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Berlin GW, Dermody SS, Noor SW, Skakoon-Sparling S, Ghauri Y, Zahran A, Card KG, Lachowsky NJ, Cox J, Moore DM, Lambert G, Jollimore J, Grace D, Zhang H, Apelian H, Sang JM, Dvorakova M, Lal A, Hart TA. Minority Stress, Psychological Distress, Sexual Compulsivity, and Avoidance-Based Motivations Associated with Methamphetamine Use Among Sexual Minority Men Living with HIV: Examining Direct and Indirect Associations Using Cross-Sectional Structural Equation Modeling. Subst Use Misuse 2024:1-11. [PMID: 38950280 DOI: 10.1080/10826084.2024.2369159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
OBJECTIVE Sexual minority men (SMM) living with HIV report significantly greater methamphetamine use compared with heterosexual and HIV-negative peers. Greater use may be related to stressors (e.g., HIV-related stigma) faced by SMM living with HIV and subsequent psychological and behavioral sequelae. We tested an integrated theoretical model comprised of pathways between stigma, discrimination, childhood sexual abuse, psychological distress, sexual compulsivity, and cognitive escape in predicting methamphetamine use among SMM living with HIV. METHODS Among 423 SMM living with HIV, we tested a structural equation model examining factors hypothesized to be directly and indirectly associated with methamphetamine use. Analyses were adjusted for demographic covariates and sampling bias. RESULTS The model showed good fit (CFI = 0.96, RMSEA = 0.01). Heterosexist discrimination was associated with psychological distress (β = 0.39, p < 0.001) and psychological distress was associated with sexual compulsivity (β = 0.33, p < 0.001). Sexual compulsivity was associated with cognitive escape (β = 0.31, p < 0.001), which was associated with methamphetamine use (β = 0.51, p < 0.001). Psychological distress was associated with methamphetamine use via serial indirect effects of sexual compulsivity and cognitive escape (β = 0.05, p < 0.05). CONCLUSIONS Heterosexist discrimination contributed to psychological distress among SMM living with HIV. Psychological distress is linked to methamphetamine use via sexual compulsivity and cognitive avoidance. Interventions seeking to reduce the likelihood that SMM living with HIV use methamphetamine should include coping strategies specific to heterosexism and related psychological distress.
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Affiliation(s)
| | | | - Syed W Noor
- Toronto Metropolitan University, Toronto, Canada
- Louisiana State University Shreveport, Shreveport, Louisiana, USA
| | | | - Yusuf Ghauri
- Toronto Metropolitan University, Toronto, Canada
| | - Adhm Zahran
- Toronto Metropolitan University, Toronto, Canada
| | - Kiffer G Card
- University of Victoria, Victoria, Canada
- Simon Fraser University, Vancouver, Canada
| | | | - Joseph Cox
- McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Gilles Lambert
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Institute National de Santé Publique du Québec, Montreal, Canada
| | - Jody Jollimore
- Canadian AIDS Treatment Information Exchange (CATIE), Toronto, Canada
| | | | | | - Herak Apelian
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Jordan M Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Milada Dvorakova
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Trevor A Hart
- Toronto Metropolitan University, Toronto, Canada
- University of Toronto, Toronto, Canada
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Avallone F, Engler K, Cox J, Hickson F, Lebouché B. Interventions, Barriers, and Facilitators to Address the Sexual Problems of Gay, Bisexual and Other Men Who Have Sex with Men Living with HIV: A Rapid Scoping Review. AIDS Behav 2024; 28:450-472. [PMID: 38296920 DOI: 10.1007/s10461-023-04237-3] [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] [Accepted: 11/28/2023] [Indexed: 02/02/2024]
Abstract
Sexual problems are common among gay, bisexual, and other men who have sex with men (GBM) after diagnosis with HIV. However, these are often overlooked in care and research, where sexual risk reduction and biomedical aspects of sexual health tend to dominate. We conducted a rapid scoping review to investigate which sexual problems of GBM living with HIV are addressed by interventions, and the barriers and facilitators to their implementation. Literature from high-income countries published in English since 2010 was reviewed. Medline, Embase, PsycInfo, and Scopus databases were searched on July 4, 2022. Targeted sexual problems were categorized according to the ten dimensions of Robinson's Sexual Health Model, and barriers and facilitators, according to the five domains of the Consolidated Framework for Implementation Research (CFIR). Interventions focused solely on the dimension of Sexual Health Care/Safer Sex were excluded. Relevant information was extracted from the qualifying documents with NVivo 12 software for content analysis. Fifty-two documents were included, referring to 37 interventions which mainly took place in the United States (n = 29/37; 78%), were group-based (n = 16; 41%), and used counselling techniques (n = 23; 62%; e.g., motivational interviewing, cognitive-behavioral therapy). Their settings were mostly primary care (n = 15; 40%) or community-based (n = 16; 43%). On average, interventions addressed three sexual health dimensions (SD = 2; range: 1-10). The most targeted dimension was Sexual Health Care/Safer Sex (n = 26; 70%), which concerned sexual risk reduction. Next, Challenges (n = 23; 62%), included substance use (n = 7; 19%), sexual compulsivity (n = 6; 16%), sexual abuse (n = 6; 16%), and intimate partner violence (n = 4; 11%). Third was Talking About Sex (n = 22; 59%) which mostly concerned HIV disclosure. About a third of interventions addressed Culture/Sexual identity (n = 14; 38%), Intimacy/Relationships (n = 12; 33%), and Positive sexuality (n = 11; 30%). Finally, few targeted Body Image (n = 4; 11%), Spirituality (n = 3; 8%), Sexual Anatomy Functioning (n = 2; 5%) or Masturbation/Fantasy (n = 1; 3%). Forty-one documents (79%) mentioned implementation barriers or facilitators, particularly about the characteristics of the interventions (41% and 78%, respectively; e.g., cost, excessive duration, acceptability, feasibility) and of the individuals involved (37% and 46%; e.g., perceived stigmatization, provider expertise). The other three CFIR dimensions were less common (5%-17%). The search strategy of this review may not have captured all eligible documents, due to its limit to English-language publications. Overall, most interventions incorporated a focus on Sexual Health Care/Safer Sex, at the expenses of other prevalent sexual problems among GBM living with HIV, such as intimate partner violence (Challenges), erectile dysfunction (Sexual Anatomy Functioning), and Body Image dissatisfaction. These findings suggest they could receive more attention within clinical care and at the community level. They also highlight the importance of cost-effective and acceptable interventions conducted in non-stigmatizing environments, where patients' needs can be met by providers who are adequately trained on sexuality-related topics.
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Affiliation(s)
- Francesco Avallone
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Kim Engler
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Joseph Cox
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada
- Department of Epidemiology and Biostatistics, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Ford Hickson
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Bertrand Lebouché
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada.
- Department of Family Medicine, McGill University, Montreal, QC, Canada.
- Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.
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Xu W, Zhao P, Li H, Wang C. HCV knowledge and attitudes among HIV-negative MSM and MSM living with HIV in China: results from a cross-sectional online survey. BMC Infect Dis 2023; 23:599. [PMID: 37704973 PMCID: PMC10500868 DOI: 10.1186/s12879-023-08586-1] [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: 05/24/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are at high risk of hepatitis C virus (HCV) infection, especially for those living with human immunodeficiency virus (HIV). Learning about knowledge of and attitudes towards HCV is essential to inform health promotion interventions development. This is one of very limited studies to examine the level of knowledge and attitudes towards HCV and their determinants among HIV-negative MSM and MSM living with HIV in China. METHODS A cross-sectional survey was conducted across seven provinces in China from December 2021 to January 2022. All the MSM living with HIV were recruited offline, whereas the recruitment ratio for HIV-negative MSM was half online and half offline. Data on socio-demographic characteristics, sexual behaviors, knowledge about HCV, and attitude towards HCV from participants were collected through the online survey. Univariate and multivariable logistic regressions were used to determine the associated factors. RESULTS Only 39.3% (33/84) of HIV-negative men and 44.0% (37/84) of men living with HIV had a good level knowledge about HCV. Nearly one-third (32.1%, 27/84) of HIV-negative men and 41.7% (35/84) of men living with HIV reported a positive attitude towards HCV. For HIV-negative men, positive attitude towards HCV was associated with the multiple sexual partners (aOR: 5.8, 95%CI:1.9-18.1) and the use of recreational substances (aOR: 3.1, 95%CI: 1.0-9.4). For men living with HIV, knowledge about HCV was associated with disclosing sexual orientation to healthcare providers, family or friends (aOR: 7.0, 1.9-26.0), the multiple sexual partners (aOR: 0.2, 0.1-1.0), the use of recreational substances (aOR: 3.7, 95%CI: 1.1-13.1) and the HBV testing history (aOR: 7.3, 95%CI: 1.6-32.7); positive attitude towards HCV was associated with the use of recreational substances (aOR: 3.1, 95%CI: 1.1-9.0). CONCLUSIONS The majority of Chinese MSM showed an inadequate knowledge of and negative attitude towards HCV irrespective of HIV infection status. More tailored education campaigns and multicomponent interventions are required to be targeted on MSM, and more researches are also needed to inform how best to address the negative attitudes of this population towards HCV.
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Affiliation(s)
- Wenqian Xu
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- Southern Medical University Institute for Global Health, Guangzhou, China
- Guangdong Provincial Center for Skin Diseases and STIs Control, Guangzhou, China
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Peizhen Zhao
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- Southern Medical University Institute for Global Health, Guangzhou, China
- Guangdong Provincial Center for Skin Diseases and STIs Control, Guangzhou, China
| | - Haiyi Li
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- Southern Medical University Institute for Global Health, Guangzhou, China
- Guangdong Provincial Center for Skin Diseases and STIs Control, Guangzhou, China
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Cheng Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, China.
- Southern Medical University Institute for Global Health, Guangzhou, China.
- Guangdong Provincial Center for Skin Diseases and STIs Control, Guangzhou, China.
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Han S, Zhang Y, Yang X, Chai X, Guo J, Zhang L, Shao Y, Ma J, Li K, Wang Z. The effectiveness and sustainability of peer support interventions for persons living with HIV: a realist synthesis. BMJ Glob Health 2023; 8:bmjgh-2022-010966. [PMID: 36804731 PMCID: PMC9943909 DOI: 10.1136/bmjgh-2022-010966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/08/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Peer support is an important supplement to medical resources for persons living with HIV (PLHIV). However, previous studies have shown mixed results about intervention effects. It is necessary to explain the mechanism of peer support interventions' effectiveness and sustainability to help design more valid peer support interventions. OBJECTIVE To identify and explain the mechanisms that drive the effectiveness and maintain the sustainability of peer support interventions. METHODS A preliminary theoretical framework was developed through a scoping review of the grey literature and international project frameworks in five professional websites. We then refined the framework by systematically searching evidence in databases including PubMed, EMBASE, Web of Science, ProQuest, CINAHL, CNKI and Wanfang. Qualitative methods were used to generate codes and themes relating to the studies' context, mechanisms and outcomes. We checked chains of inference (connections) across extracted data and themes through an iterative process. RESULTS A total of 6345 articles were identified, and 52 articles were retained for final synthesis. The refined theoretical framework presents five areas of peer support, including informational support, instrumental support, emotional support, affiliational support and appraisal support; five types of outcomes that peer support can improve for PLHIV, including physiological outcomes, psychological outcomes, behavioural outcomes, cognitive outcomes and social outcomes; the effectiveness mechanism coding system from peer volunteers and the relationship between peer volunteers and PLHIV; and the sustainability mechanism coding system in terms of peer volunteers, PLHIV and study context. CONCLUSIONS Given that peer support has huge potential human resources, that is, all the qualified PLHIV, irreplaceable advantages in dealing with barriers to HIV-related discrimination and potential comprehensive benefits for PLHIV, it is necessary to develop and organise more peer support projects for PLHIV. Our study highlights that the expansion of peer support projects should be based on their effectiveness and sustainability. PROSPERO REGISTRATION NUMBER CRD42022339079.
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Affiliation(s)
- Shuyu Han
- School of Nursing, Peking University, Beijing, People's Republic of China
| | - Yizhu Zhang
- School of Nursing, Peking University, Beijing, People's Republic of China
| | - Xianxia Yang
- School of Public Health, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Xinru Chai
- School of Nursing, Peking University, Beijing, People's Republic of China
| | - Jinzheng Guo
- School of Nursing, Peking University, Beijing, People's Republic of China
| | - Lili Zhang
- Department of Nursing, Beijing Youan Hospital Affiliated with Capital Medical University, Beijing, People's Republic of China
| | - Ying Shao
- Department of Infection, Beijing Youan Hospital Affiliated with Capital Medical University, Beijing, People's Republic of China
| | - Jianhong Ma
- Department of Infection, Beijing Youan Hospital Affiliated with Capital Medical University, Beijing, People's Republic of China
| | - Ke Li
- Department of Emergency, Peking University First Hospital, Beijing, People's Republic of China
| | - Zhiwen Wang
- School of Nursing, Peking University, Beijing, People's Republic of China
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Kokay W, Power E, McGrath M. Mixed Study Systematic Review and Meta-analysis of Sexuality and Sexual Rehabilitation in LGBTQI+ Adults Living With Chronic Disease. Arch Phys Med Rehabil 2023; 104:108-118. [PMID: 35973583 DOI: 10.1016/j.apmr.2022.07.018] [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: 01/11/2022] [Revised: 07/19/2022] [Accepted: 07/29/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To systematically review how sexuality is experienced by lesbian, gay, bisexual, transgender, queer or questioning, intersex plus (other gender identifies and sexual orientations) (LGBTQI+) persons living with chronic disease. DATA SOURCES PsycINFO, Embase, MEDLINE, Scopus, Cumulative Index to Nursing and Allied Health, and Web of Science were searched from date of inception to November 2021 for English language publications. Reference lists of relevant publications were also searched. STUDY SELECTION Eligible studies reported on sexuality among LGBTQI+ persons living with chronic disease. The search yielded 12,626 records; 665 full texts were assessed for eligibility and 63 documents included (59 unique studies). Study quality was rated using the Mixed Methods Appraisal Tool. DATA EXTRACTION Characteristics of included studies were recorded independently by 2 authors. Differences were resolved through discussion or with a third author. DATA SYNTHESIS A sequential, exploratory mixed-studies approach was used for synthesis. Pooled analysis indicated that among gay and bisexual men living with prostate cancer, 68.3% experienced erectile dysfunction and 62.9% had insufficient quality of erection to engage in anal sex. Among gay and bisexual men living with HIV or AIDS, 29.3% experienced loss of libido and 25.3% experienced erectile dysfunction. Although sexual dysfunction was common, LGBTQI+ persons had difficulty accessing appropriate sexual counseling and identified negative attitudes and heteronormative assumptions by health care providers as significant barriers to sexual health. Interventions to address sexuality focused entirely on reduction of risky sexual behavior among men living with HIV or AIDS. Women, transgender persons, and intersex persons were largely excluded from the research studies. CONCLUSIONS Current understandings of the effect of chronic disease on LGBTQI+ sexuality are limited and mostly focus on the male sexual response. LGBTQI+ persons who experience difficulty with sexuality struggle to identify appropriate services, and there is an absence of evidence-based interventions to promote sexual health and well-being in this population.
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Affiliation(s)
- William Kokay
- Sydney School of Health Sciences, University of Sydney, Sydney.
| | - Emma Power
- Graduate School of Health, University of Technology Sydney, Sydney
| | - Margaret McGrath
- Sydney School of Health Sciences, University of Sydney, Australia
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Robles G, Hong C, Yu M, Starks TJ. Intersecting Communities and PrEP Uptake among US-based Latinx Sexual Minority Men. J Racial Ethn Health Disparities 2022; 9:2157-2163. [PMID: 34554441 PMCID: PMC9034471 DOI: 10.1007/s40615-021-01154-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 05/28/2021] [Accepted: 09/14/2021] [Indexed: 12/29/2022]
Abstract
The Latinx community in the USA continues to be disproportionately burdened by the HIV epidemic, especially among Latinx sexual minority men (LSMM). Research indicates that up to two-thirds of new HIV infections occur among men who have sex with men (MSM) within primary partnerships. One promising biomedical approach for HIV prevention includes community scale-up of pre-exposure prophylaxis (PrEP) among LSMM. We examine the relationship between community connectedness (with the Latinx and gay communities) and PrEP uptake among 307 partnered LSMM who reported casual partner sex (i.e., non-monogamous relationships). Within the sample, approximately thirty percent (29.7%) of participants were on PrEP, and 43.3% reported partner approval for PrEP (i.e., my partner is in favor of PrEP generally), while only 7.2% were opposed to PrEP. Insurance status and income levels were significantly associated with PrEP uptake. There was a significant interaction term (gay community connectedness and Latinx group membership), which was positively associated with PrEP uptake (OR = 2.18; p = .007). Findings suggest that there may be structural barriers preventing this population from seeking and initiating PrEP care. Results point to the utility of integrating culturally relevant content related to intersecting identities and their corresponding communities when conceptualizing community-based and culturally informed interventions to improve the PrEP care cascade among LSMM.
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Affiliation(s)
- Gabriel Robles
- School of Social Work, Rutgers University, 390 George Street, Room 606, New Brunswick, NJ, 08901, USA.
| | - Chenglin Hong
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Melanie Yu
- School of Social Work, Rutgers University, 390 George Street, Room 606, New Brunswick, NJ, 08901, USA
| | - Tyrel J Starks
- Department of Psychology, Hunter College, New York, NY, USA
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Effectiveness of interventions aimed at reducing HIV acquisition and transmission among gay and bisexual men who have sex with men (GBMSM) in high income settings: A systematic review. PLoS One 2022; 17:e0276209. [PMID: 36260550 PMCID: PMC9581368 DOI: 10.1371/journal.pone.0276209] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/30/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION HIV transmission continues among gay and bisexual men who have sex with men (GBMSM), with those who are younger, or recent migrants, or of minority ethnicity or who are gender diverse remaining at increased risk. We aimed to identify and describe recent studies evaluating the effectiveness of HIV prevention interventions for GBMSM in high income countries. METHODS We searched ten electronic databases for randomized controlled trials (RCTs), conducted in high income settings, and published since 2013 to update a previous systematic review (Stromdahl et al, 2015). We predefined four outcome measures of interest: 1) HIV incidence 2) STI incidence 3) condomless anal intercourse (CLAI) (or measure of CLAI) and 4) number of sexual partners. We used the National Institute for Health and Care Excellence (UK) Quality Appraisal of Intervention Studies tool to assess the quality of papers included in the review. As the trials contained a range of effect measures (e.g. odds ratio, risk difference) comparing the arms in the RCTs, we converted them into standardized effect sizes (SES) with 95% confidence intervals (CI). RESULTS We identified 39 original papers reporting 37 studies. Five intervention types were identified: one-to-one counselling (15 papers), group interventions (7 papers), online interventions (9 papers), Contingency Management for substance use (2 papers) and Pre-exposure Prophylaxis (PrEP) (6 papers). The quality of the studies was mixed with over a third of studies rated as high quality and 11% rated as poor quality. There was some evidence that one-to-one counselling, group interventions (4-10 participants per group) and online (individual) interventions could be effective for reducing HIV transmission risk behaviours such as condomless anal intercourse. PrEP was the only intervention that was consistently effective at reducing HIV incidence. CONCLUSIONS Our systematic review of the recent evidence that we were able to analyse indicates that PrEP is the most effective intervention for reducing HIV acquisition among GBMSM. Targeted and culturally tailored behavioural interventions for sub-populations of GBMSM vulnerable to HIV infection and other STIs should also be considered, particularly for GBMSM who cannot access or decline to use PrEP.
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Pichon LC, Teti M, Betts JE, Brantley M. 'PrEP'ing Memphis: A qualitative process evaluation of peer navigation support. EVALUATION AND PROGRAM PLANNING 2022; 90:101989. [PMID: 34419307 PMCID: PMC9523887 DOI: 10.1016/j.evalprogplan.2021.101989] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/23/2021] [Accepted: 08/06/2021] [Indexed: 05/20/2023]
Abstract
BACKGROUND HIV PrEP (pre-exposure prophylaxis) navigation comprises intervention strategies used to improve PrEP uptake via education, linkage, and follow-up/ongoing engagement. During 2016-2019, the Tennessee Department of Health (TDH) implemented a CDC-funded demonstration project ("Project PrIDE") focused on PrEP navigation in Memphis community-based organizations (CBOs) and the Shelby County Health Department (HD). A process evaluation was conducted to determine facilitators and barriers to the implementation of the Memphis-based Project PrIDE PrEP navigation activities. METHODS A total of fourteen in-depth qualitative interviews were conducted, with nine PrEP navigators in evaluation year 1 (2018) and five of the original navigators in evaluation year 2 (2019), to understand the navigation processes using thematic analysis. RESULTS Facilitators of PrEP navigation included accessing clients at testing events, accompanying clients to first appointments, rapport building with patient and clinic staff, and maintaining consistent engagement with clients. Factors impeding PrEP navigation included difficulties assessing client readiness, tracking client navigation status, and stigmatizing clinic and social experiences for clients. CONCLUSIONS AND LESSONS LEARNED Findings have informed the scale-up of PrEP navigation implementation statewide, along with priority setting and resource allocation for the local Ending the HIV Epidemic (EHE) initiative in Memphis.
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Affiliation(s)
- Latrice C Pichon
- The University of Memphis School of Public Health, Division of Social and Behavioral Sciences, 3825 Desoto Avenue, 209 Robison Hall, Memphis, TN 38152, USA.
| | - Michelle Teti
- The University of Missouri Department of Public Health, 512 Clark Hall Columbia, MO 65211, USA.
| | - Joshua E Betts
- ICF, 2635 Century Center Parkway, Suite 1000, Atlanta, GA 30345, USA; CDC, Atlanta, GA, USA.
| | - Meredith Brantley
- Tennessee Department of Health, HIV/STD/Viral Hepatitis, 710 James Robertson Pkwy, Nashville, TN 37243, USA.
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Scales to Assess Knowledge, Motivation, and Self-Efficacy for HIV PrEP in Colombian MSM: PrEP-COL Study. AIDS Res Treat 2021; 2021:4789971. [PMID: 34540289 PMCID: PMC8443363 DOI: 10.1155/2021/4789971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/19/2021] [Accepted: 08/06/2021] [Indexed: 12/18/2022] Open
Abstract
Objective We evaluated the construct validity Spanish version of knowledge, stigma, norms, and self-efficacy scales regarding PrEP in MSM. Methods Sample of 287 MSM. Exploratory confirmatory factor analysis and item response theory were used to validate the constructs. Correlations and confidence interval-based estimation of relevance analyses were conducted to correlate the scales with willingness and intention to use PrEP. Results Attitude, stigma, and descriptive and subjective norms scales showed good construct validity and were related to intention and willingness to use PrEP. However, the knowledge scale and self-efficacy scales require further refinement. Conclusions The study provides useful information for assessing information, motivation, and self-efficacy related to PrEP use. Our results could be used to test the scales and the theoretical model in other contexts to confirm their usefulness.
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Efficacy of affirmative cognitive behavioural group therapy for sexual and gender minority adolescents and young adults in community settings in Ontario, Canada. BMC Psychol 2021; 9:94. [PMID: 34099063 PMCID: PMC8183324 DOI: 10.1186/s40359-021-00595-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/20/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study tested the efficacy of AFFIRM, a brief affirmative cognitive-behavioural group intervention tailored to reduce psychosocial distress and improve coping among sexual and gender minority adolescents and young adults (SGMY). METHOD SGMY (n = 138; M age = 22.44) were allocated to immediate 8-week AFFIRM intervention delivered at 12 community-based organisations or an 8-week waitlisted control. At baseline, post-intervention or post-waitlist, participants completed self-reported assessments of depression, hope, coping, and stress appraisal. Implementation outcomes of feasibility and acceptability were also assessed. RESULTS Compared to waitlist, SGMY in the intervention condition significantly reduced their depressive symptoms (b = - 5.79, p = .001) as well as increased reports of hope (agency: b = 0.84, p = .001; pathway: b = 0.79, p = .001), and coping by emotional support (b = 0.59, p < .001), instrumental support (b = 0.67, p < .001), positive framing (b = 0.59, p < .001), humour (b = 0.36, p = .014), planning (b = 0.49, p < .001) as well as reflective coping (b = 0.27, p = .009). Intervention participants were also less likely to perceive stress as a threat (b = - 0.43, p = .001), and more likely to perceive stress as challenge (b = 0.67, p < .001) and have the resources to deal with that stress (b = 0.38, p = .016) in comparison to waitlisted control participants. All outcomes had medium to large effect sizes. AFFIRM participants reported low attrition (8.5%) and high levels of engagement and acceptability (e.g. 99% agreed intervention was relevant to their lives). Over 63% of the community organizations that participated in the training hosted AFFIRM at least once during the study. CONCLUSIONS Results demonstrate efficacy for the community-based implementation of an affirmative clinical intervention designed for SGMY to address depression and foster coping with universal and minority stressors.
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Alvarado BE, Martinez-Cajas JL, Mueses HF, Correa Sanchez D, Adam BD, Hart TA. Adaptation and Pilot Evaluation of an Intervention Addressing the Sexual Health Needs of Gay Men Living with HIV Infection in Colombia. Am J Mens Health 2021; 15:1557988321989916. [PMID: 33511900 PMCID: PMC7871071 DOI: 10.1177/1557988321989916] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Interventions addressing the sexual health need of HIV-positive men who have sex with men (MSM) in Latin America are scarce. We adapted and evaluated GPS, a group-based intervention led by peers, developed using the Information-Motivation-Behavioral (IMB) model and motivational interviewing (MI). We used McKleroy et al framework to culturally adapt GPS to MSM living with HIV infection in Colombia. Then, a one-armed pilot trial examined changes in depressive symptoms, loneliness, self-efficacy for engaging in sexual risk reduction behaviors, sexual sensation seeking and sexual compulsivity at pre-intervention, post-intervention, and 3-month follow-up. These results were complemented with semistructured interviews with participants 3 months after the intervention. GPS was identified to be culturally acceptable with few changes in materials and exercises. Facilitators showed high levels of adherence and fidelity to MI principles. Seven of 11 eligible participants finished the intervention; GPS positively influenced self-efficacy for condom negotiation, depressive symptoms, and condomless anal sex with partners of unknown HIV status. Exit interviews revealed that GPS was well-designed, relevant, facilitated discussion of sex in a nonjudgmental manner, and helped make positive changes in participants’ sexual lives. These results provided preliminary evidence of an intervention to address sexual and mental health of MSM living with HIV in Latin America.
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Affiliation(s)
- Beatriz E Alvarado
- Department of Public Health Sciences, Queens University, Kingston, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jorge Luis Martinez-Cajas
- Department of Medicine, Division of infectious Diseases, Queens University, Kingston, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Diego Correa Sanchez
- Departamento de Ciencias Sociales y del Departamento de Salud Pública y Epidemiología de la Pontificia Universidad Javeriana Cali, Cali, Colombia
| | - Barry D Adam
- Professor Emeritus of Sociology, Sociology, Anthropology, and Criminology, University of Windsor, Windsor, ON, Canada
| | - Trevor A Hart
- Department of Psychology, Ryerson University, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
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