1
|
Chambers LC, Malyuta Y, Goedel WC, Chan PA, Sutten Coats C, Allen K, Nunn AS. Identifying Effective Components of a Social Marketing Campaign to Improve Engagement With Express Sexual Health Services Among Gay, Bisexual, and Other Men Who Have Sex With Men: Case Study. JMIR Public Health Surveill 2024; 10:e50944. [PMID: 39177671 PMCID: PMC11363878 DOI: 10.2196/50944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 08/24/2024] Open
Abstract
Background Little is known about how best to reach people with social marketing messages promoting use of clinical HIV and sexually transmitted infection (STI) services. Objective We evaluated a multiplatform, digital social marketing campaign intended to increase use of HIV/STI testing, treatment, and prevention services among gay, bisexual, and other men who have sex with men (MSM) at an LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and/or questioning) community health center. Methods We evaluated engagement with a social marketing campaign launched by Open Door Health, the only LGBTQ+ community health center in Rhode Island, during the first 8 months of implementation (April to November 2021). Three types of advertisements encouraging use of HIV/STI services were developed and implemented on Google Search, Google Display, Grindr, and Facebook. Platforms tracked the number of times that an advertisement was displayed to a user (impressions), that a user clicked through to a landing page that facilitated scheduling (clicks), and that a user requested a call to schedule an appointment from the landing page (conversions). We calculated the click-through rate (clicks per impression), conversion rate (conversions per click), and the dollar amount spent per 1000 impressions and per click and conversion. Results Overall, Google Search yielded the highest click-through rate (7.1%) and conversion rate (7.0%) compared to Google Display, Grindr, and Facebook (click-through rates=0.4%-3.3%; conversion rates=0%-0.03%). Although the spend per 1000 impressions and per click was higher for Google Search compared to other platforms, the spend per conversion-which measures the number of people intending to attend the clinic for services-was substantially lower for Google Search (US $48.19 vs US $3120.42-US $3436.03). Conclusions Campaigns using the Google Search platform may yield the greatest return on investment for engaging MSM in HIV/STI services at community health clinics. Future studies are needed to measure clinical outcomes among those who present to the clinic for services after viewing campaign advertisements and to compare the return on investment with use of social marketing campaigns relative to other approaches.
Collapse
Affiliation(s)
- Laura C Chambers
- Division of Infectious Diseases, The Miriam Hospital, Providence, RI, United States
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States
| | - Yelena Malyuta
- Open Door Health, Rhode Island Public Health Institute, Providence, RI, United States
| | - William C Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States
| | - Philip A Chan
- Division of Infectious Diseases, The Miriam Hospital, Providence, RI, United States
- Open Door Health, Rhode Island Public Health Institute, Providence, RI, United States
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Cassandra Sutten Coats
- Open Door Health, Rhode Island Public Health Institute, Providence, RI, United States
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
| | - Ken Allen
- The Allen Company, Inc, Jackson, MS, United States
| | - Amy S Nunn
- Open Door Health, Rhode Island Public Health Institute, Providence, RI, United States
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, United States
| |
Collapse
|
2
|
Boudewyns V, Uhrig JD, Williams PA, Anderson SKE, Stryker JE. Message Framing Strategies to Promote the Uptake of PrEP: Results from Formative Research with Diverse Adult Populations in the United States. AIDS Behav 2024; 28:535-546. [PMID: 38151665 DOI: 10.1007/s10461-023-04242-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/29/2023]
Abstract
There are no evidence-based recommendations for communicating about pre-exposure prophylaxis (PrEP) as part of a broader HIV-prevention messaging approach. To inform future message development related to PrEP uptake, we interviewed 235 individuals across ten locations in the U.S. to explore their understanding and perceptions of draft HIV prevention messages and assess their overall preferences for a broad or PrEP-focused messaging approach. Participants responded favorably to and related to both draft messages. Participants who were not aware of PrEP were more likely to say the broad HIV-prevention message was personally relevant than those aware of PrEP. There were no significant differences in perceived personal relevance for the PrEP-focused message. Qualitative findings suggest that HIV prevention messages should use specific well-defined terms, include links to additional information, and use choice-enhancing language that emphasizes personal agency and frames the call to action as an informed decision among an array of effective prevention options.
Collapse
Affiliation(s)
- Vanessa Boudewyns
- RTI International, 3040 E. Cornwallis Road, PO Box 12194, Research Triangle Park, NC, USA.
| | - Jennifer D Uhrig
- RTI International, 3040 E. Cornwallis Road, PO Box 12194, Research Triangle Park, NC, USA
| | - Pamela A Williams
- RTI International, 3040 E. Cornwallis Road, PO Box 12194, Research Triangle Park, NC, USA
| | - Stefanie K E Anderson
- Division of HIV Prevention, Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jo Ellen Stryker
- Division of HIV Prevention, Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
3
|
Kalwicz DA, Rao S, Modrakovic D, Zea MC, Dovidio JF, Magnus M, Kharfen M, Patel V, Calabrese SK. 'There are people like me who will see that, and it will just wash over them': Black sexual minority men's perspectives on messaging in PrEP visual advertisements. CULTURE, HEALTH & SEXUALITY 2023; 25:1371-1386. [PMID: 36598172 PMCID: PMC10318116 DOI: 10.1080/13691058.2022.2157491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
The high incidence of HIV among US Black sexual minority men is a public health crisis that pre-exposure prophylaxis (PrEP) for HIV can help address. Public health campaigns, which often include pictures of Black sexual minority men alongside PrEP-related messaging, have been developed to encourage PrEP awareness and uptake. However, the acceptability of the messaging within these campaigns among Black sexual minority men is unclear. We conducted four focus groups with 18 HIV-negative Black sexual minority men in Washington, DC to explore their perspectives regarding promotional messaging (textual elements) in PrEP visual advertisements, including their reactions to three large-scale public health campaigns. Primary themes included: (1) the need for additional information about PrEP, (2) preference for slogan simplicity, (3) the desire to normalise PrEP use, and (4) mixed views on the inclusion of condoms. Results indicated that the messaging in current PrEP visual advertisements may not sufficiently address Black sexual minority men's questions about PrEP. Providing basic PrEP information and methods to access more information; using simple, unambiguous language; presenting PrEP use in a destigmatising, normalising fashion; and conveying the relevance of condoms if included in the advertisement could help increase the acceptability of future PrEP advertising among Black sexual minority men.
Collapse
Affiliation(s)
- David A. Kalwicz
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Sharanya Rao
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Djordje Modrakovic
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Maria Cecilia Zea
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - John F. Dovidio
- Department of Psychology, Yale University, New Haven, CT, USA
- Social and Behavioral Sciences Department, Yale University, New Haven, CT, USA
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, USA
| | - Michael Kharfen
- District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD and TB Administration, Washington, DC, USA
| | - Viraj Patel
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sarah K. Calabrese
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
- Department of Prevention and Community Health, George Washington University, Washington, DC, USA
| |
Collapse
|
4
|
Coleman JL, Jones M, Washington D, Almirol E, Forberg P, Dyer TV, Spieldenner A, Martinez O, Rodriguez-Diaz CE, Parker SD, Schneider JA, Brewer R. Using the Meaningful Involvement of People Living with HIV/AIDS (MIPA) Framework to Assess the Engagement of Sexual Minority Men of Color in the US HIV Response: a Literature Review. J Racial Ethn Health Disparities 2023; 10:2374-2396. [PMID: 36171496 PMCID: PMC10098811 DOI: 10.1007/s40615-022-01417-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/29/2022]
Abstract
Black and Latino sexual minority men (SMM) continue to be disproportionately impacted by HIV. We utilized eight components of the Meaningful Involvement of People Living with HIV/AIDS (MIPA) framework to assess the engagement of Black and Latino SMM. Thirty-six (36) studies were included in the literature review. Forty-two percent of studies were Black SMM-specific, followed by Latino SMM-specific (31%) studies. Twenty-eight percent of studies were conducted among both groups. Most studies (72%) were intervention-related and focused on HIV prevention. The top five most common methods of community engagement were focus groups (39%), followed by interviews (36%), community-based participatory research (14%), the utilization of community advisory boards or peer mentorship (11%), and the establishment of multi-stakeholder coalitions, observations, or surveys (8%). We documented at least 7 MIPA components in 47% of the included studies. Community-based participatory research was more commonly utilized to engage Latino SMM. Researchers were more likely to initiate the engagement across all included studies. Few studies documented how Black and Latino SMM perceived the engagement. Engagement responsiveness was a well-documented MIPA component. In terms of engagement power dynamics, there were several examples of power imbalances, especially among Black SMM-specific studies. The inclusion of Black and Latino SMM had robust impacts on HIV research and interventions. There were limited examples of engagement capacity and maintenance. This is one of the first studies focused on utilizing MIPA to document the engagement of SMM of color. MIPA served as a useful framework for understanding the engagement of SMM of color in the US HIV response. The engagement of SMM of color is critical to reducing health inequities.
Collapse
Affiliation(s)
| | - Mickaya Jones
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | | | - Ellen Almirol
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, MC 5065, Chicago, IL, 60637, USA
| | | | - Typhanye V Dyer
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, MD, USA
| | - Andrew Spieldenner
- MPact Global, Oakland, CA, USA
- California State University-San Marcos, San Marcos, CA, USA
| | - Omar Martinez
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Carlos E Rodriguez-Diaz
- Department of Prevention and Community Health, George Washington University - Milken Institute School of Public Health, Washington, DC, USA
| | - Sharon D Parker
- North Carolina Agricultural and Technical State University, Greensboro, NC, USA
| | - John A Schneider
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, MC 5065, Chicago, IL, 60637, USA
| | - Russell Brewer
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, MC 5065, Chicago, IL, 60637, USA.
| |
Collapse
|
5
|
Awareness and use of HIV pre-exposure prophylaxis and factors associated with awareness among MSM in Beijing, China. Sci Rep 2023; 13:554. [PMID: 36631515 PMCID: PMC9834337 DOI: 10.1038/s41598-023-27485-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023] Open
Abstract
Human immunodeficiency virus (HIV) sexual transmission among men who have sex with men (MSM) has increased markedly in Beijing, China in the past decade. Pre-exposure prophylaxis (PrEP) is a highly efficacious biomedical prevention strategy that remarkably reduces HIV-transmission risk. This study examined PrEP awareness among MSM and the factors influencing it. From April to July 2021, respondent-driven sampling was used to conduct a cross-sectional survey among MSM in Beijing, China. Demographic, behavior, and awareness data regarding PrEP were collected. The factors influencing PrEP awareness were assessed using univariate and multivariable logistic regression. In total, 608 eligible responders were included in the study. Among the respondents, 27.9% had PrEP awareness, 3.3% had taken PrEP, and 57.9% expressed interest in receiving PrEP, if required. Greater odds of PrEP awareness were associated with higher education level (adjusted odds ratio [aOR] 3.525, 95% confidence interval [CI] 2.013-6.173, P < 0.0001), greater HIV-related knowledge (aOR 3.605, 95% CI 2.229-5.829, P < 0.0001), HIV testing (aOR 2.647, 95% CI 1.463-4.788, P = 0.0013), and sexually transmitted infections (aOR 2.064, 95% CI 1.189-3.584, P = 0.0101). Lower odds of PrEP awareness were associated with higher stigma score (aOR 0.729, 95% CI 0.591-0.897, P = 0.0029). The findings indicate sub-optimal awareness and low utilization of PrEP in Beijing and highlight PrEP inequities among MSM with stigma. Strengthening the training of peer educators in disseminating PrEP knowledge and reducing stigma are critical for improving PrEP awareness.
Collapse
|
6
|
Lockhart E, Turner D, Ficek J, Livingston T, Logan RG, Marhefka SL. Understanding Technology Fit Among People with HIV Based on Intersections of Race, Sex, and Sexual Behavior: An Equitable Approach to Analyzing Differences Across Multiple Social Identities. AIDS Behav 2021; 25:2618-2629. [PMID: 33751311 PMCID: PMC7982513 DOI: 10.1007/s10461-021-03223-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 11/25/2022]
Abstract
HIV disproportionately impacts individuals based on intersecting categories (e.g. gender, race/ethnicity, behavior), with groups most at-risk deemed priority populations. Using weighted effects coding to account for differential group sizes, this study used multilevel mixed logistic models to investigate differences in eHealth use and willingness to use eHealth for HIV-related information among priority populations. Compared to the sample average, Black men who had sex with women were less likely to use all technologies except cellphones with text-messaging and less likely to be willing to use computers and tablets. White and Hispanic men who had sex with men were more likely to use all technologies. No significant differences existed for use or willingness to use cellphones with text-messaging. Future research should consider approaches used here to account for equity and multiple intersecting social identities; practitioners may use these findings or similar local data to ensure fit between eHealth programs and priority populations.
Collapse
Affiliation(s)
- Elizabeth Lockhart
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., Tampa, FL, 33612, USA
| | - DeAnne Turner
- Yale AIDS Prevention Training Program (Y-APT), Center for Interdisciplinary Research On AIDS (CIRA), Yale University, 135 College St. Suite 200, New Haven, CT, 06510, USA
| | - Joseph Ficek
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., Tampa, FL, 33612, USA
| | - Taylor Livingston
- University of Nebraska-Lincoln, 816 Oldfather Hall, Lincoln, NE, 68588-0368, USA
| | | | - Stephanie L Marhefka
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., Tampa, FL, 33612, USA.
| |
Collapse
|
7
|
Keene LC, Dehlin JM, Pickett J, Berringer KR, Little I, Tsang A, Bouris AM, Schneider JA. #PrEP4Love: success and stigma following release of the first sex-positive PrEP public health campaign. CULTURE, HEALTH & SEXUALITY 2021; 23:397-413. [PMID: 32212962 DOI: 10.1080/13691058.2020.1715482] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is an effective yet under-utilised method for preventing HIV transmission in high-risk groups. Despite ongoing social marketing to increase PrEP awareness, few studies have evaluated public responses. This paper contextualises negative responses to Chicago's PrEP4Love campaign. In February 2016, a sex-positive ad campaign called PrEP4Love was launched online and throughout public spaces in Chicago. A gender and sexuality inclusive campaign, PrEP4Love is intended to be culturally responsive and sex positive, while retaining a focus on risk reduction. Advertisements prominently feature Black sexual minority men, and Black transgender women, and were strategically placed in diverse Chicago neighbourhoods. In response, there were 212 new callers to the PrEPLine during the two-month study period. Negative responses were concerned with: negatively depicting Black homosexuality (4), general anti-LGBTQ comments (7), adverse effects on children (6), sexually explicit nature (5), and general stigmatisation of racial minorities (4). Discussion focuses on sex-positive frameworks, normalising intimacy, stigma and historical mistrust of medical and pharmaceutical institutions, and the social meanings of biomedical prevention technologies (e.g. PrEP) in relation to dominant norms of sexuality and gender. This study is the first to investigate public responses to a sex-positive PrEP campaign. More studies of PrEP social marketing are needed to evaluate targeted public health campaigns to guide future PrEP promotion strategies.
Collapse
Affiliation(s)
- Lance C Keene
- School of Social Service Administration, University of Chicago, Chicago, IL, USA
| | | | - Jim Pickett
- AIDS Foundation of Chicago, Chicago, IL, USA
| | | | - Iman Little
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Ashley Tsang
- Department of Family and Community Medicine, University of California, San Francisco, CA, USA
| | - Alida M Bouris
- School of Social Service Administration, University of Chicago, Chicago, IL, USA
| | - John A Schneider
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| |
Collapse
|
8
|
Peinado S, Treiman K, Uhrig JD, Taylor JC, Stryker JE. Effectively Communicating About HIV and Other Health Disparities: Findings From a Literature Review and Future Directions. FRONTIERS IN COMMUNICATION 2020; 5:10.3389/fcomm.2020.539174. [PMID: 33594338 PMCID: PMC7884094 DOI: 10.3389/fcomm.2020.539174] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Despite significant progress in the prevention and treatment of HIV, disparities in rates of infection remain among key groups in the United States, including blacks and African Americans; Hispanics/Latinos; and men who have sex with men (MSM). The U.S. Department of Health and Human Services' initiative, Ending the HIV Epidemic: A Plan for America, calls for addressing HIV-related disparities and reducing stigma and discrimination associated with HIV. The goal of this literature review was to identify approaches for effectively communicating about health disparities across the HIV care continuum. We reviewed the literature to investigate strategies used to communicate health disparities and to identify potential unintended adverse effects resulting from this messaging. Messages about health disparities often target subgroups at higher risk and can be framed in a variety of ways (e.g., social comparison, progress, impact, etiological). Studies have examined the effects of message framing on the risk perceptions, emotional reactions, and behaviors of individuals exposed to the messaging. The evidence points to several potential unintended adverse effects of using social comparison framing and individual responsibility framing to communicate about health disparities, and visual images and exemplars to target messages to higher-risk subgroups. There is not yet a clear evidence-based approach for communicating about health disparities and avoiding potential unintended effects. However, we offer recommendations for communicating about HIV-related disparities based on our findings. Because we found limited literature that addressed our research questions in the context of HIV, we propose a research agenda to build an evidence base for developing effective messages about HIV-related disparities.
Collapse
Affiliation(s)
- Susana Peinado
- Center for Communication Science, RTI International, Durham, NC, United States
| | - Katherine Treiman
- Center for Communication Science, RTI International, Durham, NC, United States
| | - Jennifer D. Uhrig
- Center for Communication Science, RTI International, Durham, NC, United States
| | - Jocelyn Coleman Taylor
- Prevention Communication Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jo Ellen Stryker
- Prevention Communication Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| |
Collapse
|
9
|
Brief Report: Quantitative Assessment of Brief Messages About HIV Pre-exposure Prophylaxis Among HIV-Infected and HIV-Uninfected Black/African American and Hispanic/Latino MSM. J Acquir Immune Defic Syndr 2019; 80:31-35. [PMID: 30272636 DOI: 10.1097/qai.0000000000001869] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND HIV pre-exposure prophylaxis (PrEP) is efficacious; however, many men who have sex with men (MSM) (especially racial/ethnic minorities) are still unaware of and underuse it. METHODS The 2014 Messages4Men Study focuses on black and Hispanic/Latino MSM in Chicago, Fort Lauderdale, and Kansas City (n = 937). Brief (2-3 sentence) messages were tested: a PrEP message tailored for HIV-uninfected MSM (n = 607) and a PrEP message tailored for HIV-infected MSM (n = 330). After reading the message, participants reported believability and awareness, and intent to use PrEP and condoms. Analyses consisted of bivariate and multivariable approaches. RESULTS Among HIV-uninfected MSM, black (vs Hispanic/Latino) MSM indicated greater intentions to use PrEP (81% vs 70% respectively, P < 0.05); 72% overall had similar intentions to use condoms after hearing a PrEP message. PrEP information was new (63%) and believable (80%), with no racial/ethnic differences (P > 0.05). In multivariable analysis, men who reported recent condomless anal sex were less likely to report that the PrEP message enhanced their intent to use condoms in the future. DISCUSSION Several years into the availability of PrEP, black and Hispanic/Latino MSM continue to be unaware of PrEP and its benefits, although information is largely believable once provided. The HIV prevention field should be prepared to incorporate new information about HIV prevention options into brief messages delivered through technology and social media.
Collapse
|
10
|
The PrEP Care Continuum and Black Men Who Have Sex with Men: A Scoping Review of Published Data on Awareness, Uptake, Adherence, and Retention in PrEP Care. AIDS Behav 2019; 23:2654-2673. [PMID: 31463711 DOI: 10.1007/s10461-019-02641-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Pre-exposure prophylaxis (PrEP) has demonstrated high efficacy to reduce HIV infections, however, racial/ethnic HIV disparities continue among black MSM. The purpose of this review was to assess available data to inform interventions to increase PrEP awareness, uptake, and adherence among black MSM. Of the 3024 studies retrieved, 36 met final inclusion criteria and were categorized into the PrEP care continuum: (1) awareness (n = 16), (2) uptake (n = 9), and (3) adherence (n = 12). Only 26 of the studies presented analytical findings by race/ethnicity. Key barrier themes included cost, HIV-related stigma, and fear of potential side effects. A key facilitator theme identified by black MSM included gaining PrEP awareness from social and sexual networks. There are significant gaps in research on black MSM and PrEP utilization, especially regarding PrEP uptake and adherence. These data are needed to inform interventions to address current inequities in PrEP services, to help improve care outcomes for black MSM.
Collapse
|
11
|
"We have a stronger survival mode": exploring knowledge gaps and culturally sensitive messaging of PrEP among Latino men who have sex with men and Latina transgender women in Los Angeles, CA. AIDS Care 2019; 31:1221-1227. [PMID: 30939901 DOI: 10.1080/09540121.2019.1601669] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Latino men who have sex with men (LMSM) and Latina transgender women (LTGW) often lack access to HIV prevention information and strategies such as pre-exposure prophylaxis (PrEP). We explored knowledge gaps and culturally sensitive messaging about PrEP among HIV-negative LMSM and LTGW in Los Angeles. We recruited participants from a Latinx LGBT community-based organization. We conducted nine focus groups (n = 91 participants) with 52 LMSM and 39 LTGW. We used a rapid assessment process to create narrative reports that we analyzed using thematic analysis. Key quotes were transcribed verbatim; they were reviewed by the team, then uploaded to Dedoose to identify themes across sites and between groups. Three themes emerged for both LMSM and LTGW: knowledge gaps regarding PrEP remain; people who have knowledge about PrEP often served as its champions; highlighting positive aspects of culture could help improve PreP's uptake and sustained use. Only LMSM worried that PrEP could impact condom use. Some issues were more pronounced among LTGW (e.g., more limited access to PrEP); others were unique to LTGW (e.g., worry about drug-hormones interactions). Collaborative research, programs, and policies, informed by LMSM and LTGW themselves, are needed to narrow existing knowledge gaps and promote PrEP uptake and sustained utilization.
Collapse
|
12
|
Wheeler DP, Fields SD, Beauchamp G, Chen YQ, Emel LM, Hightow‐Weidman L, Hucks‐Ortiz C, Kuo I, Lucas J, Magnus M, Mayer KH, Nelson LE, Hendrix CW, Piwowar‐Manning E, Shoptaw S, Watkins P, Watson CC, Wilton L. Pre-exposure prophylaxis initiation and adherence among Black men who have sex with men (MSM) in three US cities: results from the HPTN 073 study. J Int AIDS Soc 2019; 22:e25223. [PMID: 30768776 PMCID: PMC6376611 DOI: 10.1002/jia2.25223] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 11/23/2018] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Randomized clinical trials have demonstrated the efficacy of antiretroviral pre-exposure prophylaxis (PrEP) in preventing HIV acquisition among men who have sex with men (MSM). However, limited research has examined initiation and adherence to PrEP among Black MSM (BMSM) in the United States (US) who are disproportionately represented among newly HIV infected and late to care individuals. This research reports on the HIV Prevention Trials Network 073 (HPTN 073) study aimed to examine PrEP initiation, utilization and adherence among Black MSM utilizing the theoretically principled, culturally informed and client-centered care coordination (C4) model. METHODS The HPTN 073 study enrolled and followed 226 HIV-uninfected Black MSM in three US cities (Los Angeles, CA; Washington DC; and Chapel Hill, NC) from February 2013 through September 2015. Study participants were offered once daily oral emtricitabine/tenofovir (FTC/TDF) PrEP combined with C4 and followed up for 52 weeks. Participants received HIV testing, risk reduction education and clinical monitoring. RESULTS Of the 226 men enrolled, 178 participants initiated PrEP (79%), and of these 64% demonstrated PrEP utilization at week 26 (mid-point of the study) based on pharmacokinetic testing. Condomless anal sex with an HIV-infected or unknown status casual male partner was statistically significantly associated with a greater likelihood of PrEP initiation (adjusted odds ratio (OR) 4.4, 95% confidence interval (CI) 1.7, 11.7). Greater age (≥25 vs. <25, OR 2.95, 95% CI 1.37 -6.37), perception of having enough money (OR 3.6, 95% CI 1.7 to 7.7) and knowledge of male partner taking PrEP before sex (OR 2.22, 95% CI 1.03 to 4.79) were statistically significantly associated with increased likelihood of PrEP adherence at week 26. Annualized HIV incidence was 2.9 (95% CI 1.2 to 7.9) among those who initiated PrEP, compared to 7.7 (95% CI 2.5 to 24.1) among those who did not initiate PrEP (p = 0.18). CONCLUSIONS Results suggest a high level of PrEP initiation among at-risk Black MSM, a group historically characterized as hard to reach. The data support the importance of addressing contextual factors that affect PrEP initiation and adherence, and of additional research on the ultimate benefit of PrEP in HIV prevention among Black MSM.
Collapse
Affiliation(s)
| | - Sheldon D Fields
- School of Health ProfessionsNew York Institute of TechnologyNew YorkNYUSA
| | - Geetha Beauchamp
- Statistical Center for HIV/AIDS Research & Prevention (SCHARP)Vaccine and Infectious Disease Division (VIDD)Fred Hutchinson Cancer Research CenterSeattleWAUSA
| | - Ying Q Chen
- Statistical Center for HIV/AIDS Research & Prevention (SCHARP)Vaccine and Infectious Disease Division (VIDD) and Public Health Sciences DivisionFred Hutchinson Cancer Research CenterSeattleWAUSA
| | - Lynda M Emel
- Statistical Center for HIV/AIDS Research & Prevention (SCHARP)Vaccine and Infectious Disease Division (VIDD)Fred Hutchinson Cancer Research CenterSeattleWAUSA
| | - Lisa Hightow‐Weidman
- Division of Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | | | - Irene Kuo
- Department of Epidemiology and BiostatisticsMilken Institute School of Public HealthGeorge Washington UniversityWashingtonDCUSA
| | | | - Manya Magnus
- Department of Epidemiology and BiostatisticsMilken Institute School of Public HealthGeorge Washington UniversityWashingtonDCUSA
| | - Kenneth H Mayer
- The Fenway InstituteFenway HealthBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
- Beth Israel Deaconess Medical CenterBostonMAUSA
| | - LaRon E Nelson
- School of NursingUniversity of RochesterRochesterNYUSA
- Centre for Urban Health SolutionsLi Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoONCanada
| | - Craig W Hendrix
- Department of Medicine (Clinical Pharmacology)John Hopkins School of MedicineBaltimoreMDUSA
| | - Estelle Piwowar‐Manning
- Department of PathologyJohn Hopkins School of MedicineBaltimoreMDUSA
- Present address:
CRS director for the GWU site and HPTN Black Caucus Chair
| | - Steven Shoptaw
- Department of Family MedicineDavid Geffen School of MedicineUniversity of California Los Angeles (UCLA)Los AngelesCAUSA
| | | | | | - Leo Wilton
- Department of Human DevelopmentState University of New York at BinghamtonBinghamtonNYUSA
- Faculty of HumanitiesUniversity of JohannesburgJohannesburgSouth Africa
| |
Collapse
|
13
|
Sun CJ, Anderson KM, Toevs K, Morrison D, Wells C, Nicolaidis C. "Little Tablets of Gold": An Examination of the Psychological and Social Dimensions of PrEP Among LGBTQ Communities. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:51-62. [PMID: 30742478 DOI: 10.1521/aeap.2019.31.1.51] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
There are significant psychological, social, and cultural dimensions to the HIV epidemic in the United States, especially among lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities. Biomedical HIV treatment has been shown to impact these dimensions. However, there is little understanding of the real-world psychosocial and sociocultural effects of the latest biomedical HIV prevention strategy, HIV pre-exposure prophylaxis (PrEP). This study explored the psychosocial and sociocultural dimensions of PrEP use among LGBTQ adults. We interviewed 23 LGBTQ adults who were current or former users of PrEP. Results included that PrEP users' experiences were shaped by multiple forms of stigma. Participants were highly motivated to challenge PrEP stigma and to support PrEP use among other community members. Lastly, participants described positive impacts on their individual well-being and their sexual partnerships. Findings suggest that PrEP has significant impacts beyond biomedical outcomes for both the individuals who use PrEP and their communities.
Collapse
Affiliation(s)
- Christina J Sun
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon
| | - Kirsten M Anderson
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon
| | - Kim Toevs
- Multnomah County Health Department, Portland, Oregon
| | - Dayna Morrison
- Oregon AIDS Education and Training Center at Portland Veterans Affairs Research Foundation, Portland, Oregon
| | | | - Christina Nicolaidis
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, and the School of Social Work, Portland State University, Portland, Oregon
| |
Collapse
|
14
|
Sagaon-Teyssier L, Mabire X, Laguette V, Fressard L, Suzan-Monti M, Rojas Castro D, Hall N, Capitant C, Meyer L, Chidiac C, Tremblay C, Préau M, Spire B, Molina JM. A Group-Based Trajectory Model for Changes in Pre-Exposure Prophylaxis and Condom Use Among Men Who Have Sex with Men Participating in the ANRS IPERGAY Trial. AIDS Patient Care STDS 2018. [DOI: 10.1089/apc.2018.0081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Xavier Mabire
- Groupe de Recherche en Psychologie Sociale (EA 4163), Université Lumière Lyon 2, Université de Lyon, Lyon, France
| | - Vanessa Laguette
- Groupe de Recherche en Psychologie Sociale (EA 4163), Université Lumière Lyon 2, Université de Lyon, Lyon, France
- University of Picardie Jules Verne, Amiens, France
| | - Lisa Fressard
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Marie Suzan-Monti
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Daniela Rojas Castro
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France
- AIDES, MIRE, Paris, France
- Coalition Plus, Pantin, France
| | - Nolwenn Hall
- Department of Infectious diseases, CHU de Nantes, Nantes, France
| | | | - Laurence Meyer
- INSERM SC10 US19, Villejuif, France
- Université Paris Sud, Paris Saclay, France
| | - Christian Chidiac
- Department of Infectious Diseases, Hôpital de la Croix Rousse, INSERM U1052, Lyon, France
| | - Cécile Tremblay
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Marie Préau
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France
- Groupe de Recherche en Psychologie Sociale (EA 4163), Université Lumière Lyon 2, Université de Lyon, Lyon, France
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Jean-Michel Molina
- Department of Infectious Diseases, Hospital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | | |
Collapse
|
15
|
Meyers K, Wu Y, Qian H, Sandfort T, Huang X, Xu J, Zhang J, Xia W, Glidden D, Wu H, Shang H. Interest in Long-Acting Injectable PrEP in a Cohort of Men Who have Sex with Men in China. AIDS Behav 2018; 22:1217-1227. [PMID: 28707025 DOI: 10.1007/s10461-017-1845-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Long-acting injectable (LAI) formulations of antiretrovirals (ARVs) as pre-exposure prophylaxis (PrEP) could be an attractive alternative for men who have sex with men (MSM) who are interested in ARV-based biomedical prevention but will not use a daily pill. This study investigated interest in LAI-PrEP in a cohort of MSM in China and characterized how MSM willing to use only injectable PrEP differed from MSM who would use PrEP regardless of modality or not at all. Demographic, behavioral, and risk perception measures were collected and associations investigated. A licensed LAI-PrEP agent would increase the proportion interested in PrEP by 24.5% over oral PrEP alone. Combining interest in oral and injectable PrEP, 78.5% of the sample could be covered if reported interest in PrEP translated into actual uptake. Partnership factors differentiated those who would be willing to use only LAI-PrEP versus any PrEP modality, while higher self-perception of risk was associated with interest in LAI-PrEP versus no PrEP. The addition of a second PrEP modality could yield increased population coverage of PrEP. Social and behavioral research should be undertaken in parallel with clinical development of injectable PrEP agents to identify characteristics of those who are not interested in oral PrEP but would take advantage of ARV-based prevention with the introduction of an injectable product.
Collapse
Affiliation(s)
- Kathrine Meyers
- Aaron Diamond AIDS Research Center, The Rockefeller University, New York, NY, USA
- Aaron Diamond AIDS Research Center, 455 First Avenue, Floor 7, New York, NY, 10016, USA
| | - Yumeng Wu
- Aaron Diamond AIDS Research Center, The Rockefeller University, New York, NY, USA
| | - Haoyu Qian
- Aaron Diamond AIDS Research Center, The Rockefeller University, New York, NY, USA
| | - Theodorus Sandfort
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, NY, USA
| | - Xiaojie Huang
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Junjie Xu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Jing Zhang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Wei Xia
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | | | - Hao Wu
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China.
| | - Hong Shang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.
| |
Collapse
|
16
|
Fuchs JD, Stojanovski K, Vittinghoff E, McMahan VM, Hosek SG, Amico KR, Kouyate A, Gilmore HJ, Buchbinder SP, Lester RT, Grant RM, Liu AY. A Mobile Health Strategy to Support Adherence to Antiretroviral Preexposure Prophylaxis. AIDS Patient Care STDS 2018; 32:104-111. [PMID: 29565183 PMCID: PMC5865612 DOI: 10.1089/apc.2017.0255] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Preexposure prophylaxis is a highly protective HIV prevention strategy, yet nonadherence can significantly reduce its effectiveness. We conducted a mixed methods evaluation of a mobile health intervention (iText) that utilized weekly bidirectional text or e-mail support messages to encourage preexposure prophylaxis (PrEP) adherence among participants in the multi-site iPrEx open-label extension study. A convenience sample of PrEP users from the San Francisco and Chicago sites participated in a 12-week pilot study. Fifty-six men who have sex with men were enrolled; a quarter of them were less than 30 years of age, 13% were black/African American, 11% were Latino, and most (88%) completed some college. Two-thirds opted for text message delivery. Of the 667 messages sent, only 1 individual requested support; initial nonresponse was observed in 22% and was higher among e-mail compared to text message recipients. Poststudy, a majority of participants would recommend the intervention to others, especially during PrEP initiation. Moreover, younger participants and men of color were more likely to report that they would use the iText strategy if it were available to them. Several participants commented that while they were aware that the messages were automated, they felt supported and encouraged that “someone was always there.” Study staff reported that the intervention is feasible to administer and can be incorporated readily into clinic flow. A pre–post intervention regression discontinuity analysis using clinic-based pill counts showed a 50% reduction in missed doses [95% confidence interval (CI) 16–71; p = 0.008] and 77% (95% CI 33–92; p = 0.007) when comparing pill counts at quarterly visits just before and after iText enrollment. A mobile health intervention using weekly bidirectional messaging was highly acceptable and demonstrated promising effects on PrEP adherence warranting further evaluation for efficacy in a randomized controlled trial.
Collapse
Affiliation(s)
- Jonathan D. Fuchs
- San Francisco Department of Public Health, San Francisco, California
- University of California, San Francisco, San Francisco, California
| | | | - Eric Vittinghoff
- University of California, San Francisco, San Francisco, California
| | | | | | - K. Rivet Amico
- University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Aminta Kouyate
- San Francisco Department of Public Health, San Francisco, California
| | | | - Susan P. Buchbinder
- San Francisco Department of Public Health, San Francisco, California
- University of California, San Francisco, San Francisco, California
| | | | - Robert M. Grant
- University of California, San Francisco, San Francisco, California
- Gladstone Institute of Virology, San Francisco, California
| | - Albert Y. Liu
- San Francisco Department of Public Health, San Francisco, California
- University of California, San Francisco, San Francisco, California
| |
Collapse
|
17
|
Frye V, Wilton L, Hirshfield S, Chiasson MA, Lucy D, Usher D, McCrossin J, Greene E, Koblin B. Preferences for HIV test characteristics among young, Black Men Who Have Sex With Men (MSM) and transgender women: Implications for consistent HIV testing. PLoS One 2018; 13:e0192936. [PMID: 29462156 PMCID: PMC5819791 DOI: 10.1371/journal.pone.0192936] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 01/24/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Promoting consistent HIV testing is critical among young, Black Men Who Have Sex With Men (MSM) and transgender women who are overrepresented among new HIV cases in the United States. New HIV test options are available, including mobile unit testing, one-minute testing, at home or self-testing and couples HIV testing and counseling (CHTC). In the context of these newer options, the objective of this study was to explore whether and how preferences for specific characteristics of the tests acted as barriers to and/or facilitators of testing in general and consistent testing specifically among young Black MSM and transgender women aged 16 to 29. METHODS We conducted 30 qualitative, semi-structured, in-depth interviews with young, Black, gay, bisexual or MSM and transgender women in the New York City metropolitan area to identify preferences for specific HIV tests and aspects of HIV testing options. Participants were primarily recruited from online and mobile sites, followed by community-based, face-to-face recruitment strategies to specifically reach younger participants. Thematic coding was utilized to analyze the qualitative data based on a grounded theoretical approach. RESULTS We identified how past experiences, perceived test characteristics (e.g., accuracy, cost, etc.) and beliefs about the "fit" between the individual, and the test relate to preferred testing methods and consistent testing. Three major themes emerged as important to preferences for HIV testing methods: the perceived accuracy of the test method, venue characteristics, and lack of knowledge or experience with the newer testing options, including self-testing and CHTC. CONCLUSIONS These findings suggest that increasing awareness of and access to newer HIV testing options (e.g., free or reduced price on home or self-tests or CHTC available at all testing venues) is critical if these new options are to facilitate increased levels of consistent testing among young, Black MSM and transgender women. Addressing perceptions of test accuracy and supporting front line staff in creating welcoming and safe testing environments may be key intervention targets. Connecting young Black MSM and transgender women to the best test option, given preferences for specific characteristics, may support more and more consistent HIV testing.
Collapse
Affiliation(s)
- Victoria Frye
- Department of Community Health and Social Medicine, Sophie Davis School of Biomedical Education, CUNY School of Medicine, City University of New York, New York, New York, United States of America
- Laboratory of Social and Behavioral Sciences, New York Blood Center, New York, New York, United States of America
| | - Leo Wilton
- Department of Human Development, College of Community and Public Affairs (CCPA), Binghamton University, Binghamton, New York, United States of America
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Sabina Hirshfield
- Division of Research and Evaluation, Public Health Solutions, New York, New York, United States of America
| | - Mary Ann Chiasson
- Division of Research and Evaluation, Public Health Solutions, New York, New York, United States of America
| | - Debbie Lucy
- Project ACHIEVE, Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York, United States of America
| | - DaShawn Usher
- Project ACHIEVE, Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York, United States of America
| | - Jermaine McCrossin
- Project ACHIEVE, Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York, United States of America
| | - Emily Greene
- Laboratory of Social and Behavioral Sciences, New York Blood Center, New York, New York, United States of America
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Beryl Koblin
- Project ACHIEVE, Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York, United States of America
| | | |
Collapse
|
18
|
Grace D, Jollimore J, MacPherson P, Strang MJ, Tan DH. The Pre-Exposure Prophylaxis-Stigma Paradox: Learning from Canada's First Wave of PrEP Users. AIDS Patient Care STDS 2018; 32:24-30. [PMID: 29185801 PMCID: PMC5756933 DOI: 10.1089/apc.2017.0153] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
With the emergence of daily oral tenofovir disoproxil fumarate and emtricitabine-based pre-exposure prophylaxis (PrEP) use in Canada, questions have emerged concerning the impacts of this HIV prevention tool on gay men's social and sexual lives. We conducted small focus groups and individual qualitative interviews with 16 gay men in Toronto who were part of the ‘first wave’ of Canadian PrEP users. Participants were on PrEP for at least one year as part of a demonstration project (November 2014–June 2016). These participants accessed PrEP before regulatory approval by Health Canada in February 2016. The mean age of participants was 37.6 years (SD 11.02); 94% completed secondary education, and 69% were white. Sex-stigma emerged as a complex theme in men's accounts of PrEP use across three overlapping domains: (1) PrEP-related stigma, including discussions of concealment and stigma from friends, family, and sexual partners, (2) PrEP as a perceived tool for combating HIV-related stigma, where some men said that they no longer discussed HIV status with sexual partners, and (3) PrEP as illuminating structural stigma, where it was attributed to unmasking stigma related to sex and sexuality. For some participants, PrEP has allowed for liberating sex and a self-described return to normalcy—normal, exciting, pleasurable sex that was no longer reliant on condom use. Paradoxically, some men said that PrEP use both led them to experience stigmatizing reactions within their social and sexual networks, while also helping to remove stigma, shame, and fear related to HIV, sexuality, and sex with gay men living with HIV.
Collapse
Affiliation(s)
- Daniel Grace
- University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Jody Jollimore
- Community-Based Research Centre for Gay Men's Health, Vancouver, British Columbia, Canada
| | | | | | | |
Collapse
|
19
|
Marks SJ, Merchant RC, Clark MA, Liu T, Rosenberger JG, Bauermeister J, Mayer KH. Potential Healthcare Insurance and Provider Barriers to Pre-Exposure Prophylaxis Utilization Among Young Men Who Have Sex with Men. AIDS Patient Care STDS 2017; 31:470-478. [PMID: 29087744 DOI: 10.1089/apc.2017.0171] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Young adult men-who-have-sex-with-men (YMSM) continue to have among the highest incidence of HIV infection in the United States. Pre-exposure prophylaxis (PrEP) is an effective and safe method of preventing HIV infection; however, despite US Food and Drug Administration approval, utilization remains low, in part, due to structural barriers, particularly access to healthcare. In this study, we used social media to recruit black, Hispanic, and white HIV-uninfected 18- to 24-year-old YMSM. Participants completed an online survey about their sexual behavior, healthcare access, and previous use of PrEP. Of the 2297 YMSM surveyed, only 3.4% had used PrEP. PrEP use was associated with higher levels of education, living alone, older age, higher levels of sexual activity, and greater healthcare access, specifically having healthcare insurance and a clinic or primary care provider (PCP) from whom they received care. Among PrEP nonusers, 65% met at least one of the US Centers for Disease Control and Prevention recommended indications for PrEP use, and of these, 59% had healthcare insurance and received care in a clinic and/or had a PCP. Multi-variable multi-nomial logistic regression modeling identified disparities in access to healthcare by age, race/ethnicity, education, and region. Specifically, older YMSM, blacks and Hispanics, those with fewer years of formal education, and residents of the southern and the western United States were more likely to lack healthcare access. These results demonstrate both potential opportunities and barriers to the scale-up of PrEP among YMSM.
Collapse
Affiliation(s)
- Sarah J. Marks
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Roland C. Merchant
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Melissa A. Clark
- Department of Quantitative Health Sciences, Center for Health Policy and Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, Rhode Island
| | - Joshua G. Rosenberger
- Department of Biobehavioral Health, Pennsylvania State University, State College, Pennsylvania
| | - Jose Bauermeister
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kenneth H. Mayer
- Fenway Health, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
20
|
Freese TE, Padwa H, Oeser BT, Rutkowski BA, Schulte MT. Real-World Strategies to Engage and Retain Racial-Ethnic Minority Young Men Who Have Sex with Men in HIV Prevention Services. AIDS Patient Care STDS 2017; 31:275-281. [PMID: 28530444 DOI: 10.1089/apc.2016.0310] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Racial/ethnic minority young men who have sex with men (YMSM)-particularly African Americans and Hispanics/Latinos-are at particularly high risk for HIV infection. Devising strategies to improve engagement and retention in HIV prevention services among minority YMSM is critical if the United States is going to achieve the National HIV/AIDS Strategy goal of reducing HIV health-related disparities. This article presents findings from a national summit on racial/ethnic YMSM services convened by the Substance Abuse and Mental Health Services Administration-funded Center of Excellence on Racial and Ethnic Minority Young Men Who Have Sex with Men and Other Lesbian, Gay, Bisexual, and Transgender Populations (YMSM + LGBT CoE) in September 2015. The summit included (1) subgroup discussions focused on issues related to treatment access, outreach/engagement/retention, continuing care/recovery support, and health literacy for minority YMSM; and (2) a ranking process, where the NIATx Nominal Group Technique was used to identify the strategies and approaches that summit participants believed to be most promising for engaging and retaining minority YMSM in HIV prevention services. Analyses of results from summit activities highlight four key cross-cutting strategies-utilizing peers, providing holistic care, making services fun, and utilizing technology-as critical for engaging minority YMSM in HIV prevention care. Examples of programs that utilize these strategies and implications of these findings for policy and practice are discussed.
Collapse
Affiliation(s)
- Thomas E. Freese
- Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles, California
| | - Howard Padwa
- Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles, California
| | - Brandy T. Oeser
- Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles, California
| | - Beth A. Rutkowski
- Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles, California
| | - Marya T. Schulte
- Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles, California
| |
Collapse
|
21
|
Herbst JH, Mansergh G, Pitts N, Denson D, Mimiaga MJ, Holman J. Effects of Brief Messages About Antiretroviral Therapy and Condom Use Benefits Among Black and Latino MSM in Three U.S. Cities. JOURNAL OF HOMOSEXUALITY 2017; 65:154-166. [PMID: 28346077 DOI: 10.1080/00918369.2017.1311554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This pilot study examined effects of HIV prevention messages about self and partner benefits of antiretroviral therapy (ART) and condom effectiveness on increased intentions for behavior change. Data were from Messages4Men, a study examining prevention messages among 320 HIV-positive and 605 HIV-negative Black and Latino MSM. Men completed a computer-based assessment after message exposure, and multivariable models controlled for risky sex and demographics. A majority of HIV-positive men reported increased intentions for ART use; 22% reported partner benefit information was new. HIV-positive men with a detectable viral load had significantly greater adjusted odds of reporting intentions for ART use. Over half of HIV-negative MSM reported ART benefit information was new, and 88% reported increased intentions to discuss ART use with infected partners. Black MSM anticipated they would increase condom use in response to the self and partner benefit messages. Tailored messages on benefits of ART are needed for MSM.
Collapse
Affiliation(s)
- Jeffrey H Herbst
- a Division of HIV/AIDS Prevention , National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention , Atlanta , Georgia , USA
| | - Gordon Mansergh
- a Division of HIV/AIDS Prevention , National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention , Atlanta , Georgia , USA
| | | | - Damian Denson
- a Division of HIV/AIDS Prevention , National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention , Atlanta , Georgia , USA
| | - Matthew J Mimiaga
- c John Snow Inc ., Boston , Massachusetts , USA
- d Departments of Epidemiology and Behavioral and Social Health Sciences , Brown University, School of Public Health , Providence , Rhode Island , USA
- e Institute for Community Health Promotion , Brown University , Providence , Rhode Island , USA
| | | |
Collapse
|