sexuality and its potential to increase HIV/STI risk. Cross-sectional individual- and dyad-level data from 766 TW and MSM in Lima, Peru were used to assess the partnership contexts within which insertive anal intercourse was practiced despite receptive role preference (receptive role strain), and receptive anal intercourse practiced despite insertive role preference (insertive role strain). Sexual role strain for TW was more common with non-primary partners, while for MSM it occurred more frequently in the context of a primary partnership. Receptive role strain was more prevalent for TW with unknown HIV status (reference: without HIV) or pre-sex drug use (reference: no pre-sex drug use). For homosexual MSM, receptive role strain was more prevalent during condomless anal intercourse (reference: condom-protected) and with receptive or versatile partners (reference: insertive). Among heterosexual or bisexual MSM, insertive role strain was more prevalent with insertive or versatile partners (reference: receptive), and less prevalent with casual partners (reference: primary). Our findings suggest TW and MSM experience different vulnerabilities during sexual role negotiation with different partner-types. Future studies should explore the impact of sexual role strain on condom use agency, HIV/STI risk, and discordances between public and private presentations of gender and sexual orientation.
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Affiliation(s)
- Milan F Satcher
- Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Dr., Lebanon, NH, 03766, USA.
- Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.
| | - Eddy R Segura
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Alfonso Silva-Santisteban
- Unit of Health, Sexuality and Human Development, Cayetano Heredia University School of Public Health, Lima, Peru
| | - Sari L Reisner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Amaya Perez-Brumer
- Social and Behavioral Health Sciences Division, University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Javier R Lama
- Asociación Civil Impacta Salud Y Educación, Lima, Peru
| | - Don Operario
- Brown University School of Public Health, Providence, RI, USA
| | - Jesse L Clark
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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16
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Naz-McLean S, Clark JL, Reisner SL, Prenner JC, Weintraub B, Huerta L, Salazar X, Lama JR, Mayer KH, Perez-Brumer A. Decision-Making at the Intersection of Risk and Pleasure: A Qualitative Inquiry with Trans Women Engaged in Sex Work in Lima, Peru. AIDS Behav 2022; 26:843-852. [PMID: 34436712 PMCID: PMC9897010 DOI: 10.1007/s10461-021-03445-z] [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] [Accepted: 08/16/2021] [Indexed: 02/06/2023]
Abstract
To inform culturally relevant HIV prevention interventions, we explore the complexity of sex work among Peruvian transgender women. In 2015, we conducted twenty in-depth interviews and demographic surveys with transgender women in Lima, Peru to examine how transgender women enact individual- and community-level resistance strategies within a context of pervasive marginalization. Although 40% self-identified as "sex workers," 70% recently exchanged sex for money. Participants described nuanced risk-benefit analyses surrounding paid sexual encounters. Classification of clients as "risky" or "rewarding" incorporated issues of health, violence, and pleasure. Interviews highlighted context-informed decision-making (rejecting disrespectful clients, asserting condom use with specific partner types) demonstrating that motivations were not limited to HIV prevention or economic renumeration, but considered safety, health, attraction, gender validation, hygiene, and convenience. These findings underscore the complex risk assessments employed by Peruvian trans women. These individual-level decision-making and context-specific health promotion strategies represent critical frameworks for HIV prevention efforts.
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Affiliation(s)
- Sarah Naz-McLean
- Department of Medicine, Division of Infectious Diseases, Brigham and Women's Hospital, 181 Longwood Ave, Boston, MA, 02115, USA.
| | - Jesse L Clark
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Sari L Reisner
- Department of Medicine, Division of Infectious Diseases, Brigham and Women's Hospital, 181 Longwood Ave, Boston, MA, 02115, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Joshua C Prenner
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Javier R Lama
- Asociación Civil Impacta Salud Y Educación, Lima, Peru
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Kenneth H Mayer
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Beth Israel Lahey Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Amaya Perez-Brumer
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Al-Attar MM, Cosar EF, Clark JL. Malignant Mixed Germ Cell Tumor of the Testis with Associated Nephroblastoma: A Rare Entity. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.149] [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: 11/14/2022] Open
Abstract
Abstract
Introduction/Objective
While nephroblastoma is the most common primary childhood renal malignancy, it rarely occurs at extra-renal sites. Testicular nephroblastoma is exceedingly rare, with only 5 previously reported cases arising in association with primary testicular teratoma (4 of which arising in non-atrophic, and 1 arising in atrophic testis). We report a case of testicular nephroblastoma with multiple associated germ cell components.
Methods/Case Report
The case is that of a 28-year-old male presenting with an enlarging, painless right scrotal swelling. Laboratory results showed elevated serum AFP with normal LDH and beta-HCG, and imaging confirmed the presence of a heterogenous testicular mass. A radical orchiectomy was performed, revealing a tan-white, fleshy, nodular 5.5 cm mass almost entirely replacing the testicular parenchyma. Microscopically, the tumor consisted of multiple components. The nephroblastoma component was associated with teratoma with immature elements and consisted of epithelial tubular structures, small blue blastemal cells, and pale mesenchymal stroma which demonstrated pan-cytokeratin and patchy WT1 expression by immunohistochemistry. Additional components included yolk sac tumor and minor component of seminoma. Foci of germ cell neoplasia in-situ were also identified, supported by immunohistochemical stains for PLAP and OCT3/4. The patient’s post-resection tumor markers normalized, and further assessment for metastasis and chemotherapy is pending.
Results (if a Case Study enter NA)
NA
Conclusion
Malignant mixed germ cell tumors of the testis with associated nephroblastoma are exceedingly rare, further studies nand followup are required to determine prognostic values and achieve a more complete understanding of this combination of entities.
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Affiliation(s)
- M M Al-Attar
- Department of Pathology and Laboratory Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, UNITED STATES
| | - E F Cosar
- Department of Pathology and Laboratory Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, UNITED STATES
| | - J L Clark
- Department of Pathology and Laboratory Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, UNITED STATES
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18
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Perez‐Brumer A, Naz‐McLean S, Huerta L, Salazar X, Lama JR, Sanchez J, Silva‐Santisteban A, Reisner SL, Mayer KH, Clark JL. The wisdom of mistrust: qualitative insights from transgender women who participated in PrEP research in Lima, Peru. J Int AIDS Soc 2021; 24:e25769. [PMID: 34569152 PMCID: PMC9936804 DOI: 10.1002/jia2.25769] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/28/2021] [Accepted: 06/24/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Although pre-exposure prophylaxis (PrEP) is a remarkable biomedical advance to prevent HIV, ongoing research on PrEP contributes to and interacts with a legacy of HIV experimentation on marginalized communities in resource-limited settings. This paper explores the complexity of PrEP research mistrust among Peruvian transgender (trans) women who completed a PrEP adherence intervention and those who refused participation (i.e. declined to enrol, voluntarily withdrew, and/or were lost to follow-up). METHODS Data were derived from 86 trans women (mean age 29 years) participants in the formative (four focus groups (n = 32), 20 interviews) and the evaluation stages (34 interviews) of a social network-based PrEP intervention for trans women in Lima, Peru. The formative stage took place from May to July 2015, while the evaluative stage took place from April to May 2018. Audio files were transcribed verbatim and analysed via an immersion crystallization approach using Dedoose (v.6.1.18). RESULTS Three paradoxes of trans women's participation in PrEP science as a "key" population emerged as amplifying mistrust: (1) increases in PrEP research targeting trans women but limited perceived improvements in HIV outcomes; (2) routine dismissal by research physicians and staff of PrEP-related side effects and the social realities of taking PrEP, resulting in questions about who PrEP research is really for and (3) persistent limitations on PrEP access for trans women despite increasing involvement in clinical trials, fostering feelings of being a "guinea pig" to advance PrEP science. CONCLUSIONS Findings highlight the wisdom inherent in PrEP mistrust as a reflection of trans women's experiences that underscore the broken bonds of trust between communities, researchers and the research enterprise. PrEP mistrust is amplified through perceived paradoxes that suggest to trans women that they are key experimental participants but not target PrEP users outside of research settings. Findings highlight the urgent need to reframe mistrust not as a characteristic of trans women to be addressed through education and outreach, but as a systemic institutional- and industry-level problem replicated, manifested and ultimately to be corrected, through global HIV science.
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Affiliation(s)
- Amaya Perez‐Brumer
- Division of Social and Behavioural HealthDalla Lana School of Public HealthUniversity of TorontoTorontoONCanada
| | - Sarah Naz‐McLean
- Department of MedicineDivision of Infectious DiseasesBrigham and Women’s HospitalBostonMAUSA
| | | | | | - Javier R Lama
- Asociación Civil Impacta Salud y EducaciónLimaPeru,Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Jorge Sanchez
- Asociación Civil Impacta Salud y EducaciónLimaPeru,Department of Global HealthUniversity of WashingtonSeattleWAUSA,Centro de Investigaciones Tecnologicas y BiomedicasUniversidad Nacional de San MarcosLimaPeru
| | | | - Sari L Reisner
- Harvard T.H. Chan School of Public HealthBostonMAUSA,The Fenway InstituteFenway HealthBostonMAUSA,Beth Israel Deaconess Medical CenterBostonMAUSA
| | - Kenneth H Mayer
- The Fenway InstituteFenway HealthBostonMAUSA,Beth Israel Deaconess Medical CenterBostonMAUSA,Harvard Medical SchoolBostonMAUSA
| | - Jesse L Clark
- Department of MedicineDivision of Infectious DiseasesUniversity of California Los Angeles David Geffen School of MedicineLos AngelesCAUSA
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19
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Blair KJ, Segura ER, Garner A, Lai J, Ritterbusch A, Leon-Giraldo S, Guilamo-Ramos V, Lake JE, Clark JL, Holloway IW. Pre-exposure prophylaxis awareness, use, and intention to use in a regional sample of Latin American geosocial networking application users in 2018-2019. Int J STD AIDS 2021; 32:1261-1267. [PMID: 34340629 DOI: 10.1177/09564624211034618] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pre-exposure prophylaxis (PrEP) access is increasing in Latin America. We explored PrEP use among Spanish-speaking, Hornet geosocial networking application users from Latin American countries with limited PrEP data via an online survey completed between December 2018 and February 2019. A total of 718 Hornet users from 10 countries were included, of whom 72.1% reported PrEP awareness. Few (5.6%) were currently taking PrEP, though 32.1% intended to take PrEP in the subsequent 6 months. PrEP awareness was lower in 18-25 year olds compared to 26+ (62.4% vs. 75.6%, aOR 0.67, [95% CI 0.46-0.97]), and higher among those living in larger versus smaller cities (74.4% vs. 58.8%, aOR 1.96, [95% CI 1.25-3.07]) or countries with at least partial versus no PrEP policy adoption (79.1% vs. 60.8%, aOR 2.20, [95% CI 1.56-3.12]). Intention to use PrEP was higher among PrEP-eligible respondents (51.8% vs. 29.6%, aOR 2.26, [95% CI 1.26-4.07]) and those recently tested for a sexually transmitted infection (35.4% vs. 25.5%, aOR 1.58, [95% CI 1.01-2.48]). Efforts to expand PrEP use in Latin America should focus on national PrEP policy adoption, and research should explore barriers to awareness and use among young men who have sex with men.
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Affiliation(s)
- Kevin J Blair
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, 8783University of California Los Angeles, Los Angeles, CA, USA.,Department of Surgery, 8783University of California Los Angeles, Los Angeles, CA, USA
| | - Eddy R Segura
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, 8783University of California Los Angeles, Los Angeles, CA, USA.,Escuela de Medicina, 33217Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Alex Garner
- Hornet Gay Social Network, Los Angeles, CA, USA.,Gay Sexuality and Social Policy Initiative, Luskin School of Public Affairs, 8783University of California Los Angeles, Los Angeles, CA, USA
| | - Jianchao Lai
- Gay Sexuality and Social Policy Initiative, Luskin School of Public Affairs, 8783University of California Los Angeles, Los Angeles, CA, USA
| | - Amy Ritterbusch
- Gay Sexuality and Social Policy Initiative, Luskin School of Public Affairs, 8783University of California Los Angeles, Los Angeles, CA, USA
| | - Sebastian Leon-Giraldo
- Escuela de Gobierno Alberto Lleras Camargo, 27991Universidad de Los Andes, Bogotá, Colombia
| | | | - Jordan E Lake
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, 8783University of California Los Angeles, Los Angeles, CA, USA.,McGovern Medical School, 12339The University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Jesse L Clark
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, 8783University of California Los Angeles, Los Angeles, CA, USA
| | - Ian W Holloway
- Gay Sexuality and Social Policy Initiative, Luskin School of Public Affairs, 8783University of California Los Angeles, Los Angeles, CA, USA
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20
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Ayer A, Segura ER, Perez-Brumer A, Chavez-Gomez S, Fernandez R, Gutierrez J, Suárez K, Lake JE, Clark JL, Cabello R. Sexual health norms and communication patterns within the close social networks of men who have sex with men and transgender women in Lima, Peru: a 2017 cross-sectional study. BMC Public Health 2021; 21:1090. [PMID: 34098916 PMCID: PMC8186208 DOI: 10.1186/s12889-021-11091-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 05/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social networks, norms, and discussions about sexual health may inform sexual practices, influencing risk of human immunodeficiency virus (HIV) or sexually transmitted infection (STI) acquisition. To better understand social networks of Peruvian men who have sex with men (MSM) and transgender women (trans women), we examined key social network members (SNMs), participant perceptions of these network members' opinions toward sexual health behaviors, and associations between network member characteristics and condomless anal intercourse (CAI). METHODS In a 2017 cross-sectional study, a convenience sample of 565 MSM and trans women with HIV-negative or unknown serostatus was asked to identify three close SNMs; describe discussions about HIV and STI prevention with each; and report perceived opinions of condom use, HIV/STI testing, and partner notification of STIs. Generalized estimating equations evaluated relationships between SNM characteristics, opinions, and discussions and participant-reported CAI. RESULTS Among participants who identified as MSM, 42.3% of key SNMs were perceived to identify as gay. MSM "never" discussed HIV and STI prevention concerns with 42.4% of heterosexual SNMs, but discussed them "at least once weekly" with 16.9 and 16.6% of gay- and bisexual- identifying SNMs, respectively. Among participants who identified as trans women, 28.2% of key SNMs were perceived as heterosexual; 25.9%, as bisexual; 24.7%, as transgender; and 21.2%, as gay. Trans women discussed HIV/STI prevention least with cis-gender heterosexual network members (40.2% "never") and most with transgender network members (27.1% "at least once weekly"). Participants perceived most of their close social network to be completely in favor of condom use (71.2% MSM SNMs, 61.5% trans women SNMs) and HIV/STI testing (73.1% MSM SNMs, 75.6% trans women SNMs), but described less support for partner STI notification (33.4% MSM SNMs, 37.4% trans women SNMs). Most participants reported CAI with at least one of their past three sexual partners (77.5% MSM, 62.8% trans women). SNM characteristics were not significantly associated with participant-reported frequency of CAI. CONCLUSIONS Findings compare social support, perceived social norms, and discussion patterns of Peruvian MSM and trans women, offering insight into social contexts and sexual behaviors. TRIAL REGISTRATION The parent study from which this analysis was derived was registered at ClinicalTrials.gov (Identifier: NCT03010020 ) on January 4, 2017.
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Affiliation(s)
- Amrita Ayer
- South American Program in HIV Prevention Research, University of California Los Angeles David Geffen School of Medicine, 10833 Le Conte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA. .,University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA.
| | - Eddy R Segura
- South American Program in HIV Prevention Research, University of California Los Angeles David Geffen School of Medicine, 10833 Le Conte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.,Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Amaya Perez-Brumer
- University of Toronto Dalla Lana School of Public Health, Toronto, Canada
| | | | | | | | | | - Jordan E Lake
- South American Program in HIV Prevention Research, University of California Los Angeles David Geffen School of Medicine, 10833 Le Conte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.,Department of Internal Medicine, Division of Infectious Diseases, McGovern Medical School at UT Health, Houston, USA
| | - Jesse L Clark
- South American Program in HIV Prevention Research, University of California Los Angeles David Geffen School of Medicine, 10833 Le Conte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.,Department of Internal Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Robinson Cabello
- South American Program in HIV Prevention Research, University of California Los Angeles David Geffen School of Medicine, 10833 Le Conte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.,Asociación Civil Via Libre, Lima, Peru
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21
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Blair CS, Lake JE, Passaro RC, Chavez-Gomez S, Segura ER, Elliott J, Fulcher JA, Shoptaw S, Cabello R, Clark JL. Brief Report: HIV-1 Seroconversion Is Not Associated With Prolonged Rectal Mucosal Inflammation. J Acquir Immune Defic Syndr 2021; 86:e134-e138. [PMID: 33351532 PMCID: PMC7933122 DOI: 10.1097/qai.0000000000002601] [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] [Received: 09/24/2020] [Accepted: 12/07/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Determine the impact of HIV-1 seroconversion on inflammatory cytokines in the rectal mucosa. SETTING Secondary analysis of data from men who have sex with men and transgender women who participated in a HIV prevention trial Lima, Peru. METHODS From July to December 2017, 605 men who have sex with men and transgender women were screened for rectal gonorrhea/chlamydia (GC/CT). Fifty GC/CT-positive cases were randomly selected and matched with 52 GC/CT-negative controls by age and number of receptive anal intercourse partners in the last month. All participants were HIV-negative at baseline and those with GC/CT at baseline and/or follow-up received appropriate antibiotic therapy. Participants underwent sponge collection of rectal secretions for the measurement of inflammatory cytokines (IL-1β, IL-6, IL-8, and TNF-α) and were screened for rectal GC/CT and HIV at baseline, 3 months, and 6 months. Wilcoxon rank-sum tests compared inflammatory cytokine levels between participants diagnosed with HIV during follow-up and persons who remained HIV-negative. RESULTS Eight participants were diagnosed with HIV at the 3-month (n = 6) or 6-month (n = 2) visit. The median number of receptive anal intercourse partners in the month before HIV diagnosis was the same for those who acquired HIV and those who did not. There were no significant differences in inflammatory cytokine levels in rectal mucosa between participants who did and did not experience HIV seroconversion at any time point. CONCLUSIONS Despite a surge in viral replication during acute infection, findings from this study suggest that there is no prolonged effect of HIV-1 seroconversion on inflammatory cytokine levels in the rectal mucosa.
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Affiliation(s)
- Cheríe S Blair
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jordan E Lake
- Department of Medicine, Division of Infectious Diseases, McGovern Medical School at University of Texas at Houston, Houston, TX
| | - Ryan C Passaro
- Department of Emergency Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA
| | | | - Eddy R Segura
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru ; and
| | - Julie Elliott
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jennifer A Fulcher
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Jesse L Clark
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
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22
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Saiyed FK, Segura ER, Tan D, Clark JL, Lake JE, Holloway IW. Social networks and condomless intercourse with female partners among male sex workers in the Dominican Republic. Int J STD AIDS 2020; 32:176-183. [PMID: 33334269 PMCID: PMC10387283 DOI: 10.1177/0956462420920406] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Male sex workers (MSW) in the Dominican Republic (DR) have multiple sexual partners, including personal and client-relationships, and are disproportionately affected by human immunodeficiency virus (HIV). We examined the prevalence of condomless anal and/or vaginal intercourse (CI) among MSW in the DR as a function of social network factors. Self-report surveys and social network interviews were administered to MSW recruited through venue-based sampling (N = 220). A generalized linear model was used to complete a Poisson Regression model and identify variables significantly associated with the outcome of interest. CI was more common with female (28.3%) than with male partners (4.9%). Factors associated with CI with the last female partner included older age of MSW, CI with the last male partner, having a stable female partner (a consistent or main partner), and having ≥1 family member in the participants' social network. Partner and social network characteristics associated with CI among MSW suggest the utility of dyadic and network interventions to reduce HIV risk.
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Affiliation(s)
- Faiez K Saiyed
- McGovern Medical School at UTHealth, Houston, TX, USA.,South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Eddy R Segura
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Diane Tan
- Center for HIV Identification, Prevention, and Treatment Services, Department of Family Medicine, UCLA, Los Angeles, CA, USA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Jesse L Clark
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Center for HIV Identification, Prevention, and Treatment Services, Department of Family Medicine, UCLA, Los Angeles, CA, USA
| | - Jordan E Lake
- McGovern Medical School at UTHealth, Houston, TX, USA.,South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Ian W Holloway
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Center for HIV Identification, Prevention, and Treatment Services, Department of Family Medicine, UCLA, Los Angeles, CA, USA.,Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA, USA
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23
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Passaro RC, Chávez-Gomez S, Castañeda-Huaripata A, Gonzales-Saavedra W, Beymer MR, Segura ER, Nanclares F, Dilley J, Cabello R, Clark JL. Personalized Cognitive Counseling Reduces Drinking Expectancy Among Men Who Have Sex with Men and Transgender Women in Lima, Peru: A Pilot Randomized Controlled Trial. AIDS Behav 2020; 24:3205-3214. [PMID: 32418164 DOI: 10.1007/s10461-020-02882-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Personalized cognitive counseling (PCC) is an evidence-based intervention designed to modify HIV-related risk behavior. We assessed the impact of PCC on sexual behavior, drinking expectancy, and incidence of sexually transmitted infections (STIs) in a 6-month randomized controlled trial among 153 HIV-uninfected men who have sex with men (MSM) and transgender women (TW) in Peru. Study retention was ≥ 90%, with three HIV infections (3 Control) and 19 cases of GC/CT (10 Control, 9 PCC) at 6 months. There was a decline in condomless receptive anal intercourse in the Control (0.74, 95% CI 0.60-0.91; p < 0.01) and PCC arms (0.72, 0.55-0.94; p = 0.02) at 6-month follow-up. There was a decrease in drinking expectancy at 6 months among participants endorsing alcohol use in the PCC arm (0.89, 0.83-0.96; p < 0.01), versus no change in the Control arm (0.98, 0.92-1.04; p = 0.54). PCC was efficacious in reducing drinking expectancy and HIV risk among MSM and TW in Peru.
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24
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Passaro RC, Segura ER, Gonzales-Saavedra W, Lake JE, Perez-Brumer A, Shoptaw S, Dilley J, Cabello R, Clark JL. Sexual Partnership-Level Correlates of Intimate Partner Violence Among Men Who Have Sex with Men and Transgender Women in Lima, Peru. Arch Sex Behav 2020; 49:2703-2713. [PMID: 32270400 PMCID: PMC7494565 DOI: 10.1007/s10508-020-01682-2] [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] [Received: 05/16/2018] [Revised: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 06/11/2023]
Abstract
To improve understanding of factors associated with intimate partner violence (IPV) and explore its role in sexually transmitted infection (STI) acquisition, we analyzed partnership-level correlates of IPV among men who have sex with men (MSM) and transgender women (TW) in Peru. In a 2017 cross-sectional study of rectal STI screening and HIV prevention, MSM/TW completed a sociobehavioral survey addressing demographic characteristics, sexual risk behaviors, and substance use, and were tested for rectal gonorrhea and chlamydia, syphilis, and HIV. Generalized estimating equations estimated individual- and partner-level correlates of IPV. Of 576 participants (median age, 27 years), 7.9% (36/456) of MSM and 15.0% (18/120) of TW reported IPV with ≥ 1 of their last three partners. MSM/TW reporting IPV were more likely to meet criteria for an alcohol use disorder (74.1%) than participants reporting no IPV (56.7%; p < .01). Physical violence (4.5% MSM; 9.2% TW) was associated with stable partnerships (aPR 3.79, 95% CI 1.79-8.04), partner concurrency (4.42, 1.19-16.40), and participant alcohol (4.71, 1.82-12.17) or drug use (5.38, 2.22-13.02) prior to sex. Psychological violence (4.5% MSM; 5.0% TW) was associated with stable partnerships (2.84, 1.01-7.99). Sexual IPV was reported by 1.1% of MSM and 5.0% of TW. Physical, psychological, and sexual IPV were reported in sexual partnerships of Peruvian MSM and TW, particularly with stable partners and in conjunction with substance use.
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Affiliation(s)
- R Colby Passaro
- Department of Emergency Medicine, Los Angeles County and University of Southern California Medical Center, Los Angeles, CA, USA.
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., CHS 37-121, Los Angeles, CA, 90095-1688, USA.
| | - Eddy R Segura
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., CHS 37-121, Los Angeles, CA, 90095-1688, USA
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | - Jordan E Lake
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., CHS 37-121, Los Angeles, CA, 90095-1688, USA
- Department of Internal Medicine, Division of Infectious Diseases, McGovern Medical School at UT Health, Houston, TX, USA
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Steven Shoptaw
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., CHS 37-121, Los Angeles, CA, 90095-1688, USA
- Department of Family Medicine, Center for HIV Identification, Prevention, and Treatment Services, University of California Los Angeles, Los Angeles, CA, USA
| | - James Dilley
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Robinson Cabello
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., CHS 37-121, Los Angeles, CA, 90095-1688, USA
- Asociación Civil Via Libre, Lima, Peru
| | - Jesse L Clark
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., CHS 37-121, Los Angeles, CA, 90095-1688, USA
- Department of Family Medicine, Center for HIV Identification, Prevention, and Treatment Services, University of California Los Angeles, Los Angeles, CA, USA
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25
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Moriarty KE, Segura ER, Gonzales W, Lake JE, Cabello R, Clark JL. Assessing Sexually Transmitted Infections and HIV Risk Among Transgender Women in Lima, Peru: Beyond Behavior. LGBT Health 2020; 6:370-376. [PMID: 31618167 DOI: 10.1089/lgbt.2018.0087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The purpose of this study was to explore risk factors for HIV and sexually transmitted infections (STIs) among transgender women (TW) in Lima, Peru. Methods: HIV-negative or serostatus unknown TW reporting recent condomless receptive anal intercourse underwent testing for STIs and HIV and completed a sociobehavioral survey. Results: Among 120 TW, 29.6% had rectal Neisseria gonorrhoeae (GC) or Chlamydia trachomatis (CT) and 12.6% had HIV. Age and migrant status were associated with rectal GC/CT, and rectal GC/CT predicted HIV infection. Conclusions: Further study is needed to understand individual and social factors that contribute to HIV/STI vulnerability among TW.
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Affiliation(s)
- Kathleen E Moriarty
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Alpert Medical School, Brown University, Providence, Rhode Island
| | - Eddy R Segura
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | - Jordan E Lake
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Robinson Cabello
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Asociación Civil Vía Libre, Lima, Peru
| | - Jesse L Clark
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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Murphy EC, Segura ER, Lake JE, Huerta L, Perez-Brumer AG, Mayer KH, Reisner SL, Lama JR, Clark JL. Intimate Partner Violence Against Transgender Women: Prevalence and Correlates in Lima, Peru (2016-2018). AIDS Behav 2020; 24:1743-1751. [PMID: 31720954 PMCID: PMC7214207 DOI: 10.1007/s10461-019-02728-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Limited data exists on intimate partner violence (IPV) among transgender women (TW), though global trends suggest IPV is associated with HIV risk in this population. We describe the prevalence of verbal, physical, and/or sexual violence as well as participant- and partner-level correlates of IPV among TW in Lima, Peru. Among 389 respondents, 15.2% reported IPV with one or more of their last three sexual partners: 9.2% verbal, 8.2% physical, and 2.3% sexual violence. Physical and verbal violence were more common with stable partners (aPR 3.46, 95% CI 1.17-10.25, aPR 2.46, 95% CI 1.14-5.28, respectively). Physical violence was associated with condomless receptive anal intercourse (cRAI) (aPR 2.22, 95% CI 1.19-4.13) and partner alcohol use (aPR 4.38, 95% CI 1.56-12.33) while verbal violence correlated with participant inebriation (aPR 4.86, 95% CI 1.63-14.46). Our results link IPV with stable partnerships, alcohol use, and cRAI, suggesting TW in Peru may benefit from multidimensional IPV prevention strategies to foster supportive relationships and reduce HIV transmission.
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Affiliation(s)
- Ellen C Murphy
- Wayne State University School of Medicine, Detroit, MI, USA
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Eddy R Segura
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Jordan E Lake
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | | | - Amaya G Perez-Brumer
- Department of Sociomedical Sciences, Columbia Mailman School of Public Health, New York, NY, USA
| | - Kenneth H Mayer
- Fenway Health and Department of Medicine, Harvard Medical School, The Fenway Institute, Boston, MA, USA
| | - Sari L Reisner
- Fenway Health and Department of Medicine, Harvard Medical School, The Fenway Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Javier R Lama
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| | - Jesse L Clark
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
- Division of Infectious Diseases, Department of Medicine, UCLA Geffen School of Medicine, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.
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Garcia J, Vargas N, Clark JL, Magaña Álvarez M, Nelons DA, Parker RG. Social isolation and connectedness as determinants of well-being: Global evidence mapping focused on LGBTQ youth. Glob Public Health 2020; 15:497-519. [PMID: 31658001 DOI: 10.1080/17441692.17442019.11682028] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Social isolation describes a lack of a sense of belonging, the inability to engage and connect with others, and the neglect or deterioration of social relationships. This conceptual review describes how social isolation and connectedness affect the well-being of LGBTQ youth. Most studies focused on the psychosocial experience of social isolation, which led to suicide attempt, self-harm, sexual risk, and substance use. Scholarly work has drawn from a variety of frameworks, ranging from minority stress theory to positive youth development, to devise interventions that target isolation and connectedness in schools, community-based organisations, and in online environments. Finally, we discuss the importance of addressing social, cultural, and structural dimensions of social isolation in order to foster enabling environments that allow LGBTQ youth to thrive. This conceptual review suggests that individual and social transformations are the result of young people's meaningful participation in shaping their environment, which is made possible when their capabilities are fostered through social well-being. Our findings suggest the need for measures of social isolation among youth in databanks produced by global institutions, such as the World Health Organization.
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Affiliation(s)
- Jonathan Garcia
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Nancy Vargas
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Jesse L Clark
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Mario Magaña Álvarez
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Devynne A Nelons
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Richard G Parker
- Associação Brasileira Interdisciplinar de AIDS (ABIA), Rio de Janeiro, Brazil
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Passaro RC, Segura ER, Lama JR, Sanchez J, Lake JE, Shoptaw S, Clark JL. High-Risk, but Hidden: Binge Drinking among Men Who Have Sex with Men and Transgender Women in Lima, Peru, 2012-2014. Subst Use Misuse 2020; 55:399-404. [PMID: 31682179 PMCID: PMC7002235 DOI: 10.1080/10826084.2019.1681451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 01/29/2023]
Abstract
Background: Binge drinking (BD) is common in Peru, but may not be routinely detected by standard assessments of hazardous drinking. Objectives: We describe prevalence and risk behaviors of men who have sex with men (MSM) and transgender women (TW) in Peru who met criteria for BD as compared with those who met criteria for hazardous drinking. Methods: In a cross-sectional sample of MSM and TW from Lima (2012-2014), we calculated prevalence of BD (consuming ≥6 alcoholic drinks per occasion by AUDIT-3 criteria), conducted bivariate analyses of associations of BD with demographic and behavioral characteristics, and compared prevalence and behaviors of BD to those of hazardous drinkers (identified by AUDIT-10 criteria). Results: Of 1,520 MSM (n = 1,384) and TW (n = 137) with median age 27 years, 74.4% of MSM and 86.9% of TW met criteria for BD. Among MSM, BD was associated with a greater likelihood of using alcohol (41.6% vs. 13.8%; p < .01) or drugs (7.8% vs. 2.8%; p < .01) prior to a recent sexual contact. Among TW, BD was associated with greater frequency of alcohol use (44.9% vs. 11.1%; p < .01) or unprotected anal intercourse (58.8% vs. 33.3%; p = .04) during ≥1 of their three most recent sexual contacts. There was a higher prevalence of BD (75.5%) than hazardous drinking (53.2%) in our sample, with binge drinkers exhibiting similar sexual risk behaviors to hazardous drinkers. Conclusions: Binge drinking is common among MSM and TW in Lima, associated with risky sexual behavior, and may not be adequately captured by AUDIT-10 criteria.
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Affiliation(s)
- R Colby Passaro
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,South American Program in HIV Prevention Research, c/o UCLA Department of Medicine, Division of Infectious Diseases, Los Angeles, California, USA
| | - Eddy R Segura
- South American Program in HIV Prevention Research, c/o UCLA Department of Medicine, Division of Infectious Diseases, Los Angeles, California, USA.,Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Javier R Lama
- Asociación Civil Impacta Salud y Educación, Lima, Peru.,Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Jorge Sanchez
- Asociación Civil Impacta Salud y Educación, Lima, Peru.,Department of Global Health, University of Washington, Seattle, Washington, USA.,Centro de Investigaciones Tecnológicas Biomédicas y Medioambientales, Lima, Peru
| | - Jordan E Lake
- South American Program in HIV Prevention Research, c/o UCLA Department of Medicine, Division of Infectious Diseases, Los Angeles, California, USA.,Department of Internal Medicine, Division of Infectious Diseases, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Steven Shoptaw
- South American Program in HIV Prevention Research, c/o UCLA Department of Medicine, Division of Infectious Diseases, Los Angeles, California, USA.,Department of Family Medicine, UCLA, Los Angeles, California, USA
| | - Jesse L Clark
- South American Program in HIV Prevention Research, c/o UCLA Department of Medicine, Division of Infectious Diseases, Los Angeles, California, USA
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Clark JL, Perez-Brumer AG, Reisner SL, Salazar X, McLean S, Huerta L, Silva-Santisteban A, Moriarty KM, Mimiaga MJ, Sanchez J, Mayer KH, Lama JR. Social Network Organization, Structure, and Patterns of Influence Within a Community of Transgender Women in Lima, Peru: Implications for Biomedical HIV Prevention. AIDS Behav 2020; 24:233-245. [PMID: 30989553 PMCID: PMC6801001 DOI: 10.1007/s10461-019-02506-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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] [Indexed: 11/24/2022]
Abstract
Understanding social network structures can contribute to the introduction of new HIV prevention strategies with socially marginalized populations like transgender women (TW). We conducted 20 semi-structured interviews and four focus groups (n = 32) with TW from selected social networks in Lima, Peru between May and July, 2015. Participants described layers of social influence from diverse actors in their social networks. The majority identified a close relative as their primary social support, with whom they confided secrets but avoided issues of transgender identity, sexuality, and sex work. Participants described close circles of TW friends with whom they shared information about gender identity, body modification, and sexual partners, but avoided issues like HIV. Community leadership included political leaders (who advocated for transgender rights) as well as social leaders (who introduced TW to hormone therapy, body modification, and commercial sex). Detailed analysis of TW social networks can contribute to implementation and acceptability of new HIV prevention technologies.
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Affiliation(s)
- J L Clark
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.
| | - A G Perez-Brumer
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - S L Reisner
- Department of Pediatrics, Harvard Medical School and Boston Children's Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - X Salazar
- Instituto de Estudios de Sexualidad y Derechos Humanos, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - S McLean
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - L Huerta
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| | - A Silva-Santisteban
- Instituto de Estudios de Sexualidad y Derechos Humanos, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - K M Moriarty
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA
- Brown University Alpert School of Medicine, Providence, RI, USA
| | - M J Mimiaga
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert School of Medicine, Providence, RI, USA
| | - J Sanchez
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
- CITBM, Universidad Nacional Mayor San Marcos, Lima, Peru
- Department of Global Health, University of Washington School of Medicine, Seattle, WA, USA
| | - K H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - J R Lama
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
- Department of Global Health, University of Washington School of Medicine, Seattle, WA, USA
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Passaro RC, Castañeda-Huaripata A, Gonzales-Saavedra W, Chavez-Gomez S, Segura ER, Lake JE, Cabello R, Clark JL. Contextualizing condoms: a cross-sectional study mapping intersections of locations of sexual contact, partner type, and substance use as contexts for sexual risk behavior among MSM in Peru. BMC Infect Dis 2019; 19:958. [PMID: 31711433 PMCID: PMC6849170 DOI: 10.1186/s12879-019-4517-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 09/27/2019] [Indexed: 12/14/2022] Open
Abstract
Background Condomless anal intercourse (CAI) appears to be increasing among men who have sex with men (MSM) globally, and is reported to be as high as 70% in recent studies in Peru. To improve understanding of the evolving context of CAI among MSM in Peru, we studied associations between partner type, substance use, and condomless anal intercourse (CAI) in locations where MSM commonly report having sexual encounters. Methods In a 2017 cross-sectional study of rectal STI screening and HIV prevention, a convenience sample of MSM recruited from community venues in Lima completed a survey of demographic characteristics and sexual risk behavior with their three most recent partners. Generalized estimating equations estimated correlations of CAI with location of last sexual contact, participant substance use prior to sex, and negotiation of condom use before or during sex. The network data integration application, Cytoscape, mapped intersections of partner type, sexual orientation, substance use, and CAI by four types of locations where sex occurred: 1) Home, 2) Hotel, 3) Sauna or Internet Cabin, and 4) Public Spaces. Results Of 447 MSM (median age 27 years), 76.9% reported CAI with ≥1 of their last three partners. Participants reported sex with casual partners most commonly in homes (64.6%) and hotels (60.4%), and with anonymous partners most often in saunas/Internet cabins (57.5%) and public spaces (52.6%). CAI was less commonly reported in hotels (aPR, 95% CI: 0.85, 0.75–0.97) compared to homes. Participants who used marijuana before sex at home were more likely to report CAI than MSM who did not use marijuana (1.36, 1.01–1.92). Partner alcohol use before sex was associated with CAI in saunas/Internet cabins (3.17, 1.45–6.91) and public spaces (2.65, 1.41–4.98). In the sexual network maps, almost all MSM who used drugs prior to their sexual encounters used drugs with more than one of their last three partners. Conclusions CAI was common and associated with different risk factors, like partner type and substance use, based on location where sex occurred. Novel combination HIV, STI, and substance use prevention interventions must consider how the social environments of MSM influence condom use and other sexual risk behaviors. Trial registration ClinicalTrials.gov Identifier NCT03010020, January 4, 2017.
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Affiliation(s)
- R Colby Passaro
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA. .,South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | | | | | | | - Eddy R Segura
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Jordan E Lake
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Internal Medicine, Division of Infectious Diseases, McGovern Medical School at UTHealth, Houston, TX, USA
| | | | - Jesse L Clark
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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31
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Garcia J, Vargas N, Clark JL, Magaña Álvarez M, Nelons DA, Parker RG. Social isolation and connectedness as determinants of well-being: Global evidence mapping focused on LGBTQ youth. Glob Public Health 2019; 15:497-519. [PMID: 31658001 DOI: 10.1080/17441692.2019.1682028] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Social isolation describes a lack of a sense of belonging, the inability to engage and connect with others, and the neglect or deterioration of social relationships. This conceptual review describes how social isolation and connectedness affect the well-being of LGBTQ youth. Most studies focused on the psychosocial experience of social isolation, which led to suicide attempt, self-harm, sexual risk, and substance use. Scholarly work has drawn from a variety of frameworks, ranging from minority stress theory to positive youth development, to devise interventions that target isolation and connectedness in schools, community-based organisations, and in online environments. Finally, we discuss the importance of addressing social, cultural, and structural dimensions of social isolation in order to foster enabling environments that allow LGBTQ youth to thrive. This conceptual review suggests that individual and social transformations are the result of young people's meaningful participation in shaping their environment, which is made possible when their capabilities are fostered through social well-being. Our findings suggest the need for measures of social isolation among youth in databanks produced by global institutions, such as the World Health Organization.
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Affiliation(s)
- Jonathan Garcia
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Nancy Vargas
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Jesse L Clark
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Mario Magaña Álvarez
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Devynne A Nelons
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Richard G Parker
- Associação Brasileira Interdisciplinar de AIDS (ABIA), Rio de Janeiro, Brazil
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Bakal DR, Coelho LE, Luz PM, Clark JL, De Boni RB, Cardoso SW, Veloso VG, Lake JE, Grinsztejn B. Obesity following ART initiation is common and influenced by both traditional and HIV-/ART-specific risk factors. J Antimicrob Chemother 2019; 73:2177-2185. [PMID: 29722811 DOI: 10.1093/jac/dky145] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 03/21/2018] [Indexed: 12/11/2022] Open
Abstract
Background Obesity rates are increasing among HIV-infected individuals, but risk factors for obesity development on ART remain unclear. Objectives In a cohort of HIV-infected adults in Rio de Janeiro, Brazil, we aimed to determine obesity rates before and after ART initiation and to analyse risk factors for obesity on ART. Methods We retrospectively analysed data from individuals initiating ART between 2000 and 2015. BMI was calculated at baseline (time of ART initiation). Participants who were non-obese at baseline and had ≥90 days of ART exposure were followed until the development of obesity or the end of follow-up. Obesity incidence rates were estimated using Poisson regression models and risk factors were assessed using Cox regression models. Results Of participants analysed at baseline (n = 1794), 61.3% were male, 48.3% were white and 7.9% were obese. Among participants followed longitudinally (n = 1567), 66.2% primarily used an NNRTI, 32.9% a PI and 0.9% an integrase strand transfer inhibitor (INSTI); 18.3% developed obesity and obesity incidence was 37.4 per 1000 person-years. In multivariable analysis, the greatest risk factor for developing obesity was the use of an INSTI as the primary ART core drug (adjusted HR 7.12, P < 0.0001); other risk factors included younger age, female sex, higher baseline BMI, lower baseline CD4+ T lymphocyte count, higher baseline HIV-1 RNA, hypertension and diabetes mellitus. Conclusions Obesity following ART initiation is frequent among HIV-infected adults. Key risk factors include female sex, HIV disease severity and INSTI use. Further research regarding the association between INSTIs and the development of obesity is needed.
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Affiliation(s)
- David R Bakal
- Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Le Conte Ave, Los Angeles, CA 90095, USA
| | - Lara E Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, Manguinhos, Rio de Janeiro, Brazil
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, Manguinhos, Rio de Janeiro, Brazil
| | - Jesse L Clark
- Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Le Conte Ave, Los Angeles, CA 90095, USA
| | - Raquel B De Boni
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, Manguinhos, Rio de Janeiro, Brazil
| | - Sandra W Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, Manguinhos, Rio de Janeiro, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, Manguinhos, Rio de Janeiro, Brazil
| | - Jordan E Lake
- Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Le Conte Ave, Los Angeles, CA 90095, USA.,Department of Medicine, The University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, 6431 Fannin St., Houston, TX, USA
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, Manguinhos, Rio de Janeiro, Brazil
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Lama JR, Mayer KH, Perez-Brumer AG, Huerta L, Sanchez H, Clark JL, Sanchez J, Reisner SL. Integration of Gender-Affirming Primary Care and Peer Navigation With HIV Prevention and Treatment Services to Improve the Health of Transgender Women: Protocol for a Prospective Longitudinal Cohort Study. JMIR Res Protoc 2019; 8:e14091. [PMID: 31250829 PMCID: PMC6620883 DOI: 10.2196/14091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Public health strategies are urgently needed to improve HIV disparities among transgender women, including holistic intervention approaches that address those health needs prioritized by the community. Hormone therapy is the primary method by which many transgender women medically achieve gender affirmation. Peer navigation has been shown to be effective to engage and retain underserved populations living with HIV in stable primary medical care. OBJECTIVE This study aims to assess the feasibility and acceptability of an integrated innovative HIV service delivery model designed to improve HIV prevention and care by combining gender-affirming primary care and peer navigation with HIV prevention and treatment services. METHODS A 12-month, nonrandomized, single-arm cohort study was implemented in Lima, Peru, among adult individuals, assigned a male sex at birth, who identified themselves as transgender women, regardless of initiation or completion of medical gender affirmation, and who were unaware of their HIV serostatus or were living with HIV but not engaged in HIV treatment. HIV-negative participants received quarterly HIV testing and were offered to initiate pre-exposure prophylaxis. HIV-positive participants were offered to initiate antiretroviral treatment and underwent quarterly plasma HIV-1 RNA and peripheral CD4+ lymphocyte cell count monitoring. All participants received feminizing hormone therapy and adherence counseling and education on their use. Peer health navigation facilitated retention in care by visiting participants at home, work, or socialization venues, or by contacting them by social media and phone. RESULTS Patient recruitment started in October 2016 and finished in March 2017. The cohort ended follow-up on March 2018. Data analysis is currently underway. CONCLUSIONS Innovative and culturally sensitive strategies to improve access to HIV prevention and treatment services for transgender women are vital to curb the burden of HIV epidemic for this key population. Findings of this intervention will inform future policies and research, including evaluation of its efficacy in a randomized controlled trial. TRIAL REGISTRATION ClinicalTrials.gov NCT03757117; https://clinicaltrials.gov/ct2/show/NCT03757117. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/14091.
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Affiliation(s)
- Javier R Lama
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| | | | - Amaya G Perez-Brumer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | | | | | - Jesse L Clark
- Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Jorge Sanchez
- Centro de Investigaciones Tecnologicas, Biomedicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Sari L Reisner
- The Fenway Institute, Boston, MA, United States
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, United States
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Zachek CM, Coelho LE, Domingues RMSM, Clark JL, De Boni RB, Luz PM, Friedman RK, de Andrade ÂCV, Veloso VG, Lake JE, Grinsztejn B. The Intersection of HIV, Social Vulnerability, and Reproductive Health: Analysis of Women Living with HIV in Rio de Janeiro, Brazil from 1996 to 2016. AIDS Behav 2019; 23:1541-1551. [PMID: 30652206 DOI: 10.1007/s10461-019-02395-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Comprehensive care for sexual and reproductive health (SRH) and social needs for women living with HIV remains limited globally. We aimed to assess trends in baseline sociodemographic, clinical, sexual, and reproductive characteristics among a cohort of HIV-infected women in Rio de Janeiro from 1996 to 2016. Participants were stratified into four time periods based on year of enrollment; we compared cross-sectional data from each period. Of 1361 participants (median age 36), most were black or mixed race (60.1%), unemployed (52.1%), and without secondary education (54%). Adolescent pregnancy was common (51.5%), and 18.3% reported sexual debut at < 15 years old. Nearly half (45.2%) had < 5 lifetime sexual partners, yet prior syphilis and oncogenic human papillomavirus prevalence were 10.9% and 43.1%, respectively. Lifetime prevalence of induced abortion was 30.3%, and 16% used no contraceptive method. Future research should explore interactions between social vulnerability, HIV, and poor SRH outcomes and healthcare models to alleviate these disparities.
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35
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Perez-Brumer AG, Passaro RC, Oldenburg CE, Garcia J, Sanchez J, Salvatierra HJ, Lama JR, Clark JL. Homophobia and heteronormativity as dimensions of stigma that influence sexual risk behaviors among men who have sex with men (MSM) and women (MSMW) in Lima, Peru: a mixed-methods analysis. BMC Public Health 2019; 19:617. [PMID: 31113398 PMCID: PMC6528354 DOI: 10.1186/s12889-019-6956-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/08/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Stigma differentially influences HIV and STI care among MSM, especially regarding partner notification practices. Recognizing the heterogeneous behaviors/identities within the category "MSM," we used mixed-methods to assess sexual risk behaviors among men who have sex with men only (MSMO) and behaviorally bisexual MSM (MSMW) with HIV and/or other STIs. METHODS MSMO/MSMW recently diagnosed (< 30 days) with HIV, syphilis, urethritis, or proctitis completed a cross-sectional survey assessing sexual risk behaviors, anticipated disclosure, and sexual partnership characteristics (n = 332). Multivariable generalized estimating equation models assessed characteristics associated with female compared to male partners in the last three partnerships. Follow-up qualitative interviews (n = 30) probed partner-specific experiences (e.g., acts and disclosure). RESULTS Among all participants, 13.9% (n = 46) described at least one of their last three sex partners as female (MSMW). MSMW (mean age of 31.8) reported a mean of 3.5 partners (SD = 4.5) in the past 3 months and MSMO (mean age 30.6) reported a mean of 4.6 partners (SD = 9.7) in the past 3 months. MSMW were more likely to report unprotected insertive anal sex (77.9%) than MSMO (43.1%; p < 0.01). Cisgender female partners were associated with condomless insertive sex in the last 3 months (aPR: 3.97, 95%CI: 1.98-8.00) and classification as a "primary" partnership (2.10, 1.34-3.31), and with lower prevalence of recent HIV diagnosis (0.26, 0.11-0.61). Planned notification of HIV/STI diagnoses was less common for female than for male partners (0.52, 0.31-0.85). Narratives illustrate internal (e.g., women as 'true' partners) and community-level processes (e.g., discrimination due to exposure of same-sex behavior) that position homosexual behavior and bisexual identity as divergent processes of deviance and generate vulnerability within sexual networks. CONCLUSIONS MSMW recently diagnosed with HIV/STI in Peru report varying partnership characteristics, with different partner-specific risk contexts and prevention needs. Descriptions highlight how behaviorally bisexual partnerships cut across traditional risk group boundaries and suggest that HIV/STI prevention strategies must address diverse, partnership-specific risks.
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Affiliation(s)
- Amaya G Perez-Brumer
- Columbia Mailman School of Public Health, Department of Sociomedical Sciences, 722 West 168th St., New York, NY, 10032, USA.
| | - Ryan C Passaro
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Catherine E Oldenburg
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Jonathan Garcia
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Jorge Sanchez
- Centro de Investigaciones Tecnologicas y Biomedicas Universidad Nacional de San Marcos, Lima, Peru
| | | | - Javier R Lama
- Asociación Civil Impacta Salud y Educación, Lima, Peru
| | - Jesse L Clark
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Blair C, Passaro RC, Segura ER, Lake JE, Perez-Brumer AG, Sanchez J, Lama JR, Clark JL. Sexual network characteristics of men who have sex with men with syphilis and/or gonorrhoea/chlamydia in Lima, Peru: network patterns as roadmaps for STI prevention interventions. Sex Transm Infect 2019; 95:336-341. [PMID: 31010954 DOI: 10.1136/sextrans-2018-053865] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 03/04/2019] [Accepted: 04/02/2019] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE While men who have sex with men (MSM) are disproportionately affected by Peru's overlapping HIV and STI epidemics, there are few data on how partnership-level and network-level factors affect STI transmission in Peru. We explored partnership-level and network-level factors associated with gonorrhoea/chlamydia (Neisseria gonorrhoeae and/or Chlamydia trachomatis (NG/CT)) and/or syphilis infection among MSM in Peru. METHODS We present the results of a cross-sectional secondary analysis of MSM (n=898) tested for syphilis and NG/CT infection as part of the screening process for two STI control trials in Lima, Peru. Participants completed questionnaires on demographics, sexual identity and role, characteristics of their three most recent sexual partners (partner sexual orientation, gender, role, partnership type, partner-specific sexual acts) and 30-day sexual network characteristics (number of sexual partners, partnership types, frequency of anal/vaginal intercourse). Participants were tested for syphilis and urethral, rectal and oropharyngeal NG/CT. Differences in network characteristics were analysed with χ2 and Kruskal-Wallis tests. RESULTS Approximately 38.9% of participants had a new STI diagnosis (syphilis (rapid plasma reagin ≥16): 10.6%; NG/CT: 22.9%; syphilis-NG/CT coinfection: 5.4%). Condomless anal intercourse (CAI) was not significantly associated with an STI diagnosis. Gay-identified participants with exclusively homosexual networks had a higher prevalence of STIs (47.4%) than gay-identified MSM with only heterosexual/bisexual partners (34.6%, p=0.04), despite reporting fewer sexual partners (any partners: 2, 1-4 vs 3, 2-6; p=0.001; casual partners: 1, 0-3 vs 2, 1-4; p=0.001) and more stable partnerships (1, 0-1 vs 0, 0-1; p=0.003) in the last month. CONCLUSIONS Network size and the number of casual sexual partners were associated with NG/CT infection among MSM in Peru. Despite reporting fewer sexual risk behaviours (smaller network size, more stable partnerships, less CAI), MSM with homosexual-only sexual networks had a higher prevalence of NG/CT and syphilis. These findings suggest network composition among MSM in Peru plays an important role in the risk for STI acquisition.
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Affiliation(s)
- Cherie Blair
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ryan Colby Passaro
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Eddy R Segura
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Jordan E Lake
- Department of Internal Medicine, McGovern Medical School at UTHealth, Houston, Texas, USA
| | | | - Jorge Sanchez
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Callao, Peru
| | - Javier R Lama
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| | - Jesse L Clark
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Abstract
: Transgender women have recently been acknowledged as a unique and important risk group in HIV research and care. Although transgender men also face specific problems related to HIV infection, less is known about the risk behaviours and HIV prevalence of this important population. This article highlights key issues relating to the epidemiology, prevention, treatment and management of complications of HIV infection in transgender adults living with HIV, and explores future areas for HIV-related research, with the ultimate goal of improving healthcare provision and quality of life for transgender persons worldwide.
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Affiliation(s)
- Jordan E Lake
- University of Texas Health Science Center at Houston, Houston, Texas
| | - Jesse L Clark
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA
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Passaro RC, Ramsey K, Segura ER, Lake JE, Reback CJ, Clark JL, Shoptaw S. Speed kills: Associations between methamphetamine use, HIV infection, tobacco use, and accelerated mortality among gay and bisexual men in Los Angeles, CA 20years after methamphetamine dependence treatment. Drug Alcohol Depend 2019; 195:164-169. [PMID: 30429048 PMCID: PMC6512788 DOI: 10.1016/j.drugalcdep.2018.06.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 03/13/2018] [Revised: 06/29/2018] [Accepted: 06/30/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND To better characterize mortality among methamphetamine users, we estimated rates of all-cause mortality by HIV serostatus and smoking history in gay and bisexual men (GBM) treated for methamphetamine dependence, and explored associated clinical and socio-behavioral characteristics. METHODS We searched public records to identify deaths among men screened between 1998-2000 for a trial of outpatient therapy for GBM with methamphetamine dependence. Crude mortality rates (CMRs) were calculated, and standardized mortality ratios (SMRs) estimated, comparing data with historical information from CDC WONDER. Associations of mortality with HIV infection, tobacco use, and other factors were explored using Kaplan-Meier survival analysis and Cox proportional hazards models. RESULTS Of 191 methamphetamine-dependent GBM (median age 35 years; majority Caucasian), 62.8% had HIV infection, and 31.4% smoked tobacco at baseline. During the 20-year follow-up period, 12.6% died. Relative to controls, methamphetamine-dependent GBM had a three-fold higher 20-year SMR: 3.39, 95% CI: 2.69-4.09. Especially high mortality was observed among participants reporting tobacco use (adjusted HR 3.48, 95% CI: 1.54-7.89), club drug use prior to starting methamphetamine (2.63, 1.15-6.00), or other clinical diagnoses at baseline (3.89, 1.15-13.22). At 20 years, the CMR for HIV infected participants (7.7 per 1000 PY) was 1.5 times that for men without HIV (5.2 per 1000 PY; p = 0.22) and there was a 5-fold difference in CMRs for HIV infected tobacco smokers (16.9 per 1000 PY) compared to non-smokers (3.4 per 1000 PY; p < 0.01). CONCLUSION In our sample of methamphetamine-dependent GBM, concomitant HIV infection and tobacco use were associated with dramatic increases in mortality.
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Affiliation(s)
- R. Colby Passaro
- College of Medicine, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN, 38163, USA,South American Program in HIV Prevention Research, c/o UCLA Department of Medicine, Division of Infectious Diseases, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA 90095, USA
| | - Keenan Ramsey
- UCLA Center for Behavioral and Addiction Medicine, 10880 Wilshire Blvd., Ste. 1800, Los Angeles, CA, 90024, USA; National Institute on Drug Abuse, Office of Science Policy and Communications, Public Information and Liaison Branch, 6001 Executive Blvd., Room 5213, MSC 9561, Bethesda, MD, 20892, USA.
| | - Eddy R. Segura
- South American Program in HIV Prevention Research, c/o UCLA Department of Medicine, Division of Infectious Diseases, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA 90095, USA,Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Av. Alameda San Marcos s/n, Chorrillos (Lima 09), Lima, Peru
| | - Jordan E. Lake
- South American Program in HIV Prevention Research, c/o UCLA Department of Medicine, Division of Infectious Diseases, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA 90095, USA,McGovern Medical School at UTHealth, Department of Internal Medicine, Division of Infectious Diseases, 6341 Fannin St., MSB 2.112, Houston, TX, 77030, USA
| | - Cathy J. Reback
- UCLA Center for HIV Identification, Prevention, and Treatment Services, 10880 Wilshire Blvd., Ste. 1800, Los Angeles, CA, 90024, USA,Friends Research Institute, 11835 Olympic Blvd., #775E, Los Angeles, CA, 90064, USA
| | - Jesse L. Clark
- South American Program in HIV Prevention Research, c/o UCLA Department of Medicine, Division of Infectious Diseases, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA 90095, USA,UCLA Center for HIV Identification, Prevention, and Treatment Services, 10880 Wilshire Blvd., Ste. 1800, Los Angeles, CA, 90024, USA
| | - Steve Shoptaw
- South American Program in HIV Prevention Research, UCLA Department of Medicine, Division of Infectious Diseases, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA; UCLA Center for Behavioral and Addiction Medicine, 10880 Wilshire Blvd., Ste. 1800, Los Angeles, CA, 90024, USA; UCLA Center for HIV Identification, Prevention, and Treatment Services, 10880 Wilshire Blvd., Ste. 1800, Los Angeles, CA, 90024, USA.
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Molina Y, Ulrich A, Greer AC, Primbas A, Wandell G, Sanchez H, Bain C, Konda KA, Clark JL, De la Grecca R, Villarán MV, Pasalar S, Lama JR, Duerr AC. Impact of pre-diagnosis awareness of HIV-related stigma and dispositional coping on linkage to HIV care among newly diagnosed HIV+ Peruvian patients. AIDS Care 2019; 31:848-856. [PMID: 30616376 DOI: 10.1080/09540121.2018.1563282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A substantial body of literature has characterized how psychosocial factors, including HIV-related stigma and coping, are associated with HIV testing and HIV care utilization post-diagnosis. Less is known about if certain psychosocial characteristics pre-diagnosis may also predict linkage to care among individuals who receive an HIV-positive diagnosis. We examined if pre-diagnosis awareness/perception about HIV-related stigma and dispositional coping styles predicted linkage to HIV care within three months post-diagnosis with a secondary analysis of 604 patients from a randomized controlled trial (Sabes Study). Awareness/perception about HIV-related stigma, dispositional maladaptive and adaptive coping were measured before patients underwent an HIV test. Linkage to care was measured as receipt of care within three months of receiving the diagnosis. After adjusting for covariates, individuals who reported greater dispositional maladaptive coping pre-diagnosis had lower odds of linking to care, OR = 0.82, 95%CI [0.67, 1.00], p = .05. There was also a non-significant inverse association between dispositional adaptive coping pre-diagnosis and linkage to care. These preliminary data suggest the need for further longitudinal research and highlight the potential utility of pre-diagnosis psychosocial assessment and tailored counseling when providing positive HIV diagnosis results.
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Affiliation(s)
- Yamilé Molina
- a Community Health Sciences, Center for Research on Women and Gender , University of Illinois at Chicago , Chicago , IL , USA.,b Cancer Center, Center for Research on Women and Gender , University of Illinois at Chicago , Chicago , IL , USA
| | - Angela Ulrich
- c Vaccine and Infectious Disease & Public Health Science Divisions , Fred Hutchinson Cancer Research Center , Seattle , WA , USA.,d Division of Epidemiology and Community Health , University of Minnesota , Minneapolis , MN , USA
| | | | - Angela Primbas
- e University of Washington , Seattle , WA , USA.,f Department of Medicine , Stanford University , Stanford , WA , USA
| | | | | | - Carolyn Bain
- c Vaccine and Infectious Disease & Public Health Science Divisions , Fred Hutchinson Cancer Research Center , Seattle , WA , USA.,h PATH , Seattle , WA , USA
| | - Kelika A Konda
- i Department of Epidemiology, School of Public Health , University of California Los Angeles , Lima , Peru
| | - Jesse L Clark
- j Department of Medicine, Division of Infectious Diseases , University of California Los Angeles , Los Angeles , CA , USA
| | - Robert De la Grecca
- k Asociación Civil Impacta Salud y Educación , Lima , Peru.,l HIV Vaccine Trials Network (HVTN), Fred Hutchinson Cancer Research Center , Seattle , WA , USA
| | | | - Siavash Pasalar
- c Vaccine and Infectious Disease & Public Health Science Divisions , Fred Hutchinson Cancer Research Center , Seattle , WA , USA
| | - Javier R Lama
- k Asociación Civil Impacta Salud y Educación , Lima , Peru
| | - Ann C Duerr
- c Vaccine and Infectious Disease & Public Health Science Divisions , Fred Hutchinson Cancer Research Center , Seattle , WA , USA
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Garcia J, Perez-Brumer AG, Cabello R, Clark JL. "And Then Break the Cliché": Understanding and Addressing HIV Vulnerability Through Development of an HIV Prevention Telenovela with Men Who Have Sex with Men and Transwomen in Lima, Peru. Arch Sex Behav 2018; 47:1995-2005. [PMID: 29464455 PMCID: PMC6082681 DOI: 10.1007/s10508-017-1119-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/07/2017] [Accepted: 11/14/2017] [Indexed: 06/08/2023]
Abstract
HIV and other sexually transmitted infections (STIs) continue to affect men who have sex with men (MSM) and transgender women (TW) in Peru at disproportionately high rates. The ineffectiveness of traditional prevention strategies may be due to the disconnect between health promotion messages and community-level understandings of sexual cultures. We conducted 15 workshops with MSM and TW to develop a community-based sexual health intervention. Intervention development consisted of focus groups and scenic improvisation to identify sexual scripts for an HIV prevention telenovela, or Spanish soap opera. Workshops were stratified by self-reported socioeconomic status, sexual orientation, and gender identity: (1) low-income MSM (n = 9); (2) middle/high-income MSM (n = 6); and (3) TW (n = 8). Employing a conceptual model based on sexual scripts and critical consciousness theories, this paper reports on three themes identified during the telenovela-development process as participants sought to "rescript" social and sexual stereotypes associated with HIV-related vulnerability: (1) management of MSM and TW social identities at the intersection of socioeconomic status, sexuality, and gender performance; (2) social constructions of gender and/or sexual role and perceived and actual HIV/STI risk(s) within sexual partnership interactions; and (3) idealized and actual sexual scripts in the negotiation of safer sex practices between MSM/TW and their partners. These findings are key to reframing existing prevention strategies that fail to effectively engage poorly defined "high-risk populations." Leveraging community-based expertise, the results provide an alternative to the static transfer of information through expert-patient interactions in didactic sessions commonly used in HIV prevention interventions among MSM and TW.
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Affiliation(s)
- Jonathan Garcia
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, 118C Milam Hall, Corvallis, OR, 97331, USA.
| | - Amaya G Perez-Brumer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Jesse L Clark
- Department of Medicine/Division of Infectious Diseases, UCLA Geffen School of Medicine, Los Angeles, CA, USA
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Clark JL, Segura ER, Oldenburg CE, Salvatierra HJ, Rios J, Perez-Brumer AG, Gonzales P, Sheoran B, Sanchez J, Lama JR. Traditional and Web-Based Technologies to Improve Partner Notification Following Syphilis Diagnosis Among Men Who Have Sex With Men in Lima, Peru: Pilot Randomized Controlled Trial. J Med Internet Res 2018; 20:e232. [PMID: 29970355 PMCID: PMC6053614 DOI: 10.2196/jmir.9821] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 01/14/2018] [Revised: 02/28/2018] [Accepted: 03/13/2018] [Indexed: 12/02/2022] Open
Abstract
Background Patient-initiated partner notification (PN) following the diagnosis of a sexually transmitted infection is a critical component of disease control in men who have sex with men (MSM) sexual networks. Both printed and internet-based technologies offer potential tools to enhance traditional partner notification approaches among MSM in resource-limited settings. Objective This randomized controlled trial aimed to evaluate the effect of 2 different PN technologies on notification outcomes following syphilis diagnosis among MSM in Peru: a Web-based notification system and patient-delivered partner referral cards. Methods During 2012-2014, we screened 1625 MSM from Lima, Peru, for syphilis infection and enrolled 370 MSM with symptomatic primary or secondary syphilis (n=58) or asymptomatic latent syphilis diagnosed by serology (rapid plasma reagin, RPR, and Microhemagglutination assay for Treponema pallidum antibody; n=312). Prior to enrollment, potential participants used a computer-based self-interviewing system to enumerate their recent sexual partnerships and provide details of their 3 most recent partners. Eligible participants were randomly assigned to one of 4 intervention arms: (1) counseling and patient-initiated Web-based PN (n=95), (2) counseling with Web-based partner notification and partner referral cards (n=84), (3) counseling and partner referral cards (n=97), and (4) simple partner notification counseling (control; n=94). Self-reported partner notification was assessed after 14 days among 354 participants who returned for the follow-up assessment. Results The median age of enrolled participants was 27 (interquartile range, IQR 23-34) years, with a median of 2 partners (IQR 1-5) reported in the past month. Compared with those who received only counseling (arm 4), MSM provided with access to Web-based partner notification (arms 1 and 2) or printed partner referral cards (arms 2 and 3) were more likely to have notified one or more of their sexual partners (odds ratio, OR, 2.18, 95% CI 1.30-3.66; P=.003 and OR 1.68, 95% CI 1.01-2.79; P=.045, respectively). The proportion of partners notified was also higher in both Web-based partner notification (241/421, 57.2%; P<.001) and referral card (240/467, 51.4%; P=.006) arms than in the control arm (82/232, 35.3%). Conclusions Both new Web-based technologies and traditional printed materials support patient-directed notification and improve self-reported outcomes among MSM with syphilis. Additional research is needed to refine the use of these partner notification tools in specific partnership contexts. Trial Registration ClinicalTrials.gov NCT01720641; https://clinicaltrials.gov/ct2/show/NCT01720641 (Archived by WebCite at http://www.webcitation.org/70A89rJL4)
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Affiliation(s)
- Jesse L Clark
- David Geffen School of Medicine, Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Eddy R Segura
- David Geffen School of Medicine, Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Catherine E Oldenburg
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, United States
| | | | - Jessica Rios
- Asociacion Civil Impacta Salud y Educación, Lima, Peru
| | - Amaya Gabriela Perez-Brumer
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, NY, United States
| | | | | | - Jorge Sanchez
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Nacional Mayor San Marcos, Lima, Peru
| | - Javier R Lama
- Asociacion Civil Impacta Salud y Educación, Lima, Peru
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Braun HM, Segura ER, Lake JE, Gandhi M, Rios J, Villaran MV, Sanchez J, Lama JR, Clark JL. Individual and partnership factors associated with anticipated versus actual partner notification following STI diagnosis among men who have sex with men and/or with transgender women in Lima, Peru. Sex Transm Infect 2017; 94:607-610. [PMID: 29191814 DOI: 10.1136/sextrans-2017-053292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/10/2017] [Accepted: 11/11/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES A detailed understanding of intentions and practices related to partner notification (PN) following STI diagnosis can improve control strategies. We assessed participant-level and partner-level factors guiding notification behaviour among men who have sex with men and/or with transgender women (MSM-TW) in Lima, Peru, including discordances between anticipated and actual notification. METHODS Men newly diagnosed with gonorrhoea, chlamydia and/or syphilis between 2012 and 2014 reported recent partners' characteristics, anticipated PN practices, and actual PN outcomes following diagnosis. Generalised estimating equation Poisson regression analyses assessed factors guiding PN outcomes. RESULTS Participants (n=150) predominantly identified as homosexual (70%) and moderno (versatile sexual role, 55%); 55% of partners (n=402) were casual. Among all sexual partners, 35% were notified of the STI diagnosis, though only 51% of predicted PN occurred and 26% of actual notifications were unanticipated. 47% of participants notified no partners, while 24% notified all partners. PN was more common with stable versus casual (adjusted prevalence ratio (aPR), 95% CI: 0.53, 0.39 to 0.73) or commercial (aPR, 95% CI: 0.38, 0.12 to 1.21) partners, and among participants who perceived PN as normative among their peers (aPR, 95% CI: 1.96, 1.37 to 2.82). A trend towards greater notification following condom-protected intercourse was observed (aPR, 95% CI: 1.33, 0.98 to 1.81). PN frequency did not differ by type of STI diagnosed.Anticipated notification predicted actual notification (aPR, 95% CI: 1.67, 1.19 to 2.33) only imperfectly: 81 (54%) participants' PN practices did not match their anticipated behaviour. Successful notification despite anticipated silence (40 participants, 63 partners) was associated with stable partnerships and a normative perception of PN. Non-notification despite intention (43 participants, 73 partners) frequently occurred among participants reporting exclusively oral sex with the partner or with partners identified as activo (insertive role). CONCLUSIONS Anticipated notification imperfectly reflects actual PN behaviour. Future interventions to improve PN among MSM-TW in Peru need to acknowledge partnership contexts.
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Affiliation(s)
- Hannan M Braun
- School of Medicine, University of California, San Francisco, San Francisco, California, USA.,Department of Medicine, Division of Infectious Diseases, South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Eddy R Segura
- Department of Medicine, Division of Infectious Diseases, South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California, Los Angeles, California, USA.,Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Jordan E Lake
- Department of Medicine, Division of Infectious Diseases, South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California, Los Angeles, California, USA.,Department of Internal Medicine, Division of Infectious Diseases, McGovernMedical School at UTHealth, Houston, Texas, USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, California, USA
| | - Jessica Rios
- Asociación Civil Impacta Salud y Educación, Lima, Peru
| | | | - Jorge Sanchez
- Asociación Civil Impacta Salud y Educación, Lima, Peru.,Department of Global Health, University of Washington, Seattle, Washington, USA.,Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Lima, Peru
| | - Javier R Lama
- Asociación Civil Impacta Salud y Educación, Lima, Peru.,Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Jesse L Clark
- Department of Medicine, Division of Infectious Diseases, South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Bakal D, Coelho L, Luz PM, Clark JL, De Boni R, Cardoso SW, Veloso V, Lake J, Grinsztejn B. Obesity Following Antiretroviral Therapy (ART) Initiation is Common and Influenced by Both Traditional and HIV-/ART-Specific Risk Factors. Open Forum Infect Dis 2017. [PMCID: PMC5631765 DOI: 10.1093/ofid/ofx162.091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Weight gain commonly occurs among HIV-infected (HIV+) adults initiating modern ART regimens, and obesity is increasingly reported in this population. However, data regarding specific risk factors for obesity development after ART initiation are conflicting. Methods We retrospectively analyzed data from a cohort of HIV+ adults who initiated ART between January 1, 2000 and December 31, 2015 in Rio de Janeiro, Brazil. Body mass index (BMI) was assessed at ART initiation. Participants who were non-obese (BMI < 30kg/m2) at baseline and had ≥90 days of ART exposure were followed for development of obesity. Participants were censored at the time of obesity diagnosis or at end of follow-up (defined as death, loss to follow-up, end of study period or 2 years after their last weight measurement). Incidence rates were estimated using Poisson regression models and risk factor assessment was calculated using Cox regression models accounting for death and loss to follow-up as competing risks. Results Participants (n = 1,794) were 61.3% male, 48.3% white and had a median age of 36.3 years. At ART initiation, participants had a median BMI of 22.6kg/m2 and BMI category distribution was: underweight 14%, normal weight 56%, overweight 22% and obese 8%. Of the 1,567 non-obese participants followed after ART initiation, 76% gained weight, 44% increased their BMI category and 18% developed obesity. Median BMI at the end of follow-up was 24.7kg/m2 (0.4kg/m2 median annual change), the obesity incidence rate was 37.4 per 1000 person-years and the median time to obesity diagnosis was 1.9 years (vs. 4.7 years of follow-up for participants remaining non-obese). Factors associated with obesity after ART initiation included younger age at ART initiation, female sex, higher baseline BMI, lower baseline CD4+ T lymphocyte count, higher baseline HIV-1 RNA, having an integrase inhibitor as the most-used ART core drug and having diagnoses of hypertension and diabetes mellitus (Figure). Conclusion Obesity following ART initiation is frequent among HIV+ adults, with rates increasing in recent years. Both traditional (female sex) and HIV-specific (more advanced HIV disease, integrase inhibitor use) risk factors contribute importantly to obesity incidence following ART initiation. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- David Bakal
- Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Lara Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jesse L Clark
- Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Raquel De Boni
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Sandra Wagner Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Valdilea Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jordan Lake
- Department of Medicine, University of California, Los Angeles, Los Angeles, California
- Mcgovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Braun HM, Candelario J, Hanlon CL, Segura ER, Clark JL, Currier JS, Lake JE. Transgender Women Living with HIV Frequently Take Antiretroviral Therapy and/or Feminizing Hormone Therapy Differently Than Prescribed Due to Drug-Drug Interaction Concerns. LGBT Health 2017; 4:371-375. [PMID: 28876170 DOI: 10.1089/lgbt.2017.0057] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Both hormone therapy (HT) and antiretroviral therapy (ART) can be lifesaving for transgender women (TW) living with HIV, but each has side effects and potential drug-drug interactions (DDI). We assessed how concerns about HT-ART interactions affect treatment adherence. METHODS This study used a cross-sectional survey of TW (n = 87) in Los Angeles, CA. RESULTS Fifty-four percent were living with HIV; 64% used HT. Only 49% of TW living with HIV discussed ART-HT DDI with their provider; 40% reported not taking ART (12%), HT (12%), or both (16%) as directed due to DDI concerns. CONCLUSION Imperfect HT/ART use and limited provider communication suggests a need for improved HT-ART integration.
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Affiliation(s)
- Hannan M Braun
- 1 School of Medicine, University of California , San Francisco, San Francisco, California.,2 South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine , Los Angeles, California
| | - Jury Candelario
- 3 APAIT, Special Service for Groups , Los Angeles, California
| | - Courtney L Hanlon
- 4 Geisel School of Medicine, Dartmouth College , Hanover, New Hampshire
| | - Eddy R Segura
- 2 South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine , Los Angeles, California.,5 Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas , Lima, Peru
| | - Jesse L Clark
- 2 South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine , Los Angeles, California
| | - Judith S Currier
- 2 South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine , Los Angeles, California
| | - Jordan E Lake
- 2 South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine , Los Angeles, California.,6 Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston , Houston, Texas
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Brown SE, Vagenas P, Konda KA, Clark JL, Lama JR, Gonzales P, Sanchez J, Duerr AC, Altice FL. Men Who Have Sex With Men in Peru: Acceptability of Medication-Assisted Therapy for Treating Alcohol Use Disorders. Am J Mens Health 2017; 11:1269-1278. [PMID: 25787988 PMCID: PMC4573823 DOI: 10.1177/1557988315576775] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 11/15/2022] Open
Abstract
In Peru, the HIV epidemic is concentrated in men who have sex with men (MSM) and transgender women (TGW). Multiple studies correlate alcohol use disorders (AUDs) with risky sexual behaviors among Peruvian MSM. Qualitative research was used to inform a clinical trial on the acceptability of medication-assisted therapies to assist management of AUDs and improve antiretroviral therapy (ART) adherence among MSM/TGW in Peru. Three focus groups involving HIV-infected or HIV-uninfected MSM/TGW ( n = 26) with AUDs (AUDIT ≥ 8) were transcribed, translated from Spanish into English, and analyzed using thematic content analysis. Despite having an AUD, participants considered themselves "social" drinkers, minimized their drinking behaviors, and differed about whether or not alcohol problems could be treated. Participants expressed skepticism about medication for treating AUDs. Three concepts emerged as necessary components of a treatment program for alcohol problems: cost, family support, and the potential to drink less alcohol without attaining total abstinence. This study reveals important areas of education to increase potential acceptability of a medication for treating AUDs among MSM/TGW. Given the social conditions and knowledge base of the participants, medication-assisted therapies using naltrexone may be a beneficial strategy for MSM with AUDs.
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Affiliation(s)
| | | | - Kelika A. Konda
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jesse L. Clark
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | | | - Jorge Sanchez
- Asociación Civil Impacta Salud y Educación, Lima, Perú
| | - Ann C. Duerr
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Frederick L. Altice
- Yale School of Medicine, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
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Vagenas P, Brown SE, Clark JL, Konda KA, Lama JR, Sánchez J, Duerr AC, Altice FL. A Qualitative Assessment of Alcohol Consumption and Sexual Risk Behaviors Among Men Who Have Sex With Men and Transgender Women in Peru. Subst Use Misuse 2017; 52:831-839. [PMID: 28426357 PMCID: PMC5595368 DOI: 10.1080/10826084.2016.1264968] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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] [Indexed: 12/24/2022]
Abstract
BACKGROUND Peruvian men who have sex with men (MSM) and transgender women (TGW) experience the double burden of a highly concentrated HIV epidemic with a high prevalence of alcohol use disorders (AUDs). Recent research has associated both with risky sexual behaviors, including unprotected sex, having multiple sexual partners, engaging in sex work, having recent sexually transmitted infections, and having HIV-infected partners. AUDs have also been associated in MSM/TGW with being unaware of HIV+ status. OBJECTIVES This study aims to further examine issues associated with alcohol consumption, HIV infection, and risk behaviors in a qualitative analysis of focus groups conducted with MSM/TGW in Peru. METHODS A total of 26 MSM/TGW participants with AUDs participated in three semi-structured focus groups in Lima, Peru. Content analysis was facilitated by software, and specific themes were elucidated. RESULTS Participants described their drinking patterns, including the types of alcoholic drinks they consumed. They depicted drinking frequently and over multiple-day sessions. Problematic drinking behaviors were described, as well as the perceived characteristics of alcohol dependence. Interestingly, HIV-infected participants who were prescribed antiretroviral therapy did not believe that their drinking affected their medication adherence. These insights can aid in the design of future interventions aiming to reduce problematic drinking as well as HIV-related risk behaviors and, subsequently, HIV incidence. CONCLUSIONS Peruvian MSM/TGW exhibit problematic drinking, which may be associated with risky sexual behaviors and HIV transmission. Interest in reducing alcohol consumption was high, suggesting the need for targeted behavioral and pharmacological interventions.
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Affiliation(s)
- Panagiotis Vagenas
- a AIDS Program , Yale School of Medicine , New Haven , Connecticut , USA
| | - Shan-Estelle Brown
- a AIDS Program , Yale School of Medicine , New Haven , Connecticut , USA
| | - Jesse L Clark
- b David Geffen School of Medicine , University of California Los Angeles , Los Angeles , California , USA
| | - Kelika A Konda
- b David Geffen School of Medicine , University of California Los Angeles , Los Angeles , California , USA
| | - Javier R Lama
- c Asociación Civil Impacta Salud y Educación , Lima , Peru
| | - Jorge Sánchez
- c Asociación Civil Impacta Salud y Educación , Lima , Peru
| | - Ann C Duerr
- d Fred Hutchinson Cancer Research Center , Seattle , Washington , USA
| | - Frederick L Altice
- a AIDS Program , Yale School of Medicine , New Haven , Connecticut , USA.,e Division of Epidemiology of Microbial Diseases , Yale School of Public Health , New Haven , Connecticut , USA
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Clark JL, Segura ER, Oldenburg CE, Rios J, Montano SM, Perez-Brumer A, Villaran M, Sanchez J, Coates TJ, Lama JR. Expedited Partner Therapy (EPT) increases the frequency of partner notification among MSM in Lima, Peru: a pilot randomized controlled trial. BMC Med 2017; 15:94. [PMID: 28468648 PMCID: PMC5415724 DOI: 10.1186/s12916-017-0858-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 04/20/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Expedited Partner Therapy (EPT) has been shown to improve treatment outcomes among heterosexual partners of individuals with curable sexually transmitted infections (STIs). Although the use of EPT with men who have sex with men (MSM) has been debated, due to the potential for missed opportunities to diagnose unidentified cases of HIV and syphilis infection in symptomatic partners, increases in partner notification (PN) resulting from use of EPT may promote testing and treatment of otherwise unidentified partners. We assessed the impact of EPT on self-reported PN among MSM in Peru with gonorrheal (GC) and/or chlamydial (CT) infection. METHODS We enrolled 173 MSM in Lima, Peru with symptomatic or asymptomatic GC and/or CT infection between 2012 and 2014. We enrolled 44 MSM with symptomatic urethritis/proctitis and 129 MSM with asymptomatic GC/CT infection, diagnosed based on nucleic acid testing (Aptima Combo 2 Transcription-Mediated Amplification [TMA]) from urethral, pharyngeal, and rectal sites. Eligible participants were randomly assigned to receive either standard PN counseling (n = 84) or counseling plus EPT (cefixime 400 mg/azithromycin 1 g) for up to five recent partners (n = 89). Self-reported notification was assessed by computer-assisted self-administered survey among 155 participants who returned for 14-day follow-up. RESULTS The median age of participants was 26 (interquartile range [IQR]: 23-31) with a median of 3 sexual partners (IQR: 2-4) in the previous 30-day period. Among all participants, 111/155 (71.6%) notified at least one partner at 14-day follow-up with a median of 1 partner notified per participant (IQR: 0-2). For participants randomized to receive EPT, 69/83 (83.1%) reported notifying at least one partner, compared with 42/72 (58.3%) of participants in the control arm (odds ratio = 3.52; 95% confidence interval [CI]: 1.68-7.39). The proportion of all recent partners notified was significantly greater in the EPT than in the control arm (53.5%, 95% CI: 45.0-62.0% versus 36.4%, 95% CI: 27.0-47.4%). CONCLUSIONS Provision of EPT led to significant increases in notification among Peruvian MSM diagnosed with GC/CT infection. Additional research is needed to assess the impact of EPT on biological outcomes, including persistent or recurrent infection, antimicrobial resistance, and HIV/STI transmission, in MSM sexual networks. TRIAL REGISTRATION ClinicalTrials.gov, NCT01720654 . Registered on 10/29/2012.
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Affiliation(s)
- Jesse L Clark
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA. .,Department of Medicine, Division of Infectious Diseases, UCLA Geffen School of Medicine, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.
| | - Eddy R Segura
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Escuela de Medicina, Universidad de Ciencias Aplicadas, Lima, Peru
| | | | - Jessica Rios
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| | | | | | | | - Jorge Sanchez
- Universidad Nacional Mayor San Marcos, Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Lima, Peru
| | - Thomas J Coates
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Javier R Lama
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
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Machado IK, Luz PM, Lake JE, Castro R, Velasque L, Clark JL, Veloso VG, Grinsztejn B, De Boni RB. Self-rated health and substance use among individuals in HIV care in Rio de Janeiro, Brazil: a cross-sectional study. Int J STD AIDS 2017; 28:1175-1183. [PMID: 28152664 DOI: 10.1177/0956462417692278] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Self-rated health (SRH) is associated with morbidity and mortality in HIV-uninfected populations but is understudied in HIV. Substance use may affect SRH in addition to its deleterious effect on HIV disease. This analysis aimed to estimate SRH and substance use prevalence and evaluate factors associated with poor SRH among individuals in HIV care in Rio de Janeiro, Brazil. A convenience sample of HIV-infected adults completed one item of SRH, the Alcohol, Smoking and Substance Involvement Screening Test, and the Patient Health Questionnaire-2 (PHQ-2). Logistic regression models identified factors associated with poor SRH. Participants' (n = 1029) median age was 42.9 years, 64.2% were male, and 54.5% were nonwhite. Poor SRH was reported by 19.5% and the use of alcohol, tobacco, marijuana, and crack/cocaine by 30.1, 19.5, 3.9, and 3.5%, respectively. Less than high school education (adjusted odds ratio [aOR] 1.54, 95% confidence interval [CI]: 1.08-2.20), lack of sexual activity in previous 12 months (aOR 1.53, 95% CI: 1.01-2.30), crack/cocaine use (aOR 3.82, 95% CI: 1.80-8.09), positive PHQ-2 screen (aOR 3.43, 95% CI: 2.09-5.62), and HIV-1 RNA ≥40 c/ml (aOR 2.51, 95% CI: 1.57-4.02) were significantly associated with poor SRH as identified by logistic regression analyses. Alcohol, marijuana, and sedative use were not significantly associated with poor SRH. These results emphasize the need for substance use and mental health screening and treatment in this population. Further research may elucidate the consequences of poor SRH on treatment adherence, morbidity, and mortality in HIV-infected individuals.
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Affiliation(s)
- Iona K Machado
- 1 University of California, Los Angeles, Los Angeles, CA, USA.,2 Columbia College of Physicians & Surgeons, New York City, NY, USA
| | - Paula M Luz
- 3 Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jordan E Lake
- 1 University of California, Los Angeles, Los Angeles, CA, USA
| | - Rodolfo Castro
- 3 Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.,4 Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luciane Velasque
- 4 Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jesse L Clark
- 1 University of California, Los Angeles, Los Angeles, CA, USA
| | - Valdilea G Veloso
- 3 Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- 3 Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Raquel B De Boni
- 3 Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Delgado JR, Segura ER, Lake JE, Sanchez J, Lama JR, Clark JL. Event-level analysis of alcohol consumption and condom use in partnership contexts among men who have sex with men and transgender women in Lima, Peru. Drug Alcohol Depend 2017; 170:17-24. [PMID: 27865150 PMCID: PMC5183551 DOI: 10.1016/j.drugalcdep.2016.10.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 05/26/2016] [Revised: 09/08/2016] [Accepted: 10/03/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND We explored the association between alcohol use and condomless receptive (CRAI) and insertive (CIAI) anal intercourse within partnership contexts of men who have sex with men (MSM) and transgender women (TGW) in Lima, Peru. METHODS From 2012-2014, we surveyed men and TGW (n=1607) who reported anal intercourse with ≥1 male or TGW. Alcohol use with up to 3 sexual partners during the prior 90days was evaluated. Bivariate and multivariate analyses used generalized estimating equations to assess event-level associations between alcohol use, CRAI, CIAI, and partnership characteristics while adjusting for participant clustering from multiple partners. RESULTS Of 4774 sexual partnerships reported, 48% were casual, 34% primary, 10% anonymous, and 8% commercial. Alcohol use preceding sex was significantly (p<0.05) associated with CRAI (PR=1.26) and CIAI (PR=1.37). Partnership characteristics significantly associated with alcohol use included commercial sex work (PR=2.21) and trended (p<0.10) towards alcohol use with casual (PR=1.16), transgender (PR=1.48), and moderno ("versatile"; PR=1.17) partners. CRAI and CIAI were more common among participants who reported knowing they (PR=1.52; PR=1.41, respectively) or their partner (PR=1.47; PR=1.44, respectively) was HIV-uninfected. Yet, only CIAI (PR=1.42) was more commonly reported with known HIV-infected partners. Participants who drank alcohol prior to sex were less likely to know their partner's HIV serostatus. CONCLUSIONS Alcohol use prior to intercourse was associated with CRAI and CIAI, varied by partnership type, and may impair knowledge of partner HIV serostatus. Detailed knowledge of alcohol use within partner-specific contexts is essential for informing condom-based and alternative HIV prevention strategies for MSM and TGW in Peru.
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Affiliation(s)
- Jeanne R. Delgado
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA 90095, UCLA,The Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, Rhode Island, 02912, USA
| | - Eddy R. Segura
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA 90095, UCLA
| | - Jordan E. Lake
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA 90095, UCLA
| | - Jorge Sanchez
- Asociación Civil Impacta Salud y Educación, Avenida Almirante Miguel Grau 1010, Barranco (Lima 4) Peru
| | - Javier R. Lama
- Asociación Civil Impacta Salud y Educación, Avenida Almirante Miguel Grau 1010, Barranco (Lima 4) Peru
| | - Jesse L. Clark
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA 90095, UCLA
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50
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Clark JL, Perez-Brumer AG, Segura ER, Salvatierra HJ, Sanchez J, Lama JR. Anticipated Notification of Sexual Partners following STD Diagnosis among Men Who Have Sex with Men and Transgender Women in Lima, Peru: A Mixed Methods Analysis. PLoS One 2016; 11:e0163905. [PMID: 27685158 PMCID: PMC5042523 DOI: 10.1371/journal.pone.0163905] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 09/18/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND New strategies to support partner notification (PN) are critical for STD control and require detailed understanding of how specific individual and partnership characteristics guide notification decisions. METHODS From 2011 to 2012, 397 MSM and TW recently diagnosed with HIV, syphilis, or another STD completed a survey on anticipated notification of recent sexual partners and associated factors. Qualitative interviews were conducted with a subset of participants to provide further depth to quantitative findings. Prevalence ratios and generalized estimating equation (GEE) models were used to analyze participant- and partner-level factors associated with anticipated PN. RESULTS Among all partners reported, 52.5% were described as "Very Likely" or "Somewhat Likely" to be notified. Anticipated notification was more likely for main partners than casual (adjusted Prevalence Ratio [aPR], 95% CI: 0.63, 0.54-0.75) or commercial (aPR, 95% CI: 0.44, 0.31-0.62) partners. Other factors associated with likely notification included perception of the partner as an STD source (aPR, 95% CI: 1.27, 1.10-1.48) and anticipated future sexual contact with the partner (aPR, 95% CI: 1.30, 1.11-1.52). An HIV diagnosis was associated with a lower likelihood of notification than non-HIV STDs (aPR: 0.68, 0.55-0.86). Qualitative discussion of the barriers and incentives to PN reflected a similar differentiation of anticipated notification according to partnership type and type of HIV/STD diagnosis. DISCUSSION Detailed attention to how partnership characteristics guide notification outcomes is essential to the development of new PN strategies. By accurately and thoroughly assessing the diversity of partnership interactions among individuals with HIV/STD, new notification techniques can be tailored to partner-specific circumstances.
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Affiliation(s)
- Jesse L. Clark
- UCLA Geffen School of Medicine, Department of Medicine, Division of Infectious Diseases, Los Angeles, CA, United States of America
- * E-mail:
| | - Amaya G. Perez-Brumer
- Columbia University Mailman School of Public Health, New York, NY, United States of America
| | - Eddy R. Segura
- UCLA Geffen School of Medicine, Department of Medicine, Division of Infectious Diseases, Los Angeles, CA, United States of America
| | | | - Jorge Sanchez
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
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