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Toledo LDSG, Palmieri P, Ribeiro GDR, Silva AD, Bastos FI. Barriers and facilitators for HIV rapid testing among transgender women and gay and other men who have sex with men in Brazil: A scoping review. Glob Public Health 2024; 19:2360982. [PMID: 38937916 DOI: 10.1080/17441692.2024.2360982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/21/2024] [Indexed: 06/29/2024]
Abstract
Transgender women (TGW) and men who have sex with other men (MSM) often encounter disparities in accessing HIV testing, leading to delayed diagnoses and worse prognoses. We analysed barriers and facilitators for accessing HIV rapid testing by TGW and MSM in Brazil, 2004-2023. Citations were included whether the study population consisted of individuals aged ≥18y old, and studies addressed HIV testing and have been conducted in Brazil. The study protocol was based on Joanna Briggs' recommendations for scoping reviews. We included 11 studies on TGW and 17 on MSM. The belief that one is not at risk of contracting HIV infection, fear expressed in different ways (e.g. lack of confidentiality) and younger age were the main barriers. Feeling at risk for HIV infection, curiosity, and favourable characteristics of the setting where the testing takes place were cited as the main facilitators. Barriers and facilitators specifically for HIV self-testing included, respectively, concerns about conducting the test alone vs. autonomy/flexibility. Brazil is unlikely to achieve the UN' 95-95-95 goal without minimising testing disparities. Combating prejudice against TGW and MSM in testing settings, along with educational campaigns and transparent protocols to ensure confidentiality, can help increase HIV testing among these populations.
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Affiliation(s)
| | - Paloma Palmieri
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Gizele da Rocha Ribeiro
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Adriano da Silva
- National School of Public Health Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Francisco Inácio Bastos
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Guilamo-Ramos V, Thimm-Kaiser M, Benzekri A. Is the USA on track to end the HIV epidemic? Lancet HIV 2023; 10:e552-e556. [PMID: 37541707 DOI: 10.1016/s2352-3018(23)00142-x] [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: 01/09/2023] [Revised: 05/26/2023] [Accepted: 06/09/2023] [Indexed: 08/06/2023]
Abstract
Despite progress in reducing new HIV infections in the USA, publicly available data suggest that new HIV infections continue to occur at an alarming rate. In this Viewpoint, we highlight the regularity with which the existing systems for HIV prevention and treatment delivery in the USA fail and the clearly inequitable effect of the systems' failure among several priority populations of the Ending the HIV Epidemic (EHE) initiative. Existing data cast doubt on whether the current EHE efforts will suffice to achieve its 2030 goal of reducing annual new HIV infections to fewer than 3000. We outline future directions in four priority areas to regain lost ground in pursuit of the 2030 EHE goals: reducing the stigma affecting people living with and most at risk of HIV; broadening the HIV workforce; mitigating harmful social determinants of health; and recommitting and reinvesting in health in the USA more broadly.
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Affiliation(s)
- Vincent Guilamo-Ramos
- Center for Latino Adolescent and Family Health and School of Nursing, Duke University, Durham, NC, USA; Department of Family Medicine and Community Health and Department of Infectious Diseases, School of Medicine, Duke University, Durham, NC, USA; Presidential Advisory Council on HIV/AIDS, US Department of Health and Human Services, Washington, DC, USA; CDC/HRSA Advisory Committee on HIV, Viral Hepatitis and STD Prevention and Treatment, US Department of Health and Human Services, Atlanta, GA, USA; Panel on Antiretroviral Guidelines for Adults and Adolescents, Office of AIDS Research Advisory Council, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA.
| | - Marco Thimm-Kaiser
- Center for Latino Adolescent and Family Health and School of Nursing, Duke University, Durham, NC, USA
| | - Adam Benzekri
- Center for Latino Adolescent and Family Health and School of Nursing, Duke University, Durham, NC, USA
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Bien-Gund CH, Shaw PA, Agnew-Brune C, Baugher A, Brady KA, Gross R. HIV Self-testing and Risk Behaviors Among Men Who Have Sex With Men in 23 US Cities, 2017. JAMA Netw Open 2022; 5:e2247540. [PMID: 36534398 PMCID: PMC9856873 DOI: 10.1001/jamanetworkopen.2022.47540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE HIV self-testing (HIVST) is a promising strategy to expand the HIV care continuum, particularly among priority populations at high risk of HIV infection. However, little is known about HIVST uptake among men who have sex with men (MSM) outside of clinical trial settings. OBJECTIVE To evaluate HIVST use among urban MSM in the US who reported testing within the past 12 months. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study of adult MSM in the 2017 National HIV Behavioral Surveillance system, which used venue-based sampling methods to collect data related to HIV testing, receipt of prevention services, and risk factors for HIV, was conducted at 588 venues in 23 urban areas in the contiguous US and Puerto Rico. All participants were offered HIV testing. Adult cisgender MSM who reported HIV-negative or unknown HIV status and obtained HIV testing in the past 12 months were included. Data for this study were collected between June 4, 2017, and December 22, 2017, and analyzed between October 23, 2020, and August 20, 2021. MAIN OUTCOMES AND MEASURES Self-reported HIVST in the past year. Adjusted prevalence ratios (aPRs) using survey weights were calculated to assess factors associated with HIVST. RESULTS A total of 6563 MSM in 23 urban areas met inclusion criteria, of whom 506 (7.7%) individuals reported HIVST in the past year. The median age of self-testers was 29 (IQR, 25-35) years, 52.8% had completed college, and 37.9% reported non-Hispanic White race. One self-tester reported seroconverting in the prior 12 months, and an additional 10 self-testers were diagnosed with HIV during the survey. HIVST was associated with sexual orientation disclosure (aPR, 10.27; 95% CI, 3.45-30.60; P < .001), perceived discrimination against people with HIV (aPR, 1.53; 95% CI, 1.09-2.03; P = .01), younger age (aPR, 0.74; 95% CI, 0.66-0.84; P < .001), higher educational level (aPR, 1.20; 95% CI, 1.04-1.37; P = .01), and higher income levels (aPR, 1.18; 95% CI, 1.04-1.32; P = .009). No association was noted with condomless anal sex (aPR, 0.96; 95% CI, 0.88-1.06, P = .88), sexually transmitted infections (aPR, 0.96; 95% CI, 0.70-1.30; P = .77), or preexposure prophylaxis use (aPR, 0.99; 95% CI, 0.75-1.30; P = .92). CONCLUSIONS AND RELEVANCE In this study, HIVST was relatively uncommon in this sample of urban MSM. HIVST may not be reaching those with lower socioeconomic status or who have not disclosed their sexual identity. The findings of this study suggest that efforts to increase HIVST should focus on engaging underserved and vulnerable subgroups of MSM.
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Affiliation(s)
- Cedric H. Bien-Gund
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Pamela A. Shaw
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Christine Agnew-Brune
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy Baugher
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathleen A. Brady
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
- AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Robert Gross
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Schnarrs PW, Bond M, Stone AL, Salcido R, Young L, Dean J, Grigsby TJ. The Relationship Between Adverse Childhood Experiences and Utilization of Different HIV Testing Strategies Among Young Men Who Have Sex with Men in Texas. AIDS Behav 2022; 26:3642-3653. [PMID: 35583575 PMCID: PMC9115744 DOI: 10.1007/s10461-022-03690-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/24/2022]
Abstract
Adverse childhood experiences (ACEs) are a well-documented HIV-risk factor, but less is known about the relationship between ACEs and different HIV testing strategies. This study used data from an LGBTQ + community health assessment, that was part of a multi-staged community-based participatory research project in San Antonio, Texas. Overall, 464 young men who have sex with men (YMSM; < 36-years-old) completed an online, cross-sectional survey that included questions about ACEs and HIV testing behavior. An association between increased ACEs exposure and the odds of clinic-based testing and HIVST HIV significantly decreased relative to never testing for HIV. Additionally, greater ACEs exposure was significantly associated with increased odds of reporting community-based testing (AOR = 1.09, 95% CI = 1.00, 1.20) and significantly reduced odds of HIV self-testing (AOR = 0.72, 95% CI = 0.63, 0.82) compared to clinic-based testing. Cumulative ACEs exposure is important in understanding HIV testing behaviors in YMSM and should be considered when developing HIV testing programs.
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Affiliation(s)
- Phillip W Schnarrs
- Division of Community Engagement and Health Equity, Department of Population Health, Dell Medical School, The University of Texas at Austin, Health Discovery Building (HDB) 4.814, Austin, TX, 78712, USA.
- Department of Human Development and Family Sciences, School of Human Ecology, College of Natural Sciences, The University of Texas at Austin, Austin, TX, 78712, USA.
- Population Research Center, The College of Liberal Arts, The University of Texas at Austin, Austin, TX, 78712, USA.
| | - Mark Bond
- Department of Psychiatry, Dell Medical School, The University of Texas at Austin, Austin, TX, 78712, USA
| | - Amy L Stone
- Department of Sociology and Anthropology, Trinity University, San Antonio, TX, 78212, USA
| | - Robert Salcido
- The Pride Center San Antonio, San Antonio, TX, 78212, USA
| | - Lindsay Young
- Annenberg School for Communication and Journalism, University of Southern California, Los Angeles, CA, 90089, USA
| | - Judith Dean
- School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia
| | - Timothy J Grigsby
- Department of Environmental and Occupational Health, University of Nevada, Las Vegas, NV, 89154, USA
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Norelli J, Zlotorzynska M, Sanchez T, Sullivan PS. Scaling Up CareKit: Lessons Learned from Expansion of a Centralized Home HIV and Sexually Transmitted Infection Testing Program. Sex Transm Dis 2021; 48:S66-S70. [PMID: 34030160 PMCID: PMC8284343 DOI: 10.1097/olq.0000000000001473] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite advances in implementing human immunodeficiency virus (HIV)/sexually transmitted infection (STI) services for men who have sex with men (MSM), many remain underserved because of barriers like stigma, low facility coverage, and provider competency. This article describes the implementation of centralized nationwide mailed HIV/STI home testing (CareKit). METHODS The Emory Center for AIDS Research developed CareKit for research study participants to request HIV self-test kits, STI specimen collection kits, and condom/lubricant packs to be shipped to any mailing address in the United States. Sexually transmitted infection kits were customized according to study needs and could include materials to collect whole blood, dried blood spots, urine sample, and rectal and pharyngeal swab samples for syphilis, gonorrhea, and chlamydia testing. Specimens were mailed back to a central Clinical Laboratory Improvement Amendments-approved laboratory for testing, and results were returned to participants. RESULTS CareKit was used by 12 MSM studies and mailed 1132 STI kits to 775 participants between January 2018 and March 2020. Participants returned 507 (45%) STI kits, which included 1594 individual specimens. Eighty-one kits (16%) had at least one positive STI test result: pharyngeal chlamydia (n = 7), pharyngeal gonorrhea (n = 11), rectal chlamydia (n = 15), rectal gonorrhea (n = 12), genital chlamydia (n = 6), genital gonorrhea (n = 1), and syphilis (n = 54). In this same 2-year period, 741 HIV self-test kits were mailed to 643 MSM. CONCLUSIONS CareKit successfully met studies' needs for home HIV/STI testing and diagnosed many STIs. These processes continue to be adapted for research and programs. The ability to mail home test kits has become increasingly important to reach those who may have limited access to health care services, particularly during the COVID-19 pandemic.
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Hawk ME, Chung A, Creasy SL, Egan JE. A Scoping Review of Patient Preferences for HIV Self-Testing Services in the United States: Implications for Harm Reduction. Patient Prefer Adherence 2020; 14:2365-2375. [PMID: 33293799 PMCID: PMC7719302 DOI: 10.2147/ppa.s251677] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/20/2020] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Despite marked progress in the ability to test for, treat, and prevent HIV, the epidemic remains a significant public health concern, especially among key populations including prisoners; sex workers; transgender individuals; gay, bisexual, and other men who have sex with men (MSM); and Black and Latinx MSM. This scoping review was conducted to provide an overview of the current research describing patient preferences for HIVST in the United States to understand what key populations value about HIVST and why they are willing to use it. A targeted search for published literature on patient preferences for HIVST was conducted using Ovid Medline, PsychINFO, and an HIVST research database. RESULTS We reviewed 700 abstracts and 139 full texts. We found 19 articles published between January 2014 and April 2020 that included findings related to HIVST preferences. Overall, HIVST was preferred to more traditional testing. Six primary factors emerged as important HIVST values including: 1) convenience, 2) type of test; 3) cost, 4) stigma reduction, 5) risk reduction, and 6) self-control. Linkage to care was also identified as a key factor when considering HIVST as an option. Much of what makes HIVST attractive to individuals is their ability to self-determine how HIVST can be best integrated into their lives as a harm reduction tool for stigma and sexual risk mitigation. CONCLUSION While there is substantial evidence suggesting HIVST is feasible for use and there are aspects of HIVST that are beneficial and preferred over traditional testing approaches, there is a lack of rigorous implementation studies exploring how best to scale up HIVST in community settings. HIVST has the potential to be a powerful biobehavioral HIV prevention and harm reduction tool to empower individuals to engage with testing on their own terms while providing pathways to prevention and care support.
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Affiliation(s)
- Mary E Hawk
- Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Evaluation Institute, Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Correspondence: Mary E Hawk Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA15261, USATel +1-412-648-2342 Email
| | - Ashley Chung
- Jewish Healthcare Foundation, Pittsburgh, PA, USA
| | - Stephanie L Creasy
- Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Evaluation Institute, Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - James E Egan
- Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Evaluation Institute, Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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