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Rivera-Castellar G, Moore BE, Kapadia F. Prevalence and Correlates of HIV-Associated Health Behaviors in a Population-Based Sample of Puerto Rican Adults, 2019. Ethn Dis 2023; 33:17-25. [PMID: 38846258 PMCID: PMC11152152 DOI: 10.18865/1721] [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] [Indexed: 06/09/2024] Open
Abstract
Introduction High incidence and prevalence of HIV persist in Puerto Rico. To inform HIV prevention efforts, this study examines factors linked to HIV-associated behaviors in the territory. Methods Using data from the 2019 Behavioral Risk Factor Surveillance System, multivariable logistic regression models were constructed to explore factors related to HIV-associated behaviors. Results Among Puerto Rican residents (n=4446), 5.6% reported engaging in ≥1 HIV-associated behavior (past 12 months), and 39.2% had never been tested for HIV. Reporting HIV-associated behaviors was associated with male sex (adjusted odds ratio [aOR], 1.74; 95% confidence interval [CI], 1.30-2.33), higher household income (aOR, 1.71; 95% CI, 1.14-2.58), heavy alcohol use (aOR, 2.67; 95% CI, 1.68-4.25), and ever receiving an HIV test (aOR, 2.00; 95% CI, 1.40-2.86) in a multivariable model. Conversely, being married (aOR, 0.51; 95% CI, 0.35-0.72), having a recent routine checkup (aOR, 0.48; 95% CI, 0.32-0.72), and reporting 0 days of poor mental health (aOR, 0.61; 95% CI, 0.45-0.81) were associated with decreased odds of engaging in HIV-associated behaviors. Conclusions Future surveys should incorporate measures of social and structural determinants that would provide greater context for understanding behavioral factors associated with HIV vulnerability as well as for developing appropriate HIV interventions in Puerto Rico.
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Affiliation(s)
- German Rivera-Castellar
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY
| | - Brandi E. Moore
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY
| | - Farzana Kapadia
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY
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Hamilton A, Shin S, Taggart T, Whembolua GL, Martin I, Budhwani H, Conserve D. HIV testing barriers and intervention strategies among men, transgender women, female sex workers and incarcerated persons in the Caribbean: a systematic review. Sex Transm Infect 2020; 96:189-196. [PMID: 31506346 PMCID: PMC7062576 DOI: 10.1136/sextrans-2018-053932] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/16/2019] [Accepted: 08/13/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND This systematic review summarises evidence on the HIV testing barriers and intervention strategies among Caribbean populations and provides pertinent implications for future research endeavours designed to increase rates of HIV testing in the region. METHODS We used a systematic approach to survey all literature published between January 2008 and November 2018 using four electronic databases (MEDLINE/PubMed, Embase, Web of Science and Global Health). Only peer-reviewed articles published in English that examined HIV testing uptake and interventions in the Caribbean with men, men who have sex with men, female sex workers, transgender women and incarcerated individuals were included. RESULTS Twenty-one studies met the inclusion criteria. Lack of confidentiality, access to testing sites, stigma, discrimination, poverty and low HIV risk perception were identified as key barriers to HIV testing. These barriers often contributed to late HIV testing and were associated with delayed treatment initiation and decreased survival rate. Intervention strategies to address these barriers included offering rapid HIV testing at clinics and HIV testing outreach by trained providers and peers. CONCLUSION HIV testing rates remain unacceptably low across the Caribbean for several reasons, including stigma and discrimination. Future HIV testing interventions should target places where at-risk populations congregate, train laypersons to conduct rapid tests and consider using oral fluid HIV self-testing, which allows individuals to test at home.
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Affiliation(s)
- Akeen Hamilton
- Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, University of South Carolina System, Columbia, SC, USA
| | - Stephen Shin
- University of North Carolina at Chapel Hill, Department of Sociology, Chapel Hill, NC, USA
| | - Tamara Taggart
- George Washington University, Department of Prevention and Community Health, Washington, DC, USA
- Yale School of Public Health, Department of Social and Behavioral Sciences, New Haven, CT, USA
| | - Guy-Lucien Whembolua
- Yale School of Public Health, Department of Social and Behavioral Sciences, New Haven, CT, USA
| | - Indira Martin
- Government of the Bahamas Ministry of Health, Nassau, Bahamas
| | - Henna Budhwani
- University of Alabama at Birmingham, Department of Health Care Organization and Policy, Birmingham, AL, USA
| | - Donaldson Conserve
- Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, University of South Carolina System, Columbia, SC, USA
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Bay MB, Freitas MRD, Lucas MCV, Souza ECFD, Roncalli AG. HIV testing and HIV knowledge among men who have sex with men in Natal, Northeast Brazil. Braz J Infect Dis 2019; 23:2-7. [PMID: 30742795 PMCID: PMC9427798 DOI: 10.1016/j.bjid.2019.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 01/03/2019] [Accepted: 01/13/2019] [Indexed: 11/24/2022] Open
Abstract
Background Men who have sex with men (MSM) account for the highest prevalence of HIV in Brazil. HIV testing allows to implement preventive measures, reduces transmission, morbidity, and mortality. Methods We conducted a cross-sectional study to evaluate HIV testing during lifetime, factors associated with the decision to test, knowledge about HIV transmission, and use of condoms between MSM from the city of Natal, northeast Brazil. Results Out of 99 participants, 62.6% had been tested for HIV during lifetime, 46.2% in the last year. The most frequent reported reason to be tested for HIV infection was curiosity (35.5%). Correct knowledge about HIV was observed in only 9.2% of participants. In multivariate analysis, age (PR 0.95; 95%CI, 0.91–0.99; p = 0.041) and previous syphilis test (PR 4.21; 95%CI, 1.52–11.70; p = 0.006) were associated with HIV testing. Conclusions The frequency of HIV testing among MSM from Natal is rather low, especially in younger MSM, and knowledge about HIV transmission is inappropriate.
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Affiliation(s)
- Monica Baumgardt Bay
- Universidade Federal do Rio Grande do Norte, Departamento de Doenças Infecciosas, Natal, RN, Brazil.
| | - Marise Reis de Freitas
- Universidade Federal do Rio Grande do Norte, Departamento de Doenças Infecciosas, Natal, RN, Brazil
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Chen YT, Bowles K, An Q, DiNenno E, Finlayson T, Hoots B, Paz-Bailey G, Wejnert C. Surveillance Among Men Who have Sex with Men in the United States: A Comparison of Web-Based and Venue-Based Samples. AIDS Behav 2018; 22:2104-2112. [PMID: 28667468 DOI: 10.1007/s10461-017-1837-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although men who have sex with men (MSM) recruited through web-based and venue-based sampling methods have been compared, no large web-based and venue-based samples using similar survey instruments have been examined in the U.S. This study describes the differences in sociodemographic characteristics and risk behaviors between the 2012 Web-based HIV Behavioral Survey (n = 3221) and 2011 National HIV Behavioral Surveillance (n = 9256). Compared with participants in the venue-based sample, participants in the web-based sample were older, less likely to be black or Hispanic, more likely to have higher socioeconomic status, and more likely to have anal sex without a condom with their last male sex partner. Web-based participants were less likely to have multiple male sex partners, ever injected drugs, been tested for HIV in the past 12 months, and received free condoms than venue-based participants. The method for sampling MSM into a behavioral survey should consider the sub-population of MSM to be reached.
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Affiliation(s)
- Yen-Tyng Chen
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Kristina Bowles
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Qian An
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth DiNenno
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Teresa Finlayson
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brooke Hoots
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cyprian Wejnert
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Qiao S, Zhou G, Li X. Disclosure of Same-Sex Behaviors to Health-care Providers and Uptake of HIV Testing for Men Who Have Sex With Men: A Systematic Review. Am J Mens Health 2018; 12:1197-1214. [PMID: 29947563 PMCID: PMC6142161 DOI: 10.1177/1557988318784149] [Citation(s) in RCA: 63] [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
To promote HIV-testing and offer optimal care for men who have sex with men (MSM), health-care providers (HCPs) must first be aware of their patients’ sexual behaviors. Otherwise, HCPs may overlook MSM’s risks for HIV infection and their special health-care needs. For MSM, reporting their same-sex behaviors to HCPs (disclosure to HCPs) may promote their linkage to HIV prevention and treatment cascade and improve their health outcomes. No literature review has been conducted to examine the relationship between disclosure to HCPs and uptake of HIV-testing among MSM. The current study reviewed and synthesized findings from 29 empirical studies published in English by 2016. We summarized the rates of MSM’s disclosure to HCPs, investigated the association between disclosure and HIV-testing among MSM, identified potential facilitators and barriers for disclosure, and discussed the implications of our findings in research and clinical practices. The disclosure rates varied across subgroups and study settings, ranging from 16% to 90% with a median of 61%. Disclosure to HCPs was positively associated with uptake of HIV-testing. African American MSM were less likely to disclose to HCPs. MSM who lived in urban settings with higher education attainment and higher income were more likely to disclose. MSM tended to perceive younger or gay-friendly doctors as safer targets of disclosure. Clinics with LGBT-friendly signs were viewed as safer contexts for disclosure. Having previous communications about substance use, sex, and HIV with HCPs could also facilitate disclosure. The main reasons for nondisclosure included lack of probing from HCPs, concerns on confidentiality breach and stigma, and perceived irrelevance with services. Providing appropriate trainings for HCPs and creating gay-friendly clinical settings can be effective strategies to facilitate disclosures of same-sex behaviors among MSM and meet their specific medical needs. Interventions to promote disclosure should give priorities to MSM from the most marginalized subgroups (e.g., MSM in rural areas, MSM of ethnic minorities).
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Affiliation(s)
- Shan Qiao
- 1 Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Guangyu Zhou
- 1 Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Columbia, SC, USA.,2 School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Xiaoming Li
- 1 Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Columbia, SC, USA
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de León SM, Sánchez-Díaz CT, Machin-Rivera M, Valencia-Torres IM, Rolón Y, Colón-López V. Original title: HIV infection and unawareness among men who have sex with men in Puerto Rico: data from The National HIV behavioral surveillance system 2011-2014. ETHNICITY & HEALTH 2017; 24:211-223. [PMID: 28393613 DOI: 10.1080/13557858.2017.1315371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 03/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Unawareness of HIV infection is a public health challenge that needs to be addressed, particularly in the case of men who have sex with men (MSM), since recent data are reporting increasing rates of HIV in this population in Puerto Rico. OBJECTIVES We examined differences in the prevalence of HIV infection and unawareness among MSM in 2011 and 2014 using data from the National HIV Behavioral Surveillance System, 2011 and 2014. METHODS Bivariate analyses was used to compare demographical and behavioral characteristics in both cycles (2011 and 2014). Prevalence ratio (PR) was assessed with Poisson regression models to determine changes in HIV prevalence and unawareness across cycles, using the 2011 NHBS-MSM cycle as reference group. RESULTS A stable rate in HIV prevalence was observed in 2011 and 2014. There was a higher prevalence in 2014 than in 2011 in multiple behavioral characteristics such as age at sexual initiation, the number of sexual partners in the 12 months prior to being interviewed, HIV testing in the year prior to being interview, and the disclosure of sexual orientation to a healthcare provider. A significant decrease in HIV unawareness was reported (76.67%, 2011; 46.51%, 2014). Age-adjusted regression models showed a marginal reduction of 55% in HIV unawareness for men who disclosed their sexual orientation to their healthcare providers. CONCLUSION Behavioral surveillance systems in groups such as MSM in on the island will aid to monitor prospectively the effectiveness of HIV testing outreach and engagement, as well as capacity capacity-building strategies targeted towards health care providers, aimed to increase HIV testing and awareness among this group.
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Affiliation(s)
| | - Carola T Sánchez-Díaz
- b Population Sciences and Cancer Control Division , Puerto Rico Comprehensive Cancer Center, University of Puerto Rico Medical Sciences Campus , San Juan , Puerto Rico
| | - Mark Machin-Rivera
- b Population Sciences and Cancer Control Division , Puerto Rico Comprehensive Cancer Center, University of Puerto Rico Medical Sciences Campus , San Juan , Puerto Rico
| | - Ileska M Valencia-Torres
- b Population Sciences and Cancer Control Division , Puerto Rico Comprehensive Cancer Center, University of Puerto Rico Medical Sciences Campus , San Juan , Puerto Rico
| | - Yadira Rolón
- a Puerto Rico HIV Surveillance System , Department of Health , San Juan , Puerto Rico
| | - Vivian Colón-López
- b Population Sciences and Cancer Control Division , Puerto Rico Comprehensive Cancer Center, University of Puerto Rico Medical Sciences Campus , San Juan , Puerto Rico
- c Department of Health Services Administration , University of Puerto Rico Graduate School of Public Health , San Juan , Puerto Rico
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