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Freitas CAM, Rossi TA, Dourado I, Castellanos MEP, Guimarães NS, Magno L. Mapping evidence on health promotion in HIV testing among men who have sex with men and transgender women using the social-ecological model and the vulnerability theoretical framework: a scoping review. BMC Public Health 2023; 23:1946. [PMID: 37805484 PMCID: PMC10559455 DOI: 10.1186/s12889-023-16860-9] [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: 02/02/2023] [Accepted: 09/29/2023] [Indexed: 10/09/2023] Open
Abstract
This study aimed to map the scientific evidence on health promotion in human immunodeficiency virus) HIV testing among men who have sex with men (MSM) and transgender women (TGW) based on the social-ecological model (i.e., individual, organizational and social levels) and the theoretical framework of vulnerability (i.e., individual, social, and programmatic levels). The reviewed studies indicated several barriers to accessing HIV testing (e.g., economic, structural, and bureaucratic) and demonstrated the potential for community approaches to promote greater access to HIV testing and minimize the stigma and discrimination associated with HIV testing, primarily through community leadership and social support networks. The socio-ecological model of health promotion and the vulnerability approach have the potential to contribute to improving HIV testing services by balancing the technical and political power of health services and providers with community participation while considering the social contexts. Therefore, there is a need for reflection on health promotion policies and programs aimed at expanding access to HIV testing among MSM and TGW through interventions that consider the social contexts and cultural perspectives. Moreover, inter-sectoral strategies aimed at improving living conditions and access to fundamental resources for maintaining health and well-being should be considered.
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Affiliation(s)
- Camila Amaral Moreno Freitas
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Basílio da Gama Street, Salvador, BA, 40110-040, Brazil.
| | - Thais Aranha Rossi
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), 2555 Silveira Martins Street, Salvador, BA, 41150000, Brazil
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Basílio da Gama Street, Salvador, BA, 40110-040, Brazil
| | | | - Nathalia Sernizon Guimarães
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Basílio da Gama Street, Salvador, BA, 40110-040, Brazil
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), 2555 Silveira Martins Street, Salvador, BA, 41150000, Brazil
| | - Laio Magno
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Basílio da Gama Street, Salvador, BA, 40110-040, Brazil
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), 2555 Silveira Martins Street, Salvador, BA, 41150000, Brazil
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Zhang H, Wang M, Zhang Y, Tan S, Huang H, Zhu J, Tian W, Mo J, Mo J, Cen P, Ning C. Usability of dual HIV/syphilis self-testing among men who have sex with men in China: study protocol for a three-arm randomised controlled trial. BMJ Open 2022; 12:e059034. [PMID: 36216414 PMCID: PMC9558798 DOI: 10.1136/bmjopen-2021-059034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION HIV self-testing (HIVST) provides a key measure for the early detection of HIV infection in men who have sex with men (MSM). However, dual HIV/syphilis self-testing in the MSM population has not been studied. We describe a randomised controlled trial to evaluate the effect of dual HIV/syphilis self-testing on the testing frequency among MSM in China. METHODS AND ANALYSIS This randomised controlled trial will be implemented in Guangxi, China. 330 MSM, including 255 frequent testers and 75 less frequent testers, will be recruited and randomly assigned in a 1:1:1 ratio into one of three arms: a site-based testing arm, a single HIVST arm and a dual HIV/syphilis self-testing arm. Participants in the single HIVST arm and dual HIV/syphilis self-testing arm will receive two free finger-prick-based HIVST or HIV/syphilis self-testing kits at enrolment. The data will be collected at five separate times: baseline, 3 months, 6 months, 9 months and 12 months. The primary outcome is the mean frequency of HIV testing used by MSM after intervention comparing each group during the study period. The secondary outcome includes changes in sex behaviours (eg, number of male sex partners and the proportion of consistent condom use) and the mean number of HIV tests used by the social network members over the study period. ETHICS AND DISSEMINATION The study protocol was reviewed and approved by the Medical Ethics Committee of Guangxi Medical University, China (20210173). The study results will be disseminated through conferences and academic journals. TRIAL REGISTRATION NUMBER ChiCTR2100050898.
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Affiliation(s)
- Hong Zhang
- Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, China
| | - Min Wang
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Yun Zhang
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Sumin Tan
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Haimei Huang
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Jiawen Zhu
- The Second Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Weiyi Tian
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Jinli Mo
- The Second Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Jieling Mo
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Ping Cen
- AIDS/STD Control and Prevention, Nanning Municipal Center for Disease Prevention and Control, Nanning, Guangxi, China
| | - Chuanyi Ning
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
- Key Lab of AIDS Prevention and Treatment, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, China
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HIV Testing Patterns Among Recently Self-Tested Russian Men Who Have Sex With Men: A Qualitative Study. J Assoc Nurses AIDS Care 2022; 33:550-558. [DOI: 10.1097/jnc.0000000000000344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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HIV Testing, Knowledge and Willingness to Use PrEP Among Partnered Men Who Have Sex With Men in South Africa and Namibia. AIDS Behav 2021; 25:1993-2004. [PMID: 33389373 DOI: 10.1007/s10461-020-03129-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 01/30/2023]
Abstract
There is strong evidence that gay, bisexual and other men who have sex with men (GBMSM) in African countries experience high prevalence of HIV. However, missing from the literature is an understanding of the HIV risk behaviors and prevention needs of partnered GBMSM in African countries. The Together Tomorrow project sampled 440 partnered GBMSM (220 couples) in South Africa and Namibia. Prevalence of HIV was high at 42%, with 33% of men in sero-discordant relationships. Despite high levels of HIV testing in the past 6 months (65%), condom use with main and outside sex partners was low. Men reported low levels of willingness to use pre-exposure prophylaxis (PrEP) (16%). HIV testing in the past 12 months and willingness to use PrEP were significantly associated with recent binge drinking and substance use. Men in sero-discordant relationships, those with sexual agreements and those who had experienced any form of IPV were all less likely to report that they had recently tested for HIV. There is a need to develop interventions that meet the unique needs of African partnered GBMSM and tackle stigma and discrimination as drivers of HIV risk in these settings.
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Sullivan PS, Taussig J, Valentine-Graves M, Luisi N, Del Rio C, Guest JL, Jones J, Millett G, Rosenberg ES, Stephenson R, Kelley C. Disparities in Care Outcomes in Atlanta Between Black and White Men Who Have Sex With Men Living With HIV: Protocol for a Prospective Cohort Study (Engage[men]t). JMIR Res Protoc 2021; 10:e21985. [PMID: 33320821 PMCID: PMC7943338 DOI: 10.2196/21985] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The US HIV epidemic is driven by infections in men who have sex with men and characterized by profound disparities in HIV prevalence and outcomes for Black Americans. Black men who have sex with men living with HIV are reported to have worse care outcomes than other men who have sex with men, but the reasons for these health inequities are not clear. We planned a prospective observational cohort study to help understand the reasons for worse HIV care outcomes for Black versus White men who have sex with men in Atlanta. OBJECTIVE The aim of this study is to identify individual, dyadic, network, neighborhood, and structural factors that explain disparities in HIV viral suppression between Black and White men who have sex with men living with HIV in Atlanta. METHODS Black and White men who have sex with men living with HIV were enrolled in a prospective cohort study with in-person visits and viral suppression assessments at baseline, 12 months, and 24 months; additional surveys of care and risk behaviors at 3, 6, and 18 months; analysis of care received outside the study through public health reporting; and qualitative interviews for participants who experienced sentinel health events (eg, loss of viral suppression) during the study. The study is based on the Bronfenbrenner socioecological theoretical model. RESULTS Men who have sex with men (n=400) were enrolled between June 2016 and June 2017 in Atlanta. Follow-up was completed in June 2019; final study retention was 80% at 24 months. CONCLUSIONS Health disparities for Black men who have sex with men are hypothesized to be driven by structural racism and barriers to care. Observational studies are important to document and quantify the specific factors within the socioecological framework that account for disparities in viral suppression. In the meantime, it is also critical to push for steps to improve access to care, including Medicaid expansion in Southern states, such as Georgia, which have not yet moved to expand Medicaid. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21985.
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Affiliation(s)
- Patrick Sean Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Jennifer Taussig
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Mariah Valentine-Graves
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Nicole Luisi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Carlos Del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, United States
| | - Jodie L Guest
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Jeb Jones
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Greg Millett
- amFAR, the Foundation for AIDS Research, Washington, DC, United States
| | - Eli S Rosenberg
- Department of Epidemiology, School of Public Health, University at Albany, State University of New York, Albany, NY, United States
| | - Rob Stephenson
- Department of Systems, Population, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, United States.,The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - Colleen Kelley
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, United States
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Daniels J, Struthers H, Soler J, Ricco E, Blackmon J, Teklehaimanot S, McIntyre J, Coates T. Building self-advocacy in HIV care: the use of role-play to examine healthcare access for HIV-positive MSM in rural South Africa. Glob Health Promot 2020; 28:32-40. [PMID: 33300432 DOI: 10.1177/1757975920974008] [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] [Indexed: 11/15/2022]
Abstract
There is high HIV prevalence and low rates of viral suppression for men who have sex with men (MSM) in South Africa, with few MSM-centered interventions to address these outcomes along the HIV treatment cascade. Participatory interventions may support community building among HIV-positive MSM through which they can share approaches of self-advocacy that are contextually grounded. We conducted a pilot study to assess the use of role-plays in influencing social isolation while also updating our understanding of MSM healthcare experiences in Mpumalanga, South Africa. The study was conducted with 21 MSM leaders who were HIV-positive. There were three groups of seven participants each who created and performed role-plays based on their healthcare experiences, with a focus group discussion (FGD) conducted afterward. Audio-recordings were transcribed, translated, and analyzed using a constant comparison approach. We found that MSM described role-play as cathartic and a future HIV care educational tool for other MSM, and that they outlined points of self-advocacy during HIV care in clinics. Our study suggests that future research should utilize role-play so to integrate contextual factors influencing HIV treatment, especially in high HIV prevalence settings.
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Affiliation(s)
- Joseph Daniels
- Department of Psychiatry and Human Behaviors, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Helen Struthers
- Anova Health Institute, Johannesburg, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Joshua Soler
- Department of Psychiatry and Human Behaviors, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Emilio Ricco
- Department of Psychiatry and Human Behaviors, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Joshaun Blackmon
- Department of Psychiatry and Human Behaviors, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Senait Teklehaimanot
- Department of Psychiatry and Human Behaviors, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - James McIntyre
- Anova Health Institute, Johannesburg, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Thomas Coates
- Center for World Health, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
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Robbins SJ, Dauda W, Kokogho A, Ndembi N, Mitchell A, Adebajo S, Gaydos CA, Peel S, Ramadhani HO, Robb ML, Baral SD, Ake JA, Charurat ME, Crowell TA, Nowak RG. Oral sex practices among men who have sex with men and transgender women at risk for and living with HIV in Nigeria. PLoS One 2020; 15:e0238745. [PMID: 32886722 PMCID: PMC7473579 DOI: 10.1371/journal.pone.0238745] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/21/2020] [Indexed: 12/15/2022] Open
Abstract
Background Men who have sex with men (MSM) and transgender women (TGW) are at risk for sexually transmitted infections (STIs), including those of the oropharynx. We estimated the prevalence and factors associated with oral sex practices and characterized oropharyngeal STIs among a cohort of MSM and TGW in Nigeria. Methods From 2013 to 2018, TRUST/RV368 recruited MSM and TGW into HIV/STI diagnosis and treatment at community-based clinics in Nigeria. Participants who completed HIV testing and oral sex questions at enrollment were selected. Cross-sectional analyses with bivariate and multivariable logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs). Oropharyngeal swab testing for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) began in 2014 and for those with diagnostic results at enrollment, the unadjusted association of oral sex practices with oropharyngeal STIs was conducted. Results A total of 1342 participants had a median age of 25 years (interquartile range: 22–29), 58% were living with HIV, and 69% reported oral sex practices. Factors associated with increased odds of engaging in oral sex included living with HIV (adjusted [a]OR: 1.4, 95% CI: 1.1–1.8), self-identifying as a woman (aOR:1.8, 95% CI: 1.1–2.8), mobile phone ownership (aOR:2.3, 95% CI: 1.3–3.9), receptive anal sex (aOR:1.7, 95% CI:1.3–2.3) and multiple male sexual partners (2 to 4 vs. ≤1, aOR:1.5, 95% CI: 1.0–2.2; 5+ vs ≤1, aOR:2.9, 95% CI:1.9–4.3). Oropharyngeal STI prevalence was 7% (52/752) and higher among those who engaged in oral sex compared to those who did not (unadjusted OR: 2.5, 95% CI:1.2–5.3). Conclusions Oral sex was common and associated with an increased odds of oropharyngeal STIs among MSM and TGW from Nigeria. In the absence of screening and treatment guidelines, condoms continue to be the mainstay for oral STI prevention. A pre-exposure prophylaxis for bacterial STIs would complement current prevention strategies to curb transmission.
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Affiliation(s)
- Sarah J. Robbins
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Wuese Dauda
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Afoke Kokogho
- HJF Medical Research International, Abuja, Nigeria
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Nicaise Ndembi
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States of America
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Andrew Mitchell
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Sylvia Adebajo
- Maryland Global Initiatives Corporation- A University of Maryland Baltimore Affiliate, Abuja, Nigeria
| | - Charlotte A. Gaydos
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Sheila Peel
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Habib O. Ramadhani
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Merlin L. Robb
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Stefan D. Baral
- Johns Hopkins School of Public Health, Baltimore, MD, United States of America
| | - Julie A. Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Man E. Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Trevor A. Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Rebecca G. Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States of America
- * E-mail:
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Fearon E, Tenza S, Mokoena C, Moodley K, Smith AD, Bourne A, Weatherburn P, Palanee-Phillips T. HIV testing, care and viral suppression among men who have sex with men and transgender individuals in Johannesburg, South Africa. PLoS One 2020; 15:e0234384. [PMID: 32555703 PMCID: PMC7299351 DOI: 10.1371/journal.pone.0234384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 05/26/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Men who have sex with men and transgender individuals (MSM/TG) carry a disproportionately high burden of HIV, including in South Africa. However, there are few empirical population-representative estimates of viral suppression and the HIV care cascade including HIV testing among this population, nor of factors associated with these outcomes. METHODS We conducted a respondent driven sampling (RDS) survey among 301 MSM/TG in Johannesburg in 2017. Participants gave blood samples for HIV testing and viral load. Participants self-completed a survey including sociodemographics, HIV testing history, and engagement in care. We calculated RDS-II weighted estimates of the percentage of HIV-negative MSM/TG reporting HIV testing in the previous 6 months, their testing experience and preferences. Among those HIV-positive, we estimated the percentage status-aware, on ART, and virally suppressed (<50 viral copies/ml plasma). We conducted RDS-weighted robust Poisson regression to obtain weighted prevalence ratios of factors associated with 1) HIV testing among those HIV-negative; and 2) viral suppression among those HIV-positive. RESULTS There were 118/300 HIV-positive MSM/TG, (37.5%). Of the HIV-negative MSM/TG, 61.5% reported that they had tested for HIV in the previous 6 months, which was associated with selling sex to men (Prevalence Ratio = 1.67, 95% CI 1.36-2.05). There were 76/118 HIV-positive MSM/TG (56.5%) who reported having previously tested positive for HIV and 39/118 (30.0%) who reported current ART. There were 58/118 HIV-positive MSM/TG with viral loads <50 copies/ml plasma (46.9%). Viral suppression was associated with older age (adjusted PR = 1.03, 95% CI 1.00-1.06 for each year), neighbourhood, and having bought sex from men (adjusted PR = 1.53, 95% CI 1.12-2.08). CONCLUSIONS HIV prevalence was very high. Viral suppression among those HIV-positive was similar to the general male population in South Africa, but remains far short of national and international targets. A majority of HIV-negative MSM/TG had HIV tested in the previous 6 months, though there is room for improvement.
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Affiliation(s)
- Elizabeth Fearon
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Siyanda Tenza
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Cecilia Mokoena
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Kerushini Moodley
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Adrian D. Smith
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, LaTrobe University, Melbourne, Australia
| | - Peter Weatherburn
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Stannah J, Dale E, Elmes J, Staunton R, Beyrer C, Mitchell KM, Boily MC. HIV testing and engagement with the HIV treatment cascade among men who have sex with men in Africa: a systematic review and meta-analysis. Lancet HIV 2019; 6:e769-e787. [PMID: 31601542 PMCID: PMC6993044 DOI: 10.1016/s2352-3018(19)30239-5] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/27/2019] [Accepted: 07/04/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND HIV disproportionately affects gay, bisexual, and other men who have sex with men (MSM) in Africa, where many countries criminalise same-sex behaviour. We assessed changes in the engagement of African MSM with HIV testing and treatment cascade stages over time, and the effect of anti-LGBT legislation and stigma. METHODS We systematically searched Embase, Global Health, MEDLINE, Scopus, and Web of Science for peer-reviewed cross-sectional or longitudinal studies recruiting at least ten MSM, published from Jan 1, 1980, to Oct 10, 2018. We extracted or derived estimates of HIV testing, engagement with the HIV treatment cascade, or both among African MSM from published reports. We derived pooled estimates using inverse-variance random-effects models. We used subgroup and meta-regression analysis to assess associations between testing and status awareness outcomes and study and participant characteristics, including the severity of country-level anti-LGBT legislation. FINDINGS Our searches identified 75 independent eligible studies that provided estimates for 44 993 MSM across one or more of five testing and treatment cascade outcomes. HIV testing increased significantly over time overall, with pooled proportions of MSM ever tested for HIV of 67·3% (95% CI 62·1-72·3; 44 estimates) and tested in the past 12 months of 50·1% (42·4-57·8, 31 estimates) after 2011, which were 14·8 percentage points and 17·9 percentage points higher than before 2011, respectively. After 2011, ever testing was highest in southern Africa (80·0%), and lowest in northern Africa (34·4%), with the greatest increase in western Africa (from 42·4% to 70·9%). Levels of testing ever, in the past 12 months, and status awareness were statistically significantly lower in countries with the most severe anti-LGBT legislation compared with countries with the least severe legislation (57·4% vs 71·6%, p=0·0056; 35·5% vs 49·3%, p=0·010; 6·7% vs 22·0%, p=0·0050). Few estimates were available for later stages of the treatment cascade. Available data after 2011 suggest that the pooled proportion of MSM HIV-positive aware has remained low (18·5%, 12·5-25·3; 28 estimates), whereas proportions of current antiretroviral therapy (ART) use were 23·7% (15·5-33·0; 13 estimates) among all MSM living with HIV and 60·1% (48·6-71·1; five estimates) among MSM HIV-positive aware of their status. Pooled levels of viral suppression among MSM currently on ART were 75·6% (64·4-85·5; four estimates), but only 24·7% (18·8-31·2; four estimates) among all MSM living with HIV. INTERPRETATION Despite improvements in HIV testing among MSM in Africa, HIV status awareness, ART coverage, and viral suppression remain much lower than required to achieve UNAIDS 90-90-90 targets. Further studies are urgently needed to provide more accurate estimates of levels of status awareness, engagement in care, ART coverage, and viral suppression among MSM to inform prevention efforts aimed at improving access to HIV services for MSM. Severe anti-LGBT legislation might be associated with lower HIV testing and status awareness; therefore, further research is needed to assess the effect of such legislation on HIV testing and engagement with the HIV treatment cascade among MSM. FUNDING US National Institutes of Health, UK Medical Research Council.
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Affiliation(s)
- James Stannah
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Elizabeth Dale
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Jocelyn Elmes
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Roisin Staunton
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Chris Beyrer
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA
| | - Kate M Mitchell
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK; HIV Prevention Trials Network Modelling Centre, Imperial College London, London, UK
| | - Marie-Claude Boily
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK; HIV Prevention Trials Network Modelling Centre, Imperial College London, London, UK.
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Mathias A, Alves dos Santos L, Grangeiro A, Couto MT. Thematic synthesis HIV prevention qualitative studies in men who have sex with men (MSM). Colomb Med (Cali) 2019; 50:201-214. [PMID: 32284665 PMCID: PMC7141148 DOI: 10.25100/cm.v50i3.4078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/16/2019] [Accepted: 08/30/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Qualitative studies on HIV prevention strategies and methods among men who have sex with men (MSM) allow identify knowledge gaps and improve preventive actions. OBJECTIVE To make a thematic synthesis of the scientific productions that use the qualitative methodology in the strategies and methods of HIV prevention area among MSM. METHODS We conducted a literature review following the guidelines of the ENTREQ protocol. The analysis included 48 empirical studies published in Portuguese, English and Spanish between 2001 and 2018 available in the Medline, Embase, Scielo, Scopus, Bireme and Web of Science databases. RESULTS Where an increased production in the last six years and concentration in northern countries. Seven prevention methods were part of the study, with emphasis on pre-exposure prophylaxis, testing, condoms and behavioral strategies. The main topics discussed were stigma and support and care networks. CONCLUSION we notice that an increasing production on prevention in the men who have sex with men segment results from the emergence of multiple preventive methods and strategies and their combined actions beyond the star role of condoms.
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Affiliation(s)
- Augusto Mathias
- Universidade de São Paulo, Facultad de Medicina, Departamento de Medicina Preventiva, Programa de Salud Colectiva, São Paulo, Brasil
| | - Lorruan Alves dos Santos
- Universidade de São Paulo, Facultad de Medicina, Departamento de Medicina Preventiva, Programa de Salud Colectiva, São Paulo, Brasil
| | - Alexandre Grangeiro
- Universidade de São Paulo, Facultad de Medicina, Departamento de Medicina Preventiva, São Paulo, Brasil
| | - Marcia Thereza Couto
- Universidade de São Paulo, Facultad de Medicina, Departamento de Medicina Preventiva, São Paulo, Brasil
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11
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Harichund C, Kunene P, Simelane S, Abdool Karim Q, Moshabela M. Repeat HIV testing practices in the era of HIV self-testing among adults in KwaZulu-Natal, South Africa. PLoS One 2019; 14:e0212343. [PMID: 30794580 PMCID: PMC6386490 DOI: 10.1371/journal.pone.0212343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/31/2019] [Indexed: 11/30/2022] Open
Abstract
Repeat HIV testing is important in high HIV burden communities to enable sustainability of prevention initiatives; however, an understanding of repeat testing practices is limited. Additional HIV testing approaches may be required to increase testing. HIV self-testing is an additional testing approach, but knowledge on its potential for repeat testing is limited. This study explored repeat HIV testing practices and uptake of HIV self-testing among repeat testers, following exposure to HIV self-testing. HIV testing practices were explored at two time points. During Phase 1, eighty in-depth interviews were conducted among 40 consenting adults, and 30 telephonic contacts were completed during Phase 2. Framework analysis was used to analyse the transcripts from the in-depth interviews. The practice of repeat HIV testing is primarily influenced by HIV status awareness and risk exposure. Thirteen regular testers and one HIV naïve tester at baseline had undergone repeat testing through the use of a traditional testing approach such as HIV counselling and testing as reported in Phase 2. HIV self-testing has a role among repeat testers, but affordability and access are barriers.
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Affiliation(s)
- Charlene Harichund
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
- * E-mail:
| | - Pinky Kunene
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
| | | | - Quarraisha Abdool Karim
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
- Department of Epidemiology, Columbia University, New York, New York, United States of America
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Africa Health Research Institute, KwaZulu-Natal, South Africa
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12
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Shaver J, Sullivan P, Siegler A, de Voux A, Phaswana-Mafuya N, Bekker LG, Baral SD, Wirtz AL, Beyrer C, Brown B, Stephenson R. Comparing Provider and Client Preferences for HIV Prevention Services in South Africa among Men Who Have Sex with Men. J Int Assoc Provid AIDS Care 2017; 16:562-571. [PMID: 29108450 DOI: 10.1177/2325957417736611] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Combination prevention efforts are now recommended toward reducing HIV incidence among men who have sex with men (MSM). Understanding the perceptions of both MSM and service providers is critical to informing the development of prevention packages and ultimately improving intervention effectiveness. This study assessed the preferences of MSM and health service providers in the administration of HIV-prevention efforts. Qualitative data were gathered from a series of separate MSM and health care provider focus groups in 2 South African cities. Participants discussed HIV-prevention services and MSM client experiences within South Africa and identified the 3 most important clinic characteristics and 3 most important HIV-prevention services for MSM clients. Priorities indicated by both MSM and health care providers were confidentiality of visit, friendly staff, and condoms, while discrepancies existed between MSM and providers regarding provider consistency and the provision of pre-exposure prophylaxis/post-exposure prophylaxis (PrEP/PEP) and lubricant as prevention methods. Effective interventions must address these discrepancies through the design of intervention and provider training to optimally accommodate MSM.
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Affiliation(s)
- John Shaver
- 1 Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Patrick Sullivan
- 2 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Aaron Siegler
- 2 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alex de Voux
- 2 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nancy Phaswana-Mafuya
- 3 HIV/AIDS/STI/and TB (HAST), Human Sciences Research Council, Port Elizabeth, South Africa.,4 Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - Linda-Gail Bekker
- 2 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,5 Desmond Tutu HIV Foundation, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Stefan D Baral
- 6 Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea L Wirtz
- 6 Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chris Beyrer
- 6 Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ben Brown
- 4 Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - Rob Stephenson
- 1 Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
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13
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de Voux A, Baral S, Bekker LG, Beyrer C, Phaswana-Mafuya N, Siegler A, Sullivan P, Winskell K, Stephenson R. A social network typology and sexual risk-taking among men who have sex with men in Cape Town and Port Elizabeth, South Africa. CULTURE, HEALTH & SEXUALITY 2015; 18:509-23. [PMID: 26569376 PMCID: PMC4930490 DOI: 10.1080/13691058.2015.1096419] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Despite the high prevalence of HIV among men who have sex with men in South Africa, very little is known about their lived realities, including their social and sexual networks. Given the influence of social network structure on sexual risk behaviours, a better understanding of the social contexts of men who have sex with men is essential for informing the design of HIV programming and messaging. This study explored social network connectivity, an understudied network attribute, examining self-reported connectivity between friends, family and sex partners. Data were collected in Cape Town and Port Elizabeth, South Africa, from 78 men who have sex with men who participated in in-depth interviews that included a social network mapping component. Five social network types emerged from the content analysis of these social network maps based on the level of connectivity between family, friends and sex partners, and ranged from disconnected to densely connected networks. The ways in which participants reported sexual risk-taking differed across the five network types, revealing diversity in social network profiles. HIV programming and messaging for this population can greatly benefit from recognising the diversity in lived realities and social connections between men who have sex with men.
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Affiliation(s)
- Alex de Voux
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Linda-Gail Bekker
- Desmond Tutu HIV Foundation, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Chris Beyrer
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Nancy Phaswana-Mafuya
- HIV/AIDS/STI and TB (HAST), Human Sciences Research Council, Port Elizabeth, South Africa
| | - Aaron Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Kate Winskell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta
| | - Rob Stephenson
- Department of Health Behavior and Biological Sciences, School of Nursing, Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, USA
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14
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Stalter R, Chen M, Uwizeye G, Mutunge E, Ahayo A, Mugwaneza P, Shumbusho F, Wesson J. Association of sexual risk behaviour with previous HIV testing among voluntary HIV counselling and testing clients in Kigali, Rwanda. Int J STD AIDS 2015; 27:1317-1325. [PMID: 26568251 DOI: 10.1177/0956462415617590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 10/26/2015] [Indexed: 11/17/2022]
Abstract
With increased coverage of voluntary HIV counselling and testing (VCT) in Rwanda and a greater focus on repeat testing of key populations, it is important to understand whether the right clients are returning for repeat testing and if repeat testing is effective at reducing risk. We assessed the association between repeat testing and recent sexual risk behaviours among 1852 first time or repeat HIV testing clients in Kigali who had had sex, using data from a cross-sectional survey. Repeat testing was associated with being female, older and type of occupation. Multivariable analyses indicate that individuals who tested for HIV 1-2 times (aOR = 1.52, 95% CI: 1.08, 2.15) and 3+ times (aOR = 1.51, 95% CI: 1.06, 2.17) previously were more likely to report recent unprotected sex. Those with 3+ previous tests were more likely to have recently had multiple sexual partners (aOR = 2.19, 95% CI: 1.22, 3.92). However, a significant decrease in HIV prevalence is shown as individuals receive more HIV tests in their lifetime (p < 0.001). These findings show that individuals who report high-risk behaviours are returning for repeat tests. However, VCT may not be successful at addressing certain sexual risk behaviours. Therefore more intensive counselling or additional HIV prevention services may be needed.
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Affiliation(s)
| | | | - Glorieuse Uwizeye
- FHI 360, Kigali, Rwanda.,Human Resources for Health (HRH) Program, Ministry of Health, Kigali, Rwanda
| | - Elise Mutunge
- Institute of HIV/AIDS, Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Anita Ahayo
- Institute of HIV/AIDS, Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Placidie Mugwaneza
- Institute of HIV/AIDS, Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Fabienne Shumbusho
- FHI 360, Kigali, Rwanda.,Rwanda Healthcare Federation (RHF), Kigali, Rwanda
| | - Jennifer Wesson
- FHI 360, Kigali, Rwanda.,IntraHealth International, Chapel Hill, North Carolina, USA
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15
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McNaghten A, Kearns R, Siegler AJ, Phaswana-Mafuya N, Bekker LG, Stephenson R, Baral SD, Brookmeyer R, Yah CS, Lambert AJ, Brown B, Rosenberg E, Blalock Tharp M, de Voux A, Beyrer C, Sullivan PS. Sibanye Methods for Prevention Packages Program Project Protocol: Pilot Study of HIV Prevention Interventions for Men Who Have Sex With Men in South Africa. JMIR Res Protoc 2014; 3:e55. [PMID: 25325296 PMCID: PMC4210958 DOI: 10.2196/resprot.3737] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/11/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) prevention intervention programs and related research for men who have sex with men (MSM) in the southern African region remain limited, despite the emergence of a severe epidemic among this group. With a lack of understanding of their social and sexual lives and HIV risks, and with MSM being a hidden and stigmatized group in the region, optimized HIV prevention packages for southern African MSM are an urgent public health and research priority. OBJECTIVE The objective of the Sibanye Health Project is to develop and evaluate a combination package of biomedical, behavioral, and community-level HIV prevention interventions and services for MSM in South Africa. METHODS The project consists of three phases: (1) a comprehensive literature review and summary of current HIV prevention interventions (Phase I), (2) agent-based mathematical modeling of HIV transmission in southern African MSM (Phase II), and (3) formative and stigma-related qualitative research, community engagement, training on providing health care to MSM, and the pilot study (Phase III). The pilot study is a prospective one-year study of 200 men in Cape Town and Port Elizabeth, South Africa. The study will assess a package of HIV prevention services, including condom and condom-compatible lubricant choices, risk-reduction counseling, couples HIV testing and counseling, pre-exposure prophylaxis (PrEP) for eligible men, and non-occupational post-exposure prophylaxis for men with a high risk exposure. The pilot study will begin in October 2014. RESULTS Preliminary results from all components but the pilot study are available. We developed a literature review database with meta-data extracted from 3800 documents from 67 countries. Modeling results indicate that regular HIV testing and promotion of condom use can significantly impact new HIV infections among South African MSM, even in the context of high coverage of early treatment of HIV-positive men and high coverage of PrEP for at-risk HIV-negative men. Formative qualitative research consisted of 79 in-depth interviews, and six focus group discussions in Cape Town and Port Elizabeth. Analysis of these data has informed pilot study protocol development and has been documented in peer-reviewed manuscripts. Qualitative work regarding stigma faced by South African MSM resulted in finalized scales for use in the pilot study questionnaire. A total of 37 health care providers completed training designed to facilitate clinically and culturally competent care for MSM in the Eastern Cape. CONCLUSIONS The design of a future, larger study of the HIV prevention package will be conducted at the end of the pilot study, powered to detect efficacy of the prevention package. Data from the updated mathematical model, results of the pilot study, acceptability data, and advancements in HIV prevention sciences will be considered in developing the final proposed package and study design. TRIAL REGISTRATION ClinicalTrials.gov NCT02043015; http://clinicaltrials.gov/show/NCT02043015 (Archived by WebCite at http://www.webcitation.org/6THvp7rAj).
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Affiliation(s)
- Ad McNaghten
- Department of Epidemiology, Emory University, Atlanta, GA, United States.
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