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Concerns about contracting HIV, knowing partners' HIV sero-status and discussion of HIV/STI with sexual partners as determinants of uptake of HIV testing. J Biosoc Sci 2018; 51:549-561. [PMID: 30516121 DOI: 10.1017/s0021932018000330] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Worldwide, adolescents and young adults (aged 15-25 years) account for the highest proportion of new HIV infections, yet the uptake of HIV testing among this cohort is sub-optimal. Understanding factors that predict the uptake of HIV testing among adolescents and young adults is critical for designing effective and relevant interventions to increase testing. Drawing from the psychosocial constructs of the Health Belief Model, the study examined the effects of HIV risk perception, discussion of HIV with partners and knowing partners' HIV status on HIV testing uptake among adolescents and young adults in two Nigerian universities. The study was conducted in 2018 and was cross-sectional in design, with a final sample of 784 male and female students selected using stratified random sampling. Adjusted and unadjusted logistic regression models were used to examine the effect of HIV risk perception, discussion of HIV with partners and knowing partners' HIV status on HIV testing uptake. Only 50.6% of participants had ever tested for HIV with 30.7% being tested in the last year, with no significant differences by sex. After controlling for other covariates (age, sex and being sexually active), knowing partners' HIV status, having discussed HIV with partners and being very concerned about contracting HIV were found to be significantly associated with ever being tested for HIV and recent HIV testing uptake. Uptake of HIV testing was found to be low in the study setting and fell short of the first '90%' UNAIDS target. Age-appropriate strategies, targeting open communication on HIV/STIs and disclosure of sero-status between sexual partners are required to promote uptake of HIV testing among young adults and adolescents in Nigeria.
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152
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Pitasi MA, Chavez PR, DiNenno EA, Jeffries WL, Johnson CH, Demeke H, August EM, Bradley H. Stigmatizing Attitudes Toward People Living with HIV Among Adults and Adolescents in the United States. AIDS Behav 2018; 22:3887-3891. [PMID: 29948338 DOI: 10.1007/s10461-018-2188-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Stigmatizing attitudes toward people living with HIV (PLWH) cause psychological distress for PLWH and hinder HIV prevention efforts. We estimated the prevalence of stigmatizing attitudes among 6809 adults and 885 adolescents who responded to online surveys in 2015. Fear of casual contact with PLWH was reported by 17.5% [95% confidence interval (CI) 16.3-18.6%] of adults and 31.6% (CI 27.8-35.4%) of adolescents. Among adults, 12.5% (CI 11.6-13.5%) endorsed a measure of moral judgment toward PLWH. Stigmatizing attitudes toward PLWH persist in the United States. Continued monitoring of these attitudes and efforts to reduce associated stigma are warranted.
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153
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Thapa S, Hannes K, Cargo M, Buve A, Peters S, Dauphin S, Mathei C. Stigma reduction in relation to HIV test uptake in low- and middle-income countries: a realist review. BMC Public Health 2018; 18:1277. [PMID: 30453923 PMCID: PMC6245520 DOI: 10.1186/s12889-018-6156-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 10/26/2018] [Indexed: 11/20/2022] Open
Abstract
Background This realist review was conducted to understand how stigma is reduced in relation to HIV test uptake in low- and middle-income countries (LMICs). Methods A systematic search of eight databases resulted in 34 articles considered for synthesis. Data synthesis was guided by a preliminary programme theory and included coding the meaning units to develop themes or intervention pathways that corresponded to context-mechanism-outcome configurations. Results We found that the interventions produced an effect through two pathways: (a) knowledge leads to changes in stigmatizing attitudes and increases in HIV test uptake and (b) knowledge and attitudes lead to changes in stigmatizing behaviours and lead to HIV test uptake. We also found one competing pathway that illustrated the direct impact of knowledge on HIV test uptake without changing stigmatizing attitudes and behaviour. The identified pathways were found to be influenced by some structural factors (e.g., anti-homosexuality laws, country-specific HIV testing programmes and policies), community factors (e.g., traditional beliefs and practices, sexual taboos and prevalence of intimate partner violence) and target-population characteristics (e.g., age, income and urban-rural residence). Conclusions The pathways and underlying mechanisms support the adaptation of intervention strategies in terms of social context and the target population in LMICs.
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Affiliation(s)
- Subash Thapa
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, 5000, Denmark.
| | - Karin Hannes
- Social Research Methodology Group, Faculty of Social Sciences, KU Leuven, Parkstraat 45, 3000, Leuven, Belgium
| | - Margaret Cargo
- Health Research Institute, University of Canberra, University Drive, 22-B17, Bruce, ACT, 2601, Australia
| | - Anne Buve
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Sanne Peters
- Department of Public Health and Primary care, KU Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
| | - Stephanie Dauphin
- Department of Public Health and Primary care, KU Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
| | - Catharina Mathei
- Department of Public Health and Primary care, KU Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
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Frasca K, Nassau T, McLaughlin C, Brady KA. Factors Associated with Recent HIV Testing among Men Who Have Sex with Men in Philadelphia: a Cross-Sectional Analysis of the National Behavioral Surveillance System Survey. AIDS Care 2018; 31:230-237. [PMID: 30304956 DOI: 10.1080/09540121.2018.1533228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The main objective of this study was to determine the demographic, geographic and socioeconomic characteristics of men who have sex with men (MSM) in Philadelphia that were associated with having a recent HIV test. We used data from the National HIV Behavioral Surveillance System (NHBS) surveys from 2011 and 2014 among MSM in Philadelphia, with the outcome of interest of having received an HIV test in the past twelve months. Of 1043 HIV-negative MSM, 70.2% had an HIV test. Multivariable analysis showed that seeing a medical provider (aOR: 1.73; p = .0039) or having heard of PrEP (aOR: 2.24; p < .0001) was associated with recent HIV testing. Those participants forty-five years of age or older (aOR 0.40, p = .0001) and those with Medicaid had lower rates of HIV testing (aOR 0.48, p = .002). Although over 80% of participants had seen a medical provider in the past year, only 50% had been offered an HIV test by a provider. Optimizing HIV testing through the expansion and increased awareness of PrEP, especially among older MSM, is critical. Further research is needed to delineate barriers that prevent MSM from utilizing medical providers for HIV testing and for those with Medicaid from receiving HIV testing.
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Affiliation(s)
- Katherine Frasca
- a Division of Infectious Diseases , University of Colorado , Denver , CO , USA
| | - Tanner Nassau
- b Philadelphia Department of Public Health , Philadelphia , PA , USA
| | - Carol McLaughlin
- c Division of Infectious Diseases , University of Pennsylvania , Philadelphia , PA , USA
| | - Kathleen A Brady
- b Philadelphia Department of Public Health , Philadelphia , PA , USA
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155
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Hammack PL, Meyer IH, Krueger EA, Lightfoot M, Frost DM. HIV testing and pre-exposure prophylaxis (PrEP) use, familiarity, and attitudes among gay and bisexual men in the United States: A national probability sample of three birth cohorts. PLoS One 2018; 13:e0202806. [PMID: 30192791 PMCID: PMC6128476 DOI: 10.1371/journal.pone.0202806] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/09/2018] [Indexed: 12/12/2022] Open
Abstract
This study examined HIV testing and use, familiarity, and attitudes toward pre-exposure prophylaxis (PrEP) among HIV-negative gay and bisexual men in the United States. A national probability sample (N = 470) of three age cohorts (18-25, 34-41, and 52-59 years) completed a survey between March, 2016 and March, 2017. Most men did not meet CDC recommendations for HIV testing, and 25.2% of men in the younger cohort had never tested. Only 4.1% used PrEP across cohorts. Visiting an LGBT clinic and searching for LGBT resources online were associated with PrEP use. Men in the middle cohort were more familiar with PrEP (79%) than men in the younger (52%) and older (57%) cohorts. Bisexual and non-urban men were less familiar with PrEP. Attitudes were positive among most men (68.4%) familiar with PrEP. Findings suggest that most men potentially at risk for HIV do not meet CDC guidelines for testing, and PrEP use continues to be minimal. Efforts to educate gay and bisexual men about HIV risk and prevention need to be reinvigorated and expanded to include non-gay-identified and non-urban men.
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Affiliation(s)
- Phillip L. Hammack
- Department of Psychology, University of California, Santa Cruz, California, United States of America
| | - Ilan H. Meyer
- Williams Institute, UCLA School of Law, Los Angeles, California, United States of America
| | - Evan A. Krueger
- Williams Institute, UCLA School of Law, Los Angeles, California, United States of America
| | - Marguerita Lightfoot
- Department of Medicine, University of California, San Francisco, California, United States of America
| | - David M. Frost
- Department of Social Science, University College, London, United Kingdom
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156
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Tang W, Wei C, Cao B, Wu D, Li KT, Lu H, Ma W, Kang D, Li H, Liao M, Mollan KR, Hudgens MG, Liu C, Huang W, Liu A, Zhang Y, Smith MK, Mitchell KM, Ong JJ, Fu H, Vickerman P, Yang L, Wang C, Zheng H, Yang B, Tucker JD. Crowdsourcing to expand HIV testing among men who have sex with men in China: A closed cohort stepped wedge cluster randomized controlled trial. PLoS Med 2018; 15:e1002645. [PMID: 30153265 PMCID: PMC6112627 DOI: 10.1371/journal.pmed.1002645] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/26/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND HIV testing rates are suboptimal among at-risk men. Crowdsourcing may be a useful tool for designing innovative, community-based HIV testing strategies to increase HIV testing. The purpose of this study was to use a stepped wedge cluster randomized controlled trial (RCT) to evaluate the effect of a crowdsourced HIV intervention on HIV testing uptake among men who have sex with men (MSM) in eight Chinese cities. METHODS AND FINDINGS An HIV testing intervention was developed through a national image contest, a regional strategy designathon, and local message contests. The final intervention included a multimedia HIV testing campaign, an online HIV testing service, and local testing promotion campaigns tailored for MSM. This intervention was evaluated using a closed cohort stepped wedge cluster RCT in eight Chinese cities (Guangzhou, Shenzhen, Zhuhai, and Jiangmen in Guangdong province; Jinan, Qingdao, Yantai, and Jining in Shandong province) from August 2016 to August 2017. MSM were recruited through Blued, a social networking mobile application for MSM, from July 29 to August 21 of 2016. The primary outcome was self-reported HIV testing in the past 3 months. Secondary outcomes included HIV self-testing, facility-based HIV testing, condom use, and syphilis testing. Generalized linear mixed models (GLMMs) were used to analyze primary and secondary outcomes. We enrolled a total of 1,381 MSM. Most were ≤30 years old (82%), unmarried (86%), and had a college degree or higher (65%). The proportion of individuals receiving an HIV test during the intervention periods within a city was 8.9% (95% confidence interval [CI] 2.2-15.5) greater than during the control periods. In addition, the intention-to-treat analysis showed a higher probability of receiving an HIV test during the intervention periods as compared to the control periods (estimated risk ratio [RR] = 1.43, 95% CI 1.19-1.73). The intervention also increased HIV self-testing (RR = 1.89, 95% CI 1.50-2.38). There was no effect on facility-based HIV testing (RR = 1.00, 95% CI 0.79-1.26), condom use (RR = 1.00, 95% CI 0.86-1.17), or syphilis testing (RR = 0.92, 95% CI 0.70-1.21). A total of 48.6% (593/1,219) of participants reported that they received HIV self-testing. Among men who received two HIV tests, 32 individuals seroconverted during the 1-year study period. Study limitations include the use of self-reported HIV testing data among a subset of men and non-completion of the final survey by 23% of participants. Our study population was a young online group in urban China and the relevance of our findings to other populations will require further investigation. CONCLUSIONS In this setting, crowdsourcing was effective for developing and strengthening community-based HIV testing services for MSM. Crowdsourced interventions may be an important tool for the scale-up of HIV testing services among MSM in low- and middle-income countries (LMIC). TRIAL REGISTRATION ClinicalTrials.gov NCT02796963.
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Affiliation(s)
- Weiming Tang
- University of North Carolina Project-China, Guangzhou, China
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Chongyi Wei
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Social and Behavioral Health Sciences, School of Public Health, Rutgers University, Piscataway, New Jersey, United States of America
| | - Bolin Cao
- University of North Carolina Project-China, Guangzhou, China
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- School of Media and Communication, Shenzhen University, Shenzhen, China
| | - Dan Wu
- University of North Carolina Project-China, Guangzhou, China
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
| | - Katherine T. Li
- University of North Carolina Project-China, Guangzhou, China
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Weill Cornell Medical College, New York, New York, United States of America
| | - Haidong Lu
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Wei Ma
- Shandong University School of Public Health, Jinan, China
| | - Dianmin Kang
- Shandong Center for Disease Control and Prevention, Jinan, China
| | - Haochu Li
- University of North Carolina Project-China, Guangzhou, China
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Shandong University School of Public Health, Jinan, China
| | - Meizhen Liao
- Shandong Center for Disease Control and Prevention, Jinan, China
| | - Katie R. Mollan
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Michael G. Hudgens
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Chuncheng Liu
- University of North Carolina Project-China, Guangzhou, China
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Department of Sociology, University of California San Diego, La Jolla, California, United States of America
| | - Wenting Huang
- University of North Carolina Project-China, Guangzhou, China
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
| | - Aifeng Liu
- University of North Carolina Project-China, Guangzhou, China
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
| | - Ye Zhang
- University of North Carolina Project-China, Guangzhou, China
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - M. Kumi Smith
- Department of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States of America
| | - Kate M. Mitchell
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Jason J. Ong
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hongyun Fu
- Division of Community Health and Research, Eastern Virginia Medical School, Norfolk, Virginia, United States of America
| | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Ligang Yang
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Cheng Wang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Heping Zheng
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Bin Yang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Joseph D. Tucker
- University of North Carolina Project-China, Guangzhou, China
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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157
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Campbell CK, Lippman SA, Moss N, Lightfoot M. Strategies to Increase HIV Testing Among MSM: A Synthesis of the Literature. AIDS Behav 2018; 22:2387-2412. [PMID: 29550941 DOI: 10.1007/s10461-018-2083-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
More than 30 years into the HIV epidemic, men who have sex with men (MSM) continue to be disproportionately impacted. It is estimated that worldwide nearly half of MSM infected with HIV are unaware of their status, making HIV testing along with early linkage to care crucial to HIV prevention efforts. However, there remain significant barriers to HIV testing among MSM, due largely to complex issues of layered stigma that deter MSM from accessing traditional, clinic-based testing. We conducted a review and synthesis of the literature on strategies to increase uptake of HIV testing among MSM. We found that social network-based strategies, community-based testing, HIV self-testing, and modifications to the traditional clinic-based model can effectively reach a subset of MSM, but success was often context-specific and there are significant gaps in evidence. We provide recommendations for increasing HIV testing rates and status awareness among MSM.
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Affiliation(s)
- Chadwick K Campbell
- Center for AIDS Prevention Studies, University of California San Francisco, UCSF Mail Code 0886, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA.
| | - Sheri A Lippman
- Center for AIDS Prevention Studies, University of California San Francisco, UCSF Mail Code 0886, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA
| | - Nicholas Moss
- Division of Communicable Disease Control & Prevention, Alameda County Public Health Department, Oakland, CA, USA
| | - Marguerita Lightfoot
- Center for AIDS Prevention Studies, University of California San Francisco, UCSF Mail Code 0886, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA
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158
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Vargas SK, Konda KA, Leon SR, Brown B, Klausner JD, Lindan C, Caceres CF. The Relationship Between Risk Perception and Frequency of HIV Testing Among Men Who Have Sex with Men and Transgender Women, Lima, Peru. AIDS Behav 2018; 22:26-34. [PMID: 29313193 PMCID: PMC6149521 DOI: 10.1007/s10461-017-2018-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
HIV infections in Peru are concentrated among men who have sex with men (MSM) and transgender women (TW). HIV testing rates among them remain low, delaying entrance into care. We assessed the prevalence of frequent HIV testing (at least every 6 months) and associated factors among 310 MSM and TW who attend sexual health clinics in Lima, Peru, and who reported that they were HIV seronegative or unaware of their status. Only 39% of participants tested frequently, and 22% had never tested; 29% reported that they were at low or no risk for acquiring HIV. Reporting low or no risk for acquiring HIV was associated with frequent testing (adjusted prevalence ratio [aPR] = 1.53, 95% CI 1.13-2.08); those reporting unprotected anal sex were less likely to test frequently (aPR = 0.66, 95% CI 0.50-0.87). HIV prevalence was 12% and did not vary by risk perception categories. This at-risk population tests infrequently and may not understand the risk of having unprotected sex.
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Affiliation(s)
- S K Vargas
- Laboratory of Sexual Health, Center for Interdisciplinary Research on Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.
- Laboratorio de Salud Sexual, Laboratorios de Investigación y Desarrollo (LID), Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru.
| | - K A Konda
- Program in Global Health, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Unit of Health, Sexuality and Human Development, Center for Interdisciplinary Research on Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - S R Leon
- Laboratory of Sexual Health, Center for Interdisciplinary Research on Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - B Brown
- Center for Healthy Communities, School of Medicine, University of California Riverside, Riverside, CA, USA
| | - J D Klausner
- Program in Global Health, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - C Lindan
- Department of Epidemiology and Biostatistics, Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - C F Caceres
- Unit of Health, Sexuality and Human Development, Center for Interdisciplinary Research on Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
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159
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Kahle EM, Sharma A, Sullivan SP, Stephenson R. HIV Prioritization and Risk Perception Among an Online Sample of Men Who Have Sex With Men in the United States. Am J Mens Health 2018; 12:676-687. [PMID: 29781331 PMCID: PMC6131427 DOI: 10.1177/1557988318776581] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Men who have sex with men (MSM) may prioritize interpersonal and structural
factors, such as LGBTQ-related inequalities, housing instability, financial
insecurity, and relationship seeking, over HIV prevention. The aim of this study
was to assess how MSM prioritize HIV relative to other factors and the
association between HIV prioritization, HIV testing and sexual risk behavior,
and perceived risk. Data were collected from a national online survey of MSM in
the United States assessing HIV knowledge and prioritization. Participants
ranked HIV prevention relative to LGBTQ-related concerns and life issues (e.g.,
housing, job, relationship). Adjusted regression models were conducted to assess
the association of HIV prioritization with HIV testing and condomless anal sex
(CAS) and to evaluate associations between perceived risk and HIV risk behavior.
Among 516 participants, HIV prevention was ranked significantly higher among MSM
reporting recent CAS (p = .04) and HIV testing within the past
(p = .02); HIV prevention was prioritized higher relative
to life issues among MSM reporting last HIV test more than 1 year ago
(p = .02). Perceived HIV risk was significantly associated
with higher HIV prioritization relative to LGBTQ concerns (p =
.001) and life issues (p = .001). Higher HIV perceived risk was
associated with lower odds of any CAS (p < .001) and higher
odds of having an HIV test in the past year (p < .001). In
this online study, HIV prioritization was identified as differentially
associated with HIV testing, sexual risk behavior, and perceived HIV risk. HIV
prevention programs should integrate strategies to address social and structural
inequalities based on priority needs of MSM.
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Affiliation(s)
- Erin M Kahle
- 1 Department of Health Behavior and Biological Sciences, School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Akshay Sharma
- 1 Department of Health Behavior and Biological Sciences, School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Stephen P Sullivan
- 1 Department of Health Behavior and Biological Sciences, School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Rob Stephenson
- 1 Department of Health Behavior and Biological Sciences, School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
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160
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Measurements of Sexuality-Based Stigma among Gay, Bisexual, and Other Men Who Have Sex with Men (GBMSM) in Resource-Poor Settings: A Review. AIDS Behav 2018; 22:1614-1638. [PMID: 29128941 DOI: 10.1007/s10461-017-1975-3] [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] [Indexed: 10/18/2022]
Abstract
Gay, bisexual, and other men who have sex with men (GBMSM) in resource-poor settings are disproportionately affected by the HIV/AIDS epidemic. GBMSM living in these settings may face unique barriers to HIV prevention, including legal barriers and increased sexuality-based stigma. It is therefore imperative to tailor HIV prevention and care resources to recognize the lived realities of GBMSM in these settings. Central to this is the accurate measurement of sexuality-based stigma. However, there is wide inconsistency in how sexuality-based stigma is measured among GBMSM in resource-poor settings. This paper reviews recent studies of sexuality-based stigma among GBMSM in resource-poor settings, finding great variability in measurements. The results of the review call for greater attention to the development of contextually and culturally specific measures of sexuality-based stigma for GBMSM living in resource-poor settings.
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161
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Gwadz M, Leonard NR, Honig S, Freeman R, Kutnick A, Ritchie AS. Doing battle with "the monster:" how high-risk heterosexuals experience and successfully manage HIV stigma as a barrier to HIV testing. Int J Equity Health 2018; 17:46. [PMID: 29678188 PMCID: PMC5910579 DOI: 10.1186/s12939-018-0761-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 04/10/2018] [Indexed: 12/22/2022] Open
Abstract
Background Annual HIV testing is recommended for populations at-risk for HIV in the United States, including heterosexuals geographically connected to urban high-risk areas (HRA) with elevated rates of HIV prevalence and poverty, who are primarily African American/Black or Hispanic. Yet this subpopulation of “individuals residing in HRA” (IR-HRA) evidence low rates of regular HIV testing. HIV stigma is a recognized primary barrier to testing, in part due to its interaction with other stigmatized social identities. Guided by social-cognitive and intersectionality theories, this qualitative descriptive study explored stigma as a barrier to HIV testing and identified ways IR-HRA manage stigma. Methods In 2012-2014, we conducted in-depth qualitative interviews with 31 adult IR-HRA (74% male, 84% African American/Black) with unknown or negative HIV status, purposively sampled from a larger study for maximum variation on HIV testing experiences. Interviews were audio-recorded and professionally transcribed verbatim. Data were analyzed using a systematic content analysis approach that was both theory-driven and inductive. Results Stigma was a primary barrier to HIV testing among IR-HRA. In the context of an under-resourced community, HIV stigma was experienced as emerging from, and being perpetuated by, health care organizations and educational institutions, as well as community members. Participants noted it was “better not to know” one’s HIV status, to avoid experiencing HIV-related stigma, which could interact with other stigmatized social identities and threaten vital social relationships, life chances, and resources. Yet most had tested for HIV previously. Factors facilitating testing included health education to boost knowledge of effective treatments for HIV; understanding HIV does not necessitate ending social relationships; and tapping into altruism. Conclusions In the context of economic and social inequality, HIV stigma operates on multiple, intersecting layers. IR-HRA struggle with an aversion to HIV testing, because adopting another stigmatized status is dangerous. They also find ways to manage stigma to engage in testing, even if not at recommended levels. Findings highlight strategies to reduce HIV stigma at the levels of communities, institutions, and individuals to improve rates of annual HIV testing necessary to eliminate HIV transmission and reduce HIV-related racial and ethnic health disparities among IR-HRA.
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Affiliation(s)
- Marya Gwadz
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, 6th floor, New York, NY, 10010, USA.
| | - Noelle R Leonard
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, 6th floor, New York, NY, 10010, USA
| | - Sylvie Honig
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, 6th floor, New York, NY, 10010, USA
| | - Robert Freeman
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, 6th floor, New York, NY, 10010, USA
| | - Alexandra Kutnick
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, 6th floor, New York, NY, 10010, USA
| | - Amanda S Ritchie
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, 6th floor, New York, NY, 10010, USA
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162
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Eaton LA, Earnshaw VA, Maksut JL, Thorson KR, Watson RJ, Bauermeister JA. Experiences of stigma and health care engagement among Black MSM newly diagnosed with HIV/STI. J Behav Med 2018; 41:458-466. [PMID: 29626312 DOI: 10.1007/s10865-018-9922-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/03/2018] [Indexed: 12/23/2022]
Abstract
Rates of HIV/STI transmission among Black men who have sex with men (BMSM) are alarmingly high and demand urgent public health attention. Stigma related concerns are a key barrier to accessing health care and prevention tools, yet limited research has been focused in this area. Experiences of stigma related to health care were evaluated among 151 BMSM residing in the Atlanta, GA area, both prior to and post HIV or STI diagnosis in a longitudinal study (data collected from 2014 to 2016). Findings demonstrated that inadequate health care engagement is associated with post-diagnosis anticipated stigma (b = - 0.38, SE = 0.17 p ≤ .05). Pre-diagnosis prejudice is a predictor of post-diagnosis enacted (b = 0.39, SE = 0.14, p < .01), anticipated (b = .28, SE = 0.14, p < .05), and internalized (b = .22, SE = 0.06, p < .001) stigmas. This study is the first of its kind to assess experiences of stigma among BMSM during a critical time (i.e., before and after diagnosis) for HIV/STI prevention and treatment. Results provide a novel understanding of how stigma unfolds over-time and provide direction for stigma intervention development.
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Affiliation(s)
- Lisa A Eaton
- Department of Human Development and Family Studies, Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06269-1248, USA.
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Jessica L Maksut
- Department of Human Development and Family Studies, Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06269-1248, USA
| | | | - Ryan J Watson
- Department of Human Development and Family Studies, Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06269-1248, USA
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163
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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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164
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Murray A, Gaul Z, Sutton MY, Nanin J. "We hide…": Perceptions of HIV Risk Among Black and Latino MSM in New York City. Am J Mens Health 2018; 12:180-188. [PMID: 29161954 PMCID: PMC5818124 DOI: 10.1177/1557988317742231] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 09/06/2017] [Accepted: 09/11/2017] [Indexed: 12/28/2022] Open
Abstract
Black and Latino men who have sex with men (BLMSM) are disproportionately infected with HIV; they comprised 66% of HIV diagnoses among men who have sex with men (MSM) in the United States in 2015. Risk factors for HIV infection among BLMSM include a high community prevalence of diagnosed and undiagnosed HIV/STDs, and dense sex partner networks. Perceptions of HIV risk among BLMSM were explored to inform HIV prevention efforts. During 2011-2012, semistructured interviews were conducted with BLMSM in New York City. Using computer-assisted thematic analyses (NVivo), transcribed interview responses to questions regarding HIV risk for main themes were examined. Interview data were available for 108 BLMSM: 86% Black, 13% Latino, 26% aged 18-24 years, 59% self-identified as "gay," and 33% self-identified as "bisexual." The main emergent theme was stigma. Subthemes related to stigma included: (a) homophobia in the Black and Latino community, (b) fear of losing support from family and friends, and (c) lack of support leading to low self-esteem. Addressing the stigma felt by BLMSM may be an important strategy to facilitate improved HIV prevention efforts, HIV care and treatment, and to decrease HIV-related disparities.
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Affiliation(s)
- Ashley Murray
- Division of HIV/AIDS Prevention, NCHHSTP, CDC, Atlanta, GA, USA
| | - Zaneta Gaul
- Division of HIV/AIDS Prevention, NCHHSTP, CDC, Atlanta, GA, USA
- ICF, Atlanta, GA, USA
| | | | - Jose Nanin
- Kingsborough Community College, CUNY, New York, NY, USA
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165
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Tobin K, Edwards C, Flath N, Lee A, Tormohlen K, Gaydos CA. Acceptability and feasibility of a Peer Mentor program to train young Black men who have sex with men to promote HIV and STI home-testing to their social network members. AIDS Care 2018; 30:896-902. [PMID: 29482342 DOI: 10.1080/09540121.2018.1442553] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Young Black men who have sex with men (YBMSM) experience persistently high rates of undiagnosed HIV and other sexually transmitted infections (STIs) and testing rates remain sub-optimal. Home-based testing (HBT) has been found to be acceptable among MSM and while awareness about HBT is relatively high, uptake has been low. Peer-based approaches have been shown to be effective in reducing HIV risk behavior, yet have not been used to increase utilization of HBT. The purpose of this study was to assess acceptability and feasibility of a program to train YBMSM as Peer Mentors to use and promote HIV and STI home-based testing and specimen collection to their social network members. Fifteen YBMSM ages 18-30 completed in-depth structured interviews and were asked to talk with their social network members about home-based testing. Participants reported acceptability of the Peer Mentor role and two-thirds had conversations with diverse social network members (e.g., male and female, sex partners, friends, family). Facilitators of peer outreach included the novelty of home-based testing, confidence about accuracy of the tests, and resources for linkage to care. Barriers included concerns about negative responses and disclosure of sexual identity/behavior. Results of this study suggest that YBMSM are willing and able to promote HBT to their social networks. This is a promising approach to increasing dissemination of HBT kits for both HIV and STI testing.
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Affiliation(s)
- Karin Tobin
- a Department of Health, Behavior and Society , Bloomberg School of Public Health, Johns Hopkins University , Baltimore , MD , USA
| | - Catie Edwards
- a Department of Health, Behavior and Society , Bloomberg School of Public Health, Johns Hopkins University , Baltimore , MD , USA
| | - Natalie Flath
- a Department of Health, Behavior and Society , Bloomberg School of Public Health, Johns Hopkins University , Baltimore , MD , USA
| | - Alexandra Lee
- a Department of Health, Behavior and Society , Bloomberg School of Public Health, Johns Hopkins University , Baltimore , MD , USA
| | - Kayla Tormohlen
- a Department of Health, Behavior and Society , Bloomberg School of Public Health, Johns Hopkins University , Baltimore , MD , USA
| | - Charlotte A Gaydos
- b Division of Infectious Diseases, Department of Medicine , Johns Hopkins University , Baltimore , MD , USA
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166
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Frye V, Wilton L, Hirshfield S, Chiasson MA, Lucy D, Usher D, McCrossin J, Greene E, Koblin B. Preferences for HIV test characteristics among young, Black Men Who Have Sex With Men (MSM) and transgender women: Implications for consistent HIV testing. PLoS One 2018; 13:e0192936. [PMID: 29462156 PMCID: PMC5819791 DOI: 10.1371/journal.pone.0192936] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 01/24/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Promoting consistent HIV testing is critical among young, Black Men Who Have Sex With Men (MSM) and transgender women who are overrepresented among new HIV cases in the United States. New HIV test options are available, including mobile unit testing, one-minute testing, at home or self-testing and couples HIV testing and counseling (CHTC). In the context of these newer options, the objective of this study was to explore whether and how preferences for specific characteristics of the tests acted as barriers to and/or facilitators of testing in general and consistent testing specifically among young Black MSM and transgender women aged 16 to 29. METHODS We conducted 30 qualitative, semi-structured, in-depth interviews with young, Black, gay, bisexual or MSM and transgender women in the New York City metropolitan area to identify preferences for specific HIV tests and aspects of HIV testing options. Participants were primarily recruited from online and mobile sites, followed by community-based, face-to-face recruitment strategies to specifically reach younger participants. Thematic coding was utilized to analyze the qualitative data based on a grounded theoretical approach. RESULTS We identified how past experiences, perceived test characteristics (e.g., accuracy, cost, etc.) and beliefs about the "fit" between the individual, and the test relate to preferred testing methods and consistent testing. Three major themes emerged as important to preferences for HIV testing methods: the perceived accuracy of the test method, venue characteristics, and lack of knowledge or experience with the newer testing options, including self-testing and CHTC. CONCLUSIONS These findings suggest that increasing awareness of and access to newer HIV testing options (e.g., free or reduced price on home or self-tests or CHTC available at all testing venues) is critical if these new options are to facilitate increased levels of consistent testing among young, Black MSM and transgender women. Addressing perceptions of test accuracy and supporting front line staff in creating welcoming and safe testing environments may be key intervention targets. Connecting young Black MSM and transgender women to the best test option, given preferences for specific characteristics, may support more and more consistent HIV testing.
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Affiliation(s)
- Victoria Frye
- Department of Community Health and Social Medicine, Sophie Davis School of Biomedical Education, CUNY School of Medicine, City University of New York, New York, New York, United States of America
- Laboratory of Social and Behavioral Sciences, New York Blood Center, New York, New York, United States of America
| | - Leo Wilton
- Department of Human Development, College of Community and Public Affairs (CCPA), Binghamton University, Binghamton, New York, United States of America
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Sabina Hirshfield
- Division of Research and Evaluation, Public Health Solutions, New York, New York, United States of America
| | - Mary Ann Chiasson
- Division of Research and Evaluation, Public Health Solutions, New York, New York, United States of America
| | - Debbie Lucy
- Project ACHIEVE, Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York, United States of America
| | - DaShawn Usher
- Project ACHIEVE, Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York, United States of America
| | - Jermaine McCrossin
- Project ACHIEVE, Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York, United States of America
| | - Emily Greene
- Laboratory of Social and Behavioral Sciences, New York Blood Center, New York, New York, United States of America
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Beryl Koblin
- Project ACHIEVE, Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York, United States of America
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167
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Freeman AE, Sullivan P, Higa D, Sharma A, MacGowan R, Hirshfield S, Greene GJ, Gravens L, Chavez P, McNaghten AD, Johnson WD, Mustanski B. Perceptions of HIV Self-Testing Among Men Who Have Sex With Men in the United States: A Qualitative Analysis. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:47-62. [PMID: 29481298 DOI: 10.1521/aeap.2018.30.1.47] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
HIV testing is the gateway into both prevention and treatment services. It is important to understand how men who have sex with men (MSM) perceive HIV self-tests. We conducted focus groups and individual interviews to collect feedback on two HIV self-tests, and on a dried blood spot (DBS) specimen collection kit. Perceptions and attitudes around HIV self-testing (HIVST), and willingness to distribute HIV self-tests to others were assessed. MSM reported HIVST to be complementary to facility-based testing, and liked this approach because it offers privacy and convenience, does not require counseling, and could lead to linkage to care. However, they also had concerns around the accuracy of HIV self-tests, their cost, and receiving a positive test result without immediate access to follow-up services. Despite these issues, they perceived HIVST as a positive addition to their HIV prevention toolbox.
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Affiliation(s)
- Arin E Freeman
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Patrick Sullivan
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Darrel Higa
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Akshay Sharma
- University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Robin MacGowan
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - George J Greene
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Laura Gravens
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Pollyanna Chavez
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - A D McNaghten
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wayne D Johnson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian Mustanski
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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168
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Gamarel KE, Nelson KM, Stephenson R, Santiago Rivera OJ, Chiaramonte D, Miller RL. Anticipated HIV Stigma and Delays in Regular HIV Testing Behaviors Among Sexually-Active Young Gay, Bisexual, and Other Men Who Have Sex with Men and Transgender Women. AIDS Behav 2018; 22:522-530. [PMID: 29214408 PMCID: PMC5820119 DOI: 10.1007/s10461-017-2005-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Young gay, bisexual and other men who have sex with men (YGBMSM) and young transgender women are disproportionately affected by HIV/AIDS. The success of biomedical prevention strategies is predicated on regular HIV testing; however, there has been limited uptake of testing among YGBMSM and young transgender women. Anticipated HIV stigma-expecting rejection as a result of seroconversion- may serve as a significant barrier to testing. A cross-sectional sample of YGBMSM (n = 719, 95.5%) and young transgender women (n = 33, 4.4%) ages 15-24 were recruited to participate in a one-time survey. Approximately one-third of youth had not tested within the last 6 months. In a multivariable model, anticipated HIV stigma and reporting a non-gay identity were associated with an increased odds of delaying regular HIV testing. Future research and interventions are warranted to address HIV stigma, in order to increase regular HIV testing among YGBMSM and transgender women.
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Affiliation(s)
- Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
- The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA.
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
| | - Kimberly M Nelson
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Centers for Behavioral and Preventative Medicine, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Rob Stephenson
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
- The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Robin Lin Miller
- Department of Psychology, Michigan State University, East Lansing, MI, USA
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169
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Anne Crock E. HIV and AIDS: An overview of the current issues, treatment and prevention. Nurs Stand 2017; 32:51-63. [PMID: 29210536 DOI: 10.7748/ns.2017.e11045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2017] [Indexed: 11/09/2022]
Abstract
The theme of World AIDS Day 2017 is 'let's end it'. After almost 40 years since the first occurrences of human immunodeficiency virus (HIV), it is possible to envision an end to the HIV epidemic, one of the most serious health and development challenges humanity has faced. This article provides an overview of the current approaches to the treatment, care and support of people living with HIV and acquired immune deficiency syndrome (AIDS). It also discusses the challenges associated with HIV and AIDS that remain, HIV prevention strategies, and the nurse's role in caring for people living with HIV. It outlines the Australian partnership approach to HIV, which provides a background for reflection on the response to HIV and AIDS in the UK and worldwide.
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170
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Salas-Espinoza KJ, Menchaca-Diaz R, Patterson TL, Urada LA, Smith D, Strathdee SA, Pitpitan EV. HIV Prevalence and Risk Behaviors in Male to Female (MTF) Transgender Persons in Tijuana, Mexico. AIDS Behav 2017; 21:3271-3278. [PMID: 29032411 PMCID: PMC5736304 DOI: 10.1007/s10461-017-1931-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Compared to HIV research on men who have sex with men, less is known about the risks and vulnerabilities for HIV among Male to Female (MTF) transgender persons, particularly in different geographic regions like Mexico. In Tijuana, Mexico, a border city experiencing a dynamic HIV epidemic, no precedent data exists on the MTF transgender population. Our aims were to estimate HIV prevalence and examine the behaviors and characteristics of the population. We conducted a cross-sectional study of 100 MTF transgender persons recruited through time location sampling in 2012. Participants underwent interviewer-administered (paper and pen) surveys and rapid tests for HIV. Descriptive univariate analyses were conducted on various factors, including sociodemographics, substance use, accessing social services (requested vs. received), stigma, and sex behaviors. A total of 22% tested positive for HIV, a prevalence higher than other key populations at risk for HIV in Tijuana.
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Affiliation(s)
| | - Rufino Menchaca-Diaz
- Escuela de Medicina y Psicología, Universidad Autónoma de Baja California, Tijuana, Mexico
| | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Lianne A Urada
- Division of Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
- School of Social Work, San Diego State University, San Diego, CA, USA
| | - Davey Smith
- Division of Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Eileen V Pitpitan
- Division of Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA.
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171
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Story CR, Kao WK, Currin J, Brown C, Charles V. Evaluation of the Southern Harm Reduction Coalition for HIV Prevention: Advocacy Accomplishments. Health Promot Pract 2017; 19:695-703. [PMID: 29186992 DOI: 10.1177/1524839917742850] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND HIV/AIDS rates are higher in the Southern United States compared to other regions of the country. Reasons for disparities include poverty, health care access, and racism. People who inject drugs (PWID) account for 8% of HIV/AIDS incidence rates. Harm reduction can connect PWID to needed resources. AIDS United Southern REACH grantees developed the Southern Harm Reduction Coalition (SHRC) as a means to decrease HIV/AIDS and viral hepatitis rates, criminalization of drug users and sex workers, and drug overdose. METHOD Investigators used an intrinsic case study design to examine the context of harm reduction in the Southern United States, successful strategies, and outcomes. Data collection included key informant interviews and coalition documents. The community coalition action theory was used to examine the data. RESULTS The SHRC initiated regional conferences and customized trainings. Strengths-based language and utilization of diverse strengths among coalition members were used to effect change. Coalition outcomes included syringe decriminalization legislation, syringe exchange, naloxone access, naloxone funding legislation, and 911 Good Samaritan laws, along with expanded support for PWID. CONCLUSIONS Advocacy successes can be applied to similar organizations in the Southern United States to promote harm reduction and potentially decrease HIV/AIDS burden, viral hepatitis, criminalization, and overdose.
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Affiliation(s)
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- 2 Southern Harm Reduction Coalition, Raleigh-Durham, NC, USA
| | - Wei-Kang Kao
- 3 Oklahoma State University, Stillwater, OK, USA
| | - Joe Currin
- 3 Oklahoma State University, Stillwater, OK, USA
| | - Colton Brown
- 3 Oklahoma State University, Stillwater, OK, USA
| | - Vignetta Charles
- 4 ETR (Education, Training and Research), Scotts Valley, CA, USA
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Stigmatizing attitudes toward people living with HIV among general adult Thai population: Results from the 5th Thai National Health Examination Survey (NHES). PLoS One 2017; 12:e0187231. [PMID: 29145519 PMCID: PMC5690635 DOI: 10.1371/journal.pone.0187231] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 10/16/2017] [Indexed: 11/30/2022] Open
Abstract
Background HIV-related stigma and discrimination is a significant driver of the HIV and AIDS epidemic. UNAIDS encourages all nations to monitor progress toward elimination of this problem. This study measured the level of stigmatizing attitudes toward people living with HIV (PLHIV) among Thai adults in the general population using recommended global tools. Methods Data from the 5th National Health Examination Survey, conducted in 2014 were used. The survey utilized six questions recommended by the Global Stigma and Discrimination Indicator Working Group and was administered to participants aged 20–59 years old. All analyses were weighted to take into account of the probability of sampling the same-age Thai population. Factors related to a discriminatory attitude according to UNAIDS, defined as agreed to at least one of the two discriminatory issues, were evaluated using Chi square tested and multivariable logistic regression. Results Of the 10,522 respondents, the most prevalent stigmatizing attitude was anticipated stigma (76.9%), followed by perceived stigma (69.2%), fear of HIV infection (57.0%), and social judgment (38.2%). Fifty-eight point six percent had discriminatory attitudes according to the UNAIDS global indicator. Independent predictors were being female (AOR = 1.21: 95% CI 1.14–1.29), aged 20–39 (AOR = 1.19: 95% CI 1.09–1.30) or 50–59 (AOR = 1.18: 95%CI 1.12–1.26), being Muslim (AOR = 2.03: 95%CI 1.55–2.66), earning < 10,000 Baht/month (AOR = 0.93: 95%CI 0.88–0.99), and living in the Northeast (AOR = 1.67: 95%CI 1.39–2.00) or in Bangkok (AOR = 1.73: 95%CI 1.45–2.07). Conclusions More than half of the general adult Thai population had stigmatizing attitudes toward PLHIV. The study provided valuable baseline information which could be used as comparison for follow-up surveys with other countries. Interventions to improve Thai society’s knowledge and attitudes toward HIV/AIDS are urgently needed.
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Vermund SH. The Continuum of HIV Care in the Urban United States: Black Men Who Have Sex With Men (MSM) Are Less Likely Than White MSM to Receive Antiretroviral Therapy. J Infect Dis 2017; 216:790-794. [PMID: 28368523 PMCID: PMC5853891 DOI: 10.1093/infdis/jix009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/05/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Sten H Vermund
- Vanderbilt Institute for Global Health and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
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174
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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: 63] [Impact Index Per Article: 9.0] [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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175
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Ho CLL, Pan W, Taylor LD. Stigma of HIV Testing on Online HIV Forums: Self-Stigma and the Unspoken. J Psychosoc Nurs Ment Health Serv 2017; 55:34-43. [PMID: 28892555 DOI: 10.3928/02793695-20170905-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/31/2017] [Indexed: 11/20/2022]
Abstract
Most studies examining HIV-related content in web forums have revolved around the most frequently used terms in HIV-related messages and topics, as well as the supportive nature of those messages. The current study explored barriers that prevent individuals from seeking HIV testing (specifically stigma). The current study analyzed a total of 210 threads and 319 posts, yielding 13 threads that revealed how individuals self-stigmatize and expressed how the fear of being diagnosed prevented them from seeking HIV testing. Results suggest that forums or online communities may perpetuate subculture values that deviate from mainstream values. Another important finding is that there is a lack of HIV testing information in forums for adolescents, which may contribute to the trend of young individuals engaging in risky sexual behaviors not getting tested in a timely fashion. [Journal of Psychosocial Nursing and Mental Health Services, 55(12), 34-43.].
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176
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Hines DD, Draucker CB, Habermann B. HIV Testing and Entry to Care Among Trans Women in Indiana. J Assoc Nurses AIDS Care 2017; 28:723-736. [PMID: 28652131 PMCID: PMC5572502 DOI: 10.1016/j.jana.2017.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
Abstract
Trans women in the United States are disproportionately affected by HIV infection. To improve HIV services for this population, more information is needed about their experiences in early stages of the HIV Care Continuum. Trans women in states such as Indiana, which has moderate HIV incidence but little public health investment in HIV prevention and treatment, experience special challenges. Our qualitative descriptive study describes the circumstances influencing HIV testing and entry to care by 18 trans women living with HIV in Central Indiana. In-depth interviews regarding participants' HIV care experiences were analyzed using standard content analysis. Participants discussed three main topics: (a) HIV testing circumstances, (b) facilitators and barriers to entering care, and (c) motivators for entering care after a delay. Findings indicate that social relationships play a significant role in trans women's care experiences and that stigma, discrimination, and adverse life circumstance are powerful deterrents to care. Practice and policy implications are discussed.
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Affiliation(s)
- Dana D. Hines
- Assistant Professor of Nursing, George Washington University, Washington, DC, USA
| | - Claire Burke Draucker
- Angela Barron McBride Endowed Professor in Psychiatric Mental Health Nursing, Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Barbara Habermann
- Nannie Longfellow Professor of Nursing Science, University of Delaware, Newark, Delaware, USA
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177
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Hubach RD, Currin JM, Sanders CA, Durham AR, Kavanaugh KE, Wheeler DL, Croff JM. Barriers to Access and Adoption of Pre-Exposure Prophylaxis for the Prevention of HIV Among Men Who Have Sex With Men (MSM) in a Relatively Rural State. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2017; 29:315-329. [PMID: 28825858 DOI: 10.1521/aeap.2017.29.4.315] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Biomedical intervention approaches, including antiretroviral pre-exposure prophylaxis (PrEP), have been demonstrated to reduce HIV incidence among several at-risk populations and to be cost effective. However, there is limited understanding of PrEP access and uptake among men who have sex with men (MSM) residing in relatively rural states. Twenty semistructured interviews were conducted (August-November 2016) to assess opinions of and perceived barriers to accessing and adopting PrEP among MSM residing in Oklahoma. Participants perceived substantial barriers to accessing PrEP including a stigmatizing environment and less access to quality, LGBT-sensitive medical care. Overall, geographic isolation limits access to health providers and resources that support sexual health for Oklahoma MSM. Addressing stigma situated across ecological levels in an effort to increase adoption of PrEP by MSM residing in rural states remains necessary. Without this, social determinants may continue to negatively influence PrEP adoption and sexual health outcomes.
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Affiliation(s)
- Randolph D Hubach
- School of Community Health Sciences, Counseling, and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Joseph M Currin
- School of Community Health Sciences, Counseling, and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Carissa A Sanders
- School of Community Health Sciences, Counseling, and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - André R Durham
- School of Educational Foundations, Leadership, and Aviation, Oklahoma State University
| | - Katherine E Kavanaugh
- School of Community Health Sciences, Counseling, and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Denna L Wheeler
- Center for Rural Health, Center for Health Sciences, Oklahoma State University, Tulsa, Oklahoma
| | - Julie M Croff
- School of Community Health Sciences, Counseling, and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma
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178
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Frye V, Paige MQ, Gordon S, Matthews D, Musgrave G, Kornegay M, Greene E, Phelan JC, Koblin BA, Taylor-Akutagawa V. Developing a community-level anti-HIV/AIDS stigma and homophobia intervention in new York city: The project CHHANGE model. EVALUATION AND PROGRAM PLANNING 2017; 63:45-53. [PMID: 28371668 DOI: 10.1016/j.evalprogplan.2017.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/03/2017] [Accepted: 03/08/2017] [Indexed: 06/07/2023]
Abstract
HIV/AIDS stigma and homophobia are associated with significant negative health and social outcomes among people living with HIV/AIDS (PLWHA) and those at risk of infection. Interventions to decrease HIV stigma have focused on providing information and education, changing attitudes and values, and increasing contact with people living with HIV/AIDS (PLWHA), activities that act to reduce stereotyped beliefs and prejudice, as well as acts of discrimination. Most anti-homophobia interventions have focused on bullying reduction and have been implemented at the secondary and post-secondary education levels. Few interventions address HIV stigma and homophobia and operate at the community level. Project CHHANGE, Challenge HIV Stigma and Homophobia and Gain Empowerment, was a community-level, multi-component anti-HIV/AIDS stigma and homophobia intervention designed to reduce HIV stigma and homophobia thus increasing access to HIV prevention and treatment access. The theory-based intervention included three primary components: workshops and trainings with local residents, businesses and community-based organizations (CBO); space-based events at a CBO-partner drop-in storefront and "pop-up" street-based events and outreach; and a bus shelter ad campaign. This paper describes the intervention design process, resultant intervention and the study team's experiences working with the community. We conclude that CHHANGE was feasible and acceptable to the community. Promoting the labeling of gay and/or HIV-related "space" as a non-stigmatized, community resource, as well as providing opportunities for residents to have contact with targeted groups and to understand how HIV stigma and homophobia relate to HIV/AIDS prevalence in their neighborhood may be crucial components of successful anti-stigma and discrimination programming.
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Affiliation(s)
- Victoria Frye
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, United States; Laboratory of Social and Behavioral Sciences, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, United States; Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States.
| | - Mark Q Paige
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, United States
| | - Steven Gordon
- Gay Men of African Descent (GMAD), Brooklyn, NY, United States
| | - David Matthews
- Brooklyn Men Konnect/Bridging Access to Care (BMK), Brooklyn, NY, United States
| | | | | | - Emily Greene
- Laboratory of Social and Behavioral Sciences, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, United States
| | - Jo C Phelan
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Beryl A Koblin
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, United States
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180
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Koblin BA, Nandi V, Hirshfield S, Chiasson MA, Hoover DR, Wilton L, Usher D, Frye V. Informing the Development of a Mobile Phone HIV Testing Intervention: Intentions to Use Specific HIV Testing Approaches Among Young Black Transgender Women and Men Who Have Sex With Men. JMIR Public Health Surveill 2017; 3:e45. [PMID: 28687531 PMCID: PMC5522583 DOI: 10.2196/publichealth.7397] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/11/2017] [Accepted: 05/09/2017] [Indexed: 11/16/2022] Open
Abstract
Background Regular human immunodeficiency virus (HIV) testing of persons at risk is critical to HIV prevention. Infrequent HIV testing and late diagnosis of HIV infection have been observed among young black men who have sex with men (MSM) and transwomen (transgender women)—two groups overrepresented in the HIV epidemic. Objective The objective of this study was to inform the development of a brief mobile phone intervention to increase HIV testing among young black MSM and transwomen by providing a tailored recommendation of an optimal HIV testing approach. We identified demographic, behavioral, psychosocial, and sociostructural factors associated with intentions to use three specific HIV testing approaches: self-testing, testing at a clinic or other provider, and couples HIV testing and counseling (CHTC). Methods Individuals were eligible for a Web-based survey if they were male at birth; were between the ages of 16 and 29 years; self-identified as black, African American, Caribbean black, African black, or multiethnic black; were not known to be HIV-infected; and reported insertive or receptive anal intercourse with a man or transwoman in the last 12 months. Recruitment occurred via banner advertisements placed on a range of social and sexual networking websites and apps in New York City and nationally, and via events attended by young black MSM and transwomen in New York City. Intention to test by each testing method was analyzed using logistic regression with best subset models and stepwise variable selection. Results Among 169 participants, intention to use a self-test was positively associated with comfort in testing by a friend or a partner at home (Adjusted odds ratio, AOR, 2.40; 95% CI 1.09-5.30), and stigma or fear as a reason not to test (AOR 8.61; 95% CI 2.50-29.68) and negatively associated with higher social support (AOR 0.48; 95% CI 0.33-0.72) and having health insurance (AOR 0.21; 95% CI 0.09-0.54). Intention to test at a clinic or other provider was positively associated with self-efficacy for HIV testing (AOR 2.87; 95% CI 1.48-5.59) and social support (AOR 1.98; 95% CI 1.34-2.92), and negatively associated with a lifetime history of incarceration (AOR 0.37; 95% CI 0.16-0.89). Intention to test by CHTC was negatively associated with higher educational level (Some college or Associate’s degree vs high school graduate or less [AOR 0.81; 95% CI 0.39-1.70]; Bachelor’s degree or more vs high school graduate or less [AOR 0.28; 95% CI 0.11-0.70]). Conclusions Unique factors were associated with intention to test using specific testing approaches. These data will be critical for the development of a tailored intervention that shows promise to increase comfort and experiences with a variety of testing approaches among young black MSM and transwomen.
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Affiliation(s)
- Beryl A Koblin
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, United States
| | - Vijay Nandi
- New York Blood Center, New York, NY, United States
| | | | | | - Donald R Hoover
- Department of Statistics and Biostatistics, Institute of Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Leo Wilton
- Department of Human Development, Binghamton University, Binghamton, NY, United States.,Faculty of Humanities, University of Johannesburg, Auckland Park, Johannesburg, South Africa
| | - DaShawn Usher
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, United States
| | - Victoria Frye
- Department of Community Health and Social Medicine, CUNY School of Medicine, City College of New York, New York, NY, United States
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181
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Barriers and facilitators to HIV testing among young men who have sex with men and transgender women in Kingston, Jamaica: a qualitative study. J Int AIDS Soc 2017; 20:21385. [PMID: 28406274 PMCID: PMC5515029 DOI: 10.7448/ias.20.1.21385] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction: Young men who have sex with men (MSM) in Jamaica have the highest HIV prevalence in the Caribbean. There is little information about HIV among transgender women in Jamaica, who are also overrepresented in the Caribbean epidemic. HIV-related stigma is a barrier to HIV testing among Jamaica’s general population, yet little is known of MSM and transgender women’s HIV testing experiences in Jamaica. We explored perceived barriers and facilitators to HIV testing among young MSM and transgender women in Kingston, Jamaica. Methods: We implemented a community-based research project in collaboration with HIV and lesbian, gay, bisexual and transgender (LGBT) agencies in Kingston. We held two focus groups, one with young (aged 18–30 years) transgender women (n = 8) and one with young MSM (n = 10). We conducted 53 in-depth individual semi-structured interviews focused on HIV testing experiences with young MSM (n = 20), transgender women (n = 20), and community-based key informants (n = 13). We conducted thematic analysis to identify, analyze, and report themes. Results: Participant narratives revealed social-ecological barriers and facilitators to HIV testing. Barriers included healthcare provider mistreatment, confidentiality breaches, and HIV-related stigma: these spanned interpersonal, community and structural levels. Healthcare provider discrimination and judgment in HIV testing provision presented barriers to accessing HIV services (e.g. treatment), and resulted in participants hiding their sexual orientation and/or gender identity. Confidentiality concerns included: clinic physical arrangements that segregated HIV testing from other health services, fear that healthcare providers would publicly disclose their status, and concerns at LGBT-friendly clinics that peers would discover they were getting tested. HIV-related stigma contributed to fear of testing HIV-positive; this intersected with the stigma of HIV as a “gay” disease. Participants also anticipated healthcare provider mistreatment if they tested HIV positive. Participants identified individual (belief in benefits of knowing one’s HIV status), social (social support) and structural (accessible testing) factors that can increase HIV testing uptake. Conclusions: Findings suggest the need for policy and practice changes to enhance confidentiality and reduce discrimination in Jamaica. Interventions to challenge HIV-related and LGBT stigma in community and healthcare settings can enhance access to the HIV prevention cascade among MSM and transgender youth in Jamaica.
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182
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Golub SA, Gamarel KE, Surace A. Demographic Differences in PrEP-Related Stereotypes: Implications for Implementation. AIDS Behav 2017; 21:1229-1235. [PMID: 26143247 PMCID: PMC4701641 DOI: 10.1007/s10461-015-1129-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Qualitative interviews about pre-exposure prophylaxis (PrEP) stereotypes were conducted with a subsample of 160 MSM who participated in a PrEP messaging study. Negative stereotypes about PrEP users were identified by 80 % of participants. Two types of stereotypes were most common: PrEP users are HIV-infected (and lying about it), and PrEP users are promiscuous and resistant to condom use. Participants' identification of these stereotype categories differed significantly by demographic factors (i.e., race/ethnicity, education). Expanding access to PrEP requires recognizing potential differences in the experience or anticipation of PrEP-related stereotypes that might impact willingness to discuss PrEP with providers, friends, or partners.
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Affiliation(s)
- Sarit A Golub
- Department of Psychology, Hunter College and the Graduate Center of the City University of New York (CUNY), 695 Park Avenue, New York, NY, 10065, USA.
- Hunter HIV/AIDS Research Team (HART), Hunter College of the City of New York (CUNY), New York, NY, USA.
| | - Kristi E Gamarel
- Hunter HIV/AIDS Research Team (HART), Hunter College of the City of New York (CUNY), New York, NY, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Anthony Surace
- Hunter HIV/AIDS Research Team (HART), Hunter College of the City of New York (CUNY), New York, NY, USA
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183
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Thapa S, Hannes K, Cargo M, Buve A, Aro AR, Mathei C. Building a Conceptual Framework to Study the Effect of HIV Stigma-Reduction Intervention Strategies on HIV Test Uptake: A Scoping Review. J Assoc Nurses AIDS Care 2017; 28:545-560. [PMID: 28473183 DOI: 10.1016/j.jana.2017.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 04/10/2017] [Indexed: 11/25/2022]
Abstract
A scoping review of grey and peer-reviewed literature was conducted to develop a conceptual framework to illustrate mechanisms involved in reducing HIV stigma and increasing HIV test uptake. We followed a three-step approach to exploring the literature: developing concepts, organizing and categorizing concepts, and synthesizing concepts into a framework. The framework contains four types of intervention strategies: awareness creation, influencing normative behavior, providing support, and developing regulatory laws. The awareness creation strategy generally improves knowledge and the influencing normative behavior strategy changes stigmatizing attitudes and behaviors, and subsequently, increases HIV test uptake. Providing support and development of regulatory law strategies changes actual stigmatizing behaviors of the people, and subsequently, increases HIV test uptake. The framework further outlines that the mechanisms described are influenced by the interaction of various social-contextual and individual factors. The framework sheds new light on the effects of HIV stigma-reduction intervention strategies and HIV test uptake.
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184
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Mental Health Experiences of Older Adults Living with HIV: Uncertainty, Stigma, and Approaches to Resilience. Can J Aging 2017; 36:125-140. [PMID: 28349859 DOI: 10.1017/s0714980817000022] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This study describes the mental health experiences of older adults living with HIV in Ottawa. Eleven participants aged 52 to 67 completed in-depth personal interviews. Mental health concerns pervaded the lives of these older adults. We identified three central themes common to the participants' stories: uncertainty, stigma, and resilience. For some of these participants, uncertainty impacting mental health centred on unexpected survival; interpretation of one's symptoms; and medical uncertainty. Participants' experiences of stigma included discrimination in health care interactions; misinformation; feeling stigmatized due to aspects of their physical appearance; compounded stigma; and anticipated stigma. Participants reported using several coping strategies, which we frame as individual approaches to resilience. These strategies include reducing the space that HIV takes up in one's life; making lifestyle changes to accommodate one's illness; and engaging with social support. These findings inform understandings of services for people aging with HIV who may experience mental health concerns.
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185
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Katz-Wise SL, Budge SL, Orovecz JJ, Nguyen B, Nava-Coulter B, Thomson K. Imagining the future: Perspectives among youth and caregivers in the trans youth family study. J Couns Psychol 2017; 64:26-40. [PMID: 28068129 DOI: 10.1037/cou0000186] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Future perspectives of transgender youth and their caregivers may be shaped by knowledge of discrimination and adverse mental health among transgender adults. Qualitative data from the Trans Youth Family Study were analyzed to examine how transgender and gender nonconforming (TGN) youth and their caregivers imagine the youth's future. A community-based sample of 16 families (16 TGN youth, ages 7-18 years, and 29 caregivers) was recruited from 2 regions in the United States. Participants completed in-person qualitative interviews and surveys. Interview transcripts were analyzed using grounded theory methodology for coding procedures. Analyses yielded 104 higher order themes across 45 interviews, with 8 prominent themes: comparing experiences with others, gender affirming hormones, gender affirming surgery, gender norms, questioning whether the youth is really transgender, expectations for romantic relationships, uncertainty about the future, and worries about physical and emotional safety. A conceptual model of future perspectives in TGN youth and caregivers is presented and clinical implications are discussed. (PsycINFO Database Record
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Affiliation(s)
- Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital
| | - Stephanie L Budge
- Department of Counseling Psychology, University of Wisconsin-Madison
| | - Joe J Orovecz
- Department of Counseling Psychology, University of Wisconsin-Madison
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186
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Cooke IJ, Jeremiah RD, Moore NJ, Watson K, Dixon MA, Jordan GL, Murray M, Keeter MK, Hollowell CMP, Murphy AB. Barriers and Facilitators toward HIV Testing and Health Perceptions among African-American Men Who Have Sex with Women at a South Side Chicago Community Health Center: A Pilot Study. Front Public Health 2017; 4:286. [PMID: 28097120 PMCID: PMC5206579 DOI: 10.3389/fpubh.2016.00286] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/15/2016] [Indexed: 11/13/2022] Open
Abstract
In the United States, African-Americans' (AAs) HIV infection rates are higher than any other racial group, and AA men who have sex with women (MSW) are a significant proportion of new cases. There is little research into AA MSW HIV/AIDS knowledge, barriers, and facilitators of HIV testing in Chicago. We enrolled a convenience sample of AA MSW from a community health clinic who completed self-administered surveys assessing HIV knowledge and testing-related barriers and facilitators. The survey was a combination of questions from several validated instruments, and additional questions were written based on key informant interviews with social scientists to tailor the questionnaire for AA men living on the South Side of Chicago. We recruited 20 AA MSW (mean age 47.4 years). Sixty-five percent had incomes <$10,000/year, 30% were insured, and 50% had post-secondary education. Despite low socioeconomic status, their HIV literacy was relatively high. The identified major barriers to testing were low perceived HIV risk, concerns over privacy, and external stigma at testing sites. Future efforts should focus on educating AA MSW on actual risk for HIV and address issues of privacy and stigma at testing sites.
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Affiliation(s)
- Ian J. Cooke
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rohan D. Jeremiah
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | | | | | - Michael A. Dixon
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Mary K. Keeter
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Adam B. Murphy
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Balaji AB, Bowles KE, Hess KL, Smith JC, Paz-Bailey G. Association Between Enacted Stigma and HIV-Related Risk Behavior Among MSM, National HIV Behavioral Surveillance System, 2011. AIDS Behav 2017; 21:227-237. [PMID: 27830344 DOI: 10.1007/s10461-016-1599-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
MSM bear a disproportionate burden of the HIV epidemic. Enacted stigma (overt negative actions) against sexual minorities may play an important role in increasing HIV risk among this population. Using data from the 2011 National HIV Behavioral Surveillance system, MSM cycle, we examined the independent associations between three measures of enacted stigma (verbal harassment, discrimination, physical assault) and engagement in each of four HIV-related risk behaviors as outcomes: condomless anal intercourse (CAI) at last sex with a male partner of HIV discordant or unknown status and, in the past 12 months, CAI with a male partner, ≥4 male sex partners, and exchange sex. Of 9819 MSM, 32% experienced verbal harassment in the past 12 months, 23% experienced discrimination, and 8% experienced physical assault. Discordant CAI at last sex with a male partner was associated with previous discrimination and physical assault. Past 12 month CAI with a male partner, ≥4 male sex partners, and exchange sex were each associated with verbal harassment, discrimination, and physical assault. These findings indicate that a sizable proportion of MSM report occurrences of past 12 month enacted stigma and suggest that these experiences may be associated with HIV-related risk behavior. Addressing stigma towards sexual minorities must involve an integrated, multi-faceted approach, including interventions at the individual, community, and societal level.
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Johnson BA, McKenney J, Ricca AV, Rosenberg ES, Liu C, Sharma A, Sullivan PS. Risk Factors Associated With Repeated HIV Testing Among Internet-Using Men Who Have Sex With Men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:511-523. [PMID: 27925484 PMCID: PMC5726263 DOI: 10.1521/aeap.2016.28.6.511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED Men who have sex with men (MSM) represent a disproportionately impacted risk group for HIV incidence among at-risk U.S. POPULATIONS Few studies have identified risk factors associated with HIV testing frequency both within and outside of traditional health care settings. MSM enrolled in a prospective cohort were mailed at-home specimen collection kits and followed for a year. Incidence density rate ratios (IDRR) of testing were calculated, and generalized estimating equations were used to analyze the association between HIV testing and behavioral factors. The incidence rate of testing was higher among Black MSM than White MSM (IDRR: 1.3, 95% confidence interval CI [1.1, 1.5]) and higher among MSM who reported 3+ condomless anal intercourse partners (CAI) than MSM who reported no CAI (IDRR: 1.6, 95% CI [1.3, 2.0]). Increasing availability of HIV testing outside traditional health care settings, including at-home testing kits, in conjunction with targeted behavioral interventions and biomedical treatment preventions is needed.
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Affiliation(s)
- Brent A. Johnson
- University of Rochester, Rochester, New York, USA, Department of Biostatistics and Computational Biology, School of Medicine and Dentistry
| | - Jennie McKenney
- Emory University, Atlanta, Georgia, USA, Department of Epidemiology, Rollins School of Public Health
| | - Alexandra V. Ricca
- Emory University, Atlanta, Georgia, USA, Department of Epidemiology, Rollins School of Public Health
| | - Eli S. Rosenberg
- Emory University, Atlanta, Georgia, USA, Department of Epidemiology, Rollins School of Public Health
| | - Chang Liu
- University of Rochester, Rochester, New York, USA, Department of Biostatistics and Computational Biology, School of Medicine and Dentistry
| | - Akshay Sharma
- Emory University, Atlanta, Georgia, USA, Department of Epidemiology, Rollins School of Public Health
| | - Patrick S. Sullivan
- Emory University, Atlanta, Georgia, USA, Department of Epidemiology, Rollins School of Public Health
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Li R, Pan X, Ma Q, Wang H, He L, Jiang T, Wang D, Zhang Y, Zhang X, Xia S. Prevalence of prior HIV testing and associated factors among MSM in Zhejiang Province, China: a cross-sectional study. BMC Public Health 2016; 16:1152. [PMID: 27832761 PMCID: PMC5103478 DOI: 10.1186/s12889-016-3806-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 10/27/2016] [Indexed: 11/30/2022] Open
Abstract
Background Men who have sex with men (MSM) have become one of high-risk population for human immunodeficiency virus (HIV) infection, due to their multiple sex partners and unprotected anal intercourse. Promoting HIV testing is an effective strategy for the prevention and control of HIV infection. We assessed the factors associated with a prior HIV testing history, which could provide guidance for implementation of future HIV intervention programs. Methods A cross-sectional study was conducted in three cities of Zhejiang Province, namely, Hangzhou, Ningbo and Wenzhou, using respondent-driven sampling, between December 2013 and June 2014. A face-to-face questionnaire survey was employed to collect relevant information about HIV testing. Univariate and multivariate logistic regression analyses were used to identify the factors associated with a prior HIV testing history. Results The adjusted rate of prior HIV testing among MSM in Zhejiang Province was 55.9 %. The adjusted rates of HIV and syphilis infections among MSM in Zhejiang Province were 14.0 % and 11.4 %, respectively. A weighted multivariate analysis showed that MSM of older age were more likely to be tested, as were MSM with higher level of education, self-reported homosexuality and a higher frequency of receiving AIDS/sexually transmitted infections educational intervention in the past year. MSM with suicidal inclination and self-perceived lower possibility of HIV infection were less likely to report ever having undergone an HIV test. Conclusions The prevalence of prior HIV testing among MSM in Zhejiang Province, China is low. Effective and more frequent interventional measures should be adopted to improve risk awareness and psychosocial support for younger, less educated MSM, and to encourage more MSM to undergo HIV testing.
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Affiliation(s)
- Runhua Li
- Zhejiang Provincial Center for Disease Control and Prevention, No.3399, Binsheng Road, Hangzhou, Zhejiang Province, 310051, People's Republic of China.,Department of Epidemiology and Health Statistics, School of Medicine, Ningbo University, Ningbo, Zhejiang Province, People's Republic of China
| | - Xiaohong Pan
- Zhejiang Provincial Center for Disease Control and Prevention, No.3399, Binsheng Road, Hangzhou, Zhejiang Province, 310051, People's Republic of China
| | - Qiaoqin Ma
- Zhejiang Provincial Center for Disease Control and Prevention, No.3399, Binsheng Road, Hangzhou, Zhejiang Province, 310051, People's Republic of China
| | - Hui Wang
- Zhejiang Provincial Center for Disease Control and Prevention, No.3399, Binsheng Road, Hangzhou, Zhejiang Province, 310051, People's Republic of China
| | - Lin He
- Zhejiang Provincial Center for Disease Control and Prevention, No.3399, Binsheng Road, Hangzhou, Zhejiang Province, 310051, People's Republic of China
| | - Tingting Jiang
- Zhejiang Provincial Center for Disease Control and Prevention, No.3399, Binsheng Road, Hangzhou, Zhejiang Province, 310051, People's Republic of China
| | - Dayong Wang
- Wenzhou Center for Disease Control and Prevention, Wenzhou, Zhejiang Province, People's Republic of China
| | - Yan Zhang
- Ningbo Center for Disease Control and Prevention, Ningbo, Zhejiang Province, People's Republic of China
| | - Xingliang Zhang
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, People's Republic of China
| | - Shichang Xia
- Zhejiang Provincial Center for Disease Control and Prevention, No.3399, Binsheng Road, Hangzhou, Zhejiang Province, 310051, People's Republic of China.
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190
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Adamou M, Graham K, MacKeith J, Burns S, Emerson LM. Advancing services for adult ADHD: the development of the ADHD Star as a framework for multidisciplinary interventions. BMC Health Serv Res 2016; 16:632. [PMID: 27821125 PMCID: PMC5100092 DOI: 10.1186/s12913-016-1894-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 11/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder is prevalent in adulthood, resulting in serious impairment across multiple domains of living. Despite clinical guidance recommendations, the relative infancy of research on service provision for adults with ADHD, along with the evidence transfer gap, means that there is a lack of specific frameworks for service delivery. Igniting research and developing service delivery frameworks within adult ADHD is an essential step in the provision of effective services for adults with ADHD. METHOD Following the methodology used in previous related research that utilises a Participatory Action Research approach, we gathered data from clinicians and service users on the domains of living in which they wish to create change, and the steps and end point of the change process. This data was utilised, alongside data gathered from previous research and policies, to develop the domains of assessment for the ADHD Star, and the scale on which change is assessed. RESULTS The resulting tool, the ADHD Star, consists of eight domains: understanding your ADHD, focus and attention, organising yourself, friends and social life, thinking and reacting, physical health, how you feel and meaningful use of time. Each domain is rated on a five-point scale, the 'ladder of change', ranging from 'stuck' to 'choice'. CONCLUSIONS The ADHD Star offers a guiding framework for the development of care pathways and subsequent service provision for adults with ADHD, based on multi-disciplinary, holistic and person-centred care.
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Affiliation(s)
- Marios Adamou
- Manygates Clinic, South West Yorkshire Partnership NHS Foundation Trust, Wakefield, Portobello Road, WF1 5PN, UK.
- University of Huddersfield, School of Human Health Sciences, Queensgate, HD13DH, UK.
| | - Katharine Graham
- Triangle Consulting Social Enterprise, The Dock Hub, Wilbury Villas, Hove, BN3 6AH, UK
| | - Joy MacKeith
- Triangle Consulting Social Enterprise, The Dock Hub, Wilbury Villas, Hove, BN3 6AH, UK
| | - Sara Burns
- Triangle Consulting Social Enterprise, The Dock Hub, Wilbury Villas, Hove, BN3 6AH, UK
| | - Lisa-Marie Emerson
- Manygates Clinic, South West Yorkshire Partnership NHS Foundation Trust, Wakefield, Portobello Road, WF1 5PN, UK
- Department of Psychology, University of Sheffield, Sheffield, UK
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191
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Batey DS, Whitfield S, Mulla M, Stringer KL, Durojaiye M, McCormick L, Turan B, Nyblade L, Kempf MC, Turan JM. Adaptation and Implementation of an Intervention to Reduce HIV-Related Stigma Among Healthcare Workers in the United States: Piloting of the FRESH Workshop. AIDS Patient Care STDS 2016; 30:519-527. [PMID: 27849373 DOI: 10.1089/apc.2016.0223] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
HIV-related stigma has been shown to have profound effects on people living with HIV (PLWH). When stigma is experienced in a healthcare setting, negative health outcomes are exacerbated. We sought to assess the feasibility and acceptability of a healthcare setting stigma-reduction intervention, the Finding Respect and Ending Stigma around HIV (FRESH) Workshop, in the United States. This intervention, adapted from a similar strategy implemented in Africa, brought together healthcare workers (HW) and PLWH to address HIV-related stigma. Two pilot workshops were conducted in Alabama and included 17 HW and 19 PLWH. Participants completed questionnaire measures pre- and post-workshop, including open-ended feedback items. Analytical methods included assessment of measures reliability, pre-post-test comparisons using paired t-tests, and qualitative content analysis. Overall satisfaction with the workshop experience was high, with 87% PLWH and 89% HW rating the workshop "excellent" and the majority agreeing that others like themselves would be interested in participating. Content analysis of open-ended items revealed that participants considered the workshop informative, interactive, well-organized, understandable, fun, and inclusive, while addressing real and prevalent issues. Most pre- and post-test measures had good-excellent internal consistency reliability (Cronbach's alphas ranging from 0.70 to 0.96) and, although sample sizes were small, positive trends were observed, reaching statistical significance for increased awareness of stigma in the health facility among HW (p = 0.047) and decreased uncertainty about HIV treatment among PLWH (p = 0.017). The FRESH intervention appears to be feasible and highly acceptable to HW and PLWH participants and shows great promise as a healthcare setting stigma-reduction intervention for US contexts.
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Affiliation(s)
- D. Scott Batey
- Department of Social Work, College of Arts & Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Samantha Whitfield
- Healthcare Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mazheruddin Mulla
- Department of Psychology, College of Arts & Sciences, The University of Alabama, Tuscaloosa, Alabama
| | - Kristi L. Stringer
- Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Modupeoluwa Durojaiye
- Healthcare Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lisa McCormick
- Healthcare Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bulent Turan
- Department of Psychology, College of Arts & Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Laura Nyblade
- Division of Global Health, International Development Group and HP+, RTI International, Washington, District of Columbia
| | - Mirjam-Colette Kempf
- Nursing Family, Community & Health Systems, College of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Janet M. Turan
- Healthcare Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
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192
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HIV Testing Behavior and Social Network Characteristics and Functions Among Young Men Who have Sex with Men (YMSM) in Metropolitan Detroit. AIDS Behav 2016; 20:2739-2761. [PMID: 26837634 DOI: 10.1007/s10461-016-1296-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
HIV testing promotion is a critical HIV prevention strategy, especially among at-risk groups such as young men who have sex with men (YMSM). Based on a web survey of 194 YMSM (18-24), we examine the association of social network characteristics and functions, and of individual-level characteristics, with three HIV testing behaviors (ever, repeat, and recent testing). Network homophily was associated with recent testing in multivariable models. The network function of information acquisition was associated with ever testing and repeat testing. Perceived stigma regarding HIV-related help-seeking was negatively related to recent testing. Individual characteristics were associated with testing outcomes in all models; age, perceived behavioral control, and positive attitudes had the greatest influence. Individual characteristics had a stronger association with ever testing and repeat testing than network characteristics and functions; however, this relationship was reversed for recent testing. Findings support the value of multi-level and network-focused interventions for promoting HIV testing among YMSM.
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193
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HIV prevalence and demographic determinants of condomless receptive anal intercourse among trans feminine individuals in Beirut, Lebanon. J Int AIDS Soc 2016; 19:20787. [PMID: 27431468 PMCID: PMC4949314 DOI: 10.7448/ias.19.3.20787] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 04/14/2016] [Accepted: 04/25/2016] [Indexed: 11/28/2022] Open
Abstract
Introduction Growing evidence suggests increased HIV incidence in the Middle East and North Africa among “key populations.” To date, epidemiological data have not accurately included and measured HIV prevalence and risk among trans feminine individuals in the region. Through the lens of the Gender Affirmation Framework, we assessed demographic correlates of risk behaviour and the prevalence of HIV among trans feminine individuals in Lebanon. Methods Long-chain referral sampling was used to recruit 53 participants for completion of a behavioural survey and optional free rapid HIV tests. Data were collected using interviewer-administered questionnaires. A multivariable logistic regression model was used to identify demographic determinants of HIV risk behaviour. Results Fifty-seven percent of participants reported condomless receptive anal intercourse (CRAI) with male partner(s) in the last three months, 40% of whom reported not knowing the HIV status of the partner(s). Of the participants tested for HIV as part of the study or via self-report, four (10%) were HIV positive; 13 declined HIV testing. Forty percent of the sample had no prior history of HIV testing. A history of trauma such as sexual abuse/assault was reported by almost half of the participants (49%). Sixty-eight percent reported experiencing physical violence and 32% police arrest, because of gender identity or presentation. A staggering 98% reported having experienced gender identity or gender presentation-related discrimination. Sixty-six percent of the sample reported current sex work; sex work was correlated with CRAI but was not significant in multivariate analysis. In regression analysis, “openness”/“outness” about transgender identity at work or school was significantly associated with CRAI. Surprisingly, a history of sexual abuse/assault was negatively correlated with CRAI, suggesting the need for further inquiry. Conclusions The results of this study provide implications for how to address sexual health among trans feminine individuals in Lebanon and the greater Middle East and North Africa region.
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194
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HIV epidemics among transgender populations: the importance of a trans-inclusive response. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.3.21259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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195
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Reisner SL, White Hughto JM, Gamarel KE, Keuroghlian AS, Mizock L, Pachankis JE. Discriminatory experiences associated with posttraumatic stress disorder symptoms among transgender adults. J Couns Psychol 2016; 63:509-519. [PMID: 26866637 DOI: 10.1037/cou0000143] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Discrimination has been shown to disproportionately burden transgender people; however, there has been a lack of clinical attention to the mental health sequelae of discrimination, including posttraumatic stress disorder (PTSD) symptoms. Additionally, few studies contextualize discrimination alongside other traumatic stressors in predicting PTSD symptomatology. The current study sought to fill these gaps. A community-based sample of 412 transgender adults (mean age 33, SD = 13; 63% female-to-male spectrum; 19% people of color; 88% sampled online) completed a cross-sectional self-report survey of everyday discrimination experiences and PTSD symptoms. Multivariable linear regression models examined the association between self-reported everyday discrimination experiences, number of attributed domains of discrimination, and PTSD symptoms, adjusting for prior trauma, sociodemographics, and psychosocial comorbidity. The mean number of discrimination attributions endorsed was 4.8 (SD = 2.4) and the 5 most frequently reported reasons for discrimination were: gender identity and/or expression (83%), masculine and feminine appearance (79%), sexual orientation (68%), sex (57%), and age (44%). Higher everyday discrimination scores (β = 0.25; 95% CL [0.21, 0.30]) and greater number of attributed reasons for discrimination experiences (β = 0.05; 95% CL [0.01, 0.10]) were independently associated with PTSD symptoms, even after adjusting for prior trauma experiences. Everyday discrimination experiences from multiple sources necessitate clinical consideration in treatment for PTSD symptoms in transgender people. (PsycINFO Database Record
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Affiliation(s)
- Sari L Reisner
- Division of General Pediatrics, Boston Children's Hospital/ Harvard Medical School
| | | | - Kristi E Gamarel
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | | | - Lauren Mizock
- Department of Psychology, Worcester State University
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196
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Logie CH, Newman PA, Weaver J, Roungkraphon S, Tepjan S. HIV-Related Stigma and HIV Prevention Uptake Among Young Men Who Have Sex with Men and Transgender Women in Thailand. AIDS Patient Care STDS 2016; 30:92-100. [PMID: 26788978 DOI: 10.1089/apc.2015.0197] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
HIV-related stigma is a pervasive structural driver of HIV. With an HIV epidemic among young men who have sex with men (MSM) and transgender women (TG) in Thailand characterized as explosive, we conducted a cross-sectional survey among MSM and TG aged 18-30 years. From April-August 2013, participants recruited using venue-based sampling from gay entertainment sites and community-based organizations completed a tablet-assisted survey interview in Thai language. We conducted multiple logistic regression to assess correlations between HIV-related stigma (felt-normative, vicarious domains) and socio-demographic variables, HIV vulnerabilities (gay entertainment employment, sex work, forced sex history), and HIV prevention uptake (condom use, HIV testing, rectal microbicide acceptability). Among participants (n = 408), 54% identified as gay, 25% transgender, and 21% heterosexual. Two-thirds (65.7%) were employed at gay entertainment venues, 67.0% had more than three male partners (past month), 55.6% had been paid for sex, and 4.5% were HIV-positive. One-fifth (21.3%) reported forced sex. Most participants reported experiencing felt-normative and vicarious HIV-related stigma. Adjusting for socio-demographics, participants with higher total HIV-related stigma scores had significantly lower odds of HIV testing and rectal microbicide acceptability, and higher odds of having experienced forced sex. Both vicarious and felt-normative dimensions of HIV-related stigma were inversely associated with HIV testing and rectal microbicide acceptability. Our findings suggest that HIV-related stigma harms the health of HIV-negative MSM and TG at high risk for HIV infection. HIV-related interventions and research among young MSM and TG in Thailand should address multiple dimensions of HIV-related stigma as a correlate of risk and a barrier to accessing prevention.
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Affiliation(s)
- Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Peter A. Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - James Weaver
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Surachet Roungkraphon
- Faculty of Science and Technology, Rajamangala University of Technology Phra Nakhon, Bangkok, Thailand
| | - Suchon Tepjan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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197
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Liu Y, Osborn CY, Qian HZ, Yin L, Xiao D, Ruan Y, Simoni JM, Zhang X, Shao Y, Vermund SH, Amico KR. Barriers and Facilitators of Linkage to and Engagement in HIV Care Among HIV-Positive Men Who Have Sex with Men in China: A Qualitative Study. AIDS Patient Care STDS 2016; 30:70-7. [PMID: 26784360 DOI: 10.1089/apc.2015.0296] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Linking and engaging HIV-positive patients in care is the key bridging step to glean the documented health and prevention advantages of antiretroviral therapy (ART). In China, HIV transmission among men who have sex with men (MSM) is surging, yet many HIV-positive MSM do not use HIV care services. We conducted a qualitative study in order to help positive interventions to promote linkage-to-care in this key population. Four focus group discussions (FGD) were held among HIV-positive MSM in Beijing, China, to ascertain knowledge, beliefs, attitudes, and practices related to HIV care. FGD participates highlighted six major barriers of linkage to/engagement in HIV care: (1) perceived discrimination from health care workers; (2) lack of guidance and follow-up; (3) clinic time or location inconvenience; (4) privacy disclosure concerns; (5) psychological burden of committing to HIV care; and (6) concerns about treatment. Five major sub-themes emerged from discussions on the facilitators of linkage to/engagement in care: (1) peer referral and accompaniment; (2) free HIV care; (3) advocacy from HIV-positive MSM counselors; (4) extended involvement for linking MSM to care; and (5) standardization of HIV care (i.e., reliable high quality care regardless of venue). An understanding of the barriers and facilitators that may impact the access to HIV care is essential for improving the continuum of care for MSM in China. Findings from our study provide research and policy guidance for how current HIV prevention and care interventions can be enhanced to link and engage HIV-positive MSM in HIV care.
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Affiliation(s)
- Yu Liu
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Chandra Y. Osborn
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Lu Yin
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Dong Xiao
- Chaoyang Chinese Aids Volunteer Group, Beijing, China
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jane M. Simoni
- Department of Psychology, University of Washington, Seattle, Washington
| | - Xiangjun Zhang
- Xicheng District Center for Disease Control and Prevention, Beijing, China
| | - Yiming Shao
- Chaoyang Chinese Aids Volunteer Group, Beijing, China
| | - Sten H. Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - K. Rivet Amico
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan
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198
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Sweeney SM, Vanable PA. The Association of HIV-Related Stigma to HIV Medication Adherence: A Systematic Review and Synthesis of the Literature. AIDS Behav 2016; 20:29-50. [PMID: 26303196 DOI: 10.1007/s10461-015-1164-1] [Citation(s) in RCA: 233] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This paper provides a review of the quantitative literature on HIV-related stigma and medication adherence, including: (1) synthesis of the empirical evidence linking stigma to adherence, (2) examination of proposed causal mechanisms of the stigma and adherence relationship, and (3) methodological critique and guidance for future research. We reviewed 38 studies reporting either cross-sectional or prospective analyses of the association of HIV-related stigma to medication adherence since the introduction of antiretroviral therapies (ART). Although there is substantial empirical evidence linking stigma to adherence difficulties, few studies provided data on psychosocial mechanisms that may account for this relationship. Proposed mechanisms include: (a) enhanced vulnerability to mental health difficulties, (b) reduction in self-efficacy, and (c) concerns about inadvertent disclosure of HIV status. Future research should strive to assess the multiple domains of stigma, use standardized measures of adherence, and include prospective analyses to test mediating variables.
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Affiliation(s)
- Shannon M Sweeney
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244-2340, USA.
| | - Peter A Vanable
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244-2340, USA.
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199
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Position statement: HIV criminalization laws and policies promote discrimination and must be reformed. J Assoc Nurses AIDS Care 2015; 26:215-7. [PMID: 25815388 DOI: 10.1016/j.jana.2014.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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200
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Wilton L, Koblin B, Nandi V, Xu G, Latkin C, Seal D, Flores SA, Spikes P. Correlates of Seroadaptation Strategies Among Black Men Who have Sex with Men (MSM) in 4 US Cities. AIDS Behav 2015; 19:2333-46. [PMID: 26363789 DOI: 10.1007/s10461-015-1190-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We assessed associations of demographic, psychosocial, and substance use factors with seroadaptation strategies among 835 BMSM in four US cities. Seroadaptation strategies were practiced by 59.8 % of men, with 10.5 % practicing 100 % condom use, 26.5 % serosorting, 7.2 % condom serosorting, and 15.6 % seropositioning. In multivariable analyses, compared to men who used no seroadaptation strategies, serosorters were older, were less likely to be HIV infected, had fewer male sex partners, and had higher levels of social support and sexual self-efficacy. Condom serosorters had less psychological distress, were more likely to use methamphetamine, and had higher levels of sexual self-efficacy. Seropositioners were older, were less likely to be HIV infected, to have a main partner, and report alcohol/drug use with sex, while having higher levels of sexual self-efficacy. Seroadaptation practices among BMSM need to be considered to address perceived safer sex strategies and strengthen access to a broader reach of culturally-relevant prevention efforts.
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