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Kanamori M, Shrader CH, Johnson A, Arroyo-Flores J, Rodriguez E, Skvoretz J, Fallon S, Gonzalez V, Safren S, Williams M, Doblecki-Lewis S. The Association Between Homophily on Illicit Drug Use and PrEP Conversations Among Latino Men Who Have Sex with Men Friends: A Dyadic Network and Spatially Explicit Study. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2485-2495. [PMID: 34791583 PMCID: PMC10102898 DOI: 10.1007/s10508-021-02131-4] [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: 01/11/2021] [Revised: 07/19/2021] [Accepted: 08/10/2021] [Indexed: 05/26/2023]
Abstract
Despite the wide availability of PrEP, Latino men who have sex with men (LMSM) continue to experience access barriers. Novel HIV prevention research strategies to increase PrEP uptake and adherence among the high incidence populations, such as LMSM who misuse drugs, include social network analyses. This study identified the associations of drug use homophily within LMSM friendship networks and PrEP promotion conversations and described the physical overlap between geographic drug risk areas with conversations of PrEP promotion. Respondent-driven sampling was used to recruit 10 sociocentric networks. Quadratic assignment procedure (QAP) correlations and multiple regression QAPs were used to identify influences of drug use homophily, and geocoding and visualizations to describe drug use polygons and PrEP conversations. Friendship relationships in which both friends used cocaine or marijuana were more likely to report PrEP-related conversations in the past six months. The likelihood of talking about PrEP in the next six months was higher among dyads with cocaine use homophily and ecstasy use homophily, while lower among dyads with marijuana use homophily. Participants reported using marijuana and cocaine throughout Miami-Dade County while ecstasy polygons were mostly in urban areas. The majority of drug polygons associated with PrEP conversations were located in north and central Miami. Future interventions can consider enrolling entire sociocentric friendship groups, configuring friendship networks to connect those without PrEP information to those with information, and incorporating peer leaders.
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Affiliation(s)
- Mariano Kanamori
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St. STE 1006, Miami, FL, 33136, USA.
| | - Cho-Hee Shrader
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St. STE 1006, Miami, FL, 33136, USA
| | - Ariana Johnson
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St. STE 1006, Miami, FL, 33136, USA
| | - Juan Arroyo-Flores
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St. STE 1006, Miami, FL, 33136, USA
| | - Edda Rodriguez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St. STE 1006, Miami, FL, 33136, USA
| | - John Skvoretz
- Department of Sociology, University of South Florida, Tampa, FL, USA
| | | | | | - Steven Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Mark Williams
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AK, USA
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Hawkinson DE, Operario D, Hess S, van den Berg JJ. Bridging the age gap: intergenerational communication of HIV risk and prevention among younger and older men who have sex with men. AIDS Care 2022; 35:538-544. [PMID: 35670016 DOI: 10.1080/09540121.2022.2085865] [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: 10/18/2022]
Abstract
ABSTRACTTrends in HIV incidence and prevalence vary between younger MSM (YMSM) and older MSM (OMSM). HIV prevention was revolutionized with the advent of pre-exposure prophylaxis (PrEP), but uptake of PrEP among OMSM is relatively unknown. Community connectedness among MSM is a strong driver of prevention. This qualitative study sought to explore similarities and differences between YMSM and OMSM's knowledge, perceptions, and barriers of HIV prevention and understand how intergenerational communication may enhance engagement in prevention, especially PrEP. Twenty semi-structured, in-depth interviews (ten YMSM and ten OMSM) were conducted with HIV-negative, non-monogamous MSM aged 18-24 and 55+ years. Interviews were transcribed and coded using NVivo 12 to identify themes within each age group and compare between age groups. YMSM expressed greater knowledge and more positive perceptions of PrEP than OMSM. OMSM felt that PrEP use increased engagement in sexual risk behavior. Both groups emphasized a need for more conversations between different age groups of MSM to educate each other about forms of prevention and reduce stigma. Intergenerational communication among MSM about HIV risk and prevention strategies may be an effective way to address the generational gaps in knowledge and perceptions and enhance engagement in HIV prevention.
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Affiliation(s)
- Drew E Hawkinson
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Don Operario
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Skylar Hess
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Jacob J van den Berg
- Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
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3
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Brooks RA, Landrian A, Lazalde G, Galvan FH, Liu H, Chen YT. Predictors of Awareness, Accessibility and Acceptability of Pre-exposure Prophylaxis (PrEP) Among English- and Spanish-Speaking Latino Men Who have Sex with Men in Los Angeles, California. J Immigr Minor Health 2021; 22:708-716. [PMID: 31823164 DOI: 10.1007/s10903-019-00955-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Uptake of pre-exposure prophylaxis (PrEP) among Latino men who have sex with men (LMSM) remains low. We examined awareness, accessibility, acceptability and use of PrEP among LMSM. LMSM were recruited using social/sexual networking apps. Multiple Logistic regressions identified significant predictors of PrEP awareness, accessibility and acceptability. Among 276 participants, only 6% reported current PrEP use. Among non-PrEP users, 85% reported PrEP awareness, 71% indicated high likelihood of future PrEP use, but only 35% reported knowledge about accessing PrEP. In multiple logistic regressions, a lower likelihood of PrEP awareness was associated with lower level education, whereas a higher likelihood was associated with reporting 6-10 or over 10 sexual partners. A lower likelihood of PrEP accessibility was associated with lower level education and undocumented status. A lower likelihood of PrEP acceptability was associated with an income of $15,001-30,000, whereas a higher likelihood was associated with lower level education and reporting 6-10 or over 10 sexual partners. PrEP promotion targeting Latino MSM should be expanded for those with lower levels of education and those who are undocumented.
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Affiliation(s)
- Ronald A Brooks
- Bienestar Human Services, Inc., Los Angeles, California, USA. .,Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA. .,Department of Family Medicine, UCLA, 10880 Wilshire Boulevard, Suite 1800, Los Angeles, CA, 90024, USA.
| | - Amanda Landrian
- Bienestar Human Services, Inc., Los Angeles, California, USA.,Department of Community Health Sciences, Fielding School of Public Health, Jonathan and Karin University of California, Los Angeles, California, USA
| | - Gabriela Lazalde
- Bienestar Human Services, Inc., Los Angeles, California, USA.,Department of Community Health Sciences, Fielding School of Public Health, Jonathan and Karin University of California, Los Angeles, California, USA
| | - Frank H Galvan
- Bienestar Human Services, Inc., Los Angeles, California, USA
| | - Honghu Liu
- Division of Public Health & Community Dentistry, School of Dentistry, University of California, Los Angeles, California, USA.,Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, California, USA.,Department of Biostatistics, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Ying-Tung Chen
- Bienestar Human Services, Inc., Los Angeles, California, USA
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4
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Brief Report: Using Behavioral Economics to Increase HIV Knowledge and Testing Among Latinx Sexual Minority Men and Transgender Women: A Quasi-Experimental Pilot Study. J Acquir Immune Defic Syndr 2021; 85:189-194. [PMID: 32931684 DOI: 10.1097/qai.0000000000002433] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine how weekly text messages and small incentives impact HIV knowledge and frequency of HIV testing among Latinx sexual minority men (LSMM) and transgender women (LTGW). DESIGN Prospectively randomized participants into 2 intervention arms compared with a nonrandomized comparison group. SETTING Bienestar, a primarily Latinx focused HIV service provider located across Los Angeles County. SUBJECTS, PARTICIPANTS Two hundred eighteen participants self-identifying as LSMM or LTGW, HIV negative, having regular mobile phone access, ≥18 years, and fluent in English or Spanish. INTERVENTION The "information only" (IO) group received text messages with HIV prevention information. The "information plus" (IP) group additionally could win incentives by answering weekly quiz questions correctly and testing for HIV once every 3 months. We followed participants for 12 months. MAIN OUTCOME MEASURE(S) HIV knowledge and frequency of HIV testing. RESULTS We found no effect on HIV knowledge in the IO group but a statistically significant improvement in the IP group (79.2%-88.1%; P = 0.007). The frequency of HIV testing was higher in both intervention groups relative to the comparison group: On average, 22.0% of IO participants and 24.9% of IP participants tested at a Bienestar site within a given 3-month period, compared with 13.0% in the comparison group. This represents unadjusted relative risk ratios of 1.69 for the IO group (95% CI: 1.25 to 2.1; P < 0.01) and 1.91 for the IP group (95% CI: 1.51 to 2.31; P < 0.01), respectively. CONCLUSIONS This study demonstrates that a simple, low-cost intervention may help increase HIV testing frequency among LSMM and LTGW, 2 groups at high HIV risk.
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5
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MacCarthy S, Mendoza-Graf A, Wagner Z, L Barreras J, Kim A, Giguere R, Carballo-Dieguez A, Linnemayr S. The acceptability and feasibility of a pilot study examining the impact of a mobile technology-based intervention informed by behavioral economics to improve HIV knowledge and testing frequency among Latinx sexual minority men and transgender women. BMC Public Health 2021; 21:341. [PMID: 33579242 PMCID: PMC7880516 DOI: 10.1186/s12889-021-10335-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background We developed a novel intervention that uses behavioral economics incentives and mobile-health text messages to increase HIV knowledge and testing frequency among Latinx sexual minority men and Latinx transgender women. Here we provide a theoretically-grounded assessment regarding the intervention’s acceptability and feasibility. Methods We conducted 30-min exit interviews with a stratified sample of participants (n = 26 Latinx sexual minority men, 15 Latinx transgender women), supplemented with insights from study staff (n = 6). All interviews were recorded, transcribed, and translated for a content analysis using Dedoose. Cohen’s Kappa was 89.4% across coded excerpts. We evaluated acceptability based on how participants cognitively and emotionally reacted to the intervention and whether they considered it to be appropriate. We measured feasibility based on resource, scientific and process assessments (e.g., functionality of text messaging service, feedback on study recruitment procedures and surveys). Results Regarding acceptability, most participants clearly understood the intervention as a program to receive information about HIV prevention methods through text messages. Participants who did not complete the intervention shared they did not fully understand what it entailed at their initial enrollment, and thought it was a one-time engagement and not an ongoing program. Though some participants with a higher level of education felt the information was simplistic, most appreciated moving beyond a narrow focus on HIV to include general information on sexually transmitted infections; drug use and impaired sexual decision-making; and differential risks associated with sexual positions and practices. Latinx transgender women in particular appreciated receiving information about Pre-Exposure Prophylaxis. While participants didn’t fully understand the exact chances of winning a prize in the quiz component, most enjoyed the quizzes and chance of winning a prize. Participants appreciated that the intervention required a minimal time investment. Participants shared that the intervention was generally culturally appropriate. Regarding feasibility, most participants reported the text message platform worked well though inactive participants consistently said technical difficulties led to their disengagement. Staff shared that clients had varying reactions to being approached while being tested for HIV, with some unwilling to enroll and others being very open and curious about the program. Both staff and participants relayed concerns regarding the length of the recruitment process and study surveys. Conclusions Our theoretically-grounded assessment shows the intervention is both acceptable and feasible. Trial registration The trial was registered on May 5, 2017 with the ClinicalTrials.gov registry [NCT03144336]. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10335-5.
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Affiliation(s)
- Sarah MacCarthy
- RAND Corporation, Behavioral and Policy Sciences, 1776 Main Street, Santa Monica, CA, USA.
| | | | - Zachary Wagner
- RAND Corporation, Economics, Sociology, and Statistics, 1776 Main Street, Santa Monica, CA, USA
| | - Joanna L Barreras
- Bienestar Human Services, Inc., 5326 East Beverly Blvd, Los Angeles, CA, 90022, USA.,School of Social Work, California State University, Long Beach, CA, USA
| | - Alice Kim
- RAND Corporation, Behavioral and Policy Sciences, 1776 Main Street, Santa Monica, CA, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Health and Sexuality, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, USA
| | - Alex Carballo-Dieguez
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Health and Sexuality, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, USA
| | - Sebastian Linnemayr
- RAND Corporation, Economics, Sociology, and Statistics, 1776 Main Street, Santa Monica, CA, USA
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6
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Lee JJ, Katz DA, Glick SN, Moreno C, Kerani RP. Immigrant Status and Sexual Orientation Disclosure: Implications for HIV/STD Prevention Among Men Who Have Sex with Men in Seattle, Washington. AIDS Behav 2020; 24:2819-2828. [PMID: 32170508 DOI: 10.1007/s10461-020-02831-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Men who have sex with men (MSM) are disproportionately affected by HIV and may avoid disclosing their sexual preferences to others. With heightened attention on immigrant status in the United States, foreign-born MSM may be particularly concerned about disclosing their sexual orientation. We sought to examine how immigrant status is associated with sexual orientation disclosure among MSM and to assess the impact of disclosure on HIV/STD prevention outcomes stratified by nativity. We analyzed data from the 2014 and 2017 Seattle-area surveys of MSM from the National HIV Behavioral Surveillance (NHBS) system. Foreign-born MSM were less likely than U.S.-born MSM to have disclosed their sexuality to friends who are not gay, lesbian, or bisexual (85.0% vs. 95.5%; p < .001) or to family members (80.5% vs. 91.3%; p < .001). Further, disclosure to one's health care provider significantly increased the likelihood of having tested for HIV in the past 12 months among foreign-born and U.S.-born MSM. Findings highlight the need to better understand the risks and benefits of disclosure among foreign-born MSM. Future research may explore how responses and reactions to disclosure among foreign-born MSM shape pathways to HIV risk and prevention.
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7
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Walters SM, Coston B, Neaigus A, Rivera AV, Starbuck L, Ramirez V, Reilly KH, Braunstein SL. The role of syringe exchange programs and sexual identity in awareness of pre-exposure prophylaxis (PrEP) for male persons who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 77:102671. [PMID: 32092665 DOI: 10.1016/j.drugpo.2020.102671] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 01/13/2020] [Accepted: 01/20/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Male persons who inject drugs (male PWID) are at heightened risk for HIV, particularly if they also have sex with men. Pre-exposure prophylaxis (PrEP) could aid in HIV prevention for this population, but PrEP awareness within different sexual identities among male PWID is not well-understood. We report factors associated with greater awareness among male PWID to identify efficient means of awareness dissemination. METHODS Data from the 2015 National HIV Behavioral Surveillance (NHBS) system cycle on injection drug use collected in New York City (NYC) were used. Bivariable analyses, using chi-squared statistics, were conducted to examine correlates of awareness of PrEP with socio-demographic, behavioral, and health care variables. Log-linked Poisson regression with robust standard errors was used to estimate adjusted prevalence ratios and determine differences in awareness of PrEP. RESULTS Among a sample of 332 male PWID (i.e., PWID who identified as male, not transgender) we find awareness of PrEP to be low (23%) among male PWID despite 68% reporting condomless vaginal/anal sex and 32% reporting injection equipment sharing in the last twelve months. Multivariable analysis found greater PrEP awareness associated with gay or bisexual identity (aPR: 2.77, 95% CI: 1.81-4.24) and having a conversation about HIV prevention at a syringe exchange program (SEP) (aPR: 2.71, 95% CI: 1.87-3.94) to be associated with increased PrEP awareness. CONCLUSION We found low rates of PrEP awareness among male PWID. However, our findings provide insight into information diffusion that can be utilized to increase PrEP awareness among male PWID and among all PWID. We suggest that gay and bisexual social networks and syringe exchange programs are diffusing PrEP awareness among male PWID and can be harnessed to increase PrEP awareness among male PWID.
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Affiliation(s)
- Suzan M Walters
- Rory Meyers College of Nursing, New York University, New York, NY, United States; Center for Drug Use and HIV/HCV Research, New York, NY, United States.
| | - Bethany Coston
- Department of Gender, Sexuality, and Women's Studies, Virginia Commonwealth University, Richmond, VA, United States
| | - Alan Neaigus
- Department of Epidemiology Joseph L. Mailman School of Public Health, Columbia University, NY, United States
| | - Alexis V Rivera
- New York City Department of Health and Mental Hygiene, New York, NY, United States
| | - Lila Starbuck
- New York City Department of Health and Mental Hygiene, New York, NY, United States
| | - Valentina Ramirez
- New York City Department of Health and Mental Hygiene, New York, NY, United States
| | - Kathleen H Reilly
- New York City Department of Health and Mental Hygiene, New York, NY, United States
| | - Sarah L Braunstein
- New York City Department of Health and Mental Hygiene, New York, NY, United States
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8
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Algarin AB, Shrader CH, Bhatt C, Hackworth BT, Cook RL, Ibañez GE. The Pre-exposure Prophylaxis (PrEP) Continuum of Care and Correlates to Initiation Among HIV-Negative Men Recruited at Miami Gay Pride 2018. J Urban Health 2019; 96:835-844. [PMID: 31165357 PMCID: PMC6904709 DOI: 10.1007/s11524-019-00362-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
While the national HIV infection rate is decreasing, the highest rates of infections continue among men who have sex with men (MSM), particularly minority MSM. It is important to understand attitudes, knowledge, and behaviors surrounding HIV prevention methods, such as pre-exposure prophylaxis (PrEP). In the present study, we created a snapshot of the PrEP continuum of care and identified participant demographic and sources of PrEP awareness factors that were associated with PrEP initiation. Data were collected using anonymous paper-based surveys employing a venue intercept procedure. A total of 188 HIV-negative men completed the survey at Miami Gay Pride 2018. Participants answered questions regarding demographics, PrEP use, and sources of PrEP awareness. The sample was majority Hispanic (55.4%), gay (83.0%), and single (57.7%). The constructed PrEP continuum revealed that a low proportion of those identified as PrEP naïve (n = 143) for HIV infection had PrEP interest (49/143). Moreover, among those who initiated PrEP (n = 45), a high proportion were retained in a PrEP program (37/45), with approximately half achieving medication adherence (25/45). Age group, PrEP knowledge, and source of PrEP awareness were all significantly associated with PrEP initiation. In areas with high HIV infection rates, studies like these offer crucial insight on how public health practitioners should proceed in the goal of decreasing HIV transmission rates. More research is needed to increase PrEP uptake and adherence.
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Affiliation(s)
- Angel B Algarin
- Department of Epidemiology; Robert Stempel College of Public Health & Social Work, Florida International University, 11200 SW 8th Street AHC5, Miami, FL, 33199, USA.
| | - Cho Hee Shrader
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Chintan Bhatt
- Department of Health Promotion and Disease Prevention; Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | | | - Robert L Cook
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Gladys E Ibañez
- Department of Epidemiology; Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
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9
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Moeller RW, Seehuus M, Wahl L, Gratch I. Use of PrEP, sexual behaviors and mental health correlates in a sample of gay, bisexual and other men who have sex with men. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2019. [DOI: 10.1080/19359705.2019.1688216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Robert W. Moeller
- Department of Psychology, Middlebury College, Middlebury, Vermont, USA
| | - Martin Seehuus
- Department of Psychology, Middlebury College, Middlebury, Vermont, USA
- Department of Psychological Science, University of Vermont, Burlington, Vermont, USA
| | - Logan Wahl
- Department of Psychology, Middlebury College, Middlebury, Vermont, USA
| | - Ilana Gratch
- Department of Psychology, Middlebury College, Middlebury, Vermont, USA
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10
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Walsh JL. Applying the Information-Motivation-Behavioral Skills Model to Understand PrEP Intentions and Use Among Men Who Have Sex with Men. AIDS Behav 2019; 23:1904-1916. [PMID: 30554396 PMCID: PMC6571043 DOI: 10.1007/s10461-018-2371-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Research is needed to determine targets for interventions to increase pre-exposure prophylaxis (PrEP) uptake. The Information-Motivation-Behavioral Skills (IMB) model has not been tested for PrEP use among men who have sex with men (MSM). Men and transgender women and men were surveyed at a community event in the Midwest in 2016 (N = 476, 60% White, Mage = 35). New measures assessed PrEP knowledge, attitudes, stigma, descriptive and subjective norms, and intentions, and participants reported on PrEP use. We tested the IMB model for a subsample of HIV-negative MSM and transgender individuals (N = 357) using structural equation modeling. Only 12% of participants used PrEP. New measures performed well and were reliable (αs = 0.83-0.94). Structural models generally supported the IMB model: knowledge, stigma, and self-efficacy were directly associated with use, and attitudes, stigma, and descriptive norms had indirect effects on use via self-efficacy. The IMB model may be useful when developing PrEP interventions for MSM.
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Affiliation(s)
- Jennifer L Walsh
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, The Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI, 53202, USA.
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11
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"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.
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12
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John SA, Rendina HJ, Starks TJ, Grov C, Parsons JT. Decisional Balance and Contemplation Ladder to Support Interventions for HIV Pre-Exposure Prophylaxis Uptake and Persistence. AIDS Patient Care STDS 2019; 33:67-78. [PMID: 30653348 DOI: 10.1089/apc.2018.0136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Fewer than 60,000 males-inclusive of all sexual identities-were prescribed HIV pre-exposure prophylaxis (PrEP) by mid-2017 in the United States. Efforts to increase PrEP uptake among gay, bisexual, and other men who have sex with men (GBM), in particular, are ongoing in research and practice settings, but few tools exist to support interventions. We aimed to develop and validate tools to support motivational interviewing interventions for PrEP. In 2017, a national sample of HIV-negative GBM of relatively high socioeconomic status (n = 786) was asked about sexual behaviors that encompass Centers for Disease Control and Prevention guidelines for PrEP use, a 35-item decisional-balance scale (i.e., PrEP-DB) assessing benefits and consequences of PrEP use, and questions assessing location on the motivational PrEP cascade and derivative-the PrEP contemplation ladder. Principal axis factoring with oblique promax rotation was used for PrEP-DB construct identification and item reduction. The final 20-item PrEP-DB performed well; eigenvalues indicating a 4-factor solution provided an adequate fit to the data. Factors included the following: health benefits (α = 0.91), health consequences (α = 0.82), social benefits (α = 0.72), and social consequences (α = 0.86). Ladder scores increased across the cascade (ρ = 0.89, p < 0.001), and health benefits (β = 0.50, p < 0.001) and health consequences (β = -0.37, p < 0.001) were more strongly associated with ladder location than social benefits (β = 0.05, p > 0.05) and social consequences (β = -0.05, p > 0.05) in the fully adjusted regression model. The PrEP-DB demonstrated good reliability and predictive validity, and the ladder had strong construct validity with the motivational PrEP cascade. PrEP uptake and persistence interventions and additional empirical work could benefit from the utility of these measures.
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Affiliation(s)
- Steven A. John
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - H. Jonathon Rendina
- Department of Psychology, Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, New York
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, New York
| | - Tyrel J. Starks
- Department of Psychology, Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, New York
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, New York
| | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, The CUNY Institute for Implementation Science in Population Health, New York, New York
| | - Jeffrey T. Parsons
- Department of Psychology, Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, New York
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, New York
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13
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Dubov A, Altice FL, Fraenkel L. An Information-Motivation-Behavioral Skills Model of PrEP Uptake. AIDS Behav 2018; 22:3603-3616. [PMID: 29557540 DOI: 10.1007/s10461-018-2095-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Despite documented effectiveness of pre-exposure prophylaxis (PrEP), PrEP uptake remains low among at-risk populations. The 2015 CDC report estimates that about 1.2 million people in the US have indications for PrEP. However, only 49,158 or 4% of the targeted population are currently using PrEP. Efforts to optimize uptake of PrEP may be facilitated by the development of a comprehensive theoretical framework which can be used to understand reasons for poor uptake and to develop interventions to maximize PrEP uptake and adherence. This article reviews research on correlates of PrEP uptake and presents findings organized within an Information-Motivation-Behavioral Skills (IMB) model framework. In the context of PrEP uptake, the IMB model asserts that to the extent that at-risk groups are well-informed about PrEP, motivated to act on their knowledge, and have necessary behavioral skills to seek out and initiate PrEP regimen, they will successfully overcome obstacles to initiate and adhere to PrEP. The article proposes an adaptation the IMB model for PrEP uptake, provides empirical support for the adapted IMB model extracted from related research, and discusses its application in PrEP uptake interventions.
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Brooks RA, Nieto O, Landrian A, Donohoe TJ. Persistent stigmatizing and negative perceptions of pre-exposure prophylaxis (PrEP) users: implications for PrEP adoption among Latino men who have sex with men. AIDS Care 2018; 31:427-435. [PMID: 30021456 DOI: 10.1080/09540121.2018.1499864] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The Centers for Disease Control and Prevention (CDC) estimates the lifetime HIV risk is one in four for Latino men who have sex with men (MSM). Pre-Exposure Prophylaxis (PrEP) is an efficacious biomedical prevention strategy to help prevent the acquisition of HIV. At present, there has been limited uptake of PrEP by Latino MSM. Unfortunately, the negative perceptions and social stigma surrounding PrEP and those who use it may deter uptake of this novel prevention strategy, particularly among high-risk Latino MSM. In this qualitative study, we explore the experiences of using PrEP among Latino MSM. Participants were recruited using gay-oriented social and sexual networking apps to complete an interviewer-administered, semi-structured qualitative interview. Thematic analysis was used to identify emerging themes relating to perceptions of PrEP users and PrEP as an HIV prevention strategy. Major themes included: feelings of protection and sexual freedom; negative and stigmatizing labels associated with PrEP use; assumptions about sexual behaviors and perceptions of sexual risk taking and irresponsibility; and attitudes related to PrEP use in relationships. A striking but not prevalent theme was the perception reported by participants that monolingual Spanish-speaking Latino MSM are skeptical about the effectiveness of PrEP. These findings suggest that efforts are needed to address the stigmatizing and negative perceptions of PrEP that persist in the gay community that may deter adoption among Latino MSM.
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Affiliation(s)
- Ronald A Brooks
- a Department of Family Medicine , University of California , Los Angeles , CA , USA
| | - Omar Nieto
- a Department of Family Medicine , University of California , Los Angeles , CA , USA
| | - Amanda Landrian
- a Department of Family Medicine , University of California , Los Angeles , CA , USA.,b Department of Community Health Sciences , Fielding School of Public Health, University of California , Los Angeles , CA , USA
| | - Thomas J Donohoe
- a Department of Family Medicine , University of California , Los Angeles , CA , USA
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Differences in Awareness of Pre-exposure Prophylaxis and Post-exposure Prophylaxis Among Groups At-Risk for HIV in New York State: New York City and Long Island, NY, 2011-2013. J Acquir Immune Defic Syndr 2017; 75 Suppl 3:S383-S391. [PMID: 28604443 DOI: 10.1097/qai.0000000000001415] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) to reduce the risk of HIV was approved in 2012 and post-exposure prophylaxis (PEP) in 2005. We report the differences in awareness of PrEP/PEP and factors associated with awareness by examining 3 risk groups (men who have sex with men (MSM), people who inject drugs, and high-risk heterosexuals). METHODS National HIV Behavioral Surveillance system data collected in New York City (NYC) and Long Island, NY in 2011-2013 were used. Logistic regressions by region were developed to estimate adjusted associations [Adjusted Odds Ratios (AOR)] and determine differences in awareness of PrEP/PEP. RESULTS Awareness of PrEP/PEP was low for all groups. In multivariate analysis controlling for sociodemographic factors, noninjection drug use, HIV status, and exposure to HIV prevention, males who inject drugs in NYC had significantly decreased odds of PrEP/PEP awareness [AOR: 0.45; confidence interval (CI): 0.25 to 0.81] compared with MSM. MSM aged 18-29 years had increased awareness of PrEP (AOR: 2.94; 95% CI 1.11 to 7.80). On Long Island, females who inject drugs (AOR: 0.18; 95% CI: 0.05 to 0.62), males who inject drugs (AOR: 0.14; 95% CI: 0.05 to 0.39), female heterosexuals (AOR: 0.25; 95% CI: 0.11 to 0.59), and male heterosexuals (AOR: 0.32; 95% CI: 0.14 to 0.73) had significantly decreased odds of PrEP/PEP awareness. Black MSM had increased awareness of PrEP (AOR: 4.08 CI:1.21 to 13.73). CONCLUSIONS Large proportions of groups at-risk for HIV were unaware of PrEP/PEP. When comparing risk groups to MSM, we found MSM to have greater awareness in both regions. On Long Island, people who inject drugs and heterosexuals were far less likely to have PrEP/PEP awareness than in NYC. On Long Island, Black MSM had increased PrEP awareness and in NYC MSM aged 18-29 had increased PrEP awareness. These findings suggest that awareness may be spreading through networks and highlight the importance of targeted educational and prevention efforts by group and region.
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Walters SM, Reilly KH, Neaigus A, Braunstein S. Awareness of pre-exposure prophylaxis (PrEP) among women who inject drugs in NYC: the importance of networks and syringe exchange programs for HIV prevention. Harm Reduct J 2017; 14:40. [PMID: 28662716 PMCID: PMC5492910 DOI: 10.1186/s12954-017-0166-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women who inject drugs (WWID) are at heightened risk for HIV due to biological, behavioral, and structural factors. Pre-exposure prophylaxis (PrEP) could aid in HIV prevention for WWID. However, little is known about WWID awareness of PrEP, which is a necessary step that must occur before PrEP uptake. We report factors associated with greater awareness among WWID to identify efficient means of awareness dissemination. METHODS Data from the 2015 National HIV Behavioral Surveillance (NHBS) system cycle on injection drug use collected in New York City (NYC) were used. Bivariable analyses, using chi-squared statistics, were conducted to examine correlates of awareness of PrEP with socio-demographic, behavioral, and health care variables. Multivariable logistic regression was used to estimate adjusted associations and determine differences in awareness of PrEP. RESULTS The analysis consisted of 118 WWID. Awareness of PrEP was relatively low (31%), and risk factors were high. In the last 12 months, almost two thirds (65%) reported condomless sex, approximately one third (31%) reported transactional sex, and one third (32%) reported sharing injection equipment. In multivariable logistic regression, increased PrEP awareness was associated with reported transactional sex (AOR 3.32, 95% CI 1.22-9.00) and having a conversation about HIV prevention at a syringe exchange program (SEP) (AOR 7.61, 95% CI 2.65-21.84). We did not find race, education, household income, age, binge drinking, or sexual identity to be significantly associated with PrEP awareness. CONCLUSIONS Large proportions of WWID were unaware of PrEP. These findings suggest that social networks (specifically sex work and SEP networks) are an efficient means for disseminating messaging about prevention materials such as PrEP. We recommend that SEP access increase, SEP processes be adopted in other health care settings, and WWID networks be utilized to increase PrEP awareness.
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Affiliation(s)
- Suzan M Walters
- Department of Sociology, State University of New York at Stony Brook, Stony Brook, NY, USA.
- , Stony Brook, New York, NY, 11794-4356, USA.
| | - Kathleen H Reilly
- New York City Department of Health and Mental Hygiene, New York City, NY, USA
| | - Alan Neaigus
- Department of Epidemiology Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sarah Braunstein
- New York City Department of Health and Mental Hygiene, New York City, NY, USA
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Gupta S, Lounsbury DW, Patel VV. Low Awareness and Use of Preexposure Prophylaxis in a Diverse Online Sample of Men Who Have Sex With Men in New York City. J Assoc Nurses AIDS Care 2016; 28:27-33. [PMID: 27816387 DOI: 10.1016/j.jana.2016.10.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/10/2016] [Indexed: 01/03/2023]
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Goedel WC, Halkitis PN, Greene RE, Hickson DA, Duncan DT. HIV Risk Behaviors, Perceptions, and Testing and Preexposure Prophylaxis (PrEP) Awareness/Use in Grindr-Using Men Who Have Sex With Men in Atlanta, Georgia. J Assoc Nurses AIDS Care 2016; 27:133-42. [PMID: 26708834 PMCID: PMC5453651 DOI: 10.1016/j.jana.2015.11.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/12/2015] [Indexed: 11/29/2022]
Abstract
Geosocial-networking smartphone applications such as Grindr can help men who have sex with men (MSM) meet sexual partners. Given the high incidence of HIV in the Deep South, the purpose of our study was to assess HIV risk and preexposure prophylaxis (PrEP) awareness and use in a sample of HIV-uninfected, Grindr-using MSM residing in Atlanta, Georgia (n = 84). Most (n = 71; 84.6%) reported being somewhat or very concerned about becoming HIV infected. Most (n = 74; 88.1%) had been tested for HIV in their lifetimes. About three fourths (n = 65; 77.4%) were aware of PrEP, but only 11.9% currently used the medication. HIV continues to disproportionately impact MSM and represents a significant source of concern. As the number of new infections continues to rise, it is important to decrease risks associated with acquisition and transmission of HIV by increasing rates of HIV testing and the use of biobehavioral interventions such as PrEP.
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Affiliation(s)
- William C. Goedel
- Undergraduate student at the New York University College of Global Public Health, New York, New York, USA
| | - Perry N. Halkitis
- Associate Dean for Academic Affairs, New York University College of Global Public Health, New York, New York, USA
| | - Richard E. Greene
- Director of Gender and Health Education, New York University School of Medicine, New York, New York, USA
| | - DeMarc A. Hickson
- Director of Planning and Development, My Brother’s Keeper, Inc., Jackson, Mississippi, USA
| | - Dustin T. Duncan
- Assistant Professor, New York University School of Medicine, Department of Population Health, New York, New York, USA
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Merchant RC, Corner D, Garza E, Guan W, Mayer KH, Brown L, Chan PA. Preferences for HIV pre-exposure prophylaxis (PrEP) information among men-who-have-sex-with-men (MSM) at community outreach settings. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2015; 20:21-33. [PMID: 27076865 DOI: 10.1080/19359705.2015.1105115] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Community outreach efforts to increase HIV pre-exposure prophylaxis (PrEP) utilization by at risk men-who-have-sex-with-men (MSM) first need to elucidate preferences for learning about PrEP and linking to PrEP resources. In this pilot study, we observed that among MSM recruited through community outreach, HIV sexual risk-taking was significant, yet self-perceived PrEP knowledge was low and interest in learning more about PrEP was moderate. Most preferred learning about PrEP and being provided local PrEP clinic information through electronic media. However, receipt of PrEP information alone did not appear to motivate these men into presenting to a local clinic for PrEP evaluation.
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Affiliation(s)
- Roland C Merchant
- Department of Emergency Medicine, Brown University, Providence, RI; Department of Epidemiology, Brown University, Providence, RI
| | - David Corner
- Alpert Medical School of Brown University, Providence, RI
| | - Eduardo Garza
- Alpert Medical School of Brown University, Providence, RI
| | - Wentao Guan
- Department of Biostatistics, Brown University, Providence, RI
| | | | - Larry Brown
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI
| | - Philip A Chan
- Department of Medicine, Division of Infectious Diseases, Brown University, Providence, RI
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Hoff CC, Chakravarty D, Bircher AE, Campbell CK, Grisham K, Neilands TB, Wilson PA, Dworkin S. Attitudes Towards PrEP and Anticipated Condom Use Among Concordant HIV-Negative and HIV-Discordant Male Couples. AIDS Patient Care STDS 2015; 29:408-17. [PMID: 26057304 DOI: 10.1089/apc.2014.0315] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Since the July 2012 approval by the FDA of emtricitabine/ tenofovir disoproxil fumarate (Truvada) for use as pre-exposure prophylaxis (PrEP) against HIV, its feasibility and acceptability has been under study. HIV-discordant couples are likely targets for PrEP but little is known about how this new prevention tool impacts relationships. We examined, among gay male couples, the acceptability of individual and partner use of PrEP and intentions to use condoms with primary and outside partners in the context of PrEP use. Data are from two independent samples of couples recruited in the San Francisco bay area and New York City-a qualitative one (N=48 couples) between March and November, 2011, and a quantitative one (N=171 couples) between June, 2012 and May, 2013. Data were categorized by couple HIV status and general linear models; chi-square tests of independence were used to examine condom-use intentions with primary and outside partners, by sexual risk profile, and race. Almost half of the HIV-negative couples felt PrEP was a good HIV prevention strategy for themselves and their partner. Over half reported that they would not change their current condom use if they or their partner were taking PrEP. However, approximately 30% of HIV-negative couples reported that they would stop using condoms or use them less with primary and outside partners if they were on PrEP or if their partner was on PrEP. A large percentage of couples view PrEP positively. However, to ensure safety for both partners, future programing must consider those who intend not to use condoms while on PrEP.
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Affiliation(s)
- Colleen C. Hoff
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, California
| | - Deepalika Chakravarty
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, California
- Center for AIDS Prevention Studies, University of California at San Francisco, San Francisco, California
| | - Anja E. Bircher
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, California
| | - Chadwick K. Campbell
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, California
| | - Kirk Grisham
- Columbia University, Mailman School of Public Health, New York City, New York
| | - Torsten B. Neilands
- Center for AIDS Prevention Studies, University of California at San Francisco, San Francisco, California
| | - Patrick A. Wilson
- Columbia University, Mailman School of Public Health, New York City, New York
| | - Shari Dworkin
- Department of Social and Behavioral Sciences, University of California at San Francisco, San Francisco, California
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Acceptability of PrEP among HIV negative Portuguese men who have sex with men that attended 2014 Lisbon pride fair. J Int AIDS Soc 2014; 17:19734. [PMID: 25397480 PMCID: PMC4225295 DOI: 10.7448/ias.17.4.19734] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Consistent use of PrEP reduces HIV transmission from sexual practices amongst men who have sex with men (MSM) up to 92% [1]. Lisbon MSM cohort study estimates point that 59.3% of their participants at entrance (1593 HIV negative MSM enrolled between April 2011 and May 2013) were eligible for PrEP [2], according to the 2014 USA PrEP guidelines [3]. Studies about PrEP acceptability and implementation support policies aimed at increasing and rolling out its use. Hence, the exploratory study about PrEP acceptability in MSM at Lisbon. Materials and Methods A street-based intercept survey, adapted from Mantell et al. study [4], was the one used on MSM attending the 2014 Lisbon pride fair. The survey included socio-demographic data, PrEP awareness and readiness to use it, probability of MSM's social network to also use it, promptness to join PrEP-related studies, type of PrEP warranted and condomless anal sex practice in the last six months. Results A total of 110 HIV negative Portuguese MSM responded, with a median age of 33% and 84% of them identified themselves as gay. A majority of MSM were unaware of PrEP (59%); those that were aware, had heard of it trough CheckpointLx (31%), internet (22%) or health professionals (20%). 66% were likely or very likely to participate in PrEP-related studies. 57% of MSM were likely or very likely to use PrEP if available and reported that some, if not almost all of their social network, will do it too (70%). Type of PrEP preferred was oral, a pill a day (43%), followed by oral, intermittent intake (32%). Overall 41% of MSM had condomless anal sex practice in the last six months. Conclusions In this MSM Portuguese sample, a general willingness to adopt PrEP was predominant, specially the oral daily intake. Forty-one percent of participants had had condomless anal sex practice in the last six months and therefore fitted within the criteria to be on Pre-Exposure Prophylaxis (PrEP), according to MSM Risk Index in 2014 USA PrEP guidelines. PrEP, when available in Portugal, should be a powerful tool for HIV prevention in this key population.
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International Congress of Drug Therapy in HIV Infection 2-6 November 2014, Glasgow, UK. J Int AIDS Soc 2014. [DOI: 10.7448/ias.17.4.19856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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