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Rossotti R, Tavelli A, Calzavara D, De Bona A, Muccini C, Moschese D, Caruso E, Soria A, Bossolasco S, Lapadula G, Cernuschi M, Monforte AD. Do we Still Need Eligibility Criteria to Recommend PrEP? Impact of National Prescribing Requirements on Retention in Care and Sexually Transmitted Infections Acquisition. AIDS Behav 2024; 28:2258-2263. [PMID: 38526636 DOI: 10.1007/s10461-024-04320-3] [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] [Accepted: 03/12/2024] [Indexed: 03/27/2024]
Abstract
Italian guidelines recommend HIV pre-exposure prophylaxis (PrEP) only upon satisfying strict eligibility criteria. The objective of this study is to evaluate if PrEP candidates attending a community-based service comply with these criteria and whether these prescribing conditions affect retention in care and sexually transmitted infections (STIs) acquisition. A retrospective analysis was performed on PrEP candidates evaluated from January 2019 to June 2022. Data were collected from self-administered questionnaires and clinical files. The population was divided in subjects with 0/1 (0/1 C) and ≥ 2 (≥ 2 C) criteria. Descriptive statistics and non-parametric tests were employed to describe study population. Incidence of PrEP discontinuation and of STIs was estimated per 100 persons-year of follow up (PYFU), and incidence rate ratio (IRR) was calculated. Univariate and multivariable Cox regression analyses were used to evaluate the association strength between PrEP drop out and other variables. The analyses enrolled 659 individuals: 422 individuals were included in 0/1 C, 237 in ≥ 2 C group, respectively. Inconsistent condom use was the most reported prescribing criteria (399 individuals, 60.6%), followed by a previous STI (186 individuals, 28.2%). 0/1 C exhibited lower STIs incidence. PrEP discontinuation was 29% in 0/1 C and 38% in ≥ 2 C (p = 0.031). Cox model revealed that inconsistent condom use was the only prescribing criteria associated to PrEP persistence. The majority of PrEP candidate did not comply with prescribing conditions. Eligibility criteria failed to identify individuals with better retention in care. Our results suggest that Italian guidelines should be updated removing barriers to prescription.
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Affiliation(s)
- Roberto Rossotti
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, Milan, 20162, Italy.
- Milano Checkpoint ETS, Milan, Italy.
| | | | | | - Anna De Bona
- Milano Checkpoint ETS, Milan, Italy
- Department of Infectious Diseases, ASST Santi Paolo e Carlo, Milan, Italy
| | - Camilla Muccini
- Milano Checkpoint ETS, Milan, Italy
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Davide Moschese
- Milano Checkpoint ETS, Milan, Italy
- Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Alessandro Soria
- Milano Checkpoint ETS, Milan, Italy
- Department of Infectious Diseases, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Simona Bossolasco
- Milano Checkpoint ETS, Milan, Italy
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Lapadula
- Milano Checkpoint ETS, Milan, Italy
- Department of Infectious Diseases, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Massimo Cernuschi
- Milano Checkpoint ETS, Milan, Italy
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella d'Arminio Monforte
- Milano Checkpoint ETS, Milan, Italy
- ICONA Foundation, Milan, Italy
- School of Medicine, University of Milano, Milan, Italy
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MacPhail C, Manlik K, Dews H, Mao L, Rutherford A. Ending HIV Transmission in Australia: Expanding PrEP to Cisgender Women: A Scoping Review. AIDS Behav 2024:10.1007/s10461-024-04386-z. [PMID: 38806843 DOI: 10.1007/s10461-024-04386-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 05/30/2024]
Abstract
Pre-exposure prophylaxis (PrEP) availability through the Pharmaceutical Benefits Scheme provides real potential for the elimination of HIV transmission in Australia, as evidenced by a rapid decline in HIV incidence among gay and bisexual men (GBM). However, HIV elimination will not be possible without also extending PrEP to other populations, including cisgender women. We conducted a scoping review to examine the extent to which PrEP access for cisgender women has been considered in Australia. A comprehensive search across five databases, grey literature, and hand search of references was conducted. A single reviewer conducted title and abstract screening and two reviewers completed full-text screening and data extraction. Nineteen documents were included in the final review and included both peer-reviewed journal articles and guidelines and strategies. Focused discussion of cisgender women's use of PrEP was largely missing from the literature and, although their use of PrEP is supported in some relevant guidelines, little has been done to actively develop strategies to inform cisgender women about PrEP as a precursor to prescribing for HIV prevention. Healthcare providers' narrow view of PrEP as being the domain of GBM further limits cisgender women's potential access. If HIV elimination in Australia is to be a reality, we need to develop mechanisms to specifically engage with cisgender women about PrEP.
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Affiliation(s)
- Catherine MacPhail
- School of Health and Society, University of Wollongong, Wollongong, Australia.
| | - Kate Manlik
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Hannah Dews
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Limin Mao
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Alison Rutherford
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
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3
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Punchihewa TM, Wiles J, Saxton PJW. More than prevention: early adoption of HIV pre-exposure prophylaxis (PrEP) by gay and bisexual men in New Zealand. CULTURE, HEALTH & SEXUALITY 2024; 26:222-235. [PMID: 37067151 DOI: 10.1080/13691058.2023.2195474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/22/2023] [Indexed: 06/19/2023]
Abstract
Pre-exposure prophylaxis (PrEP) minimises HIV risk and New Zealand was one of the first countries to publicly fund PrEP in 2018. However, no studies have explored in-depth the experience and meaning of living 'on PrEP' among individuals at elevated risk of HIV, such as gay and bisexual men. This qualitative study builds on findings from the NZPrEP demonstration project of early PrEP-adopting gay and bisexual men in Auckland, New Zealand. We interviewed 10 of the 150 NZPrEP participants using an ethnicity equity quota (five European ethnicities and five non-European ethnicities). A phenomenologically-inspired thematic analysis was conducted. We identified three themes. The first, Trusting in the Pill, focuses on the relationship between PrEP and its user, while the second theme, A Liberation of Sorts, details the freedom PrEP offered men, sexually, mentally and socially. The final theme, Reframing Risk, explores the risk perceptions and the conflicting discourses surrounding gay and bisexual men using PrEP. This first qualitative study in New Zealand about the experiences of PrEP early-adopters suggests that the role of PrEP extends well beyond HIV prevention and, for many, involves redefining safe sex even in a country with historically high levels of condom promotion and low HIV incidence.
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Affiliation(s)
- T Minushika Punchihewa
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Janine Wiles
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Peter J W Saxton
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Avallone F, Engler K, Cox J, Hickson F, Lebouché B. Interventions, Barriers, and Facilitators to Address the Sexual Problems of Gay, Bisexual and Other Men Who Have Sex with Men Living with HIV: A Rapid Scoping Review. AIDS Behav 2024; 28:450-472. [PMID: 38296920 DOI: 10.1007/s10461-023-04237-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 02/02/2024]
Abstract
Sexual problems are common among gay, bisexual, and other men who have sex with men (GBM) after diagnosis with HIV. However, these are often overlooked in care and research, where sexual risk reduction and biomedical aspects of sexual health tend to dominate. We conducted a rapid scoping review to investigate which sexual problems of GBM living with HIV are addressed by interventions, and the barriers and facilitators to their implementation. Literature from high-income countries published in English since 2010 was reviewed. Medline, Embase, PsycInfo, and Scopus databases were searched on July 4, 2022. Targeted sexual problems were categorized according to the ten dimensions of Robinson's Sexual Health Model, and barriers and facilitators, according to the five domains of the Consolidated Framework for Implementation Research (CFIR). Interventions focused solely on the dimension of Sexual Health Care/Safer Sex were excluded. Relevant information was extracted from the qualifying documents with NVivo 12 software for content analysis. Fifty-two documents were included, referring to 37 interventions which mainly took place in the United States (n = 29/37; 78%), were group-based (n = 16; 41%), and used counselling techniques (n = 23; 62%; e.g., motivational interviewing, cognitive-behavioral therapy). Their settings were mostly primary care (n = 15; 40%) or community-based (n = 16; 43%). On average, interventions addressed three sexual health dimensions (SD = 2; range: 1-10). The most targeted dimension was Sexual Health Care/Safer Sex (n = 26; 70%), which concerned sexual risk reduction. Next, Challenges (n = 23; 62%), included substance use (n = 7; 19%), sexual compulsivity (n = 6; 16%), sexual abuse (n = 6; 16%), and intimate partner violence (n = 4; 11%). Third was Talking About Sex (n = 22; 59%) which mostly concerned HIV disclosure. About a third of interventions addressed Culture/Sexual identity (n = 14; 38%), Intimacy/Relationships (n = 12; 33%), and Positive sexuality (n = 11; 30%). Finally, few targeted Body Image (n = 4; 11%), Spirituality (n = 3; 8%), Sexual Anatomy Functioning (n = 2; 5%) or Masturbation/Fantasy (n = 1; 3%). Forty-one documents (79%) mentioned implementation barriers or facilitators, particularly about the characteristics of the interventions (41% and 78%, respectively; e.g., cost, excessive duration, acceptability, feasibility) and of the individuals involved (37% and 46%; e.g., perceived stigmatization, provider expertise). The other three CFIR dimensions were less common (5%-17%). The search strategy of this review may not have captured all eligible documents, due to its limit to English-language publications. Overall, most interventions incorporated a focus on Sexual Health Care/Safer Sex, at the expenses of other prevalent sexual problems among GBM living with HIV, such as intimate partner violence (Challenges), erectile dysfunction (Sexual Anatomy Functioning), and Body Image dissatisfaction. These findings suggest they could receive more attention within clinical care and at the community level. They also highlight the importance of cost-effective and acceptable interventions conducted in non-stigmatizing environments, where patients' needs can be met by providers who are adequately trained on sexuality-related topics.
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Affiliation(s)
- Francesco Avallone
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Kim Engler
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Joseph Cox
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada
- Department of Epidemiology and Biostatistics, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Ford Hickson
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Bertrand Lebouché
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada.
- Department of Family Medicine, McGill University, Montreal, QC, Canada.
- Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.
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Nakiganda LJ, Bavinton BR, Poynten IM, Serwadda D, Bazaale JM, Grulich AE. Sexual pleasure and HIV-related worry in female sex workers on oral pre-exposure prophylaxis in south-western Uganda. Sex Health 2024; 21:SH23056. [PMID: 38267368 DOI: 10.1071/sh23056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 01/07/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Female sex workers (FSWs) contribute disproportionately to HIV transmission in Uganda, and pre-exposure prophylaxis (PrEP) is effective in preventing HIV among cisgender women. Psychological factors are important for PrEP uptake, but few studies have examined psychosocial changes due to PrEP use in Uganda. METHODS In 2021, we recruited 524 FSWs in three Trans-African Highway towns and four fishing communities in south-western Uganda. We conducted structured interviews among women who were attending routine PrEP follow-up visits in six health units. Bivariable and multivariable modified regression using a robust covariance matrix estimator were used to identify factors associated with experiencing increased sexual pleasure and less worry about HIV because of PrEP. RESULTS Overall, 80.9% participants reported that sex was more pleasurable because of taking PrEP. There were statistical trends for sex being more pleasurable when taking PrEP or when having condomless sex with casual paying partners (aPR=1.19, 95% CI=1.07-1.32, P =0.001). Almost three-quarters of the participants (76.3%) were less worried about getting HIV because of PrEP. Condomless sex with casual paying partners (aPR=1.17, 95% CI=1.05-1.31, P =0.032, P =0.003) and being On PrEP for the past 1-2years (aPR=1.18, 95% CI=1.00-1.38, P =0.032) was significantly associated with HIV-related worry (aPR=1.17, 95% CI=1.05-1.31, P =0.032, P =0.003) Conclusions : We found a positive impact of PrEP in Ugandan FSWs on two key psychosocial dimensions: (1) more pleasurable sex; and (2) less worry about acquiring HIV. Interventions aiming to increase PrEP uptake may find it useful to focus on psychosocial dimensions.
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Affiliation(s)
| | - Benjamin R Bavinton
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, NSW, Australia
| | - Isobel Mary Poynten
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, NSW, Australia
| | - David Serwadda
- Rakai Health Sciences Program, Kalisizo, Uganda; and Makerere University School of Public Health, Kampala, Uganda
| | | | - Andrew E Grulich
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, NSW, Australia
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Application of Bayesian networks to identify factors influencing acceptability of HIV pre-exposure prophylaxis in Guilin, China. Sci Rep 2022; 12:20542. [PMID: 36446859 PMCID: PMC9707149 DOI: 10.1038/s41598-022-24965-1] [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: 03/29/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022] Open
Abstract
Pre-exposure prophylaxis (PrEP) is an effective strategy to prevent uninfected individuals from contracting human immunodeficiency virus (HIV), however it must be acceptable to stakeholders in order to be effective. This study aimed to assess the acceptability of PrEP and related influencing factors. A cross-sectional survey was conducted among female sex workers (FSW), people who inject drugs (PWID), and men who have sex with men (MSM) using respondent driven sampling. Factors influencing PrEP acceptability were estimated using ordinal logistic regression and Bayesian networks. The survey included 765 eligible participants. The mean score of the perceived acceptability index was 3.9 (SD = 1.97). Multivariable logistic regression analysis revealed a higher acceptance of PrEP was associated with elder age, having other medical insurance, higher perceived utility of PrEP in facilitating prevention of HIV, higher perceived ease of use, higher perceived risk of increased risk behavior, higher perceived privacy problem in using PrEP, higher perceived comparative advantage over condom use, higher perceived comparative advantage of having sex when the urge arises, and higher perceived image of PrEP user as having sexual risky behavior, as public-minded and as health-conscious. The Bayesian network model showed perceived ease of use, perceived image of user as health-conscious, and perceived comparative advantage of having sex when the urge arises were directly associated with acceptability of PrEP. If these three factors were at a high level, 74.6% of the participants would have a high level of acceptability of PrEP. Effective education strategies to promote the acceptance of PrEP are needed. Implementation strategies should incorporate more inclusive messaging and build positive publicity for PrEP to reduce the stigma that PrEP use indicates risky behavior.
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Curley CM, Rosen AO, Mistler CB, Eaton LA. Pleasure and PrEP: A Systematic Review of Studies Examining Pleasure, Sexual Satisfaction, and PrEP. JOURNAL OF SEX RESEARCH 2022; 59:848-861. [PMID: 35089110 PMCID: PMC9329484 DOI: 10.1080/00224499.2021.2012638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is an effective form of Human Immunodeficiency Virus (HIV) prevention for people at potential risk for exposure. Despite its demonstrated efficacy, PrEP uptake and adherence have been discouraging, especially among groups most vulnerable to HIV transmission. A primary message to persons who are at elevated risk for HIV has been to focus on risk reduction, sexual risk behaviors, and continued condom use, rarely capitalizing on the positive impact on sexuality, intimacy, and relationships that PrEP affords. This systematic review synthesizes the findings and themes from 16 quantitative, qualitative, and mixed methods studies examining PrEP motivations and outcomes focused on sexual satisfaction, sexual pleasure, sexual quality, and sexual intimacy. Significant themes emerged around PrEP as increasing emotional intimacy, closeness, and connectedness; PrEP as increasing sexual options and opportunities; PrEP as removing barriers to physical closeness and physical pleasure; and PrEP as reducing sexual anxiety and fears. It is argued that positive sexual pleasure motivations should be integrated into messaging to encourage PrEP uptake and adherence, as well as to destigmatize sexual pleasure and sexual activities of MSM.
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Affiliation(s)
- Christine M. Curley
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- The first two authors are co-authors on this manuscript, as they contributed equally to design and analyses
| | - Aviana O. Rosen
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
- The first two authors are co-authors on this manuscript, as they contributed equally to design and analyses
| | - Colleen B. Mistler
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Lisa A. Eaton
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
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Wiginton JM, Eaton LA, Watson RJ, Maksut JL, Earnshaw VA, Berman M. Sex-Positivity, Medical Mistrust, and PrEP Conspiracy Beliefs Among HIV-Negative Cisgender Black Sexual Minority Men in Atlanta, Georgia. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2571-2581. [PMID: 34761347 PMCID: PMC9085967 DOI: 10.1007/s10508-021-02174-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 08/18/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
Because the public health response to the disproportionate HIV burden faced by Black sexual minority men (BSMMM) has focused on sexual risk reduction and disease prevention, other vital components of sexual health (e.g., intimacy, pleasure, benefits of sex) have been often overlooked. Sex-positive describes a more open, holistic approach toward sex and sexuality that prioritizes these other components, though such an approach is rarely applied to BSMM's sexual health. For sex-positive BSMM, risk/preventive discourse may foster or exacerbate medical mistrust as a reaction to the dissonance between how these men view sexual health and how the medical establishment views it, which may discourage sexual healthcare-seeking. We assessed sex-positivity and its association with medical mistrust and PrEP conspiracy beliefs among 206 HIV-negative cisgender BSMM in Atlanta, Georgia. We performed exploratory factor analytic procedures on responses to a sex-positivity scale, followed by multivariable linear regressions to determine sex-positivity's associations with medical mistrust and PrEP conspiracy beliefs. We extracted two sex-positivity factors: sexual freedom (α = 0.90), reflecting openness toward casual sex and rejection of sexual mores, and essence of sex (α = 0.77), reflecting the intimate, relational, and pleasurable qualities of sex. Sexual freedom was independently associated with perceived provider deception (β = 0.19, CI = 0.04, 0.34). Essence of sex was independently associated with PrEP conspiracy beliefs (β = 0.16, CI = 0.02, 0.31) and marginally associated with perceived provider deception (β = 0.14, CI = - 0.00, 0.29). Healthcare providers and public health practitioners may cultivate greater trust with BSMM by incorporating a sex-positive approach into patient/participant interactions, clinical decision-making, and interventions. Improving access to sexual pleasure acknowledges BSMM's right to optimal, holistic sexual health.
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Affiliation(s)
- John Mark Wiginton
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway Street, Baltimore, MD, 21205, USA.
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Jessica L Maksut
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Marcie Berman
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
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Ssempijja V, Nakigozi G, Ssekubugu R, Kagaayi J, Kigozi G, Nalugoda F, Nantume B, Batte J, Kigozi G, Yeh PT, Nakawooya H, Serwadda D, Quinn TC, Gray RH, Wawer MJ, Grabowski KM, Chang LW, van't Hoog A, Cobelens F, Reynolds SJ. High Rates of Pre-exposure Prophylaxis Eligibility and Associated HIV Incidence in a Population With a Generalized HIV Epidemic in Rakai, Uganda. J Acquir Immune Defic Syndr 2022; 90:291-299. [PMID: 35259129 PMCID: PMC9177156 DOI: 10.1097/qai.0000000000002946] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The utility of using pre-exposure prophylaxis (PrEP) eligibility assessments to identify eligibility in general populations has not been well studied in sub-Saharan Africa. We used the Rakai Community Cohort Study to conduct a cross-sectional analysis to estimate PrEP eligibility and a cohort analysis to estimate HIV incidence associated with PrEP eligibility. METHODS Based on Uganda's national PrEP eligibility tool, we defined eligibility as reporting at least one of the following HIV risks in the past 12 months: sexual intercourse with more than one partner of unknown HIV status; nonmarital sex act without a condom; sex engagement in exchange for money, goods, or services; or experiencing genital ulcers. We used log-binomial and modified Poisson models to estimate prevalence ratios for PrEP eligibility and HIV incidence, respectively. FINDINGS We identified 12,764 participants among whom to estimate PrEP eligibility prevalence and 11,363 participants with 17,381 follow-up visits and 30,721 person-years (pys) of observation to estimate HIV incidence. Overall, 29% met at least one of the eligibility criteria. HIV incidence was significantly higher in PrEP-eligible versus non-PrEP-eligible participants (0.91/100 pys versus 0.41/100 pys; P < 0.001) and independently higher in PrEP-eligible versus non-PrEP-eligible female participants (1.18/100 pys versus 0.50/100 pys; P < 0.001). Among uncircumcised male participants, HIV incidence was significantly higher in PrEP-eligible versus non-PrEP-eligible participants (1.07/100 pys versus 0.27/100 pys; P = 0.001), but there was no significant difference for circumcised male participants. INTERPRETATION Implementing PrEP as a standard HIV prevention tool in generalized HIV epidemics beyond currently recognized high-risk key populations could further reduce HIV acquisition and aid epidemic control efforts.
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Affiliation(s)
- Victor Ssempijja
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD
- Rakai Health Sciences Program, Entebbe, Uganda;
| | | | | | | | | | | | | | - James Batte
- Rakai Health Sciences Program, Entebbe, Uganda;
| | | | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - David Serwadda
- Rakai Health Sciences Program, Entebbe, Uganda;
- Makerere University School of Public Health, Kampala, Uganda;
| | - Thomas C. Quinn
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Ronald H. Gray
- Rakai Health Sciences Program, Entebbe, Uganda;
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Maria J. Wawer
- Rakai Health Sciences Program, Entebbe, Uganda;
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kate M. Grabowski
- Rakai Health Sciences Program, Entebbe, Uganda;
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD; and
| | - Larry W. Chang
- Rakai Health Sciences Program, Entebbe, Uganda;
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Anja van't Hoog
- Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
| | - Frank Cobelens
- Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
| | - Steven J. Reynolds
- Rakai Health Sciences Program, Entebbe, Uganda;
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
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10
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Van Dijk M, De Wit JBF, Guadamuz TE, Martinez JE, Jonas KJ. Quality of Sex Life and Perceived Sexual Pleasure of PrEP Users in the Netherlands. JOURNAL OF SEX RESEARCH 2022; 59:303-308. [PMID: 34128741 DOI: 10.1080/00224499.2021.1931653] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Next to its benefits for HIV prevention, PrEP may have psychosocial benefits relating to improved quality of sex life. The aim of the current study was to investigate the onset of changes in the quality of sex life and sexual pleasure of PrEP users in the first months of commencing PrEP use. Moreover, we investigated what factors were related to the quality of sex life of PrEP users. We recruited 145 participants via the Dutch PrEP-advocacy website PrEPnu.nl, and they received follow-up questionnaires after three and six months. We found that PrEP users reported an increase in the quality of their sex life, which was related to reduced fear of HIV since they started using PrEP but not to decreased condom use. PrEP users were more interested in experimenting with sex practices, but they did not always feel more desirable as a sex partner because of PrEP use. Health-care providers and health promotion campaigns could emphasize the positive effects of PrEP on the quality of sex life, in addition to the HIV-preventive effects of PrEP, to decrease PrEP stigma and increase PrEP uptake.
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Affiliation(s)
- Mart Van Dijk
- Department of Work & Social Psychology, Maastricht University
| | - John B F De Wit
- Department of Interdisciplinary Social Science, Utrecht University
| | | | | | - Kai J Jonas
- Department of Work & Social Psychology, Maastricht University
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11
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García-Iglesias J. 'PrEP is like an adult using floaties': meanings and new identities of PrEP among a niche sample of gay men. CULTURE, HEALTH & SEXUALITY 2022; 24:153-166. [PMID: 33000987 DOI: 10.1080/13691058.2020.1821096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PrEP, pre-exposure prophylaxis, is a novel HIV prevention strategy. Highly efficacious, its development and delivery has caused significant debate. This paper explores the ways in which PrEP is signified and some of the new identities it gives rise to through the analysis of PrEP discourses among 'bugchasers'. Bugchasers comprise a niche group of gay men who eroticise HIV and fantasise with or seek to get infected. The research explores how bugchasers negatively conceptualise PrEP as a barrier to thrill and masculinity and discusses PrEP as a positive intervention that allows them to understand their own desires for risk-taking. Finally, it addresses a new identity position, the 'poz pleaser' who identifies as a bugchaser yet uses PrEP. Findings link to current debates about PrEP meanings and signification by using bugchasing as a niche yet illustrative example of how men make sense of this intervention based on their existing frameworks. Discussion highlights how this helps us understand how people make sense of biomedical interventions, the importance of emotional 'side effects', and the development of new identity positions. In so doing, it advances existing work on PrEP signification and contributes to ongoing debates about bugchasing.
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12
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Makhakhe NF, MeyerWeitz A, Sliep Y. Motivating factors associated with oral pre-exposure prophylaxis use among female sex workers in South Africa. J Health Psychol 2022; 27:2820-2833. [PMID: 34991407 DOI: 10.1177/13591053211072674] [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: 11/16/2022] Open
Abstract
To explore the motivating factors that encourage female sex workers to take oral PrEP, despite the challenges that come with adherence. The 39 participants in this study consisted of female sex workers, peer educators, a counselor, and a researcher. Participants took PrEP as an expression of self-love. Some participants described PrEP as empowering because they could independently prevent HIV. They were also motivated by parenting, hope and future aspirations. It is important for future PrEP interventions to incorporate behavioral strategies that appeal to the user's personal and deeper motivations for living.
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13
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Stewart J, Baeten JM. HIV pre-exposure prophylaxis and sexually transmitted infections: intersection and opportunity. Nat Rev Urol 2022; 19:7-15. [PMID: 34697493 PMCID: PMC9249100 DOI: 10.1038/s41585-021-00527-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 12/29/2022]
Abstract
Pre-exposure prophylaxis (PrEP) has revolutionized HIV prevention, but PrEP does not protect against other sexually transmitted infections (STIs). Rates of STIs are rising worldwide, with notably high incidences among PrEP-using men who have sex with men in high-income countries; in low-income and middle-income countries, data are sparse, but results from a limited number of studies among African women initiating and taking PrEP have shown high STI prevalence and incidence. Efforts aimed at markedly reducing HIV in populations worldwide include a major focus on increasing PrEP use, along with improving HIV testing and treatment in order to eliminate HIV transmission. Together, these efforts could augment continued expansion of the global STI epidemic, but they could alternatively create an opportunity to improve STI control, including the development of comprehensive sexual health programmes and research to develop new STI prevention strategies. The introduction of PrEP globally has been characterized by challenges and many successes, and its role as part of a range of robust strategies to reduce HIV infections is clear. Looking ahead, understanding rising rates of curable STIs and their relationship to HIV prevention, and considering the future directions for synergies in PrEP and STI prevention will be integral to improving sexual health.
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Affiliation(s)
- Jenell Stewart
- Department of Medicine, University of Washington, Seattle, WA, USA.
- Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Jared M Baeten
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Epidemiology, University of Washington, Seattle, WA, USA
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14
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Beyond HIV prevention: Additional individual and community-level benefits of PrEP among Latino gay and bisexual men. PLoS One 2022; 17:e0269688. [PMID: 35696399 PMCID: PMC9191695 DOI: 10.1371/journal.pone.0269688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 05/25/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND HIV infections disproportionately impact Latino gay and bisexual men (GBM) in the United States. Pre-Exposure Prophylaxis (PrEP) is a proven prevention strategy that can help reduce new HIV infections in this population. Unfortunately, PrEP adoption and persistence among Latino GBM remain low. The added benefits of using PrEP experienced by Latino GBM can provide important insights to inform the development of PrEP messaging to motivate this population to explore and consider PrEP as an appropriate and acceptable HIV prevention tool. METHODS We conducted in-depth interviews with Latino GBM PrEP users to explore positive feelings and emotions, and additional benefits gained from using PrEP. Data were analyzed using thematic analysis. RESULTS A total of 29 Latino GBM completed the study interview. The average age of participants was 30 years, and the mean length of time using PrEP was 17.1 months. Five themes were constructed from the data representing the additional benefits gained by Latino GBM PrEP users, and included: (1) reduced fear, anxiety, and stress about HIV, HIV testing, and sex; (2) feeling empowered and in control of their HIV risk; (3) greater awareness of sexual risk behaviors and sexual health; (4) greater sexual exploration and pleasure, and comfort having condomless sex; and (5) a greater connection to community and a feeling of contributing to the elimination of HIV. CONCLUSIONS The added benefits identified in this study represent a range of social, emotional, and psychological benefits that Latino GBM experience while using PrEP. They speak to the complementary benefits that PrEP can bring to Latino GBM who decide to use the medication, that go beyond HIV prevention. These findings can inform the development of future PrEP messaging to help improve motivation for PrEP uptake and persistent use among Latino GBM.
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15
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Koester KA, Erguera XA, Udoh I, Kang Dufour MS, Burack JH, Myers JJ. Exploring the Shift From HIV Pre-exposure Prophylaxis Awareness to Uptake Among Young Gay and Bisexual Men. Front Public Health 2021; 9:677716. [PMID: 34950622 PMCID: PMC8688695 DOI: 10.3389/fpubh.2021.677716] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/15/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: HIV pre-exposure prophylaxis (PrEP) in the form of a daily oral medication is highly effective at preventing HIV. In the United States, awareness about PrEP has steadily increased over time among individuals vulnerable to HIV, however awareness has not translated into widescale uptake. Estimates are that fewer than 20% of 1.2 million Americans for whom PrEP is indicated are utilizing it. We sought to understand how individuals moved from PrEP awareness to PrEP utilization. Methods: We conducted a series (n = 31) of in-depth interviews with young people, predominantly gay and bisexual men, ages 18–29 years old between February 2015 and January 2016, as part of the evaluation of a multi-year demonstration project funded to test innovative approaches to improve sexual health outcomes and curb the HIV epidemic in California. Interviews were audio-recorded and transcribed verbatim. We conducted a thematic analysis. Results: We present a continuum of PrEP awareness that spans three phases—basic, moderate and advanced. Participants rarely reported becoming well-informed about PrEP over the course of an initial exposure to PrEP information. Learning occurred after multiple exposures to PrEP information through numerous intersecting forms, messengers and formal and informal communication channels. Positively framed messages delivered by formal messengers emphasizing PrEP as a sensible HIV prevention strategy and explicitly communicating a regard for sexual wellness were overwhelmingly persuasive and facilitated movement to the advanced awareness phase. Once participants reached the advanced phase of PrEP awareness, uptake was possible. Conclusions: Our analysis provides insights into how PrEP awareness led to PrEP uptake among young gay and bi-sexual men. Building demand among those in the basic awareness phase took longer than those in the moderate phase. Individuals involved in formal and informal PrEP education can set reasonable expectations about whether, when and how eventual uptake may occur when keeping the continuum of PrEP awareness framework in mind. Many young, gay and bi-sexual male prospective PrEP users will benefit from positively framed messages that emphasize personal well-being, including social, sexual and emotional benefits of PrEP use.
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Affiliation(s)
- Kimberly A Koester
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, United States
| | - Xavier A Erguera
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, United States
| | - Ifeoma Udoh
- Pangaea Global AIDS, Oakland, CA, United States
| | - Mi-Suk Kang Dufour
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, United States
| | - Jeffrey H Burack
- East Bay AIDS Center, Alta Bates Summit Medical Center, Oakland, CA, United States
| | - Janet J Myers
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, United States
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16
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Huang ST, Huang JH, Chu JH. Health Beliefs Linked to HIV Pre-Exposure Prophylaxis Use Intention Among Young Men Who Have Sex with Men in Taiwan. AIDS Patient Care STDS 2021; 35:474-480. [PMID: 34748400 DOI: 10.1089/apc.2021.0146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pre-exposure prophylaxis (PrEP) is an effective tool to prevent HIV and has recently been approved in Taiwan. However, more research regarding PrEP acceptability and effective PrEP implementation is needed in Taiwan. Little is known about the intention to use PrEP and salient psychosocial factors among men who have sex with men (MSM). The purpose of this study was to examine health beliefs linked to PrEP use intention among young MSM (YMSM) in Taiwan. Using the Health Belief Model (HBM) as a guiding framework, an anonymous online survey was used to collect data from participants who were recruited using multiple channels to ensure diversity. Multivariate logistic regression was performed to examine the health beliefs linked to high PrEP use intention. Data from 1329 HIV-negative YMSM were analyzed; 488 (36.7%) were classified as having high PrEP use intention, which was found to be associated with having high perceived susceptibility to HIV infection [adjusted odds ratio (AOR) = 2.11], high perceived benefits of PrEP use (AOR = 2.14), high self-efficacy in PrEP use (AOR = 4.19), and many cues to action concerning PrEP use (AOR = 1.49). YMSM with high perceived barriers to PrEP use (AOR = 0.64) had lower PrEP use intention. In addition, the effects of HBM constructs and specific health beliefs on PrEP use intention varied by preferred penile-anal sexual role. The study findings may inform efforts aimed at improving PrEP acceptability and optimizing PrEP implementation programs tailored for YMSM of different sexual roles.
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Affiliation(s)
- Shih-Tse Huang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan
| | - Jiun-Hau Huang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
- Master of Public Health Degree Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Jen-Hao Chu
- Master of Public Health Degree Program, College of Public Health, National Taiwan University, Taipei, Taiwan
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17
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Ikeda DJ, Kidia K, Agins BD, Haberer JE, Tsai AC. Roll-out of HIV pre-exposure prophylaxis: a gateway to mental health promotion. BMJ Glob Health 2021; 6:e007212. [PMID: 34916275 PMCID: PMC8679108 DOI: 10.1136/bmjgh-2021-007212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/25/2021] [Indexed: 12/11/2022] Open
Abstract
HIV remains a pressing global health problem, with 1.5 million new infections reported globally in 2020. HIV pre-exposure prophylaxis (PrEP) can lower the likelihood of HIV acquisition among populations at elevated risk, yet its global roll-out has been discouragingly slow. Psychosocial factors, such as co-occurring mental illness and substance use, are highly prevalent among populations likely to benefit from PrEP, and have been shown to undermine persistence and adherence. In this analysis, we review the high burden of mental health problems among PrEP candidates and contend that inattention to mental health stands to undermine efforts to implement PrEP on a global scale. We conclude that integration of mental health screening and treatment within PrEP scale-up efforts represents an important strategy for maximising PrEP effectiveness while addressing the high burden of mental illness among at-risk populations. As implementers seek to integrate mental health services within PrEP services, efforts to keep access to PrEP as low-threshold as possible should be maintained. Moreover, programmes should seek to implement mental health interventions that are sensitive to local resource constraints and seek to reduce intersecting stigmas associated with HIV and mental illness.
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Affiliation(s)
| | - Khameer Kidia
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Bruce D Agins
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Jessica E Haberer
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
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18
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Alcantar Heredia JL, Goldklank S. The relevance of pre-exposure prophylaxis in gay men's lives and their motivations to use it: a qualitative study. BMC Public Health 2021; 21:1829. [PMID: 34627221 PMCID: PMC8502319 DOI: 10.1186/s12889-021-11863-w] [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: 11/11/2020] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
Background HIV has affected gay men disproportionately in the U.S. for four decades. Pre-exposure prophylaxis (PrEP) was developed as a prevention strategy for individuals at high risk of HIV infection. Although highly effective, many gay and other men who have sex with men continue not to take PrEP. Researchers have focused on sexual risk behaviors as the primary determinant of who should be on PrEP and identified various objective systemic and societal barriers to PrEP access. Public health measures have promoted PrEP based on these objective criteria. Researchers have recently begun to inquire into subjective and relational motivators for PrEP usage beyond self-perceived risk. Methods Participants were recruited through snowball sampling. Data were collected between August and November 2018 from PrEP users (n = 7) and PrEP non-users (n = 6). Data were analyzed in a modified grounded theory qualitative analysis. Results The thirteen participants’ narratives contained three superordinate categories: (1) what it’s like to be someone on PrEP, (2) an environment of changing sexual norms, and (3) the continued importance of education. These categories comprised ten themes, each of which had various repeating ideas. The ten themes were the following: (1) PrEP’s social acceptability, (2) PrEP and HIV stigma, (3) PrEP and sexual relationships, (4) dissatisfaction with condoms, (5) negotiating risk, (6) peace of mind, (7) developing a relationship with PrEP, (8) putting yourself first, (9) PrEP awareness, and (10) PrEP logistics. Conclusions The gay men in our study took into consideration their social roles and relationships, their personal beliefs, and emotional histories as well as risk as prominent motivators for PrEP use. They stated that PrEP use is associated with their sense of belonging, trust, and security about their sexuality. They also identified the most relevant aspects of the medication (e.g., side effects, adherence, and awareness) to their lives. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11863-w.
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Affiliation(s)
- Jorge L Alcantar Heredia
- Adult Clinical PsyD Program, Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave., The Bronx, NY, 10003, New York, USA.
| | - Shelly Goldklank
- Adult Clinical PsyD Program, Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave., The Bronx, NY, 10003, New York, USA
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19
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Grant RM, Pellegrini M, Defechereux PA, Anderson PL, Yu M, Glidden DV, O’Neal J, Yager J, Bhasin S, Sevelius J, Deutsch MB. Sex Hormone Therapy and Tenofovir Diphosphate Concentration in Dried Blood Spots: Primary Results of the Interactions Between Antiretrovirals And Transgender Hormones Study. Clin Infect Dis 2021; 73:e2117-e2123. [PMID: 32766890 PMCID: PMC8492111 DOI: 10.1093/cid/ciaa1160] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/03/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sex hormone and preexposure prophylaxis (PrEP) drug interactions among transgender women (TGW), transgender men (TGM), and cisgender men (CGM) are not fully understood. METHODS TGM and TGW on at least 6 months of stable sex hormone therapy containing testosterone or estradiol (respectively) were enrolled in a 4-week study of directly observed dosing of daily oral coformulated emtricitabine and tenofovir disoproxil fumarate (FTC/TDF). TFV-DP in dried blood spots and sex hormones in serum were measured at weekly intervals. TFV-DP was compared with 2- and 4-week samples from Directly Observed Therapy Dried Blood Spots (DOT-DBS) Study (NCT02022657). RESULTS From May 2017 to June 2018, 24 TGM and 24 TGW were enrolled. Testosterone (total and free) and estradiol concentrations were comparable before and after 4 weeks of PrEP use in TGM and TGW, respectively. Historical controls included 17 cisgender women (CGW) and 15 CGM. TFV-DP concentrations at week 4 were comparable between TGW and TGM (mean difference, -6%; 95% confidence interval [CI], -21% to 12%; P = .47), comparable between TGW and CGM (mean difference, -12%; 95% CI, -27% to 7%; P = .21) and were lower among TGM compared with CGW (mean difference, -23%; 95% CI, -36% to -7%; P = .007). All persons in all groups were projected to reach the TFV-DP threshold that has been associated with high protection from human immunodeficiency virus. CONCLUSIONS CGM, TGM, and TGW had comparable TFV-DP concentrations in dried blood spots after 4 weeks of directly observed daily FTC/TDF PrEP use. Serum hormone concentrations were not affected by FTC/TDF PrEP use. CLINICAL TRIALS REGISTRATION NCT04050371.
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Affiliation(s)
- Robert M Grant
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| | | | - Patricia A Defechereux
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michelle Yu
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| | - David V Glidden
- Department of Epidemiology and Biostatistics, University of California - San Francisco, San Francisco, California, USA
| | - Joshua O’Neal
- San Francisco AIDS Foundation, San Francisco, California, USA
| | - Jenna Yager
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Shalender Bhasin
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jae Sevelius
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Madeline B Deutsch
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
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20
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Marcus JL, Sewell WC, Powell VE, Ochoa A, Mayer KH, Krakower DS. HIV Preexposure Prophylaxis and Sexual Satisfaction Among Men Who Have Sex With Men. Sex Transm Dis 2021; 48:e135-e137. [PMID: 33657578 PMCID: PMC8373989 DOI: 10.1097/olq.0000000000001361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
ABSTRACT In this large online survey of primarily men who have sex with men, those who used preexposure prophylaxis reported greater sexual satisfaction than did nonusers, including sexual sensations, sexual presence/awareness, and sexual exchange. Person-centered care and messaging may require acknowledging that some people use preexposure prophylaxis for reasons beyond HIV prevention.
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Affiliation(s)
| | - Whitney C Sewell
- From the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute
| | - Victoria E Powell
- From the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute
| | - Aileen Ochoa
- From the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute
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21
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Sandset T, Villadsen K, Heggen K, Engebretsen E. Discipline for pleasure: a new governmentality of HIV prevention. BIOSOCIETIES 2021; 18:102-127. [PMID: 34608399 PMCID: PMC8481318 DOI: 10.1057/s41292-021-00257-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/21/2022]
Abstract
This article explores recent HIV prevention campaigns for pre-exposure prophylaxis (PrEP), focusing on how they integrate pleasure and desire in their calls for self-discipline through a continual use of pharmaceuticals. This emerging type of health promotion, here represented by ads promoting the preventive use of pharmaceuticals, no longer simply approaches target groups with demands to abstain from harmful substances or practices and thus control risks, but also includes messages that recognize individuals' habits, values, and their desires for pleasure. Drawing on Foucault's work concerning discipline and security, we suggest that a novel, permissive discipline is emerging in contemporary HIV prevention. Further guided by Barthes's theory of images, we analyse posters used in prevention campaigns, scrutinizing their culture-specific imagery and linguistic messages, i.e. how the words and images interact. We conclude that these campaigns introduce a new temporality of prevention, one centred on pleasure through the pre-emption and planning that PrEP enables.
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Affiliation(s)
- Tony Sandset
- grid.5510.10000 0004 1936 8921Institute for Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kaspar Villadsen
- grid.4655.20000 0004 0417 0154Department of Management, Politics, and Philosophy, Copenhagen Business School, Frederiksberg, Denmark
| | - Kristin Heggen
- grid.5510.10000 0004 1936 8921Institute for Interdisciplinary Health Education, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Eivind Engebretsen
- grid.5510.10000 0004 1936 8921Institute for Interdisciplinary Health Education, Faculty of Medicine, University of Oslo, Oslo, Norway
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22
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Mujugira A, Nakyanzi A, Kasiita V, Kamusiime B, Nalukwago GK, Nalumansi A, Twesigye CC, Muwonge TR, Baeten JM, Wyatt MA, Haberer JE, Ware NC. HIV self-testing and oral pre-exposure prophylaxis are empowering for sex workers and their intimate partners: a qualitative study in Uganda. J Int AIDS Soc 2021; 24:e25782. [PMID: 34473405 PMCID: PMC8412089 DOI: 10.1002/jia2.25782] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/19/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction HIV self‐testing (HIVST) and oral pre‐exposure prophylaxis (PrEP) are complementary, evidence‐based, self‐controlled HIV prevention tools that may be particularly appealing to sex workers. Understanding how HIVST and PrEP are perceived and used by sex workers and their intimate partners could inform prevention delivery for this population. We conducted qualitative interviews to examine ways in which HIVST and PrEP use influence prevention choices among sex workers in Uganda. Methods Within a randomized trial of HIVST and PrEP among 110 HIV‐negative cisgender women, cisgender men and transgender women sex workers (NCT03426670), we conducted 40 qualitative interviews with 30 sex workers and 10 intimate partners (June 2018 to January 2020). Sex worker interviews explored (a) experiences of using HIVST kits; (b) how HIVST was performed with sexual partners; (c) impact of HIVST on PrEP pill taking; and (d) sexual risk behaviours after HIVST. Partner interviews covered (i) introduction of HIVST; (ii) experiences of using HIVST; (iii) HIV status disclosure; and (iv) HIVST's effect on sexual behaviours. Data were analysed using an inductive content analytic approach centering on descriptive category development. Together, these categories detail the meaning of HIVST and PrEP for these qualitative participants. Results Using HIVST and PrEP was empowering for this group of sex workers and their partners. Three types of empowerment were observed: (a) economic; (b) relational; and (c) sexual health. (i) Using HIVST and PrEP made sex without condoms safer. Sex workers could charge more for condomless sex, which was empowering economically. (ii) Self‐testing restored trust in partners’ fidelity upon being reunited after a separation. This trust, in combination with condomless sex made possible by PrEP use, restored intimacy, empowering partnered relationships. (iii) HIVST and PrEP enabled sex workers to take control of their HIV prevention efforts and avoid the stigma of public clinic visits. In this way they were empowered to protect their sexual health. Conclusions In this sample, sex workers’ use of HIVST and PrEP benefitted not only prevention efforts, but also economic and relational empowerment. Understanding these larger benefits and communicating them to stakeholders could strengthen uptake and use of combination prevention interventions in this marginalized population.
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Affiliation(s)
- Andrew Mujugira
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.,Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda.,Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Agnes Nakyanzi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Vicent Kasiita
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Brenda Kamusiime
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Grace K Nalukwago
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Alisaati Nalumansi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Chris C Twesigye
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Timothy R Muwonge
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Monique A Wyatt
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Harvard Global, Cambridge, Massachusetts, USA
| | - Jessica E Haberer
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Norma C Ware
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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23
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Hensen B, Machingura F, Busza J, Birdthistle I, Chabata S, Chiyaka T, Floyd S, Jamali G, Mushati P, Hargreaves J, Cowan F. How Can We Support the Use of Oral PrEP Among Young Women who Sell Sex? A PrEP Cascade Analysis. J Acquir Immune Defic Syndr 2021; 88:45-56. [PMID: 34050101 PMCID: PMC8357043 DOI: 10.1097/qai.0000000000002733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/19/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND We constructed self-reported pre-exposure prophylaxis (PrEP) cascades and explored factors associated with and barriers to PrEP use to inform efforts to support PrEP use among young women who sell sex. METHODS Using self-reported data from HIV-negative young women who sell sex enrolled into a cohort study using respondent-driven sampling in Zimbabwe, we constructed PrEP cascades assessing knowledge of, ever offered, ever used, and current PrEP use in 2017 and 2019. We used logistic regression to examine factors associated with PrEP use by 2019. Through qualitative interviews with 43 women enrolled in the cohort, we investigated barriers to PrEP use. RESULTS At enrollment, 50% of women had heard of PrEP, 12% had ever been offered PrEP, and 7% ever used PrEP. Over time, all cascade domains: 96% of women had heard of and 55% reported an active offer of PrEP. Among women retained in the study in 2019 (56%; n = 538), 34% ever took PrEP by 2019. PrEP use was associated with, at enrollment, reporting more clients in the past month (10+: 45% vs 1-3: 27% adjOR = 1.71 95% CI: 1.06 to 2.76), duration of selling sex (24% <2 years vs 38% 2-3 years; adjOR = 0.51 95% CI: 0.32 to 0.83), and having visited a female sex worker program in the past 12 months (55% vs 27%; adjOR = 2.92 95% CI: 1.91 to 4.46). Qualitative interviews revealed fear of disclosing sex work, HIV-related/ART-related stigma, and (opportunity) costs of accessing PrEP as barriers to use. CONCLUSION PrEP use was associated with factors known to increase HIV risk. Fear of stigma, disclosure, and supply-side barriers need to be addressed to increase women's ability to use PrEP.
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Affiliation(s)
- B. Hensen
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom;
| | - F. Machingura
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe;
| | - J. Busza
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, London, United Kingdom;
| | - I. Birdthistle
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; and
| | - S.T. Chabata
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe;
| | - T. Chiyaka
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe;
| | - S. Floyd
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; and
| | - G. Jamali
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe;
| | - P. Mushati
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe;
| | - J. Hargreaves
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, London, United Kingdom;
| | - F.M. Cowan
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe;
- Faculty of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
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Grov C, Westmoreland DA, D’Angelo AB, Pantalone DW. How Has HIV Pre-Exposure Prophylaxis (PrEP) Changed Sex? A Review of Research in a New Era of Bio-behavioral HIV Prevention. JOURNAL OF SEX RESEARCH 2021; 58:891-913. [PMID: 34180743 PMCID: PMC9729849 DOI: 10.1080/00224499.2021.1936440] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
In 2012, the U.S. FDA approved the first drug for use as HIV Pre-Exposure Prophylaxis (PrEP), which is nearly 99% effective when taken as prescribed. Although the manifest function of PrEP is to prevent HIV infection in the event of exposure, the drug has also had a significant impact on various facets of sexuality. In this review, we focus on research that emerged in the near decade since PrEP's approval, with a specific focus on the ways in which different elements of sex and sexuality have been impacted by gay, bisexual, and other men who have sex with men (GBMSM), cisgender women, and transgender individuals. We highlight evidence showing how PrEP has enhanced sexual self-esteem, improved sexual pleasure, reduced sexual anxiety, and has increased sexual agency for those taking it. For many, PrEP also serves as a gateway to improve routine health and increase sexual health-care utilization. Additionally, we review the question of whether PrEP is associated with increased sexual risk taking (i.e. risk compensation), and note that, although some data are mixed, PrEP is not intended as an intervention to reduce condomless anal sex or STIs: it aims to prevent HIV. Finally, our review highlights that, although the volume of research on PrEP among GBMSM is robust, it is underdeveloped for cisgender women and transgender populations and insufficient for inclusion in such a review for cisgender heterosexual men was. PrEP research with these populations is an important direction for future research. Finally, from 2012 to 2019, a single PrEP formulation and delivery method was FDA approved (oral emtricitabine/tenofovir disoproxil fumarate). As additional drug formulations (ie.g., emtricitabine/tenofovir alafenamide) and delivery methods (e.g., microbiocides, vaginal ring, injectable) come to market, it will be important to examine how these, too, impact the spectrum of sexuality.
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Affiliation(s)
- Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY
- CUNY Institute for Implementation Science in Population Health, New York, NY
| | | | - Alexa B. D’Angelo
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY
- CUNY Institute for Implementation Science in Population Health, New York, NY
| | - David W. Pantalone
- Department of Psychology, University of Massachusetts Boston
- The Fenway Institute, Fenway Health, Boston, MA
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Van Dijk M, De Wit JBF, Guadamuz TE, Martinez JE, Jonas KJ. Bridging the serodivide: attitudes of PrEP users towards sex partners living with HIV. AIDS Care 2021; 34:349-352. [PMID: 34280060 DOI: 10.1080/09540121.2021.1954588] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The introduction of biomedical HIV prevention methods, such as pre-exposure prophylaxis (PrEP), holds the potential to overcome the serodivide. We investigated the attitudes of PrEP users towards having sex with partners living with HIV. PrEP users in the Netherlands were recruited online and completed three questionnaires over a period of six months. We investigated changes over time in feelings of fear of HIV, comfort, and attitudes towards condom use when having sex with men living with HIV (MLHIV). A majority of PrEP users in our sample (up to 71.6%) had sex with MLHIV. Feeling comfortable to have sex with MLHIV did not change over time, but was already at a high level at T1. Most importantly, feeling safe not to use condoms with HIV-positive partners significantly increased, and did so in a rather short period of time after the onset of PrEP use (3-6 months). Taken together, the findings suggest that that PrEP may contribute to decreasing the serodivide between MSM rather quickly after the onset of PrEP use.
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Affiliation(s)
- Mart Van Dijk
- Department of Work & Social Psychology, Maastricht University, Maastricht, the Netherlands
| | - John B F De Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
| | - Thomas E Guadamuz
- Department of Society and Health, Mahidol University, Bangkok, Thailand
| | - Joel E Martinez
- Department of Psychology, Princeton University, Princeton, NJ, USA
| | - Kai J Jonas
- Department of Work & Social Psychology, Maastricht University, Maastricht, the Netherlands
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What's in a Name? A Mixed Method Study on How Young Women Who Sell Sex Characterize Male Partners and Their Use of Condoms. J Acquir Immune Defic Syndr 2021; 87:652-662. [PMID: 33507013 DOI: 10.1097/qai.0000000000002623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Young women who sell sex (YWSS) are at disproportionate risk of HIV. Reducing YWSS' vulnerability requires engaging their male sexual partners. To achieve this, we need to understand the characteristics and dynamics of their sexual partnerships to inform effective interventions. METHODS We conducted a mixed-methods study to compare YWSS' qualitative descriptions of male partners with categories reported in a behavioral survey. Data were drawn from enrollment into an evaluation of the DREAMS initiative in Zimbabwe in 2017. As part of a respondent-driven sampling survey, we recruited 40 seed participants from 2 intervention and 4 comparison sites. We conducted semistructured interviews with 19 "seeds," followed by a behavioral survey with 2387 YWSS. We interpreted quantitative and qualitative data together to understand how YWSS perceived male sexual partners, assess how well survey variables related to narrative descriptions, and describe patterns of risk behavior within partnerships. RESULTS Qualitative data suggest survey categories "husband" and "client" reflect YWSS' perceptions but "regular partner/boyfriend" and "casual partner" do not. In interviews, use of the term "boyfriend" was common, describing diverse relationships with mixed emotional and financial benefits. More than 85% of male partners provided money to YWSS, but women were less likely to report condomless sex with clients than regular partners (11% vs 37%) and more likely to report condomless sex with partners who ever forced them to have sex (37% vs 21%). CONCLUSIONS Reducing HIV risk among YWSS requires prevention messages and tools that recognize diverse and changing vulnerability within and between sexual relationships with different male partners.
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Textor L, Schlesinger W. Treating risk, risking treatment: experiences of iatrogenesis in the HIV/AIDS and opioid epidemics. Anthropol Med 2021; 28:239-254. [PMID: 34190020 DOI: 10.1080/13648470.2021.1926916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This paper explores how poor health outcomes in the HIV/AIDS and opioid epidemics in the United States are undergirded by iatrogenesis. Data are drawn from two projects in Southern California: one among men who have sex with men (MSM) engaging with pre-exposure prophylaxis to HIV (PrEP) and the other in a public hospital system encountering patients with chronic pain and opioid use disorder (OUD). Ethnographic evidence demonstrates how efforts to minimize risk via PrEP and opioid prescription regulation paradoxically generate new forms of risk. Biomedical risk management paradigms engaged across the paper's two ethnographic field sites hinge on the production and governance of deserving patienthood, which is defined by providers and experienced by patients through moral judgments about risk underlying both increased surveillance and abandonment. This paper argues that the logic of deservingness disconnects clinical evaluations of risk from patients' lived, intersectional experiences of race, class, gender, and sexuality. This paper's analysis thus re-locates patients in the context of broader historical and sociopolitical trajectories to highlight how notions of clinical risk designed to protect patients can in fact imperil them. Misalignment between official, clinical constructions of risk and the embodied experience of risk borne by patients produces iatrogenesis.
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Affiliation(s)
- Lauren Textor
- Department of Anthropology and David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - William Schlesinger
- Department of Anthropology and David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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28
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Issues Associated With Prescribing HIV Pre-exposure Prophylaxis for HIV Anxiety: A Qualitative Analysis of Australian Providers' Views. J Assoc Nurses AIDS Care 2021; 32:94-104. [PMID: 33165182 DOI: 10.1097/jnc.0000000000000219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT HIV pre-exposure prophylaxis (PrEP) can alleviate anxiety about acquiring HIV, particularly for gay men and other men who have sex with men. However, research with PrEP providers has rarely examined HIV anxiety. We conducted 25 semistructured interviews in 2019-2020 with PrEP providers in New South Wales and Western Australia, and analyzed data thematically. Participants included general practitioners and sexual health nurses and doctors. Our analysis explores providers' views on providing PrEP to reduce HIV anxiety for gay men, serodiscordant couples where the partner with HIV has an undetectable viral load, and for "worried well" individuals who the providers speculated might have undisclosed risk. Although providers viewed PrEP as beneficial for many people's personal lives and relationships, they felt cautious about prescribing PrEP solely for HIV anxiety, while at the same time reporting that they prescribed PrEP if individuals insisted on it and had no medical contraindications.
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29
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Bavinton BR, Grulich AE. HIV pre-exposure prophylaxis: scaling up for impact now and in the future. LANCET PUBLIC HEALTH 2021; 6:e528-e533. [PMID: 34087117 DOI: 10.1016/s2468-2667(21)00112-2] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 12/13/2022]
Abstract
More than a decade after the first efficacy evidence for oral HIV pre-exposure prophylaxis (PrEP) was reported, PrEP uptake globally has been inadequate and global HIV prevention targets have been missed. Access to PrEP is still highly concentrated in a fairly small number of countries and, even within countries with widespread PrEP access, inequalities have emerged. More ambitious, high-priority global targets for PrEP uptake are required and could accelerate the HIV prevention response in a similar way to the success of the 90-90-90 testing and treatment targets. Health systems must be PrEP-friendly and allow PrEP to be prescribed in settings already attended by large numbers of HIV-negative individuals who are at risk. Several models have been advanced for the greater demedicalisation of PrEP. Individual-level barriers to PrEP uptake and persistence have been characterised, such as low awareness, low willingness to use PrEP, and the gap between self-perceived and actual HIV risk. Overcoming these barriers will require further efforts to understand and address them first. New PrEP modalities are emerging; as more options become available, we need to develop a greater understanding of the long-term patterns of PrEP use in different populations and to develop models of such use that can accommodate people alternating through periods of use and non-use, as well as switching between dosing regimens or modalities as they become available. Scaling up PrEP is crucial to achieving the UNAIDS prevention targets for 2030. Simply getting more people onto PrEP cannot be the only goal: the big-picture definition of success for PrEP programmes must be their impact on the HIV epidemic.
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Affiliation(s)
| | - Andrew E Grulich
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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30
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Reyniers T, Nöstlinger C, Vuylsteke B, De Baetselier I, Wouters K, Laga M. The Impact of PrEP on the Sex Lives of MSM at High Risk for HIV Infection: Results of a Belgian Cohort. AIDS Behav 2021; 25:532-541. [PMID: 32857317 DOI: 10.1007/s10461-020-03010-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
There is a need for an in-depth understanding of the impact of PrEP on users' sexual health and behaviour, beyond the focus on 'risk'. This mixed-method study was part of a Belgian PrEP demonstration project following 200 men who have sex with men (MSM) for at least 18 months. Taking a grounded-theory approach, 22 participants were interviewed and their transcripts analysed. The preliminary analysis guided the analysis of the questionnaire data. Overall, PrEP improved sexual health. Participants felt better protected against HIV, which enabled them to change their sexual behaviour. The reduction in condom use was moderated by interviewees' attitudes towards the risk for other STIs. Other changes included having more anal sex and experimentation with new sexual behaviours. While PrEP empowers MSM in taking care of their sexual health, comprehensive sexual health counselling is crucial to provide care for users who feel less in control over their sexual health.
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Affiliation(s)
- Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.
| | - Christiana Nöstlinger
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Irith De Baetselier
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Kristien Wouters
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Marie Laga
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
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31
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Sudler A, Cournos F, Arnold E, Koester K, Riano NS, Dilley J, Liu A, Mangurian C. The case for prescribing PrEP in community mental health settings. Lancet HIV 2021; 8:e237-e244. [PMID: 33493438 DOI: 10.1016/s2352-3018(20)30273-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/04/2020] [Accepted: 10/08/2020] [Indexed: 11/27/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a biomedical HIV prevention modality that is up to 99% effective in preventing HIV acquisition through sex if taken as directed. People with serious mental illness (eg, schizophrenia and bipolar disorder) are at high risk of acquiring HIV due to sexual behaviours, injection drug use, social factors, and structural discrimination that limits access to all types of preventive health services. We seek to show the importance of prioritising access to PrEP for people living with serious mental illness treated in community mental health settings. We describe barriers to prescribing PrEP, including provider attitudes and provider knowledge gaps, patient attitudes and knowledge, and systems issues. We also address the concerns that community mental health clinic administrators might have about taking on the responsibility of offering PrEP. In summary, despite the barriers to prescribing PrEP in these settings, we believe that there is a unique opportunity for community mental health settings to help address the HIV epidemic by facilitating the prescribing of PrEP to the at-risk populations they currently serve.
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Affiliation(s)
- Andrew Sudler
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Francine Cournos
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA; Mailman School of Public Health, Columbia University, New York, NY, USA; Northeast/Caribbean AIDS Education and Training Center, New York, NY, USA
| | - Emily Arnold
- Department of Medicine, University of California, San Francisco, CA, USA; Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Kimberly Koester
- Department of Medicine, University of California, San Francisco, CA, USA; Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Nicholas S Riano
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - James Dilley
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Alliance Health Project, University of California, San Francisco, CA, USA
| | - Albert Liu
- Department of Medicine, University of California, San Francisco, CA, USA; San Francisco Department of Public Health, San Francisco, CA, USA
| | - Christina Mangurian
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA; Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.
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Richmond A, Pfieffer ML, Henry-Okafor Q. Update on Guidelines for Sexually Transmitted Infection Treatment and Management in the Adult and Adolescent Population. Nurs Clin North Am 2020; 55:307-323. [PMID: 32762852 DOI: 10.1016/j.cnur.2020.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Sexually transmitted infections (STIs) are a prevalent global health care problem. Incidence rates are rising yearly. STI incidence is highest for adolescents and young adults ages 15 to 24, who are diagnosed with half of all new STIs. Chlamydia trachomatis and Neisseria gonorrhea are common STIs caused by bacteria. Treatment guidelines change frequently as a result of antimicrobial resistance and public health trends. It is important for primary care providers to remain up to date with new guidelines. This article provides updates on pharmacologic treatment as well as patient education and follow-up specific to the primary care setting.
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Affiliation(s)
- Anna Richmond
- Vanderbilt University School of Nursing, 356 Frist Hall, 461 21st Avenue South, Nashville, TN 37240, USA.
| | - Mary Lauren Pfieffer
- Vanderbilt University School of Nursing, 354 Frist Hall, 461 21st Avenue South, Nashville, TN 37240, USA
| | - Queen Henry-Okafor
- Vanderbilt University School of Nursing, 354 Frist Hall, 461 21st Avenue South, Nashville, TN 37240, USA
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34
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Nagington M, Sandset T. Putting the NHS England on trial: uncertainty-as-power, evidence and the controversy of PrEP in England. MEDICAL HUMANITIES 2020; 46:176-179. [PMID: 32054770 DOI: 10.1136/medhum-2019-011780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 06/10/2023]
Abstract
Pre-exposure prophylaxis (PrEP) (Truvada) is a medication which if taken correctly is almost entirely effective in preventing HIV infection. In regions and countries where it has been widely taken up, HIV seroconversion rates have significantly decreased. Alongside testing and treatment, it offers the very real prospect of ending HIV infections. However, in England, commissioning it has (and still is) a controversial process, where NHS England has repeatedly raised supposed 'uncertainties', first legal and then scientific. The same has not happened in Scotland, where PrEP was commissioned to anyone who needed it in April 2017. This article presents a close reading of the IMPACT trial protocol, which we conclude cannot answer the questions it sets out to answer. We then suggest that the uncertainties the trial claims to address are in fact a tool of power which is deployed to strategically ration healthcare; introduce uncertainty about commissioning PrEP; and shift the boundary between individual responsibilities and state responsibilities for public health and HIV prevention. We conclude that all the above constitute an unethical use of clinical trial rhetoric, systematically discriminate against minority and vulnerable groups, and ration healthcare for those who most need it. As such, we call on all academics, clinicians and activists to resist further unethical misuses of clinical trial rhetoric.
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Affiliation(s)
- Maurice Nagington
- School of Health Sciences, Faculty of Medicine Biology and Health, University of Manchester, Manchester, United Kingdom
| | - Tony Sandset
- Institute for Interdisciplinary Health Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
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Use of HIV Pre-exposure Prophylaxis (PrEP) Associated With Lower HIV Anxiety Among Gay and Bisexual Men in Australia Who Are at High Risk of HIV Infection: Results From the Flux Study. J Acquir Immune Defic Syndr 2020; 83:119-125. [PMID: 31935203 DOI: 10.1097/qai.0000000000002232] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Many gay and bisexual men (GBM) experience HIV anxiety, particularly around condomless anal intercourse. HIV pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy that may reduce HIV anxiety among GBM. METHODS The Following Lives Undergoing Change (Flux) Study is a national, online, open-prospective observational study of licit and illicit drug use among GBM in Australia. In 2018, participants responded to newly included items regarding anxiety about HIV transmission. Stratifying GBM as high or low risk as determined by the Australian PrEP Guidelines, we assess whether PrEP use is associated with lower levels of HIV anxiety. Multivariate logistic regression was used to compare factors associated with PrEP use among GBM at high risk (PrEP-eligible) and low risk (PrEP-ineligible) of HIV infection. Results are reported as adjusted odds ratios and corresponding 95% confidence intervals. RESULTS Among 1547 men, the mean age was 37.1 years (SD 13.1). Men aged 25 years or younger had higher HIV anxiety scores than older men. Among PrEP-eligible men, men who use PrEP reported lower levels of HIV anxiety (adjusted odds ratio = 0.92; 95% confidence interval = 0.87 to 0.99; P < 0.001). No differences were observed on HIV anxiety among PrEP-ineligible men. CONCLUSIONS Among PrEP-eligible men, PrEP use was independently associated with lower levels of HIV anxiety. In addition to avoiding HIV infection, PrEP use may help reduce anxiety among men at risk of HIV. This feature of PrEP could be promoted as part of demand creation initiatives to increase PrEP uptake.
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Mabire X, Puppo C, Morel S, Mora M, Rojas Castro D, Chas J, Cua E, Pintado C, Suzan-Monti M, Spire B, Molina JM, Préau M. Pleasure and PrEP: Pleasure-Seeking Plays a Role in Prevention Choices and Could Lead to PrEP Initiation. Am J Mens Health 2020; 13:1557988319827396. [PMID: 30819060 PMCID: PMC6440035 DOI: 10.1177/1557988319827396] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pleasure-seeking plays a role in prevention (means choices and use), and in the sexual quality of life of men who have sex with men (MSM). Since HIV is a major threat to MSM health, new means of prevention, like pre-exposure prophylaxis (PrEP), must meet the needs of MSM to be fully efficient. Using a psychosocial approach, we examined how pleasure-seeking plays a role in participation of MSM in “ANRS-IPERGAY,” a community-based trial on sexual health which included sexual on-demand PrEP. Thirteen semistructured collective interviews were conducted with 45 participants. First, we analyzed participants’ search for new prevention means due to previous failures in condom use. We found that participants perceived condoms as a barrier—both materially and symbolically—to pleasure and desire, causing anxiety and stress considering sexual intercourse. Second, we explored representations and attitudes concerning pleasure within the context of PrEP. We found that PrEP allowed participants to freely choose their desired sexual positions and to better enjoy intimacy. Third, we studied the sexual quality of life for PrEP users in ANRS-IPERGAY and found an improvement. Thanks to the community-based design of the trial, this new prevention tool became a means to develop agency and empowerment for participants, not only in negotiating individual prevention but also in opposing the normative and stigmatizing discourse on sexuality and HIV. In conclusion, pleasure-seeking appears to be an essential element of sexual fulfillment that needs to be integrated as a positive notion in the study of HIV prevention.
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Affiliation(s)
| | | | | | - Marion Mora
- 3 Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France.,4 ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Daniela Rojas Castro
- 3 Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France.,5 Community-based Research Laboratory, Coalition PLUS, Pantin, France
| | | | | | - Claire Pintado
- 8 Hospital Saint-Louis, Department of infectious Disease, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marie Suzan-Monti
- 3 Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France.,4 ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Bruno Spire
- 3 Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France.,4 ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Jean-Michel Molina
- 8 Hospital Saint-Louis, Department of infectious Disease, Assistance Publique Hôpitaux de Paris, Paris, France
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Khalili J, Landovitz RJ. HIV Preexposure Prophylaxis-The Role of Primary Care Clinicians in Ending the HIV Epidemic. JAMA Intern Med 2020; 180:126-130. [PMID: 31738380 DOI: 10.1001/jamainternmed.2019.5456] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A global human immunodeficiency virus (HIV) epidemic persists despite data to support multiple effective and safe tools that prevent HIV transmission and acquisition. Human immunodeficiency virus preexposure prophylaxis (PrEP) for HIV-uninfected at-risk populations using tenofovir disoproxil fumarate emtricitabine is highly effective, safe, and recently endorsed by the US Preventive Services Task Force (USPSTF) as a grade A recommendation. In this Special Communication, we summarize current guidelines and expert recommendations in a call for wider adoption of PrEP prescribing activities by frontline primary care clinicians. Key components include the ideal contexts in which PrEP may be prescribed, eligibility criteria, clinical considerations and pitfalls, laboratory monitoring, prescription practices, situations that may warrant expert consultation, and future directions. Given the broad scope, access, and point-of-entry status of primary clinicians in health systems, generalists will need to be at the center of any successful effort to leverage the power of, and destigmatize PrEP to end the HIV epidemic.
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Affiliation(s)
- Joshua Khalili
- Center for Clinical AIDS Research and Education, David Geffen School of Medicine, Department of Medicine, University of California, Los Angeles
| | - Raphael J Landovitz
- Center for Clinical AIDS Research and Education, David Geffen School of Medicine, Division of Infectious Diseases, University of California, Los Angeles
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Devarajan S, Sales JM, Hunt M, Comeau DL. PrEP and sexual well-being: a qualitative study on PrEP, sexuality of MSM, and patient-provider relationships. AIDS Care 2019; 32:386-393. [PMID: 31760759 DOI: 10.1080/09540121.2019.1695734] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Most new diagnoses of HIV in the United States are among men who have sex with men (MSM). Pre-exposure prophylaxis (PrEP) is a medication that mitigates risk of HIV acquisition and requires regular STI testing and prescription refills with PrEP providers. Because PrEP care monitors sexual behavior, there is a need to understand how PrEP providers approach sexual health care for MSM patients. In this study, semi-structured qualitative interviews were conducted with 20 MSM in Atlanta, Georgia with current or past prescriptions for PrEP. Data were analyzed with thematic analysis using four major steps: (1) code and codebook development, (2) assigning codes to segments of interviews, (3) code-based and comparative analysis methods, and (4) developing thematic findings. Findings from interviews about changes in sexuality while using PrEP include decreased anxiety surrounding sex, increased feelings of control over personal health, and experiencing less stigma towards sexual partners with HIV. Participants indicated needs for tailored health advice based on individual sexual preferences, sexual health care free from stereotypical assumptions, and improved access to PrEP providers identifying as gay men or who practice in LGBT-friendly settings. Study findings support a call for a gain-frame approach to sexual health in PrEP care for MSM.
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Affiliation(s)
| | - Jessica M Sales
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Machel Hunt
- Hope Clinic of the Emory Vaccine Center, Emory School of Medicine, Decatur, GA, USA
| | - Dawn L Comeau
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Abstract
BACKGROUND Low adherence can undermine the efficacy of daily oral pre-exposure prophylaxis (PrEP). Mental health conditions, particularly depression, could be associated with low PrEP adherence, especially for women. SETTING We analyzed data from 1013 Kenyan and Ugandan HIV-uninfected participants in the Partners Demonstration Project, an open-label study of PrEP delivered to HIV-uninfected members of serodiscordant couples. METHODS Participants completed quarterly visits over 2 years and were encouraged to use PrEP until their partners living with HIV had ≥6 months of antiretroviral therapy use (when viral suppression was expected). PrEP adherence was measured daily with electronic medication event monitoring system caps and dichotomized into low (<80% of expected bottle openings) and high adherence. Depression was assessed annually using the 16-item Hopkins Symptom Checklist screening tool; scores >1.75 indicate "probable depression." The association between probable depression and PrEP adherence was assessed separately for men and women using generalized estimating equations and marginal structural models. RESULTS At enrollment, 39 (11.7% of 334) women and 64 (9.4% of 679) men reported symptoms indicating probable depression, and these proportions decreased during follow-up (P < 0.001 for women and men). Probable depression was significantly associated with low PrEP adherence among women (adjusted risk ratio = 1.77; 95% confidence interval: 1.14 to 2.77; P = 0.01); there was no association between depression and adherence among men (P = 0.50). Marginal structural models and sensitivity analyses confirmed these findings. CONCLUSIONS Depression was relatively uncommon in this population and was an independent risk factor for low PrEP adherence among women. For PrEP programs targeting African women, integration of depression screening may improve PrEP effectiveness.
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Velloza J, Bacchetti P, Hendrix CW, Murnane P, Hughes JP, Li M, E. Curlin M, Holtz TH, Mannheimer S, Marzinke MA, Amico KR, Liu A, Piwowar-Manning E, Eshleman SH, Dye BJ, Gandhi M, Grant RM. Short- and Long-Term Pharmacologic Measures of HIV Pre-exposure Prophylaxis Use Among High-Risk Men Who Have Sex With Men in HPTN 067/ADAPT. J Acquir Immune Defic Syndr 2019; 82:149-158. [PMID: 31335588 PMCID: PMC6749964 DOI: 10.1097/qai.0000000000002128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 06/21/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The effectiveness of oral emtricitabine (FTC)/tenofovir (TFV) disoproxil fumarate-based HIV pre-exposure prophylaxis (PrEP) depends on adherence. Pharmacologic measures help interpret patterns and predictors of PrEP adherence. SETTING We analyzed data from the subsample of men who have sex with men enrolled in HPTN 067/ADAPT in Bangkok, Thailand, and Harlem, NY, U.S. METHODS After a 5-week directly observed therapy period, participants were randomized to daily, time-driven, or event-driven PrEP. Follow-up occurred at weeks 4, 12, and 24 after randomization. Plasma and hair FTC/TFV levels indicated short- and long-term PrEP use, respectively. Electronic pill bottle data (Wisepill) were collected weekly. Pearson correlation coefficients between PrEP use measures were calculated; linear mixed models assessed predictors of plasma and hair drug concentrations. RESULTS Among 350 participants (median age: 31 years, interquartile range: 25-38), 49.7% were from Harlem, half had less than college education, and 21% reported heavy alcohol use. In multivariable models, being enrolled in Harlem, being in non-daily arms, and having less than college education were associated with lower hair FTC/TFV concentrations; heavy alcohol use was associated with higher concentrations. Similar results were found for plasma concentrations by site and arm, but older age and greater number of sex partners were associated with higher concentrations. Hair and plasma FTC/TFV concentrations were moderately correlated with Wisepill data (r ≥ 0.29) across visits. CONCLUSIONS In HPTN067, plasma, hair, and Wisepill data correlated with one another and served as complementary adherence measures. Site, arm, education, age, alcohol, and sexual behavior influenced patterns of adherence.
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Affiliation(s)
- Jennifer Velloza
- Department of Global Health, University of Washington, Seattle, WA
| | - Peter Bacchetti
- School of Medicine, University of California at San Francisco, San Francisco, CA
| | | | - Pamela Murnane
- School of Medicine, University of California at San Francisco, San Francisco, CA
| | - James P. Hughes
- Department of Global Health, University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Maoji Li
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Marcel E. Curlin
- U.S. Centers for Disease Control and Prevention, Atlanta, GA
- Thailand MOPH–U.S. CDC Collaboration, Bangkok, Thailand
- Division of Infectious Disease, Oregon Health & Science University, Portland, OR
| | - Timothy H. Holtz
- U.S. Centers for Disease Control and Prevention, Atlanta, GA
- Thailand MOPH–U.S. CDC Collaboration, Bangkok, Thailand
| | | | | | - K. Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Albert Liu
- San Francisco Department of Public Health, San Francisco, CA
| | | | | | | | - Monica Gandhi
- School of Medicine, University of California at San Francisco, San Francisco, CA
| | - Robert M. Grant
- School of Medicine, University of California at San Francisco, San Francisco, CA
- Gladstone Institute of Virology and Immunology, University of California at San Francisco, San Francisco, CA
| | - HPTN 067/ADAPT Study Team
- Department of Global Health, University of Washington, Seattle, WA
- School of Medicine, University of California at San Francisco, San Francisco, CA
- Department of Medicine, Johns Hopkins University, Baltimore, MD
- Fred Hutchinson Cancer Research Center, Seattle, WA
- U.S. Centers for Disease Control and Prevention, Atlanta, GA
- Thailand MOPH–U.S. CDC Collaboration, Bangkok, Thailand
- Division of Infectious Disease, Oregon Health & Science University, Portland, OR
- Columbia University, New York, NY
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
- San Francisco Department of Public Health, San Francisco, CA
- FHI 360, Durham, NC; and
- Gladstone Institute of Virology and Immunology, University of California at San Francisco, San Francisco, CA
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Abstract
Tremendous biomedical advancements in HIV prevention and treatment have led to aspirational efforts to end the HIV epidemic. However, this goal will not be achieved without addressing the significant mental health and substance use problems among people living with HIV (PLWH) and people vulnerable to acquiring HIV. These problems exacerbate the many social and economic barriers to accessing adequate and sustained healthcare, and are among the most challenging barriers to achieving the end of the HIV epidemic. Rates of mental health problems are higher among both people vulnerable to acquiring HIV and PLWH, compared with the general population. Mental health impairments increase risk for HIV acquisition and for negative health outcomes among PLWH at each step in the HIV care continuum. We have the necessary screening tools and efficacious treatments to treat mental health problems among people living with and at risk for HIV. However, we need to prioritize mental health treatment with appropriate resources to address the current mental health screening and treatment gaps. Integration of mental health screening and care into all HIV testing and treatment settings would not only strengthen HIV prevention and care outcomes, but it would additionally improve global access to mental healthcare.
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Luz PM, Osher B, Grinsztejn B, Maclean RL, Losina E, Stern ME, Struchiner CJ, Parker RA, Freedberg KA, Mesquita F, Walensky RP, Veloso VG, Paltiel AD. The cost-effectiveness of HIV pre-exposure prophylaxis in men who have sex with men and transgender women at high risk of HIV infection in Brazil. J Int AIDS Soc 2019; 21:e25096. [PMID: 29603888 PMCID: PMC5878414 DOI: 10.1002/jia2.25096] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 03/01/2018] [Indexed: 12/22/2022] Open
Abstract
Introduction Men who have sex with men (MSM) and transgender women (TGW) in Brazil experience high rates of HIV infection. We examined the clinical and economic outcomes of implementing a pre‐exposure prophylaxis (PrEP) programme in these populations. Methods We used the Cost‐Effectiveness of Preventing AIDS Complications (CEPAC)‐International model of HIV prevention and treatment to evaluate two strategies: the current standard of care (SOC) in Brazil, including universal ART access (No PrEP strategy); and the current SOC plus daily tenofovir/emtracitabine PrEP (PrEP strategy) until age 50. Mean age (31 years, SD 8.4 years), age‐stratified annual HIV incidence (age ≤ 40 years: 4.3/100 PY; age > 40 years: 1.0/100 PY), PrEP effectiveness (43% HIV incidence reduction) and PrEP drug costs ($23/month) were from Brazil‐based sources. The analysis focused on direct medical costs of HIV care. We measured the comparative value of PrEP in 2015 United States dollars (USD) per year of life saved (YLS). Willingness‐to‐pay threshold was based on Brazil's annual per capita gross domestic product (GDP; 2015: $8540 USD). Results Lifetime HIV infection risk among high‐risk MSM and TGW was 50.5% with No PrEP and decreased to 40.1% with PrEP. PrEP increased per‐person undiscounted (discounted) life expectancy from 36.8 (20.7) years to 41.0 (22.4) years and lifetime discounted HIV‐related medical costs from $4100 to $8420, which led to an incremental cost‐effectiveness ratio (ICER) of $2530/YLS. PrEP remained cost‐effective (<1x GDP) under plausible variation in key parameters, including PrEP effectiveness and cost, initial cohort age and HIV testing frequency on/off PrEP. Conclusion Daily tenofovir/emtracitabine PrEP among MSM and TGW at high risk of HIV infection in Brazil would increase life expectancy and be highly cost‐effective.
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Affiliation(s)
- Paula M Luz
- The Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Benjamin Osher
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Beatriz Grinsztejn
- The Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Rachel L Maclean
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Elena Losina
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.,Harvard University Center for AIDS Research, Harvard Medical School, Boston, MA, USA.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Madeline E Stern
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Claudio J Struchiner
- The Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Robert A Parker
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.,Harvard University Center for AIDS Research, Harvard Medical School, Boston, MA, USA.,Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Kenneth A Freedberg
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard University Center for AIDS Research, Harvard Medical School, Boston, MA, USA.,Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA
| | - Fabio Mesquita
- The Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Rochelle P Walensky
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard University Center for AIDS Research, Harvard Medical School, Boston, MA, USA.,Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA.,Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA, USA
| | - Valdilea G Veloso
- The Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Golub SA, Myers JE. Next-Wave HIV Pre-Exposure Prophylaxis Implementation for Gay and Bisexual Men. AIDS Patient Care STDS 2019; 33:253-261. [PMID: 31094576 DOI: 10.1089/apc.2018.0290] [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: 01/09/2023] Open
Abstract
Data indicate that diffusion of pre-exposure prophylaxis (PrEP) programs for HIV prevention is increasing in the United States; however, persistent disparities in PrEP access remain. Earlier waves of PrEP implementation focused on development (2012-2015) and diffusion (2016-2018). To reduce disparities, the next wave of PrEP implementation should focus on integration; that is, the assimilation of PrEP service as an integral part of HIV prevention, sexual health, and primary care. This review analyzes PrEP implementation literature in the context of three "next-wave" challenges: increasing patient demand, enhancing provider investment and competency, and improving health systems capacity. Our review revealed five activities we consider critical to successful next-wave PrEP implementation efforts: (1) redefining PrEP eligibility assessment, (2) de-emphasizing risk perception as a strategy to increase demand, (3) rejecting risk compensation arguments, (4) altering guidelines to make PrEP follow-up less onerous, and (5) focusing directly on strategies to reduce the cost of PrEP medication. This article ends with a case study of a research-practice partnership designed to instantiate new approaches to integrative implementation efforts.
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Affiliation(s)
- Sarit A. Golub
- Department of Psychology, Hunter College of the City University of New York, New York, New York
- Basic and Applied Social Psychology (BASP) PhD Program, Department of Psychology, Graduate Center of the City University of New York, New York, New York
| | - Julie E. Myers
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York
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44
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Abstract
PURPOSE OF REVIEW Despite its promise as an HIV prevention strategy, PrEP uptake remains slow, especially among highest priority populations. One factor that may be impeding implementation and driving disparities is PrEP-related stigma. This paper reviews the role of PrEP-related stigma in PrEP access, adherence, and persistence and examines its antecedents and consequences. RECENT FINDINGS Although PrEP stigma is often experienced at the community level (i.e., by potential and current users), it can be reinforced and even amplified by public health programs, policy, and research. PrEP stigma disproportionately impacts disadvantaged groups and impedes scalability by influencing behavior of both patients and providers. Reducing PrEP stigma and its negative impact on the epidemic requires a significant shift in perspective, language, and programs. Such a shift is necessary to ensure broader reach of PrEP as a prevention strategy and improve its utilization by the individuals who need it most.
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Sun CJ, Anderson KM, Toevs K, Morrison D, Wells C, Nicolaidis C. "Little Tablets of Gold": An Examination of the Psychological and Social Dimensions of PrEP Among LGBTQ Communities. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:51-62. [PMID: 30742478 DOI: 10.1521/aeap.2019.31.1.51] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
There are significant psychological, social, and cultural dimensions to the HIV epidemic in the United States, especially among lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities. Biomedical HIV treatment has been shown to impact these dimensions. However, there is little understanding of the real-world psychosocial and sociocultural effects of the latest biomedical HIV prevention strategy, HIV pre-exposure prophylaxis (PrEP). This study explored the psychosocial and sociocultural dimensions of PrEP use among LGBTQ adults. We interviewed 23 LGBTQ adults who were current or former users of PrEP. Results included that PrEP users' experiences were shaped by multiple forms of stigma. Participants were highly motivated to challenge PrEP stigma and to support PrEP use among other community members. Lastly, participants described positive impacts on their individual well-being and their sexual partnerships. Findings suggest that PrEP has significant impacts beyond biomedical outcomes for both the individuals who use PrEP and their communities.
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Affiliation(s)
- Christina J Sun
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon
| | - Kirsten M Anderson
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon
| | - Kim Toevs
- Multnomah County Health Department, Portland, Oregon
| | - Dayna Morrison
- Oregon AIDS Education and Training Center at Portland Veterans Affairs Research Foundation, Portland, Oregon
| | | | - Christina Nicolaidis
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, and the School of Social Work, Portland State University, Portland, Oregon
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46
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Nakku‐Joloba E, Pisarski EE, Wyatt MA, Muwonge TR, Asiimwe S, Celum CL, Baeten JM, Katabira ET, Ware NC. Beyond HIV prevention: everyday life priorities and demand for PrEP among Ugandan HIV serodiscordant couples. J Int AIDS Soc 2019; 22:e25225. [PMID: 30657642 PMCID: PMC6338102 DOI: 10.1002/jia2.25225] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 12/05/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) to prevent HIV infection is being rolled out in Africa. The uptake of PrEP to date has varied across populations and locations. We seek to understand the drivers of demand for PrEP through analysis of qualitative data collected in conjunction with a PrEP demonstration project involving East African HIV serodiscordant couples. Our goal was to inform demand creation by understanding what PrEP means - beyond HIV prevention - for the lives of users. METHODS The Partners Demonstration Project evaluated an integrated strategy of PrEP and antiretroviral therapy (ART) delivery in which time-limited PrEP served as a "bridge" to long-term ART. Uninfected partners in HIV serodiscordant couples were offered PrEP at baseline and encouraged to discontinue once infected partners had taken ART for six months. We conducted 274 open-ended interviews with 93 couples at two Ugandan research sites. Interviews took place one month after enrolment and at later points in the follow-up period. Topics included are as follows: (1) discovery of serodiscordance; (2) decisions to accept/decline PrEP and/or ART; (3) PrEP and ART initiation; (4) experiences of using PrEP and ART; (5) PrEP discontinuation; (6) impact of PrEP and ART on the partnered relationship. Interviews were audio-recorded and transcribed. We used an inductive, content analytic approach to characterize meanings of PrEP stemming from its effectiveness for HIV prevention. Relevant content was represented as descriptive categories. RESULTS Discovery of HIV serodiscordance resulted in fear of HIV transmission for couples, which led to loss of sexual intimacy in committed relationships, and to abandonment of plans for children. As a result, partners became alienated from each other. PrEP countered the threat to the relationship by reducing fear and reinstating hopes of having children together. Condom use worked against the re-establishment of intimacy and closeness. By increasing couples' sense of protection against HIV infection and raising the prospect of a return to "live sex" (sex without condoms), PrEP was perceived by couples as solving the problem of serodiscordance and preserving committed relationships. CONCLUSIONS The most effective demand creation strategies for PrEP may be those that address the everyday life priorities of potential users in addition to HIV prevention. CLINICAL TRIAL NUMBER NCT02775929.
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Affiliation(s)
- Edith Nakku‐Joloba
- Department of Epidemiology and BiostatisticsMakerere University College of Health SciencesKampalaUganda
- STD Clinic/Ward 12Mulago HospitalKampalaUganda
| | - Emily E Pisarski
- Department of Global Health and Social MedicineHarvard Medical SchoolBostonMAUSA
| | - Monique A Wyatt
- Department of Global Health and Social MedicineHarvard Medical SchoolBostonMAUSA
- Harvard GlobalCambridgeMAUSA
| | | | | | - Connie L Celum
- Departments of Global Health, Medicine, and EpidemiologySchool of Medicine and School of Public HealthUniversity of WashingtonSeattleWAUSA
| | - Jared M Baeten
- Departments of Global Health, Medicine, and EpidemiologySchool of Medicine and School of Public HealthUniversity of WashingtonSeattleWAUSA
| | | | - Norma C Ware
- Department of Global Health and Social MedicineHarvard Medical SchoolBostonMAUSA
- Department of MedicineBrigham & Women's HospitalBostonMAUSA
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Newman PA, Guta A, Lacombe‐Duncan A, Tepjan S. Clinical exigencies, psychosocial realities: negotiating HIV pre-exposure prophylaxis beyond the cascade among gay, bisexual and other men who have sex with men in Canada. J Int AIDS Soc 2018; 21:e25211. [PMID: 30474351 PMCID: PMC6253066 DOI: 10.1002/jia2.25211] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 10/29/2018] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Notwithstanding the efficacy of oral pre-exposure prophylaxis (PrEP) in clinical trials, a number of obstacles exist to achieving population-level impact among gay, bisexual and other men who have sex with men (GBM). However, few studies have explored the subjective experiences of GBM PrEP users and non-users in the community, outside of clinical trials. The objectives of this study were to explore GBM's experiences of considering, accessing and using (or not using) PrEP, and to understand emerging sexual health, social and community issues among GBM in the PrEP era. METHODS From October 2015 to March 2016, we purposively sampled PrEP-naïve and PrEP-experienced GBM from community organizations and health centres in Toronto, Canada. In-depth, 45- to 90-minute semi-structured interviews explored PrEP perspectives and decision-making, access, initiation, use over time, sexual practices and psychosocial considerations. Interviews were recorded, transcribed verbatim, uploaded into NVIVO, reviewed using thematic analysis and then contrasted with the PrEP cascade. RESULTS Participants included PrEP users (n = 15) and non-users (n = 14) (mean age = 36.7 years; SD = 8.2), largely gay-identified (86.2%), cisgender male (89.7%) and white (79.3%). Themes indicate not only correspondences, but also limitations of the PrEP cascade by complicating a user/non-user binary and challenging the unilateral presupposition that HIV risk perception leads to PrEP acceptance. Findings further call into question assumptions of a linear stage progression and retention in care as a universal endpoint, instead revealing alternate trajectories of seasonal or intermittent PrEP use and, for some, an end goal of terminating PrEP. GBM's narratives also revealed potent psychological/affective experiences of untethering sex from HIV anxiety; multifaceted PrEP stigma; and challenges to sexual norms and practices that complicate existing behavioural prevention strategies and sexual and social relationships. CONCLUSIONS An expanded PrEP cascade should consider alternate trajectories of use based on dynamic relationships and behavioural risks that may call for seasonal or intermittent use; systemic barriers in access to and sustaining PrEP; and multiple end goals including PrEP maintenance and discontinuation. Incorporating GBM's lived experiences, evolving preferences, and psychosocial and community-level challenges into PrEP implementation models, rather than a circumscribed biomedical approach, may more effectively support HIV prevention and GBM's broader sexual and psychological health.
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Affiliation(s)
- Peter A Newman
- Factor‐Inwentash Faculty of Social WorkUniversity of TorontoTorontoONCanada
| | - Adrian Guta
- School of Social WorkUniversity of WindsorWindsorONCanada
| | - Ashley Lacombe‐Duncan
- Factor‐Inwentash Faculty of Social WorkUniversity of TorontoTorontoONCanada
- School of Social WorkUniversity of MichiganAnn ArborMIUSA
| | - Suchon Tepjan
- Factor‐Inwentash Faculty of Social WorkUniversity of TorontoTorontoONCanada
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48
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Meyers K, Wu Y, Brill A, Sandfort T, Golub SA. To switch or not to switch: Intentions to switch to injectable PrEP among gay and bisexual men with at least twelve months oral PrEP experience. PLoS One 2018; 13:e0200296. [PMID: 30024903 PMCID: PMC6053164 DOI: 10.1371/journal.pone.0200296] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 06/22/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Phase III trials of long-acting injectable (LAI) PrEP, currently underway, have great potential for expanding the menu of HIV prevention options. Imagining a future in which multiple PrEP modalities are available to potential users of biomedical HIV prevention, we investigated which factors might help direct a patient-physician shared-decision making process to optimize the choice of biomedical HIV prevention method. METHODS Participants (n = 105; ages 19-63; 46.7% men of color) were former participants in a PrEP demonstration project and had taken daily oral PrEP for ≥ 12 months. Participants were given information about LAI PrEP and asked whether they would be interested in switching from oral to LAI PrEP. Participants were also asked about specific pros/cons of LAI PrEP, PrEP attitudes and experiences, and personality factors. RESULTS Two-thirds (66.7%) of current oral PrEP users would switch to LAI PrEP. Intention to switch was associated with product-level and psychosocial factors. Attitudes towards logistical factors (i.e. getting to regular clinic visits for recurring shots) featured more prominently than factors related to the physical experience of PrEP modality (i.e., concerns about injection pain) as motivators for switching. In a multivariate regression model, psychosocial factors including the emotional burden of daily pill taking, deriving a sense of responsibility from PrEP use, and self-identifying as an early adopter, were the strongest predictors of switching. CONCLUSIONS These data underscore the importance of attending not only to product-level factors, but also to the logistical and psychological experience of prevention methods for users. Findings have significant implications for the development of patient education materials and patient-provider shared decision aids.
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Affiliation(s)
- Kathrine Meyers
- Aaron Diamond AIDS Research Center, The Rockefeller University, New York, New York, United States of America
| | - Yumeng Wu
- Aaron Diamond AIDS Research Center, The Rockefeller University, New York, New York, United States of America
| | - Atrina Brill
- Department of Psychology, Hunter College of the City University of New York, New York, New York, United States of America
| | - Theodorus Sandfort
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, New York, United States of America
| | - Sarit A. Golub
- Department of Psychology, Hunter College of the City University of New York, New York, New York, United States of America
- Department of Psychology, the Graduate Center of the City University of New York, New York, New York, United States of America
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49
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Risk Perception, Sexual Behaviors, and PrEP Adherence Among Substance-Using Men Who Have Sex with Men: a Qualitative Study. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018; 18:737-747. [PMID: 28578516 DOI: 10.1007/s11121-017-0799-8] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The antiretroviral drug combination emtricitabine and tenofovir disoproxil fumarate (TDF/FTC) taken as pre-exposure prophylaxis (PrEP) is effective in preventing HIV infection, yet it also requires adherence and potentially decreases condom use. This study sought to examine these issues among a key population at risk of HIV infection, substance-using men who have sex with men (MSM). We conducted semi-structured interviews with an ethnically diverse sample of 30 young (aged 20-35) MSM prescribed PrEP within a large integrated healthcare system in San Francisco, who had reported recent drug use or hazardous drinking and one or more missed doses of PrEP. We explored participants' risk perception and sexual risk behavior, drug and alcohol use, and PrEP adherence in the context of substance use. Interviews were transcribed and coded using a directed content analysis approach to identify key categories and commonalities, and differences across participants. Salient subcategories included positive psychological effects of being on PrEP (e.g., decreased anxiety, feelings of empowerment), social effects (e.g., reduced HIV stigma), and reduction in overall perceptions of HIV risk. While overall reported use of condoms went down and many reported a brief period of increased condomless sex following PrEP initiation, others continued condom use with most of their sexual partners. Contextual factors influencing their decision to engage in condomless sex included how well they knew the partner and whether the partner was on PrEP or HIV antiretroviral treatment. Factors associated with poor adherence included disruptions in daily routine and use of alcohol and methamphetamine. PrEP-prescribing clinicians should support their patients in making informed decisions about condom use and identifying strategies to maximize adherence in the context of substance use.
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50
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John SA, Starks TJ, Rendina HJ, Grov C, Parsons JT. Should I Convince My Partner to Go on Pre-Exposure Prophylaxis (PrEP)? The Role of Personal and Relationship Factors on PrEP-Related Social Control among Gay and Bisexual Men. AIDS Behav 2018. [PMID: 28634660 DOI: 10.1007/s10461-017-1835-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
An estimated 35-68% of new HIV infections among gay, bisexual, and other men who have sex with men (GBM) are transmitted through main partnerships. Pre-exposure prophylaxis (PrEP) is highly effective in reducing HIV seroconversion, yet PrEP uptake has been modest. PrEP-naïve GBM with HIV-negative, PrEP-naïve main partners enrolled in One Thousand Strong (n = 409), a U.S. national cohort of GBM, were asked about (1) the importance of partner PrEP use and (2) their willingness to convince their partner to initiate PrEP. On average, participants thought partner PrEP was only modestly important and were only moderately willing to try to convince their partner to initiate PrEP. Personal PrEP uptake willingness and intentions were the strongest indicators of partner PrEP outcomes. Being in a monogamish relationship arrangement (as compared to a monogamous arrangement) and the experience of intimate partner violence victimization were associated with increased willingness to persuade a partner to initiate PrEP.
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Affiliation(s)
- Steven A John
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, USA
| | - Tyrel J Starks
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, USA
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Avenue, New York, NY, 10065, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA
| | - H Jonathon Rendina
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, USA
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Avenue, New York, NY, 10065, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA
| | - Christian Grov
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, USA
- CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Jeffrey T Parsons
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, USA.
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Avenue, New York, NY, 10065, USA.
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA.
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