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Jessani A, Peter N, Hernandez-Viovy N. The two-spirit, lesbian, gay, bisexual, transgender, queer, and other sexual and gender identity curriculum in Canadian Dental Schools: What are the gaps and proposed next steps? J Dent Educ 2024. [PMID: 38650373 DOI: 10.1002/jdd.13549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/01/2024] [Accepted: 03/15/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVES This study aimed to investigate gaps in the delivery of two-spirit, lesbian, gay, bisexual, transgender, queer, and other sexual and gender identity (2SLGBTQ+) curricula and identify curricular challenges within Canadian dental schools. METHODS A 21-item closed-ended questionnaire was distributed to curriculum experts across 10 dental schools in Canada. The survey questions were organized into three sections: institution characteristics, current 2SLGBTQ+ content and delivery, and opinions on the improvement of the 2SLGBTQ+ curriculum. Microsoft Excel (2020) was used to perform a descriptive analysis of the survey responses. RESULTS Nine dental schools participated in the survey. All participating schools reported the offering of undergraduate, graduate, and degree completion programs. The most reported methods of teaching 2SLGBTQ+ content were 'lecture-based teaching' (n = 5), 'small-group teaching' (n = 4), and 'case-based discussions' (n = 4). The most common topics taught were 'gender identity' (n = 7) and '2SLGBTQ+ discrimination in healthcare care settings' (n = 7). The topics of 'sex reassignment surgery,' 'alcohol, tobacco, or other substance use by 2SLGBTQ+ people,' '2SLGBTQ+ pediatric and adolescent oral health issues,' 'coming out,' and 'sex reassignment surgery' were not included or were unknown by the majority of dental schools (n = 8). Overall, participants were unsatisfied with the level of 2SLGBTQ+-specific content covered at their institution and reported a 'lack of space within the curriculum and time constraints' as a barrier to implementation (n = 8). CONCLUSION Community-based research is needed to identify the unmet oral health needs of the 2SLGBTQ+ population, which can be translated into the development of a risk-based oral health curriculum within Canada and beyond.
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Affiliation(s)
- Abbas Jessani
- Department of Dentistry, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Nedra Peter
- Faculty of Education, Western University, London, Canada
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Stalter RM, Dong TQ, Hendrix CW, Palanee-Phillips T, van der Straten A, Hillier SL, Kiweewa FM, Mgodi NM, Marzinke MA, Bekker LG, Soto-Torres L, Baeten JM, Brown ER. Assessing Per-Sex-Act HIV-1 Risk Reduction Among Women Using the Dapivirine Vaginal Ring. J Infect Dis 2024; 229:1158-1165. [PMID: 38099506 PMCID: PMC11011174 DOI: 10.1093/infdis/jiad550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 11/10/2023] [Accepted: 12/13/2023] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Confounding introduced by individuals' sexual risk behavior is potentially a significant source of bias in HIV-1 prevention intervention studies. To more completely account for sexual behaviors when assessing the efficacy of the monthly dapivirine ring, a new longer-acting HIV-1 prevention option for women, we estimated per-sex-act risk reduction associated with product use. METHODS We conducted a secondary analysis of data from MTN-020/ASPIRE, a phase 3, randomized, placebo-controlled efficacy trial of the dapivirine ring that recruited HIV-uninfected, African women aged 18-45 years. With cumulative sex acts as the time scale, we used multivariable Cox regression with inverse probability of censoring weights to estimate HIV-1 risk reduction associated with a rate of dapivirine release indicative of consistent product use. RESULTS Women in the dapivirine ring group (n = 1187) had an estimated incidence rate of 2.3 (95% confidence interval [CI], 1.8-3.1) HIV-1 acquisition events per 10 000 sex acts versus 3.6 (95% CI, 2.9-4.4) per 10 000 acts in the placebo group (n = 1187). Dapivirine release indicative of consistent ring use was associated with a 63% (95% CI, 33%-80%) per-sex-act HIV-1 risk reduction. CONCLUSIONS These results support the efficacy of the dapivirine vaginal ring for HIV-1 prevention and help to inform decision-making for women, providers, and policymakers regarding product use. CLINICAL TRIALS REGISTRATION NCT01617096.
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Affiliation(s)
- Randy M Stalter
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Tracy Q Dong
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Craig W Hendrix
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Thesla Palanee-Phillips
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Wits Reproductive Health and HIV Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ariane van der Straten
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- ASTRA consulting, Kensington, CA, USA
| | - Sharon L Hillier
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Flavia M Kiweewa
- Research Department, Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Nyaradzo M Mgodi
- Clinical Trials Research Centre, University of Zimbabwe, Harare, Zimbabwe
| | - Mark A Marzinke
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Lydia Soto-Torres
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jared M Baeten
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Departments of Medicine and Global Health, University of Washington, Seattle, WA, USA
| | - Elizabeth R Brown
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
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Liu J, Guo T, Han B, Cheng X, Qu S, Wang R, Dong X, Fang J, Wang J, Tang M, Yao Y, Jin L. Adverse childhood experiences and human immunodeficiency virus testing among adults with human immunodeficiency virus risk behaviours. Stress Health 2024; 40:e3262. [PMID: 37226429 DOI: 10.1002/smi.3262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 02/28/2023] [Accepted: 04/25/2023] [Indexed: 05/26/2023]
Abstract
Adverse childhood experiences (ACEs) have been associated with poor HIV testing in adulthood yet, they have not been extensively described in those at increased risk for HIV. Cross-sectional analysis data (n = 204,231) on ACEs and HIV testing were obtained from the 2019-2020 Behavioural Risk Factor Surveillance Survey. Weighted logistic regression models were used to access the association of ACEs exposure, ACEs score, and ACEs type with HIV testing among adults with HIV risk behaviours, and stratified analysis was also performed to examine gender differences. The results indicated the overall rate of HIV testing was 38.8% and was higher among those with HIV risk behaviours (64.6%) than those without (37.2%). In populations with HIV risk behaviours, the negative association of HIV testing with ACEs exposure, ACEs score, and ACEs type was identified. Relative to those without ACEs, adults who were exposed to ACEs might decrease the rate of HIV testing, participants with ≥4 ACEs scores were less likely to have HIV testing, and childhood exposure to sexual abuse had the greatest impact on HIV testing. For both males and females, childhood exposure to ACEs was associated with lower odds of HIV testing and ACEs score ≥4 had the most robust associations with HIV testing. For males, those who experienced witnessed domestic violence had the lowest odds of HIV testing but the odds of engaging in HIV testing for females were the lowest among those who experienced childhood sexual abuse.
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Affiliation(s)
- Jun Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Tingting Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Baihui Han
- Chaoyang Center for Disease Control and Prevention, Beijing, China
| | - Xiaowei Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Shifang Qu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Ruying Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Xinxin Dong
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Jiaxin Fang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Jin Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Mengyao Tang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yan Yao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Lina Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
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Tordoff DM, Minalga B, Trejo A, Shook A, Kerani RP, Herbeck JT. Lessons learned from community engagement regarding phylodynamic research with molecular HIV surveillance data. J Int AIDS Soc 2023; 26 Suppl 1:e26111. [PMID: 37408448 PMCID: PMC10323319 DOI: 10.1002/jia2.26111] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 05/09/2023] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION The widespread implementation of molecular HIV surveillance (MHS) has resulted in an increased discussion about the ethical, human rights and public health implications of MHS. We narrate our process of pausing our research that uses data collected through MHS in response to these growing concerns and summarize the key lessons we learned through conversations with community members. METHODS The original study aimed to describe HIV transmission patterns by age and race/ethnicity among men who have sex with men in King County, Washington, by applying probabilistic phylodynamic modelling methods to HIV-1 pol gene sequences collected through MHS. In September 2020, we paused the publication of this research to conduct community engagement: we held two public-facing online presentations, met with a national community coalition that included representatives of networks of people living with HIV, and invited two members of this coalition to provide feedback on our manuscript. During each of these meetings, we shared a brief presentation of our methods and findings and explicitly solicited feedback on the perceived public health benefit and potential harm of our analyses and results. RESULTS Some community concerns about MHS in public health practice also apply to research using MHS data, namely those related to informed consent, inference of transmission directionality and criminalization. Other critiques were specific to our research study and included feedback about the use of phylogenetic analyses to study assortativity by race/ethnicity and the importance of considering the broader context of stigma and structural racism. We ultimately decided the potential harms of publishing our study-perpetuating racialized stigma about men who have sex with men and eroding the trust between phylogenetics researchers and communities of people living with HIV-outweighed the potential benefits. CONCLUSIONS HIV phylogenetics research using data collected through MHS data is a powerful scientific technology with the potential to benefit and harm communities of people living with HIV. Addressing criminalization and including people living with HIV in decision-making processes have the potential to meaningfully address community concerns and strengthen the ethical justification for using MHS data in both research and public health practice. We close with specific opportunities for action and advocacy by researchers.
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Affiliation(s)
- Diana M. Tordoff
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Brian Minalga
- Fred Hutch, Office of HIV/AIDS Network CoordinationSeattleWashingtonUSA
| | - Alfredo Trejo
- Department of Political ScienceUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Alic Shook
- Seattle University, College of NursingSeattleWashingtonUSA
- Seattle Children's Center for Pediatric Nursing ResearchSeattleWashingtonUSA
| | - Roxanne P. Kerani
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Public Health – Seattle & King County, HIV/STD ProgramSeattleWashingtonUSA
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Joshua T. Herbeck
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
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Gao X, Zhang W, Sun J, Adeloye D, Jin H, Rudan I, Song P, Jin M. Lifetime prevalence and adherence rate of cervical cancer screening among women living with HIV: a systematic review and meta-analysis. J Int AIDS Soc 2023; 26:e26090. [PMID: 37247380 DOI: 10.1002/jia2.26090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION Women living with HIV (WLWH) are more likely to develop cervical cancer. Screening and available healthcare can effectively reduce its incidence and mortality rates. We aimed to summarize the lifetime prevalence and adherence rate of cervical cancer screening among WLWH across low- and middle-income countries (LMICs), and high-income countries (HICs). METHODS We systematically searched PubMed, Web of Science and Embase for studies published between database inception and 2 September 2022, without language or geographical restrictions. Those reporting the lifetime prevalence and/or adherence rate of cervical cancer screening among WLWH were included. Pooled estimates across LMICs and HICs were obtained using DerSimonian-Laird random-effects models. When the number of eligible studies was greater than 10, we further conducted stratified analyses by the World Health Organization (WHO) region, setting (rural vs. urban), investigation year, screening method, type of cervical cancer screening programme, age and education level. RESULTS Among the 63 included articles, 26 provided data on lifetime prevalence, 24 on adherence rate and 13 on both. The pooled lifetime prevalence in LMICs was 30.2% (95% confidence interval [CI]: 21.0-41.3), compared to 92.4% in HICs (95% CI: 89.6-94.6). The pooled adherence rate was 20.1% in LMICs (95% CI: 16.4-24.3) and 59.5% in HICs (95% CI: 51.2-67.2). DISCUSSION There was a large gap in cervical cancer screening among WLWH between LMICs and HICs. Further analysis found that those in LMICs had higher lifetime prevalence in subgroups with urban settings, with older age and with higher education levels; and those in HICs had higher adherence in subgroups with younger age and with higher education levels. CONCLUSIONS Cervical cancer screening among WLWH falls considerably short of the WHO's goal. There should be continuous efforts to further increase screening among these women, especially those residing in the rural areas of LMICs and with lower education levels.
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Affiliation(s)
- Xiangrong Gao
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wanting Zhang
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingyi Sun
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Davies Adeloye
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Huyi Jin
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Peige Song
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mingjuan Jin
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Maisto SA, Simons JS, Palfai TP, Moskal D, Sheinfil AZ, Tahaney KD. Effects of Alcohol Intoxication on Sexual Decision-Making among Men Who Have Sex with Men (MSM): Alcohol's Influences on Self-Control Processes. Clin Psychol Sci 2023; 11:40-58. [PMID: 36865995 PMCID: PMC9976705 DOI: 10.1177/21677026221079780] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This experiment tested mechanisms linking alcohol intoxication and analogue determinants of condomless anal intercourse (CAI) in a sample of 257 men who have sex with men (MSM). The two mechanisms tested were implicit approach biases toward CAI stimuli and executive working memory. Participants were randomized to 3 conditions (water control, placebo, or alcohol) and following beverage administration completed a working memory task, an Approach Avoidance Task of sexual vs. condom stimuli, and two video role-play vignettes of high-risk sexual scenarios. Sexual arousal and CAI intentions were assessed by self-report, and behavioral skills and risk exposure were derived from participants' role-play behavior. Estimation of four path models showed that the hypothesized mechanisms were supported for the CAI intention outcome, but the findings for the skills and risk exposure outcome were mixed. Implications for development and enhancement of HIV prevention interventions were discussed.
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Affiliation(s)
| | - Jeffrey S. Simons
- Department of Psychology, University of South Dakota, Vermillion, USA
| | - Tibor P. Palfai
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
| | - Dezarie Moskal
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, NY, USA,School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Alan Z Sheinfil
- Department of Psychology, Syracuse University, Syracuse, USA
| | - Kelli D. Tahaney
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
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Status-Neutral Interventions to Support Health Equity for Black Sexual Minority Men. Curr HIV/AIDS Rep 2022; 19:265-280. [PMID: 35794447 DOI: 10.1007/s11904-022-00610-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Status-neutral care, a person-centered approach to healthcare not predicated on HIV serostatus, may improve health equity among Black sexual minority men (BSMM). We reviewed current status-neutral, HIV, and Pre-Exposure Prophylaxis (PrEP) interventions, and coded each for social-ecological focus and use of six approaches: (1) person-centered, (2) anti-stigma, (3) social support, (4) the social determinants of health (SDOH), (5) community engagement, and (6) multi-sectoral partnerships. RECENT FINDINGS We reviewed 25 studies, of which 3 were status-neutral. Nineteen studies utilized person-centered approaches, with several employing BSMM peers. For SDOH, financial incentives and reducing clinic-level barriers to care improved cascade outcomes. Direct text messaging, anti-stigma, social support, community-engagement, and multi-sectoral partnerships also improved outcomes in some studies. Few status-neutral programs exist and additional research is needed to identify key intervention components and mechanisms of influence. Programs targeting SDOH and multiple social-ecological levels offer promise for providing holistic care to BSMM, while addressing HIV prevention and treatment and health equity.
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DiCarlo MC, Dallabetta GA, Akolo C, Bautista-Arredondo S, Digolo HV, Fonner VA, Kumwenda GJ, Mbulaje P, Mwangi PW, Persuad NE, Sikwese S, Wheeler TA, Wolf RC, Mahler HR. Adequate funding of comprehensive community-based programs for key populations needed now more than ever to reach and sustain HIV targets. J Int AIDS Soc 2022; 25:e25967. [PMID: 35880969 PMCID: PMC9318644 DOI: 10.1002/jia2.25967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/06/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Globally, over half of the estimated new HIV infections now occur among key populations, including men who have sex with men, sex workers, people who inject drugs, transgender individuals, and people in prisons and other closed settings, and their sexual partners. Reaching epidemic control will, for many countries, increasingly require intensified programming and targeted resource allocation to meet the needs of key populations and their sexual partners. However, insufficient funding, both in terms of overall amounts and the way the funding is spent, contributes to the systematic marginalization of key populations from needed HIV services. Discussion The Joint United Nations Programme on HIV/AIDS (UNAIDS) has recently highlighted the urgent need to take action to end inequalities, including those faced by key populations, which have only been exacerbated by the COVID‐19 pandemic. To address these inequalities and improve health outcomes, key population programs must expand the use of a trusted access platform, scale up differentiated service delivery models tailored to the needs of key populations, rollout structural interventions and ensure service integration. These critical program elements are often considered “extras,” not necessities, and consequently costing studies of key population programs systematically underestimate the total and unitary costs of services for key populations. Findings from a recent costing study from the LINKAGES project suggest that adequate funding for these four program elements can yield benefits in program performance. Despite this and other evidence, the lack of data on the true costs of these elements and the costs of failing to provide them prevents sufficient investment in these critical elements. Conclusions As nations strive to reach the 2030 UNAIDS goals, donors, governments and implementers should reconsider the true, but often hidden costs in future healthcare dollars and in lives if they fail to invest in the community‐based and community‐driven key population programs that address structural inequities. Supporting these efforts contributes to closing the remaining gaps in the 95‐95‐95 goals. The financial and opportunity cost of perpetuating inequities and missing those who must be reached in the last mile of HIV epidemic control must be considered.
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Affiliation(s)
- Meghan C DiCarlo
- Global Health Population and Nutrition, FHI 360, Washington, DC, USA
| | | | - Chris Akolo
- Global Health Population and Nutrition, FHI 360, Washington, DC, USA
| | - Sergio Bautista-Arredondo
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP), Cuernavaca, Mexico
| | | | - Virginia A Fonner
- Global Health Population and Nutrition, FHI 360, Washington, DC, USA
| | - Grace Jill Kumwenda
- Pakachere Institute for Health and Development Communication, Blantyre, Malawi
| | | | - Peninah W Mwangi
- Bar Hostess Empowerment and Support Program (BHESP), Nairobi, Kenya
| | | | - Simon Sikwese
- Pakachere Institute for Health and Development Communication, Blantyre, Malawi
| | - Tisha A Wheeler
- Office of HIV/AIDS, United States Agency for International Development (USAID), Washington, DC, USA
| | - R Cameron Wolf
- Office of HIV/AIDS, United States Agency for International Development (USAID), Washington, DC, USA
| | - Hally R Mahler
- Global Health Population and Nutrition, FHI 360, Washington, DC, USA
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Pantelic M, Steinert JI, Ayala G, Sprague L, Chang J, Thomas RM, Nininahazwe C, Caswell G, Bach‐Mortensen AM, Bourne A. Addressing epistemic injustice in HIV research: a call for reporting guidelines on meaningful community engagement. J Int AIDS Soc 2022; 25:e25880. [PMID: 35049122 PMCID: PMC8771147 DOI: 10.1002/jia2.25880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 01/11/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Discussion Conclusions
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Affiliation(s)
- Marija Pantelic
- Brighton and Sussex Medical SchoolUniversity of SussexBrightonUK
- Department of Social Policy and InterventionOxford UniversityOxfordUK
| | - Janina I. Steinert
- Department of Social Policy and InterventionOxford UniversityOxfordUK
- Department of Social Sciences and TechnologyTechnical University of MunichMunichGermany
| | - George Ayala
- Alameda County Public Health DepartmentSan LeandroCaliforniaUSA
| | | | - Judy Chang
- International Network of People Who Use DrugsLondonUK
| | | | | | | | | | - Adam Bourne
- Australian Research Centre in SexHealth and SocietyLa Trobe UniversityMelbourneVictoriaAustralia
- UNSW SydneyKirby InstituteSydneyNew South WalesAustralia
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Pantelic M, Steinert JI, Ayala G, Sprague L, Chang J, Thomas RM, Nininahazwe C, Caswell G, Bach‐Mortensen AM, Bourne A. Addressing epistemic injustice in HIV research: a call for reporting guidelines on meaningful community engagement. J Int AIDS Soc 2022; 25:e25880. [PMID: 35049122 PMCID: PMC8771147 DOI: 10.1002/jia2.25880/full|10.1002/jia2.25880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 01/11/2022] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION Despite the widely recognized ethical and practical benefits of community engagement in HIV research, epistemic injustice persists within the field. Namely, the knowledge held by communities disproportionately affected by HIV is systematically afforded less credibility than that of more privileged academic researchers. In order to illustrate what this looks like in practice, we synthesized the extent of reporting on community engagement within recent high-impact HIV intervention research papers. However, we also posit that the HIV research sector has the potential to devise and showcase world-leading examples of equitable research-community partnerships and suggest actionable key steps to achieving this goal. DISCUSSION In the absence of reporting requirements within the publishing process, it is difficult to infer whether and how the community have been consulted in the design, implementation, analysis and/or interpretation of findings. As an illustrative exercise, we offer a rapid synthesis of the extent of reporting on community engagement in HIV research from 2017 to 2019, which highlighted sporadic and very low rates of reporting of community engagement in recent high-impact HIV intervention studies. Of note is that none of the included studies reported on community engagement through all stages of the research process. There were also discrepancies in how community involvement was reported. We provide three actionable recommendations to enhance reporting on community engagement in HIV research: (1) community-led organizations, researchers and scientific journals should band together to develop, publish and require adherence to standardized guidelines for reporting on community involvement in HIV research; (2) research funders should (continue to) require details about how relevant communities have been engaged prior to the submission of funding requests; and (3) researchers should take proactive measures to describe their engagement with community organizations in a clear and transparent manner. CONCLUSIONS There is a clear and urgent need for guidelines that facilitate transparent and consistent reporting on community engagement in HIV intervention research. Without standardized reporting requirements and accountability mechanisms within the research sector, the extent of meaningful community engagement cannot be established and may remain a catchphrase rather than reality.
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Affiliation(s)
- Marija Pantelic
- Brighton and Sussex Medical SchoolUniversity of SussexBrightonUK
- Department of Social Policy and InterventionOxford UniversityOxfordUK
| | - Janina I. Steinert
- Department of Social Policy and InterventionOxford UniversityOxfordUK
- Department of Social Sciences and TechnologyTechnical University of MunichMunichGermany
| | - George Ayala
- Alameda County Public Health DepartmentSan LeandroCaliforniaUSA
| | | | - Judy Chang
- International Network of People Who Use DrugsLondonUK
| | | | | | | | | | - Adam Bourne
- Australian Research Centre in SexHealth and SocietyLa Trobe UniversityMelbourneVictoriaAustralia
- UNSW SydneyKirby InstituteSydneyNew South WalesAustralia
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Mukumbang FC, Ndlovu S, van Wyk B. Comparing Patients' Experiences in Three Differentiated Service Delivery Models for HIV Treatment in South Africa. QUALITATIVE HEALTH RESEARCH 2022; 32:238-254. [PMID: 34911400 PMCID: PMC8727825 DOI: 10.1177/10497323211050371] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Differentiated service delivery for HIV treatment seeks to enhance medication adherence while respecting the preferences of people living with HIV. Nevertheless, patients' experiences of using these differentiated service delivery models or approaches have not been qualitatively compared. Underpinned by the tenets of descriptive phenomenology, we explored and compared the experiences of patients in three differentiated service delivery models using the National Health Services' Patient Experience Framework. Data were collected from 68 purposively selected people living with HIV receiving care in facility adherence clubs, community adherence clubs, and quick pharmacy pick-up. Using the constant comparative thematic analysis approach, we compared themes identified across the different participant groups. Compared to facility adherence clubs and community adherence clubs, patients in the quick pharmacy pick-up model experienced less information sharing; communication and education; and emotional/psychological support. Patients' positive experience with a differentiated service delivery model is based on how well the model fits into their HIV disease self-management goals.
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Affiliation(s)
- Ferdinand C. Mukumbang
- University of the Western Cape, Cape Town, South Africa
- School of Medicine, University of Washington, Seattle, WA, USA
| | | | - Brian van Wyk
- University of the Western Cape, Cape Town, South Africa
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Ayala G, Sprague L, van der Merwe LLA, Thomas RM, Chang J, Arreola S, Davis SLM, Taslim A, Mienies K, Nilo A, Mworeko L, Hikuam F, de Leon Moreno CG, Izazola-Licea JA. Peer- and community-led responses to HIV: A scoping review. PLoS One 2021; 16:e0260555. [PMID: 34852001 PMCID: PMC8635382 DOI: 10.1371/journal.pone.0260555] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/18/2021] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION In June 2021, United Nations (UN) Member States committed to ambitious targets for scaling up community-led responses by 2025 toward meeting the goals of ending the AIDS epidemic by 2030. These targets build on UN Member States 2016 commitments to ensure that 30% of HIV testing and treatment programmes are community-led by 2030. At its current pace, the world is not likely to meet these nor other global HIV targets, as evidenced by current epidemiologic trends. The COVID-19 pandemic threatens to further slow momentum made to date. The purpose of this paper is to review available evidence on the comparative advantages of community-led HIV responses that can better inform policy making towards getting the world back on track. METHODS We conducted a scoping review to gather available evidence on peer- and community-led HIV responses. Using UNAIDS' definition of 'community-led' and following PRISMA guidelines, we searched peer-reviewed literature published from January 1982 through September 2020. We limited our search to articles reporting findings from randomized controlled trials as well as from quasi-experimental, prospective, pre/post-test evaluation, and cross-sectional study designs. The overall goals of this scoping review were to gather available evidence on community-led responses and their impact on HIV outcomes, and to identify key concepts that can be used to quickly inform policy, practice, and research. FINDINGS Our initial search yielded 279 records. After screening for relevance and conducting cross-validation, 48 articles were selected. Most studies took place in the global south (n = 27) and a third (n = 17) involved youth. Sixty-five percent of articles (n = 31) described the comparative advantage of peer- and community-led direct services, e.g., prevention and education (n = 23) testing, care, and treatment programs (n = 8). We identified more than 40 beneficial outcomes linked to a range of peer- and community-led HIV activities. They include improved HIV-related knowledge, attitudes, intentions, self-efficacy, risk behaviours, risk appraisals, health literacy, adherence, and viral suppression. Ten studies reported improvements in HIV service access, quality, linkage, utilization, and retention resulting from peer- or community-led programs or initiatives. Three studies reported structural level changes, including positive influences on clinic wait times, treatment stockouts, service coverage, and exclusionary practices. CONCLUSIONS AND RECOMMENDATIONS Findings from our scoping review underscore the comparative advantage of peer- and community-led HIV responses. Specifically, the evidence from the published literature leads us to recommend, where possible, that prevention programs, especially those intended for people living with and disproportionately affected by HIV, be peer- and community-led. In addition, treatment services should strive to integrate specific peer- and community-led components informed by differentiated care models. Future research is needed and should focus on generating additional quantitative evidence on cost effectiveness and on the synergistic effects of bundling two or more peer- and community-led interventions.
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Affiliation(s)
- George Ayala
- MPact Global Action for Gay Men’s Health and Rights, Oakland, CA, United States of America
- Alameda County Department of Public Health, Oakland, CA, United States of America
- * E-mail:
| | - Laurel Sprague
- Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - L. Leigh-Ann van der Merwe
- Social, Health and Empowerment Feminist Collective of Transgender Women in Africa, East London, South Africa
- Innovative Response Globally to Transgender Women and HIV (IRGT), Oakland, CA, United States of America
| | | | - Judy Chang
- International Network of People Who Use Drugs, London, United Kingdom
| | - Sonya Arreola
- MPact Global Action for Gay Men’s Health and Rights, Oakland, CA, United States of America
- Arreola Research, San Francisco, CA, United States of America
| | | | | | - Keith Mienies
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland
| | | | - Lillian Mworeko
- International Community of Women Living with HIV Eastern Africa, Kampala, Uganda
| | - Felicita Hikuam
- AIDS and Rights Alliance for Southern Africa, Windhoek, Namibia
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Maisto SA, Simons JS, Palfai TP, Moskal D, Luehring-Jones P. Daily Associations Among Alcohol Intoxication, Partner Familiarity, Participant Effortful Control, Urgency, and PrEP Uptake on Sexual Behavior in Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2843-2860. [PMID: 33594529 DOI: 10.1007/s10508-020-01852-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to examine the effects of alcohol intoxication and its interaction with contextual or situation (partner familiarity) and individual differences variables (effortful control, urgency, and whether taking pre-exposure prophylaxis (PrEP) medication) on sexual behaviors in men who have sex with men (MSM), a subgroup for whom HIV continues to be a major public health problem in the U.S. The participants were 236 men recruited from two northeastern U.S. cities and aged 21-50 years, M = 27.8). These men participated in a 6-week (two 3-week sampling bursts) experience sampling method (ESM) study. The ESM data were collected via use of software installed on the participant's own or study-provided mobile phone. Individual differences variables were measured by participants' completing questionnaires measuring effortful control and urgency, and the participant's self-report of whether he was currently taking PrEP. The ESM data pertained to sexual behavior as well as situation variables of familiarity of relevant sexual partners and number of standard alcohol drinks consumed. The results generally were consistent with hypotheses, as alcohol intoxication showed a curvilinear relation to the occurrence of condomless anal intercourse. Furthermore, the likelihood of occurrence of condomless anal sex increased with increased familiarity of the sexual partner. Similarly, taking PrEP increased the likelihood of occurrence of condomless anal sex. At the same time, alcohol's effects were moderated by all three individual differences variables as expected, but the prediction that partner familiarity would moderate alcohol's effects on the occurrence of condomless sex was not supported. Clinical implications of the findings center on the application of the data to HIV prevention programs toward inclusion of more empirically supported, nuanced information on the relation between acute alcohol intoxication and sexual behavior. Directions for further research address the need for additional testing and refinement of a person × situation approach to alcohol and sexual behavior. Furthermore, it is argued that it is important to refine further the concept of sexual risk in the context of taking PrEP and to conduct more detailed, multivariate studies of the relation between taking PrEP and patterns of sexual behavior.
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Affiliation(s)
- Stephen A Maisto
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA.
| | - Jeffrey S Simons
- Department of Psychology, University of South Dakota, Vermillion, SD, USA
| | - Tibor P Palfai
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Dezarie Moskal
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA
| | - Peter Luehring-Jones
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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Irungu EM, Odoyo J, Wamoni E, Bukusi EA, Mugo NR, Ngure K, Morton JF, Mugwanya KK, Baeten JM, O'Malley G. Process evaluation of PrEP implementation in Kenya: adaptation of practices and contextual modifications in public HIV care clinics. J Int AIDS Soc 2021; 24:e25799. [PMID: 34496148 PMCID: PMC8425783 DOI: 10.1002/jia2.25799] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION In Africa, oral pre-exposure prophylaxis (PrEP) is largely provided via over-burdened public HIV care clinics. Successfully incorporating PrEP services into these clinics may require adaptations to practices outlined in national implementation guidelines and modifications to routine existing service delivery. We aimed to describe adaptations made by public HIV clinics in Kenya to integrate PrEP delivery into existing services. METHODS The Partners Scale-Up Project aimed to catalyse integration of PrEP in 25 public HIV care clinics. Between May and December 2018, we conducted qualitative interviews with health providers and documented clinic observations in technical assistance (TA) reports to understand the process of PrEP service integration. We analysed 36 health provider interview transcripts and 25 TA reports to identify clinic-level adaptations to activities outlined in Kenyan Ministry of Health PrEP guidelines and modifications made to existing service delivery practices to successfully incorporate PrEP services. Identified adaptations were reported using the expanded framework for reporting adaptations and modifications (FRAME). RESULTS All clinics (n = 25) performed HIV testing, HIV risk assessment, PrEP education and adherence counselling as stipulated in the guidelines. Most clinics initiated clients on PrEP without creatinine testing if otherwise healthy. While monthly refill appointments are recommended, a majority of clinics issued PrEP users two to three months of pills at a time. Clinics also implemented practices that had not been specified in the guidelines including incorporating PrEP-related topics into routine health talks, calling clients with missed PrEP appointments, discussing PrEP service delivery in regular staff meetings, 'fast-tracking' PrEP clients and dispensing PrEP in clinic rooms rather than at clinic-based pharmacies. PrEP initiation numbers were highest among clinics that did not require creatinine testing, conducted peer on-the-job PrEP training and those that discussed PrEP delivery in their routine meetings. Above-average continuation was observed among clinics that discussed PrEP in their routine meetings, dispensed PrEP in clinic rooms and offered PrEP at nonregular hours. CONCLUSIONS Health providers in public HIV care clinics instituted practices and made innovative adaptations to PrEP delivery to reduce barriers for clients and staff. Encouraging clinic level adaptations to national implementation guidelines will facilitate scale-up of PrEP delivery.
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Affiliation(s)
- Elizabeth M. Irungu
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Centre for Clinical ResearchKenya Medical Research InstituteNairobiKenya
| | - Josephine Odoyo
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| | - Elizabeth Wamoni
- Centre for Clinical ResearchKenya Medical Research InstituteNairobiKenya
| | - Elizabeth A. Bukusi
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of Obstetrics and GynecologyUniversity of WashingtonSeattleWashingtonUSA
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| | - Nelly R. Mugo
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Centre for Clinical ResearchKenya Medical Research InstituteNairobiKenya
| | - Kenneth Ngure
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- School of Public HealthJomo Kenyatta University of Agriculture and TechnologyNairobiKenya
| | | | | | - Jared M. Baeten
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
- Gilead SciencesFoster CityCAUSA
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Murphy E, Shwe YY, Bhatia R, Bakkali T, Vannakit R. What will it take to end AIDS in Asia and the Pacific region by 2030? Sex Health 2021; 18:41-49. [PMID: 33653504 DOI: 10.1071/sh20204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/18/2021] [Indexed: 01/03/2023]
Abstract
The 2016 global commitments towards ending the AIDS epidemic by 2030 require the Asia-Pacific region to reach the Fast-Track targets by 2020. Despite early successes, the region is well short of meeting these targets. The overall stalled progress in the HIV response has been further undermined by rising new infections among young key populations and the unprecedented COVID-19 pandemic. This paper examines the HIV situation, assesses the gaps, and analyses what it would take the region to end AIDS by 2030. Political will and commitments for ending AIDS must be reaffirmed and reinforced. Focused regional strategic direction that answers the specific regional context and guides countries to respond to their specific needs must be put in place. The region must harness the power of innovative tools and technology in both prevention and treatment. Community activism and meaningful community engagement across the spectrum of HIV response must be ensured. Punitive laws, stigma, and discrimination that deter key populations and people living with HIV from accessing health services must be effectively tackled. The people-centred public health approach must be fully integrated into national universal health coverage while ensuring domestic resources are available for community-led service delivery. The region must utilise its full potential and draw upon lessons that have been learnt to address common challenges of the HIV and COVID-19 pandemics and achieve the goal of ending AIDS by 2030, in fulfillment of the United Nations' Sustainable Development Goals.
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Affiliation(s)
- Eamonn Murphy
- Joint United Nations Programme on HIV/AIDS (UNAIDS), Regional Support Team, Asia and the Pacific, 9th Floor, Block A, United Nations Building, Rajadamnern Nok Avenue, Bangkok, 10200, Thailand
| | - Ye Yu Shwe
- Joint United Nations Programme on HIV/AIDS (UNAIDS), Regional Support Team, Asia and the Pacific, 9th Floor, Block A, United Nations Building, Rajadamnern Nok Avenue, Bangkok, 10200, Thailand; and Corresponding author.
| | - Reeta Bhatia
- Joint United Nations Programme on HIV/AIDS (UNAIDS), Regional Support Team, Asia and the Pacific, 9th Floor, Block A, United Nations Building, Rajadamnern Nok Avenue, Bangkok, 10200, Thailand
| | - Taoufik Bakkali
- Joint United Nations Programme on HIV/AIDS (UNAIDS), Regional Support Team, Asia and the Pacific, 9th Floor, Block A, United Nations Building, Rajadamnern Nok Avenue, Bangkok, 10200, Thailand
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Abstract
It has been more than 38 years since the first reported case of human immunodeficiency virus (HIV). Over this period of time, there has been an evolution in the care, management, and survival of those living with HIV and acquired immunodeficiency syndrome (AIDS). Current efforts to stabilize HIV incidence have targeted pharmacologic management with antiretroviral therapy (ART) coupled with programs that focus on individual characteristics, social norms, and structural barriers. It is important that clinicians are knowledgeable of prevention efforts and up-to-date clinical practice guidelines in order to best provide care for people living with HIV.
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Affiliation(s)
- Courtney J Pitts
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA.
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Pantelic M, Steinert JI, Park J, Mellors S, Murau F. 'Management of a spoiled identity': systematic review of interventions to address self-stigma among people living with and affected by HIV. BMJ Glob Health 2019; 4:e001285. [PMID: 30997170 PMCID: PMC6441299 DOI: 10.1136/bmjgh-2018-001285] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/21/2018] [Accepted: 01/12/2019] [Indexed: 12/12/2022] Open
Abstract
Background Self-stigma, also known as internalised stigma, is a global public health threat because it keeps people from accessing HIV and other health services. By hampering HIV testing, treatment and prevention, self-stigma can compromise the sustainability of health interventions and have serious epidemiological consequences. This review synthesised existing evidence of interventions aiming to reduce self-stigma experienced by people living with HIV and key populations affected by HIV in low-income and middle-income countries. Methods Studies were identified through bibliographic databases, grey literature sites, study registries, back referencing and contacts with researchers, and synthesised following Cochrane guidelines. Results Of 5880 potentially relevant titles, 20 studies were included in the review. Represented in these studies were 9536 people (65% women) from Ethiopia, India, Kenya, Lesotho, Malawi, Nepal, South Africa, Swaziland, Tanzania, Thailand, Uganda and Vietnam. Seventeen of the studies recruited people living with HIV (of which five focused specifically on pregnant women). The remaining three studies focused on young men who have sex with men, female sex workers and men who inject drugs. Studies were clustered into four categories based on the socioecological level of risk or resilience that they targeted: (1) individual level only, (2) individual and relational levels, (3) individual and structural levels and (4) structural level only. Thirteen studies targeting structural risks (with or without individual components) consistently produced significant reductions in self-stigma. The remaining seven studies that did not include a component to address structural risks produced mixed effects. Conclusion Structural interventions such as scale-up of antiretroviral treatment, prevention of medication stockouts, social empowerment and economic strengthening may help substantially reduce self-stigma among individuals. More research is urgently needed to understand how to reduce self-stigma among young people and key populations, as well as how to tackle intersectional self-stigma.
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Affiliation(s)
- Marija Pantelic
- Department of Social Policy and Intervention, Oxford University, Oxford, UK.,Frontline AIDS, Brighton, UK
| | - Janina I Steinert
- Department of Economics, University of Goettingen, Goettingen, Germany
| | - Jay Park
- School of Experimental Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Pantelic M, Stegling C, Shackleton S, Restoy E. Power to participants: a call for person-centred HIV prevention services and research. J Int AIDS Soc 2018; 21 Suppl 7:e25167. [PMID: 30334609 PMCID: PMC6193315 DOI: 10.1002/jia2.25167] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/06/2018] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION While biomedical HIV prevention offers promise for preventing new HIV infections, access to and uptake of these technologies remain unacceptably low in some settings. New models for delivery of HIV prevention are clearly needed. This commentary highlights the potential of person-centred programming and research for increasing the cultural relevance, applicability and use of efficacious HIV prevention strategies. It calls for a shift in perspective within HIV prevention programmes and research, whereby people are recognized for their agency rather than assumed to be passive beneficiaries or research participants. DISCUSSION Person-centred HIV prevention reorientates power dynamics so that individuals (rather than interventions) are at the centre of the response. Respecting personal choice and agency - and understanding how these are shaped by the context in which people exercise these choices - are critical dimensions of the person-centred approach. Community-based participatory research should be employed to inform and evaluate person-centred HIV prevention. We argue that community-based participatory research is an orientation rather than a method, meaning that it can be integrated within a range of research methods including randomized controlled trials. But embracing community-based participatory approaches in HIV prevention research requires a systemic shift in how this type of research is reported in high impact journals and in how research impact is conceived. Community-based organizations have a critical role to play in both person-centred HIV prevention and research. CONCLUSIONS HIV prevention is situated at the intersection of unprecedented opportunity and crisis. Person-centred approaches to HIV prevention and research shift power dynamics, and have the potential to ensure a more sustainable response with each individual actively participating in their own care and meaningfully contributing to the production of knowledge on HIV prevention. This approach taps into the resourcefulness, resilience and knowledge of the person and their communities, to strengthen research and programmes, making them more relevant, appropriate and effective.
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Affiliation(s)
- Marija Pantelic
- International HIV/AIDS AllianceBrighton & HoveUnited Kingdom
- Department of Social Policy and InterventionUniversity of OxfordOxfordUnited Kingdom
| | | | | | - Enrique Restoy
- International HIV/AIDS AllianceBrighton & HoveUnited Kingdom
- School of Global StudiesUniversity of SussexSussexUnited Kingdom
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MacQueen KM, Auerbach JD. It is not just about "the trial": the critical role of effective engagement and participatory practices for moving the HIV research field forward. J Int AIDS Soc 2018; 21 Suppl 7:e25179. [PMID: 30334608 PMCID: PMC6193314 DOI: 10.1002/jia2.25179] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/06/2018] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Judith D Auerbach
- Department of Medicine, University of California, San Francisco, CA, USA
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