1
|
Li J, Liu Y, Nehl E, Tucker JD. A behavioral economics approach to enhancing HIV preexposure and postexposure prophylaxis implementation. Curr Opin HIV AIDS 2024; 19:212-220. [PMID: 38686773 DOI: 10.1097/coh.0000000000000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
PURPOSE OF REVIEW The 'PrEP cliff' phenomenon poses a critical challenge in global HIV PrEP implementation, marked by significant dropouts across the entire PrEP care continuum. This article reviews new strategies to address 'PrEP cliff'. RECENT FINDINGS Canadian clinicians have developed a service delivery model that offers presumptive PEP to patients in need and transits eligible PEP users to PrEP. Early findings are promising. This service model not only establishes a safety net for those who were not protected by PrEP, but it also leverages the immediate salience and perceived benefits of PEP as a natural nudge towards PrEP use. Aligning with Behavioral Economics, specifically the Salience Theory, this strategy holds potential in tackling PrEP implementation challenges. SUMMARY A natural pathway between PEP and PrEP has been widely observed. The Canadian service model exemplifies an innovative strategy that leverages this organic pathway and enhances the utility of both PEP and PrEP services. We offer theoretical insights into the reasons behind these PEP-PrEP transitions and evolve the Canadian model into a cohesive framework for implementation.
Collapse
Affiliation(s)
- Jingjing Li
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health
| | - Yaxin Liu
- Department of Psychology, Emory University, Atlanta, Georgia
| | - Eric Nehl
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health
| | - Joseph D Tucker
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| |
Collapse
|
2
|
Boudewyns V, Uhrig JD, Williams PA, Anderson SKE, Stryker JE. Message Framing Strategies to Promote the Uptake of PrEP: Results from Formative Research with Diverse Adult Populations in the United States. AIDS Behav 2024; 28:535-546. [PMID: 38151665 DOI: 10.1007/s10461-023-04242-6] [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] [Accepted: 11/28/2023] [Indexed: 12/29/2023]
Abstract
There are no evidence-based recommendations for communicating about pre-exposure prophylaxis (PrEP) as part of a broader HIV-prevention messaging approach. To inform future message development related to PrEP uptake, we interviewed 235 individuals across ten locations in the U.S. to explore their understanding and perceptions of draft HIV prevention messages and assess their overall preferences for a broad or PrEP-focused messaging approach. Participants responded favorably to and related to both draft messages. Participants who were not aware of PrEP were more likely to say the broad HIV-prevention message was personally relevant than those aware of PrEP. There were no significant differences in perceived personal relevance for the PrEP-focused message. Qualitative findings suggest that HIV prevention messages should use specific well-defined terms, include links to additional information, and use choice-enhancing language that emphasizes personal agency and frames the call to action as an informed decision among an array of effective prevention options.
Collapse
Affiliation(s)
- Vanessa Boudewyns
- RTI International, 3040 E. Cornwallis Road, PO Box 12194, Research Triangle Park, NC, USA.
| | - Jennifer D Uhrig
- RTI International, 3040 E. Cornwallis Road, PO Box 12194, Research Triangle Park, NC, USA
| | - Pamela A Williams
- RTI International, 3040 E. Cornwallis Road, PO Box 12194, Research Triangle Park, NC, USA
| | - Stefanie K E Anderson
- Division of HIV Prevention, Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jo Ellen Stryker
- Division of HIV Prevention, Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
3
|
Josma D, Morris J, Hopkins R, Quamina A, Siegler AJ, Holland D, Sullivan P, Harrington KRV, Alohan DI, Crawford ND. Comparing open-ended question methods to vignette methods to explore willingness to obtain pre-exposure prophylaxis access in pharmacies among black men who have sex with men. AIDS Care 2023; 35:1955-1962. [PMID: 36892947 PMCID: PMC10491733 DOI: 10.1080/09540121.2023.2185193] [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: 03/01/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023]
Abstract
Black men who have sex with men (BMSM) are at higher risk of HIV transmission than any other group; however, their uptake of the highly effective HIV prevention medication, pre-exposure prophylaxis (PrEP), is low. In collaboration with a communitybased organization in Atlanta, Georgia, we explored ten HIV-negative BMSM's willingness to obtain PrEP in pharmacies using standard open-ended and vignette qualitative methods. Three overarching themes were identified: privacy, patient-pharmacist interactions, and HIV/STI screening. While open-ended questions allowed participants to provide broad answers on their willingness to receive prevention services at a pharmacy, the vignette drew out specific responses to facilitate in-pharmacy PrEP delivery. Using both openended questions and vignette data collection strategies, BMSM reported high willingness to screen for and uptake PrEP in pharmacies. However, the vignette method allowed for greater depth. Open-ended questions elicited responses that highlighted general barriers and facilitators of PrEP dispensing in pharmacies. However, the vignette allowed participants to customize a plan of action that would best fit their needs. Vignette methods are underutilized in HIV research and may be helpful in supplementing standard open-ended interview questions to uncovering unknown challenges about health behaviors and obtain more robust data on highly sensitive research topics in HIV research.
Collapse
Affiliation(s)
| | - Joseph Morris
- National Center for Emerging, Zoonotic, and Infectious Diseases, Office of Innovation, Development, Analytics, and Evaluation, Centers for Disease Control and Prevention
| | - Roderick Hopkins
- Division of Global Migration and Quarantine (DGMQ), Community Interventions for Infection Control Unit (CI-ICU), Centers for Disease Control and Prevention
| | | | - Aaron J. Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Daniel I. Alohan
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, GA, USA
| | - Natalie D. Crawford
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, GA, USA
| |
Collapse
|
4
|
Mizushima D, Nagai Y, Mezzio D, Harada K, Piao Y, Barnieh L, El Moustaid F, Cawson M, Taniguchi T. Cost-effectiveness analysis of HIV pre-exposure prophylaxis in Japan. J Med Econ 2023:1-14. [PMID: 37421417 DOI: 10.1080/13696998.2023.2233824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND While global efforts have been made to prevent transmission of HIV, the epidemic persists. Men who have sex with men (MSM) are at high risk of infection. Despite evidence of its cost-effectiveness in other jurisdictions, pre-exposure prophylaxis (PrEP) for MSM is neither approved nor reimbursed in Japan. METHOD The cost-effectiveness analysis compared the use of once daily PrEP versus no PrEP among MSM over a 30-year time horizon from a national healthcare perspective. Epidemiological estimates for each of the 47 prefectures informed the model. Costs included HIV/AIDS treatment, HIV and testing for sexually transmitted infections, monitoring tests and consults, and hospitalization costs. Analyses included health and cost outcomes, as well as the incremental cost-effectiveness ratio (ICER) reported as the cost per quality-adjusted life year (QALY) for all of Japan and each prefecture. Sensitivity analyses were performed. FINDINGS The estimated proportion of HIV infections prevented with the use of PrEP ranged from 48% to 69% across Japan, over the time horizon. Cost savings due to lower monitoring costs and general medical costs were observed. Assuming 100% coverage, for Japan overall, daily use of PrEP costs less and was more effective; daily use of PrEP was cost-effective at a willingness to pay threshold of ¥5,000,000 per QALY in 32 of the 47 prefectures. Sensitivity analyses found that the ICER was most sensitive to the cost of PrEP. INTERPRETATION Compared to no PrEP use, once daily PrEP is a cost-effective strategy in Japanese MSM, reducing the clinical and economic burden associated with HIV.
Collapse
Affiliation(s)
- Daisuke Mizushima
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | | | | | | | - Yi Piao
- Gilead Sciences, Tokyo, Japan
| | | | | | | | | |
Collapse
|
5
|
Virdi AK, Ho S, Seaton MS, Olali AZ, Narasipura SD, Barbian HJ, Olivares LJ, Gonzalez H, Winchester LC, Podany AT, Ross RD, Al-Harthi L, Wallace J. An Efficient Humanized Mouse Model for Oral Anti-Retroviral Administration. Cells 2023; 12:1034. [PMID: 37048107 PMCID: PMC10093470 DOI: 10.3390/cells12071034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
HIV anti-retrovirals (ARVs) have vastly improved the life expectancy of people living with HIV (PLWH). However, toxic effects attributed to long-term ARV use also contribute to HIV-related co-morbidities such as heart disease, bone loss and HIV-associated neurocognitive disorders (HAND). Unfortunately, mouse models used to study the effects of ARVs on viral suppression, toxicity and HIV latency/tissue reservoirs have not been widely established. Here, we demonstrate an effective mouse model utilizing immune-compromised mice, reconstituted with infected human peripheral blood mononuclear cell (PBMCs). ARVs areincorporated into mouse chow and administered daily with combination ARV regimens includingAtripla (efavirenz, tenofovir disoproxil fumarate, and emtricitabine) and Triumeq (abacavir, dolutegravir and lamivudine). This model measures HIV-infected human cell trafficking, and ARV penetration throughout most relevant HIV organs and plasma, with a large amount of trafficking to the secondary lymphoid organs. Furthermore, the HIV viral load within each organ and the plasma was reduced in ARV treated vs. untreated control. Overall, we have demonstrated a mouse model that is relatively easy and affordable to establish and utilize to study ARVs' effect on various tissues, including the co-morbid conditions associated with PLWH, such as HAND, and other toxic effects.
Collapse
Affiliation(s)
- Amber K. Virdi
- Department of Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, IL 60612, USA
| | - Sang Ho
- Department of Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, IL 60612, USA
| | - Melanie S. Seaton
- Department of Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, IL 60612, USA
| | - Arnold Z. Olali
- Center for Mitochondrial and Epigenomic Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Srinivas D. Narasipura
- Department of Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, IL 60612, USA
| | - Hannah J. Barbian
- Department of Internal Medicine, Division of Infectious Diseases, Rush Medical College, Chicago, IL 60612, USA
| | - Leannie J. Olivares
- Department of Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, IL 60612, USA
| | - Hemil Gonzalez
- Department of Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, IL 60612, USA
- Department of Internal Medicine, Division of Infectious Diseases, Rush Medical College, Chicago, IL 60612, USA
| | - Lee C. Winchester
- UNMC Center for Drug Discovery, University of Nebraska Medical Center, Omaha, NE 68182, USA
| | - Anthony T. Podany
- UNMC Center for Drug Discovery, University of Nebraska Medical Center, Omaha, NE 68182, USA
| | - Ryan D. Ross
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Lena Al-Harthi
- Department of Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, IL 60612, USA
| | - Jennillee Wallace
- Department of Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, IL 60612, USA
| |
Collapse
|
6
|
Wang Y, Tanuma J, Li J, Iwahashi K, Peng L, Chen C, Hao Y, Gilmour S. Elimination of HIV transmission in Japanese MSM with combination interventions. THE LANCET REGIONAL HEALTH - WESTERN PACIFIC 2022; 23:100467. [PMID: 35602412 PMCID: PMC9118161 DOI: 10.1016/j.lanwpc.2022.100467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Japan has a concentrated HIV epidemic, with the majority of transmission among men who have sex with men (MSM). This study aimed to explore the effect of behavioral and biomedical interventions on the HIV epidemic and forecast the time required to eliminate HIV transmission among Japanese MSM. Methods A deterministic compartmental model was built to estimate and forecast the HIV epidemic among Japanese MSM from 2010 to 2050. Elimination of HIV transmission among MSM was defined as incidence less than 1/1000 person-years. The time required for eliminating HIV transmission under different scenarios was calculated. Findings Under the current policies, HIV transmission cannot be eliminated by 2050. Both behavioral and biomedical interventions can achieve elimination of HIV among MSM by 2050 with annual number of sexual partners among high-risk MSM less than 9, or with condom use rate above 65%, or with testing and treatment rate above 80%, or with more than 10% PrEP coverage rate. Under comprehensive interventions, HIV elimination will be achieved in 2032, 2025 and 2024 using weak, moderate and strong intervention combinations, respectively. Interpretation Both behavioural and biomedical interventions can achieve elimination of HIV among MSM by 2050, but comprehensive interventions can accelerate the realization of this goal with higher feasibility. Funding This study was funded by a Health and Labor Sciences Research Grant (Research on HIV/AIDS) from The Ministry of Health Labour and Welfare (21HB0701) and National Natural Science Foundation of China (No. 81773543 and 81973150), and the KC Wong Education Foundation.
Collapse
|
7
|
Biello KB, Valente PK, Lin WY, Lodge Ii W, Drab R, Hightow-Weidman L, da Silva DT, Mayer K, Bauermeister JA. PrEParing for NextGen: Cognitive Interviews to Improve Next Generation PrEP Modality Descriptions for Young Men Who have Sex with Men. AIDS Behav 2022; 26:1956-1965. [PMID: 34860304 PMCID: PMC9050851 DOI: 10.1007/s10461-021-03545-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Abstract
Next generation PrEP formulations may circumvent factors that impede daily oral pre-exposure prophylaxis (PrEP) use among young men who have sex with men (YMSM). We conducted video-based cognitive interviews with 20 YMSM (age 16-24) recruited in the US Northeast to assess participants' attitudes and comprehension of written descriptions of next generation PrEP modalities. Participants were predominately racial/ethnic minorities and half used daily oral PrEP. We identified four main areas for improvement of descriptions: defining scientific terms and balancing medical jargon and casual language; referencing more established products to contextualize PrEP formulations (e.g., hormonal implants); ensuring clarity and reducing redundancy; and including imagery (e.g., rectal douche applicator). The refined descriptions serve as exemplar text that may be used in future studies examining YMSM's preferences across next generation PrEP modalities. Accurate descriptions of next generation PrEP products strengthen measurement accuracy and can help roll-out products that become approved for clinical use.
Collapse
Affiliation(s)
- Katie B Biello
- School of Public Health, Brown University, 121 South Main Street, Box G-S121-8, Providence, RI, 02912, USA.
- Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Pablo K Valente
- School of Public Health, Brown University, 121 South Main Street, Box G-S121-8, Providence, RI, 02912, USA
| | - Willey Y Lin
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - William Lodge Ii
- School of Public Health, Brown University, 121 South Main Street, Box G-S121-8, Providence, RI, 02912, USA
| | - Ryan Drab
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Daniel Teixeira da Silva
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, USA
| | | | | |
Collapse
|
8
|
Does the Ring Work? Perceptions and Understanding of the Efficacy of a Dapivirine Vaginal Ring for HIV Prevention Amongst Women in a Placebo-Controlled Trial. AIDS Behav 2022; 26:1597-1606. [PMID: 34727272 DOI: 10.1007/s10461-021-03512-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 10/19/2022]
Abstract
As demonstrated by the Phase III clinical trial, MTN-020/ASPIRE, the monthly dapivirine vaginal ring is well tolerated and reduces the risk of HIV-1 as a woman-initiated prevention option. This analysis uses data from the follow-on MTN-032/Assessment of ASPIRE and HOPE Adherence (AHA) qualitative study to understand how perceptions (or misperceptions) of ring efficacy may have influenced behavior during ASPIRE, and affected intention to use the ring in future ring projects, specifically HOPE, the planned open-label extension study. Single in-depth interviews (n = 98) and 12 focus group discussions (n = 89) were conducted with women at seven sites in Malawi, South Africa, Uganda and Zimbabwe. Eligibility included participation in the ASPIRE active arm, and ring use for ≥ 3 months or at least 1 month if seroconversion occurred. Interviews were audio-recorded, transcribed into English, coded in Dedoose and thematically analyzed. Demographic and behavioral questionnaire data were summarized in Stata. Most AHA participants perceived the ring to be effective, and described simply trusting it or having confidence in it because they, or other participants in risky situations, remained HIV-uninfected. Participants described ring efficacy after receiving ASPIRE results as a binary assessment: the ring worked or not. Many did not remember exact efficacy percentages because of lack of comprehension or memory but recalled key details about age differences. The majority expressed interest in future ring use. There is a need to investigate improved ways of explaining placebo-controlled trials and efficacy to women in Sub-Saharan Africa. Now that ring efficacy, is known, these benefits must be well communicated, and understood by end-users and key stakeholders. Engagement with end-users to construct effective messages and to develop tools to measure understanding of partial efficacy will be essential.
Collapse
|
9
|
Yamamoto N, Koizumi Y, Tsuzuki S, Ejima K, Takano M, Iwami S, Mizushima D, Oka S. Evaluating the cost-effectiveness of a pre-exposure prophylaxis program for HIV prevention for men who have sex with men in Japan. Sci Rep 2022; 12:3088. [PMID: 35197543 PMCID: PMC8866502 DOI: 10.1038/s41598-022-07116-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 02/14/2022] [Indexed: 11/09/2022] Open
Abstract
Men who have sex with men (MSM) have been disproportionally affected by the HIV epidemic in many countries, including Japan. Although pre-exposure prophylaxis (PrEP) is a strong prevention tool, it is not yet approved in Japan. A Markov model was developed to describe HIV infection and disease progression in an MSM cohort (N = 1000) in Japan receiving a PrEP program. The model was used to evaluate the cost-effectiveness of a PrEP program. HIV/AIDS treatment, screening, hospitalization due to AIDS, and PrEP were considered as costs and quality-adjusted life-years (QALYs) gained as utilities. Cost-effectiveness was assessed by comparing the incremental cost-effectiveness ratio (ICER) over a 30-year period against the willingness to pay (WTP) threshold. One-way sensitivity and probabilistic sensitivity analyses were performed. With 50% PrEP coverage, the PrEP program became dominant against the program without PrEP, using a threshold of 5.0 million JPY/QALY (45,455 USD). The probabilistic sensitivity analysis revealed that the PrEP program was dominant or at least cost-effective in most cases of 10,000 simulations. Therefore, preparing cheaper PrEP pills, which results in PrEP being dominant or ICER being lower than the WTP threshold, is important to make the program cost-effective. Introduction of PrEP to an MSM cohort in Japan would be cost-effective over a 30-year time horizon.
Collapse
Affiliation(s)
- Nao Yamamoto
- School of Human Evolution and Social Change, Arizona State University, Tempe, USA
| | - Yoshiki Koizumi
- National Center for Global Health and Medicine AIDS Clinical Center, Tokyo, Japan
| | - Shinya Tsuzuki
- National Center for Global Health and Medicine AMR Clinical Reference Center, Tokyo, Japan.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Keisuke Ejima
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, USA
| | - Misao Takano
- National Center for Global Health and Medicine AIDS Clinical Center, Tokyo, Japan
| | - Shingo Iwami
- Division of Biological Science, Graduate School of Science, Nagoya University, Nagoya, Japan. .,MIRAI, JST, Saitama, Japan. .,Nstitute for the Advanced Study of Human Biology (ASHBi), Kyoto University, Kyoto, Japan. .,NEXT-Ganken Program, Japanese Foundation for Cancer Research (JFCR), Tokyo, Japan. .,Science Groove Inc., Fukuoka, Japan.
| | - Daisuke Mizushima
- National Center for Global Health and Medicine AIDS Clinical Center, Tokyo, Japan.
| | - Shinichi Oka
- National Center for Global Health and Medicine AIDS Clinical Center, Tokyo, Japan.
| |
Collapse
|
10
|
Gómez W, Holloway IW, Pantalone DW, Grov C. PrEP uptake as a social movement among gay and bisexual men. CULTURE, HEALTH & SEXUALITY 2022; 24:241-253. [PMID: 33118858 PMCID: PMC8081761 DOI: 10.1080/13691058.2020.1831075] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 09/28/2020] [Indexed: 05/31/2023]
Abstract
Despite PrEP's effectiveness as an HIV prevention intervention, uptake among gay and bisexual men remains low. Historical involvement in AIDS activism may reveal important ways of mobilising gay and bisexual men to increase PrEP uptake. Data come from a qualitative study to understand New York City gay and bisexual men's experiences with PrEP. Informed by a constructivist grounded theory approach, we assessed ways in which gay and bisexual men's relational experiences concerning PrEP were congruent with features of past AIDS activism. Participants' mean age was 32.5 years, half were men of colour, and over half had been taking PrEP for less than one year. Analysis revealed three primary themes related to AIDS activism strategies: (1) framing, which referenced how participants referred to PrEP as an empowering, liberatory and community-building intervention (2) reactions, which encompassed positive to negative expressions about PrEP and sex; and (3) innovation, which conveyed ways that participants engaged in processes of transferring lay knowledge about PrEP through leadership roles across social and digital encounters. Findings suggest that the ways in which gay and bisexual men communicate about PrEP with peers are consistent with features of AIDS activism. Deploying lay knowledge using framing strategies through peer-based intervention could expand PrEP uptake. However, elements of PrEP stigma must be addressed to engage with the wide-ranging HIV prevention needs of gay and bisexual men.
Collapse
Affiliation(s)
- Walter Gómez
- School of Social Welfare, University of California, Berkeley, CA, USA
| | - Ian W. Holloway
- Luskin School of Public Affairs, University of California, Los Angeles, CA, USA
| | - David W. Pantalone
- College of Liberal Arts, University of Massachusetts, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Christian Grov
- City University of New York, Graduate School of Public Health and Health Policy, New York, NY, USA
- City University of New York, Institute for Implementation Science in Population Health, New York, NY, USA
| |
Collapse
|
11
|
Salabarría-Peña Y, Douglas C, Brantley M, Johnson AK. Informing the future of PrEP navigation: Findings from a five-site cluster evaluation. EVALUATION AND PROGRAM PLANNING 2022; 90:101999. [PMID: 34503854 DOI: 10.1016/j.evalprogplan.2021.101999] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
Abstract
The PrEP (pre-exposure prophylaxis) Implementation, Data to Care and Evaluation (PrIDE) demonstration project funded 12 health departments (HD) (2016-2019) to scale up PrEP among sexual minorities at risk for HIV. Each health department (HD) conducted an evaluation of at least one local strategy, and, to maximize crossvalidation, an adapted cluster evaluation approach was employed. As a result, five HDs with similar evaluation questions regarding PrEP navigation were identified. Overall, PrEP navigation fit in well with HD clinics and community-based organizations. A hybrid model of patient, peer, and systems navigation linking clients to PrEP and social services was commonly used. Although there were no differences by setting regarding linking clients to PrEP providers, one HD demonstrated that having all PrEP services in the same location contributed the most to PrEP uptake. Navigator skill for case management and rapport building facilitated navigation, whereas staff turnover and lack of client health insurance were challenges. While one HD in a non-Medicaid expansion state was affected by health insurance issues the most, another HD demonstrated that providing payment assistance increased client PrEP use. The findings pinpoint PrEP navigation hybrid modality and having health insurance as promising strategies to increase PrEP uptake among priority groups.
Collapse
Affiliation(s)
- Yamir Salabarría-Peña
- Centers for Disease Control and Prevention, 1600 Clifton Road, MS US8-5, Atlanta, GA 30329, USA.
| | - Chelsea Douglas
- Centers for Disease Control and Prevention, 1600 Clifton Road, MS US8-5, Atlanta, GA 30329, USA.
| | - Meredith Brantley
- Tennessee Department of Health, Andrew Johnson Tower, 4th Floor, 710 James Robertson Pkwy, Nashville, TN 37243, USA.
| | - Amy K Johnson
- Ann & Robert H. Lurie Children's Hospital and Northwestern University, 225 East Chicago Avenue, Box 161, Chicago, IL 60611-2605, USA.
| |
Collapse
|
12
|
Iseselo MK, Tarimo EAM, Sandstrom E, Kulane A. Awareness and willingness to use HIV oral pre-exposure prophylaxis among people who inject drugs in Dar es Salaam, Tanzania: A cross-sectional survey. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000776. [PMID: 36962766 PMCID: PMC10121179 DOI: 10.1371/journal.pgph.0000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/31/2022] [Indexed: 11/23/2022]
Abstract
People who inject drugs (PWID) are at increased risk of HIV infection. Pre-exposure prophylaxis (PrEP) could help in HIV prevention among PWIDs. However, little is known about PrEP use among PWIDs in low and middle-income countries. This study reports the awareness of and willingness to use PrEP and the associated factors among PWID in Tanzania. A cross-sectional survey was conducted using respondent-driven sampling (RDS) to recruit PWIDs in Dar es Salaam, Tanzania. Data were collected using an interviewer-administered questionnaire. Chi-square statistical test was used during data analysis. The P-value of < 0.05 was used to ascertain the statistically significant relationship. IBM SPSS Statistics 25.0 was used to analyze the data. The analysis consisted of 260 PWIDs. The mean age of the respondents was 39.0 years with a standard deviation (SD) of ±7.5. Most of the respondents were male (n = 232, 89.2%) with primary education (n = 176, 67.7%). Despite the low awareness of PrEP (n = 42, 165.28%) in the study sample, the majority (n = 239, 91.9%) were willing to use PrEP. Both awareness of and willingness to use PrEP were associated with gender (p = .002 and p = < .001), awareness of HIV prevention programs(p = < .001 and p = .006), selling sex (p = .010 and p = .021), and frequency of condomless sexual intercourse (p = .029 and p = .025) respectively. In multivariable logistic regression, only gender(p = 0.046) was related to awareness of PrEP while awareness of HIV prevention programs (p = 0.009), the risk level of HIV infection(p = < .001), number of sexual partners(p = 0.046), and frequency of condomless sex(p = 0.032) were associated with willingness to use PrEP. Other factors were not statistically significant. Despite low awareness, PWIDs are highly willing to use PrEP. Future research should assess the acceptability of injectable PrEP for PWID, as their acquaintance with injection may make the formulation more practical.
Collapse
Affiliation(s)
- Masunga K Iseselo
- Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, Sweden
| | - Edith A M Tarimo
- Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Eric Sandstrom
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Asli Kulane
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
13
|
Sun S, Yang C, Zaller N, Zhang Z, Zhang H, Operario D. PrEP Willingness and Adherence Self-Efficacy Among Men Who have Sex with Men with Recent Condomless Anal Sex in Urban China. AIDS Behav 2021; 25:3482-3493. [PMID: 33932186 PMCID: PMC8558112 DOI: 10.1007/s10461-021-03274-0] [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] [Accepted: 04/19/2021] [Indexed: 12/23/2022]
Abstract
This study investigates PrEP willingness, adherence self-efficacy and potential impact of PrEP among HIV-negative, Chinese men who have sex with men (MSM; n = 622) with recent condomless anal sex. Facilitative factors of PrEP willingness included migrant status, sexual risk, and prior PrEP use, whereas barriers included concerns over being treated as an HIV/AIDS patient, recent HIV testing, identity concealment, and HIV prevention service usage. Adherence self-efficacy was associated with PrEP knowledge and confidence in PrEP efficacy of HIV prevention. A total of 39.3% anticipated increase in sex partners, 25.6% anticipated decrease in condom use, and 38.0% anticipated increased HIV testing following PrEP uptake. Results suggest a two-step approach to (1) promote PrEP acceptance among Chinese MSM and (2) enhance adherence and risk monitoring among PrEP-willing MSM. Efforts to reduce stigma, incorporate PrEP in the HIV prevention continuum, and increase PrEP knowledge will be crucial to optimize PrEP implementation.
Collapse
Affiliation(s)
- Shufang Sun
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main St, Providence, RI, 02903, USA.
| | - Cui Yang
- Johns Hopkins University, Baltimore, USA
| | - Nickolas Zaller
- University of Arkansas for Medical Sciences, Little Rock, USA
| | | | | | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main St, Providence, RI, 02903, USA
| |
Collapse
|
14
|
Giovenco D, Kuo C, Underhill K, Hoare J, Operario D. Adolescent-Centered HIV Prevention: Perspectives on Acceptability of Oral Antiretroviral Pre-exposure Prophylaxis for Adolescents in a Global Priority Setting. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2921-2931. [PMID: 34561792 PMCID: PMC8744480 DOI: 10.1007/s10508-021-02052-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 05/07/2021] [Accepted: 05/15/2021] [Indexed: 06/13/2023]
Abstract
With oral antiretroviral pre-exposure prophylaxis (PrEP) rollout expanding to include adolescents in South Africa, research is needed to better understand perceptions of PrEP acceptability among adolescents and clinical service providers. We conducted an exploratory mixed-methods study among 57 adolescents, 16-17 years of age, living with and without HIV, and 25 clinical service providers in Cape Town, South Africa from 2015 to 2016. Cross-sectional survey and semi-structured qualitative interview data were used to explore (1) willingness to use PrEP and support partner PrEP use among adolescents living with and without HIV, (2) willingness to prescribe or support prescription of PrEP among service providers, and (3) perceptions of barriers and facilitators to PrEP implementation and interpretations of PrEP efficacy messaging for adolescent HIV prevention among all participants. Acceptability of PrEP among participants was high. Support for PrEP uptake was linked to messages that positively framed PrEP's protection potential (i.e., success- versus failure-framed messaging) among both adolescents and providers. Adolescents living without HIV endorsed high willingness to use PrEP and adolescents living with HIV endorsed high support for partner PrEP use. However, both groups noted that potential side effects, stigma, and PrEP's partial efficacy may hinder uptake. Clinical service providers endorsed PrEP for sexually active adolescents and shared stigma and efficacy concerns. Further, service providers expressed desire for adolescent-tailored training and integration of PrEP delivery into primary care and family planning services. Efforts to educate adolescents and service providers about PrEP should consider how message framing may influence acceptability. Community PrEP education and adolescent-friendly delivery should be prioritized to alleviate predicted PrEP stigma and facilitate uptake.
Collapse
Affiliation(s)
- Danielle Giovenco
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516, USA.
| | - Caroline Kuo
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Jacqueline Hoare
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| |
Collapse
|
15
|
Bärnighausen K, Geldsetzer P, Matse S, Hettema A, Hughey AB, Dlamini P, Mavuso M, Fakudze D, Kahn K, Bärnighausen T, McMahon SA. Qualitative accounts of PrEP discontinuation from the general population in Eswatini. CULTURE, HEALTH & SEXUALITY 2021; 23:1198-1214. [PMID: 32633617 DOI: 10.1080/13691058.2020.1770333] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
People in receipt of pre-exposure prophylaxis (PrEP) for the prevention of HIV in Sub-Saharan Africa often discontinue taking the medication. We conducted 27 semi-structured interviews with men and women who had started PrEP but did not return to the clinic for a refill after a 1, 2 or 3-month period. These 'discontinuation' clients were enrolled in a PrEP demonstration project for the general population in nurse-led, public-sector, primary-care clinics in Eswatini. Reasons for discontinuation included changes to self-perceived HIV risk such as the end of pregnancy and absent partners. Others described PrEP as inaccessible when working away from home and many described difficulties relating to a daily pill regimen and managing side effects. Female clients described being prohibited from using PrEP by their partners and co-wives. From these results, we recommend that client-centred counselling stresses the prevention-effective adherence paradigm, which promotes PrEP use in risk periods that are identifiable and PrEP discontinuation when the risk period has finished. A national scale up of PrEP may mitigate problems accessing PrEP. Extended counselling and support could assist with adherence and the management of side effects. Education and support for partners and families of PrEP clients may also contribute to better PrEP continuation.
Collapse
Affiliation(s)
- Kate Bärnighausen
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Pascal Geldsetzer
- Faculty of Medicine, Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Stanford University School of Medicine, Stanford, CA, USA
| | - Sindy Matse
- Eswatini Ministry of Health, Mbabane, Eswatini
| | - Anita Hettema
- Clinton Health Access Initiative Eswatini, Mbabane, Eswatini
| | | | - Phiwa Dlamini
- Clinton Health Access Initiative Eswatini, Mbabane, Eswatini
| | - Mxolisi Mavuso
- Clinton Health Access Initiative Eswatini, Mbabane, Eswatini
| | - David Fakudze
- Clinton Health Access Initiative Eswatini, Mbabane, Eswatini
| | - Kathleen Kahn
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Till Bärnighausen
- Faculty of Medicine, Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Shannon A McMahon
- Faculty of Medicine, Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
16
|
Ware KB, Ajonina MU. Awareness of and willingness to use HIV pre-exposure prophylaxis among community residents. Res Social Adm Pharm 2021; 17:1957-1961. [PMID: 33658158 DOI: 10.1016/j.sapharm.2021.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Human Immunodeficiency Virus (HIV) Pre-exposure prophylaxis (PrEP) helps to decrease HIV acquisition and transmission rates. The purpose of this study was to assess awareness of HIV PrEP and willingness to use it, if available, among individuals residing in Buea, Cameroon. METHODS Residents in different communities throughout Buea, Cameroon participated in the study through survey completion with their responses assessed by age, marital status, highest level of education completed, profession, and health area (urban or rural). RESULTS 421 participants completed the survey with the majority being 20-29 years of age, single, having secondary or tertiary education, residing in rural Cameroonian areas. Eighty percent of respondents had not previously heard of HIV PrEP. Ninety-five percent of the study sample expressed willingness to use HIV PrEP, if available. Participants ages 40 years old and above were less aware of HIV PrEP than those 39 years old and younger. Primary education, serving in the role of a nurse, doctor, or scientist, along with hospital affiliations were characteristics closely associated with HIV PrEP awareness. Participants younger than 20 years old were less likely to report willingness to use HIV PrEP whereas married participants found HIV PrEP to be a more favorable option. CONCLUSIONS Awareness of HIV PrEP was minimal with healthcare personnel having more familiarity. Willingness to use HIV PrEP decreased by age but higher among married participants. Further promotion of HIV PrEP and facilitating its accessibility can lead to less transmissions of HIV worldwide.
Collapse
Affiliation(s)
- Kenric B Ware
- South University School of Pharmacy, Department of Pharmacy Practice, 10 Science Court, Columbia, SC, 29203, USA.
| | - Marcelus U Ajonina
- Department of Public Health, Faculty of Health Sciences, University of Bamenda, Bambili, Bamenda, Cameroon; School of Health Sciences, Meridian Global University, Southwest Region, Buea, Cameroon.
| |
Collapse
|
17
|
Shangani S, Bhaskar N, Richmond N, Operario D, van den Berg JJ. A systematic review of early adoption of implementation science for HIV prevention or treatment in the United States. AIDS 2021; 35:177-191. [PMID: 33048881 DOI: 10.1097/qad.0000000000002713] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To provide the first systematic review of the early adoption of implementation science for HIV prevention or treatment in the United States. We identified primary research studies that addressed implementation of HIV prevention or treatment in the United States and qualitatively assessed the reporting of implementation outcomes and intervention descriptions. METHODS We searched PubMed, PsycInfo, and CINAHL databases for evaluations of HIV prevention or treatment interventions that at least reported one implementation outcome and were published between 2014 and 2018. We used the 12-item Template for Intervention Description and Replication to assess study interventions. RESULTS A total of 2275 articles were identified. Thirty-nine studies met inclusion criteria. Of these, 84.6% used quantitative methods with 5% being hybrid effectiveness-implementation studies and 15% used qualitative methods. No studies cited a formal theoretical framework for implementation science. Acceptability and feasibility were the most frequently reported implementation outcomes. Eligible studies were diverse with regard to demographic categories. Most interventions focused on HIV prevention, particularly risk-reduction strategies. HIV treatment interventions targeted linkage to care and adherence to medications. Key implementation outcome findings indicated that these interventions are feasible and acceptable in the real world. CONCLUSION HIV implementation science could support dissemination of HIV prevention or treatment in the United States, although HIV treatment interventions are limited. Theoretical frameworks and key implementation outcomes like fidelity, penetration, and appropriateness could promote the rigor of future HIV treatment implementation research, helping the field deliver the promise of HIV prevention or treatment efforts in the United States.
Collapse
Affiliation(s)
- Sylvia Shangani
- College of Health Sciences, Department of Community & Environmental Health, Old Dominion University, Norfolk, Virginia
| | - Nidhi Bhaskar
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
| | - Natasha Richmond
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
| | - Don Operario
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
| | - Jacob J van den Berg
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| |
Collapse
|
18
|
Pre-exposure Prophylaxis Knowledge and Use Among Men Who Have Sex With Men in a Small Metropolitan Region of the Southeastern United States. J Assoc Nurses AIDS Care 2020; 31:80-91. [PMID: 31433361 DOI: 10.1097/jnc.0000000000000115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Men who have sex with men (MSM) in the southeastern United States continue to be at high risk for HIV. Pre-exposure prophylaxis (PrEP) provides effective prevention, but PrEP awareness varies across communities. We assessed sexual risk, HIV/sexually transmitted infection (STI) testing history, health care experiences associated with PrEP awareness, provider discussions, and PrEP use in a sample of 164 MSM in the Central Savannah River Area of the South. Results revealed that 80.5% of participants were aware of PrEP, 16.4% had discussed PrEP with a provider, and 9.2% had used PrEP. Education, gay identity, HIV status, recent HIV testing, and lack of provider awareness about sexual minorities independently predicted PrEP awareness. Recent STI testing independently predicted increased odds of PrEP discussion. Recent HIV and STI testing and non-White identity were associated with PrEP use. Effective, tailored marketing, provider competence, and open communication can increase PrEP adoption by southern MSM.
Collapse
|
19
|
Young I, Valiotis G. Strategies to support HIV literacy in the roll-out of pre-exposure prophylaxis in Scotland: findings from qualitative research with clinical and community practitioners. BMJ Open 2020; 10:e033849. [PMID: 32350011 PMCID: PMC7213852 DOI: 10.1136/bmjopen-2019-033849] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Limited understanding of pre-exposure prophylaxis (PrEP), coupled with negative public discourse, are significant barriers to its introduction. What works to support PrEP awareness and broader HIV literacy among diverse communities in the context of biomedical HIV prevention remains unclear. This article considers how PrEP can be translated across diverse communities and what the HIV literacy challenges might be in the current context of PrEP provision. SETTING We developed an HIV literacy informed community tool to support the roll-out of PrEP in Scotland. We undertook qualitative research with practitioners in urban and rural settings across nine Scottish health boards. PRIMARY OUTCOME MEASURE To examine HIV literacy challenges in the context of PrEP provision. PARTICIPANTS Interviews and focus groups with community (n=19) and clinical (n=13) practitioners working with gay and bisexual men and African communities were undertaken between March and October 2017 concerning PrEP support, stigma and HIV literacy. RESULTS HIV literacy in the context of PrEP needs to consider more than the provision of individually targeted information. Practitioners identified and responded to stratified communities and social norms of knowledge, which influenced messaging, support and informed how practitioners enabled PrEP engagement and dialogue. Social barriers in HIV literacy, including structural stigmas relating to HIV and homophobia, shaped practitioner concerns and support for community members' willingness to engage with PrEP. CONCLUSION Critical HIV literacy in the age of PrEP is a complex social practice. Attention needs to be paid to how information is provided and facilitates engagement, rather than simply what information is given.By exploring practitioner use of the Know about PrEP tool, we have shown how consideration of the patterns of access to services and information, the delivery of and support for engagement with PrEP information and the wider strategies employed to negotiate ongoing structural social barriers can support more equitable and diverse PrEP community conversations.
Collapse
Affiliation(s)
- Ingrid Young
- Centre for Biomedicine, Self and Society, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | |
Collapse
|
20
|
Sullivan PS, Mena L, Elopre L, Siegler AJ. Implementation Strategies to Increase PrEP Uptake in the South. Curr HIV/AIDS Rep 2020; 16:259-269. [PMID: 31177363 DOI: 10.1007/s11904-019-00447-4] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Seven years after TDF/FTC was approved for pre-exposure prophylaxis to reduce risks of HIV infection, there have been large increases in the number of persons using PrEP in the USA. However, recent data on pre-exposure prophylaxis (PrEP) use at the state level indicate that people living in the Southern United States are underserved by PrEP relative to their epidemic need. We sought to review possible reasons for inequitable uptake of PrEP in the South and identify implementation approaches to increase PrEP uptake in the South. RECENT FINDINGS Published literature, data on the locations of PrEP service providers, recent data on PrEP utilization from pharmacy prescription databases, HIV surveillance data and government data on healthcare providers, and health literacy indicate a confluence of factors in the South that are likely limiting PrEP uptake. A variety of approaches are needed to address the complex challenges to PrEP implementation in the South. These include considering alternative PrEP provision strategies (e.g., pharmacy-based PrEP, telemedicine-delivered PrEP), conducting gain-based stigma-reduction campaigns, increasing capacity for reimbursement for PrEP medications and services through policy change to expand Medicaid and to preserve access to Affordable Care Act-compliant health plans, expanding STI screening programs and improving integration of PrEP offering with delivery of positive STI results, using mHealth tools to screen groups at highest risk for HIV (e.g., men who have sex with men) periodically to increase correct perception of risk, and streamlining clinical procedures to allow same-day PrEP starts for patients without obvious medical contraindications. Overcoming the structural, capacity, and policy challenges to increasing PrEP uptake in the South will require innovations in clinical approaches, leveraging technologies, and policy changes. The South has unique challenges to achieving equitable PrEP uptake, and addressing key barriers to expanded PrEP use will require multisectoral responses.
Collapse
Affiliation(s)
- Patrick S Sullivan
- Rollins School of Public Health, Department of Epidemiology, Emory University, 1518 Clifton Road NE, Room 464, Atlanta, GA, 30322, USA.
| | - Leandro Mena
- John D. Bower School of Population Health, Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Latesha Elopre
- School of Medicine, University of Alabama, Birmingham, AL, USA
| | - Aaron J Siegler
- Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA
| |
Collapse
|
21
|
Underhill K. Perceptions of Protection under Nondiscrimination Law. AMERICAN JOURNAL OF LAW & MEDICINE 2020; 46:21-54. [PMID: 32460651 DOI: 10.1177/0098858820919551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Nondiscrimination rules-statutes, regulations, and soft law protections-are critical for reducing health and health care disparities. Although scholarship has interrogated how nondiscrimination rules affect behavior by discriminators, comparatively little has considered how protections can affect choices made by members of protected groups. A number of states and some interpretations of federal law protect people from discrimination on the basis of sexual orientation. This Article seeks to identify relationships between actual state law, perceived state law, and experiences of discrimination and medical mistrust. This Article reports the results of a national cross-sectional survey of over 3,000 men using Grindr to meet male partners. Participants scored comparable to chance in knowledge about state nondiscrimination protections, with "optimistic errors" (erroneous beliefs that one was protected) significantly more common than pessimistic errors. Perceptions of protection were significantly correlated with lower medical mistrust and greater uptake of care, as well as lower perceived barriers to disclosure and care-seeking. Actual state law protections, however, were significant predictors of having had discussions with providers that depended on disclosure of sexual behavior or orientation. Building on these results, this Article considers pathways by which nondiscrimination law may exert welcome mat (and "unwelcome mat") effects.
Collapse
Affiliation(s)
- Kristen Underhill
- Associate Professor of Law, Columbia Law School. Associate Professor of Population & Family Health, Mailman School of Public Health, Columbia University. J.D., Yale Law School; D.Phil., University of Oxford. This research was funded by K01-MH093273 from the National Institute of Mental Health. I am grateful to the study participants for sharing their thoughts and experiences. I am also grateful to the peer reviewers and commentators at the American Society of Law, Medicine & Ethics Health Law Professors Conference; the Behavioral Law and Economics conference; the Columbia Faculty Workshop; the Harvard Health Law Workshop; the Mailman School Department of Population & Family Health; the Penn State Health Services Research Colloquium; and the Regional Health Law Works-in-Progress Retreat for valuable feedback on this work. I thank Leo Beletsky, I. Glenn Cohen, Carl Coleman, Mark Hatzenuehler, Suzanne Goldberg, Bert Huang, Craig Konnoth, Terry McGovern, Adam Muchmore, Govind Persad, and Brian Sheppard for helpful comments and discussion. I am grateful to Kenneth H. Mayer, Don Operario, Kate Guthrie, Peter Salovey, Christopher Kahler, and Sarah K. Calabrese for guidance and collaboration on the K01 study that included this survey. All errors herein are my own
| |
Collapse
|
22
|
Pagkas-Bather J, Jaramillo J, Henry J, Grandberry V, Ramirez LF, Cervantes L, Stekler JD, Andrasik MP, Graham SM. What's PrEP?: peer navigator acceptability among minority MSM in Washington. BMC Public Health 2020; 20:248. [PMID: 32070318 PMCID: PMC7029512 DOI: 10.1186/s12889-020-8325-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 02/05/2020] [Indexed: 01/01/2023] Open
Abstract
Background Peer navigation is a promising strategy to link at-risk minority men who have sex with men (MSM) to HIV prevention services including pre-exposure prophylaxis (PrEP). Methods Thirty-two Black and 63 Latinx HIV-negative MSM living in western Washington completed a survey examining attitudes towards peer navigation and PrEP. Factor analysis derived a score for peer navigator acceptability, and linear regression identified associations with this outcome. Results Forty-eight percent were interested in peer navigation. Being insured, higher sexual stigma, and higher PHQ-9 score were associated with higher acceptability, while higher income and having a regular medical provider were associated with lower acceptability. In multivariable analysis, higher sexual stigma predicted higher acceptability, while higher income predicted lower acceptability. Men preferred that peers be matched on sexual orientation, race, age and culture. Conclusion Peer navigation interventions to reach minority men should address stigma, focus on lower-income men, and try to match peers to clients to the extent possible.
Collapse
Affiliation(s)
- Jade Pagkas-Bather
- Department of Medicine, University of Washington, Seattle, WA, USA. .,Department of Medicine, Section of Infectious Diseases & Global Health, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL, 60637, USA.
| | - Jahn Jaramillo
- Centers for Disease Control and Prevention, Guatemala City, Guatemala
| | - Jsani Henry
- Seattle & King County Public Health HIV/STD Program, Seattle, WA, USA
| | | | | | | | - Joanne D Stekler
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Susan M Graham
- Department of Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|
23
|
Brief Report: Quantitative Assessment of Brief Messages About HIV Pre-exposure Prophylaxis Among HIV-Infected and HIV-Uninfected Black/African American and Hispanic/Latino MSM. J Acquir Immune Defic Syndr 2019; 80:31-35. [PMID: 30272636 DOI: 10.1097/qai.0000000000001869] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND HIV pre-exposure prophylaxis (PrEP) is efficacious; however, many men who have sex with men (MSM) (especially racial/ethnic minorities) are still unaware of and underuse it. METHODS The 2014 Messages4Men Study focuses on black and Hispanic/Latino MSM in Chicago, Fort Lauderdale, and Kansas City (n = 937). Brief (2-3 sentence) messages were tested: a PrEP message tailored for HIV-uninfected MSM (n = 607) and a PrEP message tailored for HIV-infected MSM (n = 330). After reading the message, participants reported believability and awareness, and intent to use PrEP and condoms. Analyses consisted of bivariate and multivariable approaches. RESULTS Among HIV-uninfected MSM, black (vs Hispanic/Latino) MSM indicated greater intentions to use PrEP (81% vs 70% respectively, P < 0.05); 72% overall had similar intentions to use condoms after hearing a PrEP message. PrEP information was new (63%) and believable (80%), with no racial/ethnic differences (P > 0.05). In multivariable analysis, men who reported recent condomless anal sex were less likely to report that the PrEP message enhanced their intent to use condoms in the future. DISCUSSION Several years into the availability of PrEP, black and Hispanic/Latino MSM continue to be unaware of PrEP and its benefits, although information is largely believable once provided. The HIV prevention field should be prepared to incorporate new information about HIV prevention options into brief messages delivered through technology and social media.
Collapse
|
24
|
Friedman MR, Sang JM, Bukowski LA, Chandler CJ, Egan JE, Eaton LA, Matthews DD, Ho K, Raymond HF, Stall R. Prevalence and Correlates of PrEP Awareness and Use Among Black Men Who Have Sex with Men and Women (MSMW) in the United States. AIDS Behav 2019; 23:2694-2705. [PMID: 30820849 PMCID: PMC6713621 DOI: 10.1007/s10461-019-02446-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Men who have sex with men and women (MSMW), including those who are Black, experience HIV-related disparities compared to men who have sex with men only (MSMO). Few studies have assessed the prevalence and correlates of pre-exposure prophylaxis (PrEP) awareness and use among Black MSMW. We recruited MSM ≥ 18 attending Black Gay Pride events between 2014-2017. We conducted multivariable logistic regressions to assess differences in PrEP awareness and use among HIV-negative Black MSM (n = 2398) and within Black MSMW (n = 419). MSMW were less likely than MSMO to report PrEP awareness (p < 0.001). Among PrEP-aware MSM, MSMW were more likely than MSMO to report PrEP use (p < 0.05). MSMW receiving gay community support were more likely to be PrEP-aware (p < 0.01). MSMW reporting any past-year STI diagnoses were more likely to report PrEP use (p < 0.01). Findings suggest that PrEP awareness campaigns tailored for Black MSMW, concomitant with STI-to-PrEP interventions, will facilitate greater PrEP uptake in this population.
Collapse
Affiliation(s)
- M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, PO Box 7319, Pittsburgh, PA, 15213, USA.
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Jordan M Sang
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Leigh A Bukowski
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cristian J Chandler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - James E Egan
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa A Eaton
- Department of Human Development and Family Studies, University of Connecticut, Hartford, CT, USA
| | - Derrick D Matthews
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Ken Ho
- Division of Infectious Diseases, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Henry F Raymond
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Ron Stall
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
25
|
Longino A, Montano MA, Sanchez H, Bayer A, Sanchez J, Tossas-Milligan K, Duerr A, Molina Y. Increasing PrEP uptake and adherence among MSM and TW sex workers in Lima, Perú: what and whom do different patients trust? AIDS Care 2019; 32:255-260. [PMID: 31242753 DOI: 10.1080/09540121.2019.1634787] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In Perú, men who have sex with men (MSM) and transgender women (TW) suffer rates of HIV 50 times greater than the general population. MSM or TW sex workers (SWs) are at especially high risk. Daily oral pre-exposure prophylaxis (PrEP) effectively prevents HIV infection if patients adhere to a daily or on-demand regimen. Necessary levels of adoption and adherence require data-driven intervention strategies for these marginalized groups. We conducted qualitative content analysis of data obtained from focus groups (FGs) with MSM and TW SWs. Both groups expressed strong skepticism about the motives behind international drug trials, and the safety of participating in them. Important differences between MSM and TW groups' beliefs about trustworthy information as well as community and public institutions also emerged. MSM SWs were less trusting of information from other MSM SWs, and preferred to receive information from institutional medical sources, while TGW SWs preferred to receive information from other TGW SWs. Successful strategies to encourage PrEP uptake and adherence must address the distrust patients feel towards international and institutional actors by providing patients with tailored, reliable information from local and community sources that they trust.
Collapse
Affiliation(s)
- August Longino
- School of Medicine, University of Washington, Seattle, USA
| | | | | | - Angela Bayer
- Epidemiology, STI, and HIV Research Unit, School of Public Health and Administration, Universidad Perúana Cayetano Heredia, Lima, Perú.,David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jorge Sanchez
- Centro de Investigación Tecnologicas, Biomedicas y Medioambientales, Universidad Mayor de San Marcos, Lima, Perú
| | - Kathy Tossas-Milligan
- University of Illinois Cancer Center, Office of Global Assets and Innovative Solutions, Chicago, USA
| | - Ann Duerr
- School of Medicine, University of Washington, Seattle, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Yamilé Molina
- University of Illinois Cancer Center, Office of Global Assets and Innovative Solutions, Chicago, USA.,School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
26
|
Wu Y, Xie L, Meng S, Hou J, Fu R, Zheng H, He N, Meyers K. Mapping Potential Pre-Exposure Prophylaxis Users onto a Motivational Cascade: Identifying Targets to Prepare for Implementation in China. LGBT Health 2019; 6:250-260. [PMID: 31170020 DOI: 10.1089/lgbt.2018.0256] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose: China recently commenced several pre-exposure prophylaxis (PrEP) projects, but little work has characterized potential users. This study describes awareness of, intention to use, and uptake of PrEP in a sample of men who have sex with men (MSM), a key population experiencing high rates of HIV in China. Methods: Through a cross-sectional survey administered to 708 MSM in four cities, we mapped respondents onto a Motivational PrEP Cascade. We conducted bivariable and multivariable analysis to examine factors associated with progression through the Cascade. Results: Among 45.6% of MSM who were PrEP eligible, 36% were in Contemplation, 9% were in PrEParation, 2% were in PrEP Action and Initiation, and none reached Maintenance and Adherence. We found no association between individual risk factors and progression through the Cascade. In multivariable analysis, friends' positive attitudes toward PrEP, more frequent sexually transmitted infection testing, and higher scores on the perceived PrEP benefits scale were positively associated with entering PrEP Contemplation. Having higher condom use self-efficacy was associated with decreased odds of entering PrEP Contemplation. Having sex with men and women in the past 6 months, having heard of PrEP from medical providers, and knowing a PrEP user were positively associated with entering PrEParation. Conclusion: We found a high proportion of MSM who were PrEP eligible and identified several intervention targets to prepare for PrEP introduction in China: community education to increase accurate knowledge, gain-framed messaging for PrEP and sexual health, and provider trainings to build MSM-competent services that can support shared decision-making for PrEP initiation.
Collapse
Affiliation(s)
- Yumeng Wu
- 1 Aaron Diamond AIDS Research Center, The Rockefeller University, New York, New York
| | - Lu Xie
- 2 Institute of HIV/AIDS, The First Hospital of Changsha, Changsha, China
| | - Siyan Meng
- 3 School of Public Health, Fudan University, Shanghai, China
| | - Jianhua Hou
- 4 Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Rong Fu
- 5 Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Huang Zheng
- 6 Shanghai CSW & MSM Center, Shanghai, China
| | - Na He
- 3 School of Public Health, Fudan University, Shanghai, China
| | - Kathrine Meyers
- 1 Aaron Diamond AIDS Research Center, The Rockefeller University, New York, New York
| |
Collapse
|
27
|
Sun CJ, Anderson KM, Toevs K, Morrison D, Wells C, Nicolaidis C. "Little Tablets of Gold": An Examination of the Psychological and Social Dimensions of PrEP Among LGBTQ Communities. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:51-62. [PMID: 30742478 DOI: 10.1521/aeap.2019.31.1.51] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
There are significant psychological, social, and cultural dimensions to the HIV epidemic in the United States, especially among lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities. Biomedical HIV treatment has been shown to impact these dimensions. However, there is little understanding of the real-world psychosocial and sociocultural effects of the latest biomedical HIV prevention strategy, HIV pre-exposure prophylaxis (PrEP). This study explored the psychosocial and sociocultural dimensions of PrEP use among LGBTQ adults. We interviewed 23 LGBTQ adults who were current or former users of PrEP. Results included that PrEP users' experiences were shaped by multiple forms of stigma. Participants were highly motivated to challenge PrEP stigma and to support PrEP use among other community members. Lastly, participants described positive impacts on their individual well-being and their sexual partnerships. Findings suggest that PrEP has significant impacts beyond biomedical outcomes for both the individuals who use PrEP and their communities.
Collapse
Affiliation(s)
- Christina J Sun
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon
| | - Kirsten M Anderson
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon
| | - Kim Toevs
- Multnomah County Health Department, Portland, Oregon
| | - Dayna Morrison
- Oregon AIDS Education and Training Center at Portland Veterans Affairs Research Foundation, Portland, Oregon
| | | | - Christina Nicolaidis
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, and the School of Social Work, Portland State University, Portland, Oregon
| |
Collapse
|
28
|
Rivet Amico K, Bekker LG. Global PrEP roll-out: recommendations for programmatic success. Lancet HIV 2019; 6:e137-e140. [PMID: 30660592 DOI: 10.1016/s2352-3018(19)30002-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 12/17/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is being adopted and rolled out in diverse regions, communities, and groups. Although it has been shown to be effective, in some settings PrEP roll-out has lagged, in part due to flawed messaging. Lessons can be learned and principles applied from marketing to highlight the potential pitfalls of current roll-out strategies focused on selective and siloed service provision. After exploration of the way PrEP is promoted in awareness messaging (the sell), marketed to select and often stigmatised groups (the brand), and offered as a special or non-integrated service (product placement), we propose that current strategies can ultimately slow roll-out and contribute to stigma surrounding PrEP use. We propose alternatives for programmes and ministries to consider as they develop long-term plans for HIV prevention. We propose that the sell should focus on protection or wellness framing, the branding should convey PrEP as appropriate for anyone in need, and the provision of PrEP should be placed in the context of other relevant and valued health services. As has been shown in some PrEP programmes, it is possible for programmes to adopt modern marketing strategies that are attractive to healthy clients and might promote an inclusive and holistic vision of biomedical prevention.
Collapse
Affiliation(s)
- K Rivet Amico
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, Cape Town, South Africa.
| |
Collapse
|
29
|
Rubincam C, Newman PA, Atujuna M, Bekker LG. 'Why would you promote something that is less percent safer than a condom?': Perspectives on partially effective HIV prevention technologies among key populations in South Africa. SAHARA J 2018; 15:179-186. [PMID: 30360675 PMCID: PMC6211311 DOI: 10.1080/17290376.2018.1536561] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
New biomedical prevention technologies (NPTs) for HIV, including oral Pre-Exposure Prophylaxis, and vaginal and rectal microbicides and HIV vaccines in development, may contribute substantially to controlling the HIV epidemic. However, their effectiveness is contingent on product acceptability and adherence. We explored perceptions and understanding of partially effective NPTs with key populations in South African townships. From October 2013 to February 2014, we conducted six focus groups and 18 individual interviews with Xhosa-speaking adolescents (n = 14), adult men who have sex with men (MSM) (n = 15), and adult heterosexual men (n = 9) and women (n = 10), and eight key informant (KI) interviews with healthcare workers. Interviews/focus groups were transcribed and reviewed using a thematic approach and framework analysis. Overall, participants and KIs indicated scepticism about NPTs that were not 100% efficacious. Some participants equated not being 100% effective with not being completely safe, and thus not appropriate for dissemination. KIs expressed concerns that promoting partially effective NPTs would encourage substitution of a more effective with a less effective method or encourage risk compensation. Educational and social marketing interventions that address the benefits and appropriate use of partially effective NPTs, including education and support tailored for frontline service providers, are needed to prepare for successful NPT implementation in South Africa.
Collapse
Affiliation(s)
- Clara Rubincam
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Peter A. Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Millicent Atujuna
- Desmond Tutu HIV Foundation, Institute of Infectious Disease, Health Sciences Faculty, University of Cape Town, Cape Town, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Foundation, Institute of Infectious Disease, Health Sciences Faculty, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
30
|
Bazzi AR, Biancarelli DL, Childs E, Drainoni ML, Edeza A, Salhaney P, Mimiaga MJ, Biello KB. Limited Knowledge and Mixed Interest in Pre-Exposure Prophylaxis for HIV Prevention Among People Who Inject Drugs. AIDS Patient Care STDS 2018; 32:529-537. [PMID: 30311777 DOI: 10.1089/apc.2018.0126] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
People who inject drugs (PWID) experience sexual and injection-related HIV risks, but uptake of pre-exposure prophylaxis (PrEP) for HIV prevention among PWID has been low. Improving PrEP uptake in this population will require understanding of PrEP knowledge and interest. In 2017, we conducted in-depth, semistructured interviews with HIV-uninfected PWID and key informants (PrEP and harm reduction providers) in the US Northeast. Thematic analysis of coded data explored PrEP knowledge and the factors that influence PrEP interest. Among PWID (n = 33), median age was 36 years, 55% were male, 67% were white, and 24% identified as Hispanic/Latino. Accurate PrEP knowledge among PWID was low, which key informants (n = 12) attributed to PrEP marketing focused on other risk populations, as well as healthcare providers' lack of time and unwillingness to discuss PrEP with PWID. There was a discrepancy between self-reported HIV risk behaviors, which were common, and HIV risk perceptions, which varied and strongly influenced PrEP interest. Most PWID and key informants thought that PrEP would be most beneficial for those who shared syringes, used discarded syringes, engaged in transactional sex, or were homeless. Improving uptake of PrEP for HIV prevention among high-risk PWID will require education to increase PrEP knowledge and addressing factors that negatively influence PrEP interest such as perceptions regarding low HIV risk and the process for obtaining PrEP. This may require specialized PrEP marketing and outreach efforts and improved capacity of healthcare providers to effectively assess HIV risk (and perceptions) and communicate the benefits of PrEP to at-risk PWID.
Collapse
Affiliation(s)
- Angela R. Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Dea L. Biancarelli
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
- Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, Massachusetts
| | - Ellen Childs
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, Massachusetts
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts
| | - Alberto Edeza
- Center for Health Equity Research, Brown University, Providence, Rhode Island
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Peter Salhaney
- Center for Health Equity Research, Brown University, Providence, Rhode Island
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Matthew J. Mimiaga
- Center for Health Equity Research, Brown University, Providence, Rhode Island
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, Rhode Island
| | - Katie B. Biello
- Center for Health Equity Research, Brown University, Providence, Rhode Island
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| |
Collapse
|
31
|
Halkitis PN, Jaiswal J, Griffin-Tomas M, Krause KD, D'Avanzo P, Kapadia F. Beliefs About the End of AIDS, Concerns About PrEP Functionality, and Perceptions of HIV Risk as Drivers of PrEP Use in Urban Sexual Minority Men: The P18 Cohort Study. AIDS Behav 2018; 22:3705-3717. [PMID: 29971731 PMCID: PMC10976398 DOI: 10.1007/s10461-018-2218-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Using cross-sectional data from an ongoing cohort study of young gay, bisexual, and other men who have sex with men (N = 492), we examined the extent to which cognitive factors such as beliefs about the end of AIDS, concerns about the manner in which PrEP works, and perceptions about risk of contracting HIV, are related to PrEP uptake and use. While almost all participants indicted awareness of PrEP, a mere 14% had ever used PrEP. Those with lower concerns about the side effects of PrEP and greater belief that treatment and PrEP would eliminate AIDS were also more likely to have ever used PrEP. Our findings support the ongoing challenges of PrEP uptake as means of curtailing HIV in young sexual minority men, and suggest that beyond the structural factors, consideration must be given to further educating the population as a means of adjusting potentially faulty beliefs, concerns, and perceptions which may influence PrEP utilization.
Collapse
Affiliation(s)
- Perry N Halkitis
- Department of Biostatistics, Rutgers School of Public Health, Rutgers University, 683 Hoes Lane West, Piscataway, NJ, 08854, USA.
- Department of Social and Behavioral Health Sciences, Rutgers University, 683 Hoes Lane West, Piscataway, NJ, 08854, USA.
- Center for Health, Identity, Behavior & Prevention Studies, 65 Bergen St, Newark, 07107, NJ, USA.
- Graduate School of Applied & Professional Psychology, Rutgers University, 152 Frelinghuysen Road, Busch Campus, Piscataway, NJ, 08854, USA.
- Robert Wood Johnson School of Medicine, Rutgers University, 675 Hoes Ln W, Piscataway, NJ, 08854, USA.
- School of Public Policy and Administration, Rutgers University, 401 Cooper Street, Camden, NJ, 08102, USA.
| | - Jessica Jaiswal
- Center for Health, Identity, Behavior & Prevention Studies, 65 Bergen St, Newark, 07107, NJ, USA
- Center for Interdisciplinary Research on AIDS, Yale University, 135 College St., Ste. 200, New Haven, CT, 06510, USA
| | - Marybec Griffin-Tomas
- Center for Health, Identity, Behavior & Prevention Studies, 65 Bergen St, Newark, 07107, NJ, USA
| | - Kristen D Krause
- Center for Health, Identity, Behavior & Prevention Studies, 65 Bergen St, Newark, 07107, NJ, USA
| | - Paul D'Avanzo
- Center for Health, Identity, Behavior & Prevention Studies, 65 Bergen St, Newark, 07107, NJ, USA
- College of Public Health, Temple University, 1101 W. Montgomery Ave, Philadelphia, PA, 19122, USA
| | - Farzana Kapadia
- Center for Health, Identity, Behavior & Prevention Studies, 65 Bergen St, Newark, 07107, NJ, USA
- Department of Epidemiology, College of Global Public Health, New York University, 719 Broadway, 10th Floor, New York, NY, 10003, USA
- Department of Population Health, School of Medicine, New York University, 227 East 30th Street, New York, NY, 10016, USA
| |
Collapse
|
32
|
Zheng ZW, Qiu JL, Gu J, Xu HF, Cheng WB, Hao C. Preexposure prophylaxis comprehension and the certainty of willingness to use preexposure prophylaxis among men who have sex with men in China. Int J STD AIDS 2018; 30:4-11. [PMID: 30139308 DOI: 10.1177/0956462418781142] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Preexposure prophylaxis (PrEP) is not available in China and the willingness to use PrEP among Chinese men who have sex with men (MSM) is not clear. The aim of this study was to better understand the association between PrEP comprehension and the willingness to use PrEP under varying conditions among MSM. An online survey investigating personal characteristics, PrEP comprehension, and PrEP willingness among MSM was conducted. A third of respondents (36.2%, 196 out of 541) reported that they would like to use PrEP. Compared with MSM with a basic level of PrEP comprehension, MSM with a high level were more likely to report clear choices: a willingness or unwillingness to use PrEP (82.4% versus 65.7%, p <0.01). Among 350 MSM willing to use PrEP or uncertain about uptake, those with a high level of PrEP comprehension were more likely to use PrEP daily (adjusted odds ratio [AOR] = 1.71, 95% confidence interval 1.04-2.80), and to use PrEP with mild or other side effects (AOR = 2.72 or 2.77). A high level of PrEP comprehension is a key factor in urging MSM to use PrEP under varying conditions. Our findings call attention to the need for health education to improve PrEP comprehension.
Collapse
Affiliation(s)
- Zhi-Wei Zheng
- 1 Department of Medical Statistics and Epidemiology & Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, China
| | - Jia-Ling Qiu
- 1 Department of Medical Statistics and Epidemiology & Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, China
| | - Jing Gu
- 1 Department of Medical Statistics and Epidemiology & Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, China
- 2 Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Hui-Fang Xu
- 3 Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Wei-Bin Cheng
- 3 Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Chun Hao
- 1 Department of Medical Statistics and Epidemiology & Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, China
- 2 Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
33
|
Morgan J, Ferlatte O, Salway T, Wilton J, Hull M. Awareness of, interest in, and willingness to pay for HIV pre-exposure prophylaxis among Canadian gay, bisexual, and other men who have sex with men. Canadian Journal of Public Health 2018; 109:791-799. [PMID: 29981103 DOI: 10.17269/s41997-018-0090-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 05/03/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Pre-exposure prophylaxis (PrEP) is a highly effective, HIV prevention strategy increasingly being accessed by gay, bisexual, and other men who have sex with men (GBMSM). GBMSM face structural and individual-level barriers accessing PrEP, including awareness and cost. This paper assesses socio-demographic factors associated with awareness, interest, and willingness to pay for PrEP in a sample of Canadian GBMSM. METHODS Data were derived from the 2015 Sex Now survey, a cross-sectional, online survey of GBMSM. Respondents were recruited through social media, sex-seeking "apps," and by word of mouth. We used univariable and multivariable logistic regression models to estimate associations between socio-demographic factors and three primary outcomes. RESULTS Our sample consisted of 7176 HIV-negative Canadian GBMSM. Of respondents, 54.7% were aware of PrEP, 47.4% were interested in PrEP, and 27.9% of PrEP-interested respondents reported they would pay for PrEP out-of-pocket. Awareness and interest varied between provinces, while GBMSM outside urban areas were less likely to be PrEP aware. Bisexual-identified men, and men over 50, were less likely to be aware and interested in PrEP in multivariable models. Only annual income and educational attainment were associated with willingness to pay for PrEP. CONCLUSION This study identifies important disparities in awareness, interest, and willingness to pay for PrEP. Future interventions and educational efforts should target non-gay-identified and older GBMSM, as well as GBMSM outside urban areas. PrEP implementation may risk further perpetuating existing health inequities based on socio-economic status if PrEP continues to be accessed primarily through private insurance or paid for out-of-pocket.
Collapse
Affiliation(s)
- Jeffrey Morgan
- Community-Based Research Centre for Gay Men's Health, 1007-808 Nelson St., Vancouver, BC, V6Z 2H2, Canada.
| | | | - Travis Salway
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - James Wilton
- Ontario HIV Treatment Network, Toronto, ON, Canada
| | - Mark Hull
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| |
Collapse
|
34
|
Structural barriers to HIV prevention among men who have sex with men (MSM) in Vietnam: Diversity, stigma, and healthcare access. PLoS One 2018; 13:e0195000. [PMID: 29614104 PMCID: PMC5882136 DOI: 10.1371/journal.pone.0195000] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 03/14/2018] [Indexed: 01/22/2023] Open
Abstract
Men who have sex with men (MSM) in Vietnam experience disproportionate rates of HIV infection. To advance understanding of how structural barriers may shape their engagement with HIV prevention services, we draw on 32 in-depth interviews and four focus groups (n = 31) conducted with MSM in Hanoi between October 2015- March 2016. Three primary factors emerged: (1) Diversity, both in relation to identity and income; Vietnamese MSM described themselves as segregated into Bóng kín (hidden, often heterosexually-identified MSM) and Bóng lộ (‘out,’ transgender, or effeminate MSM). Lower-income, ‘hidden’ MSM from rural areas were reluctant to access MSM-targeted services; (2) Stigma: MSM reported being stigmatized by the healthcare system, family, and other MSM; and (3) Healthcare access: this was limited due to economic barriers and lack of MSM-friendly services. Our research suggests the need for multiple strategies to reach diverse types of MSM as well as to address barriers in access to health services such as stigma and costs. While a great deal has been written about the diversity of MSM in relation to gender performance and sexual identities, our research points to the substantial structural-level barriers that must be addressed in order to achieve meaningful and effective HIV prevention for MSM worldwide.
Collapse
|
35
|
Meyers K, Wu Y, Qian H, Sandfort T, Huang X, Xu J, Zhang J, Xia W, Glidden D, Wu H, Shang H. Interest in Long-Acting Injectable PrEP in a Cohort of Men Who have Sex with Men in China. AIDS Behav 2018; 22:1217-1227. [PMID: 28707025 DOI: 10.1007/s10461-017-1845-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Long-acting injectable (LAI) formulations of antiretrovirals (ARVs) as pre-exposure prophylaxis (PrEP) could be an attractive alternative for men who have sex with men (MSM) who are interested in ARV-based biomedical prevention but will not use a daily pill. This study investigated interest in LAI-PrEP in a cohort of MSM in China and characterized how MSM willing to use only injectable PrEP differed from MSM who would use PrEP regardless of modality or not at all. Demographic, behavioral, and risk perception measures were collected and associations investigated. A licensed LAI-PrEP agent would increase the proportion interested in PrEP by 24.5% over oral PrEP alone. Combining interest in oral and injectable PrEP, 78.5% of the sample could be covered if reported interest in PrEP translated into actual uptake. Partnership factors differentiated those who would be willing to use only LAI-PrEP versus any PrEP modality, while higher self-perception of risk was associated with interest in LAI-PrEP versus no PrEP. The addition of a second PrEP modality could yield increased population coverage of PrEP. Social and behavioral research should be undertaken in parallel with clinical development of injectable PrEP agents to identify characteristics of those who are not interested in oral PrEP but would take advantage of ARV-based prevention with the introduction of an injectable product.
Collapse
Affiliation(s)
- Kathrine Meyers
- Aaron Diamond AIDS Research Center, The Rockefeller University, New York, NY, USA
- Aaron Diamond AIDS Research Center, 455 First Avenue, Floor 7, New York, NY, 10016, USA
| | - Yumeng Wu
- Aaron Diamond AIDS Research Center, The Rockefeller University, New York, NY, USA
| | - Haoyu Qian
- Aaron Diamond AIDS Research Center, The Rockefeller University, New York, NY, USA
| | - Theodorus Sandfort
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, NY, USA
| | - Xiaojie Huang
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Junjie Xu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Jing Zhang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Wei Xia
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | | | - Hao Wu
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China.
| | - Hong Shang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.
| |
Collapse
|
36
|
Kahle EM, Sullivan S, Stephenson R. Functional Knowledge of Pre-Exposure Prophylaxis for HIV Prevention Among Participants in a Web-Based Survey of Sexually Active Gay, Bisexual, and Other Men Who Have Sex With Men: Cross-Sectional Study. JMIR Public Health Surveill 2018; 4:e13. [PMID: 29362213 PMCID: PMC5801519 DOI: 10.2196/publichealth.8089] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 10/09/2017] [Accepted: 11/08/2017] [Indexed: 01/24/2023] Open
Abstract
Background Awareness of pre-exposure prophylaxis (PrEP) for HIV prevention is increasing, but little is known about the functional knowledge of PrEP and its impact on willingness to use PrEP. Objective The objective of this study was to assess the functional knowledge of PrEP among a sample of gay, bisexual, and other men who have sex with men (MSM) participating in a Web-based survey of sexually active MSM. Methods Men at least 18 years old, residing in the United States, and reporting sex with a man in the previous 6 months were recruited through social networking websites. PrEP functional knowledge included the following 4 questions (1) efficacy of consistent PrEP use, (2) inconsistent PrEP use and effectiveness, (3) PrEP and condom use, and (4) effectiveness at reducing sexually transmitted infections (STIs). Ordinal logistic regression was used to identify respondent characteristics associated with PrEP functional knowledge. In a subsample of participants responding to HIV prevention questions, we compared willingness to use PrEP by response to PrEP functional knowledge using logistic regression analysis adjusted for age, race and ethnicity, and education level. Results Among 573 respondents, PrEP knowledge was high regarding adherence (488/573, 85.2%), condom use (532/573, 92.8%), and STIs (480/573, 83.8%), but only 252/573 (44.0%) identified the correct efficacy. Lower functional PrEP knowledge was associated with minority race/ethnicity (P=.005), lower education (P=.01), and not having an HIV test in the past year (P=.02). Higher PrEP knowledge was associated with willingness to use PrEP (P=.009). Younger age was not associated with higher PrEP functional knowledge or willingness to use PrEP. Conclusions PrEP knowledge was generally high in our study, including condom use and consistent use but may be lacking in higher risk MSM. The majority of respondents did not correctly identify PrEP efficacy with consistent use, which could impact motivation to seek out PrEP for HIV prevention. Targeted messaging to increase PrEP knowledge may increase PrEP use.
Collapse
Affiliation(s)
- Erin M Kahle
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Stephen Sullivan
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
37
|
PrEP awareness and decision-making for Latino MSM in San Antonio, Texas. PLoS One 2017; 12:e0184014. [PMID: 28953905 PMCID: PMC5617149 DOI: 10.1371/journal.pone.0184014] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 08/16/2017] [Indexed: 01/10/2023] Open
Abstract
Pre-Exposure Prophylaxis (PrEP) has been promoted among high-risk populations as an effective HIV biomedical intervention. However, limited research is available on the significance of culturally informed biomedical interventions for Latino MSM. A total of 159 self-administered Internet surveys were completed by Latino MSM ages 21–30 in San Antonio, Texas. The purpose of this research was to develop an instrument that measured Latino MSM attitudes and beliefs towards PrEP, identify associations between demographic factors and PrEP related factors and to suggest culturally appropriate strategies for the promotion of PrEP among the Latino MSM population. Research findings revealed implications for PrEP at the structural and individual level for Latino MSM. Structural level indicators emphasized the importance for raising PrEP awareness among Latino MSM in regards to PrEP related expenses, ameliorating stigmatization of high-risk populations, enhancing access to PrEP informed medical providers, and address mistrust of the government and medical providers role on addressing health disparities among Latino MSM. Overall, the findings for individual factors emphasize the need for patient-centered interventions for Latino MSM. Latino MSM currently on PrEP require supplemental resources to enhance PrEP adherence. Latino MSM not on PrEP require alternate options for PrEP delivery and/or cognitive behavioral approaches minimizing HIV risk behavior for Latino MSM concerned with PrEP toxicity, which may require non-biomedical interventions. Integration of Latino MSM currently on PrEP as peer educators provides a valuable resource for developing culturally informed PrEP interventions for Latino MSM. Peer educators are able to share their experiential knowledge of PrEP contextualized through cultural norms, beliefs, and values.
Collapse
|
38
|
Collier KL, Colarossi LG, Sanders K. Raising Awareness of Pre-Exposure Prophylaxis (PrEP) among Women in New York City: Community and Provider Perspectives. JOURNAL OF HEALTH COMMUNICATION 2017; 22:183-189. [PMID: 28248625 DOI: 10.1080/10810730.2016.1261969] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study explored the knowledge, attitudes, and perceived facilitators and barriers to adoption of HIV pre-exposure prophylaxis (PrEP) among black women and Latinas in the Bronx, NY. Data were collected in focus group discussions (FGDs) held separately with staff (n = 21) and black and Latina female clients aged 18 to 50 (n = 23) of four organizations providing health and social services. Participants were also asked to give feedback about four action messages regarding PrEP for a social marketing campaign. Transcripts were analyzed by two researchers using grounded theory. We found that the majority of clients (74%) and staff (57%) had not heard about PrEP before participating in the FGDs. Following brief educational messaging about PrEP, participants identified potential facilitators and barriers to PrEP uptake among women, and expressed enthusiasm for more widespread efforts to raise awareness about PrEP as an HIV prevention option. Participants preferred an action message that was brief, referred to PrEP as a pill, and did not mention condoms or STD testing. These findings demonstrate the need to raise awareness about PrEP among women and build the capacity of women-serving organizations to educate, screen, and refer or provide PrEP services.
Collapse
Affiliation(s)
- Kate L Collier
- a Research and Evaluation , Planned Parenthood of New York City , New York , New York , USA
| | - Lisa G Colarossi
- a Research and Evaluation , Planned Parenthood of New York City , New York , New York , USA
| | - Kim Sanders
- b Project Street Beat , Planned Parenthood of New York City , New York , New York , USA
| |
Collapse
|
39
|
Mimiaga MJ, Closson EF, Battle S, Herbst JH, Denson D, Pitts N, Holman J, Landers S, Mansergh G. Reactions and Receptivity to Framing HIV Prevention Message Concepts About Pre-Exposure Prophylaxis for Black and Latino Men Who Have Sex with Men in Three Urban US Cities. AIDS Patient Care STDS 2016; 30:484-489. [PMID: 27749110 DOI: 10.1089/apc.2016.0123] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Men who have sex with men (MSM) of color are disproportionately affected by HIV in the United States. Pre-exposure prophylaxis (PrEP) using antiretroviral medications is a newer biomedical prevention modality with established efficacy for reducing the risk of acquiring HIV. We conducted formative qualitative research to explore audience reactions and receptivity to message concepts on PrEP as part of the development of prevention messages to promote PrEP awareness among black and Latino MSM in the United States. In 2013, 48 black and 42 Latino (total study sample = 90) mixed HIV serostatus MSM from Chicago, Ft. Lauderdale, and Kansas City participated in either an individual interview or focus group discussion. Men were recruited online and at community-based organizations in each city. We elicited feedback on the comprehensibility, credibility, and relevance of two draft messages on PrEP. The messages included efficacy estimates from iPrEx, a phase III clinical trial to ascertain whether the antiretroviral medication tenofovir/emtricitabine disoproxil fumarate (commercially known as Truvada®) could safely and effectively prevent HIV acquisition through sex among MSM and transgender women. With participants' consent, the interviews and focus groups were recorded and transcribed. The data were then summarized and analyzed using a qualitative descriptive approach. The majority of men were unfamiliar with PrEP. It was suggested that additional information about the medication and clinical trials establishing efficacy was needed to enhance the legitimacy and relevancy of the messages. Participants sought to form an opinion of PrEP that was grounded in their own interpretation of the efficacy data. However, confusion about nonadherence among clinical trial subjects and individual versus average risk limited comprehension of these messages. Thematic overlaps suggest that message believability was connected to participants' ability to derive meaning from the PrEP efficacy data. Despite being concerned that other MSM would interpret the messages to mean that condom use was unnecessary while taking PrEP, participants themselves primarily understood PrEP as a supplement rather than a replacement for condoms. Based on their experience with taking antiretroviral medication, HIV-positive men considered condom use a more feasible form of HIV prevention than PrEP. Participants' responses suggest that more information about PrEP and the clinical trial would support the legitimacy of PrEP and the messages as a whole. These details may enhance believability in the concept of PrEP and reinforce confidence in the validity of the efficacy result.
Collapse
Affiliation(s)
- Matthew J. Mimiaga
- Departments of Epidemiology and Social & Behavioral Sciences, School of Public Health, Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island
- Institute for Community Health Promotion, Brown University, Providence, Rhode Island
- John Snow, Inc., Boston, Massachusetts
| | - Elizabeth F. Closson
- Department of Social and Environmental Health Research, The London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Shanice Battle
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeffrey H. Herbst
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Damian Denson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Gordon Mansergh
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, United States Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
40
|
Philbin MM, Parker CM, Parker RG, Wilson PA, Garcia J, Hirsch JS. The Promise of Pre-Exposure Prophylaxis for Black Men Who Have Sex with Men: An Ecological Approach to Attitudes, Beliefs, and Barriers. AIDS Patient Care STDS 2016; 30:282-90. [PMID: 27220036 DOI: 10.1089/apc.2016.0037] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Research has demonstrated the clinical effectiveness of pre-exposure prophylaxis (PrEP) for HIV prevention, but little is known about how factors at the individual-, interpersonal-, community-, and structural levels impact PrEP use for black men who have sex with men (BMSM). We advance existing work by examining how all levels of the ecological framework must be addressed for PrEP to be successfully implemented as an effective HIV prevention approach. We interviewed 31 BMSM three times each and 17 community stakeholders once each; interviews were taped, transcribed, and analyzed using the constant comparative method. Factors that influence how BMSM experienced PrEP emerged across all levels of the ecological framework: At the individual level, respondents were wary of giving medication to healthy people and of the potential side-effects. At the interpersonal level, BMSM believed that PrEP use would discourage condom use and that PrEP should only be one option for HIV prevention, not the main option. At the community level, men described not trusting the pharmaceutical industry and described PrEP as an option for others, not for themselves. At the structural level, BMSM talked about HIV and sexuality-related stigmas and how they must overcome those before PrEP engagement. BMSM are a key population in the US National HIV/AIDS Strategy, yet few individuals believe that PrEP would be personally helpful. Our research indicates the urgent need to raise awareness and address structural stigma and policies that could be substantial barriers to the scale-up and implementation of PrEP-related services.
Collapse
Affiliation(s)
- Morgan M. Philbin
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York
| | - Caroline M. Parker
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Richard G. Parker
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Patrick A. Wilson
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Jonathan Garcia
- College of Public Health and Human Science, Oregon State University, Corvallis, Oregon
| | - Jennifer S. Hirsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| |
Collapse
|