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Shah HS, Serrano PA, Phillips Ii G. Adaptation and Reach of a Pre-Exposure Prophylaxis Social Marketing Campaign for Latino, Latina, and Latinx Populations: Development Study. JMIR Form Res 2024; 8:e52842. [PMID: 39018099 DOI: 10.2196/52842] [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: 09/17/2023] [Revised: 03/16/2024] [Accepted: 04/24/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Latino, Latina, and Latinx (Latino/a/x) individuals remain disproportionately impacted by HIV, particularly sexual minority men and transgender women. Pre-exposure prophylaxis (PrEP) is an effective means of biomedical HIV prevention, but awareness and uptake remain low among marginalized Latino/a/x populations. Social marketing campaigns have demonstrated promise in promoting PrEP in other populations but are poorly studied in Latino/a/x sexual minority men and transgender women. OBJECTIVE This study aims to (1) adapt and pilot a PrEP social marketing campaign tailored to Latino/a/x populations with a focus on sexual minority men and transgender women through community-based participatory research (CBPR) and (2) evaluate the reach and ad performance of the adapted PrEP social marketing campaign. METHODS We used the ADAPT-ITT (assessment, decision, adaptation, production, topical experts-integration, training, and testing) framework for adapting evidence-based interventions for new settings or populations. This paper presents how each phase of the ADAPT-ITT framework was applied via CBPR to create the PrEPárate ("Be PrEPared") campaign. Key community engagement strategies included shared ownership with community partners, focus groups to guide content, crowdsourcing to name the campaign, design by local Latino/a/x artists, and featuring local influencers as the faces of PrEPárate. We evaluated campaign reach and advertisement performance using social media platform metrics (paid and organic reach, impressions, unique clicks, and click-through rates [CTR]) and website use statistics from Google Analytics. RESULTS The PrEPárate campaign ran in Cook County, Illinois, from April to September 2022. The campaign reached over 118,750 people on social media (55,750 on Facebook and Instagram [Meta Platforms Inc] and 63,000 on TikTok [ByteDance Ltd]). The Meta ads performed over the industry benchmark with ads featuring local transgender women (2% CTR) and cisgender sexual minority men (1.4% CTR). Of the different Grindr (Grindr Inc) ad formats piloted, the interstitial Grindr ads were the highest performing (1183/55,479, 2.13% CTR). YouTube (Google) ads were low performing at 0.11% (153/138,337) CTR and were stopped prematurely, given limits on sexual education-related content. In the first year, there were 5006 visitors to the website. CONCLUSIONS Adaptation of an existing evidence-based intervention served as an effective method for developing a PrEP social marketing campaign for Latino/a/x audiences. CBPR and strong community partnerships were essential to tailor materials and provide avenues to systematically address barriers to PrEP access. Social marketing is a promising strategy to promote PrEP among underserved Latino/a/x populations.
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Affiliation(s)
- Harita S Shah
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Pedro Alonso Serrano
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Gregory Phillips Ii
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
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2
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Watson RJ, Morgan E, Sherman J, Caba AE, Wheldon CW, Chan PA, Eaton LA. Pre-exposure prophylaxis (PrEP) use, anticipated PrEP stigma, and bisexual identity among a Black and Hispanic/Latino sexual and gender diverse sample. Behav Med 2023; 49:283-291. [PMID: 35465800 PMCID: PMC9592674 DOI: 10.1080/08964289.2022.2048249] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 11/02/2022]
Abstract
Black and Hispanic/Latino sexual minority men and gender diverse (SMMGD) individuals are disproportionately impacted by the HIV epidemic. Uptake and adherence to pre-exposure prophylaxis (PrEP) is suboptimal among SMMGD Black and Hispanic/Latino individuals, but most research has approached this population as homogenous (e.g., a group operationalized as men who have sex with men). Bisexual men are less likely to disclose their sexual identity and report more mental health problems than their gay counterparts, but there is less attention to the impact of different sexual identities on PrEP use over time. We utilized data from three waves of a national longitudinal study (2020-2021) to characterize Black and Hispanic/Latino SMMGD participants' PrEP use including: 1) PrEP uptake during the study; 2) consistent PrEP use across the study; and 3) discontinuation of PrEP use since study baseline. We found bisexual men were significantly less likely than gay men to be consistent PrEP users and were more likely to discontinue PrEP use over the course of the study. Of the sample who reported PrEP use across surveys, 10% initiated PrEP during the study period, 0% of whom were bisexual. Additionally, bisexual participants reported statistically significantly higher anticipated PrEP stigma relative to gay participants. These findings have implications for HIV prevention interventions. Given the differences in PrEP experiences as a function of sexual identity, researchers and clinicians should consider the disruptive role of stigma (both biphobia and anticipated PrEP stigma) in PrEP care and adherence.
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Affiliation(s)
- Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Ethan Morgan
- College of Nursing, The Ohio State University, Columbus, OH, USA
- Infectious Disease Institute, The Ohio State University, Columbus, OH, USA
| | - Jessica Sherman
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Antonia E Caba
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Christopher W Wheldon
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Philip A Chan
- Department of Medicine, Brown University, Providence, RI, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
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Valente PK, Bauermeister JA, Lin WY, Silva DTD, Hightow-Weidman L, Drab R, Mayer KH, Operario D, Rusley J, Biello KB. Preferences Across Pre-Exposure Prophylaxis Modalities Among Young Men Who Have Sex with Men in the United States: A Latent Class Analysis Study. AIDS Patient Care STDS 2022; 36:431-442. [PMID: 36367995 PMCID: PMC9910107 DOI: 10.1089/apc.2022.0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Access to daily oral pre-exposure prophylaxis (PrEP) is suboptimal among young cisgender men who have sex with men (YMSM) in the United States. Next-generation modalities that do not involve daily oral regimens may mitigate some of the barriers to PrEP use. We identified latent classes of YMSM based on health care decision-making patterns and examined associations between latent classes and access to health care and PrEP modality preferences (i.e., daily and event-driven oral, rectal douches, broadly neutralizing antibodies, subcutaneous implants, and an injectable). Between October 2020 and June 2021, we administered an online survey to 737 YMSM. Latent class analysis (LCA) identified groups of YMSM based on communication with providers, stigma and mistrust in health care, and autonomy in sexual health decisions. Logistic regression examined associations between class membership and health care access, and exploded logit regression examined associations between class membership and ranked PrEP modality preferences. LCA identified three classes: shared decision-making (high communication with providers and high autonomy); provider-led decision-making (high communication and low autonomy); and patient-driven decision-making (low communication and high autonomy). Shared decision-making was associated with higher access to health care in comparison with the other classes. Across all classes, YMSM preferred daily oral PrEP over all next-generation PrEP modalities. Preferences for daily oral PrEP over next-generation PrEP modalities were particularly marked among the patient-driven decision-making class. Shared decision-making is associated with access to health care and HIV prevention and higher acceptability of next-generation PrEP modalities, and should be considered as part of future interventions to promote use of daily oral and next-generation PrEP.
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Affiliation(s)
- Pablo K. Valente
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | | | - Willey Y. Lin
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel Teixeira Da Silva
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa Hightow-Weidman
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ryan Drab
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Don Operario
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Jack Rusley
- School of Public Health, Brown University, Providence, Rhode Island, USA
- Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Katie B. Biello
- School of Public Health, Brown University, Providence, Rhode Island, USA
- Fenway Institute, Fenway Health, Boston, Massachusetts, USA
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Budhwani H, Yigit I, Maragh-Bass AC, Rainer CB, Claude K, Muessig KE, Hightow-Weidman LB. Validation of HIV Pre-Exposure Prophylaxis (PrEP) Medication Scales with Youth on PrEP: PrEP Confidence Scale and PrEP Difficulties Scale. AIDS Patient Care STDS 2022; 36:443-450. [PMID: 36306520 PMCID: PMC9700336 DOI: 10.1089/apc.2022.0072] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) is a lifesaving medical intervention that protects against human immunodeficiency virus (HIV), but to date, PrEP uptake has been limited. PrEP utilization and adherence among youth, including stigmatized and highly vulnerable young sexual and gender minorities, have been exceptionally low across all regions, leading to preventable HIV transmission. Considering the scientific value of measuring and understanding predictors or associations of PrEP adherence, our study team validated two scales: a PrEP Difficulties Scale and a PrEP Confidence Scale tested within the Adolescent Trials Network P3 study (2019-2021). Data from sexual and gender minorities who were prescribed PrEP across nine domestic sites were evaluated (N = 235). Descriptive statistics, exploratory factor analysis, and correlation coefficients are reported herein. Results for the PrEP Difficulties Scale yielded a four-factor solution (Disclosure, Health Effects, Logistics, and Cost), and results for the PrEP Confidence Scale produced a three-factor solution (Scheduling, Distraction, and Planning). Factor loadings and Cronbach's alphas suggested good internal consistency for both scales. PrEP Confidence Scale subscales were correlated with PrEP adherence, and subscales of both scales were associated with dimensions of social support and PrEP-related stigma. Given the persistence of preventable HIV infections among key populations, multi-level barriers and facilitators to medication adherence, and expansion of PrEP modalities, the PrEP Difficulties Scale and PrEP Confidence Scale have the potential to enhance intervention, exploratory, and mechanistic HIV prevention research. ClinicalTrials.gov Identifier: NCT03320512.
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Affiliation(s)
- Henna Budhwani
- Center of Population Sciences for Health Equity, College of Nursing, Florida States University (FSU), Tallahassee, Florida, USA
| | - Ibrahim Yigit
- Department of Psychology, Faculty of Arts and Sciences, TED University, Ankara, Turkey
| | - Allysha C. Maragh-Bass
- Behavioral, Epidemiological, Clinical Sciences Division, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Crissi B. Rainer
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA
| | - Kristina Claude
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA
| | - Kathryn E. Muessig
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA
| | - Lisa B. Hightow-Weidman
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA
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Jaramillo J, Pagkas-Bather J, Waters K, Shackelford LB, Campbell RD, Henry J, Grandberry V, Ramirez LF, Cervantes L, Stekler J, Andrasik MP, Graham SM. Perceptions of Sexual Risk, PrEP Services, and Peer Navigation Support among HIV-Negative Latinx and Black Men who have Sex with Men (MSM) Residing in Western Washington. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:1058-1068. [PMID: 36387840 PMCID: PMC9642978 DOI: 10.1007/s13178-021-00595-6] [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: 05/23/2021] [Indexed: 05/27/2023]
Abstract
Introduction HIV PrEP (pre-exposure prophylaxis) is underutilized among Latinx and Black men who have sex with men (MSM) in the United States. Although peer navigation approaches may increase PrEP uptake and adherence, it remains unclear what strategies work best for MSM of color. Methods From July 2017 to August 2018, we conducted semi-structured in-depth interviews with 25 purposively sampled Latinx and Black cisgender MSM to evaluate how the intersectionality of race/ethnicity, sexual orientation, and other identities influenced men's views on PrEP in general and on peer navigation specifically. Thematic analysis was used to identify and analyze emergent themes. Results Emergent themes included: (1) awareness of vulnerability in intimate relationships; (2) barriers to PrEP initiation including perceived side effects, stigma, and financial concerns; (3) a wish to connect with other Latinx and Black MSM in a health and prevention space; and (4) the desire for peer matching based on identity considerations and lived experience. Younger men and Spanish-speaking Latinx men were most interested in peer navigation to access PrEP, while bisexual men had confidentiality concerns. Conclusions In our study, Latinx and Black MSM viewed peer navigation services favorably, especially if they addressed men's desire to connect with other MSM of color. Policy Implications Developing culturally-congruent peer navigation programming could help improve PrEP uptake and care engagement for Latinx and Black MSM. Programs should recruit peers from the racial/ethnic minority communities most impacted by HIV and prioritize matching peers to clients based on identity concerns, needs, and preferences.
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Affiliation(s)
- Jahn Jaramillo
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Jade Pagkas-Bather
- Department of Medicine, Section of Infectious Diseases & Global Health, The University of Chicago, Chicago, Illinois, USA
| | - Kimiam Waters
- College of Arts & Sciences, University of Washington, Seattle, WA, USA
| | | | | | - Jsani Henry
- Public Health- Seattle & King County HIV/STD Program, Seattle, WA, USA
| | | | | | | | - Joanne Stekler
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Michele P. Andrasik
- Department of Global Health, University of Washington, Seattle, WA, USA
- Fred Hutchinson Vaccine and Infectious Disease Division, Seattle, WA, USA
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Susan M. Graham
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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Prevalence and Risk Factors of PrEP Use Stigma Among Adolescent Girls and Young Women in Johannesburg, South Africa and Mwanza, Tanzania Participating in the EMPOWER Trial. AIDS Behav 2022; 26:3950-3962. [PMID: 35776254 PMCID: PMC9640431 DOI: 10.1007/s10461-022-03721-6] [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: 05/13/2022] [Indexed: 11/01/2022]
Abstract
Adolescent girls and young women (AGYW) in sub-Saharan Africa may benefit from pre-exposure prophylaxis (PrEP), yet stigma may limit PrEP acceptance and continuation. We examined factors associated with PrEP use stigma among 307 participants of the EMPOWER trial (2016-2018), an unblinded randomized controlled trial among HIV-negative, AGYW, aged 16-24, in South Africa and Tanzania. The 6-item, brief-PrEP use stigma scale (B-PSS) had high internal reliability. At the end of the trial, 34.2% of study participants reported any PrEP use stigma. Three latent classes were observed, reflecting low (46.9%), medium (31.9%), and high (21.2%) reported PrEP use stigma. Disclosure of PrEP use to sexual partner and belief that PrEP prevents HIV were associated with less reported PrEP use stigma. Conversely, participants who reported fear and shame about people living with HIV were more likely to report PrEP use stigma. Our validated tool and findings will enable practitioners to identify AGYW at high risk of PrEP use stigma who may benefit from additional support.Pan African clinical trials registry PACTR202006754762723, 5 April 2020, retrospectively registered.
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Reyniers T, Zimmermann HML, Davidovich U, Vuylsteke B, Laga M, Hoornenborg E, Prins M, De Vries HJC, Nöstlinger C. The social meanings of PrEP use - A mixed-method study of PrEP use disclosure in Antwerp and Amsterdam. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1311-1327. [PMID: 33997998 DOI: 10.1111/1467-9566.13283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 03/31/2021] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
Pre-Exposure Prophylaxis (PrEP) is a novel HIV prevention tool. PrEP stigma is a frequently reported barrier, while social disclosure of PrEP use may be an important facilitator. We explored how PrEP users managed PrEP use disclosure using a symbolic interactionist approach. We interviewed 32 participants from two PrEP demonstration projects (Be-PrEP-ared, Antwerp; AMPrEP, Amsterdam). We validated qualitative findings through Be-PrEP-ared questionnaire data. A minority of participants had received negative reactions on PrEP. The way PrEP use was disclosed was highly dependent on the social situation. In a sexual context among MSM, PrEP use was associated with condomless sex. Friends endorsed PrEP use as a healthy choice, but also related it to carelessness and promiscuity. It was seldom disclosed to colleagues and family, which is mostly related to social norms dictating when it is acceptable to talk about sex. The study findings reveal that PrEP stigma experiences were not frequent in this population, and that PrEP users actively manage disclosure of their PrEP user status. Frequent disclosure and increased use may have helped PrEP becoming normalised in these MSM communities. To increase uptake, peer communication, community activism and framing PrEP as health promotion rather than a risk-reduction intervention may be crucial.
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Affiliation(s)
- Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Hanne M L Zimmermann
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Social Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marie Laga
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Amsterdam UMC, Amsterdam Institute for Infection and Immunity (AI&II), University of Amsterdam, Amsterdam, The Netherlands
| | - Henry J C De Vries
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Dermatology, Amsterdam UMC, Amsterdam Institute for Infection and Immunity (AI&II), University of Amsterdam, Amsterdam, The Netherlands
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PrEP4Love: The Role of Messaging and Prevention Advocacy in PrEP Attitudes, Perceptions, and Uptake Among YMSM and Transgender Women. J Acquir Immune Defic Syndr 2020; 83:450-456. [PMID: 31939870 DOI: 10.1097/qai.0000000000002297] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Despite high efficacy, use of pre-exposure prophylaxis (PrEP) remains low among young men who have sex with men (MSM) and transgender women (TW), primarily because of barriers such as stigma and resource awareness. We evaluated a social marketing campaign known as PrEP4Love that works to eliminate PrEP stigma; and awareness gaps through targeted advertising. SETTING Chicago, Illinois. METHODS Participants were enrolled within a cohort study of young MSM and TW (RADAR). Data were collected between June 2017 and April 2018 from HIV-negative individuals attending a follow-up visit. Surveys assessed demographics, PrEP attitudes and perceptions, and PrEP4Love campaign awareness. Associations between PrEP4Love awareness and PrEP perceptions, uptake, and behaviors were assessed using multiple logistic regression controlling for age, race/ethnicity, gender, sexual identity, and ever having used PrEP. RESULTS Of 700 participants, the majority (75.9%) indicated seeing PrEP4Love ads in Chicago. Those who had seen ads were more likely to be out to their providers (odds ratio = 1.95; 95% confidence interval: 1.17 to 3.23) than those who had not, and those who had conversations were significantly more likely to have initiated the conversation themselves. Individuals who had seen ads were more likely to have taken PrEP in the last 6 months (odds ratio = 1.87; 95% confidence interval: 1.15 to 3.16) and more likely to believe their friends and the general public approved of and used PrEP. CONCLUSION Social marketing campaigns are promising interventions that have the potential to alleviate barriers to HIV prevention, particularly among MSM and TW. Future research should evaluate the impact of these initiatives at multiple time points.
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Social-Environmental Resilience, PrEP Uptake, and Viral Suppression among Young Black Men Who Have Sex with Men and Young Black Transgender Women: the Neighborhoods and Networks (N2) Study in Chicago. J Urban Health 2020; 97:728-738. [PMID: 32468507 PMCID: PMC7560645 DOI: 10.1007/s11524-020-00425-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Young black men who have sex with men (YBMSM) and young black transgender women (TGW) have experienced a stark disparity in HIV prevention and care. Resilience, collective resources to adapt stressors or adversities, may improve HIV prevention and care outcomes. The present study investigated the association of resilience-based factors with PrEP uptake and viral suppression from a socioecological perspective among YBMSM and young black TGW. Data were from the baseline cycle of the Neighborhoods and Networks (N2) Study, an ongoing cohort study of 16-34-year-old YBMSM and young black TGW in Chicago (n = 324). Confidant network-level and neighborhood affiliation variables were created to measure the social-environmental context of resilience. All analyses were stratified by participants' HIV status (184 HIV-negative participants and 140 HIV-positive participants). Among HIV-negative participants, having a parental figure within an individual's confidant network was significantly associated with a greater likelihood of PrEP use. Among HIV-positive participants, confidant network members' awareness of an individual's HIV status was associated with viral suppression. Social support resources from confidant networks could improve HIV prevention and care engagement among YBMSM and young black TGW. Understanding the social and environmental contexts of resilience resource is critical for HIV prevention and care engagement.
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Phillips G, Feinstein BA, Levy M, Kuo I, Glick SN, Fields SD, Dyer TV, Felt D, Magnus M. Changes in Sexual and Gender Identity and Their Associations with Internalized Homophobia Among Black Men Who Have Sex with Men in the HPTN 061 BROTHERS Cohort. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2375-2387. [PMID: 31897832 PMCID: PMC7329594 DOI: 10.1007/s10508-019-01618-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 06/02/2023]
Abstract
Sexual and gender identity have frequently been assessed in public health research as static states. However, a substantial and growing body of evidence indicates that both identities may have greater potential for change over time than once supposed. Despite this evidence, research into adult identity change remains relatively limited. Using longitudinal data from 1553 Black men who have sex with men (BMSM) aged 18-68 years and recruited from study locations in six major cities across the country, we examined changes in sexual and gender identities over a period of 12 months. The results showed that sexual and gender identity did indeed change among adult BMSM. Additionally, we explored internalized homophobia (IH) as a potential driver of identity change and found that IH significantly impacts the degree and direction of change, with individuals who reported higher baseline IH more likely to demonstrate a shift toward a heterosexual/straight identity at 6 and 12 months. The results are discussed in light of what is known and unknown regarding identity change, and potential avenues for future research are explored.
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Affiliation(s)
- Gregory Phillips
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave., #14-043, Chicago, IL, 60611, USA.
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA.
| | - Brian A Feinstein
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Matthew Levy
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Irene Kuo
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Sara N Glick
- Division of Allergy and Infectious Diseases, School of Medicine, University of Washington, Seattle, WA, USA
| | - Sheldon D Fields
- School of Health Professions, New York Institute of Technology, Old Westbury, NY, USA
| | - Typhanye V Dyer
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
| | - Dylan Felt
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave., #14-043, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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Connolly MD, Dankerlui DN, Eljallad T, Dodard-Friedman I, Tang A, Joseph CL. Outcomes of a PrEP Demonstration Project with LGBTQ Youth in a Community-Based Clinic Setting with Integrated Gender-Affirming Care. Transgend Health 2020; 5:75-79. [PMID: 32656351 PMCID: PMC7347018 DOI: 10.1089/trgh.2019.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Tony Eljallad
- Department of Pediatrics, Henry Ford Health System, Detroit, Michigan, USA
| | - Isadore Dodard-Friedman
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Amy Tang
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Christine L.M. Joseph
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
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Westmoreland DA, Patel VV, D’Angelo AB, Nash D, Grov C. Sociocultural influences on attitudes towards pre-exposure prophylaxis (PrEP), history of PrEP use, and future PrEP use in HIV-vulnerable cisgender men who have sex with men across the U.S. ANNALS OF LGBTQ PUBLIC AND POPULATION HEALTH 2020; 1:128-158. [PMID: 34296211 PMCID: PMC8294708 DOI: 10.1891/lgbtq-2020-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Despite its proven effectiveness in reducing HIV transmission, pre-exposure prophylaxis (PrEP) use remains low. This study used data from a 2017-2018 U.S. national cohort to investigate social influences on PrEP experience and future PrEP use among cisgender men who have sex with men. We used descriptive statistics and multivariable logistic analyses to examine social influences (e.g., how participants heard about PrEP and number of persons they knew taking PrEP) associated with each previous PrEP use and intentions to use PrEP. Among participants who knew of PrEP, commonly reported ways of first hearing about PrEP were through social media (27.4%) and friends (26.8%). These were also cited top influences on participants' current attitudes toward PrEP (friends 23.5%, social media 22.1%). Multivariable logistic regression analyses found that knowing more people taking PrEP was associated with increased odds of previously using PrEP and intending to use PrEP. Friends and social media were common and influential sources of information regarding PrEP. Results suggest that tapping into these social connections may effectively disseminate public health messaging about PrEP and encourage use among key populations to reduce HIV burden.
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Affiliation(s)
- Drew A. Westmoreland
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
| | - Viraj V. Patel
- Division of General Internal Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Alexa B. D’Angelo
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
- CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Denis Nash
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
- CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Christian Grov
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
- CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
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