The Association Between Disclosure of Same Sex Behavior to Healthcare Providers and PrEP Awareness Among BMSM in Baltimore

Evaluating Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes: Quantitative Findings from the Ryan White HIV/AIDS Program Special Projects of National Significance Black Men Who Have Sex with Men Initiative

The Black Men who have Sex with Men (MSM) Initiative was implemented at eight sites to engage and retain Black MSM in HIV medical care and supportive services (SS) by addressing their behavioral health (BH) care needs. Using a pre-post design and generalized logistic mixed-effects models adjusting for patient-level random effects, site, baseline age, and baseline mental health status, we evaluated whether participants experienced increased postintervention attainment of (1) Awareness of HIV medical care, BH care, and SS; (2) Screening, referral, linkage, receipt, and engagement in HIV care, BH care, and SS; and (3) Retention, antiretroviral therapy prescription, and suppressed viral load. Among 758 evaluated participants, the proportion of participants who were aware of, screened for, screened positive for, and referred to BH and SS, retention in care (72% to 79%), and viral load suppression (68% to 75%) increased between baseline and postintervention. Among participants who screened positive and received BH services were statistically more likely to be linked to [OR, 1.34 (95% CI: 1.08-1.66)] and retained in [OR, 1.36 (95% CI: 1.00-1.83)] care. Among those who screened positive and received SS were statistically more likely to be retained in care [OR, 1.54 (95% CI: 1.07-2.22)]. Measures of linkage to care declined significantly during the study period, perhaps because of COVID-19 that delayed in-person care. This study suggests that interventions designed to increase utilization of BH services and SS can be effective at improving retention in care and viral load suppression among Black MSM, at least among those currently using HIV services.

Implementation of Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes for Black Men who have Sex with Men: Protocol for the SPNS Black MSM Initiative (Preprint)

Background

The HIV epidemic in the United States disproportionately affects Black communities. Nearly half of Black men who have sex with men (MSM) will be diagnosed with HIV in their lifetime. There is a significant unmet need for behavioral health care services among Black MSM, and untreated behavioral health needs make it less likely the person is retained in HIV care.

Objective

This paper offers a description of the Implementation of Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes for Black Men who have Sex with Men (Black MSM) Initiative, a program to integrate clinical care and behavioral health/supportive services for Black MSM with HIV. The Black MSM Initiative is funded through the Health Resources & Services Administration HIV/AIDS Bureau Ryan White HIV/AIDS Program (RWHAP) Part F Special Projects of National Significance.

Methods

The components of the Black MSM Initiative include providing technical assistance to 8 Initiative demonstration sites; conducting a comprehensive and culturally responsive, mixed method, multisite evaluation; and disseminating evaluation findings and lessons learned to the RWHAP community.

Results

As of December 31, 2020, demonstration sites enrolled 809 clients in the multisite evaluation. The research team will continue evaluation data collection through December 2021 for analysis and dissemination starting in 2022. The Black MSM Initiative fully supports the US Department of Health and Human Services’ Ending the HIV Epidemic in the United States Initiative.

Conclusions

In order to succeed, providers and programs will need to engage populations traditionally considered “hard to reach,” like many people receiving RWHAP services. Findings and lessons learned from the Black MSM Initiative will expand the tool kit of solutions to support and retain Black MSM in HIV care, furthering the goals of the Ending the HIV Epidemic Initiative and the RWHAP.

International Registered Report Identifier (IRRID)

DERR1-10.2196/36025

Same-sex behavior disclosure to health care providers associated with greater awareness of pre-exposure prophylaxis

BACKGROUND

This study aimed to determine whether the disclosure of same-sex behavior to health care providers (HCPs) is associated with higher rates of prior human immunodeficiency virus (HIV) testing experience and greater awareness of immediate antiretroviral therapy (ART), Undetectable = Untransmittable (U=U), and pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM).

METHODS

We conducted a cross-sectional survey among 689 adult males in Chengdu, China who self-reported having had anal intercourse with at least one man in the past 6 months. We measured same-sex behavior disclosure to three types of HCPs (hospital clinicians, community-based organization peer educators, and Center for Disease Control and Prevention public health specialists), and the awareness of immediate ART, U=U, and PrEP.

RESULTS

Of the 689 enrolled participants, 31.4% had disclosed their same-sex behavior to some or all of the clinicians, 83.9% had done so to the peer educators, and 56.8% had done so to the public health specialists. Approximately four in five (82.1%) of the participants had ever been tested for HIV. The awareness rate was 84.8% for immediate ART, 20.2% for U=U, and 50.7% for PrEP. After controlling for significant background variables, same-sex behavior disclosure to clinicians was associated with greater awareness of PrEP (adjusted odds ratio [AOR] = 1.64; 95% confidence interval [CI]: 1.08-2.48), but similar findings were not reported regarding disclosure to peer educators or public health specialist. Same-sex behavior disclosure to any types of HCPs was not associated with HIV testing experience, and awareness of immediate ART or U=U.

CONCLUSIONS

The rates of same-sex behavior disclosure varied with different types of HCPs. Disclosure to clinicians was associated with greater awareness of PrEP, but not awareness of immediate ART or U=U.

PrEP Willingness and Adherence Self-Efficacy Among Men Who have Sex with Men with Recent Condomless Anal Sex in Urban China

This study investigates PrEP willingness, adherence self-efficacy and potential impact of PrEP among HIV-negative, Chinese men who have sex with men (MSM; n = 622) with recent condomless anal sex. Facilitative factors of PrEP willingness included migrant status, sexual risk, and prior PrEP use, whereas barriers included concerns over being treated as an HIV/AIDS patient, recent HIV testing, identity concealment, and HIV prevention service usage. Adherence self-efficacy was associated with PrEP knowledge and confidence in PrEP efficacy of HIV prevention. A total of 39.3% anticipated increase in sex partners, 25.6% anticipated decrease in condom use, and 38.0% anticipated increased HIV testing following PrEP uptake. Results suggest a two-step approach to (1) promote PrEP acceptance among Chinese MSM and (2) enhance adherence and risk monitoring among PrEP-willing MSM. Efforts to reduce stigma, incorporate PrEP in the HIV prevention continuum, and increase PrEP knowledge will be crucial to optimize PrEP implementation.

"That's kind of like the big struggle right now is can we get PrEP?": Facilitators and Barriers to PrEP Uptake Among Active Duty Gay and Bisexual Men

Introduction

The US Military is experiencing a rise in HIV infections among gay and bisexual men (GBM) serving on active duty, yet little is known about this population's uptake of pre-exposure prophylaxis (PrEP), an evidence-based intervention for HIV prevention. This mixed methods study examines the facilitators and barriers to PrEP access and uptake among active duty GBM.

Methods

Active duty GBM were recruited using respondent-driven sampling (2017 and 2018). Participants (n = 93) answered quantitative survey questions on PrEP interest and accessibility. Another set of participants (n = 10) discussed their PrEP experiences in qualitative interviews. We conducted descriptive and bivariate analyses of quantitative data, while qualitative data were analyzed using structural and descriptive coding techniques.

Results

Approximately 71% of active duty GBM indicated interest in accessing PrEP. A greater proportion of those who disclosed (vs. did not disclose) their sexual orientation to their military doctor discussed (p < 0.001) or accessed (p = 0.017) PrEP. The following qualitative themes emerged: (1) providers' negative views and knowledge gaps related to PrEP; (2) lack of a systems approach to PrEP access; (3) confidentiality concerns; and (4) reliance on peer networks for PrEP guidance and support.

Conclusions

Study results indicate that active duty GBM are interested in and want to discuss PrEP with their military doctors, but gaps in providers' PrEP-related knowledge and skills, as well as mistrust in the military health care system, remain.

Policy Implications

A system-wide approach that addresses confidentiality concerns and removes procedural barriers to PrEP access is recommended to improve PrEP uptake in this population.

Health care access, health care utilisation and sexual orientation disclosure among Black sexual minority men in the Deep South

Background Black gay, bisexual, and other sexual minority men (BSMM) account for 39.1% of new HIV infections among men who have sex with men and 78.9% of newly diagnosed cases among Black men. Health care access, health care utilisation and disclosing sexuality to providers are important factors in HIV prevention and treatment. This study explored the associations among sexual orientation disclosure, health care access and health care utilisation among BSMM in the Deep South.

METHODS

Secondary analysis of existing data of a population-based study in Jackson, Mississippi, and Atlanta, Georgia, was conducted among 386 BSMM. Poisson regression models were used to estimate prevalence ratios (PR) between sexual orientation disclosure to healthcare providers, health care access and health care utilisation.

RESULTS

The mean (±s.d.) age of participants was 30.5 ± 11.2 years; 35.3% were previously diagnosed with HIV and 3.7% were newly diagnosed with HIV. Two-thirds (67.2%) self-identified as homosexual or gay; 70.6% reported being very open about their sexual orientation with their healthcare providers. After adjustment, BSMM who were not open about their sexual orientation had a lower prevalence of visiting a healthcare provider in the previous 12 months than those who were very open with their healthcare provider (PR 0.42; 95% confidence interval 0.18-0.97).

CONCLUSION

Clinics, hospitals and other healthcare settings should promote affirming environments that support sexuality disclosure for BSMM.

Who Do You Reach? A Norwegian Pilot Project on HIV Self-Testing that Targeted Men Who Have Sex with Men

HIV self-testing reduces barriers associated with other HIV testing services, such as concerns about confidentiality and inconvenience. This article demonstrates who might benefit from this approach to HIV testing by describing the characteristics of men who have sex with men (MSM) who took interest in a Norwegian pilot project on HIV self-testing. Of the MSM users, 27% reported that they had never been tested for HIV. Not disclosing one's same-sex sexuality, particularly among non-gay-identified MSM, was associated with a higher probability of never having been tested for HIV and choosing to test with an HIV self-test because of its anonymity. Never having been tested for HIV was also associated with a higher probability of choosing to test with an HIV self-test due to anonymity. The results suggest that the HIV self-tests' ability to reach MSM who otherwise would not be tested is partly because it is an anonymous HIV testing alternative.