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Lee JA, Schafer MH. Social network characteristics and HIV testing among older adults in South Africa. AGEING & SOCIETY 2023; 43:499-515. [PMID: 36875285 PMCID: PMC9983780 DOI: 10.1017/s0144686x21000532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Drawing from theory and research on the role of social networks in promoting or undermining preventative public health measures, this article considers how structural, compositional and functional aspects of older adults' close social networks are associated with HIV testing in the context of rural South Africa. Analyses use data from the population-based Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) - a sample of rural adults age 40+ (N = 4,660). Results from multiple logistic regression show older South African adults with larger, more heavily non-kin and more literate networks were most likely to report testing for HIV. People whose network members provided frequent information were also most likely to be tested, though interaction effects indicate that this pattern is primarily found among those with highly literate networks. Taken together, the findings reinforce a key insight from social capital perspectives: network resourcefulness - literacy in particular - is crucial for promoting preventative health practice. The synergy between network literacy and informational support reveals the complex interplay between network characteristics in shaping health-seeking behaviour. Continued research is needed on the connection between networks and HIV testing among sub-Saharan older adults, as this population is not currently well served by many public health efforts in the region.
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Affiliation(s)
- Jin A. Lee
- Department of Sociology, University of Toronto, Toronto, Canada
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2
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HIV Testing Strategies, Types of Tests, and Uptake by Men Who have Sex with Men and Transgender Women: A Systematic Review and Meta-analysis. AIDS Behav 2023; 27:678-707. [PMID: 35984608 DOI: 10.1007/s10461-022-03803-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 11/01/2022]
Abstract
This systematic review and meta-analysis investigated the effectiveness of strategies and types of tests on HIV testing uptake by men who have sex with men (MSM) and transgender women (TGW), and in reaching PLWH. Articles published up to July 2020 were identified from major electronic databases and grey literature. Data were extracted and assessed for risk of bias. Estimates were pooled using random-effect meta-analysis while heterogeneity was evaluated by Cochran's Q test and I2. This study is registered with PROSPERO (CRD42020192740). Of 6820 titles, 263 studies (n = 67,288 participants) were included. The testing strategies reported in most studies were community- (71.2%) and facility-based (28.8%). Highest uptake, with facility-based testing, occurred and reached more PLWH while with standard laboratory tests, it occurred with the highest HIV prevalence among MSM. However, urine test showed a highest rate of new HIV infection. Multiple test combinations had the highest uptake and reached more PLWH among TGW. Various testing strategies, considering barriers and regional differences, and different test types, need be considered, to increase uptake among MSM and TGW.
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3
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Biello KB, Daddario SR, Hill-Rorie J, Futterman D, Sullivan PS, Hightow-Weidman L, Jones J, Mimiaga MJ, Mayer KH. Uptake and Acceptability of MyChoices: Results of a Pilot RCT of a Mobile App Designed to Increase HIV Testing and PrEP Uptake Among Young American MSM. AIDS Behav 2022; 26:3981-3990. [PMID: 35829971 DOI: 10.1007/s10461-022-03724-3] [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: 05/18/2022] [Indexed: 11/26/2022]
Abstract
Young men who have sex with men (YMSM) remain at disproportionate risk for HIV acquisition in the United States (US), yet use of evidence-based prevention strategies, including routine HIV testing and pre-exposure prophylaxis (PrEP), remain low. Smartphones and mobile app usage are nearly ubiquitous in this population. Given the potential for scalability, a mobile app to increase HIV testing and PrEP use among YMSM has the potential to make an extraordinary public health impact if efficacious. Based on extensive formative, community-engaged research, we developed a theory-driven mobile app-MyChoices-to increase HIV testing and PrEP uptake among YMSM. In a pilot randomized controlled trial (RCT), participants (n = 60) were randomized 2:1 to receive MyChoices or standard of care (SOC). Data from 3 to 6-month post-baseline assessments demonstrate that the app was highly acceptable (System Usability Score; mean = 75.8, SD = 10.7) and feasible (94% used the MyChoices app at least once; mean = 15.3 sessions, SD = 9.8). While not powered to assess efficacy, those in the MyChoices arm had 22% higher prevalence of HIV testing over follow-up compared to those in the SOC arm (NS). There was no difference in PrEP uptake. A fully-powered efficacy trial is warranted; if efficacy is demonstrated, the MyChoices app could be easily scaled to reach YMSM across the US.
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Affiliation(s)
- Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
- Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, Box G-S121-8, Providence, RI, 02912, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Salvatore R Daddario
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Donna Futterman
- Adolescent AIDS Program, Children's Hospital at Montefiore Medical Center, The Bronx, NY, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Global Public Health, Emory University, Atlanta, GA, USA
| | - Lisa Hightow-Weidman
- Division of Infectious Diseases, UNC School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Jeb Jones
- Department of Epidemiology, Rollins School of Global Public Health, Emory University, Atlanta, GA, USA
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
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4
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Iott BE, Loveluck J, Benton A, Golson L, Kahle E, Lam J, Bauermeister JA, Veinot TC. The impact of stigma on HIV testing decisions for gay, bisexual, queer and other men who have sex with men: a qualitative study. BMC Public Health 2022; 22:471. [PMID: 35264132 PMCID: PMC8908600 DOI: 10.1186/s12889-022-12761-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background Stigmatization may prompt gay, bisexual, queer and other men who have sex with men (GBQMSM) to avoid or delay HIV testing. There has been little attention to GBQMSMs’ perspectives about how stigma may influence their decisions about whether, where, and how often to get tested for HIV. Methods We conducted nine focus groups with 64 adult GBQMSM in Metropolitan Detroit, including HIV-negative men and people living with HIV (PLWH). Data were thematically analyzed deductively and inductively in three rounds. Results Three themes emerged regarding whether to get tested: (1) Perceived promiscuity, risk perceptions and HIV testing; (2) Fearing sexual rejection; and (3) Fearing friend and family member distancing and rejection. Themes concerning where to get tested included: (4) Conflating HIV testing and diagnosis; and (5) Seeking privacy and safety at specialized services. As for how often to get tested, themes included: (6) Reducing contact with healthcare providers due to intersectional stigma; (7) Responsibility and regular testing; and (8) HIV stigma and testing as routine care. Black participants articulated themes (3), (4), and (6) with greater frequency than other participants. Framing HIV testing as a personal responsibility may have created a “new stigma,” with unintended consequences not observed with “routine healthcare” messaging. Conclusions GBQMSMs’ perspectives indicate the potential for new foci for HIV testing promotion interventions based on stigma-related issues that they deem important. There is a need for interventions to challenge the “promiscuity” stereotype, and to reduce the sexual stigmatization of GBQMSM living with HIV/AIDS—especially online. Provider stigma requires both intervention and continued availability of specialized services. Future stigma-reduction interventions for Black GBQMSM could focus on building family support/acceptance, awareness of multiple testing options, and integrating LGBTQ-related issues into initiatives for racial justice in health care. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12761-5.
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Affiliation(s)
- Bradley E Iott
- School of Information, University of Michigan, Ann Arbor, MI, USA.,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Akilah Benton
- Detroit Health Department, City of Detroit, Detroit, MI, USA
| | - Leon Golson
- Unified - HIV Health and Beyond, Ypsilanti, MI, USA
| | - Erin Kahle
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Jason Lam
- School of Information, University of Michigan, Ann Arbor, MI, USA
| | | | - Tiffany C Veinot
- School of Information, University of Michigan, Ann Arbor, MI, USA. .,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
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5
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Stigma in a Collectivistic Culture: Social Network of Female Sex Workers in China. AIDS Behav 2022; 26:297-309. [PMID: 34312739 DOI: 10.1007/s10461-021-03383-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
In this egocentric network study, we explored Chinese collectivism in relation to social network characteristics and sex work-related stigma among mid-age female sex workers (FSWs). Respondent-driven sampling was used to recruit 1245 mid-age FSWs from three cities in China. We found that a one standard deviation (SD) increase in FSWs' collectivism was associated with a 0.18 SD decrease in social support (95% CI - 0.32, - 0.04), a 0.20 SD decrease in network effective size (i.e., the diversity of a social network; 95% CI - 0.30, - 0.10), and a 0.21 SD decrease in network betweenness (i.e., the "bridging potential" of egos within their networks; 95% CI - 0.33, - 0.09). Among participants who perceived more sex work stigma, the association between collectivism and FSWs' network betweenness was attenuated. In a collective culture emphasizing group values and honor, belonging to a less interconnected social network may give FSWs a structural advantage to cope with stigma and secure social support.
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Pullen E, Gupta A, Stockman JK, Green HD, Wagner KD. Association of social network characteristics with HIV knowledge, stigma, and testing: findings from a study of racial and ethnic minority women in a small Western city. AIDS Care 2022; 34:39-46. [PMID: 33856953 PMCID: PMC8517041 DOI: 10.1080/09540121.2021.1913717] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Black and Latina women are disproportionately impacted by HIV/AIDS. Despite existing research linking social networks and HIV risk among men who have sex with men (MSM) and other high-risk populations, little research has examined how ethnic/racial minority women's social networks shape HIV prevention and intervention targets. Using interviews with a sample of 165 predominantly Black and Latina-identifying women from a small city in the Western U.S., this research examines the relationship between egocentric network characteristics and HIV knowledge, attitudes, and testing history. Results reveal that network characteristics play a significant role in shaping HIV-related knowledge, prejudice, and testing intention but not HIV testing history. Individual-level factors like homelessness and perceptions of testing barriers are more salient for explaining testing behaviors than network characteristics. Intervention efforts to improve knowledge and reduce prejudice among Black and Latina women may benefit from mobilizing network ties.
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Affiliation(s)
- Erin Pullen
- Indiana University Network Science Institute (IUNI), Indiana University, Bloomington, Indiana
| | - Akrati Gupta
- Department of Health Administration, Midwestern State University, Wichita Falls, Texas
| | - Jamila K. Stockman
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Harold D. Green
- Department of Applied Health Sciences, Indiana University, Bloomington, Indiana
| | - Karla D. Wagner
- School of Community Health Sciences, University of Nevada, Reno, Reno, Nevada
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7
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Crawford ND, Josma D, Harrington KRV, Morris J, Quamina A, Birkett M, Phillips Ii G. Using the Think-Aloud Method to Assess the Feasibility and Acceptability of Network Canvas Among Black Men Who Have Sex With Men and Transgender Persons: Qualitative Analysis. JMIR Form Res 2021; 5:e30237. [PMID: 34499040 PMCID: PMC8461526 DOI: 10.2196/30237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/09/2021] [Accepted: 08/16/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Characteristics of an individual's social network have been important factors in understanding infectious disease transmission patterns. Social network data collection is generally time and resource intensive, yet it is crucial to our understanding of the complex epidemiologic landscape of human behaviors among stigmatized social groups. OBJECTIVE We sought to evaluate the feasibility and acceptability of a self-administered social network data collection tool, Network Canvas, among Black men who have sex with men (BMSM) and transgender persons using the think-aloud method, which is a robust and flexible research technique used to perform usability testing. METHODS We piloted a self-administered network interview within the Network Canvas Software Suite. Participants aged 18 years and older were recruited through a community-based organization in Atlanta, GA, and were included based upon their willingness to share information on sexual behaviors and drug use for themselves and their social networks. A semistructured interview guide was used to document cognitive decision-making processes while using the tool. Recorded interviews were transcribed verbatim, and thematic analyses were performed. RESULTS Among 7 BMSM and transgender participants, three main themes were identified from cognitive processes: (1) the utility, (2) navigation, and (3) intuitive design of Network Canvas. Overall, Network Canvas was described as "easy to use," with suggestions mainly directed toward improving navigation tools and implementing an initial tutorial on the program prior to use. Participants were willing to use Network Canvas to document their social networks and characteristics. In general, observed verbal responses from participants matched their behavior, although there were some discrepancies between verbal affirmations of use and understanding versus external observation. CONCLUSIONS We found Network Canvas to be a useful new tool to capture social network data. Self-administration allowed participants the opportunity to provide sensitive information about themselves and their social networks. Furthermore, automated name generation and visualization of an individuals' social network in the app has the potential to reduce cognitive burden during data collection. More efficient methods of social network data collection have the potential to provide epidemiologic information to guide prevention efforts for populations with stigmatized health conditions or behaviors.
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Affiliation(s)
- Natalie D Crawford
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Dorie Josma
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Kristin R V Harrington
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Joseph Morris
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- Department of Population Health, School of Public Health, Georgia State University, Atlanta, GA, United States
| | | | - Michelle Birkett
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Gregory Phillips Ii
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Williamson A, Barbarin A, Campbell B, Campbell T, Franzen S, Reischl TM, Zimmerman M, Veinot TC. Uptake of and Engagement With an Online Sexual Health Intervention (HOPE eIntervention) Among African American Young Adults: Mixed Methods Study. J Med Internet Res 2021; 23:e22203. [PMID: 34269689 PMCID: PMC8325088 DOI: 10.2196/22203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 04/16/2021] [Accepted: 05/16/2021] [Indexed: 01/30/2023] Open
Abstract
Background Regarding health technologies, African American young adults have low rates of uptake, ongoing usage, and engagement, which may widen sexual health inequalities. Objective We aimed to examine rates of uptake and ongoing usage, and factors influencing uptake, ongoing usage, and engagement for a consumer health informatics (CHI) intervention for HIV/sexually transmitted infection (STI) prevention among African American young adults, using the diffusion of innovation theory, trust-centered design framework, and O’Brien and Toms’ model of engagement. Methods This community-based participatory mixed methods study included surveys at four time points (n=315; 280 African American participants) among young adults aged 18 to 24 years involved in a blended offline/online HIV/STI prevention intervention (HIV Outreach, Prevention, and Education [HOPE] eIntervention), which was described as a “HOPE party.” Qualitative interviews were conducted with a subset of participants (n=19) after initial surveys and website server logs indicated low uptake and ongoing usage. A generalized linear mixed-effects model identified predictors of eIntervention uptake, server logs were summarized to describe use over time, and interview transcripts were coded and thematically analyzed to identify factors affecting uptake and engagement. Results Participants’ initial self-reported eIntervention uptake was low, but increased significantly over time, although uptake never reached expectations. The most frequent activity was visiting the website. Demographic factors and HOPE party social network characteristics were not significantly correlated with uptake, although participant education and party network gender homophily approached significance. According to interviews, one factor driving uptake was the desire to share HIV/STI prevention information with others. Survey and interview results showed that technology access, perceived time, and institutional and technological trust were necessary conditions for uptake. Interviews revealed that factors undermining uptake were insufficient promotion and awareness building, and the platform of the intervention, with social media being less appealing due to previous negative experiences concerning discussion of sexuality on social media. During the interaction with the eIntervention, interview data showed that factors driving initial engagement were audience-targeted website esthetics and appealing visuals. Ongoing usage was impeded by insufficiently frequent updates. Similarly, lack of novelty drove disengagement, although a social media contest for sharing intervention content resulted in some re-engagement. Conclusions To encourage uptake, CHI interventions for African American young adults can better leverage users’ desires to share information about HIV/STI prevention with others. Ensuring implementation through trusted organizations is also important, though vigorous promotion is needed. Visual appeal and targeted content foster engagement at first, but ongoing usage may require continual content changes. A thorough analysis of CHI intervention use can inform the development of future interventions to promote uptake and engagement. To guide future analyses, we present an expanded uptake and engagement model for CHI interventions targeting African American young adults based on our empirical results.
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Affiliation(s)
- Alicia Williamson
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | | | | | - Terrance Campbell
- YOUR Center, Flint, MI, United States.,TigerLIFE, University of Memphis, Memphis, TN, United States
| | - Susan Franzen
- Prevention Research Center of Michigan, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Thomas M Reischl
- Prevention Research Center of Michigan, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Marc Zimmerman
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States.,Department of Psychology, University of Michigan, Ann Arbor, MI, United States
| | - Tiffany Christine Veinot
- School of Information, University of Michigan, Ann Arbor, MI, United States.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
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9
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Fehrenbacher AE, Fletcher JB, Clark K, Kisler KA, Reback CJ. Social Networks and Exchange Sex among Transgender Women. JOURNAL OF SEX RESEARCH 2021; 58:743-753. [PMID: 33779427 PMCID: PMC8273090 DOI: 10.1080/00224499.2021.1892575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Transgender women are more likely to exchange sex than cisgender individuals. This study investigated how social networks were associated with exchange sex among transgender women in Los Angeles County. From July 2015 to September 2016, transgender women (N = 271; "egos") reported their sexual and substance use behaviors and perceptions of the same behaviors among their peers (N = 2,619; "alters"). Clustered logistic and negative binomial regressions were used to model odds of exchange sex and number of exchange sex partners in the past 6 months, respectively. Transgender women who perceived that any of their peers were engaged in exchange sex were approximately four times more likely to exchange sex themselves and reported three times as many exchange sex partners as those who did not perceive any peers engaged in exchange sex. Perceived ecstasy use among peers was associated with higher odds of exchange sex and more exchange sex partners, whereas perceived marijuana use among peers was associated with lower odds of exchange sex and fewer exchange sex partners. Peer behaviors were strongly associated with both transgender women's likelihood and rate of engagement in exchange sex. Risk reduction interventions with transgender women should attend to network dynamics that are often overlooked in existing programs.
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Affiliation(s)
- Anne E. Fehrenbacher
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- UCLA Center for HIV Identification, Prevention, and Treatment Services, Los Angeles, CA, USA
| | | | - Kirsty Clark
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Kimberly A. Kisler
- Friends Research Institute, Inc., Los Angeles, CA, USA
- Department of Public Health, Rongxiang Xu College of Health and Human Services, California State University, Los Angeles, CA, USA
| | - Cathy J. Reback
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- UCLA Center for HIV Identification, Prevention, and Treatment Services, Los Angeles, CA, USA
- Friends Research Institute, Inc., Los Angeles, CA, USA
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10
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Chiou PY, Ko NY, Chien CY. Mobile HIV Testing Through Social Networking Platforms: Comparative Study. J Med Internet Res 2021; 23:e25031. [PMID: 33769298 PMCID: PMC8035663 DOI: 10.2196/25031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/20/2021] [Accepted: 01/31/2021] [Indexed: 11/24/2022] Open
Abstract
Background Improving HIV screening in key populations is a crucial strategy to achieve the goal of eliminating AIDS in 2030. Social networking platforms can be used to recruit high risk-taking men who have sex with men (MSM) to promote the delivery of voluntary counseling and testing (VCT) as mobile HIV testing. Therefore, client recruitment and availability of mobile HIV testing through social networking platforms requires further evaluation. Objective The aim of this study is to compare the effects of targeting high risk-taking MSM and HIV case finding between two mobile HIV testing recruitment approaches: through the traditional website-based approach and through social networking platforms. Methods A comparative study design and propensity score matching was applied. The traditional VCT model, that is, the control group, recruited MSM through a website, and a trained research assistant visited the walk-in testing station at a gay village on Friday and Saturday nights. The social networking VCT model, the experimental group, recruited MSM from social networking platforms by periodically reloading into and conducting web-based discussions on dating apps and Facebook. The participants then referred to others in their social networks via a popular messenger app in Taiwan. The test was conducted at a designated time and place during weekdays by a trained research assistant. Across both modes of contact, before the mobile HIV testing, participants needed to provide demographic characteristics and respond to a questionnaire about HIV risk-taking behaviors. Results We recruited 831 MSM over 6 months, with a completion rate of 8.56% (616/7200) in the traditional VCT model and 20.71% (215/1038) in the social networking VCT model. After propensity score matching, there were 215 MSM in each group (mean age 29.97, SD 7.61 years). The social networking model was more likely to reach MSM with HIV risk-taking behaviors, that is, those seeking sexual activity through social media, having multiple sexual partners and unprotected anal intercourse, having experience of recreational drug use, and never having or not regularly having an HIV test, compared with the traditional model. HIV positive rates (incidence rate ratio 3.40, 95% CI 1.089-10.584; P=.03) and clinic referral rates (incidence rate ratio 0.03, 95% CI 0.001-0.585; P=.006) were significantly higher among those in the social networking VCT model than in the traditional VCT model. Conclusions Through effective recruitment strategies on social networking platforms, the social networking VCT mode can be smoothly promoted, as compared with the traditional VCT model, to target high risk-taking MSM and increase testing outcomes.
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Affiliation(s)
- Piao-Yi Chiou
- Department of Nursing, National Taiwan University Hospital, Taipei City, Taiwan.,School of Nursing, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung, Tainan, Taiwan
| | - Chien-Yu Chien
- School of Nursing, College of Medicine, National Taiwan University, Taipei City, Taiwan
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11
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Brown LK, Veinot TC. Information behavior and social control: Toward an understanding of conflictual information behavior in families managing chronic illness. J Assoc Inf Sci Technol 2021. [DOI: 10.1002/asi.24362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Lindsay K. Brown
- School of Information University of Michigan Ann Arbor Michigan USA
| | - Tiffany C. Veinot
- Schools of Information and Public Health University of Michigan Ann Arbor Michigan USA
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12
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Zhao Y, Bromberg DJ, Khoshnood K, Sheng Y. Factors associated with regular HIV testing behavior of MSM in China: a cross-sectional survey informed by theory of triadic influence. Int J STD AIDS 2020; 31:1340-1351. [PMID: 33081648 DOI: 10.1177/0956462420953012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The prevalence of HIV infection among men who have sex with men (MSM) in China has increased in recent years. Regular HIV testing is a key prevention strategy for identifying HIV infections among MSM. Informed by the theory of triadic influence, we aimed to determine individual, social and environmental factors associated with regular HIV testing behavior. Regular HIV testing is defined as taking an HIV test every 3 to 6 months. Both an online survey and a face-to-face survey was administered to MSM in China. Logistic regression was used to examine associations with testing behavior. 500 MSM were surveyed, the prevalence of regular testing was 56.4%. In the final model, age of first sexual intercourse, self-efficacy, perceived risk, number of partners, orientation disclosure, knowledge of HIV testing, behavioral intention and HIV relevant behaviors (sexually transmitted infection testing history) were associated with regular HIV testing; social stream characteristics had stronger associations with regular testing than individual and environmental factors. Findings implicated that interventions aimed at improving the effective counseling service from healthcare providers and the medical environment and intrapersonal changes should be combined to encourage MSM to have their first HIV test and to keep coming back at regular intervals.
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Affiliation(s)
- Yafang Zhao
- School of Nursing, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Daniel J Bromberg
- Yale School of Public Health, Yale University. New Haven, CT, USA.,Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Kaveh Khoshnood
- Yale School of Public Health, Yale University. New Haven, CT, USA
| | - Yu Sheng
- School of Nursing, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Wood S, Dowshen N, Bauermeister JA, Lalley-Chareczko L, Franklin J, Petsis D, Swyryn M, Barnett K, Weissman GE, Koenig HC, Gross R. Social Support Networks Among Young Men and Transgender Women of Color Receiving HIV Pre-Exposure Prophylaxis. J Adolesc Health 2020; 66:268-274. [PMID: 31672523 PMCID: PMC7007865 DOI: 10.1016/j.jadohealth.2019.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/01/2019] [Accepted: 08/01/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of the study was to characterize perceived social support for young men and transgender women who have sex with men (YM/TWSM) taking HIV pre-exposure prophylaxis (PrEP). METHODS Mixed-methods study of HIV-negative YM/TWSM of color prescribed oral PrEP. Participants completed egocentric network inventories characterizing their social support networks and identifying PrEP adherence support figures. A subset (n = 31) completed semistructured interviews exploring adherence support and qualities of PrEP support figures. We calculated proportions of role types (e.g., family), individuals disclosed to regarding PrEP use, and PrEP-supportive individuals within each participant network. Interviews were analyzed using an inductive approach. RESULTS Participants (n = 50) were predominately African American men who have sex with men. Median age was 22 years (interquartile range: 20-23). Biologic family were the most common support figures, reported by 75% of participants (mean family proportion .37 [standard deviation (SD): .31]), followed by 67% reporting friends (mean friend proportion .38 [SD: .36]). Most network members were aware (mean disclosed proportion .74 [SD: .31]) and supportive (mean supportive proportion .87 [SD: .28]) of the participants' PrEP use. Nearly all (98%) participants identified ≥1 figure who provided adherence support; more often friends (48%) than family (36%). Participants characterized support as instrumental (e.g., transportation); emotional (e.g., affection); and social interaction (e.g., taking medication together). Key characteristics of PrEP support figures included closeness, dependability, and homophily (alikeness) with respect to sexual orientation. CONCLUSIONS Although most YM/TWSM identified family in their support networks, friends were most often cited as PrEP adherence support figures. Interventions to increase PrEP adherence should consider integrated social network and family-based approaches.
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Affiliation(s)
- Sarah Wood
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Nadia Dowshen
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA,Children’s Hospital of Philadelphia Division of Adolescent Medicine 34th and Civic Center Blvd., Philadelphia, PA 19104, USA
| | - José A. Bauermeister
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, USA
| | | | - Joshua Franklin
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA,Children’s Hospital of Philadelphia Division of Adolescent Medicine 34th and Civic Center Blvd., Philadelphia, PA 19104, USA
| | - Danielle Petsis
- Children’s Hospital of Philadelphia Division of Adolescent Medicine 34th and Civic Center Blvd., Philadelphia, PA 19104, USA
| | - Meghan Swyryn
- Philadelphia FIGHT Community Health Centers, 1233 Locust St. Philadelphia, PA 19107, USA
| | - Kezia Barnett
- Children’s Hospital of Philadelphia Division of Adolescent Medicine 34th and Civic Center Blvd., Philadelphia, PA 19104, USA
| | - Gary E. Weissman
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Helen C. Koenig
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA,Philadelphia FIGHT Community Health Centers, 1233 Locust St. Philadelphia, PA 19107, USA
| | - Robert Gross
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA,Corporal Michael J. Crescenz VA Medical Center, 21 S University Ave, Philadelphia, PA 19104, USA
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15
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Reback CJ, Clark K, Fletcher JB, Holloway IW. A Multilevel Analysis of Social Network Characteristics and Technology Use on HIV Risk and Protective Behaviors Among Transgender Women. AIDS Behav 2019; 23:1353-1367. [PMID: 30617525 DOI: 10.1007/s10461-019-02391-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examined the empirical structure (i.e., size, density, duration) of transgender women's social networks and estimated how network alters' perceived HIV risk/protective behaviors influenced transgender women's own HIV risk/protective behaviors. From July 2015 to September 2016, 271 transgender women completed surveys on sociodemographic characteristics, HIV risk/protective behaviors, and social networks. Hierarchical generalized linear models examined the associations of social network alter member data 'nested' within participant data. Analyses revealed that social network factors were associated with HIV risk/protective behaviors, and that the gender identity of the alters (cisgender vs. transgender), and social network sites and technology use patterns ("SNS/tech") moderated these associations. Among network alters with whom the participant communicated via SNS/tech, participants' HIV risk behavior was positively associated with alters' HIV risk behavior (cisgender alters aOR 4.10; transgender alters aOR 5.87). Among cisgender alters (but not transgender alters) with whom the participant communicated via SNS/tech, participants' HIV protective behavior was positively associated with alters' HIV protective behavior (aOR 8.94).
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Affiliation(s)
- Cathy J Reback
- Friends Research Institute, Inc., 1419 N. La Brea Ave, Los Angeles, CA, 90028, USA.
- David Geffen School of Medicine, Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, CA, 90024, USA.
- Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, CA, 90024, USA.
| | - Kirsty Clark
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, 90095, USA
| | - Jesse B Fletcher
- Friends Research Institute, Inc., 1419 N. La Brea Ave, Los Angeles, CA, 90028, USA
| | - Ian W Holloway
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA, 90095, USA
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16
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Beach LB, Greene GJ, Lindeman P, Johnson AK, Adames CN, Thomann M, Washington PC, Phillips G. Barriers and Facilitators to Seeking HIV Services in Chicago Among Young Men Who Have Sex with Men: Perspectives of HIV Service Providers. AIDS Patient Care STDS 2018; 32:468-476. [PMID: 30398956 DOI: 10.1089/apc.2018.0094] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Young men who have sex with men (YMSM) are disproportionally impacted by HIV, and continue to lag behind other age groups in the receipt of HIV prevention and care services. To inform the development of interventions to improve pre-exposure prophylaxis and HIV care engagement outcomes among YMSM, a growing number of studies have reported the barriers and facilitators YMSM encounter when accessing HIV services. Few studies, however, have assessed how HIV service providers perceive these facilitators and barriers. In total, 21 interviews were conducted with HIV service providers in Chicago about barriers and facilitators they perceived affected YMSM's engagement in HIV services. Barriers included lack of comprehensive wraparound services, lack of trust of providers, unfamiliarity with seeking HIV services, feelings of invincibility, lack of knowledge of HIV service providers, intersectional and structural concerns (e.g., not thinking the site's services were for YMSM), geography and distance to clinic, and HIV stigma. Facilitators included presence of comprehensive wraparound services, high trust in providers, a clinic's willingness to serve uninsured patients, community engagement, word-of-mouth recommendations from lesbian, gay, bisexual, and transgender (LGBT) friends, intersectionality (e.g., offering LGBT-tailored services), geography and distance, lack of HIV stigma. Axial coding revealed that five conceptual themes cut across multiple barriers and facilitators, including health system characteristics, intersectionality, geography and transportation, community outreach, and stigma. These conceptual themes map closely onto Bronfenbrenner's ecological model. Overall, these findings highlight the importance of a multi-level approach to future intervention development to increase engagement in HIV services among YMSM.
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Affiliation(s)
- Lauren B. Beach
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Evaluation, Data Integration, and Technical (EDIT) Assistance Program, Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, Illinois
| | - George J. Greene
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Evaluation, Data Integration, and Technical (EDIT) Assistance Program, Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, Illinois
| | - Peter Lindeman
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Evaluation, Data Integration, and Technical (EDIT) Assistance Program, Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, Illinois
| | - Amy K. Johnson
- Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
- AIDS Foundation of Chicago, Chicago, Illinois
| | - Christian N. Adames
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Evaluation, Data Integration, and Technical (EDIT) Assistance Program, Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, Illinois
| | - Matthew Thomann
- Department of Anthropology and Sociology, Kalamazoo College, Kalamazoo, Michigan
| | - Patrick C.T. Washington
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Sociology, University of Illinois at Chicago, Chicago, Illinois
| | - Gregory Phillips
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Evaluation, Data Integration, and Technical (EDIT) Assistance Program, Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, Illinois
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17
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Shelton RC, Lee M, Brotzman LE, Crookes DM, Jandorf L, Erwin D, Gage-Bouchard EA. Use of social network analysis in the development, dissemination, implementation, and sustainability of health behavior interventions for adults: A systematic review. Soc Sci Med 2018; 220:81-101. [PMID: 30412922 DOI: 10.1016/j.socscimed.2018.10.013] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 11/30/2022]
Abstract
Interest in conceptualizing, measuring, and applying social network analysis (SNA) in public health has grown tremendously in recent years. While these studies have broadened our understanding of the role that social networks play in health, there has been less research that has investigated the application of SNA to inform health-related interventions. This systematic review aimed to capture the current applied use of SNA in the development, dissemination, implementation, and sustainability of health behavior interventions for adults. We identified 52 articles published between 2004 and 2016. A wide variety of study settings were identified, most commonly in the US context and most often related to sexual health and HIV prevention. We found that 38% of articles explicitly applied SNA to inform some aspect of interventions. Use of SNA to inform intervention development (as opposed to dissemination, implementation, or sustainability) was most common. The majority of articles represented in this review (n = 39) were quantitative studies, and 13 articles included a qualitative component. Partial networks were most represented across articles, and over 100 different networks measures were assessed. The most commonly described measures were network density, size, and degree centrality. Finally, very few articles defined SNA and not all articles using SNA were theoretically-informed. Given the nascent and heterogeneous state of the literature in this area, this is an important time for the field to coalesce on terminology, measures, and theoretical frameworks. We highlight areas for researchers to advance work on the application of SNA in the design, dissemination, implementation and sustainability of behavioral interventions.
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Affiliation(s)
- Rachel C Shelton
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, 722 West 168th Street, New York, NY, 10032, USA.
| | - Matthew Lee
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, 722 West 168th Street, New York, NY, 10032, USA.
| | - Laura E Brotzman
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, 722 West 168th Street, New York, NY, 10032, USA.
| | - Danielle M Crookes
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 West 168th Street, New York, NY, 10032, USA.
| | - Lina Jandorf
- Icahn School of Medicine at Mount Sinai, Department of Oncological Sciences, One Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Deborah Erwin
- Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
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18
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Crawford G, Maycock B, Tobin R, Brown G, Lobo R. Prevention of HIV and Other Sexually Transmissible Infections in Expatriates and Traveler Networks: Qualitative Study of Peer Interaction in an Online Forum. J Med Internet Res 2018; 20:e10787. [PMID: 30185404 PMCID: PMC6231883 DOI: 10.2196/10787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 08/11/2018] [Accepted: 08/16/2018] [Indexed: 01/19/2023] Open
Abstract
Background In high-income countries such as Australia, an increasing proportion of HIV cases have been acquired overseas, including among expatriates and travelers. Australia’s national strategies have highlighted the need for public health interventions for priority populations. One approach is to expand efforts to places or spaces where expatriate communities reside. Online settings such as forums used by expatriates and travelers have potential for preventing sexually transmissible infections with those hard to reach through more traditional interventions. Objective Our objectives were to (1) identify and describe domains of social interaction and engagement in 1 online forum used by Australian expatriates and travelers living or working in Thailand; and (2) make recommendations to health-promoting organizations and policy makers regarding the role of these forums in public health interventions with mobile populations who may be at risk of acquiring HIV or other sexually transmissible infections. Methods We identified forums and users in 2 stages. We identified 13 online forums and analyzed them for inclusion criteria. We searched 1 forum that met the required criteria for users who met inclusion criteria (n=5). Discussion threads, rather than individual posts, were units of analysis. For each user, we collected as transcripts the first 100 posts and 10 most recent posts, including the thread in which they were posted. We analyzed and thematically coded each post (n=550). Transcripts and analyses were reviewed and refined by multiple members of the research team to improve rigor. Themes were not totally emergent but explored against symbolic interactionism concepts of presentation of self, meaning, and socialization. Results Key domains were as follows: the forum (characteristics of the space and reasons for use), gaining access (forum hierarchy and rules), identity (presentation of self and role of language), advice, support, and information (sources of information, support provided, influencers, topics of discussion, and receptiveness to advice), and risk (expectations and perceptions). The forum exhibited evidence of unique language, rules and norms, and processes for managing conflict and key influencers. The forum was a substantial source of health information and advice provided to users via confirmation, reassurance, or affirmation of beliefs and experiences. Risk perception and expectations varied. Risk taking, including around sex, appeared to be a key expectation of travel or the experience of being an expatriate or traveler. Conclusions Australian expatriate and long-term traveler participation in the online forum formed, influenced, and reinforced knowledge, attitudes, interaction, and identity. Such forums can be used by policy makers and health-promoting organizations to provide supplementary sources of support and information to hard-to-reach mobile populations who may be at risk of acquiring HIV or other sexually transmissible infections. This will complement existing engagement with health professionals and other public health interventions.
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Affiliation(s)
- Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, Australia
| | - Bruce Maycock
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, Australia
| | - Rochelle Tobin
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, Australia
| | - Graham Brown
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, Australia.,Australian Research Centre in Sex Health and Society, La Trobe University, Bundoora, Australia
| | - Roanna Lobo
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, Australia
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19
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Fan H, Fife KH, Cox D, Cox AD, Zimet GD. Behavior and health beliefs as predictors of HIV testing among women: a prospective study of observed HIV testing. AIDS Care 2018; 30:1062-1069. [PMID: 29466877 PMCID: PMC6143364 DOI: 10.1080/09540121.2018.1442555] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Much of the research examining predictors of HIV testing has used retrospective self-report to assess HIV testing. FINDINGS therefore, may be subject to recall bias and to difficulties determining the direction of associations. In this prospective study, we administered surveys to women in community clinics to identify predictors of subsequent observed HIV testing, overcoming these limitations. Eighty-three percent were tested. In the adjusted multivariable model, being born in the U.S., perceived benefits of testing, worries about being infected with HIV, having had more than 15 lifetime sexual partners, and having had one or more casual sexual partners in the previous three months predicted acceptance of testing. Perceived obstacles to testing predicted non-acceptance. Those who had never been tested for HIV and those tested two to five years previously had greater odds of test acceptance than those who had been tested within the last year. The findings from this study with observed testing as the outcome, confirm some of the results from retrospective, self-report studies. Participants made largely rational decisions about testing, reflecting assessments of their risk and their history of HIV testing. Health beliefs are potentially modifiable through behavioral intervention, and such interventions might result in greater acceptance of testing. ABBREVIATIONS HIV: human immunodeficiency virus; AIDS: acquired immune deficiency syndrome; CDC: Centers for Disease Control and Prevention; ACASI: audio computer-assisted self-interview; TRA: theory of reasoned action; HBM: Health Belief Model; STI: sexually transmitted infection; STD: Sexually Transmitted Disease; AOR: adjusted odds ratio; CI: confidence interval.
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Affiliation(s)
- Hao Fan
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Kenneth H. Fife
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dena Cox
- Department of Marketing, Kelley School of Business, Indiana University, Indianapolis, IN, USA
| | - Anthony D. Cox
- Department of Marketing, Kelley School of Business, Indiana University, Indianapolis, IN, USA
| | - Gregory D. Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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20
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Traynor SM, Brincks AM, Feaster DJ. Correlates of Unknown HIV Status Among MSM Participating in the 2014 American Men's Internet Survey (AMIS). AIDS Behav 2018; 22:2113-2126. [PMID: 28852893 DOI: 10.1007/s10461-017-1894-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Increasing serostatus awareness is a key HIV prevention strategy. Despite expanded testing efforts, some men who have sex with men (MSM) remain unaware of their HIV status. This study explored demographic characteristics, sexual identity, sexual role, and behavioral factors associated with unknown HIV status among MSM in the United States. Data from 9170 MSM in the 2014 American Men's Internet Survey were analyzed using logistic regression to identify correlates of unknown HIV status. Young age, race, low education, rural residence, and lack of recent healthcare visits were significantly associated with unknown HIV status. In addition, nondisclosure of one's sexual orientation (OR = 3.70, 95% CI 2.99-4.59) and a self-identified sexual role as "bottom" (OR = 1.45, 95% CI 1.24-1.70) were predictors of unknown HIV status. Post-hoc analysis showed HIV-negative MSM not tested in the last year had fewer self-reported risk behaviors than recent testers, suggesting that repeat testing among MSM may be aligned with individual risk.
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Affiliation(s)
- S M Traynor
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - A M Brincks
- College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - D J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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21
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Measurements of Sexuality-Based Stigma among Gay, Bisexual, and Other Men Who Have Sex with Men (GBMSM) in Resource-Poor Settings: A Review. AIDS Behav 2018; 22:1614-1638. [PMID: 29128941 DOI: 10.1007/s10461-017-1975-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Gay, bisexual, and other men who have sex with men (GBMSM) in resource-poor settings are disproportionately affected by the HIV/AIDS epidemic. GBMSM living in these settings may face unique barriers to HIV prevention, including legal barriers and increased sexuality-based stigma. It is therefore imperative to tailor HIV prevention and care resources to recognize the lived realities of GBMSM in these settings. Central to this is the accurate measurement of sexuality-based stigma. However, there is wide inconsistency in how sexuality-based stigma is measured among GBMSM in resource-poor settings. This paper reviews recent studies of sexuality-based stigma among GBMSM in resource-poor settings, finding great variability in measurements. The results of the review call for greater attention to the development of contextually and culturally specific measures of sexuality-based stigma for GBMSM living in resource-poor settings.
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22
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Koblin BA, Nandi V, Hirshfield S, Chiasson MA, Hoover DR, Wilton L, Usher D, Frye V. Informing the Development of a Mobile Phone HIV Testing Intervention: Intentions to Use Specific HIV Testing Approaches Among Young Black Transgender Women and Men Who Have Sex With Men. JMIR Public Health Surveill 2017; 3:e45. [PMID: 28687531 PMCID: PMC5522583 DOI: 10.2196/publichealth.7397] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/11/2017] [Accepted: 05/09/2017] [Indexed: 11/16/2022] Open
Abstract
Background Regular human immunodeficiency virus (HIV) testing of persons at risk is critical to HIV prevention. Infrequent HIV testing and late diagnosis of HIV infection have been observed among young black men who have sex with men (MSM) and transwomen (transgender women)—two groups overrepresented in the HIV epidemic. Objective The objective of this study was to inform the development of a brief mobile phone intervention to increase HIV testing among young black MSM and transwomen by providing a tailored recommendation of an optimal HIV testing approach. We identified demographic, behavioral, psychosocial, and sociostructural factors associated with intentions to use three specific HIV testing approaches: self-testing, testing at a clinic or other provider, and couples HIV testing and counseling (CHTC). Methods Individuals were eligible for a Web-based survey if they were male at birth; were between the ages of 16 and 29 years; self-identified as black, African American, Caribbean black, African black, or multiethnic black; were not known to be HIV-infected; and reported insertive or receptive anal intercourse with a man or transwoman in the last 12 months. Recruitment occurred via banner advertisements placed on a range of social and sexual networking websites and apps in New York City and nationally, and via events attended by young black MSM and transwomen in New York City. Intention to test by each testing method was analyzed using logistic regression with best subset models and stepwise variable selection. Results Among 169 participants, intention to use a self-test was positively associated with comfort in testing by a friend or a partner at home (Adjusted odds ratio, AOR, 2.40; 95% CI 1.09-5.30), and stigma or fear as a reason not to test (AOR 8.61; 95% CI 2.50-29.68) and negatively associated with higher social support (AOR 0.48; 95% CI 0.33-0.72) and having health insurance (AOR 0.21; 95% CI 0.09-0.54). Intention to test at a clinic or other provider was positively associated with self-efficacy for HIV testing (AOR 2.87; 95% CI 1.48-5.59) and social support (AOR 1.98; 95% CI 1.34-2.92), and negatively associated with a lifetime history of incarceration (AOR 0.37; 95% CI 0.16-0.89). Intention to test by CHTC was negatively associated with higher educational level (Some college or Associate’s degree vs high school graduate or less [AOR 0.81; 95% CI 0.39-1.70]; Bachelor’s degree or more vs high school graduate or less [AOR 0.28; 95% CI 0.11-0.70]). Conclusions Unique factors were associated with intention to test using specific testing approaches. These data will be critical for the development of a tailored intervention that shows promise to increase comfort and experiences with a variety of testing approaches among young black MSM and transwomen.
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Affiliation(s)
- Beryl A Koblin
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, United States
| | - Vijay Nandi
- New York Blood Center, New York, NY, United States
| | | | | | - Donald R Hoover
- Department of Statistics and Biostatistics, Institute of Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Leo Wilton
- Department of Human Development, Binghamton University, Binghamton, NY, United States.,Faculty of Humanities, University of Johannesburg, Auckland Park, Johannesburg, South Africa
| | - DaShawn Usher
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, United States
| | - Victoria Frye
- Department of Community Health and Social Medicine, CUNY School of Medicine, City College of New York, New York, NY, United States
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