51
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Chan PA, Patel RR, Mena L, Marshall BD, Rose J, Sutten Coats C, Montgomery MC, Tao J, Sosnowy C, Mayer KH, Nunn A. Long-term retention in pre-exposure prophylaxis care among men who have sex with men and transgender women in the United States. J Int AIDS Soc 2019. [PMID: 31423756 DOI: 10.1002/jia] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Retention in HIV pre-exposure prophylaxis (PrEP) care in real-world settings, outside of controlled trials or demonstration projects, remains poorly understood. METHODS We evaluated retention in PrEP care outcomes among men who have sex with men (MSM) and transgender women prescribed PrEP through March 2017 at three clinical sites in the United States (US): Jackson, Mississippi; Providence, Rhode Island; and St. Louis, Missouri. We determined retention rates by attendance of clinical visits every three months, per US Centers for Disease Control and Prevention (CDC) guidelines, as well as by the timing of patients' actual clinical visits. Multivariable analyses examined demographic and behavioural factors associated with retention. RESULTS From 2013 to 2015, 282 MSM and transgender women were prescribed PrEP; 82% attended a follow-up visit. Based on CDC recommendations, 56% of patients were retained in PrEP care at the first follow-up visit, having attended a visit three months after initiation. However, 76% had a follow-up visit within eight months. Thirty-percent were retained at 12 months by CDC criteria, but 62% were retained when using a 16-month endpoint. Self-reported adherence was strongly correlated with retention. In multivariable analyses, younger age was associated with decreased odds of retention at initial follow-up, and completing college was associated with increased odds of retention at 16 months. Eight participants were newly diagnosed with HIV; six were African American, and seven were under 30 years of age. CONCLUSIONS Measuring retention in PrEP care using three-month follow-up intervals may underestimate true retention. Nevertheless, retention in PrEP care is suboptimal in real-world settings and should be the focus of future interventions.
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Affiliation(s)
- Philip A Chan
- Department of Medicine, Brown University, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Rupa R Patel
- Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Leandro Mena
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Brandon Dl Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | | | - Cassandra Sutten Coats
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Madeline C Montgomery
- Department of Medicine, Brown University, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Jun Tao
- Department of Medicine, Brown University, Providence, RI, USA
| | | | - Kenneth H Mayer
- The Fenway Institute, Boston, MA, USA.,Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Amy Nunn
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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52
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Schueler K, Ferreira M, Nikolopoulos G, Skaathun B, Paraskevis D, Hatzakis A, Friedman SR, Schneider JA. Pre-exposure Prophylaxis (PrEP) Awareness and Use Within High HIV Transmission Networks. AIDS Behav 2019; 23:1893-1903. [PMID: 30706217 PMCID: PMC6800107 DOI: 10.1007/s10461-019-02411-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Improved implementation of pre-exposure prophylaxis (PrEP) should be a valuable tool within communities experiencing high HIV incidence, such as black men who have sex with men (MSM). Using baseline data from the Chicago arm of the Transmission Reduction Intervention Project (TRIP), we examined awareness and use of PrEP within HIV potential transmission networks. Transmission Reduction Intervention Project recruited participants ages 18-69 (N = 218) during 2014-2016 from networks originating from recently and chronically HIV-infected MSM and transgender persons. In total, 53.2% of participants had heard of PrEP, while 8 (6.5%) HIV-negative participants reported ever using PrEP. In multivariable regression, PrEP awareness was associated with identifying as gay, attending some college or higher, having an HIV test in the previous 6 months, and experiencing HIV-related social support. PrEP awareness was not associated with experiencing or observing HIV-related stigma. PrEP use was associated with participants knowing two or more other PrEP-users. These findings demonstrate moderate awareness, but low uptake of PrEP within HIV potential transmission networks in Chicago. Future research should explore how to increase PrEP use in these networks and investigate the social dynamics behind our finding that PrEP users are more likely to know other PrEP users.
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Affiliation(s)
- Kellie Schueler
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Suite 104, Chicago, IL, 60637, USA
| | - Matthew Ferreira
- Chicago Center for HIV Elimination, University of Chicago, 5841 S Maryland Ave, MC5065, Chicago, IL, 60637, USA
| | | | - Britt Skaathun
- Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Samuel R Friedman
- National Development and Research Institutes, New York City, NY, USA
| | - John A Schneider
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Suite 104, Chicago, IL, 60637, USA.
- Chicago Center for HIV Elimination, University of Chicago, 5841 S Maryland Ave, MC5065, Chicago, IL, 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL, USA.
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53
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Walsh JL. Applying the Information-Motivation-Behavioral Skills Model to Understand PrEP Intentions and Use Among Men Who Have Sex with Men. AIDS Behav 2019; 23:1904-1916. [PMID: 30554396 PMCID: PMC6571043 DOI: 10.1007/s10461-018-2371-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Research is needed to determine targets for interventions to increase pre-exposure prophylaxis (PrEP) uptake. The Information-Motivation-Behavioral Skills (IMB) model has not been tested for PrEP use among men who have sex with men (MSM). Men and transgender women and men were surveyed at a community event in the Midwest in 2016 (N = 476, 60% White, Mage = 35). New measures assessed PrEP knowledge, attitudes, stigma, descriptive and subjective norms, and intentions, and participants reported on PrEP use. We tested the IMB model for a subsample of HIV-negative MSM and transgender individuals (N = 357) using structural equation modeling. Only 12% of participants used PrEP. New measures performed well and were reliable (αs = 0.83-0.94). Structural models generally supported the IMB model: knowledge, stigma, and self-efficacy were directly associated with use, and attitudes, stigma, and descriptive norms had indirect effects on use via self-efficacy. The IMB model may be useful when developing PrEP interventions for MSM.
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Affiliation(s)
- Jennifer L Walsh
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, The Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI, 53202, USA.
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54
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Dubin S, Goedel WC, Park SH, Hambrick HR, Schneider JA, Duncan DT. Perceived Candidacy for Pre-exposure Prophylaxis (PrEP) Among Men Who Have Sex with Men in Paris, France. AIDS Behav 2019; 23:1771-1779. [PMID: 30250992 DOI: 10.1007/s10461-018-2279-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Low perception of HIV risk is a challenge to PrEP implementation. We analyzed associations between perceptions of PrEP candidacy, behavioral indications for PrEP, and sexual behaviors. We recruited a sample of 580 MSM from a geosocial-networking smartphone application in Paris, France. A modified Poisson regression model was conducted to examine associations between perceived candidacy for PrEP and behavioral indications for PrEP, and relationships among engagement in group sex, transactional sex, HIV test history, and indications for PrEP. Adjusted risk ratios (aRR) and 95% confidence intervals (CIs) were calculated. For the outcome of perceived candidacy for PrEP, a multinomial logistic regression was performed, and adjusted relative risk ratios (aRRR) were calculated. Multivariate analyses were adjusted for socio-demographics. Respondents who considered themselves PrEP candidates were more likely to meet PrEP eligibility criteria compared to those who did not consider themselves candidates (aRR 1.65; 95% CI 1.34-2.03). Those who had engaged in group or transactional sex were more likely to have behavioral indications for PrEP (aRR 1.27; 95% CI 1.07-1.50, aRR 1.32; 95% CI 1.13-1.56, respectively), whereas HIV test history was not significantly associated with behavioral indications for PrEP. Respondents who had engaged in group sex or transactional sex were more likely to perceive themselves as candidates for PrEP (aRRR 2.24; 95% CI 1.21-4.16, aRRR 2.58; 95% CI 1.09-6.13, respectively), although those never tested for HIV were less likely to perceive themselves as candidates for PrEP (aRRR 0.18; 95% CI 0.03-0.91). The elucidation of candidacy perceptions and risk behaviors is key to furthering the effective implementation of PrEP engagement interventions.
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55
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Buttram ME, Kurtz SP. Preliminary evidence of HIV seroconversion among HIV-negative men who have sex with men taking non-prescribed antiretroviral medication for HIV prevention in Miami, Florida, USA. Sex Health 2019; 14:193-195. [PMID: 27764648 DOI: 10.1071/sh16108] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/13/2016] [Indexed: 11/23/2022]
Abstract
Background Limited information suggests that men who have sex with men (MSM) are informally obtaining antiretroviral medication (ARVs) and using them for HIV pre-exposure prophylaxis (PrEP). METHODS Data are drawn from an on-going study examining the use of non-prescribed ARVs for PrEP. To date, 24 qualitative interviews have been conducted with HIV-negative, substance-using MSM living in Miami, Florida, USA. Data are presented from two participants who reported HIV seroconversion while using non-prescribed ARVs for PrEP. RESULTS Preliminary data indicate that some young MSM: (i) lack awareness of and accurate information about the efficacious use of PrEP; (ii) obtain non-prescribed ARVs from HIV-positive sex partners and use these medications for PrEP in a way that does not provide adequate protection against HIV infection or cohere with established guidelines; and (iii) engage in multiple HIV transmission risk behaviours, including condomless anal sex and injection drug use. CONCLUSIONS The informal, non-prescribed and non-medically supervised use of ARVs for HIV prevention has the potential to undermine the protective benefits of PrEP and leave men unprotected against HIV transmission and at risk for ARV resistance.
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Affiliation(s)
- Mance E Buttram
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, 7255 NE 4th Avenue, Suite 112, Miami, FL 33138, USA
| | - Steven P Kurtz
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, 7255 NE 4th Avenue, Suite 112, Miami, FL 33138, USA
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56
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"A Gay Man and a Doctor are Just like, a Recipe for Destruction": How Racism and Homonegativity in Healthcare Settings Influence PrEP Uptake Among Young Black MSM. AIDS Behav 2019; 23:1951-1963. [PMID: 30565092 DOI: 10.1007/s10461-018-2375-z] [Citation(s) in RCA: 146] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Young, Black, gay bisexual or other MSM are significantly less likely to use PrEP than their White counterparts. These disparities may be due, in part, to medical mistrust and mistreatment within the healthcare system. This study aimed to uncover how young Black MSM's perceptions of, and experiences with, health care contribute to low engagement in the healthcare system and low PrEP utilization. In late 2017 and early 2018, we conducted six focus groups with 44 Black MSM ages 16-25 in Milwaukee. Focus group topics included participants' knowledge and perceptions of PrEP, perceptions and stereotypes about PrEP users, and general healthcare utilization patterns and behaviors. Focus group transcripts were transcribed verbatim and coded using MAXQDA qualitative analysis software. We used a team-based approach to thematic content analysis to understand how racism and homonegativity affected healthcare access and experiences. Results from this study help to characterize what contributes to mistrust of the healthcare system and healthcare providers to negatively affect PrEP use among young Black MSM. Focus group discussions revealed how previous and anticipated negative interactions with physicians and skepticism about the healthcare system have alienated young Black MSM from the health care system and created significant barriers to PrEP. Efforts to increase PrEP uptake and must address negative and discriminatory interactions with providers and the healthcare system.
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57
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Brinkley-Rubinstein L, Dauria E, Tolou-Shams M, Christopoulos K, Chan PA, Beckwith CG, Parker S, Meyer J. The Path to Implementation of HIV Pre-exposure Prophylaxis for People Involved in Criminal Justice Systems. Curr HIV/AIDS Rep 2019. [PMID: 29516265 DOI: 10.1007/s11904-018-0389-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Lauren Brinkley-Rubinstein
- Department of Social Medicine, University of North Carolina, Chapel Hill, USA.
- Center for Health Equity Research, University of North Carolina, Chapel Hill, USA.
| | - Emily Dauria
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Marina Tolou-Shams
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, USA
| | | | - Philip A Chan
- Department of Medicine, Brown University, Providence, USA
| | | | - Sharon Parker
- Department of Social Work and Sociology, North Carolina Agricultural and Technical University, Greensboro, USA
| | - Jaimie Meyer
- AIDS Program, Yale School of Medicine, New Haven, USA
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58
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Rendina HJ, Parsons JT. Factors associated with perceived accuracy of the Undetectable = Untransmittable slogan among men who have sex with men: Implications for messaging scale-up and implementation. J Int AIDS Soc 2019; 21. [PMID: 29334178 PMCID: PMC5810313 DOI: 10.1002/jia2.25055] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/19/2017] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Recent research has shown high efficacy of HIV treatment for reducing the risk of HIV transmission to sexual partners. As the efficacy of treatment as prevention (TasP) has proliferated, a new messaging campaign, Undetectable = Untransmittable, has been gaining popularity. The purpose of this paper was to assess factors associated with the perceived accuracy of this TasP messaging strategy among a large and diverse sample of gay, bisexual, and other men who have sex with men (GBMSM) in order to inform subsequent efforts at large-scale and implementation of the HIV prevention message. METHODS We conducted a nationwide survey of GBMSM in the U.S. recruited from an online social networking site and a mobile sexual networking app. We analysed data from 12,222 GBMSM separately by HIV status to examine sociodemographic and behavioural factors associated with ratings of the accuracy of the Undetectable = Untransmittable message, which included the option to indicate not understanding what "undetectable" meant. RESULTS Among HIV-negative and unknown men, multivariable linear regression indicated that being on pre-exposure prophylaxis (PrEP), identifying as gay or queer (versus bisexual or straight), recent serodiscordant condomless anal sex (CAS), testing every six months or more often, less concern about sexually transmitted infection (STI) infection, and lower perceived risk of HIV infection were the factors with the largest independent effect on rating the Undetectable = Untransmittable statement as more accurate. Fewer factors emerged as associated with accuracy ratings among HIV-positive participants-reporting an undetectable viral load, a lifetime acquired immune deficiency syndrome (AIDS) diagnosis, and lower concern about STI infection were the factors most strongly associated with rating the statement as more accurate. CONCLUSIONS The findings of the current study highlight variability in the perceived accuracy of the Undetectable = Untransmittable message, suggesting potential subgroups who might benefit from targeted educational campaigns, perhaps broadcast utilizing sexual networking apps. Numerous factors, particularly among HIV-negative and unknown GBMSM, were associated with rating the message as more accurate. In particular, being on PrEP and testing regularly were two of the variables most strongly associated with higher accuracy ratings among HIV-negative GBMSM, suggesting HIV prevention services as potential points of intervention for increasing HIV knowledge and decreasing HIV stigma.
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Affiliation(s)
- H Jonathon Rendina
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA.,Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA.,The Center for HIV Educational Studies & Training (CHEST), Hunter College of the City University of New York (CUNY), New York, NY, USA
| | - Jeffrey T Parsons
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA.,Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA.,The Center for HIV Educational Studies & Training (CHEST), Hunter College of the City University of New York (CUNY), New York, NY, USA
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59
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Jaiswal J, Griffin M, Singer SN, Greene RE, Acosta ILZ, Kaudeyr SK, Kapadia F, Halkitis PN. Structural Barriers to Pre-exposure Prophylaxis Use Among Young Sexual Minority Men: The P18 Cohort Study. Curr HIV Res 2019; 16:237-249. [PMID: 30062970 DOI: 10.2174/1570162x16666180730144455] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 07/11/2018] [Accepted: 07/15/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Despite decreasing rates of HIV among many populations, HIV-related health disparities among gay, bisexual and other men who have sex with men persist, with disproportional percentages of new HIV diagnoses among racial and ethnic minority men. Despite increasing awareness of HIV pre-exposure prophylaxis (PrEP), PrEP use remains low. In addition to exploring individual-level factors for this slow uptake, structural drivers of PrEP use must also be identified in order to maximize the effectiveness of biomedical HIV prevention strategies. METHOD Using cross-sectional data from an ongoing cohort study of young sexual minority men (N=492), we examine the extent to which structural-level barriers, including access to health care, medication logistics, counseling support, and stigma are related to PrEP use. RESULTS While almost all participants indicated awareness of PrEP, only 14% had ever used PrEP. PrEP use was associated with lower concerns about health care access, particularly paying for PrEP. Those with greater concerns talking with their provider about their sexual behaviors were less likely to use PrEP. CONCLUSION Paying for PrEP and talking to one's provider about sexual behaviors are concerns for young sexual minority men. In particular, stigma from healthcare providers poses a significant barrier to PrEP use in this population. Providers need not only to increase their own awareness of and advocacy for PrEP as an effective risk-management strategy for HIV prevention, but also must work to create open and non-judgmental spaces in which patients can discuss sexual behaviors without the fear of stigma.
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Affiliation(s)
- Jessica Jaiswal
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 715 Broadway, New York, NY 10012, United States.,Social and Behavioral Sciences, College of Global Public Health, New York University, 715 Broadway, New York, NY 10012, United States.,Center for Interdisciplinary Research on AIDS, Yale University, 135 College St., Ste. 200, New Haven, CT 06510, United States
| | - Marybec Griffin
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 715 Broadway, New York, NY 10012, United States.,Social and Behavioral Sciences, College of Global Public Health, New York University, 715 Broadway, New York, NY 10012, United States
| | - Stuart N Singer
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 715 Broadway, New York, NY 10012, United States.,Graduate School of Applied & Professional Psychology, Rutgers University, 152 Frelinghuysen Road, Busch Campus, Piscataway, NJ 08854, United States
| | - Richard E Greene
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 715 Broadway, New York, NY 10012, United States.,School of Medicine, New York University, 550 1st Avenue, New York, NY 10016, United States
| | - Ingrid Lizette Zambrano Acosta
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 715 Broadway, New York, NY 10012, United States
| | - Saara K Kaudeyr
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 715 Broadway, New York, NY 10012, United States
| | - Farzana Kapadia
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 715 Broadway, New York, NY 10012, United States.,Department of Epidemiology, College of Global Public Health, New York University, 719 Broadway, 10th floor, New York NY 10003, United States.,Department of Population Health, School of Medicine, New York University, 227 East 30th Street, New York, NY 10016, United States
| | - Perry N Halkitis
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 715 Broadway, New York, NY 10012, United States.,Graduate School of Applied & Professional Psychology, Rutgers University, 152 Frelinghuysen Road, Busch Campus, Piscataway, NJ 08854, United States.,Department of Social and Behavioral Health Sciences, Rutgers University, 683 Hoes Lane West Piscataway, NJ 08854, United States.,Robert Wood Johnson School of Medicine, Rutgers University, 675 Hoes Ln W, Piscataway Township, NJ 08854, United States.,School of Public Policy and Administration, Rutgers University, 401 Cooper Street, Camden, NJ 08102, United States
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60
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"We have a stronger survival mode": exploring knowledge gaps and culturally sensitive messaging of PrEP among Latino men who have sex with men and Latina transgender women in Los Angeles, CA. AIDS Care 2019; 31:1221-1227. [PMID: 30939901 DOI: 10.1080/09540121.2019.1601669] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Latino men who have sex with men (LMSM) and Latina transgender women (LTGW) often lack access to HIV prevention information and strategies such as pre-exposure prophylaxis (PrEP). We explored knowledge gaps and culturally sensitive messaging about PrEP among HIV-negative LMSM and LTGW in Los Angeles. We recruited participants from a Latinx LGBT community-based organization. We conducted nine focus groups (n = 91 participants) with 52 LMSM and 39 LTGW. We used a rapid assessment process to create narrative reports that we analyzed using thematic analysis. Key quotes were transcribed verbatim; they were reviewed by the team, then uploaded to Dedoose to identify themes across sites and between groups. Three themes emerged for both LMSM and LTGW: knowledge gaps regarding PrEP remain; people who have knowledge about PrEP often served as its champions; highlighting positive aspects of culture could help improve PreP's uptake and sustained use. Only LMSM worried that PrEP could impact condom use. Some issues were more pronounced among LTGW (e.g., more limited access to PrEP); others were unique to LTGW (e.g., worry about drug-hormones interactions). Collaborative research, programs, and policies, informed by LMSM and LTGW themselves, are needed to narrow existing knowledge gaps and promote PrEP uptake and sustained utilization.
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61
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Pinto RM, Witte SS. No Easy Answers: Avoiding Potential Pitfalls of De-implementation. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 63:239-242. [PMID: 30549283 PMCID: PMC6590245 DOI: 10.1002/ajcp.12298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
In 2012, the Centers for Disease Control and Prevention (CDC) began to de-emphasize and de-implement multiple evidence-based HIV prevention practices that had been around for 20 years, thus changing the scope of implementation across the globe. The authors provide evidence how existing interventions (e.g., CDC HIV interventions) may influence implementation of interventions that came after the program was discontinued. De-implementation is an ecological event that influences, and is influenced by, many parts of a system, for instance, implementation of one type of intervention may influence the implementation of other interventions (biomedical and/or behavioral) after a long-running program is discontinued. Researchers and policy makers ought to consider how de-implementation of behavioral interventions is influenced by biomedical interventions mass-produced by companies with lobbying power. The scientific study of de-implementation will be inadequate without consideration of the political climate that surrounds de-implementation of certain types of interventions and the promotion of more-profitable ones.
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Affiliation(s)
- Rogério M. Pinto
- School of Social WorkUniversity of Michigan‐Ann ArborAnn ArborMIUSA
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62
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Edeza A, Galarraga O, Novak D, Mayer K, Rosenberger J, Mimiaga M, Biello K. The role of sexual risk behaviors on PrEP awareness and interest among men who have sex with men in Latin America. Int J STD AIDS 2019; 30:542-549. [PMID: 30722750 DOI: 10.1177/0956462419825944] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In Latin America, men who have sex with men (MSM) remain disproportionately impacted by HIV. Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool and has been FDA approved in the United States since 2012, but no Latin American state, with the recent exception of Brazil, has implemented PrEP guidelines. We carried out a multinational online survey of MSM in Latin America (n = 22698) in 2012 to assess whether MSM at highest risk of HIV acquisition (i.e., those engaging in condomless anal sex [CAS; n = 2606] and transactional sex [n = 1488]) had higher levels of awareness of PrEP, PrEP use and interest in participating in a PrEP trial. After adjusting for demographic and psychosocial characteristics including depressive symptoms, hazardous alcohol use, childhood sexual abuse, and sexual compulsivity, transactional sex and CAS were associated with increased PrEP awareness (aOR = 1.29, 95% CI: 1.05-1.59, p < .001 and aOR = 1.22, 95% CI: 1.11-1.34, p < .001, respectively) and PrEP trial interest (aOR = 1.45, 95% CI: 1.25-1.71, p < .001 and aOR = 1.74, 95% CI: 1.57-1.95, p < .001, respectively). Findings demonstrate substantial awareness of and interest in PrEP among MSM with behavioral risk factors for HIV in Latin America, suggesting that this region is primed for PrEP implementation, which has been slow.
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Affiliation(s)
- Alberto Edeza
- 1 Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Omar Galarraga
- 2 Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | - David Novak
- 3 OLB Research Institute, Cambridge, MA, USA
| | - Kenneth Mayer
- 4 The Fenway Institute, Boston, MA, USA.,5 Department of Infectious Disease, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Joshua Rosenberger
- 6 College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Matthew Mimiaga
- 1 Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA.,4 The Fenway Institute, Boston, MA, USA.,7 Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Katie Biello
- 1 Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA.,4 The Fenway Institute, Boston, MA, USA.,7 Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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63
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Pre-exposure Prophylaxis Among Men Who have Sex with Men: Dual Motivational Model of Intention to Use Pre-exposure Prophylaxis. AIDS Behav 2019; 23:534-543. [PMID: 29980993 DOI: 10.1007/s10461-018-2214-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Men who have sex with men (MSM) account for most new HIV infections in the United States. Despite representing a fraction of the population, MSM make up an estimated 65% of new infections. To address this epidemic, pre-exposure prophylaxis (PrEP) is recommended to supplement condom use. Despite its effectiveness, PrEP uptake among MSM is low. Few studies have employed theoretical approaches to understand PrEP use intention. Incorporating factors like safe sex fatigue, expectation of better sexual experiences, and perceived risk are proposed in this dual motivational path model of PrEP use intention. This model hypothesized that PrEP use intention is influenced by two key pathways: (1) protection motivation pathway, and (2) sexual expectancy pathway. Data were collected using social networking applications from 402 MSM. The model was tested using structural equation modeling. We elaborate the complex decision-making process proposed by this novel theoretical model and discuss its practical implications.
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Liu A, Coleman K, Bojan K, Serrano PA, Oyedele T, Garcia A, Enriquez-Bruce E, Emmanuel P, Jones J, Sullivan P, Hightow-Weidman L, Buchbinder S, Scott H. Developing a Mobile App (LYNX) to Support Linkage to HIV/Sexually Transmitted Infection Testing and Pre-Exposure Prophylaxis for Young Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e10659. [PMID: 30681964 PMCID: PMC6367663 DOI: 10.2196/10659] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 07/08/2018] [Accepted: 09/13/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Young men who have sex with men (YMSM) in the United States have among the highest incidence of HIV and sexually transmitted infection (STI) and the lowest uptake of HIV and STI testing and pre-exposure prophylaxis (PrEP). Nearly universal mobile phone ownership among youth provides an opportunity to leverage mobile health apps to increase HIV/STI testing and PrEP uptake among YMSM. OBJECTIVE The goals of this project are to develop and refine LYNX, a novel mobile app to support linkage to HIV/STIs testing and PrEP services among YMSM in the United States, and to evaluate the acceptability and feasibility of LYNX in a pilot randomized controlled trial (RCT). METHODS This research protocol will be conducted in 3 phases: an iterative development phase with a series of 3 focus groups among 20 YMSM to refine the LYNX app; an open technical pilot among 15 YMSM to optimize usability of the app; and then a 6-month pilot RCT among 60 HIV-uninfected YMSM at risk for HIV acquisition. Developed using the Information, Motivation, and Behavioral skills theoretical model, the LYNX app includes an electronic diary to track sexual behaviors (information), a personalized risk score to promote accurate risk perception (information/motivation), testing reminders (motivation/behavioral skills), and access to home-based HIV/STI testing options and geospatial-based HIV/STI testing care sites (behavioral skills). Feasibility and acceptability will be assessed through app analytics of usage patterns and acceptability scales administered via computer-assisted self-interview at 3 and 6 months. We will also evaluate preliminary efficacy by comparing the proportion of YMSM who test at least once during the 6-month pilot and the proportion who successfully link to a PrEP provider in the intervention versus control groups. RESULTS Formative work is currently underway. The LYNX pilot RCT will begin enrollment in October 2018, with study results available in 2019. CONCLUSIONS The LYNX app is one of the first mobile apps designed to increase HIV/STI testing and PrEP uptake among YMSM. As low-perceived risk is a barrier to HIV/STI testing and PrEP use among youth, the personalized risk assessment and interactive sexual diary in LYNX could assist YMSM in better understanding their HIV risk and providing motivation to test for HIV/STIs and initiate PrEP. Coupled with community-based recruitment, this novel mobile app has great potential to reach and engage YMSM not currently involved in care and increase rates of HIV/STI testing and PrEP uptake in this vulnerable population. TRIAL REGISTRATION ClinicalTrials.gov NCT03177512; https://clinicaltrials.gov/ct2/show/NCT03177512 (Archived by WebCite at http://www.webcitation.org/73c917wAw). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/10659.
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Affiliation(s)
- Albert Liu
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, United States.,Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Kenneth Coleman
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Kelly Bojan
- John H Stroger Jr Hospital, Chicago, IL, United States.,The Ruth M Rothstein CORE Center, Chicago, IL, United States
| | - Pedro Alonso Serrano
- John H Stroger Jr Hospital, Chicago, IL, United States.,The Ruth M Rothstein CORE Center, Chicago, IL, United States
| | - Temitope Oyedele
- John H Stroger Jr Hospital, Chicago, IL, United States.,The Ruth M Rothstein CORE Center, Chicago, IL, United States
| | - Amayvis Garcia
- Department of Pediatrics, University of South Florida, Tampa, Tampa, FL, United States
| | | | - Patricia Emmanuel
- Department of Pediatrics, University of South Florida, Tampa, Tampa, FL, United States
| | - Jeb Jones
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Lisa Hightow-Weidman
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Susan Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, United States.,Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Hyman Scott
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, United States.,Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Biello KB, Marrow E, Mimiaga MJ, Sullivan P, Hightow-Weidman L, Mayer KH. A Mobile-Based App (MyChoices) to Increase Uptake of HIV Testing and Pre-Exposure Prophylaxis by Young Men Who Have Sex With Men: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e10694. [PMID: 30617042 PMCID: PMC6329428 DOI: 10.2196/10694] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/16/2018] [Accepted: 09/13/2018] [Indexed: 11/26/2022] Open
Abstract
Background HIV incidence is growing most rapidly in the United States among young men who have sex with men (YMSM). Overwhelming evidence demonstrates that routine testing and expanded use of pre-exposure prophylaxis (PrEP) would dramatically reduce the population burden of HIV; however, uptake of both interventions is suboptimal among young adults. The use of mobile phone apps by YMSM is ubiquitous and may offer unique opportunities for public health interventions. MyChoices is a theory-driven app to increase HIV testing and PrEP uptake. It was developed by an interdisciplinary team based on feedback from a diverse sample of YMSM. Objective The aim of this paper is to describe the protocol for the refinement, beta testing, and pilot randomized controlled trial (RCT) to examine the acceptability and feasibility of the MyChoices app. Methods This 3-phase study includes 4 theater testing groups for app refinement with a total of approximately 30 YMSM; for beta testing, including quantitative assessments and exit interviews, with approximately 15 YMSM over a 2-month period; and for a pilot RCT with 60 YMSM. The pilot will assess feasibility, acceptability, and preliminary efficacy of the MyChoices app, compared with referrals only, in increasing HIV testing and PrEP uptake. All participants will be recruited at iTech clinical research sites in Boston, MA, and Bronx, NY. Results App refinement is underway. Enrollment for the pilot RCT began in October 2018. Conclusions MyChoices is one of the first comprehensive, theory-driven HIV prevention apps designed specifically for YMSM. If MyChoices demonstrates acceptability and feasibility in this pilot RCT, a multicity, 3-arm randomized controlled efficacy trial of this app and another youth-optimized app (LYNX) versus standard of care is planned within iTech. If shown to be efficacious, the app will be scalable, with the ability to reach YMSM across the United States as well as be geographically individualized, with app content integrated with local prevention and testing activities. International Registered Report Identifier (IRRID) PRR1-10.2196/10694
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Affiliation(s)
- Katie B Biello
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, United States.,Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI, United States.,The Fenway Institute, Fenway Health, Boston, MA, United States.,Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | - Elliot Marrow
- The Fenway Institute, Fenway Health, Boston, MA, United States
| | - Matthew J Mimiaga
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, United States.,Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI, United States.,The Fenway Institute, Fenway Health, Boston, MA, United States.,Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Lisa Hightow-Weidman
- Behavior and Technology Lab, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, United States.,Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, United States
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66
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Zhang HL, Murthy B, Johnston B, Mortiboy M, Wu J, Samsa GP, Seña AC, McKellar MS. Public Awareness of HIV Pre-Exposure Prophylaxis in Durham, North Carolina: Results of a Community Survey. N C Med J 2019; 80:7-11. [PMID: 30622197 PMCID: PMC9970027 DOI: 10.18043/ncm.80.1.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Adoption of HIV pre-exposure prophylaxis (PrEP) remains limited among populations at greatest risk for HIV acquisition. This study aims to assess awareness of PrEP among individuals in Durham, North Carolina, which has one of the highest rates of HIV diagnoses in the state.METHOD In 2015-2016, we administered a survey including questions to assess PrEP awareness to individuals at multiple venues throughout Durham, North Carolina.RESULTS A total of 139 respondents were surveyed. The majority were male (66%) and black/African American (75%); 21% were Hispanic/Latino. There were an estimated 53 men who have sex with men (MSM), of which 18 (33%) were black MSM M 24 years of age. Overall, only 53/138 (38%) respondents were aware of PrEP. Awareness was reported among 33/52 (63%) MSM respondents, 29/46 (63%) black MSM, and 10/17 (59%) black MSM M 24 years of age. In multivariate analysis, non-heterosexual orientation, health-insured status, and prior HIV testing were significantly associated with PrEP awareness. Ninety-four (69%) of 137 respondents reported prior HIV testing.LIMITATIONS Limitations include non-random sampling and limited sample size. Further research needs to be done in other areas of North Carolina, and assessment of PrEP acceptability and uptake needs to be performed.CONCLUSION This study reveals low overall awareness of PrEP in Durham, North Carolina, indicating that expanded outreach is necessary to increase public awareness and encourage adoption of PrEP among all demographics at risk for HIV.
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Affiliation(s)
- Helen L. Zhang
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Bhavini Murthy
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Barbara Johnston
- Department of Medicine, Duke University Medical Center, Durham, North Carolina,Lincoln Community Health Center, Durham, North Carolina
| | - Marissa Mortiboy
- Durham County Department of Public Health, Durham, North Carolina
| | - Jiewei Wu
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Gregory P. Samsa
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Arlene C. Seña
- Durham County Department of Public Health, Durham, North Carolina,Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mehri S. McKellar
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
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Brinkley-Rubinstein L, Peterson M, Arnold T, Nunn AS, Beckwith CG, Castonguay B, Junious E, Lewis C, Chan PA. Knowledge, interest, and anticipated barriers of pre-exposure prophylaxis uptake and adherence among gay, bisexual, and men who have sex with men who are incarcerated. PLoS One 2018; 13:e0205593. [PMID: 30532275 PMCID: PMC6286000 DOI: 10.1371/journal.pone.0205593] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/27/2018] [Indexed: 11/19/2022] Open
Abstract
Criminal justice (CJ) settings disproportionately include populations at high risk for acquiring HIV, and CJ-involved individuals are often at the intersection of multiple overlapping risk factors. However, few studies have examined attitudes about pre-exposure prophylaxis (PrEP) among incarcerated men who have sex with men (MSM). This study explored interest in, knowledge of, and barriers to PrEP uptake among gay, bisexual, and other men who have sex with men at the Rhode Island Department of Corrections. Using semi-structured interviews, 26 MSM were interviewed about PrEP knowledge, interest, timing preferences for provision (e.g. before or after release), and barriers to uptake and adherence during community re-entry. Interviews were coded and analyzed using a general inductive approach. Participants demonstrated low initial knowledge of PrEP but high interest after being told more about it. Participants self-identified risk factors for HIV acquisition, including condomless sex and substance use. In addition, participants preferred provision of PrEP prior to release. Post-release barriers to PrEP uptake and adherence included 1) concerns about costs of PrEP medications; 2) anticipated partner or family disapproval; 3) lack of access to transportation; 4) unstable housing; 5) compounding impacts of multiple hardships leading to a de-prioritization of PrEP and 6) fears of future re-incarceration. These results point to the need for future PrEP interventions among incarcerated populations that address incarceration and PrEP related barriers during community re-entry via wraparound services that address PrEP and incarceration-related barriers.
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Affiliation(s)
- Lauren Brinkley-Rubinstein
- Department of Social Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Center for Health Equity Research, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Meghan Peterson
- Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, Rhode Island, United States of America
| | - Trisha Arnold
- Department of Psychology, Jackson State University, Jackson, Missouri, United States of America
- Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Amy S. Nunn
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
| | - Curt G. Beckwith
- Department of Medicine, Brown University, Providence, Rhode Island, United States of America
| | - Breana Castonguay
- Center for AIDS Research, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Eric Junious
- College of Health and Human Services, University of North Carolina, Charlotte, North Carolina, United States of America
| | - Chantal Lewis
- Center for Health Equity Research, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Philip A. Chan
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
- Department of Medicine, Brown University, Providence, Rhode Island, United States of America
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68
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Mosley T, Khaketla M, Armstrong HL, Cui Z, Sereda P, Lachowsky NJ, Hull MW, Olarewaju G, Jollimore J, Edward J, Montaner JSG, Hogg RS, Roth EA, Moore DM. Trends in Awareness and Use of HIV PrEP Among Gay, Bisexual, and Other Men who have Sex with Men in Vancouver, Canada 2012-2016. AIDS Behav 2018; 22:3550-3565. [PMID: 29344740 DOI: 10.1007/s10461-018-2026-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Gay, bisexual, and other men who have sex with men (gbMSM) are at the highest risk for HIV infection in British Columbia (BC). Pre-exposure prophylaxis (PrEP) has been recently licensed but is currently not publicly funded in BC. Using respondent-driven sampling, we recruited a cohort of gbMSM to complete a computer-assisted self-interview with follow-up every 6 months. Stratified by HIV status, we examined trends in awareness of PrEP from 11/2012 to 02/2016 and factors associated with PrEP awareness. 732 participants responded to the PrEP awareness question. Awareness of PrEP among HIV-negative men increased from 18 to 80% (p < 0.0001 for trend); among HIV-positive men, awareness increased from 36 to 77% (p < 0.0001). PrEP awareness was associated with factors related to HIV risk including sero-adaptive strategies and sexual sensation seeking. Eight HIV-negative men reported using PrEP. Low PrEP uptake highlights that PrEP access should be expanded for at-risk gbMSM in BC.
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Affiliation(s)
- Terrance Mosley
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
- The Momentum Health Study, 505-1200, Burrard St., Vancouver, BC, V6Z 1Z5, Canada.
| | - Moliehi Khaketla
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Heather L Armstrong
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Centre for Excellence, HIV/AIDS, Vancouver, BC, Canada
- The Momentum Health Study, 505-1200, Burrard St., Vancouver, BC, V6Z 1Z5, Canada
| | - Zishan Cui
- BC Centre for Excellence, HIV/AIDS, Vancouver, BC, Canada
| | - Paul Sereda
- BC Centre for Excellence, HIV/AIDS, Vancouver, BC, Canada
| | - Nathan J Lachowsky
- BC Centre for Excellence, HIV/AIDS, Vancouver, BC, Canada
- University of Victoria, Victoria, BC, Canada
- The Momentum Health Study, 505-1200, Burrard St., Vancouver, BC, V6Z 1Z5, Canada
| | - Mark W Hull
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Centre for Excellence, HIV/AIDS, Vancouver, BC, Canada
| | - Gbolahan Olarewaju
- BC Centre for Excellence, HIV/AIDS, Vancouver, BC, Canada
- The Momentum Health Study, 505-1200, Burrard St., Vancouver, BC, V6Z 1Z5, Canada
| | - Jody Jollimore
- Community-Based Research Centre for Gay Men's Health, Vancouver, BC, Canada
| | | | - Julio S G Montaner
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Centre for Excellence, HIV/AIDS, Vancouver, BC, Canada
| | - Robert S Hogg
- BC Centre for Excellence, HIV/AIDS, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- The Momentum Health Study, 505-1200, Burrard St., Vancouver, BC, V6Z 1Z5, Canada
| | - Eric A Roth
- University of Victoria, Victoria, BC, Canada
- The Momentum Health Study, 505-1200, Burrard St., Vancouver, BC, V6Z 1Z5, Canada
| | - David M Moore
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Centre for Excellence, HIV/AIDS, Vancouver, BC, Canada
- The Momentum Health Study, 505-1200, Burrard St., Vancouver, BC, V6Z 1Z5, Canada
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69
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Halkitis PN, Jaiswal J, Griffin-Tomas M, Krause KD, D'Avanzo P, Kapadia F. Beliefs About the End of AIDS, Concerns About PrEP Functionality, and Perceptions of HIV Risk as Drivers of PrEP Use in Urban Sexual Minority Men: The P18 Cohort Study. AIDS Behav 2018; 22:3705-3717. [PMID: 29971731 PMCID: PMC10976398 DOI: 10.1007/s10461-018-2218-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Using cross-sectional data from an ongoing cohort study of young gay, bisexual, and other men who have sex with men (N = 492), we examined the extent to which cognitive factors such as beliefs about the end of AIDS, concerns about the manner in which PrEP works, and perceptions about risk of contracting HIV, are related to PrEP uptake and use. While almost all participants indicted awareness of PrEP, a mere 14% had ever used PrEP. Those with lower concerns about the side effects of PrEP and greater belief that treatment and PrEP would eliminate AIDS were also more likely to have ever used PrEP. Our findings support the ongoing challenges of PrEP uptake as means of curtailing HIV in young sexual minority men, and suggest that beyond the structural factors, consideration must be given to further educating the population as a means of adjusting potentially faulty beliefs, concerns, and perceptions which may influence PrEP utilization.
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Affiliation(s)
- Perry N Halkitis
- Department of Biostatistics, Rutgers School of Public Health, Rutgers University, 683 Hoes Lane West, Piscataway, NJ, 08854, USA.
- Department of Social and Behavioral Health Sciences, Rutgers University, 683 Hoes Lane West, Piscataway, NJ, 08854, USA.
- Center for Health, Identity, Behavior & Prevention Studies, 65 Bergen St, Newark, 07107, NJ, USA.
- Graduate School of Applied & Professional Psychology, Rutgers University, 152 Frelinghuysen Road, Busch Campus, Piscataway, NJ, 08854, USA.
- Robert Wood Johnson School of Medicine, Rutgers University, 675 Hoes Ln W, Piscataway, NJ, 08854, USA.
- School of Public Policy and Administration, Rutgers University, 401 Cooper Street, Camden, NJ, 08102, USA.
| | - Jessica Jaiswal
- Center for Health, Identity, Behavior & Prevention Studies, 65 Bergen St, Newark, 07107, NJ, USA
- Center for Interdisciplinary Research on AIDS, Yale University, 135 College St., Ste. 200, New Haven, CT, 06510, USA
| | - Marybec Griffin-Tomas
- Center for Health, Identity, Behavior & Prevention Studies, 65 Bergen St, Newark, 07107, NJ, USA
| | - Kristen D Krause
- Center for Health, Identity, Behavior & Prevention Studies, 65 Bergen St, Newark, 07107, NJ, USA
| | - Paul D'Avanzo
- Center for Health, Identity, Behavior & Prevention Studies, 65 Bergen St, Newark, 07107, NJ, USA
- College of Public Health, Temple University, 1101 W. Montgomery Ave, Philadelphia, PA, 19122, USA
| | - Farzana Kapadia
- Center for Health, Identity, Behavior & Prevention Studies, 65 Bergen St, Newark, 07107, NJ, USA
- Department of Epidemiology, College of Global Public Health, New York University, 719 Broadway, 10th Floor, New York, NY, 10003, USA
- Department of Population Health, School of Medicine, New York University, 227 East 30th Street, New York, NY, 10016, USA
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70
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Dubov A, Altice FL, Fraenkel L. An Information-Motivation-Behavioral Skills Model of PrEP Uptake. AIDS Behav 2018; 22:3603-3616. [PMID: 29557540 DOI: 10.1007/s10461-018-2095-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Despite documented effectiveness of pre-exposure prophylaxis (PrEP), PrEP uptake remains low among at-risk populations. The 2015 CDC report estimates that about 1.2 million people in the US have indications for PrEP. However, only 49,158 or 4% of the targeted population are currently using PrEP. Efforts to optimize uptake of PrEP may be facilitated by the development of a comprehensive theoretical framework which can be used to understand reasons for poor uptake and to develop interventions to maximize PrEP uptake and adherence. This article reviews research on correlates of PrEP uptake and presents findings organized within an Information-Motivation-Behavioral Skills (IMB) model framework. In the context of PrEP uptake, the IMB model asserts that to the extent that at-risk groups are well-informed about PrEP, motivated to act on their knowledge, and have necessary behavioral skills to seek out and initiate PrEP regimen, they will successfully overcome obstacles to initiate and adhere to PrEP. The article proposes an adaptation the IMB model for PrEP uptake, provides empirical support for the adapted IMB model extracted from related research, and discusses its application in PrEP uptake interventions.
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71
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Biskupiak A, Smith S, Kushalnagar P. Pre-Exposure Prophylaxis Knowledge and Perceived Effectiveness to Prevent HIV Among Deaf Gay, Bisexual, and Queer Men. LGBT Health 2018; 5:469-476. [PMID: 30383466 DOI: 10.1089/lgbt.2018.0102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose: There have been recent advances to the adoption of pre-exposure prophylaxis (PrEP) as an effective human immunodeficiency virus (HIV) preventive treatment among men who have sex with men, but PrEP services and resources are often not accessible to those who are deaf and use American Sign Language (ASL). This article investigates PrEP knowledge among deaf gay, bisexual, and queer (GBQ) men and the contribution of social support to their perceptions regarding the effectiveness of PrEP at preventing HIV. Methods: An online health survey in ASL and English included questions about sexual orientation, HIV testing, PrEP knowledge and perceived effectiveness at preventing HIV, coming out to healthcare providers, and social support. We gathered data from 121 deaf GBQ men recruited from diverse cities in the United States, with 87% self-identifying as gay. Logistic regression analyses were used to examine the relationships between self-reported level of social support and perceived effectiveness of PrEP at preventing HIV after controlling for sociodemographic and health-related variables. Results: There was a significant relationship between meeting new lesbian, gay, bisexual, transgender, and queer (LGBTQ) friends online and PrEP knowledge (χ2 = 14.93; p < 0.001). After controlling for sociodemographic and health-related variables, those who discussed LGBT-related issues online and/or on a social networking site regularly were threefold more likely to perceive PrEP as being effective at preventing HIV than those who did not engage in online discussions (odds ratio = 3.12; 95% confidence interval: 1.12-8.75). Conclusion: For deaf GBQ men, PrEP knowledge might be attained through meeting and making new LGBTQ friends online. Active engagement in online discussions about LGBT-related issues might enhance perceptions regarding the effectiveness of PrEP to prevent HIV.
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Affiliation(s)
- Andrew Biskupiak
- Deaf Health Communication and Quality of Life Center, Gallaudet University, Washington, District of Columbia
| | - Scott Smith
- National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, New York
| | - Poorna Kushalnagar
- Deaf Health Communication and Quality of Life Center, Gallaudet University, Washington, District of Columbia.,Department of Psychology, Gallaudet University, Washington, District of Columbia
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72
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Pinto RM, Berringer KR, Melendez R, Mmeje O. Improving PrEP Implementation Through Multilevel Interventions: A Synthesis of the Literature. AIDS Behav 2018; 22:3681-3691. [PMID: 29872999 PMCID: PMC6208917 DOI: 10.1007/s10461-018-2184-4] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There are many challenges to accessing PrEP and thus low uptake in the United States. This review (2007–2017) of PrEP implementation identified barriers to PrEP and interventions to match those barriers. The final set of articles (n = 47) included content on cognitive aspects of HIV service providers and individuals at risk for infection, reviews, and case studies. Cognitive barriers and interventions regarding patients and providers included knowledge, attitudes, and beliefs about PrEP. The “purview paradox” was identified as a key barrier—HIV specialists often do not see HIV-negative patients, while primary care physicians, who often see uninfected patients, are not trained to provide PrEP. Healthcare systems barriers included lack of communication about, funding for, and access to PrEP. The intersection between PrEP-stigma, HIV-stigma, transphobia, homophobia, and disparities across gender, racial, and ethnic groups were identified; but few interventions addressed these barriers. We recommend multilevel interventions targeting barriers at multiple socioecological domains.
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Affiliation(s)
- Rogério M Pinto
- School of Social Work, University of Michigan, Ann Arbor, MI, USA.
- University of Michigan School of Social Work, Room 2850, 1080 South University, Ann Arbor, MI, 48109, USA.
| | | | - Rita Melendez
- Sociology and Sexuality Studies, San Francisco State University, San Francisco, CA, USA
| | - Okeoma Mmeje
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
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73
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Biello KB, Hosek S, Drucker MT, Belzer M, Mimiaga MJ, Marrow E, Coffey-Esquivel J, Brothers J, Mayer KH. Preferences for Injectable PrEP Among Young U.S. Cisgender Men and Transgender Women and Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:2101-2107. [PMID: 28929260 DOI: 10.1007/s10508-017-1049-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 06/02/2017] [Accepted: 07/19/2017] [Indexed: 05/25/2023]
Abstract
Young men who have sex with men account for approximately 20% of incident HIV infections in the U.S. Antiretroviral pre-exposure prophylaxis (PrEP) administered as a daily pill has been shown to decrease HIV acquisition in at-risk individuals. New modalities for PrEP are being developed and tested, including injectable PrEP; however, acceptability of these emerging modalities has not yet been examined in youth. We conducted six focus groups with 36 young men and transgender men and women who have sex with men in Boston, Chicago, and Los Angeles in 2016 to assess interest in and preference for different PrEP modalities. Youth were purposively recruited based on diversity of age, race/ethnicity, and prior PrEP experience. Data were coded using content coding based on key domains of the interview guide, in particular around the central themes of interest in and barriers and facilitators to injectable PrEP use. Participants were knowledgeable about oral PrEP but suggested barriers to broader uptake, including stigma, marginalization, and access to information. While participants were split on preference for injectable versus oral PrEP, they agreed quarterly injections may be more manageable and better for those who have adherence difficulties and for those who engage in sex more frequently. Concerns specific to injectable PrEP included: severity/duration of side effects, pain, level of protection prior to next injection, distrust of medical system and injections, and cost. Understanding barriers to and preferences for diverse prevention modalities will allow for more HIV prevention options, improved products, and better interventions, thus allowing individuals to make informed HIV prevention choices.
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Affiliation(s)
- Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, 02912, USA.
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
- Center for Health Equity Research, Brown University, Providence, RI, USA.
| | - Sybil Hosek
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, IL, USA
| | | | - Marvin Belzer
- Division of Adolescent Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Matthew J Mimiaga
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, 02912, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Center for Health Equity Research, Brown University, Providence, RI, USA
| | - Elliot Marrow
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | - Jennifer Brothers
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, IL, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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74
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Underhill K, Guthrie KM, Colleran C, Calabrese SK, Operario D, Mayer KH. Temporal Fluctuations in Behavior, Perceived HIV Risk, and Willingness to Use Pre-Exposure Prophylaxis (PrEP). ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:2109-2121. [PMID: 29327091 PMCID: PMC6041197 DOI: 10.1007/s10508-017-1100-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 07/25/2017] [Accepted: 10/11/2017] [Indexed: 06/07/2023]
Abstract
Individual perceptions of HIV risk influence willingness to use pre-exposure prophylaxis (PrEP) for HIV prevention. Among men who have sex with men (MSM) and male sex workers (MSWs), temporal or episodic changes in risk behavior may influence perceived risk and PrEP acceptability over time. We investigated fluctuations in perceived HIV risk and PrEP acceptability, comparing MSWs against MSM who do not engage in sex work. We conducted 8 focus groups (n = 38) and 56 individual interviews among MSM and MSWs in Providence, RI. Perceived HIV risk shaped willingness to use PrEP among both MSWs and MSM who did not engage in sex work, and risk perceptions changed over time depending on behavior. For MSWs, perceived risk cycled according to patterns of substance use and sex work activity. These cycles yielded an "access-interest paradox": an inverse relationship between willingness to use and ability to access PrEP. MSM who did not engage in sex work also reported temporal shifts in risk behavior, perceived risk, and willingness to use PrEP, but changes were unrelated to access. MSM attributed fluctuations to seasonal changes, vacations, partnerships, behavioral "phases," and episodic alcohol or drug use. Efforts to implement PrEP among MSM and street-based MSWs should address temporal changes in willingness to use PrEP, which are linked to perceived risk. Among MSWs, confronting the access-interest paradox may require intensive outreach during high-risk times and efforts to address low perceived risk during times of reduced sex work.
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Affiliation(s)
- Kristen Underhill
- Columbia Law School, Columbia University, 435 W 116th St., New York, NY, 10027, USA.
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Kate M Guthrie
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Christopher Colleran
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Sarah K Calabrese
- Department of Psychology, George Washington University, Washington, DC, USA
| | - Don Operario
- School of Public Health, Brown University, Providence, RI, USA
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75
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Geographic and Individual Associations with PrEP Stigma: Results from the RADAR Cohort of Diverse Young Men Who have Sex with Men and Transgender Women. AIDS Behav 2018; 22:3044-3056. [PMID: 29789985 DOI: 10.1007/s10461-018-2159-5] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Increasing the uptake of pre-exposure prophylaxis (PrEP) to prevent HIV acquisition among at-risk populations, such as young men who have sex with men (YMSM), is of vital importance to slowing the HIV epidemic. Stigma and negative injunctive norms, such as the so called "Truvada Whore" phenomenon, hamper this effort. We examined the prevalence and types of PrEP stigma and injunctive norm beliefs among YMSM and transgender women and associated individual and geospatial factors. A newly created measure of PrEP Stigma and Positive Attitudes was administered to 620 participants in an ongoing longitudinal cohort study. Results indicated lower stigma among White, compared to Black and Latino participants, and among participants not identifying as male. Prior knowledge about PrEP was associated with lower stigma and higher positive attitudes. PrEP stigma had significant geospatial clustering and hotspots were identified in neighborhoods with high HIV incidence and concentration of racial minorities, whereas coldspots were identified in areas with high HIV incidence and low LGBT stigma. These results provide important information about PrEP attitudes and how PrEP stigma differs between individuals and across communities.
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76
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Dubov A, Galbo P, Altice FL, Fraenkel L. Stigma and Shame Experiences by MSM Who Take PrEP for HIV Prevention: A Qualitative Study. Am J Mens Health 2018; 12:1843-1854. [PMID: 30160195 PMCID: PMC6199453 DOI: 10.1177/1557988318797437] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) uptake has been extremely low among key groups. PrEP-related stigma and shaming are potential barriers to uptake and retention in PrEP programs. There is a lack of literature describing PrEP stigma. In order to fill this gap, we recruited online 43 HIV-negative Men who have Sex with Men (MSM) who use PrEP. Semistructured interviews were conducted to explore their perceptions and experience of stigma related to PrEP use. Data were analyzed using Strauss and Corbin's grounded theory and constant comparison techniques to enhance understanding of the lived experiences of MSM who use PrEP. The participants experienced PrEP stigma as rejection by potential/actual partners, stereotypes of promiscuity or chemsex, and labeling of both the user and the medication. They connected PrEP stigma with HIV stigma, generational differences, moralization of condom use, and inability to embrace one's own sexuality. These findings point to a need to develop tailored interventions to address PrEP-related stigma and shaming for individuals, health-care professionals, and the MSM community-at-large.
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Affiliation(s)
- Alex Dubov
- 1 Assistant Professor, Loma Linda University School of Public Health, Sanitarium Dr. Loma Linda, CA, USA
| | - Phillip Galbo
- 2 Department of Neuro-Oncology, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, USA
| | - Frederick L Altice
- 3 Professor of Medicine and Public Health, Director of Clinical and Community Research, Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Liana Fraenkel
- 4 Professor of Medicine, Yale University School of Medicine, Section of Rheumatology, New Haven, CT, USA
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77
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Patel VV, Ginsburg Z, Golub SA, Horvath KJ, Rios N, Mayer KH, Kim RS, Arnsten JH. Empowering With PrEP (E-PrEP), a Peer-Led Social Media-Based Intervention to Facilitate HIV Preexposure Prophylaxis Adoption Among Young Black and Latinx Gay and Bisexual Men: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e11375. [PMID: 30154071 PMCID: PMC6134229 DOI: 10.2196/11375] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 11/15/2022] Open
Abstract
Background Young black and Latinx, gay, bisexual, and other men who have sex with men (YBLGBM, aged 18-29 years) have among the highest rates of new HIV infections in the United States and are not consistently reached by existing prevention interventions. Preexposure prophylaxis (PrEP), an oral antiretroviral regimen taken daily by HIV-uninfected individuals to prevent HIV acquisition, is highly efficacious in reducing HIV acquisition and could help stop the HIV epidemic in YBLGBM. Use of social media (eg, Facebook, Twitter, online dating sites) is ubiquitous among young people, providing an efficient avenue to engage YBLGBM to facilitate PrEP adoption. Objective Our overall goal was to develop and pilot test a theoretically grounded, social media–based, peer-led intervention to increase PrEP uptake in YBLGBM. We used diffusion of innovation and information-motivation-behavioral skills frameworks to (1) identify potential factors associated with interest in and adoption of PrEP among YBLGBM; (2) develop Empowering with PrEP (E-PrEP), a social media–based, peer-led intervention to increase PrEP uptake in YBLGBM; and (3) pilot test the feasibility and acceptability of E-PrEP, and determine its preliminary efficacy for increasing adoption of PrEP by YBLGBM. We describe the development and protocol for E-PrEP. Methods Using a participatory research approach, we partnered with YBLGBM intervention development partners to develop a social media–based behavioral intervention to facilitate PrEP uptake, which involved an online messaging campaign disseminated by YBLGBM peer leaders to their existing online networks. We designed the 6-week campaign to provide education about PrEP, increase motivation to use PrEP, and facilitate access to PrEP. We then conducted a cluster-randomized trial of E-PrEP compared with an attention-matched general health control condition (E-Health) among YBLGBM aged 18 to 29 years to assess E-PrEP’s feasibility, acceptability, preliminary efficacy for increasing self-reported intention to use PrEP, PrEP uptake, and impact on knowledge and attitudes about PrEP at 12-week follow-up (6 weeks after the end of the online campaign). Results From October 2016 to March 2017, we developed, pretested, and refined E-PrEP with 6 YBLGBM intervention development partners. From May to June 2017, we recruited, enrolled, and randomly assigned 10 peer leaders (n=5 for each condition). The 10 peer leaders then recruited and enrolled 152 participants from their existing online networks (range 3-33 per peer leader), during June and July 2017. Intervention follow-up was completed after 12 weeks, in November 2017, with analyses underway. Conclusions We hypothesize that, compared with E-Health, participants randomly assigned to E-PrEP will be more likely to express intention to use PrEP and greater PrEP uptake, and will also show changes in potential mediators of PrEP uptake (knowledge, attitudes, stigma, and access). A Web-based biobehavioral intervention model such as E-PrEP could be rapidly scaled even with limited resources and have significant population-level impact. Trial Registration ClinicalTrials.gov NCT03213366; https://clinicaltrials.gov/ct2/show/NCT03213366 (Archived by WebCite at http://www.webcitation.org/71onSdcXY) Registered Report Identifier RR1-10.2196/11375
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Affiliation(s)
- Viraj V Patel
- Division of General Internal Medicine, Department of Medicine, Montefiore Health System / Albert Einstein College of Medicine, Bronx, NY, United States
| | - Zoë Ginsburg
- Department of Family Medicine, Swedish Cherry Hill Campus, Swedish Medical Center, Seattle, WA, United States
| | - Sarit A Golub
- Hunter HIV/AIDS Research Team, Department of Psychology, Hunter College, City University of New York, New York, NY, United States
| | - Keith J Horvath
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Nataly Rios
- Division of General Internal Medicine, Department of Medicine, Montefiore Health System / Albert Einstein College of Medicine, Bronx, NY, United States
| | - Kenneth H Mayer
- The Fenway Institute, Boston, MA, United States.,Infectious Disease Fellowship, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Ryung S Kim
- Division of General Internal Medicine, Department of Medicine, Montefiore Health System / Albert Einstein College of Medicine, Bronx, NY, United States
| | - Julia H Arnsten
- Division of General Internal Medicine, Department of Medicine, Montefiore Health System / Albert Einstein College of Medicine, Bronx, NY, United States
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78
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Hightow-Weidman LB, Muessig K, Rosenberg E, Sanchez T, LeGrand S, Gravens L, Sullivan PS. University of North Carolina/Emory Center for Innovative Technology (iTech) for Addressing the HIV Epidemic Among Adolescents and Young Adults in the United States: Protocol and Rationale for Center Development. JMIR Res Protoc 2018; 7:e10365. [PMID: 30076126 PMCID: PMC6098243 DOI: 10.2196/10365] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/02/2018] [Accepted: 05/08/2018] [Indexed: 01/09/2023] Open
Abstract
Background Over a fifth of all new HIV infections in the United States occur among persons aged 13 24 years, with most of these diagnoses occurring among gay and bisexual males (81%). While the epidemic of HIV in the United States has leveled off for many age groups, the annual number of new HIV diagnoses among young men who have sex with men (YMSM; 13-24 years old) remains high. Traditional approaches to continuum improvement for youth have been insufficient, and targeted interventions are urgently needed for young people at risk for or infected with HIV. Interventions delivered through mobile health technology represent a promising approach for improving outcomes in this population. Mobile phones have nearly reached saturation among youth, making mobile technology a particularly promising tool for reaching this population. Objective The University of North Carolina/Emory Center for Innovative Technology (iTech) is a National Institutes of Health cooperative agreement as part of the Adolescent Medicine Trials Network for HIV/AIDS Interventions. iTech aims to impact the HIV epidemic by conducting innovative, interdisciplinary research on technology-based interventions across the HIV prevention and care continuum for adolescents and young adults in the United States, particularly YMSM, by providing the following: (1) evaluation of novel approaches to identifying youth with undiagnosed HIV infections; (2) evaluation of multilevel, combination prevention approaches, particularly relevant to gender- and sexual-minority youth facing co-occurring health risks; (3) evaluation of uptake of and adherence to biomedical prevention modalities; and 4) evaluation of interventions designed to promote or optimize engagement in care and antiretroviral therapy adherence in HIV-positive youth, to optimize viral load suppression. Methods iTech brings together multidisciplinary experts in the fields of adolescent HIV treatment and prevention, development and evaluation of technology-based interventions, HIV surveillance and epidemiology, and intervention design and evaluation. This initiative will support 8 efficacy trials and 2 exploratory projects, each led by 2 principal investigators. Taken together, the studies address all of the key steps of the HIV prevention and care continuum for youth in the United States. Each proposal uses technology in a scientifically rigorous and innovative way to access, engage, and impact at-risk or infected youth. Nine iTech subject recruitment venues are spread across 8 US cities. Three cores (management, analytic, and technology) support all iTech activities and form the research network’s infrastructure, facilitating all aspects of study implementation and evaluation. Results Formative work has already begun on many of the above-mentioned iTech trials. We expect the first randomized controlled trials to begin in mid-2018. Additional details can be found in the individual intervention protocol papers in this issue. Conclusions Through its comprehensive research portfolio, iTech aims to effectively advance HIV prevention and care for youth through technology-based, youth-relevant interventions that maximize adaptability and sustainability. Registered Report Identifier RR1-10.2196/10365
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Affiliation(s)
- Lisa B Hightow-Weidman
- Behavior and Technology Lab, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kathryn Muessig
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Eli Rosenberg
- Department of Epidemiology and Biostatistics, State University of New York at Albany, Albany, NY, United States
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Sara LeGrand
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Laura Gravens
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Getty CA, Subramaniam S, Holtyn AF, Jarvis BP, Rodewald A, Silverman K. Evaluation of a Computer-Based Training Program to Teach Adults at Risk for HIV About Pre-Exposure Prophylaxis. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:287-300. [PMID: 30148669 PMCID: PMC6247787 DOI: 10.1521/aeap.2018.30.4.287] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study developed a computer-based program to teach HIV prevention behaviors and raise awareness of pre-exposure prophylaxis (PrEP) among individuals at risk for HIV. The program was divided into modules containing educational material and multiple-choice questions. Participants received immediate feedback for responses and incentives for correct responses to multiple-choice questions. Participants trained on each module until they met speed and accuracy criteria. The modules were divided into: Course 1 (HIV), Course 2 (PrEP), and Course 3 (HIV risk behaviors). Tests of content from all three courses were delivered before and after participants completed each course. Test scores on the content delivered in the courses improved only after participants completed training on each course. HIV and PrEP knowledge was initially low and increased following completion of each part of the program. Computer-based training offers a convenient and effective approach to promoting HIV prevention knowledge, including use of PrEP.
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Affiliation(s)
- Carol-Ann Getty
- Ulster University, Psychology Department, Coleraine, Northern Ireland, UK
- Johns Hopkins University School of Medicine, Center for Learning and Health, Department of Psychiatry & Behavioral Sciences, Baltimore, USA
- King’s College London, Addictions Department, London, UK
| | - Shrinidhi Subramaniam
- Johns Hopkins University School of Medicine, Center for Learning and Health, Department of Psychiatry & Behavioral Sciences, Baltimore, USA
| | - August F. Holtyn
- Johns Hopkins University School of Medicine, Center for Learning and Health, Department of Psychiatry & Behavioral Sciences, Baltimore, USA
| | - Brantley P. Jarvis
- Johns Hopkins University School of Medicine, Center for Learning and Health, Department of Psychiatry & Behavioral Sciences, Baltimore, USA
| | - Andrew Rodewald
- Johns Hopkins University School of Medicine, Center for Learning and Health, Department of Psychiatry & Behavioral Sciences, Baltimore, USA
| | - Kenneth Silverman
- Johns Hopkins University School of Medicine, Center for Learning and Health, Department of Psychiatry & Behavioral Sciences, Baltimore, USA
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80
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van den Berg JJ, Silverman T, Fernandez MI, Henny KD, Gaul ZJ, Sutton MY, Operario D. Using eHealth to Reach Black and Hispanic Men Who Have Sex With Men Regarding Treatment as Prevention and Preexposure Prophylaxis: Protocol for a Small Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e11047. [PMID: 30012549 PMCID: PMC6066633 DOI: 10.2196/11047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Black and Hispanic men who have sex with men in the United States continue to be disproportionately affected by HIV and AIDS. Uptake of and knowledge about biobehavioral HIV prevention approaches, such as treatment as prevention and preexposure prophylaxis, are especially low in these populations. eHealth campaigns and social media messaging about treatment as prevention and preexposure prophylaxis may help to fill this gap in knowledge and lead to increased uptake of such strategies; however, no evidence exists of the effects of these targeted forms of communication on treatment as prevention and preexposure prophylaxis uptake in these populations. OBJECTIVE We describe the protocol for a 3-part study aiming to develop and evaluate an eHealth intervention with information about treatment as prevention and preexposure prophylaxis for HIV-positive and HIV-negative black and Hispanic men who have sex with men. METHODS Phases 1 and 2 will involve focus groups and cognitive interviews with members of the target populations, which we will use to create a culturally tailored, interactive website and applicable social media messaging for these men. Phase 3 will be a small randomized controlled trial of the eHealth intervention, in which participants will receive guided social media messages plus the newly developed website (active arm) or the website alone (control arm), with assessments at baseline and 6 months. RESULTS Participant recruitment began in August 2017 and will end in August 2020. CONCLUSIONS Public health interventions are greatly needed to increase knowledge about and uptake of biobehavioral HIV prevention strategies such as treatment as prevention and preexposure prophylaxis among black and Hispanic men who have sex with men. eHealth communication campaigns offer a strategy for engaging these populations in health communication about biobehavioral HIV prevention. TRIAL REGISTRATION ClinicalTrials.gov NCT03404531; https://www.clinicaltrials.gov/ct2/show/NCT03404531 (Archived by WebCite at http://www.webcitation.org/70myofp0R). REGISTERED REPORT IDENTIFIER RR1-10.2196/11047.
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Affiliation(s)
- Jacob J van den Berg
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States
| | - Taylor Silverman
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States
| | - M Isabel Fernandez
- College of Osteopathic Medicine, Division of Health Professions, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Kirk D Henny
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Zaneta J Gaul
- Centers for Disease Control and Prevention, Atlanta, GA, United States.,ICF, Atlanta, GA, United States
| | - Madeline Y Sutton
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Don Operario
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States
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81
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Brennan DJ, Souleymanov R, Lachowsky N, Betancourt G, Pugh D, McEwen O. Providing Online-Based Sexual Health Outreach to Gay, Bisexual, and Queer Men in Ontario, Canada: Qualitative Interviews with Multisectoral Frontline Service Providers and Managers. AIDS Patient Care STDS 2018; 32:282-287. [PMID: 29897787 DOI: 10.1089/apc.2018.0027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The Internet is a common tool for gay, bisexual, and other men who have sex with men (MSM) to find sexual partners and sexual health information. Given persistently high human immunodeficiency virus (HIV) infection rates among MSM, it is important to examine the role of online outreach for MSM as part of HIV prevention and care. We provide an overview of the unique perspectives of online sexual health outreach, delivered through AIDS Service Organizations (ASOs) through sociosexual Internet sites and mobile applications. Data were drawn from the qualitative arm of the community-based Cruising Counts study conducted across Ontario from December 2013 to January 2014. ASO online outreach providers and managers (n = 22) were recruited to complete a 1-h in-person/telephone interview to explore in-depth their experiences with, and perspectives on, delivering online outreach services for MSM in Ontario. Thematic analyses were conducted inductively using NVivo 10. Service providers suggested a high demand for online outreach services for MSM. Strengths and advantages of online outreach over face-to-face outreach included anonymity, instant access to services, peer model, and accessing hard-to-reach populations of MSM. Barriers included consistent quality of service, collaborations between companies that own online technologies and outreach service agencies, budgetary and staff capacity issues, and uncertainty of best practices and evaluation parameters for online outreach. Findings from these interviews can inform service providers, policy makers, and researchers on how online sexual health outreach can play a greater role in HIV prevention by better acknowledging and addressing the opportunities and barriers experienced by service providers working with MSM communities online.
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Affiliation(s)
- David J. Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- Ontario HIV Treatment Network, Toronto, Canada
| | - Rusty Souleymanov
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Nathan Lachowsky
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Gerardo Betancourt
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
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82
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Rivierez I, Quatremere G, Spire B, Ghosn J, Rojas Castro D. Lessons learned from the experiences of informal PrEP users in France: results from the ANRS-PrEPage study. AIDS Care 2018; 30:48-53. [PMID: 29848005 DOI: 10.1080/09540121.2018.1468014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Before January 2016, Pre-Exposure Prophylaxis (PrEP), a new biomedical HIV-prevention tool, was only available in France via ANRS-Ipergay clinical study but informal use was reported outside this setting. PrEPage qualitative study reports profiles and experiences of participants who used PrEP outside of a biomedical trial before this prevention method was authorized. Between March 2015 and February 2016, a cross-section of twenty-four informal PrEP users, mostly MSM, was recruited to complete in-depth semi-structured interviews. While ANRS-Ipergay was still ongoing (2012-2016), participants described their initiation to PrEP, the way they used it and the difficulties they faced to acquire antiretroviral drugs in an environment where PrEP was still not widely known and often criticized . Through the testimonies, different user profiles and motivation toward informal PrEP use emerged: (a) participants who have increasing difficulties using condoms, (b) "opportunists" who tried PrEP without the intention of using it regularly and (c) participants with a risk aversion who sought additional protection against HIV. Participants chose to use PrEP and/or their usual prevention strategies depending on available supplies, type of partners and individual attitudes toward risk. The feeling of living a safer sex life helped participants to outweigh the fear of possible toxicity and drug resistance. Participants' needs and expectations about PrEP implementation in France were also presented.
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Affiliation(s)
- I Rivierez
- a AIDES, Community Based Research Department , Pantin , France.,b Paris Descartes University, UMR 8070, CERLIS , Paris , France
| | - G Quatremere
- a AIDES, Community Based Research Department , Pantin , France
| | - B Spire
- c Aix Marseille University, INSERM, IRD, SESSTIM , Marseille , France
| | - J Ghosn
- d APHP, Department of Infectious Diseases , Bichat University Hospital , Paris , France.,e IAME, UMR 1137, INSERM, Paris Diderot University, Sorbonne Paris Cité , Paris , France
| | - D Rojas Castro
- c Aix Marseille University, INSERM, IRD, SESSTIM , Marseille , France.,f Coalition PLUS, Research Department , Pantin , France.,g Lyon 2 University, GRePS EA 4163 , Lyon , France
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83
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High prevalence of syndemic health problems in patients seeking post-exposure prophylaxis for sexual exposures to HIV. PLoS One 2018; 13:e0197998. [PMID: 29791514 PMCID: PMC5965882 DOI: 10.1371/journal.pone.0197998] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 05/11/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction The standard clinical approach to non-occupational HIV post-exposure prophylaxis (nPEP) focuses on biomedical aspects of the intervention, but may overlook co-occurring or ‘syndemic’ psychosocial problems that reinforce future vulnerability to HIV. We therefore sought to determine the prevalence of syndemic health problems in a cohort of Ontario nPEP patients, and explored the relationship between syndemic burden and HIV risk. Methods Between 07/2013-08/2016, we distributed a self-administered questionnaire to patients presenting to three clinics in Toronto and Ottawa seeking nPEP for sexual HIV exposures. We used validated screening tools to estimate the prevalence of depression (CES-D score ≥16), harmful alcohol use (AUDIT ≥8), problematic drug use (DUDIT ≥6 men/≥2 women), and sexual compulsivity (SCS ≥24) among men who have sex with men (MSM) respondents. In exploratory analyses, we examined the relationships between syndemic conditions using univariable logistic regression models, and the relationship between syndemic count (total number of syndemic conditions per participant) and HIV risk, as estimated by the HIRI-MSM score, using linear regression models. Results The 186 MSM included in the analysis had median age 31 (IQR = 26–36), including 87.6% having a college/undergraduate degree or higher. Overall, 53.8% screened positive for depression, 34.4% for harmful alcohol use, 30.1% for problematic drug use, and 16.1% for sexual compulsivity. Most participants (74.2%) had at least one syndemic condition and 46.8% had more than one. Exploratory analyses suggested positive associations between depression and harmful alcohol use (OR = 2.11, 95%CI = 1.13, 3.94) and between harmful alcohol use and problematic drug use (OR = 1.22, 95%CI = 0.65, 2.29). Syndemic count was associated with increased HIRI-MSM risk scores in univariable (2.2, 95%CI = 1.0, 3.3 per syndemic condition) and multivariable (2.1, 95%CI = 0.6, 3.6) linear regression models. Conclusions The prevalence of syndemic conditions in MSM seeking nPEP for sexual exposure is alarmingly high, and is associated with underlying HIV risk. Routine screening for these conditions may identify opportunities for intervention and could alleviate future vulnerability to HIV.
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84
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Willie TC, Stockman JK, Overstreet NM, Kershaw TS. Examining the Impact of Intimate Partner Violence Type and Timing on Pre-exposure Prophylaxis Awareness, Interest, and Coercion. AIDS Behav 2018; 22:1190-1200. [PMID: 28887703 DOI: 10.1007/s10461-017-1901-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Previous research suggests that intimate partner violence (IPV) is associated with acceptability of and adherence to pre-exposure prophylaxis (PrEP). However, very few studies have examined whether the type (i.e., physical, sexual, and psychological IPV) and timing (i.e., lifetime, past-year) of IPV experiences differentially relate to PrEP awareness, interest, and perceived PrEP coercion. Therefore, the objective of this study is to examine associations between lifetime and past-year physical, sexual, and psychological IPV experiences on PrEP awareness, interest, and perceived PrEP coercion. Data were collected from an online survey administered to 210 women and men. Past-year physical IPV experiences (AOR 4.53, 95% CI 1.85, 11.11) were significantly associated with being interested in using PrEP. Lifetime sexual (AOR 3.69, 95% CI 1.62, 8.40), psychological IPV (AOR 4.70, 95% CI 1.01, 21.89), and past-year sexual IPV experiences (AOR 3.01, 95% CI 1.10, 8.27) were also significantly associated with believing a recent partner would attempt to control the participant's use of PrEP, if she or he were currently using it. Understanding that engaging in PrEP care is influenced differently by the type and timing of IPV has potential implications for PrEP candidacy guidelines and interventions.
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Affiliation(s)
- Tiara C Willie
- School of Public Health, Yale University, 60 College Street, P.O. Box 208034, New Haven, CT, 06520, USA.
- Yale Center for Interdisciplinary Research on AIDS, 135 College Street, Suite 200, New Haven, CT, 06510-2483, USA.
| | - Jamila K Stockman
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Nicole M Overstreet
- Department of Psychology, Clark University, 950 Main Street, Worcester, MA, 01610, USA
| | - Trace S Kershaw
- School of Public Health, Yale University, 60 College Street, P.O. Box 208034, New Haven, CT, 06520, USA
- Yale Center for Interdisciplinary Research on AIDS, 135 College Street, Suite 200, New Haven, CT, 06510-2483, USA
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85
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Biello KB, Mimiaga MJ, Santostefano CM, Novak DS, Mayer KH. MSM at Highest Risk for HIV Acquisition Express Greatest Interest and Preference for Injectable Antiretroviral PrEP Compared to Daily, Oral Medication. AIDS Behav 2018; 22:1158-1164. [PMID: 29119472 PMCID: PMC5878965 DOI: 10.1007/s10461-017-1972-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Men who have sex with men (MSM) account for nearly 70% of new HIV diagnoses, with young black MSM at the highest risk for infection in the United States. Pre-exposure prophylaxis (PrEP) can decrease HIV acquisition in at-risk individuals by over 90%. However, therapeutic efficacy requires a daily pill, posing adherence challenges. Experimental modalities, including injectable PrEP given once every 2 months, may improve adherence among those most in need. To assess interest in and preference for injectable PrEP, an online survey was mounted on two popular MSM sexual networking apps. Differences by age, race, and other characteristics were examined using multinomial logistic regressions. Of 4638 respondents, 73% expressed interest in injectable PrEP and 47% indicated they would prefer an injection (compared to 17% who prefer a daily pill and 36% who were unsure). Within this sample, interest in and preference for injectable PrEP was highest among MSM at highest risk for HIV infection (i.e., younger age groups, racial/ethnic minorities, those with risker sexual behavior). As a result, if proven effective in clinical trials, injectable PrEP has the potential to reduce social disparities in HIV transmission among MSM.
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Affiliation(s)
- Katie B Biello
- Departments of Behavioral & Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA.
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA.
- Fenway Health, Fenway Institute, Boston, MA, USA.
| | - Matthew J Mimiaga
- Departments of Behavioral & Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA
- Fenway Health, Fenway Institute, Boston, MA, USA
| | | | | | - Kenneth H Mayer
- Fenway Health, Fenway Institute, Boston, MA, USA
- Division of Infectious Diseases, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA
- Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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86
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Hannaford A, Lipshie-Williams M, Starrels JL, Arnsten JH, Rizzuto J, Cohen P, Jacobs D, Patel VV. The Use of Online Posts to Identify Barriers to and Facilitators of HIV Pre-exposure Prophylaxis (PrEP) Among Men Who Have Sex with Men: A Comparison to a Systematic Review of the Peer-Reviewed Literature. AIDS Behav 2018; 22:1080-1095. [PMID: 29285638 PMCID: PMC5991474 DOI: 10.1007/s10461-017-2011-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pre-exposure prophylaxis (PrEP) remains an under-utilized HIV prevention tool among men who have sex with men (MSM). To more comprehensively elucidate barriers and facilitators to PrEP use among US MSM, we conducted a systematic review of peer-reviewed published articles and content analysis of online posts about PrEP. We searched peer-reviewed databases (Medline, Web of Science, Google Scholar) using MESH headings and keywords about PrEP and/or HIV prevention from 2005 to 2015. We included original studies among MSM in the US that reported on barriers, facilitators, or other factors related to PrEP use. We also searched online posts and associated comments (news articles, opinion pieces, blogs and other social media posts) in diverse venues (Facebook, Slate Outward, Huffington Post Gay Voices, Queerty, and My PrEP Experience blog) to identify posts about PrEP. We used content analysis to identify themes and compare potential differences between the peer-reviewed literature and online posts. We identified 25 peer-reviewed articles and 28 online posts meeting inclusion criteria. We identified 48 unique barriers and 46 facilitators to using PrEP. These 94 themes fit into six overarching categories: (1) access (n = 14), (2) attitudes/beliefs (n = 24), (3) attributes of PrEP (n = 13), (4) behaviors (n = 11), (5) sociodemographic characteristics (n = 8), and (6) social network (n = 6). In all categories, analysis of online posts resulted in identification of a greater number of unique themes. Thirty-eight themes were identified in the online posts that were not identified in the peer-reviewed literature. We identified barriers and facilitators to PrEP in online posts that were not identified in a systematic review of the peer-reviewed literature. By incorporating data both from a systematic review of peer-reviewed articles and from online posts, we have identified salient and novel information about barriers to and facilitators of PrEP use. Traditional research approaches may not comprehensively capture current factors important for designing and implementing PrEP related interventions.
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Affiliation(s)
| | | | - Joanna L Starrels
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Julia H Arnsten
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | | | - Phillip Cohen
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Damon Jacobs
- Licensed Marriage and Family Therapist, New York, NY, USA
| | - Viraj V Patel
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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87
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Peng P, Su S, Fairley CK, Chu M, Jiang S, Zhuang X, Zhang L. A Global Estimate of the Acceptability of Pre-exposure Prophylaxis for HIV Among Men Who have Sex with Men: A Systematic Review and Meta-analysis. AIDS Behav 2018; 22:1063-1074. [PMID: 28176168 DOI: 10.1007/s10461-017-1675-z] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a new biomedical intervention for HIV prevention. This study systematically reviews the acceptability of PrEP among men who have sex with men (MSM) worldwide. We searched major English databases to identify English-language articles published between July 2007 and July 2016, which reported the acceptability of PrEP and associated population characteristics. Meta-analysis was conducted to estimate a pooled acceptability, and meta-regression and subgroup analysis were used to analyse heterogeneities. The estimated acceptance from included sixty-eight articles was 57.8% (95% confidence internal 52.4-63.1%). MSM who were younger (4/5 studies, range of adjusted odds ratio (aOR) = 1.39-3.47), better educated (aOR = 1.49-7.70), wealthier (aOR = 1.31-13.03) and previously aware of PrEP (aOR = 1.33-3.30) showed significantly higher acceptance. Male sex workers (84.0% [26.3-98.7%] were more likely to accept PrEP than general MSM. Self-perceived low efficacy, concern about side effects, adherence, affordability, and stigma were main barriers. This review identifies a moderate acceptability of PrEP in MSM. Efficacy, perception of HIV risk and experienced stigma determine its acceptance.
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88
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Zablotska IB, O'Connor CC. Preexposure Prophylaxis of HIV Infection: the Role of Clinical Practices in Ending the HIV Epidemic. Curr HIV/AIDS Rep 2018; 14:201-210. [PMID: 29071519 DOI: 10.1007/s11904-017-0367-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW The aim of this study is to summarise the recent evidence from high-income settings about providers' ability to deliver on the UNAIDS goal of at least three million people at substantial risk of HIV infection with PrEP by 2020, including awareness and knowledge about PrEP, willingness to prescribe PrEP, current levels of prescribing and service delivery models and issues. RECENT FINDINGS Awareness about PrEP among health providers is growing, but at different pace depending on provider type. HIV and sexual health specialists are more likely to have knowledge about PrEP than generalists, and to be willing to prescribe it, mainly because of their closer contact with people at high risk for HIV and better risk assessment skills. There is still no consensus as to who should be responsible for providing PrEP, but clearly all hands on deck will be useful in delivering on the international target of three million people at substantial risk for HIV on PrEP by 2020. Only about 5% of the target has been reached so far. Local guidance and large-scale education and information programs for clinicians will be necessary to upskill health providers. High cost of PrEP is still a major barrier for its broad implementation, even in countries were PrEP roll-out has started. Health services are facing major structural challenges due to implementation of PrEP services to a substantial volume of patients. The early implementation experiences demonstrated that PrEP can be successfully delivered across a variety of settings, and a broad range of strategies and models of care can streamline PrEP delivery. Education of the providers and PrEP cost solutions will be essential for rapid roll-out of PrEP.
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Affiliation(s)
- Iryna B Zablotska
- The Kirby Institute, University of New South Wales Sydney, Sydney, 2052, Australia.
| | - Catherine C O'Connor
- The Kirby Institute, University of New South Wales Sydney, Sydney, 2052, Australia
- Sexual Health Service, Sydney Local Health District, Camperdown, 2050, Australia
- Central Clinical School, University of Sydney, Sydney, 2006, Australia
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89
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Brooks RA, Allen VC, Regan R, Mutchler MG, Cervantes-Tadeo R, Lee SJ. HIV/AIDS conspiracy beliefs and intention to adopt preexposure prophylaxis among black men who have sex with men in Los Angeles. Int J STD AIDS 2018; 29:375-381. [PMID: 28853676 PMCID: PMC6221185 DOI: 10.1177/0956462417727691] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the United States, black men who have sex with men (MSM) are the group most affected by the HIV/AIDS epidemic. Pre-exposure prophylaxis (PrEP) is an important new HIV prevention strategy that may help reduce new HIV infections among black MSM. This analysis examined the association between HIV/AIDS conspiracy beliefs and intentions to adopt PrEP among 224 black MSM. The likelihood of adopting PrEP was assessed and more than half (60%) of the study population indicated a high intention to adopt PrEP. HIV/AIDS genocidal and treatment-related conspiracies were assessed using scales previously validated with black MSM. Almost two-thirds (63%) endorsed at least one of eight HIV/AIDS conspiracy beliefs presented. In multivariable analyses, black MSM who agreed with the genocidal or treatment-related conspiracy beliefs scales had a lower intention to adopt PrEP (Adjusted Odds Ratio [AOR] = 0.73, 95% CI = 0.54, 0.99 and AOR = 0.36, 95% CI = 0.23, 0.55, respectively). Our findings indicate that preexisting HIV/AIDS conspiracy beliefs may deter some black MSM from adopting PrEP. We suggest strategies PrEP implementers may want to employ to address the influence that HIV/AIDS conspiracy beliefs may have on the adoption of PrEP among black MSM, a population disproportionately affected by HIV/AIDS.
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Affiliation(s)
- Ronald A Brooks
- 1 Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Vincent C Allen
- 2 Georgia State University Counseling and Testing Center, Atlanta, GA, USA
| | - Rotrease Regan
- 3 Department of Medicine, Division of Infectious Diseases, 1371 Emory University , Atlanta, GA, USA
| | - Matt G Mutchler
- 4 Department of Sociology, California State University, Dominguez Hills, CA, USA
- 5 Community-Based Research, AIDS Project Los Angeles, CA, USA
| | - Ramon Cervantes-Tadeo
- 1 Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Sung-Jae Lee
- 6 Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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90
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Wang Z, Lau JTF, Fang Y, Ip M, Gross DL. Prevalence of actual uptake and willingness to use pre-exposure prophylaxis to prevent HIV acquisition among men who have sex with men in Hong Kong, China. PLoS One 2018; 13:e0191671. [PMID: 29432470 PMCID: PMC5809018 DOI: 10.1371/journal.pone.0191671] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 01/09/2018] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES This study was to investigate the prevalence of actual uptake of pre-exposure prophylaxis (PrEP), willingness to use daily oral PrEP under two cost scenarios, and potential issues related to PrEP use among men who have sex with men (MSM) with HIV negative/unknown sero-status in Hong Kong, China. Factors associated with the two measures of willingness were also investigated. METHODS 403 eligible MSM completed the anonymous venue-based face-to-face interview/telephone interview. RESULTS Only 1% had ever used PrEP. After being briefed about some facts of PrEP, the prevalence of willingness to use daily oral PrEP was 7.7% if they could purchase PrEP at private hospitals/clinics at HK$8,000 (US$1,032)/month (market rate) and 45.2% if free PrEP was provided by public hospitals/clinics in Hong Kong (free PrEP). After adjusted for significant background variables, significant factors of these two measures of willingness included: (1) number of correct responses to knowledge on PrEP, (2) perceived risk of HIV infection in the next six months, and (3) constructs of the Theory of Planned Behavior: positive and negative attitudes toward PrEP, perceived their significant others would support them take PrEP (perceived subjective norm), perceived number of local MSM who were willing to take PrEP (perceived descriptive norm), and confidence in using PrEP under the two scenarios (perceived behavioral control). Among all participants, 9.7% and 25.1% would start and discontinue using PrEP without consulting doctors; 26.0% would not take PrEP daily if it was provided for free, and 42.4% would not take up HIV testing every 3 months after using PrEP. CONCLUSION Different strategies should be considered for promoting PrEP at market rate and if free PrEP is made available. Future promotion should increase their knowledge about PrEP, modify their perceptions related to HIV and PrEP, and address some potential issues related to PrEP use.
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Affiliation(s)
- Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- Community Research Program on AIDS, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
- * E-mail: (ZW); (JTFL)
| | - Joseph T. F. Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- * E-mail: (ZW); (JTFL)
| | - Yuan Fang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mary Ip
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Danielle L. Gross
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
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Mayer KH, Chan PA, R Patel R, Flash CA, Krakower DS. Evolving Models and Ongoing Challenges for HIV Preexposure Prophylaxis Implementation in the United States. J Acquir Immune Defic Syndr 2018; 77:119-127. [PMID: 29084044 PMCID: PMC5762416 DOI: 10.1097/qai.0000000000001579] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The use of preexposure prophylaxis (PrEP) for HIV prevention was approved by the Food and Drug Administration in 2012, but delivery to at-risk persons has lagged. This critical review analyzes the current state of PrEP implementation in the United States, by reviewing barriers and innovative solutions to enhance PrEP access and uptake. SETTING Clinical care settings, public health programs, and community-based organizations (CBOs). METHODS Critical review of recent peer-reviewed literature. RESULTS More than 100 papers were reviewed. PrEP is currently provided in diverse settings. Care models include sexually transmitted disease clinics, community health centers, CBOs, pharmacies, and private primary care providers (PCPs). Sexually transmitted disease clinics have staff trained in sexual health counseling and are linked to public health programs (eg, partner notification services), whereas PCPs and community health centers may be less comfortable counseling and feel time-constrained in managing PrEP. However, PCPs may be ideal PrEP providers, given their long-term relationships with patients, integrating PrEP into routine care. Collaborations with CBOs can expand PrEP care through adherence support and insurance navigation. Pharmacies can deliver PrEP, given their experience with medication dispensing and counseling, and may be more accessible for some patients, but to address other health concerns, liaisons with PCPs may be needed. CONCLUSIONS PrEP implementation in the United States is moving forward with the development of diverse models of delivery. Optimal scale-up will require learning about the best features of each model and providing choices to consumers that enhance engagement and uptake.
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Affiliation(s)
- Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Philip A Chan
- Department of Medicine, Brown University, Providence, RI
| | - Rupa R Patel
- Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO
| | - Charlene A Flash
- Section of Infectious Diseases, Division of Internal Medicine, Baylor College of Medicine, Houston, TX
| | - Douglas S Krakower
- The Fenway Institute, Fenway Health, Boston, MA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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Torres TS, De Boni RB, de Vasconcellos MT, Luz PM, Hoagland B, Moreira RI, Veloso VG, Grinsztejn B. Awareness of Prevention Strategies and Willingness to Use Preexposure Prophylaxis in Brazilian Men Who Have Sex With Men Using Apps for Sexual Encounters: Online Cross-Sectional Study. JMIR Public Health Surveill 2018; 4:e11. [PMID: 29358160 PMCID: PMC5799718 DOI: 10.2196/publichealth.8997] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 11/06/2017] [Accepted: 11/26/2017] [Indexed: 12/12/2022] Open
Abstract
Background Geosocial networking (GSN) smartphone apps are becoming the main venue for sexual encounters among Brazilian men who have sex with men (MSM). To address the increased HIV incidence in this population, preexposure prophylaxis (PrEP) was recently implemented in the Brazilian public health system in the context of combined HIV prevention. Objective This study aimed to describe the characteristics of MSM using GSN apps for sexual encounters, their awareness of prevention strategies, and willingness to use PrEP. Methods This study was an online cross-sectional study conducted in 10 Brazilian state capitals from July 1 to July 31, 2016. The questionnaire was programmed on SurveyGizmo and advertised in two GSN apps used by MSM to find sexual partners (Hornet and Grindr). Inclusion criteria were >18 years of age, cisgender men, with an HIV-negative status. Eligible individuals answered questions on: demographics; behavior; and knowledge, preferences, and willingness to use PrEP, nonoccupational postexposure prophylaxis (nPEP), HIV self-testing (HIVST), and condoms. Logistic regression modeling was performed to assess the factors associated with daily oral PrEP willingness. Results During the study period, 8885 individuals provided consent and started the questionnaire. Of these, 23.05% (2048/8885) were ineligible, 6837 (6837/8885, 76.94%) initiated, and 5065 (5065/8885, 57.00%) completed the entire questionnaire and were included in the present analysis. Median age was 30 years (interquartile range: 25-36), most self-declared as MSM (4991/5065, 98.54%), white (3194/5065, 63.06%), middle income (2148/5065, 42.41%), and had 12 or more years of schooling (3106/5062, 61.36%). The majority of MSM (3363/5064, 66.41%) scored >10 points (high risk) on The HIV Incidence Risk for MSM Scale, but only 21.39% (1083/5064) had a low perceived likelihood of getting HIV in the next year. Daily use of apps for sex was reported by 35.58% (1798/5054). Most MSM (4327/5065, 85.43%) reported testing for HIV at least once in their lifetime and 9.16% (464/5065) used nPEP in the previous year. PrEP, nPEP, and HIVST awareness was reported by 57.89% (2932/5065), 57.39% (2907/5065), and 26.57% (1346/5065) of participants, respectively. Half of all respondents (2653/5065, 52.38%) were willing to use daily oral PrEP, and this finding was associated with higher numbers of male sexual partners (adjusted odds ratio [AOR] 1.26, 95% CI 1.09-1.47), condomless receptive anal intercourse (AOR 1.27, 95% CI 1.12-1.44), sex with HIV-positive partner versus no HIV-positive partner (one HIV-positive partner: AOR 1.36, 95% CI 1.11-1.67), daily use of apps for sexual encounters (AOR 1.48, 95% CI 1.17-1.87), high and unknown perceived likelihood of getting HIV in the next year (AOR 1.72, 95% CI 1.47-2.02 and AOR 1.39, 95% CI 1.13-1.70), sexually transmitted infection diagnosis (AOR 1.25, 95% CI 1.03-1.51), stimulant use (AOR 1.24, 95% CI 1.07-1.43), PrEP awareness (AOR 1.48, 95% CI 1.30-1.70), and unwillingness to use condoms (AOR 1.16, 95% CI 1.00-1.33). Conclusions Our results evidenced high-risk scores in the studied population, suggesting the importance of PrEP use. Those individuals presenting risky sexual behaviors were more willing to use PrEP. Nonetheless, only 58% (2932/5065) of individuals had heard about this prevention strategy. Efforts to increase awareness of new prevention strategies are needed, and mobile health tools are a promising strategy to reach MSM.
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Affiliation(s)
- Thiago Silva Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Raquel Brandini De Boni
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Paula Mendes Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ronaldo Ismerio Moreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Holloway IW, Tan D, Gildner JL, Beougher SC, Pulsipher C, Montoya JA, Plant A, Leibowitz A. Facilitators and Barriers to Pre-Exposure Prophylaxis Willingness Among Young Men Who Have Sex with Men Who Use Geosocial Networking Applications in California. AIDS Patient Care STDS 2017; 31:517-527. [PMID: 29211513 PMCID: PMC5724584 DOI: 10.1089/apc.2017.0082] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
While correlates of pre-exposure prophylaxis (PrEP) uptake have been explored among older men who have sex with men (MSM), less is known about the facilitators and barriers that encourage uptake among younger MSM (YMSM). This study explores the association between willingness to take PrEP and demographic characteristics, sexual risk, and substance use, and attitudinal factors among YMSM in California who use geosocial networking applications (GSN apps). Based on survey data from YMSM recruited through GSN apps (n = 687), PrEP willingness was positively associated with Hispanic ethnicity [adjusted odds ratio (aOR): 1.73; confidence interval (CI): 1.01-2.98; p = 0.046], concerns about drug effects (aOR: 0.46; CI: 0.33-0.65; p < 0.001), medical mistrust (aOR: 0.71; CI: 0.53-0.96; p < 0.001), and concerns about adherence (aOR: 0.65; CI: 0.49-0.89; p = 0.005). PrEP willingness was positively associated with medium (aOR: 1.87; CI: 1.14-3.07; p = 0.014) and high concern (aOR: 1.84; CI: 1.13-3.01; p < 0.001) about contracting HIV and perceived benefits of taking PrEP (aOR: 2.59; CI: 1.78-3.78; p < 0.001). In addition to emphasizing the benefits of using PrEP, campaigns that address concerns regarding adherence and side effects may increase interest in and demand for PrEP among YMSM. More opportunities are needed to educate YMSM about PrEP, including addressing their concerns about this new prevention strategy. Providers should speak openly and honestly to YMSM considering PrEP about what to do if side effects occur and how to handle missed doses. Outreach using GSN apps for PrEP education and screening may be an effective way to reach YMSM.
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Affiliation(s)
- Ian W Holloway
- 1 University of California , Los Angeles, Los Angeles, California
| | - Diane Tan
- 1 University of California , Los Angeles, Los Angeles, California
| | | | - Sean C Beougher
- 1 University of California , Los Angeles, Los Angeles, California
| | | | | | - Aaron Plant
- 3 Sentient Research , Los Angeles, California
| | - Arleen Leibowitz
- 1 University of California , Los Angeles, Los Angeles, California
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94
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Nideröst S, Gredig D, Hassler B, Uggowitzer F, Weber P. The intention to use HIV-pre-exposure prophylaxis (PrEP) among men who have sex with men in Switzerland: testing an extended explanatory model drawing on the unified theory of acceptance and use of technology (UTAUT). JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2017; 26:247-259. [PMID: 29780687 PMCID: PMC5948261 DOI: 10.1007/s10389-017-0869-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 11/05/2017] [Indexed: 11/29/2022]
Abstract
Aim The aim of this study was to determine the intention to use pre-exposure prophylaxis (PrEP) when available and to identify predictors of the intention to use PrEP among men who have sex with men (MSM) living in Switzerland. The theoretical model drew on the Unified Theory of Acceptance and Use of Technology and considered additional variables related specifically to PrEP, HIV protection and the resources of MSM. Subject and methods For data collection, we used an anonymous, standardized self-administered online questionnaire. In 2015, we gathered a convenience sample of 556 HIV-negative MSM living in Switzerland. We analyzed the data using descriptive and bivariate statistics and used structural equation modeling to test the hypothesized model. Results Predictors of respondents’ moderate intention to use PrEP were performance expectancy, effort expectancy, perceived social influence, concerns about using PrEP, attitudes toward condom use, negative experiences of condom use and age. These variables were predicted by HIV protection-related aspects and resources. Conclusion The findings provide insights into the complex dynamic underlying the intention to use PrEP.
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Affiliation(s)
- Sibylle Nideröst
- University of Applied Sciences and Arts Northwestern Switzerland, School of Social Work, Riggenbachstrasse 16, 4600 Olten, Switzerland
| | - Daniel Gredig
- University of Applied Sciences and Arts Northwestern Switzerland, School of Social Work, Riggenbachstrasse 16, 4600 Olten, Switzerland
| | - Benedikt Hassler
- University of Applied Sciences and Arts Northwestern Switzerland, School of Social Work, Riggenbachstrasse 16, 4600 Olten, Switzerland
| | - Franziska Uggowitzer
- University of Applied Sciences and Arts Northwestern Switzerland, School of Social Work, Riggenbachstrasse 16, 4600 Olten, Switzerland
| | - Patrick Weber
- University of Applied Sciences and Arts Northwestern Switzerland, School of Social Work, Riggenbachstrasse 16, 4600 Olten, Switzerland
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95
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Awareness and willingness to use HIV pre-exposure prophylaxis among men who have sex with men in low- and middle-income countries: a systematic review and meta-analysis. J Int AIDS Soc 2017; 20:21580. [PMID: 28691439 PMCID: PMC5515024 DOI: 10.7448/ias.20.1.21580] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction: To facilitate provision of pre-exposure prophylaxis (PrEP) in low- and middle-income countries (LMIC), a better understanding of potential demand and user preferences is required. This review assessed awareness and willingness to use oral PrEP among men who have sex with men (MSM) in LMIC. Methods: Electronic literature search of Cochrane library, Embase, PubMed, PsychINFO, CINHAL, Web of Science, and Google Scholar was conducted between July and September 2016. Reference lists of relevant studies were searched, and three authors contacted for additional data. Non-peer reviewed publications were excluded. Studies were screened for inclusion, and relevant data abstracted, assessed for bias, and synthesized. Results: In total, 2186 records were identified, of which 23 studies involving 14,040 MSM from LMIC were included. The proportion of MSM who were aware of PrEP was low at 29.7% (95% CI: 16.9–44.3). However, the proportion willing to use PrEP was higher, at 64.4% (95% CI: 53.3–74.8). Proportions of MSM aware of PrEP was <50% in 11 studies and 50–70% in 3 studies, while willingness to use PrEP was <50% in 6 studies, 50–70% in 9 studies, and over 80% in 5 studies. Several factors affected willingness to use PrEP. At the individual domain, poor knowledge of PrEP, doubts about its effectiveness, fear of side effects, low perception of HIV risk, and the need to adhere or take medicines frequently reduced willingness to use PrEP, while PrEP education and motivation to maintain good health were facilitators of potential use. Demographic factors (education, age, and migration) influenced both awareness and willingness to use PrEP, but their effects were not consistent across studies. At the social domain, anticipated stigma from peers, partners, and family members related to sexual orientation, PrEP, or HIV status were barriers to potential use of PrEP, while partner, peer, and family support were facilitators of potential use. At the structural domain, concerns regarding attitudes of healthcare providers, quality assurance, data protection, and cost were determinants of potential use. Conclusions: This review found that despite low levels of awareness of PrEP, MSM in LMIC are willing to use it if they are supported appropriately to deal with a range of individual, social, and structural barriers.
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96
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Lee YC, Chang SY, Lin KY, Chang LH, Liu WC, Wu CH, Sun HY, Hung CC, Chang SC. Awareness and willingness towards pre-exposure prophylaxis against HIV infection among individuals seeking voluntary counselling and testing for HIV in Taiwan: a cross-sectional questionnaire survey. BMJ Open 2017; 7:e015142. [PMID: 29042372 PMCID: PMC5652491 DOI: 10.1136/bmjopen-2016-015142] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES We aimed to investigate the awareness and willingness towards pre-exposure prophylaxis (PrEP) among individuals seeking voluntary counselling and testing (VCT) for HIV in Taiwan, where PrEP is currently not reimbursed by the insurance. METHODS Between April and October 2016, a questionnaire interview was conducted among VCT clients to inquire about the attitudes towards PrEP against HIV infection. Multivariate logistic regression analysis was performed to identify the associated factors with willingness to initiate PrEP. RESULTS During the 6-month period, 1173 VCT clients (99.8%) completed the interviews, with 67.4% being homosexual or bisexual male. While 67.2% of the clients knew of postexposure prophylaxis, 40.2% heard of PrEP. Overall, 546 clients (46.5%) were willing to initiate PrEP and 89.5% of them would choose event-driven PrEP. In multivariate analysis, male gender (OR 1.796; 95% CI 1.165 to 2.768), full-time job (OR 1.354; 95% CI 1.052 to 1.742), one-night stand (OR 1.374; 95% CI 1.043 to 1.810), having casual sex partners within 3 months (OR 1.329; 95% CI 1.031 to 1.714), condomless anal sex (OR 1.405; 95% CI 1.122 to 1.878) and ever having chemsex or attending a drug party in the past 1 year (OR 2.571; 95% CI 1.541 to 4.287), regular screening for HIV infection (OR 1.321; 95% CI 1.021 to 1.711) and knowledge of PrEP (OR 1.504; 95% CI, 1.159 to 1.953) were associated with willingness to initiate PrEP. CONCLUSIONS Understanding the willingness to initiate PrEP against HIV among the VCT clients in Taiwan, which was associated with male gender, risky sexual behaviours and awareness of PrEP, will help inform the implementation of PrEP programme.
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Affiliation(s)
- Yi-Chieh Lee
- Department of Internal Medicine, Lotung Poh-Ai Hospital, Medical Lo-Hsu Foundation, I-Lan, Taiwan
| | - Sui-Yuan Chang
- Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuan-Yin Lin
- Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan
| | - Lan-Hsin Chang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Chun Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Hsin Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- China Medical University, Taichung, Taiwan
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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97
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Differences in Awareness of Pre-exposure Prophylaxis and Post-exposure Prophylaxis Among Groups At-Risk for HIV in New York State: New York City and Long Island, NY, 2011-2013. J Acquir Immune Defic Syndr 2017; 75 Suppl 3:S383-S391. [PMID: 28604443 DOI: 10.1097/qai.0000000000001415] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) to reduce the risk of HIV was approved in 2012 and post-exposure prophylaxis (PEP) in 2005. We report the differences in awareness of PrEP/PEP and factors associated with awareness by examining 3 risk groups (men who have sex with men (MSM), people who inject drugs, and high-risk heterosexuals). METHODS National HIV Behavioral Surveillance system data collected in New York City (NYC) and Long Island, NY in 2011-2013 were used. Logistic regressions by region were developed to estimate adjusted associations [Adjusted Odds Ratios (AOR)] and determine differences in awareness of PrEP/PEP. RESULTS Awareness of PrEP/PEP was low for all groups. In multivariate analysis controlling for sociodemographic factors, noninjection drug use, HIV status, and exposure to HIV prevention, males who inject drugs in NYC had significantly decreased odds of PrEP/PEP awareness [AOR: 0.45; confidence interval (CI): 0.25 to 0.81] compared with MSM. MSM aged 18-29 years had increased awareness of PrEP (AOR: 2.94; 95% CI 1.11 to 7.80). On Long Island, females who inject drugs (AOR: 0.18; 95% CI: 0.05 to 0.62), males who inject drugs (AOR: 0.14; 95% CI: 0.05 to 0.39), female heterosexuals (AOR: 0.25; 95% CI: 0.11 to 0.59), and male heterosexuals (AOR: 0.32; 95% CI: 0.14 to 0.73) had significantly decreased odds of PrEP/PEP awareness. Black MSM had increased awareness of PrEP (AOR: 4.08 CI:1.21 to 13.73). CONCLUSIONS Large proportions of groups at-risk for HIV were unaware of PrEP/PEP. When comparing risk groups to MSM, we found MSM to have greater awareness in both regions. On Long Island, people who inject drugs and heterosexuals were far less likely to have PrEP/PEP awareness than in NYC. On Long Island, Black MSM had increased PrEP awareness and in NYC MSM aged 18-29 had increased PrEP awareness. These findings suggest that awareness may be spreading through networks and highlight the importance of targeted educational and prevention efforts by group and region.
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98
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Morgan E, Skaathun B, Lancki N, Jimenez AD, Ramirez-Valles J, Bhatia R, Masiello-Schuette S, Benbow N, Prachand N, Schneider JA. Trends in HIV Risk, Testing, and Treatment among MSM in Chicago 2004-2014: Implications for HIV Elimination Planning. J Urban Health 2017; 94:699-709. [PMID: 28631059 PMCID: PMC5610127 DOI: 10.1007/s11524-017-0175-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Men who have sex with men (MSM) in the USA continue to have high rates of HIV infection. Increasingly, in addition to behavioral factors, biomedical interventions have been found to play important roles in HIV prevention. In this analysis, we used four waves of cross-sectional data (2004, 2008, 2011, and 2014) from the National HIV Behavioral Surveillance System (NHBS) to examine trends in key behaviors and biomedical interventions among MSM in Chicago (N = 3298). Logistic regression was used to determine changes in behaviors and use of biomedical interventions. Condomless sex increased significantly in waves 3 and 4, compared to wave 1: wave 3 (AOR = 2.07; 95% CI 1.53, 2.78) and wave 4 (AOR = 2.19; 95% CI 1.62, 2.96). Compared to those aged 18-24, older participants were significantly less likely to be routinely tested for HIV: 30-39 (AOR = 0.63; 95% CI 0.48, 0.83), 40-49 (AOR = 0.40; 95% CI 0.29, 0.55), and >50 (AOR = 0.28; 95% CI 0.18, 0.43). Awareness of both post-exposure prophylaxis (PEP)(AOR = 3.13; 95% CI 1.22, 8.03) and pre-exposure prophylaxis (PrEP)(AOR = 10.02; 95% CI 2.95, 34.01) increased significantly in wave 4, compared to wave 3. These results suggest a potential increase in HIV rates among men with main and casual partners and should be monitored closely as PrEP becomes more widespread among MSM of all races and ethnicities in Chicago. This study also suggests that further analyses of the barriers to PEP and PreP uptake among high-risk populations are necessary.
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Affiliation(s)
- Ethan Morgan
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.
| | - Britt Skaathun
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Nicola Lancki
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Antonio D Jimenez
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Ramona Bhatia
- Chicago Department of Public Health, Chicago, IL, USA
| | | | - Nanette Benbow
- Center for Implementation Science, Northwestern University, Chicago, IL, USA
| | | | - John A Schneider
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
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99
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Klassen BJ, Lachowsky NJ, Lin SY, Edward JB, Chown SA, Hogg RS, Moore DM, Roth EA. Gay Men's Understanding and Education of New HIV Prevention Technologies in Vancouver, Canada. QUALITATIVE HEALTH RESEARCH 2017; 27:1775-1791. [PMID: 28936925 PMCID: PMC5664952 DOI: 10.1177/1049732317716419] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Effective rollout of HIV treatment-based prevention such as pre-exposure prophylaxis and treatment as prevention has been hampered by poor education, limited acceptability, and stigma among gay men. We undertook a thematic analysis regarding the education sources and acceptability of these New Prevention Technologies (NPTs) using 15 semistructured interviews with gay men in Vancouver, Canada, who were early adopters of NPTs. NPT education was derived from a variety of sources, including the Internet, health care providers, community organizations, sexual partners, and peers; participants also emphasized their own capacities as learners and educators. Acceptable forms of NPT education featured high-quality factual information, personal testimony, and easy access. Stigma was highlighted as a major barrier. For public health, policy makers, and gay communities to optimize the personal and population benefits of NPTs, there is a need for increased community support and dialogue, antistigma efforts, early NPT adopter testimony, and personalized implementation strategies.
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Affiliation(s)
- Benjamin J Klassen
- 1 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Nathan J Lachowsky
- 1 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- 2 University of Victoria, Victoria, British Columbia, Canada
| | - Sally Yue Lin
- 1 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Joshua B Edward
- 3 Health Initiative for Men, Vancouver, British Columbia, Canada
| | - Sarah A Chown
- 4 YouthCO HIV & Hep C Society, Vancouver, British Columbia, Canada
| | - Robert S Hogg
- 1 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- 5 Simon Fraser University, Burnaby, British Columbia, Canada
| | - David M Moore
- 1 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- 6 University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric A Roth
- 2 University of Victoria, Victoria, British Columbia, Canada
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100
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PrEP awareness and decision-making for Latino MSM in San Antonio, Texas. PLoS One 2017; 12:e0184014. [PMID: 28953905 PMCID: PMC5617149 DOI: 10.1371/journal.pone.0184014] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 08/16/2017] [Indexed: 01/10/2023] Open
Abstract
Pre-Exposure Prophylaxis (PrEP) has been promoted among high-risk populations as an effective HIV biomedical intervention. However, limited research is available on the significance of culturally informed biomedical interventions for Latino MSM. A total of 159 self-administered Internet surveys were completed by Latino MSM ages 21–30 in San Antonio, Texas. The purpose of this research was to develop an instrument that measured Latino MSM attitudes and beliefs towards PrEP, identify associations between demographic factors and PrEP related factors and to suggest culturally appropriate strategies for the promotion of PrEP among the Latino MSM population. Research findings revealed implications for PrEP at the structural and individual level for Latino MSM. Structural level indicators emphasized the importance for raising PrEP awareness among Latino MSM in regards to PrEP related expenses, ameliorating stigmatization of high-risk populations, enhancing access to PrEP informed medical providers, and address mistrust of the government and medical providers role on addressing health disparities among Latino MSM. Overall, the findings for individual factors emphasize the need for patient-centered interventions for Latino MSM. Latino MSM currently on PrEP require supplemental resources to enhance PrEP adherence. Latino MSM not on PrEP require alternate options for PrEP delivery and/or cognitive behavioral approaches minimizing HIV risk behavior for Latino MSM concerned with PrEP toxicity, which may require non-biomedical interventions. Integration of Latino MSM currently on PrEP as peer educators provides a valuable resource for developing culturally informed PrEP interventions for Latino MSM. Peer educators are able to share their experiential knowledge of PrEP contextualized through cultural norms, beliefs, and values.
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