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Dangerfield Ii DT, Anderson JN, Wylie C, Bluthenthal R, Beyrer C, Farley JE. A Multicomponent Intervention (POSSIBLE) to Improve Perceived Risk for HIV Among Black Sexual Minority Men: Feasibility and Preliminary Effectiveness Pilot Study. JMIR Hum Factors 2024; 11:e54739. [PMID: 38861707 PMCID: PMC11200034 DOI: 10.2196/54739] [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: 11/20/2023] [Revised: 02/17/2024] [Accepted: 04/22/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Increased pre-exposure prophylaxis (PrEP) use is urgently needed to substantially decrease HIV incidence among Black sexual minority men. Low perceived risk for HIV (PRH) is a key unaddressed PrEP barrier for Black sexual minority men. Peers and smartphone apps are popular intervention tools to promote community health behaviors, but few studies have used these together in a multicomponent strategy. Therefore, we designed a multicomponent intervention called POSSIBLE that used an existing smartphone app called PrEPme (Emocha Mobile Health, Inc) and a peer change agent (PCA) to increase PRH as a gateway to PrEP. OBJECTIVE This paper aims to describe the feasibility and preliminary impact of POSSIBLE on PRH and willingness to accept a PrEP referral among Black sexual minority men. METHODS POSSIBLE was a theoretically guided, single-group, 2-session pilot study conducted among Black sexual minority men from Baltimore, Maryland between 2019 and 2021 (N=69). POSSIBLE integrated a PCA and the PrEPme app that allows users to self-monitor sexual risk behaviors and chat with the in-app community health worker to obtain PrEP service information. PRH was assessed using the 8-item PRH scale before and after baseline and follow-up study visits. At the end of each study visit, the PCA referred interested individuals to the community health worker to learn more about PrEP service options. RESULTS The average age of participants was 32.5 (SD 8.1, range 19-62) years. In total, 55 (80%) participants were retained for follow-up at month 1. After baseline sessions, 29 (42%) participants were willing to be referred to PrEP services, 20 (69%) of those confirmed scheduled appointments with PrEP care teams. There were no statistically significant differences in PRH between baseline and follow-up visits (t122=-1.36; P=.17). CONCLUSIONS We observed no statistically significant improvement in PRH between baseline and month 1. However, given the high retention rate and acceptability, POSSIBLE may be feasible to implement. Future research should test a statistically powered peer-based approach on PrEP initiation among Black sexual minority men. TRIAL REGISTRATION ClinicalTrials.gov NCT04533386; https://clinicaltrials.gov/study/NCT04533386.
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Affiliation(s)
- Derek T Dangerfield Ii
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Janeane N Anderson
- University of Tennessee Health Science Center, Memphis, TN, United States
| | - Charleen Wylie
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Ricky Bluthenthal
- Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Chris Beyrer
- Duke Global Health Institute, Durham, NC, United States
| | - Jason E Farley
- Johns Hopkins School of Nursing, Baltimore, MD, United States
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Dangerfield Ii DT, Anderson JN. A Scripted, PrEP-Using Peer Change Agent Improves Perceived Risk for HIV and Willingness to Accept Referrals Quickly Among Black Sexual Minority Men: Preliminary Findings from POSSIBLE. AIDS Behav 2024; 28:2156-2165. [PMID: 38551719 DOI: 10.1007/s10461-024-04313-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 09/18/2024]
Abstract
PrEP use remains suboptimal among Black sexual minority men (SMM) partly due to low perceived risk for HIV (PRH). This study describes baseline results of POSSIBLE, a multicomponent pilot intervention including a peer change agent (PCA) to increase PRH among Black SMM. POSSIBLE was a theoretically guided two-session, single-group feasibility intervention in Baltimore, MD conducted between 2019 and 2021 (N = 69). Baseline study visits involved a 20-minute session with a PrEP-using PCA who used a motivational interview-based script to discuss participants' lifestyles, goals, and values, HIV risk behaviors, and PRH and tailor communication to encourage PrEP use. Bivariate analyses were conducted to assess differences in PRH before and after baseline sessions along with the correlates of PrEP referral willingness. A total of 75% of participants identified as gay; 73% were employed; 84% reported having insurance; 78% were single; 51% reported ever being diagnosed with an STI. Baseline results showed a statistically significant improvement in PRH after the first session (t=-3.09; p < .01). Additionally, 64% were willing to be referred to PrEP care after baseline; 45% of whom made a PrEP appointment. PRH was not associated with referral willingness. However, receptive anal intercourse in the previous 6 months was statistically significantly associated with referral willingness. Findings suggests that a scripted PCA could independently improve PRH among Black SMM quickly. The person-centered nature of the scripted PCA could be key to improving PrEP use among a highly marginalized and elusive community.
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Affiliation(s)
- Derek T Dangerfield Ii
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, D.C, USA.
| | - Janeane N Anderson
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA
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Ostermann J, Njau B, van Zwetselaar M, Yamanis T, McClimans L, Mwangi R, Beti M, Hobbie A, Gass SJ, Mtuy T, Thielman N. Mobile Phone-Based Confidential Social Network Referrals for HIV Testing (CONSORT): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e55068. [PMID: 38814692 PMCID: PMC11176874 DOI: 10.2196/55068] [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: 12/01/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Critical to efforts to end the HIV epidemic is the identification of persons living with HIV who have yet to be diagnosed and engaged in care. Expanded HIV testing outreach efforts need to be both efficient and ambitious, targeting the social networks of persons living with HIV and those at above-average risk of undiagnosed HIV infection. The ubiquity of mobile phones across many high HIV prevalence settings has created opportunities to leverage mobile health (mHealth) technologies to engage social networks for HIV testing outreach, prevention, and treatment. OBJECTIVE The purpose of this study is to evaluate the acceptability and efficacy of a novel mHealth intervention, "Confidential Social Network Referrals for HIV Testing (CONSORT)," to nudge at-risk individuals to test for HIV using SMS text messages. METHODS We will conduct the CONSORT study in Moshi, Tanzania, the commercial center and administrative capital of the Kilimanjaro Region in northern Tanzania. After qualitative formative work and pilot testing, we will enroll 400 clients presenting for HIV counseling and testing and 200 persons living with HIV and receiving care at HIV care and treatment centers as "inviters" into a randomized controlled trial. Eligible participants will be aged 18 years or older and live, work, or regularly receive care in Moshi. We will randomize inviters into 1 of 2 study arms. All inviters will be asked to complete a survey of their HIV testing and risk behaviors and to think of social network contacts who would benefit from HIV testing. They will then be asked to whom they would prefer to extend an HIV testing invitation in the form of a physical invitation card. Arm 1 participants will also be given the opportunity to extend CONSORT invitations in the form of automated confidential SMS text messages to any of their social network contacts or "invitees." Arm 2 participants will be offered physical invitation cards alone. The primary outcome will be counselor-documented uptake of HIV testing by invitees within 30 days of inviter enrollment. Secondary outcomes will include the acceptability of CONSORT among inviters, the number of new HIV diagnoses, and the HIV risk of invitees who present for testing. RESULTS Enrollment in the randomized controlled trial is expected to start in September 2024. The findings will be disseminated to stakeholders and published in peer-reviewed journals. CONCLUSIONS If CONSORT is acceptable and effective for increasing the uptake of HIV testing, given the minimal costs of SMS text reminders and the potential for exponential but targeted growth using chain referrals, it may shift current practices for HIV testing programs in the area. TRIAL REGISTRATION ClincalTrials.gov NCT05967208; https://clinicaltrials.gov/study/NCT05967208. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/55068.
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Affiliation(s)
- Jan Ostermann
- Department of Health Services Policy & Management, University of South Carolina, Columbia, SC, United States
| | - Bernard Njau
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | | | - Thespina Yamanis
- School of International Service, American University, Washington, DC, United States
| | - Leah McClimans
- Department of Philosophy, University of South Carolina, Columbia, SC, United States
| | - Rose Mwangi
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Melkiory Beti
- Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Amy Hobbie
- Center for Health Policy and Inequalities Research, Duke University, Durham, SC, United States
| | - Salomé-Joelle Gass
- Department of Health Services Policy & Management, University of South Carolina, Columbia, SC, United States
| | - Tara Mtuy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nathan Thielman
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
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Johnson AL, Butts SA, Rodriguez E, Craker L, Kanamori M, Doblecki-Lewis S. "Test-To-PrEP": Assessing Reach and Adoption of a New Approach to Increase HIV Testing and PrEP Knowledge Using HIV Self-Test Kit Distribution Through PrEP Clients' Social Networks. J Acquir Immune Defic Syndr 2023; 94:421-428. [PMID: 37949445 PMCID: PMC10651164 DOI: 10.1097/qai.0000000000003294] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/15/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND HIV self-testing (HIVST) can increase the reach of HIV testing. Preexposure prophylaxis (PrEP) clients may be ideal distributors of HIVST kits and PrEP information within their social networks. This study uses the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to evaluate the distribution of HIVST bundled with PrEP information ("Test-to-PrEP" kits) among egocentric friendship networks of PrEP users. METHODS The study was conducted in Miami from November 2021 to March 2022. Enrolled PrEP clients (egos; n = 100) were offered Test-to-PrEP kits for distribution. Egos and Test-to-PrEP kit users completed brief online surveys. Descriptive statistics are reported for participants, their reported network members, and users of the Test-to-PrEP kits. Logistic and Poisson regression assessed the relationship between characteristics of egos, alters, and the distribution of Test-to-PrEP kits. RESULTS The 100 enrolled egos reported a total of 414 alters. Participants received 293 Test-to-PrEP kits for distribution with 47 of the 100 participants distributing at least 1 kit. Of those who scanned the quick-response code and responded to the survey, 16.2% reported no previous HIV test and 38.5% reported no prior knowledge of PrEP; 32.5% reported interest in distributing Test-to-PrEP kits, 3 successfully distributed kits, and 2 initiated PrEP. CONCLUSIONS An approach using PrEP clients' social networks can disseminate HIVST bundled with PrEP information to critical populations including individuals lacking knowledge of PrEP or who have never been tested for HIV. Future studies will assess whether this use of network effects can increase reach and efficiency of HIV testing and PrEP information distribution.
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Affiliation(s)
- Ariana L. Johnson
- Department of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stefani A. Butts
- Department of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Edda Rodriguez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lacey Craker
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mariano Kanamori
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Susanne Doblecki-Lewis
- Department of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
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Temelkovska T, Moriarty K, Huerta L, Perez-Brumer AG, Segura ER, Passaro RC, Lake JE, Clark JL, Blair CS. Both/And: Mixed methods analysis of network composition, communication patterns, and socio-economic support within social networks of transgender women involved in sex work in Lima, Peru. BMC Public Health 2023; 23:2385. [PMID: 38041045 PMCID: PMC10690964 DOI: 10.1186/s12889-023-17278-z] [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: 07/07/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023] Open
Abstract
INTRODUCTION Social networks contribute to normative reinforcement of HIV prevention strategies, knowledge sharing, and social capital, but little research has characterized the social networks of transgender women (TW) in Latin America. We conducted a mixed methods analysis of three network clusters of TW in Lima, Peru, to evaluate network composition, types of support exchanged, and patterns of communication. METHODS We recruited TW residing in or affiliated with three "casas trans" (houses shared among TW) in Lima between April-May 2018. Eligible participants were 18 or older, self-reported HIV-negative, and reported recent intercourse with a cis-male partner. Participants completed demographic questionnaires, social network interviews, and semi-structured interviews to assess egocentric network structures, support exchanged, and communication patterns. Quantitative and qualitative data were analyzed using Stata v14.1 and Atlas.ti, respectively. RESULTS Of 20 TW, median age was 26 years and 100% reported involvement in commercial sex work. Respondents identified 161 individuals they interacted with in the past month (alters), of whom 33% were TW and 52% family members. 70% of respondents reported receiving emotional support from family, while 30% received financial support and instrumental support from family. Of the 13 (65%) respondents who nominated someone as a source of HIV prevention support (HPS), the majority (69%) nominated other TW. In a GEE regression analysis adjusted for respondent education and region of birth, being a family member was associated with lower likelihood of providing financial support (aOR 0.21, CI 0.08-0.54), instrumental support (aOR 0.16, CI 0.06-0.39), and HPS (aOR 0.18, CI 0.05-0.64). In qualitative interviews, most respondents identified a cis-female family member as their most trusted and closest network member, but other TW were more often considered sources of day-to-day support, including HPS. CONCLUSION TW have diverse social networks where other TW are key sources of knowledge sharing and support, and family members may also represent important and influential components. Within these complex networks, TW may selectively solicit and provide support from different network alters according to specific contexts and needs. HIV prevention messaging could consider incorporating network-based interventions with TW community input and outreach efforts for supportive family members.
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Affiliation(s)
- Tijana Temelkovska
- Department of Obstetrics and Gynecology, University of Colorado, 12631 East 17th Avenue, AO1, 4th Floor, Aurora, CO, 80045, USA.
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, UCLA, 911 Broxton Ave, Suite 301, Los Angeles, CA, 90024, USA.
| | - Kathleen Moriarty
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC, 20007, USA
| | - Leyla Huerta
- Feminas, Jiron Carlos de los Heros 265, Cercado de Lima 15084, Lima, Peru
| | - Amaya G Perez-Brumer
- Division of Social and Behavioral Health Sciences, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 5th Floor, Room 554, Toronto, ON, Canada
| | - Eddy R Segura
- Facultad de Ciencias de la Salud, Universidad de Huánuco, Jirón Hermilio, Valdizan, Huánuco, 859-885, 10001, Peru
| | - Ryan Colby Passaro
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, 1200 N State Street, Los Angeles, CA, 90033, USA
| | - Jordan E Lake
- Department of Internal Medicine, McGovern Medical School at UTHealth, MSB 1.150, Houston, Fannin, Houston, Texas, 6431, 77030, USA
| | - Jesse L Clark
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, UCLA, 911 Broxton Ave, Suite 301, Los Angeles, CA, 90024, USA
| | - Cheríe S Blair
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, UCLA, 911 Broxton Ave, Suite 301, Los Angeles, CA, 90024, USA
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McFall AM, Solomon SS, Lau B, Latkin C, Srikrishnan AK, Anand S, Vasudevan CK, Kumar MS, Lucas GM, H Mehta S. Respondent-driven sampling is more efficient than facility-based strategies at identifying undiagnosed people who inject drugs living with HIV in India. Drug Alcohol Depend 2023; 249:110834. [PMID: 37352733 PMCID: PMC10330670 DOI: 10.1016/j.drugalcdep.2023.110834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION Injection drug use drives HIV epidemics in many low-resource settings, yet many people who inject drugs (PWID) living with HIV are not diagnosed. We assessed the ability of respondent-driven sampling (RDS) - which uses peer network connections - to identify undiagnosed PWID living with HIV compared to a facility-based strategy in India. METHODS In six Indian cities from 2014 to 2017, integrated care centers (ICCs) provided HIV testing. From 2016 to 2017, RDS samples of PWID in these same cities were conducted. Using biometric matching, characteristics associated with identification by RDS only and both RDS and ICC, compared to ICC only were explored. Undiagnosed individuals tested positive and did not report a prior diagnosis. The number needed to recruit (NNR) (average number recruited to find one undiagnosed PWID living with HIV) and the identification rate (average number undiagnosed PWID identified per week) assessed the efficiency of RDS vs. ICCs. RESULTS There were 10,759 ICC clients and 6012 RDS participants; 40% of RDS participants were also ICC clients resulting in 14,397 unduplicated PWID. PWID identified by RDS vs. ICC only were more likely to be male (adjusted odds ratios [aOR] RDS only: 6.8, both: 2.7) and living with HIV but undiagnosed (aOR RDS only: 2.5, both: 1.5). Overall, the RDS NNR was 11 and the ICC NNR was 26. The RDS identification rate (18.6/week) was faster than the ICC identification rate (2.7/week) overall and in all cities. CONCLUSIONS RDS required screening fewer PWID and more rapidly identified undiagnosed PWID living with HIV as compared to ICCs.
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Affiliation(s)
- Allison M McFall
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States.
| | - Sunil S Solomon
- Johns Hopkins University School of Medicine, Infectious Diseases Department, Baltimore, MD, United States
| | - Bryan Lau
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States
| | - Carl Latkin
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society, Baltimore, MD, United States
| | | | - Santhanam Anand
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | | | | | - Gregory M Lucas
- Johns Hopkins University School of Medicine, Infectious Diseases Department, Baltimore, MD, United States
| | - Shruti H Mehta
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States
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McBride M, Cooper SM, Cryer-Coupet Q, Burnett M, Garrett S, Gibson S. Multidimensional social support and parenting among Black fathers: A profile-oriented approach. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:1876-1900. [PMID: 36480656 DOI: 10.1002/jcop.22972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 09/14/2022] [Accepted: 10/29/2022] [Indexed: 06/14/2023]
Abstract
Though studies have examined the role of social support in the lives of Black men, less is known about the role and function of multi-domain social support as they navigate fatherhood. This investigation utilizes a profile-oriented approach to identify patterns of general and parenting-specific social support (i.e., family; peers; community) among a sample of 759 Black American fathers. Additionally, this study examines how identified support profiles are associated with Black fathers' parenting outcomes (i.e., stress, satisfaction, self-efficacy, and involvement). Latent class analyses identified 10 distinct social support profiles among Black fathers. Results also indicated that there was some profile variation in levels parenting outcomes. Findings suggest variation in the availability and utilization of general and parenting support among Black fathers.
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Affiliation(s)
- Margarett McBride
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shauna M Cooper
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Marketa Burnett
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - Shedrick Garrett
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephen Gibson
- Psychology Department, Virginia Commonwealth University, Richmond, Virginia, USA
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Dangerfield DT. A Principal Investigator as a PrEP-Using Peer Change Agent for HIV Prevention among Black Gay and Bisexual Men: An Autoethnography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5309. [PMID: 37047925 PMCID: PMC10093874 DOI: 10.3390/ijerph20075309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
HIV pre-exposure prophylaxis (PrEP) use remains suboptimal among Black gay and bisexual men (GBM). Multilevel factors such as medication costs, intersectional stigma, patient-clinician communication, medical mistrust, side effect concerns, and low perceived HIV risk (PHR) are well-established PrEP initiation barriers for this group. Peer change agents (PCAs) are culturally congruent interventionists who can circumvent multilevel PrEP barriers among Black GBM. I led an intervention as a PrEP-using PCA to improve PHR and PrEP willingness among 69 Black GBM from 2019-2022 and conducted an autoethnography to better understand multilevel barriers and identify the personal/professional challenges of being an in-group HIV interventionist serving Black SMM. Findings provide novel perspectives regarding PrEP barriers, the role of cultural homophily in behavior change interventions, and how interpersonal dynamics can impact staff fatigue, protocol fidelity, and research participation. Recommendations to prepare and support culturally congruent research staff are also provided.
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Affiliation(s)
- Derek T. Dangerfield
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA; ; Tel.: +1-667-355-5188
- Us Helping Us, People Into Living, Inc., Washington, DC 20010, USA
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HIV Testing Strategies, Types of Tests, and Uptake by Men Who have Sex with Men and Transgender Women: A Systematic Review and Meta-analysis. AIDS Behav 2023; 27:678-707. [PMID: 35984608 DOI: 10.1007/s10461-022-03803-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 11/01/2022]
Abstract
This systematic review and meta-analysis investigated the effectiveness of strategies and types of tests on HIV testing uptake by men who have sex with men (MSM) and transgender women (TGW), and in reaching PLWH. Articles published up to July 2020 were identified from major electronic databases and grey literature. Data were extracted and assessed for risk of bias. Estimates were pooled using random-effect meta-analysis while heterogeneity was evaluated by Cochran's Q test and I2. This study is registered with PROSPERO (CRD42020192740). Of 6820 titles, 263 studies (n = 67,288 participants) were included. The testing strategies reported in most studies were community- (71.2%) and facility-based (28.8%). Highest uptake, with facility-based testing, occurred and reached more PLWH while with standard laboratory tests, it occurred with the highest HIV prevalence among MSM. However, urine test showed a highest rate of new HIV infection. Multiple test combinations had the highest uptake and reached more PLWH among TGW. Various testing strategies, considering barriers and regional differences, and different test types, need be considered, to increase uptake among MSM and TGW.
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Distribution of HIV Self-tests by Men Who have Sex with Men (MSM) to Social Network Associates. AIDS Behav 2022; 27:1716-1725. [PMID: 36318431 PMCID: PMC9628448 DOI: 10.1007/s10461-022-03903-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 11/18/2022]
Abstract
Internet-recruited gay, bisexual, and other men who have sex with men (MSM) were offered HIV self-tests (HIVSTs) after completing baseline, 3-, 6-, and 9-month follow-up surveys. The surveys asked about the use and distribution of these HIVSTs. Among 995 who reported on their distribution of HIVSTs, 667 (67.0%) distributed HIVSTs to their social network associates (SNAs), which resulted in 34 newly identified HIV infections among 2301 SNAs (1.5%). The main reasons participants reported not distributing HIVSTs included: wanting to use the HIVSTs themselves (74.9%); thinking that their SNAs would get angry or upset if offered HIVSTs (12.5%); or not knowing that they could give the HIVSTs away (11.3%). Self-testing programs can provide multiple HIVSTs and encourage the distribution of HIVST by MSM to their SNAs to increase awareness of HIV status among persons disproportionately affected by HIV.
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Zhou Y, Lu Y, Ni Y, Wu D, He X, Ong JJ, Tucker JD, Sylvia SY, Jing F, Li X, Huang S, Shen G, Xu C, Xiong Y, Sha Y, Cheng M, Xu J, Jiang H, Dai W, Huang L, Zou F, Wang C, Yang B, Mei W, Tang W. Monetary incentives and peer referral in promoting secondary distribution of HIV self-testing among men who have sex with men in China: A randomized controlled trial. PLoS Med 2022; 19:e1003928. [PMID: 35157727 PMCID: PMC8887971 DOI: 10.1371/journal.pmed.1003928] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 03/01/2022] [Accepted: 01/21/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Digital network-based methods may enhance peer distribution of HIV self-testing (HIVST) kits, but interventions that can optimize this approach are needed. We aimed to assess whether monetary incentives and peer referral could improve a secondary distribution program for HIVST among men who have sex with men (MSM) in China. METHODS AND FINDINGS Between October 21, 2019 and September 14, 2020, a 3-arm randomized controlled, single-blinded trial was conducted online among 309 individuals (defined as index participants) who were assigned male at birth, aged 18 years or older, ever had male-to-male sex, willing to order HIVST kits online, and consented to take surveys online. We randomly assigned index participants into one of the 3 arms: (1) standard secondary distribution (control) group (n = 102); (2) secondary distribution with monetary incentives (SD-M) group (n = 103); and (3) secondary distribution with monetary incentives plus peer referral (SD-M-PR) group (n = 104). Index participants in 3 groups were encouraged to order HIVST kits online and distribute to members within their social networks. Members who received kits directly from index participants or through peer referral links from index MSM were defined as alters. Index participants in the 2 intervention groups could receive a fixed incentive ($3 USD) online for the verified test result uploaded to the digital platform by each unique alter. Index participants in the SD-M-PR group could additionally have a personalized peer referral link for alters to order kits online. Both index participants and alters needed to pay a refundable deposit ($15 USD) for ordering a kit. All index participants were assigned an online 3-month follow-up survey after ordering kits. The primary outcomes were the mean number of alters motivated by index participants in each arm and the mean number of newly tested alters motivated by index participants in each arm. These were assessed using zero-inflated negative binomial regression to determine the group differences in the mean number of alters and the mean number of newly tested alters motivated by index participants. Analyses were performed on an intention-to-treat basis. We also conducted an economic evaluation using microcosting from a health provider perspective with a 3-month time horizon. The mean number of unique tested alters motivated by index participants was 0.57 ± 0.96 (mean ± standard deviation [SD]) in the control group, compared with 0.98 ± 1.38 in the SD-M group (mean difference [MD] = 0.41),and 1.78 ± 2.05 in the SD-M-PR group (MD = 1.21). The mean number of newly tested alters motivated by index participants was 0.16 ± 0.39 (mean ± SD) in the control group, compared with 0.41 ± 0.73 in the SD-M group (MD = 0.25) and 0.57 ± 0.91 in the SD-M-PR group (MD = 0.41), respectively. Results indicated that index participants in intervention arms were more likely to motivate unique tested alters (control versus SD-M: incidence rate ratio [IRR = 2.98, 95% CI = 1.82 to 4.89, p-value < 0.001; control versus SD-M-PR: IRR = 3.26, 95% CI = 2.29 to 4.63, p-value < 0.001) and newly tested alters (control versus SD-M: IRR = 4.22, 95% CI = 1.93 to 9.23, p-value < 0.001; control versus SD-M-PR: IRR = 3.49, 95% CI = 1.92 to 6.37, p-value < 0.001) to conduct HIVST. The proportion of newly tested testers among alters was 28% in the control group, 42% in the SD-M group, and 32% in the SD-M-PR group. A total of 18 testers (3 index participants and 15 alters) tested as HIV positive, and the HIV reactive rates for alters were similar between the 3 groups. The total costs were $19,485.97 for 794 testers, including 450 index participants and 344 alter testers. Overall, the average cost per tester was $24.54, and the average cost per alter tester was $56.65. Monetary incentives alone (SD-M group) were more cost-effective than monetary incentives with peer referral (SD-M-PR group) on average in terms of alters tested and newly tested alters, despite SD-M-PR having larger effects. Compared to the control group, the cost for one more alter tester in the SD-M group was $14.90 and $16.61 in the SD-M-PR group. For newly tested alters, the cost of one more alter in the SD-M group was $24.65 and $49.07 in the SD-M-PR group. No study-related adverse events were reported during the study. Limitations include the digital network approach might neglect individuals who lack internet access. CONCLUSIONS Monetary incentives alone and the combined intervention of monetary incentives and peer referral can promote the secondary distribution of HIVST among MSM. Monetary incentives can also expand HIV testing by encouraging first-time testing through secondary distribution by MSM. This social network-based digital approach can be expanded to other public health research, especially in the era of the Coronavirus Disease 2019 (COVID-19). TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR) ChiCTR1900025433.
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Affiliation(s)
- Yi Zhou
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
- Faculty of Medicine, Macau University of Science and Technology, Macau SAR, China
| | - Ying Lu
- Dermatology Hospital of South Medical University, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Yuxin Ni
- Dermatology Hospital of South Medical University, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Dan Wu
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Xi He
- Zhuhai Xutong Voluntary Services Center, Zhuhai, China
| | - Jason J. Ong
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Joseph D. Tucker
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Sean Y. Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Fengshi Jing
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- School of Data Science, City University of Hong Kong, Hong Kong SAR, China
| | - Xiaofeng Li
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Shanzi Huang
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Guangquan Shen
- Dermatology Hospital of South Medical University, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Chen Xu
- Dermatology Hospital of South Medical University, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Yuan Xiong
- Dermatology Hospital of South Medical University, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Yongjie Sha
- Dermatology Hospital of South Medical University, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Mengyuan Cheng
- Dermatology Hospital of South Medical University, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Junjie Xu
- Peking University Shenzhen Hospital, Shenzhen, China
| | - Hongbo Jiang
- Guangdong Pharmaceutical University, Guangzhou, China
| | - Wencan Dai
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Liqun Huang
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Fei Zou
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Cheng Wang
- Dermatology Hospital of South Medical University, Guangzhou, China
| | - Bin Yang
- Dermatology Hospital of South Medical University, Guangzhou, China
| | - Wenhua Mei
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Weiming Tang
- Dermatology Hospital of South Medical University, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- * E-mail:
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12
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Bien-Gund CH, Shah J, Ho JI, Stephens-Shields A, Shea K, Fishman J, Thirumurthy H, Acri T, Dugosh K, Gross R. The COVID-19 Self-Testing through Rapid Network Distribution (C-STRAND) trial: A randomized controlled trial to increase COVID-19 testing in underserved populations. Contemp Clin Trials 2021; 110:106585. [PMID: 34606989 PMCID: PMC8486581 DOI: 10.1016/j.cct.2021.106585] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/17/2021] [Accepted: 09/27/2021] [Indexed: 12/02/2022]
Abstract
Background Widely available population testing is critical to public health efforts to control the ongoing COVID-19 pandemic. However, COVID-19 testing has been low in underserved communities disproportionately affected by COVID-19. One approach to increase testing rates is through the secondary distribution of self-collection kits, where an individual distributes test kits to contacts in their social network and encourages them to self-collect test specimens. We outline a randomized clinical trial, COVID-19 Self-testing Through Rapid Network Distribution (C-STRAND), and a cohort study of individuals with COVID-19, to determine the impact of a secondary distribution strategy on COVID-19 testing among medically underserved populations. Methods The clinical trial will seek to enroll 1048 adult index participants from federally health qualified centers in Philadelphia, PA seeking COVID-19 testing. Eligible participants will be randomized 1:1 to receive multiple self-collection test kits or multiple referrals for standard clinic-based tests to distribute to contacts within their social network. The primary outcome will be testing among at least two network contacts at 8 weeks. Index participants and network contacts who test positive for COVID-19 from C-STRAND will be eligible to join the COVID-19 Close Contact Self-testing Study (CloseST), assessing the secondary distribution of self-collection test kits among individuals with COVID-19. The primary outcome of this cohort will be the number of close contacts who test positive at 8 weeks. Conclusion Novel strategies to promote COVID-19 testing are necessary, particularly among underserved populations most affected by COVID-19. We will determine the efficacy of a self-testing secondary distribution strategy. The results may inform efforts to increase testing rates during the current pandemic.
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Affiliation(s)
- Cedric H. Bien-Gund
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA,Corresponding author at: Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Silverstein 3 Suite E, 3400 Spruce Street, Philadelphia, PA 19143, USA
| | - Jesal Shah
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Joshua I. Ho
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Alisa Stephens-Shields
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Kathleen Shea
- Public Health Management Corporation, Philadelphia, USA
| | - Jessica Fishman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Harsha Thirumurthy
- Division of Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Trisha Acri
- Courage Medicine Health Center, Philadelphia, USA
| | - Karen Dugosh
- Public Health Management Corporation, Philadelphia, USA
| | - Robert Gross
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA,Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
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13
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Winiker AK, Schneider KE, Dayton L, Latkin CA, Tobin KE. Associations between depressive esymptoms and identity-specific social support among Black men who have sex with men (BMSM) in Baltimore City, Maryland. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2021; 27:175-195. [PMID: 37347093 PMCID: PMC10281699 DOI: 10.1080/19359705.2021.1957741] [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: 08/13/2020] [Revised: 04/18/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
Introduction Depression and other adverse mental health outcomes are prevalent among Black men who have sex with men (BMSM). Social support can be protective against symptoms of depression, the effects of which may be amplified by experiences of a shared social identity. Methods We explored the associations between BMSM-specific social support and depressive symptoms among a sample of 280 BMSM. We used chi-square and t-tests to examine bivariate associations between social support, depressive symptoms, and key correlates, and logistic regression to adjust the relationship between social support and depressive symptoms. Results Most participants reported high (43.2%) or moderate (41.8%) levels of BMSM-specific social support, 38% reported depressive symptoms, and 47.6% were living with HIV. Adjusting for socioeconomic and structural vulnerabilities, health, and involvement in the gay community, high social support was associated with a marginal decrease in the odds of depressive symptoms compared to low social support. Conclusions Results indicate that BMSM-specific social support is protective against depressive symptoms even in the context of other socioeconomic and structural vulnerabilities, suggesting that strengths-based interventions focused on building community and mutual support among BMSM may be valuable tools to prevent depression and promote positive mental health outcomes for members of this population.
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Affiliation(s)
- Abigail K. Winiker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Kristin E. Schneider
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Lauren Dayton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Carl A. Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Karin E. Tobin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
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14
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Network Characteristics Associated with HIV Testing Conversations Among Transgender Women in Los Angeles County, California. AIDS Behav 2021; 25:2336-2347. [PMID: 33609204 DOI: 10.1007/s10461-021-03196-x] [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: 02/09/2021] [Indexed: 10/22/2022]
Abstract
This study examined associations between transgender women's social network characteristics, perceived network member HIV risk/protective behaviors and HIV testing conversations between transgender women and their network members. From July 2015 to September 2016, 264 transgender women who nominated 2529 social network members completed surveys on sociodemographic characteristics, HIV risk/protective behaviors, and egocentric social networks. Mixed-effects logistic regression evaluated discussion of HIV testing with network member characteristics and perceived HIV risk/protective behaviors. HIV testing conversations were positively associated with being named as a trans "mother" (aOR 2.05; 95% CI 1.03-4.06) relationships of longer duration, and the following network member characteristics: perception as a confidant (3.09; 1.89-5.05), discussion of condom use (29.65; 16.75-52.49), knowledge of HIV pre-exposure prophylaxis (4.14; 2.11-8.15), and receipt of HIV testing (22.13; 11.47-42.69). HIV testing conversations were negatively associated with relationships where stimulants were used (aOR 0.32; 95% CI 0.12-0.84). These results indicate the importance of leveraging close relationship networks to increase HIV testing and the potential role for network-based HIV prevention strategies among transgender women.
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15
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Chiou PY, Ko NY, Chien CY. Mobile HIV Testing Through Social Networking Platforms: Comparative Study. J Med Internet Res 2021; 23:e25031. [PMID: 33769298 PMCID: PMC8035663 DOI: 10.2196/25031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/20/2021] [Accepted: 01/31/2021] [Indexed: 11/24/2022] Open
Abstract
Background Improving HIV screening in key populations is a crucial strategy to achieve the goal of eliminating AIDS in 2030. Social networking platforms can be used to recruit high risk-taking men who have sex with men (MSM) to promote the delivery of voluntary counseling and testing (VCT) as mobile HIV testing. Therefore, client recruitment and availability of mobile HIV testing through social networking platforms requires further evaluation. Objective The aim of this study is to compare the effects of targeting high risk-taking MSM and HIV case finding between two mobile HIV testing recruitment approaches: through the traditional website-based approach and through social networking platforms. Methods A comparative study design and propensity score matching was applied. The traditional VCT model, that is, the control group, recruited MSM through a website, and a trained research assistant visited the walk-in testing station at a gay village on Friday and Saturday nights. The social networking VCT model, the experimental group, recruited MSM from social networking platforms by periodically reloading into and conducting web-based discussions on dating apps and Facebook. The participants then referred to others in their social networks via a popular messenger app in Taiwan. The test was conducted at a designated time and place during weekdays by a trained research assistant. Across both modes of contact, before the mobile HIV testing, participants needed to provide demographic characteristics and respond to a questionnaire about HIV risk-taking behaviors. Results We recruited 831 MSM over 6 months, with a completion rate of 8.56% (616/7200) in the traditional VCT model and 20.71% (215/1038) in the social networking VCT model. After propensity score matching, there were 215 MSM in each group (mean age 29.97, SD 7.61 years). The social networking model was more likely to reach MSM with HIV risk-taking behaviors, that is, those seeking sexual activity through social media, having multiple sexual partners and unprotected anal intercourse, having experience of recreational drug use, and never having or not regularly having an HIV test, compared with the traditional model. HIV positive rates (incidence rate ratio 3.40, 95% CI 1.089-10.584; P=.03) and clinic referral rates (incidence rate ratio 0.03, 95% CI 0.001-0.585; P=.006) were significantly higher among those in the social networking VCT model than in the traditional VCT model. Conclusions Through effective recruitment strategies on social networking platforms, the social networking VCT mode can be smoothly promoted, as compared with the traditional VCT model, to target high risk-taking MSM and increase testing outcomes.
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Affiliation(s)
- Piao-Yi Chiou
- Department of Nursing, National Taiwan University Hospital, Taipei City, Taiwan.,School of Nursing, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung, Tainan, Taiwan
| | - Chien-Yu Chien
- School of Nursing, College of Medicine, National Taiwan University, Taipei City, Taiwan
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16
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McFall AM, Lau B, Latkin C, Srikrishnan AK, Anand S, Vasudevan CK, Mehta SH, Solomon SS. Optimizing respondent-driven sampling to find undiagnosed HIV-infected people who inject drugs. AIDS 2021; 35:485-494. [PMID: 33252482 PMCID: PMC7842595 DOI: 10.1097/qad.0000000000002763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE We evaluated whether identification of undiagnosed HIV-infected people who inject drugs (PWID) via respondent-driven sampling (RDS) can be enhanced through a precision RDS (pRDS) approach. DESIGN/METHODS First, using prior RDS data from PWID in India, we built a prediction algorithm for recruiting undiagnosed HIV-infected PWID. pRDS was tested in Morinda, Punjab where participants were randomly assigned to standard or pRDS. In the standard RDS approach, all participants received two recruitment coupons. For pRDS, the algorithm determined an individual's probability of recruiting an undiagnosed PWID, and individuals received either two (low probability) or five (high probability) coupons. Efficiency in identifying undiagnosed HIV-infected PWID for the RDS approaches was evaluated in two ways: the number needed to recruit (NNR) and identification rate/week. RESULTS Predictors of recruiting undiagnosed PWID included HIV/HCV infection, network size, syringe services utilization, and injection environment. 1631 PWID were recruited in Morinda. From the standard RDS approach, 615 were recruited, including 39 undiagnosed; from pRDS, 1012 were recruited, including 77 undiagnosed. In pRDS, those with higher predicted probability were more likely to recruit others with HIV/HCV co-infection, undiagnosed and viremic HIV, and who utilized services. pRDS had a significantly higher identification rate of undiagnosed PWID (1.5/week) compared with the standard (0.8/week). The NNR for pRDS (13.1) was not significantly lower than the standard approach (15.8). CONCLUSION pRDS identified twice as many undiagnosed and viremic PWID significantly faster than the standard approach. Leveraging RDS or similar network-based strategies should be considered alongside other strategies to ensure meeting UNAIDS targets.
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Affiliation(s)
- Allison M McFall
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Mayland, USA
| | - Bryan Lau
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Mayland, USA
| | - Carl Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Mayland, USA
| | | | - Santhanam Anand
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | | | - Shruti H Mehta
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Mayland, USA
| | - Sunil S Solomon
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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17
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Parchem B, Molock SD. Brief report: Identified barriers and proposed solutions for recruiting young Black sexual minority men in HIV-related research. J Adolesc 2021; 87:1-5. [PMID: 33429132 DOI: 10.1016/j.adolescence.2020.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/13/2020] [Accepted: 12/21/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Young Black sexual minority men represent a high priority population for HIV prevention research yet the existing literature is not proportional to the current health disparity observed. The challenge of engaging this intersectional population in research on a stigmatized topic likely contributes to the dearth of literature. METHODS This brief report examines the current recruitment strategies for engaging sexual minority men in HIV-related research and identifies individual and system-level barriers that contribute to the underrepresentation of Black sexual minority men in HIV-related research. Qualitative data is integrated from Project HATCH (Helping African American Teens Combat HIV), an ongoing recruitment effort of 14-21-year-old Black sexual minority men in Washington D.C., United States. RESULTS Identified barriers to recruiting young Black sexual minority men include cultural stigma, mistrust of research institutions, the 'coming out' process for queer youth, assent procedures for youth, and others. CONCLUSIONS We propose several solutions for recruitment including geospatial technology, social media, and community spaces of trust (i.e., churches and schools). Additional larger scale solutions include destigmatizing youths' sexuality and prioritizing the advancement of Black scholars in academia and research endeavors.
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Affiliation(s)
- Benjamin Parchem
- Department of Psychological and Brain Sciences, George Washington University, 2125 G St NW, Washington, DC, 20052, USA.
| | - Sherry Davis Molock
- Department of Psychological and Brain Sciences, George Washington University, 2125 G St NW, Washington, DC, 20052, USA
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18
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Dong ZL, Gao GF, Lyu F. Advances in research of HIV transmission networks. Chin Med J (Engl) 2020; 133:2850-2858. [PMID: 33273335 PMCID: PMC10631577 DOI: 10.1097/cm9.0000000000001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Indexed: 11/26/2022] Open
Abstract
Transmission network analysis is a crucial evaluation tool aiming to explore the characteristics of the human immunodeficiency virus epidemic, develop evidence-based prevention strategies, and contribute to various areas of human immunodeficiency virus/acquired immunodeficiency syndrome prevention and control. Over recent decades, transmission networks have made tremendous strides in terms of modes, methods, applications, and various other aspects. Transmission network methods, including social, sexual, and molecular transmission networks, have played a pivotal role. Each transmission network research method has its advantages, as well as its limitations. In this study, we established a systematic review of these aforementioned transmission networks with respect to their definitions, applications, limitations, recent progress, and synthetic applications.
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Affiliation(s)
- Zhi-Long Dong
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - George Fu Gao
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Fan Lyu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
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19
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Tieu HV, Koblin BA, Latkin C, Curriero FC, Greene ER, Rundle A, Frye V. Neighborhood and Network Characteristics and the HIV Care Continuum among Gay, Bisexual, and Other Men Who Have Sex with Men. J Urban Health 2020; 97:592-608. [PMID: 29845586 PMCID: PMC7560681 DOI: 10.1007/s11524-018-0266-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
In order for treatment as prevention to work as a national strategy to contain the HIV/AIDS epidemic in the United States (US), the HIV care continuum must become more robust, retaining more individuals at each step. The majority of people living with HIV/AIDS (PLWHA) in the US are gay, bisexual, and other men who have sex with men (MSM). Within this population, there are distinct race- and ethnicity-based disparities in rates of HIV infection, engagement, and retention in HIV care, and viral suppression. Compared with White MSM, HIV-infected Black MSM are less likely to be on anti-retroviral therapy (ART), adhere to ART, and achieve viral suppression. Among MSM living in urban areas, falling off the continuum may be influenced by factors beyond the individual level, with new research identifying key roles for network- and neighborhood-level characteristics. To inform multi-level and multi-component interventions, particularly to support Black MSM living in urban areas, a clearer understanding of the pathways of influence among factors at various levels of the social ecology is required. Here, we review and apply the empirical literature and relevant theoretical perspectives to develop a series of potential pathways of influence that may be further evaluated. Results of research based on these pathways may provide insights into the design of interventions, urban planning efforts, and assessments of program implementation, resulting in increased retention in care, ART adherence, and viral suppression among urban-dwelling, HIV-infected MSM.
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Affiliation(s)
- Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Beryl A Koblin
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frank C Curriero
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily R Greene
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Andrew Rundle
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Victoria Frye
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, USA.
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Arrington-Sanders R, Hailey-Fair K, Wirtz A, Cos T, Galai N, Brooks D, Castillo M, Dowshen N, Trexler C, D'Angelo LJ, Kwait J, Beyrer C, Morgan A, Celentano D. Providing Unique Support for Health Study Among Young Black and Latinx Men Who Have Sex With Men and Young Black and Latinx Transgender Women Living in 3 Urban Cities in the United States: Protocol for a Coach-Based Mobile-Enhanced Randomized Control Trial. JMIR Res Protoc 2020; 9:e17269. [PMID: 32935662 PMCID: PMC7527910 DOI: 10.2196/17269] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/05/2020] [Accepted: 06/03/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The US National HIV/AIDS Strategy 2020 calls for increasing access to care, improving outcomes of people living with HIV, and targeting biomedical prevention efforts, including access to pre-exposure prophylaxis (PrEP) in communities where HIV is most heavily concentrated. The cities of Baltimore, Maryland (MD); Washington, DC; and Philadelphia, Pennsylvania (PA) are disproportionately burdened by high rates of new cases of HIV infection, with high prevalence among young Black and Latinx men who have sex with men (YBLMSM) and young Black and Latinx transgender women (YBLTW) aged 15-24 years. OBJECTIVE This study aims (1) to identify and recruit YBLMSM and YBLTW who are at risk or living with HIV in Baltimore, MD; Philadelphia, PA; and Washington, DC, using respondent-driven sampling (RDS) with targeted seed selection, and (2) to assess the efficacy of a coach-based mobile-enhanced intervention (MEI) compared with standard of care (SOC) to increase successful engagement and retention into HIV, PrEP, and substance use treatment care across the HIV care and prevention continua in 3 Mid-Atlantic cities. This paper describes the protocol and progress as of October 20, 2019. METHODS This study uses a multiphase mixed methods design. The first phase is a formative, qualitative research with focus group discussions and key informant interviews. The second phase consists of evaluating the ability of RDS with targeted seed selection. The third phase includes 2 embedded randomized controlled trials (RCTs), where participants complete a baseline sociobehavioral survey, rapid HIV testing, and eligible youth enroll in parallel status-dependent RCTs that randomize the participant to 1 of 2 study arms: MEI with coach or SOC. Participants are asked to complete a web-based survey and provide biologic specimens-HIV-1 RNA (viral load) or HIV-1 antibody test and urine drug screen-at baseline and at 3, 6, and 12 months, and an exit interview at 18 months. RESULTS A formative qualitative research was conducted in February 2017 and May 2018, and this led to further refinement of recruitment and study methods. Aim 1 recruitment began in September 2017 with subsequent enrollment into the RCTs. Recruitment is ongoing with 520 participants screened and 402 (77.3%) enrolled in aim 1 by October 2020. Of these, 159 are enrolled in the 2 randomized trials: 36 (22.6%) HIV-positive not virally suppressed (aim 2) and 123 (77.4%) high-risk HIV-negative (aim 3). CONCLUSIONS This study has the potential to significantly impact the medical and substance use services provided to YBLMSM and YBLTW in the United States by providing rigorous scientific evidence outlining approaches and strategies that improve the uptake and engagement of YBLMSM and YBLTW in the HIV treatment and prevention continuum. TRIAL REGISTRATION ClinicalTrials.gov NCT03194477; https://clinicaltrials.gov/ct2/show/NCT03194477. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/17269.
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Affiliation(s)
- Renata Arrington-Sanders
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Kimberly Hailey-Fair
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Andrea Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Travis Cos
- Public Health Management Corporation Research & Evaluation Group, Philadelphia, PA, United States
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - Durryle Brooks
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Marne Castillo
- The Adolescent Initiative, Children's Hospital of Philadelphia, Philadelphia, MD, United States
| | - Nadia Dowshen
- Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, MD, United States
| | - Constance Trexler
- Adolescent Clinical Research Burgess Clinic, Children's National Medical Center, Washington, DC, United States
| | - Lawrence J D'Angelo
- Adolescent Clinical Research Burgess Clinic, Children's National Medical Center, Washington, DC, United States
| | - Jennafer Kwait
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Chris Beyrer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Anthony Morgan
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - David Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,The Adolescent Initiative, Children's Hospital of Philadelphia, Philadelphia, MD, United States.,Adolescent Clinical Research Burgess Clinic, Children's National Medical Center, Washington, DC, United States
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21
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Op de Coul E, den Daas C, Spijker R, Heijman T, de Vos M, Götz H, Vermey K, Zuilhof W, Van den Boogaard J, Davidovich U, Zuure F. Web-Supported Social Network Testing for HIV Among Men Who Have Sex With Men With a Migration Background: Protocol for a Mixed Methods Pilot Study. JMIR Res Protoc 2020; 9:e14743. [PMID: 32039817 PMCID: PMC7055807 DOI: 10.2196/14743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/24/2019] [Accepted: 08/30/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Of newly diagnosed HIV positive men who have sex with men (MSM) in the Netherlands, 29% have a non-Western migration background (MSM-NW). Among MSM-NW, HIV positivity rates are high (0.8%-2.0%), as is the proportion of late stage infections (39%). Factors such as HIV and sexual orientation-related stigma may form barriers for timely testing. Innovative approaches for HIV testing are needed to better reach MSM-NW. Social network testing (SNT) for HIV is an evidence-supported approach where peer recruiters identify persons (network associates) who could benefit from testing in their social or sexual networks. Web-supported SNT might be particularly promising for reaching people who may not be reached by regular care. OBJECTIVE The purpose of this paper is to describe the design of our pilot PREVENT (Peer-Empowered Voluntary Extended Network Testing). In this pilot, we will explore whether SNT using HIV self-tests is feasible and acceptable among MSM-NW in the Netherlands and whether it reaches those who were never or not recently tested for HIV (>1 year ago). METHODS The project aims to include 50 to 60 MSM and MSM-NW peers who will distribute 4 to 5 oral HIV self-tests each aiming to reach 200 network associates (NAs). Enrollment of peers includes 4 steps: (1) fostering interest in becoming a peer by health care professionals at sexual health clinics, HIV treatment clinics, and community settings; (2) sending peer contact information to the peer coordinator; (3) registering peers and giving program instructions by the peer coordinator and referring to the Web-based training at time2test; and (4) receiving precoded HIV self-tests for distribution in the peers' networks. NAs who receive the self-test will log in with their test package code in the time2test application for step-by-step test instructions. After testing is complete, NAs receive tailored follow-up information depending on their test result. RESULTS Between January and May 2019, 10 STI clinics and 7 HIV treatment clinics started recruiting peers. Results of the PREVENT pilot are expected in December 2020. CONCLUSIONS This is the first Web-supported peer-driven SNT pilot using HIV self-tests in the Netherlands and one of the first in Europe. Implementation is considered successful if it reaches MSM-NW who were never or not recently tested for HIV. Additionally, it may encourage conversations within the networks about risk behavior and barriers to HIV testing, potentially contributing to the Joint United Nations Programme on HIV/AIDS goal of zero HIV infections. TRIAL REGISTRATION Netherlands Trial Registry NL7424; https://www.trialregister.nl/trial/7424. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/14743.
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Affiliation(s)
- Eline Op de Coul
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Chantal den Daas
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands.,Interdisciplinary Social Science, Utrecht University, Utrecht, Netherlands
| | - Ralph Spijker
- Aidsfonds-Soa Aids Nederland, Amsterdam, Netherlands
| | - Titia Heijman
- Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Marvin de Vos
- Aidsfonds-Soa Aids Nederland, Amsterdam, Netherlands
| | - Hannelore Götz
- Public Health Service Rotterdam-Rijnmond, Rotterdam, Netherlands
| | | | - Wim Zuilhof
- Aidsfonds-Soa Aids Nederland, Amsterdam, Netherlands
| | - Jossy Van den Boogaard
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Udi Davidovich
- Public Health Service of Amsterdam, Amsterdam, Netherlands.,Department of Social Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Freke Zuure
- Public Health Service of Amsterdam, Amsterdam, Netherlands
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- Please see Authors' Contribution section for more information,
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22
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Barnes SL, Hollingsworth C. Spirituality and Social Media: The Search for Support Among Black Men Who Have Sex With Men in Tennessee. JOURNAL OF HOMOSEXUALITY 2020; 67:79-103. [PMID: 30307800 DOI: 10.1080/00918369.2018.1525945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Young Black Men Who Have Sex With Men (BMSM) have been the subject of much research focused on health disparities in HIV occurrence, stigma, and mental health. Although such research is important, fewer studies focus on other equally salient areas of their lives such as spirituality, religious practices, and social support. Informed by literature on social support, this research endeavors to better understand these dynamics for a group of young BMSM who reside in a metropolitan city in Tennessee. Focus group results and content analysis uncover themes related to religion and resilience; queering Christianity; and virtual spirituality. Participants expressed an overarching need for support, safe spaces, genuine relationships, and godly instruction, conveyed through traditional Black Church involvement and nontraditional Internet usage. Findings are important for strategic, proactive, cross-generational collaboration with young BMSM to holistically meet their varied needs.
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Affiliation(s)
- Sandra L Barnes
- Department of Human and Organizational Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Charrise Hollingsworth
- Department of Human and Organizational Development, Vanderbilt University, Nashville, Tennessee, USA
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23
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Dangerfield Ii DT, Harawa NT, McWells C, Hilliard C, Bluthenthal RN. Exploring the preferences of a culturally congruent, peer-based HIV prevention intervention for black men who have sex with men. Sex Health 2019; 15:424-430. [PMID: 30185352 DOI: 10.1071/sh18057] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/31/2018] [Indexed: 11/23/2022]
Abstract
Background HIV testing, treatment initiation and treatment adherence have been emphasised for Black men who have sex with men (BMSM). However, many BMSM do not get tested, obtain HIV treatment or adhere to treatment. It is essential to highlight barriers to HIV testing, treatment adherence and the ideal components for an intervention: peer mentors, socioeconomic resources and participant incentives. METHODS Five focus groups (n=24) were conducted among HIV-negative and HIV-positive BMSM aged ≥18 years in Los Angeles, California, USA to explore motivations and barriers to testing and treatment and the components of an ideal, culturally competent HIV testing intervention for BMSM. RESULTS Barriers to HIV testing included fear and stigma associated with discovering a HIV-positive status and drug use. Motivations for testing included experiencing symptoms, beginning new relationships, perceptions of risk and peer mentors. CONCLUSIONS Future HIV prevention and treatment efforts should consider these components to improve health outcomes among BMSM.
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Affiliation(s)
- Derek T Dangerfield Ii
- The REACH Initiative, Johns Hopkins School of Nursing, 525N. Wolfe St, Baltimore, MD 21205, USA
| | - Nina T Harawa
- David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| | - Charles McWells
- Los Angeles Centers for Alcohol and Drug Abuse, 470 E. 3rd St, Los Angeles, CA 90013, USA
| | - Charles Hilliard
- Charles R. Drew University School of Medicine & Science, 1731 E. 120th St, Los Angeles, CA 90059, USA
| | - Ricky N Bluthenthal
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001N. Soto St, Los Angeles, CA 90005, USA
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24
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Using a Social Network Strategy to Distribute HIV Self-Test Kits to African American and Latino MSM. J Acquir Immune Defic Syndr 2019; 79:38-45. [PMID: 29771792 DOI: 10.1097/qai.0000000000001726] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) continue to be disproportionately impacted globally by the HIV epidemic. Studies suggest that HIV self-testing (HIVST) is highly acceptable among MSM. Social network strategies to increase testing are effective in reaching MSM, particularly MSM of color, who may not otherwise test. We tested a social network-based strategy to distribute HIVST kits to African American MSM (AAMSM) and Latino MSM (LMSM). SETTING This study was conducted in Alameda County, California, a large, urban/suburban county with an HIV epidemic mirroring the national HIV epidemic. METHODS From January 2016 to March 2017, 30 AAMSM, LMSM, and transgender women were trained as peer recruiters and asked to distribute 5 self-test kits to MSM social network members and support those who test positive in linking to care. Testers completed an online survey after their test. We compared peer-distributed HIVST testing outcomes to outcomes from Alameda County's targeted, community-based HIV testing programs using χ tests. RESULTS Peer-distributed HIVST to 143 social and sexual network members, of whom 110 completed the online survey. Compared with MSM who used the County's sponsored testing programs, individuals reached through the peer-based self-testing strategy were significantly more likely to have never tested for HIV (3.51% vs. 0.41%, P < 0.01) and to report a positive test result (6.14% vs. 1.49%, P < 0.01). CONCLUSION Findings suggest that a network-based strategy for self-test distribution is a promising intervention to increase testing uptake and reduce undiagnosed infections among AAMSM and LMSM.
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25
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den Daas C, Geerken MBR, Bal M, de Wit J, Spijker R, Op de Coul ELM. Reducing health disparities: key factors for successful implementation of social network testing with HIV self-tests among men who have sex with men with a non-western migration background in the Netherlands. AIDS Care 2019; 32:50-56. [PMID: 31416354 DOI: 10.1080/09540121.2019.1653440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Improving testing uptake among men who have sex with men with a non-western migration background (MSM-NW) is a public health priority, as people who are unaware of their HIV infection are at higher risk of transmitting HIV and are unable to benefit from HIV treatment. Formative semi-structured interviews with 13 MSM-NW assessed key factors for the successful implementation of social network testing with HIV self-tests (SNT-HIVST). Interviews were thematically analysed. Participants mentioned that SNT-HIVST might overcome barriers to regular HIV testing including; being seen while testing, disclosure of sexual identity, and stigma related to HIV and sexual practices. Trust between the HIVST distributer and receiver was important. Finally, SNT-HIVST requires tailored peer support to address practical, informational, and emotional needs. MSM-NW distributing HIVST can have an important role in reducing health disparities in testing uptake among MSM-NW. Provided sufficient trust among MSM-NW; key factors found for successful implementation were education through an e-tool, and establishing quality support by a peer-coordinator for unanticipated questions. In conclusion, HIVST distribution has the potential to reduce health disparities in testing uptake, in particular, if adjusted to MSM-NWs individual preferences and the needs and preferences of the person they are inviting to test.
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Affiliation(s)
- C den Daas
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.,Interdisciplinary Social Science, Utrecht University, Utrecht, Netherlands
| | - M B R Geerken
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.,STI AIDS Netherlands, Amsterdam, Netherlands
| | - M Bal
- Interdisciplinary Social Science, Utrecht University, Utrecht, Netherlands
| | - J de Wit
- Interdisciplinary Social Science, Utrecht University, Utrecht, Netherlands
| | - R Spijker
- STI AIDS Netherlands, Amsterdam, Netherlands
| | - E L M Op de Coul
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
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26
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D’Angelo AB, Lopez-Rios J, Flynn AWP, Pantalone DW, Holloway IW, Grov C. What motivates gay and bisexual men to participate in PrEP-related research? INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2019; 31:283-290. [PMID: 32864033 PMCID: PMC7454037 DOI: 10.1080/19317611.2019.1634173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/24/2019] [Accepted: 06/16/2019] [Indexed: 06/01/2023]
Abstract
Pre-Exposure Prophylaxis (PrEP) has been demonstrated effective at preventing HIV among key populations like gay and bisexual men (GBM). Yet, there remains a continued need to engage GBM in PrEP behavioral and clinical research (e.g., to monitor adherence and retention in the PrEP treatment cascade). We report on the factors motivating GBM to participate in a PrEP behavioral study, with the aim of our results to inform future recruitment efforts for future PrEP research. In 2015-2016, 103 PrEP-using GBM in NYC completed qualitative interviews about their experiences on PrEP. Participants were also asked about factors that motivated them to join the study. Thematic analysis was used analyze the data. We identified five salient themes as rationale for joining the study: 58.3% cited altruistic reasons, 32% reported intellectual curiosity in the subject matter, 30.1% indicated that remuneration inspired them, 18.4% indicated that familiarity or referral to the research institute influenced their decision. Researchers attempting to enroll PrEP-using GBM may benefit from attending to the altruistic and intellectually curious nature of this population. Further, researchers may benefit from establishing familiarity among diverse communities of GBM. This in turn may contribute to the successful engagement of GBM for PrEP research.
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Affiliation(s)
- Alexa B. D’Angelo
- CUNY Graduate School of Public Health and Health Policy, New York, NY
- CUNY Institute for Implementation Science in Population Health, New York, NY
| | - Javier Lopez-Rios
- CUNY Graduate School of Public Health and Health Policy, New York, NY
| | | | - David W. Pantalone
- University of Massachusetts Boston, Boston, MA
- The Fenway Institute, Fenway Health, Boston, MA
| | | | - Christian Grov
- CUNY Graduate School of Public Health and Health Policy, New York, NY
- CUNY Institute for Implementation Science in Population Health, New York, NY
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27
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Lillie TA, Persaud NE, DiCarlo MC, Gashobotse D, Kamali DR, Cheron M, Nishimoto L, Akolo C, Mahler HR, Au MC, Wolf RC. Reaching the unreached: Performance of an enhanced peer outreach approach to identify new HIV cases among female sex workers and men who have sex with men in HIV programs in West and Central Africa. PLoS One 2019; 14:e0213743. [PMID: 30943205 PMCID: PMC6447144 DOI: 10.1371/journal.pone.0213743] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 02/27/2019] [Indexed: 12/14/2022] Open
Abstract
Finding new HIV-positive cases remains a priority to achieve the UNAIDS goals. An enhanced peer outreach approach (EPOA) was implemented to expand the delivery of HIV services to female sex workers (FSWs) and men who have sex with men (MSM) in three countries in West and Central Africa. The aim of EPOA is to identify new HIV-positive cases. EPOA was implemented in Burundi among FSWs, and in Cote d'Ivoire and Democratic Republic of the Congo (DRC) among both FSWs and MSM. Implementation ranged from five to nine weeks and was nested within a three-month reporting period. Standard outreach was suspended for the duration of EPOA implementation but was resumed thereafter. Summary service statistics were used to compare HIV seropositivity during standard outreach and EPOA. Trends were analyzed during the quarter in which EPOA was implemented, and these were compared with the two preceding quarters. Differences in proportions of HIV seropositivity were tested using Pearson's chi-square test; p-values of less than 0.05 were considered statistically significant. Overall, EPOA resulted in a higher proportion of new HIV-positive cases being found, both within and between quarters. In Burundi, HIV seropositivity among FSWs was significantly higher during EPOA than during standard outreach (10.8% vs. 4.1%, p<0.001). In Cote d'Ivoire, HIV seropositivity was significantly higher during EPOA among both populations (FSWs: 5.6% vs. 1.81%, p<0.01; MSM: 15.4% vs. 5.9%; p<0.01). In DRC, HIV seropositivity was significantly higher during EPOA among MSM (6.9% vs. 1.6%; p<0.001), but not among FSWs (5.2% vs. 4.3%; p = 0.08). Trends in HIV seropositivity during routine outreach for both populations were constant during three successive quarters but increased with the introduction of EPOA. EPOA is a public health approach with great potential for reaching new populations and ensuring that they are aware of their HIV status.
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Affiliation(s)
| | | | | | | | | | - Magda Cheron
- FHI 360/LINKAGES, Kinshasa, Democratic Republic of Congo
| | | | | | | | - Maria C. Au
- U.S. Agency for International Development (USAID), Washington, DC, United States of America
| | - R. Cameron Wolf
- U.S. Agency for International Development (USAID), Washington, DC, United States of America
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28
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Liu A, Coleman K, Bojan K, Serrano PA, Oyedele T, Garcia A, Enriquez-Bruce E, Emmanuel P, Jones J, Sullivan P, Hightow-Weidman L, Buchbinder S, Scott H. Developing a Mobile App (LYNX) to Support Linkage to HIV/Sexually Transmitted Infection Testing and Pre-Exposure Prophylaxis for Young Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e10659. [PMID: 30681964 PMCID: PMC6367663 DOI: 10.2196/10659] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 07/08/2018] [Accepted: 09/13/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Young men who have sex with men (YMSM) in the United States have among the highest incidence of HIV and sexually transmitted infection (STI) and the lowest uptake of HIV and STI testing and pre-exposure prophylaxis (PrEP). Nearly universal mobile phone ownership among youth provides an opportunity to leverage mobile health apps to increase HIV/STI testing and PrEP uptake among YMSM. OBJECTIVE The goals of this project are to develop and refine LYNX, a novel mobile app to support linkage to HIV/STIs testing and PrEP services among YMSM in the United States, and to evaluate the acceptability and feasibility of LYNX in a pilot randomized controlled trial (RCT). METHODS This research protocol will be conducted in 3 phases: an iterative development phase with a series of 3 focus groups among 20 YMSM to refine the LYNX app; an open technical pilot among 15 YMSM to optimize usability of the app; and then a 6-month pilot RCT among 60 HIV-uninfected YMSM at risk for HIV acquisition. Developed using the Information, Motivation, and Behavioral skills theoretical model, the LYNX app includes an electronic diary to track sexual behaviors (information), a personalized risk score to promote accurate risk perception (information/motivation), testing reminders (motivation/behavioral skills), and access to home-based HIV/STI testing options and geospatial-based HIV/STI testing care sites (behavioral skills). Feasibility and acceptability will be assessed through app analytics of usage patterns and acceptability scales administered via computer-assisted self-interview at 3 and 6 months. We will also evaluate preliminary efficacy by comparing the proportion of YMSM who test at least once during the 6-month pilot and the proportion who successfully link to a PrEP provider in the intervention versus control groups. RESULTS Formative work is currently underway. The LYNX pilot RCT will begin enrollment in October 2018, with study results available in 2019. CONCLUSIONS The LYNX app is one of the first mobile apps designed to increase HIV/STI testing and PrEP uptake among YMSM. As low-perceived risk is a barrier to HIV/STI testing and PrEP use among youth, the personalized risk assessment and interactive sexual diary in LYNX could assist YMSM in better understanding their HIV risk and providing motivation to test for HIV/STIs and initiate PrEP. Coupled with community-based recruitment, this novel mobile app has great potential to reach and engage YMSM not currently involved in care and increase rates of HIV/STI testing and PrEP uptake in this vulnerable population. TRIAL REGISTRATION ClinicalTrials.gov NCT03177512; https://clinicaltrials.gov/ct2/show/NCT03177512 (Archived by WebCite at http://www.webcitation.org/73c917wAw). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/10659.
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Affiliation(s)
- Albert Liu
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, United States.,Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Kenneth Coleman
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Kelly Bojan
- John H Stroger Jr Hospital, Chicago, IL, United States.,The Ruth M Rothstein CORE Center, Chicago, IL, United States
| | - Pedro Alonso Serrano
- John H Stroger Jr Hospital, Chicago, IL, United States.,The Ruth M Rothstein CORE Center, Chicago, IL, United States
| | - Temitope Oyedele
- John H Stroger Jr Hospital, Chicago, IL, United States.,The Ruth M Rothstein CORE Center, Chicago, IL, United States
| | - Amayvis Garcia
- Department of Pediatrics, University of South Florida, Tampa, Tampa, FL, United States
| | | | - Patricia Emmanuel
- Department of Pediatrics, University of South Florida, Tampa, Tampa, FL, United States
| | - Jeb Jones
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Lisa Hightow-Weidman
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Susan Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, United States.,Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Hyman Scott
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, United States.,Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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29
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Ezell JM, Ferreira MJ, Duncan DT, Schneider JA. The Social and Sexual Networks of Black Transgender Women and Black Men Who Have Sex with Men: Results from a Representative Sample. Transgend Health 2018; 3:201-209. [PMID: 30581993 PMCID: PMC6301432 DOI: 10.1089/trgh.2018.0039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Little research has evaluated the social and sexual network-related health outcomes of young black transgender women (TGW) or compared these outcomes with those of black men who have sex with men (MSM). Social network analysis offers one potent means of understanding the dynamics driving the broad spectrum of adverse outcomes experienced by these subgroups. Methods: We examined the social and sexual health network traits of 618 black individuals assigned male at birth who have sex with men, 47 (7.6%) of whom identified as TGW. Using respondent-driven sampling, data collection occurred over three waves between 2013 and 2016, in Chicago, Illinois. Univariate, logistic regression, and confidant and sexual network analyses were conducted to characterize dynamic network features. Results: TGW's mean age was 22.1 (standard deviation ±2.6). TGW's sexual networks were significantly less stable (stability ratio of 0.175 vs. 0.278 among MSM, p=0.03) and had greater network turnover (turnover ratio of 0.825 vs. 0.735, p=0.04). TGW also had significantly more sex partners (7.6 vs. 4.0, p=0.0002) and exchange sex (odds ratio=2.97; 95% confidence interval: 1.66–5.32, p<0.001), lower rates of employment (39.6% vs. 71.1%, p<0.001), and more reported an income <$20,000 (93.5% vs. 80.8%, p=0.029). Within confidant networks, TGW had a borderline significantly higher network turnover ratio (0.703 vs. 0.625, p=0.06). Furthermore, both TGW and MSM had high, but similar, HIV rates (42.3% vs. 30.6%, respectively; p=0.17). There were no significant structural network differences vis-à-vis mean degree (p=0.46), betweenness centrality (p=0.40), closeness centrality (p=0.18), or average shortest path length (borderline statistically significant at p=0.06). Conclusion: Using data from a representative sample of younger black individuals, we observed black TGW have less sexual network stability in contrast to black MSM but comparable structural network features. We further observed that both groups, and black TGW especially, possess considerable system-level, socioeconomic, and sexual health burdens.
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Affiliation(s)
- Jerel M Ezell
- Section of Infectious Diseases and Global Health, University of Chicago Medical Center, Chicago, Illinois.,Department of Sociology, University of Chicago, Chicago, Illinois
| | - Matthew J Ferreira
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois
| | - Dustin T Duncan
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, New York
| | - John A Schneider
- Section of Infectious Diseases and Global Health, University of Chicago Medical Center, Chicago, Illinois.,Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois.,Department of Public Health Sciences, University of Chicago, Chicago, IL
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Ramadhani HO, Ndembi N, Nowak RG, Ononaku U, Gwamna J, Orazulike I, Adebajo S, Crowell TA, Liu H, Baral SD, Ake J, Charurat ME. Individual and Network Factors Associated With HIV Care Continuum Outcomes Among Nigerian MSM Accessing Health Care Services. J Acquir Immune Defic Syndr 2018; 79:e7-e16. [PMID: 29781881 PMCID: PMC6092228 DOI: 10.1097/qai.0000000000001756] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND SETTING Because data on the determinants of the HIV care continuum from key populations such as men who have sex with men (MSM) in resource-limited settings are limited, the study aimed to characterize HIV care continuum outcomes and assess individual and network barriers to progression through the HIV care continuum among MSM in Abuja and Lagos, Nigeria. METHODS TRUST/RV368 study used respondent-driven sampling to accrue MSM into community-based clinics in Nigeria. Participants received HIV testing at enrollment. HIV-infected participants were offered antiretroviral therapy (ART) with HIV RNA testing every 3 months (Abuja) or 6 months (Lagos). Multiple logistic regression models were used to calculate adjusted odds ratios for factors associated with each point in the HIV care continuum, including HIV testing, ART initiation, and 6-month viral suppression. RESULTS A total of 1506 MSM were recruited, 1178 (78.2%) tested for HIV and 369 (31.3%) were HIV positive newly diagnosed. Of these, 188 (50.1%) initiated ART, 136 (72.3%) completed 6 months, and 96 (70.6%) were virally suppressed. Larger network size and stronger social network support were each positively associated with HIV testing uptake. Factors associated with ART initiation were higher education and stronger social network support. Having stronger social network support was associated with increased odds of viral suppression at 6 months. CONCLUSIONS Social determinants of health potentiated increased HIV care continuum outcomes. Integration of HIV prevention, HIV counseling and testing services, and universal coverage of ART into a community-based clinic is critical in achieving better HIV care continuum outcomes.
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Affiliation(s)
- Habib O Ramadhani
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD
| | - Nicaise Ndembi
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD
- Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Rebecca G Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD
| | - Uchenna Ononaku
- Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Jerry Gwamna
- U.S. Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
| | - Ifeanyi Orazulike
- International Center for Advocacy and Rights to Health, Abuja, Federal Capital Territory, Nigeria
| | - Sylvia Adebajo
- Population Council, Abuja, Federal Capital Territory, Nigeria
| | - Trevor A Crowell
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Hongjie Liu
- University of Maryland School of Public Health, College Park, MD
| | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Julie Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Man E Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD
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31
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Santos GM, Rowe C, Hern J, Walker JE, Ali A, Ornelaz M, Prescott M, Coffin P, McFarland W, Raymond HF. Prevalence and correlates of hazardous alcohol consumption and binge drinking among men who have sex with men (MSM) in San Francisco. PLoS One 2018; 13:e0202170. [PMID: 30118495 PMCID: PMC6097698 DOI: 10.1371/journal.pone.0202170] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 07/30/2018] [Indexed: 01/19/2023] Open
Abstract
Objectives To describe heavy alcohol use patterns and correlates in a diverse sample of MSM. Methods We used respondent-driven sampling (RDS) to enroll 252 alcohol-using MSM in San Francisco from March 2015-July 2017. We examined heavy alcohol use patterns and conducted RDS-adjusted multivariable analyses to characterize correlates of hazardous alcohol consumption and binge drinking. Results RDS-adjusted prevalence of weekly and at least weekly binge drinking was 24.9% and 19.3%, respectively. Hazardous consumption was common; prevalence of mid- and high-levels of hazardous drinking was 11.4% and 29.9%, respectively. In multivariable analyses, identifying as Hispanic/Latino or mixed/other race; being moderately or extremely interested in reducing alcohol use; ever receiving alcohol treatment; using ecstasy; reporting syphilis diagnosis; and having more than 5 male partners were independently associated with hazardous alcohol consumption. Less hazardous consumption was associated with having a bachelor's degree or completing post-graduate studies; and not being in a relationship. Reporting chlamydia infection; being somewhat, moderately or extremely interested in reducing alcohol use; and having multiple male sex partners were associated with higher odds of at least weekly binge drinking. Lower odds of binge drinking were associated with completing post-graduate studies. Moreover, for the outcomes of hazardous alcohol consumption and binge-drinking, we observed significant interaction effects between race/ethnicity and interest in reducing alcohol, past receipt of alcohol treatment, use of ecstasy, syphilis diagnosis, and number of male partners. Conclusion Among alcohol-using MSM in San Francisco, heavy drinking patterns were common and independently associated with greater number of male sexual partners and sexually transmitted infections (STI). Moreover, significant racial/ethnic and socioeconomic disparities related to heavy alcohol use were observed and race/ethnicity modified the effect of the risk factors associated with these outcomes. These findings underscore the need to develop more MSM-specific interventions that jointly address heavy alcohol use and HIV/STI risk, as well as culturally-tailored and targeted strategies to alleviate health disparities.
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Affiliation(s)
- Glenn-Milo Santos
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Christopher Rowe
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
- School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Jaclyn Hern
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - John E. Walker
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Arsheen Ali
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Marcial Ornelaz
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Maximo Prescott
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
- School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Phillip Coffin
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
- Division of HIV, ID & Global Medicine, University of California, San Francisco, California, United States of America
| | - Willi McFarland
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - H. Fisher Raymond
- Department of Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, United States of America
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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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Franks J, Mannheimer SB, Hirsch‐Moverman Y, Hayes‐Larson E, Colson PW, Ortega H, El‐Sadr WM. Multiple strategies to identify HIV-positive black men who have sex with men and transgender women in New York City: a cross-sectional analysis of recruitment results. J Int AIDS Soc 2018; 21:e25091. [PMID: 29537178 PMCID: PMC5850046 DOI: 10.1002/jia2.25091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 02/09/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Black men who have sex with men and transgender women are at high risk for HIV infection, but are more likely to be unaware of their infection or not in care for diagnosed HIV compared to other races. Respondent driven sampling has been advanced as a method to reach stigmatized and hidden populations for HIV testing. We compared strategies to recruit black, substance-using men who have sex with men and transgender women to identify newly diagnosed HIV infection, or those previously diagnosed but not in care. METHODS The STAR (Seek, Test, and Retain) study (ClinicalTrials.gov NCT01790360) used several recruitment strategies to identify black, substance-using men who have sex with men and transgender women with undiagnosed HIV infection or with previously diagnosed HIV infection but who were not in HIV care. Respondent-driven sampling, community-based recruitment and online advertising were used to recruit participants. Incentivized peer referral was integrated into all recruitment strategies. Participants completed interviewer-administered questionnaires and HIV testing. Demographic and HIV risk-related characteristics and recruitment strategy were summarized and stratified by HIV status. Associations were tested using Pearson's chi-squared, Fisher's exact, and Wilcoxon rank sum tests. Factors associated with HIV-positive diagnosis at p < 0.1 were included in a multivariable logistic regression model. RESULTS From July 2012 through October 2015, the study enrolled 1929 participants; 96.3% men who have sex with men and 3.7% transgender women. Behavioural risk factors included recent condomless anal sex (55.6%) and recent substance use during sex (73.1%). HIV prevalence was 8.7%. In multivariable analysis, significant associations with HIV infection included being transgender; non-Hispanic black; gay/homosexual orientation; not homeless; and less likely to have insufficient income for necessities. Among recruitment strategies, respondent driven sampling was least effective in identifying HIV-positive participants. CONCLUSIONS Integrating multiple recruitment strategies yielded a large sample of black men who have sex with men and transgender women at substantial risk for HIV. Respondent-driven sampling was less effective than other strategies at identifying men who have sex with men and transgender women with HIV.
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Affiliation(s)
- Julie Franks
- Harlem Prevention CenterICAP at Columbia UniversityNew YorkNYUSA
| | - Sharon B Mannheimer
- Harlem Prevention CenterICAP at Columbia UniversityNew YorkNYUSA
- Harlem Hospital CenterNew YorkNYUSA
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkNYUSA
| | - Yael Hirsch‐Moverman
- Harlem Prevention CenterICAP at Columbia UniversityNew YorkNYUSA
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkNYUSA
| | - Eleanor Hayes‐Larson
- Harlem Prevention CenterICAP at Columbia UniversityNew YorkNYUSA
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkNYUSA
| | - Paul W Colson
- Harlem Prevention CenterICAP at Columbia UniversityNew YorkNYUSA
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkNYUSA
| | - Hugo Ortega
- Harlem Prevention CenterICAP at Columbia UniversityNew YorkNYUSA
| | - Wafaa M El‐Sadr
- Harlem Prevention CenterICAP at Columbia UniversityNew YorkNYUSA
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkNYUSA
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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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Iribarren SJ, Ghazzawi A, Sheinfil AZ, Frasca T, Brown W, Lopez-Rios J, Rael CT, Balán IC, Crespo R, Dolezal C, Giguere R, Carballo-Diéguez A. Mixed-Method Evaluation of Social Media-Based Tools and Traditional Strategies to Recruit High-Risk and Hard-to-Reach Populations into an HIV Prevention Intervention Study. AIDS Behav 2018; 22:347-357. [PMID: 29124420 DOI: 10.1007/s10461-017-1956-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Men who have sex with men and transgender women are hard-to-reach populations for research. Social media-based tools may overcome certain barriers in accessing these groups and are being tested in an ongoing study exploring HIV home-test kit use to reduce risk behavior. We analyzed pre-screening responses about how volunteers learned about the study (n = 896) and demographic data from eligible participants who came for an initial study visit (n = 216) to determine the strengths and weaknesses of recruitment strategies. Social media-based strategies resulted in the highest number of individuals screened (n = 444, 26% eligible). Dating sites/apps reached large numbers of eligible participants. White-Hispanics and African-Americans were more likely to be recruited through personal contacts; community events successfully reached Hispanic volunteers. Incorporating recruitment queries into pre-screening forms can help modify recruitment strategies for greater efficacy and efficiency. Findings suggest that recruitment strategies need to be tailored to reach specific target populations.
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Affiliation(s)
- Sarah J Iribarren
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA.
| | - Alhasan Ghazzawi
- New York State Psychiatric Institute and Columbia University, Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York, NY, USA
| | - Alan Z Sheinfil
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Timothy Frasca
- New York State Psychiatric Institute and Columbia University, Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York, NY, USA
| | - William Brown
- New York State Psychiatric Institute and Columbia University, Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York, NY, USA
- University of California San Francisco, Department of Medicine, Division of Prevention Science, Center for AIDS Prevention Studies, San Francisco, CA, USA
- UCSF Center for Vulnerable Populations, Health Communications Research Program, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
- University of California San Francisco, Institute for Computational Health Sciences, San Francisco, CA, USA
| | - Javier Lopez-Rios
- New York State Psychiatric Institute and Columbia University, Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York, NY, USA
- CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Christine T Rael
- New York State Psychiatric Institute and Columbia University, Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York, NY, USA
| | - Iván C Balán
- New York State Psychiatric Institute and Columbia University, Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York, NY, USA
| | - Raynier Crespo
- New York State Psychiatric Institute and Columbia University, Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York, NY, USA
| | - Curtis Dolezal
- New York State Psychiatric Institute and Columbia University, Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York, NY, USA
| | - Rebecca Giguere
- New York State Psychiatric Institute and Columbia University, Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York, NY, USA
| | - Alex Carballo-Diéguez
- New York State Psychiatric Institute and Columbia University, Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York, NY, USA
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The Where and How for Reaching Transgender Women and Men Who Have Sex with Men with HIV Prevention Services in Guatemala. AIDS Behav 2017; 21:3279-3286. [PMID: 28008544 DOI: 10.1007/s10461-016-1655-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study aims to describe the transgender women and men who have sex with men (MSM) missed through venue-based sampling and illustrate how data on venues can be used to prioritize service delivery. Respondent-driven sampling (RDS) and time-location sampling (TLS) were used concurrently in 2010 for behavioral surveillance among MSM and transgender women in Guatemala City. RDS recruits who did not frequent venues (n = 106) were compared to TLS recruits (n = 609). TLS participants recruited at different types of venues were compared. RDS recruits who did not frequent venues were less educated, less likely to identify as gay, more likely to have concurrent partners and female sexual partners. Participants recruited at NGOs, saunas, hotels, streets and parks had more partners, were more likely to receive money for sex or have concurrent partners. Prevention programs for MSM and transgender women should characterize social venues and people that frequent them and improve service coverage through venues and social networks.
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Differences in Awareness of Pre-exposure Prophylaxis and Post-exposure Prophylaxis Among Groups At-Risk for HIV in New York State: New York City and Long Island, NY, 2011-2013. J Acquir Immune Defic Syndr 2017; 75 Suppl 3:S383-S391. [PMID: 28604443 DOI: 10.1097/qai.0000000000001415] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) to reduce the risk of HIV was approved in 2012 and post-exposure prophylaxis (PEP) in 2005. We report the differences in awareness of PrEP/PEP and factors associated with awareness by examining 3 risk groups (men who have sex with men (MSM), people who inject drugs, and high-risk heterosexuals). METHODS National HIV Behavioral Surveillance system data collected in New York City (NYC) and Long Island, NY in 2011-2013 were used. Logistic regressions by region were developed to estimate adjusted associations [Adjusted Odds Ratios (AOR)] and determine differences in awareness of PrEP/PEP. RESULTS Awareness of PrEP/PEP was low for all groups. In multivariate analysis controlling for sociodemographic factors, noninjection drug use, HIV status, and exposure to HIV prevention, males who inject drugs in NYC had significantly decreased odds of PrEP/PEP awareness [AOR: 0.45; confidence interval (CI): 0.25 to 0.81] compared with MSM. MSM aged 18-29 years had increased awareness of PrEP (AOR: 2.94; 95% CI 1.11 to 7.80). On Long Island, females who inject drugs (AOR: 0.18; 95% CI: 0.05 to 0.62), males who inject drugs (AOR: 0.14; 95% CI: 0.05 to 0.39), female heterosexuals (AOR: 0.25; 95% CI: 0.11 to 0.59), and male heterosexuals (AOR: 0.32; 95% CI: 0.14 to 0.73) had significantly decreased odds of PrEP/PEP awareness. Black MSM had increased awareness of PrEP (AOR: 4.08 CI:1.21 to 13.73). CONCLUSIONS Large proportions of groups at-risk for HIV were unaware of PrEP/PEP. When comparing risk groups to MSM, we found MSM to have greater awareness in both regions. On Long Island, people who inject drugs and heterosexuals were far less likely to have PrEP/PEP awareness than in NYC. On Long Island, Black MSM had increased PrEP awareness and in NYC MSM aged 18-29 had increased PrEP awareness. These findings suggest that awareness may be spreading through networks and highlight the importance of targeted educational and prevention efforts by group and region.
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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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Tucker C, Arandi CG, Bolaños JH, Paz-Bailey G, Barrington C. Understanding social and sexual networks of sexual minority men and transgender women in Guatemala city to improve HIV prevention efforts. J Health Care Poor Underserved 2016; 25:1698-717. [PMID: 25418236 DOI: 10.1353/hpu.2014.0163] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Sexual minority men and transgender women are disproportionately affected by HIV in Guatemala. Innovative prevention strategies are urgently needed to address these disparities. While social network approaches are frequently used to reach sexual minorities, little is known about the unique network characteristics among sub-groups. We conducted in-depth qualitative interviews with 13 gay-identifying men, eight non-gay-identifying men who have sex with men (MSM) and eight transgender women in Guatemala City. Using narrative and thematic coding procedures, we identified distinct patterns in the size, composition, and overlap between social and sexual networks across groups. Gay-identifying men had the largest, most supportive social networks, predominantly comprising family. For both non-gay-identifying MSM and transgender women, friends and sex clients provided more support. Transgender women reported the smallest social networks, least social support, and the most discrimination. HIV prevention efforts should be tailored to the specific sexual minority population and engage with strong ties.
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Siembida EJ, Eaton LA, Maksut JL, Driffin DD, Baldwin R. A Comparison of HIV-Related Risk Factors Between Black Transgender Women and Black Men Who Have Sex with Men. Transgend Health 2016; 1:172-180. [PMID: 28861530 PMCID: PMC5549536 DOI: 10.1089/trgh.2016.0003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Purpose: Rates of HIV infection among transgender women (TW) are higher than rates observed among men who have sex with men (MSM), and black or African American individuals are at a disproportionately higher risk for HIV than individuals of other races. Limited information, however, is available regarding the needs of black TW and their risk for HIV. Numerous scholarly works and surveillance reports have combined TW with MSM, which has stymied our ability to understand the unique needs of black TW. Methods: To identify patterns of HIV risk among black TW and black MSM, the current study utilized a cross-sectional, convenience sample to compare sociodemographic risk factors, HIV prevention tools, HIV-related risk factors, and psychosocial and sexual risk factors in a sample of 58 black TW and 764 black MSM. Participants were recruited between 2012 and 2014 from Atlanta, GA. Results: Findings demonstrated that black TW were significantly more likely to report lower educational attainment (odds ratio [OR]=0.60, 95% confidence interval [CI]: 0.42-0.85, p=0.005), greater likelihood of being homeless (OR=2.49, 95% CI: 1.30-4.78, p=0.006), lower HIV testing knowledge (OR=0.66, 95% CI: 0.52-0.83, p=0.001), and higher likelihood of having engaged in transactional sex (OR=1.95, 95% CI: 0.99-3.83, p=0.052) compared to black MSM. Conclusions: These findings highlight the need to understand how risk factors for HIV present themselves similarly and differently for both black TW and black MSM, and for HIV prevention programs and interventions to incorporate evidence-based content for each group.
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Affiliation(s)
- Elizabeth J. Siembida
- Department of Human Development and Family Studies, University of Connecticut, Storrs, Connecticut
| | - Lisa A. Eaton
- Department of Human Development and Family Studies, University of Connecticut, Storrs, Connecticut
- SHARE Project, Atlanta, Georgia
| | - Jessica L. Maksut
- Department of Human Development and Family Studies, University of Connecticut, Storrs, Connecticut
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Sheehan DM, Trepka MJ, Fennie KP, Prado G, Ibanez G, Maddox LM. Racial/ethnic disparities in delayed HIV diagnosis among men who have sex with men, Florida, 2000-2014. AIDS Care 2016; 29:311-318. [PMID: 27455856 DOI: 10.1080/09540121.2016.1211609] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Only about 85% of men who have sex with men (MSM) with human immunodeficiency virus (HIV) have been tested for and diagnosed with HIV. Racial/ethnic disparities in HIV risk and HIV care outcomes exist within MSM. We examined racial/ethnic disparities in delayed HIV diagnosis among MSM. Males aged ≥13 reported to the Florida Enhanced HIV/AIDS Reporting System 2000-2014 with a reported HIV transmission mode of MSM were analyzed. We defined delayed HIV diagnosis as an AIDS diagnosis within three months of the HIV diagnosis. Multilevel logistic regressions were used to estimate adjusted odds ratios (aOR). Of 39,301 MSM, 27% were diagnosed late. After controlling for individual factors, neighborhood socioeconomic status, and rural-urban residence, non-Latino Black MSM had higher odds of delayed diagnosis compared with non-Latino White MSM (aOR 1.15, 95% confidence interval [CI] 1.08-1.23). Foreign birth compared with US birth was a risk factor for Black MSM (aOR 1.27, 95% CI 1.12-1.44), but a protective factor for White MSM (aOR 0.77, 95% CI 0.68-0.87). Rural residence was a risk for Black MSM (aOR 1.79, 95% CI 1.36-2.35) and Latino MSM (aOR 1.87, 95% CI 1.24-2.84), but not for White MSM (aOR 1.26, 95% CI 0.99-1.60). HIV testing barriers particularly affect non-Latino Black MSM. Social and/or structural barriers to testing in rural communities may be significantly contributing to delayed HIV diagnosis among minority MSM.
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Affiliation(s)
- Diana M Sheehan
- a Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University , Miami , FL , USA.,b Department of Epidemiology, Robert Stempel College of Public Health and Social Work , Florida International University , Miami , FL , USA
| | - Mary Jo Trepka
- a Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University , Miami , FL , USA.,b Department of Epidemiology, Robert Stempel College of Public Health and Social Work , Florida International University , Miami , FL , USA
| | - Kristopher P Fennie
- b Department of Epidemiology, Robert Stempel College of Public Health and Social Work , Florida International University , Miami , FL , USA
| | - Guillermo Prado
- c Department of Public Health Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Gladys Ibanez
- b Department of Epidemiology, Robert Stempel College of Public Health and Social Work , Florida International University , Miami , FL , USA
| | - Lorene M Maddox
- d Florida Department of Health , HIV/AIDS Section , Tallahassee , FL , USA
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Crosby RA, Mena L, Geter A. Are HIV-positive young black MSM having safer sex than those who are HIV-negative? Int J STD AIDS 2016; 28:441-446. [PMID: 27193422 DOI: 10.1177/0956462416651386] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the United States, young Black men who have sex with men (YBMSM) bear the single largest burden of the HIV/AIDS epidemic. Whether HIV-positive men in this population practice relatively safer sex than their HIV negative counterparts has not been recently investigated. The purpose of this study was to compare selected sexual risk behaviors between YBMSM who are HIV-positive to their HIV-negative counterparts of the same geographic location in the southern US. A convenience sample of 600 YBMSM completed a computer-assisted self-interview in a private area of a clinic dedicated to sexual health. Frequency/prevalence of 16 sexual risk behaviors was compared between men who were HIV-positive and those who were HIV-negative at the time. Bivariate associations were tested in regression models adjusted for age and having a main male sex partner. One-quarter of the sample (25.5%) was HIV-positive at study enrollment. Remarkably few differences in sexual risk behaviors were observed. HIV-positive men were less likely to report recent sex with a woman ( P = .003), and they were more likely to report recent sex with persons known to be HIV-positive ( P < .001). Of 16 assessed outcome measures, these two significant findings represented the only significant differences in the adjusted analyses. YBMSM residing in the southern US may experience high levels of HIV exposure risk or risk of exposing others to HIV. A particularly urgent need exists to improve post-diagnostic HIV prevention efforts for HIV-positive YBMSM.
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Affiliation(s)
- Richard A Crosby
- 1 College of Public Health at the University of Kentucky, Kentucky, USA
| | - Leandro Mena
- 2 University of Mississippi Medical Center, Mississippi, USA
| | - Angelica Geter
- 1 College of Public Health at the University of Kentucky, Kentucky, USA
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43
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Chamberlain N, Mena L, Geter A, Crosby RA. Does Age Matter Among Young Black Men Who Have Sex With Men? A Comparison of Risk Behaviors Stratified by Age Category. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:246-51. [PMID: 27244192 PMCID: PMC5810128 DOI: 10.1521/aeap.2016.28.3.246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The purpose of this study is to assess whether different sexual risk behavior exists among young Black men who have sex with men (YBMSM) as a function of age. A total of 382 YBMSM completed a computer-assisted self-interview at a sexual health clinic. The frequency/prevalence of fifteen sexual risk behaviors was compared between three groups (ages 16-19, 20-25, and 26-29, respectively) in the 90 days prior to enrollment in the study. Regression models were used to control for the confounding influence of Human Immunodeficiency Virus (HIV) status. One hundred seven participants were HIV-infected at study enrollment. Of the 15 measures assessed, none significantly differed among the groups. These null findings did not change in multivariate analyses. Our findings suggest that there is no differential sexual risk based on age among YBMSM and that this group should be considered a homogenous population with regards to intervention strategies that aim to reduce the sexual risk behaviors of YBMSM.
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Affiliation(s)
| | - Leandro Mena
- University of Mississippi Medical Center, Division of Infectious Diseases, Jackson, MS
| | | | - Richard A. Crosby
- University of Mississippi Medical Center, Division of Infectious Diseases, Jackson, MS
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Alonzo J, Mann L, Tanner AE, Sun CJ, Painter TM, Freeman A, Reboussin BA, Song E, Rhodes SD. Reducing HIV risk among Hispanic/Latino men who have sex with men: Qualitative analysis of behavior change intentions by participants in a small-group intervention. ACTA ACUST UNITED AC 2016; 7. [PMID: 27468361 DOI: 10.4172/2155-6113.1000572] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The southeastern United States has the fastest-growing Hispanic/Latino population in the country and carries a disproportionate HIV burden. Among Hispanics/Latinos, men, and men who have sex with men (MSM) in particular, are at elevated risk of HIV infection; however, very few efficacious behavioral HIV prevention interventions are available for use with this vulnerable population. To address this shortage of prevention resources, our community-based participatory research (CBPR) partnership developed and is currently evaluating the efficacy of the HOLA en Grupos intervention to increase condom use and HIV testing among Hispanic/Latino MSM. METHODS We recruited 304 Hispanic/Latino MSM who were randomized to receive the small group HOLA en Grupos intervention that was implemented during four 4-hour long sessions over four consecutive Sundays, or a 4-session small group general health education comparison intervention. At the end of the fourth session of the HOLA en Grupos intervention, the intervention facilitators asked participants to write down the sexual health-related behaviors they intended to change as a result of their participation. RESULTS Qualitative analysis of the participants' responses identified six types of intended behavior changes: increasing and maintaining condom use; identifying strategies to support correct and consistent condom use; increasing communication and negotiation with sexual partners about condom use; getting tested for HIV and other sexually transmitted infections; applying other sexual health promotion strategies; and sharing newly learned sexual health information with their peers. CONCLUSION Most risk-reduction intentions aligned with the intervention's key messages of using condoms consistently and getting tested for HIV. However, participants' stated intentions may have also depended on which behavior changes they perceived as most salient after participating in the intervention. Participants' intentions to share information with their peers may result in elements of the intervention content reaching others within their social networks, and potentially contributing to a broader community-level impact.
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Affiliation(s)
- Jorge Alonzo
- Wake Forest School of Medicine Department of Social Sciences and Health Policy, Winston-Salem, NC, USA; ; Tel: 336-713-5048
| | - Lilli Mann
- Wake Forest School of Medicine Department of Social Sciences and Health Policy, Winston-Salem, NC, USA; ; Tel: 336-716-7441
| | - Amanda E Tanner
- University of North Carolina at Greensboro, Department of Public Health Education, Greensboro, NC, USA; ; Tel: 336-334-5389
| | - Christina J Sun
- Portland State University, School of Community Health, OR, USA; ; Tel: 503-725-3616
| | - Thomas M Painter
- Prevention Research Branch Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta GA, USA; ; Tel: 404-639-6113
| | - Arin Freeman
- Prevention Research Branch Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta GA, USA; ; Tel: 404-639-8432
| | - Beth A Reboussin
- Wake Forest School of Medicine Department of Social Sciences and Health Policy, Winston-Salem, NC, USA; ; Tel: 336-713-5213
| | - Eunyoung Song
- Wake Forest School of Medicine Department of Social Sciences and Health Policy, Winston-Salem, NC, USA; ; Tel: 336-716-9280
| | - Scott D Rhodes
- Wake Forest School of Medicine Department of Social Sciences and Health Policy, Winston-Salem, NC, USA 27157; ; Tel: 336-713-5080
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If You Are Not Counted, You Don't Count: Estimating the Number of African-American Men Who Have Sex with Men in San Francisco Using a Novel Bayesian Approach. J Urban Health 2015; 92:1052-64. [PMID: 26392276 PMCID: PMC4675739 DOI: 10.1007/s11524-015-9981-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
African-American men who have sex with men (AA MSM) have been disproportionately infected with and affected by HIV and other STIs in San Francisco and the USA. The true scope and scale of the HIV epidemic in this population has not been quantified, in part because the size of this population remains unknown. We used the successive sampling population size estimation (SS-PSE) method, a new Bayesian approach to population size estimation that incorporates network size data routinely collected in respondent-driven sampling (RDS) studies, to estimate the number of AA MSM in San Francisco. This method was applied to data from a 2009 RDS study of AA MSM. An estimate from a separate study of local AA MSM was used to model the prior distribution of the population size. Two-hundred and fifty-six AA MSM were included in the RDS survey. The estimated population size was 4917 (95% CI 1267-28,771), using a flat prior estimated 1882 (95% CI 919-2463) as a lower acceptable bound, and a large prior estimated 6762 (95% CI 1994-13,863) as an acceptable upper bound. Point estimates from the SS-PSE were consistent with estimates from multiplier methods using external data. The SS-PSE method is easily integrated into RDS studies and therefore provides a simple and appealing tool to rapidly produce estimates of the size of key populations otherwise difficult to reach and enumerate.
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Fuqua V, Scott H, Scheer S, Hecht J, Snowden JM, Raymond HF. Trends in the HIV Epidemic Among African American Men Who Have Sex with Men, San Francisco, 2004-2011. AIDS Behav 2015; 19:2311-6. [PMID: 25686574 DOI: 10.1007/s10461-015-1020-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
African American men who have sex with men have been disproportionately affected by the HIV epidemic in the United States and remain to this day one of the groups with highest HIV prevalence and incidence. Our goal was to clarify the current state of HIV risk, sexual behaviors, and structural/network-network level factors that affect black MSM's population risk of HIV, enabling the formulation of targeted and up-to-date public health messages/campaigns directed at this vulnerable population. Our approach maximized the use of local data through a process of synthesis and triangulation of multiple independent and overlapping sources of information that are sometimes separately published and often not examined side-by-side. Among African American MSM, we observed stable HIV incidence despite increases in reported individual risk behavior and STDs. An increasing proportion of African American MSM are reporting HIV testing in the past 6 months and seroadaptive behaviors, which may play a role in this observed decline in HIV among MSM in San Francisco, California. Our analysis suggests that currently the HIV epidemic is stable among African American MSM in San Francisco. However, we suggest that the observed stability is due to factors prohibiting expansion of new infections rather than decreasing risks for HIV infection among African American MSM.
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Affiliation(s)
- V Fuqua
- San Francisco Department of Public Health, 25 Van Ness, Suite 500, San Francisco, CA, 94102, USA
| | - H Scott
- San Francisco Department of Public Health, 25 Van Ness, Suite 500, San Francisco, CA, 94102, USA
| | - S Scheer
- San Francisco Department of Public Health, 25 Van Ness, Suite 500, San Francisco, CA, 94102, USA
| | - J Hecht
- San Francisco AIDS Foundation, San Francisco, CA, USA
| | - J M Snowden
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - H Fisher Raymond
- San Francisco Department of Public Health, 25 Van Ness, Suite 500, San Francisco, CA, 94102, USA.
- Epidemiology and Biostatistics, University of California, San Francisco, USA.
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IAPAC Guidelines for Optimizing the HIV Care Continuum for Adults and Adolescents. J Int Assoc Provid AIDS Care 2015; 14 Suppl 1:S3-S34. [PMID: 26527218 DOI: 10.1177/2325957415613442] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND An estimated 50% of people living with HIV (PLHIV) globally are unaware of their status. Among those who know their HIV status, many do not receive antiretroviral therapy (ART) in a timely manner, fail to remain engaged in care, or do not achieve sustained viral suppression. Barriers across the HIV care continuum prevent PLHIV from achieving the therapeutic and preventive effects of ART. METHODS A systematic literature search was conducted, and 6132 articles, including randomized controlled trials, observational studies with or without comparators, cross-sectional studies, and descriptive documents, met the inclusion criteria. Of these, 1047 articles were used to generate 36 recommendations to optimize the HIV care continuum for adults and adolescents. RECOMMENDATIONS Recommendations are provided for interventions to optimize the HIV care environment; increase HIV testing and linkage to care, treatment coverage, retention in care, and viral suppression; and monitor the HIV care continuum.
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Correlates of HIV Testing Among Men Who have Sex with Men in Three Urban Areas of Mozambique: Missed Opportunities for Prevention. AIDS Behav 2015; 19:1978-89. [PMID: 25987189 PMCID: PMC4598353 DOI: 10.1007/s10461-015-1044-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This is the first study to identify levels of recent HIV testing and associated factors among men who have sex with men (MSM) in Mozambique. Using data from Maputo (n = 493), Beira (n = 572), and Nampula/Nacala (n = 347), collected via respondent-driven sampling in 2011, and excluding those with prior known infection, we found that 30.4 % [95 % confidence interval (CI) 25.0–36.3 %], 42.1 % (95 % CI 36.8–47.3 %) and 29.8 % (95 % CI 22.9–36.9 %), respectively, had recently tested for HIV (≤12 months), while between three and five out of 10 MSM had never tested. A range of factors was associated with recent HIV testing such as familiarity with the modes of transmission, knowledge of antiretroviral treatment for HIV, contact with peer educators and awareness of partner serostatus; yet, surprisingly recent healthcare utilization was not associated with recent testing. Findings provide evidence that structural and behavioral interventions among MSM may play an important role in increasing HIV testing.
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Frye V, Wilton L, Hirshfield S, Chiasson MA, Usher D, Lucy D, McCrossin J, Greene E, Koblin B. "Just Because It's Out There, People Aren't Going to Use It." HIV Self-Testing Among Young, Black MSM, and Transgender Women. AIDS Patient Care STDS 2015; 29:617-24. [PMID: 26376029 PMCID: PMC4808283 DOI: 10.1089/apc.2015.0100] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
HIV disproportionately affects young black MSM and transgender women in the US. Increasing HIV testing rates among these populations is a critical public health goal. Although HIV self-tests are commercially available, there is a need to better understand access to and uptake of HIV self-testing among this population. Here, we report results of a qualitative study of 30 young black MSM and transgender women residing in the New York City area to understand facilitators of and barriers to a range of HIV testing approaches, including self-testing. Mean age was 23.7 years (SD = 3.4). Over half (54%) had some college or an associate's degree, yet 37% had an annual personal income of less than $10,000 per year. Most (64%) participants had tested in the past 6 months; venues included community health/free clinics, medical offices, mobile testing units, hospitals, emergency departments, and research sites. Just one participant reported ever using a commercially available HIV self-test. Facilitators of self-testing included convenience, control, and privacy, particularly as compared to venue-based testing. Barriers to self-testing included the cost of the test, anxiety regarding accessing the test, concerns around correct test operation, and lack of support if a test result is positive. Participants indicated that instruction in correct test operation and social support in the event of a positive test result may increase the likelihood that they would use the self-test. Alongside developing new approaches to HIV prevention, developing ways to increase HIV self-testing is a public health priority for young, black MSM, and transgender women.
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Affiliation(s)
- Victoria Frye
- Laboratories of Social and Behavioral Sciences, New York Blood Center, New York, New York
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, Binghamton, New York
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | | | | | - DaShawn Usher
- Project ACHIEVE, Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York
| | - Debbie Lucy
- Project ACHIEVE, Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York
| | - Jermaine McCrossin
- Project ACHIEVE, Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York
| | - Emily Greene
- Laboratories of Social and Behavioral Sciences, New York Blood Center, New York, New York
- Department of Epidemiology, Columbia University, New York, New York
| | - Beryl Koblin
- Laboratories of Infectious Disease Prevention, New York Blood Center, New York, New York
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Piloting a Social Networks Strategy to Increase HIV Testing and Counseling Among Men Who Have Sex with Men in Greater Accra and Ashanti Region, Ghana. AIDS Behav 2015; 19:1990-2000. [PMID: 25903507 DOI: 10.1007/s10461-015-1069-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The 2011 Ghana Men's Study identified a high prevalence of HIV among men who have sex with men (MSM) in Accra/Tema (34.4 %) and in Kumasi (13.6 %), whereas the HIV rate among MSM referred through peer educators (PEs) to HIV testing and counseling (HTC) services in these two sites was substantially lower (8.4 %). These findings raised questions about possible limitations of the peer-education strategy to reach high-risk MSM. Therefore, a pilot study was conducted to assess the feasibility of using a social network strategy (SNS) to identify and refer MSM to HTC services. Within 3 months, 166 MSM were reached and referred to HTC services: 62.7 % reported no recent exposure to PEs; 61.5 % were unaware of their recent HIV serostatus; and 32.9 % were newly diagnosed HIV positive. This pilot study suggests that an SNS could be an important strategy to reach MSM and to increase the uptake of HTC.
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