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Muessig KE, Vecchio AC, Hanshaw BD, Soberano Z, Knudtson KA, Claude KF, Larsen MA, Hightow-Weidman LB. Barriers, Facilitators and Opportunities for HIV Status Disclosure Among Young Men Who Have Sex With Men: Qualitative Findings from the Tough Talks Intervention. AIDS Behav 2024:10.1007/s10461-024-04406-y. [PMID: 38951455 DOI: 10.1007/s10461-024-04406-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 07/03/2024]
Abstract
Disclosing one's HIV status can involve complex individual and interpersonal processes interacting with discriminatory societal norms and institutionalized biases. To support disclosure decision-making among young men who have sex with men (YMSM) living with HIV, we developed Tough Talks™, an mHealth intervention that uses artificially intelligent-facilitated role-playing disclosure scenarios and informational activities that build disclosure skills and self-efficacy. Qualitative interviews were conducted with 30 YMSM living with HIV (mean age 24 years, 50% Black) who were enrolled in a randomized controlled trial assessing Tough Talks™ to understand their experiences with HIV status disclosure. Interviews were recorded, transcribed, and thematically coded. Barriers to disclosure focused on fear, anxiety, stigma, and trauma. Facilitators to disclosure are described in the context of these barriers including how participants built comfort and confidence in disclosure decisions and ways the Tough Talks™ intervention helped them. Participants' narratives identified meaning-making within disclosure conversations including opportunities for educating others and advocacy. Findings revealed ongoing challenges to HIV status disclosure among YMSM and a need for clinical providers and others to support disclosure decision-making and affirm individuals' autonomy over their decisions to disclose. Considering disclosure as a process rather than discrete events could inform future intervention approaches.
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Affiliation(s)
- Kathryn E Muessig
- University of North Carolina-Chapel Hill, Institute of Global Health and Infectious Diseases, Chapel Hill, USA.
- University of North Carolina-Chapel Hill, Gillings School of Global Public Health Chapel Hill, Chapel Hill, USA.
- Florida State University, College of Nursing, Institute on Digital Health and Innovation, Innovation Park, Research Building B, 2010 Levy Ave, RM B3400, Tallahassee, FL, 32306-4310, USA.
| | - Alyssa C Vecchio
- University of North Carolina-Chapel Hill, Institute of Global Health and Infectious Diseases, Chapel Hill, USA
| | - Brady D Hanshaw
- University of North Carolina-Chapel Hill, Institute of Global Health and Infectious Diseases, Chapel Hill, USA
- Harvard Medical School, Harvard University, Boston, USA
| | - Zachary Soberano
- University of North Carolina-Chapel Hill, Institute of Global Health and Infectious Diseases, Chapel Hill, USA
- Florida State University, College of Nursing, Institute on Digital Health and Innovation, Innovation Park, Research Building B, 2010 Levy Ave, RM B3400, Tallahassee, FL, 32306-4310, USA
| | - Kelly A Knudtson
- University of North Carolina-Chapel Hill, Institute of Global Health and Infectious Diseases, Chapel Hill, USA
| | - Kristina Felder Claude
- University of North Carolina-Chapel Hill, Institute of Global Health and Infectious Diseases, Chapel Hill, USA
- Florida State University, College of Nursing, Institute on Digital Health and Innovation, Innovation Park, Research Building B, 2010 Levy Ave, RM B3400, Tallahassee, FL, 32306-4310, USA
| | | | - Lisa B Hightow-Weidman
- University of North Carolina-Chapel Hill, Institute of Global Health and Infectious Diseases, Chapel Hill, USA
- University of North Carolina-Chapel Hill, Gillings School of Global Public Health Chapel Hill, Chapel Hill, USA
- Florida State University, College of Nursing, Institute on Digital Health and Innovation, Innovation Park, Research Building B, 2010 Levy Ave, RM B3400, Tallahassee, FL, 32306-4310, USA
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Yao TY, Liou BH, Chien WC, Wu FL. Disclosure Concerns and the Correlation Among Gay, Bisexual, and Other Men Who Have Sex With Men Living With HIV Receiving Antiretroviral Therapy in Taiwan. Health Serv Insights 2024; 17:11786329231224620. [PMID: 38264172 PMCID: PMC10804901 DOI: 10.1177/11786329231224620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/19/2023] [Indexed: 01/25/2024] Open
Abstract
Gay, bisexual, and other men who have sex with men (GBMSM) are associated with the widespread human immunodeficiency virus (HIV) transmission in Taiwan. Additionally, little is known about disclosure patterns and rates, as well as factors influencing disclosure, among GBMSM living with HIV in the country. HIV prevention for GBMSM is effective when HIV status is disclosed. For instance, GBMSM disclosing their HIV status can result in early pre-exposure prophylaxis with a serodiscordant partner. In this cross-sectional study of 200 GBMSM living with HIV conducted from June to November 2020, we assessed internalized homophobia (IHP Scale) and social support (Multidimensional Scale of Perceived Social Support), as well as self-reported disclosure and non-disclosure. Among the participants, 75.5% revealed their HIV status within 3 months of diagnosis. Younger age, occupation type, and number of sexual partners were some factors associated with disclosure. Those receiving more social support and who experienced less IHP were more likely to reveal their HIV status. On the contrary, older GBMSM and GBMSM living with HIV who worked in educational enterprises still experienced severe IHP. Policymakers and healthcare practitioners should be aware of the problems faced by GBMSM living with HIV and offer practical assistance to improve their mental health.
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Affiliation(s)
- Tzy-Yu Yao
- Department of Nursing, MacKay Memorial Hospital, Hsinchu City, Taiwan R.O.C
| | - Bo-Huang Liou
- Department of Internal Medicine, MacKay Memorial Hospital, Hsinchu City, Taiwan R.O.C
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital and school of Public Health, National Defense Medical Center, Taipei City, Taiwan R.O.C
| | - Fei-Ling Wu
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan R.O.C
- Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan R.O.C
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Roth GH, Walker ER, Talley CL, Hussen SA. 'It's a very grey, very messy area': a qualitative examination of factors influencing undetectable gay men's HIV status disclosure to sexual partners. CULTURE, HEALTH & SEXUALITY 2023; 25:664-679. [PMID: 35697340 DOI: 10.1080/13691058.2022.2086708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
HIV disclosure to sexual partners remains a multifaceted yet stigmatised process. The 'undetectable equals untransmittable' (U = U) concept has raised ethical and moral concerns about the obligation and need to disclose, and using Internet applications to seek sex partners has modified disclosure practices. While previous qualitative literature has examined the HIV disclosure process, there is a dearth of information on this topic among gay men in the USA who have an undetectable viral load. Using thematic analysis of data collected during a period of expanded U = U knowledge, this study explores the cognitive, contextual, interpersonal and structural factors impacting undetectable gay men's HIV status disclosure decisions to sexual partners. In-depth interviews were conducted in August 2020 over Zoom with 20 gay men with undetectable viral loads. The main themes included 'sense of obligation,' 'situational disclosure' and 'partners' responsibility in the disclosure process.' Participants balanced the aforementioned factors to inform their disclosure decisions, and disclosure patterns varied across participants dependent upon thoughts regarding ethics and morality of (non-)disclosure. The findings provide new insights to how participants navigate disclosure while considering U = U, HIV criminalisation laws, and finding partners through Internet applications while providing direction for future studies and support for decriminalising HIV and expanding HIV education.
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Affiliation(s)
- Grant H Roth
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Elizabeth Reisinger Walker
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Colin L Talley
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sophia A Hussen
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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HIV Status Disclosure and Associated Characteristics Among HIV-Positive MSM Receiving Antiretroviral Therapy in Jinan, China. AIDS Behav 2022; 27:2205-2215. [DOI: 10.1007/s10461-022-03952-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
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Reis RK, Sousa LRM, Melo ES, Fernandes NM, Sorensen W, Gir E. Predictors of HIV Status Disclosure to Sexual Partners Among People Living with HIV in Brazil. AIDS Behav 2021; 25:3538-3546. [PMID: 34173896 DOI: 10.1007/s10461-021-03362-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/26/2022]
Abstract
The objective of this study was to identify the factors associated with the non-disclosure of HIV seropositivity among people living with HIV/AIDS undergoing antiretroviral treatment. A cross-sectional study was carried out in five HIV clinics in the interior of the state of São Paulo, Brazil. Logistic regression analysis was used to determine independent predictors of HIV status disclosure. It was found that 68.5% revealed their HIV seropositivity to their most recent sexual partner. The variables "casual partner" [OR 19.08, 95% CI (4.08, 20.23), p = 0.001], "sexual partners with negative HIV or unknown HIV" [OR 4.54, 95% CI (1.58, 1.01), p = 0.005], "multiple sexual partners" [OR = 3.17, 95% CI (1.34, 7.35), p = 0.009], and "lack of communication with the partner on HIV prevention"[OR = 8.3, 95% CI (3.88, 16.61), p = 0.001] were independently associated with non-disclosure of the diagnosis. Future HIV prevention interventions should encourage open communication between sexual partners.
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Affiliation(s)
- Renata Karina Reis
- Department of General and Specialized Nursing, WHO Collaborating Centre for Nursing Research Development, University of São Paulo At Ribeirão Preto College of Nursing, Avenida: Bandeirantes, 3900 Campus Universitário - Bairro Monte Alegre, Ribeirão Preto, São Paulo, Brazil.
| | - Laelson Rochelle Milanês Sousa
- Department of General and Specialized Nursing, WHO Collaborating Centre for Nursing Research Development, University of São Paulo At Ribeirão Preto College of Nursing, Avenida: Bandeirantes, 3900 Campus Universitário - Bairro Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Elizabete Santos Melo
- Department of General and Specialized Nursing, WHO Collaborating Centre for Nursing Research Development, University of São Paulo At Ribeirão Preto College of Nursing, Avenida: Bandeirantes, 3900 Campus Universitário - Bairro Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | | | - William Sorensen
- Department of Health and Kinesiology, University of Texas, Tyler, TX, USA
| | - Elucir Gir
- Department of General and Specialized Nursing, WHO Collaborating Centre for Nursing Research Development, University of São Paulo At Ribeirão Preto College of Nursing, Avenida: Bandeirantes, 3900 Campus Universitário - Bairro Monte Alegre, Ribeirão Preto, São Paulo, Brazil
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Grov C, Westmoreland DA, D’Angelo AB, Pantalone DW. How Has HIV Pre-Exposure Prophylaxis (PrEP) Changed Sex? A Review of Research in a New Era of Bio-behavioral HIV Prevention. JOURNAL OF SEX RESEARCH 2021; 58:891-913. [PMID: 34180743 PMCID: PMC9729849 DOI: 10.1080/00224499.2021.1936440] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
In 2012, the U.S. FDA approved the first drug for use as HIV Pre-Exposure Prophylaxis (PrEP), which is nearly 99% effective when taken as prescribed. Although the manifest function of PrEP is to prevent HIV infection in the event of exposure, the drug has also had a significant impact on various facets of sexuality. In this review, we focus on research that emerged in the near decade since PrEP's approval, with a specific focus on the ways in which different elements of sex and sexuality have been impacted by gay, bisexual, and other men who have sex with men (GBMSM), cisgender women, and transgender individuals. We highlight evidence showing how PrEP has enhanced sexual self-esteem, improved sexual pleasure, reduced sexual anxiety, and has increased sexual agency for those taking it. For many, PrEP also serves as a gateway to improve routine health and increase sexual health-care utilization. Additionally, we review the question of whether PrEP is associated with increased sexual risk taking (i.e. risk compensation), and note that, although some data are mixed, PrEP is not intended as an intervention to reduce condomless anal sex or STIs: it aims to prevent HIV. Finally, our review highlights that, although the volume of research on PrEP among GBMSM is robust, it is underdeveloped for cisgender women and transgender populations and insufficient for inclusion in such a review for cisgender heterosexual men was. PrEP research with these populations is an important direction for future research. Finally, from 2012 to 2019, a single PrEP formulation and delivery method was FDA approved (oral emtricitabine/tenofovir disoproxil fumarate). As additional drug formulations (ie.g., emtricitabine/tenofovir alafenamide) and delivery methods (e.g., microbiocides, vaginal ring, injectable) come to market, it will be important to examine how these, too, impact the spectrum of sexuality.
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Affiliation(s)
- Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY
- CUNY Institute for Implementation Science in Population Health, New York, NY
| | | | - Alexa B. D’Angelo
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY
- CUNY Institute for Implementation Science in Population Health, New York, NY
| | - David W. Pantalone
- Department of Psychology, University of Massachusetts Boston
- The Fenway Institute, Fenway Health, Boston, MA
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Nelson LE. Awakening to an Intersectional Reality: Ending the HIV Epidemic in the USA Starts with Reducing Inequities among Black MSM. J Urban Health 2020; 97:589-591. [PMID: 33025307 PMCID: PMC7560685 DOI: 10.1007/s11524-020-00487-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 01/13/2023]
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