1
|
Jamison KE, Braunstein SL, Pathela P. Racial inequities in HIV incidence among men who have sex with men prior to and amidst an Ending the HIV Epidemic initiative. AIDS 2024; 38:1047-1055. [PMID: 38265417 DOI: 10.1097/qad.0000000000003845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE The aim of this study was to examine trends in HIV incidence among men who have sex with men (MSM) relative to the scale up of Ending the HIV Epidemic (EHE) initiatives, including biomedical prevention strategies, and to describe racial inequities over time. DESIGN A cross-sectional study, matching annual cohorts of New York City (NYC) Sexual Health Clinic (SHC) patients from 2010 to 2018 to the citywide HIV registry to identify seroconversions during 1 year of follow-up, through 2019. METHODS We examined HIV incidence for each annual cohort of MSM using diagnoses within 1 year after last negative HIV test. We calculated incidence rates and rate ratios (IRR) pooled across 3-year intervals (2010-2012, 2013-2015, 2016-2018) by race/ethnicity, age, neighborhood poverty level, recent STI diagnosis, and condom use during anal sex. RESULTS There were 36 156 study visits among MSM attending NYC SHCs, including 37% among White MSM and 63% among MSM of color. From 2010 to 2018, HIV incidence decreased overall from 2.82 to 0.82/100 person-years, and among all race/ethnicity, age, poverty, STI, and condom use subgroups. For 2010-2012 vs. 2016-2018, adjusted IRRs (95% CI) increased for Black MSM [1.8 (1.3-2.6) vs. 6.0 (3.5-10.2)], Latino MSM [1.4 (1.0-2.0) vs. 4.0 (2.3-6.8)], and MSM of other races [1.0 (0.6-1.7) vs. 2.5 (1.3-4.9)] compared with White MSM. Black and Latino MSM seroconverted at significantly higher rates than White MSM in the same age groups and neighborhood poverty level. CONCLUSION Despite decreases in HIV incidence among MSM, racial inequities were exacerbated over time. Addressing structural factors that impact racial inequities in risk of HIV should undergird EHE initiatives.
Collapse
Affiliation(s)
- Kelly E Jamison
- New York City Department of Health & Mental Hygiene, Long Island City, New York, USA
| | | | | |
Collapse
|
2
|
Ransome Y, Kershaw T, Kawachi I, Nash D, Mayer KH. Racial disparity in ART adherence is closed in states with high social trust: Results from the Medical Monitoring Project (MMP), 2015. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:3659-3680. [PMID: 35460588 PMCID: PMC10485770 DOI: 10.1002/jcop.22862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/23/2022] [Accepted: 04/02/2022] [Indexed: 06/14/2023]
Abstract
Racial/ethnic disparities persist in antiretroviral therapy (ART) adherence and viral suppression. We examined associations between state-level social trust and individual-level ART adherence and viral suppression and assessed whether these relationships varied by race/ethnicity. The Medical Monitoring Project (MMP) annually reports nationally representative estimates of the behavioral and clinical characteristics of HIV-positive adults in primary care. A total of 3298 adults diagnosed with HIV between 2015 and 2016 from 16 US states were included. We used weighted logistic regression to model the association between state-level social trust, race/ethnicity (Non-Hispanic Black, White, and Hispanic/Latino), and cross-product interactions with ART adherence (a binary measure derived from three self-reported questions), and viral suppression (a binary measure corresponding to plasma HIV RNA < 200 copies/ml). Social trust was the percentage of people in each state who agreed that most people in their neighborhood could be trusted. A high level of social trust was associated with a higher likelihood of ART adherence (PR [prevalence ratio] = 1.17; 95% confidence interval [CI]: 1.05-1.30). In covariate-adjusted analyses, the association between state-level social trust and individual-level ART adherence significantly varied by race/ethnicity (Wald χ2 F = 9.8 [df = 4], p = 0.044). Social trust was positively associated with ART, but the effect was smaller for Blacks than for Whites (PR = 0.66; 95% CI: 0.57-0.82) in states with the lowest social trust. Black-White differences were closed and no longer significant above mean social trust (PP [predicted probability] = 0.50 vs. 0.53, at two standard deviations). Racial/ethnic disparities in ART adherence were closed among individuals living in states with high social trust. Understanding the mechanisms that promote social trust among neighbors may have downstream impacts on reducing disparities in ART adherence among people with HIV (PWH).
Collapse
Affiliation(s)
- Yusuf Ransome
- Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Trace Kershaw
- Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Ichiro Kawachi
- Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| |
Collapse
|
3
|
Brewer R, Ramani SL, Khanna A, Fujimoto K, Schneider JA, Hotton A, Wilton L, Escobedo T, Harawa NT. A Systematic Review up to 2018 of HIV and Associated Factors Among Criminal Justice-Involved (CJI) Black Sexual and Gender Minority Populations in the United States (US). J Racial Ethn Health Disparities 2022; 9:1357-1402. [PMID: 34296420 PMCID: PMC8297427 DOI: 10.1007/s40615-021-01076-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022]
Abstract
Black men who have sex with men (BMSM) and Black transgender women (BTW) are impacted by dual epidemics of HIV and incarceration. We advanced understanding of the relationship between criminal justice involvement, HIV, and other key HIV-related characteristics among these key populations in the US. We conducted a systematic review up to 2018 and 47 articles met the inclusion criteria of scientific publications involving quantitative findings of US-based HIV-related studies focused on criminal justice-involved (CJI) BMSM and BTW. Overall, there was a dearth of studies focused specifically on BTW. Criminal justice involvement was relatively high among BMSM and BTW and more pronounced among BTW. The current evidence favors no association between incarceration and HIV acquisition among BMSM with limited information about BTW. Criminal justice involvement was associated with a greater likelihood of STIs among BMSM with mixed results for sexual risk behaviors. Criminal justice settings served as an important venue for HIV testing/diagnosis for both BMSM and BTW. However, these settings were not conducive for subsequent stages of the HIV care continuum. Studies pointed to an independent association between criminal justice involvement, substance use, housing instability, and greater odds of incarceration among BMSM who were unemployed and had limited education. Future incarceration was associated with high levels of perceived racism among BMSM. Among young BMSM, high network criminal justice prevalence was also associated with sexual risk behaviors, poorer mental health outcomes, drug use, and housing instability. CJI BMSM and BTW represent a critical subpopulation to end the HIV epidemic in the US.
Collapse
Affiliation(s)
- Russell Brewer
- Department of Medicine, University of Chicago, 5837 S. Maryland Ave, MC5065, Chicago, IL, 60637, USA.
| | - Santhoshini L Ramani
- Department of Medicine, University of Chicago, 5837 S. Maryland Ave, MC5065, Chicago, IL, 60637, USA
| | - Aditya Khanna
- Department of Behavioral and Social Science, Brown University, Providence, RI, USA
| | - Kayo Fujimoto
- Division of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - John A Schneider
- Department of Medicine, University of Chicago, 5837 S. Maryland Ave, MC5065, Chicago, IL, 60637, USA
| | - Anna Hotton
- Department of Medicine, University of Chicago, 5837 S. Maryland Ave, MC5065, Chicago, IL, 60637, USA
| | - Leo Wilton
- State University of New York at Binghamton, Binghamton, NY, USA
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Tania Escobedo
- Department of Medicine, University of Chicago, 5837 S. Maryland Ave, MC5065, Chicago, IL, 60637, USA
| | - Nina T Harawa
- David Geffen School of Medicine, General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA, USA
- College of Medicine, Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| |
Collapse
|
4
|
Carter JW, Salabarría-Peña Y, Fields EL, Robinson WT. Evaluating for health equity among a cluster of health departments implementing PrEP services. EVALUATION AND PROGRAM PLANNING 2022; 90:101981. [PMID: 34392968 PMCID: PMC11194854 DOI: 10.1016/j.evalprogplan.2021.101981] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 06/30/2021] [Accepted: 07/25/2021] [Indexed: 06/13/2023]
Abstract
African American/Black and Hispanic/Latino sexual and gender minority populations are disproportionately affected by HIV in the United States and continue to experience HIV-related disparities. CDC funded project PrIDE to support 12 health departments (HD) with implementing pre-exposure prophylaxis (PrEP) strategies for men who have sex with men (MSM) and transgender persons, with a health-equity focus established by HDs. Each HD conducted mixed-methods evaluation of at least one local strategy. CDC employed a cluster evaluation approach to maximize cross validation. As a result, this cluster evaluation focused on three HDs that evaluated health equity-focused PrEP implementation strategies. Findings suggest that integrating health equity strategies such as storytelling and healthcare worker (HCW) trainings can help reduce HIV-related disparities. Storytelling improved HCW's understanding of clients' experiences of stigma due to racial, gender, and sexual identities. Provider training increased competencies on culturally appropriate care and the use of clinic services by Black and Hispanic MSM and transgender persons. Good practices included community engagement, seeking leadership buy-in, and integration of programmatic staff in health equity and evaluation activities. Evaluating strategies and training policies addressing social determinants of health that adversely affect HIV outcomes may help mitigate barriers Black and Hispanic MSM and transgender populations encounter in their HIV prevention seeking efforts.
Collapse
Affiliation(s)
- Jarvis W Carter
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329 USA.
| | - Yamir Salabarría-Peña
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329 USA
| | - Errol L Fields
- Johns Hopkins School of Medicine, Department of Pediatrics, Division of Adolescent/Young Adult Medicine, 200 N. Wolfe St., Baltimore, MD, 21287, USA
| | - William T Robinson
- Louisiana Department of Health, Office of Public Health, 1450 Poydras St., New Orleans, LA, 70112, USA; Louisiana State University Health Sciences Center, School of Public Health 2020 Gravier St, New Orleans, LA, 70112, USA
| |
Collapse
|
5
|
Prevalence and Correlates of SARS CoV-2 Among a Community-Based Sample Recruited Using Randomized Venue-Based Sampling. Essex County, NJ, 2020. J Racial Ethn Health Disparities 2022; 9:2387-2394. [PMID: 34748172 PMCID: PMC8574940 DOI: 10.1007/s40615-021-01175-5] [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: 06/24/2021] [Revised: 09/29/2021] [Accepted: 10/21/2021] [Indexed: 12/29/2022]
Abstract
Disparities in morbidity and mortality related to COVID-19 based on race and ethnicity have been documented in the USA. However, it is unclear if these disparities also exist at the exposure stage. To determine this, studies are needed to document the underlying burden of disease, potential disparities through serologic surveillance. Additionally, such studies can help identify where along the disease spectrum (e.g., exposure, infection, diagnosis, treatment, death) and with regard to the structural factors that necessitate public health and/or clinical interventions. Our objectives in this study were to estimate the true burden of SARS CoV-2 in the community of Essex County, NJ, an early and hard hit area, to determine the correlates of SARS CoV-2 prevalence and to determine if COVID-19 disparities seen by race/ethnicity were also reflected in SARS CoV-2 burden. We utilized venue-based-sampling (VBS) to sample members of the community in Essex County. Participants completed a short electronic survey and provided finger stick blood samples for testing. We sampled 924 residents of Essex County, New Jersey. Testing conducted in this study identified 83 (9.0%) participants as positive for SARS-CoV-2 antibodies. Importantly, our findings suggest that the true burden of SARS-Cov-2 and the pool of persons potentially spreading the virus are slightly more than six times than that suggested by PCR testing Notably, there were no significant differences in odds of testing positive for SARS CoV-2 antibodies in terms of race/ethnicity where we compared Black and Latinx participants to other race participants. Our study suggests that disparities in COVID-19 outcomes stem from potential upstream issues such as underlying conditions, access to testing, and access to care rather than disparities in exposure to the virus.
Collapse
|
6
|
Maloney KM, Le Guillou A, Driggers RA, Sarkar S, Anderson EJ, Malik AA, Jenness SM. Projected Impact of Concurrently Available Long-Acting Injectable and Daily-Oral Human Immunodeficiency Virus Preexposure Prophylaxis: A Mathematical Model. J Infect Dis 2021; 223:72-82. [PMID: 32882043 DOI: 10.1093/infdis/jiaa552] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/27/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Long-acting injectable (LAI) human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) is reportedly efficacious, although full trial results have not been published. We used a dynamic network model of HIV transmission among men who have sex with men to assess the population impact of LAI-PrEP when available concurrently with daily-oral (DO) PrEP. METHODS The reference model represents the current HIV epidemiology and DO-PrEP coverage (15% among those with behavioral indications for PrEP) among men who have sex with men in the southeastern United States. Primary analyses investigated varied PrEP uptake and proportion selecting LAI-PrEP. Secondary analyses evaluated uncertainty in pharmacokinetic efficacy and LAI-PrEP persistence relative to DO-PrEP. RESULTS Compared with the reference scenario, if 50% chose LAI-PrEP, 4.3% (95% simulation interval, -7.3% to 14.5%) of infections would be averted over 10 years. The impact of LAI-PrEP is slightly greater than that of the DO-PrEP-only regimen, based on assumptions of higher adherence and partial protection after discontinuation. If the total PrEP initiation rate doubled, 17.1% (95% simulation interval, 6.7%-26.4%) of infections would be averted. The highest population-level impact occurred when LAI-PrEP uptake and persistence improved. CONCLUSIONS If LAI-PrEP replaces DO-PrEP, its availability will modestly improve the population impact. LAI-PrEP will make a more substantial impact if its availability drives higher total PrEP coverage, or if persistence is greater for LAI-PrEP.
Collapse
Affiliation(s)
- Kevin M Maloney
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Adrien Le Guillou
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA.,Department of Research and Public Health, Reims Teaching Hospitals, Robert Debré Hospital, Reims, France
| | | | - Supriya Sarkar
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA.,ViiV Healthcare, Research Triangle, North Carolina, USA
| | - Emeli J Anderson
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Amyn A Malik
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA.,Yale Institute for Global Health, New Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Samuel M Jenness
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
7
|
Characteristics of Sexual Partnerships Among Men With Diagnosed HIV Who Have Sex With Men, United States and Puerto Rico-2015-2019. J Acquir Immune Defic Syndr 2021; 84:443-452. [PMID: 32692102 DOI: 10.1097/qai.0000000000002388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Understanding sexual partnerships of HIV-positive persons, particularly at the dyad level, can help in quantifying HIV transmission risk. We described sexual partnerships among HIV-positive men who have sex with men (MSM), including partnerships with a high risk for sexual HIV transmission. SETTING The Medical Monitoring Project is an annual, cross-sectional study that reports representative estimates on U.S. HIV-positive adults. METHODS During 2015-2019, we assessed sexual behaviors by interview, and viral load results from medical records. Among sexually active HIV-positive MSM (n = 4923), we described prevalence of high-risk sex, defined as: (1) not having sustained viral suppression, and (2) having condomless sex with an HIV-negative partner not known to be taking pre-exposure prophylaxis or an HIV-unknown partner. We described sexual partnerships among HIV-positive MSM (n = 13,024 partnerships among 4923 MSM). For HIV-discordant partnerships (n = 7768), we reported the proportion involved in high-risk sex, and associations with high-risk sex using prevalence ratios with predicted marginal means, controlling for age of the HIV-positive partner (P < 0.05). RESULTS More than half (66%) of sexually active HIV-positive MSM had condomless sex; 11% had high-risk sex. Blacks were more likely to have detectable viral loads, but less likely to have condomless sex, making prevalence of high-risk sex comparable between racial/ethnic groups. Dyad-level analyses among HIV-discordant partnerships indicated that prevalence of high-risk sex was higher among partnerships with HIV-positive white MSM, which was not observed using person-level data alone. CONCLUSIONS In the context of ending the HIV epidemic, behavioral and clinical surveillance data can help monitor HIV transmission risk and target prevention efforts to reduce transmission among populations at disproportionate risk.
Collapse
|
8
|
Tieu HV, Koblin BA, Latkin C, Curriero FC, Greene ER, Rundle A, Frye V. Neighborhood and Network Characteristics and the HIV Care Continuum among Gay, Bisexual, and Other Men Who Have Sex with Men. J Urban Health 2020; 97:592-608. [PMID: 29845586 PMCID: PMC7560681 DOI: 10.1007/s11524-018-0266-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
In order for treatment as prevention to work as a national strategy to contain the HIV/AIDS epidemic in the United States (US), the HIV care continuum must become more robust, retaining more individuals at each step. The majority of people living with HIV/AIDS (PLWHA) in the US are gay, bisexual, and other men who have sex with men (MSM). Within this population, there are distinct race- and ethnicity-based disparities in rates of HIV infection, engagement, and retention in HIV care, and viral suppression. Compared with White MSM, HIV-infected Black MSM are less likely to be on anti-retroviral therapy (ART), adhere to ART, and achieve viral suppression. Among MSM living in urban areas, falling off the continuum may be influenced by factors beyond the individual level, with new research identifying key roles for network- and neighborhood-level characteristics. To inform multi-level and multi-component interventions, particularly to support Black MSM living in urban areas, a clearer understanding of the pathways of influence among factors at various levels of the social ecology is required. Here, we review and apply the empirical literature and relevant theoretical perspectives to develop a series of potential pathways of influence that may be further evaluated. Results of research based on these pathways may provide insights into the design of interventions, urban planning efforts, and assessments of program implementation, resulting in increased retention in care, ART adherence, and viral suppression among urban-dwelling, HIV-infected MSM.
Collapse
Affiliation(s)
- Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Beryl A Koblin
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frank C Curriero
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily R Greene
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Andrew Rundle
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Victoria Frye
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, USA.
| |
Collapse
|
9
|
Jeffries WL, Dailey AF, Jin C, Carter JW, Scales L. Trends in Diagnosis of HIV Infection, Linkage to Medical Care, and Viral Suppression Among Men Who Have Sex with Men, by Race/Ethnicity and Age - 33 Jurisdictions, United States, 2014-2018. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:1337-1342. [PMID: 32970045 PMCID: PMC7727492 DOI: 10.15585/mmwr.mm6938a1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
During 2018, gay, bisexual, and other men who have sex with men (MSM) accounted for 69.4% of all diagnoses of human immunodeficiency virus (HIV) infection in the United States (1). Moreover, in all 42 jurisdictions with complete laboratory reporting of CD4 and viral load results,* percentages of MSM linked to care within 1 month (80.8%) and virally suppressed (viral load <200 copies of HIV RNA/mL or interpreted as undetected) within 6 months (68.3%) of diagnosis were below target during 2018 (2). African American/Black (Black), Hispanic/Latino (Hispanic), and younger MSM disproportionately experience HIV diagnosis, not being linked to care, and not being virally suppressed. To characterize trends in these outcomes, CDC analyzed National HIV Surveillance System† data from 2014 to 2018. The number of diagnoses of HIV infection among all MSM decreased 2.3% per year (95% confidence interval [CI] = 1.9-2.8). However, diagnoses did not significantly change among either Hispanic MSM or any MSM aged 13-19 years; increased 2.2% (95% CI = 1.0-3.4) and 2.0% (95% CI = 0.6-3.3) per year among Black and Hispanic MSM aged 25-34 years, respectively; and were highest in absolute count among Black MSM. Annual percentages of linkage to care within 1 month and viral suppression within 6 months of diagnosis among all MSM increased (2.9% [95% CI = 2.4-3.5] and 6.8% [95% CI = 6.2-7.4] per year, respectively). These findings, albeit promising, warrant intensified prevention efforts for Black, Hispanic, and younger MSM.
Collapse
|
10
|
Azmach NN, Hamza TA, Husen AA. Socioeconomic and Demographic Statuses as Determinants of Adherence to Antiretroviral Treatment in HIV Infected Patients: A Systematic Review of the Literature. Curr HIV Res 2020; 17:161-172. [PMID: 31538899 DOI: 10.2174/1570162x17666190919130229] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/24/2019] [Accepted: 09/04/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Socioeconomic and demographic statuses are associated with adherence to the treatment of patients with several chronic diseases. However, there is a controversy regarding their impact on adherence among HIV/AIDS patients. Thus, we performed a systematic review of the evidence regarding the association of socioeconomic and demographic statuses with adherence to antiretroviral therapy (ART) among HIV/AIDS patients. METHODS The PubMed database was used to search and identify studies concerning about socioeconomic and demographic statuses and HIV/AIDS patients. Data were collected on the association between adherence to ART and varies determinants factors of socioeconomic (income, education, and employment/occupation) and socio-demographic (sex and age). FINDINGS From 393 potentially-relevant articles initially identified, 35 original studies were reviewed in detail, which contained data that were helpful in evaluating the association between socioeconomic/ demographic statuses and adherence to ART among HIV patients. Two original research study has specifically focused on the possible association between socioeconomic status and adherence to ART. Income, level of education, and employment/occupational status were significantly and positively associated with the level of adherence in 7 studies (36.8%), 7 studies (28.0%), and 4 studies (23.5%) respectively out of 19, 25, and 17 studies reviewed. Sex (being male), and age (per year increasing) were significantly and positively associated with the level of adherence in 5 studies (14.3%), and 9 studies (25.7%) respectively out of 35 studies reviewed. However, the determinant of socioeconomic and demographic statuses was not found to be significantly associated with adherence in studies related to income 9(47.4%), education 17(68.0%), employment/ occupational 10(58.8%), sex 27(77.1%), and age 25(71.4%). CONCLUSION The majority of the reviewed studies reported that there is no association between socio- demographic and economic variables and adherence to therapy. Whereas, some studies show that age of HIV patients (per year increasing) and sex (being male) were positively associated with adherence to ART. Among socio-economic factors, the available evidence does not provide conclusive support for the existence of a clear association with adherence to ART among HIV patients. There seems to be a positive trend between socioeconomic factors and adherence to ART in some of the reviewed studies.
Collapse
Affiliation(s)
- Nuredin Nassir Azmach
- Department of Statistics, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Temam Abrar Hamza
- Department of Biotechnology, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Awel Abdella Husen
- Department of Physics, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
| |
Collapse
|
11
|
Weiss KM, Goodreau SM, Morris M, Prasad P, Ramaraju R, Sanchez T, Jenness SM. Egocentric sexual networks of men who have sex with men in the United States: Results from the ARTnet study. Epidemics 2020; 30:100386. [PMID: 32004795 PMCID: PMC7089812 DOI: 10.1016/j.epidem.2020.100386] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 01/13/2023] Open
Abstract
In this paper, we present an overview and descriptive results from one of the first egocentric network studies of men who have sex with men (MSM) from across the United States: the ARTnet study. ARTnet was designed to support prevention research for human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) that are transmitted across partnership networks. ARTnet implemented a population-based egocentric network study design that sampled egos from the target population and asked them to report on the number, attributes, and timing of their sexual partnerships. Such data provide the foundation needed for parameterizing stochastic network models that are used for disease projection and intervention planning. ARTnet collected data online from 2017 to 2019, with a final sample of 4904 participants who reported on 16198 sexual partnerships. The aims of this paper were to characterize the joint distribution of three network parameters needed for modeling: degree distributions, assortative mixing, and partnership age, with heterogeneity by partnership type (main, casual and one-time), demography, and geography. Participants had an average of 1.19 currently active partnerships ("mean degree"), which was higher for casual partnerships (0.74) than main partnerships (0.45). The mean rate of one-time partnership acquisition was 0.16 per week (8.5 partners per year). Main partnerships lasted 272.5 weeks on average, while casual partnerships lasted 133.0 weeks. There was strong but heterogenous assortative mixing by race/ethnicity for all groups. The mean absolute age difference for all partnership types was 9.5 years, with main partners differing by 6.3 years compared to 10.8 years for casual partners. Our analysis suggests that MSM may be at sustained risk for HIV/STI acquisition and transmission through high network degree of sexual partnerships. The ARTnet network study provides a robust and reproducible foundation for understanding the dynamics of HIV/STI epidemiology among U.S. MSM and supporting the implementation science that seeks to address persistent challenges in HIV/STI prevention.
Collapse
Affiliation(s)
- Kevin M Weiss
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States
| | - Steven M Goodreau
- Department of Anthropology, University of Washington, Seattle, Washington, United States
| | - Martina Morris
- Departments of Statistics and Sociology, University of Washington, Seattle, Washington, United States
| | - Pragati Prasad
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States
| | - Ramya Ramaraju
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States
| | - Travis Sanchez
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States
| | - Samuel M Jenness
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States.
| |
Collapse
|
12
|
Abstract
Black men who have sex with men (MSM) in the South have the highest rates of HIV diagnosis in the country adding to the persistent racial disparities in HIV experienced by this population. The current HIV prevention and care landscape is heavily driven by individual-level clinical and biomedical approaches that have shown progress in reducing HIV diagnoses, but yield less than adequate results in reducing the HIV racial disparities for Black MSM in the South. In efforts to enhance focus on reducing the racial HIV disparities and more completely address the needs of Black MSM in the South, we offer insight on comprehensive approaches that can complement our current HIV prevention and care portfolio. There are five domains we discuss which include: (1) leveraging and integrating resources; (2) building upon existing program models designed to reduce disparities; (3) workforce development and cultural sensitivity; (4) social determinants of health data utilization; and 5) policy considerations. We urge public health practitioners and healthcare providers to consider and incorporate the outlined approaches to improve HIV outcomes along the continuum of care and ultimately reduce disparities in HIV affecting the quality of life of Black MSM living in the South.
Collapse
Affiliation(s)
- Jarvis W Carter
- Division of HIV/AIDS Prevention, Centers for Disease Control & Prevention, 1600 Clifton Rd, NE Mailstop US8-5, Atlanta, GA, 30329, USA.
| | - Stephen A Flores
- Division of HIV/AIDS Prevention, Centers for Disease Control & Prevention, 1600 Clifton Rd, NE Mailstop US8-5, Atlanta, GA, 30329, USA
| |
Collapse
|
13
|
New Human Immunodeficiency Virus Diagnoses Among Men Who Have Sex With Men Attending Sexually Transmitted Disease Clinics, STD Surveillance Network, January 2010 to June 2013. Sex Transm Dis 2019; 45:577-582. [PMID: 29465646 DOI: 10.1097/olq.0000000000000802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To estimate new human immunodeficiency virus (HIV) diagnosis rates among HIV negative men who have sex with men (MSM) who are repeatedly tested for HIV in sexually transmitted disease (STD) clinics and assess the impact of demographic and disease-specific characteristics that are associated with higher HIV diagnosis rates. STUDY DESIGN Retrospective analysis using 2010 to 2013 data from the STD Surveillance Network (SSuN), a sentinel surveillance system comprised of health departments in 12 cities conducting sentinel surveillance in 40 STD clinics. We analyzed data from all MSM repeatedly (≥2 times) tested for HIV, with an initial negative HIV test required for staggered cohort entry. Follow-up time was accrued from the date of the first negative HIV test to the most recent negative test or the first positive HIV test. The STD diagnoses during the follow-up period were reviewed. We estimated HIV diagnoses rates (number of HIV diagnoses/total number of person-years [PY] at risk) by demographic and clinical characteristics with 95% confidence intervals (CI) using an inverse variance weighted random effects model, adjusting for heterogeneity between SSuN jurisdictions. RESULTS Overall, 640 HIV diagnoses occurred among 14,824 individuals and 20,951.6 PY of observation, for an adjusted incidence of HIV diagnosis of 3.0 per 100 PY (95% CI, 2.6-3.4). Rates varied across race/ethnicity groups with the highest rate among Blacks (4.7/100 PY; 95% CI, 4.1-5.3) followed by Hispanics, whites, and persons of other races/ethnicities. Men who have sex with men having a diagnosis of primary or secondary (P&S) syphilis on or after the first negative HIV test had a higher new HIV diagnosis rate (7.2/100 PY; 95% CI, 5.8-9.0) compared with MSM who did not have a P&S syphilis diagnosis (2.8/100 PY; 95% CI, 2.6-3.1). Men who have sex with men who tested positive for rectal gonorrhea (6.3/100 PY; 95% CI, 5.7-6.9) or rectal chlamydia (5.6/100 PY; 95% CI, 4.6-6.6) had higher rates of new HIV diagnosis when compared to those with negative test results. CONCLUSIONS Men who have sex with men attending SSuN STD clinics have high rates of new HIV diagnoses, particularly those with a previous diagnosis of P&S syphilis, rectal chlamydia, and/or gonorrhea. Sexually transmitted disease clinics continue to be important clinical setting for diagnosing HIV among MSM populations.
Collapse
|
14
|
Nelson EJ, Luetke MC, Kianersi S, Willis E, Rosenberg M. Knowledge and perceptions of Zika virus transmission in the community of Puerto Plata, Dominican Republic. BMC Infect Dis 2019; 19:339. [PMID: 31014275 PMCID: PMC6480501 DOI: 10.1186/s12879-019-3952-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background Zika virus is associated with increased cases of both microcephaly and Guillain-Barré syndrome. Community knowledge, perceptions and practices to prevent infection with the Zika virus are not well understood, particularly among high risk populations living in resource-poor and Zika-endemic areas. Our objective was to assess knowledge of symptoms, health effects and prevention practices associated with Zika virus in rural communities on the northern coast of the Dominican Republic. Methods Study participants were contacted while attending community events such as free medical clinics and invited to be interviewed regarding their knowledge, attitudes, and perceptions of Zika virus using the World Health Organization’s Zika survey tool. Results Of the 75 Dominicans that participated, 33% did not know who could become infected with Zika. In addition, only 40% of respondents were able to identify mosquitoes or sexual transmission as the primary routes of infection though 51% of respondents thought that Zika was an important issue in their community. Conclusions This study found that general knowledge regarding the basic risks and transmission of Zika were not well understood among a sample of rural Dominicans. Our findings highlight disparities in knowledge and perception of risk from Zika in rural areas compared to previous studies conducted in the Dominican Republic. Education about the basic risks and transmission of Zika are critically needed in these remote populations to reduce Zika transmission.
Collapse
Affiliation(s)
- Erik J Nelson
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health - Bloomington, 1025 E. 7th Street, Room C03, Bloomington, IN, 47405, USA.
| | - Maya C Luetke
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health - Bloomington, 1025 E. 7th Street, Room C03, Bloomington, IN, 47405, USA
| | - Sina Kianersi
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health - Bloomington, 1025 E. 7th Street, Room C03, Bloomington, IN, 47405, USA
| | - Erik Willis
- Department of Spanish and Portuguese, Indiana University -Bloomington, Bloomington, Indiana, USA
| | - Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health - Bloomington, 1025 E. 7th Street, Room C03, Bloomington, IN, 47405, USA
| |
Collapse
|
15
|
Jenness SM, Maloney KM, Smith DK, Hoover KW, Goodreau SM, Rosenberg ES, Weiss KM, Liu AY, Rao DW, Sullivan PS. Addressing Gaps in HIV Preexposure Prophylaxis Care to Reduce Racial Disparities in HIV Incidence in the United States. Am J Epidemiol 2019; 188:743-752. [PMID: 30312365 DOI: 10.1093/aje/kwy230] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 09/18/2018] [Accepted: 10/02/2018] [Indexed: 12/15/2022] Open
Abstract
The potential for human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) to reduce the racial disparities in HIV incidence in the United States might be limited by racial gaps in PrEP care. We used a network-based mathematical model of HIV transmission for younger black and white men who have sex with men (BMSM and WMSM) in the Atlanta, Georgia, area to evaluate how race-stratified transitions through the PrEP care continuum from initiation to adherence and retention could affect HIV incidence overall and disparities in incidence between races, using current empirical estimates of BMSM continuum parameters. Relative to a no-PrEP scenario, implementing PrEP according to observed BMSM parameters was projected to yield a 23% decline in HIV incidence (hazard ratio = 0.77) among BMSM at year 10. The racial disparity in incidence in this observed scenario was 4.95 per 100 person-years at risk (PYAR), a 19% decline from the 6.08 per 100 PYAR disparity in the no-PrEP scenario. If BMSM parameters were increased to WMSM values, incidence would decline by 47% (hazard ratio = 0.53), with an associated disparity of 3.30 per 100 PYAR (a 46% decline in the disparity). PrEP could simultaneously lower HIV incidence overall and reduce racial disparities despite current gaps in PrEP care. Interventions addressing these gaps will be needed to substantially decrease disparities.
Collapse
Affiliation(s)
- Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kevin M Maloney
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Dawn K Smith
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karen W Hoover
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Steven M Goodreau
- Department of Anthropology, University of Washington, Seattle, Washington
| | - Eli S Rosenberg
- Department of Epidemiology and Biostatistics, School of Public Health, University of Albany, Albany, New York
| | - Kevin M Weiss
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Albert Y Liu
- Bridge HIV, Population Health Division, San Francisco Department of Public Health, San Francisco, California
| | - Darcy W Rao
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| |
Collapse
|
16
|
Wiewel EW, Borrell LN, Jones HE, Maroko AR, Torian LV. Healthcare facility characteristics associated with achievement and maintenance of HIV viral suppression among persons newly diagnosed with HIV in New York City. AIDS Care 2019; 31:1484-1493. [PMID: 30909714 DOI: 10.1080/09540121.2019.1595517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Health care facility characteristics have been shown to influence intermediary health outcomes among persons with HIV, but few longitudinal studies of suppression have included these characteristics. We studied the association of these characteristics with the achievement and maintenance of HIV viral suppression among New York City (NYC) residents aged 13 years and older newly diagnosed with HIV between 2006 and 2012. The NYC HIV surveillance registry provided individual and facility data (N = 12,547 persons). Multivariable proportional hazards models estimated the likelihood of individual achievement and maintenance of suppression by type of facility, patient volume, and distance from residence, accounting for facility clustering and for individual-level confounders. Viral suppression was achieved within 12 months by 44% and at a later point by another 29%. Viral suppression occurred at a lower rate in facilities with low HIV patient volume (e.g., 10-24 diagnoses per year vs. ≥75, adjusted hazard ratio [AHR] = 0.87, 95% confidence interval [CI] 0.79-0.95) and in screening/diagnosis sites (vs. hospitals, AHR = 0.86, 95% CI 0.80-0.92). Among persons achieving viral suppression, 18% experienced virologic failure within 12 months and 24% later. Those receiving care at large outpatient facilities or large private practices had a lower rate of virologic failure (e.g., large outpatient facilities vs. large hospitals, AHR = 0.63, 95% CI 0.53-0.75). Achievement and maintenance of viral suppression were associated with facilities with higher HIV-positive caseloads. Some facilities with small caseloads and screening/diagnosis sites may need stronger care or referral systems to help persons with HIV achieve and maintain viral suppression.
Collapse
Affiliation(s)
- Ellen W Wiewel
- Division of Disease Control, New York City Department of Health and Mental Hygiene , Long Island City , NY , USA
| | - Luisa N Borrell
- Epidemiology and Biostatistics, City University of New York (CUNY) Graduate School of Public Health and Health Policy , New York , NY , USA
| | - Heidi E Jones
- Epidemiology and Biostatistics, City University of New York (CUNY) Graduate School of Public Health and Health Policy , New York , NY , USA
| | - Andrew R Maroko
- Environmental, Occupational, and Geospatial Health Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy , New York , NY , USA
| | - Lucia V Torian
- Division of Disease Control, New York City Department of Health and Mental Hygiene , Long Island City , NY , USA
| |
Collapse
|
17
|
Ridgway J, Almirol E, Schmitt J, Bender A, Anderson G, Leroux I, McNulty M, Schneider J. Exploring Gender Differences in PrEP Interest Among Individuals Testing HIV Negative in an Urban Emergency Department. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:382-392. [PMID: 30332310 PMCID: PMC6517836 DOI: 10.1521/aeap.2018.30.5.382] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PrEP is greater than 90% effective at preventing HIV infection, but many people who are vulnerable to HIV choose not to take PrEP. Among women, men who have sex with women (MSW) and men who have sex with men (MSM) who tested HIV negative in our emergency department, we assessed behavioral risk factors, self-perception of HIV risk, and interest in PrEP linkage. Women had lower odds of perceiving any HIV risk versus no risk than MSM, while Whites had greater odds of perceiving themselves as high risk than Blacks. Age and self-perception of risk were not associated with PrEP interest, but patients who were objectively classified as "at risk" had greater odds of interest in PrEP than those not at risk (p < .01). Discordance between HIV risk self-perception and objective risk demonstrates the limitation of relying on patient self-referral for PrEP based on their own subjective risk perception.
Collapse
Affiliation(s)
- Jessica Ridgway
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Ellen Almirol
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Jessica Schmitt
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Alvie Bender
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Grace Anderson
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Ivan Leroux
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Moira McNulty
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - John Schneider
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| |
Collapse
|
18
|
Mauck DE, Sheehan DM, Fennie KP, Maddox LM, Trepka MJ. Role of Gay Neighborhood Status and Other Neighborhood Factors in Racial/Ethnic Disparities in Retention in Care and Viral Load Suppression Among Men Who Have Sex with Men, Florida, 2015. AIDS Behav 2018; 22:2978-2993. [PMID: 29372456 PMCID: PMC6060015 DOI: 10.1007/s10461-018-2032-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study's objective was to examine the role of gay neighborhood residence and other neighborhood factors in racial/ethnic disparities in retention in HIV care and viral load suppression during 2015. Florida residents diagnosed 2000-2014 with HIV infection and with transmission mode of men who have sex with men (MSM) were included in multi-level logistic regression models. Of 29,156 MSM, 29.4% were not retained and 34.2% were not virally suppressed. Non-Hispanic Blacks (NHB) had a higher likelihood of not being retained (adjusted prevalence ratio [aPR] 1.31, 95% confidence interval [CI] 1.24-1.38, p value < 0.0001) and not being virally suppressed (aPR 1.82, 95% CI 1.67-1.98, p value < 0.0001) compared with non-Hispanic Whites. Among NHBs, rural residence was protective for both outcomes. Although gay neighborhood residence was not associated with either outcome, the role of other neighborhood factors suggests that individual and neighborhood barriers to HIV care and treatment should be addressed among MSM.
Collapse
Affiliation(s)
- Daniel E Mauck
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
- Center for Research on US Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, FL, USA
| | - Kristopher P Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Lorene M Maddox
- HIV/AIDS Section, Florida Department of Health, Tallahassee, FL, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.
- Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Room 487, Miami, FL, 33199, USA.
| |
Collapse
|
19
|
Jeffries WL, Greene KM, Paz-Bailey G, McCree DH, Scales L, Dunville R, Whitmore S. Determinants of HIV Incidence Disparities Among Young and Older Men Who Have Sex with Men in the United States. AIDS Behav 2018; 22:2199-2213. [PMID: 29633094 DOI: 10.1007/s10461-018-2088-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This study sought to determine why young men who have sex with men (MSM) have higher HIV incidence rates than older MSM in the United States. We developed hypotheses that may explain this disparity. Data came from peer-reviewed studies published during 1996-2016. We compared young and older MSM with respect to behavioral, clinical, psychosocial, and structural factors that promote HIV vulnerability. Compared with older MSM, young MSM were more likely to have HIV-discordant condomless receptive intercourse. Young MSM also were more likely to have "any" sexually transmitted infection and gonorrhea. Among HIV-positive MSM, young MSM were less likely to be virally suppressed, use antiretroviral therapy, and be aware of their infection. Moreover, young MSM were more likely than older MSM to experience depression, polysubstance use, low income, decreased health care access, and early ages of sexual expression. These factors likely converge to exacerbate age-associated HIV incidence disparities among MSM.
Collapse
Affiliation(s)
- William L Jeffries
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA.
- Centers for Disease Control and Prevention, 1600 Clifton Road, MS E40, Atlanta, GA, 30333, USA.
| | - Kevin M Greene
- Office of Health Equity, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - Donna Hubbard McCree
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - Lamont Scales
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - Richard Dunville
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - Suzanne Whitmore
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| |
Collapse
|
20
|
Luo W, Katz DA, Hamilton DT, McKenney J, Jenness SM, Goodreau SM, Stekler JD, Rosenberg ES, Sullivan PS, Cassels S. Development of an Agent-Based Model to Investigate the Impact of HIV Self-Testing Programs on Men Who Have Sex With Men in Atlanta and Seattle. JMIR Public Health Surveill 2018; 4:e58. [PMID: 29959112 PMCID: PMC6045793 DOI: 10.2196/publichealth.9357] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 04/05/2018] [Accepted: 04/24/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the United States HIV epidemic, men who have sex with men (MSM) remain the most profoundly affected group. Prevention science is increasingly being organized around HIV testing as a launch point into an HIV prevention continuum for MSM who are not living with HIV and into an HIV care continuum for MSM who are living with HIV. An increasing HIV testing frequency among MSM might decrease future HIV infections by linking men who are living with HIV to antiretroviral care, resulting in viral suppression. Distributing HIV self-test (HIVST) kits is a strategy aimed at increasing HIV testing. Our previous modeling work suggests that the impact of HIV self-tests on transmission dynamics will depend not only on the frequency of tests and testers' behaviors but also on the epidemiological and testing characteristics of the population. OBJECTIVE The objective of our study was to develop an agent-based model to inform public health strategies for promoting safe and effective HIV self-tests to decrease the HIV incidence among MSM in Atlanta, GA, and Seattle, WA, cities representing profoundly different epidemiological settings. METHODS We adapted and extended a network- and agent-based stochastic simulation model of HIV transmission dynamics that was developed and parameterized to investigate racial disparities in HIV prevalence among MSM in Atlanta. The extension comprised several activities: adding a new set of model parameters for Seattle MSM; adding new parameters for tester types (ie, regular, risk-based, opportunistic-only, or never testers); adding parameters for simplified pre-exposure prophylaxis uptake following negative results for HIV tests; and developing a conceptual framework for the ways in which the provision of HIV self-tests might change testing behaviors. We derived city-specific parameters from previous cohort and cross-sectional studies on MSM in Atlanta and Seattle. Each simulated population comprised 10,000 MSM and targeted HIV prevalences are equivalent to 28% and 11% in Atlanta and Seattle, respectively. RESULTS Previous studies provided sufficient data to estimate the model parameters representing nuanced HIV testing patterns and HIV self-test distribution. We calibrated the models to simulate the epidemics representing Atlanta and Seattle, including matching the expected stable HIV prevalence. The revised model facilitated the estimation of changes in 10-year HIV incidence based on counterfactual scenarios of HIV self-test distribution strategies and their impact on testing behaviors. CONCLUSIONS We demonstrated that the extension of an existing agent-based HIV transmission model was sufficient to simulate the HIV epidemics among MSM in Atlanta and Seattle, to accommodate a more nuanced depiction of HIV testing behaviors than previous models, and to serve as a platform to investigate how HIV self-tests might impact testing and HIV transmission patterns among MSM in Atlanta and Seattle. In our future studies, we will use the model to test how different HIV self-test distribution strategies might affect HIV incidence among MSM.
Collapse
Affiliation(s)
- Wei Luo
- Spatial Analysis Research Center, School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ, United States
| | - David A Katz
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Deven T Hamilton
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, United States
| | - Jennie McKenney
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Steven M Goodreau
- Center for Studies in Demography and Ecology, Department of Anthropology, University of Washington, Seattle, WA, United States
| | - Joanne D Stekler
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Eli S Rosenberg
- School of Public Health, Epidemiology and Biostatistics, Rensselaer, Albany, NY, United States
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Susan Cassels
- Department of Geography, University of California Santa Barbara, Santa Barbara, CA, United States
| |
Collapse
|
21
|
Friedman EE, Dean HD, Duffus WA. Incorporation of Social Determinants of Health in the Peer-Reviewed Literature: A Systematic Review of Articles Authored by the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Public Health Rep 2018; 133:392-412. [PMID: 29874147 DOI: 10.1177/0033354918774788] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Social determinants of health (SDHs) are the complex, structural, and societal factors that are responsible for most health inequities. Since 2003, the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) has researched how SDHs place communities at risk for communicable diseases and poor adolescent health. We described the frequency and types of SDHs discussed in articles authored by NCHHSTP. METHODS We used the MEDLINE/PubMed search engine to systematically review the frequency and type of SDHs that appeared in peer-reviewed publications available in PubMed from January 1, 2009, through December 31, 2014, with a NCHHSTP affiliation. We chose search terms to identify articles with a focus on the following SDH categories: income and employment, housing and homelessness, education and schooling, stigma or discrimination, social or community context, health and health care, and neighborhood or built environment. We classified articles based on the depth of topic coverage as "substantial" (ie, one of ≤3 foci of the article) or "minimal" (ie, one of ≥4 foci of the article). RESULTS Of 862 articles authored by NCHHSTP, 366 (42%) addressed the SDH factors of interest. Some articles addressed >1 SDH factor (366 articles appeared 568 times across the 7 categories examined), and we examined them for each category that they addressed. Most articles that addressed SDHs (449/568 articles; 79%) had a minimal SDH focus. SDH categories that were most represented in the literature were health and health care (190/568 articles; 33%) and education and schooling (118/568 articles; 21%). CONCLUSIONS This assessment serves as a baseline measurement of inclusion of SDH topics from NCHHSTP authors in the literature and creates a methodology that can be used in future assessments of this topic.
Collapse
Affiliation(s)
- Eleanor E Friedman
- 1 Association of Schools and Programs of Public Health/CDC Public Health Fellowship Program, Atlanta, GA, USA.,2 Office of Health Equity, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.,3 Chicago Center for HIV Elimination and University of Chicago Department of Medicine, Chicago, IL, USA
| | - Hazel D Dean
- 4 Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wayne A Duffus
- 2 Office of Health Equity, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
22
|
Franks J, Mannheimer SB, Hirsch‐Moverman Y, Hayes‐Larson E, Colson PW, Ortega H, El‐Sadr WM. Multiple strategies to identify HIV-positive black men who have sex with men and transgender women in New York City: a cross-sectional analysis of recruitment results. J Int AIDS Soc 2018; 21:e25091. [PMID: 29537178 PMCID: PMC5850046 DOI: 10.1002/jia2.25091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 02/09/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Black men who have sex with men and transgender women are at high risk for HIV infection, but are more likely to be unaware of their infection or not in care for diagnosed HIV compared to other races. Respondent driven sampling has been advanced as a method to reach stigmatized and hidden populations for HIV testing. We compared strategies to recruit black, substance-using men who have sex with men and transgender women to identify newly diagnosed HIV infection, or those previously diagnosed but not in care. METHODS The STAR (Seek, Test, and Retain) study (ClinicalTrials.gov NCT01790360) used several recruitment strategies to identify black, substance-using men who have sex with men and transgender women with undiagnosed HIV infection or with previously diagnosed HIV infection but who were not in HIV care. Respondent-driven sampling, community-based recruitment and online advertising were used to recruit participants. Incentivized peer referral was integrated into all recruitment strategies. Participants completed interviewer-administered questionnaires and HIV testing. Demographic and HIV risk-related characteristics and recruitment strategy were summarized and stratified by HIV status. Associations were tested using Pearson's chi-squared, Fisher's exact, and Wilcoxon rank sum tests. Factors associated with HIV-positive diagnosis at p < 0.1 were included in a multivariable logistic regression model. RESULTS From July 2012 through October 2015, the study enrolled 1929 participants; 96.3% men who have sex with men and 3.7% transgender women. Behavioural risk factors included recent condomless anal sex (55.6%) and recent substance use during sex (73.1%). HIV prevalence was 8.7%. In multivariable analysis, significant associations with HIV infection included being transgender; non-Hispanic black; gay/homosexual orientation; not homeless; and less likely to have insufficient income for necessities. Among recruitment strategies, respondent driven sampling was least effective in identifying HIV-positive participants. CONCLUSIONS Integrating multiple recruitment strategies yielded a large sample of black men who have sex with men and transgender women at substantial risk for HIV. Respondent-driven sampling was less effective than other strategies at identifying men who have sex with men and transgender women with HIV.
Collapse
Affiliation(s)
- Julie Franks
- Harlem Prevention CenterICAP at Columbia UniversityNew YorkNYUSA
| | - Sharon B Mannheimer
- Harlem Prevention CenterICAP at Columbia UniversityNew YorkNYUSA
- Harlem Hospital CenterNew YorkNYUSA
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkNYUSA
| | - Yael Hirsch‐Moverman
- Harlem Prevention CenterICAP at Columbia UniversityNew YorkNYUSA
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkNYUSA
| | - Eleanor Hayes‐Larson
- Harlem Prevention CenterICAP at Columbia UniversityNew YorkNYUSA
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkNYUSA
| | - Paul W Colson
- Harlem Prevention CenterICAP at Columbia UniversityNew YorkNYUSA
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkNYUSA
| | - Hugo Ortega
- Harlem Prevention CenterICAP at Columbia UniversityNew YorkNYUSA
| | - Wafaa M El‐Sadr
- Harlem Prevention CenterICAP at Columbia UniversityNew YorkNYUSA
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkNYUSA
| |
Collapse
|
23
|
Tan JY, Pollack L, Rebchook G, Peterson J, Huebner D, Eke A, Johnson W, Kegeles S. The Role of the Primary Romantic Relationship in HIV Care Engagement Outcomes Among Young HIV-Positive Black Men Who Have Sex with Men. AIDS Behav 2018; 22:774-790. [PMID: 27844296 PMCID: PMC5839634 DOI: 10.1007/s10461-016-1601-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The primary romantic relationship plays a fundamental role in health maintenance, but little is known about its role in HIV care engagement among young Black men who have sex with men (MSM) living with HIV. We examined how HIV care engagement outcomes (i.e., having a primary healthcare provider, receiving HIV treatment, taking antiretroviral medication, and medication adherence) vary by partnership status (single vs. concordant-positive vs. discordant) in a sample of young Black MSM living with HIV. Results showed mixed findings. Partnership status was significantly associated with HIV care engagement, even after adjusting for individual, social, and structural factors. While partnered men were consistently more likely than their single counterparts to have a regular healthcare provider, to receive recent treatment, and to have ever taken antiretroviral medication, they were less likely to report currently receiving antiretroviral therapy. Moreover, men with a discordant partner reported better adherence compared to men with a concordant or no partner. The association between partnership status and HIV care engagement outcomes was not consistent across the stages of the HIV Care Continuum, highlighting the complexity in how and why young Black men living with HIV engage in HIV healthcare. Given the social context of HIV disease management, more research is needed to explicate underlying mechanisms involved in HIV care and treatment that differ by relational factors for young Black MSM living with HIV.
Collapse
Affiliation(s)
- Judy Y Tan
- Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California, 550 16th Street, 3rd Floor, 0886, San Francisco, CA, 94158-2549, USA.
| | - Lance Pollack
- Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California, 550 16th Street, 3rd Floor, 0886, San Francisco, CA, 94158-2549, USA
| | - Greg Rebchook
- Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California, 550 16th Street, 3rd Floor, 0886, San Francisco, CA, 94158-2549, USA
| | - John Peterson
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - David Huebner
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Agatha Eke
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wayne Johnson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan Kegeles
- Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California, 550 16th Street, 3rd Floor, 0886, San Francisco, CA, 94158-2549, USA
| |
Collapse
|
24
|
Dale SK, Bogart LM, Galvan FH, Wagner GJ, Pantalone DW, Klein DJ. Discrimination and Hate Crimes in the Context of Neighborhood Poverty and Stressors Among HIV-Positive African-American Men Who Have Sex with Men. J Community Health 2018; 41:574-83. [PMID: 26696119 DOI: 10.1007/s10900-015-0132-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In a sample of HIV-positive African-American men who have sex with men (MSM), we examined neighborhood factors that may contextualize perceived discrimination from three intersecting stigmatized characteristics: race, HIV status, and sexual orientation. HIV-positive African-American MSM (N = 162, mean age = 44, SD = 8) provided information on neighborhood-related stressors and discrimination experiences related to being Black, HIV-positive, or perceived as gay. Residential ZIP codes and US Census data were used to determine neighborhood poverty rates. Regressions, controlling for socio-demographics, indicated that (1) higher neighborhood poverty was significantly related to more frequent experiences with hate crimes (Gay-related: b = 1.15, SE = .43, p < .008); and (2) higher neighborhood-related stressors were significantly related to more frequent discrimination (Black-related: b = .91, SE = .28, p = .001; gay-related: b = .71, SE = .29, p = .01; and HIV-related: b = .65, SE = .28, p = .02) and hate crimes (Gay-related: b = .48, SE = .13, p = .001; and Black-related: b = .28, SE = .14, p = .04). For HIV-positive African-American MSM, higher neighborhood poverty and related stressors are associated with experiencing more discrimination and hate crimes. Interventions for this group should promote individual- and neighborhood-level socioeconomic empowerment and stigma reduction.
Collapse
Affiliation(s)
- Sannisha K Dale
- Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | | | | | | | - David W Pantalone
- University of Massachusetts, Boston, MA, USA.,The Fenway Institute of Fenway Health, Boston, MA, USA
| | | |
Collapse
|
25
|
Neighborhood Characteristics Associated with Achievement and Maintenance of HIV Viral Suppression Among Persons Newly Diagnosed with HIV in New York City. AIDS Behav 2017; 21:3557-3566. [PMID: 28160107 DOI: 10.1007/s10461-017-1700-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We investigated the effect of neighborhood characteristics on achievement and maintenance of HIV viral suppression among New York City (NYC) residents aged 13 years and older diagnosed between 2006 and 2012. Individual records from the NYC HIV surveillance registry (n = 12,547) were linked to U.S. Census and American Community Survey data by census tract of residence. Multivariable proportional hazards regression models indicated the likelihood of achievement and maintenance of suppression by neighborhood characteristics including poverty, accounting for neighborhood clustering and for individual characteristics. In adjusted analyses, no neighborhood factors were associated with achievement of suppression. However, residents of high- or very-high-poverty neighborhoods were less likely than residents of low-poverty neighborhoods to maintain suppression. In conclusion, higher neighborhood poverty was associated with lesser maintenance of suppression. Assistance with post-diagnosis retention in care, antiretroviral therapy prescribing, or adherence targeted to residents of higher-poverty neighborhoods may improve maintenance of viral suppression in NYC.
Collapse
|
26
|
Beymer MR, Harawa NT, Weiss RE, Shover CL, Toynes BR, Meanley S, Bolan RK. Are Partner Race and Intimate Partner Violence Associated with Incident and Newly Diagnosed HIV Infection in African-American Men Who Have Sex with Men? J Urban Health 2017; 94:666-675. [PMID: 28616719 PMCID: PMC5610124 DOI: 10.1007/s11524-017-0169-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Black gay, bisexual, and other men who have sex with men (BMSM) experience a disparate rate of HIV infections among MSM. Previous analyses have determined that STI coinfection and undiagnosed HIV infection partly explain the disparity. However, few studies have analyzed the impact of partner-level variables on HIV incidence among BMSM. Data were analyzed for BMSM who attended the Los Angeles LGBT Center from August 2011 to July 2015 (n = 1974) to identify risk factors for HIV infection. A multivariable logistic regression was used to analyze predictors for HIV prevalence among all individuals at first test (n = 1974; entire sample). A multivariable survival analysis was used to analyze predictors for HIV incidence (n = 936; repeat tester subset). Condomless receptive anal intercourse at last sex, number of sexual partners in the last 30 days, and intimate partner violence (IPV) were significant partner-level predictors of HIV prevalence and incidence. Individuals who reported IPV had 2.39 times higher odds (CI 1.35-4.23) and 3.33 times higher hazard (CI 1.47-7.55) of seroconverting in the prevalence and incidence models, respectively. Reporting Black partners only was associated with increased HIV prevalence, but a statistically significant association was not found with incidence. IPV is an important correlate of both HIV prevalence and incidence in BMSM. Further studies should explore how IPV affects HIV risk trajectories among BMSM. Given that individuals with IPV history may struggle to negotiate safer sex, IPV also warrants consideration as a qualifying criterion among BMSM for pre-exposure prophylaxis (PrEP).
Collapse
Affiliation(s)
- Matthew R Beymer
- Los Angeles LGBT Center, McDonald/Wright Building, 1625 N Schrader Blvd, Room 205, Los Angeles, CA, 90028-6213, USA.
- Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Nina T Harawa
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
- College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Chelsea L Shover
- Los Angeles LGBT Center, McDonald/Wright Building, 1625 N Schrader Blvd, Room 205, Los Angeles, CA, 90028-6213, USA
| | - Brian R Toynes
- Los Angeles LGBT Center, McDonald/Wright Building, 1625 N Schrader Blvd, Room 205, Los Angeles, CA, 90028-6213, USA
| | - Steven Meanley
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert K Bolan
- Los Angeles LGBT Center, McDonald/Wright Building, 1625 N Schrader Blvd, Room 205, Los Angeles, CA, 90028-6213, USA
| |
Collapse
|
27
|
Garnett M, Hirsch-Moverman Y, Franks J, Hayes-Larson E, El-Sadr WM, Mannheimer S. Limited awareness of pre-exposure prophylaxis among black men who have sex with men and transgender women in New York city. AIDS Care 2017; 30:9-17. [PMID: 28791876 DOI: 10.1080/09540121.2017.1363364] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Awareness of Pre-exposure prophylaxis (PrEP) was assessed among a cohort of substance-using black men who have sex with men and transgender women (MSM/TGW) participating in the STAR Study, which recruited black MSM/TGW in New York City for HIV testing and linked HIV-infected individuals into care from July 2012 to April 2015. Sociodemographic, psychosocial, known HIV risk factors, and PrEP awareness were assessed among participants. Multivariable logistic regression was conducted to assess factors associated with PrEP awareness. Of 1673 participants, median age was 43 years and 25% were under age 30. Most participants (85.8%) reported having insufficient income for basic necessities at least occasionally, 54.8% were homeless, and 71.3% were unemployed. Awareness of PrEP was reported among 18.2% of participants. PrEP awareness was associated with younger age (adjusted odds ratio [aOR] 0.87, per 5 years), gay identity (aOR 2.46), higher education (aOR 1.70), more frequent past HIV testing (aOR 3.18), less HIV stigma (aOR 0.61), less hazardous/harmful alcohol use (aOR 0.61), and more sexual partners (aOR 1.04, per additional partner in past 30 days). In this substance-using black MSM/TGW cohort with high rates of poverty and homelessness, PrEP awareness was low. This study demonstrates the need for targeted dissemination of PrEP information to key populations to increase awareness and ultimately improve uptake and utilization of PrEP.
Collapse
Affiliation(s)
- Matthew Garnett
- a ICAP at Columbia University, Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Yael Hirsch-Moverman
- a ICAP at Columbia University, Mailman School of Public Health , Columbia University , New York , NY , USA.,b Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Julie Franks
- a ICAP at Columbia University, Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Eleanor Hayes-Larson
- a ICAP at Columbia University, Mailman School of Public Health , Columbia University , New York , NY , USA.,b Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Wafaa M El-Sadr
- a ICAP at Columbia University, Mailman School of Public Health , Columbia University , New York , NY , USA.,b Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Sharon Mannheimer
- a ICAP at Columbia University, Mailman School of Public Health , Columbia University , New York , NY , USA.,b Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA.,c Department of Medicine, Division of Infectious Diseases , Harlem Hospital Center , New York , NY , USA
| |
Collapse
|
28
|
Daskalopoulou M, Rodger AJ, Phillips AN, Sherr L, Elford J, McDonnell J, Edwards S, Perry N, Wilkins E, Collins S, Johnson AM, Burman WJ, Speakman A, Lampe FC. Condomless sex in HIV-diagnosed men who have sex with men in the UK: prevalence, correlates, and implications for HIV transmission. Sex Transm Infect 2017; 93:590-598. [PMID: 28679630 PMCID: PMC5739863 DOI: 10.1136/sextrans-2016-053029] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 04/12/2017] [Accepted: 04/18/2017] [Indexed: 11/18/2022] Open
Abstract
Objective HIV transmission is ongoing among men who have sex with men (MSM) in the UK. Sex without a condom (condomless sex, CLS) is the main risk factor. We investigated the prevalence of and factors associated with types of CLS. Methods Cross-sectional questionnaire study in UK HIV clinics in 2011/2012 (ASTRA). MSM diagnosed with HIV for ≥3 months reported on anal and vaginal sex, CLS with HIV-serodifferent partners (CLS-D) and CLS with HIV-seroconcordant (CLS-C) partners in the previous 3 months. Mutually exclusive sexual behaviours were as follows: (1) Higher HIV risk CLS-D (not on antiretroviral therapy (ART) or clinic-recorded viral load(VL) >50 c/mL), (2) Other CLS-D, (3) CLS-C without CLS-D, (4) Condom-protected sex only and (5) No anal or vaginal sex. Associations were examined of sociodemographic, HIV-related, lifestyle, and other sexual measures with the five categories of sexual behaviour. We examined the prevalence of higher HIV risk CLS-D incorporating (in addition to ART and VL) time on ART, ART non-adherence, and recent sexually transmitted infections (STIs). Results Among 2189 HIV-diagnosed MSM (87% on ART), prevalence of any CLS in the past 3 months was 38.2% (95% CI 36.2% to 40.4%) and that of any CLS-D was 16.3% (14.8%–17.9%). The five-category classification was as follows: (1) Higher HIV risk CLS-D: 4.2% (3.5% to 5.2%), (2) Other CLS-D: 12.1% (10.8% to 13.5%), (3) CLS-C without CLS-D: 21.9% (20.2% to 23.7%), (4) Condom-protected sex only: 25.4% (23.6% to 27.3%) and (5) No anal or vaginal sex: 36.4% (34.3% to 38.4%). Compared with men who reported condom-protected sex only, MSM who reported any CLS in the past 3 months had higher prevalence of STIs, chemsex-associated drug use, group sex, higher partner numbers, and lifetime hepatitis C. Prevalence of higher HIV risk CLS-D ranged from 4.2% to 7.5% according to criteria included. Conclusion CLS was prevalent among HIV-diagnosed MSM, but CLS-D with higher HIV transmission risk was overall low. CLS-D is no longer the most appropriate measure of HIV transmission risk behaviour among people with diagnosed HIV; accounting for VL is important.
Collapse
Affiliation(s)
- Marina Daskalopoulou
- Research Department of Infection and Population Health, University College London, London, UK
| | - Alison J Rodger
- Research Department of Infection and Population Health, University College London, London, UK
| | - Andrew N Phillips
- Research Department of Infection and Population Health, University College London, London, UK
| | - Lorraine Sherr
- Research Department of Infection and Population Health, University College London, London, UK
| | | | - Jeffrey McDonnell
- Research Department of Infection and Population Health, University College London, London, UK
| | - Simon Edwards
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Nicky Perry
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Ed Wilkins
- Pennine Acute Hospitals NHS Trust, Manchester, UK
| | | | - Anne M Johnson
- Research Department of Infection and Population Health, University College London, London, UK
| | | | - Andrew Speakman
- Research Department of Infection and Population Health, University College London, London, UK
| | - Fiona C Lampe
- Research Department of Infection and Population Health, University College London, London, UK
| | | |
Collapse
|
29
|
Okeke N, McFarland W, Raymond HF. Closing the Gap? The HIV Continuum in Care for African-American Men Who Have Sex with Men, San Francisco, 2004-2014. AIDS Behav 2017; 21:1741-1744. [PMID: 27380391 DOI: 10.1007/s10461-016-1472-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We examined trends in the HIV continuum in care in the National HIV Behavioral Surveillance surveys for MSM in San Francisco from 2004 to 2014. In 2004, HIV-positive African-American MSM were less likely to be diagnosed (42.9 vs. 87.5 %, p = 0.003), linked to care (42.9 vs. 85.7 %, p = 0.007), or to have ever used antiretroviral treatment (ART) (28.6 vs. 69.6 %, p = 0.032) compared to white MSM. By 2014, these gaps had narrowed but not closed, including diagnosis (85.7 vs. 100 %, Fisher's exact p = 0.106), linkage to care (85.7 vs. 96.8 %, Fisher's exact p = 0.290), and ART use (85.7 vs. 94.9 %, Fisher's exact p = 0.369).
Collapse
Affiliation(s)
- N Okeke
- San Francisco Department of Public Health, 25 Van Ness Avenue, San Francisco, CA, 94102-6033, USA
| | - W McFarland
- San Francisco Department of Public Health, 25 Van Ness Avenue, San Francisco, CA, 94102-6033, USA.
| | - H F Raymond
- San Francisco Department of Public Health, 25 Van Ness Avenue, San Francisco, CA, 94102-6033, USA
| |
Collapse
|
30
|
Carrico AW, Storholm ED, Flentje A, Arnold EA, Pollack LM, Neilands TB, Rebchook GM, Peterson JL, Eke A, Johnson W, Kegeles SM. Spirituality/religiosity, substance use, and HIV testing among young black men who have sex with men. Drug Alcohol Depend 2017; 174:106-112. [PMID: 28319751 PMCID: PMC5482005 DOI: 10.1016/j.drugalcdep.2017.01.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/10/2017] [Accepted: 01/12/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Spirituality and religiosity may serve as both a resource and a barrier to HIV prevention with young black men who have sex with men (YBMSM). We examined indices of spirituality/religiosity as correlates of binge drinking, stimulant use, and recent HIV testing in a sample of YBMSM. METHODS From 2011-2013, annual venue-based surveys of sexually active YBMSM ages 18-29 were conducted in Dallas and Houston, Texas. Binge drinking and stimulant use were assessed in the past two months. Participants recently tested for HIV (i.e., within the past six months) were compared to those without recent HIV testing (i.e., never tested or tested more than six months ago). RESULTS Among the 1565 HIV-negative or HIV-unknown YBMSM enrolled, more engagement in spiritual and religious activities was associated with greater odds of reporting stimulant use (Adjusted Odds Ratio [AOR]=1.20; 95% CI=1.04-1.40) while higher spiritual coping was associated with lower odds of reporting stimulant use (AOR=0.66; 95% CI=0.56-0.78). Binge drinking was independently associated with 29% lower odds of recent HIV testing (AOR=0.71; 95% CI=0.55-0.92), but lower odds of binge drinking did not mediate the association of engagement in spiritual and religious activities with 27% greater odds of recent HIV testing (AOR=1.27; 95% CI=1.11-1.46). CONCLUSIONS Among YBMSM, culturally tailored approaches addressing spirituality/religiosity could support prevention of stimulant use and increase HIV testing. In particular, expanded efforts are needed to promote HIV testing in binge drinkers.
Collapse
Affiliation(s)
- Adam W. Carrico
- University of Miami, School of Medicine, Department of Public Health Sciences
| | | | - Annesa Flentje
- University of California, San Francisco School of Nursing, Department of Community Health Systems
| | - Emily A. Arnold
- University of California, San Francisco, Center for AIDS Prevention Studies
| | - Lance M. Pollack
- University of California, San Francisco, Center for AIDS Prevention Studies
| | | | | | | | - Agatha Eke
- Centers for Disease Control and Prevention
| | | | - Susan M. Kegeles
- University of California, San Francisco, Center for AIDS Prevention Studies
| |
Collapse
|
31
|
Shacham E, Nelson EJ, Hoft DF, Schootman M, Garza A. Potential High-Risk Areas for Zika Virus Transmission in the Contiguous United States. Am J Public Health 2017; 107:724-731. [PMID: 28323468 PMCID: PMC5388944 DOI: 10.2105/ajph.2017.303670] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To understand where transmission of Zika virus has the highest likelihood to occur in the contiguous United States with regard to its transmission both sexually and via Aedes aegypti mosquito bites. METHODS We evaluated the 2 routes of transmission risk with predictors of sexually transmitted infections (percentage women of childbearing age, birthrate, gonorrhea and chlamydia rates, concentrated disadvantage) as a surrogate for unprotected sexual activity and the demographic distribution of the A. aegypti mosquito across 3108 counties in the contiguous United States. RESULTS We found that 507 counties had the highest risk of virus exposure via mosquito vector or unprotected sexual activity; these were concentrated in southern states extending northward along the Atlantic coast and southern California, with the highest predicted risk in Mississippi counties. CONCLUSIONS Identifying areas with higher transmission risk can inform prevention strategies and vector control, and assist in planning for diagnosis and treatment.
Collapse
Affiliation(s)
- Enbal Shacham
- Enbal Shacham is with the Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO. Erik J. Nelson is with the Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington. Daniel F. Hoft is with the Departments of Internal Medicine and Molecular Microbiology, School of Medicine, Saint Louis University. Mario Schootman and Alexander Garza are with the Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University
| | - Erik J Nelson
- Enbal Shacham is with the Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO. Erik J. Nelson is with the Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington. Daniel F. Hoft is with the Departments of Internal Medicine and Molecular Microbiology, School of Medicine, Saint Louis University. Mario Schootman and Alexander Garza are with the Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University
| | - Daniel F Hoft
- Enbal Shacham is with the Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO. Erik J. Nelson is with the Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington. Daniel F. Hoft is with the Departments of Internal Medicine and Molecular Microbiology, School of Medicine, Saint Louis University. Mario Schootman and Alexander Garza are with the Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University
| | - Mario Schootman
- Enbal Shacham is with the Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO. Erik J. Nelson is with the Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington. Daniel F. Hoft is with the Departments of Internal Medicine and Molecular Microbiology, School of Medicine, Saint Louis University. Mario Schootman and Alexander Garza are with the Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University
| | - Alexander Garza
- Enbal Shacham is with the Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO. Erik J. Nelson is with the Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington. Daniel F. Hoft is with the Departments of Internal Medicine and Molecular Microbiology, School of Medicine, Saint Louis University. Mario Schootman and Alexander Garza are with the Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University
| |
Collapse
|
32
|
Graves SK, Little SJ, Hoenigl M. Risk profile and HIV testing outcomes of women undergoing community-based testing in San Diego 2008-2014. Sci Rep 2017; 7:42183. [PMID: 28165056 PMCID: PMC5292713 DOI: 10.1038/srep42183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 01/06/2017] [Indexed: 11/09/2022] Open
Abstract
Women comprised 19% of new HIV diagnoses in the United States in 2014, with significant racial and ethnic disparities in infection rates. This cross-sectional analysis of women enrolled in a cohort study compares demographics, risk behaviour, and sexually transmitted infections (STI) in those undergoing HIV testing in San Diego County. Data from the most recent screening visit of women undergoing voluntary HIV screening April 2008 -July 2014 was used. HIV diagnosis, risk behaviour and self-reported STIs were compared among women aged ≤24, 25-49, and ≥50, as well as between HIV-infected and uninfected women and between Hispanic and non-Hispanic women. Among the 2535 women included, Hispanic women were less likely than other women to report unprotected vaginal intercourse (p = 0.026) or stimulant drug use (p = 0.026), and more likely to report one or fewer partners (p < 0.0001), but also more likely to report sex with an HIV-infected individual (p = 0.027). New HIV infection was significantly more prevalent among Hispanic women (1.6% vs. 0.2%; p < 0.001). Hispanic women were more likely than other women to be diagnosed with HIV despite significantly lower rates of risk behaviour. Culturally specific risk reduction interventions for Hispanic women should focus on awareness of partner risk and appropriate testing.
Collapse
Affiliation(s)
- Susannah K. Graves
- Division of Infectious Diseases, University of California San Diego, San Diego, California, USA
| | - Susan J. Little
- Division of Infectious Diseases, University of California San Diego, San Diego, California, USA
| | - Martin Hoenigl
- Division of Infectious Diseases, University of California San Diego, San Diego, California, USA
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| |
Collapse
|
33
|
Blake Helms C, Turan JM, Atkins G, Kempf MC, Clay OJ, Raper JL, Mugavero MJ, Turan B. Interpersonal Mechanisms Contributing to the Association Between HIV-Related Internalized Stigma and Medication Adherence. AIDS Behav 2017; 21:238-247. [PMID: 26864692 DOI: 10.1007/s10461-016-1320-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Previous research suggests that people living with HIV (PLWH) sometimes internalize HIV-related stigma existing in the community and experience feelings of inferiority and shame due to their HIV status, which can have negative consequences for treatment adherence. PLWH's interpersonal concerns about how their HIV status may affect the security of their existing relationships may help explain how internalized stigma affects adherence behaviors. In a cross-sectional study conducted between March 2013 and January 2015 in Birmingham, AL, 180 PLWH recruited from an outpatient HIV clinic completed previously validated measures of internalized stigma, attachment styles, and concern about being seen while taking HIV medication. Participants also self-reported their HIV medication adherence. Higher levels of HIV-related internalized stigma, attachment-related anxiety (i.e., fear of abandonment by relationship partners), and concerns about being seen by others while taking HIV medication were all associated with worse medication adherence. The effect of HIV-related internalized stigma on medication adherence was mediated by attachment-related anxiety and by concerns about being seen by others while taking HIV medication. Given that medication adherence is vitally important for PLWH to achieve long-term positive health outcomes, understanding interpersonal factors affecting medication adherence is crucial. Interventions aimed at improving HIV treatment adherence should address interpersonal factors as well as intrapersonal factors.
Collapse
Affiliation(s)
- C Blake Helms
- The Department of Psychology, University of Alabama at Birmingham, 415 Campbell Hall, Birmingham, AL, 35294-1170, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ghislaine Atkins
- The Department of Psychology, University of Alabama at Birmingham, 415 Campbell Hall, Birmingham, AL, 35294-1170, USA
| | - Mirjam-Colette Kempf
- Department of Family, Community and Health Systems and Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Olivio J Clay
- The Department of Psychology, University of Alabama at Birmingham, 415 Campbell Hall, Birmingham, AL, 35294-1170, USA
| | - James L Raper
- The Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael J Mugavero
- The Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bulent Turan
- The Department of Psychology, University of Alabama at Birmingham, 415 Campbell Hall, Birmingham, AL, 35294-1170, USA.
| |
Collapse
|
34
|
Abstract
Identifying predictors that contribute to geographic disparities in sexually transmitted infections (STIs) is necessary in order to reduce disparities. This study assesses the spatial relationship condom availability and accessibility in order to better identify determinants of geographic disparities in STIs. We conducted a telephone-based audit among potential-condom selling establishments. Descriptive analyses were conducted to detect differences in condom-selling characteristics by stores and by store type. Geocoding, mapping, and spatial analysis were conducted to measure the availability of condoms. A total of 850 potential condom-selling establishments participated in the condom availability and accessibility audit in St. Louis city; 29 % sold condoms. There were several significant geographic clusters of stores identified across the study area. The first consisted of fewer convenience stores and gas stations that sold condoms in the northern section of the city, whereas condoms were less likely to be sold in non-convenience store settings in the southwestern and central parts of the city. Additionally, locations that distributed free condoms clustered significantly in city center. However, there was a dearth of businesses that were neither convenience stores nor gas stations in the northern region of the city, which also had the highest concentration of condoms sold. This initial study was conducted to provide evidence that condom availability and accessibility differ by geographic region, and likely are a determinant of social norms surrounding condom use and ultimately impact STI rates.
Collapse
|
35
|
Burch LS, Smith CJ, Anderson J, Sherr L, Rodger AJ, O'Connell R, Geretti AM, Gilson R, Fisher M, Elford J, Jones M, Collins S, Azad Y, Phillips AN, Speakman A, Johnson MA, Lampe FC. Socioeconomic status and treatment outcomes for individuals with HIV on antiretroviral treatment in the UK: cross-sectional and longitudinal analyses. LANCET PUBLIC HEALTH 2016; 1:e26-e36. [PMID: 28299369 PMCID: PMC5341147 DOI: 10.1016/s2468-2667(16)30002-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Few studies have assessed the effect of socioeconomic status on HIV treatment outcomes in settings with universal access to health care. Here we aimed to investigate the association of socioeconomic factors with antiretroviral therapy (ART) non-adherence, virological non-suppression, and virological rebound, in HIV-positive people on ART in the UK. Methods We used data from the Antiretrovirals, Sexual Transmission Risk and Attitudes (ASTRA) questionnaire study, which recruited participants aged 18 years or older with HIV from eight HIV outpatient clinics in the UK between Feb 1, 2011, and Dec 31, 2012. Participants self-completed a confidential questionnaire on sociodemographic, health, and lifestyle issues. In participants on ART, we assessed associations of financial hardship, employment, housing, and education with: self-reported ART non-adherence at the time of the questionnaire; virological non-suppression (viral load >50 copies per mL) at the time of questionnaire in those who started ART at least 6 months ago (cross-sectional analysis); and subsequent virological rebound (viral load >200 copies per mL) in those with initial viral load of 50 copies per mL or lower (longitudinal analysis). Findings Of the 3258 people who completed the questionnaire, 2771 (85%) reported being on ART at the time of the questionnaire, and 2704 with complete data were included. 873 (32%) of 2704 participants reported non-adherence to ART and 219 (9%) of 2405 had virological non-suppression in cross-sectional analysis. Each of the four measures of lower socioeconomic status was strongly associated with non-adherence to ART, and with virological non-suppression (prevalence ratios [PR] adjusted for gender/sexual orientation, age, and ethnic origin: greatest financial hardship vs none 2·4, 95% CI 1·6–3·4; non-employment 2·0, 1·5–2·6; unstable housing vs homeowner 3·0, 1·9–4·6; non-university education 1·6, 1·2–2·2). 139 (8%) of 1740 individuals had subsequent virological rebound (rate=3·6/100 person-years). Low socioeconomic status was predictive of longitudinal rebound risk (adjusted hazard ratio [HR] for greatest financial hardship vs none 2·3, 95% CI 1·4–3·9; non-employment 3·0, 2·1–4·2; unstable housing vs homeowner 3·3, 1·8–6·1; non-university education 1·6, 1·1–2·3). Interpretation Socioeconomic disadvantage was strongly associated with poorer HIV treatment outcomes in this setting with universal health care. Adherence interventions and increased social support for those most at risk should be considered. Funding National Institute for Health Research.
Collapse
Affiliation(s)
- Lisa S Burch
- Research Department of Infection and Population Health, University College London, London, UK
| | - Colette J Smith
- Research Department of Infection and Population Health, University College London, London, UK
| | - Jane Anderson
- Centre for the Study of Sexual Health and HIV, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Lorraine Sherr
- Research Department of Infection and Population Health, University College London, London, UK
| | - Alison J Rodger
- Research Department of Infection and Population Health, University College London, London, UK
| | | | - Anna-Maria Geretti
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Richard Gilson
- Research Department of Infection and Population Health, University College London, London, UK
| | | | - Jonathan Elford
- School of Health Sciences, City, University of London, London, UK
| | - Martin Jones
- East Sussex Healthcare NHS Trust, Eastbourne, UK
| | | | | | - Andrew N Phillips
- Research Department of Infection and Population Health, University College London, London, UK
| | - Andrew Speakman
- Research Department of Infection and Population Health, University College London, London, UK
| | | | - Fiona C Lampe
- Research Department of Infection and Population Health, University College London, London, UK
| |
Collapse
|
36
|
Hernández-Romieu AC, Sullivan PS, Rothenberg R, Grey J, Luisi N, Sanchez T, Siegler AJ, Rosenberg ES. Concordance of Demographic Characteristics, Sexual Behaviors, and Relationship Attributes Among Sex Dyads of Black and White Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:1463-70. [PMID: 26758456 DOI: 10.1007/s10508-015-0668-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 10/30/2015] [Accepted: 11/15/2015] [Indexed: 05/23/2023]
Abstract
Differences in individual behaviors have failed to explain racial disparities between Black and White men who have sex with men (MSM). However, reporting of behaviors and partner characteristics are assumed to be non-differentially reported by race. From 314 participants, this study used the two-sided data-where sexual partners provide information on each other and their relationship-of 127 dyads of Black and White MSM from Atlanta, GA, to assess the reliability of partner-reported demographic characteristics and the concordance of sexual behaviors and partnership attributes by race. We compared proportions of concordance by race using a modified kappa (K m) to assess chance-corrected agreement. The median difference in age between self- and partner-reports was 0 (0-1) years. Compared to self-reports, 97 % of the partners of Black participants and 96 % of the partners of White participants correctly classified their race. We observed poor agreement on pre-sexual discussion (K m = 0.18) and being in an ongoing relationship (K m = 0.13), with no differences by race (p = 0.11). Although not statistically significant, Black MSM dyads had lower levels of concordance for unprotected anal intercourse in the previous 12 months (68 %) compared to White dyads (90 %), with fair agreement among Black dyads (K m = 0.26). Measures of partner-reported age and race are likely accurate; however, certain self-reported sexual behaviors and partnership attributes may be unreliable and differentially reported by race. Our findings highlight the need to assess the validity of measures used to estimate HIV transmission and inform racial disparities research.
Collapse
Affiliation(s)
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Richard Rothenberg
- Department of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Jeremy Grey
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Nicole Luisi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Eli S Rosenberg
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| |
Collapse
|
37
|
Chakraborty H, Weissman S, Duffus WA, Hossain A, Varma Samantapudi A, Iyer M, Albrecht H. HIV community viral load trends in South Carolina. Int J STD AIDS 2016; 28:265-276. [PMID: 27037110 DOI: 10.1177/0956462416642349] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Community viral load is an aggregate measure of HIV viral load in a particular geographic location, community, or subgroup. Community viral load provides a measure of disease burden in a community and community transmission risk. This study aims to examine community viral load trend in South Carolina and identify differences in community viral load trends between selected population subgroups using a state-wide surveillance dataset that maintains electronic records of all HIV viral load measurements reported to the state health department. Community viral load trends were examined using random mixed effects models, adjusting for age, race, gender, residence, CD4 counts, HIV risk group, and initial antiretroviral regimen during the study period, and time. The community viral load gradually decreased from 2004 to 2013 ( p < 0.0001). The number of new infections also decreased ( p = 0.0001) over time. A faster rate of decrease was seen among men compared to women ( p < 0.0001), men who have sex with men ( p = 0.0001) compared to heterosexuals, patients diagnosed in urban areas compared to that in rural areas ( p = 0.0004), and patients prescribed single-tablet regimen compared to multiple-tablet regimen ( p < 0.0001). While the state-wide community viral load decreased over time, the decline was not uniform among residence at diagnosis, HIV risk group, and single-tablet regimen versus multiple-tablet regimen subgroups. Slower declines in community viral load among females, those in rural areas, and heterosexuals suggest possible disparities in care that require further exploration. The association between using single-tablet regimen and faster community viral load decline is noteworthy.
Collapse
Affiliation(s)
- Hrishikesh Chakraborty
- 1 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Sharon Weissman
- 2 Division of Infectious Disease, Department of Medicine, University of South Carolina, School of Medicine, Columbia, South Carolina, USA
| | - Wayne A Duffus
- 2 Division of Infectious Disease, Department of Medicine, University of South Carolina, School of Medicine, Columbia, South Carolina, USA
| | - Akhtar Hossain
- 1 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Ashok Varma Samantapudi
- 1 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Medha Iyer
- 3 Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Helmut Albrecht
- 2 Division of Infectious Disease, Department of Medicine, University of South Carolina, School of Medicine, Columbia, South Carolina, USA
| |
Collapse
|
38
|
Castel AD, Kalmin MM, Hart RLD, Young HA, Hays H, Benator D, Kumar P, Elion R, Parenti D, Ruiz ME, Wood A, D'Angelo L, Rakhmanina N, Rana S, Bryant M, Hebou A, Fernández R, Abbott S, Peterson J, Wood K, Subramanian T, Binkley J, Happ LP, Kharfen M, Masur H, Greenberg AE. Disparities in achieving and sustaining viral suppression among a large cohort of HIV-infected persons in care - Washington, DC. AIDS Care 2016; 28:1355-64. [PMID: 27297952 DOI: 10.1080/09540121.2016.1189496] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
One goal of the HIV care continuum is achieving viral suppression (VS), yet disparities in suppression exist among subpopulations of HIV-infected persons. We sought to identify disparities in both the ability to achieve and sustain VS among an urban cohort of HIV-infected persons in care. Data from HIV-infected persons enrolled at the 13 DC Cohort study clinical sites between January 2011 and June 2014 were analyzed. Univariate and multivariate logistic regression were conducted to identify factors associated with achieving VS (viral load < 200 copies/ml) at least once, and Kaplan-Meier (KM) curves and Cox proportional hazards models were used to identify factors associated with sustaining VS and time to virologic failure (VL ≥ 200 copies/ml after achievement of VS). Among the 4311 participants, 95.4% were either virally suppressed at study enrollment or able to achieve VS during the follow-up period. In multivariate analyses, achieving VS was significantly associated with age (aOR: 1.04; 95%CI: 1.03-1.06 per five-year increase) and having a higher CD4 (aOR: 1.05, 95% CI 1.04-1.06 per 100 cells/mm(3)). Patients infected through perinatal transmission were less likely to achieve VS compared to MSM patients (aOR: 0.63, 95% CI 0.51-0.79). Once achieved, most participants (74.4%) sustained VS during follow-up. Blacks and perinatally infected persons were less likely to have sustained VS in KM survival analysis (log rank chi-square p ≤ .001 for both) compared to other races and risk groups. Earlier time to failure was observed among females, Blacks, publically insured, perinatally infected, those with longer standing HIV infection, and those with diagnoses of mental health issues or depression. Among this HIV-infected cohort, most people achieved and maintained VS; however, disparities exist with regard to patient age, race, HIV transmission risk, and co-morbid conditions. Identifying populations with disparate outcomes allows for appropriate targeting of resources to improve outcomes along the care continuum.
Collapse
Affiliation(s)
- Amanda D Castel
- a Department of Epidemiology and Biostatistics , George Washington University Milken Institute School of Public Health , Washington , DC , USA
| | - Mariah M Kalmin
- a Department of Epidemiology and Biostatistics , George Washington University Milken Institute School of Public Health , Washington , DC , USA
| | | | - Heather A Young
- a Department of Epidemiology and Biostatistics , George Washington University Milken Institute School of Public Health , Washington , DC , USA
| | - Harlen Hays
- b Cerner Corporation , Kansas City , MO , USA
| | - Debra Benator
- c Veterans Affairs Medical Center , Washington , DC , USA
| | - Princy Kumar
- d Division of Infectious Diseases, Georgetown University , Washington , DC , USA
| | | | - David Parenti
- f Division of Infectious Disease , George Washington Medical Faculty Associates , Washington , DC , USA
| | - Maria Elena Ruiz
- g Division of Infectious Diseases, Department of Medicine , Washington Hospital Center , Washington , DC , USA
| | - Angela Wood
- h Family and Medical Counseling Service , Washington , DC , USA
| | - Lawrence D'Angelo
- i Burgess Adolescent Clinic, Children's National Medical Center , Washington , DC , USA
| | - Natella Rakhmanina
- j Special Immunology Service Pediatric Clinic Children's National Medical Center , Washington , DC , USA
| | - Sohail Rana
- k Department of Pediatric and Child Health , Howard University Hospital , Washington , DC , USA
| | - Maya Bryant
- l Howard University Hospital Adult Infectious Disease Clinic , Washington , DC , USA
| | | | | | | | - James Peterson
- a Department of Epidemiology and Biostatistics , George Washington University Milken Institute School of Public Health , Washington , DC , USA
| | - Kathy Wood
- p Cerner Corporation , Vienna , VA , USA
| | | | | | - Lindsey Powers Happ
- a Department of Epidemiology and Biostatistics , George Washington University Milken Institute School of Public Health , Washington , DC , USA
| | - Michael Kharfen
- r District of Columbia Department of Health , HIV/AIDS, Hepatitis, Sexually Transmitted Diseases, Tuberculosis Administration (HAHSTA) , Washington , DC , USA
| | - Henry Masur
- s Department of Critical Care Medicine , National Institutes of Health , Bethesda , MD , USA
| | - Alan E Greenberg
- a Department of Epidemiology and Biostatistics , George Washington University Milken Institute School of Public Health , Washington , DC , USA
| |
Collapse
|
39
|
Herbst JH, Raiford JL, Carry MG, Wilkes AL, Ellington RD, Whittier DK. Adaptation and National Dissemination of a Brief, Evidence-Based, HIV Prevention Intervention for High-Risk Men Who Have Sex with Men. MMWR Suppl 2016; 65:42-50. [PMID: 26916033 DOI: 10.15585/mmwr.su6501a7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
CDC's high-impact human immunodeficiency virus (HIV) prevention approach calls for targeting the most cost-effective and scalable interventions to populations of greatest need to reduce HIV incidence. CDC has funded research to adapt and demonstrate the efficacy of Personalized Cognitive Counseling (PCC) as an HIV prevention intervention. Project ECHO, based in San Francisco, California, during 2010-2012, involved an adaptation of PCC for HIV-negative episodic substance-using men who have sex with men (SUMSM) and a randomized trial to test its efficacy in reducing sexual and substance-use risk behaviors. Episodic substance use is the use of substances recreationally and less than weekly. PCC is a 30-minute to 50-minute counseling session that involves addressing self-justifications men use for engaging in risky sexual behavior despite knowing the potential for HIV infection. By exploring these justifications, participants become aware of the ways they make sexual decisions, become better prepared to realistically assess their risk for HIV during future risky situations, and make decisions to decrease their HIV risk. The findings of Project ECHO demonstrated the efficacy of PCC for reducing HIV-related substance-use risk behaviors. The study also demonstrated efficacy of PCC for reducing sexual risk behaviors among SUMSM screened as nondependent on targeted drug substances. CDC has identified PCC as a "best evidence" HIV behavioral intervention and supports its national dissemination. Several features of PCC enhance its feasibility of implementation: it is brief, delivered with HIV testing, relatively inexpensive, allows flexibility in counselor qualifications and delivery settings, and is individualized to each client. The original PCC and its adapted versions can contribute to reducing HIV-related health disparities among high-risk MSM, including substance users, by raising awareness of and promoting reductions in personal risk behaviors.
Collapse
|
40
|
Paz-Bailey G, Smith A, Masciotra S, Zhang W, Bingham T, Flynn C, German D, Al-Tayyib A, Magnus M, LaLota M, Rose CE, Owen SM. Early HIV Infections Among Men Who Have Sex with Men in Five Cities in the United States. AIDS Behav 2015; 19:2304-10. [PMID: 25680518 DOI: 10.1007/s10461-015-1011-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We tested blood samples from men who have sex with men (MSM) to detect early HIV infection. Early HIV included both acute (infected past 30 days) and recent (estimated recency past 240 days). Acute infections were defined as screen immunoassay (IA) negative/NAAT-positive or IA-positive/Multispot-negative/NAAT-positive. Recent infections were defined as avidity index cutoff <30 % on an avidity-based IA and, (1) not reporting antiretroviral therapy use or, (2) HIV RNA >150 copies/mL. Of 937 samples, 26 % (244) were HIV-infected and of these 5 % (12) were early. Of early infections, 2 were acute and 10 recent; most (8/12) were among black MSM. Early infection was associated with last partner of black race [adjusted relative risk (ARR) = 4.6, confidence intervals (CI) 1.2-17.3], receptive anal sex at last sex (ARR = 4.3, CI 1.2-15.0), and daily Internet use to meet partners/friends (ARR = 3.3, CI 1.1-9.7). Expanding prevention and treatment for black MSM will be necessary for reducing incidence in the United States.
Collapse
Affiliation(s)
- G Paz-Bailey
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30329, USA.
| | - A Smith
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30329, USA
| | - S Masciotra
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30329, USA
| | - W Zhang
- Dynamic Research Corporation, Atlanta, GA, USA
| | - T Bingham
- Department of Public Health, Los Angeles County, CA, USA
| | - C Flynn
- Maryland Department of Health & Mental Hygiene, Baltimore, MA, USA
| | - D German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA
| | - A Al-Tayyib
- Denver Public Health, Denver Health and Hospital Authority, Denver, CO, USA
| | - M Magnus
- School of Public Health and Health Services, George Washington University, Washington, DC, USA
| | - M LaLota
- Florida Department of Health, Tallahassee, FL, USA
| | - C E Rose
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30329, USA
| | - S M Owen
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30329, USA
| |
Collapse
|
41
|
Forsyth AD, Valdiserri RO. A State-Level Analysis of Social and Structural Factors and HIV Outcomes Among Men Who Have Sex With Men in the United States. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2015; 27:493-504. [PMID: 26595263 DOI: 10.1521/aeap.2015.27.6.493] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
We apply a social determinants of health model to examine the association of select social and structural influences on AIDS diagnosis rates among men who have sex with men (MSM) in the U.S. states. Secondary data for key social and structural variables were acquired and analyzed. Standard descriptive and inferential statistics were used to examine bivariate and multivariate associations of selected social and structural variables with estimated rate of Stage 3 HIV infection (AIDS) per 100,000 MSM in 2010. We found that living in states with a higher demographic density of lesbian, gay, bisexual, and transgender persons is independently associated with lower AIDS diagnosis rates among MSM. In addition, we found that greater income inequality and higher syphilis rates among men were associated with greater AIDS diagnosis rates among MSM, which may be attributable to state policy environments that underinvest in social goods that benefit population health, and to the fact that ulcerative sexually-transmitted infections increase biological risk of HIV transmission and acquisition. To end the epidemic in the U.S., it will be critical to identify and address state-level social and structural factors that may be associated with adverse HIV outcomes for MSM.
Collapse
Affiliation(s)
| | - Ronald O Valdiserri
- Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services, Washington, DC
| |
Collapse
|
42
|
Shacham E, Nelson EJ, Schulte L, Bloomfield M, Murphy R. Condom deserts: geographical disparities in condom availability and their relationship with rates of sexually transmitted infections. Sex Transm Infect 2015; 92:194-9. [PMID: 26567330 DOI: 10.1136/sextrans-2015-052144] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 09/21/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Identifying predictors that contribute to geographical disparities in sexually transmitted infections (STIs) is necessary. This study assesses the spatial relationship between condom availability to locations of STIs in order to better understand these geographical disparities. OBJECTIVES We conducted a condom availability audit among potential condom-selling establishments. New gonorrhoea and chlamydia cases in 2011 (n=6034) and HIV infection cases from 2006 to 2011 (n=565) were collected by census tract in St Louis, Missouri. 829 potential condom-selling establishments participated in the condom availability audit in St Louis City; 242 of which sold condoms. RESULTS A negative linear relationship exists between condom vendors and cases of gonorrhoea and chlamydia, after adjusting for concentrated disadvantage and free condom locations. Higher concentrated disadvantage, higher proportions of convenience vendors and free locations were associated with higher rates of HIV. CONCLUSIONS This study was conducted to provide evidence that lack of condom availability is associated with STI rates, and likely is an integral component to influencing the subjective norms surrounding condom use and STI rates. Condom distribution interventions may be addressing availability needs and social norms, yet are more likely to be effective when placed in locations with the highest STI rates.
Collapse
Affiliation(s)
- Enbal Shacham
- College for Public Health and Social Justice, Saint Louis University, St Louis, Missouri, USA
| | - Erik J Nelson
- College for Public Health and Social Justice, Saint Louis University, St Louis, Missouri, USA
| | - Lauren Schulte
- College for Public Health and Social Justice, Saint Louis University, St Louis, Missouri, USA
| | - Mark Bloomfield
- College for Public Health and Social Justice, Saint Louis University, St Louis, Missouri, USA
| | - Ryan Murphy
- College for Public Health and Social Justice, Saint Louis University, St Louis, Missouri, USA
| |
Collapse
|
43
|
Twenge JM, Sherman RA, Wells BE. Changes in American Adults' Sexual Behavior and Attitudes, 1972-2012. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:2273-2285. [PMID: 25940736 DOI: 10.1007/s10508-015-0540-2] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 11/01/2014] [Accepted: 12/26/2014] [Indexed: 06/04/2023]
Abstract
In the nationally representative General Social Survey, U.S. Adults (N = 33,380) in 2000-2012 (vs. the 1970s and 1980s) had more sexual partners, were more likely to have had sex with a casual date or pickup or an acquaintance, and were more accepting of most non-marital sex (premarital sex, teen sex, and same-sex sexual activity, but not extramarital sex). The percentage who believed premarital sex among adults was "not wrong at all" was 29 % in the early 1970s, 42 % in the 1980s and 1990s, 49 % in the 2000s, and 58 % between 2010 and 2012. Mixed effects (hierarchical linear modeling) analyses separating time period, generation/birth cohort, and age showed that the trend toward greater sexual permissiveness was primarily due to generation. Acceptance of non-marital sex rose steadily between the G.I. generation (born 1901-1924) and Boomers (born 1946-1964), dipped slightly among early Generation X'ers (born 1965-1981), and then rose so that Millennials (also known as Gen Y or Generation Me, born 1982-1999) were the most accepting of non-marital sex. Number of sexual partners increased steadily between the G.I.s and 1960s-born GenX'ers and then dipped among Millennials to return to Boomer levels. The largest changes appeared among White men, with few changes among Black Americans. The results were discussed in the context of growing cultural individualism and rejection of traditional social rules in the U.S.
Collapse
Affiliation(s)
- Jean M Twenge
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4611, USA.
| | - Ryne A Sherman
- Department of Psychology, Florida Atlantic University, Boca Raton, FL, USA
| | - Brooke E Wells
- Department of Psychology, Hunter College of the City University of New York, The Graduate Center of the City University of New York, New York, NY, USA
- The Center for HIV Educational Studies and Training, New York, NY, USA
| |
Collapse
|
44
|
Wejnert C, Hess KL, Rose CE, Balaji A, Smith JC, Paz-Bailey G. Age-Specific Race and Ethnicity Disparities in HIV Infection and Awareness Among Men Who Have Sex With Men--20 US Cities, 2008-2014. J Infect Dis 2015; 213:776-83. [PMID: 26486637 DOI: 10.1093/infdis/jiv500] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 10/13/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Over half of human immunodeficiency virus (HIV) infections in the United States occur among men who have sex with men (MSM). Among MSM, 16% of estimated new infections in 2010 occurred among black MSM <25 years old. METHODOLOGY We analyzed National HIV Behavioral Surveillance data on MSM from 20 cities. Poisson models were used to test racial disparities, by age, in HIV prevalence, HIV awareness, and sex behaviors among MSM in 2014. Data from 2008, 2011, and 2014 were used to examine how racial/ethnic disparities changed across time. RESULTS While black MSM did not report greater sexual risk than other MSM, they were most likely to be infected with HIV and least likely to know it. Among black MSM aged 18-24 years tested in 2014, 26% were HIV positive. Among white MSM aged 18-24 years tested in 2014, 3% were HIV positive. The disparity in HIV prevalence between black and white MSM increased from 2008 to 2014, especially among young MSM. CONCLUSIONS Disparities in HIV prevalence between black and white MSM continue to increase. Black MSM may be infected with HIV at younger ages than other MSM and may benefit from prevention efforts that address the needs of younger men.
Collapse
Affiliation(s)
- Cyprian Wejnert
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Kristen L Hess
- Oak Ridge Institute for Science and Education, Atlanta, Georgia
| | - Charles E Rose
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Alexandra Balaji
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Justin C Smith
- Oak Ridge Institute for Science and Education, Atlanta, Georgia
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | | |
Collapse
|
45
|
Glick SN, Houston E, Peterson J, Kuo I, Magnus M. Understanding Engagement in HIV Risk and Prevention Research Among Black Young Men Who Have Sex with Men and Transgender Women in the District of Columbia. LGBT Health 2015; 3:308-13. [PMID: 26651365 DOI: 10.1089/lgbt.2015.0047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To develop optimal methods to study sexual health among black young men who have sex with men and transgender women (BYMSM/TW). METHODS We conducted a mixed-methods prospective study to identify recruitment and retention strategies for BYMSM/TW (age 16-21) in Washington D.C., and describe HIV risk behaviors and context. RESULTS Incentivized peer referral was highly productive, and 60% of BYMSM/TW were retained for 3 months. Participants reported high levels of sexual risk, homophobia, racism, and maternal support. CONCLUSION BYMSM/TW studies should utilize a combination of peer-based, in-person, and technology-based recruiting strategies. Additional research is needed to leverage mobile technology and social media to enhance retention.
Collapse
Affiliation(s)
- Sara Nelson Glick
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University , Washington, District of Columbia
| | - Ebony Houston
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University , Washington, District of Columbia
| | - James Peterson
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University , Washington, District of Columbia
| | - Irene Kuo
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University , Washington, District of Columbia
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University , Washington, District of Columbia
| |
Collapse
|
46
|
Hoots BE, Finlayson TJ, Wejnert C, Paz-Bailey G. Early Linkage to HIV Care and Antiretroviral Treatment among Men Who Have Sex with Men--20 Cities, United States, 2008 and 2011. PLoS One 2015; 10:e0132962. [PMID: 26176856 PMCID: PMC4503664 DOI: 10.1371/journal.pone.0132962] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/20/2015] [Indexed: 11/23/2022] Open
Abstract
Early linkage to care and antiretroviral (ARV) treatment are associated with reduced HIV transmission. Male-to-male sexual contact represents the largest HIV transmission category in the United States; men who have sex with men (MSM) are an important focus of care and treatment efforts. With the release of the National HIV/AIDS Strategy and expanded HIV treatment guidelines, increases in early linkage to care and ARV treatment are expected. We examined differences in prevalence of early linkage to care and ARV treatment among HIV-positive MSM between 2008 and 2011. Data are from the National HIV Behavioral Surveillance System, which monitors behaviors among populations at high risk of HIV infection in 20 U.S. cities with high AIDS burden. MSM were recruited through venue-based, time-space sampling. Prevalence ratios comparing 2011 to 2008 were estimated using linear mixed models. Early linkage was defined as an HIV clinic visit within 3 months of diagnosis. ARV treatment was defined as use at interview. Prevalence of early linkage to care was 79% (187/236) in 2008 and 83% (241/291) in 2011. In multivariable analysis, prevalence of early linkage did not differ significantly between years overall (P = 0.44). Prevalence of ARV treatment was 69% (790/1,142) in 2008 and 79% (1,049/1,336) in 2001. In multivariable analysis, ARV treatment increased overall (P = 0.0003) and among most sub-groups. Black MSM were less likely than white MSM to report ARV treatment (P = 0.01). While early linkage to care did not increase significantly between 2008 and 2011, ARV treatment increased among most sub-groups. Progress is being made in getting MSM on HIV treatment, but more efforts are needed to decrease disparities in ARV coverage.
Collapse
Affiliation(s)
- Brooke E. Hoots
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Teresa J. Finlayson
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Cyprian Wejnert
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - 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, Georgia, United States of America
| | | |
Collapse
|
47
|
Saunders P, Goodman AL, Smith CJ, Marshall N, O'Connor JL, Lampe FC, Johnson MA. Does gender or mode of HIV acquisition affect virological response to modern antiretroviral therapy (ART)? HIV Med 2015; 17:18-27. [PMID: 26140659 DOI: 10.1111/hiv.12272] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Previous UK studies have reported disparities in HIV treatment outcomes for women. We investigated whether these differences persist in the modern antiretroviral treatment (ART) era. METHODS A single-centre cohort analysis was carried out. We included in the study all previously ART-naïve individuals at our clinic starting triple ART from 1 January 2006 onwards with at least one follow-up viral load (VL). Time to viral suppression (VS; first viral load < 50 HIV-1 RNA copies/mL), virological failure (VF; first of two consecutive VLs > 200 copies/mL more than 6 months post-ART) and treatment modification were estimated using standard survival methods. RESULTS Of 1086 individuals, 563 (52%) were men whose risk for HIV acquisition was sex with other men (MSM), 207 (19%) were men whose risk for HIV acquisition was sex with women (MSW) and 316 (29%) were women. Median pre-ART CD4 count and time since HIV diagnosis in these groups were 298, 215 and 219 cells/μL, and 2.3, 0.3 and 0.3 years, respectively. Time to VS was comparable between groups, but women [adjusted hazard ratio (aHR) 2.32; 95% confidence interval (CI) 1.28-4.22] and MSW (aHR 3.28; 95% CI 1.91-5.64) were at considerably higher risk of VF than MSM. Treatment switches and complete discontinuation were also more common among MSW [aHR 1.38 (95% CI 1.04-1.81) and aHR 1.73 (95% CI 0.97-3.16), respectively] and women [aHR 1.87 (95% CI 1.43-2.46) and aHR 3.20 (95% CI 2.03-5.03), respectively] than MSM. CONCLUSIONS Although response rates were good in all groups, poorer virological outcomes for women and MSW have persisted into the modern ART era. Factors that might influence the differences include socioeconomic status and mental health disorders. Further interventions to ensure excellent response rates in women and MSW are required.
Collapse
Affiliation(s)
- P Saunders
- Royal Free London NHS Foundation Trust, London, UK
| | - A L Goodman
- Royal Free London NHS Foundation Trust, London, UK.,Department of Infection and Immunity, University College London, London, UK
| | - C J Smith
- Research Department of Infection and Population Health, University College London, London, UK
| | - N Marshall
- Royal Free London NHS Foundation Trust, London, UK
| | - J L O'Connor
- Research Department of Infection and Population Health, University College London, London, UK
| | - F C Lampe
- Research Department of Infection and Population Health, University College London, London, UK
| | - M A Johnson
- Royal Free London NHS Foundation Trust, London, UK
| |
Collapse
|
48
|
Individual and community factors associated with geographic clusters of poor HIV care retention and poor viral suppression. J Acquir Immune Defic Syndr 2015; 69 Suppl 1:S37-43. [PMID: 25867777 DOI: 10.1097/qai.0000000000000587] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Previous analyses identified specific geographic areas in Philadelphia (hotspots) associated with negative outcomes along the HIV care continuum. We examined individual and community factors associated with residing in these hotspots. METHODS Retrospective cohort of 1404 persons newly diagnosed with HIV in 2008-2009 followed for 24 months after linkage to care. Multivariable regression examined associations between individual (age, sex, race/ethnicity, HIV transmission risk, and insurance status) and community (economic deprivation, distance to care, access to public transit, and access to pharmacy services) factors and the outcomes: residence in a hotspot associated with poor retention-in-care and residence in a hotspot associated with poor viral suppression. RESULTS In total, 24.4% and 13.7% of persons resided in hotspots associated with poor retention and poor viral suppression, respectively. For persons residing in poor retention hotspots, 28.3% were retained in care compared with 40.4% of those residing outside hotspots (P < 0.05). Similarly, for persons residing in poor viral suppression hotspots, 51.4% achieved viral suppression compared with 75.3% of those outside hotspots (P < 0.0.05). Factors significantly associated with residence in poor retention hotspots included female sex, lower economic deprivation, greater access to public transit, shorter distance to medical care, and longer distance to pharmacies. Factors significantly associated with residence in poor viral suppression hotspots included female sex, higher economic deprivation, and shorter distance to pharmacies. CONCLUSIONS Individual and community-level associations with geographic hotspots may inform both content and delivery strategies for interventions designed to improve retention-in-care and viral suppression.
Collapse
|
49
|
Using Surveillance Data to Assess the HIV Tipping Point in the United States. J Acquir Immune Defic Syndr 2015; 69:e82-4. [PMID: 25647526 DOI: 10.1097/qai.0000000000000564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
50
|
Maulsby C, Jain K, Sifakis F, German D, Flynn CP, Holtgrave D. Individual-Level and Partner-Level Predictors of Newly Diagnosed HIV Infection Among Black and White Men Who Have Sex with Men in Baltimore, MD. AIDS Behav 2015; 19:909-17. [PMID: 25092514 DOI: 10.1007/s10461-014-0861-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Black MSM continue to be the group most disproportionately impacted by HIV in the United States. This study assesses the relationship between partner-level and respondent-level characteristics and newly diagnosed HIV infection among a sample of MSM. Ego-centric data were gathered using venue-based time-space sampling on 335 men who reported on a total of 831 male anal sex partners. In multivariate analyses, age of partner, HIV status of partner, and respondent having had an STD in the past twelve months were associated with a newly diagnosed HIV infection among black MSM. Efforts for black MSM are needed that aim to increase HIV and STD testing, foster open communication between partners about HIV status, and address social determinants of health.
Collapse
Affiliation(s)
- Cathy Maulsby
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,
| | | | | | | | | | | |
Collapse
|