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Nicol MR, Corbino JA, Cottrell ML. Pharmacology of Antiretrovirals in the Female Genital Tract for HIV Prevention. J Clin Pharmacol 2018; 58:1381-1395. [PMID: 29901863 PMCID: PMC6333200 DOI: 10.1002/jcph.1270] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/15/2018] [Indexed: 02/06/2023]
Abstract
Preexposure prophylaxis (PrEP) is a powerful tool that, as part of a comprehensive prevention package, has potential to significantly impact the HIV epidemic. PrEP effectiveness is believed to be dependent on the exposure and efficacy of antiretrovirals at the site of HIV transmission. Clinical trial results as well as modeling and simulation indicate the threshold of adherence required for PrEP efficacy of emtricitabine/tenofovir disoproxil fumarate may differ between sites of HIV transmission with less forgiveness for missed doses in women exposed through genital tissue compared to people exposed through colorectal tissue. This suggests a role for local and host factors to influence mucosal pharmacology. Here we review the mucosal pharmacology of antiretrovirals in the female genital tract and explore potential determinants of PrEP efficacy. Host factors such as inflammation, coinfections, hormonal status, and the vaginal microbiome will be explored as well as the role of drug-metabolizing enzymes and transporters in regulating local drug exposure. The use of preclinical and early clinical models to predict clinical effectiveness is also discussed.
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Affiliation(s)
- Melanie R Nicol
- University of Minnesota College of Pharmacy, Department of Experimental and Clinical Pharmacology
| | - Joseph A Corbino
- University of Minnesota College of Pharmacy, Department of Experimental and Clinical Pharmacology
| | - Mackenzie L Cottrell
- University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Division of Pharmacotherapy and Experimental Therapeutics
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102
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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: 144] [Impact Index Per Article: 24.0] [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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103
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Philbin MM, Parker CM, Parker RG, Wilson PA, Garcia J, Hirsch JS. Gendered Social Institutions and Preventive Healthcare Seeking for Black Men Who Have Sex with Men: The Promise of Biomedical HIV Prevention. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:2091-2100. [PMID: 29926263 PMCID: PMC6309278 DOI: 10.1007/s10508-018-1211-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 03/23/2018] [Accepted: 04/02/2018] [Indexed: 06/01/2023]
Abstract
Research on gender and health, including research conducted among Black men who have sex with men (BMSM), has primarily focused on how gender norms and roles shape healthcare engagement. Here we advance that work by demonstrating how a broader theorization of gender, particularly one that moves beyond gender norms and performance to incorporate structures such as the healthcare system and the labor market, can facilitate an understanding of how gender affects preventive healthcare seeking among BMSM, particularly the uptake of pre-exposure prophylaxis (PrEP), a promising approach to alleviate HIV disparities. This article is based on a year-long ethnographic study conducted in New York City with BMSM (n = 31; three interviews each) and community stakeholders (n = 17). Two primary findings emerged: (1) the labor market systematically excluded the men in our sample, which limited their ability to access employer-sponsored healthcare. Such discrimination may promote overt demonstrations of masculinity that increase their HIV vulnerability and decrease healthcare seeking, and (2) healthcare systems are not structured to promote preventive healthcare for men, particularly BMSM. In fact, they constrained men's access to primary providers and were usually tailored to women. Applying a structural, gendered lens to men's health-in addition to the more frequently researched individual or interpersonal levels-provides insight into factors that affect healthcare seeking and HIV prevention for BMSM. These findings have implications for the design of policies and institutional reforms that could enhance the impact of PrEP among BMSM. Findings are also relevant to the management of chronic disease among men more broadly.
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Affiliation(s)
- Morgan M Philbin
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, Floor 5, Room 536, New York, NY, 10032, USA.
| | - Caroline M Parker
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, Floor 5, Room 536, New York, NY, 10032, USA
| | - Richard G Parker
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, Floor 5, Room 536, New York, NY, 10032, USA
| | - Patrick A Wilson
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, Floor 5, Room 536, New York, NY, 10032, USA
| | - Jonathan Garcia
- College of Public Health and Human Science, Oregon State University, Corvallis, OR, USA
| | - Jennifer S Hirsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, Floor 5, Room 536, New York, NY, 10032, USA
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104
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Shover CL, Javanbakht M, Shoptaw S, Bolan RK, Lee SJ, Parsons JT, Rendina J, Gorbach PM. HIV Preexposure Prophylaxis Initiation at a Large Community Clinic: Differences Between Eligibility, Awareness, and Uptake. Am J Public Health 2018; 108:1408-1417. [PMID: 30138062 PMCID: PMC6137770 DOI: 10.2105/ajph.2018.304623] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To characterize uptake of HIV preexposure prophylaxis (PrEP) in a community setting and to identify disparities in PrEP use by demographic and behavioral factors associated with increased HIV risk. METHODS We conducted a cross-sectional study of 19 587 men who have sex with men and transgender people visiting a Los Angeles, California, clinic specializing in lesbian, gay, bisexual, and transgender care between August 2015 and February 2018 by using clinical care data. RESULTS Seventy percent of patients met PrEP eligibility criteria, while 10% reported PrEP use. Using sex drugs, reporting both condomless anal intercourse and recent sexually transmitted infection, older age, and higher education level were associated with higher odds of PrEP use given eligibility. Latino or Asian race/ethnicity and bisexual orientation were associated with lower odds of PrEP use given eligibility. Higher odds of perceived need were associated with demographic risk factors but PrEP use was not similarly elevated. CONCLUSIONS Discrepancies between PrEP eligibility, perceived need, and use reveal opportunities to improve PrEP delivery in community settings. Public Health Implications. Efforts are needed to facilitate PrEP uptake in populations with highest HIV incidence.
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Affiliation(s)
- Chelsea L Shover
- Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine
| | - Marjan Javanbakht
- Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine
| | - Steven Shoptaw
- Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine
| | - Robert K Bolan
- Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine
| | - Sung-Jae Lee
- Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine
| | - Jeffrey T Parsons
- Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine
| | - Jonathon Rendina
- Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine
| | - Pamina M Gorbach
- Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine
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105
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Deutsch MB. Pre-Exposure Prophylaxis in Trans Populations: Providing Gender-Affirming Prevention for Trans People at High Risk of Acquiring HIV. LGBT Health 2018; 5:387-390. [PMID: 30272493 DOI: 10.1089/lgbt.2018.0086] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Transgender (trans) people, particularly trans women of color, face alarmingly high rates of HIV. HIV pre-exposure prophylaxis (PrEP) with daily coformulated emtricitabine and tenofovir disoproxil fumarate is a promising biomedical HIV prevention modality; however, it has not yet been shown to be efficacious in the transgender population due to data limitations. Initial data suggest that barriers exist to PrEP uptake in the trans community, including lack of access to healthcare and concerns about interactions with hormone therapy. This article discusses these factors and reviews considerations for enhancing PrEP uptake and adherence in trans people at risk for HIV.
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Affiliation(s)
- Madeline B Deutsch
- 1 Department of Family and Community Medicine, University of California , San Francisco, San Francisco, California.,2 UCSF Transgender Care, UCSF Medical Center, University of California , San Francisco, San Francisco, California
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106
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Gianella S, Sonya Haw J, Blumenthal J, Sullivan B, Smith D. The Importance of Human Immunodeficiency Virus Research for Transgender and Gender-Nonbinary Individuals. Clin Infect Dis 2018; 66:1460-1466. [PMID: 29126186 PMCID: PMC5905620 DOI: 10.1093/cid/cix990] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/07/2017] [Indexed: 02/04/2023] Open
Abstract
Transgender and gender-nonbinary (trans/GNB) individuals are disproportionally affected by human immunodeficiency virus (HIV), yet they are not adequately represented in HIV research and often underserved in clinical care. By building on community strengths and addressing structural, psychological and biological challenges, we can improve the engagement of trans/GNB people in research and ultimately improve prevention, testing, and care for this population. Here, we review the current state of the science related to HIV for trans/GNB people and discuss next steps to expand research that aims to improve the lives and well-being of trans/GNB persons.
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Affiliation(s)
| | - J Sonya Haw
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Davey Smith
- University of California, San Diego, La Jolla
- Veterans Affairs San Diego Healthcare System, California
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107
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Smirnoff M, Wilets I, Ragin D, Adams R, Holohan J, Rhodes R, Winkel G, Ricc E, Clesca C, Richardson LD. A paradigm for understanding trust and mistrust in medical research: The Community VOICES study. AJOB Empir Bioeth 2018; 9:39-47. [PMID: 29368998 PMCID: PMC6092744 DOI: 10.1080/23294515.2018.1432718] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND To promote justice in research practice and rectify health disparities, greater diversity in research participation is needed. Lack of trust in medical research is one of the most significant obstacles to research participation. Multiple variables have been identified as factors associated with research participant trust/mistrust. A conceptual model that provides meaningful insight into the interplay of factors impacting trust may promote more ethical research practice and provide an enhanced, actionable understanding of participant mistrust. METHODS A structured survey was developed to capture attitudes toward research conducted in emergency situations; this article focuses on items designed to assess respondents' level of trust or mistrust in medical research in general. Community-based interviews were conducted in English or Spanish with 355 New York City residents (white 42%, African American 29%, Latino 22%). RESULTS Generally favorable attitudes toward research were expressed by a majority (85.3%), but many respondents expressed mistrust. Factor analysis yielded four specific domains of trust/mistrust, each of which was associated with different demographic variables: general trustworthiness (older age, not disabled); perceptions of discrimination (African American, Latino, Spanish language preference); perceptions of deception (prior research experience, African American); and perceptions of exploitation (less education). CONCLUSIONS The four domains identified in the analysis provide a framework for understanding specific areas of research trust/mistrust among disparate study populations. This model offers a conceptual basis for the design of tailored interventions that target specific groups to promote trust of individual researchers and research institutions as well as to facilitate broader research participation.
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Affiliation(s)
| | - I Wilets
- Icahn School of Medicine at Mount Sinai
| | | | | | - J. Holohan
- New York Presbyterian Weill Cornell Hospital
| | - R. Rhodes
- Icahn School of Medicine at Mount Sinai
| | - G. Winkel
- Icahn School of Medicine at Mount Sinai
| | | | - C. Clesca
- Icahn School of Medicine at Mount Sinai
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108
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Reisner SL, Jadwin-Cakmak L, White Hughto JM, Martinez M, Salomon L, Harper GW. Characterizing the HIV Prevention and Care Continua in a Sample of Transgender Youth in the U.S. AIDS Behav 2017. [PMID: 29138982 DOI: 10.1007/s10461-017-1938-] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
In the U.S., transgender and other gender minority (TG) youth are an at-risk group understudied in HIV prevention and treatment. This study sought to characterize the HIV prevention and care continua in a diverse sample of 181 sexually-active TG ages 16-24 years (mean age = 20.7 years; 76.8% trans feminine; 69.1% youth of color) recruited July-December 2015 in 14 U.S. cities. Overall, 30.9% reported living with HIV, of which 71.4% were on antiretroviral therapy (ART) and 55.0% were medication adherent; 65.6% were known to be virally suppressed. In multivariable models, medical gender affirmation was associated with lower odds of viral suppression. Medical gender affirmation and stigma in HIV care were each independently associated with elevated odds of having missed HIV care appointments. Among at-risk TG youth not living with HIV, only 8.2% had accessed pre-exposure prophylaxis (PrEP). Early biobehavioral prevention and treatment interventions are needed for TG youth.
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Affiliation(s)
- Sari L Reisner
- Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Laura Jadwin-Cakmak
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Center for Sexuality & Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Jaclyn M White Hughto
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Miguel Martinez
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Liz Salomon
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Gary W Harper
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA.
- Center for Sexuality & Health Disparities, University of Michigan, Ann Arbor, MI, USA.
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109
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Reisner SL, Jadwin-Cakmak L, White Hughto JM, Martinez M, Salomon L, Harper GW. Characterizing the HIV Prevention and Care Continua in a Sample of Transgender Youth in the U.S. AIDS Behav 2017; 21:3312-3327. [PMID: 29138982 PMCID: PMC5705332 DOI: 10.1007/s10461-017-1938-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In the U.S., transgender and other gender minority (TG) youth are an at-risk group understudied in HIV prevention and treatment. This study sought to characterize the HIV prevention and care continua in a diverse sample of 181 sexually-active TG ages 16-24 years (mean age = 20.7 years; 76.8% trans feminine; 69.1% youth of color) recruited July-December 2015 in 14 U.S. cities. Overall, 30.9% reported living with HIV, of which 71.4% were on antiretroviral therapy (ART) and 55.0% were medication adherent; 65.6% were known to be virally suppressed. In multivariable models, medical gender affirmation was associated with lower odds of viral suppression. Medical gender affirmation and stigma in HIV care were each independently associated with elevated odds of having missed HIV care appointments. Among at-risk TG youth not living with HIV, only 8.2% had accessed pre-exposure prophylaxis (PrEP). Early biobehavioral prevention and treatment interventions are needed for TG youth.
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Affiliation(s)
- Sari L Reisner
- Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Laura Jadwin-Cakmak
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Center for Sexuality & Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Jaclyn M White Hughto
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Miguel Martinez
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Liz Salomon
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Gary W Harper
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA.
- Center for Sexuality & Health Disparities, University of Michigan, Ann Arbor, MI, USA.
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110
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Braun HM, Candelario J, Hanlon CL, Segura ER, Clark JL, Currier JS, Lake JE. Transgender Women Living with HIV Frequently Take Antiretroviral Therapy and/or Feminizing Hormone Therapy Differently Than Prescribed Due to Drug-Drug Interaction Concerns. LGBT Health 2017; 4:371-375. [PMID: 28876170 DOI: 10.1089/lgbt.2017.0057] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Both hormone therapy (HT) and antiretroviral therapy (ART) can be lifesaving for transgender women (TW) living with HIV, but each has side effects and potential drug-drug interactions (DDI). We assessed how concerns about HT-ART interactions affect treatment adherence. METHODS This study used a cross-sectional survey of TW (n = 87) in Los Angeles, CA. RESULTS Fifty-four percent were living with HIV; 64% used HT. Only 49% of TW living with HIV discussed ART-HT DDI with their provider; 40% reported not taking ART (12%), HT (12%), or both (16%) as directed due to DDI concerns. CONCLUSION Imperfect HT/ART use and limited provider communication suggests a need for improved HT-ART integration.
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Affiliation(s)
- Hannan M Braun
- 1 School of Medicine, University of California , San Francisco, San Francisco, California.,2 South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine , Los Angeles, California
| | - Jury Candelario
- 3 APAIT, Special Service for Groups , Los Angeles, California
| | - Courtney L Hanlon
- 4 Geisel School of Medicine, Dartmouth College , Hanover, New Hampshire
| | - Eddy R Segura
- 2 South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine , Los Angeles, California.,5 Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas , Lima, Peru
| | - Jesse L Clark
- 2 South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine , Los Angeles, California
| | - Judith S Currier
- 2 South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine , Los Angeles, California
| | - Jordan E Lake
- 2 South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine , Los Angeles, California.,6 Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston , Houston, Texas
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111
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No one left behind: how are we doing in the roll-out of PrEP as part of combination HIV prevention? J Int AIDS Soc 2016; 19:21364. [PMID: 27760690 PMCID: PMC5071753 DOI: 10.7448/ias.19.7.21364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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112
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Global implementation of PrEP as part of combination HIV prevention - Unsolved challenges. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.7.21479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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