Predictors of HIV Testing and Their Influence on PrEP Acceptance in Men Who Have Sex with Men: A Cross-Sectional Study

Body (dis)satisfaction and health screening behaviors: A systematic review of observational studies

Engagement in health-promoting behaviors has been argued to be dependent on psychological factors in addition to simply having knowledge or access to resources. We systematically reviewed the evidence for the association between body (dis)satisfaction and health screening behaviors using six electronic databases and supplementary manual searches in the current study. To be included in the review, studies had to be empirical, in any language, and examined the potential link between body (dis)satisfaction and health screening. Findings from the final 16 quantitative and 12 qualitative studies generally suggest that people who were more satisfied or less dissatisfied with their bodies were more likely to engage in health screening. This review also highlighted key gaps in the literature such as the limited studies that included men as participants and the lack of examination of the underlying mechanisms and contingencies of the relationship between body (dis)satisfaction and health screening behaviors.

Tracking adaptation strategies of an HIV prevention intervention among youth in Nigeria: a theoretically informed case study analysis of the 4 Youth by Youth Project

BACKGROUND

Although many behavioral interventions are adapted, little is known about the reasons for adaptations and the process and outcomes influencing adaptations. To address this gap, we explored the adaptations made to promote HIV prevention services, including HIV self-testing (HIVST), among Nigerian youth.

METHODS

The main objective of this qualitative case study design was to document the adaptations made over time using the Framework for Reporting Adaptations and Modifications - Expanded (FRAME). Between 2018 and 2020, we organized four participatory activities as part of the 4 Youth by Youth project to increase the uptake of HIVST services in Nigeria-an open call, a designathon, a capacity-building bootcamp and a pilot feasibility trial. We also began the process of implementing a final intervention using a pragmatic randomized control trial (RCT). The open call solicited creative strategies to promote HIVST among Nigerian youth and then had experts evaluate them. The designathon brought together youth teams to further develop their HIVST service strategies into implementation protocols. Teams determined to be exceptional were invited to a four-week capacity-building bootcamp. The five teams that emerged from the bootcamp were supported to pilot their HIVST service strategies over a 6-month period. The adapted intervention is currently being evaluated in a pragmatic RCT. We transcribed meeting reports and conducted document reviews of study protocols and training manuals.

RESULTS

Sixteen adaptations were identified and categorized into three domains: (1) modifications to the content of the intervention (i.e. photo verification system and/or Unstructured Supplementary Service Data (USSD) system to verify HIVST); (2) modifications to the delivery the intervention (i.e. implement participatory learning community sessions to provide supportive supervision and technical support); (3) modifications to the evaluation processes (i.e. economic evaluation to estimate the cost of implementing intervention on a larger scale). Frequent reasons for adaptation included increasing intervention reach, modifying interventions to enhance their appropriateness and fit with the recipient, and increasing the intervention's feasibility and acceptability. Most adaptations were planned and reactive, and the need for modifications was determined by the youths, 4YBY program staff, and advisory group.

CONCLUSIONS

Findings suggest that the nature of adaptations made throughout the implementation process reflects the necessity of evaluating services in context while adjusting to specific challenges as they are identified. Further research is needed to understand the effect of these adaptations on the overall intervention effect as well as the quality of youth engagement.

Orthorexia nervosa in gay men-the result of a spanish-polish eating disorders study

BACKGROUND

The purpose of this exploratory study was to identifying demographic factors and unique predictors of ON e.g., the use of pre-exposure prophylaxis (PrEP), the use of social media and the Grindr ® dating application among a sample group of Spanish and Polish identifying gay men.

METHODS

The study was conducted in Poland and Spain between March and June 2021 using questionary: ORTO-15. Data was collected using a three-section self-administered questionnaire. The first section contained demographic data, the second part was the Polish and Spanish version of the Orto-15, and the third part was the Polish and Spanish version of the EAT-26.

RESULTS

Total enrollment was 394 gay men. In regression proportional hazards single model, significant predictors of ON were: age (OR = 0.964, 95% CI, 0.944-0.984), BMI (OR = 0.895, 95% CI, 0.848-0.944), staying in an informal relationship compared to being single (OR = 2.138, 95%CI, 1.225-3.732), occasional use of Pre-exposure Prophylaxis (OR = 4.667, 95%CI, 1.186-18.362) and use of the Grindr application (OR = 5.312, 95%CI, 3.373-8.365). Instagram users had lower risk of ON (OR = 0.479, 95%CI, 0.279-0.822). The multivariate analysis showed that Grindr usages (OR = 4.72; 95%CI, 2.89-7.72) correlated with higher risk of ON. Higher BMI (OR = 0.913, 95%CI, 0.861-0.98) and daily use of Pre-exposure Prophylaxis (OR = 0.142, 95%CI, 0.03-0.674) is associated with lower risk of ON.

CONCLUSIONS

The most important predictors of orthorexia nervosa in gay men are: low BMI and the use of Grindr. The effect of daily usage of PrEP is associated with lower risk, and occasional use is associated with increased risk, of orthorexia nervosa.

Body image and associated factors among sexual minority men: A systematic review

Research suggests that the risk of body image concerns among sexual minority men is high. Recent work has increasingly examined body image in relation to psychological, interpersonal, and behavioral constructs, but these findings have yet to be consolidated and critically examined to identify potential risk and protective factors. The present study sought to systematically review and synthesize published findings on body image among sexual minority men. A total of 136 articles published between January 2011 and March 2022 were included. Sexual minority men were generally reported to have more negative body image compared to heterosexual men, yet findings varied across body image constructs. In correlational work, body image was often examined in relation to disordered eating, mental health, internalization of appearance ideals, objectification, sexual behavior and relationships, gay community identification and discrimination, and health concerns (e.g., HIV, AIDS). Robust relationships emerged among body image and stigma variables, including internalized homophobia and harassment related to LGBTQ+ presentation and intersecting minority identities. Sociocultural, objectification, and minority stress theories were employed to interpret findings and to delineate future directions grounded in intersectional approaches. Additional work focused on the role of stigma and discrimination in the development of these concerns across the lifespan is needed.

Sex Conservatism, Internalized Homonegativity, PrEP Stigma, and Intention to Use PrEP: A Study of Chinese-Speaking Gay and Bisexual Male Youth in Hong Kong

Pre-exposure prophylaxis (PrEP) stigma has been found to be a major barrier to PrEP acceptability and uptake. Research has found that different ethnic/cultural groups display varying levels of PrEP stigma. This article studies sex conservatism and internalized homonegativity as two sexuality- and culture-related aspects that influence PrEP stigma and intention to use PrEP. An online survey of 279 young gay and bisexual men in Hong Kong found that internalized homonegativity was positively associated with PrEP stigma. Respondents who were more conservative about sex showed lower intention to use PrEP, whereas those who had higher income and more positive attitudes about PrEP were more likely to express intention to use PrEP. This study provides novel empirical evidence for understanding PrEP stigma and uptake from a sexuality and cultural perspective. The influence of sexuality- and culture-related factors on PrEP stigma and uptake warrants greater attention, especially in the Asia-Pacific region.

User Experience and Usability of Neumorphism and Gamification User Interface Designs in an HIV Self-Test Referral Program for Men Who Have Sex With Men: Prospective Open-Label Parallel-Group Randomized Controlled Trial

Background

Digital interventions have been applied for promoting HIV prevention and care among men who have sex with men (MSM). As user interface (UI) design plays a role in determining usability and user experience (UX), the intervention outcome could be affected.

Objective

In this study, we hypothesized that 2 UI design styles, namely gamification and neumorphism, could impact usability and be differentially preferred by distinct groups of MSM.

Methods

A prospective parallel-group open-label randomized controlled trial was conducted in Hong Kong. Eligible participants were adult MSM recruited by the research team or referred by enrolled participants, who followed instructions for performing an HIV self-test and promoted its use within their social network. Participants were randomized in a 1:1 ratio into either a gamification or neumorphism arm, with primarily visual differences in the UI only. The primary outcome was usability measured by the System Usability Scale (SUS) between the 2 arms. Distinct characteristics of promoters in the 2 arms who gave an SUS score of 80 or above were identified.

Results

Of 463 MSM registered in the study, 232 and 231 were randomized to the gamification and neumorphism arms, respectively. Excluding those who did not request a self-test kit, data from 218 and 216 participants in the gamification and neumorphism arms, respectively, were analyzed (totally 434 participants). With a median SUS score of 80 overall, participants in the neumorphism arm gave a higher score (P<.001), with a higher proportion giving a promoter-level SUS score (P=.002). Promoters used social media for sex networking (P=.02), used pre-exposure prophylaxis in the preceding year (P=.006), had higher satisfaction in UI design (P<.001), and had made a self-test referral (P=.04). In general, higher usability was recorded among participants who were confident in performing the HIV self-test (P<.001), and this was associated with a promoter-level SUS score in both arms. While no other personal characteristics were associated with promoters in the neumorphism arm, those in the gamification arm had higher HIV-related knowledge (P=.01), preferred a specific partner body image type (P=.03), and progressed toward peer referral by completing online training (P=.04).

Conclusions

Both gamified and neumorphic UI designs were well-accepted by MSM. UX and satisfaction of UI were both crucial in influencing the willingness of MSM to promote the application by referring their peers in the community to participate. The simplistic visual design of neumorphism conferred a more general acceptance in the community, whereas gamification was preferred in certain MSM subcommunities. Appropriate UI/UX design should be considered when developing digital interventions targeting the MSM community.

Trial Registration

ClinicalTrials.gov NCT04379206; https://clinicaltrials.gov/ct2/show/NCT04379206

Examining the Factors Affecting PrEP Implementation Within Community-Based HIV Testing Sites in Florida: A Mixed Methods Study Applying the Consolidated Framework for Implementation Research

HIV testing/counseling is a critical point during which non-clinical staff could intervene, discuss and/or refer clients for pre-exposure prophylaxis (PrEP). This analysis investigated the contextual factors affecting PrEP implementation within HIV testing sites. Two generalized linear mixed models were conducted to estimate PrEP implementation as a function of constructs from the Consolidated Framework for Implementation Research (CFIR). Qualitative interviews were analyzed thematically. Data integration occurred via joint analysis and triangulation. Constructs from the CFIR domain Characteristics of Individuals did not predict PrEP implementation when controlling for demographic characteristics; qualitative data signaled divergent findings in PrEP knowledge. Within the CFIR domains Inner and Outer Settings, relevant priority and available resources predicted PrEP implementation; qualitative data confirmed the importance of available resources and provided insight into the impact of cosmopolitanism and leadership. Addressing the contextual factors that affect PrEP implementation may help HIV testing staff to better implement PrEP programs.

Delineation of chemsex patterns of men who have sex with men in association with their sexual networks and linkage to HIV prevention

BACKGROUND

Previous studies have shown that men who have sex with men (MSM) and who engage in drug use in sexualized contexts (chemsex) were more likely to be HIV positive. Their social networks and adoption of HIV prevention measures have, however, not been fully investigated. We aim to compare the sexual behavior, HIV prevention efforts and social networks of MSM by the intensity and patterns of their drug use.

METHODS

Data from respondents of a community-based, cross-sectional survey (PRiSM) conducted among MSM in Hong Kong in 2017 were collected retrospectively. Characteristics of MSM engaged and not engaged in chemsex were compared in logistic regressions, delineated by latent class analysis (LCA) and compared in multinominal logistic regression.

FINDINGS

Of 4133 respondents, 3044 were sexually active with an HIV prevalence of 6.5%. The prevalence of chemsex engagement in the preceding 6 months was 12%, after excluding use of poppers or erectile dysfunction agents (EDA) alone. Four types of drug user were identified by LCA: Minimal (mainly poppers), low-threshold (mainly poppers and EDA), medium-threshold (mainly methamphetamine, GHB, poppers and EDA) and intense (extensive use of different types of drug). Medium-threshold and intense drug users were more likely to be HIV positive, be diagnosed with sexually transmitted infections, make gay friends through mobile apps and sex parties, and intend to take pre-exposure prophylaxis (PrEP). Medium-threshold drug users had a more influential role in their social network, as shown by their higher centrality in mobile apps network.

CONCLUSION

Chemsex engagement in MSM is significantly associated with HIV infection in Hong Kong. The HIV transmission risk could however be offset by the inclination of MSM belonging to medium-threshold and intense drug users to take PrEP, should the intervention become accessible to the community. Further mobile apps could be a good channel to access MSM who are medium-threshold drug users.

Congruence between Hypothetical Willingness to Use Pre-Exposure Prophylaxis (PrEP) and Eligibility: An Online Survey among Belgian Men Having Sex with Men

Men who have sex with men (MSM) are at high risk for acquiring HIV in Belgium. This study explores MSMs’ hypothetical willingness to use pre-exposure prophylaxis (PrEP), assesses it against formal PrEP eligibility criteria, and identifies factors associated with incongruence between eligibility and willingness. We used data from an online survey of n = 1444 self-reported HIV-negative MSM. Participants were recruited through social media of MSM organizations and dating apps. Univariate analysis described PrEP willingness and eligibility; bivariate analyses examined how specific co-variates (socio-demographic, knowledge-related, and attitudinal and behavioral factors) were associated with eligibility and willingness. About 44% were eligible for PrEP and about 70% were willing to use it. Those who were eligible were significantly more likely be willing to take PrEP (p < 0.001). Two incongruent groups emerged: 16% of eligible participants were unwilling and 58% of ineligible participants were willing to use PrEP. Factors associated with this incongruence were sexual risk behavior, HIV risk perception, partner status, PrEP knowledge, and attitudinal factors. Because the two groups differ in terms of profiles, it is important to tailor HIV prevention and sexual health promotion to their needs. Among those at risk but not willing to take PrEP, misconceptions about PrEP, and adequate risk perception should be addressed.

Mobilizing civil society for the HIV treatment cascade: a global analysis on democracy and its association with people living with HIV who know their status

INTRODUCTION

Civil society organizations (CSOs) play an essential role in the global HIV/AIDS response. Past studies have described the beneficial role of CSOs in meeting the United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target, but have not explored how political conditions, which influence the ability of CSOs to organize, have an impact on the cascade. This study explores the relationship between measures of democracy and its association with diagnosis rates among people living with HIV (PLHIV).

METHODS

This study analyses 2016 data derived from the Economist Intelligence Unit's Democracy Index (EIUDI), UNAIDS country estimates for PLHIV and PLHIV who knew their status in 2016, World Bank's 2016 data on nominal gross domestic product (GDP) per capita and country population, HIV Justice Network's 2016 data on HIV criminalization, and country-level estimates for PLHIV, PLHIV who know their status, and expenditure on HIV prevention from other independent sources. An estimated HIV prevalence variable was constructed by dividing the estimated PLHIV population with the total population of a country. Analyses were limited to countries with available data on PLHIV who know their status (n = 111).

RESULTS

Of the 111 countries in the analytic sample, the mean democracy index score was 5.93 (of the 10), median estimated HIV prevalence was 0.20% (IQR 0.10-0.65), median GDP per capita (in thousands, US dollar) was 4.88 (IQR 2.11-13.79), and mean PLHIV who know their status is 67.12%. Preliminary analysis on the five component measures of the EIUDI revealed multicollinearity, and thus the composite democracy index score was used as the measure for democracy. Multivariate linear regression analyses revealed that democracy index scores (β = 2.10, SE = 1.02, p = 0.04) and GDP per capita (in thousands; β = 0.34. SE = 0.11, p < 0.01) were positively associated with diagnosis rates among PLHIV, controlling for country-level expenditure on HIV prevention, HIV criminalization laws and estimated HIV prevalence.

CONCLUSIONS

Results indicate that higher levels of democracy were positively associated with rates of diagnosis among PLHIV. Further analyses following wider implementation of universal testing and treatment is warranted, as well as the need for further research on the mechanisms through which political cultures specifically influence rates of diagnosis among PLHIV.

Bridging Awareness and Acceptance of Pre-Exposure Prophylaxis Among Men Who Have Sex With Men and the Need for Targeting Chemsex and HIV Testing: Cross-Sectional Survey

Background

Pre-exposure prophylaxis (PrEP) is currently an important tool for HIV prevention, especially in communities with higher risk of infection, notably men who have sex with men (MSM). To date, PrEP has remained generally unavailable in many cities around the world. In the planning of strategies for PrEP targeting MSM, community assessment is crucial to understand members’ responses to the new intervention.

Objective

Awareness and acceptance are 2 different but intricately linked contexts of PrEP. The aim of this study was to identify the determinants of awareness and acceptance of PrEP among MSM and to delineate their interrelationships in Hong Kong where PrEP services have not been developed.

Methods

A Web-based questionnaire survey was administered in light of the popularity of the internet as a platform for information and networking in the MSM community. Factors associated with PrEP acceptance and awareness were separately analyzed, and their predictors were subsequently tested by multivariate logistic regression. Associations between acceptance and awareness of PrEP were examined by factor network analysis.

Results

Between August and September 2016, results from a total of 453 HIV-negative MSM were analyzed. Half (49.7%, 225/453) of the respondents were aware of PrEP, and 78.3% (355/453) would consider using PrEP when it becomes available. Awareness of PrEP was associated with recent (P=.01) and ongoing (P=.04) use of psychotropic drugs for sex (chemsex). MSM who used online forums to seek sex partners had lower awareness (P=.04) than those visiting physical venues for sex networking. MSM who accepted PrEP were more likely users of internet channels for sex networking (P=.049), especially location-based social network apps (P=.04). MSM accepting PrEP were more concerned about their partners’ HIV status (P=.002), history of sexually transmitted infections (P=.01), condom use (P=.02), and HIV testing behavior (P=.02). Multivariate logistic regressions revealed that PrEP awareness was related to one’s networking pattern, whereas its acceptance was associated with inclination to self-protect from HIV. Factor network analysis highlighted the importance of chemsex, which was linked by over half of the edges, whereas the rest were contributed by HIV testing behaviors.

Conclusions

In Hong Kong, the overall awareness among MSM toward PrEP was only moderate but their acceptance was higher. Targeting MSM with chemsex behaviors through Web-based platforms and parallel development of tailored HIV testing services are important when introducing PrEP in the community.

HIV Testing and Associated Factors Among Men Who Have Sex with Men in Changsha, China

Promoting HIV testing is an important strategy to end the HIV epidemic. HIV incidence among men who have sex with men (MSM) has increased rapidly in China in recent years, but HIV testing rates are still low. Our cross-sectional study investigated HIV testing rates and analyzed associated factors in 565 MSM in Changsha between April and December 2014. In the previous year, 37.7% of participants had not been tested, 38.2% had had one test, and 24.1% had had two or more tests. Those who initiated sexual debut at an older age, had known someone infected with HIV, or had been diagnosed with a sexually transmitted illness (STI) were more likely to have had an HIV test. HIV intervention programs in China should focus on sexually active young MSM, integrate HIV testing and counseling services in STI clinics, and describe real experiences of living with HIV to improve HIV testing in MSM.

Pre-exposure prophylaxis (PrEP) for MSM in low HIV incidence places: should high risk individuals be targeted?

Pre-exposure prophylaxis (PrEP) targeting high-risk men who have sex with men (MSM) has been shown to be a cost-effective HIV control measure. However, the approach could be a challenge in low HIV incidence places with a low proportion of high-risk MSM. To examine the impact of PrEP in such setting in Asia, we developed an epidemic model and conducted cost-effectiveness analysis using empirical multicentre clinical and HIV sequence data from HIV-infected MSM in Hong Kong, in conjunction with behavioural data of local MSM. Without PrEP, the HIV incidence (per 100 person-years) would increase from 1.1 to 1.6 between 2011 and 2021. PrEP could avert 3–63% of total new infections in a five-year period (2017–2021), the variability of which depends on the implementation strategies and combination with test-and-treat. However, under current market drug price in 2016, the incremental cost per quality-adjusted life-year gained (QALYG) of PrEP (USD1583136/QALYG) is almost 3 times higher than test-and-treat intervention alone (USD396874/QALYG). Assuming 93% fall of PrEP drug price and in combination with test-and-treat, putting 30% of MSM on non-targeting PrEP would be more feasible, cost-effective (USD268915/QALYG), and could avert more new infections (40%). PrEP could contribute to HIV epidemic control in a low incidence place.

Racial/ethnic differences in HIV testing: An application of the health services utilization model

This study applying the health services utilization model examined the importance of predisposing, enabling, and need variables to the social mechanisms explaining lifetime HIV testing across racial/ethnic groups. Data for the study were derived from the National Health Interview Survey (collected 2013–2014), our final sample numbering 18,574 adults. Four subsamples reflected race/ethnicity: 13,347 Whites, 2267 Blacks, 2074 Hispanics, and 886 Asians. Logistic regression established respondent odds of ever having received HIV testing. Further statistical testing evaluated race/ethnicity’s potential moderating role in HIV testing. The findings generally support a role for Aday’s predisposing, enabling, and need factors in explaining HIV testing. Across the four subsamples, female gender, older age, and sexual minority status consistently increased lifetime HIV testing. However, we found racial/ethnic differences in HIV testing’s associations with these factors and others. Our study made a beginning in the effort to specify mechanisms leading to HIV testing—and reliable diagnosis—among four racial/ethnic groups. Understanding these mechanisms might multiply opportunities to raise testing rates for all, in turn reducing racial/ethnic disparities in HIV treatment.