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Luvuno ZPB, Wiafe E, Mpofana N, Urusla MM, Nxumalo CT. Fast-track interventions for HIV and AIDS epidemic control among key populations: A rapid review. Afr J Prim Health Care Fam Med 2024; 16:e1-e12. [PMID: 38708735 PMCID: PMC11079388 DOI: 10.4102/phcfm.v16i1.4088] [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] [Received: 03/15/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Targeted interventions for key populations remain critical for realisation of epidemic control for human immunodeficiency virus (HIV) infection because of the causal relationship between HIV infection in the general population and among key population groups. AIM To consolidate evidence on the fast-track interventions towards achieving HIV epidemic control among key populations. METHODS A rapid scoping review was conducted using the methodological framework by Arksey and O' Malley. The Population, Intervention, Context and Outcome (PICO) framework was used to identify relevant studies using key words with Boolean operators in electronic data bases, namely CINHAL, Web of Science, Psych Info and Sabinet. Studies were extracted using a modified data extraction tool, and results were presented narratively. RESULTS A total of 19 articles were included in this review. Most articles were primary studies (n = 17), while another involved the review of existing literature and policies (n = 2) and routinely collected data (n = 1). Most studies were conducted in the United States of America (n = 6), while another were conducted in China, Kenya, Botswana, South Africa and Mozambique. All studies revealed findings on tested interventions to achieve HIV epidemic control among key populations. CONCLUSION Effective interventions for HIV epidemic control were stand-alone behavioural preventive interventions, stand-alone biomedical preventive strategies and combination prevention approaches. Furthermore, the findings suggest that effective activities to achieve HIV epidemic control among key populations should be centred around prevention.Contribution: The findings of this study have policy and practice implications for high HIV burden settings such as South Africa in terms of interventions to facilitate realisation of the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets, thereby contributing to HIV epidemic control.
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Affiliation(s)
- Zamasomi P B Luvuno
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Howard Campus, Durban.
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Nevendorff L, Pedrana A, Bourne A, Traeger M, Sindunata E, Reswana WA, Alharbi RM, Stoové M. Characterizing Socioecological Markers of Differentiated HIV Risk Among Men Who Have Sex with Men in Indonesia. AIDS Behav 2024; 28:657-668. [PMID: 38270714 PMCID: PMC10876766 DOI: 10.1007/s10461-023-04253-3] [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: 12/08/2023] [Indexed: 01/26/2024]
Abstract
HIV prevention programs typically focus on changing individuals' risk behaviors, often without considering the socioecological factors that can moderate this risk. We characterized HIV risk among men who have sex with men (MSM) in Indonesia (n = 1314) using latent class analysis and used multinomial logistic regression to identify latent class relationships with demographics, social/sexual networks, and community-level socioecological indicators of HIV risk. Three HIV risk latent classes were identified-"Sexually Moderate" (n = 333), "Sexual Explorative" (n = 575), and "Navigating Complexities" (n = 406). Using "Sexually Moderate" (lowest risk) as the reference group, MSM in the "Sexual Explorative" class had additional social/sexual network-level risks (meeting partner(s) using both online and offline methods [RR = 3.8; 95%CI 1.7-8.6] or general social media and gay-specific online platforms [RR = 2.6; 95%CI 1.9-3.6] to meet partners, group sex [RR = 10.9; 95%CI 4.5-25.4], transactional sex [RR = 1.6; 95%CI 1.2-2.2]), and community-level risks (experiencing homosexual-related assaults [RR = 1.4; 95%CI 1.1-1.9]). MSM in the "Navigating Complexities" class had additional social/sexual network-level risks (low social support [RR = 1.6; 95%CI 1.1-2.5], less disclosure of their sexuality [RR = 1.4; 95%CI 1.0-1.9]) and community-level risks (higher internalized homonegativity scores [RR = 1.2; 95%CI 1.1-1.4], ever experiencing homosexual-related assaults [RR = 1.4:95%CI 1.1-1.9], less exposure to HIV/STI health promotion [RR = 0.7; 95%CI 0.5-0.9], attending STI-related services in the past 6 months [RR = 0.6; 95%CI 0.4-0.8]). Co-occurring individual and socioecological risk recommend holistic HIV prevention strategies tailored to consider the social and structural conditions of MSM in Indonesia are needed.
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Affiliation(s)
- Laura Nevendorff
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
- HIV AIDS Research Center Atma Jaya Catholic University Jakarta, Jakarta, Indonesia.
| | - Alisa Pedrana
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Michael Traeger
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia
| | - Eric Sindunata
- HIV AIDS Research Center Atma Jaya Catholic University Jakarta, Jakarta, Indonesia
| | - Wawa A Reswana
- Jaringan Indonesia Positive (The Positive Indonesia Network), Jakarta, Indonesia
| | - Rosidin M Alharbi
- Jaringan Indonesia Positive (The Positive Indonesia Network), Jakarta, Indonesia
| | - Mark Stoové
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Kirby Institute, University of New South Wales, Sydney, Australia
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3
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Kalu N, Ross MW, Taegtmeyer M, Spicer N, Adebajo S, Owolabi R, Lamontagne E, Howell S, Neuman M. Is Internalised Homonegativity associated with HIV testing and HIV risk behaviours of men who have sex with men: a multilevel cross-sectional study of sub-Saharan African countries. BMJ Open 2024; 14:e074791. [PMID: 38286695 PMCID: PMC10826579 DOI: 10.1136/bmjopen-2023-074791] [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: 04/17/2023] [Accepted: 10/30/2023] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVES This study assessed the associations of Internalised Homonegativity (IH) with HIV testing and risk behaviours of adult men who have sex with men (MSM) in sub-Saharan Africa (SSA) and effect modification by the legal climate. DESIGN We used data from the cross-sectional 2019 Global Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI+) Internet survey study. SETTING AND PARTICIPANTS Overall, the 2019 Global LGBTI Internet Survey collected data from 46 SSA countries. In this secondary analysis, we included data from 3191 MSM in 44 SSA countries as there were no eligible MSM responses in the 2 countries excluded. OUTCOME MEASURES Our response variables were self-reported binary indicators of ever tested for HIV, recently tested in the past 6 months (from those who reported ever testing), transactional sex (paying for and being paid for sex in the past 12 months), and unprotected anal sex (that is without a condom or pre-exposure prohylaxis (PrEP)) with a non-steady partner (in the past 3 months). RESULTS Our findings showed high levels of IH (range 1-7) in MSM across SSA (mean (SD)=5.3 (1.36)). We found that MSM with higher IH levels were more likely to have ever (adjusted OR (aOR) 1.18, 95% CI 1.03 to 1.35) and recently tested (aOR 1.19, 95% CI 1.07 to 1.32) but no evidence of an association with paying for sex (aOR 1.00, 95% CI 0.89 to 1.12), selling sex (aOR 1.06, 95% CI 0.95 to 1.20) and unprotected sex (aOR 0.99, 95% CI 0.89 to 1.09). However, we observed that a favourable legal climate modifies the associations of IH and paying for sex (aOR 0.75, 95% CI 0.60 to 0.94). Increasing levels of IH had a negative association with paying for sex in countries where same-sex relationships are legal. We found no associations of IH with unprotected anal sex in the population surveyed. CONCLUSIONS We confirm that IH is widespread across SSA but in countries that legalise same-sex relationships, MSM were less likely to engage in transactional sex compared with those in countries where homosexuality is criminalised.
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Affiliation(s)
- Ngozi Kalu
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael W Ross
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Neil Spicer
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Sylvia Adebajo
- An affiliate of the University of Maryland, Abuja, Nigeria
| | - Rotimi Owolabi
- Nigerian Institute of Medical Research (NIMR), Abuja, Nigeria
| | | | - Sean Howell
- LGBT Foundation, San Francisco, California, USA
| | - Melissa Neuman
- MRC International Statistics and Epidemiology Group and Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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4
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Fynn L, Gill K, Wallace M, Atujuna M, Duyver M, Ngcobo P, Spiegel H, Rinehart A, Hosek S, Bekker LG. "It's already in your body and it's preventing": a qualitative study of African female adolescent's acceptability and preferences for proxy HIV prevention methods in Cape Town, South Africa. BMC Public Health 2023; 23:2143. [PMID: 37919697 PMCID: PMC10621226 DOI: 10.1186/s12889-023-16955-3] [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] [Received: 07/19/2022] [Accepted: 10/06/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Advances in biomedical HIV prevention will soon offer young women a choice of HIV prevention methods, including various pre-exposure prophylaxis (PrEP) modalities such as daily oral pills, dapivirine vaginal ring, and long-acting injectable agents. By understanding preferences for contraceptive methods, we may draw analogies for the HIV prevention needs of young women. The UChoose Study was an open-label randomised cross-over study designed to evaluate the acceptability and preference for several contraceptive options as a proxy for HIV prevention methods that use similar types of administration. The study enrolled healthy HIV uninfected young women aged 15 to 19 years. At enrolment, participants were randomly assigned to a contraceptive method for a period of 16 weeks in the form of monthly Nuvaring® (vaginal ring), daily combined oral contraceptive (daily pills), or bi-monthly injectable contraceptive (injectable). After 16 weeks, participants crossed over to another contraceptive method, and those who had received the injectable and the daily pills received the vaginal ring for another 16 weeks, whereas those who had received the vaginal ring were able to choose between the injectable and daily pills, to ensure that all participants tried the vaginal ring-the least familiar option to the study population. RESULTS Thirty-three participants were purposively recruited to participate in seven focus group discussions (FGD) and completed a pre-survey for their assigned group. Our sample comprised 14 participants randomised to use of the vaginal ring and daily pills and 19 participants randomised to use of the vaginal ring and injectable. For most participants, their preferences for a prevention method were based primarily on their desire to avoid negative aspects of one method rather than their positive user experience with another method. Most participants expressed initial hesitancy for trying new contraception method products; however, a lack of familiarity was moderated by a strong interest in diverse user-controlled prevention methods. Participants valued methods that had infrequent dosing and simplified use requirements. The injection and vaginal ring were preferred over daily pills as a potential HIV prevention method. CONCLUSION Expanding the availability of diverse products could provide adolescents with multiple choices in HIV prevention for the uninitiated. TRIAL REGISTRATION ClinicalTrials.gov ( NCT02404038 ). Registered March 31, 2015-Registered.
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Affiliation(s)
- Lauren Fynn
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
| | - Katherine Gill
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Melissa Wallace
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Millicent Atujuna
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Menna Duyver
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Penelope Ngcobo
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Hans Spiegel
- Department of Health and Human Services, Kelly Government Solutions, Contractor to National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | | | - Sybil Hosek
- Stroger Hospital of Cook County, Chicago, IL, USA
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
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5
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de Wit JBF, Adam PCG, den Daas C, Jonas K. Sexually transmitted infection prevention behaviours: health impact, prevalence, correlates, and interventions. Psychol Health 2022; 38:675-700. [PMID: 35748408 DOI: 10.1080/08870446.2022.2090560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Sexually transmitted infections (STIs) remain a major public health threat, disproportionately affecting young people, and men who have sex with men. In this narrative review of the current state of behavioural science research on STI prevention, we consider the definition, health impacts, correlates and determinants, and interventions to promote STI prevention behaviour. Research on STI prevention behaviour has extended from a focus on abstinence, partner reduction and condom use, to also include novel preventive behaviours, notably treatment-as-prevention, pre-exposure prophylaxis (i.e., the preventive use of medicines by uninfected people), and vaccination for some STIs. Social-cognitive factors specified by, for instance the theory of planned behaviour, are critical proximal determinants of STI prevention behaviours, and related interventions can effectively promote STI prevention behaviours. Social-ecological perspectives highlight that individual-level determinants are embedded in more distal environmental influences, with social stigma especially affecting STI prevention behaviours and requiring effective intervention. Further to providing a major domain of application, STI prevention also poses critical challenges and opportunities for health psychology theory and research. We identify a need for health behaviour theory that addresses the processes linking multiple levels of influence on behaviour and provides practical guidance for multi-level behaviour change interventions adapted to specific contexts.
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Affiliation(s)
- John B. F. de Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
- Centre for Social Research in Health, UNSW Sydney, Kensington, Australia
| | - Philippe C. G. Adam
- Centre for Social Research in Health, UNSW Sydney, Kensington, Australia
- Institute for Prevention and Social Research, Bangkok, Thailand
| | - Chantal den Daas
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland
| | - Kai Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
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6
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Arends RM, Grintjes KJT, van den Heuvel TJ, Foeken-Verwoert EGJ, Schene AH, van der Ven AJAM, Schellekens AFA. Effectiveness of a group intervention to reduce sexual transmission risk behavior among MSM living with HIV: a non-randomized controlled pilot study. AIDS Care 2021; 34:515-526. [PMID: 34851810 DOI: 10.1080/09540121.2021.2002252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ABSTRACTWith an annual incidence of about 1.5 million new infections, HIV is an ongoing public health concern. Sexual transmission risk behavior (STRB) is a main driver of the HIV epidemic in most Western countries, particularly among specific populations such as men who have sex with men (MSM). This quasi-experimental pilot study examined the effectiveness of a ten-session group intervention, aiming to reduce STRB among a high-risk subpopulation of MSM living with HIV. Self-reported STRB, impulsivity, mental health symptoms, and functional impairment were compared between the intervention group (n = 12) and a control group (n = 16). At baseline, participants in the intervention group had higher levels of STRB, impulsivity, mental health problems, and functional impairment, compared to the control group. A significant time-by-group interaction effect revealed that after the intervention, STRB, impulsivity, and functional impairment reduced in the intervention group to levels comparable to the control group. These findings suggest that a targeted behavioral intervention might be an effective strategy to reduce persistent STRB and related factors in MSM living with HIV. Future studies should confirm these findings in larger samples, using randomized designs.
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Affiliation(s)
- Rachel M Arends
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands.,Donders Institute for Brain, Cognition and Behavior, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Karin J T Grintjes
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Thom J van den Heuvel
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands.,GGNet, Scelta, Nijmegen, Netherlands
| | | | - Aart H Schene
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands.,Donders Institute for Brain, Cognition and Behavior, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Arnt F A Schellekens
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands.,Donders Institute for Brain, Cognition and Behavior, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, Netherlands
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7
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Palfai TP, Luehring-Jones P. How Alcohol Influences Mechanisms of Sexual Risk Behavior Change: Contributions of Alcohol Challenge Research to the Development of HIV Prevention Interventions. AIDS Behav 2021; 25:314-332. [PMID: 34148189 DOI: 10.1007/s10461-021-03346-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
This paper examines the contributions of laboratory-based alcohol challenge research (ACR) to the development of HIV prevention interventions. Following a brief overview of HIV prevention interventions and related health behavior change models, we discuss how alcohol may influence mechanisms of behavior change. The paper highlights the value of ACR for: (1) elucidating mechanisms of action through which alcohol affects sexual risk behavior, (2) testing how alcohol may influence mechanisms thought to underlie HIV prevention interventions, (3) clarifying moderators of the causal influences of alcohol, (4) identifying novel intervention targets, and (5) developing strategies to reduce sexual risk among those who consume alcohol. We conclude with a discussion of the importance of using experimental research to identify mechanisms of behavior change that are specific to populations at high risk for HIV and outline some key implications for developing HIV prevention interventions that integrate the role of alcohol.
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8
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Holmes D, Hammond C, Orser L, Nguyen H. Assembling bodies-without-organs: A poststructuralist analysis of group sex between men. Nurs Philos 2021; 23:e12374. [PMID: 34729896 DOI: 10.1111/nup.12374] [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] [Received: 07/29/2021] [Revised: 09/30/2021] [Accepted: 10/17/2021] [Indexed: 11/30/2022]
Abstract
Group sex among men who have sex with men may be understood as a 'radical' practice insofar as it transgresses dominant social discourses around appropriate sexual relations-prioritizing heteronormative, monogamous and risk-averse sex. These practices are generally defined as steeped in risk, most commonly due to the potential for transmitting human immunodeficiency virus and sexually transmitted infections and accompanied by the possibility of legal and social repercussions. Our ethnographic research study explored the desires, practices and contexts of group sex participants (n = 10) within a popular group sex party destination located in the United States. We employ a poststructuralist perspective (utilizing the work of Deleuze and Guattari) to understand group sex events with the pretext that bodies have no inherent ethics, meaning or essence: they are 'bodies without organs'. We identify group sex as a form of boundary play, in which participants pursue new limits to what their bodies can do but within a carefully constructed environment that establishes norms of interaction meant to secure trust and safety between participants. A variety of risk reduction practices are shown to be promoted and honoured within these eventful sexual(ized) spaces. The application of poststructuralist concepts of 'boundary play' and 'bodies without organs' helped to depict the construction and navigation of pleasure, safety and risk among group sex participants.
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Affiliation(s)
- Dave Holmes
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Chad Hammond
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lauren Orser
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Huy Nguyen
- Sue and Bill Gross School of Nursing, University of California, Irvine, California, USA
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9
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Nguyen LH, Nguyen HLT, Tran BX, Larsson M, Rocha LEC, Thorson A, Strömdahl S. A qualitative assessment in acceptability and barriers to use pre-exposure prophylaxis (PrEP) among men who have sex with men: implications for service delivery in Vietnam. BMC Infect Dis 2021; 21:472. [PMID: 34030652 PMCID: PMC8147440 DOI: 10.1186/s12879-021-06178-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/12/2021] [Indexed: 11/20/2022] Open
Abstract
Background HIV Pre-exposure prophylaxis (PrEP) is being considered for implementation among MSM nationwide in Vietnam. However, there may be concerns about potential obstacles for PrEP adherence among Vietnamese MSM. This study aims to assess the acceptability to use PrEP, potential barriers and facilitators, and the preferences for PrEP service accessibility and delivery among Vietnamese MSM. Methods Four focus group discussions (FGDs) were conducted with 30 HIV-negative MSM in January 2018 in Hanoi, Vietnam. FGDs explored MSM’s awareness regarding PrEP, perceived benefits and barriers of PrEP use, and willingness to use PrEP. FGDs were audio-recorded and transcribed verbatim. Content analysis was used. Results The mean age of participants was 23.9 years old. Most participants realized the advantages of PrEP given its efficacy in HIV risk reduction and expressed high motivation and interest to use PrEP in the future. PrEP was considered as a supplement alongside condoms. Common concerns about PrEP included side-effects, forgetting to take the pill daily, stigmatization due to using PrEP, negative attitudes toward PrEP from other MSM and accessibility of PrEP. Participants would prefer an injectable PrEP regime if available as it was seen as easier to adhere to. Concerns were also raised that PrEP usage could be interpreted as an indication of engaging in sexual risk behavior for HIV, potentially causing suspicion in love relationships or by family and friends. Participants preferred to receive PrEP in civil business organizations and MSM-friendly clinics, and recommended that pharmacy stores would not be suitable for PrEP implementation due to lack of trust and fear of fake drugs. Conclusion This study indicated a high level of willingness to use PrEP among MSM in Vietnam in combination with condom. Strategies to raise awareness of PrEP, reduce stigma towards PrEP, and improve the accessibility among MSM in Vietnam is needed. Existing MSM-friendly clinics were recommended to implement PrEP programs in Vietnam.
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Affiliation(s)
- Long Hoang Nguyen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden. .,VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.
| | - Huong Lan Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.,Faculty of Nursing, Duy Tan University, Da Nang, Vietnam
| | - Bach Xuan Tran
- Department of Health Economics, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Department of Health, Behaviours, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Mattias Larsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Luis E C Rocha
- Department of Economics & Department of Physics and Astronomy, Ghent University, Ghent, Belgium
| | - Anna Thorson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Susanne Strömdahl
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden
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Abstract
PURPOSE OF REVIEW The WHO has set ambitious targets for hepatitis C virus (HCV) elimination by 2030. In this review, we explore the possibility of HCV micro-elimination in HIV-positive (+) MSM, discussing strategies for reducing acute HCV incidence and the likely interventions required to meet these targets. RECENT FINDINGS With wider availability of directly acting antivirals (DAAs) in recent years, reductions in acute HCV incidence have been reported in some cohorts of HIV+ MSM. Recent evidence demonstrates that treatment in early infection is well tolerated, cost effective and may reduce the risk of onward transmission. Modelling studies suggest that to reduce incidence, a combination approach including behavioural interventions and access to early treatment, targeting both HIV+ and negative high-risk groups, will be required. HCV vaccine trials have not yet demonstrated efficacy in human studies, however phase one and two studies are ongoing. SUMMARY Some progress towards the WHO HCV elimination targets has been reported. Achieving sustained HCV elimination is likely to require a combination approach including early access to DAAs in acute infection and reinfection, validated and reproducible behavioural interventions and an efficacious HCV vaccine.
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11
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Wray TB, Monti PM, Kahler CW, Guigayoma JP. Using ecological momentary assessment (EMA) to explore mechanisms of alcohol-involved HIV risk behavior among men who have sex with men (MSM). Addiction 2020; 115:2293-2302. [PMID: 32281718 PMCID: PMC7554063 DOI: 10.1111/add.15053] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/17/2019] [Accepted: 03/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Heavy drinking is associated with increased risk of incident HIV infection among men who have sex with men (MSM). Past studies suggest that this association may be due to the tendency for intoxication to interfere with condom use. However, research on potential causal mechanisms explaining this relationship has been limited primarily to laboratory studies. In this study, we tested several potential mediators of the relationship between alcohol use level and HIV risk behavior. DESIGN Ecological momentary assessment (EMA) methods conducted over a 30-day period. SETTING AND PARTICIPANTS/CASES MSM (n = 100) in the northeastern United States. MEASUREMENTS Participants completed daily diary surveys and up to six experience sampling surveys randomly prompted throughout the day. FINDINGS Very heavy levels of drinking (12+ drinks) increased the odds of engaging in any sex [odds ratio (OR) = 1.87, P < 0.001]. Coefficient products and 95% confidence intervals indicated that both subjective sexual arousal (OR = 1.52, P < 0.001) and sex intentions (OR = 1.74, P < 0.001) significantly mediated the association between very heavy drinking and the odds of sex. When participants reported sex, the odds of engaging in high-risk condomless anal sex (CAS) increased incrementally after drinking heavily (five to 11 drinks; OR = 3.27, P = 0.006) and very heavily (12+ drinks; OR = 4.42, P < 0.001). Only subjective sexual arousal significantly mediated the association between alcohol use level and high-risk CAS (OR = 1.16, P = 0.040). CONCLUSIONS Increases in subjective sexual arousal after drinking heavily appear to partly account for alcohol-related HIV risk behaviors in the daily lives of men who have sex with men. Alcohol's role in strengthening motivationally consistent emotional states may therefore play a more important role in facilitating alcohol-involved HIV risk than explicit sexual motivation.
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Affiliation(s)
- Tyler B. Wray
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, 121. S. Main Street, Box G-S121-5, Providence, RI 02903
| | - Peter M. Monti
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, 121. S. Main Street, Box G-S121-5, Providence, RI 02903
| | - Christopher W. Kahler
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, 121. S. Main Street, Box G-S121-5, Providence, RI 02903
| | - John P. Guigayoma
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, 121. S. Main Street, Box G-S121-5, Providence, RI 02903
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Nguyen LH, Nguyen HLT, Larsson M, Tran BX, L Stein M, Rocha LEC, Strömdahl S. An exploratory assessment of the preference for eHealth interventions to prevent HIV and sexually transmitted infections among men who have sex with men in Hanoi, Vietnam. BMC Public Health 2020; 20:1387. [PMID: 32917157 PMCID: PMC7488431 DOI: 10.1186/s12889-020-09449-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Electronic health (eHealth) interventions are promising in HIV and sexually transmitted infections (STIs) prevention among men who have sex with men (MSM), given a high rate of the Internet use in this population. This study determined the preferences for eHealth interventions to prevent HIV and STIs among MSM in Hanoi, Vietnam to guide the development of future eHealth interventions. METHODS Five focus group discussions (FGD) were conducted with 35 MSM recruited by purposive sampling in January 2018 in Hanoi, Vietnam. The FGDs addressed attitudes towards the feasibility and uptake of HIV/STI interventions via online modalities such as smartphone applications (apps, social network sites, or emails); preferences and concerns regarding an online HIV/STI intervention. FGDs were audio-recorded and transcribed verbatim. Content analysis was used to determine themes. RESULTS MSM reported that they commonly searched for information regarding HIV/STI and sexual health on Facebook and a variety of mobile apps. They perceived a lack of reliable online sources, a high need, and interest for an online intervention. Most of them preferred short and concise messages without perceived sensitive words such as "HIV" or "STI". Diversity of online modalities were preferred with information from credible sources about HIV/STI symptoms, testing and treatment, safe sex practices and testing locations with a focus on safe MSM-friendly clinics. Concerns about the need to trust the organization behind the online information and interventions, and the importance of confidentiality when participating in online interventions were raised. CONCLUSION High acceptance and perceived need for an online HIV/STI intervention were reported. The importance of establishing trust within the MSM community as a reliable source of information was emphasized, as well as the importance of confidentiality.
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Affiliation(s)
- Long Hoang Nguyen
- Department of Global Public Health Sciences, Karolinska Institutet, SE-171 77, Stockholm, Sweden. .,Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam.
| | | | - Mattias Larsson
- Department of Global Public Health Sciences, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Bach Xuan Tran
- Department of Health Economics, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Department of Health, Behaviours, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mart L Stein
- National Coordination Centre for Communicable Disease Control, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Luis E C Rocha
- Department of Economics & Department of Physics and Astronomy, Ghent University, Ghent, Belgium
| | - Susanne Strömdahl
- Department of Global Public Health Sciences, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden
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Higa DH, Crepaz N, McDonald CM, Adegbite-Johnson A, DeLuca JB, Kamitani E, Sipe TA. HIV Prevention Research on Men Who Have Sex With Men: A Scoping Review of Systematic Reviews, 1988-2017. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:1-S7. [PMID: 32073309 DOI: 10.1521/aeap.2020.32.1.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In the United States, men who have sex with men (MSM) are disproportionately affected by HIV. To identify research gaps and inform HIV prevention for MSM, we conducted a scoping review of systematic reviews using CDC's Prevention Research Synthesis database. Eligibility criteria comprised English-language systematic reviews focused on HIV prevention for MSM, published during 1988-2017, and included at least one U.S. primary study. We coded data type, subpopulations, topics, and key findings. To assess study quality, we used the Assessment of Multiple Systematic Reviews (AMSTAR). Among 129 relevant systematic reviews, study quality was high or moderate for 63%. Most common topics were sexual behavior and disease vulnerability. The most frequently mentioned MSM subgroups were HIV-positive, Black or African American, and young. Research gaps include Hispanic/Latino MSM, pre-exposure prophylaxis (PrEP), treatment as prevention, social determinants of health, health disparities, syndemics, and protective factors for sexual health.
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Affiliation(s)
- Darrel H Higa
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Nicole Crepaz
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Christina M McDonald
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | | | - Julia B DeLuca
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Emiko Kamitani
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Theresa Ann Sipe
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
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Frey K, Lociciro S, Blank P, Schwenkglenks M, Dubois-Arber F, Rosenbrock R, Lehner A, Staub R, Derendinger S, Schmidt A, Bize R, Kübler D, Low N. 'Break the Chains 2015' community-based HIV prevention campaign for men who have sex with men in Switzerland: non-randomised evaluation and cost analysis. BMJ Open 2020; 10:e032459. [PMID: 31969364 PMCID: PMC7044933 DOI: 10.1136/bmjopen-2019-032459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To study the implementation, effects and costs of Break the Chains, a community-based HIV prevention campaign for men who have sex with men (MSM) in Switzerland, from March to May 2015, which aimed to reduce early HIV transmission by promoting the campaign message to adopt short-term risk reduction followed by HIV testing. DESIGN Non-randomised evaluation and cost analysis. SETTING Gay venues in 11 of 26 cantons in Switzerland and national online media campaign. PARTICIPANTS MSM in online surveys (precampaign n=834, postcampaign n=688) or attending HIV testing centres (n=885); campaign managers (n=9); and campaign staff (n=38) or further intermediaries (n=80) in an online survey. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was the proportion of MSM at risk of HIV acquisition or transmission who adhered to the campaign message. Secondary outcomes were postcampaign test uptake, knowledge about HIV primary infection and sense of belonging to the gay community. RESULTS Campaign staff estimated that they contacted 17 145 MSM in 11 cantons. Among 688 respondents to the postcampaign survey, 311 (45.2%) were categorised as MSM at risk. Of 402/688 (58.5%) MSM who had heard about Break the Chains 2015, MSM categorised as being at risk were less likely to report adherence to the campaign message than MSM not at risk (adjusted OR 0.24; 95% CI 0.14 to 0.42). Twenty per cent of MSM with a defined risk of HIV acquisition or transmission who adopted risk reduction declared having done so because of the campaign. Costs for one MSM at risk to adhere to the campaign message were estimated at USD purchasing power parity 36-55. The number of HIV tests in the month after the campaign was twice the monthly average. CONCLUSION Break the Chains increased HIV testing, implying that community-based campaigns are useful HIV prevention strategies for MSM. Additional interventions are needed to reach MSM at the highest risk of infection more effectively.
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Affiliation(s)
- Kathrin Frey
- Department of Political Science, Faculty of Arts and Humanities, University of Zurich, Zurich, Switzerland
| | - Stéphanie Lociciro
- Centre for Primary Care and Public Health (Unisanté), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Patricia Blank
- Epidemiology, Biostatistics and Prevention Institute, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Matthias Schwenkglenks
- Epidemiology, Biostatistics and Prevention Institute, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Françoise Dubois-Arber
- Centre for Primary Care and Public Health (Unisanté), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | | | | | - Roger Staub
- Swiss Federal Office of Public Health, Bern, Switzerland
| | | | - Axel Schmidt
- Swiss Federal Office of Public Health, Bern, Switzerland
| | - Raphael Bize
- Centre for Primary Care and Public Health (Unisanté), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Daniel Kübler
- Department of Political Science, Faculty of Arts and Humanities, University of Zurich, Zurich, Switzerland
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Willingness of MSM Living with HIV to Take Part in Video-Groups: Application of the Technology Readiness and Acceptance Model. AIDS Behav 2019; 23:3165-3174. [PMID: 31123856 DOI: 10.1007/s10461-019-02534-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Group-based programs are important for the psychosocial care of people living with HIV; however, programs are often limited by geography and availability. Video-groups, conducted via group-based video-conferencing on video-phones or computer, offer the benefits of group-based programs while overcoming barriers to attendance. This study sought to explore if, and how, the Technology Readiness and Acceptance Model (TRAM) could be used to explain the willingness of men to take part in video-groups. The TRAM was used as the guiding framework for thematic qualitative analysis. Among 106 participants, there was a general willingness to participate in video-groups. TRAM constructs were present in the data-with perceived usefulness (extent that participating in a technology-based program would facilitate group intervention behaviors) and insecurity (distrust/skepticism of technology) emerging as the most salient themes. The TRAM alone did not account for concerns related to group settings or the level of privacy needed when talking about HIV.
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Interventions to improve healthcare workers' hand hygiene compliance: A systematic review of systematic reviews. Infect Control Hosp Epidemiol 2019; 39:1449-1456. [PMID: 30526716 DOI: 10.1017/ice.2018.262] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To synthesize the existing evidence base of systematic reviews of interventions to improve healthcare worker (HCW) hand hygiene compliance (HHC). METHODS PRISMA guidelines were followed, and 10 information sources were searched in September 2017, with no limits to language or date of publication, and papers were screened against inclusion criteria for relevance. Data were extracted and risk of bias was assessed. RESULTS Overall, 19 systematic reviews (n=20 articles) were included. Only 1 article had a low risk of bias. Moreover, 15 systematic reviews showed positive effects of interventions on HCW HHC, whereas 3 reviews evaluating monitoring technology did not. Findings regarding whether multimodal rather than single interventions are preferable were inconclusive. Targeting social influence, attitude, self-efficacy, and intention were associated with greater effectiveness. No clear link emerged between how educational interventions were delivered and effectiveness. CONCLUSIONS This is the first systematic review of systematic reviews of interventions to improve HCW HHC. The evidence is sufficient to recommend the implementation of interventions to improve HCW HHC (except for monitoring technology), but it is insufficient to make specific recommendations regarding the content or how the content should be delivered. Future research should rigorously apply behavior change theory, and recommendations should be clearly described with respect to intervention content and how it is delivered. Such recommendations should be tested for longer terms using stronger study designs with clearly defined outcomes.
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Nguyen LH, Tran BX, Rocha LEC, Nguyen HLT, Yang C, Latkin CA, Thorson A, Strömdahl S. A Systematic Review of eHealth Interventions Addressing HIV/STI Prevention Among Men Who Have Sex With Men. AIDS Behav 2019; 23:2253-2272. [PMID: 31401741 DOI: 10.1007/s10461-019-02626-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A systematic review was conducted to summarize and appraise the eHealth interventions addressing HIV/STI prevention among men who have sex with men (MSM), and characterize features of successful eHealth interventions. Fifty-five articles (17 pilots and 38 full efficacy trials) were included with the predominance of web-based interventions in the United States-based settings. Intervention modalities include web-based, short message service (SMS)/text messges/email reminder, online video-based, computer-assisted, multimedia-based, social network, live chat and chat room, virtual simulation intervention, and smartphone applications. Forty-nine eHealth interventions achieved a short-term behaviour change among participants. Four studies were conducted with 12-month follow-ups; and only one of them could maintain the behaviour change over this longer time period which could be due to the lack of booster interventions. Our study suggests that eHealth interventions can achieve short term behaviour change among MSM, however limited interventions could maintain behaviour change over 12 months. Further eHealth intervention strategies to promote HIV prevention among MSM should be conducted and rigorously evaluated.
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Sophus AI, Mitchell JW. A Review of Approaches Used to Increase Awareness of Pre-exposure Prophylaxis (PrEP) in the United States. AIDS Behav 2019; 23:1749-1770. [PMID: 30306434 DOI: 10.1007/s10461-018-2305-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PrEP is an important and useful HIV prevention strategy, yet awareness remains low among at-risk populations in the United States and elsewhere in the world. As previous studies have shown PrEP awareness to be important to PrEP uptake, understanding approaches to increase PrEP awareness is imperative. The current systematic review provides an overview of published articles and on-going research on PrEP awareness. Using PRISMA guidelines, two published articles and seven on-going research studies were identified that use different approaches to increase PrEP awareness. Findings highlight the need for research to target other at-risk populations and geographic areas. Future research should consider the use of technology and network approaches to assess whether they lead to increased awareness, accurate knowledge, and uptake of PrEP, along with examining which messaging works best for specific targeted, at-risk population(s).
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Affiliation(s)
- Amber I Sophus
- Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Rd, Biomed T110, Honolulu, HI, 96822, USA.
| | - Jason W Mitchell
- Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Rd, Biomed T110, Honolulu, HI, 96822, USA
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King C, Llewellyn C, Shahmanesh M, Abraham C, Bailey J, Burns F, Clark L, Copas A, Howarth A, Hughes G, Mercer C, Miners A, Pollard A, Richardson D, Rodger A, Roy A, Gilson R. Sexual risk reduction interventions for patients attending sexual health clinics: a mixed-methods feasibility study. Health Technol Assess 2019; 23:1-122. [PMID: 30916641 PMCID: PMC6452239 DOI: 10.3310/hta23120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) continue to represent a major public health challenge. There is evidence that behavioural interventions to reduce risky sexual behaviours can reduce STI rates in patients attending sexual health (SH) services. However, it is not known if these interventions are effective when implemented at scale in SH settings in England. OBJECTIVES The study (Santé) had two main objectives - (1) to develop and pilot a package of evidence-based sexual risk reduction interventions that can be delivered through SH services and (2) to assess the feasibility of conducting a randomised controlled trial (RCT) to determine effectiveness against usual care. DESIGN The project was a multistage, mixed-methods study, with developmental and pilot RCT phases. Preparatory work included a systematic review, an analysis of national surveillance data, the development of a triage algorithm, and interviews and surveys with SH staff and patients to identify, select and adapt interventions. A pilot cluster RCT was planned for eight SH clinics; the intervention would be offered in four clinics, with qualitative and process evaluation to assess feasibility and acceptability. Four clinics acted as controls; in all clinics, participants would be consented to a 6-week follow-up STI screen. SETTING SH clinics in England. PARTICIPANTS Young people (aged 16-25 years), and men who have sex with men. INTERVENTION A three-part intervention package - (1) a triage tool to score patients as being at high or low risk of STI using routine data, (2) a study-designed web page with tailored SH information for all patients, regardless of risk and (3) a brief one-to-one session based on motivational interviewing for high-risk patients. MAIN OUTCOME MEASURES The three outcomes were (1) the acceptability of the intervention to patients and SH providers, (2) the feasibility of delivering the interventions within existing resources and (3) the feasibility of obtaining follow-up data on STI diagnoses (primary outcome in a full trial). RESULTS We identified 33 relevant trials from the systematic review, including videos, peer support, digital and brief one-to-one sessions. Patients and SH providers showed preferences for one-to-one and digital interventions, and providers indicated that these intervention types could feasibly be implemented in their settings. There were no appropriate digital interventions that could be adapted in time for the pilot; therefore, we created a placeholder for the purposes of the pilot. The intervention package was piloted in two SH settings, rather than the planned four. Several barriers were found to intervention implementation, including a lack of trained staff time and clinic space. The intervention package was theoretically acceptable, but we observed poor engagement. We recruited patients from six clinics for the follow-up, rather than eight. The completion rate for follow-up was lower than anticipated (16% vs. 46%). LIMITATIONS Fewer clinics were included in the pilot than planned, limiting the ability to make strong conclusions on the feasibility of the RCT. CONCLUSION We were unable to conclude whether or not a definitive RCT would be feasible because of challenges in implementation of a pilot, but have laid the groundwork for future research in the area. TRIAL REGISTRATION Current Controlled Trials ISRCTN16738765. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Carina King
- Institute for Global Health, University College London, London, UK
| | - Carrie Llewellyn
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | | | | | - Julia Bailey
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Fiona Burns
- Institute for Global Health, University College London, London, UK
| | - Laura Clark
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
- London Hub for Trials Methodology Research, Medical Research Council Clinical Trials Unit, London, UK
| | - Alison Howarth
- Institute for Global Health, University College London, London, UK
| | - Gwenda Hughes
- Sexually Transmitted Infection Surveillance, Public Health England, London, UK
| | - Cath Mercer
- Institute for Global Health, University College London, London, UK
| | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Alex Pollard
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | | | - Alison Rodger
- Institute for Global Health, University College London, London, UK
| | - Anupama Roy
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, UK
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Abstract
HIV behavioral research has provided an invaluable knowledge base for effective approaches to behavioral challenges along the HIV care cascade. Little attention has been paid to tracking unanticipated effects of research participation, whether negative or positive. We used qualitative methods to elicit impressions of unanticipated effects of participation in behavioral research. An instrument was developed and piloted to assess positive (emotional gains, practical gains, HIV prevention knowledge and skills gains) and negative (emotional stress, discomfort with research) unanticipated effects. Participants (N = 25) from five projects, including men who have sex with men, adults who use substances, and youth, reported multiple positive unanticipated effects (sexual and drug risk reduction, goal setting, improvements in self-esteem and mood, relationship gains, health care behavior gains, knowledge and introspection gains) and rare unanticipated negative effects. Developing a systematic tool of unanticipated positive and negative effects of participation in behavioral research is a crucial next step.
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Flowers P, Wu O, Lorimer K, Ahmed B, Hesselgreaves H, MacDonald J, Cayless S, Hutchinson S, Elliott L, Sullivan A, Clutterbuck D, Rayment M, McDaid L. The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development. Health Technol Assess 2018; 21:1-164. [PMID: 28145220 DOI: 10.3310/hta21050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) experience significant inequalities in health and well-being. They are the group in the UK at the highest risk of acquiring a human immunodeficiency virus (HIV) infection. Guidance relating to both HIV infection prevention, in general, and individual-level behaviour change interventions, in particular, is very limited. OBJECTIVES To conduct an evidence synthesis of the clinical effectiveness of behaviour change interventions to reduce risky sexual behaviour among MSM after a negative HIV infection test. To identify effective components within interventions in reducing HIV risk-related behaviours and develop a candidate intervention. To host expert events addressing the implementation and optimisation of a candidate intervention. DATA SOURCES All major electronic databases (British Education Index, BioMed Central, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Educational Resource Index and Abstracts, Health and Medical Complete, MEDLINE, PsycARTICLES, PsycINFO, PubMed and Social Science Citation Index) were searched between January 2000 and December 2014. REVIEW METHODS A systematic review of the clinical effectiveness of individual behaviour change interventions was conducted. Interventions were examined using the behaviour change technique (BCT) taxonomy, theory coding assessment, mode of delivery and proximity to HIV infection testing. Data were summarised in narrative review and, when appropriate, meta-analysis was carried out. Supplemental analyses for the development of the candidate intervention focused on post hoc realist review method, the assessment of the sequential delivery and content of intervention components, and the social and historical context of primary studies. Expert panels reviewed the candidate intervention for issues of implementation and optimisation. RESULTS Overall, trials included in this review (n = 10) demonstrated that individual-level behaviour change interventions are effective in reducing key HIV infection risk-related behaviours. However, there was considerable clinical and methodological heterogeneity among the trials. Exploratory meta-analysis showed a statistically significant reduction in behaviours associated with high risk of HIV transmission (risk ratio 0.75, 95% confidence interval 0.62 to 0.91). Additional stratified analyses suggested that effectiveness may be enhanced through face-to-face contact immediately after testing, and that theory-based content and BCTs drawn from 'goals and planning' and 'identity' groups are important. All evidence collated in the review was synthesised to develop a candidate intervention. Experts highlighted overall acceptability of the intervention and outlined key ways that the candidate intervention could be optimised to enhance UK implementation. LIMITATIONS There was a limited number of primary studies. All were from outside the UK and were subject to considerable clinical, methodological and statistical heterogeneity. The findings of the meta-analysis must therefore be treated with caution. The lack of detailed intervention manuals limited the assessment of intervention content, delivery and fidelity. CONCLUSIONS Evidence regarding the effectiveness of behaviour change interventions suggests that they are effective in changing behaviour associated with HIV transmission. Exploratory stratified meta-analyses suggested that interventions should be delivered face to face and immediately after testing. There are uncertainties around the generalisability of these findings to the UK setting. However, UK experts found the intervention acceptable and provided ways of optimising the candidate intervention. FUTURE WORK There is a need for well-designed, UK-based trials of individual behaviour change interventions that clearly articulate intervention content and demonstrate intervention fidelity. STUDY REGISTRATION The study is registered as PROSPERO CRD42014009500. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Paul Flowers
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment and National Institute for Health Research Complex Reviews Support Unit, University of Glasgow, Glasgow, UK
| | - Karen Lorimer
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Bipasha Ahmed
- GCU London, Glasgow Caledonian University, London, UK
| | - Hannah Hesselgreaves
- Health Economics and Health Technology Assessment and National Institute for Health Research Complex Reviews Support Unit, University of Glasgow, Glasgow, UK
| | - Jennifer MacDonald
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Sandi Cayless
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Sharon Hutchinson
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lawrie Elliott
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Ann Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Lisa McDaid
- Chief Scientist Office/Medical Research Council Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Psychological distress, health protection, and sexual practices among young men who have sex with men: Using social action theory to guide HIV prevention efforts. PLoS One 2017; 12:e0184482. [PMID: 28886128 PMCID: PMC5590937 DOI: 10.1371/journal.pone.0184482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 08/24/2017] [Indexed: 12/12/2022] Open
Abstract
The present study addresses gaps in the literature related to theory development for young men who have sex with men (YMSM) sexual practices through the application and modification of Social Action Theory. Data come from the Healthy Young Men study (N = 526), which longitudinally tracked a diverse cohort of YMSM ages 18–24 to characterize risk and protective factors associated with drug use and sexual practices. Structural equation modeling examined the applicability of, and any necessary modifications to a YMSM-focused version of Social Action Theory. The final model displayed excellent fit (CFI = 0.955, TLI = 0.947, RMSEA = 0.037) and suggested concordance between social support and personal capacity for sexual health promotion. For YMSM, practicing health promotion and avoiding practices that may put them at risk for HIV was associated with both social isolation and psychological distress (β = -0.372, t = -4.601, p<0.001); psychological distress is an internalized response to environmental and cognitive factors and sexual practices are an externalized response. Results point to the utility of Social Action Theory as a useful model for understanding sexual practices among YMSM, the application of which shows health protective sexual practices are a function of sociocognitive factors that are influenced by environmental contexts. Social Action Theory can help prevention scientists better address the needs of this vulnerable population.
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Grangeiro A, Ferraz D, Calazans G, Zucchi EM, Díaz-Bermúdez XP. The effect of prevention methods on reducing sexual risk for HIV and their potential impact on a large-scale: a literature review. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 18 Suppl 1:43-62. [PMID: 26630298 DOI: 10.1590/1809-4503201500050005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 06/15/2015] [Indexed: 12/23/2022] Open
Abstract
A spectrum of diverse prevention methods that offer high protection against HIV has posed the following challenge: how can national AIDS policies with high coverage for prevention and treatment make the best use of new methods so as to reverse the current high, and even rising, incidence rates among specific social groups? We conducted a narrative review of the literature to examine the prevention methods and the structural interventions that can have a higher impact on incidence rates in the context of socially and geographically concentrated epidemics. Evidence on the protective effect of the methods against sexual exposure to HIV, as well as their limits and potential, is discussed. The availability and effectiveness of prevention methods have been hindered by structural and psychosocial barriers such as obstacles to adherence, inconsistent use over time, or only when individuals perceive themselves at higher risk. The most affected individuals and social groups have presented limited or absence of use of methods as this is moderated by values, prevention needs, and life circumstances. As a result, a substantial impact on the epidemic cannot be achieved by one method alone. Programs based on the complementarity of methods, the psychosocial aspects affecting their use and the mitigation of structural barriers may have the highest impact on incidence rates, especially if participation and community mobilization are part of their planning and implementation.
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Affiliation(s)
- Alexandre Grangeiro
- Department of Preventive Medicine, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Dulce Ferraz
- Department of Preventive Medicine, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Gabriela Calazans
- Department of Preventive Medicine, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Eliana Miura Zucchi
- Study Group for AIDS prevention, Universidade de São Paulo, São Paulo, SP, Brazil
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Crowell TA, Keshinro B, Baral SD, Schwartz SR, Stahlman S, Nowak RG, Adebajo S, Blattner WA, Charurat ME, Ake JA. Stigma, access to healthcare, and HIV risks among men who sell sex to men in Nigeria. J Int AIDS Soc 2017; 20:21489. [PMID: 28453241 PMCID: PMC5515015 DOI: 10.7448/ias.20.01.21489] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 04/06/2017] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Among men who have sex with men (MSM), men who sell sex (MSS) may be subject to increased sexual behaviour-related stigma that affects uptake of healthcare and risk of sexually transmitted infections (STIs). The objectives of this study were to characterize stigma, access to care, and prevalence of HIV among MSS in Nigeria. METHODS Respondent-driven sampling was used to recruit MSM in Abuja and Lagos into the ongoing TRUST/RV368 study, which provides HIV testing and treatment. Detailed behavioural data were collected by trained interviewers. MSS were identified by self-report of receiving goods or money in exchange for sex with men. Poisson regression with robust error variance was used to explore the impact of sex-selling on the risk of HIV. RESULTS From 12 initial seed participants, 1552 men were recruited from March 2013-March 2016. Of these, 735 (47.4%) reported sex-selling. Compared to other MSM, MSS were younger (median 22 vs. 24 years, p < 0.001) and more likely to identify as gay/homosexual (42.4% vs. 31.5%, p < 0.001). MSS were more likely to report perceived and experienced stigmas such as healthcare avoidance (27.6% vs. 21.5%, p = 0.005) and verbal harassment (39.2% vs. 26.8%, p < 0.001). Total HIV prevalence was 53.4%. After controlling for other factors, HIV prevalence among MSS was similar to that observed among other MSM (relative risk 0.94 [95% confidence interval 0.84-1.05]). CONCLUSION These data highlight increased sexual behaviour-related stigma affecting MSS, as compared with other MSM, that limits uptake of healthcare services. The distinct characteristics and risks among MSS suggest the need for specific interventions to optimize linkage to HIV prevention and treatment services in Nigeria.
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Affiliation(s)
- Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | | | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sheree R Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shauna Stahlman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca G Nowak
- Institute of Human Virology, University of Maryland, Baltimore, MD, USA
| | | | | | | | - Julie A Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - for the TRUST/RV368 Study Group
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Walter Reed Program-Nigeria, Abuja, Nigeria
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Institute of Human Virology, University of Maryland, Baltimore, MD, USA
- Population Council Nigeria, Abuja, Nigeria
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Eaton LA, Kalichman SC, Kalichman MO, Driffin DD, Baldwin R, Zohren L, Conway-Washington C. Randomised controlled trial of a sexual risk reduction intervention for STI prevention among men who have sex with men in the USA. Sex Transm Infect 2017; 94:40-45. [PMID: 28404766 DOI: 10.1136/sextrans-2016-052835] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 03/08/2017] [Accepted: 03/27/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Novel interventions to address sexual risk taking and slow rates of STIs are urgently needed, in particular among black men who have sex with men (MSM) in the USA. Serosorting, or limiting condomless sex acts to partners of the same HIV status, is commonly practised among MSM, yet can lead to STI and remains largely unaddressed by public health agencies. METHODS A two-arm, randomised controlled trial was conducted from 2012 to 2015. This trial assessed the effects of a single-session, sexual partner selection and risk decision intervention (experimental arm) versus a single-session, Centers for Disease Control and Prevention-based, sexual risk reduction intervention (control arm) on psychosocial measures, sexual risk taking and STI. RESULTS At study follow-ups, multiple beneficial changes were observed on sexual risk beliefs measures (ie, changes in serosorting and condom use beliefs, and HIV risk perceptions) and sexual risk taking among the experimental arm relative to the control arm. Overall main effects, however, of the intervention on STI outcomes on year-long follow-ups were non-significant. There was evidence for short-term effects on STI outcomes, and self-report of multiple STIs and STI symptoms demonstrated positive effects over the follow-up period. CONCLUSIONS Brief interventions to address sexual risk taking can result in short-term beneficial outcomes and can be incorporated into currently existing infrastructure at healthcare agencies. Additional intervention will be necessary for demonstrating long-term results. TRIAL REGISTRATION NUMBER NCT02128594.
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Affiliation(s)
- Lisa A Eaton
- Human Development and Family Studies, University of Connecticut, Storrs, Connecticut, USA
| | - Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Moira O Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Daniel D Driffin
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Robert Baldwin
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Larissa Zohren
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
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Neville S, Adams J, Moorley C, Jackson D. The condom imperative in anal sex - one size may not fit all: a qualitative descriptive study of men who have sex with men. J Clin Nurs 2017; 25:3589-3596. [PMID: 27539386 DOI: 10.1111/jocn.13507] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2016] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To explore men who have sex with men's views about condom use when having anal intercourse. BACKGROUND Internationally, health promotion campaigns use behavioural change strategies to support men who have sex with men to always use condoms when having anal sex with other men. The health promotion message given to this group is consistent and explicitly stated that 'use a condom every time for anal sex regardless of relationship status'. DESIGN Qualitative analysis of data from a cohort of New Zealand men who have sex with men. METHODS A total of 960 useable questionnaires were completed: 571 online and 389 in hard copy. Qualitative data were analysed using a thematic data analytic process. RESULTS Three themes relating to condom use in men who have sex with men were identified. These are as follows: 'Safer sex is good sex', 'Condom use is good but …' and 'I use condoms sometimes'. CONCLUSIONS The range of responses towards condom use for anal sex in men who have sex with men in our sample reveal this as a complex public health issue, with not all men who have sex with men willing to consistently use condoms. RELEVANCE TO CLINICAL PRACTICE It is important that nurses do not assume that all men who have sex with men are willing to use condoms for anal sex, and should create opportunities for men who have sex with men to raise any concerns about the use of condoms. In this way, nurses can assist in providing information that may help men who have sex with men to make decisions that will minimise risk of contracting infections associated with sexual activity.
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Affiliation(s)
- Stephen Neville
- Department of Nursing, AUT University, Auckland, New Zealand
| | - Jeffery Adams
- SHORE & Whariki Research Centre, Massey University, Auckland, New Zealand
| | - Calvin Moorley
- School of Health & Social Care, London South Bank University, London, UK
| | - Debra Jackson
- Faculty of Health & Life Sciences, Oxford Brookes University, Oxford, UK
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Prevalence and Correlates of a Diagnosis of Sexually Transmitted Infection Among Young Aboriginal and Torres Strait Islander People: A National Survey. Sex Transm Dis 2016; 43:177-84. [PMID: 26859805 DOI: 10.1097/olq.0000000000000417] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Young Aboriginal and Torres Strait Islander (Aboriginal) people are recognized as a priority population for the control of sexually transmissible infections (STIs) in Australia. This article reports the prevalence of self-reported STI diagnoses and their correlates among Aboriginal people aged 16 to 29 years. METHODS Results were analyzed from a survey conducted between 2011 and 2013 at regular community events. Univariate and multivariate logistic regression models were used to identify the correlates of a history of STI diagnosis among participants who reported being sexually active and ever having been tested for STIs. All analyses were stratified by sex. RESULTS Of the 2877 participants in this study, 2320, comprising 60% females, self-reported ever having had vaginal or anal sex, and a further subset of 1589 (68%) reported ever being tested for any of the following STIs: chlamydia, gonorrhea, syphilis, or trichomonas. Within this latter group, the proportion who reported that they had had a positive STI diagnosis was 25%. In multivariate analysis, women who reported sexual debut before the age of 16 years (prevalence ratio [PR], 1.53; 95% confidence interval, 1.16-2.81; P < 0.05), ever having had oral sex (PR, 2.66; 1.47-4.82; P < 0.001), inconsistent condom use in the past 12 months (PR, 1.71; 1.13-2.58; P < 0.012), having had sex with someone they had just met (adjusted odds ratio, 1.74; 1.21-2.50; P < 0.003), and using ecstasy (PR, 1.81; 1.16-2.81; P < 0.009) were significantly associated with a self-reported history of an STI diagnosis. For men, being older (25-29 years; PR, 2.10; 1.10-3.96; P < 0.023), being gay or bisexual (PR, 2.22; 1.16-4.27; P < 0.016), not using a condom during last sex, (PR, 1.74; 1.10-2.76; P < 0.019), past ecstasy use (PR, 1.88; 1.11-3.20; P < 0.019), and injecting drug use (PR, 2.81; 1.35-5.88); P < 0.006) were independent predictors of ever reporting being diagnosed as having an STI. DISCUSSION In the first community-based survey of this population, a self-reported history of ever being diagnosed as having prevalent STIs was common in sexually active young Aboriginal people who reported STI testing in the past. This population requires targeted education and health service interventions to address the high burden of STIs.
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Albarracín D, Wilson K, Durantini MR, Sunderrajan A, Livingood W. A meta-intervention to increase completion of an HIV-prevention intervention: Results from a randomized controlled trial in the state of Florida. J Consult Clin Psychol 2016; 84:1052-1065. [PMID: 27786499 DOI: 10.1037/ccp0000139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE A randomized control trial with 722 eligible clients from a health department in the State of Florida was conducted to identify a simple, effective meta-intervention to increase completion of an HIV-prevention counseling program. METHOD The overall design involved 2 factors representing an empowering and instrumental message, as well as an additional factor indicating presence or absence of expectations about the counseling. Completion of the 3-session counseling was determined by recording attendance. RESULTS A logistic regression analysis with the 3 factors of empowering message, instrumental message, and presence of mediator measures, as well as all interactions, revealed significant interactions between instrumental and empowering messages and between instrumental messages and presence of mediator measures. Results indicated that (a) the instrumental message alone produced most completion than any other message, and (b) when mediators were not measured, including the instrumental message led to greater completion. CONCLUSIONS The overall gains in completion as a result of the instrumental message were 16%, implying success in the intended facilitation of counseling completion. The measures of mediators did not detect any experimental effects, probably because the effects were happening without much conscious awareness. (PsycINFO Database Record
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Affiliation(s)
- Dolores Albarracín
- Department of Psychology and Marketing, University of Illinois at Urbana Champaign
| | | | - Marta R Durantini
- Department of Psychology, University of Illinois at Urbana Champaign
| | | | - William Livingood
- Department of Office of the Dean, College of Medicine, University of Florida, Jacksonville
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Implementation and Operational Research: Computer-Assisted Intervention for Safer Sex in HIV-Positive Men Having Sex With Men: Findings of a European Randomized Multi-Center Trial. J Acquir Immune Defic Syndr 2016; 71:e63-72. [PMID: 26866955 PMCID: PMC4770369 DOI: 10.1097/qai.0000000000000882] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Men who have sex with men (MSM) are the key population most affected by HIV in Europe. We performed the first European multicenter, simple-randomized parallel-group study to test the effectiveness of a theory-guided computer-assisted intervention to improve safer sex among HIV-positive men who have sex with men. METHODS Between February, 2011 and February, 2013, 112 participants were enrolled in 8 different European HIV-care settings. Intervention participants received 3 individual counseling sessions facilitated by trained service providers using computer-assisted tools. The control-group received sexual health advice delivered as part of regular HIV care. Outcome behavior (self-reported condom use at last intercourse; combined HIV transmission risk score), its influencing factors, and mediating variables were assessed at baseline, and at 3 and 6 months follow-up. Mixed effects models were used to compare primary outcomes (condom use at last intercourse, HIV transmission risk score), and mediation analysis to explore intervention effects. RESULTS Condom use at last intercourse increased more among intervention than control participants at 3 months follow-up (odds ratio of 3.83; P = 0.03), but not significantly at 6 months follow-up. Intervention participants reported a lower transmission risk at 3 months follow-up than controls (odds ratio compared with baseline of 11.53 and 1.28, respectively; P = 0.008), but this effect became nonsignificant at 6 months. Intervention effects were mediated by the proximal variables, self-efficacy to negotiate condom use and condom attitudes. CONCLUSIONS This intervention showed short-term effectiveness. The intervention should be replicated in other settings, eventually investigating if booster-counseling sessions would yield a longer lasting effect.
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Covey J, Rosenthal-Stott HES, Howell SJ. A synthesis of meta-analytic evidence of behavioral interventions to reduce HIV/STIs. J Behav Med 2016; 39:371-85. [PMID: 26831053 PMCID: PMC4853449 DOI: 10.1007/s10865-016-9714-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 01/07/2016] [Indexed: 11/24/2022]
Abstract
To identify the mode of delivery, communicator, and content dimensions that make STI/HIV prevention interventions most successful at increasing condom use/protected sex or reducing STI/HIV incidence. A literature search for published meta-analyses of STI/HIV prevention interventions yielded 37 meta-analyses that had statistically tested the moderating effects of the dimensions. Significant and non-significant moderators from the coded dimensions were extracted from each meta-analysis. The most consistently significant moderators included matching the gender or ethnicity of the communicator to the intervention recipients, group targeting or tailoring of the intervention, use of a theory to underpin intervention design, providing factual information, presenting arguments designed to change attitudes, and providing condom skills and intrapersonal skills training. The absence of significant effects for intervention duration and expert delivery are also notable. The success of HIV/STI prevention interventions may be enhanced not only by providing skills training and information designed to change attitudes, but also by ensuring that the content is tailored to the target group and delivered by individuals of the same gender and ethnicity as the recipients.
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Affiliation(s)
- Judith Covey
- Department of Psychology, Wolfson Research Institute for Health and Wellbeing, Durham University, Queen's Campus, Stockton-on-Tees, TS17 6BH, UK.
| | - Harriet E S Rosenthal-Stott
- Department of Psychology, Wolfson Research Institute for Health and Wellbeing, Durham University, Queen's Campus, Stockton-on-Tees, TS17 6BH, UK
| | - Stephanie J Howell
- Department of Psychology, University of York, Heslington, York, YO10 5DD, UK
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Rowe C, Liou T, Vittinghoff E, Coffin PO, Santos GM. Binge drinking concurrent with anal intercourse and condom use among men who have sex with men. AIDS Care 2016; 28:1566-1570. [PMID: 27241085 DOI: 10.1080/09540121.2016.1191616] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Men who have sex with men (MSM) are the demographic group most severely affected by HIV in the USA. Global association studies have shown that MSM who binge drink are more likely to engage in risky sexual behaviors and day- and event-level analyses have linked binge drinking to sexual risk behavior on specific days and during specific sexual encounters. Despite this strong foundation of research, no studies have examined the association between the frequency of situational binge drinking (i.e., binge drinking concurrent with sexual activity) and aggregated sexual risk over periods of longer duration. We used multivariable logistic regression to assess the relationship between situational binge drinking (i.e., binge drinking concurrent with anal intercourse) and condomless anal intercourse (CAI) and among a cross-sectional sample of 124 MSM in San Francisco, CA. There was a positive relationship between frequency of situational binge drinking and CAI (1-5 times vs. never: adjusted odds ratio = 2.78, 95% CI = 1.01-7.63; 6-10 times vs. never: 6.19, 1.27-30.22; more than 10 times vs. never: 11.88, 1.31-107.60). By filling a methodological gap and complementing existing global and event-level analyses, this positive situational relationship strengthens the evidence linking binge drinking and sexual risk, enhances the comparability of the existing literature, and further suggests that the integration of dual strategies that aim to prevent HIV and reduce binge drinking may be warranted.
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Affiliation(s)
- Christopher Rowe
- a San Francisco Department of Public Health , San Francisco , CA , USA
| | - Todd Liou
- a San Francisco Department of Public Health , San Francisco , CA , USA
| | - Eric Vittinghoff
- a San Francisco Department of Public Health , San Francisco , CA , USA.,b Department of Epidemiology and Biostatistics Biostatistics (Eric Vittinghoff), School of Medicine , University of California San Francisco , San Francisco , CA , USA.,c Division of HIV/AIDS (Phillip O. Coffin), School of Medicine , University of California San Francisco , San Francisco , CA , USA.,d Department of Community Health Systems (Glenn-Milo Santos), School of Nursing , University of California San Francisco , San Francisco , CA , USA
| | - Philip O Coffin
- a San Francisco Department of Public Health , San Francisco , CA , USA.,b Department of Epidemiology and Biostatistics Biostatistics (Eric Vittinghoff), School of Medicine , University of California San Francisco , San Francisco , CA , USA.,c Division of HIV/AIDS (Phillip O. Coffin), School of Medicine , University of California San Francisco , San Francisco , CA , USA.,d Department of Community Health Systems (Glenn-Milo Santos), School of Nursing , University of California San Francisco , San Francisco , CA , USA
| | - Glenn-Milo Santos
- a San Francisco Department of Public Health , San Francisco , CA , USA.,b Department of Epidemiology and Biostatistics Biostatistics (Eric Vittinghoff), School of Medicine , University of California San Francisco , San Francisco , CA , USA.,c Division of HIV/AIDS (Phillip O. Coffin), School of Medicine , University of California San Francisco , San Francisco , CA , USA.,d Department of Community Health Systems (Glenn-Milo Santos), School of Nursing , University of California San Francisco , San Francisco , CA , USA
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Macaya Pascual A, Ferreres Riera J, Campoy Sánchez A. Behavioral Interventions for Preventing Sexually Transmitted Infections and Unintended Pregnancies: An Overview of Systematic Reviews. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.adengl.2016.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nieblas R, Hughes L, Andrews R, Relf M. Reframing and understanding the HIV epidemic in MSM: masculinity, racism, and homophobia. J Assoc Nurses AIDS Care 2016; 26:514-9. [PMID: 26279384 DOI: 10.1016/j.jana.2015.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
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Macaya Pascual A, Ferreres Riera JR, Campoy Sánchez A. Behavioral Interventions for Preventing Sexually Transmitted Infections and Unintended Pregnancies: An Overview of Systematic Reviews. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:301-17. [PMID: 26801866 DOI: 10.1016/j.ad.2015.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 10/08/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Countless sex education programs have been implemented worldwide in recent decades, but epidemiological data show no improvement in rates of sexually transmitted infections or unintended pregnancies. OBJECTIVE To summarize the evidence from higher-quality systematic reviews on the efficacy of behavioral interventions for the prevention of sexually transmitted infections and unintended pregnancies. METHODS We conducted an overview of reviews by selecting systematic reviews that met minimum quality criteria in terms of the design of the studies reviewed. We compared the results obtained when the effects of interventions were assessed on the basis of objective criteria (biological data) to those obtained when outcomes were assessed on the basis of subjective criteria (self-reports). The results of Cochrane and non-Cochrane reviews were also compared. RESULTS We identified 55 systematic reviews. No overall effect on the sexual behavior of program participants was observed in 72.5% of the reviews that used objective criteria and in 48.1% of the reviews based on subjective criteria. In the Cochrane reviews, no evidence of an overall effect was observed in 86% of reviews based on objective variables and in 70.5% of those based on subjective variables. CONCLUSIONS There is no evidence that behavioral interventions modify rates of sexually transmitted infections (including human immunodeficiency virus infections) or unintended pregnancies, particularly when effects are assessed using objective, biological data. Primary prevention strategies for sexually transmitted infections and unintended pregnancies need to be re-evaluated.
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Affiliation(s)
- A Macaya Pascual
- Universitat Internacional de Catalunya, Barcelona, España; Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, España.
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Maisto SA, Simons JS. Research on the Effects of Alcohol and Sexual Arousal on Sexual Risk in Men who have Sex with Men: Implications for HIV Prevention Interventions. AIDS Behav 2016; 20 Suppl 1:S158-72. [PMID: 26459332 DOI: 10.1007/s10461-015-1220-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this paper was to describe and appraise the research evidence on the effects of acute alcohol intoxication and sexual arousal on sexual risk behaviors in men who have sex with men (MSM) and to examine its implications for design of HIV prevention interventions that target MSM. Toward that end, the paper begins with a discussion of research on sexual arousal in men and alcohol and their acute effects on sexual behaviors. This is followed by a review of empirical evidence on the combined acute effects of alcohol and sexual arousal in heterosexual men (the large majority of studies) and then in MSM. The empirical evidence and related theoretical developments then are integrated to derive implications for developing effective HIV prevention interventions that target MSM.
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Affiliation(s)
- Stephen A Maisto
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA.
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More than just tracking time: Complex measures of user engagement with an internet-based health promotion intervention. J Biomed Inform 2015; 59:299-307. [PMID: 26732997 DOI: 10.1016/j.jbi.2015.12.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 10/25/2015] [Accepted: 12/20/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND There has been a rise in internet-based health interventions without a concomitant focus on new methods to measure user engagement and its effect on outcomes. We describe current user tracking methods for internet-based health interventions and offer suggestions for improvement based on the design and pilot testing of healthMpowerment.org (HMP). METHODS HMP is a multi-component online intervention for young Black men and transgender women who have sex with men (YBMSM/TW) to reduce risky sexual behaviors, promote healthy living and build social support. The intervention is non-directive, incorporates interactive features, and utilizes a point-based reward system. Fifteen YBMSM/TW (age 20-30) participated in a one-month pilot study to test the usability and efficacy of HMP. Engagement with the intervention was tracked using a customized data capture system and validated with Google Analytics. Usage was measured in time spent (total and across sections) and points earned. RESULTS Average total time spent on HMP was five hours per person (range 0-13). Total time spent was correlated with total points earned and overall site satisfaction. CONCLUSION Measuring engagement in internet-based interventions is crucial to determining efficacy. Multiple methods of tracking helped derive more comprehensive user profiles. Results highlighted the limitations of measures to capture user activity and the elusiveness of the concept of engagement.
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Persson KI, Tikkanen R, Bergström J, Berglund T, Thorson A, Forsberg BC. Experimentals, bottoms, risk-reducers and clubbers: exploring diverse sexual practice in an Internet-active high-risk behaviour group of men who have sex with men in Sweden. CULTURE, HEALTH & SEXUALITY 2015; 18:639-653. [PMID: 26569463 DOI: 10.1080/13691058.2015.1103384] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study aimed to identify sub-groups of men who have sex with men at high risk of HIV infection. Data from the Swedish MSM2013 survey were analysed with a focus on respondents (n = 714) who reported having had unprotected anal intercourse with male casual partner(s) in the past 12 months. Weighted Latent Class Analysis with covariates and distal outcomes was conducted to identify sub-groups of men sharing the same sexual practice characteristics. Four latent classes emerged: experimentals, bottoms, risk-reducers and clubbers. Experimentals appeared to differ most from the other classes. They had extensive experience of barebacking, the use of poppers and fisting. Higher number of casual male sex partners and reporting having HIV were predictors for belonging to experimentals. No evidence for an association between self-rated HIV prevention knowledge and taking less part in risky practices was found. Hence, knowledge-intensive interventions may not be the best fit for reducing HIV transmission. This diversity of men based on similar sexual practice patterns should be taken into account when designing future HIV prevention interventions.
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Affiliation(s)
- Kristina Ingemarsdotter Persson
- a Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
- b Department of Knowledge Development, Unit for Health and Sexuality , Public Health Agency of Sweden , Solna , Sweden
| | - Ronny Tikkanen
- c Department of Social Work , University of Gothenburg , Göteborg , Sweden
| | - Jakob Bergström
- d Department of Monitoring and Evaluation, Unit for Statistics and Surveillance , Public Health Agency of Sweden , Solna , Sweden
| | - Torsten Berglund
- e Department of Monitoring and Evaluation, Unit for Epidemiology and Health Economics , Public Health Agency of Sweden , Solna , Sweden
| | - Anna Thorson
- a Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
| | - Birger C Forsberg
- a Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
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Rubio Mendoza ML, Jacobson JO, Morales-Miranda S, Sierra Alarcón CÁ, Luque Núñez R. High HIV Burden in Men Who Have Sex with Men across Colombia's Largest Cities: Findings from an Integrated Biological and Behavioral Surveillance Study. PLoS One 2015; 10:e0131040. [PMID: 26252496 PMCID: PMC4529092 DOI: 10.1371/journal.pone.0131040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 05/29/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Among Latin America's concentrated HIV epidemics, little is known about men who have sex with men (MSM) in Colombia, the region's third largest country. To date, surveillance studies have been limited to Bogota, while 80% of HIV cases and deaths originate from Colombia's other cities and departments. The extent to which interventions should prioritize MSM outside of Bogota is unknown. METHODS We recruited 2603 MSM using respondent-driven sampling from seven of Colombia's largest cities. HIV prevalence was estimated by site from dried blood spot samples. Behavioral data were collected through face-to-face interviews and risk factors for HIV infection analyzed using weighted, multi-level logistical regression models accounting for recruitment patterns. RESULTS Across cities, HIV prevalence averaged 15%, varied from 6% to 24% and was highest in Cali, Bogota, and Barranquilla. In the past 12 months, 65% of MSM had ≥ 5 casual male partners and 23% had a female partner. Across partnerships (i.e., casual, stable, and commercial), the proportion of MSM engaging in unprotected sex was ≥ 52% with male partners and ≥ 66% with female partners. Self-reported history of STI (24%) and past-year illicit drug use (38%) were also common. In multivariate analysis, age ≥ 35 (adjusted odds ratio [AOR], 19.2) and 25-39 (AOR, 5.6) relative to ≤ 18-24 years, identifying as homosexual relative to heterosexual (AOR 0.1), meeting casual partners on the Internet (adjusted odds ratio [AOR], 3.1) and age of sexual debut of ≤ 13 years (AOR, 3.1) predicted HIV infection. HIV testing and prevention messaging reached just 24% of MSM in the past year. CONCLUSIONS Findings support consistently elevated HIV burden among MSM throughout Colombia's largest cities and a need for enhanced behavioral prevention and HIV testing, emphasizing men who use the Internet as well as physical venues to meet sex partners.
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Nöstlinger C, Borms R, Dec-Pietrowska J, Dias S, Rojas D, Platteau T, Vanden Berghe W, Kok G. Development of a theory-guided pan-European computer-assisted safer sex intervention. Health Promot Int 2015; 31:782-792. [PMID: 26092853 DOI: 10.1093/heapro/dav061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
HIV is a growing public health problem in Europe, with men-having-sex-with-men and migrants from endemic regions as the most affected key populations. More evidence on effective behavioral interventions to reduce sexual risk is needed. This article describes the systematic development of a theory-guided computer-assisted safer sex intervention, aiming at supporting people living with HIV in sexual risk reduction. We applied the Intervention Mapping (IM) protocol to develop this counseling intervention in the framework of a European multicenter study. We conducted a needs assessment guided by the information-motivation-behavioral (IMB) skills model, formulated change objectives and selected theory-based methods and practical strategies, i.e. interactive computer-assisted modules as supporting tools for provider-delivered counseling. Theoretical foundations were the IMB skills model, social cognitive theory and the transtheoretical model, complemented by dual process models of affective decision making to account for the specifics of sexual behavior. The counseling approach for delivering three individual sessions was tailored to participants' needs and contexts, adopting elements of motivational interviewing and cognitive-behavioral therapy. We implemented and evaluated the intervention using a randomized controlled trial combined with a process evaluation. IM provided a useful framework for developing a coherent intervention for heterogeneous target groups, which was feasible and effective across the culturally diverse settings. This article responds to the need for transparent descriptions of the development and content of evidence-based behavior change interventions as potential pillars of effective combination prevention strategies.
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Affiliation(s)
- Christiana Nöstlinger
- Department of Public Health, ITM's HIV/AIDS Center, Institute of Tropical Medicine, Nationalestraat 155, Antwerp B-2000, Belgium
| | | | | | - Sonia Dias
- Institute of Tropical Medicine and Hygiene, Lisbon, Portugal
| | - Daniela Rojas
- MIRE (Mission Innovation, Recherche, Évaluation), AIDES, Paris, France
| | - Tom Platteau
- Department of Clinical Sciences, ITM's HIV/AIDS Center, ITM, Antwerp, Belgium
| | - Wim Vanden Berghe
- Department of Public Health, ITM's HIV/AIDS Center, Institute of Tropical Medicine, Nationalestraat 155, Antwerp B-2000, Belgium
| | - Gerjo Kok
- Faculty of Psychology, University of Maastricht, Maastricht, The Netherlands
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Stromdahl S, Hickson F, Pharris A, Sabido M, Baral S, Thorson A. A systematic review of evidence to inform HIV prevention interventions among men who have sex with men in Europe. ACTA ACUST UNITED AC 2015; 20. [PMID: 25953133 DOI: 10.2807/1560-7917.es2015.20.15.21096] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An estimated 42% of all newly diagnosed HIV cases in Europe in 2013 were transmitted during sex between men. This review was performed to identify and describe studies evaluating the efficacy and effectiveness of HIV prevention interventions among men who have sex with men (MSM), in relation to implementation data from European settings. A systematic search was performed individually for 24 interventions.Data were extracted from studies including efficacy or implementation data from European settings,appraised for efficacy, implementation and plausibility, and assigned a grade (1-4) according to the Highest Attainable Standard of Evidence (HASTE)framework. Four interventions (condom use, peer outreach,peer-led groups, and using universal coverage of antiretroviral treatment and treatment as prevention)were assigned the highest HASTE grade, 1. Another four interventions were assigned 2a for probable recommendation, including voluntary counseling and testing for HIV, using condom-compatible lubricant,using post-exposure prophylaxis, and individual counselling for MSM living with HIV. In addition, seven interventions were assigned a grade of 2b, for possible recommendation. Encouragingly, 15 interventions were graded to be strongly, probably or possibly recommended.In the relatively resource-rich European setting, there is an opportunity to provide global leadership with regard to the regional scale-up of comprehensive HIV prevention interventions for MSM.
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Affiliation(s)
- S Stromdahl
- Department of Public Health Sciences, Karolinska Institutet, Sweden
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Abstract
PURPOSE OF REVIEW Globally, HIV infection remains a significant issue for key populations such as men who have sex with men (MSM) and female sex workers. A review of recent articles was conducted for west African countries to assess the burden of disease among female sex workers and MSM, access to services and identify barriers to implementation of services for key populations. RECENT FINDINGS In west Africa, key populations engage in high-risk practices for the acquisition of HIV and other sexually transmitted infections. Available HIV prevalence data fluctuate across and within countries for both MSM and female sex workers and may be five to ten times as high as that of the general population. HIV prevalence varied from 15.9% in The Gambia to 68% in Benin among female sex workers, whereas it ranged from 9.8% in The Gambia to 34.9% in Nigeria for MSM. Yet, important data gaps exist, including key populations size estimations in several countries as well as HIV prevalence, incidence and other biomarkers of HIV risk. Because of sociocultural, legal, political and economic challenges, exacerbated by a poor health system infrastructure, the HIV response is not strategically directed toward programs for key populations in countries with concentrated epidemics. Noteworthy is the low coverage of prevention care and treatment interventions offered to key populations. SUMMARY Sufficient planning and political will with legal and structural frameworks that reconcile public health and human rights are needed to prioritize HIV prevention, care and treatment programming for key populations programs in west Africa.
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Pandor A, Kaltenthaler E, Higgins A, Lorimer K, Smith S, Wylie K, Wong R. Sexual health risk reduction interventions for people with severe mental illness: a systematic review. BMC Public Health 2015; 15:138. [PMID: 25886371 PMCID: PMC4330652 DOI: 10.1186/s12889-015-1448-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 01/20/2015] [Indexed: 11/22/2022] Open
Abstract
Background Despite variability in sexual activity among people with severe mental illness, high-risk sexual behavior (e.g. unprotected intercourse, multiple partners, sex trade and illicit drug use) is common. Sexual health risk reduction interventions (such as educational and behavioral interventions, motivational exercises, counselling and service delivery), developed and implemented for people with severe mental illness, may improve participants’ knowledge, attitudes, beliefs behaviors or practices (including assertiveness skills) and could lead to a reduction in risky sexual behavior. This systematic review evaluates the effectiveness of sexual health risk reduction interventions for people with severe mental illness. Methods Thirteen electronic databases (including MEDLINE, EMBASE and PsycINFO) were searched to August 2014, and supplemented by hand-searching relevant articles and contacting experts. All controlled trials (randomized or non-randomized) comparing the effectiveness of sexual health risk reduction interventions with usual care for individuals living in the community with severe mental illness were included. Outcomes included a range of biological, behavioral and proxy endpoints. Narrative synthesis was used to combine the evidence. Results Thirteen controlled trials (all from the USA) were included. Although there was no clear and consistent evidence that interventions reduce the total number of sex partners or improved behavioral intentions in sexual risk behavior, positive effects were generally observed in condom use, condom protected intercourse and on measures of HIV knowledge, attitudes to condom use and sexual behaviors and practices. However, the robustness of these findings is low due to the large between study variability, small sample sizes and low-to-moderate quality of included studies. Conclusions There is insufficient evidence at present to fully support or reject the identified sexual health risk reduction interventions for people with severe mental illness. Given the serious consequences of high-risk sexual behaviors, there is an urgent need for well-designed UK based trials, as well as training and support for staff implementing sexual health risk reduction interventions. Trial registration PROSPERO CRD42013003674. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1448-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Abdullah Pandor
- Health Economics and Decision Science, ScHARR, University of Sheffield, Sheffield, UK.
| | - Eva Kaltenthaler
- Health Economics and Decision Science, ScHARR, University of Sheffield, Sheffield, UK.
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
| | - Karen Lorimer
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
| | - Shubulade Smith
- Institute of Psychiatry at Kings College London, London, UK.
| | | | - Ruth Wong
- Health Economics and Decision Science, ScHARR, University of Sheffield, Sheffield, UK.
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Miller CT, Solomon SE, Bunn JY, Varni SE, Hodge JJ. Psychological symptoms are associated with both abstinence and risky sex among men with HIV. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:453-65. [PMID: 25614050 PMCID: PMC4324502 DOI: 10.1007/s10508-014-0464-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 12/06/2014] [Accepted: 12/10/2014] [Indexed: 06/04/2023]
Abstract
Sexual abstinence is often deemed the "safest behavior" in HIV prevention, but is sometimes associated with psychological symptoms (e.g., depression) just as sexually risky behavior is. This study explored whether sexual abstinence and risky sexual behavior among men with HIV were associated with similar constellations of psychological symptoms. Prior research has not addressed this issue because abstinent people often are not included in the sample or, when data are analyzed, researchers combine abstinent people with sexually active people who practice safer sex. Past research also neglects the co-morbidity of psychological symptoms. A latent class analysis of the psychological symptoms (assessed with the Symptom Check List 90-R; Derogatis, 1994) of 140 men with HIV, mostly from rural New England, revealed three latent classes: men who were asymptomatic on all symptom domains (28.8 %), men who were symptomatic on all domains (34.1 %), and men who were symptomatic on internalizing domains (37.1 %), but were asymptomatic on the externalizing symptoms of hostility and paranoid ideation. Logistic regression showed that sexual behavior during the past 90 days of men in the all symptom class and the internalizing symptoms class was similar, with abstinence and risky sex predominating, and safer sex being relatively uncommon for both classes. The sexual behavior of men in the asymptomatic class differed, with safer sex being relatively more likely to occur compared to the symptomatic classes. These findings suggest that the psychological symptom profile of sexually abstinent people places them at risk for inconsistent condom use should they engage in sexual behavior.
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Affiliation(s)
- Carol T Miller
- Department of Psychological Science, University of Vermont, 360 John Dewey Hall, 2 Colchester Ave., Burlington, VT, 05405, USA,
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Nelson LE, Wilton L, Agyarko-Poku T, Zhang N, Zou Y, Aluoch M, Apea V, Hanson SO, Adu-Sarkodie Y. Predictors of condom use among peer social networks of men who have sex with men in Ghana, West Africa. PLoS One 2015; 10:e0115504. [PMID: 25635774 PMCID: PMC4312093 DOI: 10.1371/journal.pone.0115504] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 11/20/2014] [Indexed: 11/18/2022] Open
Abstract
Ghanaian men who have sex with men (MSM) have high rates of HIV infection. A first step in designing culturally relevant prevention interventions for MSM in Ghana is to understand the influence that peer social networks have on their attitudes and behaviors. We aimed to examine whether, in a sample of Ghanaian MSM, mean scores on psychosocial variables theorized to influence HIV/STI risk differed between peer social networks and to examine whether these variables were associated with condom use. We conducted a formative, cross-sectional survey with 22 peer social networks of MSM (n = 137) in Ghana. We assessed basic psychological-needs satisfaction, HIV/STI knowledge, sense of community, HIV and gender non-conformity stigmas, gender equitable norms, sexual behavior and condom use. Data were analyzed using analysis of variance, generalized estimating equations, and Wilcoxon two sample tests. All models were adjusted for age and income, ethnicity, education, housing and community of residence. Mean scores for all psychosocial variables differed significantly by social network. Men who reported experiencing more autonomy support by their healthcare providers had higher odds of condom use for anal (AOR = 3.29, p<0.01), oral (AOR = 5.06, p<0.01) and vaginal (AOR = 1.8, p<0.05) sex. Those with a stronger sense of community also had higher odds of condom use for anal sex (AOR = 1.26, p<0.001). Compared to networks with low prevalence of consistent condom users, networks with higher prevalence of consistent condom users had higher STD and HIV knowledge, had norms that were more supportive of gender equity, and experienced more autonomy support in their healthcare encounters. Healthcare providers and peer social networks can have an important influence on safer-sex behaviors in Ghanaian MSM. More research with Ghanaian MSM is needed that considers knowledge, attitudes, and norms of their social networks in the development and implementation of culturally relevant HIV/STI prevention intervention strategies.
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Affiliation(s)
- LaRon E. Nelson
- School of Nursing, University of Rochester, Rochester, NY, United States of America
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- * E-mail:
| | - Leo Wilton
- State University of New York at Binghamton, College of Community and Public Affairs, Department of Human Development, Binghamton, NY, United States of America
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | | | - Nanhua Zhang
- Cincinnati Children’s Hospital Medical Center, Division of Biostatistics and Epidemiology, Cincinnati, OH, United States of America
| | - Yuanshu Zou
- Cincinnati Children’s Hospital Medical Center, Division of Biostatistics and Epidemiology, Cincinnati, OH, United States of America
| | - Marilyn Aluoch
- University of South Florida, College of Nursing, Tampa, FL, United States of America
| | - Vanessa Apea
- Department of Genitourinary Medicine, Barts & the Royal London Hospital, London, United Kingdom
| | | | - Yaw Adu-Sarkodie
- Kwame Nkrumah University of Science & Technology, School of Medical Sciences, Kumasi, Ghana
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Wamai RG, Morris BJ, Bailey RC, Klausner JD, Boedicker MN. Male circumcision for protection against HIV infection in sub-Saharan Africa: the evidence in favour justifies the implementation now in progress. Glob Public Health 2015; 10:639-66. [PMID: 25613581 PMCID: PMC6352987 DOI: 10.1080/17441692.2014.989532] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article responds to a recent 'controversy study' in Global Public Health by de Camargo et al. directed at three randomised controlled trials (RCTs) of male circumcision (MC) for HIV prevention. These trials were conducted in three countries in sub-Saharan Africa (SSA) and published in 2005 and 2007. The RCTs confirmed observational data that had accumulated over the preceding two decades showing that MC reduces by 60% the risk of HIV infection in heterosexual men. Based on the RCT results, MC was adopted by global and national HIV policy-makers as an additional intervention for HIV prevention. Voluntary medical MC (VMMC) is now being implemented in 14 SSA countries. Thus referring to MC for HIV prevention as 'debate' and viewing MC through a lens of controversy seems mistaken. In their criticism, de Camargo et al. misrepresent and misinterpret current science supporting MC for HIV prevention, omit previous denunciations of arguments similar to theirs, and ignore evidence from ongoing scientific research. Here we point out the flaws in three areas de Camargo et al. find contentious. In doing so, we direct readers to growing evidence of MC as an efficacious, safe, acceptable, relatively low-cost one-off biomedical intervention for HIV prevention.
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Affiliation(s)
- Richard G. Wamai
- Department of African-American Studies, Northeastern University, Boston, Massachusetts, USA
| | - Brian J. Morris
- School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Robert C. Bailey
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jeffrey D. Klausner
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, California, USA
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Abstract
Global trends in HIV incidence are estimated typically by serial prevalence surveys in selected sentinel populations or less often in representative population samples. Incidence estimates are often modeled because cohorts are costly to maintain and are rarely representative of larger populations. From global trends, we can see reason for cautious optimism. Downward trends in generalized epidemics in Africa, concentrated epidemics in persons who inject drugs (PWID), some female sex worker cohorts, and among older men who have sex with men (MSM) have been noted. However, younger MSM and those from minority populations, as with black MSM in the United States, show continued transmission at high rates. Among the many HIV prevention strategies, current efforts to expand testing, linkage to effective care, and adherence to antiretroviral therapy are known as "treatment as prevention" (TasP). A concept first forged for the prevention of mother to child transmission, TasP generates high hopes that persons treated early will derive considerable clinical benefits and that lower infectiousness will reduce transmission in communities. With the global successes of risk reduction for PWID, we have learned that reducing marginalization of the at-risk population, implementation of nonjudgmental and pragmatic sterile needle and syringe exchange programs, and offering of opiate substitution therapy to help persons eschew needle use altogether can work to reduce the HIV epidemic. Never has the urgency of stigma reduction and guarantees of human rights been more urgent; a public health approach to at-risk populations requires that to avail themselves of prevention services and they must feel welcomed.
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Affiliation(s)
- Sten H Vermund
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA,
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Effective approaches for programming to reduce adolescent vulnerability to HIV infection, HIV risk, and HIV-related morbidity and mortality: a systematic review of systematic reviews. J Acquir Immune Defic Syndr 2014; 66 Suppl 2:S154-69. [PMID: 24918591 DOI: 10.1097/qai.0000000000000178] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In 2012, an estimated 2.1 million adolescents were living with HIV. Though there are effective interventions to prevent and treat HIV infection, adolescents face specific barriers in accessing them. As a result, new infections and poor outcomes among HIV-infected adolescents are common. HIV programming for adolescents should focus on interventions of proven effectiveness and address underlying factors driving incidence and lack of effective treatment and care in this age group. METHODS We conducted a systematic review of systematic reviews to summarize the global data on effectiveness of 20 intervention types, to identify characteristics of effective interventions, and to explore evidence of how adolescents can access interventions with proven effectiveness. Interventions were in 2 broad categories: those designed primarily for adults and those designed specifically for adolescents. Where available, we evaluated the evidence of impact on the key outcomes: HIV risk, HIV transmission, and HIV morbidity and mortality. RESULTS Among the interventions designed for adolescents, there was high-quality evidence that in-school interventions and some interventions in geographically defined communities can positively impact important HIV-related outcomes, such as self-reported sexual risk behaviors. Interventions designed primarily for adults that had high-quality, consistent biological evidence of efficacy included voluntary medical male circumcision (VMMC), antiretrovirals for the prevention of mother-to-child transmission, HIV testing and counseling, HIV treatment, condom use, and provision of sterile injecting equipment to people who inject drugs. There was also an evidence of potential efficacy for oral preexposure prophylaxis and behavior change interventions among certain populations. There was a dearth of systematic review data on how best to enable adolescents to access the intervention types identified as having proven effectiveness among adults. CONCLUSIONS This series of reviews allowed us to rigorously and systematically review a large number of intervention types at once using a standard, transparent methodology. Eight key interventions showed clear evidence of effectiveness, with evidence of potential efficacy for some additional interventions among certain populations. DISCUSSION These priority interventions with proven effectiveness should be included in all HIV prevention programming for adolescents. There is a pressing need for more rigorous research on how best to enable adolescents to access these effective interventions.
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Abstract
HIV prevalence is increasing worldwide because people on antiretroviral therapy are living longer, although new infections decreased from 3.3 million in 2002, to 2.3 million in 2012. Global AIDS-related deaths peaked at 2.3 million in 2005, and decreased to 1.6 million by 2012. An estimated 9.7 million people in low-income and middle-income countries had started antiretroviral therapy by 2012. New insights into the mechanisms of latent infection and the importance of reservoirs of infection might eventually lead to a cure. The role of immune activation in the pathogenesis of non-AIDS clinical events (major causes of morbidity and mortality in people on antiretroviral therapy) is receiving increased recognition. Breakthroughs in the prevention of HIV important to public health include male medical circumcision, antiretrovirals to prevent mother-to-child transmission, antiretroviral therapy in people with HIV to prevent transmission, and antiretrovirals for pre-exposure prophylaxis. Research into other prevention interventions, notably vaccines and vaginal microbicides, is in progress.
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Affiliation(s)
- Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
| | - Connie Celum
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, USA
| | - Sharon R Lewin
- Department of Infectious Diseases, Monash University, Melbourne, Australia; Infectious Diseases Unit, Alfred Hospital, Melbourne, Australia; Centre for Biomedical Research, Burnet Institute, Melbourne, Australia
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Matthews AK, Balsam K, Hotton A, Kuhns L, Li CC, Bowen DJ. Awareness of media-based antitobacco messages among a community sample of LGBT individuals. Health Promot Pract 2014; 15:857-66. [PMID: 24801020 DOI: 10.1177/1524839914533343] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Study objectives were to measure awareness of general antitobacco messages in LGBT-focused and general media outlets among LGBT (lesbian, gay, bisexual, and transgender) individuals and to examine associations between sociodemographic characteristics and awareness levels. METHOD Data were based on cross-sectional survey data from a racially diverse sample of participants (N = 726). Participants were primarily male (69.3%), with smaller percentages of female (21.8%) and transgender (8.9%). The median age was 31 years. RESULTS A higher proportion of participants reported awareness of antitobacco messages in general media outlets compared to LGBT-specific media outlets. Awareness of antitobacco messages in general media was positively associated with current smoking and negatively associated with female gender and Latino ethnicity. Awareness of antitobacco messages in LGBT media was positively associated with younger age, current smoking, frequent reading of LGBT newspapers or magazines, and frequent attendance at LGBT bars and negatively associated with Latino ethnicity. CONCLUSIONS Despite frequent readership, awareness of antitobacco messages in LGBT newspapers/magazines was quite low. We speculate that low awareness is related to the absence of antitobacco messages in LGBT-related media. LGBT-specific media outlets provide an important opportunity for future antitobacco campaigns.
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Affiliation(s)
| | | | | | - Lisa Kuhns
- Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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Jacobson JO, Sánchez-Gómez A, Montoya O, Soria E, Tarupi W, Chiriboga Urquizo M, Champutiz Ortiz E, Miranda SM, Tobar R, Gómez B, Riera C. A continuing HIV epidemic and differential patterns of HIV-STI risk among MSM in Quito, Ecuador: an urgent need to scale up HIV testing and prevention. AIDS Behav 2014; 18:88-98. [PMID: 23620242 DOI: 10.1007/s10461-013-0478-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study characterized the HIV epidemic among men who have sex with men (MSM) in Quito, Ecuador and contrasted risk patterns with other STI's. 416 MSM ages 15 years and older were recruited using respondent-driven sampling in 2010-2011. Biological testing and a self-interview survey assessed HIV and STI infections and risk behaviors. Analysis incorporated recruiter-level variables and clustering adjustments to control for recruitment patterns. We identify high levels of HIV (11 %), HSV-2 (14 %) and active syphilis (5.5 %) infections, low levels of lifetime HIV testing (57 %), limited knowledge of HIV and STI's (<48 %) and limited consistent condom use independent of partner type (<40 %). Sex work was associated with all infections while associations with residential location, how casual partners are met and other variables, varied. Scale-up of behavioral prevention and HIV testing is urgently needed. Interventions should target male sex workers and exploit differential patterns of HIV-STI risk to stay ahead of the epidemic.
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