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Conserve DF, Mathews A, Janson S, Nwaozuru U, Jennings Mayo-Wilson L, Ritchwood TD, Ahonkhai AA, Diallo H, Korede T, Dieng A, Randolph AF, Team BR. Perceptions of HIV self-testing promotion in black barbershop businesses: implications for equitable engagement of black-owned small businesses for public health programs. BMC Public Health 2024; 24:2440. [PMID: 39245719 PMCID: PMC11382491 DOI: 10.1186/s12889-024-19973-x] [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: 05/20/2024] [Accepted: 09/03/2024] [Indexed: 09/10/2024] Open
Abstract
BACKGROUND HIV self-testing (HIVST) offers an innovative and promising approach to increasing HIV testing among Black men in the United States, a population disproportionately affected by HIV. However, engaging Black men in traditional HIV prevention programs has been challenging due to stigma, medical mistrust, and limited access to preventive health services. This formative qualitative study aimed to explore the potential of utilizing barbershops as an example of a nontraditional healthcare venue to promote and distribute HIVST. METHODS Four virtual focus group discussions (FGDs) consisting of 19 participants in North Carolina were conducted with Black men, including barbershop business owners, barbers, and their customers, to assess perceptions of HIVST and the acceptability of partnering with barbershop businesses to promote HIVST. FGDs were digitally recorded, transcribed, and analyzed using a deductive coding approach to thematic analysis. RESULTS Participants reported that the trusting relationship between barbers and their customers, which may not exist between Black men and health care providers, is a facilitator of collaborating with barbershop businesses to reach Black men for HIVST distribution. Participants recommended providing education for barbers on the use of HIVST, as well as how to inform self-testers about linkage to care following HIVST to build the credibility of the barbers in delivering the intervention. Participants also raised the issue of the cost of HIVST to barbershop customers as a potential barrier to implementation, as well as the possibility that the implementation of such interventions could be seen as out of place in a barbershop business venue. Participants also expressed a strong belief that compensation to barbershops and their employees should accompany any intervention. CONCLUSION These findings suggest that barbershop business venues may provide an appropriate venue for HIVST promotion and distribution, though factors like cost, training, and incentivization of implementers are necessary to consider in implementation planning. Furthermore, partnerships between public health actors and the business community must be built on equitable engagement to ensure the long-term viability of these critical initiatives.
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Affiliation(s)
- Donaldson F Conserve
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | | | - Samuel Janson
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | | | | | | | | | - Hassim Diallo
- School of Public Health, University of Maryland, College Park, MD, USA
| | - Tayo Korede
- University of Central Lancashire, Preston, Lancashire, UK
| | - Arona Dieng
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | | | - Bridge Research Team
- Building Research and Implementation to Drive Growth and Equity (BRIDGE) Research Lab, Milken Institute School of Public Health, Washington, DC, USA
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Kherghehpoush S, McKeirnan KC. The role of community pharmacies in the HIV and HCV care continuum. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 9:100215. [PMID: 36938123 PMCID: PMC10017415 DOI: 10.1016/j.rcsop.2022.100215] [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: 07/08/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction In 2019, there were over 1.1 million people living with human immunodeficiency virus (HIV) and 2.4 million people living with hepatitis C virus (HCV) in the United States. One in seven (14%) are unaware of their HIV infection and almost half of all HCV infections are undiagnosed. People with unstable housing are disproportionately affected by HIV and HCV. The present study will evaluate interventions by community pharmacists that may reduce HIV and HCV transmission and promote linkage to care. Methods This study was conducted in an independent community pharmacy in Spokane, Washington. Eligible study participants were walk-in patients of the pharmacy, over the age of 18, and experiencing homelessness. Pharmacy patients were excluded if they had a history of HIV or HCV diagnosis, received a screening for HIV or HCV in the last six months or were unable to give informed consent. The intervention included administration of HIV and HCV point-of-care testing (POCT) using a blood sample, risk determination interview, comprehensive HIV and HCV education, and personalized post-test and risk mitigation counseling followed by referral to partnering health clinics. Results Fifty participants were included in the final data analysis. Twenty-two participants (44%) had a reactive HCV POCT, and one participant had a reactive HIV POCT. Of the 94% of participants who reported illicit drug use, 74% reported injection drug use. Seventy-six percent (n = 38) qualified for PrEP. Pharmacist referrals were made for 28 participants and 71% were confirmed to have established care. Conclusion Individuals experiencing homelessness are at an increased risk for acquiring HIV and HCV due to risky sexual behaviors and substance misuse. PrEP is underutilized in the U.S. and pharmacist involvement in the HIV and HCV care continuum may have a significant impact in improving linkage and retention in care of difficult to treat populations.
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Spensley CB, Plegue M, Seda R, Harper DM. Annual HIV screening rates for HIV-negative men who have sex with men in primary care. PLoS One 2022; 17:e0266747. [PMID: 35834582 PMCID: PMC9282649 DOI: 10.1371/journal.pone.0266747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 03/27/2022] [Indexed: 11/27/2022] Open
Abstract
Background Men who have sex with men (MSM) account for most new HIV diagnoses in the US. Annual HIV testing is recommended for sexually active MSM if HIV status is negative or unknown. Our primary study aim was to determine annual HIV screening rates in primary care across multiple years for HIV-negative MSM to estimate compliance with guidelines. A secondary exploratory endpoint was to document rates for non-MSM in primary care. Methods We conducted a three-year retrospective cohort study, analyzing data from electronic medical records of HIV-negative men aged 18 to 45 years in primary care at a large academic health system using inferential and logistic regression modeling. Results Of 17,841 men, 730 (4.1%) indicated that they had a male partner during the study period. MSM were screened at higher rates annually than non-MSM (about 38% vs. 9%, p<0.001). Younger patients (p-value<0.001) and patients with an internal medicine primary care provider (p-value<0.001) were more likely to have an HIV test ordered in both groups. For all categories of race and self-reported illegal drug use, MSM patients had higher odds of HIV test orders than non-MSM patients. Race and drug use did not have a significant effect on HIV orders in the MSM group. Among non-MSM, Black patients had higher odds of being tested than both White and Asian patients regardless of drug use. Conclusions While MSM are screened for HIV at higher rates than non-MSM, overall screening rates remain lower than desired, particularly for older patients and patients with a family medicine or pediatric PCP. Targeted interventions to improve HIV screening rates for MSM in primary care are discussed.
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Affiliation(s)
- Courtney B. Spensley
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Melissa Plegue
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States of America
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Robinson Seda
- Michigan Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Diane M. Harper
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States of America
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America
- Department of Women’s and Gender Studies, University of Michigan, Ann Arbor, MI, United States of America
- * E-mail:
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Association between having a regular healthcare provider and pre-exposure prophylaxis use among men who have sex with men: a cross-sectional survey. J Behav Med 2022; 45:428-437. [PMID: 35394241 DOI: 10.1007/s10865-022-00308-3] [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: 09/02/2021] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
Healthcare providers whom people see regularly (e.g., primary care providers [PCPs]) are likely to interact with individuals at risk of human immunodeficiency virus (HIV). However, most PCPs report never prescribing pre-exposure prophylaxis (PrEP), a medication that prevents HIV infection. This study examined the association between having a regular healthcare provider and PrEP use among men who have sex with men (MSM). We analyzed health survey data from Black (n = 151) and White (n = 113) MSM in Atlanta, GA using log binomial regressions. Among Black MSM, the proportion who used PrEP was nearly three times higher for those with a regular provider compared to those without one (aPR 2.58; 95% CI: 0.96, 6.93). Conversely, the proportion of White MSM who used PrEP was slightly lower among those with a regular provider (aPR 0.67; 95% CI: 0.36, 1.27). Findings suggest having a regular provider may be more strongly associated with PrEP among Black MSM.
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5
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de Carvalho Mesquita Ayres JR, Junqueira Calazans G, Gianini RJ, Cangussu Botelho F, Urrestarazu Devincenzi M, Bellenzani R, Silva VN, de Oliveira Amorim GH. Testing, Inequities and Vulnerability of Adolescents to Sexually Transmitted Infections. J Community Health 2021; 47:118-126. [PMID: 34480248 DOI: 10.1007/s10900-021-01028-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 01/22/2023]
Abstract
Sexually transmitted infections (STIs) should form part of the comprehensive healthcare agenda for adolescents and young people (A&Y) and testing plays a strategic role in STI prevention. However, little attention has been paid to the social and programmatic obstacles to this practice among A&Y. The aim of this study is to describe the prevalence of testing for syphilis and HIV reported by a group of A&Y, analyzing its relationship with variables potentially indicative of inequities related to vulnerability to STIs. This was a cross-sectional survey applied to students at public high schools in three cities in the state of São Paulo, Brazil. The responses of 369 young people who reported having started sexual life were analyzed. The analysis included description of the frequencies of demographic and socioeconomic variables and their associations with testing for syphilis and HIV through the chi-square test. The concentration index (CI) was also calculated, with construction of the respective concentration curve for the associated variables. Positive associations were found between occurrence of testing and living in homes with up to three inhabitants, living in a marital situation with a regular or committed partnership, previous use of primary care services and previous use of hospitals or emergency services. The concentration curve for testing STIs showed significant contributions from the associated variables. The findings indicated that situations of inequity need to be addressed in order to reduce A&Y's vulnerability to STIs.
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Affiliation(s)
| | - Gabriela Junqueira Calazans
- Hospital das Clínicas HCFMUSP, Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo 455, São Paulo, SP, 01246-903, Brazil
| | - Reinaldo José Gianini
- Faculdade de Ciências Médicas e da Saúde - PUCSP, R. Joubert Wey 290, Sorocaba, SP, 18030-070, Brazil
| | - Fernanda Cangussu Botelho
- Dep. Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, Av. Dr. Arnaldo 455, São Paulo, SP, 01246-903, Brazil
| | | | - Renata Bellenzani
- Universidade Federal de Mato Grosso do Sul, Rua José Delfino Guimarães 145. Universitário 1, Paranaíba, MS, 79.500-000, Brazil
| | - Valeria Nanci Silva
- Dep. de Psicologia Social, Instituto de Psicologia, Universidade de São Paulo, Av. Professor Mello Moraes 1721, São Paulo, SP, 05508-030, Brazil
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Harmon J, Kelley MMG, Heath SL, Ross-Davis KL, Walter LA. Characteristics of HIV Seroconverters Identified in an Emergency Department HIV Screening Program. AIDS Patient Care STDS 2021; 35:255-262. [PMID: 34242089 DOI: 10.1089/apc.2021.0031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The emergency department (ED) may represent a missed opportunity to proactively intervene upon patients at "high risk" for HIV. We sought to describe characteristics of ED HIV seroconverters (individuals who screened positive in the ED for HIV who had either (1) a previous prior negative HIV test in the electronic health record (EHR) or who (2) self-reported a prior negative HIV test) to identify a "high-risk" phenotype for pre-infection engagement. A retrospective chart-review was performed of HIV seroconverters at an academic, urban ED. General demographics, mental health illness comorbidities, and Centers for Disease Control and Prevention (CDC)-identified "high risk" factors, including intravenous drug use (IVDU) and history of sexually transmitted infection (STI) were noted. One hundred thirty total patients were identified, 48 (36.9%) with prior HER-negative test and 82 (63.1%) with self-reported previous negative test. Of total seroconverters: 100 (76.9%) were male and 77 (59.2%) were between the ages of 13-34, comparable to national rates of new HIV diagnoses. Ninety-two patients (70.8%) were Black and 16 (12.3%) had a history of IVDU, significantly increased compared with regional and national new HIV rates (p < 0.05). Fifty-two patients (40%) had an STI within 1 year before HIV-positive screen, 67 (51.5%) had a history of mental health illness, and 77 (59.2%) were uninsured. This review revealed an HIV seroconversion population disproportionately affected by race, IVDU, mental health comorbidities, and additional social factors. The ED may represent a unique opportunity for at-risk, pre-HIV exposure intervention, particularly for vulnerable populations.
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Affiliation(s)
- John Harmon
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | | | - Sonya L. Heath
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Lauren A. Walter
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Olakunde BO, Pharr JR, Adeyinka DA. HIV testing among pregnant women with prenatal care in the United States: An analysis of the 2011-2017 National Survey of Family Growth. Int J STD AIDS 2020; 31:680-688. [PMID: 32538331 DOI: 10.1177/0956462420921715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although there has been significant progress in reducing perinatal human immunodeficiency virus (HIV) transmission, the United States is yet to meet the proposed elimination goal of less than one infection per 100,000 live births. Failure to screen all pregnant women for HIV as recommended by the Centers for Disease Control and Prevention can result in missed opportunities for preventing vertical transmission of HIV with antiretroviral drugs. Using the 2011-2017 National Survey of Family Growth, this study examined HIV testing among pregnant women during prenatal care. We estimated the weighted proportion of self-reported HIV testing among women whose last pregnancy ended within 12 months prior to the interview. Logistic regression models were used to determine the factors associated with HIV testing. Of the 1566 women included in the study, 76.4% (95% confidence intervals [CI] = 72.8-80.0) reported receiving an HIV test during prenatal care. In the multivariable regression model, high school diploma (adjusted odds ratio [aOR] = 1.9, 95% CI = 1.1-3.1), two completed pregnancies (aOR = 1.7, 95% CI = 1.1-2.7), health insurance coverage in the last 12 months (aOR = 1.6, 95% CI = 1.0-2.6), Hispanic race/ethnicity (aOR = 2.8, 95% CI = 1.8-4.4), and non-Hispanic black race/ethnicity (aOR = 2.2, 95% CI = 1.3-3.8) were associated with higher odds of reporting being tested for HIV. However, household income of 300% or more of the federal poverty level (aOR = 0.6, 95% CI = 0.3-0.9) and urban residence (aOR = 0.5, 95% CI = 0.3-0.9) were associated with lower odds of reporting HIV testing. These findings suggest that HIV testing among pregnant women during prenatal care is not universal and may affect achieving the goal of elimination of mother-to-child transmission of HIV in the United States.
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Affiliation(s)
- Babayemi O Olakunde
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Jennifer R Pharr
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Daniel A Adeyinka
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
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Turpin R, Rosario AD, Dyer T. Barriers to syphilis testing among men who have sex with men: a systematic review of the literature. Sex Health 2020; 17:201-213. [PMID: 32586417 DOI: 10.1071/sh19044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 04/11/2020] [Indexed: 11/23/2022]
Abstract
Men who have sex with men (MSM) represent the highest risk group for syphilis in the United States and several other countries. Improving uptake of syphilis testing among MSM requires understanding key barriers to testing in this population. Using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a systematic review to assess proportions of syphilis testing among MSM and identify social, structural, and individual barriers to syphilis testing was conducted. All searches were conducted through the University of Maryland world catalogue search engine. Studies that measured syphilis testing in a sample of MSM were included. All studies were assessed for bias using JBI-MAStARI instruments. Studies were synthesised based on sample size, years of data collection, study selection method (e.g. hospital or clinic-based, community/venue-based), location (e.g. USA-based, other countries) and results of the bias assessment. For studies measuring barriers associated with testing, the measure of association, point estimate and statistical significance was assessed. Of 848 studies found in the initial search, 24 were included in the final review. The largest difference in syphilis testing proportions was based on hospital or clinic-based sampling (50-87%) compared with venue/community-based and online sampling (31-38%). Socioeconomic factors (four items, four studies, OR 0.23 to 0.68), healthcare interactions six items, five studies, OR 0.09 to 0.69) and community/interpersonal factors (seven items, five studies, OR 0.07 to 0.58) were identified as barriers to testing. Barriers to syphilis testing among MSM include socioeconomic factors, healthcare-related factors and community/interpersonal factors. Improving overall routine utilisation of healthcare services is an especially important focal point in testing promotion.
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Affiliation(s)
- Rodman Turpin
- University of Maryland, College Park, School of Public Health, Department of Epidemiology and Biostatistics, 4200 Valley Drive #2242, College Park, MD 20742, USA; and Corresponding author.
| | - Andre D Rosario
- Howard University Hospital, Psychiatry and Behavioral Sciences, 2041 Georgia Avenue NW, Washington, D.C. 20060, USA
| | - Typhanye Dyer
- University of Maryland, College Park, School of Public Health, Department of Epidemiology and Biostatistics, 4200 Valley Drive #2242, College Park, MD 20742, USA
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Olakunde BO, Pharr JR. HIV-related risk behaviors and HIV testing among people with sensory disabilities in the United States. Int J STD AIDS 2020; 31:1398-1406. [PMID: 32469624 DOI: 10.1177/0956462419896705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
People with disabilities are an important target population for HIV prevention and treatment programs. In this study, we examined the prevalence of HIV-related risk behaviors and HIV testing among people with visual and/or hearing impairments in the United States, and compared with people without any impairments. The study was a secondary data analysis of the 2016 Behavioral Risk Factor Surveillance System. We performed weighted descriptive statistics and logistic regression analyses to determine the association between ever testing for HIV and sociodemographic characteristics, healthcare access, and HIV-related risk behaviors. The prevalence of HIV-related risk behaviors was 7.1% (95%CI = 5.4-8.8), 3.9% (95%CI = 3.0-4.9), 3.5% (95%CI = 1.5-5.4), and 5.9% (95%CI = 5.7-6.1) among those with visual, hearing, both visual and hearing, and no impairments, respectively. HIV testing among those with visual impairment was 39.7% (95%CI = 37.0-42.3) and 28.9% (95%CI = 27.3-30.5) among those with hearing impairment. Approximately 26.8% (95%CI = 21.4-32.2) of the respondents with both impairments and 38.0% (95%CI = 37.6-38.3) of those with no impairments had ever tested for HIV. In the adjusted models, the factors associated with HIV testing varied across the subgroups, with only age, race/ethnicity, and HIV-related risk behaviors common to all the four subgroups. Compared with those without any impairments, the odds of ever testing for HIV was significantly higher among respondents with hearing impairment (aOR = 1.3, 95%CI = 1.14-1.38), after controlling for sociodemographic characteristics, healthcare access, and HIV-related risk behaviors. Targeted interventions that will meet the unique needs of people with visual and/or hearing impairments are required to reduce HIV-related risk behaviors and improve uptake of HIV testing.
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Affiliation(s)
- Babayemi O Olakunde
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Jennifer R Pharr
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV, USA
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10
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Christensen K, Berkley-Patton J, Shah B, Aduloju-Ajijola N, Bauer A, Bowe Thompson C, Lister S. HIV Risk and Sociodemographic Factors Associated with Physician-Advised HIV Testing: What Factors Are Overlooked in African American Populations? J Racial Ethn Health Disparities 2020; 7:121-128. [PMID: 31654339 PMCID: PMC7899157 DOI: 10.1007/s40615-019-00641-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 09/12/2019] [Accepted: 09/20/2019] [Indexed: 11/24/2022]
Abstract
HIV is diagnosed at eight times the rate in African Americans (AAs) compared to whites. One-third of AAs have never been tested for HIV. Studies indicate low rates of HIV testing in healthcare settings, so understanding missed opportunities for HIV testing can inform prevention efforts in these settings. Our study examined predictors of self-reported physician-advised HIV testing using baseline survey data (N = 1500) from Taking It to the Pews (TIPS), a church-basedHIV/STD testing and education intervention. One-third (33%) of participants reported that their physician ever suggested an HIV test. Results indicated that participants who identified as homosexual/bisexual, received Medicaid or were uninsured, and/or had previously diagnosed STDs were more likely to report physician-advised HIV testing. AA churches provide a unique opportunity to increase the reach of HIV testing and may be well-positioned to equip their church and community members with information on HIV risk and strategies to advocate for physician-advised routine HIV testing in medical settings.
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Affiliation(s)
- Kelsey Christensen
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA.
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
| | - Jannette Berkley-Patton
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Binoy Shah
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Natasha Aduloju-Ajijola
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Alexandria Bauer
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Carole Bowe Thompson
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Sheila Lister
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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11
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Baumann KE, Hemmige V, Kallen MA, Street RL, Giordano TP, Arya M. Whether Patients Want It or Not, Physician Recommendations Will Convince Them to Accept HIV Testing. J Int Assoc Provid AIDS Care 2019; 17:2325957417752258. [PMID: 29380668 PMCID: PMC6748523 DOI: 10.1177/2325957417752258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Physicians are not routinely offering patients HIV testing, partly due to perceived patient discomfort with discussing HIV. This study assessed patients’ comfort level and whether physician recommendations can overcome any discomfort that does exist. In a publicly funded primary care clinic, we administered a survey exploring patient facilitators to HIV testing, with 266 patients answering the 2 main survey questions of interest. Most participants wanted their physician to offer HIV testing (n = 175; 65.8%). Even among participants who did not want their physician to offer HIV testing (n = 91), over half (n = 54; 59.3%) reported they would “likely” or “very likely” accept HIV testing if their physician recommended it. Based on our findings, not only are negative attitudes about HIV testing among patients uncommon but physician recommendations may be able to convince patients to receive HIV testing in spite of patients stating they do not want the test.
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Affiliation(s)
| | - Vagish Hemmige
- 2 Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Richard Lewis Street
- 2 Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,4 Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | | | - Monisha Arya
- 2 Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,4 Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
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12
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Arya M, Marek HG, Marren RE, Hemmige V, Street RL, Giordano TP. Development and Evaluation of a Physician-Targeted Video to Promote HIV Screening. Health Promot Pract 2018; 20:922-931. [PMID: 29938534 DOI: 10.1177/1524839918783742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction. Despite national recommendations, routine opt-out HIV testing has not been widely adopted by physicians. Guided by previous research on physician barriers to HIV testing, we developed a physician-targeted video to promote routine opt-out HIV screening. The objective of this study was to evaluate this video intervention. Methods. From June to July 2016, physicians in two primary care clinics completed an online survey prior to and after watching the video. Survey items assessed acceptability of the video and HIV testing knowledge, attitudes, and intention to screen. Descriptive statistics were generated to analyze data. Results. Of the 53 participants, 90% liked or strongly liked the video. Pre- to postvideo, significant improvements were seen in the knowledge of national HIV screening recommendations (45.3% to 67.9%; p = .010) and of the proportion of unaware Houstonians living with HIV (22.6% to 75.5%; p < .001). Participant beliefs about the likelihood of patients accepting HIV testing increased from 47.2% to 84.9% pre- to postvideo (p < .001). Intention to screen did not change; participants had high intentions pre- and postvideo. Conclusions. Our study found that a video is an acceptable HIV testing promotion medium for physicians. Our video improved physician HIV testing knowledge and attitudes, overcoming key barriers to HIV testing.
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Affiliation(s)
- Monisha Arya
- Baylor College of Medicine, Houston, TX, USA.,Michael E, DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | | | | | | | - Richard L Street
- Baylor College of Medicine, Houston, TX, USA.,Michael E, DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,Texas A&M University, College Station, TX, USA
| | - Thomas P Giordano
- Baylor College of Medicine, Houston, TX, USA.,Michael E, DeBakey Veterans Affairs Medical Center, Houston, TX, USA
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Rasberry CN, Liddon N, Adkins SH, Lesesne CA, Hebert A, Kroupa E, Rose ID, Morris E. The Importance of School Staff Referrals and Follow-Up in Connecting High School Students to HIV and STD Testing. J Sch Nurs 2017; 33:143-153. [PMID: 27418443 PMCID: PMC11318524 DOI: 10.1177/1059840516658695] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study examined predictors of having received HIV and sexually transmitted disease (STD) testing and having been referred by school staff for HIV/STD testing. In 2014, students in seven high schools completed paper-and-pencil questionnaires assessing demographic characteristics, sexual behavior, referrals for HIV/STD testing, and HIV/STD testing. The analytic sample ( n = 11,303) was 50.7% female, 40.7% Hispanic/Latino, 34.7% Black/African American (non-Hispanic), and mean age was 15.86 ( SD = 1.22). After controlling for demographic characteristics, significant predictors of reporting having been tested for HIV or STDs were reporting having received a referral for HIV/STD testing (odds ratio [ OR] = 3.18; 95% CI = [2.14, 4.70]) and reporting staff following-up on the referral ( OR = 3.29; 95% CI = [1.31, 8.23]). Students reporting referrals had significantly higher odds of being male ( OR = 2.49; 95% CI = [1.70, 3.65]), "other" or multiracial (non-Hispanic; compared to White, non-Hispanic; OR = 2.72; 95% CI = [1.35, 5.46]), sexual minority ( OR = 3.80; 95% CI = [2.57, 5.62]), and sexually experienced ( OR = 2.58; 95% CI = [1.76, 3.795]). School staff referrals with follow-up may increase HIV/STD testing among students.
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Affiliation(s)
- Catherine N Rasberry
- 1 Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nicole Liddon
- 1 Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan Hocevar Adkins
- 1 Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | - Elana Morris
- 4 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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14
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Conserve DF, Oraka E, Abara WE, Wafula E, Turo A. Correlates of Never Testing for HIV Among Non-Hispanic Black Men in the United States: National Survey of Family Growth, 2011-2013. AIDS Behav 2017; 21:492-500. [PMID: 27435075 PMCID: PMC5247405 DOI: 10.1007/s10461-016-1452-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Currently, the Centers for Disease Control and Prevention recommends that persons between 15 and 64 years get tested for human immunodeficiency virus (HIV) at least once in their lifetime and persons with HIV risk factors get tested more frequently. There is limited research examining factors associated with never testing for HIV among non-Hispanic Black men in the United States. The purpose of this study was to examine the prevalence of never testing for HIV, reasons for never testing for HIV, and correlates of never testing for HIV. We analyzed 2011-2013 National Survey of Family Growth data and restricted analyses to male respondents aged 15-44 years who self-identified as being non-Hispanic Black. Logistic regression models estimated adjusted prevalence ratios (APR) assessing the association between socio-demographic and behavioral factors and never testing for HIV. An estimated 31.2 % of non-Hispanic Black males aged 15-44 years have never been tested for HIV. Non-Hispanic Black men aged 15-17 years (APR 4.45; 95 % CI 2.88-6.87) or 18-24 years (APR 1.94; 95 % CI 1.21-3.13), who did not visit a doctor or healthcare provider (APR 1.43; 95 % CI 1.10-1.86), or did not report any sexual risk behaviors in the past 12 months (APR 1.83; 95 % CI 1.34-2.51) were more likely to never test for HIV compared to their respective counterparts. Continued expansion of HIV testing initiatives and prevention programs that focus on non-Hispanic Black men is critical to addressing HIV-related health disparities and the public health burden of HIV in this population.
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Affiliation(s)
- Donaldson F Conserve
- Department of Health Promotion, Education, and Behavior, University of South Carolina, 915 Greene Street, Columbia, 29208, SC, USA.
| | | | - Winston E Abara
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
- Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, GA, USA
| | - Edith Wafula
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Angela Turo
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
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15
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Keith Branham D, Borders TF, Stewart KE, Curran GM, Booth BM. Acceptability of HIV Testing Sites Among Rural and Urban African Americans Who Use Cocaine. AIDS Behav 2017; 21:576-586. [PMID: 27557985 PMCID: PMC5290213 DOI: 10.1007/s10461-016-1527-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
African Americans (AAs) who use cocaine in the Southern region of the U.S. have a relatively high risk of HIV and need for HIV testing. Among this group, those residing in rural areas may have less favorable opinions about common HIV testing sites, which could inhibit HIV testing. We examined rural/urban variations in their acceptability of multiple HIV testing sites (private physician clinic, local health department, community health center, community HIV fair, hospital emergency department, blood plasma donation center, drug abuse treatment facility, and mobile van or community outreach worker). Results from partial proportional odds and logistic regression analyses indicate that rural AA who use cocaine have lower odds of viewing local health departments (OR = 0.09, 95 % CI = 0.03-0.21), physician offices (OR = 0.19, 95 % CI = 0.09-0.42), and drug use treatment centers (OR = 0.49; 95 % CI = 0.30-0.80) as acceptable relative to their urban counterparts. The findings have implications for further targeting HIV testing toward AAs who use of cocaine, particularly those residing in the rural South.
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Affiliation(s)
- D Keith Branham
- Department of Health Management and Policy, University of Kentucky, Lexington, KY, 40536, USA.
| | - Tyrone F Borders
- Department of Health Management and Policy, University of Kentucky, Lexington, KY, 40536, USA
| | - Katharine E Stewart
- Department of Psychology and Provost's Office, North Carolina State University, Raleigh, NC, USA
| | - Geoffrey M Curran
- Departments of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Brenda M Booth
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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16
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Estem KS, Catania J, Klausner JD. HIV Self-Testing: a Review of Current Implementation and Fidelity. Curr HIV/AIDS Rep 2016; 13:107-15. [PMID: 26879653 DOI: 10.1007/s11904-016-0307-y] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Oral HIV self-testing is an innovative and potentially high-impact means to increase HIV-case identification globally. As a screening test, oral HIV self-testing offers the potential for increased adoption through greater convenience and privacy, and the potential to increase the proportion of the population who test regularly. Research on how best to translate the innovation of oral self-testing to high-risk populations is underway. Currently only one oral HIV self-test kit is FDA-approved (OraQuick In-Home HIV Test) and available for retail sale. In the present report we review recent studies on the dissemination, adoption, and implementation of oral HIV testing. Prior work has focused primarily on adoption, but recent studies have begun to identify methods for improving dissemination and problems associated with self-implementation. At present a major barrier to wider adoption is the relatively high retail cost of the oral HIV test kit. Significant but minor barriers are represented by overly complex instructional materials for some population segments, and dissemination programs of unknown efficacy. Theoretical and practical suggestions for conducting research on dissemination, adoption, and implementation of oral HIV testing are discussed.
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Affiliation(s)
- Kristecia S Estem
- New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, 42-09 28th Street, WS 21-64, Queens, NY, 11101, USA
| | - Joseph Catania
- Social and Behavioral Health Sciences, Oregon State University College of Public Health and Human Sciences, 401 Waldo Hall, Corvallis, OR, 97331, USA
| | - Jeffrey D Klausner
- Department of Medicine, Division of Infectious Diseases, UCLA David Geffen School of Medicine and Department of Epidemiology, Fielding School of Public Health, 10920 Wilshire Blvd, Suite #350, Los Angeles, CA, 90024, USA.
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17
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Crawford ND, Dean T, Rivera AV, Guffey T, Amesty S, Rudolph A, DeCuir J, Fuller CM. Pharmacy Intervention to Improve HIV Testing Uptake Using a Comprehensive Health Screening Approach. Public Health Rep 2016; 131 Suppl 1:139-46. [PMID: 26862239 DOI: 10.1177/00333549161310s116] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE HIV testing is increasingly available, yet barriers to HIV testing persist for low-income black and Latino people, especially those who use illicit drugs. HIV exceptionalism, or the idea that a positive HIV diagnosis is drastically different from a diagnosis for any other disease, may influence HIV testing-related stigma, resulting in reduced willingness to undergo HIV testing. This pharmacy-based intervention combined HIV testing with less stigmatized chronic disease screening tests (e.g., blood pressure, glucose, and cholesterol) to equate the concept of an HIV diagnosis with other diagnoses. METHODS Three pharmacies located in low-income, minority neighborhoods in New York City were enrolled in an intervention to provide (1) HIV testing, chronic disease screening, and a healthy lifestyles video that normalized all screening tests and destigmatized HIV as a fatal disease (comprehensive arm); (2) HIV testing and the video (video arm); and (3) HIV testing only (control arm). Injection drug users (IDUs) and pharmacy staff recruited un- and underinsured pharmacy customers, IDUs, and IDU peers from 2010 to 2012. Participants in the control group were compared with those in the comprehensive and video intervention groups. RESULTS Participants in the comprehensive arm (prevalence ratio [PR] = 1.61, 95% confidence interval [CI] 1.03, 2.49, p=0.08) and the video arm (PR=1.59, 95% CI 1.00, 2.53, p=0.09) were marginally significantly more likely to receive an HIV test in the pharmacy compared with those in the control arm after adjustment. CONCLUSIONS These findings suggest that adoption of strategies that destigmatize and normalize HIV testing can improve uptake. Implementation of this strategy in low-access, minority communities with high HIV prevalence and among high-risk populations may help reduce racial/ethnic disparities in HIV.
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Affiliation(s)
- Natalie D Crawford
- Emory University, Rollins School of Public Health, Behavioral Sciences and Health Education, Atlanta, GA
| | | | - Alexis V Rivera
- Columbia University, Mailman School of Public Health, Department of Epidemiology, New York, NY
| | - Taylor Guffey
- Emory University, Rollins School of Public Health, Behavioral Sciences and Health Education, Atlanta, GA
| | - Silvia Amesty
- Columbia University, Mailman School of Public Health, Department of Population and Family Health, New York, NY; Columbia University, College of Physicians and Surgeons, Center for Family and Community Medicine, New York, NY
| | - Abby Rudolph
- The Calverton Center, Pacific Institute for Research and Evaluation, Calverton, MD
| | - Jennifer DeCuir
- Columbia University, Mailman School of Public Health, Department of Epidemiology, New York, NY
| | - Crystal M Fuller
- Nathan Kline Institute for Psychiatric Research, Division of Social Solutions and Services Research, Orangeburg, NY; New York University, School of Medicine, Department of Psychiatry, New York, NY
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18
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Arya M, Phillips AL, Street RL, Giordano TP. Physician Preferences for Physician-Targeted HIV Testing Campaigns. J Int Assoc Provid AIDS Care 2016; 15:470-476. [PMID: 27000130 DOI: 10.1177/2325957416636475] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The U.S. Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force issued HIV testing recommendations, encouraging physicians to routinely test all adult patients for HIV. Studies have found that not all physicians are abiding by these guidelines, but that physician recommendations for HIV testing could encourage patients to get tested. Our study sought to determine physician preferences for a physician-targeted campaign to encourage them to offer HIV tests to their patients. The study took place across 19 publicly-funded community health centers. A web-based survey was sent to primary care physicians, assessing their preferences for physician-targeted HIV testing campaign elements. Response frequencies were calculated for each element. 175 physicians participated. Campaign elements were divided into "HIV Testing Information," "Communication Tools," and "Promotion Strategies." Physicians selected receiving a copy of the latest HIV testing recommendations, having patients ask for the HIV test, and receiving an EMR alert for HIV testing as their top elements for each category, respectively. An effective physician HIV testing campaign should include information about HIV testing recommendations, proof of patient receptiveness to HIV testing, and strategies to prompt HIV testing conversations. A multi-faceted approach combining patient and physician prompts to discuss HIV testing might be the most effective method to improve HIV testing rates.
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Affiliation(s)
- Monisha Arya
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | | | - Richard L Street
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Communications, Texas A&M University, College Station, TX, USA
| | - Thomas P Giordano
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
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19
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Lopez-Quintero C, Rojas P, Dillon FR, Varga LM, De La Rosa M. HIV testing practices among Latina women at risk of getting infected: a five-year follow-up of a community sample in South Florida. AIDS Care 2015; 28:137-46. [PMID: 26291133 DOI: 10.1080/09540121.2015.1071769] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Latinos are more likely to delay HIV testing, present to care with an AIDS defining illness, and die within one year of learning their HIV-positive status than non-Latino blacks and whites. For this paper, we explore the role of partner-relationship characteristics and health behaviors, in predicting HIV testing among Latina adult women who engaged in risky sexual behaviors (i.e., unprotected vaginal and/or anal sex). Data from a convenience sample of 168 Latina adult women who engaged in risky sexual behavior in the year prior to assessment were analyzed for this paper. Rates and predictors of HIV testing among this sample were assessed after a five-year follow-up. Descriptive and analytical estimates include incidence rates and adjusted odds ratios (AOR) from multilevel models. At five-year follow-up, 63.7% (n = 107) women reported having been tested for HIV, of whom 12.2% (n = 13) were women who never tested before. Main reasons for not having been tested at follow-up included: low risk perception (62.1%) and trusting their partner(s)/being in a monogamous relationship/knowing their partner's HIV status (17.2%). Predictors of HIV testing included: age (AOR: 0.96; 95% CI = 0.92-0.99), provider endorsement of HIV testing (AOR: 4.59; 95% CI = 1.77-11.95), poor quality of their romantic relationships (AOR: 1.12; 95% CI = 1.03-1.26), and knowing the HIV sero-status of sexual partner (AOR: 3.61; 95% CI = 1.46-8.95). This study characterizes a group of Latina women at high risk for HIV infection and their HIV testing behaviors. Our findings underscore the need of increasing access to quality health-care services and HIV behavioral interventions, and to strengthen the adherence to HIV/sexually transmitted disease testing recommendations and guidelines among local health-care providers serving the Latino community in South Florida.
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Affiliation(s)
- Catalina Lopez-Quintero
- a Department of Epidemiology and Biostatistics , College of Human Medicine, Michigan State University , East Lansing , MI 49924 , USA
| | - Patria Rojas
- b Center for Research on US Latinos HIV/AIDS and Drug Abuse , Florida International University , 11200 SW, 8th Street, Miami , FL 33199 , USA
| | - Frank R Dillon
- b Center for Research on US Latinos HIV/AIDS and Drug Abuse , Florida International University , 11200 SW, 8th Street, Miami , FL 33199 , USA.,c Department of Education and Counseling Psychology , State University of New York at Albany , 1400 Washington Avenue, Albany , NY 12222 , USA
| | - Leah M Varga
- b Center for Research on US Latinos HIV/AIDS and Drug Abuse , Florida International University , 11200 SW, 8th Street, Miami , FL 33199 , USA
| | - Mario De La Rosa
- b Center for Research on US Latinos HIV/AIDS and Drug Abuse , Florida International University , 11200 SW, 8th Street, Miami , FL 33199 , USA
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20
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Amesty S, Crawford ND, Nandi V, Perez-Figueroa R, Rivera A, Sutton M, Weidle PJ, Willis L, Smith DK, Hernandez C, Harripersaud K, Lewis CF. Evaluation of Pharmacy-Based HIV Testing in a High-Risk New York City Community. AIDS Patient Care STDS 2015. [PMID: 26217930 DOI: 10.1089/apc.2015.0017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Blacks/Hispanics face limited access to HIV testing. We examined in-pharmacy HIV testing among customers in pharmacies participating in a nonprescription syringe program in New York City. Participants were recruited in two pharmacies to complete a survey and receive an optional HIV test. Bivariate and multivariable analyses were performed to examine associations of demographics and risk behaviors with receiving in-pharmacy HIV testing. Most participants were male (55%), black (80%), had used hard drugs (88%), and 39.5% received in-pharmacy HIV testing. Being female (AOR=2.24; 95%CI 1.24-4.05), having multiple sex partners (AOR=1.20; 95% CI 1.06-1.35), having an HIV test more than 12 months ago (AOS=4.06; CI 1.85-8.91), injecting drugs in last 3 months (AOR=2.73; 95% CI 1.31-5.69) and having continuous care (AOR=0.32; 95% CI 0.17-0.58) were associated with receiving in-pharmacy HIV test. These data provide evidence of in-pharmacy HIV testing reaching persons at risk of HIV. HIV testing in pharmacies may complement existing strategies.
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Affiliation(s)
- Silvia Amesty
- Columbia University College of Physicians and Surgeons, Center for Family and Community Medicine, New York, New York
- Columbia University Mailman School of Public Health, Heilbrunn Department of Population and Family Health, New York, New York
| | | | - Vijay Nandi
- The Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York
| | - Rafael Perez-Figueroa
- Columbia University Mailman School of Public Health, Heilbrunn Department of Population and Family Health, New York, New York
- Columbia University College of Physicians and Surgeons, Department of Pediatrics, New York, New York
| | - Alexis Rivera
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, New York
| | - Madeline Sutton
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul J. Weidle
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leigh Willis
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dawn K. Smith
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carolyn Hernandez
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, New York
| | - Katherine Harripersaud
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, New York
| | - Crystal Fuller Lewis
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, New York
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21
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Kyle TL, Horigian VE, Tross S, Gruber VA, Pereyra M, Mandler RN, Feaster DJ, Metsch LR. Uptake of HIV testing in substance use disorder treatment programs that offer on-site testing. AIDS Behav 2015; 19:536-42. [PMID: 25074737 PMCID: PMC4312252 DOI: 10.1007/s10461-014-0864-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Increasing rates of HIV testing within substance use disorder (SUD) treatment clients is an important public health strategy for reducing HIV transmission rates. The present study examined uptake of HIV testing among 1,224 clients in five SUD treatment units that offered on-site testing in Florida, New York, and California. Nearly one-third (30 %) of the participants, who had not previously tested positive, reported not having been tested for HIV within the past 12 months. Women, African Americans, and injection drug users had a higher likelihood of having been tested within the past 12 months. The SUD treatment program was the most frequently identified location of participants' last HIV test. Despite the availability of free, on-site testing, a substantial proportion of clients were not tested, suggesting that strategies to increase uptake of testing should include addressing barriers not limited to location and cost.
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Affiliation(s)
- Tiffany L Kyle
- Aspire Health Partners, 5151 Adanson Street, Orlando, FL, 32804, USA,
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22
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HIV testing experience in New York City: offer of and willingness to test in the context of new legal support of routine testing. J Acquir Immune Defic Syndr 2015; 68 Suppl 1:S45-53. [PMID: 25545493 DOI: 10.1097/qai.0000000000000390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the United States, routine HIV testing is recommended for persons aged 13-64 years. In 2010, New York State passed a law mandating offer of testing in most health-care settings. We report on the consumer perspective in New York City (NYC) shortly after the law's enactment. METHODS We analyzed data from a 2011 telephone survey representative of NYC adults aged 18-64 years (n = 1,846). This analysis focused on respondents' report of HIV test offer at last clinical visit and of willingness to test if recommended by their doctor. Offer and willingness were estimated by age, gender, race/ethnicity, education, income, marital status, sexual identity, partner number, and HIV testing history; associations were examined using multivariable regression. RESULTS Among NYC adults, 35.7% reported an HIV test in the past year and 31.8% had never tested. Among 86.7% with a clinical visit in the past year, 31.4% reported being offered a test at last visit. Offer was associated with younger age, race/ethnicity other than white, non-Hispanic, lower income, and previous testing. Only 6.7% of never-testers were offered a test at last clinical visit. Willingness to test if recommended was high overall (90.2%) and across factors examined. CONCLUSIONS After a new law was enacted in support of routine HIV testing, approximately 1 in 3 New Yorkers aged 18-64 years were offered a test at last clinical visit; 9 in 10 were willing to test if recommended by their doctor. This suggests that patient attitudes will not be a barrier to complete implementation of the law.
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23
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Andrinopoulos K, Hembling J, Guardado ME, de Maria Hernández F, Nieto AI, Melendez G. Evidence of the negative effect of sexual minority stigma on HIV testing among MSM and transgender women in San Salvador, El Salvador. AIDS Behav 2015; 19:60-71. [PMID: 24907779 DOI: 10.1007/s10461-014-0813-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A cross sectional survey was administered to 670 men who have sex with men (MSM) and transgender women (TW) in San Salvador through respondent driven sampling to identify determinants of ever testing for HIV using a minority stress framework. A positive association was found between ever testing and older age [adjusted odds ratio (aOR) 2.10], past experience of sexual assault (aOR 2.92), perceiving that most social acquaintances had tested (aOR 1.81), and knowing a PLHIV (aOR 1.94). A negative association was found between homelessness and ever testing (aOR 0.43). Among the MSM sub-sample (n = 506), similar results were found for older age (aOR 2.63), and past experience of sexual assault (aOR 2.56). Internalized homonegativity was negatively associated with ever testing for HIV among MSM (aOR 0.46), and HIV testing stigma and experienced provider discrimination further strengthened this relationship. It is important to mitigate sexual minority stigma in order to increase HIV testing among MSM. Future research should explore this construct among TW.
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Affiliation(s)
- Katherine Andrinopoulos
- Department of Global Health Systems and Development, Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA, 70112, USA,
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24
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Huy NV, Khuyen LT, Ha PN. Factors associated with HIV testing among male motorbike taxi drivers in urban Vietnam. Glob Public Health 2014; 10 Supppl 1:S56-69. [PMID: 25415855 DOI: 10.1080/17441692.2014.981832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Using the Attitude-Skills-Knowledge (ASK) model, this study examined the prevalence of, and factors associated with, human immunodeficiency virus (HIV) testing among male motorbike taxi drivers (MMTDs). In a cross-sectional design, using quantitative approaches, 291 MMTDs were recruited from 135 sites across 13 districts in Hanoi, Vietnam, for a face-to-face interview. Applying the ASK model modified as a central theory, logistic regression was used to identify determinants of HIV testing. Although many MMTDs engaged in multiple risk behaviours for HIV, only 20.6% had been tested for HIV during the past 12 months. The tested model included one factor of the ASK model, HIV prevention knowledge (adjusted odds ratio [AOR] = 4.76; 95% confidence interval [CI] = 2.12-10.7) and five additional factors: being married (AOR = 3.13; 95% CI = 1.25-4.78), preferring sex with men or with both men and women (AOR = 8.72; 95% CI = 1.48-51.5), having lower number of lifetime sex partners (AOR = 0.66; 95% CI = 0.49-0.88), higher number of past year sex partners (AOR = 2.97: 95% CI = 1.21-7.31) and discussing condom use when having sex with partners (AOR = 0.08; 95% CI = 0.01-7.31). This modified ASK model provided better fit than the ASK model, as it explained more variance in HIV testing (47 vs. 29.8%). Recognising factors associated with HIV testing among MMTDs enables us to create suitable public health intervention strategies.
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Affiliation(s)
- Nguyen Van Huy
- a Department of Health Management and Organization, Institute for Preventive Medicine and Public Health , Hanoi Medical University , Hanoi , Vietnam
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25
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Arya M, Kumar D, Patel S, Street RL, Giordano TP, Viswanath K. Mitigating HIV health disparities: the promise of mobile health for a patient-initiated solution. Am J Public Health 2014; 104:2251-5. [PMID: 25322292 DOI: 10.2105/ajph.2014.302120] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The HIV epidemic is an ongoing public health problem fueled, in part, by undertesting for HIV. When HIV-infected people learn their status, many of them decrease risky behaviors and begin therapy to decrease viral load, both of which prevent ongoing spread of HIV in the community. Some physicians face barriers to testing their patients for HIV and would rather their patients ask them for the HIV test. A campaign prompting patients to ask their physicians about HIV testing could increase testing. A mobile health (mHealth) campaign would be a low-cost, accessible solution to activate patients to take greater control of their health, especially populations at risk for HIV. This campaign could achieve Healthy People 2020 objectives: improve patient-physician communication, improve HIV testing, and increase use of mHealth.
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Affiliation(s)
- Monisha Arya
- Monisha Arya, Richard L. Street Jr, and Thomas P. Giordano are with the IQuESt, Michael E. Debakey VA Medical Center, Houston, TX, and with the Department of Medicine, Baylor College of Medicine, Houston. Disha Kumar and Sajani Patel are with the Weiss School of Natural Sciences, Rice University, Houston. Kasisomayajula Viswanath is with the Department of Social and Behavioral Science, Harvard School of Public Health, Dana-Farber Cancer Institute, Boston, MA
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Morris JL, Lippman SA, Philip S, Bernstein K, Neilands TB, Lightfoot M. Sexually transmitted infection related stigma and shame among African American male youth: implications for testing practices, partner notification, and treatment. AIDS Patient Care STDS 2014; 28:499-506. [PMID: 25133501 DOI: 10.1089/apc.2013.0316] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A self-administered, street intercept survey was conducted in order to examine the relation of stigma and shame associated with sexually transmitted infections (STI) to STI testing practices, partner notification, and partner-delivered treatment among young African American men (n=108) in a low-income, urban community in San Francisco with high STI burden. Multivariate logistic regression revealed that increasing STI-related stigma was significantly associated with a decreased odds of STI testing, such that every standard deviation increase in stigma score was associated with 0.62 decreased odds of having been tested (aOR: 0.62, 95% CI: 0.38-1.00), controlling for age. STI stigma was also significantly associated with a decreased willingness to notify non-main partners of an STI (aOR: 0.64 95% CI: 0.41-0.99). Participants with higher levels of stigma and shame were also significantly less likely to be willing to deliver STI medication to a partner (stigma aOR: 0.57, 95% CI: 0.37-0.88; shame aOR 0.53 95% CI: 0.34-0.83). Findings suggest that STI-related stigma and shame, common in this population, could undermine STI testing, treatment, and partner notification programs. The medical establishment, one of the institutional factors to have reinforced this culture of stigma, must aid efforts to reduce its effects through providing integrated services, reframing sexual health in campaigns, educating clients, and providing wider options to aid disclosure and partner notification practices.
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Affiliation(s)
- Jessica L. Morris
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, California
| | - Sheri A. Lippman
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, California
| | - Susan Philip
- San Francisco Department of Public Health, STD Prevention and Control Services, San Francisco, California
| | - Kyle Bernstein
- San Francisco Department of Public Health, STD Prevention and Control Services, San Francisco, California
| | - Torsten B. Neilands
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, California
| | - Marguerita Lightfoot
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, California
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Dias S, Marques A, Gama A, Martins MO. HIV risky sexual behaviors and HIV infection among immigrants: a cross-sectional study in Lisbon, Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:8552-66. [PMID: 25141001 PMCID: PMC4143877 DOI: 10.3390/ijerph110808552] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 07/23/2014] [Accepted: 08/12/2014] [Indexed: 11/16/2022]
Abstract
This study aimed to examine risky sexual behavior, its associated factors and HIV infection among immigrants. A participatory cross-sectional survey was conducted with 1187 immigrants at the National Immigrant Support Centre, in Lisbon (52.2% female; 34.0% Africans, 33.8% Brazilians, 32.2% Eastern Europeans). About 38% of participants reported ≥ 2 sexual partners in the previous year, 16.2% both regular and occasional sexual partners (last 12 months), 33.1% inconsistent condom use with occasional partners, and 64% no condom use in the last sexual intercourse. Unprotected sex in the last sexual intercourse was more likely among women, Africans, those older, with elementary education, those married and those who didn't receive free condoms in the previous year. No condom use was less likely among those having only occasional sexual partners and both regular and occasional sexual partners. One third of participants had never been tested for HIV. Those never tested reported more frequently inconsistent condom use than those ever tested. Overall, 2.0% reported being HIV positive (2.5% of men; 4.4% of Africans); 4.3% admitted having a STI in previous year. HIV-positive immigrants reported high-risk sexual behaviors. Tailored interventions to promote awareness of HIV serostatus among immigrants as well as culturally adapted risk reduction strategies should be strengthened.
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Affiliation(s)
- Sónia Dias
- Instituto de Higiene e Medicina Tropical - Centro de Malária e Outras Doenças Tropicais, Universidade Nova de Lisboa, Rua da Junqueira n° 100, Lisboa 1349-008, Portugal.
| | - Adilson Marques
- Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, Cruz Quebrada-Dafundo 1499-002, Portugal.
| | - Ana Gama
- Instituto de Higiene e Medicina Tropical - Centro de Malária e Outras Doenças Tropicais, Universidade Nova de Lisboa, Rua da Junqueira n° 100, Lisboa 1349-008, Portugal.
| | - Maria O Martins
- Instituto de Higiene e Medicina Tropical - Centro de Malária e Outras Doenças Tropicais, Universidade Nova de Lisboa, Rua da Junqueira n° 100, Lisboa 1349-008, Portugal.
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Ojikutu B, Nnaji C, Sithole-Berk J, Bogart LM, Gona P. Barriers to HIV Testing in Black Immigrants to the U.S. J Health Care Poor Underserved 2014; 25:1052-66. [PMID: 25130224 PMCID: PMC4442684 DOI: 10.1353/hpu.2014.0141] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Late HIV testing is common among immigrants from sub Saharan Africa and the Caribbean. Since 2010, HIV testing is no longer a required component of immigrant screening examinations or mandatory for immigrants seeking long term residence in the US. Thus, barriers to HIV testing must be addressed. METHODS Five hundred and fifty-five (555) immigrants completed a barriers-to-HIV testing scale. Univariate and multivariate linear regression were performed to examine predictors of barriers. RESULTS In multivariate analysis, primary language other than English (β=2.9, p=.04), lower education (β=5.8, p=.03), low income [= below $20K/year] (β=4.6, p=.01), no regular provider (β=5.2, p=.002) and recent immigration (β=5.7, p=.0008) were independently associated with greater barriers. Barriers due to health care access, privacy, fatalism, and anticipated stigma were greater for recent versus longer term immigrants. DISCUSSION Immigrants from sub-Saharan Africa and the Caribbean face significant barriers to HIV testing. Interventions to improve access and timely entry into care are needed.
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Chadwick JJ, Andrade LF, Altice FL, Petry NM. Correlates of having never been HIV tested among entrants to substance abuse treatment clinics: empiric findings from real-world New England settings. J Psychoactive Drugs 2014; 46:208-14. [PMID: 25052879 PMCID: PMC4780256 DOI: 10.1080/02791072.2014.915363] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Routine testing is the cornerstone to identifying HIV, but not all substance abuse treatment patients have been tested. This study is a real-world evaluation of predictors of having never been HIV tested among patients initiating substance abuse treatment. Participants (N = 614) from six New England clinics were asked whether they had ever been HIV tested. Eighty-five patients (13.8%) reported having never been tested and were compared to those who had undergone testing. Clinic, male gender (adjusted odds ratio (AOR) = 1.91, 95% confidence interval (CI) = 1.07-3.41), and having fewer employment (AOR = 0.31; 95% CI = 0.11-0.88) and medical problems (AOR = 0.40, 95% CI = 0.17-0.99) were independently correlated with having never been HIV tested. Thus, there is still considerable room for improved testing strategies as a clinically significant minority of substance abuse patients have never undergone HIV testing when they initiate treatment.
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Affiliation(s)
- Jeanne J. Chadwick
- Eastern Connecticut State University, Department of Biology, Willimantic, CT, USA
| | - Leonardo F. Andrade
- University of Connecticut School Medicine, Calhoun Cardiology Center, Farmington, CT, USA
| | - Frederick L. Altice
- Yale University School of Medicine, Infectious Diseases Section, AIDS Program, New Haven, CT, USA
- Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA
| | - Nancy M. Petry
- University of Connecticut School Medicine, Calhoun Cardiology Center, Farmington, CT, USA
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Zheng MY, Suneja A, Chou AL, Arya M. Physician barriers to successful implementation of US Preventive Services Task Force routine HIV testing recommendations. J Int Assoc Provid AIDS Care 2014; 13:200-5. [PMID: 24442739 PMCID: PMC4016109 DOI: 10.1177/2325957413514276] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In 2006, the US Centers for Disease Control and Prevention issued recommendations supporting routine HIV testing in health care settings for all persons aged 13 to 64 years. Despite these recommendations, physicians are not offering HIV testing routinely. We apply a model that has previously identified 3 central, inter-related factors (knowledge-, attitude-, and behavior-related barriers) for why physicians do not follow practice guidelines in order to better understand why physicians are not offering HIV testing routinely. This model frames our review of the existing literature on physician barriers to routine HIV testing. Within the model, knowledge barriers include lack of familiarity or awareness of clinical recommendations, attitude barriers include lack of agreement with guidelines, while behavioral barriers include external barriers related to the guidelines themselves, to patients, or to environmental factors. Our review reveals that many physicians face these barriers with regards to implementing routine HIV testing. Several factors underscore the importance of determining how to best address physician barriers to HIV testing, including: provisions of the Affordable Care Act that are likely to require or incentivize major payers to cover HIV testing, evidence which suggests that a physician's recommendation to test for HIV is a strong predictor of patient testing behavior, and data which reveals that nearly 20% of HIV-positive individuals may be unaware of their status. In April 2013, the US Preventive Services Task Force released a recommendation supporting routine HIV testing; strategies are needed to help address ongoing physician barriers to testing.
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Affiliation(s)
- Micha Yin Zheng
- University of California, Berkeley, School of Public Health, Berkeley, CA, USA
- Rice University, School of Humanities, Houston, TX, USA
| | - Amit Suneja
- Columbia University College of Physicians and Surgeons, New York, NY, USA
- Rice University, School of Social Sciences, Houston, TX, USA
| | - Ann Love Chou
- Rice University, School of Social Sciences, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Monisha Arya
- Department of Medicine, Section of Infectious Diseases Health Services Research, Baylor College of Medicine, Houston, TX, USA
- Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. Debakey VA Medical Center, Houston, TX, USA
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Arya M, Kallen MA, Street RL, Viswanath K, Giordano TP. African-American patients' preferences for a health center campaign promoting HIV testing: an exploratory study and future directions. J Int Assoc Provid AIDS Care 2014; 13:488-91. [PMID: 24739209 DOI: 10.1177/2325957414529823] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE In 2006, the US Centers for Disease Control and Prevention recommended routine HIV testing in health care settings and called for HIV testing campaigns targeting African Americans. In a 2011 national survey, 63% of African Americans wanted information on HIV testing. METHODS In our study, 176 African Americans were surveyed to determine channels and spokespersons for an HIV testing campaign. RESULTS Among 9 media channels, the top 3 ranked as "very likely" to convince them to get HIV tested were television, poster, and brochure. Among 10 spokespersons, the top 3 were doctor, nurse, and "real person like me." CONCLUSION The media are a cost-effective strategy to promote HIV prevention. Posters and brochures are inexpensive and easy to reproduce for clinical settings. Television campaigns may be feasible in clinics with closed-circuit televisions. Research is needed on campaign messages. An effective health center HIV testing campaign may help mitigate the disproportionate toll HIV is having on African Americans.
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Affiliation(s)
- Monisha Arya
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Health Decision-Making and Communication Program, Houston VA Health Services Research and Development Center of Excellence, Michael E. Debakey VA Medical Center, Houston, TX, USA
| | - Michael A Kallen
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Richard L Street
- Baylor College of Medicine and Houston VA Health Services Research and Development Center of Excellence, Michael E. Debakey VA Medical Center, Houston, TX, USA
| | | | - Thomas P Giordano
- Baylor College of Medicine and Houston VA Health Services Research and Development Center of Excellence, Michael E. Debakey VA Medical Center, Houston, TX, USA
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Arya M, Bush AL, Kallen MA, Rodriguez-Barradas MC, Giordano TP. Are VA primary care providers aware of HIV testing recommendations for Veterans? Findings at an urban VA primary care clinic. Mil Med 2014; 178:e483-8. [PMID: 23707836 DOI: 10.7205/milmed-d-12-00222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Given the prevalence of human immunodeficiency virus (HIV) in veterans and that nearly 90% of veterans have not been HIV tested, the Veterans Affairs (VA) has recommended routine HIV testing of all veterans.The objective of this study carried out at an urban VA primary care clinic was to assess provider knowledge of recent U.S. Centers for Disease Control and Prevention (CDC) and VA HIV testing recommendations and policies. Fifty-six primary care providers completed a survey. Nearly 40% of providers were unaware of the CDC recommendation to test all persons ages 13 to 64 in health care settings or the VA policy to test veterans of all ages. Over 75% of providers were unaware of the latest requirements for pre- and posttest counseling, and many were unaware of the latest consent process requirements. Educating VA providers about recent HIV testing recommendations and policies may improve the low HIV testing prevalence in the VA.
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Affiliation(s)
- Monisha Arya
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, MS 288, Houston, TX 77030, USA
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DiStefano AS, Gill JK, Hubach RD, Cayetano RT, Hilbert CJ. HIV testing in an ethnically diverse sample of American university students: associations with violence/abuse and covariates. J Behav Med 2013; 37:1030-46. [DOI: 10.1007/s10865-013-9540-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 09/07/2013] [Indexed: 10/26/2022]
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Latkin CA, Davey-Rothwell MA, Knowlton AR, Alexander KA, Williams CT, Boodram B. Social network approaches to recruitment, HIV prevention, medical care, and medication adherence. J Acquir Immune Defic Syndr 2013; 63 Suppl 1:S54-8. [PMID: 23673888 DOI: 10.1097/qai.0b013e3182928e2a] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article reviews the current issues and advancements in social network approaches to HIV prevention and care. Social network analysis can provide a method to understand health disparities in HIV rates, treatment access, and outcomes. Social network analysis is a valuable tool to link social structural factors to individual behaviors. Social networks provide an avenue for low-cost and sustainable HIV prevention interventions that can be adapted and translated into diverse populations. Social networks can be utilized as a viable approach to recruitment for HIV testing and counseling, HIV prevention interventions, optimizing HIV medical care, and medication adherence. Social network interventions may be face-to-face or through social media. Key issues in designing social network interventions are contamination due to social diffusion, network stability, density, and the choice and training of network members. There are also ethical issues involved in the development and implementation of social network interventions. Social network analyses can also be used to understand HIV transmission dynamics.
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Affiliation(s)
- Carl A Latkin
- Department of Health, Johns Hopkins Bloomberg School of Public Health, University of Pennsylvania, Baltimore, MD, USA.
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Human immunodeficiency virus testing behaviors among US adults: the roles of individual factors, legislative status, and public health resources. Sex Transm Dis 2013; 38:858-64. [PMID: 21844742 DOI: 10.1097/olq.0b013e31821a0635] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention recommended an "opt-out" human immunodeficiency virus (HIV) testing strategy in 2006 for all persons aged 13 to 64 years at healthcare settings. We conducted this study to identify individual, health, and policy factors that may be associated with HIV testing in US adults. METHODS The 2008 Behavioral Risk Factors Surveillance System data were utilized. Individuals' residency states were classified into 4 categories based on the legislation status to HIV testing laws in 2007 and HIV/acquired immune deficiency syndrome morbidity. A multivariate logistic regression adjusting for survey designs was performed to examine factors associated with HIV testing. RESULTS A total of 281,826 adults aged 18 to 64 years answered HIV testing questions in 2008. The proportions of US adults who had ever been tested for HIV increased from 35.9% in 2006 to 39.9% in 2008. HIV testing varied across the individual's characteristics including sociodemographics, access to regular health care, and risk for HIV infection. Compared with residents of "high morbidity-opt out" states, those living in "high morbidity-opt in" states with legislative restrictions for HIV testing had a slightly lower odds of being tested for HIV (adjusted odds ratio = 0.96; 95% confidence interval = 0.92, 1.01). Adults living in "low morbidity" states were significantly less likely to be tested for HIV, regardless of legislative status. CONCLUSIONS To implement routine HIV testing in the general population, the role of public health resources should be emphasized and legislative barriers should be further reduced. Strategies need to be developed to reach people who do not have regular access to health care.
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Wong EY, Jordan WC, Malebranche DJ, DeLaitsch LL, Abravanel R, Bermudez A, Baugh BP. HIV testing practices among black primary care physicians in the United States. BMC Public Health 2013; 13:96. [PMID: 23375193 PMCID: PMC3599058 DOI: 10.1186/1471-2458-13-96] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 01/24/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Centers for Disease Control and Prevention recommends routine HIV testing in all healthcare settings, but it is unclear how consistently physicians adopt the recommendation. Making the most of each interaction between black physicians and their patients is extremely important to address the HIV health disparities that disproportionately afflict the black community. The goal of this survey-based study was to evaluate the perceptions and practices of black, primary care physicians regarding HIV testing. METHODS A physician survey was administered at the 2010 National Medical Association Annual Convention, via online physician panels, and by email. Physician eligibility criteria: black race; practicing at least 1 year in the US; practice comprised of at least 60% adults and 20% black patients. Contingency tables and ordinary least squares regression were used for comparisons and statistical analyses. A Chi-square test compared percentages of physicians who gave a particular response and a t-test compared the means of values provided by physicians. RESULTS Physicians over-estimated HIV prevalence and believed that HIV is a crisis in the black community, yet reported that only 34% of patients were HIV tested in the past year. Physicians reported that 67% of those patients tested did so due to a physician recommendation. Physicians who were younger, female, obstetricians/gynecologists, and had a higher proportion of black, low-socioeconomic status, and Medicaid patients reported higher testing rates. Most testing was risk-based rather than routine, and three of the five most commonly reported barriers to testing were related to disease stigma and perceived value judgments. Physicians reported that in-office patient informational materials, increased media attention, additional education and training on HIV testing, government mandates requiring routine testing, and accurate pre-packed tests would most help them test more frequently for HIV. CONCLUSIONS In this sample of black, primary care physicians, HIV testing practices differed according to physician characteristics and practice demographics, and overall reported testing rates were low. More physician education and training around testing guidelines is needed to enable more routine testing, treatment, and long-term management of patients with HIV.
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Affiliation(s)
- Eric Y Wong
- Janssen Therapeutics, 1125 Trenton-Harbourton Road, Titusville, New Jersey, USA
| | - Wilbert C Jordan
- OASIS Clinic, 1807 East 120th Street, 90059, Los Angeles, California, USA
| | - David J Malebranche
- Emory University Division of General Medicine, 49 Jesse Hill Jr. Drive, Suite 413, 30303, Atlanta, Georgia, USA
| | - Lori L DeLaitsch
- Janssen Therapeutics, 1125 Trenton-Harbourton Road, Titusville, New Jersey, USA
| | - Rebecca Abravanel
- Added Value Cheskin, 255 Shoreline Drive, Suite 350, 94065, Redwood Shores, California, USA
| | - Alisha Bermudez
- Added Value Cheskin, 255 Shoreline Drive, Suite 350, 94065, Redwood Shores, California, USA
| | - Bryan P Baugh
- Janssen Therapeutics, 1125 Trenton-Harbourton Road, Titusville, New Jersey, USA
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Washington TA, Robles G, Malotte K. Factors associated with HIV-testing history among Black men who have sex with men (BMSM) in Los Angeles County. Behav Med 2013; 39:52-9. [PMID: 23930896 PMCID: PMC3795616 DOI: 10.1080/08964289.2013.779565] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Black men who have sex with men (BMSM) are disproportionately affected with HIV, and nearly half are unaware of their status. Those unaware of their status are more likely to engage in risky behavior; thus, HIV-testing uptake is crucial. This study explored correlates of past-two-year HIV-testing history. BMSM (n = 102) completed self-administered questionnaires. Fisher exact test indicated that BMSM at clubs/bars and Gay Pride events had higher rates of being tested within the past two years (86%-65%) than did participants who responded to online advertisements (44%, p < .001). Among those untested for HIV, slightly half reported receptive anal sex without a condom (48%, p = .033), used the Internet seeking sex (54%, p < .001), low HIV knowledge (52%, p = .005), and less education. Literacy and tailored online interventions might be worth considering to increase HIV-testing uptake.
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Affiliation(s)
- Thomas Alex Washington
- California State University, Long Beach, School of Social Work, 1250 Bellflower, SPPA 132, Long Beach, CA 90840, USA.
| | - Gabriel Robles
- Research Infrastructure for Minority Institutions (RIMI),Silver School of Social Work, New York University
| | - Kevin Malotte
- Research Infrastructure for Minority Institutions (RIMI),Center for Health Care Innovation, California State University, Long Beach
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Lechuga J, Owczarzak JT, Petroll AE. Marketing the HIV test to MSM: ethnic differences in preferred venues and sources. Health Promot Pract 2012; 14:433-40. [PMID: 23091299 DOI: 10.1177/1524839912460870] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lack of awareness of HIV status is associated with an increased likelihood of HIV transmission. We surveyed 633 men who have sex with men (MSM) from diverse ethnic groups recruited from a variety of community venues in a U.S. Midwestern city with rising HIV infection rates. Our first aim was to describe patterns of sexual risk, annual HIV testing frequency, and venues where information about HIV and HIV testing could be disseminated to inner-city MSM. Our second aim was to identify preferred sources to receive information about HIV testing and determine whether these preferences differed by ethnic background. Results indicated that despite similar proportions of high-sexual risk behaviors, compared with African American and Latino MSM, smaller proportions of non-Hispanic White MSM had received an HIV test in the last 12 months. Despite ethnic differences in health care access, a physician's office was the most common HIV testing site. Overall, a majority conveyed a preference to see advertisements in mainstream media outlets. However, when preferences were stratified by ethnicity, African American MSM were the least likely to prefer receiving information from mainstream media and conveyed a stronger preference to receive information from authority figures than non-Hispanic White and Hispanic MSM.
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Affiliation(s)
- Julia Lechuga
- Medical College of Wisconsin, Milwaukee, WI 53202, USA.
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Young men's preferences for sexually transmitted disease and reproductive health services in San Francisco, California. Sex Transm Dis 2012; 39:421-3. [PMID: 22592826 DOI: 10.1097/olq.0b013e318249d651] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We explored STD (sexually transmitted disease) service preferences among 108 African-American adolescent males recruited from a high-morbidity neighborhood. Participants largely preferred to seek care at traditional STD testing venues (86.5%) rather than nontraditional venues. Additionally, most males preferred receiving STD test results from a clinician (61.1%) rather than online (11.1%) or through email or text message (12.0%). These results highlight the need for continued strengthening of traditional public health clinics to ensure capacity to meet young men's health needs and to improve outreach and access to traditional STD services for young men.
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Wenzel SL, Rhoades H, Tucker JS, Golinelli D, Kennedy DP, Zhou A, Ewing B. HIV risk behavior and access to services: what predicts HIV testing among heterosexually active homeless men? AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2012; 24:270-279. [PMID: 22676465 PMCID: PMC3623941 DOI: 10.1521/aeap.2012.24.3.270] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
HIV is a serious epidemic among homeless persons, where rates of infection are estimated to be three times higher than in the general population. HIV testing is an effective tool for reducing HIV transmission and for combating poor HIV/AIDS health outcomes that disproportionately affect homeless persons, however, little is known about the HIV testing behavior of homeless men. This study examined the association between individual (HIV risk) and structural (service access) factors and past year HIV testing. Participants were a representative sample of 305 heterosexually active homeless men interviewed from meal programs in the Skid Row region of Los Angeles. Logistic regression examined the association between past year HIV testing and demographic characteristics, HIV risk behavior, and access to other services in the Skid Row area in the past 30 days. Despite high rates of past year HIV testing, study participants also reported high rates of HIV risk behavior, suggesting there is still significant unmet need for HIV prevention among homeless men. Having recently used medical/dental services in the Skid Row area (OR: 1.91; CI: 1.09, 3.35), and being a military veteran (OR: 2.10; CI: 1.01-4.37) were significantly associated with HIV testing service utilization. HIV testing was not associated with HIV risk behavior, but rather with access to services and veteran status, the latter of which prior research has linked to increased service access. We suggest that programs encouraging general medical service access may be important for disseminating HIV testing services to this high-risk, vulnerable population.
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Affiliation(s)
- Suzanne L Wenzel
- University of Southern California, School of Social Work, 669 W. 34th Street, Los Angeles, CA 90089-0411, USA.
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Copeland B, Shah B, Wheatley M, Heilpern K, del Rio C, Houry D. Diagnosing HIV in men who have sex with men: an emergency department's experience. AIDS Patient Care STDS 2012; 26:202-7. [PMID: 22356726 PMCID: PMC3317392 DOI: 10.1089/apc.2011.0303] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In the United States, men who have sex with men (MSM) constitute the risk group in which the prevalence of new HIV infection is increasing. The percentage of undiagnosed HIV infection and HIV risk behaviors in MSM and non-MSM participating in an emergency department-based rapid HIV screening program were compared. Medical records of all male patients participating in the program from May 2008 to October 2010 were reviewed. MSM were identified as male or male-to-female patients reporting oral and/or anal sex with a male. Males eligible for testing were aged 18 or older, English-speaking, not known to be HIV infected, and able to decline testing. A total of 6672 males were approached for testing; 5610 (84.1%) accepted, 366 (6.5%) were MSM, and 5244 (93.5%) were non-MSM. A total of 90.7% were black. Median age was 41. Fifty-nine MSM (16.1%) were diagnosed with HIV compared to 81 (1.5%) non-MSM. MSM were 10 times more likely than non-MSM to have undiagnosed HIV infection (odds ratio [OR] 10.4, 95% confidence interval [CI] 7.3, 14.0). HIV-infected MSM (median age, 26) were younger than non-MSM (median age, 41). HIV-infected non-MSM were 2 times more likely than MSM to have CD4 counts less than 200 cells per microliter. MSM were more likely to report previous HIV testing (OR 1.9, 95% CI 1.4, 2.5) and risk behaviors, including sex without a condom (OR 2.0, 95% CI 1.5, 2.6), sex with an HIV-infected partner (OR 14.6, 95% CI 8.3, 25.6) and sex with a known injection drug user (OR 4.1, 95% CI 2.0, 8.4). Further investigation of emergency department-based HIV testing and risk reduction programs targeting MSM is warranted.
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Affiliation(s)
- Brittney Copeland
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia 30303, USA.
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Glasman LR, Weinhardt LS, Hackl KL. Disparities in access to HIV prevention among men of Mexican descent living in the Midwestern United States. J Immigr Minor Health 2012; 13:1125-33. [PMID: 20686851 DOI: 10.1007/s10903-010-9373-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Men of Mexican descent (MMD) in the U.S. are disproportionately affected by HIV. Understanding MMD's access to HIV prevention is necessary to reduce their transmission rates. We explored disparities in access to HIV prevention among MMD of different assimilation status, healthcare access, and sexual risk behavior. 322 Midwestern MMD completed a survey assessing their access to passive interventions (e.g., lectures), interactive interventions (e.g., counseling), HIV testing, media information, and information from the Internet. 64% MMD had received passive interventions, 36% interactive interventions, 42% HIV testing, 41% information from media, and 12% from the Internet. MMD who were less assimilated to the U.S., had lower healthcare access, and were at risk for HIV, were less likely to have accessed prevention interventions but more likely to have received media information. Access to HIV prevention among Midwestern MMD is tied to their assimilation and healthcare access. Findings have implications for developing strategies of intervention delivery.
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Affiliation(s)
- Laura R Glasman
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI 53202, USA.
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Abstract
OBJECTIVES To assess barriers to human immunodeficiency virus (HIV) testing, health care contacts history, and HIV testing history among patients diagnosed concurrently with HIV and acquired immunodeficiency syndrome (AIDS). METHODS We surveyed patients concurrently diagnosed with HIV/AIDS who had participated in the partner notification program of the New York City Department of Health and Mental Hygiene, between January 2008 and December 2008. RESULTS The most common reason interviewees volunteered for delaying testing (64%) was that they did not believe they were at risk for HIV. When read a list of potential barriers, 69% of interviewees replied affirmatively that they did not test for HIV because they did not believe they were at risk, and 52% replied affirmatively that they did not test because they thought their behaviors kept them safe from getting HIV. Half of all interviewees reported having insurance during part or all of the year before they were diagnosed with HIV/AIDS, and 70% had at least 1 health care visit in the year before they were diagnosed with HIV/AIDS. CONCLUSIONS A lack of perception of risk was the most common reason for not testing for HIV sooner among these concurrently diagnosed patients. The majority of these patients were accessing medical care, indicating that this population could have benefited from routine HIV testing.
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Dorell CG, Sutton MY, Oster AM, Hardnett F, Thomas PE, Gaul ZJ, Mena LA, Heffelfinger JD. Missed opportunities for HIV testing in health care settings among young African American men who have sex with men: implications for the HIV epidemic. AIDS Patient Care STDS 2011; 25:657-64. [PMID: 21923415 DOI: 10.1089/apc.2011.0203] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Limited health care access and missed opportunities for HIV and other sexually transmitted infection (STI) education and testing in health care settings may contribute to risk of HIV infection. In 2008, we conducted a case-control study of African American men who have sex with men (MSM) in a southeastern city (Jackson, Mississippi) with an increase in numbers of newly reported HIV cases. Our aims were to evaluate associations between health care and HIV infection and to identify missed opportunities for HIV/STI testing. We queried 40 potential HIV-infected cases and 936 potential HIV-uninfected controls for participation in this study. Study enrollees included HIV-infected cases (n=30) and HIV-uninfected controls (n=95) who consented to participate and responded to a self-administered computerized survey about sexual risk behaviors and health care utilization. We used bivariate analysis and logistic regression to test for associations between potential risk factors and HIV infection. Cases were more likely than controls to lack health insurance (odds ratio [OR]=2.5; 95% confidence interval [CI]=1.1-5.7), lack a primary care provider (OR=6.3; CI=2.3-16.8), and to not have received advice about HIV or STI testing or prevention (OR=5.4; CI=1.3-21.5) or disclose their sexual identity (OR=7.0; CI=1.6-29.2) to a health care provider. In multivariate analysis, lacking a primary health care provider (adjusted odds ratio [AOR]=4.5; CI=1.4-14.7) and not disclosing sexual identity to a health care provider (AOR=8.6; CI=1.8-40.0) were independent risk factors for HIV infection among African American MSM. HIV prevention interventions for African American MSM should address access to primary health care providers for HIV/STI prevention and testing services and the need for increased discussions about sexual health, sexual identity, and sexual behaviors between providers and patients in an effort to reduce HIV incidence and HIV-related health disparities.
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Affiliation(s)
- Christina G. Dorell
- Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of HIV/AIDS Prevention; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Madeline Y. Sutton
- Division of HIV/AIDS Prevention; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alexandra M. Oster
- Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of HIV/AIDS Prevention; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Felicia Hardnett
- Division of HIV/AIDS Prevention; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Peter E. Thomas
- Division of HIV/AIDS Prevention; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Zaneta J. Gaul
- Division of HIV/AIDS Prevention; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leandro A. Mena
- University of Mississippi Medical Center and Mississippi State Department of Health, Jackson, Mississippi
| | - James D. Heffelfinger
- Division of HIV/AIDS Prevention; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Brooks RA, Lee SJ, Stover GN, Barkley TW. HIV testing, perceived vulnerability and correlates of HIV sexual risk behaviours of Latino and African American young male gang members. Int J STD AIDS 2011; 22:19-24. [PMID: 21364062 DOI: 10.1258/ijsa.2010.010178] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study examined HIV testing behaviours, perceived vulnerability to HIV and correlates of sexual risk behaviours of young adult Latino and African American male gang members in Los Angeles, California. Data were collected from 249 gang members aged 18-26 years. The majority (59%) of gang members reported unprotected vaginal intercourse (UVI) in the past 12 months. Only one-third (33.2%) of gang members had ever been tested for HIV. In our multivariate analysis, gang members who reported UVI were more likely to have engaged in the following behaviours: had sex with someone they just met (adjusted odds ratio [AOR] = 4.51), had sex with someone they think or know had a sexually transmitted infection (STI; AOR = 4.67) or had sex while incarcerated (AOR = 8.92). In addition, gang members with a higher perceived vulnerability to HIV were less likely to report UVI in the previous 12 months (AOR = 0.75). These findings offer implications for development of an HIV prevention intervention for young Latino and African American male gang members.
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Affiliation(s)
- R A Brooks
- David Geffen School of Medicine at UCLA, Department of Family Medicine, Los Angeles, CA, USA.
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Petroll AE, Mosack KE. Physician awareness of sexual orientation and preventive health recommendations to men who have sex with men. Sex Transm Dis 2011; 38:63-7. [PMID: 20706178 PMCID: PMC4141481 DOI: 10.1097/olq.0b013e3181ebd50f] [Citation(s) in RCA: 161] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) have unique health risks and needs. Providers who assume patients to be heterosexual may be providing suboptimal care. This study sought (1) to describe primary care provider (PCP) knowledge of patients' sexual orientation and the demographic and provider-related factors associated with such knowledge; and, (2) to assess whether PCP knowledge of sexual orientation was associated with appropriate recommendations for preventive and diagnostic health care services. METHODS A total of 271 MSM completed a cross-sectional survey. We measured MSMs' disclosure of their sexual orientation and demographic information, and PCP recommendations for preventive health services. RESULTS Most participants' PCPs (72%) knew the participants' sexual orientation. Participants with female, gay, and/or younger PCPs were more likely to have disclosed their sexual orientation. Black men, men from rural areas, and men with incomes under $15,000 per year were less likely to have disclosed their sexual orientation. PCP knowledge of sexual orientation was associated with a higher likelihood that PCPs recommended disease screening and preventive health measures: 59% versus 13% for human immunodeficiency virus testing, 32% versus 16% for hepatitis A or B vaccination. Inconsistencies were found between participants' self-reported risk behaviors and PCP recommendations. CONCLUSIONS Disclosure of sexual orientation is associated with several patient-related and provider-related characteristics. Lack of disclosure to providers significantly decreased the likelihood that appropriate health services were recommended to participants. Efforts to promote discussion of sexual orientation within the primary health care setting should be directed toward both PCPs and MSM.
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Affiliation(s)
- Andrew E Petroll
- Department of Psychiatry and Behavioral Health, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave, Milwaukee, WI 53202, USA.
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Latkin C, Weeks MR, Glasman L, Galletly C, Albarracin D. A dynamic social systems model for considering structural factors in HIV prevention and detection. AIDS Behav 2010. [PMID: 20838871 DOI: 10.1007/s10461-010-9804-y.a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
We present a model for HIV-related behaviors that emphasizes the dynamic and social nature of the structural factors that influence HIV prevention and detection. Key structural dimensions of the model include resources, science and technology, formal social control, informal social influences and control, social interconnectedness, and settings. These six dimensions can be conceptualized on macro, meso, and micro levels. Given the inherent complexity of structural factors and their interrelatedness, HIV prevention interventions may focus on different levels and dimensions. We employ a systems perspective to describe the interconnected and dynamic processes of change among social systems and their components. The topics of HIV testing and safer injection facilities (SIFs) are analyzed using this structural framework. Finally, we discuss methodological issues in the development and evaluation of structural interventions for HIV prevention and detection.
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Affiliation(s)
- Carl Latkin
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA.
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A dynamic social systems model for considering structural factors in HIV prevention and detection. AIDS Behav 2010; 14:222-38. [PMID: 20838871 DOI: 10.1007/s10461-010-9804-y] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We present a model for HIV-related behaviors that emphasizes the dynamic and social nature of the structural factors that influence HIV prevention and detection. Key structural dimensions of the model include resources, science and technology, formal social control, informal social influences and control, social interconnectedness, and settings. These six dimensions can be conceptualized on macro, meso, and micro levels. Given the inherent complexity of structural factors and their interrelatedness, HIV prevention interventions may focus on different levels and dimensions. We employ a systems perspective to describe the interconnected and dynamic processes of change among social systems and their components. The topics of HIV testing and safer injection facilities (SIFs) are analyzed using this structural framework. Finally, we discuss methodological issues in the development and evaluation of structural interventions for HIV prevention and detection.
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