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Torres RMC, Bastos LS, Gomes MFDC, Moreira RI, Périssé ARS, Cruz MMD. Risk assessment for HIV infection in men who have sex with men and the contribution of sexual partner networks. CIENCIA & SAUDE COLETIVA 2021; 26:3543-3554. [PMID: 34468650 DOI: 10.1590/1413-81232021269.2.36912019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 01/05/2020] [Indexed: 11/22/2022] Open
Abstract
This study aimed to evaluate the risk of HIV infection in men who have sex with men (MSM) by developing an index that considers sex partner networks. The index variables were age, ethnicity/skin color, schooling, relationship type, condom use in receptive and insertive relationships, self-perception of the possibility of HIV infection, sexually transmitted infections, and rapid HIV testing results. We used data from a cross-sectional MSM egocentric network survey conducted in Rio de Janeiro between 2014 and 2015. The initial research volunteer is called ego, each partner is called alter, and each pair of people in a relationship is called the dyad. Multiple logistic regression was used to define the coefficients of the equations for the elaboration of the indices. The index ranged from 0 to 1; the closer to 1, the higher the risk of HIV infection. HIV prevalence was 13.9% among egos. The mean egos index with an HIV-reactive test was 57% higher than non-reactive, and the same profile was observed in the index values of dyads. The index allowed the incorporation of network data through the dyads and contributed to the identification of individuals with a higher likelihood of acquiring HIV.
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Affiliation(s)
- Raquel Maria Cardoso Torres
- Escola Nacional de Saúde Pública Sergio Arouca, Fiocruz. R. Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro. 21041-210 Rio de Janeiro RJ Brasil.
| | - Leonardo Soares Bastos
- Programa de Computação Científica, Fiocruz. Rio de Janeiro, RJ, Brasil.,Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine. London United Kingdom
| | | | | | - André Reynaldo Santos Périssé
- Escola Nacional de Saúde Pública Sergio Arouca, Departamento de Endemias Samuel Pessoa, Fiocruz. Rio de Janeiro RJ Brasil
| | - Marly Marques da Cruz
- Escola Nacional de Saúde Pública Sergio Arouca, Departamento de Endemias Samuel Pessoa, Fiocruz. Rio de Janeiro RJ Brasil
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2
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Olawore O, Crowell TA, Ketende SC, Ramadhani HO, Liu H, Ake JA, Kokogho A, Adebajo S, Charurat ME, Nowak RG, Baral SD. Individual and partnership characteristics associated with consistent condom use in a cohort of cisgender men who have sex with men and transgender women in Nigeria. BMC Public Health 2021; 21:1277. [PMID: 34193101 PMCID: PMC8243438 DOI: 10.1186/s12889-021-11275-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 06/11/2021] [Indexed: 11/21/2022] Open
Abstract
Background This study reports on the individual and partnership characteristics that influence consistent condom use in cisgender men who have sex with men (MSM) and transgender women (TGW) attending trusted community centers that provide HIV prevention and treatment services in Nigeria. Methods Adults assigned male at birth who reported anal sex with male partners who enrolled between March 2013–2019 and had information about at least one male sexual partner were included in these analyses. At enrollment and follow-up visits every 3 months for up to 18 months, participants were administered detailed questionnaires that collected information about demographics, sexual practices, HIV risk behaviors, and characteristics and behaviors of their partners in the previous year (at enrollment) or the preceding 3 to 6-months (at follow-up visits). Logistic regression models with generalized estimating equations were used to assess the odds ratio (OR) and 95% confidence intervals (CI) of individual, partner, and partnership characteristics associated with consistent condom use (CCU). A participant was defined as consistently using condom if they reported always using condoms all the time they had insertive, receptive or both types of anal sex with a male partner. Results At the individual level, CCU was positively associated with higher education, disclosure of key population status to a healthcare worker and negatively associated with poor access to condoms. At the partner and partnership level, CCU was associated with partners with higher education (aOR: 1.36; 95% CI: 1.07–1.72), casual relationships (aOR: 1.22; 95% CI: 1.11–1.34) and relationships in which partners encouraged the participant to use condoms with other partners (aOR: 1.14; 95% CI: 1.02–1.28). Relationships in which the partner was married to a woman and/or the partner’s HIV status positive or unknown were negatively associated with CCU. Conclusions These findings suggest that individuals in relationships where partners were more open and encouraged safer sex were more likely to consistently use condoms. HIV prevention programs should consider leveraging communication to sexual partners to encourage condom use as this may support condom use with other sexual partners. Given sustained and growing HIV and STI epidemics among MSM and TGW, even with pre-exposure prophylaxis scale-up, it is crucial to continue to study optimal implementation strategies to increase condom use. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11275-w.
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Affiliation(s)
- Oluwasolape Olawore
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite 3507, Baltimore, MD, 21205, USA.
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Sosthenes C Ketende
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite 3507, Baltimore, MD, 21205, USA
| | - Habib O Ramadhani
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hongjie Liu
- School of Public Health, University of Maryland, College Park, MD, USA
| | - Julie A Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Afoke Kokogho
- HJF Medical Research International, Abuja, Nigeria.,U.S. Army Medical Research Directorate - Africa, Nairobi, Kenya
| | - Sylvia Adebajo
- Maryland Global Initiatives Corporation (MGIC), Abuja, Nigeria
| | - Man E Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rebecca G Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stefan D Baral
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite 3507, Baltimore, MD, 21205, USA
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Jones MU, Ramadhani HO, Adebajo S, Gaydos CA, Kokogho A, Baral SD, Nowak RG, Ake JA, Liu H, Charurat ME, Robb ML, Crowell TA. Seizing opportunities for intervention: Changing HIV-related knowledge among men who have sex with men and transgender women attending trusted community centers in Nigeria. PLoS One 2020; 15:e0229533. [PMID: 32119701 PMCID: PMC7051043 DOI: 10.1371/journal.pone.0229533] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/07/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Knowledge of HIV risk factors and reduction strategies is essential for prevention in key populations such as men who have sex with men (MSM) and transgender women (TGW). We evaluated factors associated with HIV-related knowledge among MSM and TGW and the impact of engagement in care at trusted community health centers in Nigeria. METHODS The TRUST/RV368 cohort recruited MSM and TGW in Lagos and Abuja, Nigeria via respondent driven sampling. During study visits every three months, participants underwent structured interviews to collect behavioral data, received HIV education, and were provided free condoms and condom compatible lubricants. Five HIV-related knowledge questions were asked at enrollment and repeated after 9 and 15 months. The mean number of correct responses was calculated for each visit with 95% confidence intervals (CIs). Multivariable Poisson regression was used to calculate adjusted risk ratios and CIs for factors associated with answering more knowledge questions correctly. RESULTS From March 2013 to April 2018, 2122 persons assigned male sex at birth were enrolled, including 234 TGW (11.2%). The mean number of correct responses at enrollment was 2.36 (95% CI: 2.31-2.41) and increased to 2.95 (95% CI: 2.86-3.04) and 3.06 (95% CI: 2.97-3.16) after 9 and 15 months in the study, respectively. Among 534 participants who completed all three HIV-related knowledge assessments, mean number of correct responses rose from 2.70 (95% CI: 2.60-2.80) to 3.02 (95% CI: 2.93-3.13) and then 3.06 (95% CI: 2.96-3.16). Factors associated with increased overall HIV-related knowledge included longer duration of study participation, HIV seropositivity, higher education level, and more frequent internet use. CONCLUSIONS There was suboptimal HIV-related knowledge among Nigerian MSM and TGW at that improved modestly with engagement in care. These data demonstrate unmet HIV education needs among Nigerian MSM and TGW and provide insights into modalities that could be used to address these needs.
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Affiliation(s)
- Milissa U. Jones
- Uniformed Services University, Bethesda, Maryland, United States of America
| | - Habib O. Ramadhani
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | | | - Charlotte A. Gaydos
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Afoke Kokogho
- U.S. Army Medical Research Directorate – Africa/Nigeria, Abuja, Nigeria
- HJF Medical Research International, Abuja, Nigeria
| | - Stefan D. Baral
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Rebecca G. Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Julie A. Ake
- Uniformed Services University, Bethesda, Maryland, United States of America
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Hongjie Liu
- University of Maryland School of Public Health, College Park, Maryland, United States of America
| | - Manhattan E. Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Merlin L. Robb
- Uniformed Services University, Bethesda, Maryland, United States of America
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Trevor A. Crowell
- Uniformed Services University, Bethesda, Maryland, United States of America
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
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Wang L, Moqueet N, Lambert G, Grace D, Rodrigues R, Cox J, Lachowsky NJ, Noor SW, Armstrong HL, Tan DHS, Burchell AN, Ma H, Apelian H, Knight J, Messier-Peet M, Jollimore J, Baral S, Hart TA, Moore DM, Mishra S. Population-Level Sexual Mixing According to HIV Status and Preexposure Prophylaxis Use Among Men Who Have Sex With Men in Montreal, Canada: Implications for HIV Prevention. Am J Epidemiol 2020; 189:44-54. [PMID: 31612213 PMCID: PMC7119299 DOI: 10.1093/aje/kwz231] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/27/2019] [Accepted: 09/27/2019] [Indexed: 12/21/2022] Open
Abstract
Using cross-sectional survey data (Engage, 2017–2018) from 1,137 men who have sex with men, ≥16 years old, in Montreal, we compared observed human immunodeficiency virus (HIV) seroconcordance in previous-6-months’ sexual partnerships with what would have been observed by chance if zero individuals serosorted. Of 5 recent partnerships where both individuals were HIV-negative, we compared observed concordance in preexposure prophylaxis (PrEP) use with the counterfactual if zero individuals selected partners based on PrEP use. We estimated the concordance by chance using a balancing-partnerships approach assuming proportionate mixing. HIV-positive respondents had a higher proportion of HIV-positive partners (66.4%, 95% confidence interval (CI): 64.0, 68.6) than by chance (23.9%, 95% CI: 23.1, 24.7). HIV-negative respondents (both on and not on PrEP) had higher proportions of HIV-negative partners (82.9% (95% CI: 81.1, 84.7) and 90.7% (95% CI: 89.6, 91.7), respectively) compared with by chance (76.1%, 95% CI: 75.3, 76.9); however, those on PrEP had a higher proportion of HIV-positive partners than those not on PrEP (17.1% (95% CI: 15.3, 18.9) vs. 9.3% (95% CI: 8.3, 10.4). Those on PrEP also had a higher proportion of partners on PrEP among their HIV-negative partners (50.6%, 95% CI: 42.5, 58.8) than by chance (28.5%, 95% CI: 27.5, 29.4). The relationship between PrEP and sexual-mixing patterns demonstrated by less population-level serosorting among those on PrEP and PrEP-matching warrants consideration during PrEP roll-out.
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Affiliation(s)
- Linwei Wang
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Nasheed Moqueet
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Gilles Lambert
- Institut National de Santé Publique du Québec, Montreal, Quebec, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ricky Rodrigues
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Joseph Cox
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Nathan J Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Syed W Noor
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Heather L Armstrong
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Darrell H S Tan
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ann N Burchell
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Huiting Ma
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Herak Apelian
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Jesse Knight
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Marc Messier-Peet
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Jody Jollimore
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Department of Medicine, Division of AIDS, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sharmistha Mishra
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
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Rodriguez-Hart C, Bradley C, German D, Musci R, Orazulike I, Baral S, Liu H, Crowell TA, Charurat M, Nowak RG. The Synergistic Impact of Sexual Stigma and Psychosocial Well-Being on HIV Testing: A Mixed-Methods Study Among Nigerian Men who have Sex with Men. AIDS Behav 2018; 22:3905-3915. [PMID: 29956115 PMCID: PMC6209528 DOI: 10.1007/s10461-018-2191-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although sexual stigma has been linked to decreased HIV testing among men who have sex with men (MSM), mechanisms for this association are unclear. We evaluated the role of psychosocial well-being in connecting sexual stigma and HIV testing using an explanatory sequential mixed methods analysis of 25 qualitative and 1480 quantitative interviews with MSM enrolled in a prospective cohort study in Nigeria from March/2013-February/2016. Utilizing structural equation modeling, we found a synergistic negative association between sexual stigma and suicidal ideation on HIV testing. Qualitatively, prior stigma experiences often generated psychological distress and perceptions of feeling unsafe, which decreased willingness to seek services at general health facilities. MSM reported feeling safe at the MSM-friendly study clinic but still described a need for psychosocial support services. Addressing stigma and unmet mental health needs among Nigerian MSM has the potential to improve HIV testing uptake.
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Affiliation(s)
- Cristina Rodriguez-Hart
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Cory Bradley
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Danielle German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rashelle Musci
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ifeanyi Orazulike
- International Center on Advocacy and Rights to Health, Abuja, Nigeria
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hongjie Liu
- School of Public Health, University of Maryland, College Park, MD, USA
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Man Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rebecca G Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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