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Wilson EC, Baguso GN, Quintana J, Suprasert B, Arayasirikul S. Detectable viral load associated with unmet mental health and substance use needs among trans women living with HIV in San Francisco, California. BMC Womens Health 2024; 24:56. [PMID: 38254161 PMCID: PMC10802058 DOI: 10.1186/s12905-024-02885-8] [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: 06/16/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Substance use and mental distress are known barriers to HIV care engagement among trans women. Less is known about access and utilization of mental health and substance use care among trans women and the relationship between unmet behavioral health needs and HIV viral suppression. We examined the relationship between mental health and substance use on HIV viral load among trans women living with HIV. We also examined the relationship between mental health and substance use services needs with HIV care engagement and having a detectable viral load by comparing engagement in care cascades. METHODS Data are from a 2022 baseline assessment for an intervention with trans women living with HIV (n = 42) in San Francisco. Chi-Squared or Fisher's exact tests were conducted to determine associations between HIV viral load, mental health, and substance use. We also examine characteristics associated with each step in the HIV, mental health, and substance use care cascades. RESULTS Most participants were trans women of color (85.7%), 40 years of age or older (80.9%), with low income (88.1%), and almost half were unstably housed (47.6%). Of the 32 participants who screened positive for depression, anxiety and/or psychological distress, 56.3% were referred for mental health services in the past 12 months. Of those who were referred, 44.4% received mental health services. Of the 26 participants who screened positive for a substance use disorder, 34.6% were referred to substance use services in the past 12 months. Of those referred, 33.3% received substance use services in the past 3 months. Latina trans women had a low referral rate to meet their mental health needs (50%) and only 16.7% of African American/Black trans women who screened positive for a substance use disorder were referred for services, while trans women of other race/ethnicities had high referral and services utilization. No significant results were found between HIV viral load and screening positive for a mental health disorder. Methamphetamine use was statistically associated with having a detectable HIV viral load (p = 0.049). CONCLUSIONS We identified significant unmet mental health and substance use services needs and noted racial/ethnic disparities in the context of high HIV care engagement among trans women living with HIV. We also found that methamphetamine use was a barrier to having an undetectable viral load for trans women living with HIV. To finally end the HIV epidemic, integration of behavioral health screening, linkage, and support are needed in HIV care services for populations most impacted by HIV, especially trans women. TRIAL REGISTRATION NCT, NCT 21-34,978. Registered January 19, 2022.
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Affiliation(s)
- Erin C Wilson
- Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, USA.
- Department of Epidemiology & Biostatistics, University of California, San Francisco, USA.
| | - Glenda N Baguso
- Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, USA
| | - Jerry Quintana
- Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, USA
| | - Bow Suprasert
- Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, USA
| | - Sean Arayasirikul
- Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, USA
- Department of Health, Society, and Behavior, Program in Public Health, University of California, Irvine, USA
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Sarwar G, Irfan SD, Reza M, Khan MNM, Khan SI. Understanding the dynamics of chemsex among men who have sex with men, male sex workers and transgender women in Dhaka, Bangladesh: a multiphase sequential mixed-method research protocol. BMJ Open 2023; 13:e073976. [PMID: 37918919 PMCID: PMC10626829 DOI: 10.1136/bmjopen-2023-073976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/06/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Chemsex is defined as drug use to enhance sexual pleasure. Global literature illustrated the pervasiveness of chemsex among men who have sex with men (MSM) and transgender women (hijra) for prolonging anal intercourse, reducing pain and intensifying pleasure, oftentimes without condoms. Global literature highlighted the association between chemsex and unsafe sexual behaviours. These circumstances warrant targeted chemsex research to explore the chemsex situation. The study aims to explore the overall dynamics of chemsex among MSM, male sex workers (MSW) and hijra in Dhaka, Bangladesh and formulate culturally relevant, context-specific, gender-sensitive and evidence-based recommendations for chemsex interventions. METHODS AND ANALYSIS This will be a sequential, exploratory, mixed-methods study. Data will be collected at four drop-in centres in Dhaka in three phases. To explore issues related to chemsex, the formative phase (phase 1) will generate evidence on the overall dynamics of chemsex through a literature review and qualitative interviews. Qualitative data will be manually analysed using thematic analysis. In phase 2, a cross-sectional survey will be conducted among 458 MSM, male sex workers and hijra to measure the prevalence, reasons and sexual risk behaviour associated with chemsex. In phase 3, qualitative interviews will be conducted with the participants involved in chemsex, service providers and relevant stakeholders to add qualitative depth to survey responses. In this phase, service provision will also be investigated for people engaging in chemsex. Moreover, based on the findings of phases 1 and 2, and qualitative interviews of phase 3, a preliminary chemsex intervention model will be developed through a series of intervention design workshops. ETHICS AND DISSEMINATION Ethical approval has been attained from the Ethical Review Committee of icddr,b. Informed consent will be obtained from the participants, and confidentiality will be maintained during data collection and storage. Findings will be disseminated via several platforms including dissemination seminars, scientific articles and study report.
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Affiliation(s)
- Golam Sarwar
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Samira Dishti Irfan
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Masud Reza
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mohammad Niaz Morshed Khan
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sharful Islam Khan
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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Palmer L, Maviglia F, Wickersham JA, Khati A, Kennedy O, Copenhaver NM, Uyer C, Halim MAA, Ikhtiaruddin WM, Azwa I, Gautam K, Shrestha R. Chemsex and Harm Reduction Practices Among Men Who Have Sex with Men in Malaysia: Findings from a Qualitative Study. J Psychoactive Drugs 2023:1-10. [PMID: 37610135 PMCID: PMC10884347 DOI: 10.1080/02791072.2023.2250342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/10/2023] [Indexed: 08/24/2023]
Abstract
Chemsex is a form of sexualized drug use commonly practiced among MSM with psychoactive substances, such as methamphetamine. While this phenomenon has gained global attention in the past two decades, there is a dearth of empirical data to inform culturally competent interventions. The current work investigates the socio-contextual factors related to chemsex and harm reduction practices among Malaysian MSM. Between February and August 2022, we conducted six online focus group sessions with Malaysian MSM who had engaged in chemsex during the previous 6 months (N = 22). We queried participants about perceived benefits and harms, harm reduction practices, and informational needs. Most participants' first chemsex experience occurred in a casual sexual encounter, often facilitated by mobile technology. Participants reported engaging in harm reduction practices before (e.g. medication reminders), during (e.g. peer support), and after (e.g. rest) chemsex. These findings have implications for future efforts to develop and implement tailored interventions to address the specific and acute needs of Malaysian MSM engaging in chemsex.
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Affiliation(s)
- Lindsay Palmer
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Francesca Maviglia
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Jeffrey A Wickersham
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Antoine Khati
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Olivia Kennedy
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | | | - Christopher Uyer
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Mohd Akbar Ab Halim
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wan Mohd Ikhtiaruddin
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Iskandar Azwa
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kamal Gautam
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Sarwar G, Khan SM, Irfan SD, Khan MNM, Reza MM, Rana AKMM, Banu RS, Ahmed S, Banu S, Khan SI. Community based peer-led TB screening intervention: an innovative approach to increase TB knowledge, presumptive case identification, and referral among sexual minority people in urban Bangladesh. BMC Health Serv Res 2023; 23:810. [PMID: 37507688 PMCID: PMC10386687 DOI: 10.1186/s12913-023-09737-5] [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: 11/10/2022] [Accepted: 06/22/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION One of the contributors to tuberculosis (TB) burden among vulnerable populations, such as sexual minority people, is the delay in case finding and notification. Given their socially excluded, hard-to-reach nature, community-led approaches need to be introduced to facilitate their screening of TB symptoms and their subsequent referral to TB healthcare providers. This article aimed to explore the existing challenges surrounding TB screening and referral, and the implementation facilitators and barriers of the proposed community-based TB screening model for sexual minority people in Dhaka, Bangladesh. METHODS This study followed the quasi-experimental design using mixed methods (i.e., qualitative and quantitative) approach. The study participants who were also a part of the community-led TB screening model included sexual minority people enrolled in HIV prevention interventions. In addition to quantitative inquiry, in-depth interviews were conducted on sexual minority people, focus group discussions were also conducted on them and HIV prevention service providers, and key-informant interviews were conducted on service providers, programmatic experts and TB researchers. Data were analyzed using content, contextual and thematic approaches. RESULTS The 'Six Steps in Quality Intervention Development' framework was used to guide the development of the community-based TB screening model. In Step 1 (identifying the problem), findings revealed low rates of TB screening among sexual minority people enrolled in the HIV prevention intervention. In Step 2 (identifying contextual factors for change), various individual, and programmatic factors were identified, which included low knowledge, low-risk perception, prioritization of HIV services over TB, and stigma and discrimination towards these populations. In Step 3 (deciding change mechanism), community-based screening approaches were applied, thus leading to Step 4 (delivery of change mechanism) which designed a community-based approach leveraging the peer educators of the HIV intervention. Step 5 (testing intervention) identified some barriers and ways forward for refining the intervention, such as home-based screening and use of social media. Step 6 (collecting evidence of effectiveness) revealed that the main strength was its ability to engage peer educators. CONCLUSION This study indicates that a community-based peer-led TB screening approach could enhance TB screening, presumptive TB case finding and referral among these populations. Therefore, this study recommends that this approach should be incorporated to complement the existing TB program.
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Affiliation(s)
- Golam Sarwar
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani Mohakhali, Dhaka, 1212, Bangladesh
| | - Shaan Muberra Khan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani Mohakhali, Dhaka, 1212, Bangladesh
| | - Samira Dishti Irfan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani Mohakhali, Dhaka, 1212, Bangladesh
| | - Mohammad Niaz Morshed Khan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani Mohakhali, Dhaka, 1212, Bangladesh
| | - Md Masud Reza
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani Mohakhali, Dhaka, 1212, Bangladesh
| | - A K M Masud Rana
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani Mohakhali, Dhaka, 1212, Bangladesh
| | - Rupali Sisir Banu
- National Tuberculosis Control Programme (NTP), Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare (MOH&FW), Dhaka, Bangladesh
| | - Shahriar Ahmed
- Programme for Emerging Infections, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sayera Banu
- Programme for Emerging Infections, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sharful Islam Khan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani Mohakhali, Dhaka, 1212, Bangladesh.
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Irfan SD, Sarwar G, Emran J, Khan SI. An uncharted territory of sexualized drug use: exploring the dynamics of chemsex among young and adolescent MSM including self-identified gay men in urban Dhaka, Bangladesh. Front Psychol 2023; 14:1124971. [PMID: 37425169 PMCID: PMC10324373 DOI: 10.3389/fpsyg.2023.1124971] [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] [Received: 01/20/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Global and local literature depicted the pervasiveness of chemsex among men who have sex with men (MSM), yet there is limited evidence on adolescents and youth. Though literature showed their engagement in chemsex, further exploration is warranted about their socio-sexual contexts and implications. Therefore, this article explored the contexts and implications of chemsex on young and adolescent MSM. This article is extracted from qualitative research evidence, and research data are triangulated by programmatic evidence on adolescent and young MSM from two ongoing pilot interventions. The key motivational factors for engaging in chemsex were primarily rooted in the dynamics of their peer networks. Specifically, the onset of drug use is predominantly attributed to curiosity toward experimentation with methamphetamine, peer influence, propensity to lose weight, and increasing courage to approach potential sexual partners. Moreover, they continued taking drugs as it enhanced their sexual performance, thus perpetuating chemsex. Additionally, the findings revealed several sexual implications of methamphetamine, e.g., bolstering their sexual "stamina," increasing their propensity toward sexual violence, and reducing their decision-making abilities and judgment, thus collectively decreasing condom use. In essence, chemsex is considerably driven by their socio-sexual contexts, thus perpetuating sexual risk behaviors and compromising sexual health outcomes. Therefore, harm reduction interventions targeted need to be designed keeping in mind their socio-sexual dynamics and age.
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Septarini NW, Hendriks J, Maycock B, Burns S. Methodologies of Stigma-Related Research Amongst Men Who Have Sex With Men (MSM) and Transgender People in Asia and the Pacific Low/Middle Income Countries (LMICs): A Scoping Review. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:688568. [PMID: 36304052 PMCID: PMC9580832 DOI: 10.3389/frph.2021.688568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/30/2021] [Indexed: 11/28/2022] Open
Abstract
Much stigma-related research focuses on marginalized populations, including men who have sex with men (MSM) and transgender people. The importance of research in this area is widely recognized, however methodologies and measures vary between studies. This scoping review will collate existing information about how stigma-related research has been conducted in low/middle income countries (LMICs) within the Asia Pacific region, and will compare research designs, sampling frameworks, and measures. Strengths and limitations of these studies will inform recommendations for future stigma-related health research. A methodological framework for scoping studies was applied. Searches of Psych INFO, Scopus, ProQuest, Global Health and PubMed were used to identify articles. Stigma-related research amongst MSM and transgender communities, published between 2010 and 2019 in LMICs within the Asia Pacific region were included. A total of 129 articles based on 123 different studies were included. Of the 129 articles 51.19% (n = 66) were quantitative; 44.96% (n = 57) were qualitative and 3.88% (n = 5) were mixed methods studies. The majority of studies (n = 57; 86.36%) implemented a cross sectional survey. In-depth interviews (n = 20, 34.48%) were also common. Only 3.88% of studies utilized mixed-methods design. Non-probabilistic and probabilistic sampling methods were employed in 99.22 and 0.78% of studies respectively. The most common measures used in quantitative studies were the Center for Epidemiological Study on Depression (CES-D) (n = 18) and the Self Stigma Scale (SSS) (n = 6). Strengths and limitations proposed by researchers included in this review are summarized as lesson learnt and best practices in stigma-related research.
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Affiliation(s)
- Ni Wayan Septarini
- School of Population Health, Curtin University, Perth, WA, Australia
- Department of Community and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
- *Correspondence: Ni Wayan Septarini ;
| | - Jacqueline Hendriks
- School of Population Health, Curtin University, Perth, WA, Australia
- Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Perth, WA, Australia
| | - Bruce Maycock
- European Center for Environmental and Human Health, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Sharyn Burns
- School of Population Health, Curtin University, Perth, WA, Australia
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Chen L, Chen W, Jiang T, Ni Z, Ma Q, Pan X. The Characteristics and Risk Factors of Web-Based Sexual Behaviors Among Men Who Have Sex With Men in Eastern China: Cross-sectional Study. JMIR Public Health Surveill 2021; 7:e25360. [PMID: 34473066 PMCID: PMC8446844 DOI: 10.2196/25360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/23/2021] [Accepted: 06/15/2021] [Indexed: 02/02/2023] Open
Abstract
Background Finding casual sex partners on the internet has been considered a huge challenge for HIV transmission among men who have sex with men (MSM) in China. Objective This study aimed to identify the characteristics and risk factors of finding causal sex partners on the internet among MSM in Zhejiang Province, China. Methods This was a cross-sectional study. Participants were enrolled by 4 community-based organizations (CBOs) and 10 Voluntary Counselling and Testing (VCT) clinics through advertisements in bathrooms, bars, and gay hook-up apps from June to December 2018. A CBO- or physician-assisted survey was conducted to collected information on finding casual sex partners, perceived HIV infection, and HIV risk behaviors. Results Among 767 participants, 310 (40.4%) reported finding causal sex partners on the internet. Factors associated with finding casual sex partners on the internet included watching pornographic videos on the internet more than once a week (adjusted odds ratio [aOR]=1.881, 95% CI 1.201-2.948), discussing “hooking-up online” with friends (aOR=4.018, 95% CI 2.910-5.548), and perceiving that the likelihood of HIV infection among casual sex partners sought on the internet was “medium” (aOR=2.034, 95% CI 1.441-2.873) or “low” (aOR=2.548, 95% CI 1.524-4.259). Among the participants who reported finding casual sex partners on the internet, 30.2% (91/310) reported having unprotected sex with casual sex partners encountered on the internet in the past 6 months. On multivariate logistic regression analyses, knowing the HIV infection status of casual sex partners sought on the internet was significantly associated with performing inserted intercourse (aOR=1.907, 95% CI 1.100-3.306) and a decreased risk of inconsistent condom use (aOR=0.327, 95% CI 0.167-0.642). Conclusions Web-based casual sexual behavior is becoming more prevalent, and the rate of unprotected sex among MSM in Zhejiang Province is high. Future HIV prevention approaches should emphasize the importance for MSM to proactively determine the HIV infection status of potential casual sex partners sought on the internet.
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Affiliation(s)
- Lin Chen
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Wanjun Chen
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Tingting Jiang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Zhikan Ni
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Qiaoqin Ma
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Xiaohong Pan
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
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Khan MNM, Sarwar G, Irfan SD, Gourab G, Rana AKMM, Khan SI. Understanding the Barriers of HIV Testing Services for Men Who Have Sex With Men and Transgender Women in Bangladesh: A Qualitative Study. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2021; 42:272684X21995672. [PMID: 33657941 DOI: 10.1177/0272684x21995672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Coverage of HIV testing services (HTS) is generally low among men who have sex with men (MSM) and transgender women (hijra) in Bangladesh, thus impeding the national goal of attaining the 90-90-90 target. In this context, this article delineates HTS uptake barriers among these populations. This qualitative study entailed 30 in-depth interviews, six focus groups and seven key-informant interviews with purposively selected MSM and hijra, alongside service providers. Participants cited individual and interpersonal barriers such as low risk perception and misconceptions about HIV testing, programmatic barriers such as knowledge gaps among peer service providers, as well as community and structural barriers such as the criminalization and stigmatization of male-to-male sex. Considering these contexts, it is essential for stakeholders to improve the HTS modality using multipronged approaches to address the multifaceted barriers of HTS uptake.
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Affiliation(s)
| | - Golam Sarwar
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Samira Dishti Irfan
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Gorkey Gourab
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - A K M Masud Rana
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Sharful Islam Khan
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
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Khan SI, Khan MNM, Irfan SD, Rumayan Hasan AM, Ross AG, Horng LMS, Lachowsky N, Knudson G, Azim T. The Effects of Methamphetamine Use on the Sexual Lives of Gender and Sexually Diverse People in Dhaka, Bangladesh: A Qualitative Study. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:479-493. [PMID: 32239362 PMCID: PMC7529687 DOI: 10.1007/s10508-020-01674-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 06/11/2023]
Abstract
Methamphetamine use has increased among gender and sexually diverse people in several countries, including Bangladesh. This study aimed to explore the effects of methamphetamine on the sexual lives of these people in Dhaka, Bangladesh. An exploratory qualitative study was conducted, comprising 30 in-depth interviews with gender and sexually diverse people including males having sex with males, male sex workers, and transgender women (hijra) under HIV intervention coverage. Ten key informant interviews were also conducted with individuals who have expertise in relevant disciplines such as drug use, harm reduction, and HIV and AIDS. Digitally recorded data were manually analyzed under the thematic analysis framework. Findings indicated that many participants reported that methamphetamine brought changes in their sexual lives such as increased sexual drive, engagement in group sex, the increased ability to perform serial sex, transactional sex, impulsive and coercive sex, initiation and switching of male-to-male sexual practices, and limited condom use. Key informants noted that there is a dearth of methamphetamine-related services in Bangladesh. Methamphetamine use was found to lead to diverse effects on the sexual lives of gender and sexually diverse people, thus making it a driving force for shaping sexual practices and, hence, sexual risks. Therefore, it is essential for policy-level stakeholders and program managers to consider the risks of methamphetamine use due to their negative ramifications on sexual health, including HIV risks.
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Affiliation(s)
- Sharful Islam Khan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Avenue, Mohakhali, Dhaka, Bangladesh.
| | - Mohammad Niaz Morshed Khan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Avenue, Mohakhali, Dhaka, Bangladesh
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Samira Dishti Irfan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Avenue, Mohakhali, Dhaka, Bangladesh
| | - A M Rumayan Hasan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Avenue, Mohakhali, Dhaka, Bangladesh
| | - Allen G Ross
- Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lily Ming-Sha Horng
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Nathan Lachowsky
- Faculty of Human and Social Development, School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Gail Knudson
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Tasnim Azim
- International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Sexual Pleasure in Transgender and Gender Diverse Individuals: an Update on Recent Advances in the Field. CURRENT SEXUAL HEALTH REPORTS 2020. [DOI: 10.1007/s11930-020-00284-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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