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Wille L, Caporale-Berkowitz N, Woznicki N, Carmona Y, Parent MC. Cisgender Sexual Minority Women's Interest in Telemental Health Services: A Latent Class Analysis. Telemed J E Health 2024. [PMID: 39185555 DOI: 10.1089/tmj.2024.0230] [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: 08/27/2024] Open
Abstract
Introduction: Telemental health is increasingly recognized for its potential to overcome barriers like cost and stigma, particularly for marginalized groups. Sexual minority women in particular may benefit from increased access to telemental health services, due to the unique health disparities faced by this population. However, very little research thus far has assessed the telemental health preferences of this group. Methods: The present study surveyed 1,092 cisgender sexual minority women regarding their demographic information, mental health, and telemental health preferences, using the Prolific.co research platform. Latent class analysis was conducted to identify subgroups within the sample based on their responses to the survey. Results: Results revealed diverse attitudes toward telemental health, with some that prefer in-person sessions, whereas others show a strong interest in virtual options. Latent class analysis identified five groups, termed the Neutral, Ambivalent, Inclined, Inclined Related to Travel, and Averse groups. There were statistically significant differences between groups on measures of rurality, socioeconomic status, previous therapy experience, and symptoms of depression and anxiety. Overall, sexual minority women demonstrated interest in telemental health, especially individuals with mobility challenges and those living in rural areas. Conclusion: This study underscores the importance of tailoring mental health services to diverse needs and suggests that telemental health could be a valuable tool in addressing health disparities among sexual minority women. Importantly, these data were conducted prior to the COVID-19 pandemic. Further research could examine how sexual minority women's attitudes toward telemental health have shifted since the COVID-19 pandemic and how telemental health services could be tailored for marginalized subgroups.
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Affiliation(s)
- Lexie Wille
- Counseling Psychology Program, Department of Educational Psychology, The University of Texas at Austin, Austin, Texas, USA
| | | | - Nate Woznicki
- Human Development, Culture, & Learning Sciences, Department of Educational Psychology, The University of Texas at Austin, Austin, Texas, USA
| | - Yaritza Carmona
- Counseling Psychology Program, Department of Educational Psychology, The University of Texas at Austin, Austin, Texas, USA
| | - Mike C Parent
- Counseling Psychology Program, Department of Educational Psychology, The University of Texas at Austin, Austin, Texas, USA
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Shrader CH, Craker L, Johnson AL, Rodriguez E, Skvoretz J, Self KJ, Kanamori M. Peer Influence on Motivation to Use Pre-Exposure Prophylaxis Among Latino Sexual Minority Men in Miami, Florida: A Network Autocorrelation Model. AIDS Patient Care STDS 2024; 38:370-379. [PMID: 39158979 DOI: 10.1089/apc.2024.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024] Open
Abstract
Despite the availability of pre-exposure prophylaxis (PrEP), Latino sexual minority men (LSMM) continue to experience disparities in PrEP uptake and subsequently, HIV vulnerability. Social network norms are an underutilized solution to increase PrEP uptake. We used a peer influence model (network autocorrelation model) to examine the role of social network descriptive norms (i.e., actual behaviors) surrounding PrEP use. A total of 11 sociocentric networks of 13 friends (n = 143 LSMM) were recruited into our study from 2018 to 2019 in South Florida. Most participants were in PrEP pre-contemplation (n = 44), and almost one-third of our sample were using PrEP (n = 38). Three network autocorrelation models were estimated using an empirically informed Bayesian analysis. We found a positive association between participants' Motivational PrEP Cascade (MPC) position and their network members' (friends') cascade position based on three different measures of connection even when accounting for PrEP knowledge: friendship (ρ = 0.22; 95% CIa = 0.01-0.42), emotional closeness (ρ = 0.24; 95% CI = 0.03-0.44), and frequency of interaction (ρ = 0.22; CI = 0.03-0.42). Our findings highlight that an individual's progress in the MPC may be influenced by their network members' progress in the MPC, suggesting that LSMM using PrEP may serve as role models to their peers for PrEP use due to descriptive norms. Our findings further suggest that PrEP interventions for LSMM along the MPC can be implemented at the social network level.
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Affiliation(s)
- Cho Hee Shrader
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Lacey Craker
- Department of Public Health Science, School of Medicine, University of Miami Miller, Miami, Florida, USA
| | - Ariana L Johnson
- Department of Public Health Science, School of Medicine, University of Miami Miller, Miami, Florida, USA
| | - Edda Rodriguez
- Department of Public Health Science, School of Medicine, University of Miami Miller, Miami, Florida, USA
| | - John Skvoretz
- Department of Sociology, University of South Florida, Tampa, Florida, USA
| | - Kyle J Self
- Department of Educational and Psychological Studies, University of Miami, Miami, Florida, USA
| | - Mariano Kanamori
- Department of Public Health Science, School of Medicine, University of Miami Miller, Miami, Florida, USA
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3
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Lelutiu-Weinberger C, Filimon ML, Zavodszky AM, Lixandru M, Hanu L, Fierbinteanu C, Patrascu R, Streinu-Cercel A, Luculescu S, Bora M, Filipescu I, Jianu C, Heightow-Weidman LB, Rochelle A, Yi B, Buckner N, Golub SA, van Dyk IS, Burger J, Li F, Pachankis JE. Prepare Romania: study protocol for a randomized controlled trial of an intervention to promote pre-exposure prophylaxis adherence and persistence among gay, bisexual, and other men who have sex with men. Trials 2024; 25:470. [PMID: 38987812 PMCID: PMC11238350 DOI: 10.1186/s13063-024-08313-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 07/03/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (GBMSM) represent a high-risk group for HIV transmission in Romania, yet they possess few resources for prevention. Despite having no formal access to pre-exposure prophylaxis (PrEP) through the health system, GBMSM in Romania demonstrate a high need for and interest in this medication. In anticipation of a national rollout of PrEP, this study tests the efficacy of a novel strategy, Prepare Romania, that combines two evidence-based PrEP promotion interventions for GBMSM living in Romania. METHODS This study uses a randomized controlled trial design to examine whether GBMSM living in Romania receiving Prepare Romania, a culturally adapted counseling and mobile health intervention (expected n = 60), demonstrate greater PrEP adherence and persistence than those assigned to a PrEP education control arm (expected n = 60). Participants from two main cities in Romania are prescribed PrEP and followed-up at 3 and 6 months post-randomization. PrEP adherence data are obtained through weekly self-report surveys and dried blood spot testing at follow-up visits. Potential mediators (e.g., PrEP use motivation) of intervention efficacy are also assessed. Furthermore, Prepare Romania's implementation (e.g., proportion of enrolled participants attending medical visits, intervention experience) will be examined through interviews with participants, study implementers, and healthcare officials. DISCUSSION The knowledge gained from this study will be utilized for further refinement and scale-up of Prepare Romania for a future multi-city effectiveness trial. By studying the efficacy of tools to support PrEP adherence and persistence, this research has the potential to lay the groundwork for PrEP rollout in Romania and similar contexts. Trial registration This study was registered on ClinicalTrials.gov, identifier NCT05323123 , on March 25, 2022.
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Affiliation(s)
| | - Mircea L Filimon
- School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, USA
| | - Anna M Zavodszky
- School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, USA
| | - Mihai Lixandru
- The Romanian Association Against AIDS, Bulevardul Eroilor Sanitari 49, 050471, Bucharest, Romania
| | - Lucian Hanu
- The Romanian Association Against AIDS, Bulevardul Eroilor Sanitari 49, 050471, Bucharest, Romania
| | - Cristina Fierbinteanu
- The Romanian Association Against AIDS, Bulevardul Eroilor Sanitari 49, 050471, Bucharest, Romania
| | - Raluca Patrascu
- The National Institute of Infectious Diseases "Professor Dr. Matei Bals", Strada Doctor Calistrat Grozovici 1, 021105, Bucharest, Romania
| | - Adrian Streinu-Cercel
- The National Institute of Infectious Diseases "Professor Dr. Matei Bals", Strada Doctor Calistrat Grozovici 1, 021105, Bucharest, Romania
| | - Sergiu Luculescu
- The Romanian Association Against AIDS, Bulevardul Eroilor Sanitari 49, 050471, Bucharest, Romania
| | - Maria Bora
- The Clinical Hospital of Infectious Diseases, Str. Iuliu Moldovan, nr. 23, 400000, Cluj-Napoca, Romania
| | - Irina Filipescu
- The Clinical Hospital of Infectious Diseases, Str. Iuliu Moldovan, nr. 23, 400000, Cluj-Napoca, Romania
| | - Cristian Jianu
- The Clinical Hospital of Infectious Diseases, Str. Iuliu Moldovan, nr. 23, 400000, Cluj-Napoca, Romania
| | | | - Aimee Rochelle
- College of Nursing, Florida State University, 98 Varsity Way, Tallahassee, FL, 32305, USA
| | - Brian Yi
- One Cow Standing, 300 W Morgan St Ste 1425, Durham, NC, 27701, USA
| | - Nickie Buckner
- One Cow Standing, 300 W Morgan St Ste 1425, Durham, NC, 27701, USA
| | - Sarit A Golub
- Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, 10065, NY, USA
| | - Ilana Seager van Dyk
- School of Psychology, Massey University, PO Box 756, Wellington, 6140, New Zealand
| | - Julian Burger
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, 06610, USA
| | - Fan Li
- Department of Biostatistics, Yale School of Public Health, 60 College Street, New Haven, CT, 06520, USA
- Social and Behavioral Sciences, Yale School of Public Health, 135 College Street, New Haven, 06520, CT, USA
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, 06610, USA
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4
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Brooks RA, Nieto O, Rosenberg-Carlson E, Morales K, Üsküp DK, Santillan M, Inzunza Z. Barriers and Facilitators to Accessing PrEP and Other Sexual Health Services Among Immigrant Latino Men Who Have Sex with Men in Los Angeles County. ARCHIVES OF SEXUAL BEHAVIOR 2024:10.1007/s10508-024-02928-z. [PMID: 38977534 DOI: 10.1007/s10508-024-02928-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 07/10/2024]
Abstract
In the United States, immigrant Latino men who have sex with men (ILMSM) are, compared to white MSM, disproportionately burdened by HIV and lack access to highly effective HIV prevention strategies, such as pre-exposure prophylaxis (PrEP). Qualitative research centered on exploring barriers that ILMSM experience in accessing PrEP and other sexual services is extremely limited, despite a high prevalence of HIV in this population. In this study, a purposive sample of ILMSM (n = 25) was recruited to participate in a semi-structured in-depth interview to identify the distinct barriers and facilitators ILMSM experience in accessing sexual health services given their complex intersectional identities of being an immigrant, Latino, and a sexual minority man. Using a thematic analysis approach, nine themes were generated from the data representing barriers and facilitators. Barriers included: (1) cost and a lack of health insurance, (2) complexity of PrEP assistance programs; (3) challenges related to the immigrant experience; (4) impact of gay stigma; and (5) communication challenges. Facilitators included: (1) improving affordability and accessibility of PrEP services; (2) receiving services from LGBT- or Latine LGBT-centered clinics; (3) receiving services from medical providers who are gay and/or Latino; and (4) providing targeted community outreach, education, and promotion of PrEP to ILMSM. While many of the barriers illuminated in the study were structural (e.g., cost and lack of health insurance), and not easy to overcome, the findings highlight a range of facilitators that can support access to PrEP and other sexual health services for ILMSM. Considering these findings, we suggest strategies that may enhance access to needed sexual health services among ILMSM.
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Affiliation(s)
- Ronald A Brooks
- Department of Family Medicine, University of California, Los Angeles, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA, 90024, USA.
- Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles, Los Angeles, CA, USA.
- Department of Research and Evaluation, Bienestar Human Services, Los Angeles, CA, USA.
| | - Omar Nieto
- Department of Family Medicine, University of California, Los Angeles, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA, 90024, USA
| | - Elena Rosenberg-Carlson
- Department of Family Medicine, University of California, Los Angeles, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA, 90024, USA
- Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles, Los Angeles, CA, USA
| | - Katherine Morales
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Dilara K Üsküp
- Department of Family Medicine, University of California, Los Angeles, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA, 90024, USA
- Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
- UCLA-CDU Center for AIDS Research, Los Angeles, CA, USA
| | - Martin Santillan
- Department of Research and Evaluation, Bienestar Human Services, Los Angeles, CA, USA
| | - Zurisadai Inzunza
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
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Seyedroudbari S, Ghadimi F, Grady G, Uzosike O, Nkwihoreze H, Jemmott JB, Momplaisir F. Assessing Structural Racism and Discrimination Along the Pre-exposure Prophylaxis Continuum: A Systematic Review. AIDS Behav 2024:10.1007/s10461-024-04387-y. [PMID: 38851649 DOI: 10.1007/s10461-024-04387-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/10/2024]
Abstract
Structural racism and discrimination (SRD) is deeply embedded across U.S. healthcare institutions, but its impact on health outcomes is challenging to assess. The purpose of this systematic literature review is to understand the impact of SRD on pre-exposure prophylaxis (PrEP) care continuum outcomes across U.S. populations who could benefit from HIV prevention. Guided by PRISMA guidelines, we conducted a systematic review of the published literature up to September 2023 using PubMed and PsycInfo and included peer-reviewed articles meeting inclusion criteria. At least two authors independently screened studies, performed quality assessments, and abstracted data relevant to the topic. Exposure variables included race/ethnicity and any level of SRD (interpersonal, intra- and extra-organizational SRD). Outcomes consisted of any steps of the PrEP care continuum. A total of 66 studies met inclusion criteria and demonstrated the negative impact of SRD on the PrEP care continuum. At the interpersonal level, medical mistrust (i.e., lack of trust in medical organizations and professionals rooted from current or historical practices of discrimination) was negatively associated with almost all the steps across the PrEP care continuum: individuals with medical mistrust were less likely to have PrEP knowledge, adhere to PrEP care, and be retained in care. At the intra-organizational level, PrEP prescription was lower for Black patients due to healthcare provider perception of higher sex-risk behaviors. At the extra-organizational level, factors such as homelessness, low socioeconomic status, and incarceration were associated with decreased PrEP uptake. On the other hand, healthcare provider trust, higher patient education, and access to health insurance were associated with increased PrEP use and retention in care. In addition, analyses using race/ethnicity as an exposure did not consistently show associations with PrEP continuum outcomes. We found that SRD has a negative impact at all steps of the PrEP care continuum. Our results suggest that when assessing the effects of race/ethnicity without the context of SRD, certain relationships and associations are missed. Addressing multi-level barriers related to SRD are needed to reduce HIV transmission and promote health equity.
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Affiliation(s)
| | - Fatemeh Ghadimi
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Hervette Nkwihoreze
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John B Jemmott
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Florence Momplaisir
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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6
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Carter-Davis J, Seymour E. Biomedical Approaches and Disparities in HIV Prevention. Nurs Clin North Am 2024; 59:289-296. [PMID: 38670695 DOI: 10.1016/j.cnur.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Human immunodeficiency virus (HIV) remains a significant public concern, with certain groups disproportionately impacted. Pre-exposure prophylaxis (PrEP) for HIV prevention was approved by the Food and Drug Administration in 2012. However, stark disparities persist in PrEP access and uptake, leaving those at highest risk of acquiring HIV without knowledge of, access to, and uptake of PrEP. Nurses play a key role in eliminating the causes of these disparities that occur at the individual, provider, and systemic level. It is imperative that we increase PrEP knowledge, access, and use, especially in groups most at risk for acquiring HIV.
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Affiliation(s)
- Jared Carter-Davis
- Division of Infectious Diseases, East Carolina University, ECU Adult Specialty Care, 2390 Hemby Lane, Greenville, NC 27834, USA.
| | - Ellen Seymour
- Access Community Health Network, 5401 South Wentworth Avenue, Chicago, IL 60609, USA
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7
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King H, Thornton N, Evans KN, Tadfor Y, German D, Flynn C, Jennings J, Fields EL. Factors Associated with the Awareness of and Willingness to Use HIV Pre-exposure Prophylaxis Among Gay, Bisexual, and Other Men Who Have Sex with Men, Baltimore, MD, 2017-2019. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01954-w. [PMID: 38436888 DOI: 10.1007/s40615-024-01954-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024]
Abstract
Pre-exposure prophylaxis (PrEP) is an effective tool in protecting persons from acquiring HIV infection through sex or injection drug use. However, awareness and willingness to use PrEP among Black gay, bisexual, and other men who have sex with men (BMSM) remain suboptimal compared to White MSM (WMSM) in the United States. Our aims were to (1) assess the factors associated with PrEP awareness and willingness to use PrEP among MSM and (2) compare the PrEP perceptions among BMSM versus non-Black MSM. Data were drawn from two cross-sectional behavioral surveys in Baltimore, MD: Behavioral Surveillance Research (BESURE) conducted in 2017, and Safe Spaces 4 Sexual Health (SS4SH), conducted in 2018 and 2019. Descriptive statistics were used to summarize the study population. We used Poisson regression models to identify variables associated with awareness of PrEP and willingness to use PrEP. PrEP perceptions were assessed via 13 items scored on a 5-point Likert scale. Finally, we conducted a post-hoc exploratory bivariate analysis of the relationship between PrEP perception and willingness to use PrEP, stratified by race/ethnicity. A total of 261 MSM participated in this study. Many of the participants were aware of PrEP (75.1%). Factors associated with greater PrEP awareness included having greater than a high school education (aRR 1.22, 95% CI 1.04, 1.43); and earning more than $25,000 annually (aRR 1.24, 95% CI 1.08, 1.42). Participants who had received money in exchange for sex one or more times were less likely to be aware of PrEP (aRR 0.59, 95% CI 0.36, 0.95). More than half of the participants were willing to use PrEP (55.3%). In bivariate and multivariable analyses, demographic or behavioral characteristics were not significantly associated with willingness to use PrEP. Higher agreement with the following statements was associated with lower willingness to use PrEP: "Having to take a pill every day is difficult" (RR 0.89, 95% CI 0.82-0.97) and, "I am concerned about the side effects of PrEP" (RR 0.89, 95% CI 0.82-0.96), and "PrEP is for people who have riskier sex lives than I do" (RR 0.86, 95% CI 0.78-0.95). Conversely, higher willingness to use PrEP was associated with comfortable having sex without a condom (RR 1.11, 95% CI 1.02-1.21), less anxious about sex (RR 1.12, 95% CI 1.02-1.24), and my friends think that I should take PrEP (RR 1.19, 95% CI 1.07-1.32). We found BMSM compared to non-Black MSM had higher mean scores related to taking a daily pill (p = 0.041), concerns about side effects (p = 0.012), concerns about people thinking they had HIV (p = 0.001), concerns about the financial costs of PrEP (p = 0.038) and caution when dealing with healthcare organizations/medical mistrust (p = 0.019). Perceptions with a statistically significant lower score among BMSM versus non-Black MSM included statements such as, comfortable having sex without a condom (p = 0.003) and less anxious about sex (p < 0.001). We conclude HIV prevention strategies, programs, and interventions should be cognizant of PrEP perceptions that facilitate or hinder PrEP uptake in Baltimore City, MD.
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Affiliation(s)
- Hope King
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, USA.
| | | | - Kimberly N Evans
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Yomi Tadfor
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Danielle German
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Colin Flynn
- Maryland Department of Health, Baltimore, USA
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8
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Walcott MM, Tieu HV, Tipre M, Nandi V, Davis A, Wu E, Wheatle M, Frye V, Figueroa JP. Factors associated with discussing HIV pre-exposure prophylaxis (PrEP) among Jamaican medical providers. Int J STD AIDS 2024; 35:188-196. [PMID: 37966358 DOI: 10.1177/09564624231201187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND The Ministry of Health and Wellness of Jamaica has endorsed the use of pre-exposure prophylaxis (PrEP) as an HIV prevention strategy; however, PrEP was not included in the national HIV prevention program in 2021. METHODS A cross-sectional online study involving physicians in Jamaica was conducted in 2021 to describe PrEP awareness, beliefs, attitudes, and practices. The study also assessed individual and social factors associated with discussing PrEP with patients and willingness to prescribe PrEP. FINDINGS The mean age and standard deviation (SD) of the 69 physicians who completed the survey were 45.5 ± 13.6 years. Most of the participants (80%) reported that they were somewhat familiar with PrEP. PrEP attitude and perceived comfort in prescribing PrEP were moderate among participating physicians, with a mean and SD of 3.9 ± 0.8 and 3.6 ± 0.9 respectively. Six percent of physicians reported that they had prescribed PrEP and 17% had discussed PrEP with their patients in the past year. However, most (90%) reported that they were willing to prescribe PrEP after being informed about it. In the unadjusted model, identifying as Christian (compared to non-Christian) and reporting stronger homophobic beliefs were associated with reduced odds of discussing PrEP with patients. In the multivariable model, only homophobia remained statistically significant (OR, 0.24; 95% CI: 0.07-0.63). CONCLUSION The findings suggest that physicians in Jamacia may be willing to prescribe PrEP; however, homophobia is a barrier to discussions, underscoring the need for the Ministry of Health and Wellness to recognize the role that homophobia plays in the national HIV program to further reduce HIV incidence in Jamaica.
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Affiliation(s)
- Melonie M Walcott
- School of Public Health, University at Albany, Rensselaer, New York, USA
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
| | - Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Meghan Tipre
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vijay Nandi
- Laboratory of Data Analytics, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
| | - Alissa Davis
- Social Intervention Group, Columbia School of Social Work, New York, NY, USA
| | - Elwin Wu
- Social Intervention Group, Columbia School of Social Work, New York, NY, USA
| | | | - Victoria Frye
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
- Community Health and Social Medicine (CSOM), City University of New York, New York, NY, USA
| | - J Peter Figueroa
- Department of Columbia, University School of Social Work, New York, NY, USA
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9
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Mustanski B, Queiroz A, Merle JL, Zamantakis A, Zapata JP, Li DH, Benbow N, Pyra M, Smith JD. A Systematic Review of Implementation Research on Determinants and Strategies of Effective HIV Interventions for Men Who Have Sex with Men in the United States. Annu Rev Psychol 2024; 75:55-85. [PMID: 37722749 PMCID: PMC10872355 DOI: 10.1146/annurev-psych-032620-035725] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Men who have sex with men (MSM) are disproportionately affected by HIV, accounting for two-thirds of HIV cases in the United States despite representing ∼5% of the adult population. Delivery and use of existing and highly effective HIV prevention and treatment strategies remain suboptimal among MSM. To summarize the state of the science, we systematically review implementation determinants and strategies of HIV-related health interventions using implementation science frameworks. Research on implementation barriers has focused predominantly on characteristics of individual recipients (e.g., ethnicity, age, drug use) and less so on deliverers (e.g., nurses, physicians), with little focus on system-level factors. Similarly, most strategies target recipients to influence their uptake and adherence, rather than improving and supporting implementation systems. HIV implementation research is burgeoning; future research is needed to broaden the examination of barriers at the provider and system levels, as well as expand knowledge on how to match strategies to barriers-particularly to address stigma. Collaboration and coordination among federal, state, and local public health agencies; community-based organizations; health care providers; and scientists are important for successful implementation of HIV-related health innovations.
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Affiliation(s)
- Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Third Coast Center for AIDS Research, Chicago, Illinois, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Artur Queiroz
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - James L Merle
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Alithia Zamantakis
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Juan Pablo Zapata
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Dennis H Li
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Third Coast Center for AIDS Research, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nanette Benbow
- Third Coast Center for AIDS Research, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Maria Pyra
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
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10
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Greenwell K, Fugit R, Nicholson L, Wright J. A Retrospective Comparison of HIV Pre-exposure Prophylaxis (PrEP) Outcomes Between a Pharmacist-led Telehealth Clinic and In-person Clinic in a Veteran Population. AIDS Behav 2023; 27:3678-3686. [PMID: 37247044 PMCID: PMC10226437 DOI: 10.1007/s10461-023-04084-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 05/30/2023]
Abstract
Pre-exposure prophylaxis (PrEP) reduces human immunodeficiency virus (HIV) transmission through sexual contact by at least 90% when taken as prescribed. This retrospective cohort study evaluated differences in adherence to PrEP medication and monitoring between the physician- and nurse practitioner (NP)-led in-person setting and the pharmacist-led telehealth setting among patients followed by the infectious diseases clinic at the VA Eastern Colorado Health Care System from July 2012 to February 2021. The primary outcomes were PrEP tablets filled per person-year, serum creatinine (SCr) tests per person-year, and HIV screens per person-year. Secondary outcomes included sexually transmitted infection (STI) screens per person-year and patients lost to follow-up.149 patients were included in the study, with 167 person-years in the in-person cohort and 153 person-years in the telehealth cohort. Adherence to PrEP medications and monitoring was similar between in-person and telehealth clinics. PrEP tablets filled per person-year was 324 in the in-person cohort and 321 in the telehealth cohort (RR = 0.99; 95% CI, 0.98-1.00). SCr screens per person-year was 3.51 in the in-person cohort and 3.37 in the telehealth cohort (RR = 0.96; 95% CI, 0.85-1.07). HIV screens per person-year was 3.55 in the in-person cohort and 3.38 in the telehealth cohort (RR = 0.95; 95% CI, 0.85-1.07). There were no new HIV infections. Additionally, patients were less likely to be lost to follow-up when followed via telehealth (11.9% vs. 30.0%), Χ2 (1, N = 149) = 6.85, p = 0.009. These findings indicate that pharmacist-driven delivery of PrEP via telehealth can be used to increase access to PrEP without sacrificing quality of care.
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Affiliation(s)
- Kellen Greenwell
- Department of Pharmacy, VA Eastern Colorado Health Care System, 1700 N Wheeling St, Aurora, CO, 80045, USA
| | - Randolph Fugit
- Department of Pharmacy, VA Eastern Colorado Health Care System, 1700 N Wheeling St, Aurora, CO, 80045, USA
| | - Lindsay Nicholson
- Department of Medicine, Division of Infectious Diseases, VA Eastern Colorado Health Care System, 1700 N Wheeling St, Aurora, CO, 80045, USA
| | - Jason Wright
- Department of Pharmacy, VA Eastern Colorado Health Care System, 1700 N Wheeling St, Aurora, CO, 80045, USA.
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11
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Riley T, Anaya G, Gallegos PA, Castaneda R, Khosropour CM. Pre-exposure Prophylaxis Use and Discontinuation in a Federally Qualified Health Center in a Mexico-US Border City. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01807-y. [PMID: 37787944 DOI: 10.1007/s40615-023-01807-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Latino men who have sex with men (MSM) experience disproportionately high rates of HIV diagnoses in the United States. Pre-exposure prophylaxis (PrEP) use is critical to reduce this inequity, but PrEP awareness, access, and use are low among Latino MSM. This study aims to describe patterns of PrEP persistence and discontinuation among predominately Latino MSM accessing PrEP in a federally qualified health center (FQHC) in El Paso, Texas. METHODS This retrospective cohort comprised individuals who were eligible for PrEP at a FQHC in El Paso, Texas, between January 30, 2019, and August 15, 2021. We defined hierarchical categories of PrEP use and discontinuation, which was defined as more than 120 days between PrEP visits. We used Kaplan-Meier survival plots to estimate median time to first PrEP discontinuation. RESULTS There were 292 patients evaluated for PrEP; 91% were Latino. The majority of PrEP patients (70%, 205/292) experienced any PrEP discontinuation, and the median time to first PrEP discontinuation was 202 days (95% CI: 179-266). The proportion of patients who remained on PrEP at 3 months after initiation was 82% (95% CI: 76%, 87%) and at 6 months after initiation was 55% (95% CI: 46%, 62%). CONCLUSION While 3-month PrEP retention was high in this predominately Latino MSM patient population, PrEP discontinuation was common. Interventions that enhance longer-term persistence and support for restarting PrEP are needed to reduce the persistent ethnoracial disparities in HIV incidence.
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Affiliation(s)
- Taylor Riley
- School of Public Health, Department of Epidemiology, Hans Rosling Center for Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA.
| | | | | | | | - Christine M Khosropour
- School of Public Health, Department of Epidemiology, Hans Rosling Center for Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
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12
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Tao J, Sosnowy C, Arnold T, Kapadia J, Parent H, Rogers BG, Almonte A, Chan PA. Perspectives of a peer-driven approach to improve pre-exposure prophylaxis and HIV prevention among Black/African American and Hispanic/Latino men who have sex with men. Sex Health 2023; 20:453-460. [PMID: 37532286 PMCID: PMC10902904 DOI: 10.1071/sh23072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/11/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Black/African American (B/AA) and Hispanic/Latino (H/L) men who have sex with men (MSM) are significantly less likely than white MSM to initiate pre-exposure prophylaxis (PrEP). A peer-driven intervention (PDI) may be an effective approach to addressing this disparity. In this study, we explored community member perspectives of a PDI to promote PrEP uptake among B/AA and H/L MSM. METHODS We conducted semi-structured interviews with B/AA and H/L HIV-negative MSM between August 2018 and October 2019 in Rhode Island, USA. Participants reported their perspectives and recommendations for a PDI. Data from participant responses were thematically analysed. RESULTS Of 15 MSM, the median age was 25years (interquartile range: 22, 33). The majority identified as B/AA (53.3%), H/L (66.7%), and having a college education or above (53.3%). Most participants viewed a PDI positively and were willing to learn and promote PrEP among their peers. Participants identified and supported several potential intervention components, such as education about the benefit of PrEP, emphasising prevention-effective dosing, and clarifying no prevention effect towards other sexually transmitted infections. They preferred in-person meetings to electronic communication. Preferred characteristics of peer educators included compassion, good communication skills, and enthusiasm about PrEP. CONCLUSIONS This in-depth qualitative interview suggested that a PDI approach is promising in promoting PrEP uptake, as it could deliver culturally appropriate education and encourage PrEP uptake via peer influence among B/AA and H/L MSM.
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Affiliation(s)
- Jun Tao
- Infectious Diseases, Brown University Warren Alpert Medical School, 593 Eddy Street, Providence, RI 02903
- Division of Infectious Diseases, The Miriam Hospital, 11 4th Street, Providence, RI 02906, USA
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912
| | - Collette Sosnowy
- Infectious Diseases, Brown University Warren Alpert Medical School, 593 Eddy Street, Providence, RI 02903
- Division of Infectious Diseases, The Miriam Hospital, 11 4th Street, Providence, RI 02906, USA
| | - Trisha Arnold
- Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, 345 Blackstone Blvd. Providence, RI 02906
| | - Jhanavi Kapadia
- Infectious Diseases, Brown University Warren Alpert Medical School, 593 Eddy Street, Providence, RI 02903
| | - Hannah Parent
- Division of Infectious Diseases, The Miriam Hospital, 11 4th Street, Providence, RI 02906, USA
| | - Brooke G. Rogers
- Infectious Diseases, Brown University Warren Alpert Medical School, 593 Eddy Street, Providence, RI 02903
- Division of Infectious Diseases, The Miriam Hospital, 11 4th Street, Providence, RI 02906, USA
| | - Alexi Almonte
- Division of Infectious Diseases, The Miriam Hospital, 11 4th Street, Providence, RI 02906, USA
| | - Philip A. Chan
- Infectious Diseases, Brown University Warren Alpert Medical School, 593 Eddy Street, Providence, RI 02903
- Division of Infectious Diseases, The Miriam Hospital, 11 4th Street, Providence, RI 02906, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 8 floor, 121 South Main Street, Providence, RI, 02912
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13
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Andrade EA, Stoukides G, Santoro AF, Karasz A, Arnsten J, Patel VV. Individual and Health System Factors for Uptake of Pre-exposure Prophylaxis Among Young Black and Latino Gay Men. J Gen Intern Med 2023; 38:2768-2774. [PMID: 37429976 PMCID: PMC10507000 DOI: 10.1007/s11606-023-08274-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/09/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Young Black and Latino men who have sex with men (YBLMSM) have the highest rates of new HIV infections in the USA and use PrEP at lower rates than White MSM. OBJECTIVE To explore YBLMSM's perspectives and experiences of PrEP use to identify factors enabling or impeding uptake. DESIGN Qualitative study using semi-structured interviews conducted between August 2015 and April 2016. PARTICIPANTS Black and Latino MSM, 18-20 years of age, who live, socialize, or work in the Bronx, and were fluent in English or Spanish. APPROACH We used a thematic analysis to identify themes related to not taking PrEP and PrEP uptake. KEY RESULTS Half the participants (n = 9) were currently using PrEP, a majority had Medicaid (n = 13), all reported having a PCP, all identified English as their primary language (n = 15), and all identified as gay. Salient themes included concerns over-side effects, stigma related to HIV and sexuality, mistrust of medical providers, provider's refusal to prescribe PrEP, and insurance and cost. CONCLUSIONS Modifiable barriers for PrEP uptake and persistence were reported by most participants, with an emphasis on PrEP misinformation and the pervasiveness of intersectional stigma, providers' low awareness, and hesitant attitudes towards PrEP and barriers created by insurance companies. Supportive infrastructures for PrEP providers and patients are needed.
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Affiliation(s)
- Elí A Andrade
- Division of General Internal Medicine, Montefiore Health System, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Georgianna Stoukides
- New York Institute of Technology College of Osteopathic Medicine, New York, NY, USA
| | - Anthony F Santoro
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, NY, USA
| | - Alison Karasz
- Chan Medical School, University of Massachusetts, North Worcester, MA, USA
| | - Julia Arnsten
- Division of General Internal Medicine, Montefiore Health System, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Viraj V Patel
- Division of General Internal Medicine, Montefiore Health System, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
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14
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Lozano A, Jaramillo J, Prado G, Safren SA, Harkness A. Barriers and facilitators to PrEP use and HIV testing for subgroups of Latino sexual minority men. AIDS Care 2023; 35:1329-1337. [PMID: 37232132 PMCID: PMC10524698 DOI: 10.1080/09540121.2023.2216009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/15/2023] [Indexed: 05/27/2023]
Abstract
Pre-exposure prophylaxis (PrEP) and HIV testing inadequately reach Latino sexual minority men (LSMM), fueling HIV disparities. This study identified determinants of LSMM's PrEP use and HIV testing and examined differences across subgroups (i.e., age and immigration history). First, we identified the most to least endorsed barriers and facilitators of PrEP use and HIV testing among LSMM (1) over vs. under 40 years old, and (2) across immigration histories (U.S. born, recent immigrant, established immigrant). Next, we examined differences in barrier/facilitator ratings across these age and immigration status groups. Key overall determinants were cost, knowledge, and perceived benefit/need. However, there was variation in determinants across age groups (i.e., cost, affordability, navigation support, and normalization) and immigration statuses (i.e., language, immigration concerns, and HIV knowledge). There were also differences across service types; mistrust and concerns was a barrier related to PrEP but not HIV testing. We found unique and common multilevel factors across prevention services and subgroups. Language, cost, and clinic/system issues are key barriers in accessing HIV prevention that should be considered when developing implementation strategies to enhance the reach of these services to LSMM.
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Affiliation(s)
- Alyssa Lozano
- Department of Public Health Sciences, University of Miami Miller School of Medicine, University of Miami, Miami, FL, USA, 33136
| | - Jahn Jaramillo
- Department of Public Health Sciences, University of Miami Miller School of Medicine, University of Miami, Miami, FL, USA, 33136
| | - Guillermo Prado
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL 33146
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, FL 33146
| | - Audrey Harkness
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL 33146
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15
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Eaton LA, Layland EA, Driver R, Kalichman SC, Kalichman MO, Watson RJ, Kalinowski J, Chandler CJ, Earnshaw VA. Novel Latent Profile Analysis of a Test of Concept, Stigma Intervention to Increase PrEP Uptake Among Black Sexual Minority Men. J Acquir Immune Defic Syndr 2023; 94:1-9. [PMID: 37195906 PMCID: PMC10524435 DOI: 10.1097/qai.0000000000003223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 03/07/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) has demonstrated efficacy for HIV prevention, yet uptake of PrEP among populations in urgent need of prevention tools (eg, Black sexual minority men) is limited, and stigma and medical mistrust remain strong barriers to accessing PrEP. PURPOSE To evaluate a test of concept brief intervention to address stigma and medical mistrust as barriers to PrEP uptake using novel latent profile analysis. METHODS Participants (N = 177) residing in the southeastern US were randomized to 1 of 4 arms to establish the potential impact of a brief, stigma focused counseling intervention (referred to as Jumpstart ) to increase PrEP uptake. We estimated intervention effect size (Cramer's V) for PrEP uptake and then explored differential intervention effects across latent profiles of psychosocial barriers to PrEP use. RESULTS The intervention resulted in small, but meaningful effect size, with self-reported PrEP uptake increasing across Jumpstart conditions with the control condition reporting 24% uptake and Jumpstart plus text/phone calls (the most intensive intervention arm) reporting 37% uptake, and a similar pattern emerging for biologically confirmed PrEP use. Among participants 30 and older, Jumpstart participants were more likely to move to a postintervention profile with fewer barriers than control participants and reported the highest uptake of PrEP. CONCLUSIONS Addressing social/emotional barriers to PrEP uptake is an essential component of bridging the gap between advances being made in biomedical forms of HIV prevention, and establishing and supporting access to those advances.
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Affiliation(s)
- Lisa A. Eaton
- Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Eric A. Layland
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Redd Driver
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | | | | | - Ryan J. Watson
- Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Jolaade Kalinowski
- Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Cristian J. Chandler
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
- Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
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16
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Harkness A, Lozano A, Bainter S, Mayo D, Hernandez Altamirano D, Rogers BG, Prado G, Safren SA. Engaging Latino sexual minority men in PrEP and behavioral health care: multilevel barriers, facilitators, and potential implementation strategies. J Behav Med 2023; 46:655-667. [PMID: 36472703 PMCID: PMC10442148 DOI: 10.1007/s10865-022-00371-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/05/2022] [Indexed: 12/12/2022]
Abstract
Latino sexual minority men (LSMM) are affected by HIV and behavioral health disparities. Evidence-based HIV-prevention and behavioral health (BH) services are not sufficiently scaled up to LSMM. The current study identified multilevel barriers and facilitators to LSMM's use of HIV-prevention and BH services. LSMM (N = 290) in South Florida, a US HIV epicenter, completed a battery of measures potentially associated with pre-exposure prophylaxis (PrEP) and BH treatment use. Stochastic search variable selection (SSVS) followed by multiple linear regression analyses identified variables associated with engagement in PrEP and BH treatment. Multilevel determinants of PrEP and BH treatment engagement were identified, with most identified determinants being at the relational level (e.g., stigma, discrimination based on income and immigration status, personal recommendation for treatment). Individual (e.g., knowledge, self-efficacy) and structural (e.g., financial stress) determinants were also identified. Accordingly, modifiable leverage points to enhance the reach of PrEP and BH treatment to LSMM include educating and enhancing the perceived relevance of services, de-stigmatizing and normalizing via peer examples, bolstering self-efficacy, and building trust.
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Affiliation(s)
- Audrey Harkness
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA.
| | - Alyssa Lozano
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Sierra Bainter
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Daniel Mayo
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Brooke G Rogers
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Guillermo Prado
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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17
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Ayangeakaa SD, Kerr J, Combs RM, Harris LM, Sears JS, Parker K, Sterrett-Hong E. Sociocultural and structural influences on HIV Pre-Exposure Prophylaxis (PrEP) Engagement and Uptake among African American Young adults. BMC Public Health 2023; 23:1427. [PMID: 37495954 PMCID: PMC10369814 DOI: 10.1186/s12889-023-16273-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/09/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) demonstrates effectiveness in decreasing new cases of HIV. However, few African Americans use PrEP, despite being disproportionately impacted by HIV. Understanding the influence of sociocultural and structural factors on PrEP use among multiple priority groups of African Americans, including but not limited to men who have sex with men, may improve PrEP engagement and uptake. The social ecological model (SEM) as a framework guided the understanding of how these factors operate on multiple levels to influence PrEP use among this population. METHODS This study derived data from the Afya PrEP study consisting of eleven focus groups (N = 63) with 18-29-year-old African American sexual and gender minority and heterosexual individuals at heightened behavioral vulnerability to HIV. We employed constructivist grounded theory processes to inductively analyze the data. A pooled kappa score of 0.90 indicated excellent inter-rater agreement. RESULTS Factors impacting PrEP engagement among African American young adults included: (1) Community/social network influences; (2) medical mistrust; (3) stigma; (4) PrEP availability and accessibility, which had two sub-categories: (a) cost and (b) where to obtain PrEP; and (5) PrEP engagement strategies, which had two sub-categories: (a) current AIDS service organizations' PrEP engagement practices and (b) recommended future PrEP engagement strategies. Categories one through three represent sociocultural factors, and categories four and five represent structural factors that influence perceptions and attitudes of African American young adults regarding PrEP. CONCLUSION Our study highlights sociocultural and structural factors that act as barriers and facilitators to PrEP engagement. The SEM guided the understanding of how these factors operated on multiple levels. One of the sociocultural factors, community/social network influences operated at the interpersonal level of the SEM; the other two, stigma and medical mistrust, operated at the community level. The structural factors (PrEP availability, accessibility, and engagement strategies) operated at the institutional/organizational level. Thus, multi-level interventions are warranted to improve PrEP engagement among various African American young adult priority groups.
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Affiliation(s)
- Suur D Ayangeakaa
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St. Durham, Durham, NC, 27701, USA.
- Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Jelani Kerr
- Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA
| | - Ryan M Combs
- Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA
| | - Lesley M Harris
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
| | - Jeanelle S Sears
- Department of Human Services, Bowling Green State University, Bowling Green, OH, USA
| | | | - Emma Sterrett-Hong
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
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18
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Gómez W. Assessing PrEP messaging and communication: A review of the qualitative literature. Curr Opin Psychol 2023; 51:101586. [PMID: 37247445 DOI: 10.1016/j.copsyc.2023.101586] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/04/2023] [Accepted: 04/27/2023] [Indexed: 05/31/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is a biomedical HIV prevention intervention approved by the FDA in 2012. Nevertheless, most sexual minority men (SMM) who could benefit from its use are not currently prescribed PrEP. The literature during the first decade of PrEP availability has suggested a diverse set of multi-level barriers and facilitators to PrEP uptake and adherence. Through a scoping review, 16 qualitative studies were surveyed to assess these barriers and facilitators, specifically regarding messaging and communication. Seven main themes were identified: information & misinformation, peer messaging, expansion of sexual experiences, relationships with providers, expectations & stigma, navigation support, and barriers to uptake & adherence. Data suggest that peer support, messaging around empowerment and agency, and PrEP's role in shifting sociosexual norms contributed to uptake and adherence. On the other hand, stigma, provider disconnection, and access issues hindered PrEP uptake and adherence. Findings could inform multi-level, strengths-based, and holistic approaches to designing effective interventions for PrEP engagement among SMM.
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Affiliation(s)
- Walter Gómez
- Jane Addams College of Social Work, University of Illinois Chicago, Chicago IL 1040 W Harrison St, #4220 Chicago, IL 60607-7134, USA.
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19
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Ayangeakaa SD, Kerr J, Combs R, Harris L, Sears J, Parker K, Sterrett-Hong E. Understanding Influences on Intention to Use Pre-exposure Prophylaxis (PrEP) Among African American Young Adults. J Racial Ethn Health Disparities 2023; 10:899-910. [PMID: 35290648 DOI: 10.1007/s40615-022-01278-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
Abstract
Pre-exposure prophylaxis (PrEP), a potent medication for HIV prevention, shows promise for reducing HIV disparities. However, PrEP is not equitably utilized by all races and ethnicities in the USA. Its uptake is especially low among African Americans, who are disproportionately impacted by HIV. Understanding factors influencing low PrEP uptake among diverse priority groups of African American young adults beyond gender and sexual minority groups (e.g., cisgender heterosexual people) may increase PrEP uptake. Data were from the Afya project, a study examining the use of PrEP for HIV prevention among multiple priority groups of African American young adults at heightened HIV risk, using Theory of Reasoned Action/Theory of Planned Behavior (TRA/TPB) as a theoretical framework. Eleven focus groups (N = 63) were conducted in Louisville, Kentucky from June to November 2018 with African American young adult priority groups (18-29 years old): men who have sex with men, transgender women, and cisgender heterosexual men and women demonstrating heightened sexual risk. Data were analyzed using constructivist grounded theory techniques. PrEP awareness, knowledge, perceived HIV risk and perceived need for PrEP (behavioral beliefs) and adherence beliefs (control beliefs), opinions of others (subjective norms), and confidence in ability to adhere to PrEP (perceived behavior controls) influenced acceptability of PrEP (participants' attitudes) and, in turn, influenced intention to use PrEP either negatively or positively. Thus, understanding factors that create reticence to PrEP use provides useful insight for tailoring outreach interventions towards African American young adults to improve PrEP uptake.
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Affiliation(s)
- Suur D Ayangeakaa
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Jelani Kerr
- Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA
| | - Ryan Combs
- Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA
| | - Lesley Harris
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
| | - Jeanelle Sears
- Department of Human Services, Bowling Green State University, Bowling Green, OH, USA
| | | | - Emma Sterrett-Hong
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
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20
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O'Byrne P, Musten A, McCready L, Robinson R, Durrant G, Tigert J, Orser L. HIV self-testing enabled access to testing for Black persons: The GetaKit study. Res Nurs Health 2023; 46:236-241. [PMID: 36573589 DOI: 10.1002/nur.22293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/05/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022]
Abstract
In Ontario, new HIV diagnoses continue to affect gay, bisexual, and other men who have sex with men (gbMSM) and persons of African, Caribbean, or Black (ACB) ethnicities. Because treatment and suppressed viral loads flow from diagnosis, testing is key. We sought to determine the outcomes of online ordering and mail-out of free at-home HIV self-testing in Ontario, Canada. We implemented the GetaKit study to offer such free HIV self-testing using the INSTI® test and offered it via a website (GetaKit.ca) to eligible persons in Ontario. From April 1, 2021 to January 31, 2022, we distributed kits to 1551 persons; 40% were white and 26% were ACB. We found that ACB participants were less likely to fulfill established criteria for HIV PrEP, such as previous sexually transmitted infections diagnoses and drug use, despite having a similar test positivity rate. We also found that ACB women, who may represent a larger number of new infections than previously thought, did not have a higher rate of first-time testing. Our results suggest that HIV self-testing can enable testing, but that work is required to increase uptake among ACB persons and women. Overall, HIV self-testing thus corresponded with increased testing among persons who were Black, yet lower rates of results reporting. Patient or Public Contributions: Community members from the AIDS Committee of Ottawa, Max Ottawa, and Black Cap, and nurses from Ottawa Public Health were involved in the design, promotion, and implementation of this study.
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Affiliation(s)
- Patrick O'Byrne
- School of Nursing, University of Ottawa, Ontario, Ottawa, Canada
| | - Alexandra Musten
- School of Nursing, University of Ottawa, Ontario, Ottawa, Canada
| | | | - Robin Robinson
- Black Coalition for AIDS Prevention, Ontario, Toronto, Canada
| | | | | | - Lauren Orser
- School of Nursing, University of Ottawa, Ontario, Ottawa, Canada
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Davis TL, Mittal M, Oragwu AC, Wang MQ, Boekeloo BO. Examining HIV Diagnosis and Linkage to PrEP Prescription Among Members at An Integrated Health System in the Southeast United States. AIDS Behav 2023; 27:796-805. [PMID: 36097086 DOI: 10.1007/s10461-022-03812-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 11/28/2022]
Abstract
Pre-Exposure Prophylaxis (PrEP) is a priority method for preventing HIV infection. This study's aims were threefold: (1) identify characteristics of members of a large health maintenance organization, Kaiser Permanente Georgia (KPGA), associated with HIV infection, (2) identify which member characteristics associated with HIV were also associated with PrEP prescription, and (3) identify which HIV-associated characteristics were associated with under- or over-prescribing of PrEP. Analysis of variables from the electronic medical record revealed that age, race, gender, mental health diagnosis, STI diagnosis, and sexual orientation were independently associated with HIV diagnosis. The same characteristics were independently associated with PrEP prescription except for race. Persons identifying as Black or unknown race, women, and/or heterosexual; and who had an STI diagnosis and/or illicit drug use had lower odds of being prescribed PrEP than of having an HIV diagnosis. The implications of these findings for improving physician identification of candidates for PrEP prescription are discussed.
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Affiliation(s)
- Teaniese L Davis
- Center for Health Research, Kaiser Permanente Georgia, Atlanta, GA, USA
| | - Mona Mittal
- Department of Family Science, University of Maryland School of Public Health, College Park, MD, USA
| | - Adanna C Oragwu
- Clinical Pharmacy , Kaiser Permanente Georgia, Atlanta, GA, USA.,Global Medical Affairs, Gilead Sciences, Foster City, CA, USA
| | - Min Qi Wang
- Department of Behavioral and Community Health, University of Maryland School of Public Health, 4200 Valley Dr, 20742. 301-405-2463, College Park, MD, USA
| | - Bradley O Boekeloo
- Department of Behavioral and Community Health, University of Maryland School of Public Health, 4200 Valley Dr, 20742. 301-405-2463, College Park, MD, USA.
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22
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Iqbal K, Dong X, Zhu W, Wiener J, Dominguez KL, Tanner MR, Kourtis AP, Singh S, Hoover KW. Decreased Human Immunodeficiency Virus Diagnosis Rates Among Black and Hispanic or Latino Men Who Have Sex With Men in US Jurisdictions Supported by the THRIVE Demonstration Project, 2014-2019. Clin Infect Dis 2023; 76:307-314. [PMID: 36124683 PMCID: PMC10999974 DOI: 10.1093/cid/ciac774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/06/2022] [Accepted: 09/14/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Black and Hispanic/Latino men who have sex with men (MSM) are disproportionately affected by human immunodeficiency virus (HIV). In the Targeted Highly Effective Interventions to Reverse the HIV Epidemic (THRIVE) demonstration project, 7 community collaboratives were developed to provide comprehensive HIV prevention services for these populations. METHODS We analyzed National HIV Surveillance System data to determine the number of HIV diagnoses for each year from 2014 to 2019 among Black, Hispanic/Latino, and White MSM in 7 THRIVE-eligible Metropolitan Statistical Areas (MSAs) that were awarded funding and 12 THRIVE-eligible MSAs that were not awarded funding. We used generalized linear Poisson regression models to estimate adjusted estimated annual percentage changes (EAPCs) with 95% confidence intervals for HIV diagnosis rates controlling for HIV prevalence, viral suppression, HIV testing rates, preexposure prophylaxis (PrEP) prescription rates, poverty, education, and insurance status. RESULTS We found larger estimated decreases in HIV diagnosis rates in THRIVE jurisdictions compared with non-THRIVE jurisdictions. The adjusted EAPC among Black MSM was -8.2 (-11.7 to -4.6) in THRIVE MSAs compared with -4.2 (-7.8 to -0.4) in non-THRIVE MSAs. The adjusted EAPC among Hispanic/Latino MSM was -8.6 (-12.2 to -4.8) in THRIVE MSAs compared with -2.6 (-5.1 to -0.1)in non-THRIVE MSAs. The adjusted EAPC among White MSM was -7.6 (-12.0 to -3.1) in THRIVE MSAs compared with 5.9 (1.8-10.1) in non-THRIVE MSAs. CONCLUSIONS The THRIVE community collaborative model was associated with a decrease in HIV diagnoses among Black and Hispanic/Latino MSM. To achieve the goals of the US Ending the HIV Epidemic initiative, effective interventions aimed to increase PrEP use need to be focused on Black and Hispanic/Latino MSM.
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Affiliation(s)
- Kashif Iqbal
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Xueyuan Dong
- Social and Scientific Systems, Inc., a DLH Holdings company, Atlanta, Georgia, USA
| | - Weiming Zhu
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jeffrey Wiener
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kenneth L Dominguez
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary R Tanner
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Athena P Kourtis
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sonia Singh
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karen W Hoover
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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23
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Buchbinder SP, Siegler AJ, Coleman K, Vittinghoff E, Wilde G, Lockard A, Scott H, Anderson PL, Laborde N, van der Straten A, Christie RH, Marlborough M, Liu AY. Randomized Controlled Trial of Automated Directly Observed Therapy for Measurement and Support of PrEP Adherence Among Young Men Who have Sex with Men. AIDS Behav 2023; 27:719-732. [PMID: 35984607 PMCID: PMC9908647 DOI: 10.1007/s10461-022-03805-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 11/26/2022]
Abstract
Measurement of adherence to oral pre-exposure prophylaxis (PrEP) in real-time has been challenging. We developed DOT Diary, a smartphone application that combines automated directly observed therapy with a PrEP adherence visualization toolkit, and tested its ability to measure PrEP adherence and to increase adherence among a diverse cohort of young men who have sex with men (MSM). We enrolled 100 MSM in San Francisco and Atlanta and randomly assigned them 2:1 to DOT Diary versus standard of care. Concordance between DOT Diary measurement and drug levels in dried blood spots was substantial, with 91.0% and 85.3% concordance between DOT Diary and emtricitabine-triphosphate and tenofovir-diphosphate, respectively. There was no significant difference in the proportion of participants with detectable PrEP drug levels at 24 weeks between study arms. These results suggest DOT Diary is substantially better than self-reported measures of adherence, but additional interventions are needed to improve PrEP adherence over time.
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Affiliation(s)
- Susan P Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA.
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
- Bridge HIV, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 100, San Francisco, CA, 94102, USA.
| | - Aaron J Siegler
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Kenneth Coleman
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Gretchen Wilde
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Annie Lockard
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Hyman Scott
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Ariane van der Straten
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- ASTRA Consulting, Kensington, CA, USA
| | | | | | - Albert Y Liu
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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24
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Boyd DT, Nelson LE, Hill MJ, Whitfield D, Ramos SR, Akyirem S, Emel L, Wilton L, Hightow-Weidman L, Shoptaw S, Magnus M, Mayer KH, Piwowar-Manning E, Wallace SE, Fields SD, Wheeler DP. Examining the Role of Autonomy Support, Goal Setting, and Care Coordination Quality on HIV PrEP Adherence in Black Men Who Have Sex with Men: HPTN 073. AIDS Patient Care STDS 2023; 37:22-30. [PMID: 36626154 PMCID: PMC10024067 DOI: 10.1089/apc.2022.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Autonomy support is a concept that is derived from self-determination theory. Autonomy refers to the freedom to act as one chooses. The current study aimed to examine if autonomy support was associated with dried blood spot validated pre-exposure prophylaxis (PrEP) adherence, and whether the association was mediated by PrEP adherence goal setting and progress toward PrEP adherence goals. Our sample was drawn from Black men who have sex with men (MSM) from across three cities (Chapel Hill, NC; Los Angeles, CA; and Washington, DC) in the United States between February 2013 and September 2014. We used logistic regression to evaluate associations between study variables and path analysis to test mediation effects. Participants were, on average, 28 [standard deviation (SD) = 1.12] years old and 25% were unemployed. We found that MSM who experienced high autonomy support were more likely to adhere to PrEP [odds ratio (OR) = 1.17; 95% confidence interval: 1.00-1.38]. MSM who set PrEP adherence goals were more likely to adhere to PrEP. Moreover, MSM who reported making progress toward their goals were also more likely to adhere to PrEP. Finally, client perception of coordination quality enhanced the magnitude of the association between goal setting and goal progress and the effect size of goal progress on PrEP adherence. Autonomy support, goal setting, goal monitoring/evaluation, and care coordination quality influenced PrEP adherence among Black MSM. Our findings indicate that while it is important to set goals for PrEP adherence, goal setting may need to be accompanied by progress monitoring to achieve the maximal effect.
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Affiliation(s)
- Donte T. Boyd
- College of Social Work, The Ohio State University, Columbus, Ohio, USA
- Yale School of Public Health, Center for Interdisciplinary Research on AIDS, New Haven, Connecticut, USA
| | - LaRon E. Nelson
- Yale School of Public Health, Center for Interdisciplinary Research on AIDS, New Haven, Connecticut, USA
- Yale School of Nursing, New Haven, Connecticut, USA
- Unity Health Toronto—St. Michael's, Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Toronto, Ontario, Canada
| | - Mandy J. Hill
- Department of Emergency Medicine, University of Texas Health Sciences Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Darren Whitfield
- School of Social Work, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - S. Raquel Ramos
- Yale School of Public Health, Center for Interdisciplinary Research on AIDS, New Haven, Connecticut, USA
- Yale School of Nursing, New Haven, Connecticut, USA
| | | | - Lynda Emel
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Leo Wilton
- State University of New York at Binghamton, Binghamton, New York, USA
- Department of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Lisa Hightow-Weidman
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Steve Shoptaw
- Division of Family Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Manya Magnus
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | | | - Estelle Piwowar-Manning
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore Maryland, USA
| | - Stephaun E. Wallace
- Vaccine and Infectious Disease Division, Fred Hutch, Seattle, Washington, USA
| | - Sheldon D. Fields
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
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25
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Mulatu MS, Carter JW, Flores SA, Benton S, Galindo CA, Johnson WD, Wilkes AL, Prather C. Expanding PrEP Services for Men Who Have Sex With Men and Transgender Persons Through Health Department Programs: Key Processes and Outcomes From Project PrIDE, 2015-2019. Public Health Rep 2023; 138:31-42. [PMID: 35023401 PMCID: PMC9730169 DOI: 10.1177/00333549211058173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Pre-exposure prophylaxis (PrEP) Implementation, Data to Care, and Evaluation (PrIDE) was a demonstration project implemented by 12 state and local health departments during 2015-2019 to expand PrEP services for men who have sex with men (MSM) and transgender persons at risk for HIV infection. We describe findings from the cross-jurisdictional evaluation of the project. METHODS We analyzed work plans, annual progress reports, and aggregate quantitative program data submitted by funded health departments (n = 12) to identify key activities implemented and summarize key project outcomes. RESULTS PrIDE jurisdictions implemented multiple health equity-focused activities to expand PrEP services to priority populations, including building program capacity, conducting knowledge and awareness campaigns, providing PrEP support services, and addressing barriers to PrEP use. Overall, PrIDE jurisdictions identified 44 813 persons with PrEP indications. Of these, 74.8% (n = 33 500) were referred and 33.1% (n = 14 821) were linked to PrEP providers, and 25.3% (n = 11 356) were prescribed PrEP. Most persons prescribed PrEP were MSM or transgender persons (87.9%) and persons from racial and ethnic minority groups (65.6%). However, among persons with PrEP indications, non-Hispanic Black/African American persons (14.9% of 18 782) were less likely than non-Hispanic White persons (31.0% of 11 633) to be prescribed PrEP (z = -33.57; P < .001). CONCLUSIONS PrIDE jurisdictions successfully expanded PrEP services for MSM, transgender persons, and racial and ethnic minority groups by implementing health equity-focused activities that addressed barriers to PrEP services. However, PrEP prescription was generally low, with significant disparities by demographic characteristics. Additional targeted interventions are needed to expand PrEP services, achieve equity in PrEP use, and contribute to ending the HIV epidemic in the United States.
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Affiliation(s)
- Mesfin S. Mulatu
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jarvis W. Carter
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephen A. Flores
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shaliondel Benton
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carla A. Galindo
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wayne D. Johnson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aisha L. Wilkes
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cynthia Prather
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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26
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Suen YT, Chan RCH, Wong EMY. Sex Conservatism, Internalized Homonegativity, PrEP Stigma, and Intention to Use PrEP: A Study of Chinese-Speaking Gay and Bisexual Male Youth in Hong Kong. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:467-480. [PMID: 36454136 DOI: 10.1521/aeap.2022.34.6.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Pre-exposure prophylaxis (PrEP) stigma has been found to be a major barrier to PrEP acceptability and uptake. Research has found that different ethnic/cultural groups display varying levels of PrEP stigma. This article studies sex conservatism and internalized homonegativity as two sexuality- and culture-related aspects that influence PrEP stigma and intention to use PrEP. An online survey of 279 young gay and bisexual men in Hong Kong found that internalized homonegativity was positively associated with PrEP stigma. Respondents who were more conservative about sex showed lower intention to use PrEP, whereas those who had higher income and more positive attitudes about PrEP were more likely to express intention to use PrEP. This study provides novel empirical evidence for understanding PrEP stigma and uptake from a sexuality and cultural perspective. The influence of sexuality- and culture-related factors on PrEP stigma and uptake warrants greater attention, especially in the Asia-Pacific region.
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Affiliation(s)
- Yiu Tung Suen
- Gender Studies Programme, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Randolph C H Chan
- Department of Special Education and Counselling, The Education University of Hong Kong, Tai Po, Hong Kong
| | - Eliz Miu Yin Wong
- Department of Social Policy, London School of Economics and Political Science, London, UK
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27
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Qasmieh S, Nash D, Gandhi M, Rozen E, Okochi H, Goldstein H, Herold BC, Jamison K, Pathela P. Self-Reported Use of HIV Preexposure Prophylaxis Is Highly Accurate Among Sexual Health Clinic Patients in New York City. Sex Transm Dis 2022; 49:790-793. [PMID: 35312670 PMCID: PMC9463403 DOI: 10.1097/olq.0000000000001622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT In New York City, 91% of sexually transmitted infection clinic patients reported preexposure prophylaxis (PrEP) use that matched the detection of PrEP in their serum. Self-report had 80% sensitivity and 96% specificity ( κ = 0.79) compared with measured PrEP. Our findings suggest that self-report may be a valid indicator of PrEP uptake.
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Affiliation(s)
- Saba Qasmieh
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY
- Institute for Implementation Science in Population Health, City University of New York, New York, NY
| | - Denis Nash
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY
- Institute for Implementation Science in Population Health, City University of New York, New York, NY
| | - Monica Gandhi
- University of California San Francisco Center for AIDS Research, San Francisco, CA
| | - Elliot Rozen
- New York City Department of Health and Mental Hygiene, Queens, NY
| | - Hideaki Okochi
- University of California San Francisco Center for AIDS Research, San Francisco, CA
| | | | | | - Kelly Jamison
- New York City Department of Health and Mental Hygiene, Queens, NY
| | - Preeti Pathela
- New York City Department of Health and Mental Hygiene, Queens, NY
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28
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Caba AE, Rathus T, Burson E, Chan PA, Eaton LA, Watson RJ. Who is using PrEP on-demand? Factors associated with PrEP use modality among Black and Hispanic/Latino emerging adults. AIDS Behav 2022; 26:3411-3421. [PMID: 35438349 PMCID: PMC9912752 DOI: 10.1007/s10461-022-03684-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 01/16/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is a highly efficacious HIV prevention medication, yet Black and Hispanic/Latino sexual minority men's and gender diverse individuals' (SMMGD) PrEP use is limited due to factors such as PrEP barriers and anticipated PrEP stigma. Although most individuals who use PrEP take it as a daily regimen, there is evidence that many SMMGD are interested in using "on-demand" (also known as event-driven or intermittent or 2-1-1) PrEP. We used stepwise multinomial logistic regression to explore factors associated with on-demand, daily, and no PrEP use among 820 Black and Hispanic/Latino SMMGD ages 18-29 in the United States. We found that greater reported PrEP barriers were associated with higher odds of using PrEP on-demand or not using PrEP compared to daily PrEP use. More past 3-month sex partners and greater comfort telling others about PrEP use were associated with lower odds of on-demand compared to daily PrEP use. In addition, compared to daily PrEP use, more past 3-month sex partners, greater comfort telling others about PrEP use, and higher anticipated PrEP stigma were associated with lower odds of no current PrEP use compared to daily PrEP use. Findings may inform clinical practices and interventions to promote PrEP uptake and adherence.
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Affiliation(s)
- Antonia E Caba
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, US.
| | - Taylor Rathus
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, US
| | - Esther Burson
- Bronfenbrenner Center for Translational Research, Cornell University, Ithaca, NY, US
| | - Philip A Chan
- Department of Medicine, Brown University, Providence, RI, US
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, US
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, US
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29
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Dangerfield Ii DT, Anderson JN, Wylie C, Arrington-Sanders R, Bluthenthal RN, Beyrer C, Farley JE. Refining a Multicomponent Intervention to Increase Perceived HIV Risk and PrEP Initiation: Focus Group Study Among Black Sexual Minority Men. JMIR Form Res 2022; 6:e34181. [PMID: 35947442 PMCID: PMC9403828 DOI: 10.2196/34181] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 04/28/2022] [Accepted: 07/08/2022] [Indexed: 11/26/2022] Open
Abstract
Background Increased preexposure prophylaxis (PrEP) initiation is needed to substantially decrease HIV incidence among Black sexual minority men (BSMM). However, BSMM perceive others as PrEP candidates instead of themselves and are less likely than other groups to use PrEP if prescribed. Peers and smartphone apps are popular HIV prevention intervention tools typically used independently. However, they could be useful together in a multicomponent strategy to improve perceived HIV risk and PrEP initiation for this group. Information regarding attitudes and preferences toward this multicomponent strategy is limited. Objective The goal of this study is to obtain attitudes and perspectives regarding the design of a multicomponent intervention that uses a smartphone app and a peer change agent (PCA) to increase perceived HIV risk and PrEP initiation. The intervention will be refined based on thematic findings for a culturally responsive approach. Methods Data were obtained guided by life course theory and the health belief model using 12 focus groups and 1 in-depth interview among HIV-negative BSMM from Baltimore, MD, between October 2019 and May 2020 (n=39). Groups were stratified by the following ages: 18 to 24 years, 25 to 34 years, and 35 years and older. Participants were provided details regarding an existing mobile app diary to self-monitor sexual behaviors and a hypothetical PCA with whom to review the app. Facilitators posed questions regarding perceived HIV risk, attitudes toward the app, working with a PCA, and preferences for PCA characteristics and approaches. Results Most participants identified as homosexual, gay, or same gender-loving (26/38, 68%), were employed (26/38, 69%), single (25/38, 66%), and interested in self-monitoring sexual behaviors (28/38, 68%). However, themes suggested that participants had low perceived HIV risk, that self-monitoring sexual behaviors using a mobile app diary was feasible but could trigger internalized stigma, and that an acceptable PCA should be a possible self for BSMM to aspire to but they still wanted clinicians to “do their job.” Conclusions HIV-negative BSMM have dissonant attitudes regarding perceived HIV risk and the utility of a mobile app and PCA to increase perceived HIV risk and PrEP initiation. Future research will explore the feasibility, acceptability, and preliminary impact of implementing the multicomponent intervention on perceived HIV risk and PrEP initiation among BSMM in a pilot study.
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Affiliation(s)
- Derek T Dangerfield Ii
- Johns Hopkins School of Nursing, Baltimore, MD, United States
- Us Helping Us, People Into Living, Inc, Washington, DC, United States
| | - Janeane N Anderson
- University of Tennessee Health Science Center, Memphis, TN, United States
| | - Charleen Wylie
- Johns Hopkins School of Nursing, Baltimore, MD, United States
| | | | - Ricky N Bluthenthal
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Christopher Beyrer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jason E Farley
- Johns Hopkins School of Nursing, Baltimore, MD, United States
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30
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Watson RJ, Morgan E, Collibee C, Kalinowski J, Cunningham C, Edelman EJ, Chan P, Eaton LA. Substance Use and Healthcare Utilization Across the Pre-Exposure Prophylaxis (PrEP) Care Cascade among Black and Latino Men Who Have Sex with Men. Subst Use Misuse 2022; 57:1698-1707. [PMID: 35938746 PMCID: PMC9554788 DOI: 10.1080/10826084.2022.2108059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Background: Despite the documented efficacy of pre-exposure prophylaxis (PrEP) for HIV prevention, large disparities in uptake and adherence exist among Black and Latino/Hispanic men who have sex with men (BLMSM). Limited data exists among BLMSM on the impact of substance use at different stages of the PrEP Care Cascade. We examined the ways substance (alcohol, cannabis, other drug) use is related to PrEP experiences across the PrEP Care Cascade (PrEP aware/no use; PrEP use/discontinuation; PrEP use/adherent).Methods: We utilized data from a national sample of 908 BLMSM (Mage = 25.17, range: 18-29), collected between February and October 2020.Results: We found that heavier alcohol use, more other drug (e.g., cocaine) use, more participant healthcare utilization, and higher number of partners across all measures of substance use were separately associated with a lower likelihood of being aware of PrEP. These same factors were also associated with a higher likelihood of PrEP adherence. Conversely, only cannabis use was associated with discontinuation of PrEP use.Conclusions: While we confirm some earlier findings (i.e., alcohol use is associated with both PrEP discontinuation and PrEP use), we newly identify cannabis as a barrier to the adherence of PrEP. Our findings highlight the need for improved PrEP interventions to increase awareness among BLMSM with substance use who are among the most at-risk for HIV infection.
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Affiliation(s)
- Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Ethan Morgan
- College of Nursing, Infectious Disease Institute, The Ohio State University, Columbus, Ohio, USA
| | - Charlene Collibee
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jolaade Kalinowski
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Casey Cunningham
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - E Jennifer Edelman
- Program in Addiction Medicine, Yale School of Medicine and Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut, USA
| | - Philip Chan
- Department of Medicine, Brown University, Providence, Rhode Island, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
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31
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Zapata JP, de St Aubin E, Rodriguez-Diaz CE, Malave-Rivera S. Using a Structural-Ecological Model to Facilitate Adoption of Preexposure Prophylaxis Among Latinx Sexual Minority Men: A Systematic Literature Review. JOURNAL OF LATINX PSYCHOLOGY 2022; 10:169-190. [PMID: 37456610 PMCID: PMC10348365 DOI: 10.1037/lat0000204] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Research has consistently shown that individual, interpersonal, community and structural factors influence the degree to which individuals' access and utilize health care services, and these factors may play a role in explaining racial and ethnic differences in health care outcomes. Differences in HIV prevalence and treatment between Latinx adults and white adults in the U.S. must be considered in the context of these factors. However, much of the existing research connecting these factors and HIV/AIDS outcomes in Latinxs remains disparate, limited in scope, and has yet not been applied to the use of biomedical HIV preventions. The following systematic literature review examined research related to PrEP in Latinx sexual minority men (SMM) to build a structural-ecological framework of the existing research, while identifying gaps in the literature and areas for future research. We searched two electronic databases using a systematic review protocol, screened 71 unique records, and identified 23 articles analyzing data from Latinx SMM and intended and/or actual PrEP-use in the United States. Based on the present review, disparities in PrEP uptake by Latinx SMM could be explained, in part, by examining how all levels of the structural-ecological framework uniquely contributes to how Latinx SMM engage with HIV prevention measures and come to understand PrEP. It is clear from the existing literature base that some of the most prominent barriers deterring Latinx SMM from seeking PrEP services are the lack of information surrounding PrEP and HIV/gay stigmas. However, higher order structural-level risks can facilitate or reduce access to PrEP. We propose a structural-ecological model to help visualize multi-level domains of unique stressors that limit the implementation of PrEP among Latinxs. At this stage, the available literature provides little guidance beyond suggesting that culturally adapted interventions can be effective in this population. The model developed here provides that needed specificity regarding targeted interventions that will fit the needs of this population.
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Affiliation(s)
| | - Ed de St Aubin
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Carlos E Rodriguez-Diaz
- Department of Prevention and Community Health, The George Washington UniversityMilken, Institute School of Public Health
| | - Souhail Malave-Rivera
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico Medical sciences Campus
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Calabrese SK, Rao S, Eldahan AI, Tekeste M, Modrakovic D, Dangaran D, Boone CA, Underhill K, Krakower DS, Mayer KH, Hansen NB, Kershaw TS, Magnus M, Betancourt JR, Dovidio JF. "Let's Be a Person to Person and Have a Genuine Conversation": Comparing Perspectives on PrEP and Sexual Health Communication Between Black Sexual Minority Men and Healthcare Providers. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2583-2601. [PMID: 35790614 PMCID: PMC10040304 DOI: 10.1007/s10508-021-02213-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 06/11/2023]
Abstract
Patient-provider communication is a key factor affecting HIV pre-exposure prophylaxis (PrEP) awareness and access among Black sexual minority men (SMM). Optimizing patient-provider communication requires a deeper understanding of communication dynamics. In this study, we investigated the perspectives of both HIV-negative/status-unknown Black SMM and practicing community healthcare providers regarding patient-provider communication about PrEP and sexual health. We conducted eleven semi-structured qualitative focus groups (six with Black SMM; five with providers) in the Northeastern USA and thematically analyzed transcripts. A total of 36 Black SMM and 27 providers participated in the focus groups. Our analysis revealed points of alignment and divergence in the two groups' perspectives related to patient-provider communication. Points of alignment included: (1) the importance ascribed to maximizing patients' comfort and (2) belief in patients' right to non-discriminatory healthcare. Points of divergence included: (1) Black SMM's preference for sexual privacy versus providers' preference that patients share sexual information, (2) Black SMM's perception that providers have an ethical responsibility to initiate conversations about PrEP with patients versus providers' perception of such conversations as being optional, and (3) Black SMM's preference for personalized sexual health conversations versus providers' preference for standardized conversations. Findings underscore a need for providers to offer more patient-centered sexual healthcare to Black SMM, which should entail routinely presenting all prevention options available-including PrEP-and inviting open dialogue about sex, while also respecting patients' preferences for privacy about their sexuality. This approach could increase PrEP access and improve equity in the US healthcare system.
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Affiliation(s)
- Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA.
- Department of Prevention and Community Health, George Washington University, Washington, DC, USA.
| | - Sharanya Rao
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
| | - Adam I Eldahan
- Columbia School of Nursing, Columbia University, New York, NY, USA
| | - Mehrit Tekeste
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
| | - Djordje Modrakovic
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
| | - D Dangaran
- Harvard Law School, Harvard University, Cambridge, MA, USA
| | - Cheriko A Boone
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
| | - Kristen Underhill
- Columbia Law School, Columbia University, New York, NY, USA
- Heilbrunn Department of Population and Family Health, Columbia University, New York, NY, USA
| | - Douglas S Krakower
- Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Population Medicine, Harvard University, Boston, MA, USA
| | - Kenneth H Mayer
- Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Global Health and Population, Harvard University, Boston, MA, USA
| | - Nathan B Hansen
- Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
| | - Trace S Kershaw
- Social and Behavioral Sciences Department, Yale University, New Haven, CT, USA
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, USA
| | | | - John F Dovidio
- Social and Behavioral Sciences Department, Yale University, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
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Driver R, Kalichman SC. Precarious manhood and intentions to initiate preexposure prophylaxis among Black sexual minority men. Health Psychol 2022; 41:474-483. [PMID: 35587889 PMCID: PMC9809501 DOI: 10.1037/hea0001194] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The use of preexposure prophylaxis (PrEP) to prevent HIV infection is significantly low among Black sexual minority men (BSMM), although this group experiences the greatest HIV burden in the United States. One contextual factor suggested to impact BSMM's HIV prevention efforts is the concern about, and adherence to, cultural conceptions and expectations of masculinity. The present study sought to better understand the association between masculinity and PrEP uptake by examining associations between gender-relevant beliefs and perceptions, and intentions to initiate PrEP among a sample of BSMM residing in the U.S. South. METHOD Participants (N = 114) completed assessments of precarious manhood beliefs, attitudes toward PrEP, concerns about PrEP use impacting support from social networks, projected perceptions of masculinity, and intentions to initiate PrEP. RESULTS Precarious manhood beliefs were associated with greater intention to initiate PrEP; however, the indirect path of this association through attitudes toward PrEP was associated with lower intentions to initiate PrEP. In a hierarchical regression model, projected perceptions of masculinity were associated with intentions to initiate PrEP over and above other factors considered. Specifically, believing that one will be perceived as less masculine for seeking PrEP was associated with lower intentions to initiate PrEP. CONCLUSIONS Findings suggest that BSMM's construal of masculinity in relation to HIV and PrEP is associated with intentions to initiate PrEP. Implications for increasing PrEP uptake among BSMM are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Redd Driver
- HIV Center for Clinical and Behavioral Studies at Columbia University and New York State, Psychiatric Institute, New York, NY
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Seth C. Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
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Harkness A, Weinstein ER, Lozano A, Mayo D, Doblecki-Lewis S, Rodríguez-Díaz CE, Hendricks Brown C, Prado G, Safren SA. Refining an Implementation Strategy to Enhance the Reach of HIV-Prevention and Behavioral Health Treatments to Latino Men Who Have Sex with Men. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221096293. [PMID: 36406189 PMCID: PMC9674182 DOI: 10.1177/26334895221096293] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Latino men who have sex with men (LMSM) experience HIV and behavioral health disparities. Yet, evidence-based interventions, such as pre-exposure prophylaxis (PrEP) and behavioral health treatments, have not been equitably scaled up to meet LMSM needs. To address quality of life and the public health importance of HIV prevention, implementation strategies to equitably scale up these interventions to LMSM need to be developed. This study identifies themes for developing culturally grounded implementation strategies to increase uptake of evidence-based HIV prevention and behavioral health treatments among LMSM. Methods Participants included 13 LMSM and 12 stakeholders in Miami, an HIV epicenter. Feedback regarding the content, design, and format of an implementation strategy to scale up HIV-prevention and behavioral health services to LMSM were collected via focus groups (N=3) and individual interviews (N=3). Themes were inductively identified across the Health Equity Implementation Framework (HEIF) domains. Results Analyses revealed five higher order themes regarding the design, content, and format of the implementation strategy: cultural context, relationships and networks, navigation of health information and systems, resources and models of service delivery, and motivation to engage. Themes were applicable across HEIF domains, meaning that the same theme could have implications for both the development and implementation of the implementation strategy. Conclusions Findings highlight the importance of addressing culturally specific factors, leveraging relational networks, facilitating navigation of health systems, tailoring to available resources, and building consumer and implementer motivation in order to refine an implementation strategy for reducing mental health burden and achieving HIV health equity among LMSM.
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Affiliation(s)
- Audrey Harkness
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | | | - Alyssa Lozano
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Daniel Mayo
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Susanne Doblecki-Lewis
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of
Medicine, Miami, FL, USA
| | - Carlos E. Rodríguez-Díaz
- Department of Community Health and Prevention, Milken Institute
School of Public Health, The George Washington University, Washington DC, USA
| | - C. Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Guillermo Prado
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
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Schexnayder J, Elamin F, Mayes E, Cox L, Martin E, Webel AR. Is Tailoring of PrEP Programs Needed to Overcome Racial Disparities in PrEP Uptake in Local Health Departments? A Mixed-Methods Evaluation of PrEP Implementation in Virginia. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:282-291. [PMID: 35045008 DOI: 10.1097/phh.0000000000001463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT African American and Hispanic adults share a disproportionate burden of HIV infections in the United States but continue to experience suboptimal uptake of HIV pre-exposure prophylaxis (PrEP). Increasing PrEP accessibility in nontraditional care settings is a potential strategy to increase PrEP uptake in these high-risk groups. PrEP implementation in local health departments (LHDs) is not well characterized. OBJECTIVE To evaluate HIV PrEP implementation for African American and Hispanic adults receiving medical care in Virginia's LHDs. DESIGN We conducted a retrospective, mixed-methods evaluation of PrEP services implementation at LHDs completing their first PrEP program year between June 1, 2016, and June 30, 2019. Using pharmacy records, we estimated PrEP coverage and adherence using PrEP to need ratios (PnRs) and medication possession ratios (MPRs), respectively. Thematic analysis was used to identify barriers to PrEP delivery in interviews with 6 multidisciplinary LHD workers. RESULTS Of the 433 PrEP clients receiving an emtricitabine/tenofovir disoproxil fumarate (Truvada) prescription in year 1, 52.0% self-identified as African American and 8.9% self-identified as Hispanic. PnRs were greater for White adults in 50.0% of clinics. The average MPR (0.79) was consistent with protective medication adherence levels; however, 25.0% of clients filled only one prescription in the program year. Qualitative findings suggest incompatibilities between health PrEP services delivery and community preferences for African American and Hispanic adults; however, LHDs in one health region were able to link communities of color to PrEP at similar rates as Whites. CONCLUSIONS Incorporating a metric sensitive to racial/ethnic differences in the burden of HIV infection improved recognition of PrEP disparities; however, population-specific targets are needed to enhance use of the PnR for program evaluation. Tailoring of PrEP services to communities with the greatest local PrEP burden may be needed to optimize the effectiveness of PrEP programs in LHDs.
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Affiliation(s)
- Julie Schexnayder
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina (Dr Schexnayder); Division of Disease Prevention (Mss Martin and Elamin), Virginia Department of Health (Mr Mayes), Richmond, Virginia; University of Virginia, Charlottesville, Virginia (Ms Cox); and Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio (Dr Webel)
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Boyd DT, Abubakari GM, Turner D, Ramos SR, Hill MJ, Nelson LE. The Influence of Family Bonding, Support, Engagement in Healthcare, on PrEP Stigma among Young Black and Latino Men Who Have Sex with Men: A Path Analysis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030330. [PMID: 35327703 PMCID: PMC8947403 DOI: 10.3390/children9030330] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023]
Abstract
This study employs the ecodevelopmental theory to examine the influence of mother and father bonding, family engagement in healthcare, and family support on PrEP stigma among BLMSM. We used a cross-sectional sample from wave five of the Healthy Young Men (HYM) study, with a survey sample of 399 participants aged 16−24 years. We conducted two-path analyses to test multiple hypotheses: (1) mother/father bonding is associated with an increase in family engagement in healthcare; (2) family engagement in healthcare is associated with family social support; and (3) family social support is associated with PrEP stigma. Family social support was negatively correlated with PrEP stigma (r = −0.15; p < 0.001). The findings show that families either led by a Black/Latino father or mother have a significant impact on the sexual health-seeking behavior of BLMSM and their perception of HIV and PrEP.
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Affiliation(s)
- Donte T. Boyd
- College of Social Work, The Ohio State University, Columbus, OH 43210, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06510, USA; (G.M.A.); (D.T.)
- Correspondence:
| | - Gamji M’Rabiu Abubakari
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06510, USA; (G.M.A.); (D.T.)
- School of Public Health, Yale University, New Haven, CT 06510, USA
| | - DeAnne Turner
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06510, USA; (G.M.A.); (D.T.)
- College of Nursing, University of South Florida, Tampa, FL 33612, USA
| | - S. Raquel Ramos
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06510, USA; (G.M.A.); (D.T.)
- School of Nursing, Yale University, New Haven, CT 06477, USA; (S.R.R.); (L.E.N.)
| | - Mandy J. Hill
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA;
| | - LaRon E. Nelson
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06510, USA; (G.M.A.); (D.T.)
- School of Nursing, Yale University, New Haven, CT 06477, USA; (S.R.R.); (L.E.N.)
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Derrick T, Harrington KRV, Alohan DI, Sullivan PS, Holland DP, Klepser DG, Quamina A, Siegler AJ, Young HN. Integrating and Disseminating Pre-Exposure Prophylaxis (PrEP) Screening and Dispensing for Black Men Who Have Sex With Men in Atlanta, Georgia: Protocol for Community Pharmacies. JMIR Res Protoc 2022; 11:e35590. [PMID: 35138252 PMCID: PMC8867290 DOI: 10.2196/35590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 12/24/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Black men who have sex with men (BMSM) suffer from alarmingly high rates of HIV in the United States. Pre-exposure prophylaxis (PrEP) can reduce the risk of HIV infection by 99% among men who have sex with men, yet profound racial disparities in the uptake of PrEP persist. Low PrEP uptake in BMSM is driven by poor access to PrEP, including inconvenient locations of PrEP-prescribing physicians, distrust of physicians, and stigma, which limit communication about PrEP and its side effects. Previous work indicates that offering HIV prevention services in pharmacies located in low-income, underserved neighborhoods is feasible and can reduce stigma because pharmacies offer a host of less stigmatized health services (eg, vaccinations). We present a protocol for a pharmacy PrEP model that seeks to address challenges and barriers to pharmacy-based PrEP specifically for BMSM. OBJECTIVE We aim to develop a sustainable pharmacy PrEP delivery model for BMSM that can be implemented to increase PrEP access in low-income, underserved neighborhoods. METHODS This study design is a pilot intervention to test a pharmacy PrEP delivery model among pharmacy staff and BMSM. We will examine the PrEP delivery model's feasibility, acceptability, and safety and gather early evidence of its impact and cost with respect to PrEP uptake. A mixed-methods approach will be performed, including three study phases: (1) a completed formative phase with qualitative interviews from key stakeholders; (2) a completed transitional pilot phase to assess customer eligibility and willingness to receive PrEP in pharmacies during COVID-19; and (3) a planned pilot intervention phase which will test the delivery model in 2 Atlanta pharmacies in low-income, underserved neighborhoods. RESULTS Data from the formative phase showed strong support of pharmacy-based PrEP delivery among BMSM, pharmacists, and pharmacy staff. Important factors were identified to facilitate the implementation of PrEP screening and dissemination in pharmacies. During the transitional pilot phase, we identified 81 individuals who would have been eligible for the pilot phase. CONCLUSIONS Pharmacies have proven to be a feasible source for offering PrEP for White men who have sex with men but have failed to reach the most at-risk, vulnerable population (ie, BMSM). Increasing PrEP access and uptake will reduce HIV incidence and racial inequities in HIV. Translational studies are required to build further evidence and scale pharmacy-based PrEP services specifically for populations that are disconnected from HIV prevention resources. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/35590.
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Affiliation(s)
| | - Kristin R V Harrington
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Daniel I Alohan
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - David P Holland
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Division of Medical and Preventative Services, Fulton County Board of Health, Atlanta, GA, United States
| | - Donald G Klepser
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, United States
| | - Alvan Quamina
- National AIDS Education and Services for Minorities Inc, Atlanta, GA, United States
| | - Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Henry N Young
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Athens, GA, United States
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Gómez W, Holloway IW, Pantalone DW, Grov C. PrEP uptake as a social movement among gay and bisexual men. CULTURE, HEALTH & SEXUALITY 2022; 24:241-253. [PMID: 33118858 PMCID: PMC8081761 DOI: 10.1080/13691058.2020.1831075] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 09/28/2020] [Indexed: 05/31/2023]
Abstract
Despite PrEP's effectiveness as an HIV prevention intervention, uptake among gay and bisexual men remains low. Historical involvement in AIDS activism may reveal important ways of mobilising gay and bisexual men to increase PrEP uptake. Data come from a qualitative study to understand New York City gay and bisexual men's experiences with PrEP. Informed by a constructivist grounded theory approach, we assessed ways in which gay and bisexual men's relational experiences concerning PrEP were congruent with features of past AIDS activism. Participants' mean age was 32.5 years, half were men of colour, and over half had been taking PrEP for less than one year. Analysis revealed three primary themes related to AIDS activism strategies: (1) framing, which referenced how participants referred to PrEP as an empowering, liberatory and community-building intervention (2) reactions, which encompassed positive to negative expressions about PrEP and sex; and (3) innovation, which conveyed ways that participants engaged in processes of transferring lay knowledge about PrEP through leadership roles across social and digital encounters. Findings suggest that the ways in which gay and bisexual men communicate about PrEP with peers are consistent with features of AIDS activism. Deploying lay knowledge using framing strategies through peer-based intervention could expand PrEP uptake. However, elements of PrEP stigma must be addressed to engage with the wide-ranging HIV prevention needs of gay and bisexual men.
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Affiliation(s)
- Walter Gómez
- School of Social Welfare, University of California, Berkeley, CA, USA
| | - Ian W. Holloway
- Luskin School of Public Affairs, University of California, Los Angeles, CA, USA
| | - David W. Pantalone
- College of Liberal Arts, University of Massachusetts, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Christian Grov
- City University of New York, Graduate School of Public Health and Health Policy, New York, NY, USA
- City University of New York, Institute for Implementation Science in Population Health, New York, NY, USA
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Greene GJ, Reidy E, Felt D, Marro R, Johnson AK, Phillips G, Green E, Stonehouse P. Implementation and evaluation of patient navigation in Chicago: Insights on addressing the social determinants of health and integrating HIV prevention and care services. EVALUATION AND PROGRAM PLANNING 2022; 90:101977. [PMID: 34373116 DOI: 10.1016/j.evalprogplan.2021.101977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/12/2021] [Accepted: 06/17/2021] [Indexed: 06/13/2023]
Abstract
Patient navigation is a primary element in linkage to HIV pre-exposure prophylaxis (PrEP) care and linkage to or re-engagement in HIV care, depending on the HIV status of the individual. However, there is a dearth of literature describing navigation services in these areas. In the context of Chicago Project PrIDE, this project conducted process and implementation evaluations with eight agencies leading demonstration projects to address these gaps. The evaluation team conducted semi-structured, individual interviews with agency staff (N = 20) assessing navigation implementation and fit, as well as project successes and challenges. Additionally, agency staff collected patient surveys (N = 300) assessing services provided, service quality, and satisfaction. The interview transcripts were coded and analyzed thematically and descriptive analyses were performed on the survey data. Analyses indicated that screening for social determinants of health, providing healthcare engagement guidance, and providing service referrals were frequently cited navigation activities. Most staff members indicated that navigation fits well within their agencies, and that limited staff and clinic capacity were often barriers to navigation. Patient navigation to support engagement in HIV prevention and care services is critical due to the extensive support provided by navigators to address social determinants of health impacting HIV disparity populations.
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Affiliation(s)
- George J Greene
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA.
| | - Emma Reidy
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA
| | - Dylan Felt
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA
| | - Rachel Marro
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA
| | - Amy K Johnson
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA; Ann & Robert H. Lurie Children's Hospital of Chicago, The Potocsnak Family Division of Adolescent and Young Adult Medicine, 225 E. Chicago Ave., Box 161, Chicago, IL, 60611, USA
| | - Gregory Phillips
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA
| | - Evelyn Green
- Chicago Department of Public Health, 333 S. State St., Suite 200, Chicago, IL, 60604, USA
| | - Patrick Stonehouse
- Chicago Department of Public Health, 333 S. State St., Suite 200, Chicago, IL, 60604, USA
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Ajiboye W, Nelson L, Odhiambo A, Yusuf A, Djiadeu P, Turner DA, Abubakari M, Pedersen C, Brown R, Ni Z, Guillaume G, Lofters A, Williams G. Decision conflict and the decision support needs of HIV PrEP-eligible Black patients in Toronto regarding the adoption of PrEP for HIV prevention. J Int Assoc Provid AIDS Care 2022; 21:23259582211073399. [PMID: 35098770 PMCID: PMC8808024 DOI: 10.1177/23259582211073399] [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] [Indexed: 02/04/2023] Open
Abstract
Objectives: This study examined factors contributing to decision conflict and the decision support needs of PrEP-eligible Black patients. Methods:The Ottawa Decision Support Framework (ODSF) was used to guide the development of a key informant guide used for qualitative data collection. Black patients assessed by healthcare providers as meeting the basic criteria for starting PrEP were recruited through the St. Michael's Hospital Academic Family Health Team and clinical and community agencies in Toronto. Participants were interviewed by trained research staff. Qualitative content analysis was guided by the ODSF, and analysis was done using the Nvivo. Results: Four women and twenty-five men (both heterosexual and men who have sex with men) were interviewed. Participants reported having difficulty in decision making regarding adoption of PrEP. The main reasons for decision-conflict regading PrEP adoption were: lack of adequate information about PrEP, concerns about the side effects of PrEP, inability to ascertain the benefits or risk of taking PrEP, provider's lack of adequate time for interaction during clinical consultation, and perceived pressure from healthcare provider. Participants identified detailed information about PrEP, and being able to clarify how their personal values align with the benefits and drawbacks of PrEP as their decision support needs. Conclusion:Many PrEP-eligible Black patients who are prescribed PrEP have decision conflict which often causes delay in decision making and sometimes rejection of PrEP. Healthcare providers should offer decision support to Black patients who are being asked to consider PrEP for HIV prevention.
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Affiliation(s)
- Wale Ajiboye
- St. Michael’s Hospital, Toronto, ON, Canada,Wale Ajiboye, PhD, St. Michael’s Hospital Toronto, ON, Canada.
| | - LaRon Nelson
- St. Michael’s Hospital, Toronto, ON, Canada,Yale School of Nursing, New Haven, CT, USA
| | | | | | | | | | | | | | | | - Zhao Ni
- Yale School of Nursing, New Haven, CT, USA
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Carnes N, Zhang J, Gelaude D, Huang YLA, Mizuno Y, Hoover KW. Restricting Access: A Secondary Analysis of Scope of Practice Laws and Pre-exposure Prophylaxis Prescribing in the United States, 2017. J Assoc Nurses AIDS Care 2022; 33:89-97. [PMID: 34086636 PMCID: PMC9811310 DOI: 10.1097/jnc.0000000000000275] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
ABSTRACT To assess advanced practitioners' scope of practice laws (i.e., legal authority providers can prescribe regulated medications) as potential barriers to HIV pre-exposure prophylaxis (PrEP), we conducted an analysis using IQVIA Real World Data in association with scope of practice law classifications supplied by the American Association of Nurse Practitioners and scopeofpracticepolicy.org. Nurse practitioners in states that allowed independent scope of practice were 1.4 times more likely to have prescribed PrEP compared with nurse practitioners in states where their prescribing authority is determined by a supervising medical doctor (MD). Physician assistants in states where the law or a state board defined their prescribing authority were more than twice as likely to prescribe PrEP compared with those in states where a supervising MD oversaw prescribing rights. Our findings suggest that restricting scope of prescribing practice by requiring MD oversight limits PrEP access and poses a barrier to scaling up PrEP.
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Affiliation(s)
- Neal Carnes
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jun Zhang
- CORE at Merck & Co, Kenilworth, New Jersey
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Deborah Gelaude
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ya-lin A. Huang
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yuko Mizuno
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karen W. Hoover
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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George WH, Blayney JA, Stappenbeck CA, Davis KC. The Role of Alcohol-Related Behavioral Risk in the Design of HIV Prevention Interventions in the Era of Antiretrovirals: Alcohol Challenge Studies and Research Agenda. AIDS Behav 2021; 25:347-364. [PMID: 34244871 DOI: 10.1007/s10461-021-03351-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/29/2022]
Abstract
HIV/AIDS remains a significant health threat and alcohol is a robust contributing factor. After 25 years of alcohol challenge studies investigating alcohol-related behavioral risk (ARBR), much has been learned delineating how drinking influences sexual transmission. We examine this research and consider its relevance for interventions in the era of antiretrovirals. We consider prototypic alcohol challenge methods, illustrative findings, and prevention/intervention implications, noting three perspectives: (a) scale up/extend existing interventions, including identifying under-targeted risk groups and intersecting with PrEP/PEP interventions; (b) modify existing interventions by cultivating psychoeducational content related to alcohol expectancies, alcohol myopia, sexual arousal, risk perception, sexual abdication, and condom use resistance; and (c) innovate new interventions through Science of Behavior Change approaches and repurposing ARBR paradigms. Finally, we suggest research directions concluding that until HIV incidence diminishes significantly, psychosocial interventions addressing the nexus of alcohol use, sexual transmission, and adherence to biomedical protocols will be an important priority.
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Affiliation(s)
- William H George
- Department of Psychology, University of Washington, Box 351525, Seattle, WA, 98195-1525, USA.
| | - Jessica A Blayney
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Cynthia A Stappenbeck
- Department of Psychology, Center for Research on Interpersonal Violence, Georgia State University, Atlanta, GA, USA
| | - Kelly Cue Davis
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
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Ragonnet-Cronin M, Benbow N, Hayford C, Poortinga K, Ma F, Forgione LA, Sheng Z, Hu YW, Torian LV, Wertheim JO. Sorting by Race/Ethnicity Across HIV Genetic Transmission Networks in Three Major Metropolitan Areas in the United States. AIDS Res Hum Retroviruses 2021; 37:784-792. [PMID: 33349132 PMCID: PMC8573809 DOI: 10.1089/aid.2020.0145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
An important component underlying the disparity in HIV risk between race/ethnic groups is the preferential transmission between individuals in the same group. We sought to quantify transmission between different race/ethnicity groups and measure racial assortativity in HIV transmission networks in major metropolitan areas in the United States. We reconstructed HIV molecular transmission networks from viral sequences collected as part of HIV surveillance in New York City, Los Angeles County, and Cook County, Illinois. We calculated assortativity (the tendency for individuals to link to others with similar characteristics) across the network for three candidate characteristics: transmission risk, age at diagnosis, and race/ethnicity. We then compared assortativity between race/ethnicity groups. Finally, for each race/ethnicity pair, we performed network permutations to test whether the number of links observed differed from that expected if individuals were sorting at random. Transmission networks in all three jurisdictions were more assortative by race/ethnicity than by transmission risk or age at diagnosis. Despite the different race/ethnicity proportions in each metropolitan area and lower proportions of clustering among African Americans than other race/ethnicities, African Americans were the group most likely to have transmission partners of the same race/ethnicity. This high level of assortativity should be considered in the design of HIV intervention and prevention strategies.
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Affiliation(s)
- Manon Ragonnet-Cronin
- Department of Medicine, University of California, San Diego, California, USA
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | - Nanette Benbow
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Christina Hayford
- Third Coast Center for AIDS Research, Northwestern University, Chicago, Illinois, USA
| | - Kathleen Poortinga
- Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Fangchao Ma
- HIV/AIDS Section, Illinois Department of Public Health, Chicago, Illinois, USA
| | - Lisa A. Forgione
- HIV Epidemiology and Field Services Program, Bureau of HIV Prevention and Control, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Zhijuan Sheng
- Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Yunyin W. Hu
- Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Lucia V. Torian
- HIV Epidemiology and Field Services Program, Bureau of HIV Prevention and Control, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Joel O. Wertheim
- Department of Medicine, University of California, San Diego, California, USA
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Crawford ND, Albarran T, Chamberlain A, Hopkins R, Josma D, Morris J, Onwubiko UN. Willingness to Discuss and Screen for Pre-Exposure Prophylaxis in Pharmacies Among Men Who Have Sex With Men. J Pharm Pract 2021; 34:734-740. [PMID: 32067554 PMCID: PMC10443399 DOI: 10.1177/0897190020904590] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the willingness to discuss and be screened for pre-exposure prophylaxis (PrEP) in pharmacies among MSM. METHODS Led by Georgia's Fulton County Board of Health, this study surveyed individuals who attended 2 Atlanta-based Gay Pride events in 2018. This analysis was limited to those who identified as men who have sex with men (MSM) who were not HIV positive and reported never using PrEP. Multivariable regression was used to determine the correlates of willingness to discuss and be screened for PrEP in-pharmacy. RESULTS Most (69%) were willing to discuss PrEP with pharmacy staff and 61.35% were willing to be screened for PrEP in-pharmacy. Those who were interested in PrEP were significantly more willing to discuss PrEP in-pharmacy compared to those not interested in PrEP (prevalence ratio [PR]: 1.65; 95% confidence interval [95% CI]: 1.11-2.48). Race was not associated with willingness to discuss PrEP with pharmacy staff. However, black MSM (BMSM) were less willing to be screened in pharmacies than white MSM, until we accounted for interest in PrEP (PR: 1.27; 95% CI: 1.09-1.48). DISCUSSION Pharmacies may be an optimal setting to expand PrEP access to reach racial minorities who have the highest need but are not being reached. Pharmacy-based PrEP discussions and screening could improve awareness of HIV status and increase PrEP knowledge and uptake. Future studies should determine optimal pharmacy conditions under which PrEP screening and uptake are acceptable for BMSM.
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Affiliation(s)
- Natalie D. Crawford
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Taynel Albarran
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Allison Chamberlain
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Fulton County Board of Health, Atlanta, GA, USA
| | - Roderick Hopkins
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Dorie Josma
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Joseph Morris
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Rosengren AL, Lelutiu-Weinberger C, Woodhouse EW, Sandanapitchai P, Hightow-Weidman LB. A Scoping Review of HIV Pre-exposure Prophylaxis Stigma and Implications for Stigma-Reduction Interventions for Men and Transwomen Who Have Sex with Men. AIDS Behav 2021; 25:2054-2070. [PMID: 33389319 PMCID: PMC10539076 DOI: 10.1007/s10461-020-03135-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 12/31/2022]
Abstract
HIV remains a public health concern in the United States. Although pre-exposure prophylaxis (PrEP) can be expected to reduce HIV incidence, its uptake, adherence, and persistence remain limited, particularly among highest priority groups such as men who have sex with men and transwomen (MSMTW). Using a socioecological framework, we conducted a scoping review to examine PrEP-related stigma to inform future research, policy, and programmatic planning. Using the PRISMA extension for scoping reviews, we conducted database searches from August 2018 to April 2020 for articles addressing PrEP stigma. Studies were independently screened and coded by three authors, resulting in thematic categorization of several types of PrEP stigma on four socioecological levels. Of 557 references, a final sample of 23 studies was coded, 61% qualitative, and 87% focusing exclusively on MSMTW. Most instances of PrEP-related stigma occurred on the interpersonal level and included associations of PrEP with risk promotion, HIV-related stigma, and promiscuity. Other frequent themes across socioecological levels included provider distrust and discrimination, government and pharmaceutical industry distrust, internalized homonegativity, PrEP efficacy distrust, and anticipated homonegativity. Notably, PrEP was also framed positively as having physical and psychological benefits, and assuming responsibility for protecting one's community via PrEP awareness-raising. PrEP-related stigma persists, demanding interventions to modify its impact. Leveraging PrEP-positive discourses to challenge PrEP stigma is an emerging avenue, alongside efforts to increase provider willingness to promote PrEP routinely by reducing provider bias, aligning with the national strategy to End the HIV Epidemic.
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Affiliation(s)
- A Lina Rosengren
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA.
| | - Corina Lelutiu-Weinberger
- Rutgers Biomedical and Health Sciences, School of Nursing, François-Xavier Bagnoud Center, Rutgers University, 65 Bergen Street, Room 846N, Newark, NJ, 07107, USA
| | - E Wilbur Woodhouse
- Department of Medicine, Vanderbilt University Medical center, 1161 21st Avenue South, Nashville, TN, 37122, USA
| | | | - Lisa B Hightow-Weidman
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA
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Meyers K, Wu Y, Shin KY, Hou J, Hu Q, Duan J, Li Y, He X. Salient Constructs for the Development of Shared Decision-Making Tools for HIV Pre-Exposure Prophylaxis Uptake and Regimen Choice: Behaviors, Behavioral Skills, and Beliefs. AIDS Patient Care STDS 2021; 35:195-203. [PMID: 34037427 DOI: 10.1089/apc.2021.0066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The availability of multiple pre-exposure prophylaxis (PrEP) regimens creates a preference-sensitive choice for individuals weighing alternative HIV prevention strategies. Investigating factors that are associated with PrEP uptake and regimen choice are key to developing tools to support that decision. A cross-sectional survey was offered to 536 participants in a PrEP demonstration project for gay, bisexual, and other men who have sex with men across 3 cities in China, of which 412 completed surveys and were included in the analysis. We conducted bivariable analyses followed by multi-variable logistic regressions to examine factors associated with overall PrEP uptake and PrEP regimen choice. Among the 412 participants, 36.9% were daily PrEP users, 28.4% were event-driven users, and 34.7% were non-PrEP users. Higher levels of education, lower PrEP use stigma, and higher perceived benefits of PrEP were associated with greater PrEP uptake. More frequent sex, higher PrEP adherence self-efficacy, higher endorsement of the belief in elevated efficacy of daily over on-demand PrEP, and lower endorsement of a desire for a PrEP method that is only taken when needed led to greater odds of choosing the daily PrEP regimen. As multiple HIV prevention modalities become available, there is a greater need for a shared decision-making approach to support this preference-sensitive choice of HIV prevention method. Our findings suggest salient constructs to inform the development of shared decision-making tools to support regimen choice.
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Affiliation(s)
- Kathrine Meyers
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Yumeng Wu
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Kee-Young Shin
- Columbia University Mailman School of Public Health, Department of Biostatistics, New York, New York, USA
| | - Jianhua Hou
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Qinghai Hu
- NHC Key Laboratory of AIDS Immunology (China Medical University), Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | | | - Yao Li
- Division of Infectious Disease, Chongqing Public Health Medical Center, Chongqing, China
| | - Xiaoqing He
- Division of Infectious Disease, Chongqing Public Health Medical Center, Chongqing, China
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Pagkas-Bather J, Khosropour CM, Golden MR, Thibault C, Dombrowski JC. Population-Level Effectiveness of HIV Pre-exposure Prophylaxis Among MSM and Transgender Persons With Bacterial Sexually Transmitted Infections. J Acquir Immune Defic Syndr 2021; 87:769-775. [PMID: 33538527 PMCID: PMC8126498 DOI: 10.1097/qai.0000000000002646] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/11/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is highly efficacious, but its effectiveness may be limited by poor adherence or discontinuation. Our objective was to estimate the effectiveness of real-world PrEP use in a population at increased risk of HIV infection. SETTING King County, Washington. METHODS We conducted a retrospective cohort study using sexually transmitted infection (STI) partner services (PS) interview data collected January 2014-August 2018 in King County, Washington, USA. During PS interviews, men who have sex with men and transgender persons who have sex with men were asked if they were taking PrEP. We linked STI PS data to HIV surveillance data to estimate HIV incidence among self-reported PrEP users vs. nonusers using Cox proportional hazards regression, adjusting for age, race/ethnicity, and calendar year. RESULTS Among 4368 individuals, 1206 (28%) were taking PrEP at the time of the PS interview. The median observation time was 14 months (interquartile range 6-23 months). Five (0.4%) of 1206 PrEP users and 97 (3%) of 2162 PrEP nonusers were subsequently diagnosed with HIV (P < 0.001). HIV incidence was lower among PrEP users than nonusers [0.17 vs. 1.86 cases per 100 person-years, adjusted hazards ratio 0.21 (95% confidence interval: 0.08 to 0.58)]. Latinx ethnicity, Native Hawaiian/Pacific Islander ethnicity, gonorrhea, and syphilis were also independently associated with higher HIV risk. CONCLUSIONS Self-reported PrEP use was associated with a 79% reduction in HIV incidence among men who have sex with men and transgender persons who have sex with men with STIs in King County.
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Affiliation(s)
| | | | - Matthew R. Golden
- Departments of Medicine; and
- Epidemiology, University of Washington, Seattle, WA; and
- Public Health-Seattle and King County HIV/STI Program, Seattle, WA
| | | | - Julia C. Dombrowski
- Departments of Medicine; and
- Epidemiology, University of Washington, Seattle, WA; and
- Public Health-Seattle and King County HIV/STI Program, Seattle, WA
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48
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Awareness and acceptability of HIV pre-exposure prophylaxis (PrEP) among students at two historically Black universities (HBCU): a cross-sectional survey. BMC Public Health 2021; 21:943. [PMID: 34006245 PMCID: PMC8132367 DOI: 10.1186/s12889-021-10996-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/04/2021] [Indexed: 12/02/2022] Open
Abstract
Background Despite young African American adults (ages 18–24) being among the highest risk groups for HIV infection, little is known about their awareness of HIV pre-exposure prophylaxis (PrEP) – a once daily pill shown to be > 90% effective in preventing HIV. To explore awareness and acceptability of PrEP among college students in this demographic, we conducted a survey of attendees at two large historically Black universities (HBCU) in North Carolina. Methods We administered a 14-item questionnaire to students at two HBCUs in North Carolina between February and April 2018. Questions were formatted in a yes/no or multiple choice format. Questionnaire items specifically addressed PrEP awareness and acceptability. Surveys were administered to students at a campus health fair and while transiting the campus student union via iPad. Response to all questions was optional. We fit a logistic regression model to determine association of key demographic determinants with PrEP acceptability and awareness. Statistical analyses were conducted using SAS 9.4 (SAS, Cary, NC). Results Overall, 210 students participated in the survey, of which 60 completed all survey items as presented. The survey cohort was 75% female, 89% heterosexual and 39% freshmen. The mean age of respondents was 19.8 years (SD: 1.8). Fifty-two percent of survey respondents reported that they were aware of PrEP prior to the time of survey administration. Only 3% of respondents reported that they were on PrEP. The most common sources of information on PrEP were campus health services (24%) and non-social media advertising (15%). Of respondents who were aware of PrEP, 61% reported that they had heard about in the 6 months prior to survey administration, while only 19% say they were aware of it for more than a year. Regarding acceptability of PrEP, 58% of respondents reported that they would take a once a day pill for HIV if they were at risk. Our logistic regression analysis found no statistically significant associations between key demographic factors and PrEP awareness. However, persons who perceived themselves to be at risk for HIV acquisition were more likely to find once daily oral PrEP (relative risk 2.66 (95% CI 1.31–5.42)) as an acceptable prevention strategy than the rest of the survey cohort. Conclusions African American HBCU students are becoming aware of PrEP, and generally perceive the intervention as acceptable and worth consideration. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10996-2.
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Dauria EF, Levine A, Hill SV, Tolou-Shams M, Christopoulos K. Multilevel Factors Shaping Awareness of and Attitudes Toward Pre-exposure Prophylaxis for HIV Prevention among Criminal Justice-Involved Women. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1743-1754. [PMID: 33236275 PMCID: PMC8276158 DOI: 10.1007/s10508-020-01834-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 05/14/2023]
Abstract
Although pre-exposure prophylaxis (PrEP) is a key tool in HIV prevention efforts, little is known about PrEP as a prevention strategy for criminal justice-involved (CJI) women. The purpose of this study was to examine multilevel factors shaping PrEP awareness and acceptability among CJI women. Between January 2017 and December 2017, we conducted 52 interviews with CJI women at high risk for HIV and stakeholders from the criminal justice (CJ) and public health (PH) systems. Interviews explored awareness of PrEP and the multilevel factors shaping PrEP acceptability. Data were analyzed using inductive thematic analysis and executive summaries. Atlas.ti facilitated analyses. The majority of CJI women (n = 27) were, on average, 41.3 years, from racial and ethnic minority groups (56% Black/African-American; 19% Latinx) and reported engaging in recent high-risk behavior (nearly 60% engaged in transactional sex, 22% reported ≥ 4 sexual partners, and 37% reported injection drug use). Of system stakeholders (n = 25), 52% represented the CJ sector. Although CJI women were generally unaware of PrEP, attitudes toward PrEP were enthusiastic. Barriers to PrEP acceptability included medication side effects (individual level); distrust in HIV prevention mechanisms (community level); lack of local HIV prevention efforts among high-risk women (public policy/HIV epidemic stage level). Factors promoting PrEP included perceived HIV risk (individual level); PrEP being an HIV prevention method that women can control without partner negotiation (social and sexual network level); and availability of public health insurance (community level). Despite low awareness of PrEP, CJI women expressed positive attitudes toward PrEP. To improve PrEP access for CJI women, implementation efforts should address barriers and leverage facilitators across multiple levels to be maximally effective.
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Affiliation(s)
- Emily F Dauria
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 1001 Potrero Ave., Bldg. 5, San Francisco, CA, 94110, USA.
| | - Andrew Levine
- Department of Sociology, New York University, New York, NY, USA
| | - Samantha V Hill
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 1001 Potrero Ave., Bldg. 5, San Francisco, CA, 94110, USA
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Harkness A, Satyanarayana S, Mayo D, Smith-Alvarez R, Rogers BG, Prado G, Safren SA. Scaling Up and Out HIV Prevention and Behavioral Health Services to Latino Sexual Minority Men in South Florida: Multi-Level Implementation Barriers, Facilitators, and Strategies. AIDS Patient Care STDS 2021; 35:167-179. [PMID: 33960844 DOI: 10.1089/apc.2021.0018] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Latino sexual minority men (LSMM) are disproportionately affected by HIV in the United States. Concurrently, behavioral health disparities, including mental health and substance use concerns, worsen HIV disparities affecting LSMM. Yet, evidence-based HIV prevention and behavioral health services are insufficiently scaled up and out to this population, perpetuating health disparities, thwarting efforts to control the HIV epidemic, and highlighting the need for culturally relevant evidence-based implementation strategies that address these disparities. Participants included 28 LSMM with varying degrees of engagement in HIV prevention and behavioral health services, and 10 stakeholders with experience delivering HIV prevention and behavioral health services to LSMM in South Florida, an HIV epicenter in general and in particular for LSMM. Participants completed semistructured interviews (English/Spanish) regarding LSMM's barriers and facilitators to engaging in HIV prevention and behavioral health services. Interviews were audio recorded and analyzed using thematic analysis. The 16 themes that emerged from the qualitative analysis were consistent with the consolidated framework for implementation research, an implementation research framework that articulates barriers and facilitators to implementing clinical interventions. Findings suggested the need for implementation strategies that simplify and reduce costs of HIV prevention and behavioral health services, address syndemic challenges impacting service use among LSMM, reduce stigma about service utilization, leverage peer networks, increase provider and community knowledge about services, and build LSMM's readiness and motivation to engage in services. Such strategies may ultimately address HIV and behavioral health disparities among LSMM and facilitate achievement of ending the HIV epidemic goals in this disproportionally affected population.
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Affiliation(s)
- Audrey Harkness
- Department of Public Health Sciences and University of Miami, Miami, Florida, USA
| | | | - Daniel Mayo
- Department of Psychology, University of Miami, Miami, Florida, USA
| | | | - Brooke G. Rogers
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Medicine, Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA
| | - Guillermo Prado
- Department of Public Health Sciences and University of Miami, Miami, Florida, USA
- Department of Psychology, University of Miami, Miami, Florida, USA
- School of Nursing and Health Studies, University of Miami, Miami, Florida, USA
| | - Steven A. Safren
- Department of Psychology, University of Miami, Miami, Florida, USA
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