1
|
Tatham C. Life and love under criminalization: The experiences of people living with HIV in Canada. PLoS One 2024; 19:e0306894. [PMID: 39052618 PMCID: PMC11271884 DOI: 10.1371/journal.pone.0306894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 06/23/2024] [Indexed: 07/27/2024] Open
Abstract
Based upon qualitative interviews with 54 women and men living with HIV across Ontario, Canada, this paper examines the impact of HIV criminalization on the sexual and romantic relationships of people living with HIV. This research highlights the navigation strategies people living with HIV create and employ to both navigate and protect themselves from the law. Through a thematic and intersectional analysis, this study shows how adoption of these strategies is unequal, with access to navigation strategies varying along lines of gender, race, and sexual orientation. As a result, women and racialized people living with HIV face more difficulties navigating the impact of the law. HIV criminalization in Canada fuels and validates HIV stigma and produces vulnerability both within and outside of the relationships of people living with HIV. This paper seeks to understand HIV criminalization from the perspective of those governed by the law, in hopes of producing knowledge which will contribute to legal reform, inform policy, and support the development of efficacious secondary prevention initiatives.
Collapse
Affiliation(s)
- Christopher Tatham
- Department of Sociology and Anthropology, University of Guelph, Guelph, Ontario, Canada
| |
Collapse
|
2
|
Agarwal H, Yeatts K, Chung SR, Harrison-Quintana J, Torres TS. Perceived Accuracy Around Undetectable = Untransmitable Among Sexual and Gender Minorities Using Smartphones in India. AIDS Behav 2024; 28:1039-1046. [PMID: 37861923 DOI: 10.1007/s10461-023-04212-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 10/21/2023]
Abstract
Sexual and gender minorities (SGM) using online venues in India are usually not reached by government HIV interventions, remaining an understudied yet important population. We investigated sociodemographic characteristics, sexual behaviours along with familiarity, knowledge, and correlated factors around perceived accuracy of the Undetectable = Untransmittable (U = U) slogan. Grindr users in India completed an online, cross-sectional survey in May-June 2022. We included individuals ≥ 18 years old who reported sex with men (excluding those who were born female and or identified as cis-gender female). Associations with perceived U = U accuracy were estimated using adjusted prevalence odds ratios (aPOR) with 95% confidence intervals (95% CI). The survey was completed by 3,126 eligible participants. The median age was 28 years and most participants lived in urban areas and had graduate or postgraduate education. HIV prevalence was 3.1%. Only 14% reported familiarity with the U = U slogan and after an explanation was provided, 25% perceived it as completely accurate. This was associated with knowing their HIV status (HIV Negative aPOR 1.37 [95%CI 1.1, 1.71], HIV Positive aPOR 3.39 [95%CI 2.11, 5.46]), having heard of PrEP (aPOR1.58 [95%CI 1.29,1.92]) or have used PrEP (aPOR1.56 [95%CI 1.15, 2.12]) along with use of party drugs (aPOR1.51 [95%CI 1.0 2.10]), being in touch with NGOs (aPOR 1.61 [95%CI 1.27, 2.02], p < .001) and having attended LGBTQIA + events (aPOR1.38 [95%CI 1.1, 1.73]). SGMs in India had low familiarity and low perceived accuracy around U = U. Education about U = U and innovating new strategies to reach this hidden population could reduce stigma around HIV in India.
Collapse
Affiliation(s)
- Harsh Agarwal
- UNC Gillings School of Global Public Health, Chapel Hill, NC, 27599, USA.
| | - Karin Yeatts
- UNC Gillings School of Global Public Health, Chapel Hill, NC, 27599, USA
| | - Stephanie R Chung
- UNC Gillings School of Global Public Health, Chapel Hill, NC, 27599, USA
| | | | - Thiago S Torres
- Instituto Nacional de Infectología Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| |
Collapse
|
3
|
Broady TR, Chan C, MacGibbon J, Mao L, Prestage G, Clifton B, Paynter H, Bavinton BR, Holt M. Changing Characteristics of HIV-Positive Gay and Bisexual Men's Relationships in the Era of Biomedical Prevention. J Acquir Immune Defic Syndr 2023; 94:10-17. [PMID: 37195893 DOI: 10.1097/qai.0000000000003224] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 03/06/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To assess changes in personal and relationship characteristics among HIV-positive Australian gay and bisexual men (GBM) as rates of antiretroviral therapy and knowledge and confidence regarding the effectiveness of viral suppression in preventing HIV transmission have increased. DESIGN Repeated behavioral surveillance of GBM recruited from venues, events, and online in 7 Australian states and territories. METHODS HIV-positive participants were included. Trends in demographics, HIV treatment, and relationship characteristics were assessed with binary and multivariable logistic regression. RESULTS A total of 3643 survey responses (2016-2020) were included. Over time, HIV-positive GBM became less likely to identify as gay or report an Anglo-Australian ethnicity. The average length of time since HIV diagnosis increased and the frequency of attending HIV-related clinical appointments decreased. There were no changes in the reported number of recent sex partners or proportion reporting regular male partners over time. Among HIV-positive GBM in relationships, the proportion reporting HIV-positive partners decreased and the proportion reporting HIV-negative partners increased. Levels of condomless sex with regular partners increased over time; however, this was concentrated among HIV-positive GBM in serodiscordant relationships. CONCLUSION Findings suggest that increased accessibility and trust in biomedical prevention strategies have contributed to broader relationship and sexual opportunities for HIV-positive GBM in Australia. Our findings suggest that future health promotion activities could highlight the social and relationship benefits of treatment as prevention to further increase trust in it as an HIV prevention strategy among GBM.
Collapse
Affiliation(s)
- Timothy R Broady
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | - Curtis Chan
- Kirby Institute, UNSW, Sydney, NSW, Australia
| | - James MacGibbon
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | | | - Brent Clifton
- National Association of People With HIV Australia, Sydney, NSW, Australia; and
| | | | | | - Martin Holt
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| |
Collapse
|
4
|
Rennie S, Henderson G, Phanuphak N, Kuczynski K, Colby D, Ormsby N, Kroon E, Hsu D, Likhitwonnawut U, Vasan S, Sacdalan C, Jupimai T, Butterworth O, Peay H. The Essential Need for Trust When Transmission Risk Cannot Be Eliminated in HIV-Remission Trials. Ethics Hum Res 2023; 45:2-15. [PMID: 37368521 PMCID: PMC11401446 DOI: 10.1002/eahr.500172] [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] [Indexed: 06/29/2023]
Abstract
Analytic treatment interruption (ATI) is scientifically necessary in HIV-remission ("cure") studies to test the effects of new interventions. However, stopping antiretroviral treatment poses risks to research participants and their sexual partners. Ethical debate about whether and how to conduct such studies has largely centered on designing risk-mitigation strategies and identifying the responsibilities of research stakeholders. In this paper, we argue that because the possibility of HIV transmission from research participants to partners during ATI cannot practicably be eliminated-that is, it is ineliminable-the successful conduct of such trials ultimately depends on relationships of trust and trustworthiness. We describe our experiences with conducting and studying HIV-remission trials with ATI in Thailand to examine the strengths, complexities, and limitations of the risk-mitigation and responsibility approaches and to explore ways in which the building of trust-and trustworthiness-may help enhance the scientific, practical, and ethical dimensions of these trials.
Collapse
Affiliation(s)
- Stuart Rennie
- Professor at the Center for Bioethics in the Department of Social Medicine at the University of North Carolina at Chapel Hill
| | - Gail Henderson
- Professor in the Department of Social Medicine and the director of the Center for Genomics and Society at the University of North Carolina at Chapel Hill
| | - Nittaya Phanuphak
- Executive director of the Institute of HIV Research and Innovation in Bangkok
| | - Kristine Kuczynski
- Program manager at the Center for Genomics and Society and PPMH Precision Genomic Screening Program in the School of Medicine at the University of North Carolina at Chapel Hill
| | - Donn Colby
- Senior research physician at the Henry M. Jackson Foundation for the Advancement of Military Medicine at the U.S. Military HIV Research Program at the Walter Reed Army Institute of Research
| | - Nuchanart Ormsby
- Research assistant and an administrative support associate in the Computational Medicine Program in the School of Medicine at the University of North Carolina at Chapel Hill
| | - Eugene Kroon
- Senior research physician at the Institute of HIV Research and Innovation in Bangkok
| | - Denise Hsu
- Associate director of therapeutics at the Henry M. Jackson Foundation for the Advancement of Military Medicine at the U.S. Military HIV Research Program at the Walter Reed Army Institute of Research
| | | | - Sandhya Vasan
- Vice president of Global Infectious Diseases Research and the director of the Henry M. Jackson Foundation for the Advancement of Military Medicine at the U.S. Military HIV Research Program at the Walter Reed Army Institute of Research
| | - Carlo Sacdalan
- Research physician at the SEARCH Research Foundation in Bangkok
| | - Thidarat Jupimai
- Clinical research assistant at the Center of Excellence in Pediatric Infectious Diseases and Vaccines Faculty of Medicine at the Chulalongkorn University in Bangkok
| | - Oratai Butterworth
- Clinical project manager at the Henry M. Jackson Foundation for the Advancement of Military Medicine at the U.S. Military HIV Research Program at the Walter Reed Army Institute of Research
| | - Holly Peay
- Senior research public health analyst at RTI International
| |
Collapse
|
5
|
Borsa A, Siegel K. Barriers to Treatment as Prevention Adoption Among Sexual and Gender Minority Individuals Who Have Sex with Men in the United States. AIDS Patient Care STDS 2023; 37:268-277. [PMID: 37155966 PMCID: PMC10171941 DOI: 10.1089/apc.2023.0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
The discovery that people with an undetectable HIV viral load are unable to transmit the virus to sex partners (U = U) has ushered in a new era in HIV care. As a result of this discovery, treatment as prevention (TasP) has become a powerful tool toward ending the epidemic. However, despite its sound scientific basis, many communities affected by HIV face barriers toward adopting TasP as a complete HIV prevention strategy. In addition, most research to date has only focused on TasP in the context of committed monogamous partnerships. To identify barriers to TasP adoption among some of those most affected by HIV, we conducted in-depth qualitative interviews with 62 sexual and gender minority individuals of varying serostatuses. Participants were identified from the results of an online survey, where those who indicated at least some awareness of TasP were invited to partake in a follow-up interview. Interviews were thematically coded to identify emergent themes relating to TasP adoption. Seven primary barriers emerged from data analysis pertaining to TasP science, internalized beliefs about HIV safety, and interactional dynamics between partners: (1) unfamiliarity with TasP science, (2) perceived limitations of TasP science, (3) difficulty changing understanding of "safe sex," (4) unwillingness to rely on partners' reports of being undetectable, (5) persistent HIV stigma, (6) less difficulty finding serosimilar partners, and (7) difficulty incorporating TasP into casual encounters. Together, these barriers confirm the existing findings about TasP adoption, and extend the literature by identifying barriers beyond a lack of education and outside of monogamous contexts.
Collapse
Affiliation(s)
- Alexander Borsa
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Karolynn Siegel
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| |
Collapse
|
6
|
Roth GH, Walker ER, Talley CL, Hussen SA. 'It's a very grey, very messy area': a qualitative examination of factors influencing undetectable gay men's HIV status disclosure to sexual partners. CULTURE, HEALTH & SEXUALITY 2023; 25:664-679. [PMID: 35697340 DOI: 10.1080/13691058.2022.2086708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
HIV disclosure to sexual partners remains a multifaceted yet stigmatised process. The 'undetectable equals untransmittable' (U = U) concept has raised ethical and moral concerns about the obligation and need to disclose, and using Internet applications to seek sex partners has modified disclosure practices. While previous qualitative literature has examined the HIV disclosure process, there is a dearth of information on this topic among gay men in the USA who have an undetectable viral load. Using thematic analysis of data collected during a period of expanded U = U knowledge, this study explores the cognitive, contextual, interpersonal and structural factors impacting undetectable gay men's HIV status disclosure decisions to sexual partners. In-depth interviews were conducted in August 2020 over Zoom with 20 gay men with undetectable viral loads. The main themes included 'sense of obligation,' 'situational disclosure' and 'partners' responsibility in the disclosure process.' Participants balanced the aforementioned factors to inform their disclosure decisions, and disclosure patterns varied across participants dependent upon thoughts regarding ethics and morality of (non-)disclosure. The findings provide new insights to how participants navigate disclosure while considering U = U, HIV criminalisation laws, and finding partners through Internet applications while providing direction for future studies and support for decriminalising HIV and expanding HIV education.
Collapse
Affiliation(s)
- Grant H Roth
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Elizabeth Reisinger Walker
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Colin L Talley
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sophia A Hussen
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| |
Collapse
|
7
|
Gray J, Prestage G, Jin F, Phanuphak N, Friedman RK, Fairley CK, Kelleher A, Templeton DJ, Zablotska-Manos I, Hoy J, McNulty A, Baker D, Brown G, Grulich A, Bavinton B. Agreements, Behaviour, and Change: Sex Outside the Relationship in Male HIV-negative Partners in HIV Serodiscordant Relationships in Australia, Brazil, and Thailand. AIDS Behav 2023:10.1007/s10461-023-04030-2. [PMID: 36917425 PMCID: PMC10386966 DOI: 10.1007/s10461-023-04030-2] [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: 02/20/2023] [Indexed: 03/15/2023]
Abstract
Male HIV serodiscordant couples have diverse relationship agreements regarding sex outside the relationship. We examined the relationship agreements as described by 343 male HIV-negative partners in HIV serodiscordant relationships in Australia, Brazil and Thailand participating in a multi-year cohort study. At baseline, 125 (34.1%) HIV-negative partners reported no agreement, 115 (33.5%) had a monogamous agreement, and 103 (37.9%) had an open agreement allowing sex outside the relationship. Relationship agreements were largely stable over time, with 76% of HIV-negative men reporting the same agreement across follow up, while changes were predominantly towards having an open agreement. Behaviour largely matched relationship agreements, and the predictors of breaking an agreement by having condomless anal intercourse (CLAI) with an outside partner were CLAI within the relationship (OR = 3.17, 95%CI: 1.64-6.14, p < 0.001) and PrEP use in the last three months (OR = 3.42, 95%CI: 1.48-7.92, p = 0.004). When considering HIV transmission risk for HIV-negative men in serodiscordant relationships, greater focus needs to be placed on sex that is occurring outside the relationship and the agreements that facilitate this.
Collapse
Affiliation(s)
- James Gray
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | | | - Fengyi Jin
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | | | - Ruth K Friedman
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | | | - David J Templeton
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
- Department of Sexual Health Medicine and Sexual Assault Medical Service, Sydney Local Health District, Camperdown, Australia
- Discipline of Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Iryna Zablotska-Manos
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Western Sydney Sexual Health, Western Sydney Local Health District, Sydney, Australia
| | - Jennifer Hoy
- Department of Infectious Diseases, Alfred Hospital, Monash University, Melbourne, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney and Sydney Eye Hospital, Sydney, Australia
- School of Population Health, UNSW Sydney, Sydney, Australia
| | | | - Graham Brown
- Centre for Social Impact, UNSW Sydney, Sydney, Australia
| | - Andrew Grulich
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | | |
Collapse
|
8
|
Dowell-Day A, Dobbins T, Chan C, Fraser D, Holt M, Vaccher SJ, Clifton B, Zablotska I, Grulich A, Bavinton BR. Attitudes Towards Treatment as Prevention Among PrEP-Experienced Gay and Bisexual Men in Australia. AIDS Behav 2023:10.1007/s10461-023-04019-x. [PMID: 36877254 PMCID: PMC10386911 DOI: 10.1007/s10461-023-04019-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 03/07/2023]
Abstract
The introduction of HIV pre-exposure prophylaxis (PrEP) has the potential to impact the attitudes gay and bisexual men (GBM) who consequently choose to take PrEP have towards treatment as prevention (TasP), and the extent to which they are willing to have condomless anal intercourse (CLAI) with an HIV-positive sexual partner who has an undetectable viral load (UVL). Using a cross-sectional sample from an observational cohort study conducted from August 2018 to March 2020, we examined the extent to which PrEP-experienced GBM are willing to have CLAI with a partner who has a UVL. Simple and multiple logistic regression models were used to identify associated variables. Of the 1386 participants included in the analyses, 79.0% believed in the effectiveness of TasP, and 55.3% were willing to have CLAI with a partner who has a UVL. Wiling participants were less worried about getting HIV when taking PrEP and more likely to believe in TasP. Further research is needed to better understand the gap between belief in TasP and willingness to have CLAI with a partner who has a UVL among PrEP-experienced GBM.
Collapse
Affiliation(s)
- Alexander Dowell-Day
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Timothy Dobbins
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Curtis Chan
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Doug Fraser
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | - Brent Clifton
- National Association of People with HIV Australia, Newtown, NSW, Australia
| | - Iryna Zablotska
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, Australia.,Sydney Infectious Diseases Institute, University of Sydney, Westmead, Australia.,Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, Australia
| | - Andrew Grulich
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | |
Collapse
|
9
|
Kolstee J, Prestage G, Philpot S, Bavinton B, Hammoud M, Keen P, Holt M. The effect of pre-exposure prophylaxis (PrEP) on negotiating casual sex between gay men: disclosure, assumptions, and communication. Sex Health 2023; 20:64-70. [PMID: 36508715 DOI: 10.1071/sh22095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The disclosure of HIV status and pre-exposure prophylaxis (PrEP) use can be important in the negotiation of safe sex. With the rapid uptake of PrEP in Australia, norms and expectations about discussion and disclosure may have changed. METHODS We explored the disclosure of PrEP use, HIV status and communication with sex partners by HIV-negative gay men in Sydney, Australia. We conducted semi-structured interviews from October 2017 to May 2018 and analysed data using a codebook thematic analysis approach. RESULTS Participants had a variety of expectations of what they should tell their partners and what they expected in return. For some participants, PrEP had negated the need for any discussion about HIV. Many participants assumed their partners would find information about their HIV status or PrEP use on their online profiles or that partners would ask, if necessary. CONCLUSIONS Building a stronger, shared understanding among gay men that disclosure and discussion no longer automatically occur before sexual encounters may be useful.
Collapse
Affiliation(s)
- Johann Kolstee
- Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Garrett Prestage
- Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Steven Philpot
- Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Benjamin Bavinton
- Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Mohamed Hammoud
- Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Phillip Keen
- Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Kensington, NSW, Australia
| |
Collapse
|
10
|
Fu R, Hou J, Gu Y, Yu NX. Do Couple-Based Interventions Show Larger Effects in Promoting HIV Preventive Behaviors than Individualized Interventions in Couples? A Systematic Review and Meta-analysis of 11 Randomized Controlled Trials. AIDS Behav 2023; 27:314-334. [PMID: 35838860 DOI: 10.1007/s10461-022-03768-5] [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: 06/25/2022] [Indexed: 01/24/2023]
Abstract
This systematic review and meta-analysis aims to compare the effects of couple-based prevention interventions against individual-level interventions on HIV prevention in randomized controlled trials (RCTs), identify potential moderators, and assess study quality. Eleven RCTs were included, comprising 3933 couples in the intervention group and 7125 individuals in the individual control group, predominantly in heterosexual couples from the USA and Africa. Couple-based interventions had a more significant effect in promoting condom use and HIV testing. Education levels of high school or above, residence in low- and middle-income countries, and intervention design incorporating HIV counseling and testing were associated with higher odds of condom use. The quality assessment analysis identified methodological and theoretical heterogeneity factors. Evidence of couple-based HIV prevention RCTs among men who have sex with men, injecting drug users, sex workers, and transgender women warrant further investigation. Recommendations are made to improve the quality and replicability of future intervention studies.
Collapse
Affiliation(s)
- Rong Fu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, People's Republic of China
| | - Jianhua Hou
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, People's Republic of China
| | - Yuzhou Gu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, People's Republic of China
| | - Nancy Xiaonan Yu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, People's Republic of China.
| |
Collapse
|
11
|
Sauermilch D, Siegel K, Hoppe T, Roth G, Meunier É. Attitudes Toward HIV-Positive Status Disclosure Among U=U-Aware Sexual and Gender Minority Individuals in the USA: a Consensual Qualitative Research Approach. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 20:692-704. [PMID: 35369684 PMCID: PMC8962277 DOI: 10.1007/s13178-022-00710-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 05/28/2023]
Abstract
Introduction The U=U (i.e., undetectable equals untransmittable) campaign is founded upon biomedical advancements that have positioned HIV as a manageable condition with effectively zero risk of transmission. In spite of these developments, attitudes of sexual and gender minority populations regarding the necessity of seropositive status disclosure remain unexamined. Methods The current study analyzed qualitative data regarding the necessity of seropositive status disclosure from 62 sexual minority men as well as transgender and gender non-conforming individuals who have sex with men from 2020 to 2021. Results The majority of participants believed disclosure to be necessary and invoked several social and structural factors that informed their attitudes. Participants cited HIV criminalization laws, the ethics of non-disclosure, and disclosure as a means of educating sex partners when appraising the necessity of disclosure. Participants also presented concerns regarding U=U efficacy and HIV stigma. Conclusions Findings indicate that the disclosure of seropositive status to sex partners is still important to U=U-aware sexual and gender minority individuals. The majority of the study sample, irrespective of HIV status, believed seropositive status disclosure was necessary in advance of sex. Policy Implications Findings suggest opportunities for public health messaging to remediate concerns about U=U efficacy, combat misinformation, and clarify out-of-date information on HIV criminalization.
Collapse
Affiliation(s)
- Daniel Sauermilch
- Department of Psychology, Long Island University, 1 University Plaza, Brooklyn, NY 11201 USA
| | - Karolynn Siegel
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, 722 West 168th Street, New York, 10032 USA
| | - Trevor Hoppe
- Department of Sociology, University of North Carolina at Greensboro, 337 Frank Porter Graham Building, PO Box 26170, Greensboro, NC 27402-6170 USA
| | - Grant Roth
- Whitman-Walker Institute, Washington, DC USA
| | - Étienne Meunier
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, 722 West 168th Street, New York, 10032 USA
| |
Collapse
|
12
|
Gray J, Prestage G, Jin F, Phanuphak N, Friedman RK, Fairley CK, Kelleher A, Templeton D, Zablotska-Manos I, Hoy J, McNulty A, Pell C, Grulich A, Bavinton B. Characteristics of Agreements to have Condomless Anal Intercourse in the Presence of an Undetectable Viral Load Among HIV Serodiscordant Male Couples in Australia, Brazil and Thailand. AIDS Behav 2021; 25:3944-3954. [PMID: 34109529 DOI: 10.1007/s10461-021-03324-7] [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: 05/27/2021] [Indexed: 10/21/2022]
Abstract
The use of undetectable viral load (VL) to negotiate condomless anal intercourse (CLAI) in HIV serodiscordant male relationships has become more common as more data regarding the effectiveness of antiretroviral treatments for the prevention of HIV transmission has been described. We examined viral load agreements (VLAs) for condomless sex in the presence of an undetectable VL in 343 HIV serodiscordant male couples in Australia, Brazil and Thailand. Factors associated with having a VLA included having agreements for the HIV-positive partner to report his VL result (p < 0.001), agreeing that VL affects agreements about sexual practice (p < 0.001), the HIV-negative partner's perception of his partner's undetectable VL (p < 0.001), the couple's belief in the efficacy of undetectable VL in preventing HIV transmission (p < 0.001), and the couple engaging in CLAI with each other (p < 0.001). Over time, these agreements became more common although 49.3% of couples in the sample never had a viral load agreement. As these agreements become more common, further education is required to support male couples in using them safely.
Collapse
|
13
|
Bor J, Fischer C, Modi M, Richman B, Kinker C, King R, Calabrese SK, Mokhele I, Sineke T, Zuma T, Rosen S, Bärnighausen T, Mayer KH, Onoya D. Changing Knowledge and Attitudes Towards HIV Treatment-as-Prevention and "Undetectable = Untransmittable": A Systematic Review. AIDS Behav 2021; 25:4209-4224. [PMID: 34036459 PMCID: PMC8147591 DOI: 10.1007/s10461-021-03296-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 12/12/2022]
Abstract
People on HIV treatment with undetectable virus cannot transmit HIV sexually (Undetectable = Untransmittable, U = U). However, the science of treatment-as-prevention (TasP) may not be widely understood by people with and without HIV who could benefit from this information. We systematically reviewed the global literature on knowledge and attitudes related to TasP and interventions providing TasP or U = U information. We included studies of providers, patients, and communities from all regions of the world, published 2008–2020. We screened 885 papers and abstracts and identified 72 for inclusion. Studies in high-income settings reported high awareness of TasP but gaps in knowledge about the likelihood of transmission with undetectable HIV. Greater knowledge was associated with more positive attitudes towards TasP. Extant literature shows low awareness of TasP in Africa where 2 in 3 people with HIV live. The emerging evidence on interventions delivering information on TasP suggests beneficial impacts on knowledge, stigma, HIV testing, and viral suppression. Review was pre-registered at PROSPERO: CRD42020153725
Collapse
Affiliation(s)
- Jacob Bor
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02119, USA.
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, GP, South Africa.
| | - Charlie Fischer
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02119, USA
| | - Mirva Modi
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02119, USA
| | | | | | - Rachel King
- UCSF Institute for Global Health Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | | | - Idah Mokhele
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, GP, South Africa
| | - Tembeka Sineke
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, GP, South Africa
| | - Thembelihle Zuma
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University of KwaZulu-Natal, Durban, South Africa
- Division of Infection and Immunity, University College London, London, UK
| | - Sydney Rosen
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02119, USA
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, GP, South Africa
| | - Till Bärnighausen
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Kenneth H Mayer
- Fenway Health Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Dorina Onoya
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, GP, South Africa
| |
Collapse
|
14
|
Philpot SP, Holt M, Murphy D, Haire B, Prestage G, Maher L, Bavinton BR, Hammoud MA, Jin F, Bourne A. Qualitative Findings on the Impact of COVID-19 Restrictions on Australian Gay and Bisexual Men: Community Belonging and Mental Well-being. QUALITATIVE HEALTH RESEARCH 2021; 31:2414-2425. [PMID: 34433350 DOI: 10.1177/10497323211039204] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
COVID-19 may threaten the already poor mental health outcomes of Australian gay and bisexual men and cut ties to important social/sexual networks and community. Qualitative research into the experiences of gay and bisexual men during COVID-19 regulations is currently sparse. We report on 489 responses to a qualitative free-text question asking Australian gay and bisexual men about the impacts of COVID-19 during April 2020. Issues pertinent to gay and bisexual men include lost ties to gay and bisexual social/sexual communities, spaces, and activities, which can reduce a sense of belonging to important sexual identity spaces, as well as significant mental well-being vulnerabilities. Reminiscing the collective response to HIV/AIDS, findings reinforce the value of gay and bisexual community organizations, spaces, and networks as supports for gay and bisexual men and emphasize the need for delivering mental health services.
Collapse
Affiliation(s)
| | - Martin Holt
- UNSW Sydney, Kensington, New South Wales, Australia
| | - Dean Murphy
- UNSW Sydney, Kensington, New South Wales, Australia
| | | | | | - Lisa Maher
- UNSW Sydney, Kensington, New South Wales, Australia
| | | | | | - Fengyi Jin
- UNSW Sydney, Kensington, New South Wales, Australia
| | - Adam Bourne
- La Trobe University, Bundoora, Victoria, Australia
| |
Collapse
|
15
|
Haire B, Murphy D, Maher L, Zablotska-Manos I, Vaccher S, Kaldor J. What does PrEP mean for 'safe sex' norms? A qualitative study. PLoS One 2021; 16:e0255731. [PMID: 34352034 PMCID: PMC8341650 DOI: 10.1371/journal.pone.0255731] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/22/2021] [Indexed: 12/04/2022] Open
Abstract
While HIV pre-exposure prophylaxis (PrEP) is highly effective, it has arguably disrupted norms of ‘safe sex’ that for many years were synonymous with condom use. This qualitative study explored the culture of PrEP adoption and evolving concepts of ‘safe sex’ in Sydney, Australia, during a period of rapidly escalating access from 2015–2018, drawing on interviews with sexually active gay men (n = 31) and interviews and focus groups with key stakeholders (n = 10). Data were analysed thematically. Our results explored the decreasing centrality of condoms in risk reduction and new patterns of sexual negotiation. With regards to stigma, we found that there was arguably more stigma related to not taking PrEP than to taking PrEP in this sample. We also found that participants remained highly engaged with promoting the wellbeing of their communities through activities as seemingly disparate as regular STI testing, promotion of PrEP in their social circles, and contribution to research. This study has important implications for health promotion. It demonstrates how constructing PrEP as a rigid new standard to which gay men ‘should’ adhere can alienate some men and potentially create community divisions. Instead, we recommend promoting choice from a range of HIV prevention options that have both high efficacy and high acceptability.
Collapse
Affiliation(s)
- Bridget Haire
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
- * E-mail:
| | - Dean Murphy
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
| | - Lisa Maher
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
| | - Iryna Zablotska-Manos
- Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
| | - Stephanie Vaccher
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
| | - John Kaldor
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
| |
Collapse
|
16
|
Gunn JKL, Patterson W, Anderson BJ, Swain CA. Understanding the Risk of Human Immunodeficiency Virus (HIV) Virologic Failure in the Era of Undetectable Equals Untransmittable. AIDS Behav 2021; 25:2259-2265. [PMID: 33439374 PMCID: PMC8165059 DOI: 10.1007/s10461-020-03154-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2020] [Indexed: 01/05/2023]
Abstract
The “Undetectable = Untransmittable” campaign indicates that persons living with Human Immunodeficiency Virus (HIV) who maintain a suppressed viral load cannot sexually transmit the virus. However, there is little knowledge of the percent of individuals at a population level who sustain viral suppression long term. The aims of this study were to: (1) establish a baseline of persons living with diagnosed HIV who resided in New York and had consecutive suppressed viral load tests; (2) describe the risk of virologic failure among those who were consecutively suppressed; and (3) gain an understanding of the length of time between consecutive viral suppression to virologic failure. A total of 102,339 New Yorkers aged 13–90 years were living with diagnosed HIV at the beginning of 2012; 47.9% were consecutively suppressed (last two HIV viral load test results from 2010–2011 that were < 420 days apart and < 200 copies/mL). Of consecutively suppressed individuals, 54.3% maintained viral suppression for the entire study period and 33.6% experienced virologic failure during the study period. Among persons who experienced virologic failure, 82.6% did so six or more months after being consecutively suppressed. Our findings support the need for ongoing viral load monitoring, adherence support, and ongoing risk reduction messaging to prevent forward HIV transmission.
Collapse
Affiliation(s)
- Jayleen K L Gunn
- New York State Department of Health, Albany, NY, USA
- United States Public Health Service, Washington, USA
| | | | | | - Carol-Ann Swain
- New York State Department of Health, Albany, NY, USA.
- Department of Health, AIDS Institute, Bureau of HIV/AIDS Epidemiology, New York State, Corning Tower, Albany, NY, USA.
| |
Collapse
|
17
|
Bourne A, Melendez-Torres GJ, Thanh Ly A, Kidd P, Cogle A, Brown G, Lyons A, Carman M, Rulee J, Power J. Anxiety about HIV criminalisation among people living with HIV in Australia. AIDS Care 2021; 34:942-948. [PMID: 34082630 DOI: 10.1080/09540121.2021.1936443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Many countries, including Australia, have laws that enable criminal prosecution of an individual based on reckless or intentional transmission of HIV to another person. Previous research has suggested that criminalisation of HIV may serve to hamper public health efforts by inhibiting HIV status disclosure or testing. Limited research to date has sought to examine the broader impact of criminalisation on the health and wellbeing of people living with HIV, which this paper aims to address. Drawing on cross-sectional data from 895 people living with HIV in Australia, this paper describes associations between standard measures of mental health and resilience with a newly devised scale measuring anxiety about HIV criminalisation. Findings suggest that laws criminalising HIV transmission have a broadly negative impact on wellbeing of people living with HIV, a situation that is exacerbated for gay and bisexual men, and other people living with HIV who may face intersecting forms of marginalisation based on race, gender or class. There is little justification for these laws being applied in Australia and the findings add weight to advocacy seeking to overturn criminalisation across the world.
Collapse
Affiliation(s)
- Adam Bourne
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia
| | - G J Melendez-Torres
- Peninsula Technology Assessment Group, College of Medicine and Health, University of Exeter, UK
| | - An Thanh Ly
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia
| | - Paul Kidd
- Fitzroy Legal Service, Melbourne, Australia
| | - Aaron Cogle
- National Association for People with HIV Australia, Sydney, Australia
| | - Graham Brown
- Centre for Social Impact, UNSW Sydney, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia
| | - Marina Carman
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia
| | - John Rulee
- National Association for People with HIV Australia, Sydney, Australia
| | - Jennifer Power
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia
| |
Collapse
|
18
|
Philpot SP, Persson A, Prestage G, Bavinton BR, Ellard J. The 'normality' of living as a gay serodiscordant couple in Sydney, Australia. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:1837-1857. [PMID: 32767697 DOI: 10.1111/1467-9566.13171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 06/23/2020] [Accepted: 07/14/2020] [Indexed: 06/11/2023]
Abstract
Serodiscordant couples are often understood through a discourse of HIV-risk or researched in terms of the psychological stressors they face. However, due to antiretroviral treatments people living with HIV can achieve undetectable viral loads, which not only make them non-infectious to partners, but allow them to think of their lives and relationships as safe and viable. These realisations mean that serodiscordant couples often embrace an HIV 'normalisation' discourse. In this article, we argue that this discourse of HIV 'normalisation' can overlook the more nuanced complexity of issues still faced by couples today, which reveal how their experiences of 'normal' are sometimes challenged and are not necessarily 'normal'. Utilising semi-structured interviews with 21 gay men in serodiscordant relationships in Sydney, Australia, we draw on the concept of 'home' life to explore how men engage with discourses of normalisation to describe and enact their relationships. We argue that although HIV is managed well enough to be insignificant in the context of home life, experiences or anticipation of stigma in public often remind couples that they are yet to be considered 'normal' socially.
Collapse
Affiliation(s)
| | - Asha Persson
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | | | | | - Jeanne Ellard
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| |
Collapse
|
19
|
Ngure K, Ongolly F, Dolla A, Awour M, Mugwanya KK, Irungu E, Mugo N, Bukusi EA, Morton J, Odoyo J, Wamoni E, Barnabee G, Peebles K, O'Malley G, Baeten JM. "I just believe there is a risk" understanding of undetectable equals untransmissible (U = U) among health providers and HIV-negative partners in serodiscordant relationships in Kenya. J Int AIDS Soc 2020; 23:e25466. [PMID: 32144888 PMCID: PMC7060133 DOI: 10.1002/jia2.25466] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 02/05/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Sustained HIV viral suppression resulting from antiretroviral therapy (ART) eliminates the risk of HIV transmission, a concept popularly framed as Undetectable = Untransmittable (U = U). We explored knowledge and acceptance of information around the elimination of HIV transmission risk with ART (U = U) in Kenya. Methods Our qualitative study was conducted within a project evaluating the use of pre‐exposure prophylaxis (PrEP) integrated into ART care for HIV serodiscordant couples in public clinics in Kenya (the Partners Scale Up Project). From February 2017 to April 2019, we conducted semi‐structured key informant interviews with 83 health providers and in‐depth interviews with 61 HIV‐negative people in serodiscordant relationships receiving PrEP services. Transcripts were coded using thematic analysis. Results Health providers reported being aware of reduced risk of HIV transmission as a result of consistent ART use and used words such as “very low,” “minimal” and “like zero” to describe HIV transmission risk after viral suppression. Providers reported finding viral load results helpful when counselling clients about the risk of HIV transmission. Many lacked confidence in U = U and counselled on consistent condom use even after viral suppression while some expressed concerns that communicating this message to people living with HIV (PLHIV) would lead them to engage in multiple sexual relationships. Other providers reported that they did not counsel about the reduced risk of HIV transmission after viral suppression for fear of being blamed if HIV transmission occurred. HIV‐negative partners reported being informed about U = U by providers but they did not believe nor trust the message. Even after their partners achieved viral suppression, some HIV‐negative partners were unwilling to stop PrEP, while others indicated that they would use condoms if they stopped PrEP to be sure that they were protected from HIV. Conclusions Despite awareness that effective ART use eliminates HIV transmission risk, there is both a lack of in‐depth knowledge and conviction about the strategy among health providers and HIV‐negative partners in serodiscordant relationships. New strategies that go beyond communicating the science of U = U to consider the local social and clinical environments could maximize the effectiveness of U = U.
Collapse
Affiliation(s)
- Kenneth Ngure
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Fernandos Ongolly
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Annabell Dolla
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Merceline Awour
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Elizabeth Irungu
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Nelly Mugo
- Department of Global Health, University of Washington, Seattle, WA, USA.,Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth A Bukusi
- Department of Global Health, University of Washington, Seattle, WA, USA.,Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Jennifer Morton
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Josephine Odoyo
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth Wamoni
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Gena Barnabee
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Kathryn Peebles
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | | | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | | |
Collapse
|
20
|
McCormack H, Nathan S, Varma R, Haire B. Dissonances in communication with sexual health consumers in an inner-Sydney sexual health clinic in relation to health literacy: A mixed-methods study. Health Promot J Austr 2020; 32 Suppl 1:133-142. [PMID: 33002246 DOI: 10.1002/hpja.429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 08/31/2020] [Accepted: 09/24/2020] [Indexed: 11/09/2022] Open
Abstract
ISSUES ADDRESSED This study examined the navigation of health care interactions by health consumers attending Sydney Sexual Health Centre (SSHC), an inner-city sexual health clinic in Sydney, Australia. We aimed to assess the accessibility and appropriateness of communications between SSHC and patients in the context of health literacy. METHODS We conducted 20 semi-structured interviews with health consumers, assessed health literacy using the Short Health Literacy Assessment for English-Speaking Adults (SAHL-E) and conducted a focus group with clinical staff. RESULTS We identified dissonances around assumed knowledge in communications between health professionals and health consumers, which were most apparent when lack of knowledge about sexual health, HIV and pre-exposure prophylaxis (PrEP) intersected with poor English fluency. SO WHAT?: This study suggests that existing models of access for HIV treatment and PrEP in Australia have been developed for high health literacy and may not support consumers who experience communication barriers due to low health literacy. The Australian Commission on Safety and Quality in Health Care recommends addressing health literacy systemically, including embedding assessment of health literacy into organisational systems and policies. We recommend developing tools to assess knowledge levels of consumers accessing sexual health services and incorporating health literacy into clinician training on working with patients from non-English-speaking backgrounds.
Collapse
Affiliation(s)
- Heather McCormack
- Sydney Sexual Health Centre, New South Wales, Australia.,School of Public Health and Community Medicine, University of New South Wales, New South Wales, Australia
| | - Sally Nathan
- School of Public Health and Community Medicine, University of New South Wales, New South Wales, Australia
| | - Rick Varma
- Sydney Sexual Health Centre, New South Wales, Australia.,The Kirby Institute, University of New South Wales, New South Wales, Australia
| | - Bridget Haire
- The Kirby Institute, University of New South Wales, New South Wales, Australia
| |
Collapse
|
21
|
Meunier É, Siegel K, Sundelson AE, Schrimshaw EW. Stages of Adoption of "Treatment as Prevention" Among HIV-Negative Men Who Have Sex with Men Who Engage in Exchange Sex. AIDS Patient Care STDS 2020; 34:380-391. [PMID: 32931316 PMCID: PMC7480714 DOI: 10.1089/apc.2020.0062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Prior research found low acceptability of HIV treatment as prevention (TasP; or Undetectable = Untransmittable) among HIV-negative men who have sex with men (MSM). This study reports on qualitative data regarding TasP adoption in a sample of 170 self-reported HIV-negative MSM who had engaged in exchange sex (received money, drugs, or other things in exchange for sex). We classified participants along five stages of TasP adoption: 1-unaware of TasP (11.2%); 2-aware, but perceived ineffective (17.1%); 3-perceived effective, but unwilling to use (35.3%); 4-willing to rely on TasP, but had never done so (24.1%); and 5-had relied on TasP (12.4%). Obstacles to TasP adoption included the following: not believing that it could completely prevent HIV transmission; deeply ingrained fears of HIV/AIDS; concerns about viral load fluctuation; and reluctance to trust a partner's claimed undetectable status. TasP promotion efforts, which can decrease barriers to HIV testing and HIV stigma, will be more effective if tailored to the obstacles specific to each stage of TasP adoption.
Collapse
Affiliation(s)
- Étienne Meunier
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Karolynn Siegel
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Anne E. Sundelson
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Eric W. Schrimshaw
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, Florida, USA
| |
Collapse
|
22
|
Kahle EM, Sharma A, Sullivan S, Stephenson R. The Influence of Relationship Dynamics and Sexual Agreements on Perceived Partner Support and Benefit of PrEP Use Among Same-Sex Male Couples in the U.S. AIDS Behav 2020; 24:2169-2177. [PMID: 31950307 DOI: 10.1007/s10461-020-02782-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Use of Pre-exposure prophylaxis (PrEP) for HIV prevention by men who have sex with men (MSM) may be impacted by relationship dynamics. We assessed perceived partner support of PrEP use and benefit of PrEP by relationship characteristics among male couples. Baseline data from a randomized control trial of video-based HIV counseling and testing among male couples in the U.S. were used in adjusted multilevel regression models to assess individual and dyadic characteristics. Among 659 participants, 73.3% thought their partner would be supportive of their PrEP use; 26.7% reported their partner would not support PrEP use, which was significantly associated with intimate partner violence (IPV) (p = 0.008). Most (57.7%) did not believe PrEP would be beneficial to them or their partner. Couples with a sexual agreement allowing outside partners were significantly associated with higher perceived support of partners for PrEP (p < 0.001) and benefit of PrEP use (p < 0.001). Perceived partner support of PrEP was high but perceived benefit of PrEP was low, both shaped by relationship dynamics that highlight the need for tailored dyadic interventions. The association between perceived PrEP support and IPV points to the need to integrate relationship contexts in HIV prevention programs.
Collapse
|
23
|
Bavinton BR, Prestage GP, Jin F, Phanuphak N, Grinsztejn B, Fairley CK, Baker D, Hoy J, Templeton DJ, Tee BK, Kelleher A, Grulich AE. Strategies used by gay male HIV serodiscordant couples to reduce the risk of HIV transmission from anal intercourse in three countries. J Int AIDS Soc 2020; 22:e25277. [PMID: 30983155 PMCID: PMC6462805 DOI: 10.1002/jia2.25277] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/15/2019] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION There are few data about the range of strategies used to prevent sexual HIV transmission within gay male serodiscordant couples. We examined HIV prevention strategies used by such couples and compared differences between countries. METHODS Opposites Attract was a cohort study of male serodiscordant couples in Australia, Brazil and Thailand, from May 2014 (Australia) or May 2016 (Brazil/Thailand) to December 2016. At visits, HIV-positive partners had viral load (VL) tested; HIV-negative partners reported sexual behaviour and perceptions of their HIV-positive partner's VL results. Within-couple acts of condomless anal intercourse (CLAI) were categorized by strategy: condom-protected, biomedically protected (undetectable VL and/or pre-exposure prophylaxis [PrEP]), or not protected by either (HIV-negative partners engaging in insertive CLAI, receptive CLAI with withdrawal, or receptive CLAI with ejaculation). RESULTS A total of 343 couples were included in this analysis (153 in Australia, 93 in Brazil and 97 in Thailand). Three-quarters of HIV-positive partners were consistently virally suppressed (<200 copies/mL) during follow-up, and HIV-negative partners had correct perceptions of their partner's VL result for 76.5% of tests. One-third of HIV-negative partners used daily PrEP during follow-up. Over follow-up, 73.8% of couples had CLAI. HIV-negative partners reported 31,532 acts of anal intercourse with their HIV-positive partner. Of these, 46.7% were protected by condoms, 48.6% by a biomedical strategy and 4.7% of acts were not protected by these strategies. Australian couples had fewer condom-protected acts and a higher proportion of biomedically protected acts than Brazilian and Thai couples. Of the 1473 CLAI acts where the perceived VL was detectable/unknown and were not protected by PrEP (4.7% of all acts), two-thirds (n = 983) were when the HIV-negative partner was insertive (strategic positioning). Of the 490 acts when the HIV-negative partner was receptive, 261 involved withdrawal and 280 involved ejaculation. Thus, <1% of acts were in the highest risk category of receptive CLAI with ejaculation. CONCLUSIONS Couples used condoms, PrEP or perceived undetectable VL for prevention in the majority of anal intercourse acts. Only a very small proportion of events were not protected by these strategies. Variation between countries may reflect differences in access to HIV treatment, education, knowledge and attitudes.
Collapse
Affiliation(s)
| | | | - Fengyi Jin
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Beatriz Grinsztejn
- Evandro Chagas Institute of Clinical Research (IPEC), FIOCRUZ, Rio de Janeiro, Brazil
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Melbourne, Australia.,Monash University, Melbourne, Australia
| | | | - Jennifer Hoy
- Monash University, Melbourne, Australia.,The Alfred Hospital, Melbourne, Australia
| | - David J Templeton
- The Kirby Institute, UNSW Sydney, Sydney, Australia.,RPA Sexual Health, Sydney, Australia
| | | | | | | | | |
Collapse
|
24
|
Awareness and Perceived Effectiveness of HIV Treatment as Prevention Among Men Who Have Sex with Men in New York City. AIDS Behav 2019; 23:1974-1983. [PMID: 30697639 DOI: 10.1007/s10461-019-02405-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To assess perceptions of HIV treatment as prevention (TasP), we conducted an online survey of MSM in New York City (n = 732) asking them to rate the effectiveness of different strategies to reduce HIV risk during serodiscordant condomless anal sex between men. Only 6.1% reported not knowing what TasP was, with significantly less awareness among non-gay-identified MSM, men with less education, men who reported fewer anal sex partners in the prior 3 months, and HIV-negative/unaware men who had never used PrEP. The strategy most frequently perceived to offer "a lot" or "complete" protection from HIV was daily PrEP (70.0%), followed by TasP (39.1%), intermittent PrEP (16.6%), strategic positioning (15.8%), and withdrawal before ejaculation (10.8%). Men who were HIV positive, who had ever used PrEP, and who identified as gay/homosexual were significantly more likely to see TasP as effective. Further studies should investigate MSM's apparent skepticism towards TasP.
Collapse
|