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Salzer HJF, Schäfer G, Hoenigl M, Günther G, Hoffmann C, Kalsdorf B, Alanio A, Lange C. Clinical, Diagnostic, and Treatment Disparities between HIV-Infected and Non-HIV-Infected Immunocompromised Patients with Pneumocystis jirovecii Pneumonia. Respiration 2018; 96:52-65. [PMID: 29635251 DOI: 10.1159/000487713] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 02/13/2018] [Indexed: 01/15/2023] Open
Abstract
The substantial decline in the Pneumocystis jirovecii pneumonia (PCP) incidence in HIV-infected patients after the introduction of antiretroviral therapy (ART) in resource-rich settings and the growing number of non-HIV-infected immunocompromised patients at risk leads to considerable epidemiologic changes with clinical, diagnostic, and treatment consequences for physicians. HIV-infected patients usually develop a subacute course of disease, while non-HIV-infected immunocompromised patients are characterized by a rapid disease progression with higher risk of respiratory failure and higher mortality. The main symptoms usually include exertional dyspnea, dry cough, and subfebrile temperature or fever. Lactate dehydrogenase may be elevated. Typical findings on computed tomography scans of the chest are bilateral ground-glass opacities with or without cystic lesions, which are usually associated with the presence of AIDS. Empiric treatment should be initiated as soon as PCP is suspected. Bronchoalveolar lavage has a higher diagnostic yield compared to induced sputum. Immunofluorescence is superior to conventional staining. A combination of different diagnostic tests such as microscopy, polymerase chain reaction, and (1,3)-β-D-glucan is recommended. Trimeth-oprim/sulfamethoxazole for 21 days is the treatment of choice in adults and children. Alternative treatment regimens include dapsone with trimethoprim, clindamycin with primaquine, atovaquone, or pentamidine. Patients with moderate to severe disease should receive adjunctive corticosteroids. In newly diagnosed HIV-infected patients with PCP, ART should be initiated as soon as possible. In non-HIV-infected immunocompromised patients, improvement of the immune status should be discussed (e.g., temporary reduction of immunosuppressive agents). PCP prophylaxis is effective and depends on the immune status of the patient and the underlying immunocompromising disease.
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Affiliation(s)
- Helmut J F Salzer
- Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.,German Center for Infection Research, Clinical Tuberculosis Center, Borstel, Germany
| | - Guido Schäfer
- Infectious Diseases Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Section of Rheumatology, 3rd Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Hoenigl
- Division of Infectious Diseases, University of California at San Diego, San Diego, California, USA.,Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Gunar Günther
- Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.,Department of Internal Medicine, School of Medicine, University of Namibia, Windhoek, Namibia
| | - Christian Hoffmann
- Infektionsmedizinisches Centrum Hamburg (ICH) Study Center, Hamburg, Germany.,Department of Medicine II, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Barbara Kalsdorf
- Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.,German Center for Infection Research, Clinical Tuberculosis Center, Borstel, Germany
| | - Alexandre Alanio
- Parasitology-Mycology Laboratory, Lariboisière Saint-Louis Fernand Widal Hospitals, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris-Diderot, Sorbonne Paris Cité University, Paris, France.,Institut Pasteur, Molecular Mycology Unit, CNRS CMR2000, Paris, France
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.,German Center for Infection Research, Clinical Tuberculosis Center, Borstel, Germany.,International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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Ali A, Ali NS, Nasir U, Aadil M, Waqas N, Zil-E-Ali A, Anwar MJ, Anjum I. Comparison of Knowledge and Attitudes of Medical and Dental Students towards HIV/AIDS in Pakistan. Cureus 2018; 10:e2426. [PMID: 30079278 PMCID: PMC6067834 DOI: 10.7759/cureus.2426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The number of new human immunodeficiency virus (HIV) cases is increasing in Pakistan while it has seen a decline globally. A survey conducted recently has found that 132,000 people in Pakistan suffer from HIV. This study aims to check the levels of knowledge and attitudes about HIV/acquired immunodeficiency syndrome (AIDS) among medical and dental students. This cross-sectional study was designed and conducted at Combined Military Hospital Lahore Medical College and the Institute of Dentistry (CMH LMC) in Lahore, Pakistan in 2016. Students enrolled in the courses of the MBBS and BDS were included in this study. The questionnaire consisted of three sections: demographics, knowledge and attitude. A total of 414 students completed the questionnaire and out of them, 286 were medical students while the rest were dental students. The mean ± standard deviation score for the students was 10.02 ± 4.37 out of 17 for knowledge related to HIV and AIDS. For acceptable attitude towards AIDS and patients afflicted with the disease, an outcome of 1.93 ± 0.75 out of 4 was observed. The results of this study indicate lack of knowledge about HIV, especially about the modes of transmission and prevention techniques. Therefore, regular interactive workshops and seminars, besides teaching sessions, focused lectures on HIV/AIDS, need to be conducted.
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Affiliation(s)
- Asad Ali
- Medicine, CMH Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Nouman Safdar Ali
- Department of Medicine, Jinnah Hospital, Allama Iqbal Medical College, Lahore, Pakistan
| | - Usama Nasir
- Medicine, CMH Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Muhammad Aadil
- Department of Medicine, FMH College of Medicine and Dentistry
| | - Neha Waqas
- Surgery, Shaikh Khalifa Bin Zayed Al Nahyan Medical & Dental College, Shaikh Zayed Medical Complex, Lahore, Pakistan. 54600, Lahore, PAK
| | | | | | - Ibrar Anjum
- Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
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Buchacz K, Armon C, Tedaldi E, Palella FJ, Novak RM, Ward D, Hart R, Durham MD, Brooks JT, Hays H, Subramanian T, Purinton S, Franklin D, Akridge C, Rayeed N, Jahangir S, Flaherty CD, Bustamante P, Hammer J, Greenberg KS, Widick B, Franklin R, Yangco BG, Chagaris K, Thomas T, Stewart C, Fuhrer J, Ording-Bauer L, Kelly R, Esteves J, Christian RA, Ruley F, Beadle D, Davenport P, Wendrow A, Young B, Scott M, Thomas B. Disparities in HIV Viral Load Suppression by Race/Ethnicity Among Men Who Have Sex with Men in the HIV Outpatient Study. AIDS Res Hum Retroviruses 2018; 34:357-364. [PMID: 29316797 DOI: 10.1089/aid.2017.0162] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Maximizing the rates of virologic suppression (VS) among gay, bisexual, and other men who have sex with men (MSM) is essential to limiting HIV morbidity and sexual transmission of HIV in the United States. We analyzed data for MSM of non-Hispanic white (white), non-Hispanic black (black), or Hispanic/Latino race/ethnicity in the HIV Outpatient Study (HOPS) at nine U.S. HIV clinics. VS (HIV RNA <50 copies/ml) was measured closest to January 1, 2015. We modeled factors associated with VS among persons prescribed antiretroviral therapy (ART) for ≥6 months and assessed VS for a subset of participants with behavioral interview data. Among 1,303 MSM studied, 24% were black and 11% were Hispanic/Latino. Fewer black than white or Hispanic/Latino MSM had any documented ART use history (92% vs. 99% and 94%, respectively), and fewer had VS (72% vs. 91% and 81%), p < .001. In analyses of MSM prescribed ART, which adjusted for insurance type, duration of ART use, and CD4+ cell count, blacks had lower prevalence of VS than whites [adjusted prevalence ratio (PR) 0.87, confidence interval (95% CI) 0.81-0.93] and Hispanics/Latinos did not (PR 0.95, 95% CI 0.88-1.02). Among 331 MSM with interview data, 6% had no VS, but reported anal sex without a condom with an HIV-uninfected or unknown HIV serostatus male partner in the past 6 months. In this study of HIV-infected MSM, blacks had a significantly lower prevalence of VS than white men. Optimizing HIV care and prevention among all MSM will require addressing underlying risk factors and social determinants of health that contribute to racial/ethnic disparities in HIV outcomes.
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Affiliation(s)
- Kate Buchacz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carl Armon
- Cerner Corporation, Kansas City, Missouri
| | - Ellen Tedaldi
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Frank J. Palella
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Richard M. Novak
- Department of Medicine, University of Illinois, Chicago, Illinois
| | - Douglas Ward
- Dupont Circle Physicians Group, Washington, District of Columbia
| | | | - Marcus D. Durham
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John T. Brooks
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Frye V, Wilton L, Hirshfield S, Chiasson MA, Lucy D, Usher D, McCrossin J, Greene E, Koblin B. Preferences for HIV test characteristics among young, Black Men Who Have Sex With Men (MSM) and transgender women: Implications for consistent HIV testing. PLoS One 2018; 13:e0192936. [PMID: 29462156 PMCID: PMC5819791 DOI: 10.1371/journal.pone.0192936] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 01/24/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Promoting consistent HIV testing is critical among young, Black Men Who Have Sex With Men (MSM) and transgender women who are overrepresented among new HIV cases in the United States. New HIV test options are available, including mobile unit testing, one-minute testing, at home or self-testing and couples HIV testing and counseling (CHTC). In the context of these newer options, the objective of this study was to explore whether and how preferences for specific characteristics of the tests acted as barriers to and/or facilitators of testing in general and consistent testing specifically among young Black MSM and transgender women aged 16 to 29. METHODS We conducted 30 qualitative, semi-structured, in-depth interviews with young, Black, gay, bisexual or MSM and transgender women in the New York City metropolitan area to identify preferences for specific HIV tests and aspects of HIV testing options. Participants were primarily recruited from online and mobile sites, followed by community-based, face-to-face recruitment strategies to specifically reach younger participants. Thematic coding was utilized to analyze the qualitative data based on a grounded theoretical approach. RESULTS We identified how past experiences, perceived test characteristics (e.g., accuracy, cost, etc.) and beliefs about the "fit" between the individual, and the test relate to preferred testing methods and consistent testing. Three major themes emerged as important to preferences for HIV testing methods: the perceived accuracy of the test method, venue characteristics, and lack of knowledge or experience with the newer testing options, including self-testing and CHTC. CONCLUSIONS These findings suggest that increasing awareness of and access to newer HIV testing options (e.g., free or reduced price on home or self-tests or CHTC available at all testing venues) is critical if these new options are to facilitate increased levels of consistent testing among young, Black MSM and transgender women. Addressing perceptions of test accuracy and supporting front line staff in creating welcoming and safe testing environments may be key intervention targets. Connecting young Black MSM and transgender women to the best test option, given preferences for specific characteristics, may support more and more consistent HIV testing.
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Affiliation(s)
- Victoria Frye
- Department of Community Health and Social Medicine, Sophie Davis School of Biomedical Education, CUNY School of Medicine, City University of New York, New York, New York, United States of America
- Laboratory of Social and Behavioral Sciences, New York Blood Center, New York, New York, United States of America
| | - Leo Wilton
- Department of Human Development, College of Community and Public Affairs (CCPA), Binghamton University, Binghamton, New York, United States of America
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Sabina Hirshfield
- Division of Research and Evaluation, Public Health Solutions, New York, New York, United States of America
| | - Mary Ann Chiasson
- Division of Research and Evaluation, Public Health Solutions, New York, New York, United States of America
| | - Debbie Lucy
- Project ACHIEVE, Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York, United States of America
| | - DaShawn Usher
- Project ACHIEVE, Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York, United States of America
| | - Jermaine McCrossin
- Project ACHIEVE, Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York, United States of America
| | - Emily Greene
- Laboratory of Social and Behavioral Sciences, New York Blood Center, New York, New York, United States of America
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Beryl Koblin
- Project ACHIEVE, Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York, United States of America
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Komninakis SV, Mota ML, Hunter JR, Diaz RS. Late Presentation HIV/AIDS Is Still a Challenge in Brazil and Worldwide. AIDS Res Hum Retroviruses 2018; 34:129-131. [PMID: 28797184 DOI: 10.1089/aid.2015.0379] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite all the efforts to contain the HIV/AIDS epidemics, there still are individuals of unknown diagnosis. These present high risk of mortality and after diagnosis respond very poorly to treatment. Late testing also represents a reduced opportunity in controlling the transmission of HIV and causes an indirect increase in the transmission rates of other diseases, such as tuberculosis. In European countries, as well as in the United States, a great number of people, represented especially by illegal immigrants, black individuals, and women, markedly present at a later state of infection. In 1996, Brazil was the very first developing country to offer free and universal access to antiretroviral therapy, as well as easy access to HIV testing and care. Nonetheless, there is still a significant number of young and adult subjects who look for HIV/AIDS services and hospitals at later stage of infection by HIV (late presenters). Here we discuss important aspects related to the late diagnosis of HIV in Brazil and worldwide.
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Affiliation(s)
- Shirley V. Komninakis
- Postgraduate Program in Health Science, FMABC, Santo André, São Paulo, Brazil
- Retrovirology Laboratory, Federal University of São Paulo, São Paulo, Brazil
| | - Magaly Lima Mota
- Postgraduate Program in Health Science, FMABC, Santo André, São Paulo, Brazil
| | | | - Ricardo Sobhie Diaz
- Retrovirology Laboratory, Federal University of São Paulo, São Paulo, Brazil
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56
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Frequent HIV Testing: Impact on HIV Risk Among Chinese Men Who Have Sex with Men. J Acquir Immune Defic Syndr 2017; 72:452-61. [PMID: 27003496 DOI: 10.1097/qai.0000000000001001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The HIV epidemic continues to expand among men who have sex with men (MSM) in China. The NIMH Project Accept/HPTN 043 trial suggested a borderline significant trend toward HIV incidence reduction among persons with higher testing rates. METHODS We assessed HIV testing histories and infection status among a community-based Beijing MSM. HIV serostatus was lab confirmed. We ascertained demographic/behavioral factors through questionnaire-based interviews. Associations of previous HIV testing with odds of current HIV infection were assessed, seeking improved like-with-like risk comparisons through multivariable logistic regression analysis with propensity score adjustment and restricted cubic spline modeling. RESULTS Among 3588 participants, 12.7% were HIV infected; 70.8% reported having ever tested for HIV. Compared with MSM who never tested, those ever testing had a 41% reduction in the odds of being HIV positive [adjusted odds ratio (aOR): 0.59; 95% confidence interval (CI): 0.48 to 0.74. Higher HIV testing frequencies were associated with a decreasing trend in the odds of being infected with HIV vs. a referent group with no previous testing [>6 tests (aOR: 0.27; 95% CI: 0.18 to 0.41); 4-6 (aOR: 0.55; 95% CI: 0.39 to 0.78); 2-3 (aOR: 0.61; 95% CI: 0.45 to 0.82); P for trend <0.001]. The multivariable-adjusted model with restricted cubic spline of HIV testing frequency showed a higher frequency of previous HIV testing associated with lower odds of HIV infection, particularly among men with ≥10 lifetime male sexual partners. CONCLUSIONS Using risk probability adjustments to enable less biased comparisons, frequent HIV testing was associated with a lower HIV odds among Chinese MSM.
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Garnett M, Hirsch-Moverman Y, Franks J, Hayes-Larson E, El-Sadr WM, Mannheimer S. Limited awareness of pre-exposure prophylaxis among black men who have sex with men and transgender women in New York city. AIDS Care 2017; 30:9-17. [PMID: 28791876 DOI: 10.1080/09540121.2017.1363364] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Awareness of Pre-exposure prophylaxis (PrEP) was assessed among a cohort of substance-using black men who have sex with men and transgender women (MSM/TGW) participating in the STAR Study, which recruited black MSM/TGW in New York City for HIV testing and linked HIV-infected individuals into care from July 2012 to April 2015. Sociodemographic, psychosocial, known HIV risk factors, and PrEP awareness were assessed among participants. Multivariable logistic regression was conducted to assess factors associated with PrEP awareness. Of 1673 participants, median age was 43 years and 25% were under age 30. Most participants (85.8%) reported having insufficient income for basic necessities at least occasionally, 54.8% were homeless, and 71.3% were unemployed. Awareness of PrEP was reported among 18.2% of participants. PrEP awareness was associated with younger age (adjusted odds ratio [aOR] 0.87, per 5 years), gay identity (aOR 2.46), higher education (aOR 1.70), more frequent past HIV testing (aOR 3.18), less HIV stigma (aOR 0.61), less hazardous/harmful alcohol use (aOR 0.61), and more sexual partners (aOR 1.04, per additional partner in past 30 days). In this substance-using black MSM/TGW cohort with high rates of poverty and homelessness, PrEP awareness was low. This study demonstrates the need for targeted dissemination of PrEP information to key populations to increase awareness and ultimately improve uptake and utilization of PrEP.
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Affiliation(s)
- Matthew Garnett
- a ICAP at Columbia University, Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Yael Hirsch-Moverman
- a ICAP at Columbia University, Mailman School of Public Health , Columbia University , New York , NY , USA.,b Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Julie Franks
- a ICAP at Columbia University, Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Eleanor Hayes-Larson
- a ICAP at Columbia University, Mailman School of Public Health , Columbia University , New York , NY , USA.,b Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Wafaa M El-Sadr
- a ICAP at Columbia University, Mailman School of Public Health , Columbia University , New York , NY , USA.,b Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Sharon Mannheimer
- a ICAP at Columbia University, Mailman School of Public Health , Columbia University , New York , NY , USA.,b Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA.,c Department of Medicine, Division of Infectious Diseases , Harlem Hospital Center , New York , NY , USA
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Frye V, Paige MQ, Gordon S, Matthews D, Musgrave G, Kornegay M, Greene E, Phelan JC, Koblin BA, Taylor-Akutagawa V. Developing a community-level anti-HIV/AIDS stigma and homophobia intervention in new York city: The project CHHANGE model. EVALUATION AND PROGRAM PLANNING 2017; 63:45-53. [PMID: 28371668 DOI: 10.1016/j.evalprogplan.2017.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/03/2017] [Accepted: 03/08/2017] [Indexed: 06/07/2023]
Abstract
HIV/AIDS stigma and homophobia are associated with significant negative health and social outcomes among people living with HIV/AIDS (PLWHA) and those at risk of infection. Interventions to decrease HIV stigma have focused on providing information and education, changing attitudes and values, and increasing contact with people living with HIV/AIDS (PLWHA), activities that act to reduce stereotyped beliefs and prejudice, as well as acts of discrimination. Most anti-homophobia interventions have focused on bullying reduction and have been implemented at the secondary and post-secondary education levels. Few interventions address HIV stigma and homophobia and operate at the community level. Project CHHANGE, Challenge HIV Stigma and Homophobia and Gain Empowerment, was a community-level, multi-component anti-HIV/AIDS stigma and homophobia intervention designed to reduce HIV stigma and homophobia thus increasing access to HIV prevention and treatment access. The theory-based intervention included three primary components: workshops and trainings with local residents, businesses and community-based organizations (CBO); space-based events at a CBO-partner drop-in storefront and "pop-up" street-based events and outreach; and a bus shelter ad campaign. This paper describes the intervention design process, resultant intervention and the study team's experiences working with the community. We conclude that CHHANGE was feasible and acceptable to the community. Promoting the labeling of gay and/or HIV-related "space" as a non-stigmatized, community resource, as well as providing opportunities for residents to have contact with targeted groups and to understand how HIV stigma and homophobia relate to HIV/AIDS prevalence in their neighborhood may be crucial components of successful anti-stigma and discrimination programming.
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Affiliation(s)
- Victoria Frye
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, United States; Laboratory of Social and Behavioral Sciences, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, United States; Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States.
| | - Mark Q Paige
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, United States
| | - Steven Gordon
- Gay Men of African Descent (GMAD), Brooklyn, NY, United States
| | - David Matthews
- Brooklyn Men Konnect/Bridging Access to Care (BMK), Brooklyn, NY, United States
| | | | | | - Emily Greene
- Laboratory of Social and Behavioral Sciences, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, United States
| | - Jo C Phelan
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Beryl A Koblin
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, United States
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Koblin BA, Nandi V, Hirshfield S, Chiasson MA, Hoover DR, Wilton L, Usher D, Frye V. Informing the Development of a Mobile Phone HIV Testing Intervention: Intentions to Use Specific HIV Testing Approaches Among Young Black Transgender Women and Men Who Have Sex With Men. JMIR Public Health Surveill 2017; 3:e45. [PMID: 28687531 PMCID: PMC5522583 DOI: 10.2196/publichealth.7397] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/11/2017] [Accepted: 05/09/2017] [Indexed: 11/16/2022] Open
Abstract
Background Regular human immunodeficiency virus (HIV) testing of persons at risk is critical to HIV prevention. Infrequent HIV testing and late diagnosis of HIV infection have been observed among young black men who have sex with men (MSM) and transwomen (transgender women)—two groups overrepresented in the HIV epidemic. Objective The objective of this study was to inform the development of a brief mobile phone intervention to increase HIV testing among young black MSM and transwomen by providing a tailored recommendation of an optimal HIV testing approach. We identified demographic, behavioral, psychosocial, and sociostructural factors associated with intentions to use three specific HIV testing approaches: self-testing, testing at a clinic or other provider, and couples HIV testing and counseling (CHTC). Methods Individuals were eligible for a Web-based survey if they were male at birth; were between the ages of 16 and 29 years; self-identified as black, African American, Caribbean black, African black, or multiethnic black; were not known to be HIV-infected; and reported insertive or receptive anal intercourse with a man or transwoman in the last 12 months. Recruitment occurred via banner advertisements placed on a range of social and sexual networking websites and apps in New York City and nationally, and via events attended by young black MSM and transwomen in New York City. Intention to test by each testing method was analyzed using logistic regression with best subset models and stepwise variable selection. Results Among 169 participants, intention to use a self-test was positively associated with comfort in testing by a friend or a partner at home (Adjusted odds ratio, AOR, 2.40; 95% CI 1.09-5.30), and stigma or fear as a reason not to test (AOR 8.61; 95% CI 2.50-29.68) and negatively associated with higher social support (AOR 0.48; 95% CI 0.33-0.72) and having health insurance (AOR 0.21; 95% CI 0.09-0.54). Intention to test at a clinic or other provider was positively associated with self-efficacy for HIV testing (AOR 2.87; 95% CI 1.48-5.59) and social support (AOR 1.98; 95% CI 1.34-2.92), and negatively associated with a lifetime history of incarceration (AOR 0.37; 95% CI 0.16-0.89). Intention to test by CHTC was negatively associated with higher educational level (Some college or Associate’s degree vs high school graduate or less [AOR 0.81; 95% CI 0.39-1.70]; Bachelor’s degree or more vs high school graduate or less [AOR 0.28; 95% CI 0.11-0.70]). Conclusions Unique factors were associated with intention to test using specific testing approaches. These data will be critical for the development of a tailored intervention that shows promise to increase comfort and experiences with a variety of testing approaches among young black MSM and transwomen.
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Affiliation(s)
- Beryl A Koblin
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, United States
| | - Vijay Nandi
- New York Blood Center, New York, NY, United States
| | | | | | - Donald R Hoover
- Department of Statistics and Biostatistics, Institute of Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Leo Wilton
- Department of Human Development, Binghamton University, Binghamton, NY, United States.,Faculty of Humanities, University of Johannesburg, Auckland Park, Johannesburg, South Africa
| | - DaShawn Usher
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, United States
| | - Victoria Frye
- Department of Community Health and Social Medicine, CUNY School of Medicine, City College of New York, New York, NY, United States
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Coleman CL. Qualitative Perspectives about Living with HIV from Seropositive African American MSM Aged 50 years and Older. Issues Ment Health Nurs 2017; 38:486-492. [PMID: 28605244 DOI: 10.1080/01612840.2017.1284969] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
It has nearly been more than three decades; yet, the research on aging seropositive African American men who have sex with men (MSM) is scarce. Exploring issues for an aging population of seropositive MSM is critical given that earlier epidemiological data suggested that by 2015, half of the AIDS cases will be in adults aged 50 years and older. A qualitative approach with the aim to examine perspectives about HIV risk from a group of seropositive African American MSM 50 years of age and older was conducted. Two separate focus groups with a total N = 30 were conducted. Four themes emerged: feeling left out, no place to call home, not a priority, and no one to grow older with.
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Affiliation(s)
- Christopher Lance Coleman
- a Institute on Aging, University of Pennsylvania School of Nursing , Philadelphia , Pennsylvania , USA
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Maksut JL, Eaton LA, Siembida EJ, Driffin DD, Baldwin R. A Test of Concept Study of At-Home, Self-Administered HIV Testing With Web-Based Peer Counseling Via Video Chat for Men Who Have Sex With Men. JMIR Public Health Surveill 2016; 2:e170. [PMID: 27974287 PMCID: PMC5196490 DOI: 10.2196/publichealth.6377] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/18/2016] [Accepted: 11/07/2016] [Indexed: 02/06/2023] Open
Abstract
Background Men who have sex with men (MSM), particularly MSM who identify as African-American or Black (BMSM), are the sociodemographic group that is most heavily burdened by the human immunodeficiency virus (HIV) epidemic in the United States. To meet national HIV testing goals, there must be a greater emphasis on novel ways to promote and deliver HIV testing to MSM. Obstacles to standard, clinic-based HIV testing include concerns about stigmatization or recognition at in-person testing sites, as well as the inability to access a testing site due to logistical barriers. Objective This study examined the feasibility of self-administered, at-home HIV testing with Web-based peer counseling to MSM by using an interactive video chatting method. The aims of this study were to (1) determine whether individuals would participate in at-home HIV testing with video chat–based test counseling with a peer counselor, (2) address logistical barriers to HIV testing that individuals who report risk for HIV transmission may experience, and (3) reduce anticipated HIV stigma, a primary psychosocial barrier to HIV testing. Methods In response to the gap in HIV testing, a pilot study was developed and implemented via mailed, at-home HIV test kits, accompanied by HIV counseling with a peer counselor via video chat. A total of 20 MSM were enrolled in this test of concept study, 80% of whom identified as BMSM. Results All participants reported that at-home HIV testing with a peer counseling via video chat was a satisfying experience. The majority of participants (13/18, 72%) said they would prefer for their next HIV testing and counseling experience to be at home with Web-based video chat peer counseling, as opposed to testing in an office or clinic setting. Participants were less likely to report logistical and emotional barriers to HIV testing at the 6-week and 3-month follow-ups. Conclusions The results of this study suggest that self-administered HIV testing with Web-based peer counseling is feasible and that MSM find it to be a satisfactory means by which they can access their test results. This study can serve as a general guideline for future, larger-scale studies of Web-based HIV test counseling for MSM.
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Affiliation(s)
- Jessica L Maksut
- Department of Human Development and Family Studies, University of Connecticut, Storrs Mansfield, CT, United States
| | - Lisa A Eaton
- Department of Human Development and Family Studies, University of Connecticut, Storrs Mansfield, CT, United States
| | - Elizabeth J Siembida
- Department of Human Development and Family Studies, University of Connecticut, Storrs Mansfield, CT, United States
| | - Daniel D Driffin
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs Mansfield, CT, United States
| | - Robert Baldwin
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs Mansfield, CT, United States
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Hurt CB, Soni K, Miller WC, Hightow-Weidman LB. Human Immunodeficiency Virus Testing Practices and Interest in Self-Testing Options Among Young, Black Men Who Have Sex With Men in North Carolina. Sex Transm Dis 2016; 43:587-93. [PMID: 27513387 PMCID: PMC4991826 DOI: 10.1097/olq.0000000000000484] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Young, black men who have sex with men (YBMSM) experience disproportionately high human immunodeficiency virus (HIV) incidence in the United States. Relative to other at-risk populations, less is known about their HIV testing behaviors and preferences regarding self-testing. METHODS We used an online survey to investigate testing practices and interest in self-testing among HIV-uninfected, 18- to 30-year-old YBMSM in North Carolina. RESULTS From July 2014 to March 2015, 212 completed the survey; median age was 24 years. Among 175 (83%) who had ever been tested, 160 (91%) reported testing in the prior year, 124 (71%) tested at least every 6 months, and 71 (40%) tested at least quarterly. About three quarters (77%; n = 164) were aware of HIV self-testing; 35 (17%) had ever purchased rapid (n = 27) or dried blood spot-based (n = 14) kits. Participants aware of kits had greater intention to test in the next 6 months, were more likely to have income for basic necessities and to ask sex partners about HIV status, and were less likely to have a main sex partner or to have had transactional sex. Among 142 participants at least somewhat likely to self-test in the future, convenience (35%), privacy (23%), and rapid result delivery (18%) were the principal motivators. CONCLUSIONS Eight of every 10 YBMSM have ever been tested for HIV, but intertest intervals remain unacceptably long for many. Awareness of and interest in self-testing is substantial, but few have used this method. Expanded use of self-tests could help increase the frequency of HIV testing in this epidemiologically important population.
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Affiliation(s)
- Christopher B Hurt
- From the *Institute for Global Health and Infectious Diseases, and †Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Bruneau L, Billaud E, Raffi F, Hanf M. Factors associated with the level of CD4 cell counts at HIV diagnosis in a French cohort: a quantile regression approach. Int J STD AIDS 2016; 28:397-403. [PMID: 27178069 DOI: 10.1177/0956462416650980] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The consensus definition of late presentation for human immunodeficiency virus patient based on a CD4 threshold of 350 cells/mm3 has limitations concerning risk factors identification since there is growing biomedical justification for earlier initiation of treatment. The objective was to overcome this problem by simultaneously determining factors associated with different levels of CD4 counts at the time of diagnosis. Between January 2000 and July 2014, 1179 patients with a first human immunodeficiency virus diagnosis and entering care in a French human immunodeficiency virus reference center were enrolled. Factors associated with each 5 percentile from 5th to 95th quantile of CD4 counts at diagnosis were simultaneously studied in a multivariable quantile regression model. At each of the quantiles, the factors identified as negatively associated with CD4 count at diagnosis were older age, male sex , foreign patients, hepatitis B virus or hepatitis C virus co-infection, employment status, non-MSM transmission, heterosexual transmission, suburban and rural's place of residence and earlier period of diagnosis. Association with CD4 count was not uniformly significant, most factors being significant for some quantiles. The only significant determinant for all quantiles was being born in a foreign country. These results are particularly helpful in the context of human immunodeficiency virus clinical care, management and prevention.
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Affiliation(s)
- Léa Bruneau
- 1 Regional Coordination Center for the Fight against HIV (COREVIH) of Pays de la Loire, Nantes, France.,2 Methodological Support and Biostatistics Unit, Saint Denis University Hospital, Saint Denis, Reunion Island, France
| | - Eric Billaud
- 1 Regional Coordination Center for the Fight against HIV (COREVIH) of Pays de la Loire, Nantes, France.,3 Infectious and Tropical Diseases Department, Nantes University Hospital, Nantes, France
| | - François Raffi
- 3 Infectious and Tropical Diseases Department, Nantes University Hospital, Nantes, France
| | - Matthieu Hanf
- 4 National Institute of Health and Medical Research (INSERM) CIC 1413, Nantes University Hospital, Nantes, France
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Chen I, Huang W, Connor MB, Frantzell A, Cummings V, Beauchamp GG, Griffith S, Fields SD, Scott HM, Shoptaw S, Del Rio C, Magnus M, Mannheimer S, Tieu HV, Wheeler DP, Mayer KH, Koblin BA, Eshleman SH. CXCR4-using HIV variants in a cohort of Black men who have sex with men: HIV Prevention Trials Network 061. HIV CLINICAL TRIALS 2016; 17:158-64. [PMID: 27300696 DOI: 10.1080/15284336.2016.1180771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate factors associated with HIV tropism among Black men who have sex with men (MSM) in the United States enrolled in a clinical study (HIV Prevention Trials Network 061). METHODS HIV tropism was analyzed using a phenotypic assay (Trofile assay, Monogram Biosciences). Samples were analyzed from 43 men who were HIV infected at enrollment and reported either exclusive insertive intercourse or exclusive receptive intercourse; samples were also analyzed from 20 men who were HIV uninfected at enrollment and seroconverted during the study. Clonal analysis of individual viral variants was performed for seroconverters who had dual/mixed (DM) viruses. RESULTS DM viruses were detected in samples from 11 (26%) of the 43 HIV-infected men analyzed at the enrollment visit; HIV tropism did not differ between those reporting exclusive insertive vs receptive intercourse. DM viruses were also detected in five (25%) of the 20 seroconverters. DM viruses were associated with lower CD4 cell counts. Seroconverters with DM viruses had dual-tropic viruses only or mixed populations of CCR5- and dual-tropic viruses. CONCLUSIONS DM viruses were frequently detected among Black MSM in this study, including seroconverters. Further studies are needed to understand factors driving transmission and selection of CXCR4- and dual-tropic viruses among Black MSM.
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Affiliation(s)
- Iris Chen
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Wei Huang
- b Monogram Biosciences , South San Francisco , CA , USA
| | - Matthew B Connor
- c Vaccine and Infectious Disease Division , Fred Hutchinson Cancer Research Center , Seattle , WA , USA
| | | | - Vanessa Cummings
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Geetha G Beauchamp
- c Vaccine and Infectious Disease Division , Fred Hutchinson Cancer Research Center , Seattle , WA , USA
| | - Sam Griffith
- d Science Facilitation Department , FHI 360 , Durham , NC , USA
| | - Sheldon D Fields
- e Mervyn M. Dymally School of Nursing , Charles R. Drew University of Medicine and Science , Los Angeles , CA , USA
| | - Hyman M Scott
- f Bridge HIV , San Francisco Department of Public Health , San Francisco , CA , USA
| | - Steven Shoptaw
- g Department of Family Medicine , University of California Los Angeles , Los Angeles , CA , USA
| | - Carlos Del Rio
- h Department of Global Health , Emory University Rollins School of Public Health , Atlanta , GA , USA
| | - Manya Magnus
- i Department of Epidemiology and Biostatistics , The George Washington University , Washington , DC , USA
| | - Sharon Mannheimer
- j Department of Medicine, Harlem Hospital , Columbia University Mailman School of Public Health , New York , NY , USA
| | - Hong-Van Tieu
- k Laboratory of Infectious Disease Prevention , Lindsley F. Kimball Research Institute, New York Blood Center , New York , NY , USA
| | - Darrell P Wheeler
- l School of Social Welfare , University at Albany, State University of New York , Albany , NY , USA
| | - Kenneth H Mayer
- m The Fenway Institute , Fenway Health , Boston , MA , USA.,n Infectious Disease Division , Beth Israel Deaconess Medical Center , Boston , MA , USA.,o Department of Medicine , Harvard Medical School , Boston , MA , USA
| | - Beryl A Koblin
- k Laboratory of Infectious Disease Prevention , Lindsley F. Kimball Research Institute, New York Blood Center , New York , NY , USA
| | - Susan H Eshleman
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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65
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McDaid LM, Aghaizu A, Frankis J, Riddell J, Nardone A, Mercey D, Johnson AM, Hart GJ, Flowers P. Frequency of HIV testing among gay and bisexual men in the UK: implications for HIV prevention. HIV Med 2016; 17:683-93. [PMID: 26991460 PMCID: PMC5026165 DOI: 10.1111/hiv.12373] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2015] [Indexed: 11/29/2022]
Abstract
Objectives The aim of the study was to explore HIV testing frequency among UK men who have sex with men (MSM) in order to direct intervention development. Methods Cross‐sectional surveys were completed by 2409 MSM in Edinburgh, Glasgow and London in 2011 and a Scotland‐wide online survey was carried out in 2012/13. The frequency of HIV testing in the last 2 years was measured. Results Overall, 21.2% of respondents reported at least four HIV tests and 33.7% reported two or three tests in the last 2 years, so we estimate that 54.9% test annually. Men reporting at least four HIV tests were younger and less likely to be surveyed in London. They were more likely to report higher numbers of sexual and anal intercourse partners, but not “higher risk” unprotected anal intercourse (UAI) with at least two partners, casual partners and/or unknown/discordant status partners in the previous 12 months. Only 26.7% (238 of 893) of men reporting higher risk UAI reported at least four tests. Among all testers (n = 2009), 56.7% tested as part of a regular sexual health check and 35.5% tested following a risk event. Differences were observed between surveys, and those testing in response to a risk event were more likely to report higher risk UAI. Conclusions Guidelines recommend that all MSM test annually and those at “higher risk” test more frequently, but our findings suggest neither recommendation is being met. Additional efforts are required to increase testing frequency and harness the opportunities provided by biomedical HIV prevention. Regional, demographic and behavioural differences and variations in the risk profiles of testers suggest that it is unlikely that a “one size fits all” approach to increasing the frequency of testing will be successful.
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Affiliation(s)
- L M McDaid
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | - J Frankis
- Glasgow Caledonian University, Glasgow, UK
| | - J Riddell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | - D Mercey
- University College London, London, UK
| | | | - G J Hart
- University College London, London, UK
| | - P Flowers
- Glasgow Caledonian University, Glasgow, UK
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66
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Brown MJ, Serovich JM, Kimberly JA, Hu J. Psychological reactance and HIV-related stigma among women living with HIV. AIDS Care 2016; 28:745-9. [PMID: 26883096 DOI: 10.1080/09540121.2016.1147015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Psychological reactance is defined as the drive to re-establish autonomy after it has been threatened or constrained. People living with HIV may have high levels of psychological reactance due to the restrictions that they may perceive as a result of living with HIV. People living with HIV may also exhibit levels of HIV-related stigma. The relationship between psychological reactance and HIV-related stigma is complex yet understudied. Therefore, the main aim of this study was to examine the association between psychological reactance and HIV-related stigma among women living with HIV. Data were obtained from one time-point (a cross-sectional assessment) of a longitudinal HIV disclosure study. Psychological reactance was measured using the 18-item Questionnaire for the Measurement of Psychological Reactance. HIV-related stigma was measured using the HIV Stigma Scale, which has four domains: personalized, disclosure concerns, negative self-image, and concerns with public attitudes. Principal component analysis was used to derive components of psychological reactance. Linear regression models were used to determine the association between overall psychological reactance and its components, and stigma and its four domains, and depressive and anxiety symptoms. The associations between stigma and mental health were also examined. Three components of psychological reactance were derived: Opposition, Irritability, and Independence. Overall psychological reactance and irritability were associated with all forms of stigma. Opposition was linked to overall and negative self-image stigma. Overall psychological reactance, opposition, and irritability were positively associated with anxiety symptoms while opposition was also associated with Centers for Epidemiologic Studies-Depression depressive symptoms. There were also positive associations between all forms of stigma, and depressive and anxiety symptoms. Health-care providers and counselors for women living with HIV addressing feelings of irritability and opposition toward others may reduce HIV-related stigma. Future research should examine the link between psychological reactance, mental health, and HIV-related stigma among other populations living with HIV.
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Affiliation(s)
- Monique J Brown
- a College of Behavioral and Community Sciences , University of South Florida , Tampa , FL , USA
| | - Julianne M Serovich
- a College of Behavioral and Community Sciences , University of South Florida , Tampa , FL , USA
| | - Judy A Kimberly
- a College of Behavioral and Community Sciences , University of South Florida , Tampa , FL , USA
| | - Jinxiang Hu
- b School of Human Development and Organizational Studies in Education, College of Education , University of Florida , Gainesville , FL , USA
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Wilton L, Koblin B, Nandi V, Xu G, Latkin C, Seal D, Flores SA, Spikes P. Correlates of Seroadaptation Strategies Among Black Men Who have Sex with Men (MSM) in 4 US Cities. AIDS Behav 2015; 19:2333-46. [PMID: 26363789 DOI: 10.1007/s10461-015-1190-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We assessed associations of demographic, psychosocial, and substance use factors with seroadaptation strategies among 835 BMSM in four US cities. Seroadaptation strategies were practiced by 59.8 % of men, with 10.5 % practicing 100 % condom use, 26.5 % serosorting, 7.2 % condom serosorting, and 15.6 % seropositioning. In multivariable analyses, compared to men who used no seroadaptation strategies, serosorters were older, were less likely to be HIV infected, had fewer male sex partners, and had higher levels of social support and sexual self-efficacy. Condom serosorters had less psychological distress, were more likely to use methamphetamine, and had higher levels of sexual self-efficacy. Seropositioners were older, were less likely to be HIV infected, to have a main partner, and report alcohol/drug use with sex, while having higher levels of sexual self-efficacy. Seroadaptation practices among BMSM need to be considered to address perceived safer sex strategies and strengthen access to a broader reach of culturally-relevant prevention efforts.
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Frye V, Wilton L, Hirshfield S, Chiasson MA, Usher D, Lucy D, McCrossin J, Greene E, Koblin B. "Just Because It's Out There, People Aren't Going to Use It." HIV Self-Testing Among Young, Black MSM, and Transgender Women. AIDS Patient Care STDS 2015; 29:617-24. [PMID: 26376029 PMCID: PMC4808283 DOI: 10.1089/apc.2015.0100] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
HIV disproportionately affects young black MSM and transgender women in the US. Increasing HIV testing rates among these populations is a critical public health goal. Although HIV self-tests are commercially available, there is a need to better understand access to and uptake of HIV self-testing among this population. Here, we report results of a qualitative study of 30 young black MSM and transgender women residing in the New York City area to understand facilitators of and barriers to a range of HIV testing approaches, including self-testing. Mean age was 23.7 years (SD = 3.4). Over half (54%) had some college or an associate's degree, yet 37% had an annual personal income of less than $10,000 per year. Most (64%) participants had tested in the past 6 months; venues included community health/free clinics, medical offices, mobile testing units, hospitals, emergency departments, and research sites. Just one participant reported ever using a commercially available HIV self-test. Facilitators of self-testing included convenience, control, and privacy, particularly as compared to venue-based testing. Barriers to self-testing included the cost of the test, anxiety regarding accessing the test, concerns around correct test operation, and lack of support if a test result is positive. Participants indicated that instruction in correct test operation and social support in the event of a positive test result may increase the likelihood that they would use the self-test. Alongside developing new approaches to HIV prevention, developing ways to increase HIV self-testing is a public health priority for young, black MSM, and transgender women.
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Affiliation(s)
- Victoria Frye
- Laboratories of Social and Behavioral Sciences, New York Blood Center, New York, New York
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, Binghamton, New York
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | | | | | - DaShawn Usher
- Project ACHIEVE, Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York
| | - Debbie Lucy
- Project ACHIEVE, Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York
| | - Jermaine McCrossin
- Project ACHIEVE, Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York
| | - Emily Greene
- Laboratories of Social and Behavioral Sciences, New York Blood Center, New York, New York
- Department of Epidemiology, Columbia University, New York, New York
| | - Beryl Koblin
- Laboratories of Infectious Disease Prevention, New York Blood Center, New York, New York
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Abstract
PURPOSE OF REVIEW People who inject drugs (PWID), sex workers, and MSM simultaneously bear a high burden of HIV and stigma and discrimination. The purpose of this review was to summarize recent information about the understanding of the HIV care cascade among PWID, sex workers, and MSM populations around the globe. RECENT FINDINGS A review of the published literature relating to the care cascade in these three key populations was conducted. Data on the care cascade among key populations are sparse, particularly for PWID and sex workers. In the 12 countries in which a study or report of the care cascade was available stratified by these populations, all three populations have care cascade outcomes that are far below the 90-90-90 target set by the Joint United Nations Programme on HIV/AIDS (UNAIDS) for 2020. Culturally tailored interventions, including colocation of services and peer navigators, can improve care cascade outcomes among key populations. SUMMARY Key populations' care cascade outcomes must be included in international reporting metrics to expand cascade data for these groups. Improving care cascade outcomes in these key populations through culturally tailored interventions should be a priority in the coming years.
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Affiliation(s)
- Kathryn Risher
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kenneth Mayer
- Harvard School of Medicine, Boston, MA, USA
- The Fenway Institute, Boston, MA, USA
| | - Chris Beyrer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Hoenigl M, Anderson CM, Green N, Mehta SR, Smith DM, Little SJ. Repeat HIV-testing is associated with an increase in behavioral risk among men who have sex with men: a cohort study. BMC Med 2015; 13:218. [PMID: 26444673 PMCID: PMC4596465 DOI: 10.1186/s12916-015-0458-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/19/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Center for Disease Control and Prevention recommends that high-risk groups, like sexually active men who have sex with men (MSM), receive HIV testing and counseling at least annually. The objective of this study was to investigate the relationship between voluntary repeat HIV testing and sexual risk behavior in MSM receiving rapid serologic and nucleic acid amplification testing. METHODS We performed a cohort study to analyze reported risk behavior among MSM receiving the "Early Test", a community-based, confidential acute and early HIV infection screening program in San Diego, California, between April 2008 and July 2014. The study included 8,935 MSM receiving 17,333 "Early Tests". A previously published risk behavior score for HIV acquisition in MSM (i.e. Menza score) was chosen as an outcome to assess associations between risk behaviors and number of repeated tests. RESULTS At baseline, repeat-testers (n = 3,202) reported more male partners and more condomless receptive anal intercourse (CRAI) when compared to single-testers (n = 5,405, all P <0.001). In 2,457 repeat testers there was a strong association observed between repeated HIV tests obtained and increased risk behavior, with number of male partners, CRAI with high risk persons, non-injection stimulant drug use, and sexually transmitted infections all increasing between the first and last test. There was also a linear increase of risk (i.e. high Menza scores) with number of tests up to the 17th test. In the multivariable mixed effects model, more HIV tests (OR = 1.18 for each doubling of the number of tests, P <0.001) and younger age (OR = 0.95 per 5-year increase, P = 0.006) had significant associations with high Menza scores. CONCLUSIONS This study found that the highest risk individuals for acquiring HIV (e.g. candidates for antiretroviral pre-exposure prophylaxis) can be identified by their testing patterns. Future studies should delineate causation versus association to improve prevention messages delivered to repeat testers during HIV testing and counseling sessions.
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Affiliation(s)
- Martin Hoenigl
- AntiViral Research Center, Division of Infectious Diseases, Department of Medicine, University of California, San Diego, 200 West Arbor Drive #8208, San Diego, CA, 92103, USA. .,Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria. .,Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
| | - Christy M Anderson
- AntiViral Research Center, Division of Infectious Diseases, Department of Medicine, University of California, San Diego, 200 West Arbor Drive #8208, San Diego, CA, 92103, USA
| | - Nella Green
- AntiViral Research Center, Division of Infectious Diseases, Department of Medicine, University of California, San Diego, 200 West Arbor Drive #8208, San Diego, CA, 92103, USA
| | - Sanjay R Mehta
- AntiViral Research Center, Division of Infectious Diseases, Department of Medicine, University of California, San Diego, 200 West Arbor Drive #8208, San Diego, CA, 92103, USA.,Veterans Affairs Healthcare System, San Diego, CA, USA
| | - Davey M Smith
- AntiViral Research Center, Division of Infectious Diseases, Department of Medicine, University of California, San Diego, 200 West Arbor Drive #8208, San Diego, CA, 92103, USA.,Veterans Affairs Healthcare System, San Diego, CA, USA
| | - Susan J Little
- AntiViral Research Center, Division of Infectious Diseases, Department of Medicine, University of California, San Diego, 200 West Arbor Drive #8208, San Diego, CA, 92103, USA.
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Tieu HV, Liu TY, Hussen S, Connor M, Wang L, Buchbinder S, Wilton L, Gorbach P, Mayer K, Griffith S, Kelly C, Elharrar V, Phillips G, Cummings V, Koblin B, Latkin C. Sexual Networks and HIV Risk among Black Men Who Have Sex with Men in 6 U.S. Cities. PLoS One 2015; 10:e0134085. [PMID: 26241742 PMCID: PMC4524662 DOI: 10.1371/journal.pone.0134085] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 07/06/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sexual networks may place U.S. Black men who have sex with men (MSM) at increased HIV risk. METHODS Self-reported egocentric sexual network data from the prior six months were collected from 1,349 community-recruited Black MSM in HPTN 061, a multi-component HIV prevention intervention feasibility study. Sexual network composition, size, and density (extent to which members are having sex with one another) were compared by self-reported HIV serostatus and age of the men. GEE models assessed network and other factors associated with having a Black sex partner, having a partner with at least two age category difference (age difference between participant and partner of at least two age group categories), and having serodiscordant/serostatus unknown unprotected anal/vaginal intercourse (SDUI) in the last six months. RESULTS Over half had exclusively Black partners in the last six months, 46% had a partner of at least two age category difference, 87% had ≤5 partners. Nearly 90% had sex partners who were also part of their social networks. Among HIV-negative men, not having anonymous/exchange/ trade partners and lower density were associated with having a Black partner; larger sexual network size and having non-primary partners were associated with having a partner with at least two age category difference; and having anonymous/exchange/ trade partners was associated with SDUI. Among HIV-positive men, not having non-primary partners was associated with having a Black partner; no sexual network characteristics were associated with having a partner with at least two age category difference and SDUI. CONCLUSIONS Black MSM sexual networks were relatively small and often overlapped with the social networks. Sexual risk was associated with having non-primary partners and larger network size. Network interventions that engage the social networks of Black MSM, such as interventions utilizing peer influence, should be developed to address stable partnerships, number of partners, and serostatus disclosure.
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Affiliation(s)
- Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, United States of America
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, United States of America
- * E-mail:
| | - Ting-Yuan Liu
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Sophia Hussen
- Division of Infectious Diseases, Emory School of Medicine, Atlanta, GA, United States of America
| | - Matthew Connor
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Lei Wang
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Susan Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, United States of America
| | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, Binghamton, NY, United States of America
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Pamina Gorbach
- Department of Epidemiology, School of Public Health, Division of InfectiousDiseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Kenneth Mayer
- Fenway Community Health Center, Boston, MA, United States of America
| | - Sam Griffith
- FHI 360, Research Triangle Park, NC, United States of America
| | - Corey Kelly
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Vanessa Elharrar
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States of America
| | - Gregory Phillips
- The George Washington University School of Public Health and Health Services, Department of Epidemiology and Biostatistics, Washington, DC, United States of America
| | - Vanessa Cummings
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Beryl Koblin
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, United States of America
| | - Carl Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Hoenigl M, Green N, Mehta SR, Little SJ. Risk Factors for Acute and Early HIV Infection Among Men Who Have Sex With Men (MSM) in San Diego, 2008 to 2014: A Cohort Study. Medicine (Baltimore) 2015; 94:e1242. [PMID: 26222863 PMCID: PMC4554110 DOI: 10.1097/md.0000000000001242] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The objectives of this study were to identify risk factors associated with acute and early HIV infection (AEH) among men who have sex with men (MSM) undergoing community HIV testing and to compare demographics in those diagnosed with AEH with those diagnosed at chronic stage of HIV infection.In this retrospective cohort study, we analyzed risk factors associated with AEH among 8925 unique MSM (including 200 with AEH [2.2%] and 219 [2.5%] with newly diagnosed chronic HIV infection) undergoing community-based, confidential AEH screening in San Diego, California.The combination of condomless receptive anal intercourse (CRAI) plus ≥5 male partners, CRAI with an HIV-positive male, CRAI with a person who injects drugs, and prior syphilis diagnosis were significant predictors of AEH in the multivariable Cox regression model. Individuals reporting ≥1 of these 4 risk factors had a hazard ratio of 4.6 for AEH. MSM diagnosed with AEH differed in race (P = 0.005; more reported white race [P = 0.001], less black race [P = 0.030], trend toward less Native American race [P = 0.061]), when compared to those diagnosed with chronic HIV infection, while there was no difference observed regarding age.We established a multivariate model for the predicting risk of AEH infection in a cohort of MSM undergoing community HIV screening, which could be potentially used to discern those in need of further HIV nucleic acid amplification testing for community screening programs that do not test routinely for AEH. In addition, we found that race differed between those diagnosed with AEH and those diagnosed at chronic stage of HIV infection underlining the need for interventions that reduce stigma and promote the uptake of HIV testing for black MSM.
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Affiliation(s)
- Martin Hoenigl
- From the Division of Infectious Diseases, University of California San Diego (UCSD), San Diego, California (MH, NG, SRM, SJL); Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine (MH); Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria (MH); and Veterans Affairs Healthcare System, San Diego, California (SRM)
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