1
|
Cogordan C, Fressard L, Brosset E, Bocquier A, Velter A, Annequin M, Bourrelly M, Constance J, Michels D, Mora M, Morel S, Oliveri C, Maradan G, Berenger C, Spire B, Verger P. Sexual and preventive behaviors associated with HAV, HBV, and HPV vaccine hesitancy among men who have sex with men in France. Hum Vaccin Immunother 2024; 20:2348845. [PMID: 38783608 PMCID: PMC11135958 DOI: 10.1080/21645515.2024.2348845] [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: 02/22/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
Vaccination coverage against hepatitis A virus (HAV), hepatitis B virus (HBV), and human papillomaviruses (HPV) is insufficient among men who have sex with men (MSM), partly because of their high prevalence of vaccine hesitancy (VH) specific to these vaccines. This study aimed to investigate determinants of specific VH in MSM, focusing on characteristics of their sexual activity, propensity to use prevention tools and medical care, disclosure of sexual orientation to health care professionals (HCPs), and perceived stigmatization. A cross-sectional electronic survey (February - August 2022) collected perceptions of HBV, HAV, and HPV, and of their respective vaccines among 3,730 French MSM and enabled the construction of a specific VH variable. Using agglomerative hierarchical cluster analysis, we constructed a typology of MSM sexual and prevention practices. We identified three MSM clusters (low- (C1, 24%), moderate- (C2, 41%), and high- (C3, 35%) "sexual activity/medical engagement") that showed an increasing gradient in the use of medical prevention with regular medical care and exposure to high-risk sexual practices. A multiple ordinal logistic regression showed that overall specific VH was higher in the C1 cluster and in men who had not informed their physician of their sexual orientation. This typology could usefully help to adapt vaccination communication strategies for MSM prevention program according to patients' profiles. HCPs should be encouraged and trained to ask men about their sexual practices and to provide appropriate vaccination recommendations nonjudgmentally.
Collapse
Affiliation(s)
- Chloé Cogordan
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Lisa Fressard
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Emeline Brosset
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Aurélie Bocquier
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
- Inserm, INSPIIRE, Université de Lorraine, Nancy, France
| | - Annie Velter
- Santé publique France (The French Public Health Agency), Saint-Maurice, France
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - Margot Annequin
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - Michel Bourrelly
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - Jean Constance
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - David Michels
- AIDES, Pantin, France
- Laboratoire de recherche communautaire, Coalition PLUS, Pantin, France
| | - Marion Mora
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | | | - Camilla Oliveri
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - Gwenaëlle Maradan
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Cyril Berenger
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Bruno Spire
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - Pierre Verger
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
- Unité des Virus Émergents, UVE: Aix-Marseille Univ Università di Corsica, Marseille, France
| |
Collapse
|
2
|
Owens C, Hurtado M, Moskowitz DA, Mustanski B, Macapagal K. Rural-Urban Differences in HIV Sexual Risk Behaviors and HIV Service Utilization Among Adolescent Sexual Minority Males in the United States. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2765-2775. [PMID: 38528296 DOI: 10.1007/s10508-024-02840-6] [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: 12/24/2021] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/27/2024]
Abstract
In the United States, HIV prevalence is increasing in rural areas, specifically among rural adolescent sexual minority males (ASMM). However, it is unclear what HIV sexual risk behaviors rural ASMM engage in and what HIV preventative services they utilize. This study aimed to (1) document the lifetime HIV sexual risk behaviors and service utilization of rural ASMM and (2) compare rural-urban differences in the prevalence of HIV sexual risk behaviors and service utilization. We analyzed data collected from 1615 ASMM who participated in a baseline survey for an online HIV prevention program from April 2018 to June 2020. We compared the prevalence of lifetime HIV sexual risk behaviors and HIV healthcare utilization among rural and urban participants via descriptive statistics, chi-square tests, linear and logistic regressions, and zero-inflated Poisson regressions. These analyses indicated that rural ASMM were more likely than urban ASMM to engage in condomless sex when they had anal sex. Rural ASMM could benefit from offline and online evidence-based HIV prevention interventions, especially interventions that increase condom use.
Collapse
Affiliation(s)
- Christopher Owens
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Manuel Hurtado
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
| | - David A Moskowitz
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave., Suite 1400, Chicago, IL, 60611, USA.
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Kathryn Macapagal
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
3
|
Seyedroudbari S, Ghadimi F, Grady G, Uzosike O, Nkwihoreze H, Jemmott JB, Momplaisir F. Assessing Structural Racism and Discrimination Along the Pre-exposure Prophylaxis Continuum: A Systematic Review. AIDS Behav 2024:10.1007/s10461-024-04387-y. [PMID: 38851649 DOI: 10.1007/s10461-024-04387-y] [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] [Accepted: 05/16/2024] [Indexed: 06/10/2024]
Abstract
Structural racism and discrimination (SRD) is deeply embedded across U.S. healthcare institutions, but its impact on health outcomes is challenging to assess. The purpose of this systematic literature review is to understand the impact of SRD on pre-exposure prophylaxis (PrEP) care continuum outcomes across U.S. populations who could benefit from HIV prevention. Guided by PRISMA guidelines, we conducted a systematic review of the published literature up to September 2023 using PubMed and PsycInfo and included peer-reviewed articles meeting inclusion criteria. At least two authors independently screened studies, performed quality assessments, and abstracted data relevant to the topic. Exposure variables included race/ethnicity and any level of SRD (interpersonal, intra- and extra-organizational SRD). Outcomes consisted of any steps of the PrEP care continuum. A total of 66 studies met inclusion criteria and demonstrated the negative impact of SRD on the PrEP care continuum. At the interpersonal level, medical mistrust (i.e., lack of trust in medical organizations and professionals rooted from current or historical practices of discrimination) was negatively associated with almost all the steps across the PrEP care continuum: individuals with medical mistrust were less likely to have PrEP knowledge, adhere to PrEP care, and be retained in care. At the intra-organizational level, PrEP prescription was lower for Black patients due to healthcare provider perception of higher sex-risk behaviors. At the extra-organizational level, factors such as homelessness, low socioeconomic status, and incarceration were associated with decreased PrEP uptake. On the other hand, healthcare provider trust, higher patient education, and access to health insurance were associated with increased PrEP use and retention in care. In addition, analyses using race/ethnicity as an exposure did not consistently show associations with PrEP continuum outcomes. We found that SRD has a negative impact at all steps of the PrEP care continuum. Our results suggest that when assessing the effects of race/ethnicity without the context of SRD, certain relationships and associations are missed. Addressing multi-level barriers related to SRD are needed to reduce HIV transmission and promote health equity.
Collapse
Affiliation(s)
| | - Fatemeh Ghadimi
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Hervette Nkwihoreze
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John B Jemmott
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Florence Momplaisir
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
4
|
Goswami S, Gannon T, Nasruddin S, Mancuso B, Kang M, Bentley JP, Bhattacharya K, Barnard M. Willingness to use PrEP among PrEP naïve men who have sex with men: a meta-analysis. AIDS Care 2024:1-14. [PMID: 38771970 DOI: 10.1080/09540121.2024.2354207] [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: 10/06/2023] [Accepted: 05/07/2024] [Indexed: 05/23/2024]
Abstract
This study aimed to measure the pooled estimate of willingness to use HIV pre-exposure prophylaxis (PrEP) (WTUP) among PrEP-naïve United States (U.S.)-based men who have sex with men (MSM). PubMed, Embase, Web of Science, CINAHL, and PsycINFO were searched. The search strategy contained the keyword willingness and interest and the MeSH terms for HIV and PrEP. Articles were included if they were published between January 2005 and May 2022, reported quantitative data on WTUP among PrEP-naïve US-based MSM, and were available as full text in English. Meta-analysis was conducted to assess the pooled effect size of WTUP prevalence using a random-effects model, heterogeneity in the pooled estimate was assessed, and subgroup analyzes were conducted. Fifteen studies were included based on the inclusion and exclusion criteria. Meta-analysis revealed a pooled prevalence proportion for WTUP of 0.58 (95% CI 0.54-0.61) (or 58 out of 100) among PrEP-naïve MSM. High inter-study heterogeneity (Q = 548.10, df = 19, p < 0.01, I2 = 96.53, τ2 = 0.09) was observed. Age of the study sample and region where the data were collected significantly moderated the pooled WTUP estimate. Age-appropriate PrEP related messaging and a focus on HIV priority areas of the U.S. would be important strategies to improve WTUP among MSM in the U.S. moving forward.
Collapse
Affiliation(s)
- Swarnali Goswami
- Complete HEOR Solutions (CHEORS), Chalfont, PA, USA (At the time this study was conducted, Dr. Goswami was a graduate student in the Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA)
| | - Taylor Gannon
- School of Pharmacy, University of Mississippi, University, MS, USA
| | - Saara Nasruddin
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA
| | - Blake Mancuso
- School of Pharmacy, University of Mississippi, University, MS, USA
| | - Minsoo Kang
- Department of Health, Exercise Science, and Recreation Management, School of Applied Sciences, University of Mississippi, University, MS, USA
| | - John P Bentley
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA
- Center for Pharmaceutical Marketing and Management, School of Pharmacy, University of Mississippi, University, MS, USA
| | - Kaustuv Bhattacharya
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA
- Center for Pharmaceutical Marketing and Management, School of Pharmacy, University of Mississippi, University, MS, USA
| | - Marie Barnard
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA
- Center for Pharmaceutical Marketing and Management, School of Pharmacy, University of Mississippi, University, MS, USA
| |
Collapse
|
5
|
Alohan DI, Evans G, Sanchez T, Harrington KR, Quamina A, Young HN, Crawford ND. Examining pharmacies' ability to increase pre-exposure prophylaxis access for black men who have sex with men in the United States. J Am Pharm Assoc (2003) 2023; 63:547-554. [PMID: 36470733 PMCID: PMC10065894 DOI: 10.1016/j.japh.2022.11.004] [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: 08/23/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) has not effectively reached black men who have sex with men (BMSM). Using innovative, nontraditional health care settings-such as community pharmacies-may improve PrEP uptake among BMSM. OBJECTIVE To examine correlates of patient willingness to be screened for PrEP (via human immunodeficiency virus [HIV] testing and risk assessment) in pharmacies among BMSM in the United States. METHODS Data from the 2020 American Men's Internet Survey were analyzed. Using a modified Poisson regression method with robust variance estimates, we examined differences in willingness to screen for PrEP in pharmacies among BMSM. A 95% confidence interval (95% CI) was calculated for each estimated prevalence ratio (PR). RESULTS Of 826 respondents, 637 (77%) were willing to be screened for PrEP in pharmacies. Having a high school degree (PR 0.76 [95% CI 0.62-0.95]), willingness to use PrEP (1.70 [1.41-2.05]), and comfort speaking with pharmacy staff about PrEP (2.5 [1.86-3.51]) were significantly associated with willingness to screen for PrEP in a pharmacy setting. Importantly, there were no observed differences in willingness by age, employment status, annual household income, or insurance status. CONCLUSION Pharmacy-based PrEP access may be an effective strategy to end inequities in HIV, given that our results indicate that most BMSM are willing to be screened for PrEP in pharmacies. Future studies should examine whether willingness to use pharmacy-based HIV prevention services is associated with subsequent uptake of these services among BMSM.
Collapse
Affiliation(s)
- Daniel I. Alohan
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - Alvan Quamina
- National AIDS Education Services for Minorities, Inc., Atlanta, GA
| | - Henry N. Young
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, GA
| | - Natalie D. Crawford
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA
| |
Collapse
|
6
|
Kamitani E, Wichser ME, Mizuno Y, DeLuca JB, Higa DH. What Factors Are Associated With Willingness to Use HIV Pre-exposure Prophylaxis (PrEP) Among U.S. Men Who Have Sex With Men Not on PrEP? A Systematic Review and Meta-analysis. J Assoc Nurses AIDS Care 2023; 34:135-145. [PMID: 36563302 PMCID: PMC10184317 DOI: 10.1097/jnc.0000000000000384] [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: 12/24/2022]
Abstract
ABSTRACT Pre-exposure prophylaxis (PrEP), an antiretroviral medication to prevent HIV, is becoming more widely available in the United States since the Federal Drug Administration approved it in 2012. However, PrEP use among men who have sex with men (MSM) is still limited and many MSM who are willing to take PrEP are not on PrEP. We performed a systematic review to identify factors associated with willingness to use PrEP among MSM who are not on PrEP. The majority of the 23 relevant studies had low risk of bias and used a cross-sectional design. Willingness was associated with being Hispanic/Latino (odds ratio [OR] = 1.68, 95% confidence interval [CI] [1.01-2.78]), Black (OR = 1.41, 95% CI [1.02-1.95]), younger (OR = 1.08, 95% CI [1.02-1.15]), having no college degree (OR = 1.37, 95% CI [1.12-1.59]), or low income (OR = 1.21, 95% CI [1.12-1.32]). A higher proportion of MSM who had recent condomless anal sex (OR = 1.85, 95% CI [1.49-2.29]) were diagnosed with sexually transmitted infection (OR = 1.60, 95% CI [1.27-2.01]), or MSM who had multiple sex partners (OR = 1.58, 95% CI [1.07-2.32]) were more willing to use PrEP compared with their respective counterparts. Findings suggest that MSM with racial/ethnic minority status, low-socioeconomic status, younger age, and engagement in HIV risk behaviors are willing to take PrEP but may lack access. Study limitations include the inability to conduct meta-analyses on certain predictor variables due to a small number of studies. This review identified MSM subpopulations who may benefit from interventions increasing PrEP access.
Collapse
Affiliation(s)
- Emiko Kamitani
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, U.S
| | - Megan E. Wichser
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, U.S
| | - Yuko Mizuno
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, U.S
| | - Julia B. DeLuca
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, U.S
| | - Darrel H. Higa
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, U.S
| |
Collapse
|
7
|
Ferrand J, Walsh-Buhi E, Dodge B, Svetina D, Herbenick D. Variations in Pre-exposure Prophylaxis (PrEP) Awareness and Healthcare Provider Interactions in a Nationally Representative Sample of American Men Aged 15-49 Years: A Cross-Sectional Study. AIDS Behav 2023:10.1007/s10461-023-04016-0. [PMID: 36786940 DOI: 10.1007/s10461-023-04016-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 02/15/2023]
Abstract
Awareness of and discussions with a healthcare provider (HCP) around pre-exposure prophylaxis (PrEP), an effective HIV prevention method, are associated with PrEP uptake, yet few studies utilize representative samples or report on these outcomes using distinct behavioral risk subgroups. This cross-sectional study utilized responses given by men on the 2017-2019 National Survey of Family Growth, a nationally representative survey of Americans aged 15-49 years. Multiple logistic regression models were used to determine how respondents' sociodemographic characteristics and HIV risk behaviors were related to PrEP awareness and HCP discussions. PrEP awareness was low (29.40%) as was the proportion who reported ever discussing PrEP with an HCP (4.48%). Odds of being PrEP aware and discussing PrEP with an HCP varied significantly within sexual behavior subgroups based on sociodemographic and behavioral characteristics highlighting the differential risks within distinct behavioral subgroupings of men. Sexual behavior subgroupings should be considered when promoting PrEP awareness and discussions as HIV risk behaviors vary considerably and sexual identity alone may not sufficiently capture one's HIV risk.
Collapse
Affiliation(s)
- John Ferrand
- Department of Applied Health Science, Indiana University, School of Public Health-Bloomington, 1025 E. 7th St., Bloomington, IN, 47405, USA.
| | - Eric Walsh-Buhi
- Department of Applied Health Science, Indiana University, School of Public Health-Bloomington, 1025 E. 7th St., Bloomington, IN, 47405, USA
| | - Brian Dodge
- Health Sciences, Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Dubravka Svetina
- Department of Counseling and Educational Psychology, Indiana University, School of Education, Bloomington, IN, USA
| | - Debby Herbenick
- Department of Applied Health Science, Indiana University, School of Public Health-Bloomington, 1025 E. 7th St., Bloomington, IN, 47405, USA
| |
Collapse
|
8
|
Wang G, Song W, Rao S, Heitgerd J, Mulatu MS, Karch D, Belcher L. HIV Positivity, Linkage to Medical Care, Interview for Partner Services, and Pre-Exposure Prophylaxis Awareness and Referral Among Men Who Have Sex With Men Tested in Non-healthcare Settings in the United States, 2019. J Acquir Immune Defic Syndr 2023; 92:34-41. [PMID: 36166309 PMCID: PMC10959101 DOI: 10.1097/qai.0000000000003106] [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: 06/15/2022] [Accepted: 09/23/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV. This study reports data on HIV testing program outcomes among MSM tested for HIV in non-healthcare settings in the United States. METHODS We analyzed Centers for Disease Control and Prevention's National HIV Prevention Program Monitoring and Evaluation data collected in 2019. Descriptive and multivariate robust Poisson regression analyses were conducted to summarize the patterns of HIV testing program outcomes [ie, positivity, linkage to HIV medical care within 30 days of diagnosis, interview for partner services (PS), and pre-exposure prophylaxis (PrEP) awareness and referral] by demographic characteristics, HIV prevalence, and testing site type. RESULTS A total of 123,251 HIV tests were conducted among MSM; of these, 1773 (1.4%) were newly diagnosed with HIV. Among MSM newly diagnosed with HIV, 75% were linked to HIV medical care and 80% were interviewed for PS. Among MSM who tested HIV-negative, 63% were aware of PrEP and 47% of those who were eligible for PrEP were referred to PrEP providers. Referral or linkage to services varied by demographic characteristics or other factors. CONCLUSIONS Linkage to HIV medical care and interview for PS among MSM newly diagnosed with HIV in non-healthcare settings were below national or funding program targets. Most MSM with risk factors for HIV infection were not referred to PrEP providers. Expanded efforts to address barriers to equitable access to services may help improve HIV-related outcomes among MSM and contribute to ending the HIV epidemic in the United States.
Collapse
Affiliation(s)
- Guoshen Wang
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wei Song
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shubha Rao
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet Heitgerd
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mesfin S. Mulatu
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Debra Karch
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa Belcher
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
9
|
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.
Collapse
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
| | | |
Collapse
|
10
|
Sharpe JD, Sanchez TH, Siegler AJ, Guest JL, Sullivan PS. Association between the geographic accessibility of PrEP and PrEP use among MSM in nonurban areas. J Rural Health 2022; 38:948-959. [PMID: 34997634 PMCID: PMC9259757 DOI: 10.1111/jrh.12645] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The US HIV epidemic has become a public health issue that increasingly affects men who have sex with men (MSM), including those residing in nonurban areas. Increasing access to pre-exposure prophylaxis (PrEP) in nonurban areas will prevent HIV acquisition and could address the growing HIV epidemic. No studies have quantified the associations between PrEP access and PrEP use among nonurban MSM. METHODS Using 2020 PrEP Locator data and American Men's Internet Survey data, we conducted multilevel log-binomial regression to examine the association between area-level geographic accessibility of PrEP-providing clinics and individual-level PrEP use among MSM residing in nonurban areas in the United States. FINDINGS Of 4,792 PrEP-eligible nonurban MSM, 20.1% resided in a PrEP desert (defined as more than a 30-minute drive to access PrEP), and 15.2% used PrEP in the past 12 months. In adjusted models, suburban MSM residing in PrEP deserts were less likely to use PrEP in the past year (adjusted prevalence ratio [aPR] = 0.35; 95% confidence interval [CI] = 0.15, 0.80) than suburban MSM not residing in PrEP deserts, and other nonurban MSM residing in PrEP deserts were less likely to use PrEP in the past year (aPR = 0.75; 95% CI = 0.60, 0.95) than other nonurban MSM not residing in PrEP deserts. CONCLUSIONS Structural interventions designed to decrease barriers to PrEP access that are unique to nonurban areas in the United States are needed to address the growing HIV epidemic in these communities.
Collapse
Affiliation(s)
- J. Danielle Sharpe
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Travis H. Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Aaron J. Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jodie L. Guest
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| |
Collapse
|
11
|
Differences in PrEP Awareness, Discussions with Healthcare Providers, and Use Among Men Who Have Sex with Men in the United States by Urbanicity and Region: A Cross-sectional Analysis. AIDS Behav 2021; 25:4102-4114. [PMID: 33937963 DOI: 10.1007/s10461-021-03267-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 12/11/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention intervention and is critical to the Ending the HIV Epidemic strategy. Most PrEP research has been conducted among urban populations; less is known about PrEP awareness, willingness to use, and actual use among rural and suburban populations. We examined these PrEP indicators by United States region and urbanicity among men who have sex with men who responded to the 2019 cycle of the American Men's Internet Survey. Rural and suburban men were less likely than urban men to be aware of PrEP, to have discussed PrEP with a healthcare provider in the past 12 months, and to have ever used PrEP. Smaller differences were observed across regions. Notably, willingness to use PrEP was similar across region and urbanicity. Additional work will be needed to increase PrEP awareness and access among rural and suburban populations.
Collapse
|
12
|
Dong W, Muessig KE, Knudtson KA, Gilbertson A, Rennie S, Soni K, Hightow-Weidman LB. Moral practices shaping HIV disclosure among young gay and bisexual men living with HIV in the context of biomedical advance. CULTURE, HEALTH & SEXUALITY 2021; 23:1641-1655. [PMID: 32748729 PMCID: PMC9426661 DOI: 10.1080/13691058.2020.1790039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 06/28/2020] [Indexed: 05/25/2023]
Abstract
Biomedical advances in diagnostics, treatment and prevention increase the means available to reduce HIV transmission risk. Subsequent shifts in HIV status disclosure obligation and ethics may impact how those living with HIV view, enact and experience disclosure. We analysed focus group and interview data to explore how these changes are reflected in disclosure decision-making to sexual partners among young gay and bisexual men living with HIV in the USA. Three interrelated themes were identified: engaging with partners' varying HIV knowledge; attribution of blame; and negotiating disclosure-related harms. Participants experienced blame from partners that questioned the timing of HIV testing, status disclosure and sex events without regards for viral suppression or use of pre-exposure prophylaxis. Substantial HIV stigma was described in response to disclosure, mitigated in some cases by partners' higher HIV knowledge. Overall, an uneven diffusion of HIV treatment and prevention knowledge and continuing HIV stigma seemed to limit the translation of biomedical advances into improved disclosure experiences. Our findings suggest that young gay and bisexual men living with HIV may continue to perform much of the moral labour involved in disclosure by managing others' reactions, correcting inaccurate sexual health information, and negotiating the risks of disclosure-related harm.
Collapse
Affiliation(s)
- Willa Dong
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Kathryn E. Muessig
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Kelly A. Knudtson
- Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Adam Gilbertson
- Department of Social Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA
- Center for Bioethics, The University of North Carolina at Chapel Hill, Chapel Hill, USA
- Institute for Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Stuart Rennie
- Department of Social Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA
- Center for Bioethics, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Karina Soni
- Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Lisa B. Hightow-Weidman
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA
- Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA
- Institute for Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| |
Collapse
|
13
|
Pre-Exposure Prophylaxis (PrEP) Uptake among Black Men Who Have Sex with Men (BMSM) in the Southern U.S. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189715. [PMID: 34574652 PMCID: PMC8470377 DOI: 10.3390/ijerph18189715] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/18/2021] [Accepted: 09/13/2021] [Indexed: 12/03/2022]
Abstract
Black men who have sex with men (BMSM) living in the United States (U.S.) South are disproportionately affected by HIV and experience significant disparities in HIV incidence, access to HIV care, and prevention across ages and socio-economic statuses. The aim of this commentary is to critically review current literature on the state of PrEP use among BMSM in the U.S. South, including identifying barriers and facilitators to PrEP use in order to inform intervention development. Extant literature shows that despite the documented benefits of PrEP as an effective HIV-prevention method, its uptake among BMSM is limited across the U.S. South. Common barriers to PrEP uptake included stigma, homophobia, mistrust of healthcare systems, negative attitudes from healthcare providers, access and transportation issues, poverty, and misinformation about PrEP. These barriers are likely to have been further exacerbated by the COVID-19 pandemic. Limited access to PrEP and other HIV-prevention programs, such as HIV testing, post-exposure prophylaxis (PEP), and condoms for BMSM are likely increase HIV incidence in this community. Moreover, the rapid expansion of telehealth services during the COVID-19 period may offer increased opportunity to scale-up PrEP through telehealth interventions, especially if in-person services remain limited due to pandemic precautions. Given the intersectional barriers that limit the access and uptake of PrEP among BMSM, we suggest that tailored programs or interventions that seek to address PrEP disparities among Southern BMSM should adopt intersectional and interdisciplinary approaches to better understand the complex challenges of scaling up PrEP. More studies are needed to investigate the impact of COVID-19 on HIV-prevention services among BMSM and to understand how to co-develop—with the BMSM community and healthcare providers—culturally acceptable interventions to reduce the identified challenges using intersectional and interdisciplinary approaches.
Collapse
|
14
|
Tao J, Montgomery MC, Williams R, Patil P, Rogers BG, Sosnowy C, Murphy M, Zanowick-Marr A, Maynard M, Napoleon SC, Chu C, Almonte A, Nunn AS, Chan PA. Loss to Follow-Up and Re-Engagement in HIV Pre-Exposure Prophylaxis Care in the United States, 2013-2019. AIDS Patient Care STDS 2021; 35:271-277. [PMID: 34242092 DOI: 10.1089/apc.2021.0074] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Retention in HIV pre-exposure prophylaxis (PrEP) care is critical for effective PrEP implementation. Few studies have reported long-term lost to follow-up (LTFU) and re-engagement in PrEP care in the United States. Medical record data for all cisgender patients presenting to the major Rhode Island PrEP clinic from 2013 to 2019 were included. LTFU was defined as no PrEP follow-up appointment within 98 days. Re-engagement in care was defined as individuals who were ever LTFU and later attended a follow-up appointment. Recurrent event survival analysis was performed to explore factors associated with PrEP retention over time. Of 654 PrEP patients, the median age was 31 years old [interquartile range (IQR): 25, 43]. The majority were male (96%), White (64%), non-Hispanic (82%), and insured (97%). Overall, 72% patients were ever LTFU and 27% of those ever LTFU re-engaged in care. Female patients were 1.37 times [crude hazard ratio (cHR): 1.37; 95% confidence interval (CI): 0.86-2.18] more likely to be LTFU than male patients, and a 1-year increase in age was associated with a 1% lower hazard of being LTFU (cHR: 0.99; CI: 0.98-0.99). Being either heterosexual (aHR: 2.25, 95% (CI): 1.70-2.99] or bisexual (aHR: 2.35, 95% CI: 1.15-4.82) was associated with a higher hazard of loss to follow-up compared with having same-sex partners only. The majority of PrEP users were LTFU, especially at the first 6 months of PrEP initiation. Although a significant number were re-engaged in care, targeted interventions are needed to improve retention in PrEP care. This study characterized the natural projection of loss to follow-up and re-engagement in HIV PrEP care using a longitudinal clinic cohort data and explored associated factors for guiding future interventions to improve retention in PrEP care.
Collapse
Affiliation(s)
- Jun Tao
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Madeline C. Montgomery
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Robert Williams
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Prasad Patil
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Brooke G. Rogers
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Collette Sosnowy
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Matthew Murphy
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Alexandra Zanowick-Marr
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Michaela Maynard
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Siena C. Napoleon
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Christina Chu
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Alexi Almonte
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Amy S. Nunn
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Philip A. Chan
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| |
Collapse
|
15
|
Multilevel Barriers to HIV PrEP Uptake and Adherence Among Black and Hispanic/Latinx Transgender Women in Southern California. AIDS Behav 2021; 25:2301-2315. [PMID: 33515132 PMCID: PMC7845787 DOI: 10.1007/s10461-021-03159-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 02/02/2023]
Abstract
Black and Hispanic/Latinx transgender women in the United States (U.S.) are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) reduces risk of HIV infection but PrEP uptake remains low among Black and Hispanic/Latinx transgender women. Between July 2018 and August 2019, we conducted individual interviews with 30 Black and Hispanic/Latinx transgender women who were prescribed PrEP through a PrEP demonstration project and 10 healthcare providers who provide PrEP services to transgender women in Los Angeles and San Diego, California. The interviews assessed general attitudes, experiences, and beliefs about PrEP as well as individual-, interpersonal-, community-, and structural-level barriers to PrEP uptake and adherence. PrEP adherence was assessed by collecting quantitative intracellular tenofovir-diphosphate (TFV-DP) levels in retrospect on batched, banked dried blood spot (DBS) samples. We utilized qualitative content analysis to identify themes from the interviews. Findings indicated the presence of individual-level barriers including cost concerns, mental health issues, substance use, and concerns about PrEP side effects including hormone interaction. Interpersonal-level barriers included the influence of intimate/romantic partners and the impact of patient-provider communication. Community-level barriers consisted of experiencing stigma and negative community opinions about PrEP use as well as having negative experiences in healthcare settings. Structural-level barriers included unreliable transportation, employment, and housing insecurity. Interventions aiming to increase PrEP uptake and adherence among Black and Hispanic/Latinx transgender women in the U.S. should employ a multilevel approach to addressing the needs of transgender women, especially the structural barriers that have greatly limited the use of PrEP.
Collapse
|
16
|
Ogunbajo A, Storholm ED, Ober AJ, Bogart LM, Reback CJ, Flynn R, Lyman P, Morris S. Multilevel Barriers to HIV PrEP Uptake and Adherence Among Black and Hispanic/Latinx Transgender Women in Southern California. AIDS Behav 2021. [PMID: 33515132 DOI: 10.1007/s10461-021-03159-2]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Black and Hispanic/Latinx transgender women in the United States (U.S.) are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) reduces risk of HIV infection but PrEP uptake remains low among Black and Hispanic/Latinx transgender women. Between July 2018 and August 2019, we conducted individual interviews with 30 Black and Hispanic/Latinx transgender women who were prescribed PrEP through a PrEP demonstration project and 10 healthcare providers who provide PrEP services to transgender women in Los Angeles and San Diego, California. The interviews assessed general attitudes, experiences, and beliefs about PrEP as well as individual-, interpersonal-, community-, and structural-level barriers to PrEP uptake and adherence. PrEP adherence was assessed by collecting quantitative intracellular tenofovir-diphosphate (TFV-DP) levels in retrospect on batched, banked dried blood spot (DBS) samples. We utilized qualitative content analysis to identify themes from the interviews. Findings indicated the presence of individual-level barriers including cost concerns, mental health issues, substance use, and concerns about PrEP side effects including hormone interaction. Interpersonal-level barriers included the influence of intimate/romantic partners and the impact of patient-provider communication. Community-level barriers consisted of experiencing stigma and negative community opinions about PrEP use as well as having negative experiences in healthcare settings. Structural-level barriers included unreliable transportation, employment, and housing insecurity. Interventions aiming to increase PrEP uptake and adherence among Black and Hispanic/Latinx transgender women in the U.S. should employ a multilevel approach to addressing the needs of transgender women, especially the structural barriers that have greatly limited the use of PrEP.
Collapse
Affiliation(s)
- Adedotun Ogunbajo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Erik D Storholm
- School of Public Health, San Diego State University, San Diego, CA, USA
- RAND Corporation, Santa Monica, CA, USA
- Department of Family Medicine, Center for HIV Identification, Prevention and Treatment Services, University of California Los Angeles, Los Angeles, CA, USA
| | - Allison J Ober
- RAND Corporation, Santa Monica, CA, USA
- Department of Family Medicine, Center for HIV Identification, Prevention and Treatment Services, University of California Los Angeles, Los Angeles, CA, USA
| | - Laura M Bogart
- RAND Corporation, Santa Monica, CA, USA
- Department of Family Medicine, Center for HIV Identification, Prevention and Treatment Services, University of California Los Angeles, Los Angeles, CA, USA
| | - Cathy J Reback
- Department of Family Medicine, Center for HIV Identification, Prevention and Treatment Services, University of California Los Angeles, Los Angeles, CA, USA
- Friends Research Institute, Los Angeles, CA, USA
| | - Risa Flynn
- Los Angeles LGBT Center, Los Angeles, CA, USA
| | | | - Sheldon Morris
- AntiViral Research Center, San Diego School of Medicine, University of California, San Diego, CA, USA
| |
Collapse
|
17
|
Mouhanna F, Castel AD, Sullivan PS, Kuo I, Hoffman HJ, Siegler AJ, Jones JS, Mera Giler R, McGuinness P, Kramer MR. Small-area spatial-temporal changes in pre-exposure prophylaxis (PrEP) use in the general population and among men who have sex with men in the United States between 2012 and 2018. Ann Epidemiol 2020; 49:1-7. [PMID: 32951802 DOI: 10.1016/j.annepidem.2020.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Oral emtricitabine/tenofovir disoproxil fumarate was approved for use as pre-exposure prophylaxis (PrEP) by the U.S. Food and Drug Administration in 2012. We used national pharmacy data to examine trends of PrEP use in U.S. counties from 2012 to 2018. METHODS Using multi-level small-area spatio-temporal modeling, we calculated the estimated annual percentage change (EAPC) in prevalence of PrEP use in the general population from 2012 to 2018. We also used a proxy measure for prevalence of PrEP use among men who have sex with men (MSM) to evaluate trends of use among MSM, the PrEP use-to-MSM ratio (PmR) or number of male PrEP users per 1000 MSM population. RESULTS The prevalence of PrEP use and PmR increased (EAPC range: (+26.9%, +71.0%) and (+28.4%, +158.7%), respectively) in all counties with varying magnitude of increase. Counties of the Midwest and the upper South and upper West had the slowest increase in prevalence of PrEP use (EAPC range: (+26.9%; +52.9%)). Counties of the northern part of the South had the lowest PmR (EAPC range: (+28.4%; +76.0%)). Counties of the most populous core-based statistical areas had a relatively faster increase in population prevalence of PrEP use but slower increase in PmR. CONCLUSIONS All counties in the U.S. have witnessed an increase in PrEP use with important geographic variabilities. Identifying areas with slow improvement in PrEP use, as well as "model counties" with the fastest pace of progress in PrEP coverage, is critical to inform local and state-level policies and program evaluation for PrEP scale up, particularly among MSM at higher risk for HIV.
Collapse
Affiliation(s)
- Farah Mouhanna
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Irene Kuo
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Heather J Hoffman
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Aaron J Siegler
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Jeb S Jones
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | | | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
| |
Collapse
|
18
|
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
|
19
|
Glick JL, Russo R, Jivapong B, Rosman L, Pelaez D, Footer KHA, Sherman SG. The PrEP Care Continuum Among Cisgender Women Who Sell Sex and/or Use Drugs Globally: A Systematic Review. AIDS Behav 2020; 24:1312-1333. [PMID: 31807973 DOI: 10.1007/s10461-019-02733-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
HIV prevalence among cisgender female sex workers (FSW) and/or women who use drugs (WWUD) is substantially higher compared to similarly aged women. Consistent with PRISMA guidelines, we conducted the first systematic review on the pre-exposure prophylaxis (PrEP) continuum among FSW and/or WWUD, searching PubMed, Embase, CINAHL, PsycInfo, and Sociological Abstracts. Eligibility criteria included: reporting a PrEP related result among FSW and/or WWUD aged 18 + ; peer-reviewed; and published in English between 2012 and 2018. Our search identified 1365 studies; 26 met eligibility requirements, across the following groups: FSW (n = 14), WWUD (n = 9) and FSW-WWUD (n = 3). Studies report on at least one PrEP outcome: awareness (n = 12), acceptability (n = 16), uptake (n = 4), and adherence (n = 8). Specific barriers span individual and structural levels and include challenges to daily adherence, cost, and stigma. Combining health services and long-acting PrEP formulas may facilitate better PrEP uptake and adherence. The limited number of studies indicates a need for more research.
Collapse
|
20
|
Annequin M, Villes V, Delabre RM, Alain T, Morel S, Michels D, Schmidt AJ, Velter A, Rojas Castro D. Are PrEP services in France reaching all those exposed to HIV who want to take PrEP? MSM respondents who are eligible but not using PrEP (EMIS 2017). AIDS Care 2020; 32:47-56. [PMID: 32189518 DOI: 10.1080/09540121.2020.1739219] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is fully reimbursed by the French health insurance system since 2016. However, uptake of PrEP is slower than expected and little is known about men who have sex with men (MSM) who are eligible for PrEP according to French guidelines, but not using it. This study aims to (1) assess and describe MSM that are eligible to PrEP but not using it, and (2) identify potential individual and structural barriers of PrEP uptake among eligible MSM who are aware and intend to take PrEP. Data from EMIS-2017, a cross-sectional internet survey among gay, bisexual, and other MSM, were used. Among 7965 respondents without diagnosed HIV, 9.2% were PrEP users. Among 7231 non-PrEP users, 35.2% were eligible to PrEP and 15.2% were eligible, aware and intended to take PrEP. Eligible MSM who are not using PrEP are mostly younger, students, less "out", living in small cities, using condoms more frequently but still with low self-efficacy regarding safe sex and more distant from preventive health care and information than PrEP users. Despite free PrEP availability in France, results suggest that PrEP is not fully accessible and that there is a need to increase PrEP demand and decentralize PrEP delivery.
Collapse
Affiliation(s)
- Margot Annequin
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
| | - Virginie Villes
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
| | | | - Tristan Alain
- Community-based Research Laboratory, Coalition PLUS, Pantin, France.,AIDES, Pantin, France
| | - Stéphane Morel
- Community-based Research Laboratory, Coalition PLUS, Pantin, France.,AIDES, Pantin, France
| | - David Michels
- Community-based Research Laboratory, Coalition PLUS, Pantin, France.,AIDES, Pantin, France
| | | | | | - Daniela Rojas Castro
- Community-based Research Laboratory, Coalition PLUS, Pantin, France.,Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| |
Collapse
|
21
|
Swann G, Newcomb ME, Crosby S, Mroczek DK, Mustanski B. Historical and Developmental Changes in Condom Use Among Young Men Who Have Sex with Men Using a Multiple-Cohort, Accelerated Longitudinal Design. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1099-1110. [PMID: 30888554 PMCID: PMC6532987 DOI: 10.1007/s10508-019-1407-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/04/2019] [Accepted: 01/21/2019] [Indexed: 06/09/2023]
Abstract
Young men who have sex with men (YMSM) have the highest HIV incidence in the U.S. The last 5 years has seen emergence of new methods for HIV prevention and societal shifts in gay rights. It is important to understand if there have been generational shifts in condom use during the developmental transition from adolescents to young adulthood. To disentangle history from development, we require a multiple-cohort, longitudinal design-a methodology never before applied to study YMSM. We followed three cohorts of YMSM recruited in 2007, 2010, and 2015 (N = 1141) from the ages of 17-26 years and modeled their longitudinal change over time in counts of anal sex acts and the ratio of condomless anal sex (CAS) acts to anal sex acts using latent curve growth modeling. We found that there was no significant developmental change in raw counts of anal sex acts, but there was a significant decline in the ratio of anal sex acts that were condomless. We also found significantly different patterns for ratio of CAS acts for the 2015 cohort. The 2015 cohort reported a significantly lower ratio of CAS acts at age 17, but significantly higher growth in ratio of CAS acts over development. The present study suggests that YMSM recruited in 2015 have very different trajectories of CAS compared to previous cohorts, including lower risk in late adolescence, but with the potential for higher risk after the transition into adulthood.
Collapse
Affiliation(s)
- Gregory Swann
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL, USA
| | - Michael E Newcomb
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL, USA
| | - Shariell Crosby
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL, USA
| | - Daniel K Mroczek
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Department of Psychology, Northwestern University Weinberg College of Arts & Sciences, Evanston, IL, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL, USA.
| |
Collapse
|