Engagement of Latino immigrant men who have sex with men for HIV prevention through eHealth: preferences across social media platforms

Effectiveness of eHealth interventions for HIV prevention, testing and management: An umbrella review

BACKGROUND

Human immunodeficiency virus (HIV) infection has become a major contributor to the global burden of disease. Globally, the number of cases of HIV continues to increase. Electronic health (eHealth) interventions have emerged as promising tools to support disease self-management among people living with HIV. The purpose of this umbrella review is to systematically evaluate and summarize the evidence and results of published systematic reviews and meta-analyses on the effectiveness of eHealth interventions for HIV prevention, testing and management.

METHODS

PubMed, Embase and the Cochrane Library were searched for reviews. The methodological quality of the included studies was assessed using AMSTAR-2.

RESULTS

A total of 22 systematic reviews were included. The methodological quality of the reviews was low or critically low. EHealth interventions range from Internet, computer, or mobile interventions to websites, programs, applications, email, video, games, telemedicine, texting, and social media, or a combination of them. The majority of the reviews showed evidence of effectiveness (including increased participation in HIV management behaviours, successfully changed HIV testing behaviours, and reduced risk behaviours). EHealth interventions were effective in the short term.

CONCLUSIONS

Ehealth interventions have the potential to improve HIV prevention, HIV testing and disease management. Due to the limitations of the low methodological quality of the currently available systematic reviews, more high-quality evidence is needed to develop clear and robust recommendations.

Multifaceted Barriers to Rapid Roll-out of HIV Pre-exposure Prophylaxis in China: A Qualitative Study Among Men Who Have Sex with Men

BACKGROUND

Oral pre-exposure prophylaxis (PrEP) as a safe and effective antiretroviral medicine-based prevention against HIV has not been widely adopted by gay, bisexual, and other men who have sex with men (MSM) in China. A deeper understanding of barriers and facilitators to PrEP uptake is needed to inform the development of effective interventions.

METHOD

During July-August 2020, we conducted one-on-one semi-structured interviews with 31 Chinese MSM with varied PrEP use experiences (PrEP-naïve, former, and current PrEP users). Interviews were digitally recorded and transcribed in Chinese. Informed by the Information-Motivation-Behavioral Skills Model (IMB), we analyzed the data using a thematic analysis approach to identify the barriers and facilitators to PrEP uptake among Chinese MSM.

RESULTS

Major barriers to PrEP uptake among MSM in the sample included uncertainty about PrEP efficacy and lack of PrEP education (information), concerns over potential side effects and cost (motivation), and difficulties in identifying authentic PrEP medications and managing PrEP care (behavioral skills). Facilitators include the perceived benefit of PrEP in improving the quality of sex life and control over health. At the contextual level, we also identified barriers to PrEP access from a thriving informal PrEP market and stressors related to being MSM.

CONCLUSION

Our findings identified a need to invest in non-discriminatory public health messaging of PrEP, explore options for MSM-friendly provision of PrEP outside of traditional HIV care settings, and be attentive to the unique context of an established informal PrEP market in future PrEP initiatives.

Factors Associated with PrEP Stigma Among Gay, Bisexual, and Other Men Who Have Sex with Men (gbMSM): A Systematic Review

Gay, bisexual, and other men who have sex with men (gbMSM) are disproportionately affected by HIV. While pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV acquisition, uptake of PrEP among gbMSM is low, which may in part be due to stigma associated with PrEP use. This systematic review aimed to explore experiences of PrEP stigma and to identify factors associated with this. Four databases were searched for papers including terms relating to (i) gbMSM, (ii) PrEP, and (iii) stigma, with narrative synthesis used to analyze results. After screening, 70 studies were included in the final analysis. Experiences of PrEP stigma were found to be characterized by a number of stereotypes and came from a range of sources. Five categories of factors were associated with stigma: (i) healthcare-related factors, (ii) cultural and contextual factors, (iii) sociodemographic factors, (iv) peer-discussion, and (v) psychosocial factors. These findings suggest that stigma can be a common experience for gbMSM. However, some are more at risk than others. Interventions aimed at reducing PrEP stigma may be useful in increasing uptake.

Sexual health challenges in migrant, immigrant, and displaced populations 2022-2023

PURPOSE OF REVIEW

This article reviews recently published research on sexual health challenges and HIV and sexually transmitted infections (STIs) among migrant, immigrant and displaced people (MIDP) worldwide. We aimed to identify current evidence gaps regarding HIV/STI epidemiology, sexual health needs and interventions.

RECENT FINDINGS

Incidence and prevalence of HIV, hepatitis B virus, hepatitis C virus and syphilis were higher among MIDP compared to host populations. However, research studies are limited in geographical distribution and few routine surveillance data are collected. Barriers to sexual health services use and participation in preventive interventions include low HIV/STI symptom knowledge and risk awareness, and intersectional experiences of stigma/discrimination. Better targeted promotion messages are needed to increase utilization of preventive sexual health interventions.

SUMMARY

Access to, and use of, sexual health services and interventions are evident needs among MIDP. These needs are intertwined with social determinants of health, including cultural/language barriers and stigma. Effective interventions require involvement of multiple stakeholder groups, encouraging engagement and providing social protection. Promising directions for interventions and further research include developing sexual health supportive environments through peer-strategies and provider training in trauma-informed care.

Digital Interventions to Enhance PrEP Uptake and Adherence Through Stigma Reduction

PURPOSE OF REVIEW

Although pre-exposure prophylaxis (PrEP) is effective for reducing risk of HIV transmission, stigma persists as a barrier to HIV prevention. Digital technologies present opportunities to access hard-to-reach populations and increase the efficiency of established interventions. This review examines current digital interventions addressing stigma to improve PrEP-related outcomes.

RECENT FINDINGS

Digital technologies are increasingly used for HIV prevention and include a wide range of formats. Recent interventions focused on stigma and PrEP tend to engage mobile phone-related technology and focus on younger populations with particular attention to men who have sex with men and transgender women. Digital interventions that address stigma are promising for improving PrEP-related outcomes. No single technology currently demonstrates consistent superiority. Limited access to PrEP and heightened stigma in under-resourced countries present challenges for interventions supporting diverse communities. Further research should examine how digital interventions can reduce stigma beyond the individual level to enhance PrEP use and explore opportunities to improve and integrate approaches to stigma measurement.

Collaborative PrEP Implementation Strategies for Latino Men Who have Sex with Men: A Health Center-Community Consensus Process

Community-based organizations (CBOs) deliver services in culturally-responsive ways, and could effectively partner with health centers to deliver HIV pre-exposure prophylaxis (PrEP) to Latino men who have sex with men (LMSM). However, few such models exist. We conducted a planning study in collaboration with three CBOs serving LMSM to identify optimal PrEP delivery strategies for health centers and CBOs to implement jointly. We established a Community Expert Panel (CEP) of eight client-facing CBO and health center staff. Over 6 months, the panel met monthly to identify collaborative strategies for PrEP delivery, using a modified Delphi method consisting of the following steps: (1) brainstorming strategies; (2) rating strategies on acceptability, appropriateness and feasibility; (3) review of data from qualitative focus group discussions with CBO clients; and (4) final strategy selection. The panel initially identified 25 potential strategies spread across three categories: improving communication between health centers and CBOs; using low-barrier PrEP options (e.g. telemedicine), and developing locally-relevant, culturally-sensitive outreach materials. Focus groups with CBO clients highlighted a desire for flexible options for PrEP-related care and emphasized trust in CBOs. The final package of strategies consisted of: (1) a web-based referral tool; (2) telemedicine appointments; (3) geographically-convenient options for lab specimen collection; (4) tailored print and social media; and (5) regular coaching sessions with CBO staff. Through a community-engaged process, we identified a package of PrEP delivery strategies that CBOs and health centers can implement in partnership, which have the potential to overcome barriers to PrEP for LMSM.

Improving access to oral pre-exposure prophylaxis for HIV among international migrant populations

Pre-exposure prophylaxis (PrEP) is recommended for people susceptible to HIV acquisition, and the scale-up of PrEP programmes has contributed to new HIV case reductions at a population level. However, international migrants continue to be disproportionately affected by HIV. Understanding barriers and facilitators to PrEP implementation among international migrants can optimise PrEP use among this population and ultimately reduce HIV incidence worldwide. We reviewed the evidence regarding factors influencing PrEP implementation among international migrants; 19 studies were included. The barriers and facilitators at the individual level were related to knowledge and risk perception of HIV. Cost, provider discriminations, and health system navigation influenced PrEP use at the service level. Positive or negative perception towards LGBT+ identities, HIV, and PrEP users affected PrEP use at the societal level. Most existing PrEP campaigns do not target international migrants; therefore, culturally tailored approaches for people from different backgrounds are warranted. Potentially migration-related and HIV-related discriminatory policies must be reviewed to increase access to HIV prevention services to end HIV transmission at a population level.

HIV Prevention Intervention-related Research with Adult, Sexual Minority Hispanic Men in the United States: A Systematic Review

The systematic review describes aims to synthesize the HIV prevention intervention-related research conducted among adult, US sexual minority Hispanic men since 2012. Following PRISMA guidelines, 15 articles representing 14 studies were included in the review: 4 randomized controlled trials, 5 pilots, and 5 formative projects. Two interventions had PrEP-related outcomes whereas 7 focused on behavioral (e.g., condoms, testing) and/or educational outcomes. Few studies used digital health. All but one study was theoretically guided. Community engagement was a common and important thread in the included studies, with community-based participatory research being the most prevalent framework. The inclusion of cultural factors varied widely, as did the availability of Spanish language or bilingual study materials. Future research opportunities are discussed and recommendations to bolster HIV prevention interventions (e.g., tailoring) are presented. These include the need for greater integration of cultural factors (e.g., nuances related to the heterogeneity of Hispanic subgroups) and mitigating critical barriers to help improve uptake of evidence-based strategies in this population.

Culturally Tailored Social Media Content to Reach Latinx Immigrant Sexual Minority Men for HIV Prevention: Web-based Feasibility Study

BACKGROUND

Latinx gay, bisexual, and other sexual minority men (SMM) are disproportionately affected by HIV in the United States. As Latinx SMM, particularly those who are foreign-born, experience inequitable access to health services, tailored strategies to engage them for HIV prevention are urgently needed.

OBJECTIVE

Our study sought to address the need for enhanced access to HIV prevention among Latinx immigrant SMM. We developed and piloted a culturally sensitive, technology-based campaign focused on HIV testing and pre-exposure prophylaxis (PrEP) uptake.

METHODS

We utilized a two-phase approach to assess the feasibility of community-informed social media content in engaging Latinx immigrant SMM for HIV testing and PrEP use. First, we conducted three iterative focus groups with 15 Latinx immigrant SMM to refine the HIV prevention content to be piloted on social media platforms. The finalized content was placed on Instagram and Facebook for 9 days in July and September 2021 to individuals who were in Washington State. Individuals who clicked on the content were directed to a website with additional HIV prevention information. Second, we conducted online surveys (n=60) with website visitors that assessed sociodemographic characteristics, barriers to HIV prevention, and HIV-related transmission risk and prevention behaviors. We conducted descriptive analyses to examine the overall profile of survey respondents and determine the feasibility of culturally informed social media content in reaching Latinx immigrant SMM.

RESULTS

Overall, 739 unique users visited the website during the 9-day period when the social media content was posted on Instagram and Facebook. Our sample included 60 Latinx immigrant SMM who completed the online survey. Participants' mean age was 30.8 years and more than half (56.7%) completed the survey in Spanish. A quarter of participants indicated that they were unauthorized immigrants and 56.7% reported not having medical insurance. Participants reported, on average, having 6 different sexual partners in the last 6 months. Nearly a third of respondents had not tested for HIV in the last 6 months. Only about half (53.3%) of respondents had used PrEP in the last 12 months.

CONCLUSIONS

Community-driven social media and web-based strategies are feasible ways to engage Latinx immigrant SMM who may traditionally lack access to HIV prevention information and services due to structural and social barriers. Results highlight that culturally relevant social media and web-based outreach strategies that are informed and developed by the community can reach Latinx immigrant SMM for HIV prevention. Findings underscore the need to examine the effectiveness of social media content in promoting HIV testing and PrEP uptake in marginalized Latinx populations.

CLINICALTRIAL