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McQuade E, Sánchez H, Hidalgo J, Cabello R, Fernandez R, Jones J, Duerr A, Lankowski A. HIV Risk Behaviors and the Use of Geosocial Networking Dating Apps among Men Who have Sex with Men and Transgender Women in Lima, Peru: a Cross-Sectional Study. AIDS Behav 2024:10.1007/s10461-024-04362-7. [PMID: 38755430 DOI: 10.1007/s10461-024-04362-7] [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: 04/30/2024] [Indexed: 05/18/2024]
Abstract
Geosocial networking dating apps (GSN apps) are an increasingly widespread technology used by populations throughout the world to facilitate sexual encounters. Studies from a variety of settings suggest a possible association between GSN app use and HIV risk behaviors, including among sexual and gender minority populations such as men who have sex with men (MSM) and transgender women (TW). However, it remains unclear to what extent GSN apps play a causal role. We explored the relationship between GSN app use and sexual risk behaviors among MSM and TW in Lima, Peru by analyzing data from a multi-site cross-sectional survey assessing both general and partner-specific sexual behaviors. We performed bivariate analysis to estimate the association of GSN app use with different individual and partner-specific factors, then fit multivariable regression models adjusting for age and education. Among 741 total participants (698 MSM, 43 TW), 64% met at least one sex partner in the prior three months using a GSN app. GSN app users were significantly more likely to report engaging in HIV risk behaviors in general, including condomless receptive anal sex, group sex, transactional sex, and sex under the influence of alcohol or drugs. Having condomless anal sex with a given partner was not associated with meeting that partner via GSN app. These findings highlight GSN app users as a particularly vulnerable subpopulation among MSM and TW in Lima. GSN apps could provide a useful vehicle for targeted HIV prevention efforts for priority populations in Peru.
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Affiliation(s)
| | | | | | | | | | - Jeb Jones
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Ann Duerr
- Vaccine & Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Alexander Lankowski
- Vaccine & Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
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Chapin-Bardales J, Algarin AB, Baruch-Dominguez R, Smith LR, Hernandez-Avila M, Sanchez T. Awareness, willingness to use pre-exposure prophylaxis, and use of post-exposure prophylaxis for HIV prevention among men who have sex with men in Mexico. Int J STD AIDS 2024:9564624241248254. [PMID: 38688306 DOI: 10.1177/09564624241248254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Little is known about awareness and willingness to use or purchase HIV pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in Mexico. METHODS MSM in Mexico were recruited via advertisements on online social venues to participate in Encuesta de Sexo Entre Hombres, an online behavioral survey. Awareness of PrEP, willingness to take PrEP if available for free, willingness to purchase PrEP, awareness of post-exposure prophylaxis (PEP), and ever PEP use were assessed in descriptive and multivariate analyses. RESULTS Overall, 54.8% (4588/8376) of participants were aware of PrEP. Of those aware, 77.6% were willing to use PrEP if free and 52.6% were willing to purchase PrEP, generally at a maximum monthly cost of $500MXP. Both awareness of and willingness to use PrEP if free or for purchase were significantly greater among MSM who were younger, and varied by demographic, recent healthcare use, and behavioral risk factors. Only 8.2% had ever used PEP, which was highly associated with healthcare utilization. CONCLUSIONS About half of Mexican MSM were aware of PrEP. The majority of those aware were willing to use PrEP if available for free and many were willing to purchase PrEP at low cost. Leveraging demographic, recent healthcare use, and behavioral risk characteristics associated with awareness and willingness to use PrEP could be useful in designing future PrEP programs for MSM in Mexico. Expanding healthcare settings in which PEP is available may also support identifying candidates for PrEP and scaling up PrEP implementation.
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Affiliation(s)
| | - Angel B Algarin
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University-Downtown Campus, Phoenix, AZ, USA
| | | | - Laramie R Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | | | - Travis Sanchez
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
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de Sousa ÁFL, Nunes Ribeiro CJ, Santos GRDS, de Oliveira LB, Camargo ELS, Lima SVMA, de Oliveira Sena IV, Bezerra-Santos M, Batista OMA, Reis de Sousa A, Mendes IAC. Intention to use PrEP among men who have sex with men and engage in chemsex: an international descriptive study. Ther Adv Infect Dis 2023; 10:20499361231206918. [PMID: 37900982 PMCID: PMC10612445 DOI: 10.1177/20499361231206918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) is a valuable tool in the response to the HIV epidemic, recommended for groups with a higher risk of HIV infection, such as men who have sex with men (MSM), particularly in the context of high-risk sexual behavior such as chemsex. Purpose This study aimed to analyze the prevalence and factors associated with the intention to use PrEP among MSM who engage in chemsex in Brazil and Portugal. Methods This was a cross-sectional study of a secondary dataset from a larger study conducted between January 2020 and May 2021 throughout Brazil and Portugal involving 1852 MSM who engage in chemsex. An initial descriptive analysis was performed to calculate the absolute and relative frequencies of independent variables related to the intention to use PrEP among MSM. A multivariate regression model was developed to identify factors independently associated with the intention to use PrEP. Results Although a high level of PrEP knowledge (85.75%) was observed among MSM who engage in chemsex, the prevalence of intention to use PrEP was only 59.07%. Five variables were associated with a higher prevalence of intention to use PrEP [engaging in double penetration - adjusted prevalence ratio (aPR): 1.56, 95% CI: 1.44-1.69; being assigned female sex at birth - aPR: 1.34, 95% CI: 1.12-1.61; cruising - aPR: 1.21, 95% CI: 1.06-1.38; not using condoms - aPR: 1.20, 95% CI: 1.05-1.36; and being an immigrant - aPR: 1.16; 95% CI: 1.07-1.25], while having knowledge of postexposure prophylaxis (aPR: 0.91; 95% CI: 0.84-0.98), having a casual sexual partner (aPR: 0.86 and 0.85; 95% CI: 0.74-0.99 and 0.74-0.98), and engaging in group sex (aPR: 0.81; 95% CI: 0.73-0.90) were associated with a lower intention to use PrEP. Conclusion The intention to use PrEP among MSM who engage in chemsex was high, and several factors were associated with this intention. Understanding the factors associated with the intention to use PrEP among MSM practicing chemsex is crucial for developing targeted interventions to increase PrEP uptake in this population. The results of this study suggest that tailored approaches are necessary to promote PrEP use in this population.
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Affiliation(s)
- Álvaro Francisco Lopes de Sousa
- Hospital Sírio-Libânes, Instituto de Ensino e Pesquisa, São Paulo, Daher Cutait, 69 - Bela Vista, São Paulo - SP, 01308-060, Brazil
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Caíque Jordan Nunes Ribeiro
- Collective Health Research Center (NISC), Federal University of Sergipe, Lagarto, Sergipe, Brazil
- Graduate Program in Nursing, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | | | - Layze Braz de Oliveira
- Ribeirão Preto College of Nursing, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Shirley Verônica Melo Almeida Lima
- Collective Health Research Center (NISC), Federal University of Sergipe, Lagarto, Sergipe, Brazil
- Graduate Program in Nursing, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | | | - Márcio Bezerra-Santos
- Complex of Medical Sciences and Nursing, Universidade Federal de Alagoas, Alagoas, Brazil
| | | | - Anderson Reis de Sousa
- Graduate Program in Nursing and Health of the Nursing School, Federal University of Bahia, Salvador, Bahia, Brazil
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Eger WH, Adaralegbe A, Khati A, Azwa I, Wickersham JA, Osborne S, Shrestha R. Exploring drivers of pre-exposure prophylaxis uptake among gay, bisexual, and other men who have sex with men in Malaysia. Int J STD AIDS 2022; 33:821-828. [PMID: 35772943 PMCID: PMC10069270 DOI: 10.1177/09564624221106535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is a valuable HIV prevention strategy, particularly among men who have sex with men (MSM); however, PrEP uptake is below the threshold needed to curb the HIV epidemic among this group, especially in settings like Malaysia, where same-sex sexual behavior is illegal. METHODS A sample of 355 participants completed an online survey between June and July 2020, recruited through geosocial networking apps for MSM and social networking websites (e.g. Facebook). We used descriptive and multivariable analyses to examine correlates of PrEP use within this population. RESULTS The sample was predominantly Malay (53.5%), had monthly incomes greater than RM 3000 (USD 730) (52.7%), and a tertiary level of education (84.5%). About 80% of participants heard of PrEP prior to the survey, with significantly less (18.3%) having ever taken PrEP. In the adjusted multivariable logistic model, using drugs before or during sexual intercourse ("chemsex") (AOR: 3.37; 95% CI: 1.44-7.89), being diagnosed with a sexually transmitted infection in the last 12 months (AOR: 2.08; 95% CI: 1.13-3.85), HIV testing in the previous 6 months (AOR: 3.23; 95% CI: 1.74-5.99), and disclosure of sexual orientation (AOR: 1.85; 95% CI: 1.02-3.34) were associated with having taken PrEP in the past. CONCLUSIONS This study revealed that PrEP use among Malaysian MSM is relatively low, despite high awareness, and is associated with healthcare engagement and high-risk behaviors. These results highlight the need to tailor outreach activities for individuals at increased risk for HIV and those disengaged with the health system.
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Affiliation(s)
- William H Eger
- Department of Internal Medicine, Section of Infectious Diseases, 12228Yale School of Medicine, New Haven, CT, USA
| | - Adeleye Adaralegbe
- Department of Allied Health Sciences, 7712University of Connecticut, Mansfield, CT, USA
| | - Antoine Khati
- Department of Allied Health Sciences, 7712University of Connecticut, Mansfield, CT, USA
| | - Iskandar Azwa
- Department of Medicine, Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia.,Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Jeffrey A Wickersham
- Department of Internal Medicine, Section of Infectious Diseases, 12228Yale School of Medicine, New Haven, CT, USA.,Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Sydney Osborne
- Department of Allied Health Sciences, 7712University of Connecticut, Mansfield, CT, USA
| | - Roman Shrestha
- Department of Internal Medicine, Section of Infectious Diseases, 12228Yale School of Medicine, New Haven, CT, USA.,Department of Allied Health Sciences, 7712University of Connecticut, Mansfield, CT, USA.,Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia.,Institute for Collaboration on Health, Intervention, and Policy (InCHIP), 7712University of Connecticut, Mansfield, CT, USA
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Viamonte M, Ghanooni D, Reynolds JM, Grov C, Carrico AW. Running with Scissors: a Systematic Review of Substance Use and the Pre-exposure Prophylaxis Care Continuum Among Sexual Minority Men. Curr HIV/AIDS Rep 2022; 19:235-250. [PMID: 35701713 PMCID: PMC9279195 DOI: 10.1007/s11904-022-00608-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
Purpose of Review Patterns of sexualized drug use, including stimulants (e.g., methamphetamine) and chemsex drugs, are key drivers of HIV incidence among sexual minority men (SMM). Although pre-exposure prophylaxis (PrEP) mitigates HIV risk, there is no consensus regarding the associations of substance use with the PrEP care continuum. Recent Findings SMM who use substances are as likely or more likely to use PrEP. Although SMM who use stimulants experience greater difficulties with daily oral PrEP adherence, some evidence shows that SMM who use stimulants or chemsex drugs may achieve better adherence in the context of recent condomless anal sex. Finally, SMM who use substances may experience greater difficulties with PrEP persistence (including retention in PrEP care). Summary SMM who use stimulants and other substances would benefit from more comprehensive efforts to support PrEP re-uptake, adherence, and persistence, including delivering behavioral interventions, considering event-based dosing, and providing injectable PrEP.
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Affiliation(s)
- Michael Viamonte
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Office 1010, Miami, FL, 33136, USA
| | - Delaram Ghanooni
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Office 1010, Miami, FL, 33136, USA
| | - John M Reynolds
- Calder Memorial Library, University of Miami, FL, Miami, USA
| | - Christian Grov
- City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Office 1010, Miami, FL, 33136, USA.
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High Rates of Sexualized Drug Use or Chemsex among Brazilian Transgender Women and Young Sexual and Gender Minorities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031704. [PMID: 35162728 PMCID: PMC8835457 DOI: 10.3390/ijerph19031704] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/17/2022]
Abstract
(1) Background: We aimed to estimate sexualized drug use (SDU) prevalence and its predictors among sexual and gender minorities. (2) Methods: We used an online and on-site survey to enroll sexual/gender minorities people between October-December/2020, and multivariate logistic regression to obtain SDU correlates. (3) Results: We enrolled 3924 individuals (280 transgender women [TGW], 3553 men who have sex with men [MSM], and 91 non-binary), 29.0% currently on pre-exposure prophylaxis (PrEP). SDU prevalence was 28.8% (95% confidence interval [CI] 27.4-30.2). TGW had 2.44-times increased odds (95%CI 1.75-3.39) of engaging in SDU compared to MSM, regardless of PrEP use. PrEP use (aOR 1.19, 95%CI 1.00-1.41), South/Southeast region (aOR 1.26, 95%CI 1.04-1.53), younger age (18-24 years: aOR 1.41, 95%CI 1.10-1.81; 25-35 years: aOR 1.24, 95%CI 1.04-1.53), white race/color (aOR 1.21, 95%CI 1.02-1.42), high income (aOR 1.32, 95%CI 1.05-1.67), binge drinking (aOR 2.66, 95%CI 2.25-3.14), >5 sexual partners (aOR 1.88, 95%CI 1.61-2.21), condomless anal sex (aOR 1.49, 95%CI 1.25-1.79), self-reported sexually transmitted infection (aOR 1.40, 95%CI 1.14-1.71), and higher perceived HIV-risk (aOR 1.37, 95%CI 1.14-1.64) were associated with SDU. (4) Conclusions: TGW had the highest SDU odds. SDU may impact HIV vulnerability among key populations and should be addressed in HIV prevention approaches.
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Blair KJ, Torres TS, Hoagland B, Bezerra DR, Veloso VG, Grinsztejn B, Clark J, Luz PM. Pre-exposure prophylaxis use, HIV knowledge, and internalized homonegativity among men who have sex with men in Brazil: A cross-sectional study. LANCET REGIONAL HEALTH. AMERICAS 2022; 6:100152. [PMID: 35291206 PMCID: PMC8920052 DOI: 10.1016/j.lana.2021.100152] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Pre-exposure prophylaxis (PrEP) use in Brazil remains low despite free national access. We explored associations of HIV knowledge and internalized homonegativity with PrEP use among PrEP-eligible men who have sex with men (MSM). Methods Brazilian Hornet users completed an online, cross-sectional survey in February-March 2020. We included cis-men ≥18 years old who reported recent sex with men and were PrEP-eligible per the following: condomless anal intercourse, partner(s) living with HIV, transactional sex, and/or sexually transmitted infection. Our outcome was current PrEP use, defined by the response, "I am currently taking PrEP." Key predictors included the HIV/AIDS Knowledge Assessment (HIV-KA) and Reactions to Homosexuality Scale (RHS); higher scores indicate greater knowledge and greater internalized homonegativity, respectively. Scales were standardized for analysis. Associations with current PrEP use were estimated using adjusted odds ratios (aOR) with 95% confidence intervals (95%CI). Findings Among 2398 PrEP-eligible MSM, n = 370 (15·4%) reported current PrEP use. Increasing HIV-KA scores were associated with greater odds of PrEP use (aOR 1·70 [95%CI 1·41-2·04], p < 0·001), and increasing RHS scores with lower odds of PrEP use (aOR 0·83 [95%CI 0·73-0·96], p = 0·010). PrEP use was lower among 18-24 versus 40+-years-old MSM (aOR 0·43 [95%CI 0·27-0·69], p = 0·005), and in Black versus White/Asian respondents (aOR 0·51 [95%CI 0·31-0·85], p = 0·040). Interpretation Among PrEP-eligible Brazilian MSM, HIV knowledge was associated with increased PrEP use and internalized homonegativity with decreased use. Wider dissemination of HIV prevention knowledge and addressing stigma experienced by MSM could promote increased PrEP use. Funding National Institute of Mental Health, Fiocruz, Conselho Nacional de Desenvolvimento Científico e Tecnológico.
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Affiliation(s)
- Kevin J. Blair
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
- Department of Surgery, UCLA, 10833 Le Conte Ave, 72-227 CHS, Los Angeles, CA 90095, USA
| | - Thiago S. Torres
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Brenda Hoagland
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Daniel R.B. Bezerra
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Valdilea G. Veloso
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Jesse Clark
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Paula M. Luz
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
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Blair KJ, Segura ER, Garner A, Lai J, Ritterbusch A, Leon-Giraldo S, Guilamo-Ramos V, Lake JE, Clark JL, Holloway IW. Pre-exposure prophylaxis awareness, use, and intention to use in a regional sample of Latin American geosocial networking application users in 2018-2019. Int J STD AIDS 2021; 32:1261-1267. [PMID: 34340629 DOI: 10.1177/09564624211034618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pre-exposure prophylaxis (PrEP) access is increasing in Latin America. We explored PrEP use among Spanish-speaking, Hornet geosocial networking application users from Latin American countries with limited PrEP data via an online survey completed between December 2018 and February 2019. A total of 718 Hornet users from 10 countries were included, of whom 72.1% reported PrEP awareness. Few (5.6%) were currently taking PrEP, though 32.1% intended to take PrEP in the subsequent 6 months. PrEP awareness was lower in 18-25 year olds compared to 26+ (62.4% vs. 75.6%, aOR 0.67, [95% CI 0.46-0.97]), and higher among those living in larger versus smaller cities (74.4% vs. 58.8%, aOR 1.96, [95% CI 1.25-3.07]) or countries with at least partial versus no PrEP policy adoption (79.1% vs. 60.8%, aOR 2.20, [95% CI 1.56-3.12]). Intention to use PrEP was higher among PrEP-eligible respondents (51.8% vs. 29.6%, aOR 2.26, [95% CI 1.26-4.07]) and those recently tested for a sexually transmitted infection (35.4% vs. 25.5%, aOR 1.58, [95% CI 1.01-2.48]). Efforts to expand PrEP use in Latin America should focus on national PrEP policy adoption, and research should explore barriers to awareness and use among young men who have sex with men.
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Affiliation(s)
- Kevin J Blair
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, 8783University of California Los Angeles, Los Angeles, CA, USA.,Department of Surgery, 8783University of California Los Angeles, Los Angeles, CA, USA
| | - Eddy R Segura
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, 8783University of California Los Angeles, Los Angeles, CA, USA.,Escuela de Medicina, 33217Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Alex Garner
- Hornet Gay Social Network, Los Angeles, CA, USA.,Gay Sexuality and Social Policy Initiative, Luskin School of Public Affairs, 8783University of California Los Angeles, Los Angeles, CA, USA
| | - Jianchao Lai
- Gay Sexuality and Social Policy Initiative, Luskin School of Public Affairs, 8783University of California Los Angeles, Los Angeles, CA, USA
| | - Amy Ritterbusch
- Gay Sexuality and Social Policy Initiative, Luskin School of Public Affairs, 8783University of California Los Angeles, Los Angeles, CA, USA
| | - Sebastian Leon-Giraldo
- Escuela de Gobierno Alberto Lleras Camargo, 27991Universidad de Los Andes, Bogotá, Colombia
| | | | - Jordan E Lake
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, 8783University of California Los Angeles, Los Angeles, CA, USA.,McGovern Medical School, 12339The University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Jesse L Clark
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, 8783University of California Los Angeles, Los Angeles, CA, USA
| | - Ian W Holloway
- Gay Sexuality and Social Policy Initiative, Luskin School of Public Affairs, 8783University of California Los Angeles, Los Angeles, CA, USA
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