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Hassan R, Thornton N, King H, Aufderheide G, Silberzahn B, Huettner S, Jennings JM, Evans KN, Fields EL. Perceptions of a community-based HIV/STI testing program among Black gay, bisexual, and other MSM in Baltimore: a qualitative analysis. AIDS Care 2024; 36:1570-1579. [PMID: 38976576 PMCID: PMC11511628 DOI: 10.1080/09540121.2024.2372722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 06/21/2024] [Indexed: 07/10/2024]
Abstract
Black gay, bisexual, and other men who have sex with men (GBM) are disproportionately affected by HIV and STIs. Safe Spaces 4 Sexual Health (SS4SH), a community-informed, status-neutral HIV/STI testing intervention combines online outreach via geo-social networking apps and social media with mobile van testing. During 2018-2019, we recruited 25 participants for interviews about their perceptions of SS4SH compared to clinic-based testing. Participants were aged 21-65 years (mean 35); 22 (88%) identified as Black/African American; 20 (80%) identified as gay; and 10 (40%) were living with HIV. Interviews were transcribed, coded, and analyzed using a modified thematic constant comparative approach. Five themes emerged; two related to perceptions of online outreach materials (participants were drawn to eye-catching and to-the-point messages and desired more diversity and representation in messages), and three related to preference for the mobile van (participants found SS4SH provided more comfort, more privacy/confidentiality, and increased accessibility and efficiency). GBM is increasingly using geo-social networking apps to meet sexual partners, and tailored online outreach has the potential to reach historically underserved populations. SS4SH is a barrier-reducing strategy that may serve as an entry to a status-neutral approach to services and help reduce stigma and normalize accessing HIV services.
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Affiliation(s)
- Rashida Hassan
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Hope King
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | - Kimberly N. Evans
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Campbell CK, Koester KA, Erguera XA, Moran L, LeTourneau N, Broussard J, Crouch PC, Lynch E, Camp C, Torres S, Schneider J, VanderZanden L, Coffey S, Christopoulos KA. Effective Messages to Reduce Stigma among People Newly Diagnosed with HIV during Rapid ART Initiation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1133. [PMID: 39338016 PMCID: PMC11431257 DOI: 10.3390/ijerph21091133] [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: 07/08/2024] [Revised: 08/23/2024] [Accepted: 08/23/2024] [Indexed: 09/30/2024]
Abstract
HIV stigma has a negative influence on antiretroviral therapy (ART) initiation and persistence and viral suppression. Immediate access to ART (RAPID ART) has been shown to accelerate viral suppression (VS) that is sustained up to one year after HIV diagnosis. Little is known about the role of RAPID ART in reducing individual-level stigma. We explored how stigma manifests in RAPID ART encounters and whether RAPID ART interventions influence individual-level HIV stigma during and in the time immediately after the diagnosis experience. We conducted in-depth interviews with 58 RAPID ART patients from three health clinics in San Francisco, CA, and Chicago, IL. Interviews were transcribed, coded, and thematically analyzed. In the results, we discuss three main themes. First, Pre-Diagnosis HIV Beliefs, which included three sub-themes: HIV is "gross" and only happens to other people; HIV (Mis)education; and People are "living long and strong" with HIV. Second, Positive and Reassuring Messages During the RAPID Experience, which included two sub-themes: Correcting Misinformation and Early Interactions with People Living with HIV. Third, The RAPID ART Process Can Disrupt Stigma. RAPID ART encounters served as a potent mechanism to disrupt internalized stigma by providing accurate information and dispelling unhelpful myths through verbal and nonverbal messages. Reducing internalized stigma and misinformation about HIV at this early stage has the potential to reduce the effect of HIV stigma on ART initiation and adherence over time.
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Affiliation(s)
- Chadwick K Campbell
- Herbert Wertheim School of Public Health and Human Longevity, University of California San Diego, La Jolla, CA 92093, USA
| | - Kimberly A Koester
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Xavier A Erguera
- Division of HIV, ID & Global Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA
| | - Lissa Moran
- Division of HIV, ID & Global Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA
| | - Noelle LeTourneau
- Division of HIV, ID & Global Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA
| | - Janessa Broussard
- School of Nursing, University of California San Francisco, San Francisco, CA 94143, USA
| | | | - Elizabeth Lynch
- Division of HIV, ID & Global Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA
| | - Christy Camp
- Division of HIV, ID & Global Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA
| | - Sandra Torres
- Division of HIV, ID & Global Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA
| | | | | | - Susa Coffey
- Division of HIV, ID & Global Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA
| | - Katerina A Christopoulos
- Division of HIV, ID & Global Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA
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Kaptchuk RP, Thakker J, Bell J, Okram S, Gopinath U, Mehta SH, Reddy AK, Loeb TA, Arumugam V, Tandon S, Parthasarathy MR, Ghosh SC, Singh A, Joshi DS, Kaur S, Solomon SS, McFall AM. HIV self-testing in India: implementation and qualitative evaluation of a web-based programme with virtual counsellor support. J Int AIDS Soc 2024; 27:e26302. [PMID: 38861458 PMCID: PMC11166186 DOI: 10.1002/jia2.26302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/16/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION To achieve epidemic control of infectious diseases, engaging higher-burden populations with accessible diagnostic services is critical. HIV self-testing (HIVST) is a promising option. METHODS We implemented an online HIVST programme for key populations across India. Eligible clients were 18 years or older, self-reported a negative or unknown HIV status and reported not taking antiretroviral therapy. Clients who reported a prior HIV diagnosis were not eligible to receive an HIVST kit. HIVST clients received kits via courier or in person at pre-determined pick-up points supported by trained counselling staff. Virtual counsellors engaged clients online and by phone and offered support to register, access, and complete HIVST free of cost. Virtual counsellors supported clients to report results and engage with follow-up services. Follow-up included linking clients with a positive result to confirmatory testing and HIV care services. We assessed programmatic data across HIV continuum outcomes and conducted a qualitative evaluation through interviews with purposively sampled clients. RESULTS Between 30 June 2021 and 30 September 2022, 5324 clients ordered an HIVST kit (76% men, 13% women, 7% transgender people, 4% unknown gender). Of the 4282 clients reporting results (94% of those who received a kit), 6% screened positive, among whom 72% (n = 184) completed confirmatory testing. Themes from 41 client interviews included satisfaction about the convenience and privacy of services and the discreet nature of kit delivery. Respondents were drawn to the convenience of HIVST and appreciated gaining courage and comfort throughout the process from virtual counsellor support. For respondents who screened positive, challenges to care linkage included fearing judgemental questions from public providers and wanting more time before starting treatment. Clients shared concerns about kit accuracy and suggested that instructional materials be provided with more diverse language options. CONCLUSIONS Web-based HIVST services with tailored support appeared to facilitate HIV service access and engagement of harder-to-reach populations across India. Assistance from a community-oriented counsellor proved important to overcome literacy barriers and mistrust in order to support the HIVST process and service linkage. Learnings can inform global efforts to improve the critical step of diagnosis in achieving epidemic control for HIV and other infectious diseases.
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Affiliation(s)
- Rose Pollard Kaptchuk
- Department of International HealthThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Jalpa Thakker
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Jade Bell
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Saya Okram
- Y.R. Gaitonde Centre for AIDS Research and EducationChennaiIndia
| | - Usha Gopinath
- Y.R. Gaitonde Centre for AIDS Research and EducationChennaiIndia
| | - Shruti H. Mehta
- Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Ajay Kumar Reddy
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Talia A. Loeb
- Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | | | | | | | | | - Aditya Singh
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | | | - Sukhvinder Kaur
- United States Agency for International DevelopmentWashingtonDCUSA
| | - Sunil Suhas Solomon
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Allison M. McFall
- Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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Yin Z, Du Y, Cheng W, Tang W. Digital Strategies Supporting Social Network Approaches to HIV Testing: A Scoping Review. Curr HIV/AIDS Rep 2024; 21:168-195. [PMID: 38733522 DOI: 10.1007/s11904-024-00699-9] [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: 04/24/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE OF REVIEW This review captured how digital strategies support social network approaches to promote HIV testing. RECENT FINDING Overall, 29 studies were identified by searching PubMed and Embase for studies published up to June 2023. Existing studies revealed three types of digital strategies (social media (n = 28), online information channels (n = 4), and multifunctional digital platforms (n = 4)) split into four major modes of digital strategy-supported social-network-based HIV testing promotion: 1) Online outreach and recruiting, 2) gathering and identifying key populations for HIV testing, 3) communicating and disseminating online HIV testing health interventions, and 4) assisting and facilitating HIV testing uptake and distribution. Social network approaches supported by digital strategies yielded advantages in HIV testing education and distribution, which increases HIV testing coverage among key populations. Studies are needed on how to facilitate the use of digital strategies for social network-based HIV testing, as well as how to integrate them with existing HIV testing approaches.
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Affiliation(s)
- Zhuoheng Yin
- Guangdong Second Provincial General Hospital, Guangzhou, China
- University of North Carolina Project China, Guangzhou, China
| | - Yumeng Du
- Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Weibin Cheng
- Guangdong Second Provincial General Hospital, Guangzhou, China
- Faculty of Health Sciences, City University of Macau, Macao, SAR, China
| | - Weiming Tang
- Guangdong Second Provincial General Hospital, Guangzhou, China.
- University of North Carolina Project China, Guangzhou, China.
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Cheung DH, Samoh N, Jonas K, Lim SH, Kongjareon Y, Guadamuz TE. Partying in Thailand: Never Testing Among Men Who Have Sex With Men Who Attend Sexualized (Drug) Parties. Sex Transm Dis 2024; 51:352-358. [PMID: 38301623 DOI: 10.1097/olq.0000000000001937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) testing for Thai men who have sex with men (MSM) is suboptimal, which undermines their linkage to care and subsequent HIV preexposure prophylaxis (PrEP) uptake. METHODS We analyzed a cross-sectional survey conducted in 2021 among Thai MSM who attended any private sex parties or circuit parties in the past 3 years ("sexualized parties"). RESULTS Of the 424 men included in our analysis, 47.6% had been recently tested for HIV in the past 1 year, 30.2% had not recently been tested, and 22.2% had never been tested. In our multivariable analysis, relative to participants who had recently tested for HIV, those who have never tested were more likely to have lower education or to live outside of Bangkok, and to have attended both circuit and private sex parties (vs. private sex party only) but were less likely to report any sexually transmitted infection diagnosis or to have heard of PrEP. Participants who had an HIV test more than a year ago were more likely to have attended both circuit and private sex parties (vs. private sex parties only) but were less likely to have any sexually transmitted infection diagnosis, meet sexual partners online, or have heard of PrEP. Rates of condomless anal sex and willingness to use PrEP were similar across groups. CONCLUSIONS Despite the high rates of sexual risk-taking, sexualized party attendees reported suboptimal HIV testing uptake. The joint promotion of HIV testing and PrEP is warranted-especially on-premise HIV testing at circuit parties and outreach at online platforms to reach sexualized party attendees.
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Affiliation(s)
- Doug H Cheung
- From the Center of Excellence in Research on Gender, Sexuality and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | - Nattharat Samoh
- From the Center of Excellence in Research on Gender, Sexuality and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | - Kai Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
| | - Sin How Lim
- Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yamol Kongjareon
- From the Center of Excellence in Research on Gender, Sexuality and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
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Eaton LA, Huedo-Medina T, Earnshaw VA, Kalichman M, Watson RJ, Driver R, Chandler CJ, Kalinowski J, Kalichman SC. Randomized Clinical Trial of Stigma Counseling and HIV Testing Access Interventions to Increase HIV Testing Among Black Sexual Minority Men and Transwomen. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:650-660. [PMID: 37898978 DOI: 10.1007/s11121-023-01603-4] [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: 10/17/2023] [Indexed: 10/31/2023]
Abstract
Advances in HIV prevention tools have outpaced our ability to ensure equitable access to these tools. Novel approaches to reducing known barriers to accessing HIV prevention, such as stigma and logistical-related factors, are urgently needed. To evaluate the efficacy of a randomized controlled trial with four intervention arms to address barriers to HIV/STI testing uptake (primary outcome) and PrEP use, depression, and HIV test results (secondary outcomes). We tested a 2 × 2 research design: main effect 1-stigma-focused vs. health information evaluation-focused counseling, main effect 2-offering HIV/STI testing appointments in person vs. at home with a counselor via video chat, and the interaction of the main effects. Participants (N = 474) residing in the southeastern USA were screened and enrolled in a longitudinal trial. Intervention efficacy was established using generalized linear modeling with binomial or Poisson distributions. Intervention efficacy demonstrated an increase in HIV/STI testing uptake when testing was made available at home with a counselor via video chat vs. in person (83% vs. 75% uptake, p < .05), and participants were also more likely to test positive for HIV over the course of the study in the at-home condition (14.5% vs. 9.4%, p < .05). Stigma-focused counseling resulted in lower depression scores and greater uptake of PrEP among participants < 30 years of age when compared with health information counseling (15.4% vs. 9.6%, p < .05). In order to prevent further disparities between HIV prevention advances and access to HIV prevention tools, we must prioritize improvements in linking people to care. Novel interventions, such as those proposed here, offer a practical, evidence-based path to addressing long-standing barriers to HIV prevention strategies. Trial registration: NCT03107910.
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Affiliation(s)
- Lisa A Eaton
- Human Development and Family Sciences, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06279-1248, USA.
| | | | - Valerie A Earnshaw
- Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | | | - Ryan J Watson
- Human Development and Family Sciences, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06279-1248, USA
| | - Redd Driver
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cristian J Chandler
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jolaade Kalinowski
- Human Development and Family Sciences, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06279-1248, USA
| | - Seth C Kalichman
- Psychological Sciences, University of Connecticut, Storrs, CT, USA
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Abrantes R, Pimentel V, Miranda MNS, Silva AR, Diniz A, Ascenção B, Piñeiro C, Koch C, Rodrigues C, Caldas C, Morais C, Faria D, Gomes da Silva E, Teófilo E, Monteiro F, Roxo F, Maltez F, Rodrigues F, Gaião G, Ramos H, Costa I, Germano I, Simões J, Oliveira J, Ferreira J, Poças J, Saraiva da Cunha J, Soares J, Fernandes S, Mansinho K, Pedro L, Aleixo MJ, Gonçalves MJ, Manata MJ, Mouro M, Serrado M, Caixeiro M, Marques N, Costa O, Pacheco P, Proença P, Rodrigues P, Pinho R, Tavares R, Correia de Abreu R, Côrte-Real R, Serrão R, Sarmento e Castro R, Nunes S, Faria T, Baptista T, Simões D, Mendão L, Martins MRO, Gomes P, Pingarilho M, Abecasis AB. Determinants of HIV late presentation among men who have sex with men in Portugal (2014-2019): who's being left behind? Front Public Health 2024; 12:1336845. [PMID: 38500732 PMCID: PMC10947991 DOI: 10.3389/fpubh.2024.1336845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/26/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction HIV late presentation (LP) remains excessive in Europe. We aimed to analyze the factors associated with late presentation in the MSM population newly diagnosed with HIV in Portugal between 2014 and 2019. Methods We included 391 newly HIV-1 diagnosed Men who have Sex with Men (MSM), from the BESTHOPE project, in 17 countrywide Portuguese hospitals. The data included clinical and socio-behavioral questionnaires and the viral genomic sequence obtained in the drug resistance test before starting antiretrovirals (ARVs). HIV-1 subtypes and epidemiological surveillance mutations were determined using different bioinformatics tools. Logistic regression was used to estimate the association between predictor variables and late presentation (LP). Results The median age was 31 years, 51% had a current income between 501-1,000 euros, 28% were migrants. 21% had never been tested for HIV before diagnosis, with 42.3% of MSM presenting LP. 60% were infected with subtype B strains. In the multivariate regression, increased age at diagnosis, higher income, lower frequency of screening, STI ever diagnosed and higher viral load were associated with LP. Conclusion Our study suggests that specific subgroups of the MSM population, such older MSM, with higher income and lower HIV testing frequency, are not being targeted by community and clinical screening services. Overall, targeted public health measures should be strengthened toward these subgroups, through strengthened primary care testing, expanded access to PrEP, information and promotion of HIV self-testing and more inclusive and accessible health services.
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Affiliation(s)
- Ricardo Abrantes
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon (IHMT/UNL), Lisbon, Portugal
| | - Victor Pimentel
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon (IHMT/UNL), Lisbon, Portugal
| | - Mafalda N. S. Miranda
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon (IHMT/UNL), Lisbon, Portugal
| | - Ana Rita Silva
- Serviço de Infeciologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - António Diniz
- U. Imunodeficiência, Hospital Pulido Valente, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - Bianca Ascenção
- Serviço de Infeciologia, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Carmela Piñeiro
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carmo Koch
- Centro de Biologia Molecular, Serviço de Imunohemoterapia do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Catarina Rodrigues
- Serviço de Medicina 1.4, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Cátia Caldas
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Célia Morais
- Serviço de Patologia Clínica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Domitília Faria
- Serviço de Medicina 3, Hospital de Portimão, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | | | - Eugénio Teófilo
- Serviço de Medicina 2.3, Hospital de Santo António dos Capuchos, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Fátima Monteiro
- Centro de Biologia Molecular, Serviço de Imunohemoterapia do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Fausto Roxo
- Hospital de Dia de Doenças Infeciosas, Hospital Distrital de Santarém, Santarém, Portugal
| | - Fernando Maltez
- Serviço de Doenças Infeciosas, Hospital Curry Cabral, Centro Hospitalar de Lisboa, Lisbon, Portugal
| | - Fernando Rodrigues
- Serviço de Patologia Clínica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Guilhermina Gaião
- Serviço de Patologia Clínica, Hospital de Sta Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - Helena Ramos
- Serviço de Patologia Clínica, Centro Hospitalar do Porto, Porto, Portugal
| | - Inês Costa
- Laboratório de Biologia Molecular (LMCBM, SPC, CHLO-HEM), Lisbon, Portugal
| | - Isabel Germano
- Serviço de Medicina 1.4, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Joana Simões
- Serviço de Medicina 1.4, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Joaquim Oliveira
- Serviço de Infeciologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - José Ferreira
- Serviço de Medicina 2, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - José Poças
- Serviço de Infeciologia, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - José Saraiva da Cunha
- Serviço de Infeciologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Jorge Soares
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sandra Fernandes
- Laboratório de Biologia Molecular (LMCBM, SPC, CHLO-HEM), Lisbon, Portugal
| | - Kamal Mansinho
- Serviço de Doenças Infeciosas, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Liliana Pedro
- Serviço de Medicina 3, Hospital de Portimão, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | | | | | - Maria José Manata
- Serviço de Doenças Infeciosas, Hospital Curry Cabral, Centro Hospitalar de Lisboa, Lisbon, Portugal
| | - Margarida Mouro
- Serviço de Infeciologia, Hospital de Aveiro, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - Margarida Serrado
- U. Imunodeficiência, Hospital Pulido Valente, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - Micaela Caixeiro
- Serviço de Infeciologia, Hospital Dr. Fernando da Fonseca, Amadora, Portugal
| | - Nuno Marques
- Serviço de Infeciologia, Hospital Garcia da Orta, Almada, Portugal
| | - Olga Costa
- Serviço de Patologia Clínica, Biologia Molecular, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Patrícia Pacheco
- Serviço de Infeciologia, Hospital Dr. Fernando da Fonseca, Amadora, Portugal
| | - Paula Proença
- Serviço de Infeciologia, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Paulo Rodrigues
- Serviço de Infeciologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - Raquel Pinho
- Serviço de Medicina 3, Hospital de Portimão, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - Raquel Tavares
- Serviço de Infeciologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - Ricardo Correia de Abreu
- Serviço de Infeciologia, Unidade de Local de Saúde de Matosinhos, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Rita Côrte-Real
- Serviço de Patologia Clínica, Biologia Molecular, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Rosário Serrão
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Sofia Nunes
- Serviço de Infeciologia, Hospital de Aveiro, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - Telo Faria
- Unidade Local de Saúde do Baixo Alentejo, Hospital José Joaquim Fernandes, Beja, Portugal
| | - Teresa Baptista
- Serviço de Doenças Infeciosas, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Daniel Simões
- Grupo de Ativistas em Tratamentos (GAT), Lisbon, Portugal
| | - Luis Mendão
- Grupo de Ativistas em Tratamentos (GAT), Lisbon, Portugal
| | - M. Rosário O. Martins
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon (IHMT/UNL), Lisbon, Portugal
| | - Perpétua Gomes
- Laboratório de Biologia Molecular (LMCBM, SPC, CHLO-HEM), Lisbon, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Almada, Portugal
| | - Marta Pingarilho
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon (IHMT/UNL), Lisbon, Portugal
| | - Ana B. Abecasis
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon (IHMT/UNL), Lisbon, Portugal
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Cummins B, Johnson K, Schneider JA, Del Vecchio N, Moshiri N, Wertheim JO, Goyal R, Skaathun B. Leveraging social networks for identification of people with HIV who are virally unsuppressed. AIDS 2024; 38:245-254. [PMID: 37890471 PMCID: PMC10843229 DOI: 10.1097/qad.0000000000003767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVES This study investigates primary peer-referral engagement (PRE) strategies to assess which strategy results in engaging higher numbers of people with HIV (PWH) who are virally unsuppressed. DESIGN We develop a modeling study that simulates an HIV epidemic (transmission, disease progression, and viral evolution) over 6 years using an agent-based model followed by simulating PRE strategies. We investigate two PRE strategies where referrals are based on social network strategies (SNS) or sexual partner contact tracing (SPCT). METHODS We parameterize, calibrate, and validate our study using data from Chicago on Black sexual minority men to assess these strategies for a population with high incidence and prevalence of HIV. For each strategy, we calculate the number of PWH recruited who are undiagnosed or out-of-care (OoC) and the number of direct or indirect transmissions. RESULTS SNS and SPCT identified 256.5 [95% confidence interval (CI) 234-279] and 15 (95% CI 7-27) PWH, respectively. Of these, SNS identified 159 (95% CI 142-177) PWH OoC and 32 (95% CI 21-43) PWH undiagnosed compared with 9 (95% CI 3-18) and 2 (95% CI 0-5) for SPCT. SNS identified 15.5 (95% CI 6-25) and 7.5 (95% CI 2-11) indirect and direct transmission pairs, whereas SPCT identified 6 (95% CI 0-8) and 5 (95% CI 0-8), respectively. CONCLUSION With no testing constraints, SNS is the more effective strategy to identify undiagnosed and OoC PWH. Neither strategy is successful at identifying sufficient indirect or direct transmission pairs to investigate transmission networks.
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Affiliation(s)
- Breschine Cummins
- Department of Mathematical Sciences, Montana State University, Bozeman, MT
| | - Kara Johnson
- Department of Mathematical Sciences, Montana State University, Bozeman, MT
| | - John A. Schneider
- Department of Medicine, University of Chicago
- Department of Public Health Sciences, University of Chicago, Chicago, IL
| | | | | | - Joel O. Wertheim
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Ravi Goyal
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Britt Skaathun
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
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Abu-Ba’are GR, Aidoo-Frimpong G, Stockton M, Zigah EY, Amuah S, Amu-Adu P, Amoh-Otoo RP, Nyblade L, Torpey K, Nelson LE. "I told myself, be bold and go and test": Motivators and barriers to HIV testing among gay, bisexual, and other cis-gender men who have sex with men in Ghana ‒ West Africa. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002231. [PMID: 38206889 PMCID: PMC10783711 DOI: 10.1371/journal.pgph.0002231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 11/17/2023] [Indexed: 01/13/2024]
Abstract
Despite a disproportionately high burden of HIV, GBMSM in Ghana and sub-Saharan Africa often delay testing until the point of illness. However, limited studies examine factors that affect their participation in testing. We used qualitative in-depth interviews (IDIs) and focus group discussions (FGDs) to collect insights into experiences, motivators, and barriers to HIV testing among GBMSM. Two community-based organizations used snowball and convenience sampling to recruit 10 GBMSM for IDIs and 8 to 12 for FGDs. We transcribed, coded, identified, and analyzed the relationship and commonalities between the participants' responses. Under experiences with testing, 1) fear of HIV infection created a stressful HIV testing experience, and 2) a friendly and supportive healthcare environment facilitated a positive experience in healthcare facilities. Motivators or facilitators of testing include 1) the perception or belief that HIV testing is an HIV prevention strategy; 2) encouragement from friends and peers; 3) understanding risk associated with certain sexual behaviors; 4) education or information on HIV; 5) access to free testing and incentives; 6) early symptoms and provider recommendation. Barriers to HIV testing include 1) negative community perceptions of HIV; 2) individual-level low-risk perception or indifference about HIV infection; 3) health system issues; 5) Perceived stigma at healthcare facilities. The findings point to the need to address critical issues around stigma, education, peer support, and healthcare resources through interventions and research to improve HIV testing among GBMSM in the country.
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Affiliation(s)
- Gamji Rabiu Abu-Ba’are
- Behavioral, Sexual and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Department of Public Health Sciences, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Yale AIDS Prevention Program (Y-APT), Center for Interdisciplinary Research on AIDS, School of Public Health/Medicine, Yale University, New Haven, Connecticut, United States of America
- Behavioral, Sexual and Global Health Lab, West Africa Site, Jama’a Action, West Legon, Accra, Ghana
| | - Gloria Aidoo-Frimpong
- Yale AIDS Prevention Program (Y-APT), Center for Interdisciplinary Research on AIDS, School of Public Health/Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Melissa Stockton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Edem Yaw Zigah
- Behavioral, Sexual and Global Health Lab, West Africa Site, Jama’a Action, West Legon, Accra, Ghana
- Priorities on Rights and Sexual Health, Accra, Ghana
| | - Samuel Amuah
- Youth Alliance for Health and Human Rights, Kumasi, Ghana
| | | | | | - Laura Nyblade
- RTI International, Washington, District of Columbia, United States of America
| | - Kwasi Torpey
- Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Legon-Accra, Ghana
| | - LaRon E. Nelson
- Yale AIDS Prevention Program (Y-APT), Center for Interdisciplinary Research on AIDS, School of Public Health/Medicine, Yale University, New Haven, Connecticut, United States of America
- School of Nursing, Yale University, New Haven, Connecticut, United States of America
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10
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Bärnighausen K, Berner-Rodoreda A, McGowan M, Reñosa MD, Mtaita C, Neuhann F. 'You Can Get That Person on ART but You Can't Give Them Back Their Social System': A Qualitative Analysis of Voluntary Assisted Partner Notification for HIV for Marginalised and Vulnerable Populations. J Int Assoc Provid AIDS Care 2024; 23:23259582241272059. [PMID: 39246275 PMCID: PMC11403698 DOI: 10.1177/23259582241272059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024] Open
Abstract
Little is known about Voluntary Assisted Partner Notification (VAPN) in groups in sub-Saharan Africa that experience marginalisation, and whether its use is suitable for referral to HIV care pathways. We conducted semi-structured in-depth interviews with purposively selected medical and health professionals (N = 15) regarding their perspectives and experiences with VAPN policy and its implementation. Data were analysed following a Reflexive Thematic Analysis approach. Respondents highlighted the flexibility in VAPN policy implementation and described adjustments made by health workers. Women were seen as vulnerable and lacked access to support against gender-based violence. Men who have sex with men could face exclusion from important social networks. Age-appropriate VAPN assistance was also considered unavailable for sexually active children. Embedding understandings of identity, belonging, and safety into VAPN could address individual priorities and needs. Community support networks, tailored care for children, and family-orientated approaches to HIV notification may overcome issues relating to vulnerability and marginalisation.
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Affiliation(s)
- Kate Bärnighausen
- Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Astrid Berner-Rodoreda
- Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
| | - Maureen McGowan
- Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- School for Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa
| | - Mark Donald Reñosa
- Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Department of Health, Muntinlupa, Philippines
| | - Caroline Mtaita
- Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
| | - Florian Neuhann
- Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- School of Medicine and Clinical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
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11
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Zapata JP, Hirshfield S, Nelson K, Horvath K, John SA. Preferred Characteristics for mHealth Interventions Among Young Sexual Minoritized Men to Support HIV Testing and PrEP Decision-Making: Focus Group Study. JMIR Form Res 2023; 7:e51103. [PMID: 37713640 PMCID: PMC10616747 DOI: 10.2196/51103] [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] [Received: 07/20/2023] [Revised: 09/01/2023] [Accepted: 09/15/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Epidemiological trends in the United States have shown an increase in HIV cases among young sexual minoritized men. Using mobile health (mHealth), which refers to health services and information delivered or enhanced through the internet and related technologies, is a crucial strategy to address HIV disparities. However, despite its potential, the practical implementation of mHealth remains limited. Additionally, it is important to consider that young individuals may become accustomed to, distracted from, or lose interest in these apps, highlighting the need for regular updates and monitoring of relevant content. OBJECTIVE In this study, we sought to highlight the voices of young sexual minoritized men aged 17-24 years and explored preferred mHealth intervention characteristics and willingness to adopt these technologies among a diverse, nationwide sample of young sexual minoritized men. METHODS From April to September 2020, we recruited participants through web-based platforms such as social media and geosocial networking apps for men. These individuals were invited to participate in synchronous web-based focus group discussions centered around topics pertaining to HIV testing and prevention and their preferences for mHealth technologies. RESULTS A total of 41 young sexual minoritized men, aged between 17 and 24 years, participated in 9 focus group discussions spanning April to September 2020, with 3-7 participants in each group. The findings shed light on three key insights regarding young sexual minoritized men's preferences: (1) the need for personalized and representative content, (2) a preference for mobile and web-based simulation of prevention scenarios, and (3) a preference for digital software with individually tailored content. As expected, preference for mHealth apps was high, which supports the potential and need to develop or adapt interventions that use smartphones as a platform for engaging young sexual minoritized men in HIV prevention. This study expands on previous research in multiple meaningful ways, delving into the use and perceptions of mHealth information amid the COVID-19 pandemic. This study also highlighted the importance of streamlined access to health care providers, especially in light of the barriers faced by young people during the COVID-19 pandemic. In terms of presentation and navigation, participants favored a user-friendly design that was easy to use and appropriate for their age, which was effectively addressed through the implementation of web-based simulations. CONCLUSIONS Ultimately, this study provides valuable insight into the preferences of young sexual minoritized men when it comes to mHealth interventions and highlights the need for further research in order to develop effective and tailored HIV prevention tools. A future direction for researchers is to evaluate how best to address participants' desire for personalized content within mHealth apps. Additionally, as technology rapidly evolves, there is a need to re-assess the effectiveness of web-based simulations, particularly those that are used in HIV prevention.
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Affiliation(s)
- Juan Pablo Zapata
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Sabina Hirshfield
- State University of New York Downstate Health Sciences University, Brooklyn, NY, United States
| | - Kimberly Nelson
- Department of Medicine, School of Public Health, Boston University, Boston, MA, United States
| | - Keith Horvath
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Steven A John
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
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12
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Zhao P, Zhou Y, Ni Y, Lu Y, Huang S, Yang J, Tang W. Testing Together Behaviors in Secondary Distribution of HIV/Syphilis Self-testing Program Among Men Who have Sex with Men in China. AIDS Behav 2023; 27:1430-1440. [PMID: 36239880 DOI: 10.1007/s10461-022-03879-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2022] [Indexed: 11/01/2022]
Abstract
HIV self-testing (HIVST) is recommended as a promising way to increase HIV testing uptake among MSM. MSM sometimes used HIVST kits together with their sexual partners or friends. However, limited data was reported on MSM's testing together behaviors with sexual partners and non-sexual contacts. Data were collected among MSM in China from June 2018 to June 2019. Eligible participants (referred to as "index participants") finished a baseline survey and applied for HIVST kits. They were encouraged to distribute the kits to other people (referred to as "alters"). Index participants finished a 3-month follow-up survey on the distribution and usage of the kits. Alters finished an online survey on the usage of HIVST kits after they returned the photographed testing results. Results were reported based on index participants and alters, respectively. Based on follow-up data, 138 index participants successfully motivated others for HIVST, most of them (77.5%) tested together with at least one alter. Around half of alters (52.3%) reported testing together with index participants. Index participants distributed more HIVST kits to friends than sexual partners. MSM who had ever tested for HIV were more likely to test together. Our study demonstrated that the testing together behaviors during HIVST distribution among sexual partners and social network contacts were common. The social network-based approach is essential in promoting testing together and HIV status disclosure among MSM.
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Affiliation(s)
- Peipei Zhao
- Jane Addams of College of Social Work, University of Illinois at Chicago, Chicago, USA
| | - Yi Zhou
- Department of AIDS Prevention and Control, Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Yuxin Ni
- Guangdong Second Provincial General Hospital, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
| | - Ying Lu
- Guangdong Second Provincial General Hospital, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
| | - Shanzi Huang
- Department of AIDS Prevention and Control, Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Junjun Yang
- Wuxi Second People's Hospital of Nanjing Medical University, Wuxi, China.
| | - Weiming Tang
- Guangdong Second Provincial General Hospital, Guangzhou, China.
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China.
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13
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Rocha GM, Cândido RCF, de Carvalho NP, Carvalho EGA, Costa AAM, Machado IV, da Cruz Pimenta MP, de Paula Júnior JA, Guimarães MDC, de Pádua CAM. Strategies to increase HIV testing among men who have sex with men and transgender women: an integrative review. BMC Infect Dis 2023; 23:240. [PMID: 37072705 PMCID: PMC10111644 DOI: 10.1186/s12879-023-08124-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/28/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) and transgender women (TGW) are disproportionately affected by HIV, with much higher incidence and prevalence rates than in the general population in different countries. There are several barriers to testing among MSM and TGW, such as low risk perception, anticipation of HIV-related stigma, discrimination of sexual orientation, in addition to difficulties related to care and access to health services. Therefore, analyzing the available evidence of the effectiveness of strategies for scaling up HIV testing among key populations is essential to point out potential knowledge gaps which may need to be addressed and develop public health policies to promote testing and early diagnosis of HIV infection. METHODS An integrative review was carried out to evaluate strategies for scaling up HIV testing in these populations. Search strategy was performed on eight electronic databases, without language restriction. We included clinical trials, quasi-experimental studies, and non-randomized studies. Study selection and data extraction were both performed independently by pairs and disagreements were solved by a third revisor. The screening of the studies was carried out through the selection of titles/abstracts and the reading of the full texts of the pre-selected studies based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Data extraction was performed using a structured form. RESULTS Thirty-seven publications referring to 35 studies were included, mostly being carried out in the United States of America and Australia. No studies were found evaluating disaggregated data on TGW. The studies were grouped into four types of intervention strategies: self-test distribution system (n = 10), organization of health services (n = 9), peer education (n = 6), and social marketing campaign (n = 10). Strategies that focused on the first three groups, combined or not, were more effective in increasing HIV testing among MSM. CONCLUSIONS Considering the diversity of interventions and the methodological heterogeneity of the included studies, strategies especially involving self-test distribution systems, associated with new information and communication technologies, should be evaluated in different communities and social contexts. Research evaluating specific studies on TGW population is still needed.
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14
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Mustanski B, Saber R, Jones JP, Macapagal K, Benbow N, Li DH, Brown CH, Janulis P, Smith JD, Marsh E, Schackman BR, Linas BP, Madkins K, Swann G, Dean A, Bettin E, Savinkina A. Keep It Up! 3.0: Study protocol for a type III hybrid implementation-effectiveness cluster-randomized trial. Contemp Clin Trials 2023; 127:107134. [PMID: 36842763 PMCID: PMC10249332 DOI: 10.1016/j.cct.2023.107134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/13/2023] [Accepted: 02/21/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND Despite evidence that eHealth approaches can be effective in reducing HIV risk, their implementation requirements for public health scale up are not well established, and effective strategies to bring these programs into practice are still unknown. Keep It Up! (KIU!) is an online program proven to reduce HIV risk among young men who have sex with men (YMSM) and ideal candidate to develop and evaluate novel strategies for implementing eHealth HIV prevention programs. KIU! 3.0 is a Type III Hybrid Effectiveness-Implementation cluster randomized trial designed to 1) compare two strategies for implementing KIU!: community-based organizations (CBO) versus centralized direct-to-consumer (DTC) recruitment; 2) examine the effect of strategies and determinants on variability in implementation success; and 3) develop materials for sustainment of KIU! after the trial concludes. In this article, we describe the approaches used to achieve these aims. METHODS Using county-level population estimates of YMSM, 66 counties were selected and randomized 2:1 to the CBO and DTC approaches. The RE-AIM model was used to drive outcome measurements, which were collected from CBO staff, YMSM, and technology providers. Mixed-methods research mapped onto the domains of the Consolidated Framework for Implementation Research will examine determinants and their relationship with implementation outcomes. DISCUSSION In comparing our implementation recruitment models, we are examining two strategies which have shown effectiveness in delivering health technology interventions in the past, yet little is known about their comparative advantages and disadvantages in implementation. The results of the trial will further the understanding of eHealth prevention intervention implementation.
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Affiliation(s)
- Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 446 E. Ontario Street, Floor 7, Chicago, IL 60611, United States of America.
| | - Rana Saber
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Justin Patrick Jones
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Kathryn Macapagal
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 446 E. Ontario Street, Floor 7, Chicago, IL 60611, United States of America
| | - Nanette Benbow
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 446 E. Ontario Street, Floor 7, Chicago, IL 60611, United States of America
| | - Dennis H Li
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 446 E. Ontario Street, Floor 7, Chicago, IL 60611, United States of America
| | - C Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 446 E. Ontario Street, Floor 7, Chicago, IL 60611, United States of America
| | - Patrick Janulis
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, 295 Chipeta Way, Williams Building, Salt Lake City, UT 84108, United States of America
| | - Elizabeth Marsh
- Boston Medical Center, Section of Infectious Diseases Crosstown Building, 801 Massachusetts Avenue, Boston, MA 02118, United States of America
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medicine, 425 East 61(st) Street, Suite 301, New York, NY 10065, United States of America
| | - Benjamin P Linas
- Boston Medical Center, Section of Infectious Diseases Crosstown Building, 801 Massachusetts Avenue, Boston, MA 02118, United States of America
| | - Krystal Madkins
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Gregory Swann
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Abigael Dean
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Emily Bettin
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL 60611, United States of America
| | - Alexandra Savinkina
- Boston Medical Center, Section of Infectious Diseases Crosstown Building, 801 Massachusetts Avenue, Boston, MA 02118, United States of America
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Ndungu K, Gichangi P, Temmerman M. Evaluation of factors associated with HIV self-testing Acceptability and Uptake among the MSM community in Nairobi, Kenya: A cross sectional study. PLoS One 2023; 18:e0280540. [PMID: 36893161 PMCID: PMC9997958 DOI: 10.1371/journal.pone.0280540] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 01/03/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Human Immunodeficiency Virus self-test (HIVST) refers to a process where a person collects his or her own specimen (blood or oral), performs a test and interprets the results. The interpretation of results can either be done in private or through support of a trusted partner. Self-test should be seen as screening and confirmatory tests are typically strongly encouraged. STUDY OBJECTIVE To determine facilitating factors for HIVST acceptability and uptake among men who have sex with men (MSM). METHODS A cross-sectional exploratory study design, targeting MSM in Nairobi was used. Adult men (aged 18-60 years) who reported to be actively engaging in anal or oral sex with men were eligible for the study. Purposive sampling was used to identify the sites where data was collected, snowballing technique was then employed to reach the respondents. Data was collected between July 2018 and June 2019. A total of 391 MSM respondent were recruited of whom 345 MSM completed the questionnaires. The missing data was handled through the listwise approach that omits those cases with the missing data and analyze the remaining data. We also excluded responses with inconsistencies in all confirmatory questions in the questionnaire. RESULTS Two-thirds (64.0%) of the participants were aged 18-24 years with 13.4% being married to women and 40.2% having tertiary level of education. Majority, 72.7% were unemployed and two-thirds (64.0%) of participants were young (18-24 years) and self reported as male sex workers (58.8). There were significant associations between willingness to undertake HIV self-tests and frequency of HIV testing as well as with previous knowledge about self-testing. Habitual HIV testers were more likely to have used the HIVST kit than the non-habitual testers. Willingness to undertake confirmatory test within one month of self-testing was associated with acceptability of HIVST. Most of the MSM preferred blood sample self-test kits as compared to oral self-test kits, believing that blood test will be more accurate than oral self-test. Other factors associated with HIVST included consistent use of protection regardless of HIV status, preference of "treatment buddies". High costs of the self-test kits and inadequate knowledge on the use of HIV self-test kits were the main hindrances to HIVST uptake. CONCLUSIONS This study has showed that age, habitual testing, self-care/partner care, as well as confirmatory testing and immediate introduction into care if found sero-positive were associated with the use of HIVST kit. This study contributes to the pool of knowledge of the characteristics of MSM that would adopt and embrace HIVST, and demonstrates that these MSM are self and partner care aware and conscious. The challenge however remains on how to encourage those that are not self/partner care aware to embrace HIV testing and particularly HIVST as routine practices. Future studies may need to explore potential motivators to self-testing among the young, elder MSM generations and the MSM with higher economic status in Kenya.
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Affiliation(s)
- Kingori Ndungu
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Peter Gichangi
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- University Administration, Technical University of Mombasa, Mombasa, Kenya
- International Centre for Reproductive Health, Mombasa, Kenya
| | - Marleen Temmerman
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- International Centre for Reproductive Health, Mombasa, Kenya
- Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Nairobi, Kenya
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Kobrak P, Remien RH, Myers JE, Salcuni P, Edelstein Z, Tsoi B, Sandfort T. Motivations and Barriers to Routine HIV Testing Among Men Who Have Sex with Men in New York City. AIDS Behav 2022; 26:3563-3575. [PMID: 35536518 PMCID: PMC9550690 DOI: 10.1007/s10461-022-03679-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 12/31/2022]
Abstract
In-depth qualitative interviews explored the experiences and understandings of men 18-39 years old who have sex with men that could facilitate or prevent HIV testing and routine HIV testing. For many men who tested frequently, testing and routine testing were motivated by awareness of the benefit of prompt treatment; public health and provider encouragement to test periodically; responsibility towards sexual partners; and wanting to share a recent HIV-negative test result when seeking sex online. For some men, any testing was impeded by anxiety around possible HIV diagnosis that made testing a stressful occasion that required time and energy to prepare for. This anxiety was often compounded by stigma related to sex between men, having condomless sex, or having HIV. Routine testing could be further stigmatized as some men felt judged by testing providers or partners if they asked for a test or said they tested frequently. We describe efforts to promote testing and routine testing by countering fear and stigma associated with HIV and testing.
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Affiliation(s)
- Paul Kobrak
- New York City Health Department, HIV Prevention Program, 42-09 28 Street, Long Island City, NY, 11101, USA.
| | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | | | - Paul Salcuni
- Relevant Healthcare Technologies, New York, NY, USA
| | - Zoe Edelstein
- New York City Health Department, HIV Prevention Program, 42-09 28 Street, Long Island City, NY, 11101, USA
| | - Benjamin Tsoi
- New York City Health Department, HIV Prevention Program, 42-09 28 Street, Long Island City, NY, 11101, USA
| | - Theodorus Sandfort
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
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Schnarrs PW, Bond M, Stone AL, Salcido R, Young L, Dean J, Grigsby TJ. The Relationship Between Adverse Childhood Experiences and Utilization of Different HIV Testing Strategies Among Young Men Who Have Sex with Men in Texas. AIDS Behav 2022; 26:3642-3653. [PMID: 35583575 PMCID: PMC9115744 DOI: 10.1007/s10461-022-03690-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/24/2022]
Abstract
Adverse childhood experiences (ACEs) are a well-documented HIV-risk factor, but less is known about the relationship between ACEs and different HIV testing strategies. This study used data from an LGBTQ + community health assessment, that was part of a multi-staged community-based participatory research project in San Antonio, Texas. Overall, 464 young men who have sex with men (YMSM; < 36-years-old) completed an online, cross-sectional survey that included questions about ACEs and HIV testing behavior. An association between increased ACEs exposure and the odds of clinic-based testing and HIVST HIV significantly decreased relative to never testing for HIV. Additionally, greater ACEs exposure was significantly associated with increased odds of reporting community-based testing (AOR = 1.09, 95% CI = 1.00, 1.20) and significantly reduced odds of HIV self-testing (AOR = 0.72, 95% CI = 0.63, 0.82) compared to clinic-based testing. Cumulative ACEs exposure is important in understanding HIV testing behaviors in YMSM and should be considered when developing HIV testing programs.
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Affiliation(s)
- Phillip W Schnarrs
- Division of Community Engagement and Health Equity, Department of Population Health, Dell Medical School, The University of Texas at Austin, Health Discovery Building (HDB) 4.814, Austin, TX, 78712, USA.
- Department of Human Development and Family Sciences, School of Human Ecology, College of Natural Sciences, The University of Texas at Austin, Austin, TX, 78712, USA.
- Population Research Center, The College of Liberal Arts, The University of Texas at Austin, Austin, TX, 78712, USA.
| | - Mark Bond
- Department of Psychiatry, Dell Medical School, The University of Texas at Austin, Austin, TX, 78712, USA
| | - Amy L Stone
- Department of Sociology and Anthropology, Trinity University, San Antonio, TX, 78212, USA
| | - Robert Salcido
- The Pride Center San Antonio, San Antonio, TX, 78212, USA
| | - Lindsay Young
- Annenberg School for Communication and Journalism, University of Southern California, Los Angeles, CA, 90089, USA
| | - Judith Dean
- School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia
| | - Timothy J Grigsby
- Department of Environmental and Occupational Health, University of Nevada, Las Vegas, NV, 89154, USA
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18
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Majam M, Phatsoane M, Wonderlik T, Rhagnath N, Schmucker LK, Singh L, Rademeyer M, Thirumurthy H, Marcus N, Lalla-Edward S. Incentives to promote accessing HIV care and viral suppression among HIV self-screening test users who obtain a reactive result. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:976021. [PMID: 36303657 PMCID: PMC9580778 DOI: 10.3389/frph.2022.976021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Achieving viral suppression in people with HIV is crucial in ending the AIDS epidemic. Among users of HIV self-screening tests, low rates of linkage to care and early retention in care are key obstacles to achieving viral suppression. This study sought to evaluate the efficacy of financial incentives in supporting HIV case management. Methods Young adults within the inner city of Johannesburg, South Africa and surrounding areas who used HIV self-tests, were able to use WhatsApp to communicate with study personnel, reported a reactive or invalid result, and were confirmed to by HIV-positive were enrolled in the study. Participants were randomised to an intervention arm that received reminders and financial rewards for engaging in care, or to a control arm that received the standard of care. The primary outcome was HIV viral load at six months. Results Among 2,388 HIV self-test kits that were distributed, 1757/2,388 (73,58%) recipients were able to use their phones to send photos to study personnel. 142/1,757 (8,08%) of these recipients reported reactive or invalid results. Upon confirmatory testing, 99/142 (69,71%) participants were identified as being HIV-positive and were enrolled in the study. 2 (1,41%) participants received an HIV negative result, and 41(28,87%) participants were either lost to follow-up or did not complete the confirmatory testing step. 20/99 (20,2%) from the intervention arm and 18/99 (18,18%) from the control arm completed the study (i.e., attended a 6 month follow up and participated in the exit interview). 29/99 (29,29%) were virally suppressed by at 6 months. Of those achieving viral suppression 15 (51,72%) were from the intervention arm. Conclusion Financial incentives and reminders were not effective in promoting engagement with HIV care and viral suppression in this setting.
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Affiliation(s)
- Mohammad Majam
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mothepane Phatsoane
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Theodore Wonderlik
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Naleni Rhagnath
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Laura K. Schmucker
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, United States
| | - Leanne Singh
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, United States
| | - Noora Marcus
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, United States
| | - Samanta Lalla-Edward
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Correspondence: Samanta Lalla-Edward
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19
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Eubanks A, Coulibaly B, Dembélé Keita B, Anoma C, Dah TTE, Mensah E, Kaba S, Lokrou KJ, Ouedraogo FR, Badjassim AMF, Maradan G, Bourrelly M, Mora M, Riegel L, Rojas Castro D, Yaya I, Spire B, Laurent C, Sagaon-Teyssier L. Socio-behavioral correlates of pre-exposure prophylaxis use and correct adherence in men who have sex with men in West Africa. BMC Public Health 2022; 22:1832. [PMID: 36175860 PMCID: PMC9520809 DOI: 10.1186/s12889-022-14211-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple barriers compromise pre-exposure prophylaxis (PrEP) engagement (i.e., use and adherence) in men who have sex with men (MSM). In low/middle-income countries, little is known about PrEP engagement in this population. In West Africa, the CohMSM-PrEP study was one of the rare interventions providing PrEP to MSM. We estimated PrEP use and correct adherence rates in CohMSM-PrEP, together with associated factors over time. METHODS: CohMSM-PrEP recruited MSM in four community-based clinics in Mali, Côte d'Ivoire, Burkina Faso, and Togo. Quarterly follow-up included collecting socio-behavioral data, and providing a comprehensive HIV prevention package, PrEP (daily or event-driven), and peer educator (PE)-led counselling. Using repeated measures, multivariate generalized estimating equations models were used to identify factors associated with self-reported i) PrEP use and ii) correct PrEP adherence during participants' most recent anal intercourse (defined as four pills/week for daily users and 2 + 1 + 1 for event-driven users). RESULTS Five hundred twenty participants were included with a median follow-up time of 12 months (IQR 6-21). Of the 2839 intercourses declared over the follow-up period, PrEP use was self-reported for 1996 (70%), and correct PrEP adherence for 1461 (73%) of the latter. PrEP use was higher in participants who also attended participating clinics outside of scheduled visits (adjusted odds ratio (aOR) [95% Confidence Interval, CI], p-value; 1.32[1.01-1.71], 0.040), and in those who practiced condomless anal sex (1.86[1.54-2.24], < 0.001). Correct adherence was higher in those who often contacted PE outside of scheduled visits (2.16[1.01-4.64], 0.047) and in participants who adopted receptive/versatile sexual positions with stable partners (1.36[1.03-1.81], 0.030). Instead, after an interaction effect between financial situation and regimen was tested, it was lower in event-driven users with a difficult/very difficult financial situation (comfortable/just making ends meet & daily, 4.19[2.56-6.86], < 0.001; difficult/very difficult & daily, 6.47[4.05-10.30], < 0.001; comfortable/just making ends meet & event-driven, 1.63[1.22-2.17], 0.001), and in participants who felt alone (0.76[0.58-0.99], 0.042). CONCLUSIONS Community-based clinic attendance and PE contact outside of scheduled visits were both associated with higher PrEP engagement, but some socially and economically marginalized participants struggled with adherence. As scale-up continues in West Africa, we recommend implementing community-based interventions and providing extra support for vulnerable users to ensure adequate PrEP engagement.
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Affiliation(s)
- August Eubanks
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France.
| | | | | | | | - Ter Tiero Elias Dah
- Association African Solidarité, Ouagadougou, Burkina Faso.,Centre Muraz, Centre Muraz, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso
| | | | | | | | | | | | - Gwenaëlle Maradan
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France.,ORS PACA, Observatoire Régional de La Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Michel Bourrelly
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France.,Coalition Plus, Community-Based Research Laboratory, Pantin, France
| | - Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France
| | - Lucas Riegel
- Coalition Plus, Community-Based Research Laboratory, Pantin, France
| | - Daniela Rojas Castro
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France.,Coalition Plus, Community-Based Research Laboratory, Pantin, France
| | - Issifou Yaya
- TransVIHMI, Univ Montpellier, INSERM, Montpellier, IRD, France
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France
| | | | - Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France.,ARCAD Santé PLUS, Bamako, Mali
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20
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Dibble KE, Murray SM, Wiginton JM, Maksut JL, Lyons CE, Aggarwal R, Augustinavicius JL, Al-Tayyib A, Sey EK, Ma Y, Flynn C, German D, Higgins E, Anderson BJ, Menza TW, Orellana ER, Flynn AB, Wermuth PP, Kienzle J, Shields G, Baral SD. Associations between HIV testing and multilevel stigmas among gay men and other men who have sex with men in nine urban centers across the United States. BMC Health Serv Res 2022; 22:1179. [PMID: 36127682 PMCID: PMC9490978 DOI: 10.1186/s12913-022-08572-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Complex manifestation of stigma across personal, community, and structural levels and their effect on HIV outcomes are less understood than effects in isolation. Yet, multilevel approaches that jointly assesses HIV criminalization and personal sexual behavior stigma in relation to HIV testing have not been widely employed or have only focused on specific subpopulations. The current study assesses the association of three types of MSM-related sexual behavior-related stigma (family, healthcare, general social stigma) measured at both individual and site levels and the presence/absence of laws criminalizing HIV transmission with HIV testing behaviors to inform HIV surveillance and prevention efforts among HIV-negative MSM in a holistic and integrated way. Methods We included nine National HIV Behavioral Surveillance (NHBS) 2017 sites: Baltimore, MD; Denver, CO; Detroit, MI; Houston, TX; Long Island/Nassau-Suffolk, NY; Los Angeles, CA; Portland, OR; San Diego, CA; and Virginia Beach and Norfolk, VA. Multivariable generalized hierarchical linear modeling was used to examine how sexual behavior stigmas (stigma from family, anticipated healthcare stigma, general social stigma) measured at the individual and site levels and state HIV criminalization legislation (no, HIV-specific, or sentence-enhancement laws) were associated with past-year HIV testing behaviors across sites (n = 3,278). Results The majority of MSM across sites were tested for HIV in the past two years (n = 2,909, 95.4%) with the average number of times tested ranging from 1.79 (SD = 3.11) in Portland, OR to 4.95 (SD = 4.35) in Los Angeles, CA. In unadjusted models, there was a significant positive relationship between stigma from family and being tested for HIV in the past two years. Site-level HIV-specific criminalization laws were associated with an approximate 5% reduction in the prevalence of receiving any HIV test in the past two years after individual level stigma and sociodemographic covariate adjustments (PR = 0.94, 95% CI, 0.90–0.99). Conclusions Structural barriers faced by MSM persist and ending the HIV epidemic in the US requires a supportive legal environment to ensure effective engagement in HIV services among MSM. Home-based solutions, such as self-testing, used to deliver HIV testing may be particularly important in punitive settings while legal change is advocated for on the community and state levels. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08572-4.
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Affiliation(s)
- Kate E Dibble
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - John Mark Wiginton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Jessica L Maksut
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Carrie E Lyons
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Rohin Aggarwal
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Jura L Augustinavicius
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Alia Al-Tayyib
- Denver Public Health & Hospital Authority, Denver, CO, 80204, USA
| | - Ekow Kwa Sey
- Los Angeles County Department of Public Health, Los Angeles, CA, 90012, USA
| | - Yingbo Ma
- Los Angeles County Department of Public Health, Los Angeles, CA, 90012, USA
| | - Colin Flynn
- Center for HIV Surveillance, Epidemiology, & Evaluation, Maryland Department of Health, Baltimore, MD, 21202, USA
| | - Danielle German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Emily Higgins
- Division of HIV and STI Programs, Michigan Department of Health and Human Services (MDHHS), Lansing, MI, 48909, USA
| | - Bridget J Anderson
- Bureau of Communicable Disease Control, New York State Department of Health, Albany, NY, 12237, USA
| | - Timothy W Menza
- HIV Data and Analysis Program, Oregon Health Authority, Portland, OR, 97232, USA
| | - E Roberto Orellana
- Regional Research Institute, Portland State University, Portland, OR, 97201, USA.,School of Social Work, University of Washington, Seattle, WA, 98105, USA
| | - Anna B Flynn
- Surveillance & Federal Reporting Section, Maternal, Child, & Adolescent Health Division, California Department of Health,, San Francisco, CA, 94102, USA
| | - Paige Padgett Wermuth
- Division of Management Policy & Community Health (MPACH), The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, 77030, USA
| | - Jennifer Kienzle
- Division of Disease Prevention, Virginia Department of Health, HIV Surveillance, Richmond, VA, 23219, USA
| | - Garrett Shields
- Division of Disease Prevention, Virginia Department of Health, HIV Surveillance, Richmond, VA, 23219, USA
| | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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21
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Kenyon C. Is Monkeypox Being Underdiagnosed in Countries with More Stigmatizing Attitudes towards Men Who Have Sex with Men? A Simple Ecological Analysis. EPIDEMIOLOGIA 2022; 3:363-368. [PMID: 36417244 PMCID: PMC9620899 DOI: 10.3390/epidemiologia3030028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 12/14/2022] Open
Abstract
It is not known why the recent outbreak of monkeypox (MPX) has been more extensive in certain European countries than others. Previous studies have found that European countries with more stigmatizing attitudes to homosexuality have more undiagnosed HIV infections in men who have sex with men (MSM). We hypothesized that MPX in MSM may be underdiagnosed in European countries with more stigmatizing attitudes to homosexuality and less access to sexually transmitted infection (STI) testing for MSM. To test this hypothesis, we used Spearman’s correlation to assess if the national incidence of MPX in European countries was negatively associated with the intensity of screening for STIs and a composite indicator of Lesbian Gay Bisexual Transgender Intersex (LGBTI) rights (the Rainbow Index). We found that the national cumulative incidence of MPX was positively correlated with the intensity of chlamydia/gonorrhoea screening (rho 0.68, p-value < 0.0001), syphilis screening (rho 0.62, p-value < 0.0001), and the Rainbow Index (rho 0.65, p-value < 0.0001). Our analysis thus suggests caution is required in interpreting the relatively lower incidence of MPX reported from several Eastern European countries. A key limitation of this analysis is that the incidence of MPX was calculated in the whole population and not limited to the MSM population.
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Affiliation(s)
- Chris Kenyon
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium;
- Department of Medicine, University of Cape Town, Cape Town 7701, South Africa
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22
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Liu Y, Hawkins M, Osman A, Zhang C. Assessing the Prevalence and Determinants of Exposure-Influenced HIV Testing among a Sample of Pre- and Post-Exposure Prophylaxis-Naïve Young Men Who Have Sex with Men in the United States. Trop Med Infect Dis 2022; 7:tropicalmed7080146. [PMID: 35893655 PMCID: PMC9331231 DOI: 10.3390/tropicalmed7080146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/19/2022] [Accepted: 07/23/2022] [Indexed: 02/01/2023] Open
Abstract
Self-initiated Human Immunodeficiency Virus (HIV) testing after potential sexual exposure to HIV (i.e., exposure-influenced HIV testing) has high utility in detecting individuals with the highest probabilities of HIV seroconversion. We conducted a cross-sectional study among a sample of sexually active, pre/post-exposure prophylaxis (PrEP/PEP)-naïve young men who have sex with men (YMSM) in two US cities to assess the determinants (e.g., demographic, psychosocial, sexual, substance use, and HIV prevention characteristics) of exposure-influenced HIV testing (never/rarely vs. mostly/always) in their lifetime. Of 261 YMSM, only 26.5% reported mostly/always seeking exposure-influenced prior to the study. Multivariable analyses showed that younger age, sexual orientation non-disclosure, perceived HIV stigma, internalized homophobia, lower general resilience, and lower social support were associated with a lower likelihood of mostly/always seeking exposure-influenced HIV testing. YMSM who never/rarely sought exposure-influenced HIV testing were more likely to use recreational drugs before sex, binge alcohol, and have group sex; while less likely to be aware of PrEP, test for sexually transmitted infections, or use condoms compared to those mostly/always seeking exposure-influenced HIV testing. Exposure-influenced HIV testing is suboptimal among YMSM with elevated risk for HIV. Our findings provide important implications for designing targeted interventions to promote exposure-influenced HIV testing among high-risk YMSM.
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Affiliation(s)
- Yu Liu
- Division of Epidemiology, Department of Public Health Sciences, University of Rochester Medical Center, 256 Crittenden Blvd., Ste. 3305, Rochester, NY 14642, USA
- Correspondence: ; Tel.: +1-585-276-3562
| | - Mary Hawkins
- Nashville Council on AIDS, Resources, Education and Support (CARES), Nashville, TN 37204, USA; (M.H.); (A.O.)
| | - Amna Osman
- Nashville Council on AIDS, Resources, Education and Support (CARES), Nashville, TN 37204, USA; (M.H.); (A.O.)
| | - Chen Zhang
- School of Nursing, University of Rochester, Rochester, NY 14642, USA;
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23
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Wang Y, Mitchell J, Liu Y. Evidence and implication of interventions across various socioecological levels to address HIV testing uptake among men who have sex with men in the United States: A systematic review. SAGE Open Med 2022; 10:20503121221107126. [PMID: 35795867 PMCID: PMC9251980 DOI: 10.1177/20503121221107126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/25/2022] [Indexed: 12/20/2022] Open
Abstract
Objectives Strengthening HIV testing uptake is critical to curtail the HIV epidemics among men who have sex with men in the United States. Despite the implementation of various interventions to promote HIV testing among men who have sex with men, few aggregated evidence is presented to reflect the "lessons learned" and inform future directions. The objective of this systematic review is to comprehensively summarize published studies that described, tested, and evaluated outcomes (e.g. efficacy, effectiveness, acceptability, feasibility and/or qualitative opinions) associated with an HIV testing intervention and identify gaps as well as opportunities to inform the design and implementation of future interventions to enhance HIV testing uptake among men who have sex with men in the United States. Methods We followed the PRISMA guidelines and conducted a systematic review of articles (published by 23 July 2021) by searching multiple databases (PubMed, MEDLINE, Web of Science and PsycINFO). Results Among the total number of 3505 articles found through multiple databases, 56 papers were included into the review. Interventional modules that demonstrated acceptability, feasibility and efficacy to improve HIV testing uptake among men who have sex with men include: HIV self-testing, interpersonal-level (e.g. peer-led, couple-based) interventions, personalized interventions and technology-based interventions (e.g. mHealth). Aggregated evidence also reflects the lack of individualized interventions that simultaneously address time-varying needs across multiple socioecological levels (e.g. individual, interpersonal, community, structural and societal). Conclusion Development of interventions to improve HIV testing rates and frequency of men who have sex with men has proliferated in recent years. Our review presents important implications in sustaining and improving interventions to address HIV testing uptake among men who have sex with men in the United States.
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Affiliation(s)
- Ying Wang
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Jason Mitchell
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Yu Liu
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
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24
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Inghels M, Kouassi AK, Niangoran S, Bekelynck A, Carilon S, Sika L, Koné M, Danel C, Degrées du Loû A, Larmarange J. Preferences and access to community-based HIV testing sites among men who have sex with men (MSM) in Côte d'Ivoire. BMJ Open 2022; 12:e052536. [PMID: 35760538 PMCID: PMC9237902 DOI: 10.1136/bmjopen-2021-052536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Measuring access and preferences to Men who have Sex with Men focused community-based HIV testing sites (MSM-CBTS) in Côte d'Ivoire. DESIGN A respondent-driven sampling telephone survey. SETTING National survey conducted in 2018 in Côte d'Ivoire. PARTICIPANTS 518 MSM aged over 18 years old. PRIMARY AND SECONDARY OUTCOME MEASURES Knowledge, practices, satisfaction and preferences regarding MSM-CBTS. Factors associated with MSM-CTBS access or knowledge and with HIV testing venue preferences were examined. RESULTS Only half of the respondents (47%) reported knowing of an MSM-CBTS. Of these, 79% had already attended one. Both knowing of and ever visiting an MSM-CBTS were significantly associated with a higher number of HIV tests performed in the past 12 months and having disclosed sexual orientation to one family member.In terms of preferences, 37% of respondents said they preferred undifferentiated HIV testing sites (ie, 'all patients' HIV testing sites), 34% preferred MSM-CBTS and 29% had no preference.Those who reported being sexually attracted to women, being bisexual and those who did not know an MSM non-governmental organisation were less likely to prefer MSM-CBTS. MSM who preferred undifferentiated HIV testing sites mentioned the lack of discretion and anonymity of community-based sites and the desire to avoid the gaze of others. CONCLUSION Community-based HIV testing is well suited for MSM who identify as homosexual and those close to the MSM community, while maintaining undifferentiated HIV testing is essential for others. Both types of activities need to be maintained and developed. Healthcare professionals in undifferentiated HIV testing sites need to be properly trained in the non-judgemental reception of MSM.
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Affiliation(s)
- Maxime Inghels
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK
- Centre Population et Développement, Université Paris Cité, Institut de Recherche pour le Développement, Inserm, Paris, France
| | - Arsène Kra Kouassi
- Centre Population et Développement, Université Paris Cité, Institut de Recherche pour le Développement, Inserm, Paris, France
| | | | - Anne Bekelynck
- Centre Population et Développement, Université Paris Cité, Institut de Recherche pour le Développement, Inserm, Paris, France
- Programme PAC-CI, Abidjan, Côte d'Ivoire
| | - Séverine Carilon
- Centre Population et Développement, Université Paris Cité, Institut de Recherche pour le Développement, Inserm, Paris, France
| | - Lazare Sika
- Ecole Nationale Supérieure de Statistique et d'Economie Appliquée d'Abidjan, Abidjan, Côte d'Ivoire
| | - Mariatou Koné
- Institut d'Ethno-Sociologie, Université Félix-Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Christine Danel
- Programme PAC-CI, Abidjan, Côte d'Ivoire
- Bordeaux Population Health, Université de Bordeaux, Inserm, Bordeaux, France
| | - Annabel Degrées du Loû
- Centre Population et Développement, Université Paris Cité, Institut de Recherche pour le Développement, Inserm, Paris, France
| | - Joseph Larmarange
- Centre Population et Développement, Université Paris Cité, Institut de Recherche pour le Développement, Inserm, Paris, France
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de Wit JBF, Adam PCG, den Daas C, Jonas K. Sexually transmitted infection prevention behaviours: health impact, prevalence, correlates, and interventions. Psychol Health 2022; 38:675-700. [PMID: 35748408 DOI: 10.1080/08870446.2022.2090560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Sexually transmitted infections (STIs) remain a major public health threat, disproportionately affecting young people, and men who have sex with men. In this narrative review of the current state of behavioural science research on STI prevention, we consider the definition, health impacts, correlates and determinants, and interventions to promote STI prevention behaviour. Research on STI prevention behaviour has extended from a focus on abstinence, partner reduction and condom use, to also include novel preventive behaviours, notably treatment-as-prevention, pre-exposure prophylaxis (i.e., the preventive use of medicines by uninfected people), and vaccination for some STIs. Social-cognitive factors specified by, for instance the theory of planned behaviour, are critical proximal determinants of STI prevention behaviours, and related interventions can effectively promote STI prevention behaviours. Social-ecological perspectives highlight that individual-level determinants are embedded in more distal environmental influences, with social stigma especially affecting STI prevention behaviours and requiring effective intervention. Further to providing a major domain of application, STI prevention also poses critical challenges and opportunities for health psychology theory and research. We identify a need for health behaviour theory that addresses the processes linking multiple levels of influence on behaviour and provides practical guidance for multi-level behaviour change interventions adapted to specific contexts.
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Affiliation(s)
- John B. F. de Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
- Centre for Social Research in Health, UNSW Sydney, Kensington, Australia
| | - Philippe C. G. Adam
- Centre for Social Research in Health, UNSW Sydney, Kensington, Australia
- Institute for Prevention and Social Research, Bangkok, Thailand
| | - Chantal den Daas
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland
| | - Kai Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
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HIV Testing Patterns Among Recently Self-Tested Russian Men Who Have Sex With Men: A Qualitative Study. J Assoc Nurses AIDS Care 2022; 33:550-558. [DOI: 10.1097/jnc.0000000000000344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Experiences of Transgender Women Who Used a Dual HIV/Syphilis Rapid Self-test to Screen Themselves and Potential Sexual Partners (the SMARTtest Study). AIDS Behav 2022; 26:1229-1237. [PMID: 34559351 DOI: 10.1007/s10461-021-03478-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
HIV/syphilis self- and partner-testing may be especially appropriate for transgender women, since they shoulder a disproportionate burden of HIV, other STIs (e.g., syphilis), and report high levels of medical mistrust. The SMARTest study enrolled N = 50 sexual and gender minority individuals. The present analysis aims to understand the experiences (via in-depth interviews) of a subset of n = 11 transgender women who used INSTI Multiplex®, a combination HIV/syphilis rapid self-test, on themselves and potential sex partners. Participants reported that many partners were willing to test, and reported no testing-related violence. Most participants completed tests successfully, though gaining comfort with blood collection took time. There were no HIV-positive tests in this study; one participant and two partners reported a positive syphilis screening. All sought care. Our sample was small and results should be interpreted with caution, but indicate potential future directions for conducting research on self- and partner-testing among transgender women.
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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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Leenen J, Wijers JNAP, Den Daas C, de Wit J, Hoebe CJPA, Dukers-Muijrers NHTM. HIV testing behaviour and associated factors in men who have sex with men by level of urbanisation: a cross-sectional study in the Netherlands. BMJ Open 2022; 12:e049175. [PMID: 35027414 PMCID: PMC8762132 DOI: 10.1136/bmjopen-2021-049175] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Regular HIV testing in men who have sex with men (MSM) enables timely entry into care and reduces the likelihood of HIV transmission. We aimed to assess HIV-testing behaviour and associated factors in MSM by urbanisation of place of residence. DESIGN Data were derived from online survey ('Men & Sexuality') in the Netherlands, which was mainly advertised on social media (Facebook and Instagram), dating websites, apps for MSM (Grindr and PlanetRomeo) and gay media. PRIMARY AND SECONDARY OUTCOME MEASURES HIV testing was defined as recent (<1 year), not recent (≥1 year) or never. Using multinominal regression analyses, factors associated with not recent testing and never testing, compared with recent testing, were assessed among MSM living in highly (>2500 residences/km2) or non-highly (≤2500 residences/km2) urbanised areas. PARTICIPANTS The study sample included 3815 MSM, currently living in the Netherlands. The mean age was 36 years (SD 14.7), and 67.6% were highly educated. RESULTS In highly urbanised areas, 11.8% was never and 19.8% was not recently HIV-tested. In non-highly urbanised areas, this was 25.2% and 19.6%. Among MSM living in highly urbanised areas, independently associated with never and not recent testing were younger age, self-identification as bisexual, fewer sex partners, never notified of HIV and no recent condomless anal intercourse. Among MSM living in non-highly urbanised areas, lower perceived HIV severity, higher perceived HIV risk and a lower proportion gay friends were associated with never and not recent testing. Among never tested MSM, those in non-highly urbanised areas preferred self-sampling/self-testing over facility-based testing; those in highly urbanised areas preferred testing at healthcare facilities. CONCLUSIONS The proportion of never tested MSM was high (25%) in non-highly urbanised areas in the Netherlands. MSM living in non-highly urbanised areas may possibly be reached with targeted approaches to increase HIV testing uptake such as self-testing/self-sampling strategies.
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Affiliation(s)
- Jeanine Leenen
- Department of Sexual Health Infectious Diseases and Environmental Health, GGD South Limburg, Heerlen, The Netherlands
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Juliën N A P Wijers
- Department of Sexual Health Infectious Diseases and Environmental Health, GGD South Limburg, Heerlen, The Netherlands
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Chantal Den Daas
- Institute of Applied Health Sciences, Health Psychology, University of Aberdeen, Aberdeen, UK
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - John de Wit
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Interdisciplinary Social Science, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health Infectious Diseases and Environmental Health, GGD South Limburg, Heerlen, The Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Nicole H T M Dukers-Muijrers
- Department of Sexual Health Infectious Diseases and Environmental Health, GGD South Limburg, Heerlen, The Netherlands
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
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Liu Y, Bleasdale J, Przybyla S, Higgins MC, Zhang C. Racial Variations in Psychosocial Vulnerabilities Linked to Differential Poppers Use and Associated HIV-Related Outcomes among Young Men Who Have Sex with Men: A Study in Two U.S. Metropolitan Areas. Subst Use Misuse 2022; 57:560-568. [PMID: 35067175 DOI: 10.1080/10826084.2021.2023185] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background: Poppers use has become increasingly prevalent and is associated with elevated HIV risk among young men who have sex with men (YMSM) in urban settings. However, knowledge regarding racial variations of poppers use and their psychosocial determinants to inform culturally-targeted interventions remain limited. Methods: We conducted a cross-sectional study among YMSM recruited from two US metropolitan areas (Nashville, TN and Buffalo, NY) to investigate the differences of socio-environmental and mental health factors associated with poppers use and important HIV-related outcomes [e.g., HIV testing, pre-exposure prophylaxis (PrEP, substance use, and risky sexual behaviors] among White and Black YMSM (i.e., YWMSM and YBMSM). Results: Among 347 YMSM aged 18-35 years, 32.3% reported poppers use. Notably, poppers-using YWMSM were more likely (p < 0.05) to report mental health burdens (e.g., depression, anxiety, loneliness), while poppers-using YBMSM were more likely (p < 0.05) to experience adverse social-environmental events (e.g., unstable housing, food insecurity, no health insurance, perceived HIV stigma, internalized homonegativity). Poppers-using YMSM showed a higher prevalence of sexual risk behaviors (e.g., event-level alcohol/drug use, condomless insertive/receptive anal sex, group sex) compared to their non-user counterparts, with YWMSM showing the highest likelihood to engage in these risk behaviors. Compared to poppers-using YBMSM, poppers-using YWMSM were associated with a higher likelihood of ever testing for HIV, ever using PrEP and willingness to use PrEP in the next 12 months. Conclusion: Given the distinctive patterns of psychosocial determinants of poppers use between YWMSM and YBMSM, culturally-tailored poppers reduction programs should be designed to tackle the associated HIV risks among YMSM with effectivenes.
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Affiliation(s)
- Yu Liu
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Jacob Bleasdale
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Sarahmona Przybyla
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | | | - Chen Zhang
- School of Nursing, University of Rochester, Rochester, New York, USA
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Hempel S, Ferguson L, Bolshakova M, Yagyu S, Fu N, Motala A, Gruskin S. Frameworks, measures, and interventions for HIV-related internalised stigma and stigma in healthcare and laws and policies: systematic review protocol. BMJ Open 2021; 11:e053608. [PMID: 34887280 PMCID: PMC8663079 DOI: 10.1136/bmjopen-2021-053608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION There is strong global commitment to eliminate HIV-related stigma. Wide variation exists in frameworks and measures, and many strategies to prevent, reduce or mitigate stigma have been proposed but critical factors determining success or failure remain elusive. METHODS AND ANALYSIS Building on existing knowledge syntheses, we designed a systematic review to identify frameworks, measures and intervention evaluations aiming to address internalised stigma, stigma and discrimination in healthcare, and stigma and discrimination at the legal or policy level. The review addresses four key questions (KQ): KQ1: Which conceptual frameworks have been proposed to assess internal stigma, stigma and discrimination experienced in healthcare settings, and stigma and discrimination entrenched in national laws and policies? KQ2: Which measures of stigma have been proposed and what are their descriptive properties? KQ3: Which interventions have been evaluated that aimed to reduce these types of stigma and discrimination or mitigate their adverse effects and what are the effectiveness and unintended consequences? KQ4: What common 'critical factors for success or failure' can be identified across interventions that have been evaluated? We will search PubMed, PsycINFO, Web of Science, Universal Human Rights Index, HeinOnline, PAIS, HIV Legal Network, CDSR, Campbell Collaboration, PROSPERO and Open Science Framework. Critical appraisal will assess the source, processes and consensus finding for frameworks; COnsensus-based Standards for the selection of health Measurement Instruments criteria for measures; and risk of bias for interventions. Quality of evidence grading will apply . A gap analysis will provide targeted recommendations for future research. We will establish a compendium of frameworks, a comprehensive catalogue of available measures, and a synthesis of intervention characteristics to advance the science of HIV-related stigma. PROSPERO REGISTRATION NUMBER CRD42021249348.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Sachi Yagyu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Ning Fu
- Department of Economics, Shanghai University of Finance and Economics, Shanghai, China
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
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Pitasi MA, Beer L, Cha S, Lyons SJ, Hernandez AL, Prejean J, Valleroy LA, Crim SM, Trujillo L, Hardman D, Painter EM, Petty J, Mermin JH, Daskalakis DC, Hall HI. Vital Signs: HIV Infection, Diagnosis, Treatment, and Prevention Among Gay, Bisexual, and Other Men Who Have Sex with Men - United States, 2010-2019. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:1669-1675. [PMID: 34855721 PMCID: PMC8641567 DOI: 10.15585/mmwr.mm7048e1] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Men who have sex with men (MSM) accounted for two thirds of new HIV infections in the United States in 2019 despite representing approximately 2% of the adult population. Methods CDC analyzed surveillance data to determine trends in estimated new HIV infections and to assess measures of undiagnosed infection and HIV prevention and treatment services including HIV testing, preexposure prophylaxis (PrEP) use, antiretroviral therapy (ART) adherence, and viral suppression, as well as HIV-related stigma. Results The estimated number of new HIV infections among MSM was 25,100 in 2010 and 23,100 in 2019. New infections decreased significantly among White MSM but did not decrease among Black or African American (Black) MSM and Hispanic/Latino MSM. New infections increased among MSM aged 25–34 years. During 2019, approximately 83% of Black MSM and 80% of Hispanic/Latino MSM compared with 90% of White MSM with HIV had received an HIV diagnosis. The lowest percentage of diagnosed infection was among MSM aged 13–24 years (55%). Among MSM with a likely PrEP indication, discussions about PrEP with a provider and PrEP use were lower among Black MSM (47% and 27%, respectively) and Hispanic/Latino MSM (45% and 31%) than among White MSM (59% and 42%). Among MSM with an HIV diagnosis, adherence to ART and viral suppression were lower among Black MSM (48% and 62%, respectively) and Hispanic/Latino MSM (59% and 67%) compared with White MSM (64% and 74%). Experiences of HIV-related stigma among those with an HIV diagnosis were higher among Black MSM (median = 33; scale = 0–100) and Hispanic/Latino MSM (32) compared with White MSM (26). MSM aged 18–24 years had the lowest adherence to ART (45%) and the highest median stigma score (39). Conclusion Improving access to and use of HIV services for MSM, especially Black MSM, Hispanic/Latino MSM, and younger MSM, and addressing social determinants of health, such as HIV-related stigma, that contribute to unequal outcomes will be essential to end the HIV epidemic in the United States.
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Liu Z, Chen Y, Yao T, Zhang T, Song D, Liu Y, Yu M, Xu J, Li Z, Yang J, Cui Z, Li C, Ma J. Factors related to HIV testing frequency in MSM based on the 2011-2018 survey in Tianjin, China: a hint for risk reduction strategy. BMC Public Health 2021; 21:1900. [PMID: 34670542 PMCID: PMC8527634 DOI: 10.1186/s12889-021-11948-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent years, HIV testing has become one of the effective strategies to reduce the risk of the infection. Frequent quarterly HIV testing can be cost effective. Therefore, an in-depth study of factors related to the testing behavior of men who have sex with men (MSM) were analyzed to optimize intervention strategies. METHODS From March 2011 to October 2018, the project was implemented in a Tianjin (China) bathhouse, and 5165 MSM were surveyed using snowball sampling. Factors related to HIV testing behavior were analyzed by ordinal logistic regression analysis after grouping according to testing frequency, and comprehensive analysis was performed. RESULTS The multivariate logistic analysis showed that 6 variables including young MSM (OR = 0.67, 95% CI: 0.49-0.92, p = 0.01), low-educated MSM (OR = 0.60, 95% CI: 0.48-0.77, p < 0.0001), low HIV/AIDS knowledge (95% CI: 0.57-0.83, p < 0.0001), marital status (OR = 1.30, 95% CI: 1.07-1.57, p = 0.007), acceptance of condom promotion and distribution (OR = 14.52, 95% CI: 12.04-17.51, p < 0.0001), and frequency of condom use (p < 0.05) could link to HIV testing behaviors. CONCLUSIONS In order to achieve the 95-95-95 goal, target publicity, HIV/AIDS education and promotion of HIV self-testing kits should be carried out to encourage frequent HIV testing among MSM who are young (especially students), married to women, poorly educated and who are reluctant to always use condoms.
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Affiliation(s)
- Zhongquan Liu
- STD & AIDS Control and Prevention Section, Tianjin Center for Disease Control and Prevention, Tianjin, China
| | - Yang Chen
- The Second People's Hospital of Guiyang, Guiyang, Guizhou, China
| | - Tingting Yao
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Tiantian Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Desheng Song
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yuanyuan Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Maohe Yu
- STD & AIDS Control and Prevention Section, Tianjin Center for Disease Control and Prevention, Tianjin, China
| | - Jie Xu
- National Center for AIDS/STD Control and Prevention, Beijing, China
| | - Zhijun Li
- GAP Program Office of US CDC, Atlanta, GA, USA
| | - Jie Yang
- Tianjin Shenlan Public Health Counseling Service Center, Tianjin, China
| | - Zhuang Cui
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China.
| | - Changping Li
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China.
| | - Jun Ma
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
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Vasconcelos R, Avelino-Silva VI, de Paula IA, Jamal LF, Gianna MC, Santos F, Camargo R, Barbosa E, Casimiro G, Cota V, Abbate MC, Cruz M, Segurado AC. HIV self-test: a tool to expand test uptake among men who have sex with men who have never been tested for HIV in São Paulo, Brazil. HIV Med 2021; 23:451-456. [PMID: 34634182 DOI: 10.1111/hiv.13178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES HIV self-testing is an effective tool to improve diagnostic coverage in key populations, enabling linkage to care and access to antiretroviral therapy. Its implementation requires better understanding of patients' perspectives on this novel strategy. The aim of the study was to investigate the perception of men who have sex with men (MSM) regarding the HIV oral fluid self-test (HIVST) in São Paulo, Brazil, and to analyse the sociodemographic characteristics and testing strategy preferences of individuals registered to undertake HIVST. METHODS Preceding the implementation of HIVST use as public policy in 2019, we recruited MSM living in São Paulo to undertake HIVST using a digital platform, and investigated their sociodemographic profiles, testing experiences and testing preferences. Results were compared according to reported lifetime HIV testing. RESULTS A total of 6477 MSM (median age 28 years) were recruited to the study from April 9th to December 31st, 2018. Seventy-eight per cent reported previous HIV testing. The opening hours of health facilities (53%), concern about disclosing intimate personal information to health care providers (34%) and fear of stigma (21%) were reported as the main barriers to testing. Older age, higher education, illicit drug use and self-identifying as gay were associated with prior HIV testing (P < 0.001). Most participants (67%) were unaware that HIVST was available before enrolling in the study. Preference for HIVST over other testing technologies was higher among those never tested (71%) than among participants with previous HIV testing (61%; P < 0.001). CONCLUSIONS HIVST was found to be an effective tool to improve testing uptake among MSM, particularly those who had never been tested before. Characterization of the most likely users of HIVST among MSM will help to inform implementation and scaling up of this novel testing method in the Brazilian public health system.
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Affiliation(s)
- Ricardo Vasconcelos
- Department/Division of Infectious Diseases, Faculty of Medicine, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | - Vivian I Avelino-Silva
- Department/Division of Infectious Diseases, Faculty of Medicine, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | - Ivone A de Paula
- STD/AIDS Reference and Training Centre, State Secretariat of Health of São Paulo, São Paulo, Brazil
| | - Leda F Jamal
- STD/AIDS Reference and Training Centre, State Secretariat of Health of São Paulo, São Paulo, Brazil
| | - Maria Clara Gianna
- STD/AIDS Reference and Training Centre, State Secretariat of Health of São Paulo, São Paulo, Brazil
| | - Flavio Santos
- STI/AIDS Coordination of the city of São Paulo, Municipal Secretariat of Health, São Paulo, Brazil
| | - Robinson Camargo
- STI/AIDS Coordination of the city of São Paulo, Municipal Secretariat of Health, São Paulo, Brazil
| | | | - Gilvane Casimiro
- Department of Chronic Health Conditions and Sexually Transmitted Infections, Ministry of Health, Brasilia, Brazil
| | - Vanda Cota
- National School of Public Health, Fiocruz, Rio de Janeiro, Brazil
| | - Maria C Abbate
- STI/AIDS Coordination of the city of São Paulo, Municipal Secretariat of Health, São Paulo, Brazil
| | - Marly Cruz
- National School of Public Health, Fiocruz, Rio de Janeiro, Brazil
| | - Aluisio C Segurado
- Department/Division of Infectious Diseases, Faculty of Medicine, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
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Pharr JR. Health Disparities Among Lesbian, Gay, Bisexual, Transgender, and Nonbinary Adults 50 Years Old and Older in the United States. LGBT Health 2021; 8:473-485. [PMID: 34534016 DOI: 10.1089/lgbt.2021.0009] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The purpose of this study was to examine health disparities among LGBT and nonbinary adult subgroups of those 50 years old and older. Methods: This was a cross-sectional analysis of data from the 2019 Behavioral Risk Factor Surveillance System survey. Access to health care, disabilities, health risk and healthy behaviors, and general health and chronic diseases and conditions were compared between gay men, bisexual men, lesbian/gay women, bisexual women, transgender women, transgender men, and nonbinary adults 50 years old and older. Rao-Scott corrected chi-square tests were utilized to determine significant differences between subgroups using weighted data. Multiple comparisons adjusted p values (Bonferroni) analyses were conducted when chi-square tests were significant. Results: Health disparities were identified among subgroups of LGBT and nonbinary older adults, with those who identified as nonbinary or as transgender women being the most vulnerable. Older nonbinary adults, transgender women, and bisexual men were more likely to not have a personal doctor or to not have had a medical checkup in the past 2 years, and nonbinary older adults were more likely to report disabilities, poor mental and physical health, depression, and asthma. Conclusion: Public health professionals and health care providers can use this information to target interventions to specific groups. Subgroup analyses of LGBT and nonbinary adults who are 50 years old and older need to continue with a focus on the most vulnerable groups. In addition, more research is needed that disaggregates transgender and nonbinary older adults to identify the unique health concerns of each group.
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Affiliation(s)
- Jennifer R Pharr
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
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Xin M, Coulson NS, Jiang CL, Sillence E, Chidgey A, Kwan NNM, Mak WWS, Goggins W, Lau JTF, Mo PKH. Web-Based Behavioral Intervention Utilizing Narrative Persuasion for HIV Prevention Among Chinese Men Who Have Sex With Men (HeHe Talks Project): Intervention Development. J Med Internet Res 2021; 23:e22312. [PMID: 34528889 PMCID: PMC8485190 DOI: 10.2196/22312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 06/01/2021] [Accepted: 07/05/2021] [Indexed: 01/02/2023] Open
Abstract
Background In the era of potent antiretroviral therapy, a high level of condomless anal intercourse continues to drive increases in HIV incidence in recent years among men who have sex with men. Effective behavior change strategies for promoting HIV-preventive behaviors are warranted. Narrative persuasion is a novel health communication approach that has demonstrated its persuasive advantages in overcoming resistance to counterattitudinal messages. The efficacy of narrative persuasion in promoting health behavior changes has been well documented, but critical research gaps exist for its application to HIV prevention. Objective In this study, we aimed to (1) capitalize on narrative persuasion to design a web-based multisession intervention for reducing condomless anal intercourse among men who have sex with men in Hong Kong (the HeHe Talks Project) by following a systematic development process; and (2) describe the main components of the narrative intervention that potentially determine its persuasiveness. Methods Persuasive themes and subtopics related to reducing condomless anal intercourse were initially proposed based on epidemiological evidence. The biographic narrative interview method was used to elicit firsthand experiential stories from a maximum variation sample of local men who have sex with men with diverse backgrounds and experiences related to HIV prevention; different types of role models were established accordingly. Framework analysis was used to aggregate the original quotations from narrators into collective narratives under 6 intervention themes. A dedicated website was finally developed for intervention delivery. Results A series of video-based intervention messages in biographic narrative format (firsthand experiential stories shared by men who have sex with men) combined with topic-equivalent argumentative messages were produced and programmed into 6 intervention sessions. The 6-week intervention program can be automatically delivered and monitored online. Conclusions We systematically created a web-based HIV prevention intervention derived from peer-generated stories. Strategies used to enhance the efficacy of the narrative intervention have been discussed within basic communication components. This paper describes the methods and experiences of the rigorous development of a narrative communication intervention for HIV prevention, which enables replication of the intervention in the future.
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Affiliation(s)
- Meiqi Xin
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Neil S Coulson
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Crystal Li Jiang
- Department of Media and Communication, City University of Hong Kong, Hong Kong, Hong Kong
| | - Elizabeth Sillence
- Department of Psychology, Northumbria University, Newcastle, United Kingdom
| | | | - Norman Nok Man Kwan
- Health and Care Service Department, Hong Kong Red Cross, Hong Kong, Hong Kong
| | - Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - William Goggins
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Joseph Tak Fai Lau
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Phoenix Kit Han Mo
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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A Systematic Review of the Social Network Strategy to Optimize HIV Testing in Key Populations to End the Epidemic in the United States. AIDS Behav 2021; 25:2680-2698. [PMID: 33871730 PMCID: PMC8054132 DOI: 10.1007/s10461-021-03259-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 02/04/2023]
Abstract
The United States (U.S.) has a plan to end the HIV epidemic by 2030. The plan’s first pillar prioritizes HIV testing. Social Network Strategy (SNS) is an intervention to reach persons not routinely testing for HIV. We conducted a systematic review of SNS to understand its implementation to optimize HIV testing in the U.S. among key populations. The eligibility criteria included peer-reviewed papers based in the U.S. and focused on HIV testing. We identified and thematically analyzed 14 articles to explore factors associated with successful implementation. Key themes included: (1) social network and recruiter characteristics; (2) strategies for and effectiveness of recruiting key populations; (3) use of and types of incentives; (4) trust, confidentiality, and stigma concerns; and (5) implementation plans and real-world guidance. Cohort studies indicated that SNS detects more incident HIV cases. Partnerships with health departments are critical to confirm new diagnoses, as are developing plans that support recruiters and staff. SNS is a promising strategy to optimize HIV testing among key populations.
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Eaton LA, Watson RJ, Maksut JL, Rucinski KB, Earnshaw VA, Berman M. Elevated Perceived Risk for HIV as a Barrier to Accessing Health Care Among Black Men Who Have Sex with Men. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 21:917-925. [PMID: 32504393 DOI: 10.1007/s11121-020-01135-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We sought to examine how self-perception of risk for HIV and HIV status information avoidance are related to HIV testing uptake and engagement in routine health care among Black men who have sex with men (BMSM)-the group at highest risk for HIV in the USA. To do so, we used generalized linear modeling and serial mediation modeling to assess data from 342 HIV-negative BMSM collected from 2017 to 2019 in Atlanta, GA, USA. Participants reported considerable concern for testing HIV-positive; 40% reported believing they would test positive for HIV; 27% reported being "extremely concerned about getting HIV"; and 17% reported worrying about HIV "all the time". Mediation analyses demonstrated that greater concern for HIV was associated with longer intervals since the last HIV test and the last health-care appointment. BMSM perceived themselves to be at considerable risk for HIV, but critically, this outlook did not yield improved health-care behaviors. Findings highlight the need to reconceptualize our public health approach to reaching BMSM. Emphasizing risk behavior and targeting efforts toward BMSM may have unintended consequences and need to be reevaluated. Despite continued efforts to improve HIV-related outcomes, we are failing to meet the needs of BMSM.
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Affiliation(s)
- Lisa A Eaton
- Institute for Collaboration on Health, Intervention, and Policy University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06269-1248, USA
| | - Ryan J Watson
- Institute for Collaboration on Health, Intervention, and Policy University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06269-1248, USA.
| | - Jessica L Maksut
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Katherine B Rucinski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Valerie A Earnshaw
- Human Development and Family Sciences, University of Delaware, 240 Academy St, Newark, DE, 19716, USA
| | - Marcie Berman
- Institute for Collaboration on Health, Intervention, and Policy University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06269-1248, USA
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Jones A, Honermann B, Lankiewicz E, Sherwood J, Millett G. Current allocations and target apportionment for HIV testing and treatment services for marginalized populations: characterizing PEPFAR investment and strategy. J Int AIDS Soc 2021; 24 Suppl 3:e25753. [PMID: 34189858 PMCID: PMC8242967 DOI: 10.1002/jia2.25753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The United States President's Emergency Plan for AIDS Relief (PEPFAR) is a large bilateral funder of the global HIV response whose policy decisions on key populations (KPs) programming determine the shape of the key populations' response in many countries. Understanding the size and relative share of PEPFAR funds going to KPs and the connection between PEPFAR's targets and resulting programming is crucial for successfully serving key populations. METHODS Publicly available PEPFAR budgets for key populations' services were assessed by country and geographical region for all 52 countries with budget data in fiscal year (FY) 2020. For the 23 countries which completed a full planning process in FY 2018 and 2019, PEPFAR targets for HIV testing and treatment initiation for key populations were assessed. Expenditures for KP programming were calculated to determine whether shifts in targets translated into programming. Implementing partners were characterized by the level of specialization using the share of assigned targets made up by KPs. The average target per year and implementing partner was calculated for each KP group and indicator. RESULTS PEPFAR country KP budgets ranged from US$35,000 to $15.2 million, and the proportion of funding to key populations varied by region, with Eastern and Southern African countries having the lowest proportion. Between FY 2018 and 2019, the KP targets for HIV testing and treatment among KPs increased, whereas expenditures on key populations decreased from US$115.4 to $111.0 million. Of the 11 countries with an increase in HIV testing targets, seven had a decrease in KP expenditures. Of the nine countries with an increase in treatment initiation targets, five had a decrease in KP expenditures. The proportion of targets assigned to partners which do not specialize in key populations increased from FY 2018 to 2019. CONCLUSIONS Current key population policies have not resulted in a tight connection between targets and expenditures. This includes assigning a large proportion of key populations programming to partners who do not specialize in key populations, which may weaken the performance management role of the targets. These results signal that a new approach to key populations programming is needed.
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Affiliation(s)
- Austin Jones
- Public Policy OfficeamfARthe Foundation for AIDS ResearchWashingtonDCUSA
| | - Brian Honermann
- Public Policy OfficeamfARthe Foundation for AIDS ResearchWashingtonDCUSA
| | - Elise Lankiewicz
- Public Policy OfficeamfARthe Foundation for AIDS ResearchWashingtonDCUSA
| | - Jennifer Sherwood
- Public Policy OfficeamfARthe Foundation for AIDS ResearchWashingtonDCUSA
| | - Greg Millett
- Public Policy OfficeamfARthe Foundation for AIDS ResearchWashingtonDCUSA
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Mugo PM, Agutu CA, Wahome E, Juma M, Nzioka J, Mohamed K, Mumba T, Shally M, Fauz I, Omar A, Rinke de Wit TF, van der Elst EM, Graham SM, Sanders EJ. Trends and predictors of HIV positivity and time since last test at voluntary counselling and testing encounters among adults in Kilifi, Kenya, 2006-2017. Wellcome Open Res 2021; 4:127. [PMID: 33884308 PMCID: PMC8042516 DOI: 10.12688/wellcomeopenres.15401.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 01/05/2023] Open
Abstract
Background: Little is known about HIV retesting uptake among key populations (KP) and general populations (GP) in Kenya. We assessed trends and predictors of first-time testing (FTT), late retesting (previous test more than one year ago for GP or three months for KP), and test positivity at three voluntary counselling and testing (VCT) centres in coastal Kenya. Methods: Routine VCT data covering 2006-2017 was collected from three VCT centres in Kilifi County. We analysed HIV testing history and test results from encounters among adults 18-39 years, categorized as GP men, GP women, men who have sex with men (MSM), and female sex workers (FSW). Results: Based on 24,728 test encounters (32% FTT), we observed declines in HIV positivity (proportion of encounters where the result was positive) among GP men, GP women, first-time testers and MSM but not among FSW. The proportion of encounters for FTT and late retesting decreased for both GP and KP but remained much higher in KP than GP. HIV positivity was higher at FTT and late retesting encounters; at FSW and MSM encounters; and at encounters with clients reporting lower educational attainment and sexually transmitted infection (STI) symptoms. HIV positivity was lower in GP men, never married clients and those less than 35 years of age. FTT was associated with town, risk group, age 18-24 years, never-married status, low educational attainment, and STI symptoms. Late retesting was less common among encounters with GP individuals who were never married, had Muslim or no religious affiliation, had lower educational attainment, or reported STI symptoms. Conclusions: HIV positive test results were most common at encounters with first-time testers and late re-testers. While the proportion of encounters at which late retesting was reported decreased steadily over the period reviewed, efforts are needed to increase retesting among the most at-risk populations.
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Affiliation(s)
- Peter M. Mugo
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Clara A. Agutu
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Elizabeth Wahome
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Margaret Juma
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Joseph Nzioka
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Khamisi Mohamed
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Teresia Mumba
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mahmoud Shally
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | - Tobias F. Rinke de Wit
- Amsterdam Institute for Global Health and Development (AIGHD), Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Elise M. van der Elst
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Susan M. Graham
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
| | - Eduard J. Sanders
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
- Amsterdam Institute for Global Health and Development (AIGHD), Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
- Nuffield Department of Medicine, University of Oxford, Headington, UK
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Yang N, Wu D, Zhou Y, Huang S, He X, Tucker J, Li X, Smith KM, Jiang X, Wang Y, Huang W, Fu H, Bao H, Jiang H, Dai W, Tang W. Sexual Health Influencer Distribution of HIV/Syphilis Self-Tests Among Men Who Have Sex With Men in China: Secondary Analysis to Inform Community-Based Interventions. J Med Internet Res 2021; 23:e24303. [PMID: 34061035 PMCID: PMC8207256 DOI: 10.2196/24303] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/02/2020] [Accepted: 04/14/2021] [Indexed: 12/14/2022] Open
Abstract
Background Social network–based strategies can expand HIV/syphilis self-tests among men who have sex with men (MSM). Sexual health influencers are individuals who are particularly capable of spreading information about HIV and other sexually transmitted infections (STIs) within their social networks. However, it remains unknown whether a sexual health influencer can encourage their peers to self-test for HIV/syphilis. Objective The aims of this study were to examine the impact of MSM sexual health influencers on improving HIV/syphilis self-test uptake within their social networks compared to that of nonsexual health influencers. Methods In Zhuhai, China, men 16 years or older, born biologically male, who reported ever having had sex with a man, and applying for HIV/syphilis self-tests were enrolled online as indexes and encouraged to distribute self-tests to individuals (alters) in their social network. Indexes scoring >3 on a sexual health influencer scale were considered to be sexual health influencers (Cronbach α=.87). The primary outcome was the mean number of alters encouraged to test per index for sexual health influencers compared with the number encouraged by noninfluencers. Results Participants included 371 indexes and 278 alters. Among indexes, 77 (20.8%) were sexual health influencers and 294 (79.2%) were noninfluencers. On average, each sexual health influencer successfully encouraged 1.66 alters to self-test compared to 0.51 alters encouraged by each noninfluencer (adjusted rate ratio 2.07, 95% CI 1.59-2.69). More sexual health influencers disclosed their sexual orientation (80.5% vs 67.3%, P=.02) and were community-based organization volunteers (18.2% vs 2.7%, P<.001) than noninfluencers. More alters of sexual health influencers came from a rural area (45.5% vs 23.8%, P<.001), had below-college education (57.7% vs 37.1%, P<.001), and had multiple casual male sexual partners in the past 6 months (25.2% vs 11.9%, P<.001). Conclusions Being a sexual health influencer was associated with encouraging more alters with less testing access to self-test for HIV/syphilis. Sexual health influencers can be engaged as seeds to expand HIV/syphilis testing coverage.
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Affiliation(s)
- Nancy Yang
- University of Hawai'i John A. Burns School of Medicine, Hawai'i, HI, United States.,Dermatology Hospital of Southern Medical University, Guangzhou, China.,University of North Carolina Project-China, Guangzhou, China.,Institute of Global Health and STI Research of Southern Medical University, Guangzhou, China
| | - Dan Wu
- University of North Carolina Project-China, Guangzhou, China.,Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Yi Zhou
- Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Shanzi Huang
- Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Xi He
- Zhuhai Xutong Voluntary Services Center, Zhuhai, China
| | - Joseph Tucker
- University of North Carolina Project-China, Guangzhou, China.,Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Xiaofeng Li
- Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Kumi M Smith
- Division of Epidemiology and Community Health, The University of Minnesota Twin cities, Minneapolis, MN, United States
| | - Xiaohui Jiang
- Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Yehua Wang
- University of North Carolina Project-China, Guangzhou, China
| | - Wenting Huang
- University of North Carolina Project-China, Guangzhou, China
| | - Hongyun Fu
- Division of Community Health and Research, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Huanyu Bao
- University of North Carolina Project-China, Guangzhou, China
| | - Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Wencan Dai
- Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,University of North Carolina Project-China, Guangzhou, China.,Institute of Global Health and STI Research of Southern Medical University, Guangzhou, China
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Kutner BA, Pho AT, López-Rios J, Lentz C, Dolezal C, Balán IC. Attitudes and Perceptions About Disclosing HIV and Syphilis Results Using Smarttest, a Smartphone App Dedicated to Self- and Partner Testing. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:234-248. [PMID: 34014111 PMCID: PMC8209687 DOI: 10.1521/aeap.2021.33.3.234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We explored interest in disclosing test results through a smartphone app dedicated to self- and partner testing for HIV/syphilis. Fifty-nine cisgender men and transgender women each participated in an in-person survey and interview. We examined their interests in sharing test results by audience (e.g., partners, physicians) and by positive versus negative test result. Participants wanted the ability to share results, with notable interest in disclosing negative results to sexual partners and on social media and forwarding positive results to physicians. Participants envisioned smartphone sharing as a means to normalize testing, to notify partners of results, and to expedite linkage to care. Some questioned the authenticity of results shared by smartphone, while others voiced optimism that a personalized, authenticated app could ensure the security and veracity of results. Smartphone testing apps for HIV/syphilis may facilitate disclosure, partner notification, and linkage to care, but need to address concerns about the security and veracity of results.
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Affiliation(s)
- Bryan A. Kutner
- The HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| | - Anthony T. Pho
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, MC5376, Palo Alto, CA 94304, USA
| | - Javier López-Rios
- The HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| | - Cody Lentz
- The HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| | - Curtis Dolezal
- The HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| | - Iván C. Balán
- The HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
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Warmbrunn I, Green-Jones M, Outlaw AY. Utilizing Alternative Testing Technology for Human Immunodeficiency Virus (HIV) in the COVID era. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2021; 9:38-44. [PMID: 33972891 PMCID: PMC8098635 DOI: 10.1007/s40138-021-00228-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 11/27/2022]
Abstract
Purpose of Review With the onset of the Coronavirus disease 2019 (COVID-19) pandemic, in-person human immunodeficiency virus (HIV) testing is no longer easily accessible. Therefore, alternative testing technologies must be considered and implemented on a large scale to continue prevention efforts. This review seeks to describe the benefits of utilizing at-home HIV testing technologies, traditionally deemed an alternative form of testing. Recent Findings Utilizing at-home testing technology during the COVID-19 pandemic overcomes novel and previously identified barriers to HIV testing. Summary Ensuring access to HIV testing is imperative to long-term prevention goals. With the Ending the HIV Epidemic (EHE) initiative in the USA targeting achievement by 2030, obstacles to HIV testing must be addressed to ensure its success. Implementing alternative testing technology more broadly allows for continued prevention efforts for HIV in light of COVID era restrictions.
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Affiliation(s)
- Isabella Warmbrunn
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI USA
| | - Monique Green-Jones
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI USA
| | - Angulique Y Outlaw
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI USA
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Abstract
The articles in this special issue of AIDS focus on the application of the so-called Big Data science (BDS) as applied to a variety of HIV-applied research questions in the sphere of health services and epidemiology. Recent advances in technology means that a critical mass of HIV-related health data with actionable intelligence is available for optimizing health outcomes, improving and informing surveillance. Data science will play a key but complementary role in supporting current efforts in prevention, diagnosis, treatment, and response needed to end the HIV epidemic. This collection provides a glimpse of the promise inherent in leveraging the digital age and improved methods in Big Data science to reimagine HIV treatment and prevention in a digital age.
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Affiliation(s)
- Bankole Olatosi
- Big Data Health Science Center, University of South Carolina, Columbia, SC 29208
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208
| | - Sten H. Vermund
- School of Public Health, Yale University, New Haven, CT 06510
| | - Xiaoming Li
- Big Data Health Science Center, University of South Carolina, Columbia, SC 29208
- Department of Health Promotion, Behavior and Education, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208
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45
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Khan MNM, Sarwar G, Irfan SD, Gourab G, Rana AKMM, Khan SI. Understanding the Barriers of HIV Testing Services for Men Who Have Sex With Men and Transgender Women in Bangladesh: A Qualitative Study. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2021; 42:272684X21995672. [PMID: 33657941 DOI: 10.1177/0272684x21995672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Coverage of HIV testing services (HTS) is generally low among men who have sex with men (MSM) and transgender women (hijra) in Bangladesh, thus impeding the national goal of attaining the 90-90-90 target. In this context, this article delineates HTS uptake barriers among these populations. This qualitative study entailed 30 in-depth interviews, six focus groups and seven key-informant interviews with purposively selected MSM and hijra, alongside service providers. Participants cited individual and interpersonal barriers such as low risk perception and misconceptions about HIV testing, programmatic barriers such as knowledge gaps among peer service providers, as well as community and structural barriers such as the criminalization and stigmatization of male-to-male sex. Considering these contexts, it is essential for stakeholders to improve the HTS modality using multipronged approaches to address the multifaceted barriers of HTS uptake.
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Affiliation(s)
| | - Golam Sarwar
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Samira Dishti Irfan
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Gorkey Gourab
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - A K M Masud Rana
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Sharful Islam Khan
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
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46
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Mugo PM, Agutu CA, Wahome E, Juma M, Nzioka J, Mohamed K, Mumba T, Shally M, Fauz I, Omar A, Rinke de Wit TF, van der Elst EM, Graham SM, Sanders EJ. Trends and predictors of HIV positivity and time since last test at voluntary counselling and testing encounters among adults in Kilifi, Kenya, 2006-2017. Wellcome Open Res 2021; 4:127. [PMID: 33884308 PMCID: PMC8042516 DOI: 10.12688/wellcomeopenres.15401.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 11/12/2023] Open
Abstract
Background: Little is known about HIV retesting uptake among key populations (KP) and general populations (GP) in Kenya. We assessed trends and predictors of first-time testing (FTT), late retesting (previous test more than one year ago for GP or three months for KP), and test positivity at three voluntary counselling and testing (VCT) centres in coastal Kenya. Methods: Routine VCT data covering 2006-2017 was collected from three VCT centres in Kilifi County. We analysed HIV testing history and test results from encounters among adults 18-39 years, categorized as GP men, GP women, men who have sex with men (MSM), and female sex workers (FSW). Results: Based on 24,728 test encounters (32% FTT), we observed declines in HIV positivity (proportion of encounters where the result was positive) among GP men, GP women, first-time testers and MSM but not among FSW. The proportion of encounters for FTT and late retesting decreased for both GP and KP but remained much higher in KP than GP. HIV positivity was higher at FTT and late retesting encounters; at FSW and MSM encounters; and at encounters with clients reporting lower educational attainment and sexually transmitted infection (STI) symptoms. HIV positivity was lower in GP men, never married clients and those less than 35 years of age. FTT was associated with town, risk group, age 18-24 years, never-married status, low educational attainment, and STI symptoms. Late retesting was less common among encounters with GP individuals who were never married, had Muslim or no religious affiliation, had lower educational attainment, or reported STI symptoms. Conclusions: HIV positive test results were most common at encounters with first-time testers and late re-testers. While the proportion of encounters at which late retesting was reported decreased steadily over the period reviewed, efforts are needed to increase retesting among the most at-risk populations.
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Affiliation(s)
- Peter M. Mugo
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Clara A. Agutu
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Elizabeth Wahome
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Margaret Juma
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Joseph Nzioka
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Khamisi Mohamed
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Teresia Mumba
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mahmoud Shally
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | - Tobias F. Rinke de Wit
- Amsterdam Institute for Global Health and Development (AIGHD), Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Elise M. van der Elst
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Susan M. Graham
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
| | - Eduard J. Sanders
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
- Amsterdam Institute for Global Health and Development (AIGHD), Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
- Nuffield Department of Medicine, University of Oxford, Headington, UK
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Zalazar V, Frola CE, Gun A, Radusky PD, Panis NK, Cardozo NF, Fabian S, Duarte MI, Aristegui I, Cahn P, Sued O. Acceptability of dual HIV/syphilis rapid test in community- and home-based testing strategy among transgender women in Buenos Aires, Argentina. Int J STD AIDS 2021; 32:501-509. [PMID: 33533303 DOI: 10.1177/0956462420979852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known of acceptability and feasibility of dual HIV and syphilis rapid tests in community- and home-based provider-initiated strategies among transgender women (TGW), in Latin America. Objectives were (1) to assess the acceptability of this strategy and, (2) to determine the percentage of positive results of HIV and syphilis, analyze the correlates of HIV or syphilis positive results, and measure the rates of effective referral and treatment completion among TGW. METHODS A multidisciplinary team tested 89 TGW in Buenos Aires. An acceptability survey was administered after the HIV/syphilis Duo test was used. All confirmed cases were referred for treatment initiation. RESULTS We found high levels of acceptability (98.8%) of this strategy among TGW. However, only 60.7% preferred simultaneous HIV and syphilis diagnosis test. Moreover, we found 9% of positive results of HIV, 51.7% of syphilis, and 3.4% of positive results for both infections. Only not being tested before was associated with an HIV positive result, and only low level of education was associated with a positive syphilis result. Among 8 TGW who tested positive for HIV, 37.5% (n = 3) started antiretroviral therapy. Of 46 who tested positive for syphilis, only 73.9% (n = 34) were effectively referred and from 23 who started treatment, only 39.1% completed it. CONCLUSIONS Community- and home-based dual HIV and syphilis rapid test is a feasible and highly acceptable approach for this hard-to-reach population. Implementing similar strategies could improve screening uptake and accessibility. However, these results highlight the need to improve strategies for treatment uptake, in order to reduce morbidity and risk of onward transmission.
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Affiliation(s)
- Virginia Zalazar
- Research Department, 541285Fundación Huésped, Buenos Aires, Argentina
| | - Claudia E Frola
- Research Department, 541285Fundación Huésped, Buenos Aires, Argentina.,Infectious Diseases Unit, 62916Hospital Juan A. Fernández, Buenos Aires, Argentina
| | - Ana Gun
- Research Department, 541285Fundación Huésped, Buenos Aires, Argentina
| | - Pablo D Radusky
- Research Department, 541285Fundación Huésped, Buenos Aires, Argentina.,Facultad de Psicologia, 28196Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Natalia K Panis
- Research Department, 541285Fundación Huésped, Buenos Aires, Argentina
| | - Nadir F Cardozo
- Research Department, 541285Fundación Huésped, Buenos Aires, Argentina.,Asociación de Travestis, Transexuales y Transgéneros de Argentina (A.T.T.T.A.), Buenos Aires, Argentina.,Red Latinoamericana y del Caribe de Personas Trans, RedLacTrans, Argentina.,Casa Trans, Buenos Aires, Argentina
| | - Solange Fabian
- Research Department, 541285Fundación Huésped, Buenos Aires, Argentina.,Asociación Civil Gondolin, Buenos Aires, Argentina
| | - Mariana I Duarte
- Research Department, 541285Fundación Huésped, Buenos Aires, Argentina.,Asociación de Travestis, Transexuales y Transgéneros de Argentina (A.T.T.T.A.), Buenos Aires, Argentina.,Red Latinoamericana y del Caribe de Personas Trans, RedLacTrans, Argentina.,Casa Trans, Buenos Aires, Argentina
| | - Inés Aristegui
- Research Department, 541285Fundación Huésped, Buenos Aires, Argentina.,Centro de Investigaciones en Psicología, 28206Universidad de Palermo, Buenos Aires, Argentina
| | - Pedro Cahn
- Research Department, 541285Fundación Huésped, Buenos Aires, Argentina
| | - Omar Sued
- Research Department, 541285Fundación Huésped, Buenos Aires, Argentina
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Palmer S, Dijkstra M, Ket JCF, Wahome EW, Walimbwa J, Gichuru E, van der Elst EM, Schim van der Loeff MF, de Bree GJ, Sanders EJ. Acute and early HIV infection screening among men who have sex with men, a systematic review and meta-analysis. J Int AIDS Soc 2020; 23 Suppl 6:e25590. [PMID: 33000916 PMCID: PMC7527764 DOI: 10.1002/jia2.25590] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/03/2020] [Accepted: 07/14/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Screening for acute and early HIV infections (AEHI) among men who have sex with men (MSM) remains uncommon in sub-Saharan Africa (SSA). Yet, undiagnosed AEHI among MSM and subsequent failure to link to care are important drivers of the HIV epidemic. We conducted a systematic review and meta-analysis of AEHI yield among MSM mobilized for AEHI testing; and assessed which risk factors and/or symptoms could increase AEHI yield in MSM. METHODS We systematically searched four databases from their inception through May 2020 for studies reporting strategies of mobilizing MSM for testing and their AEHI yield, or risk and/or symptom scores targeting AEHI screening. AEHI yield was defined as the proportion of AEHI cases among the total number of visits. Study estimates for AEHI yield were pooled using random effects models. Predictive ability of risk and/or symptom scores was expressed as the area under the receiver operator curve (AUC). RESULTS Twenty-two studies were identified and included a variety of mobilization strategies (eight studies) and risk and/or symptom scores (fourteen studies). The overall pooled AEHI yield was 6.3% (95% CI, 2.1 to 12.4; I2 = 94.9%; five studies); yield varied between studies using targeted strategies (11.1%; 95% CI, 5.9 to 17.6; I2 = 83.8%; three studies) versus universal testing (1.6%; 95% CI, 0.8 to 2.4; two studies). The AUC of risk and/or symptom scores ranged from 0.69 to 0.89 in development study samples, and from 0.51 to 0.88 in validation study samples. AUC was the highest for scores including symptoms, such as diarrhoea, fever and fatigue. Key risk score variables were age, number of sexual partners, condomless receptive anal intercourse, sexual intercourse with a person living with HIV, a sexually transmitted infection, and illicit drug use. No studies were identified that assessed AEHI yield among MSM in SSA and risk and/or symptom scores developed among MSM in SSA lacked validation. CONCLUSIONS Strategies mobilizing MSM for targeted AEHI testing resulted in substantially higher AEHI yields than universal AEHI testing. Targeted AEHI testing may be optimized using risk and/or symptom scores, especially if scores include symptoms. Studies assessing AEHI yield and validation of risk and/or symptom scores among MSM in SSA are urgently needed.
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Affiliation(s)
- Shaun Palmer
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
- International AIDS Vaccine InitiativeAmsterdamthe Netherlands
| | - Maartje Dijkstra
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamthe Netherlands
- Department of Internal MedicineDivision of Infectious Diseases, and Amsterdam Institute for Infection and Immunity (AI&II)Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Johannes CF Ket
- Medical LibraryVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Elizabeth W Wahome
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
| | | | - Evanson Gichuru
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
| | - Elise M van der Elst
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
| | - Maarten F Schim van der Loeff
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamthe Netherlands
- Department of Internal MedicineDivision of Infectious Diseases, and Amsterdam Institute for Infection and Immunity (AI&II)Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Godelieve J de Bree
- Department of Internal MedicineDivision of Infectious Diseases, and Amsterdam Institute for Infection and Immunity (AI&II)Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Eduard J Sanders
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
- Department of Global Health, and Amsterdam Institute for Global Health and DevelopmentAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
- Nuffield Department of MedicineUniversity of OxfordHeadingtonUnited Kingdom
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49
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Uptake and Impact of Short Message Service Reminders via Sexually Transmitted Infection Partner Services on Human Immunodeficiency Virus/Sexually Transmitted Infection Testing Frequency Among Men Who Have Sex With Men. Sex Transm Dis 2020; 46:641-647. [PMID: 31517803 DOI: 10.1097/olq.0000000000001043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexually transmitted infection (STI) partner services (PS) allow provision of human immunodeficiency virus (HIV)/STI prevention interventions to high-risk individuals, including testing reminders via short message service (SMS). METHODS In King County, Washington, PS attempt to reach all men who have sex with men (MSM) with early syphilis and those with gonorrhea or chlamydia as resources allow. Since 2013, PS offered quarterly SMS testing reminders. We evaluated correlates of reminder uptake and the association between reminder uptake and postinterview asymptomatic STI diagnosis using Poisson regression, and the association between preinterview SMS reminder use and intertest interval among HIV-negative MSM using median regression. RESULTS During July 1, 2013 to January 17, 2018, 8236 MSM were reported with 1 or more STI diagnoses and 5237 received PS interviews. Of these, 4087 (78%) were offered SMS reminders; 545 (13%) accepted, 265 (7%) were already receiving SMS, 3277 (80%) refused. Of 2602 patients who refused and were asked about other reminders, 37% used none, 16% received reminders from medical providers, 20% tested at routine physicals, and 26% used other reminders. SMS reminder use before and after PS interview was associated with negative HIV status, younger age, and diagnosis with gonorrhea or chlamydia (vs. syphilis) (P < 0.05 for all). Preinterview intertest interval was longer among MSM testing at physicals (9.6 months) than those using no reminder (5.6), SMS reminders (4.7, P < 0.05 vs. physicals), and non-SMS reminders (3.6, P < 0.001 vs. SMS). Reminder uptake was not associated with postinterview STI diagnosis. CONCLUSIONS Offering SMS reminders through STI PS is feasible. Uptake was low, but higher among young MSM not on preexposure prophylaxis. The SMS reminders may increase testing frequency.
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50
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Abstract
PURPOSE OF REVIEW There is renewed focus at global and national level to adopt commitments to ensure universal access to health services. The present study highlights key considerations to ensure that the commitment to 'leave no one behind' includes key populations, recognizing the specific impact of marginalization, stigma, discrimination, and criminalization on their access to health. RECENT FINDINGS Universal health coverage (UHC) means that all people can use the promotive, preventive, curative, rehabilitative, and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship. Countries commit to UHC through Sustainable Development Goals (SDG Target 3.8 Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to well tolerated, effective, quality, and affordable essential medicines). SUMMARY UHC cannot be achieved without addressing the needs of key populations. At the same time, the goal of UHC provides new opportunities to improve health equity and the health of key populations. Political commitment, defining and including essential high-impact, evidence-based interventions for key populations, and their full integration into national health benefit packages; integrated, decentralized, and differentiated health services with involvement, ownership, and acceptance of communities to ensure equity and quality; ensuring financing for UHC provides coverage for key populations, including those who may be undocumented, are needed. Developing more effective interventions and service delivery approaches, providing a supportive policy and legal environment; and measuring progress against clear targets for accountability and programme adjustment will also be required for key populations to benefit fully from UHC.
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