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Lee JJ, Wang L, Vo K, Gonzalez C, Orellana ER, Kerani RP, Katz DA, Sanchez TH, Graham SM. Characterizing the Communication Networks of Spanish- and English-Speaking Latinx Sexual Minority Men and Their Roles in Pre-Exposure Prophylaxis Uptake. JOURNAL OF HEALTH COMMUNICATION 2024; 29:467-480. [PMID: 38872332 DOI: 10.1080/10810730.2024.2366498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
While pre-exposure prophylaxis (PrEP) has demonstrated efficacy in preventing HIV transmission, disparities in access persist in the United States, especially among Hispanic/Latinx sexual minority men (SMM). Language barriers and differences in how Latinx SMM obtain information may impact access to PrEP and HIV prevention. This study used data from the 2021 American Men's Internet Survey (AMIS) to examine differences in communication networks and PrEP use among Latinx SMM by primary language (Spanish vs. English). We examined the associations between Latinx SMM's individual- and meso-level communication networks and PrEP-related outcomes using modified Poisson regression with robust variances. Spanish-speaking Latinx SMM in the study were less likely to test for HIV, be aware of PrEP, and use daily PrEP, compared to English-speaking participants. Sexuality disclosure to a healthcare provider was positively associated with PrEP uptake among all participants and predicted STI testing over the past 12 months among English-speaking Latinx SMM. Findings highlight disparities in PrEP awareness and uptake among Latinx SMM, especially among those whose primary language is Spanish. Addressing these disparities through targeted interventions, including improved communication with healthcare providers, may help facilitate PrEP access and use in this population.
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Affiliation(s)
- Jane J Lee
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Liying Wang
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Katie Vo
- School of Public Health, University of Washington, Seattle, Washington, USA
| | - Carmen Gonzalez
- Department of Communication, University of Washington, Seattle, Washington, USA
| | - E Roberto Orellana
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Roxanne P Kerani
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - David A Katz
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Travis H Sanchez
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Susan M Graham
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
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2
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Jenkins WD, Friedman SR, Hurt CB, Korthuis PT, Feinberg J, Del Toro-Mejias LM, Walters S, Seal DW, Fredericksen RJ, Westergaard R, Miller WC, Go VF, Schneider J, Giurcanu M. Variation in HIV Transmission Behaviors Among People Who Use Drugs in Rural US Communities. JAMA Netw Open 2023; 6:e2330225. [PMID: 37603331 PMCID: PMC10442709 DOI: 10.1001/jamanetworkopen.2023.30225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 07/16/2023] [Indexed: 08/22/2023] Open
Abstract
Importance People who use drugs (PWUD) continue to be at risk of HIV infection, but the frequency and distribution of transmission-associated behaviors within various rural communities is poorly understood. Objective To examine the association of characteristics of rural PWUD with HIV transmission behaviors. Design, Setting, and Participants In this cross-sectional study, surveys of PWUD in rural communities in 10 states (Illinois, Kentucky, New Hampshire, Massachusetts, North Carolina, Ohio, Oregon, Vermont, West Virginia, and Wisconsin) were collected January 2018 through March 2020 and analyzed August through December 2022. A chain-referral sampling strategy identified convenience sample seeds who referred others who used drugs. Rural PWUD who reported any past 30-day injection drug use or noninjection opioid use "to get high" were included. Exposures Individual characteristics, including age, race, gender identity, sexual orientation, partnership status, drug of choice, and location, were collected. Main Outcomes and Measures Past 30-day frequency of behaviors associated with HIV transmission, including drug injection, syringe sharing, opposite- and same-gender partners, transactional sex, and condomless sex, was assessed. Results Of 3048 rural PWUD (mean [SD] age, 36.1 [10.3] years; 225 American Indian [7.4%], 96 Black [3.2%], and 2576 White [84.5%] among 3045 with responses; and 1737 men [57.0%] among 3046 with responses), most participants were heterosexual (1771 individuals [86.8%] among 2040 with responses) and single (1974 individuals [68.6%] among 2879 with responses). Opioids and stimulants were reported as drug of choice by 1636 individuals (53.9%) and 1258 individuals (41.5%), respectively, among 3033 individuals with responses. Most participants reported recent injection (2587 of 3046 individuals [84.9%] with responses) and condomless sex (1406 of 1757 individuals [80.0%] with responses), among whom 904 of 1391 individuals (65.0%) with responses indicated that it occurred with people who inject drugs. Syringe sharing (1016 of 2433 individuals [41.8%] with responses) and transactional sex (230 of 1799 individuals [12.8%] with responses) were reported less frequently. All characteristics and behaviors, except the number of men partners reported by women, varied significantly across locations (eg, mean [SD] age ranged from 34.5 [10.0] years in Wisconsin to 39.7 [11.0] years in Illinois; P < .001). In multivariable modeling, younger age (adjusted odds ratio [aOR] for ages 15-33 vs ≥34 years, 1.36; 95% CI, 1.08-1.72) and being single (aOR, 1.37; 95% CI, 1.08-1.74) were associated with recent injection; younger age (aOR, 1.49; 95% CI, 1.20-1.85) and bisexual orientation (aOR vs heterosexual orientation, 2.27; 95% CI, 1.60-3.23) with syringe sharing; gender identity as a woman (aOR vs gender identity as a man, 1.46; 95% CI, 1.01-2.12), bisexual orientation (aOR vs heterosexual orientation, 2.59; 95% CI, 1.67-4.03), and being single (aOR, 1.71; 95% CI, 1.15-2.55) with transactional sex; and bisexual orientation (aOR vs heterosexual orientation, 1.60; 95% CI, 1.04-2.46) and stimulants as the drug of choice (aOR vs opioids, 1.45; 95 CI, 1.09-1.93) with condomless sex with someone who injects drugs. Conclusions and Relevance This study found that behaviors associated with HIV transmission were common and varied across communities. These findings suggest that interventions to reduce HIV risk among rural PWUD may need to be tailored to locally relevant factors.
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Affiliation(s)
- Wiley D. Jenkins
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield
| | - Samuel R. Friedman
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Christopher B. Hurt
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill
| | - P. Todd Korthuis
- Addiction Medicine Section, Oregon Health and Science University, Portland
| | | | | | - Suzan Walters
- School of Global Public Health, New York University, New York, New York
| | - David W. Seal
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | - Ryan Westergaard
- School of Medicine and Public Health, University of Wisconsin, Madison
| | - William C. Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus
| | - Vivian F. Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - John Schneider
- Biological Sciences Division, University of Chicago, Chicago, Illinois
| | - Mihai Giurcanu
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
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3
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Wiginton JM, Eaton LA, Watson RJ, Maksut JL, Earnshaw VA, Berman M. Sex-Positivity, Medical Mistrust, and PrEP Conspiracy Beliefs Among HIV-Negative Cisgender Black Sexual Minority Men in Atlanta, Georgia. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2571-2581. [PMID: 34761347 PMCID: PMC9085967 DOI: 10.1007/s10508-021-02174-7] [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] [Received: 10/29/2020] [Revised: 08/18/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
Because the public health response to the disproportionate HIV burden faced by Black sexual minority men (BSMMM) has focused on sexual risk reduction and disease prevention, other vital components of sexual health (e.g., intimacy, pleasure, benefits of sex) have been often overlooked. Sex-positive describes a more open, holistic approach toward sex and sexuality that prioritizes these other components, though such an approach is rarely applied to BSMM's sexual health. For sex-positive BSMM, risk/preventive discourse may foster or exacerbate medical mistrust as a reaction to the dissonance between how these men view sexual health and how the medical establishment views it, which may discourage sexual healthcare-seeking. We assessed sex-positivity and its association with medical mistrust and PrEP conspiracy beliefs among 206 HIV-negative cisgender BSMM in Atlanta, Georgia. We performed exploratory factor analytic procedures on responses to a sex-positivity scale, followed by multivariable linear regressions to determine sex-positivity's associations with medical mistrust and PrEP conspiracy beliefs. We extracted two sex-positivity factors: sexual freedom (α = 0.90), reflecting openness toward casual sex and rejection of sexual mores, and essence of sex (α = 0.77), reflecting the intimate, relational, and pleasurable qualities of sex. Sexual freedom was independently associated with perceived provider deception (β = 0.19, CI = 0.04, 0.34). Essence of sex was independently associated with PrEP conspiracy beliefs (β = 0.16, CI = 0.02, 0.31) and marginally associated with perceived provider deception (β = 0.14, CI = - 0.00, 0.29). Healthcare providers and public health practitioners may cultivate greater trust with BSMM by incorporating a sex-positive approach into patient/participant interactions, clinical decision-making, and interventions. Improving access to sexual pleasure acknowledges BSMM's right to optimal, holistic sexual health.
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Affiliation(s)
- John Mark Wiginton
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway Street, Baltimore, MD, 21205, USA.
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Jessica L Maksut
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Marcie Berman
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
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4
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Schmidt R, Carson PJ, Jansen RJ. Resurgence of Syphilis in the United States: An Assessment of Contributing Factors. Infect Dis (Lond) 2019; 12:1178633719883282. [PMID: 31666795 PMCID: PMC6798162 DOI: 10.1177/1178633719883282] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/25/2019] [Indexed: 12/22/2022] Open
Abstract
In the last decade, there has been a marked resurgence of syphilis in the United States despite the availability of effective treatments and previously reliable prevention strategies. The majority of cases are among the population of men who have sex with men (MSM); however, there has also been a recent increase among premenopausal women, coinciding with a concerning rise of congenital cases. The resurgence of syphilis can be largely attributed to changing social and behavioral factors, especially among young MSM. The biological association of syphilis with human immunodeficiency virus (HIV) transmission and acquisition is particularly alarming because of the increased individual and healthcare burden. In addition, some individual actions and public health efforts that are meant to reduce the risk of acquiring HIV may actually lead to risk compensation that facilitates the transmission of syphilis. Untreated syphilis is associated with detrimental health outcomes; therefore, both effective prevention strategies and treatment of this systemic disease have important short-term and long-term public health implications. This article offers a review of social and behavioral factors contributing to the current resurgence and recommendations for reducing syphilis incidence through medical and public health prevention strategies.
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Affiliation(s)
- Rebecca Schmidt
- Department of Public Health, North
Dakota State University, Fargo, ND, USA
| | - Paul James Carson
- Department of Public Health, North
Dakota State University, Fargo, ND, USA
- Center for Immunization Research and
Education, North Dakota State University, Fargo, ND, USA
| | - Rick J Jansen
- Department of Public Health, North
Dakota State University, Fargo, ND, USA
- Center for Immunization Research and
Education, North Dakota State University, Fargo, ND, USA
- Biostatistics Core Facility, North
Dakota State University, Fargo, ND, USA
- Genomics and Bioinformatics Program,
North Dakota State University, Fargo, ND, USA
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5
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Klassen BJ, Fulcher K, Chown SA, Armstrong HL, Hogg RS, Moore DM, Roth EA, Lachowsky NJ. "Condoms are … like public transit. It's something you want everyone else to take": Perceptions and use of condoms among HIV negative gay men in Vancouver, Canada in the era of biomedical and seroadaptive prevention. BMC Public Health 2019; 19:120. [PMID: 30691426 PMCID: PMC6350294 DOI: 10.1186/s12889-019-6452-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The emergence of biomedical and seroadaptive HIV prevention strategies has coincided with a decline in condom use among gay men. METHODS We undertook a social ecological analysis of condom use and perceptions using nineteen semi-structured interviews with HIV negative gay men in Vancouver, Canada who used HAART-based prevention strategies. RESULTS Contributors to inconsistent condom use were found at various levels of the social ecological model. Ongoing concern regarding HIV transmission and belief in the proven efficacy of condoms motivated contextual use. When condoms were not used, participants utilized seroadaptive and biomedical prevention strategies to mitigate risk. CONCLUSIONS These findings indicate that notions of "safety" and "risk" based on consistent condom use are eroding as other modes of prevention gain visibility. Community-based and public health interventions will need to shift prevention messaging from advocacy for universal condom use toward combination prevention in order to meet gay men's current prevention needs. Interventions should advance gay men's communication and self-advocacy skills in order to optimize these strategies.
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Affiliation(s)
- Benjamin J Klassen
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of History, Simon Fraser University, Burnaby, BC, Canada
| | - Karyn Fulcher
- School of Public Health & Social Policy, University of Victoria, room B202, HSD Building, 3800 Finnerty Rd, Victoria, BC, V8P 5C2, Canada
| | | | - Heather L Armstrong
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Robert S Hogg
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - David M Moore
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Eric A Roth
- Department of Anthropology, University of Victoria, Victoria, BC, Canada.,Centre for Addictions Research of British Columbia, Victoria, BC, Canada
| | - Nathan J Lachowsky
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada. .,School of Public Health & Social Policy, University of Victoria, room B202, HSD Building, 3800 Finnerty Rd, Victoria, BC, V8P 5C2, Canada.
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6
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Klein CH, Kuhn T, Huxley D, Kennel J, Withers E, Lomonaco CG. Preliminary Findings of a Technology-Delivered Sexual Health Promotion Program for Black Men Who Have Sex With Men: Quasi-Experimental Outcome Study. JMIR Public Health Surveill 2017; 3:e78. [PMID: 29066422 PMCID: PMC5676034 DOI: 10.2196/publichealth.7933] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/11/2017] [Accepted: 08/09/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) disproportionately affects black men who have sex with men (MSM), yet there are few evidence-based interventions specifically designed for black MSM communities. In response, the authors created Real Talk, a technology-delivered, sexual health program for black MSM. OBJECTIVE The objective of our study was to determine whether Real Talk positively affected risk reduction intentions, disclosure practices, condom use, and overall risk reduction sexual practices. METHODS The study used a quasi-experimental, 2-arm methodology. During the first session, participants completed a baseline assessment, used Real Talk (intervention condition) or reviewed 4 sexual health brochures (the standard of care control condition), and completed a 10-minute user-satisfaction survey. Six months later, participants from both conditions returned to complete the follow-up assessment. RESULTS A total of 226 participants were enrolled in the study, and 144 completed the 6-month follow-up. Real Talk participants were more likely to disagree that they had intended in the last 6 months to bottom without a condom with a partner of unknown status (mean difference=-0.608, P=.02), have anal sex without a condom with a positive man who was on HIV medications (mean difference=-0.471, P=.055), have their partner pull out when bottoming with a partner of unknown HIV status (mean difference=-0.651, P=.03), and pull out when topping a partner of unknown status (mean difference=-0.644, P=.03). Real Talk participants were also significantly more likely to disagree with the statement "I will sometimes lie about my HIV status with people I am going to have sex with" (mean difference=-0.411, P=.04). In terms of attitudes toward HIV prevention, men in the control group were significantly more likely to agree that they had less concern about becoming HIV positive because of the availability of antiretroviral medications (mean difference=0.778, P=.03) and pre-exposure prophylaxis (PReP) (mean difference=0.658, P=.05). There were, however, no significant differences between Real Talk and control participants regarding actual condom use or other risk reduction strategies. CONCLUSIONS Our findings suggest that Real Talk supports engagement on HIV prevention issues. The lack of behavior findings may relate to insufficient study power or the fact that a 2-hour, standalone intervention may be insufficient to motivate behavioral change. In conclusion, we argue that Real Talk's modular format facilitates its utilization within a broader array of prevention activities and may contribute to higher PReP utilization in black MSM communities.
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Affiliation(s)
- Charles H Klein
- Department of Anthropology, Portland State University, Portland, OR, United States
| | - Tamara Kuhn
- dfusion, Oakland, CA, United States.,ETR, Scotts Valley, CA, United States
| | - Danielle Huxley
- Department of Anthropology, Portland State University, Portland, OR, United States
| | - Jamie Kennel
- Department of Emergency Medical Services, Oregon Health & Sciences University, Portland, OR, United States.,Department of Emergency Medical Services, Oregon Institute of Technology, Klamath Falls, OR, United States.,Department of Sociology, Portland State University, Portland, OR, United States
| | - Elizabeth Withers
- Department of Sociology, Portland State University, Portland, OR, United States
| | - Carmela G Lomonaco
- University of California, San Francisco, San Francisco, CA, United States
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7
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Affiliation(s)
- Joseph Brennan
- University of Sydney, Media and Communications, Sydney, 2006 Australia
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8
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Levy ME, Phillips G, Magnus M, Kuo I, Beauchamp G, Emel L, Hucks-Ortiz C, Hamilton EL, Wilton L, Chen I, Mannheimer S, Tieu HV, Scott H, Fields SD, Del Rio C, Shoptaw S, Mayer K. A Longitudinal Analysis of Treatment Optimism and HIV Acquisition and Transmission Risk Behaviors Among Black Men Who Have Sex with Men in HPTN 061. AIDS Behav 2017; 21:2958-2972. [PMID: 28352984 PMCID: PMC5623129 DOI: 10.1007/s10461-017-1756-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Little is known about HIV treatment optimism and risk behaviors among Black men who have sex with men (BMSM). Using longitudinal data from BMSM in the HPTN 061 study, we examined participants' self-reported comfort with having condomless sex due to optimistic beliefs regarding HIV treatment. We assessed correlates of treatment optimism and its association with subsequent risk behaviors for HIV acquisition or transmission using multivariable logistic regression with generalized estimating equations. Independent correlates of treatment optimism included age ≥35 years, annual household income <$20,000, depressive symptoms, high HIV conspiracy beliefs, problematic alcohol use, and previous HIV diagnosis. Treatment optimism was independently associated with subsequent condomless anal sex with a male partner of serodiscordant/unknown HIV status among HIV-infected men, but this association was not statistically significant among HIV-uninfected men. HIV providers should engage men in counseling conversations to assess and minimize willingness to have condomless sex that is rooted in optimistic treatment beliefs without knowledge of viral suppression.
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Affiliation(s)
- Matthew E Levy
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, 950 New Hampshire Ave NW, 5th Floor, Washington, DC, USA.
| | - Gregory Phillips
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, 950 New Hampshire Ave NW, 5th Floor, Washington, DC, USA
| | - Irene Kuo
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, 950 New Hampshire Ave NW, 5th Floor, Washington, DC, USA
| | - Geetha Beauchamp
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lynda Emel
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Christopher Hucks-Ortiz
- Division of HIV Prevention and Care, John Wesley Community Health Institute, Los Angeles, CA, USA
| | | | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, Binghamton, NY, USA
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Iris Chen
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sharon Mannheimer
- Department of Medicine, Harlem Hospital and Columbia University Medical Center, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Hyman Scott
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Sheldon D Fields
- Nicole Weirtheim College of Nursing and Health Sciences, Florida International University, Miami, FL, USA
| | - Carlos Del Rio
- Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Steven Shoptaw
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kenneth Mayer
- Fenway Health, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, MA, USA
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