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Georgiadis N, Papamichail D, Lytras T, Halkitis PN, Tzanakaki G, Kornarou E, Vassilakou NT, Sergentanis TN. The impact of HIV preexposure prophylaxis on bacterial sexually transmitted infection occurrence in MSM: a systematic review and meta-analysis. AIDS 2024; 38:1033-1045. [PMID: 38669203 DOI: 10.1097/qad.0000000000003837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
OBJECTIVE To evaluate the effect of preexposure prophylaxis (PrEP) initiation on bacterial sexually transmitted infection (STI) occurrence (overall; chlamydia; gonorrhea; syphilis), in MSM. DESIGN Systematic review and meta-analysis. METHODS Systematic searches were performed in PubMed, Embase, and Scopus without language restrictions until 1 February 2023. We sought studies reporting data for the estimation of incidence rate ratios (IRR), prevalence ratios or cumulative incidence ratios (the latter in equal time periods before and after PrEP initiation) regarding bacterial STI occurrence. Separate analyses were performed overall for any STI, syphilis, chlamydia and gonorrhea (overall; rectal; urethral; pharyngeal for the two latter conditions); ratios greater than unity denoted increase in STI occurrence after PrEP initiation. RESULTS Twenty-three eligible studies with 11 776 participants (age range: 18-71 years) with a median follow-up of 12 months were included. Overall, PrEP initiation was associated with a significant increase in the occurrence of any STI (pooled effect size: 1.15, 95% confidence interval (CI): 1.04-1.26), any gonorrhea (pooled effect size: 1.17, 95% CI: 1.02-1.34), any chlamydia (pooled effect size: 1.31, 95% CI: 1.09-1.58) and rectal chlamydia (pooled effect size: 1.31, 95% CI: 1.05-1.64), whereas a borderline increase was found in urethral chlamydia (pooled effect size: 1.25, 95% CI: 0.99-1.60, P = 0.064). Changes in pharyngeal chlamydia and site-specific gonorrhea occurrence did not reach statistical significance. Syphilis showed virtually no change after PrEP initiation (pooled effect size: 0.99, 95% CI: 0.72-1.37). CONCLUSION These results highlight the need for more comprehensive, accessible STI testing to tackle bacterial STI infections in PrEP users.
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Affiliation(s)
- Nikolaos Georgiadis
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Dimitrios Papamichail
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Theodore Lytras
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Perry N Halkitis
- Department of Biostatistics & Epidemiology and Center for Health Identity, Behavior & Prevention Studies, School of Public Health, Rutgers University, Newark and New Brunswick, NJ, USA
| | - Georgina Tzanakaki
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Eleni Kornarou
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Nair-Tonia Vassilakou
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Theodoros N Sergentanis
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
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Chen W, Ma Q, Pan X, Chen L, Wang H, Zhou X, Jiang T, Chen W. Characteristics of men who have casual sex with men among Chinese university students: A cross-sectional study. PLoS One 2024; 19:e0301817. [PMID: 38603659 PMCID: PMC11008886 DOI: 10.1371/journal.pone.0301817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/24/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVES The characteristics of men who have sex with men (either exclusively or with both men and women; MSM) who engaged in casual sex among Chinese male university students have not been compared with the characteristics of men who have sex with only women (MSW). This information is important for tailoring targeted behavioral interventions to prevent human immunodeficiency virus (HIV)/sexually transmitted infection (STI) transmission in this subgroup of MSM. METHODS Data were derived from a large cross-sectional electronic questionnaire survey conducted at 13 universities in Zhejiang Province, China, in 2018. Bivariate analyses were used to compare demographic, HIV-related psychosocial, and behavioral characteristics between MSM and MSW students who engaged in casual sex during the previous year. Proportion differences between the two groups and their 95% confidence intervals were analyzed. RESULTS Among the 583 sexually active male students who engaged in casual sex during the previous year, 128 and 455 were MSM and MSW, respectively. Compared with MSW students, larger proportions of MSM students reported knowing that male-to-male sexual behavior was the main mode of HIV transmission among Chinese students (62.5% vs. 45.5%), consenting to commercial sex (67.2% vs. 53.4%), wanting to know the HIV serostatus of partners before casual sex (65.8% vs. 51.3%), feeling at risk of HIV infection (40.5% vs. 11.8%), high condom-decision scale scores (55.3% vs. 42.6%), engaging in sex with ≥ 5 casual sex partners (44.6% vs. 25.9%), searching for casual partners online (89.2% vs. 51.3%), consuming alcohol before casual sex (64.8% vs. 45.0%), engaging in sex with regular partners (83.1% vs. 67.0%), engaging in commercial sex (54.2% vs. 26.4%), and visiting a clinic for voluntary counselling and testing (VCT) (16.4% vs. 8.4%). However, compared with MSW students, smaller proportions of MSM students reported knowing that consistent condom use could prevent HIV transmission (80.5% vs. 95.2%) and that VCT should be actively sought after risky sexual behavior (78.9% vs. 93.8%), using condoms sometimes/often (26.4% vs. 44.3%), and consistently using condoms (28.9% vs. 40.1%) while engaging in sex with casual partners. CONCLUSIONS MSM students who engaged in casual sex were at a greater risk of HIV/STI transmission, compared with MSW students. Comprehensive interventions to address the risks of unprotected male-to-male sex, searching for casual sex partners online, and non-use of HIV testing services are needed to reduce the burden of HIV/STI transmission among this subgroup of MSM.
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Affiliation(s)
- Weiyong Chen
- Department of HIV/STI Control and Prevention, Zhejiang Provincial Center for Disease Prevention and Control, Hangzhou, Zhejiang Province, China
| | - Qiaoqin Ma
- Department of HIV/STI Control and Prevention, Zhejiang Provincial Center for Disease Prevention and Control, Hangzhou, Zhejiang Province, China
| | - Xiaohong Pan
- Department of HIV/STI Control and Prevention, Zhejiang Provincial Center for Disease Prevention and Control, Hangzhou, Zhejiang Province, China
| | - Lin Chen
- Department of HIV/STI Control and Prevention, Zhejiang Provincial Center for Disease Prevention and Control, Hangzhou, Zhejiang Province, China
| | - Hui Wang
- Department of HIV/STI Control and Prevention, Zhejiang Provincial Center for Disease Prevention and Control, Hangzhou, Zhejiang Province, China
| | - Xin Zhou
- Department of HIV/STI Control and Prevention, Zhejiang Provincial Center for Disease Prevention and Control, Hangzhou, Zhejiang Province, China
| | - Tingting Jiang
- Department of HIV/STI Control and Prevention, Zhejiang Provincial Center for Disease Prevention and Control, Hangzhou, Zhejiang Province, China
| | - Wanjun Chen
- Department of HIV/STI Control and Prevention, Zhejiang Provincial Center for Disease Prevention and Control, Hangzhou, Zhejiang Province, China
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Harkness A, Lozano A, Bainter S, Mayo D, Hernandez Altamirano D, Rogers BG, Prado G, Safren SA. Engaging Latino sexual minority men in PrEP and behavioral health care: multilevel barriers, facilitators, and potential implementation strategies. J Behav Med 2023; 46:655-667. [PMID: 36472703 PMCID: PMC10442148 DOI: 10.1007/s10865-022-00371-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/05/2022] [Indexed: 12/12/2022]
Abstract
Latino sexual minority men (LSMM) are affected by HIV and behavioral health disparities. Evidence-based HIV-prevention and behavioral health (BH) services are not sufficiently scaled up to LSMM. The current study identified multilevel barriers and facilitators to LSMM's use of HIV-prevention and BH services. LSMM (N = 290) in South Florida, a US HIV epicenter, completed a battery of measures potentially associated with pre-exposure prophylaxis (PrEP) and BH treatment use. Stochastic search variable selection (SSVS) followed by multiple linear regression analyses identified variables associated with engagement in PrEP and BH treatment. Multilevel determinants of PrEP and BH treatment engagement were identified, with most identified determinants being at the relational level (e.g., stigma, discrimination based on income and immigration status, personal recommendation for treatment). Individual (e.g., knowledge, self-efficacy) and structural (e.g., financial stress) determinants were also identified. Accordingly, modifiable leverage points to enhance the reach of PrEP and BH treatment to LSMM include educating and enhancing the perceived relevance of services, de-stigmatizing and normalizing via peer examples, bolstering self-efficacy, and building trust.
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Affiliation(s)
- Audrey Harkness
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA.
| | - Alyssa Lozano
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Sierra Bainter
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Daniel Mayo
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Brooke G Rogers
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Guillermo Prado
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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Szetela B, Łapiński Ł, Giniewicz K. Very High Incidence of Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum among Low-Risk MSM in an Outpatient Clinic in Wroclaw, Poland in 2019-2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2582. [PMID: 36767946 PMCID: PMC9915380 DOI: 10.3390/ijerph20032582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The rise in sexually transmitted infections and chemsex has led to syndemy with HIV, partly due to common routes of transmission and clustered transmissions. Despite this, barriers to STI care and PrEP still remain. We sought to determine whether MSM at low risk for HIV infection were also at low risk for other STIs. METHODS The study group was tested for HIV, HCV, and Treponema pallidum, as well as had urethral, rectal, and oropharyngeal smears performed for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) six months apart. The control group was tested once to define the background incidence. RESULTS Treponema pallidum, CT, and NG prevalence was very high at both time points and was similar to the control group. CT was especially common in the control group (20.58%) and the study group at the rectal site at the second time point (9.37%). NG dominated the oropharyngeal site (15.87%), with urethral site sparing. NG infection was associated with an increased number of partners, not condom use (OR, 1.082 [95% CI; 1.009-1.171]). Risk behavior did not change between the time points. Treponema pallidum, CT, and NG incidence was exceptionally high (12.5/100PY, 25.39/100PY, 34.92/100PY, respectively; pooled 87.5/100PY) and was comparable to other studies of high-risk MSM. CONCLUSIONS Despite a lower risk for HIV acquisition, the study group was at a very high risk for other STIs, and this risk remained high throughout the study. Patients and medical professionals should be aware of syphilis, gonorrhea, and chlamydiosis transmission risks, and screening should be performed accordingly. Prophylactic programs need to be updated to specifically include lower-risk individuals.
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Affiliation(s)
- Bartosz Szetela
- Department of Infectious Diseases, Liver Disease and Acquired Immune Deficiencies, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Łukasz Łapiński
- Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, 50-375 Wroclaw, Poland
| | - Katarzyna Giniewicz
- Statistical Analysis Centre, Wroclaw Medical University, 50-367 Wroclaw, Poland
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Feijoo-Cid M, Fernández-Cano MI, Zalazar V, Moriña-Soler D, García-Sierra R, Arreciado Marañón A, Sued O. Assessing the Underestimation of HIV Risk Infection among Young Men Who Have Sex with Men in Argentina. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15269. [PMID: 36429984 PMCID: PMC9690491 DOI: 10.3390/ijerph192215269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/08/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
The aim of this study is to describe the discordance between the self-perceived risk and actual risk of HIV among young men who have sex with men (YMSM) and its associated factors. An online, cross-sectional study was conducted with 405 men recruited from an Argentinian NGO in 2017. Risk discordance (RD) was defined as the expression of the underestimation of risk, that is, as a lower self-perception of HIV risk, as measured with the Perceived Risk of HIV Scale, than the current risk of HIV infection, as measured by the HIV Incidence Risk Index. Multivariate logistic regression models were used to analyze the associations between the RD and the explanatory variables. High HIV risk was detected in 251 (62%), while 106 (26.2%) showed high self-perceived risk. RD was found in 230 (56.8%) YMSM. The predictors that increased RD were consistent condom use with casual partners (aOR = 3.8 [CI 95:1.5-11.0]), the use of Growler to meet partners (aOR = 10.38 [CI 95:161-121.94]), frequenting gay bars (aOR = 1.9 [95% CI:1.1-3.5]) and using LSD (aOR = 5.44 [CI 95:1.32-30.29]). Underestimation of HIV risk in YMSM is associated with standard HIV risk behavior and modulated by psychosocial aspects. Thus, prevention campaigns aimed at YMSM should include these factors, even though clinical practice does not. Health professionals should reconsider adapting their instruments to measure the risk of HIV in YMSM. It is unknown what score should be used for targeting high-risk YMSM, so more research is needed to fill this gap. Further research is needed to assess what score should be used for targeting high-risk in YMSM.
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Affiliation(s)
- Maria Feijoo-Cid
- Department of Nursing, Faculty of Medicine, Universitat Autónoma de Barcelona, 08193 Bellaterra, Spain
- Grup de REcerca Multidisciplinar en SAlut i Societat (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain
| | - María Isabel Fernández-Cano
- Department of Nursing, Faculty of Medicine, Universitat Autónoma de Barcelona, 08193 Bellaterra, Spain
- Grup de REcerca Multidisciplinar en SAlut i Societat (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain
| | - Virginia Zalazar
- Dirección de Investigaciones, Fundación Huésped, Buenos Aires C1202ABB, Argentina
| | - David Moriña-Soler
- Department of Econometrics, Statistics and Applied Economics, Universitat de Barcelona, Riskcenter-IREA, 08035 Barcelona, Spain
| | - Rosa García-Sierra
- Department of Nursing, Faculty of Medicine, Universitat Autónoma de Barcelona, 08193 Bellaterra, Spain
- Grup de REcerca Multidisciplinar en SAlut i Societat (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain
- Research Support Unit Metropolitana Nord, Primary Care Research Institut Jordi Gol (IDIAPJGol), 08303 Barcelona, Spain
| | - Antonia Arreciado Marañón
- Department of Nursing, Faculty of Medicine, Universitat Autónoma de Barcelona, 08193 Bellaterra, Spain
- Grup de REcerca Multidisciplinar en SAlut i Societat (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain
| | - Omar Sued
- Dirección de Investigaciones, Fundación Huésped, Buenos Aires C1202ABB, Argentina
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Viera A, van den Berg JJ, Sosnowy CD, Mehta NA, Edelman EJ, Kershaw T, Chan PA. Barriers and Facilitators to HIV Pre-Exposure Prophylaxis Uptake Among Men Who have Sex with Men Who Use Stimulants: A Qualitative Study. AIDS Behav 2022; 26:3016-3028. [PMID: 35303188 PMCID: PMC9378498 DOI: 10.1007/s10461-022-03633-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 11/30/2022]
Abstract
The HIV epidemic disproportionately impacts men who have sex with men (MSM), particularly those who use stimulants. We explored barriers and facilitators to pre-exposure prophylaxis (PrEP) uptake among this population. From June 2018 through February 2019, we conducted semi-structured interviews in Providence, Rhode Island, and New Haven, Connecticut, with 21 MSM who reported recent (past six months) stimulant use. We identified individual, interpersonal, and structural barriers to PrEP, including: (1) high awareness but mixed knowledge of PrEP, resulting in concerns about side effects and drug interactions; (2) interest that was partly determined by substance use and perceived HIV risk; (3) fragmented and constrained social networks not conducive to disseminating PrEP information; and (4) PrEP access, such as insurance coverage and cost. Our findings suggest potential approaches to increase PrEP uptake in this group, including promotion through mainstream and social media, clarifying misinformation, and facilitating increased access through structural interventions.
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Affiliation(s)
- Adam Viera
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, 06510, New Haven, CT, USA.
- Center for Interdisciplinary Research on AIDS, 135 College Street, 06510, New Haven, CT, USA.
| | - Jacob J van den Berg
- Center for Interdisciplinary Research on AIDS, 135 College Street, 06510, New Haven, CT, USA
- Warren Alpert Medical School of Brown University, 222 Richmond St, 02903, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main St, 02903, Providence, RI, USA
- Providence/Boston Center for AIDS Research, 164 Summit Avenue CFAR Building, Room 134, 02906, Providence, RI, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, 02115, Boston, MA, USA
| | - Collette D Sosnowy
- Warren Alpert Medical School of Brown University, 222 Richmond St, 02903, Providence, RI, USA
| | - Nikita A Mehta
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, 06510, New Haven, CT, USA
| | - E Jennifer Edelman
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, 06510, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, 135 College Street, 06510, New Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, 367 Cedar St, 06510, New Haven, CT, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, 06510, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, 135 College Street, 06510, New Haven, CT, USA
| | - Philip A Chan
- Warren Alpert Medical School of Brown University, 222 Richmond St, 02903, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main St, 02903, Providence, RI, USA
- Providence/Boston Center for AIDS Research, 164 Summit Avenue CFAR Building, Room 134, 02906, Providence, RI, USA
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Factors associated with transmasculine adults recently engaging in sexual behavior with partners of unknown STI and HIV status. AIDS Behav 2022; 26:3139-3145. [PMID: 35362909 DOI: 10.1007/s10461-022-03651-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 11/01/2022]
Abstract
The sexual partnerships of transmasculine (TM) adults-those assigned female at birth who identify as transgender men or a masculine spectrum gender identity-and characteristics associated with STI/HIV risk behavior remains understudied. Participants in the current study were TM adults (n = 141) receiving care at a community health center in Boston, Massachusetts between March 2015 and September 2016. Using generalized estimating equations, we examined individual- and partnership-level factors associated with TM adults' odds of engaging in sexual behavior with a sexual partner of unknown STI/HIV status in the past 12 months. TM adults with casual sexual partnerships (vs. monogamous partnerships) and those in partnerships with cisgender men, other TM individuals, or transfeminine partners (vs. cisgender women) had statistically significantly higher odds of engaging in sexual behavior with a partner of unknown STI/HIV status in the past 12 months. Findings may inform future efforts to improve sexual health communication and STI/HIV disclosure between TM adults and their sexual partners.
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Klasko-Foster L, Wilson K, Bleasdale J, Gabriel SJ, Przybyla S. "Shades of risk": Understanding current PrEP users' sexually transmitted infection perceptions. AIDS Care 2021; 34:353-358. [PMID: 34308702 DOI: 10.1080/09540121.2021.1957762] [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: 10/20/2022]
Abstract
ABSTRACTPre-exposure prophylaxis (PrEP) is a safe and effective HIV prevention strategy. Given the possibility of increased sexual risk-taking and acquisition of other sexually transmitted infections (STIs) following PrEP initiation, it is important to explore STI risk perceptions both before and after PrEP initiation to understand the extent to which these perceptions inform decisions to engage in condomless sex. Semi-structured qualitative interviews were conducted with men who have sex with men currently using PrEP (n = 30). Prior to analysis, PrEP users were categorized into four subgroups based on condom use behavior post-PrEP initiation: (1) condom continuers (2) condomless sex continuers, (3) condomless sex increasers, and (4) condomless sex decreasers. Thematic analysis revealed two major themes that elucidated differences in (1) the appraisal of HIV risk relative to other STIs and (2) the importance of partner communication in determining STI risk perceptions by subgroup. Most PrEP users demonstrated no behavioral change after PrEP initiation. Those engaging in condomless sex prior to PrEP initiation also continued that behavior while taking PrEP. Results of this study support a tailored approach to PrEP counseling based on individual STI risk appraisal and motivations to initiate and continue PrEP.
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Affiliation(s)
| | - Kennethea Wilson
- School of Public Health and Health Professions, University at Buffalo, SUNY
| | - Jacob Bleasdale
- School of Public Health and Health Professions, University at Buffalo, SUNY
| | - Steven J Gabriel
- School of Public Health and Health Professions, University at Buffalo, SUNY
| | - Sarahmona Przybyla
- School of Public Health and Health Professions, University at Buffalo, SUNY
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Serrano PA, Daubert E, Munoz A, Hosek SG, French AL. Effect of Truvada lawsuit advertising on preexposure prophylaxis attitudes and decisions among sexual and gender minority youth and young adults at risk for HIV. AIDS 2021; 35:131-139. [PMID: 33031102 PMCID: PMC7718403 DOI: 10.1097/qad.0000000000002728] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE In 2019, US advocates reported misleading language regarding the safety of TDF/FTC (Truvada) used by lawsuit advertisements against Gilead Sciences. We sought to ascertain the reach and effects of the advertisements on preexposure prophylaxis (PrEP) opinions and decisions in a cohort of youth and young adults at-risk for HIV. DESIGN An online survey was administered to participants enrolled in Keeping it LITE, a prospective US cohort study of ethnically diverse, sexually active, cisgender and transgender persons ages 13-37. METHODS Quantitative data were analyzed using descriptive and inferential analysis in SAS, and qualitative data via thematic analysis. RESULTS Survey response rate was 51.3% (n = 1485). Mean age at baseline was 24. Previous PrEP use was reported by 43% of respondents and 32.7% reported PrEP use in the past 6 months. Almost half (48.7%) were aware of the lawsuit. Most of these participants (81.3%) reported the advertisements did not impact their PrEP use, but 13.2% decided to not to begin a Truvada-based PrEP regimen and 5.5% decided to stop taking Truvada due to the advertisements claims. Predictors of changing PrEP behavior were lower education and no previous PrEP use. The qualitative analysis revealed the advertisements increased skepticism about safety and benefit of Truvada PrEP and led to greater distrust of the pharmaceutical industry. CONCLUSION The advertisements reached a large, diverse US audience. Disturbingly, 18.7% of PrEP candidates who were aware of the lawsuit attributed not initiating or cessation of a Truvada-based PrEP regimen to exposure to the Truvada lawsuit advertisements.
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Affiliation(s)
| | | | | | - Sybil G. Hosek
- Ruth M Rothstein CORE Center, Chicago, IL USA
- John H. Jr, Stroger Hospital of Cook County, Chicago, IL USA
| | - Audrey L. French
- Ruth M Rothstein CORE Center, Chicago, IL USA
- John H. Jr, Stroger Hospital of Cook County, Chicago, IL USA
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PrEP Use Awareness and Interest Cascade among MSM and Transgender Women Living in Bali, Indonesia. Trop Med Infect Dis 2020; 5:tropicalmed5040158. [PMID: 33050477 PMCID: PMC7709693 DOI: 10.3390/tropicalmed5040158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 11/17/2022] Open
Abstract
Indonesia has not implemented HIV pre-exposure prophylaxis (PrEP) despite global calls for its scale-up, and there is limited information about attitudes towards PrEP among its potential users. We aim to present a PrEP cascade among men who have sex with men (MSM) and transgender women (known locally as “waria”) in Denpasar, Bali, from a cross-sectional survey with 220 HIV-negative MSM/waria recruited from one clinic in Denpasar. Only 16.4% of participants had heard of PrEP before. From first-to-last steps included in the cascade, we found 77.3% (170/220) of participants were classified with HIV high risk, 75.9% (129/170) perceived themselves as being at high risk, 81.4% (105/129) expressed interest in using PrEP, 78.1% (82/105) were willing to do PrEP procedures, 48.8% (40/82) were willing to pay 500,000–600,000 IDR, and only two participants had ever been on PrEP before (5.0% of those willing to pay and 0.9% of the total sample). Multivariate logistic regression analysis showed that self-perception of high HIV risk was lower among older age groups (p < 0.001 among 30–39; p = 0.002 among > 40) and higher among participants with multiple sex partners (p = 0.016). Interest in using PrEP was lower among participants with high social engagement as MSM/waria (p = 0.002) and was higher among participants with multiple sex partners (p = 0.020) and inconsistent condom use (p = 0.011). This study has shown a significantly low level of PrEP awareness among its participants and decreases in interest in PrEP use due to procedure and cost. It suggested that an appropriate PrEP campaign is needed if PrEP is going to be introduced in Indonesia.
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Ong JJ, Baggaley RC, Wi TE, Tucker JD, Fu H, Smith MK, Rafael S, Anglade V, Falconer J, Ofori-Asenso R, Terris-Prestholt F, Hodges-Mameletzis I, Mayaud P. Global Epidemiologic Characteristics of Sexually Transmitted Infections Among Individuals Using Preexposure Prophylaxis for the Prevention of HIV Infection: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e1917134. [PMID: 31825501 PMCID: PMC6991203 DOI: 10.1001/jamanetworkopen.2019.17134] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Despite a global increase in sexually transmitted infections (STIs), there is limited focus and investment in STI management within HIV programs, in which risks for STIs are likely to be elevated. OBJECTIVE To estimate the prevalence of STIs at initiation of HIV preexposure prophylaxis (PrEP; emtricitabine and tenofovir disoproxil fumarate) and the incidence of STIs during PrEP use. DATA SOURCES Nine databases were searched up to November 20, 2018, without language restrictions. The implementers of PrEP were also approached for additional unpublished data. STUDY SELECTION Studies reporting STI prevalence and/or incidence among PrEP users were included. DATA EXTRACTION AND SYNTHESIS Data were extracted independently by at least 2 reviewers. The methodological quality of studies was assessed using the Joanna Briggs Institute critical assessment tool for prevalence and incidence studies. Random-effects meta-analysis was performed. MAIN OUTCOMES AND MEASURES Pooled STI prevalence (ie, within 3 months of PrEP initiation) and STI incidence (ie, during PrEP use, after 3 months). RESULTS Of the 3325 articles identified, 88 were included (71 published and 17 unpublished). Data came from 26 countries; 62 studies (70%) were from high-income countries, and 58 studies (66%) were from programs only for men who have sex with men. In studies reporting a composite outcome of chlamydia, gonorrhea, and early syphilis, the pooled prevalence was 23.9% (95% CI, 18.6%-29.6%) before starting PrEP. The prevalence of the STI pathogen by anatomical site showed that prevalence was highest in the anorectum (chlamydia, 8.5% [95% CI, 6.3%-11.0%]; gonorrhea, 9.3% [95% CI, 4.7%-15.2%]) compared with genital sites (chlamydia, 4.0% [95% CI, 2.0%-6.6%]; gonorrhea, 2.1% [95% CI, 0.9%-3.7%]) and oropharyngeal sites (chlamydia, 2.4% [95% CI, 0.9%-4.5%]; gonorrhea, 4.9% [95% CI, 1.9%-9.1%]). The pooled incidence of studies reporting the composite outcome of chlamydia, gonorrhea, and early syphilis was 72.2 per 100 person-years (95% CI, 60.5-86.2 per 100 person-years). CONCLUSIONS AND RELEVANCE Given the high burden of STIs among individuals initiating PrEP as well as persistent users of PrEP, this study highlights the need for active integration of HIV and STI services for an at-risk and underserved population.
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Affiliation(s)
- Jason J. Ong
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | | | - Teodora E. Wi
- Department of HIV, World Health Organization, Geneva, Switzerland
| | - Joseph D. Tucker
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hongyun Fu
- Community Health and Research Division, Eastern Virginia Medical School, Norfolk
| | - M. Kumi Smith
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis
| | - Sabrina Rafael
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Vanessa Anglade
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jane Falconer
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Fern Terris-Prestholt
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Philippe Mayaud
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
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