1
|
Galeano AC, Rincón-Rodríguez CJ, Gil F, Valderrama-Beltrán S. Association between CD4 lymphocyte count and the incidence of comorbidities in Human immunodeficiency virus positive patients with virological suppression after antiretroviral treatment. Int J STD AIDS 2024:9564624241264041. [PMID: 39030669 DOI: 10.1177/09564624241264041] [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: 07/21/2024]
Abstract
BACKGROUND The incidence of comorbidities is higher in HIV-positive patients than in the general population due to factors, such as HIV-related chronic inflammation. There is no consensus on whether a low CD4 lymphocyte count after virological suppression at long-term follow-up increases the risk of comorbidities. This study evaluates the association between CD4 lymphocyte count and the incidence of comorbidities during the first 5 years of virological suppression after highly active antiretroviral treatment. METHODS We conducted a cohort study of HIV-positive adults who achieved virological suppression in an HIV program between 2002 and 2016 in Colombia. A generalized equation estimation model was used to estimate the association between CD4 lymphocyte count and the incidence of comorbidities. RESULTS A follow-up period of at least 1 year was completed in 921 HIV-positive patients with virological suppression. We found 71 comorbidities during a maximum of 5 years of follow-up; 41 (59%) were AIDS-defining comorbidities and 19 (46%) of them occurred during the first semester. Thirty cases of non-AIDS- defining comorbidities were diagnosed.We did not find any association between CD4 lymphocyte count and the incidence of comorbidities (OR 0.92, CI 95% 0.45 -1.91 for CD4 201-499 cells/µL vs CD4 ≤200 cells/µL, and OR 0.55, 95% CI 0.21-1.44 for CD4 ≥500 cells/µL vs CD4 ≤200 cells/µL). CONCLUSION No association was found between CD4 lymphocyte count and the incidence of AIDS-defining or non-AIDS-defining comorbidities in patients with virological suppression. Further studies are needed to assess the risk of comorbidities in this population to design interventions aimed at improving their prognosis.
Collapse
Affiliation(s)
- Adriana C Galeano
- School of Medicine, Pontificia Universidad Javeriana, Bogotá, DC, Colombia
| | - C J Rincón-Rodríguez
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, DC, Colombia
| | - Fabián Gil
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, DC, Colombia
| | - S Valderrama-Beltrán
- Division of Infectious Diseases, Hospital Universitario San Ignacio, Bogotá, DC, Colombia
| |
Collapse
|
2
|
Sevelius J, Veras MASM, Gomez JL, Saggese G, Mocello AR, Bassichetto KC, Neilands TB, Lippman SA. Reducing intersectional stigma among transgender women in Brazil to promote uptake of HIV testing and PrEP: study protocol for a randomised controlled trial of Manas por Manas. BMJ Open 2024; 14:e076878. [PMID: 38908840 DOI: 10.1136/bmjopen-2023-076878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2024] Open
Abstract
INTRODUCTION Globally, transgender ('trans') women experience extreme social and economic marginalisation due to intersectional stigma, defined as the confluence of stigma that results from the intersection of social identities and positions among those who are oppressed multiple times. Among trans women, gender-based stigma intersects with social positions such as engagement in sex work and substance use, as well as race-based stigma to generate a social context of vulnerability and increased risk of HIV acquisition. In Brazil, trans women are the 'most at-risk' group for HIV, with 55 times higher estimated odds of HIV infection than the general population; further, uptake of HIV testing and pre-exposure prophylaxis (PrEP) among trans women is significantly lower than other at-risk groups. Through extensive formative work, we developed Manas por Manas, a multilevel intervention using HIV prevention strategies with demonstrated feasibility and acceptability by trans women in Brazil, to address intersectional stigma and increase engagement in the HIV prevention continuum. METHODS AND ANALYSIS We are conducting a two-arm randomised wait-list controlled trial of the intervention's efficacy in São Paulo, Brazil, to improve uptake of HIV testing and PrEP among transgender women (N=400). The primary outcomes are changes in HIV testing (self-testing and clinic based), changes in PrEP uptake and changes in PrEP persistence at baseline and follow-up assessment for 12 months at 3-month intervals. ETHICS AND DISSEMINATION This study was approved by University of California, San Francisco Institutional Review Board (15-17910) and Comissão Nacional de Ética em Pesquisa (Research Ethics National Commission, CAAE: 25215219.8.0000.5479) in Brazil. Participants provided informed consent before enrolment. We are committed to collaboration with National Institutes of Health officials, other researchers, and health and social services communities for rapid dissemination of data and sharing of materials. The results will be published in peer-reviewed academic journals and scientific presentations. TRIAL REGISTRATION NUMBER NCT03081559.
Collapse
Affiliation(s)
- Jae Sevelius
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Jose Luis Gomez
- Department of Public Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Gustavo Saggese
- Department of Public Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Adrienne Rain Mocello
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Katia Cristina Bassichetto
- Department of Public Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Torsten B Neilands
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sheri A Lippman
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
3
|
Al-Kassab-Córdova A, Mendez-Guerra C, Robles-Valcarcel P, Bendezu-Quispe G, Benites-Zapata VA. Access to HIV/STI testing among male and female Venezuelan migrants in Peru: evidence from a nationwide survey. BMC Public Health 2024; 24:210. [PMID: 38233806 PMCID: PMC10795413 DOI: 10.1186/s12889-024-17655-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection and sexually transmitted infections (STIs) are major global public health issues. Migrants represent a vulnerable group that faces multiple barriers to access to healthcare services, including HIV/STI testing. This study aimed to assess the factors associated with access to HIV/STI testing in male and female Venezuelan migrants in Peru. METHODS This was a cross-sectional study involving secondary data analysis of the 2022 Venezuelan Population Residing in Peru Survey. The study was conducted in the eight most populated cities inhabited by Venezuelan migrants and refugees. For each city, the sampling design was probabilistic, stratified, and independent. The outcome variable was whether participants had access to HIV or other STI testing during their stay in Peru. Statistical analysis was stratified by sex owing to potential effect modification. Crude and adjusted prevalence ratios were calculated using generalized linear models Poisson family with log link function. Confidence intervals were calculated to 95%. RESULTS A total of 3,723 male and 3,984 female migrants were included. Access to HIV/STI testing among male and female migrants was 19.85% and 25.16%, respectively. Among male migrants, being LGBTI, health insured, and married or cohabiting were associated with increased access to HIV/STI testing. Among females, those aged 18-44 years, those who were married or cohabiting and were health insured, and those residing for more than 1 year in Peru were significantly more likely to have access to HIV/STI testing. Moreover, physical/mental disability and unemployed status were associated with a lower probability of HIV/STI testing in females. CONCLUSIONS Only two in ten Venezuelan migrants and refugees in Peru were screened for HIV/STI, with fewer males than females. Sex-specific sociodemographic, health-related, and migration-related variables were independently associated with access to HIV/STI testing.
Collapse
Affiliation(s)
| | | | | | | | - Vicente A Benites-Zapata
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru.
| |
Collapse
|
4
|
van der Merwe LLA, Cloete A, Savva H, Skinner D, November G, Fisher ZZ. Engaging transgender women in HIV research in South Africa. BMC Public Health 2023; 23:990. [PMID: 37248495 DOI: 10.1186/s12889-023-15977-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 05/23/2023] [Indexed: 05/31/2023] Open
Abstract
The Botshelo Ba Trans study was the first HIV bio-behavioral survey conducted with transgender women in South Africa. Engaging research with marginalized communities requires clear points of entry, reference points for understanding the internal culture, and establishing trust and understanding. The community-based participatory research approach guided the development and implementation of this study. We conducted a rapid qualitative and pre-surveillance formative assessment between August 2017 to January 2018 and a bio-behavioral survey between July 2018 and March 2019. At the start, a Steering Committee, comprising primarily of transgender women, was established and subsequently provided substantial input into the mixed methods study conducted in Buffalo City, Cape Town, and Johannesburg. Key to the study's success was building trust and establishing ownership of the survey by transgender women recognized as expert knowledge holders. Thus, a community-based participatory research-informed approach enhanced the validity of the data and ensured that we addressed relevant issues.
Collapse
Affiliation(s)
- L Leigh Ann van der Merwe
- Social, Health, and Empowerment (S.H.E) Feminist Collective of Transgender Women of Africa, East London, South Africa
| | - Allanise Cloete
- Public Health, Societies and Belonging (PHSB) the Human Sciences Research Council (HSRC), Cape Town, South Africa.
| | - Helen Savva
- Prevention Branch, U.S. Centers for Disease Control and Prevention (CDC), Pretoria, South Africa
| | - Donald Skinner
- School of Public Health, Stellenbosch University, Stellenbosch, South Africa
| | | | | |
Collapse
|
5
|
Cohen S, Halpern M, Stonbraker S. Mixed method evaluation of a clinic waiting room-based health education program in the Dominican Republic. HEALTH EDUCATION RESEARCH 2023; 38:177-191. [PMID: 36715740 DOI: 10.1093/her/cyad001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 12/30/2022] [Accepted: 01/09/2023] [Indexed: 05/31/2023]
Abstract
Waiting rooms provide an ideal location to disseminate health information. In this mixed-methods study, we evaluated waiting room-based health education talks at two clinics in the Dominican Republic and explored recommendations for implementing this intervention in similar settings. The talks addressed noncommunicable diseases, sexually transmitted infections, family planning and gender-based violence. We conducted pre- and posttests to assess attendees' change in knowledge and conducted semi-structured interviews with a subset of them. We conducted a semi-structured focus group with educators. Analyses included Wilcox Signed Rank Tests and McNemar tests for pre- and posttests, conventional content analysis for individual interviews and transcript coding for the focus group. Patient participants were 69.3% female aged 39.6 years (SD = 13.5) on average at one clinic (n = 127) and 100% female aged 17.4 (SD = 1.3) on average at the second clinic (n = 24). Focus group participants (n = 5) had 4.8 years (SD = 3.3) of health educator experience on average. Pre- and posttests showed significant improvement (P < 0.05) across all talks. Qualitative interviews emphasized engaging, clear and brief content delivery with visual aids. The focus group highlighted the importance of patient-centered design with culturally concordant delivery and identified implementation challenges. Findings demonstrate that waiting room-based education talks improve knowledge and provide suggestions for similar interventions.
Collapse
Affiliation(s)
- S Cohen
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - M Halpern
- Clínica de Familia La Romana, C. Gaston Fernando Deligne 168, La Romana 22000, Dominican Republic
| | - S Stonbraker
- Clínica de Familia La Romana, C. Gaston Fernando Deligne 168, La Romana 22000, Dominican Republic
- University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, CO 80045, USA
| |
Collapse
|
6
|
Pereira CCDA, Torres TS, Luz PM, Hoagland B, Farias A, Brito JDU, Lacerda MVG, Silva DAR, Benedetti M, Pimenta MC, Grinsztejn B, Veloso VG. Preferences for pre-exposure prophylaxis (PrEP) among sexual and gender minorities: a discrete choice experiment in Brazil. LANCET REGIONAL HEALTH. AMERICAS 2023; 19:100432. [PMID: 36950036 PMCID: PMC10025414 DOI: 10.1016/j.lana.2023.100432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 10/27/2022] [Accepted: 01/10/2023] [Indexed: 02/09/2023]
Abstract
Background Men who have sex with men (MSM) and transgender women (TGW) are disproportionally affected by HIV infection in Latin America. This study aims to assess pre-exposure prophylaxis (PrEP) preferences among sexual and gender minorities (SGM) and identify attributes and levels that are related to PrEP uptake and adherence, both crucial for PrEP success. Methods We conducted a discrete choice experiment (DCE) among SGM from all Brazilian regions (September-December/2020). The survey was administered face-to-face (five Brazilian capitals) and online (entire country). We used a D-efficient zero-prior blocked experimental design to select 60 paired-profile DCE choice tasks. Findings The total sample size was 3924 (90.5% MSM; 7.2% TGW and 2.3% non-binary or gender diverse persons). In random-effects logit models, highest levels of protection and "no side effects" were the most important attribute levels. For "presentation", injectable and implant were preferred over oral. Participants were willing to accept a 4.1% protection reduction to receive injectable PrEP or a 4.2% reduction if PrEP were taken monthly. The largest class in the latent class models was defined predominantly by the preference for the highest HIV protection level (p < 0.005). Respondents in this class also preferred no side effects, injectable and implant presentations. Interpretation Higher HIV protection, no side effects, and presentation, whether injectable or implant, were the most important attributes in PrEP preferences. Protection against HIV was the most important attribute. PrEP programs should make available technologies such as long-acting presentations that could reunite the most desired attributes, thus maximizing acceptability and user-appropriateness. Funding Unitaid.
Collapse
Affiliation(s)
| | - Thiago Silva Torres
- Laboratório de Pesquisa Clínica em HIV/AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas – INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Paula Mendes Luz
- Laboratório de Pesquisa Clínica em HIV/AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas – INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Brenda Hoagland
- Laboratório de Pesquisa Clínica em HIV/AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas – INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Alessandro Farias
- Centro Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Salvador, BA, Brazil
| | | | | | - Daila Alena Raenck Silva
- Centro de Testagem e Aconselhamento (CTA) Santa Marta, Secretaria Municipal de Saúde de Porto Alegre, RS, Brazil
| | - Marcos Benedetti
- Laboratório de Pesquisa Clínica em HIV/AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas – INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | | | - Beatriz Grinsztejn
- Laboratório de Pesquisa Clínica em HIV/AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas – INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Valdilea Gonçalves Veloso
- Laboratório de Pesquisa Clínica em HIV/AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas – INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
7
|
Ribeiro A, Trevizol AP, Bosso RA, Gianna MC, Vieira DL, Bernardini VB, Brietzke E, Ribeiro M, Fidalgo TM. The Interactions Between Vulnerabilities for HIV and Syphilis among Cisgender and Transgender People Who Use Drugs. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:733-740. [PMID: 36369415 DOI: 10.1007/s10508-022-02460-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
In Brazil, transgender people are most affected by HIV, and crack cocaine addiction may contribute to social vulnerability and exposure to sexual and violence-related risks. This cross-sectional study comprised 2393 individuals seeking addiction treatment, consisting of 43 trans women, 1995 cisgender men, and 355 cisgender women. Records of rapid test results for HIV and syphilis and screening responses of trans women were compared to both cisgender groups using a logistic regression model to identify associated risk factors. HIV prevalence was higher in the transgender group (39.5%) than in cis women and men (5.9% and 3.6%, respectively). Our study showed an eightfold higher chance of a positive HIV test among transgender individuals who used drugs (OR: 8.79, p < .01, 95% CI: 3.90-19.78) compared to cisgender people who used drugs. A lifetime history of syphilis infection was more common in transgender people (60.0%) and cis women (32.8%) than in cis men (9.5%). Active syphilis was also more common in the transgender population (OR: 5.46, p < .01, 95% CI: 2.63 11.32). In our sample, 44.2% of transgender individuals had a history of at least one suicide attempt in their lifetime. Our results showed that transgender women were at higher risk of crack cocaine use (OR: 5.51, p < .01, 95% CI: 2.16-14.06) than cisgender men and women. The study showed that trans women had a higher prevalence of syphilis and HIV, and a greater chance of being homeless. The synergy of these vulnerabilities may have led to our findings of high psychotic symptoms and a history of suicide attempts in transgender individuals.
Collapse
Affiliation(s)
- Ariadne Ribeiro
- Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
- The Joint United Nations Program on HIV/AIDS, UN HOUSE Conjunto C, Quadra 802, Lote 17, Federal District, Brasília, 70800-400, Brazil.
| | - Alisson Paulino Trevizol
- CAMH - Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Maria Clara Gianna
- Reference and Training Center for STI and AIDS, Sao Paulo State Secretariat of Health, Sao Paulo, SP, Brazil
| | - Denise Leite Vieira
- Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Elisa Brietzke
- Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Marcelo Ribeiro
- Reference Center for Alcohol, Tobacco and Other Drugs, Sao Paulo State Secretariat of Health, Sao Paulo, SP, Brazil
- Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Thiago M Fidalgo
- Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
8
|
Galea JT, Marhefka S, León SR, Rahill G, Cyrus E, Sánchez H, Zhang Z, Brown B. High levels of mild to moderate depression among men who have sex with men and transgender women in Lima, Peru: implications for integrated depression and HIV care. AIDS Care 2022; 34:1534-1539. [PMID: 34668797 PMCID: PMC9018879 DOI: 10.1080/09540121.2021.1991877] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/07/2021] [Indexed: 01/26/2023]
Abstract
ABSTRACTDepression disproportionally affects people at risk of acquiring or living with HIV and is associated with worse health outcomes; however, depression care is not routinely integrated with HIV prevention and treatment services. Selection of the best depression intervention(s) for integration depends both on the prevalence and severity of depression among potential users. To inform depression care integration in a community-based setting in Lima, Peru, we retrospectively analyzed routinely collected depression screening data from men who have sex with men and transgender women seeking HIV prevention and care services (N = 185). Depression was screened for using the Patient Health Questionnaire-9. Prevalence of any depression (PHQ-9 ≥ 5) was 42% and was significantly associated with the last sexual partner being "casual" (p = 0.01). Most (81%) depressive symptoms were mild to moderate (≥5 PHQ-9 ≤ 14). Integrating depression care with HIV prevention and treatment services in Peru should begin by implementing interventions targeting mild to moderate depression.
Collapse
Affiliation(s)
- Jerome T. Galea
- University of South Florida, School of Social Work, Tampa, United States
- University of South Florida, College of Public Health, Tampa, United States
- Epicentro Salud, Lima, Peru
| | - Stephanie Marhefka
- University of South Florida, College of Public Health, Tampa, United States
| | | | - Guitele Rahill
- University of South Florida, School of Social Work, Tampa, United States
| | - Elena Cyrus
- University of Central Florida, College of Medicine, Lake Nona, United States
- University of California San Francisco Center for AIDS Prevention Studies, San Francisco, United States
| | | | - Zhiwei Zhang
- University of California Riverside School of Medicine, Social Medicine and Population Health, Center for Healthy Communities, Riverside, United States
| | - Brandon Brown
- University of California Riverside School of Medicine, Social Medicine and Population Health, Center for Healthy Communities, Riverside, United States
| |
Collapse
|
9
|
Santoso D, Asfia SK, Mello MB, Baggaley RC, Johnson CC, Chow EP, Fairley CK, Ong JJ. HIV prevalence ratio of international migrants compared to their native-born counterparts: A systematic review and meta-analysis. EClinicalMedicine 2022; 53:101661. [PMID: 36147629 PMCID: PMC9486043 DOI: 10.1016/j.eclinm.2022.101661] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People on the move, including international migrants, may face health inequities that expose them to a higher risk for HIV than native-born populations. We conducted a systematic review to calculate the HIV prevalence ratio of international migrants compared with native-born populations. METHODS We searched five databases between January 2010 and March 2022. Using random-effects meta-analysis, we calculated the pooled HIV prevalence ratios (PR) by comparing the HIV prevalence of migrants with native-born populations. Our research protocol is registered in the International prospective register of systematic reviews (PROSPERO, CRD42021250867). FINDINGS In total, 5,121 studies were screened, and 38 were included in the final analysis: 7,121,699 migrants and more than 270 million natives were included in the analysis. The pooled PR for any foreign-born migrants was 1·70 (95% CI 1·11 - 2·61, I2 =99·67%, n = 33 studies), refugees was 2·37 (95% CI 0·33-16·99, I2 =99·5%, n = 5), undocumented people was 3·98 (95% CI 0·11-143·01, I2 =94·6%, n = 3), whilst asylum seekers was 54·79 (95% CI 17·23-174·23, I2 =90·2%, n = 2). Meta-regression revealed that population type (adjusted R-squared 11.5%), region of origin (11.3%) and migrant type (10.8%) accounted for heterogeneity more than country-income (2.4%) and study setting (2.3%). INTERPRETATION Although it was not possible to assess if HIV infection occurred in the country of origin or destination, the HIV prevalence ratio was higher among migrants than in native-born populations. Inclusive health policies and strategies for delivering HIV testing, prevention and treatment services for migrant populations tailored to their needs are urgently needed. FUNDING J.J.O. and E.P.F.C. are supported by the Australian National Health and Medical Research Council (NHMRC) Emerging Leader Fellowship (GNT1193955 and GNT1172873, respectively).
Collapse
Affiliation(s)
- Devy Santoso
- Central Clinical School, Monash University, Melbourne, Australia
| | | | - Maeve B. Mello
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Rachel C. Baggaley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl C. Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Eric P.F. Chow
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher K. Fairley
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
| | - Jason J. Ong
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Corresponding author at: 580 Swanston Street, Carlton, Victoria 3053, Australia.
| |
Collapse
|
10
|
Costa-Cordella S, Grasso-Cladera A, Rossi A, Duarte J, Guiñazu F, Cortes CP. Internet-based peer support interventions for people living with HIV: A scoping review. PLoS One 2022; 17:e0269332. [PMID: 36040950 PMCID: PMC9426879 DOI: 10.1371/journal.pone.0269332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 05/18/2022] [Indexed: 11/18/2022] Open
Abstract
Peer support interventions for people living with HIV and AIDS (PLWHA) are effective, but their associated time and material costs for the recipient and the health system make them reachable for only a small proportion of PLWHA. Internet-based interventions are an effective alternative for delivering psychosocial interventions for PLWHA as they are more accessible. Currently, no reviews are focusing on internet-based interventions with peer support components. This scoping review aims to map the existing literature on psychosocial interventions for PLWHA based on peer support and delivered through the internet. We conducted a systematic scoping review of academic literature following methodological guidelines for scoping reviews, and 28 articles met our criteria. We summarized the main characteristics of the digital peer support interventions for PLWHA and how they implemented peer support in a virtual environment. Overall the reported outcomes appeared promising, but more robust evidence is needed.
Collapse
Affiliation(s)
- Stefanella Costa-Cordella
- Centro de Estudios en Psicología Clínica y Psicoterapia (CEPPS), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
- Instituto Milenio Depresión y Personalidad (MIDAP), Santiago, Chile
- Centro de Estudios en Neurociencia Humana y Neuropsicología (CENHN), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | - Aitana Grasso-Cladera
- Centro de Estudios en Psicología Clínica y Psicoterapia (CEPPS), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
- Centro de Estudios en Neurociencia Humana y Neuropsicología (CENHN), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | - Alejandra Rossi
- Centro de Estudios en Neurociencia Humana y Neuropsicología (CENHN), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | - Javiera Duarte
- Centro de Estudios en Psicología Clínica y Psicoterapia (CEPPS), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
- Instituto Milenio Depresión y Personalidad (MIDAP), Santiago, Chile
| | - Flavia Guiñazu
- Web Intelligence Centre, Facultad de Ingeniería Industrial, Universidad de Chile, Santiago, Chile
| | - Claudia P. Cortes
- Hospital Clínico San Borja Arriarán & Fundación Arriarán, Santiago, Chile
- Departamento de Medicina, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- * E-mail:
| |
Collapse
|
11
|
Lippman SA, Sevelius JM, Saggese GSR, Gilmore H, Bassichetto KC, de Barros DD, de Oliveira RB, Maschião LF, Chen D, de Sousa Mascena Veras MA. Peer Navigation to Support Transgender Women's Engagement in HIV Care: Findings from the Trans Amigas Pilot Trial in São Paulo, Brazil. AIDS Behav 2022; 26:2588-2599. [PMID: 35119537 PMCID: PMC9252974 DOI: 10.1007/s10461-022-03595-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 11/26/2022]
Abstract
Trans women living with HIV (TWH) have suboptimal HIV care engagement. We pilot tested Trans Amigas, a theory-based, trans-specific peer navigation (PN) intervention to address barriers to care in São Paulo, Brazil. TWH were randomized to the PN intervention (n = 75) or control (n = 38) condition. Control participants were referred to trans-friendly HIV care. Intervention participants were assigned a navigator who conducted nine in-person one-on-one sessions and bi-weekly phone or text check-ins to help participants overcome barriers to care and work towards gender affirmation and healthcare goals. We followed participants for 9 months to determine intervention feasibility, acceptability, and preliminary efficacy in improving retention in care. Analyses were intention to treat (ITT). Intervention acceptability was high: at end line, 85.2% of PN participants said they would continue receiving services and 94.4% would recommend peer navigation to a friend. A priori feasibility criteria were met: 92% of eligible participants enrolled and 70% were retained at 9 months; however, only 47% achieved moderate or better adherence to both in-person and phone/text program components. Though the pilot was not powered for efficacy, ITT findings trended toward significance, with intervention participants 40% more likely to be retained in care at the end of the study. Population-specific peer programming to support care engagement is acceptable, feasible, and can improve HIV outcomes for Trans women living with HIV.
Collapse
Affiliation(s)
- Sheri A Lippman
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA.
| | - Jae M Sevelius
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
| | - Gustavo Santa Roza Saggese
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
- Faculty of Medical Sciences, Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Hailey Gilmore
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
| | | | | | | | | | - Dorothy Chen
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
| | | |
Collapse
|
12
|
HIV and Substance Use in Latin America: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127198. [PMID: 35742448 PMCID: PMC9222977 DOI: 10.3390/ijerph19127198] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 12/13/2022]
Abstract
This scoping review aims to explore the interplay between substance use (SU) and HIV in Latin America (LA). Database searches yielded 3481 references; 196 were included. HIV prevalence among people who used substances (PWUS) ranged from 2.8–15.2%. SU definitions were variable throughout studies, and thus data were not easily comparable. In 2019, only 2% of new HIV infections were attributed to injection drug use (IDU) in LA. Factors associated with HIV among PWUS included being female, IDU and homelessness, and PWUS were likely to engage in risky sexual behaviors, start antiretroviral treatment late, have poor adherence, have treatment failure, be lost to follow-up, have comorbidities, and experience higher mortality rates and lower quality of life, as has been reported in PLWH with SU in other regions. Five intervention studies were identified, and only one was effective at reducing HIV incidence in PWUS. Interventions in other regions have varying success depending on context-specific characteristics, highlighting the need to conduct more research in the LA region. Though progress has been made in establishing SU as a major concern in people living with HIV (PLWH), much more is yet to be done to reduce the burden of HIV and SU in LA.
Collapse
|
13
|
Avelino‐Silva VI, Vasconcelos R, Cerqueira NB, Marcus U, Schmidt AJ, Veras MA. Predictors of knowledge of and access to biomedical prevention among MSM and transgender men in Latin America: Results from the Latin American internet survey. HIV Med 2022; 23:764-773. [DOI: 10.1111/hiv.13238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/27/2021] [Accepted: 01/06/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Vivian Iida Avelino‐Silva
- Department of Infectious and Parasitic Diseases Faculdade de Medicina da Universidade de Sao Paulo Sao Paulo Brazil
| | - Ricardo Vasconcelos
- Department of Infectious and Parasitic Diseases Faculdade de Medicina da Universidade de Sao Paulo Sao Paulo Brazil
| | - Natalia B. Cerqueira
- Department of Infectious and Parasitic Diseases Faculdade de Medicina da Universidade de Sao Paulo Sao Paulo Brazil
| | - Ulrich Marcus
- Department for Infectious Disease Epidemiology Robert Koch‐Institute Berlin Germany
| | - Axel Jeremias Schmidt
- Sigma Research Department of Public Health, Environments and Society London School of Hygiene and Tropical Medicine London UK
| | - Maria Amelia Veras
- Faculdade de Ciências Medicas da Santa Casa de Sao Paulo Sao Paulo Brazil
| |
Collapse
|
14
|
Magno L, Guimarães MDC, Leal AF, Dourado I, Knauth DR, Bermúdez XPD, Rocha GM, Veras MADSM, Kendall C, Brito AMD, Kerr LRS. Perception of discrimination due to sexual orientation and associated factors among men who have sex with men in 12 Brazilian cities. CAD SAUDE PUBLICA 2022; 38:EN199121. [DOI: 10.1590/0102-311xen199121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/17/2021] [Indexed: 11/22/2022] Open
Abstract
Discrimination due to sexual orientation (DDSO) has an important association with health outcomes among men who have sex with men (MSM). This study aimed to analyze factors associated with DDSO among MSM in 12 Brazilian cities. This is a cross-sectional study with 4,176 MSM participants recruited in 2016 which used a respondent-driven sampling method in 12 Brazilian cities. DDSO levels were previously identified by a latent class analysis based on 13 variables from the discrimination section. An ordinal logistic regression was used to assess associations with these DDSO levels, and weighted ordinal odds ratios (OR) and their respective 95% confidence intervals (95%CI) were estimated using Gile’s estimator. Most participants were young (< 25 years old) black or of mixed-race (pardo), single individuals who had a religious affiliation, primary or incomplete secondary education, and a high and average socioeconomic status. More than half (65%) reported DDSO in the 12 months prior to this study. We observed an independent association among the four latent DDSO classes and the following variables: age < 25 years old (OR = 1.66; 95%CI: 1.21-2.27), white skin color (OR = 1.43; 95%CI: 1.02-2.01), history of sexual (OR = 2.33; 95%CI: 1.58-3.43) and physical violence (OR = 3.08; 95%CI: 2.11-4.49), disclosure of their sexual orientation as MSM to their fathers (OR = 2.00; 95%CI: 1.47-2.72), experienced suicidal ideation in the two weeks prior to this study (OR = 2.09; 95%CI: 1.46-2.98), and use of any illicit drugs in the last six months (OR = 1.61; 95%CI: 1.19-2.18). Our results indicate that contextual factors may contribute to high DDSO levels among MSM in Brazil. Public health policies toward human rights surveillance and protection among MSM must be urgently addressed.
Collapse
Affiliation(s)
- Laio Magno
- Universidade do Estado da Bahia, Brazil; Universidade Federal da Bahia, Brazil
| | | | | | | | | | | | | | | | - Carl Kendall
- Tulane University School of Public Health and Tropical Medicine, U.S.A
| | | | | |
Collapse
|
15
|
Elorreaga OA, Torres TS, Vega-Ramirez EH, Konda KA, Hoagland B, Benedetti M, Pimenta C, Diaz-Sosa D, Robles-Garcia R, Grinsztejn B, Caceres CF, Veloso VG. Awareness, willingness and barriers to HIV Self-testing (HIVST) among Men who Have Sex with Men (MSM) in Brazil, Mexico, and Peru: A web-based cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000678. [PMID: 36962436 PMCID: PMC10021908 DOI: 10.1371/journal.pgph.0000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/30/2022] [Indexed: 11/18/2022]
Abstract
HIV self-testing (HIVST) is an essential tool within the combined HIV prevention package and has been available in Latin America since 2015. However, HIVST use among key populations remains low. This study describes awareness, willingness, and barriers to HIVST among MSM in Brazil, Mexico, and Peru. A cross-sectional web-based survey was advertised in two geosocial networking apps (Grindr and Hornet) and Facebook in 2018. We included cisgender men ≥18 years old who self-reported HIV-negative status. We used multivariable Poisson regression models to calculate adjusted prevalence ratios (aPR) to assess the factors associated with willingness to use HIVST for each country. A total of 18,916 completed the survey, 59% from Brazil, 30% from Mexico, and 11% from Peru. Overall, 20% of MSM had never tested for HIV. Awareness and willingness to use HIVST were higher in Brazil than in Peru and Mexico (p < .001). Across the countries, the patterns of association of willingness with HIVST barriers were similar. Most participants think post-test counseling is essential and that dealing with a positive result would be difficult (aPR 1.13 to 1.37, range of aPRs across the three countries). Having the knowledge to deal with a positive HIVST resulted in increased willingness to use HIVST (aPR range: 1.11 to 1.22), while a lack of trust in HIVST compared to HIV testing in clinics was inversely associated (aPR range: 0.80 to 0.90). In general, willingness to use HIVST was associated with higher income (aPR range: 1.49 to 1.97), higher education (aPR range: 1.13 to 1.42), and willingness to use PrEP (aPR range: 1.19 to 1.72). Efforts to increase HIVST knowledge and resolve perceived barriers are warranted, especially among MSM with lower income and education from Brazil, Mexico, and Peru. Personalized virtual counseling could be crucial among this population. In addition, those willing to use HIVST are also willing to use PrEP. It indicates that HIVST delivery could be incorporated into PrEP programs within the Brazilian Public Health System and eventually in Mexico and Peru.
Collapse
Affiliation(s)
- Oliver A Elorreaga
- Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | | | - Kelika A Konda
- Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Marcos Benedetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Cristina Pimenta
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Dulce Diaz-Sosa
- National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico DF, Mexico
| | | | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Carlos F Caceres
- Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| |
Collapse
|
16
|
Stonbraker S, Liu J, Sanabria G, George M, Cunto-Amesty S, Alcántara C, Abraído-Lanza AF, Halpern M, Rowell-Cunsolo T, Bakken S, Schnall R. Clinician Use of HIV-Related Infographics During Clinic Visits in the Dominican Republic is Associated with Lower Viral Load and Other Improvements in Health Outcomes. AIDS Behav 2021; 25:4061-4073. [PMID: 34129143 PMCID: PMC8602767 DOI: 10.1007/s10461-021-03331-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 02/05/2023]
Abstract
We designed an infographic intervention to help clinicians provide health information to persons living with HIV. In this study, we assessed the extent to which our intervention may improve objectively and subjectively measured health outcomes (CD4 count, viral load, and engagement with clinician among others) when integrated into routine visits in the Dominican Republic. In this pretest-posttest study, we followed participants for 9 months at 3-month intervals. Physicians administered the intervention during participants' first 3 visits. Outcome measures, selected using a conceptual model, were assessed at 4 time points. We assessed changes in outcomes over time with general linear regressions and Wilcoxon Signed-Rank tests. Participants (N = 50) were mostly female (56%) and had been living with HIV for a mean of 6.3 years (SD = 6.1). All outcomes, except CD4 count, demonstrated statistically significant improvements by study end. This provides preliminary evidence our intervention may improve outcomes, but further testing is needed.
Collapse
Affiliation(s)
- Samantha Stonbraker
- Anschutz Medical Campus, University of Colorado College of Nursing, 13120 E. 19th Ave, Aurora, CO, 80045, USA.
- Clínica de Familia La Romana, La Romana, Dominican Republic.
| | - Jianfang Liu
- Columbia University School of Nursing, New York, NY, USA
| | | | - Maureen George
- Columbia University School of Nursing, New York, NY, USA
| | | | | | | | - Mina Halpern
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | | | - Suzanne Bakken
- Columbia University School of Nursing, New York, NY, USA
| | | |
Collapse
|
17
|
Budhwani H, Hearld KR, Butame SA, Naar S, Tapia L, Paulino-Ramírez R. Transgender Women in Dominican Republic: HIV, Stigma, Substances, and Sex Work. AIDS Patient Care STDS 2021; 35:488-494. [PMID: 34762515 PMCID: PMC8817706 DOI: 10.1089/apc.2021.0127] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Exposure to stigma, violence, sex work, and substance use are associated with increased HIV risk, but relationships between these factors have not been fully elucidated among transgender women whose data are often aggregated with men who have sex with men and other sexual and gender minorities. Considering this gap, we aimed to identify a serologically confirmed HIV estimate for transgender women and examine the relationships between stigma, sex work, substance use, and HIV among a national sample of transgender women in Dominican Republic. We analyzed biomarkers and self-report data from the third wave of Dominican Republic's Encuesta de Vigilancia y Comportamiento con Vinculación Serológica, employing logistic and negative binomial regression to estimate models (n = 307). HIV rate was 35.8%. Nearly 75% of respondents engaged in sex work. Over 20% reported experiencing violence; 61.6% reported being stigmatized. Participation in sex work was associated with higher levels of stigma [incidence rate ratio (IRR): 1.70, p < 0.05]. Respondents who experienced violence had over three times higher odds of living with HIV relative to respondents who had not been victimized [odds ratio (OR): 3.15, p < 0.05]. Marijuana users were less likely to experience stigma compared with cocaine users (IRR: 1.72, p < 0.05), and a higher risk of alcohol dependency was associated with higher odds of experiencing violence (OR: 1.17, p < 0.001). Findings illustrate the importance of disaggregating data collected from transgender women compared with other sexual and gender minorities to ascertain subpopulation-specific estimates and indicate an urgent need to implement structural interventions and policies to protect transgender women's health and their human rights.
Collapse
Affiliation(s)
- Henna Budhwani
- University of Alabama at Birmingham (UAB), School of Public Health, Department of Health Care Organization and Policy, Birmingham, Alabama, USA
| | - Kristine R Hearld
- University of Alabama at Birmingham (UAB), School of Public Health, Department of Health Care Organization and Policy, Birmingham, Alabama, USA
| | - Seyram A Butame
- Florida State University College of Medicine (FSU), Center for Translational Behavioral Science (CTBScience), Tallahassee, Florida, USA
| | - Sylvie Naar
- Florida State University College of Medicine (FSU), Center for Translational Behavioral Science (CTBScience), Tallahassee, Florida, USA
| | - Leandro Tapia
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana (UNIBE), Santo Domingo, Dominican Republic
| | - Robert Paulino-Ramírez
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana (UNIBE), Santo Domingo, Dominican Republic
| |
Collapse
|
18
|
Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990-2019, for 204 countries and territories: the Global Burden of Diseases Study 2019. Lancet HIV 2021. [PMID: 34592142 PMCID: PMC8491452 DOI: 10.1016/s2352-3018(21)00152-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. METHODS To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). FINDINGS In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1-38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78-0·91) per female living with HIV in 2019, 0·99 male infections (0·91-1·10) for every female infection, and 1·02 male deaths (0·95-1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58-35·43, and a 39·66% decrease in deaths, 36·49-42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05-0·06) and the global incidence-to-mortality ratio was 1·94 (1·76-2·12). No regions met suggested thresholds for progress. INTERPRETATION Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. FUNDING The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH.
Collapse
|
19
|
Gutiérrez JP, Trossero A. Socioeconomic inequalities in HIV knowledge, HIV testing, and condom use among adolescent and young women in Latin America and the Caribbean. Rev Panam Salud Publica 2021; 45:e47. [PMID: 34054931 PMCID: PMC8147735 DOI: 10.26633/rpsp.2021.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/17/2021] [Indexed: 12/04/2022] Open
Abstract
Objective. To appraise the presence and magnitude of inter- and intra-country health inequalities related to HIV in Latin America and the Caribbean (LAC) among young females. Methods. We analyzed household surveys in twenty LAC countries, that included data from female adolescents and young women (ages 15-24) between 2008 and 2018, measuring inequality with the concentration index of 4 indicators: 1) whether individuals have heard of HIV or not, 2) a composite variable of correct knowledge, 3) reported condom use with the last partner, and 4) whether individuals were ever tested for HIV. Results. Participants from households in countries with higher socioeconomic status are more likely to have heard of HIV, have correct knowledge of HIV transmission, and have used condoms during their last sexual intercourse. The inter-country concentration index for those indicators were 0.352, 0.302 and 0.110, respectively. Conclusions. Economically disadvantaged female adolescents and young women in LAC face an increased risk for HIV, as they are less aware of HIV and its actual transmission mechanism and are less likely to use condoms with their sexual partners. There is an urgent need to tailor prevention strategies of sexually transmitted infections and HIV for adolescents and young women that are sensitive to their socioeconomic context.
Collapse
Affiliation(s)
- Juan Pablo Gutiérrez
- National Autonomous University of Mexico (UNAM) Mexico City Mexico National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Alejandra Trossero
- UNICEF Regional Office for Latin America and the Caribbean Panama Panama UNICEF Regional Office for Latin America and the Caribbean, Panama, Panama
| |
Collapse
|
20
|
Dunbar W, Pape JW, Coppieters Y. HIV among men who have sex with men in the Caribbean: reaching the left behind. Rev Panam Salud Publica 2021; 45:e12. [PMID: 33708247 PMCID: PMC7939031 DOI: 10.26633/rpsp.2021.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 11/06/2020] [Indexed: 02/03/2023] Open
Abstract
Objectives. To present the epidemiology, social and cultural factors driving the HIV epidemic among men who have sex with men (MSM) in the Caribbean region and to highlight the regional and national responses, and what remains to be addressed to close the gaps in order to ending AIDS by 2030. Methods. A literature review was performed in the following databases: PubMed and Scopus. Articles published in the past 10 years were selected. The outcomes of interest were sociocultural risk factors, description of regional and national efforts and potential challenges and barriers to effective control of the epidemic among MSM. This report concentrates exclusively on publications related to MSM living in the Caribbean countries. Results. 11 peer-reviewed studies, 9 grey literature reports and programme frameworks were thematically analysed. The prevalence of HIV among MSM is high and the rates also do vary among Caribbean countries. Several factors influence the epidemic among MSM in the Caribbean but stigma and discrimination underlie the social vulnerability and play a central role in driving the HIV epidemic. Conclusions. To end the AIDS epidemic by 2030, MSM can no longer be kept unchecked in the era of the Sustainable Development Goals with the motto ‘Leave no one behind’.
Collapse
Affiliation(s)
- Willy Dunbar
- Université libre de Bruxelles Brussels Belgium Université libre de Bruxelles, Brussels, Belgium
| | - Jean William Pape
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) Port-au-Prince Haiti Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Yves Coppieters
- Université libre de Bruxelles Brussels Belgium Université libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
21
|
Impact of COVID-19 Pandemic on Sexual Minority Populations in Brazil: An Analysis of Social/Racial Disparities in Maintaining Social Distancing and a Description of Sexual Behavior. AIDS Behav 2021; 25:73-84. [PMID: 32737817 PMCID: PMC7394046 DOI: 10.1007/s10461-020-02984-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We conducted a web-based survey to understand the impact of social distancing measures on Brazilian MSM and transgender/non-binary lives. A total of 3486 respondents were included in this analysis and the great majority were cismen (98%). The median age was 32 years (IQR: 27-40), 44% non-white, 36% low schooling and 38% low income. Most of participants reported HIV negative/unknown status (77%). Participants on-PrEP reported more condomless anal sex than those off-PrEP. Conversely, 24% off-PrEP were at substantial HIV-risk. PrEP/ART continuation were reported by the majority, despite reports of impediments to medication refill. Transgender/non-binary reported more mental health problems and challenges to access health care. Social and racial disparities were associated with unattainability of maintaining social distancing. Tailored social and economic support policies during COVID-19 pandemic should be made available to these populations. Challenges for PrEP/ART access will demand the implementation of innovative solutions to avoid the expansion of the HIV epidemic.
Collapse
|
22
|
Wilson EC, Jalil EM, Moreira RI, Velasque L, Castro CV, Monteiro L, Veloso VG, Grinsztejn B. High risk and low HIV prevention behaviours in a new generation of young trans women in Brazil. AIDS Care 2020; 33:997-1001. [PMID: 33191759 DOI: 10.1080/09540121.2020.1844859] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Adult trans women in Brazil are highly impacted by HIV, but little is known about risk for young trans women. Our study was conducted to compare the HIV prevalence and correlates of risk for young trans women ages 18-24 years old to adult trans women in Brazil. Trans women were recruited from Rio de Janeiro and Baixada (the metropolitan area of Rio de Janeiro), Brazil (N = 345). Youth ages 18-24 years of age had significantly greater odds of being HIV negative than adults (OR 0.4, 95% CI 0.2-0.6, p = 0.0002), but significantly lower odds of having post-exposure prophylaxis (PEP) knowledge (OR 0.5, 95% CI:0.3-0.9, p = 0.02) and PrEP awareness (OR 0.5, 95% CI: 0.3-0.8, p = 0.01). Young trans women also had significantly higher odds of using substances (OR 1.8, 95% CI 1.1-2.9, p = 0.02) and condomless anal intercourse with their last three sexual partners (OR 1.8, 95% CI: 1.1-3.0, p = 0.03) compared to adults. Already by age 24, one in four trans women in Brazil were infected with HIV pointing to a new generation at high risk of acquiring HIV. HIV prevention interventions are needed to change the healthcare system to reach and engage young trans women.
Collapse
Affiliation(s)
- Erin C Wilson
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Emilia M Jalil
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ronaldo I Moreira
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Luciane Velasque
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Cristiane V Castro
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Laylla Monteiro
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| |
Collapse
|
23
|
Villalba K, Attonito J, Jean-Gilles M, Rosenberg R, Sanchez M, Devieux J. The Effects of Childhood Sexual Abuse: The Role of Anxiety and Alcohol Use among Haitian Women Living with HIV. JOURNAL OF CHILD SEXUAL ABUSE 2020; 29:788-801. [PMID: 33006528 DOI: 10.1080/10538712.2020.1801939] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/03/2020] [Accepted: 06/28/2020] [Indexed: 06/11/2023]
Abstract
Childhood abuse has been linked to problematic drinking in adulthood. It is also documented that people living with HIV have higher rates of alcohol use than the general population. In Haiti, a total of 25% of women living with HIV have experienced childhood sexual abuse (CSA), which puts them at an increased risk for alcohol abuse. CSA has also been associated with anxiety disorders in adulthood. Therefore, it is critical to understand the relationship between CSA, anxiety, and alcohol use among women living with HIV. A total of 244 women living with HIV participated in this study, with 35% reporting CSA. Alcohol abuse was measured with the AUDIT, anxiety with the State-Trait Anxiety Inventory test, and sexual abuse with the Childhood Trauma Questionnaire. Compared to participants who did not experience childhood sexual abuse, participants who experienced childhood sexual abuse reported greater levels of alcohol use [(17.0, SD = 9.1) (11.9, SD = 8.6) p =.001] and anxiety [(55.8, SD = 9.8) (48.9 SD = 8.3) p =.001] respectively. The indirect effect of anxiety on the association between CSA and alcohol use was significant [(ß =.19 p =.05) 95% bootstrap CI.019 -.13] Thus, women who reported being sexually abused as children reported anxiety, which in turn, was associated with an increased risk for alcohol abuse. Results demonstrate that alcohol may be used as a negative coping mechanism to alleviate anxiety symptoms triggered by CSA. These findings elucidate the need for further research examining the impact that sexual trauma has on mental health.
Collapse
Affiliation(s)
| | | | | | | | | | - Jessy Devieux
- Florida International University , Miami, Florida, USA
| |
Collapse
|
24
|
Rech-Medeiros AF, Marcon PDS, Tovo CDV, de Mattos AA. Evaluation of response to hepatitis B virus vaccine in adults with human immunodeficiency virus. Ann Hepatol 2020; 18:725-729. [PMID: 31176604 DOI: 10.1016/j.aohep.2019.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/26/2019] [Accepted: 02/10/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND AIM Viral hepatitis is a serious public health problem. The risk of progression to chronic hepatitis in hepatitis B virus (HBV) infection occurs in 5-10% of adults and is a leading cause of cirrhosis and hepatocellular carcinoma worldwide. Individuals infected with human immunodeficiency virus (HIV) may have coinfection with HBV. The existence of unvaccinated groups represents a significant risk not only individually but also at the community level. The aim of this study was to evaluate HBV vaccine response in adults with HIV infection. MATERIALS AND METHODS A retrospective, descriptive study of the cross-sectional type was carried out in an outpatient HIV referral center in southern Brazil. All medical records of adult HIV patients seen during January 2006 to December 2015 were selected. In statistical analysis, a significance level of 5% was used. RESULTS Of the 201 patients evaluated with a complete vaccination scheme, 55.72% were males, with a mean age of 43.86±12.68 years. Vaccine response occurred in 80.10% (161/201) of the patients, and it did not correlate with age, CD4+ cell count or viral load. CONCLUSION HBV vaccine response in a HIV population was satisfactory, highlighting the importance of vaccination for prevention, cost reduction and better prognosis in preventing HBV/HIV coinfection.
Collapse
Affiliation(s)
- Arlete F Rech-Medeiros
- Hepatology Post-Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Patrícia Dos S Marcon
- Hepatology Post-Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Department of Gastroenterology, Hospital Mãe de Deus, Porto Alegre, RS, Brazil.
| | - Cristiane do V Tovo
- Hepatology Post-Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Angelo A de Mattos
- Hepatology Post-Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| |
Collapse
|
25
|
Smith MK, Xu RH, Hunt SL, Wei C, Tucker JD, Tang W, Luo D, Xue H, Wang C, Yang L, Yang B, Li L, Joyner BL, Sylvia SY. Combating HIV stigma in low- and middle-income healthcare settings: a scoping review. J Int AIDS Soc 2020; 23:e25553. [PMID: 32844580 PMCID: PMC7448195 DOI: 10.1002/jia2.25553] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 05/08/2020] [Accepted: 05/20/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Nearly 40 years into the HIV epidemic, the persistence of HIV stigma is a matter of grave urgency. Discrimination (i.e. enacted stigma) in healthcare settings is particularly problematic as it deprives people of critical healthcare services while also discouraging preventive care seeking by confirming fears of anticipated stigma. We review existing research on the effectiveness of stigma interventions in healthcare settings of low- and middle-income countries (LMIC), where stigma control efforts are often further complicated by heavy HIV burdens, less developed healthcare systems, and the layering of HIV stigma with discrimination towards other marginalized identities. This review describes progress in this field to date and identifies research gaps to guide future directions for research. METHODS We conducted a scoping review of HIV reduction interventions in LMIC healthcare settings using Embase, Ovid MEDLINE, PsycINFO and Scopus (through March 5, 2020). Information regarding study design, stigma measurement techniques, intervention features and study findings were extracted. We also assessed methodological rigor using the Joanna Briggs Institute checklist for systematic reviews. RESULTS AND DISCUSSION Our search identified 8766 studies, of which 19 were included in the final analysis. All but one study reported reductions in stigma following the intervention. The studies demonstrated broad regional distribution across LMIC and many employed designs that made use of a control condition. However, these strengths masked key shortcomings including a dearth of research from the lowest income category of LMIC and a lack of interventions to address institutional or structural determinants of stigma. Lastly, despite the fact that most stigma measures were based on existing instruments, only three studies described steps taken to validate or adapt the stigma measures to local settings. CONCLUSIONS Combating healthcare stigma in LMIC demands interventions that can simultaneously address resource constraints, high HIV burden and more severe stigma. Our findings suggest that this will require more objective, reliable and culturally adaptable stigma measures to facilitate meaningful programme evaluation and comparison across studies. All but one study concluded that their interventions were effective in reducing healthcare stigma. Though encouraging, the fact that most studies measured impact using self-reported measures suggests that social desirability may bias results upwards. Homogeneity of study results also hindered our ability to draw substantive conclusions about potential best practices to guide the design of future stigma reduction programmes.
Collapse
Affiliation(s)
- M. Kumi Smith
- Division of Epidemiology & Community HealthUniversity of Minnesota Twin CitiesMinneapolisMNUSA
| | - Richie H. Xu
- Division of Epidemiology & Community HealthUniversity of Minnesota Twin CitiesMinneapolisMNUSA
| | - Shanda L. Hunt
- Health Sciences LibrariesUniversity of Minnesota Twin CitiesMinneapolisMNUSA
| | - Chongyi Wei
- Department of Health Behavior, Society and PolicyRutgers UniversityNew BrunswickNYUSA
| | - Joseph D. Tucker
- Institute for Global Health and Infectious DiseasesSchool of MedicineUniversity of North CarolinaChapel HillNCUSA
- London School of Hygiene and Tropical MedicineLondonUK
| | - Weiming Tang
- Institute for Global Health and Infectious DiseasesSchool of MedicineUniversity of North CarolinaChapel HillNCUSA
| | | | - Hao Xue
- Freeman Spogli Institute for International StudiesStanford UniversityStanfordCAUSA
| | - Cheng Wang
- Dermatology Hospital of Southern Medical UniversityGuangzhouChina
| | - Ligang Yang
- Dermatology Hospital of Southern Medical UniversityGuangzhouChina
| | - Bin Yang
- Dermatology Hospital of Southern Medical UniversityGuangzhouChina
| | - Li Li
- Department of EpidemiologyUniversity of CaliforniaLos AngelesCAUSA
| | - Benny L. Joyner
- Division of Pediatric Critical Care MedicineSchool of MedicineUniversity of North CarolinaChapel HillNCUSA
| | - Sean Y. Sylvia
- Department of Health Policy & ManagementUniversity of North CarolinaChapel HillNCUSA
| |
Collapse
|
26
|
Hoagland B, Torres TS, Bezerra DRB, Geraldo K, Pimenta C, Veloso VG, Grinsztejn B. Telemedicine as a tool for PrEP delivery during the COVID-19 pandemic in a large HIV prevention service in Rio de Janeiro-Brazil. Braz J Infect Dis 2020; 24:360-364. [PMID: 32504552 PMCID: PMC7261432 DOI: 10.1016/j.bjid.2020.05.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/12/2020] [Accepted: 05/16/2020] [Indexed: 01/28/2023] Open
Abstract
COVID-19 public health responses such as social distancing and community containment measures protocols are critical to preventing and containing the spread of coronavirus. Brazil accounts for almost half of Latin American HIV cases and Rio de Janeiro is the city with the second largest number of AIDS. Clinical appointments and pharmacy antiretroviral refills may be impaired due to restricted traffic and possible lockdowns, preventing people living with HIV and those using PrEP from accessing needed antiretrovirals. We hereby describe the telemedicine procedures implemented in a large PrEP delivery service in Rio de janeiro in the context of the COVID-19 pandemic. At the initial teleconsultation, individuals undergoe HIV rapid testing and are assessed by phone for PrEP related procedures. Individuals receive a digital prescription to retrieve a 120-day PrEP supply plus two HIV self-test kits. Subsequent follow-up teleconsultations will be performed remotely by phone call, including instructions for the HIV self-test performance, which results are to be sent using a digital picture. Participants will attend the service only for PrEP refill. The use of telemedicine procedures is being effective to avoid PrEP shortage and reduce the time PrEP users spend at the service during the COVID-19 pandemic and social distancing recommendations.
Collapse
Affiliation(s)
- Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil.
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil.
| | - Daniel R B Bezerra
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil.
| | - Kim Geraldo
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil.
| | | | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil.
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil.
| |
Collapse
|
27
|
Torres TS, Bastos LS, Kamel L, Bezerra DRB, Fernandes NM, Moreira RI, Garner A, Veloso VG, Grinsztejn B, De Boni RB. Do men who have sex with men who report alcohol and illicit drug use before/during sex (chemsex) present moderate/high risk for substance use disorders? Drug Alcohol Depend 2020; 209:107908. [PMID: 32078972 DOI: 10.1016/j.drugalcdep.2020.107908] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 02/08/2020] [Accepted: 02/10/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND We evaluated the prevalence of sexualized drug use (Chemsex) and its association with moderate/high risk for substance use disorders and HIV sexual risk behavior among men who have sex with men (MSM). METHODS We conducted a cross-sectional web-based survey among MSM from Rio de Janeiro (Brazil). The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was used to screen people at moderate/high-risk for substance use disorders. Individuals found to be using substances in the prior three months were asked if they used before/during sex. Sexualized drug use was classified into: no sexualized drug use, sex using only alcohol (alcohol-sex), sex using only illicit drugs (drug-sex) and sex using alcohol and illicit drugs (alcohol-drug-sex). The questionnaire included questions about sociodemographic, HIV status/prevention and risk behavior. A multinomial regression model was performed to assess the factors associated with sexualized drug use. RESULTS Overall, 1048 MSM completed the questionnaire; median age was 29 years. Prevalence of alcohol and illicit drug use in previous 3 months was 89 % and 49 %, respectively. Most MSM (64 %) reported sexualized drug use: 28 % alcohol-sex, 9 % drug-sex and 27 % alcohol-drug-sex. Median ASSIST scores were higher among those reporting sexualized drug use compared to no use. All HIV sexual risk behavior variables presented increasing prevalence across the outcome categories. In the adjusted multivariate model, having moderate/high-risk for substance use disorders were associated with sexualized drug use. CONCLUSIONS MSM reporting sexualized drug use should receive brief intervention for substance use disorders and be evaluated for combination HIV prevention strategies including PrEP.
Collapse
Affiliation(s)
- Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil.
| | - Leonardo S Bastos
- Programa de Computação Cientifica, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Luciana Kamel
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil
| | - Daniel R B Bezerra
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil
| | - Nilo M Fernandes
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil
| | - Ronaldo I Moreira
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil
| | - Alex Garner
- Hornet INC, 3962 Ince Blvd, Culver City, CA 90232, United States
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil
| | - Raquel B De Boni
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil
| |
Collapse
|
28
|
Xiao C, Jike C, Liu D, Jia P, Xu X, Xiao L, Yu G, Nan L, Sun X, Ge J, Wang J, Wang K, Liao Q, Wang Q, Wenwen Z, Yang S. The changing modes of human immunodeficiency virus transmission and spatial variations among women in a minority prefecture in southwest China: An exploratory study. Medicine (Baltimore) 2020; 99:e18776. [PMID: 32028390 PMCID: PMC7015565 DOI: 10.1097/md.0000000000018776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Liangshan Yi Autonomous Prefecture in Southwest China has a high human immunodeficiency virus (HIV) prevalence rate. This study examined the changing modes of HIV transmission among women with new HIV infections and explored the spatial heterogeneities in the factors associated with heterosexual transmission in this minority region.The data consisting of women with new HIV infections from 2011 to 2014 were collected from multiple sources. New infections were identified by BED capture enzyme immunoassay. The Bayesian hierarchical model was used to estimate the proportion of women with new HIV infections via heterosexual transmission across all townships in the Prefecture. A geographically weighted regression (GWR) model was utilized to investigate spatial variations in the sociodemographic characteristics associated with the changing modes of HIV transmission.An analytical sample of 927 women with new HIV infections was constructed and utilized to investigate the changing mode of HIV transmission. The rate of heterosexual transmission among women with new HIV infections in 2011 was below 20%. However, by 2014 this rate dramatically increased to nearly 80%. Among sociodemographic characteristics, GWR results revealed significant ethnic differences in heterosexual HIV transmission between Yi women and women in other ethnic groups, with Yi women demonstrating a lower risk of infection through heterosexual transmission. However, such ethnic differences were observed only in 30% of the townships in the Prefecture. Moreover, having a primary education decreased the odds of heterosexual transmission, which was observed in about 56% of the townships. Also, being involved in occupations other than agriculture or animal husbandry and being single or married decreased the odds of HIV infection through heterosexual contact among women, which did not significantly vary across the Prefecture.Heterosexual transmission was the predominant mode of HIV transmission among women in the Prefecture, and this transformation was clearly marked by a fast-growing trend and a spatial diffusion pattern. Spatial variations also existed in sociodemographic factors that were associated with the changing modes of HIV transmission.
Collapse
Affiliation(s)
- Chenghan Xiao
- Department of Health Related Social and Behavioral Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Chunnong Jike
- Liangshan Prefecture Center for Disease Prevention and Control, Xichang
| | - Danping Liu
- Department of Health Related Social and Behavioral Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Peng Jia
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong, China
- International Initiative on Spatial Lifecourse Epidemiology (ISLE)
- Faculty of Geo-information Science and Earth Observation, University of Twente, Enschede, The Netherlands
| | - Xiaohe Xu
- School of Public Administration, Sichuan University, Chengdu
- Department of Sociology, The University of Texas at San Antonio, TX
| | - Lin Xiao
- Liangshan Prefecture Center for Disease Prevention and Control, Xichang
| | - Gang Yu
- Liangshan Prefecture Center for Disease Prevention and Control, Xichang
| | - Lei Nan
- Liangshan Prefecture Center for Disease Prevention and Control, Xichang
| | - Xiaxia Sun
- Department of Health Related Social and Behavioral Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Jingjing Ge
- Department of Health Related Social and Behavioral Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Ju Wang
- Liangshan Prefecture Center for Disease Prevention and Control, Xichang
| | - Ke Wang
- Liangshan Prefecture Center for Disease Prevention and Control, Xichang
| | - Qiang Liao
- Liangshan Prefecture Center for Disease Prevention and Control, Xichang
| | - Qixing Wang
- Liangshan Prefecture Center for Disease Prevention and Control, Xichang
| | - Zhai Wenwen
- Department of Health Related Social and Behavioral Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Shujuan Yang
- Department of Health Related Social and Behavioral Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
- International Initiative on Spatial Lifecourse Epidemiology (ISLE)
| |
Collapse
|
29
|
Torres TS, Marins LMS, Veloso VG, Grinsztejn B, Luz PM. How heterogeneous are MSM from Brazilian cities? An analysis of sexual behavior and perceived risk and a description of trends in awareness and willingness to use pre-exposure prophylaxis. BMC Infect Dis 2019; 19:1067. [PMID: 31856746 PMCID: PMC6923868 DOI: 10.1186/s12879-019-4704-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/12/2019] [Indexed: 12/22/2022] Open
Abstract
Background Brazil has the largest population of individuals living with HIV/AIDS in Latin America, with a disproportional prevalence of infection among gays, bisexuals and other men who have sex with men (MSM). Of relevance to prevention and treatment efforts, Brazilian MSM from different regions may differ in behaviors and risk perception related to HIV. Methods We report on MSM living in 29 different cities: 26 Brazilian state capitals, the Federal District and two large cities in São Paulo state assessed in three web-based surveys (2016–2018) advertised on Grindr, Hornet and Facebook. Using logistic regression models, we assessed the association of risk behavior with HIV perceived risk as well as factors associated with high-risk behavior. Results A total of 16,667 MSM completed the survey. Overall, MSM from the North and Northeast were younger, more black/mixed-black, of lower income and lower education compared to MSM from the South, Southeast and Central-west. Though 17% had never tested for HIV (with higher percentages in the North and Northeast), condomless receptive anal sex (previous 6 months) and high-risk behavior as per HIV Incidence Risk scale for MSM were observed for 41 and 64%, respectively. Sexual behavior and HIV perceived risk had low variability by city and high-risk behavior was strongly associated with high HIV perceived risk. Younger age, being gay/homosexual, having a steady partner, binge drinking, report of sexually transmitted infection (STI) and ever testing for HIV were associated with increased odds of high-risk behavior. Awareness and willingness to use PrEP increased from 2016 to 2018 in most cities. Conclusions Overall, MSM socio-demographic characteristics were heterogeneous among Brazilian cities, but similarities were noted among the cities from the same administrative region with a marked exception of the Federal District not following the patterns for the Central-West. Combination HIV prevention is most needed among young men who self-identify as gay/homosexual, report binge drinking or prior STI.
Collapse
Affiliation(s)
- Thiago S Torres
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil.
| | - Luana M S Marins
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Valdilea G Veloso
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Paula M Luz
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| |
Collapse
|
30
|
Hodges-Mameletzis I, Dalal S, Msimanga-Radebe B, Rodolph M, Baggaley R. Going global: the adoption of the World Health Organization's enabling recommendation on oral pre-exposure prophylaxis for HIV. Sex Health 2019; 15:489-500. [PMID: 30496718 DOI: 10.1071/sh18125] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/08/2018] [Indexed: 11/23/2022]
Abstract
In September 2015, the World Health Organization (WHO) launched evidence-based guidelines by recommending that any person at substantial HIV risk should be offered oral pre-exposure prophylaxis (PrEP) containing tenofovir disoproxil fumarate (TDF) as an additional prevention choice. Since 2017, PrEP medicines have also been listed in the WHO's Essential Medicines List, including TDF/emtricitabine (FTC) and TDF in combination with lamivudine (3TC). A descriptive policy review and analysis of countries adopting WHO's 2015 recommendation on oral PrEP was conducted. As of June 2018, we identified 35 countries that had some type of policy on oral PrEP, and an additional five countries where a specific policy on PrEP is currently pending. A total of 19 high-income countries (HICs) and 21 low- and middle-income countries (LMICs) have adopted or have a pending policy. Most countries that have adopted or pending PrEP are in the European (42.9%) or African (30.0%) region. TDF/FTC is the most commonly recommended PrEP drug in the guidelines reviewed, although seven countries, namely in sub-Saharan Africa (6/7), are also recommending the use of TDF/3TC for PrEP. In sum, by the end of 2018, at least 40 countries (20.6%) are anticipated to have adopted WHO's oral PrEP recommendation. Nonetheless, policy uptake does not reflect broader programmatic coverage of PrEP services, which remain limited across all settings, irrespective of income status. Enhancing global partnerships is needed to support and track ongoing policy adoption and to ensure that policy is translated into meaningful implementation of PrEP services.
Collapse
Affiliation(s)
| | - Shona Dalal
- World Health Organization, Headquarters, Avenue Appia 20, 1202 Geneva, Switzerland
| | - Busisiwe Msimanga-Radebe
- World Health Organization, South Africa Country Office, 7th Floor Metro Park Building, 351 Francis Baard Street, Pretoria, 0002, South Africa
| | - Michelle Rodolph
- World Health Organization, Headquarters, Avenue Appia 20, 1202 Geneva, Switzerland
| | - Rachel Baggaley
- World Health Organization, Headquarters, Avenue Appia 20, 1202 Geneva, Switzerland
| |
Collapse
|
31
|
Pathways From Sexual Stigma to Inconsistent Condom Use and Condom Breakage and Slippage Among MSM in Jamaica. J Acquir Immune Defic Syndr 2019; 78:513-521. [PMID: 29697593 DOI: 10.1097/qai.0000000000001712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND HIV prevalence among men who have sex with men (MSM) in Jamaica, where same sex practices are criminalized, is among the Caribbean's highest. Sexual stigma, the devaluation, mistreatment, and reduced power afforded to sexual minorities, is a distal driver of HIV vulnerabilities. The mechanisms accounting for associations between sexual stigma and condom use outcomes are underexplored. We examined pathways from sexual stigma to condom use and condom breakage and/or slippage among MSM in Jamaica. METHODS We conducted a cross-sectional survey with a chain-referral sample of MSM (n = 556) in Kingston, Montego Bay, and Ocho Rios. Structural equation modeling using weighted least squares estimation methods was conducted to test the direct effects of sexual stigma on inconsistent condom use and condom breakage/slippage, and the indirect effects through depression, sexual abuse history, and condom use self-efficacy, adjusting for sociodemographic factors. RESULTS One-fifth of participants (21%; 90/422) who had engaged in anal sex reported inconsistent condom use, and 38% (155/410) reported condom breakage/slippage during the previous 4 weeks. The relationship between sexual stigma and inconsistent condom use was mediated by the combination effect of sexual abuse history, condom use self-efficacy, and depression. The relationship between sexual stigma and condom breakage and slippage was mediated by the combination effect of condom use self-efficacy and sexual abuse history. CONCLUSIONS Sexual stigma is associated with negative condom use outcomes in Jamaican MSM, mediated by psychosocial factors. Multilevel social ecological approaches to the HIV prevention cascade can inform interventions at individual, interpersonal, community, and systemic levels.
Collapse
|
32
|
Leyva-Moral JM, Loayza-Enriquez BK, Palmieri PA, Guevara-Vasquez GM, Elias-Bravo UE, Edwards JE, Feijoo-Cid M, Davila-Olano LY, Rodriguez-Llanos JR, Leon-Jimenez FE. Adherence to antiretroviral therapy and the associated factors among people living with HIV/AIDS in Northern Peru: a cross-sectional study. AIDS Res Ther 2019; 16:22. [PMID: 31462291 PMCID: PMC6714391 DOI: 10.1186/s12981-019-0238-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/21/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND There are approximately 72,000 people living with HIV/AIDS (PLHIV) in Peru. Non-adherence to antiretroviral therapy (ART) is the most important factor for therapeutic failure and the development of resistance. Peru has achieved moderate progress in meeting the 90-90-90 targets, but only 60% of PLHIV receiving ART are virally suppressed. The purpose of this study was to understand ART adherence in the Peruvian context, including developing sociodemographic and clinical profiles, evaluating the clinical management strategies, and analyzing the relationships between the variables and adherence of PLHIV managed at a regional HIV clinic in Lambayeque Province (Northern Peru). METHODS This was a cross-sectional study with 180 PLHIV adults, non-randomly but consecutively selected with self-reported ART compliance (78.2% of the eligible population). The PLHIV profile (PLHIV-Pro) and the Simplified Medication Adherence Questionnaire (SMAQ) were used to collect sociodemographic information, clinical variables, and data specific to ART adherence. Descriptive analysis of sociodemographic and clinical characteristics was performed. Bivariate analysis was performed with the Mann-Whitney test, Chi square test, and Yates correction. RESULTS The 180 PLHIV sample included 78.9% men, 49.4% heterosexual, 45% with a detectable HIV-1 viral load less than 40 copies/ml, 58.3% not consistently adherent, and only 26.1% receiving Tenofovir + Lamivudine + Efavirenz. Risk factors significant for non-adherence included concurrent tuberculosis, discomfort with the ART regime, and previous pauses in ART. Multivariate analysis of nested models indicated having children is a protector factor for adherence. CONCLUSIONS Self-reported adherence appeared to be low and the use of first-line therapy is not being prescribed homogeneously. Factors associated with nonadherence are both medical and behavioral, such as having tuberculosis, pausing ART, or experiencing discomfort with ART. The Peruvian government needs to update national technical standards, monitor medication availability, and provide education to health care professionals in alignment with evidence-based guidelines and international recommendations. Instruments to measure adherence need to be developed and evaluated for use in Latin America.
Collapse
Affiliation(s)
- Juan M. Leyva-Moral
- Departament d’Infermeria, Facultat de Medicina, Universitat Autonoma de Barcelona, Avda. Can Domenech, Building M. Office M3/211, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
- Center for Health Sciences Research, Universidad María Auxiliadora, Av. Canto Bello 431, San Juan de Lurigancho, Lima, Lima 15408 Peru
- Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Universitat Autonoma de Barcelona, Avda. Can Domenech, Building M. Office M3/211, 08193 Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
| | - Blanca K. Loayza-Enriquez
- Department of Research, Hospital Regional Lambayecue, Pro. Augusto B. Leguia Nro. 100 (Esquina con Av. Progreso N. 110-120), Chiclayo, Lambayeque 14101 Peru
- School of Nursing, Universidad Nacional Pedro Ruiz Gallo, Av. Juan XXIII 391, Lambayeque, Chiclayo 14013 Peru
| | - Patrick A. Palmieri
- Center for Health Sciences Research, Universidad María Auxiliadora, Av. Canto Bello 431, San Juan de Lurigancho, Lima, Lima 15408 Peru
- College of Health Sciences, Universidad Norbert Wiener, Av. Arequipa 444, Lima, Lima 15046 Peru
- Evidence-Based Health Care South America: A Joanna Briggs Institute Affiliated Group, Universidad María Auxiliadora, Av. Canto Bello 431, San Juan de Lurigancho, Lima, Lima 15408 Peru
- Doctor of Health Sciences Program, College of Graduate Health Studies, A. T. Still University, 800 West Jefferson Street, Kirksville, MO 63501 USA
| | - Genesis M. Guevara-Vasquez
- Department of Research, Hospital Regional Lambayecue, Pro. Augusto B. Leguia Nro. 100 (Esquina con Av. Progreso N. 110-120), Chiclayo, Lambayeque 14101 Peru
- Evidence-Based Health Care South America: A Joanna Briggs Institute Affiliated Group, Universidad María Auxiliadora, Av. Canto Bello 431, San Juan de Lurigancho, Lima, Lima 15408 Peru
| | - Ursula E. Elias-Bravo
- Coordinator HIV/AIDS Unit, Department of Nursing, Hospital Regional Lambayeque, Pro. Augusto B. Leguía Nro. 100 (Esquina con Av. Progreso N. 110-120), Chiclayo, Lambayeque 14101 Peru
| | - Joan E. Edwards
- Center for Global Nursing, Texas Woman’s University, 6700 Fannin St, Houston, TX 77030 USA
| | - María Feijoo-Cid
- Departament d’Infermeria, Facultat de Medicina, Universitat Autonoma de Barcelona, Avda. Can Domenech, Building M. Office M3/211, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
| | - Lucy Y. Davila-Olano
- Midwife, Department of Obstetrics, Hospital Regional Lambayeque, Pro. Augusto B. Leguia Nro. 100 (Esquina con Av. Progreso N. 110-120), Chiclayo, Lambayeque 14101 Peru
| | - Juan R. Rodriguez-Llanos
- Department of Medicine, Hospital Regional Lambayeque, Pro. Augusto B. Leguia Nro. 100 (Esquina con Av. Progreso N. 110-120), Chiclayo, Lambayeque 14101 Peru
| | - Franco E. Leon-Jimenez
- School of Medicine, Universidad Santo Toribio Mogrovejo, Av. San Josemaría Escriva de Balaguer 855, Chiclayo, Lambayeque 14101 Peru
- Department of Medicine, Hospital Regional Lambayeque, Lambayeque, Pro. Augusto B. Leguia Nro. 100 (Esquina con Av. Progreso N. 110-120), Chiclayo, Lambayeque 14101 Peru
| |
Collapse
|
33
|
De Boni RB, Veloso VG, Fernandes NM, Lessa F, Corrêa RG, Lima RDS, Cruz M, Oliveira J, Nogueira SM, de Jesus B, Reis T, Lentini N, Miranda RL, Bingham T, Johnson CC, Barbosa Junior A, Grinsztejn B. An Internet-Based HIV Self-Testing Program to Increase HIV Testing Uptake Among Men Who Have Sex With Men in Brazil: Descriptive Cross-Sectional Analysis. J Med Internet Res 2019; 21:e14145. [PMID: 31373276 PMCID: PMC6694730 DOI: 10.2196/14145] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Approximately 30% of people living with HIV worldwide are estimated to be unaware of their infection. HIV self-testing (HIVST) is a strategy recommended by the World Health Organization to increase access to and uptake of testing among key populations who are at high risk for HIV infection. OBJECTIVE This study aimed to describe the development and feasibility of a free, anonymous, internet-based HIVST strategy designed for men who have sex with men in Curitiba, Brazil (electronic testing [e-testing]). METHODS The project was developed under the scope of the "A Hora é Agora" (The Time is Now) program. Individuals aiming to request an HIVST package (two tests each) answered an anonymous 5-minute questionnaire regarding inclusion criteria and sexual risk behavior. Eligible individuals could receive one package every 6 months for free. Website analytics, response to online questionnaires, package distribution, and return of test results were monitored via a platform-integrated system. RESULTS Between February 2015 and January 2016, the website documented 17,786 unique visitors and 3218 completed online questionnaires. Most individuals self-reported being white (77.0%), young (median age: 25 years, interquartile range: 22-31 years), educated (87.3% completed secondary education or more), and previously tested for HIV (62.5%). Overall, 2526 HIVST packages were delivered; of those, 542 (21.4%) reported a result online or by mail (23 reactive and 11 invalid). During the study period, 37 individuals who reported using e-testing visited the prespecified health facility for confirmatory testing (30 positive, 7 negative). CONCLUSIONS E-testing proved highly feasible and acceptable in this study, thus supporting scale-up to additional centers for men who have sex with men in Brazil.
Collapse
Affiliation(s)
- Raquel Brandini De Boni
- Instituto Nacional de Infectologia Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Nilo Martinez Fernandes
- Instituto Nacional de Infectologia Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Flavia Lessa
- Instituto Nacional de Infectologia Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Renato Girade Corrêa
- National Department of STI, AIDS, and Viral Hepatitis, Ministry of Health, Brailia, Brazil
| | - Renato De Souza Lima
- National Department of STI, AIDS, and Viral Hepatitis, Ministry of Health, Brailia, Brazil
| | - Marly Cruz
- Escola Nacional de Saúde Pública, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | | | - Beto de Jesus
- Escola Nacional de Saúde Pública, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Nena Lentini
- Centers for Disease Control and Prevention-Brazil, Brasilia, Brazil
| | | | - Trista Bingham
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| |
Collapse
|
34
|
Torres TS, Konda KA, Vega-Ramirez EH, Elorreaga OA, Diaz-Sosa D, Hoagland B, Diaz S, Pimenta C, Bennedeti M, Lopez-Gatell H, Robles-Garcia R, Grinsztejn B, Caceres C, Veloso VG. Factors Associated With Willingness to Use Pre-Exposure Prophylaxis in Brazil, Mexico, and Peru: Web-Based Survey Among Men Who Have Sex With Men. JMIR Public Health Surveill 2019; 5:e13771. [PMID: 31210143 PMCID: PMC6601256 DOI: 10.2196/13771] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 12/23/2022] Open
Abstract
Background HIV disproportionally affects key populations including men who have sex with men (MSM). HIV prevalence among MSM varies from 17% in Brazil and Mexico to 13% in Peru, whereas it is below 0.5% for the general population in each country. Pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir is being implemented in the context of combination HIV prevention. Reports on willingness to use PrEP among MSM have started to emerge over the last few years. Previously reported factors associated with willingness to use PrEP include awareness, higher sexual risk behavior, and previous sexually transmitted infection. Objective This study aimed to evaluate the factors associated with willingness to use daily oral PrEP among MSM in 3 Latin American, middle-income countries (Brazil, Mexico, and Peru). Methods This Web-based, cross-sectional survey was advertised in 2 gay social network apps (Grindr and Hornet) used by MSM to find sexual partners and on Facebook during 2 months in 2018. Inclusion criteria were being 18 years or older, cisgender men, and HIV-negative by self-report. Eligible individuals answered questions on demographics, behavior, and PrEP (awareness, willingness to use, barriers, and facilitators). Multivariable logistic regression modeling was performed to assess the factors associated with willingness to use daily oral PrEP in each country. Results From a total sample of 43,687 individuals, 44.54% of MSM (19,457/43,687) were eligible and completed the Web-based survey—Brazil: 58.42% (11,367/19,457), Mexico: 30.50% (5934/19,457), and Peru: 11.08% (2156/19,457); median age was 28 years (interquartile range: 24-34), and almost half lived in large urban cities. Most participants were recruited on Grindr (69%, 13,349/19,457). Almost 20% (3862/19,352) had never tested for HIV, and condomless receptive anal sex was reported by 40% (7755/19,326) in the previous 6 months. Whereas 67.51% (13,110/19,376) would be eligible for PrEP, only 9.80% (1858/18,959) of participants had high HIV risk perception. PrEP awareness was reported by 64.92% (12,592/19,396); this was lower in Peru (46.60%, 1002/2156). Overall, willingness to use PrEP was reported by 64.23% (12,498/19,457); it was highest in Mexico (70%, 4158/5934) and lowest in Peru (58%, 1241/2156). In multivariate regression models adjusted for age, schooling, and income in each country, willingness to use PrEP was positively associated with PrEP awareness and PrEP facilitators (eg, free PrEP and HIV testing) and negatively associated with behavioral (eg, concerned by daily pill regimen) and belief barriers (eg, sexual partners may expect condomless sex). Conclusions In this first cross-country, Web-based survey in Latin America, willingness to use PrEP was found to be high and directly related to PrEP awareness. Interventions to increase awareness and PrEP knowledge about safety and efficacy are crucial to increase PrEP demand. This study provides important information to support the implementation of PrEP in Brazil, Mexico, and Peru.
Collapse
Affiliation(s)
- Thiago Silva Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/Fiocruz), Rio de Janeiro, Brazil
| | - Kelika A Konda
- Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru
| | - E Hamid Vega-Ramirez
- Condesa & Condesa-Iztapalapa Specialized Clinics, Mexico City, Mexico.,National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Oliver A Elorreaga
- Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru
| | - Dulce Diaz-Sosa
- Condesa & Condesa-Iztapalapa Specialized Clinics, Mexico City, Mexico.,National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/Fiocruz), Rio de Janeiro, Brazil
| | - Steven Diaz
- Center for Prevention and Comprehensive Healthcare for HIV/AIDS of Mexico City, Mexico City, Mexico
| | | | - Marcos Bennedeti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/Fiocruz), Rio de Janeiro, Brazil
| | | | | | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/Fiocruz), Rio de Janeiro, Brazil
| | - Carlos Caceres
- Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/Fiocruz), Rio de Janeiro, Brazil
| | -
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/Fiocruz), Rio de Janeiro, Brazil.,Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru.,Condesa & Condesa-Iztapalapa Specialized Clinics, Mexico City, Mexico
| |
Collapse
|
35
|
Logie CH, Wang Y, Marcus N, Levermore K, Jones N, Ellis T, Bryan N. Syndemic Experiences, Protective Factors, and HIV Vulnerabilities Among Lesbian, Gay, Bisexual and Transgender Persons in Jamaica. AIDS Behav 2019; 23:1530-1540. [PMID: 30600454 DOI: 10.1007/s10461-018-2377-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Syndemics approaches explore the convergence of psychosocial factors that elevate HIV vulnerabilities. Less research has explored syndemics among lesbian, gay, bisexual and transgender (LGBT) persons in contexts where criminalization has downstream impacts on LGBT discrimination, such as Jamaica. We implemented a cross-sectional survey with LGBT persons (n = 911) in Jamaica. We conducted structural equation modeling to examine direct and indirect effects of a latent syndemics construct (binge drinking, depressive symptoms, childhood/adult abuse) on HIV vulnerabilities (lifetime sex partners, perceived HIV risk, condom self-efficacy) and the mediating role of protective factors (social support, resilient coping). Direct paths from syndemics to lifetime sex partners, perceived HIV risk, and condom self-efficacy were significant. Resilient coping and social support partially mediated the association between syndemics and condom use self-efficacy. Resilient coping partially mediated the relationship between syndemics and lifetime sex partners. Interventions can target syndemic issues to reduce HIV vulnerabilities among Jamaican LGBT persons.
Collapse
Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street, Toronto, ON, M5S 1V4, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
| | - Ying Wang
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street, Toronto, ON, M5S 1V4, Canada
| | - Natania Marcus
- Department of Applied Psychology and Human Development, University of Toronto, Toronto, ON, Canada
| | | | | | - Tyrone Ellis
- Jamaica AIDS Support for Life, Kingston, Jamaica
| | | |
Collapse
|
36
|
Torres TS, Luz PM, De Boni RB, de Vasconcellos MTL, Hoagland B, Garner A, Moreira RI, Veloso VG, Grinsztejn B. Factors associated with PrEP awareness according to age and willingness to use HIV prevention technologies: the 2017 online survey among MSM in Brazil .. AIDS Care 2019; 31:1193-1202. [PMID: 31122033 DOI: 10.1080/09540121.2019.1619665] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Brazil has the largest population of individuals living with HIV/AIDS in Latin America with a disproportional prevalence of infection among men who have sex with men (MSM). This study evaluated PrEP awareness by age (18-24, 25-35, ≥36 years), its associated factors and the willingness to use HIV prevention technologies among MSM using a GSN app in Brazil. Inclusion criteria were ≥18 years-old, cisgender men and HIV-negative serostatus. Of 7242 individuals, 4136 (57%) completed the questionnaire. PrEP awareness was reported by 51% (though lower among MSM aged 18-24 and ≥36 years) and its associated factors were higher family income, most friends with the same sexual orientation, high number of male sexual partners and marijuana use. HIV testing (never vs. at least once) lead to an almost 3-fold increase in the odds of PrEP awareness. High HIV risk perception led to increased PrEP awareness only among MSM aged 18-24 years. A total of 2335 (56%) was willing to use daily oral PrEP. PrEP awareness remains low in Brazil and mobile tools are key strategies to reach MSM and increase awareness of prevention technologies. Community-based interventions could add to online campaigns to reach the most vulnerable, which include young, non-white and lower-income MSM.
Collapse
Affiliation(s)
- Thiago S Torres
- a Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas , Rio de Janeiro , Brazil
| | - Paula M Luz
- a Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas , Rio de Janeiro , Brazil
| | - Raquel B De Boni
- a Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas , Rio de Janeiro , Brazil
| | | | - Brenda Hoagland
- a Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas , Rio de Janeiro , Brazil
| | | | - Ronaldo I Moreira
- a Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas , Rio de Janeiro , Brazil
| | - Valdilea G Veloso
- a Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas , Rio de Janeiro , Brazil
| | - Beatriz Grinsztejn
- a Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas , Rio de Janeiro , Brazil
| |
Collapse
|
37
|
Sevelius J, Murray LR, Fernandes NM, Veras MA, Grinsztejn B, Lippman SA. Optimising HIV programming for transgender women in Brazil. CULTURE, HEALTH & SEXUALITY 2019; 21:543-558. [PMID: 30378463 PMCID: PMC6483864 DOI: 10.1080/13691058.2018.1496277] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 06/27/2018] [Accepted: 06/29/2018] [Indexed: 05/20/2023]
Abstract
In Brazil, little data is available to inform HIV prevention programming for travestis and transgender ('trans') women, despite the existence of a social movement that has gained strength in recent years. We conducted formative research in Rio de Janeiro to gather trans women's perspectives on combination HIV prevention approaches. Framing the analysis within the model of gender affirmation, we found that several social and contextual factors inhibited participants' access to HIV prevention and treatment. Experienced and anticipated gender-related discrimination and HIV stigma were linked to the avoidance of HIV testing, health services and HIV status disclosure. Participants recommended HIV prevention interventions which combined socio-structural interventions, such as peer-based empowerment and social support, with biomedical interventions such as pre-exposure prophylaxis (PrEP). Participants expressed a preference for programmes and interventions that emphasised a gender-affirmative approach, promoted autonomy and aimed to reduce stigma and discrimination in public health services.
Collapse
Affiliation(s)
- Jae Sevelius
- Department of Medicine, Division of Prevention Sciences, University of California, San Francisco, CA, USA
| | - Laura Rebecca Murray
- Department of Health Policy, Planning, and Administration, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Maria Amelia Veras
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas-Fiocruz, Rio de Janeiro, Brazil
| | - Sheri A. Lippman
- Department of Medicine, Division of Prevention Sciences, University of California, San Francisco, CA, USA
| |
Collapse
|
38
|
Hernández I, Barzallo J, Beltrán S, Castillo A, Cevallos N, Hernández P, López C, Vera R, Yerovi G, Mendoza A, Terán S, Izurieta A, Teran E. Increased incidences of noninfectious comorbidities among aging populations living with human immunodeficiency virus in Ecuador: a multicenter retrospective analysis. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2019; 11:55-59. [PMID: 31114389 PMCID: PMC6489679 DOI: 10.2147/hiv.s193412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Introduction: Besides the well-known increased risk of developing HIV-related infectious comorbidities; compared with the general population, people living with HIV (PLHIV) may also have an increased risk of developing noninfectious comorbidities (NICMs). This is the first study intended to determine the NICMs rates affecting PLHIV who were under cART regimen in Ecuador. Methods: A total of 503 HIV-positive patients were evaluated during the period June 2015-November 2016 and included in a multicenter retrospective, cross-sectional study conducted in seven main government and nongovernment community-based hospitals in Ecuador. Results: The average age of the participants was 39.2±11.9 years old and the majority of them were male (67.2%). The average age at HIV diagnosis was 34.1 years old and cART in average was started 15.9 months after HIV-diagnosis. Recruited patients were receiving cART for an average of 59.2±40.2 months. Only 9.9% (n=50) of the patients did not show any NICMs. Diabetes and pre-diabetes was found in 6% (n=30) and 16.3% (n=82) patients, respectively; however, dyslipidemia and overweight/obesity was frequent, as they affected 41.4% (n=208) and 36.4% (n=183) patients, respectively. Sixty patients (11.9%) were diagnosed with depression and 28.2% (n=142) of the studied subjects were found to have other NICMs. Conclusion: Prevalence of NICMs among subjects under cART was greater than that reported among the Ecuadorian general population, therefore specific public health actions are required to make patients aware of and prevent NICMs among PLHIV in Ecuador.
Collapse
Affiliation(s)
- Isabel Hernández
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador.,Facultad de Enfermería, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Julio Barzallo
- Hospital Teofilo Dávila, Ministerio de Salud Pública, Machala, Ecuador
| | - Simón Beltrán
- Hospital Carlos Andrade Marín, Instituto Ecuatoriano de Seguridad Social, Quito, Ecuador
| | - Alberto Castillo
- Hospital Eugenio Espejo, Ministerio de Salud Pública, Quito, Ecuador
| | - Nelson Cevallos
- Hospital Enrique Garcés, Ministerio de Salud Pública, Quito, Ecuador
| | - Patricio Hernández
- Hospital de Infectología Dr. José Daniel Rodríguez Maridueña, Ministerio de Salud Pública, Guayaquil, Ecuador
| | - Camilo López
- Hospital Teodoro Maldonado Carbo, Instituto Ecuatoriano de Seguridad Social, Guayaquil, Ecuador
| | - Rita Vera
- Hospital Abel Gilbert Pontón, Ministerio de Salud Pública, Guayaquil, Ecuador
| | - Gabriela Yerovi
- Programa Nacional para Control del VIH, Ministerio de Salud Pública, Quito, Ecuador
| | - Alejandra Mendoza
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
| | - Santiago Terán
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
| | - Andres Izurieta
- Department of Computer Engineering, College of Engineering, University of South Florida, Tampa, FL, USA
| | - Enrique Teran
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
| |
Collapse
|
39
|
Stonbraker S, Richards S, Halpern M, Bakken S, Schnall R. Priority Topics for Health Education to Support HIV Self-Management in Limited-Resource Settings. J Nurs Scholarsh 2019; 51:168-177. [PMID: 30450740 PMCID: PMC6414238 DOI: 10.1111/jnu.12448] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE The purpose of this study was to identify and prioritize the information that persons living with HIV (PLWH) in a limited-resource setting need to effectively manage their health. DESIGN AND METHODS A data sources triangulation method was used to compare data from three separate sources: (a) 107 interviews with Spanish-speaking PLWH being seen at a healthcare clinic in the Dominican Republic (DR); (b) 40 interviews with Spanish-speaking healthcare providers from the same clinic in the DR; and (c) an integrative literature review of English- and Spanish-language articles that assessed the health information needs of PLWH in Latin America and the Caribbean. We compared information needs across sources and developed a prioritized list of the topics important to provide PLWH in a clinical setting. FINDINGS Triangulation identified the most important topics for HIV-related health education for PLWH as medication and adherence, followed by transmission, including risks and prevention strategies, mental health management, and knowledge of HIV in general. CONCLUSIONS The identification of evidence-based health education priorities establishes a guide that healthcare providers may use to help PLWH effectively manage their health and creates a foundation from which further studies on improving clinical interactions may be generated. CLINICAL RELEVANCE Using the priorities identified, nurses and other health educators can improve patient education, and consequently self-management, by making evidence-based choices about what information to provide to their patients.
Collapse
Affiliation(s)
- Samantha Stonbraker
- Alpha Zeta, Postdoctoral Fellow, Columbia University School of Nursing, New York, NY, USA, and Director of Research, Clínica de Familia La Romana, Dominican Republic
| | - Sheyla Richards
- MD/MS Global Health focus student, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Mina Halpern
- Executive Director, Clínica de Familia La Romana, Dominican Republic
| | - Suzanne Bakken
- Alpha Zeta, Alumni Professor of Nursing, and Professor of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Rebecca Schnall
- Alpha Zeta, Mary Dickey Lindsay Assistant Professor of Disease Prevention and Health Promotion, Columbia University School of Nursing, New York, NY USA
| |
Collapse
|
40
|
Edeza A, Galarraga O, Novak D, Mayer K, Rosenberger J, Mimiaga M, Biello K. The role of sexual risk behaviors on PrEP awareness and interest among men who have sex with men in Latin America. Int J STD AIDS 2019; 30:542-549. [PMID: 30722750 DOI: 10.1177/0956462419825944] [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: 11/17/2022]
Abstract
In Latin America, men who have sex with men (MSM) remain disproportionately impacted by HIV. Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool and has been FDA approved in the United States since 2012, but no Latin American state, with the recent exception of Brazil, has implemented PrEP guidelines. We carried out a multinational online survey of MSM in Latin America (n = 22698) in 2012 to assess whether MSM at highest risk of HIV acquisition (i.e., those engaging in condomless anal sex [CAS; n = 2606] and transactional sex [n = 1488]) had higher levels of awareness of PrEP, PrEP use and interest in participating in a PrEP trial. After adjusting for demographic and psychosocial characteristics including depressive symptoms, hazardous alcohol use, childhood sexual abuse, and sexual compulsivity, transactional sex and CAS were associated with increased PrEP awareness (aOR = 1.29, 95% CI: 1.05-1.59, p < .001 and aOR = 1.22, 95% CI: 1.11-1.34, p < .001, respectively) and PrEP trial interest (aOR = 1.45, 95% CI: 1.25-1.71, p < .001 and aOR = 1.74, 95% CI: 1.57-1.95, p < .001, respectively). Findings demonstrate substantial awareness of and interest in PrEP among MSM with behavioral risk factors for HIV in Latin America, suggesting that this region is primed for PrEP implementation, which has been slow.
Collapse
Affiliation(s)
- Alberto Edeza
- 1 Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Omar Galarraga
- 2 Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | - David Novak
- 3 OLB Research Institute, Cambridge, MA, USA
| | - Kenneth Mayer
- 4 The Fenway Institute, Boston, MA, USA.,5 Department of Infectious Disease, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Joshua Rosenberger
- 6 College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Matthew Mimiaga
- 1 Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA.,4 The Fenway Institute, Boston, MA, USA.,7 Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Katie Biello
- 1 Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA.,4 The Fenway Institute, Boston, MA, USA.,7 Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| |
Collapse
|
41
|
Villalobos-Gallegos L, Medina-Mora ME, Benjet C, Ruiz-Velasco S, Magis-Rodriguez C, Marín-Navarrete R. Multidimensional Patterns of Sexual Risk Behavior and Psychiatric Disorders in Men with Substance Use Disorders. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:599-607. [PMID: 29845445 DOI: 10.1007/s10508-018-1227-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 05/04/2018] [Accepted: 05/05/2018] [Indexed: 06/08/2023]
Abstract
Previous evidence links substance use disorders (SUD) to STI/HIV risk and suggests that comorbid psychiatric disorders increase the probability to engage in sexual risk behaviors. This study had two aims: (1) to identify subgroups based on sexual risk behavior using a person-centered approach in a sample of substance users and (2) to measure the association of psychiatric and SUD with subgroup membership. We assessed 402 male adults with SUD, reporting sexual intercourse in the previous 12 months using the HIV-Risk Behavior Scale and the Mini International Neuropsychiatric Interview. Latent class analysis was performed to determine multidimensional patterns of sexual risk behaviors and multinomial logistic regression was utilized to associate classes with disorders. The three-class model showed the best fit, and the classes were labeled: Relationship-Based (31.34% of the sample), Condom-Based (39.55%), and Multiple Risks (29.10%). Controlling for age and marital status, major depressive disorders, antisocial personality disorder, and any psychiatric disorder were associated with the Multiple Risks class. Results stress the importance of developing a personalized assessment and counseling for sexual risk behaviors in individuals with SUD, particularly when they endorse criteria for comorbid psychiatric disorders. Future studies should focus on evaluating differential response to preventive interventions.
Collapse
Affiliation(s)
- Luis Villalobos-Gallegos
- Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz" (INPRFM), Calz. México-Xochimilco #101, San Lorenzo Huipulco, Tlalpan, 14370, Mexico City, Mexico
- Facultad de Medicina, UNAM, Mexico City, Mexico
| | - María Elena Medina-Mora
- Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz" (INPRFM), Calz. México-Xochimilco #101, San Lorenzo Huipulco, Tlalpan, 14370, Mexico City, Mexico
| | - Corina Benjet
- Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz" (INPRFM), Calz. México-Xochimilco #101, San Lorenzo Huipulco, Tlalpan, 14370, Mexico City, Mexico
| | - Silvia Ruiz-Velasco
- Instituto de Investigaciones en Matemáticas Aplicadas y Sistemas, UNAM, Mexico City, Mexico
| | | | - Rodrigo Marín-Navarrete
- Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz" (INPRFM), Calz. México-Xochimilco #101, San Lorenzo Huipulco, Tlalpan, 14370, Mexico City, Mexico.
| |
Collapse
|
42
|
Hernandez I, Reina-Ortiz M, K. Yusuf K, Ochoa T, Rosas C, Sharma V, Naik E, Salihu HM, Terán S, Izurieta R, Teran E. Risk factors for HIV and STI among female sex workers in a high HIV prevalent region of Ecuador. COGENT MEDICINE 2019. [DOI: 10.1080/2331205x.2019.1565292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Isabel Hernandez
- Facultad de Enfermería, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
| | - Miguel Reina-Ortiz
- Department of Global Health, College of Public Health, University of South Florida, Tampa, FL, USA
- Fundación Raíces, Esmeraldas, Ecuador
| | - Korede K. Yusuf
- Department of Global Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Tatiana Ochoa
- Department of Global Health, College of Public Health, University of South Florida, Tampa, FL, USA
- Moffitt Cancer Center, Tampa, FL, USA
| | - Carlos Rosas
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
| | - Vinita Sharma
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
| | - Eknath Naik
- Department of Global Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | | | - Santiago Terán
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
| | - Ricardo Izurieta
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
| | - Enrique Teran
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
| |
Collapse
|
43
|
Volkmann T, Chase M, Lockard AM, Henningham D, Albalak R. Lessons Learned From the Implementation of HIV Biological-Behavioral Surveys of Key Populations in the Caribbean. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:528-541. [PMID: 30966768 PMCID: PMC6461362 DOI: 10.1521/aeap.2018.30.6.528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In the Caribbean region, HIV prevalence is high among key population (KP) groups, such as sex workers and men who have sex with men. However, there is a lack of high-quality, population-level data estimating HIV prevalence and population sizes of KPs. The President's Emergency Plan for AIDS Relief has funded and completed five bio-behavioral surveillance (BBS) surveys using respondent-driven sampling methodology to target KP in the English-speaking Caribbean region. We describe the experience of implementing bio-behavioral surveys in the Caribbean region and document the context, processes, successes, and challenges, and make recommendations for future survey implementation. Successes include the provision of estimates of nationally representative HIV data and KP size estimates to improve HIV programming and provision of tools for routinization of BBS. Challenges include small KP sizes, the legal context, and the cost and speed of implementation. Future bio-behavioral surveys should include well-planned formative assessments and stakeholder involvement.
Collapse
Affiliation(s)
- Tyson Volkmann
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Martine Chase
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ann M Lockard
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia
- Department of Epidemiology, Emory University, Atlanta
| | - Deborah Henningham
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rachel Albalak
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
44
|
Logie CH, Abramovich A, Schott N, Levermore K, Jones N. Navigating stigma, survival, and sex in contexts of social inequity among young transgender women and sexually diverse men in Kingston, Jamaica. REPRODUCTIVE HEALTH MATTERS 2018; 26:72-83. [PMID: 30475167 DOI: 10.1080/09688080.2018.1538760] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Social inequities, including stigma, criminalisation of same-sex practices, and poverty, elevate HIV exposure among young transgender women and sexually diverse men in Jamaica. Yet the ways transgender women and sexually diverse men in Jamaica navigate sex and HIV in contexts of social inequity are underexplored. The study objective was to explore experiences and perceptions of sexual decision-making and HIV risk among young (aged 18-30) sexually diverse men and transgender women in Kingston, Jamaica. We conducted a community-based qualitative study in Kingston that involved in-depth individual interviews (transgender women: n = 20; sexually diverse men: n = 20), 2 focus groups (transgender women: n = 8; sexually diverse men: n = 10) and 13 key informant interviews. Focus groups and interviews were digitally recorded, transcribed verbatim, and analysed with a thematic approach. Findings suggest that transgender women and sexually diverse men in Kingston are aware of, and managing survival challenges and HIV risks in contexts of social inequity. Daily survival challenges include stigma and a lack of human rights protections that contributed to barriers to employment, housing, healthcare, education, and exposure to violence. Challenges maintaining sexual relationships included the need to hide for safety, often resulting in difficulties forming lasting relationships. These survival and relationship challenges converged to lower self-esteem and self-acceptance. In the face of these challenges, participants navigated sexual risk and pleasure. Findings provide insight into agency and sexual decision-making processes in contexts of social inequities. Findings can inform multi-level strategies to promote social equity, sexual health, and HIV prevention with young transgender women and sexually diverse men in Jamaica.
Collapse
Affiliation(s)
- Carmen H Logie
- a Associate Professor, Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada.,b Adjunct Scientist, Women's College Research Institute , Women's College Hospital , Toronto , ON , Canada
| | - Alex Abramovich
- c Independent Scientist , Centre for Addiction and Mental Health , Toronto , ON , Canada
| | - Nicole Schott
- d Doctoral Candidate, Ontario Institute for Studies in Education (OISE) , University of Toronto , Toronto , ON , Canada
| | - Kandasi Levermore
- e Executive Director , Jamaica AIDS Support for Life , Kingston , Jamaica
| | - Nicolette Jones
- f Research Coordinator , Jamaica AIDS Support for Life , Kingston , Jamaica
| |
Collapse
|
45
|
Logie CH, Lacombe-Duncan A, Kenny KS, Levermore K, Jones N, Baral SD, Wang Y, Marshall A, Newman PA. Social-ecological factors associated with selling sex among men who have sex with men in Jamaica: results from a cross-sectional tablet-based survey. Glob Health Action 2018; 11:1424614. [PMID: 29338660 PMCID: PMC5774420 DOI: 10.1080/16549716.2018.1424614] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Globally, men who have sex with men (MSM) experience social marginalization and criminalization that increase HIV vulnerability by constraining access to HIV prevention and care. People who sell sex also experience criminalization, rights violations, and violence, which elevate HIV exposure. MSM who sell sex may experience intersectional stigma and intensified social marginalization, yet have largely been overlooked in epidemiological and social HIV research. In Jamaica, where same sex practices and sex work are criminalized, scant research has investigated sex selling among MSM, including associations with HIV vulnerability. OBJECTIVE We aimed to examine social ecological factors associated with selling sex among MSM in Jamaica, including exchanging sex for money, shelter, food, transportation, or drugs/alcohol (past 12 months). METHODS We conducted a cross-sectional survey with a peer-driven sample of MSM in Kingston, Ocho Rios, and Montego Bay. Multivariable logistic regression analyses were conducted to estimate intrapersonal/individual, interpersonal/social, and structural factors associated with selling sex. RESULTS Among 556 MSM, one-third (n = 182; 32.7%) reported selling sex. In the final multivariable model, correlates of selling sex included: individual/intrapersonal (lower safer sex self-efficacy [AOR: 0.85, 95% CI: 0.77, 0.94]), interpersonal/social (concurrent partnerships [AOR: 5.52, 95% CI: 1.56, 19.53], a higher need for social support [AOR: 1.08, 95% CI: 1.03, 1.12], lifetime forced sex [AOR: 2.74, 95% 1.65, 4.55]) and structural-level factors (sexual stigma [AOR: 1.09, 95% CI: 1.04, 1.15], food insecurity [AOR: 2.38, 95% CI: 1.41, 4.02], housing insecurity [AOR: 1.94, 95% CI: 1.16, 3.26], no regular healthcare provider [AOR: 2.72, 95% CI: 1.60, 4.64]). CONCLUSIONS This study highlights social ecological correlates of selling sex among MSM in Jamaica, in particular elevated stigma and economic insecurity. Findings suggest that MSM in Jamaica who sell sex experience intensified social and structural HIV vulnerabilities that should be addressed in multi-level interventions to promote health and human rights.
Collapse
Affiliation(s)
- Carmen H Logie
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada.,b Women's College Research Institute , Women's College Hospital , Toronto , ON , Canada
| | - Ashley Lacombe-Duncan
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
| | - Kathleen S Kenny
- c Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | | | | | - Stefan D Baral
- e Johns Hopkins Bloomberg School of Public Health , Johns Hopkins University , Baltimore , MD , USA
| | - Ying Wang
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
| | - Annecka Marshall
- f Institute for Gender and Development Studies , Mona Campus, University of the West Indies , Kingston , Jamaica
| | - Peter A Newman
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
| |
Collapse
|
46
|
Valenzuela-Ponce H, Alva-Hernández S, Garrido-Rodríguez D, Soto-Nava M, García-Téllez T, Escamilla-Gómez T, García-Morales C, Quiroz-Morales VS, Tapia-Trejo D, Del Arenal-Sánchez S, Prado-Galbarro FJ, Hernández-Juan R, Rodríguez-Aguirre E, Murakami-Ogasawara A, Mejía-Villatoro C, Escobar-Urias IY, Pinzón-Meza R, Pascale JM, Zaldivar Y, Porras-Cortés G, Quant-Durán C, Lorenzana I, Meza RI, Palou EY, Manzanero M, Cedillos RA, Aláez C, Brockman MA, Harrigan PR, Brumme CJ, Brumme ZL, Ávila-Ríos S, Reyes-Terán G. Novel HLA class I associations with HIV-1 control in a unique genetically admixed population. Sci Rep 2018; 8:6111. [PMID: 29666450 PMCID: PMC5904102 DOI: 10.1038/s41598-018-23849-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/21/2018] [Indexed: 12/26/2022] Open
Abstract
Associations between HLA class I alleles and HIV progression in populations exhibiting Amerindian and Caucasian genetic admixture remain understudied. Using univariable and multivariable analyses we evaluated HLA associations with five HIV clinical parameters in 3,213 HIV clade B-infected, ART-naïve individuals from Mexico and Central America (MEX/CAM cohort). A Canadian cohort (HOMER, n = 1622) was used for comparison. As expected, HLA allele frequencies in MEX/CAM and HOMER differed markedly. In MEX/CAM, 13 HLA-A, 24 HLA-B, and 14 HLA-C alleles were significantly associated with at least one clinical parameter. These included previously described protective (e.g. B*27:05, B*57:01/02/03 and B*58:01) and risk (e.g. B*35:02) alleles, as well as novel ones (e.g. A*03:01, B*15:39 and B*39:02 identified as protective, and A*68:03/05, B*15:30, B*35:12/14, B*39:01/06, B*39:05~C*07:02, and B*40:01~C*03:04 identified as risk). Interestingly, both protective (e.g. B*39:02) and risk (e.g. B*39:01/05/06) subtypes were identified within the common and genetically diverse HLA-B*39 allele group, characteristic to Amerindian populations. While HLA-HIV associations identified in MEX and CAM separately were similar overall (Spearman's rho = 0.33, p = 0.03), region-specific associations were also noted. The identification of both canonical and novel HLA/HIV associations provides a first step towards improved understanding of HIV immune control among unique and understudied Mestizo populations.
Collapse
Affiliation(s)
- Humberto Valenzuela-Ponce
- National Institute of Respiratory Diseases, CIENI Center for Research in Infectious Diseases, Mexico City, Mexico
| | - Selma Alva-Hernández
- National Institute of Respiratory Diseases, CIENI Center for Research in Infectious Diseases, Mexico City, Mexico
| | - Daniela Garrido-Rodríguez
- National Institute of Respiratory Diseases, CIENI Center for Research in Infectious Diseases, Mexico City, Mexico
| | - Maribel Soto-Nava
- National Institute of Respiratory Diseases, CIENI Center for Research in Infectious Diseases, Mexico City, Mexico
| | - Thalía García-Téllez
- National Institute of Respiratory Diseases, CIENI Center for Research in Infectious Diseases, Mexico City, Mexico.,Institut Pasteur, Unité HIV, Inflammation and Persistence, Paris, France
| | - Tania Escamilla-Gómez
- National Institute of Respiratory Diseases, CIENI Center for Research in Infectious Diseases, Mexico City, Mexico
| | - Claudia García-Morales
- National Institute of Respiratory Diseases, CIENI Center for Research in Infectious Diseases, Mexico City, Mexico
| | | | - Daniela Tapia-Trejo
- National Institute of Respiratory Diseases, CIENI Center for Research in Infectious Diseases, Mexico City, Mexico
| | - Silvia Del Arenal-Sánchez
- National Institute of Respiratory Diseases, CIENI Center for Research in Infectious Diseases, Mexico City, Mexico
| | | | - Ramón Hernández-Juan
- National Institute of Respiratory Diseases, CIENI Center for Research in Infectious Diseases, Mexico City, Mexico
| | - Edna Rodríguez-Aguirre
- National Institute of Respiratory Diseases, CIENI Center for Research in Infectious Diseases, Mexico City, Mexico
| | - Akio Murakami-Ogasawara
- National Institute of Respiratory Diseases, CIENI Center for Research in Infectious Diseases, Mexico City, Mexico
| | | | | | | | | | - Yamitzel Zaldivar
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama City, Panama
| | | | | | - Ivette Lorenzana
- Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Rita I Meza
- Honduras HIV National Laboratory, Tegucigalpa, Honduras
| | - Elsa Y Palou
- Hospital Escuela Universitario, Tegucigalpa, Honduras
| | | | | | - Carmen Aláez
- National Institute of Genomic Medicine, Translational Medicine Laboratory, Mexico City, Mexico
| | - Mark A Brockman
- Simon Fraser University, Faculty of Health Sciences, Burnaby, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | | | - Chanson J Brumme
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Zabrina L Brumme
- Simon Fraser University, Faculty of Health Sciences, Burnaby, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Santiago Ávila-Ríos
- National Institute of Respiratory Diseases, CIENI Center for Research in Infectious Diseases, Mexico City, Mexico.
| | - Gustavo Reyes-Terán
- National Institute of Respiratory Diseases, CIENI Center for Research in Infectious Diseases, Mexico City, Mexico.
| | | |
Collapse
|
47
|
De Boni RB, Machado IK, De Vasconcellos MTL, Hoagland B, Kallas EG, Madruga JV, Fernandes NM, Cerqueira NB, Moreira RI, Goulart SP, Veloso VG, Grinsztejn B, Luz PM. Syndemics among individuals enrolled in the PrEP Brasil Study. Drug Alcohol Depend 2018; 185:168-172. [PMID: 29454927 DOI: 10.1016/j.drugalcdep.2017.12.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/30/2017] [Accepted: 12/02/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Concurrent psychosocial problems may synergistically increase the risk of HIV infection (syndemics), representing a challenge for prevention. We aimed to evaluate the prevalence and associated factors of syndemics among men who have sex with men (MSM) and transgender women (TGW) enrolled in the Brazilian pre-exposure prophylaxis demonstration study (PrEP Brasil Study). METHODS Secondary cross-sectional analysis of the PrEP Brasil Study was performed. Of 450 HIV-seronegative MSM/TGW enrolled in the PrEP Brasil Study- conducted at Rio de Janeiro and São Paulo, Brazil- 421 participants with complete data were included in the present analysis. Syndemics was defined as occurrence of ≥2 of the following conditions: polysubstance (≥2) use, binge drinking, positive depression screen, compulsive sexual behavior, and intimate partner violence (IPV). RESULTS The prevalence of recent polysubstance use was 22.8%, binge drinking 51.1%, positive depression screening 5.2%, compulsive sexual behavior 7.1%, and IPV 7.3%. Syndemics prevalence was 24.2%, and associated factors were younger age (adjusted Odds Ratio (aOR) 0.95, 95% Confidence Interval (95% CI) 0.92-0.98 per year increase), TGW vs. MSM (aOR 3.09, 95% CI: 1.2-8.0), some college education or more vs. less than college (aOR 2.49, 95% CI: 1.31-4.75), and multiple male sexual partners in prior 3 months (aOR 1.69, 95% CI: 0.92-3.14). CONCLUSION Given the high prevalence of syndemics, particularly of polysubstance use and binge drinking, PrEP delivery offers an opportunity to diagnose and intervene in mental and social well-being.
Collapse
Affiliation(s)
- Raquel B De Boni
- National Institute of Infectology Evandro Chagas, Lapclin STD/AIDS, Avenida Brasil 4.365, Fiocruz, Rio de Janeiro, Brazil
| | - Iona K Machado
- Columbia College of Physicians and Surgeons, 630 W. 168 St., New York City, NY, USA
| | | | - Brenda Hoagland
- National Institute of Infectology Evandro Chagas, Lapclin STD/AIDS, Avenida Brasil 4.365, Fiocruz, Rio de Janeiro, Brazil
| | - Esper G Kallas
- Division of Clinical Immunology and Allergy, University of São Paulo, São Paulo, Brazil
| | - José Valdez Madruga
- Centro de Referencia e Treinamento DST/AIDS, 81 Vila Mariana, São Paulo, Brazil
| | - Nilo M Fernandes
- National Institute of Infectology Evandro Chagas, Lapclin STD/AIDS, Avenida Brasil 4.365, Fiocruz, Rio de Janeiro, Brazil
| | - Natalia B Cerqueira
- Division of Clinical Immunology and Allergy, University of São Paulo, São Paulo, Brazil
| | - Ronaldo I Moreira
- National Institute of Infectology Evandro Chagas, Lapclin STD/AIDS, Avenida Brasil 4.365, Fiocruz, Rio de Janeiro, Brazil
| | - Silvia P Goulart
- Division of Clinical Immunology and Allergy, University of São Paulo, São Paulo, Brazil
| | - Valdilea G Veloso
- National Institute of Infectology Evandro Chagas, Lapclin STD/AIDS, Avenida Brasil 4.365, Fiocruz, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- National Institute of Infectology Evandro Chagas, Lapclin STD/AIDS, Avenida Brasil 4.365, Fiocruz, Rio de Janeiro, Brazil
| | - Paula M Luz
- National Institute of Infectology Evandro Chagas, Lapclin STD/AIDS, Avenida Brasil 4.365, Fiocruz, Rio de Janeiro, Brazil.
| |
Collapse
|
48
|
Anderson K, Biello K, Rosenberger JG, Novak D, Mayer K, Carey K, Mimiaga MJ. The impact of social support and partner relationship dynamics on engagement in HIV care and antiretroviral treatment adherence among MSM in Latin America. AIDS Care 2018; 30:1406-1412. [PMID: 29587490 DOI: 10.1080/09540121.2018.1456641] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In Latin America (LA), HIV prevalence among MSM is estimated at thirty times greater than in the general male population. Little is known about the role of social support or disclosure status in relation to the HIV care continuum among LA MSM. Using multivariable logistic generalized estimation equations, we assessed the impact of social support satisfaction and disclosure status on engagement in HIV care, ART initiation, and ART adherence with data from an online, multinational sample of HIV infected MSM in Latin America (N = 2,350). 80.0% were engaged in HIV care, 71% initiated ART, and among those, 37% reported missing at least one dose in the past month. In multivariable models, compared to being very satisfied with social support, being somewhat satisfied (aOR = 0.73, 95% CI 0.56, 0.95) or somewhat dissatisfied (aOR = 0.83, 95% CI 0.70, 0.98) were associated with reduced odds of reporting 100% ART adherence. Disclosure of status was associated with a greater odds of HIV care engagement (OR = 1.63, 95% CI 1.28, 2.07) and ART initiation (OR = 1.55, 95% CI 1.30, 1.84). Greater satisfaction with social support and comfort disclosing HIV status to these sources were associated with improved engagement in HIV care and greater initiation of ART among MSM in LA.
Collapse
Affiliation(s)
- Kelsey Anderson
- a Brown University School of Public Health , Providence , RI , USA
| | - Katie Biello
- b The Fenway Institute , Fenway Health , Boston , MA , USA.,c Departments of Behavioral and Social Health Sciences and Epidemiology , Brown University School of Public Health , Providence , RI , USA
| | - Joshua G Rosenberger
- d Department of Biobehavioral Health , Penn State University , Middletown , PA , USA
| | - David Novak
- e OLB Research Institute, Online Buddies, Inc. , Cambridge , MA , USA
| | - Kenneth Mayer
- b The Fenway Institute , Fenway Health , Boston , MA , USA.,f Division of Infectious Disease, Department of Medicine , Harvard Medical School/Beth Israel Deaconess Medical Center , Boston , MA , USA
| | - Kate Carey
- g Center for Alcohol and Addiction Studies , School of Public Health, Brown University , Providence , RI , USA
| | - Matthew J Mimiaga
- b The Fenway Institute , Fenway Health , Boston , MA , USA.,c Departments of Behavioral and Social Health Sciences and Epidemiology , Brown University School of Public Health , Providence , RI , USA.,h Department of Psychiatry and Human Behavior , Alpert Medical School, Brown University , Providence , RI , USA
| |
Collapse
|
49
|
De Boni RB, Peratikos MB, Shepherd BE, Grinsztejn B, Cortés C, Padgett D, Gotuzzo E, Belaunzarán-Zamudio PF, Rebeiro PF, Duda SN, McGowan CC. Is substance use associated with HIV cascade outcomes in Latin America? PLoS One 2018; 13:e0194228. [PMID: 29543857 PMCID: PMC5854364 DOI: 10.1371/journal.pone.0194228] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/09/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The HIV care cascade has improved in Latin America over the last decade. However, the influence of alcohol and noninjected drug use (NIDU) on cascade outcomes is mostly unknown. This study estimated the association of alcohol and NIDU with retention in care, loss to follow up (LTFU), and virologic failure (VF). METHODS Individuals ≥18 years attending routine HIV clinic visits and completing the Rapid Screening Tool (RST; evaluating NIDU and ART adherence in 7-day recall period) during 2012-13 were followed up to 2015 in the Caribbean, Central and South America network for HIV epidemiology. Adjusted odds ratios (aOR) were calculated for the association of alcohol consumption and NIDU with retention in care by logistic regression; adjusted hazard ratios (aHR) were estimated for the associations with LTFU and VF by Cox regression. RESULTS Among 3604 individuals, the proportions retained in care for one year were 84%, 79%, 72%, and 69% for patients reporting non-use, alcohol use, NIDU, and both alcohol and NIDU, respectively. For the same patient groups, the proportions LTFU over 18 months were 6%, 8%, 12%, and 13%, respectively. There were 1901 patients (53%) with HIV RNA results; VF proportions were similar between users and nonusers (ranging from 14-16%). After controlling for age, sex, study site, HIV transmission mode, time on ART, AIDS status, and CD4 count, neither alcohol use (aOR = 1.1, CI = 0.9-1.4; aHR = 1.0, CI = 0.8-1.3) nor NIDU (aOR = 1.3, CI = 0.9-1.8; aHR = 1.4, CI = 0.9-2.1) were significantly associated with retention or VF, respectively. However, both alcohol use (aHR = 1.2, CI = 1.02-1.4) and NIDU (aHR = 1.3, CI = 1.00-1.8) were associated with increased LTFU. CONCLUSION Alcohol use and NIDU in a 7-day recall period increased the risk of being LTFU during the next 18 months, highlighting the need for routine screening and targeted interventions to keep these individuals in care and on ART.
Collapse
Affiliation(s)
- Raquel B. De Boni
- Instituto Nacional de Infectologia Evandro Chagas- FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Bryan E. Shepherd
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas- FIOCRUZ, Rio de Janeiro, Brazil
| | - Claudia Cortés
- Fundación Arriaran–Facultad de Medicina Universidad de Chile, Santiago, Chile
| | - Denis Padgett
- Instituto Hondureno de Seguridad Social and Hospital Escuela, Tegucigalpa, Honduras
| | | | - Pablo F. Belaunzarán-Zamudio
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Peter F. Rebeiro
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Stephany N. Duda
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | | | | |
Collapse
|
50
|
Grinsztejn B, Hoagland B, Moreira RI, Kallas EG, Madruga JV, Goulart S, Leite IC, Freitas L, Martins LMS, Torres TS, Vasconcelos R, De Boni RB, Anderson PL, Liu A, Luz PM, Veloso VG. Retention, engagement, and adherence to pre-exposure prophylaxis for men who have sex with men and transgender women in PrEP Brasil: 48 week results of a demonstration study. Lancet HIV 2018; 5:e136-e145. [PMID: 29467098 DOI: 10.1016/s2352-3018(18)30008-0] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 12/30/2017] [Accepted: 01/02/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND PrEP Brasil was a demonstration study to assess feasibility of daily oral tenofovir diphosphate disoproxil fumarate plus emtricitabine provided at no cost to men who have sex with men (MSM) and transgender women at high risk for HIV within the Brazilian public health system. We report week 48 pre-exposure prophylaxis (PrEP) retention, engagement, and adherence, trends in sexual behaviour, and incidence of HIV and sexually transmitted infections in this study cohort. METHODS PrEP Brasil was a 48 week, open-label, demonstration study that assessed PrEP delivery at three referral centres for HIV prevention and care in Rio de Janeiro, Brazil (Fundação Oswaldo Cruz), and São Paulo, Brazil (Universidade de São Paulo and Centro de Referência e Treinamento em DST e AIDS). Eligible participants were MSM and transgender women who were HIV negative, aged at least 18 years, resident in Rio de Janeiro or São Paulo, and reported one or more sexual risk criteria in the previous 12 months (eg, condomless anal sex with two or more partners, two or more episodes of anal sex with an HIV-infected partner, or history of sexually transmitted infection [STI] diagnosis). Participants were seen at weeks 4, 12, 24, 36, and 48 for PrEP provision, clinical and laboratory evaluation, and HIV testing. Computer-assisted self-interviews were also done at study visits 12, 24, 36, and 48, and assessed sexual behaviour and drug use. PrEP retention was defined by attendance at the week 48 visit, PrEP engagement was an ordinal five-level variable combining presence at the study visit and drug concentrations, and PrEP adherence was evaluated by measuring tenofovir diphosphate concentrations in dried blood spots. Logistic regression models were used to quantify the association of variables with high adherence (≥4 doses per week). The study is registered with ClinicalTrials.gov, number NCT01989611. FINDINGS Between April 1, 2014, and July 8, 2016, 450 participants initiated PrEP, 375 (83%) of whom were retained until week 48. At week 48, 277 (74%) of 375 participants had protective drug concentrations consistent with at least four doses per week: 183 (82%) of 222 participants from São Paulo compared with 94 (63%) of 150 participants from Rio de Janeiro (adjusted odds ratio 1·88, 95% CI 1·06-3·34); 119 (80%) of 148 participants who reported sex with HIV-infected partners compared with 158 (70%) of 227 participants who did not (1·78, 1·03-3·08); 67 (87%) of 77 participants who used stimulants compared with 210 (71%) of 298 participants who did not (2·23, 1·02-4·92); and 232 (80%) of 289 participants who had protective concentrations of tenofovir disphosphate at week 4 compared with 42 (54%) of 78 participants who did not (3·28, 1·85-5·80). Overall, receptive anal sex with the last three partners increased from 45% at enrolment to 49% at week 48 (p=0·17), and the mean number of sexual partners in the previous 3 months decreased from 11·4 (SD 28·94) at enrolment to 8·3 (19·55) at week 48 (p<0·0013). Two individuals seroconverted during follow-up (HIV incidence 0·51 per 100 person-years, 95% CI 0·13-2·06); both of these patients had undetectable tenofovir concentrations at seroconversion. INTERPRETATION Our results support the effectiveness and feasibility of PrEP in a real-world setting. Offering PrEP at public health-care clinics in a middle-income setting can retain high numbers of participants and achieve high levels of adherence without risk compensation in the investigated populations. FUNDING Brazilian Ministry of Health, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Secretaria de Vigilancia em Saúde, Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro, and Fundação de Amparo à Pesquisa do Estado de São Paulo.
Collapse
Affiliation(s)
- Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil.
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ronaldo I Moreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Esper G Kallas
- Universidade de São Paulo, Faculdade de Medicina, São Paulo, Brazil
| | - Jose V Madruga
- Centro de Referência e Treinamento em DST/AIDS, São Paulo, Brazil
| | - Silvia Goulart
- Centro de Referência e Treinamento em DST/AIDS, São Paulo, Brazil
| | - Iuri C Leite
- Fundacao Oswaldo Cruz, Escola Nacional de Saude Publica, Rio de Janeiro, Brazil
| | - Lucilene Freitas
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Luana M S Martins
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Raquel B De Boni
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Peter L Anderson
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Albert Liu
- San Francisco Department of Public Health, Bridge HIV, San Francisco, CA, USA
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Valdiléa G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| |
Collapse
|