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Siziba B, Mgodi NM, Ngara B, Chawana TD, Chitukuta M, Mukwekwerere PG, Bhondai-Mhuri M, Chirenje ZM, Mhlanga FGS. Prevalence and factors associated with uptake of pre-exposure prophylaxis amongst women vulnerable to HIV who received HIV antibodies in Antibody Mediated Prevention HVTN703/HPTN081 trial in Harare, Zimbabwe: a cross-sectional study. BMJ PUBLIC HEALTH 2024; 2:e000262. [PMID: 39149557 PMCID: PMC11326454 DOI: 10.1136/bmjph-2023-000262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Introduction There is limited evidence on pre-exposure prophylaxis (PrEP) uptake post-trial participation for women vulnerable to HIV. This study investigates the prevalence and factors associated with PrEP uptake post-participation in an HIV prevention trial. Methods Former Antibody Mediated Prevention (AMP) study participants were invited to the three AMP clinical research sites in Zimbabwe after at least a year of exiting the study. The AMP study evaluated the safety and efficacy of Vaccine Research Center 01 broadly neutralising monoclonal antibody in reducing acquisition of HIV-1 infection in women in sub-Saharan Africa. Participants vulnerable to HIV were enrolled and risk reduction counselling was done throughout study participation. In a cross-sectional study, semi-structured interview administered questionnaires were completed. The primary outcome was uptake of PrEP after the study exit. Results From February 2022 to August 2022, out of 434 participants enrolled in the AMP study, a total of 298 were invited and 225 participated in the study; 28% made an attempt to access PrEP after study participation, 20% used PrEP at some point after study participation and 15% were on PrEP at the time of questionnaire administration. PrEP uptake was associated with new sexual partners after study participation and higher average number of sexual encounters in the previous month. Challenges faced in accessing PrEP included those related to the health facility, transport problems and stigma. Conclusion The majority (85%) of former AMP participants were not on PrEP at the time of questionnaire administration. We observed poor uptake of PrEP post-study exit among participants who had received risk reduction counselling through study duration. Measures to improve PrEP uptake should be considered on participants vulnerable to HIV when exiting HIV prevention trials.
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Affiliation(s)
- Bekezela Siziba
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | | | - Bernard Ngara
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | | | - Miria Chitukuta
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | | | | | - Zvavahera Mike Chirenje
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
- University of California San Francisco, San Francisco, California, USA
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Fredericksen RJ, Perkins R, Brown CE, Cannon C, Lopez C, Cohee A, Dombrowski JC, Cohen S, Malinski C, Powell M, Luetkemeyer AF, Celum C, Christopoulos K. Doxycycline as Postsexual Exposure Prophylaxis: Use, Acceptability, and Associated Sexual Health Behaviors Among a Multi-Site Sample of Clinical Trial Participants. AIDS Patient Care STDS 2024; 38:155-167. [PMID: 38656217 PMCID: PMC11236279 DOI: 10.1089/apc.2023.0289] [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: 04/26/2024] Open
Abstract
Doxycycline postexposure prophylaxis (doxy-PEP) reduces sexually transmitted infections (STIs) in men who have sex with men (MSM) and transgender women (TGW). In a clinical trial of doxy-PEP, we sought to assess acceptability, impact, and meaning of doxy-PEP use among MSM/TGW. We conducted semistructured, in-depth 1:1 interviews with MSM and TGW enrolled in the intervention arm of the Doxy-PEP study. We queried motivations for and meaning of use, attitudes, beliefs, adherence, effect on sexual behaviors, and partner, community, and structural factors related to use. We coded interview transcripts into content areas, followed by thematic analysis. We interviewed 44 participants (median age 38), 2% were TGW, 17% Black, 61% White, 30% Hispanic, and 45% persons with HIV. We identified three overarching themes. First, participants found doxy-PEP acceptable, and believed it was effective based on their history of STIs, easy to adhere to, and acceptable to sex partners. Second, doxy-PEP benefited their quality of life and mental health, offering "peace of mind" by reducing their anxiety about acquisition or unwitting transmission of STIs. Participants reported feeling more "in control" of preventing STIs, and positive about supporting their personal, partner, and community health. Third, impact on sexual behavior was variable, with most reporting no change or a brief initial change. Participants in a multi-site clinical trial of doxycycline for STI prevention perceived it to be efficacious, and that it provided quality-of-life benefits, including reduced anxiety and sense of control over sexual health. Doxy-PEP had limited impact on sexual behavior. Clinicaltrials.gov: NCT03980223.
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Affiliation(s)
- Rob J Fredericksen
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Rodney Perkins
- Department of Global Health, University of Washington, Seattle, Washington, USA
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Clare E Brown
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Chase Cannon
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Carolina Lopez
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Alison Cohee
- San Francisco Department of Public Health, San Francisco, California, USA
| | | | - Stephanie Cohen
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Cheryl Malinski
- Sexual Health Clinic, Seattle King County Department of Public Health, Seattle, Washington, USA
| | - Minh Powell
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Anne F Luetkemeyer
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Connie Celum
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Katerina Christopoulos
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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von Schreeb S, Pedersen SK, Christensen H, Jørgsensen KM, Harritshøj LH, Hertz FB, Ahlström MG, Lebech AM, Lunding S, Nielsen LN, Gerstoft J, Kronborg G, Engsig FN. Questioning risk compensation: pre-exposure prophylaxis (PrEP) and sexually transmitted infections among men who have sex with men, capital region of Denmark, 2019 to 2022. Euro Surveill 2024; 29:2300451. [PMID: 38551099 PMCID: PMC10979528 DOI: 10.2807/1560-7917.es.2024.29.13.2300451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/20/2023] [Indexed: 04/01/2024] Open
Abstract
BackgroundPre-exposure prophylaxis (PrEP) effectively prevents HIV, but its association with sexually transmitted infections (STIs) has raised concerns about risk compensation, potentially impacting the expansion of PrEP programmes.AimWe examined the relationship between PrEP and the incidence of chlamydia, gonorrhoea and syphilis.MethodsIn this prospective cohort study, we compared STI rates before and after PrEP initiation among users in the capital region of Denmark (2019-2022), calculating incidence rate ratios adjusted for age and testing frequency (aIRR). To pinpoint when increases began, we plotted weekly STI rates, adjusting the timeline to correspond with PrEP initiation.ResultsThe study included 1,326 PrEP users with a median age of 35 years. The STI incidence rate per 100,000 person-years rose from 35.3 before to 81.2 after PrEP start, with an aIRR of 1.35 (95% CI: 1.18-1.56). Notably, this increase preceded PrEP initiation by 10-20 weeks. Specific aIRR for chlamydia, gonorrhoea and syphilis were 1.23 (95% CI: 1.03-1.48), 1.24 (95% CI: 1.04-1.47) and 1.15 (95% CI: 0.76-1.72), respectively. In subanalyses for anatomical sites aIRR was 1.26 (95% CI: 1.01-1.56) for rectal chlamydia and 0.66 (95% CI: 0.45-0.96) for genital gonorrhoea.ConclusionWe found a 35% increase in STI incidence associated with PrEP use. It started before PrEP initiation, challenging the assumption that PrEP leads to risk compensation. Instead, the data suggest that individuals seek PrEP during periods of heightened sexual risk-taking. Consequently, PrEP programmes should include sexual health consultations, STI testing, treatment and prevention strategies to prevent HIV and improve sexual health.
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Affiliation(s)
- Sebastian von Schreeb
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Susanne Kriegel Pedersen
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Hanne Christensen
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | | | - Lene Holm Harritshøj
- Department of Clinical Immunology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Frederik Boetius Hertz
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Magnus Glindvad Ahlström
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Suzanne Lunding
- Department of Internal Medicine, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Lars Nørregaard Nielsen
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital - North Zealand Hospital, Copenhagen, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Gitte Kronborg
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Frederik N Engsig
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
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4
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L C, M C, P N, T D, K T, P T, P S, P P, V P, J S, L D, N T, J N, M M. Providing HIV pre-exposure prophylaxis to men who have sex with men and transgender women in hospitals and community-led clinics in Thailand: acceptance, patterns of use, trends in risk behaviors, and HIV incidence. AIDS Care 2023; 35:524-537. [PMID: 36726288 PMCID: PMC10121879 DOI: 10.1080/09540121.2022.2159312] [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: 01/05/2022] [Accepted: 12/13/2022] [Indexed: 02/03/2023]
Abstract
From May 2015 to June 2018, we conducted a PrEP demonstration project at two hospitals and four community-led clinics in Bangkok and Pattaya. HIV-negative, MSM and TGW aged ≥18 years old, reporting sex without a condom, were offered daily PrEP. Participants received HIV testing and completed a computer-based questionnaire at enrollment, 6 and 12 months. We collected self-reported PrEP adherence at months 1, 3, 6, 9, and 12. We used logistic regression to determine factors associated with the decision to take PrEP and calculated HIV incidence among baseline HIV-negative participants. Of 803 participants enrolled, 349 (43.5%) started PrEP. Participants were more likely to start PrEP if they were sex workers, had moderate or high self-perceived risk of HIV, or a high PrEP-knowledge score. Participants used PrEP for a median of 6.1 months. Reported condom use increased and the number of sex partners decreased during follow-up regardless of PrEP use. Six participants not-taking PrEP acquired HIV (HIV incidence 2.2 per 100 person-years), and five taking PrEP acquired HIV (HIV incidence 2.1 per 100 person-years). All five reported taking <4 pills the weeks before study visits.
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Affiliation(s)
- Cheewanan L
- Division of AIDS and STIs, Ministry of Public Health, Bangkok, Thailand
| | - Chomnad M
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | - Nittaya P
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | - Deondara T
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | - Thana K
- Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Tharee P
- Department of Medical Services, Ministry of Public Health, Lerdsin hospital, Bangkok, Thailand
| | - Supabhorn P
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | - Patcharaporn P
- Division of AIDS and STIs, Ministry of Public Health, Bangkok, Thailand
| | - Prin V
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | - Surang J
- Service Workers in Group Foundation (SWING), Bangkok, Thailand
| | - Danai L
- Rainbow Sky Association of Thailand, Bangkok, Thailand
| | | | - Nuchapong J
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | - Michael M
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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5
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HIV Risk Perception and Pre-Exposure Prophylaxis (PrEP) Awareness Among Transgender Women from Mexico. AIDS Behav 2023; 27:992-1002. [PMID: 36121550 DOI: 10.1007/s10461-022-03836-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/01/2022]
Abstract
This study aimed to identify factors associated with HIV risk perception among Mexican transgender women (TGW). This cross-sectional survey was conducted online and at a public HIV clinic in Mexico City. Participants were ≥ 18 years old, self-identified as TGW, and reported not living with HIV. They answered questions on sexual behavior, HIV risk perception, and pre-exposure prophylaxis (PrEP) awareness. We performed a multivariate logistic regression to accomplish the study's objective. One hundred ninety-one TGW completed the survey. High HIV risk perception was associated with > 5 sexual partners, condomless receptive anal sex, sex with a male partner(s) of unknown HIV status, and PrEP awareness. Although most TGW reported low HIV risk perception, over half had risk sexual behavior, reflecting inaccurate risk assessment. Future interventions to improve accurate risk perception among TGW should promote HIV transmission and prevention knowledge and increase PrEP awareness and uptake.
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6
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Ji-Xu A, Leslie KS. Syphilis: recommendations for dermatologists on a resurgent epidemic. Int J Dermatol 2023; 62:583-588. [PMID: 36596704 DOI: 10.1111/ijd.16574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/31/2022] [Accepted: 12/19/2022] [Indexed: 01/05/2023]
Abstract
Despite reaching historical lows in the early 2000s, cases of both primary and secondary syphilis and congenital syphilis have increased dramatically in the U.S. over the last decade. In the U.S., the current syphilis epidemic is disproportionately impacting communities that have been historically underserved in medicine. These include men who have sex with men, especially those infected with HIV; people of color; and reproductive-age women with poor access to prenatal care. With syphilis now being more commonly diagnosed in non-STI than STI clinics in all genders, and since primary and secondary syphilis and congenital syphilis present with characteristic mucocutaneous manifestations, dermatologists are in a position to help reduce the advance of this preventable epidemic, by actively considering this diagnosis and incorporating syphilis screening into their practice. Herein, we delineate strategies by which dermatologists can contribute to this critical effort in their roles as clinicians, public health advocates, and researchers. In particular, we discuss the rapidly changing demographics of syphilis, nuances in serologic testing and treatment, strategies to increase public healthcare access and equity in these underserved populations, and research gaps in this field.
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Affiliation(s)
- Antonio Ji-Xu
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA.,Department of Dermatology, University of California, San Francisco School of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Kieron S Leslie
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA.,Department of Dermatology, University of California, San Francisco School of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
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7
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Birnholtz J, Kraus A, Schnuer S, Tran L, Macapagal K, Moskowitz DA. 'Oh, I don't really want to bother with that:' gay and bisexual young men's perceptions of barriers to PrEP information and uptake. CULTURE, HEALTH & SEXUALITY 2022; 24:1548-1562. [PMID: 34524938 PMCID: PMC8920939 DOI: 10.1080/13691058.2021.1975825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
Pre-exposure prophylaxis (PrEP), a daily oral pill for HIV prevention demonstrated to be effective for adults, was recently approved by the US Food and Drug Administration for use with young people weighing at least 35 kilograms. Given that young people aged 13-19 years account for a disproportionate share of new US HIV infections, PrEP presents an important opportunity. There has been limited effort, however, to increase PrEP awareness and uptake among young people. While prior work has identified barriers young people face in getting PrEP, effective strategies for overcoming these barriers have not yet been identified. This paper presents results from interviews with 15-19 year old gay and bisexual young men about their knowledge and perceptions of PrEP, and the barriers they perceive. Results suggest that participants were aware of PrEP but confused by the details of insurance coverage and out-of-pocket costs. Participants also felt parents and providers would not be knowledgeable or supportive, and were reluctant to share their own use of PrEP on social media. Suggested next steps include online parent and provider education, systemic health care reform to streamline and simplify access to preventative care and awareness campaigns that meet youth where they are on popular platforms.
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Affiliation(s)
- Jeremy Birnholtz
- Department of Communication Studies, Northwestern University, Evanston, IL, USA
| | - Ashley Kraus
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Samantha Schnuer
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Lauren Tran
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Kathryn Macapagal
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - David A. Moskowitz
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
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8
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Madhani A, Finlay KA. Using the COM-B model to characterize the barriers and facilitators of pre-exposure prophylaxis (PrEP) uptake in men who have sex with men. Br J Health Psychol 2022; 27:1330-1353. [PMID: 35698439 PMCID: PMC9796940 DOI: 10.1111/bjhp.12605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/14/2022] [Accepted: 05/16/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Using the COM-B model, this study aimed to characterize barriers and facilitators to pre-exposure prophylaxis (PrEP) uptake amongst men who have sex with men (MSM). DESIGN AND METHOD Semistructured interviews with 13 MSM who were non-PrEP users were conducted with a specific focus on barriers and facilitators to PrEP uptake. A 15-item interview schedule was created informed by the COM-B model. Transcripts were transcribed verbatim and inductively analysed using thematic analysis. To illustrate pathways for intervention design, inductive themes were then deductively mapped onto COM-B constructs. RESULTS Results demonstrated that barriers to PrEP uptake were closely aligned with five (of six) COM-B components: psychological capability, physical opportunity, social opportunity, reflective motivation and automatic motivation. These COM-B subcomponents reflected seven thematized barriers: (1) limited information about PrEP, (2) restricted access to PrEP, (3) gay identity and sexual stigmatization, (4) social and cultural stigmatization, (5) capabilities in treatment adherence, (6) optimistic bias about sexual behaviours and (7) calculating risk. No facilitators or physical capability concerns were demonstrated. CONCLUSION This study adopted a novel behaviour change-informed approach to understanding barriers and facilitators to PrEP uptake amongst MSM. Unrealistic optimism about self-protective individual behaviours, the physical accessibility of PrEP and (mis)information together interacted closely with perceptions of personal and social stigmatization to dynamically impact PrEP uptake decisions. Barriers to PrEP uptake mapped clearly to the COM-B; therefore, these results provide the foundation for Behaviour Change Wheel intervention development to improve rates of PrEP uptake and its acceptability for MSM.
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Affiliation(s)
- Adam Madhani
- School of PsychologyUniversity of BuckinghamBuckinghamUK
| | - Katherine A. Finlay
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
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9
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Balasubramanian R, Kasaie P, Schnure M, Dowdy DW, Shah M, Fojo AT. Projected Impact of Expanded Long-Acting Injectable PrEP Use Among Men Who Have Sex With Men on Local HIV Epidemics. J Acquir Immune Defic Syndr 2022; 91:144-150. [PMID: 35636746 PMCID: PMC9474589 DOI: 10.1097/qai.0000000000003029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/04/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is a key component in helping to reduce HIV incidence in the United States. Long-acting injectable (LAI) PrEP is a new alternative to oral PrEP; its potential to affect local HIV epidemics remains unclear. METHODS The Johns Hopkins HIV Economic Epidemiological model (JHEEM) is a dynamic model of HIV transmission in 32 US urban areas. We used JHEEM to project the HIV incidence among men who have sex with men (MSM) from 2020 to 2030 under a range of interventions aimed at increasing PrEP use. RESULTS In the absence of any intervention (ie, current levels of oral PrEP and HIV care engagement), we projected a 19% reduction (95% credible interval, CrI 1% to 36%) in HIV incidence among MSM from 2020 to 2030 across all 32 cities. Adding 10% LAI PrEP uptake (above a base case of all oral PrEP) reduced the incidence by 36% (95% CrI 23% to 50%) by year 2030. This effect varied between cities, ranging from 22% in Atlanta to 51% in San Francisco. At 25% additional LAI PrEP uptake, this incidence reduction increased to 54% (95% CrI 45% to 64%). Reductions in incidence after introducing LAI PrEP were driven primarily by increased uptake and sustained usage rather than increased efficacy. CONCLUSIONS LAI PrEP has the potential to substantially reduce HIV incidence among MSM, particularly if it increases PrEP uptake and continued use beyond existing levels. Because potential effects vary by city, the effectiveness of expanding PrEP use is dependent on local dynamics.
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Affiliation(s)
| | - Parastu Kasaie
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Melissa Schnure
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Maunank Shah
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD; and
| | - Anthony Todd Fojo
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Rossotti R, Nava A, Baiguera C, Calzavara D, D'Amico F, Fanti D, Bana NB, Vismara C, Cernuschi M, Scaglione F, Puoti M. High prevalence of anal papillomavirus infection in men who have sex with men PrEP users. Sex Transm Infect 2022:sextrans-2022-055447. [PMID: 35882547 DOI: 10.1136/sextrans-2022-055447] [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: 02/09/2022] [Accepted: 07/16/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Human papillomavirus (HPV) is the most common STI and is associated with a wide range of diseases from anogenital warts to malignancies. Anal HPV infection is considerably more common in men who have sex with men (MSM) living with HIV. Aims of the present study are to (i) describe the prevalence of anal HPV infection in MSM who started pre-exposure prophylaxis (PrEP) and (ii) analyse factors associated with anal infection from genotypes that would be covered by nonavalent vaccination. METHODS This monocentric, cross-sectional study included all subjects who started PrEP from May 2018 to November 2021. PrEP candidates underwent full behavioural and clinical evaluation, including digital anal rectal examination and swabbing for HPV determination. Descriptive statistics, Mann-Whitney U test for continuous and χ2 tests for categorical variables were adopted. Unadjusted and adjusted regression analyses were performed to assess factors associated with positive anal swabs and to the presence of genotypes covered by the nonavalent vaccination. RESULTS The analysis included 288 subjects: anal swabs tested positive in 87.2% of cases, 79.2% of the subjects had a high-risk genotype (mainly 16), whereas 67.4% had a genotype covered by nonavalent vaccine. Sexual role was the only factor associated with anal HPV infection. Use of recreational drugs and a diagnosis of ≥2 STIs correlated with the presence of genotypes that would have been covered by vaccine, while previous vaccination had a protective role. CONCLUSIONS PrEP candidates showed a high prevalence of anal HPV infection, especially due to high-risk genotypes, comparable to what has been reported in MSM living with HIV.
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Affiliation(s)
- Roberto Rossotti
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alice Nava
- Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Chiara Baiguera
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Federico D'Amico
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Diana Fanti
- Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nicholas Brian Bana
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Chiara Vismara
- Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Massimo Cernuschi
- Milano Checkpoint, Milan, Italy
- Department of Infectious Diseases, Istituto Scientifico Universitario San Raffaele, Milan, Italy
| | - Francesco Scaglione
- Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Massimo Puoti
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- School of Medicine, Università degli Studi di Milano-Bicocca, Milan, Italy
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11
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Hassan A, Agustin HGS, Burke L, Kofron R, Corado K, Bolan R, Landovitz RJ, Dubé MP, Morris SR. Low incidence and prevalence of hepatitis C in two cohorts of HIV pre-exposure prophylaxis adherence interventions in men who have sex with men in Southern California. J Viral Hepat 2022; 29:529-535. [PMID: 35357767 PMCID: PMC9908082 DOI: 10.1111/jvh.13678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 02/02/2023]
Abstract
HIV pre-exposure prophylaxis (PrEP) has been associated with incident hepatitis C virus (HCV) infection in men who have sex with men (MSM) due to decreased condom use. We examined rates of HCV among MSM and transgender women at high-risk of HIV on PrEP in Southern California using data from two trials (NCT01761643 and NCT01781806). Five of 599 participants (0.84%, 95% CI, 0.27-1.93) had HCV antibodies detected at entry. Factors associated with HCV seropositivity included being older (p = .002) and lower education level (p < .001). HCV-positive participants had no reported cases of sexually transmitted infection (rectal, urethral or pharyngeal gonorrhoea and/or chlamydia) at entry while HCV-negative participants had a prevalence of 18% (95% CI, 15%-21%). There were no significant differences in substance use and sexual risk behaviour between HCV-positive and HCV-negative participants 1-3 months prior to entry. Among early PrEP adopters, incident HCV did not occur despite ongoing condomless intercourse. Screening intervals for HCV in MSM on PrEP should be led by a risk behaviour assessment.
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Affiliation(s)
- Adiba Hassan
- Department of Medicine, University of California, San Diego, CA, USA,Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, CA, USA * research was conducted at Department of Medicine, University of California, San Diego, CA, USA
| | | | - Leah Burke
- Department of Medicine, University of California, San Diego, CA, USA
| | - Ryan Kofron
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Katya Corado
- Division of HIV Medicine, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | | | - Michael P Dubé
- Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sheldon R Morris
- Department of Medicine, University of California, San Diego, CA, USA
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12
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Kusemererwa S, Abaasa A, Kabarambi A, Onyango M, Mugisha JO. Assessment of risk compensation following use of the dapivirine vaginal ring in southwestern Uganda. Sex Transm Infect 2022; 98:32-37. [PMID: 33542153 PMCID: PMC8785055 DOI: 10.1136/sextrans-2020-054718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Participation in HIV prevention trials could trigger risk compensation among participants. We evaluated potential risk compensation following use of a vaginal ring microbicide by women in a phase III trial in southwestern Uganda. METHODS We used markers of sexual risk behaviour documented on standardised questionnaires, tested for STIs at baseline and quarterly for 2 years. Risk compensation was defined as a significant increase (trend p<0.05) in the proportion of women reporting risky sexual behaviour or a diagnosed STI between baseline and end of follow-up. RESULTS Between September 2013 and December 2016, 197 women (active arm: n=132 and placebo: n=65) were enrolled at the Masaka site. There were decreases in all markers of sexual risk behaviour with statistically significant decreases in only the proportion of women reporting ≥2 sexual partners, p=0.026 and those diagnosed with Trichomonas vaginalis p<0.001 and or Neisseria gonorrhoeae p<0.001 CONCLUSIONS: No evidence of risk compensation was observed in this trial. TRIAL REGISTRATION NUMBER NCT01539226.
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Affiliation(s)
- Sylvia Kusemererwa
- Department of HIV Interventions, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Andrew Abaasa
- Department of Statistics, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Anita Kabarambi
- Department of HIV Interventions, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Martin Onyango
- Department of HIV Interventions, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Joseph Okello Mugisha
- Department of HIV Interventions, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
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13
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Psomas CK, Penaranda G, Retornaz F, Khiri H, Delord M, Halfon P, Philibert P. A cohort analysis of sexually transmitted infections among different groups of men who have sex with men in the early era of HIV pre-exposure prophylaxis in France. J Virus Erad 2022; 8:100065. [PMID: 35251684 PMCID: PMC8891709 DOI: 10.1016/j.jve.2022.100065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/07/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022] Open
Abstract
Background MSM are at particular risk of STIs due to sexual behavior and substance use. HIV PrEP use may increase this risk. Design Our aim was to comparatively assess incident STIs among different at-risk groups—PLWHIV, HIV-negative PrEP and no-PrEP users—seen at our center early after PrEP implementation. Methods Clinical data were retrospectively collected on 636 MSM seen at the Infectious Diseases Department between September 2016 and October 2018. STI incidence rate was assessed among groups for the whole period, as well as separately for each year of the study. Results Overall STI incidence rate ratio was higher in HIV-neg when compared to PLWHIV. In multivariate analysis, STI risk was significantly higher among HIV-neg no-PrEP users compared to PLWHIV, while not different between PLWHIV and PrEP users. STI incidence globally increased during the first 2 years after PrEP approval among PLWHIV and no-PrEP users, stated by odds ratio (OR = 1.77 [1.23–2.55], p = 0.0020 and OR = 2.29 [0.91–5.73], p = 0.0774 respectively) while it remained rather stable for HIV-neg PrEP users (OR = 1.19 [0.60–2.38], p = 0.6181). The HIV-neg no-PrEP group remained at higher risk of STI than PLWHIV and PrEP users during the two periods. Conclusion These results suggest that a proactive approach of an efficient follow-up of MSM participants since PrEP approval may have prevented an increase of the incidence of STIs among PrEP users.
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14
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Aidoo-Frimpong G, Orom H, Agbemenu K, Collins RL, Morse GD, Nelson LE. Exploring Awareness, Perceptions, and Willingness to Use HIV Pre-Exposure Prophylaxis: A Qualitative Study of Ghanaian Immigrants in the United States. AIDS Patient Care STDS 2022; 36:8-16. [PMID: 34910883 PMCID: PMC8905245 DOI: 10.1089/apc.2021.0156] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
HIV/AIDS disproportionately burdens African immigrants in the United States. Oral pre-exposure prophylaxis (PrEP) is an effective prevention tool for people at high HIV risk, yet uptake is low among racial and ethnic minorities-particularly immigrants. This study explores the awareness, perception, and willingness to use PrEP among Ghanaian immigrants in the United States. WhatsApp, a social media platform, was used to recruit and conduct semi-structured oral interviews with 40 Ghanaian immigrants in March 2020. Interview questions explored awareness of PrEP (whether the participants knew or had knowledge of PrEP before the study), perceptions of PrEP and PrEP users, and willingness to use PrEP. Interviews were audiorecorded, and transcribed. We used NVivo-12 Plus to analyze transcripts for emergent themes. Our sample consisted of Ghanaian adult immigrants (N = 40, 57% male, 71% college educated, age = 32.8 ± 5.7 years, 68% had lived in the United States between 1 and 10 years) residing in 12 US cities. Four major themes emerged: (1) low awareness of PrEP; (2) positive perception of PrEP for HIV prevention; (3) divergent views on PrEP users; and (4) mixed views on willingness to use PrEP. This study presents formative qualitative work, which suggests that Ghanaian immigrants, despite having low awareness of PrEP, may be willing to use PrEP. A key study implication was that stigma reduction interventions might facilitate PrEP scale-up in this population.
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Affiliation(s)
- Gloria Aidoo-Frimpong
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York, USA.,Address correspondence to: Gloria Aidoo-Frimpong, MA, MPH, Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, 3435 Main Street, 321 Kimball Tower, Buffalo, NY 14214-8028, USA
| | - Heather Orom
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Kafuli Agbemenu
- School of Nursing, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - R. Lorraine Collins
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Gene D. Morse
- Pharmacy Practice (Medicine, Pediatrics), University at Buffalo, State University of New York, Buffalo, New York, USA
| | - LaRon E. Nelson
- Yale School of Nursing, MAP Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto—St. Michael's Hospital, Toronto, Canada
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15
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Moreira JS, Vasconcelos R, Doi AM, Avelino-Silva VI. Real-life occurrence of bacterial sexually transmitted infections among PrEP users: improving the diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae with multisite screening. Rev Inst Med Trop Sao Paulo 2021; 63:e76. [PMID: 34755815 PMCID: PMC8580482 DOI: 10.1590/s1678-9946202163076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/23/2021] [Indexed: 11/22/2022] Open
Abstract
PrEP users are under high risk for bacterial sexually transmitted infections
(STI), including those caused by Treponema pallidum (Tp),
Chlamydia trachomatis (Ct) and Neisseria
gonorrhoeae (Ng). Ct and Ng screening at multiple anatomic sites
may improve the diagnostic sensitivity among high-risk populations. We analyzed
the prevalence and incidence of Ct, Ng, and Tp and investigated predictors of
bacterial STI occurrence between January 2018 and November 2019 in a
retrospective cohort of PrEP users in Sao Paulo, Brazil. We describe the
frequency and percentage of Ct/Ng per anatomical site and calculate the
percentage of missed diagnosis if molecular testing were applied only in
symptomatic patients, or only in urine samples. Patients underwent syphilis
testing every 3-4 months and Ct/Ng testing every 6 months. We included 413 PrEP
users with a median age of 31 years. At baseline, 25% had a positive treponemal
test and 7% had active syphilis; Ct and Ng were more frequently detected in the
oropharynx and anus (6.4-6.9%) than in urine samples (0.7-2.6%). Twelve months
after the onset of PrEP, the incidence of Tp, Ct and Ng was, respectively,
13.4%, 11.4% and 8.9%. During follow-up, 23 out of 33 Ct/Ng cases (69%, 95% CI
51-84) would have been missed if oropharynx and anus samples had not been
tested. In addition, if only symptomatic cases had been tested, 30 out of 33
Ct/Ng cases (90%, 95% CI 75-98) would have been missed. Participants with
incident STI had a higher baseline number of sexual partners and a longer
follow-up. Our study reinforces that active and frequent screening for STI is a
powerful strategy to improve the diagnostic sensitivity.
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Affiliation(s)
- Jorge Salomão Moreira
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Doenças Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
| | - Ricardo Vasconcelos
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Doenças Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
| | - André Mario Doi
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Escola de Medicina, São Paulo, São Paulo, Brazil
| | - Vivian Iida Avelino-Silva
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Doenças Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil.,Faculdade Israelita de Ciências da Saúde Albert Einstein, Escola de Medicina, São Paulo, São Paulo, Brazil
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Klasko-Foster L, Wilson K, Bleasdale J, Gabriel SJ, Przybyla S. "Shades of risk": Understanding current PrEP users' sexually transmitted infection perceptions. AIDS Care 2021; 34:353-358. [PMID: 34308702 DOI: 10.1080/09540121.2021.1957762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ABSTRACTPre-exposure prophylaxis (PrEP) is a safe and effective HIV prevention strategy. Given the possibility of increased sexual risk-taking and acquisition of other sexually transmitted infections (STIs) following PrEP initiation, it is important to explore STI risk perceptions both before and after PrEP initiation to understand the extent to which these perceptions inform decisions to engage in condomless sex. Semi-structured qualitative interviews were conducted with men who have sex with men currently using PrEP (n = 30). Prior to analysis, PrEP users were categorized into four subgroups based on condom use behavior post-PrEP initiation: (1) condom continuers (2) condomless sex continuers, (3) condomless sex increasers, and (4) condomless sex decreasers. Thematic analysis revealed two major themes that elucidated differences in (1) the appraisal of HIV risk relative to other STIs and (2) the importance of partner communication in determining STI risk perceptions by subgroup. Most PrEP users demonstrated no behavioral change after PrEP initiation. Those engaging in condomless sex prior to PrEP initiation also continued that behavior while taking PrEP. Results of this study support a tailored approach to PrEP counseling based on individual STI risk appraisal and motivations to initiate and continue PrEP.
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Affiliation(s)
| | - Kennethea Wilson
- School of Public Health and Health Professions, University at Buffalo, SUNY
| | - Jacob Bleasdale
- School of Public Health and Health Professions, University at Buffalo, SUNY
| | - Steven J Gabriel
- School of Public Health and Health Professions, University at Buffalo, SUNY
| | - Sarahmona Przybyla
- School of Public Health and Health Professions, University at Buffalo, SUNY
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17
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Assessing the Role of Gay Community Attachment, Stigma, and PrEP Stereotypes on Young Men Who Have Sex with Men's PrEP Uptake. AIDS Behav 2021; 25:1761-1776. [PMID: 33211207 DOI: 10.1007/s10461-020-03106-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 10/22/2022]
Abstract
Negative stereotypes about pre-exposure prophylaxis (PrEP) hinder PrEP uptake among young men who have sex with men (YMSM). Prior research suggests community homophobia may be linked to negative PrEP attitudes. Conversely, individuals with high gay community attachments (GCA) may have more access to credible PrEP information/resources. Among 285 YMSM recruited online, we estimated structural equation models to test competing conceptual models that inform pathways from perceived stigmas, GCA, and negative PrEP stereotype endorsements to PrEP uptake. In Model A, perceived stigma was directly associated with PrEP uptake, partially mediated by stereotype endorsement (β = - 0.05; 95% CI [- 0.09, - 0.01]) and GCA (β = - 0.06; 95% CI [- 0.11, 0.02]). In Model B, perceived stigma was associated with PrEP uptake (β = - 0.07; 95% CI [- 0.14, - 0.01]) through stereotype endorsement among high GCA YMSM. Complemented by anti-stigma initiatives, PrEP outreach for YMSM should utilize sex-positive messaging and disentangle negative PrEP stereotypes within gay-centric social spaces.
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Kumar S, Haderxhanaj LT, Spicknall IH. Reviewing PrEP's Effect on STI Incidence Among Men Who Have sex with Men-Balancing Increased STI Screening and Potential Behavioral Sexual Risk Compensation. AIDS Behav 2021; 25:1810-1818. [PMID: 33242186 DOI: 10.1007/s10461-020-03110-x] [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: 11/16/2020] [Indexed: 01/01/2023]
Abstract
Though pre-exposure prophylaxis (PrEP) can prevent HIV acquisition, it provides no protection against bacterial sexually transmitted infections (STIs). PrEP use may increase STI acquisition due to sexual risk compensation, but that could be counterbalanced by increased STI screening at regular PrEP visits. We conducted a literature search of studies with quantitative data published prior to March 2020, assessing sexual risk compensation or STI screening among men who have sex with men (MSM) before and after PrEP initiation. We identified 16 relevant publications. Changes in condom use were inconsistent across studies. Partner acquisition following PrEP initiation decreased in most studies, likely due to behavioral counseling. In publications comparing a PrEP arm to a non-PrEP arm, serodiscordance increased in the PrEP arm and decreased in the non-PrEP arm. STI screening among MSM was low within a month of PrEP initiation. Monitoring trends in sexual risk compensation and STI screening will be critical to understand PrEP's effects on STI burden.
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Affiliation(s)
- Sagar Kumar
- Division of STD Prevention, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 1600 Clifton Rd., US12-2, Atlanta, GA, 30316, USA.
- Oak Ridge Institute of Science and Education, Oak Ridge, TN, USA.
| | - Laura T Haderxhanaj
- Division of STD Prevention, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 1600 Clifton Rd., US12-2, Atlanta, GA, 30316, USA
| | - Ian H Spicknall
- Division of STD Prevention, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 1600 Clifton Rd., US12-2, Atlanta, GA, 30316, USA
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Socio-Sexual Experiences and Access to Healthcare Among Informal PrEP Users in the Netherlands. AIDS Behav 2021; 25:1236-1246. [PMID: 33196938 PMCID: PMC7973587 DOI: 10.1007/s10461-020-03085-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 10/25/2022]
Abstract
The aim of this qualitative study was to explore the experiences of informal PrEP users regarding access to PrEP and PrEP-related healthcare, community responses, sexual behavior and well-being. We interviewed 30 men who have sex with men (MSM) in semi-structured online interviews between March and August 2018. Interviews were analyzed using interpretive description. Informal PrEP users were well informed about the use of PrEP, but sometimes did not make use of renal testing. Participants reported a lack of PrEP knowledge among healthcare providers, which limited their access to PrEP and put them at risk, as they received incorrect information. Although some participants reported negative reactions from potential sex partners, most received positive reactions and were sometimes seen as more desirable sex partners. PrEP healthcare services should not only be accessible to formal PrEP users, but also to PrEP users who procure PrEP informally.
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20
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Jana S, Ray P, Roy S, Kadam A, Gangakhedkar RR, Rewari BB, Moses S, Becker ML. Successful integration of HIV pre-exposure prophylaxis into a community-based HIV prevention program for female sex workers in Kolkata, India. Int J STD AIDS 2021; 32:638-647. [PMID: 33596735 PMCID: PMC8091404 DOI: 10.1177/0956462420983992] [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: 11/17/2022]
Abstract
We assessed the impact of pre-exposure prophylaxis (PrEP) in the context of a community-based HIV program among female sex workers (FSWs) in Kolkata, India. This was an open-label, uncontrolled demonstration trial. HIV seronegative FSWs over 18 years were eligible. Participants were administered daily tenofovir/emtricitabine (TDF-FTC) with follow-up visits at months 1, 3, 6, 9, 12, and 15. Drug adherence was monitored by self-report, and a random subset of participants underwent plasma TDF testing. 843 women were screened and 678 enrolled and started on PrEP. Seventy-nine women (11%) did not complete all scheduled visits: four women died of reasons unrelated to PrEP and 75 withdrew, for a 15-month retention rate of 89%. Self-reported daily adherence was over 70%. Among those tested for TDF, the percentage of women whose level reached ≥40 ng/mL was 65% by their final visit. There were no HIV seroconversions, and no evidence of significant changes in sexual behavior. This study demonstrated the feasibility and effectiveness of PrEP for FSWs in Kolkata, with very high levels of adherence to PrEP and no HIV seroconversions. The integration of PrEP into an existing community-based HIV prevention program ensured community support and facilitated adherence.
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Affiliation(s)
| | - Protim Ray
- Durbar Mahila Samanwaya Committee, Kolkata, India
| | - Soma Roy
- Durbar Mahila Samanwaya Committee, Kolkata, India
| | | | | | | | - Stephen Moses
- Department of Community Health Sciences, Institute for Global Public Health, 8664University of Manitoba, Winnipeg, Canada
| | - Marissa L Becker
- Department of Community Health Sciences, Institute for Global Public Health, 8664University of Manitoba, Winnipeg, Canada
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Pasipanodya EC, Li MJ, Jain S, Sun X, Tobin J, Ellorin E, Dube M, Daar ES, Corado K, Milam J, Blumenthal J, Morris SH, Moore DJ. Greater Levels of Self-Reported Adherence to Pre-Exposure Prophylaxis (PrEP) are Associated with Increased Condomless Sex Among Men Who Have Sex with Men. AIDS Behav 2020; 24:3192-3204. [PMID: 32350774 PMCID: PMC7508761 DOI: 10.1007/s10461-020-02881-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The effectiveness of pre-exposure prophylaxis (PrEP) against HIV acquisition depends on treatment adherence; however, within-person associations between levels of PrEP adherence and engagement in condomless sex have not been well studied. In the context of a demonstration project, 372 men who have sex with men received once-daily PrEP and completed six study visits over 48 weeks. Two-part growth mixture modeling was used to examine the longitudinal trajectory of condomless anal intercourse (CAI) and self-reports of PrEP adherence, controlling for relevant covariates. Over time, greater PrEP adherence was contemporaneously associated with both a higher likelihood of engaging in any CAI and with a greater number of CAI acts. Substance use was also associated with a higher likelihood of engaging in CAI. Contemporaneous associations between self-reported PrEP adherence and CAI suggest that adherence behaviors may be motivated by the desire to mitigate risk of HIV infection; however, exact directionality is unknown.
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Affiliation(s)
| | - Michael J Li
- UCLA Center for HIV Identification, Prevention and Treatment Services (CHIPTS), Los Angeles, CA, 90024, USA
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, 92093, USA
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, 92093, USA
| | - Jessica Tobin
- Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Eric Ellorin
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, 92093, USA
| | - Michael Dube
- Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Eric S Daar
- Los Angeles Biomedical Research Institute At Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Katya Corado
- The Lundquist Institute, Torrance, CA, 90502, USA
| | - Joel Milam
- Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Jill Blumenthal
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, 92093, USA
| | - Sheldon H Morris
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, 92093, USA
| | - David J Moore
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, MC8231, San Diego, CA, 92103, USA.
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Jones J, Sanchez TH, Dominguez K, Bekker L, Phaswana‐Mafuya N, Baral SD, McNaghten AD, Kgatitswe LB, Valencia R, Yah CS, Zahn R, Siegler AJ, Sullivan PS. Sexually transmitted infection screening, prevalence and incidence among South African men and transgender women who have sex with men enrolled in a combination HIV prevention cohort study: the Sibanye Methods for Prevention Packages Programme (MP3) project. J Int AIDS Soc 2020; 23 Suppl 6:e25594. [PMID: 33000886 PMCID: PMC7527766 DOI: 10.1002/jia2.25594] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/02/2020] [Accepted: 07/15/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Men who have sex with men (MSM) and transgender women (TGW) experience high incidence and prevalence of sexually transmitted infections (STI), and data are needed to understand risk factors for STIs in these populations. The Sibanye Health Project was conducted in Cape Town and Port Elizabeth, South Africa from 2015 to 2016 to develop and test a package of HIV prevention interventions for MSM and TGW. We describe the incidence, prevalence and symptoms of Chlamydia trachomatis (CT), Neisseria gonorrhea (NG) and syphilis observed during the study. METHODS Participants completed HIV testing at baseline. All participants who were HIV negative were followed prospectively. Additionally, a sample of participants identified as living with HIV at baseline was selected to be followed prospectively so that the prospective cohort was approximately 20% HIV positive; the remaining participants identified as HIV positive at baseline were not followed prospectively. Prospective participants were followed for 12 months and returned for clinic-based STI/HIV testing and assessment of STI symptoms at months 6 and 12. Additional HIV/STI testing visits could be scheduled at participant request. RESULTS Following consent, a total of 292 participants attended a baseline visit (mean age = 26 years), and 201 were enrolled for the 12-month prospective study. Acceptance of screening for syphilis and urethral NG/CT was near universal, though acceptance of screening for rectal NG/CT was lower (194/292; 66%). Prevalence of urethral CT and NG at baseline was 10% (29/289) and 3% (8/288) respectively; incidence of urethral CT and NG was 12.8/100 person-years (PY) and 7.1/100 PY respectively. Prevalence of rectal CT and NG at baseline was 25% (47/189) and 16% (30/189) respectively; incidence of rectal CT and NG was 33.4/100 PY and 26.8/100 PY respectively. Prevalence of syphilis at baseline was 17% (45/258) and incidence was 8.2/100 PY. 91%, 95% and 97% of diagnosed rectal NG/CT, urethral NG/CT and syphilis infections, respectively, were clinically asymptomatic. CONCLUSIONS Prevalence and incidence of urethral and rectal STIs were high among these South African MSM and TGW, and were similar to rates in other settings in the world. Clinical symptoms from these infections were rare, highlighting limitations of syndromic surveillance and suggesting the need for presumptive testing and/or treatment to address the STI epidemic among MSM/TGW in South Africa.
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Affiliation(s)
| | | | - Karen Dominguez
- Emory UniversityAtlantaGAUSA
- Desmond Tutu HIV CentreUniversity of Cape TownObservatorySouth Africa
| | - Linda‐Gail Bekker
- Desmond Tutu HIV CentreUniversity of Cape TownObservatorySouth Africa
| | | | - Stefan D Baral
- Johns Hopkins University School of Public HealthBaltimoreMDUSA
| | | | | | | | - Clarence S Yah
- Wits Reproductive Health and HIV InstituteFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- School of Heath Systems and Public HealthUniversity of PretoriaPretoriaSouth Africa
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Hightow-Weidman LB, Magnus M, Beauchamp G, Hurt CB, Shoptaw S, Emel L, Piwowar-Manning E, Mayer KH, Nelson LE, Wilton L, Watkins P, Whitfield D, Fields SD, Wheeler D. Incidence and Correlates of Sexually Transmitted Infections Among Black Men Who Have Sex With Men Participating in the HIV Prevention Trials Network 073 Preexposure Prophylaxis Study. Clin Infect Dis 2020; 69:1597-1604. [PMID: 30615169 DOI: 10.1093/cid/ciy1141] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/04/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The HIV Prevention Trials Network (HPTN) Study 073 (HPTN 073) assessed the feasibility, acceptability, and safety of preexposure prophylaxis (PrEP) for black men who have sex with men (BMSM). The purpose of this analysis was to characterize the relationship between PrEP uptake and use and incident sexually transmitted infections (STIs) among participants enrolled in HPTN 073. METHODS A total of 226 human immunodeficiency virus (HIV)-uninfected BMSM were enrolled in 3 US cities; all participants received client-centered care coordination (C4) and were offered daily oral PrEP. Participants were followed for 12 months with STI testing (rectal and urine nucleic acid amplification test for gonorrhea and chlamydia, rapid plasma reagin for syphilis) conducted at baseline, week 26, and week 52. Logistic regression was used to examine associations between STI incidence and PrEP uptake. Generalized estimating equations were used to evaluate associations between age, PrEP acceptance, sexual behaviors, and incident STIs. RESULTS Baseline STI prevalence was 14.2%. Men aged <25 years were more likely to have a baseline STI (25.3% vs 6.7%; odds ratio [OR], 4.39; 95% confidence interval [CI:, 1.91, 10.11). Sixty participants (26.5%) acquired ≥1 STI during follow-up; the incidence rate was 34.2 cases per 100 person-years (95% CI, 27.4, 42.9). In adjusted analyses, baseline STI diagnosis (OR, 4.23; 95% CI, 1.82, 9.87; P < .001) and additional C4 time (OR, 1.03; 95% CI, 1.00, 1.06; P = .027) were associated with having an incident STI. STI incidence was not associated with PrEP acceptance or adherence. CONCLUSIONS While we found higher rates of STIs in younger BMSM, overall rates of STI were lower than in prior PrEP trials, with no increase over time. BMSM with STIs at PrEP initiation may require additional interventions that target STI acquisition risk. CLINICAL TRIALS REGISTRATION NCT01808352.
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Affiliation(s)
- Lisa B Hightow-Weidman
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Seattle, Washington
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, District of Columbia, Seattle, Washington
| | - Geetha Beauchamp
- Statistical Center for HIV/AIDS Research & Prevention, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Christopher B Hurt
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Seattle, Washington
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Lynda Emel
- Statistical Center for HIV/AIDS Research & Prevention, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Kenneth H Mayer
- Fenway Institute, Fenway Health and the Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - LaRon E Nelson
- School of Nursing, University of Rochester, New York.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Leo Wilton
- Department of Human Development, State University of New York, Binghamton.,Faculty of Humanities, University of Johannesburg, Auckland Park, South Africa
| | | | - Darren Whitfield
- School of Social Work, Department of Psychiatry, School of Medicine, University of Pittsburgh, Pennsylvania
| | - Sheldon D Fields
- School of Health Professions, New York Institute of Technology, Old Westbury
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24
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Rutstein SE, Smith DK, Dalal S, Baggaley RC, Cohen MS. Initiation, discontinuation, and restarting HIV pre-exposure prophylaxis: ongoing implementation strategies. Lancet HIV 2020; 7:e721-e730. [PMID: 32861269 DOI: 10.1016/s2352-3018(20)30203-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/09/2020] [Accepted: 05/05/2020] [Indexed: 12/15/2022]
Abstract
When used appropriately, pre-exposure prophylaxis (PrEP) substantially reduces the risk of HIV acquisition. Early implementation outcomes often suggest poor PrEP adherence and persistence; however, this intervention is time-limited and the need for PrEP fluctuates as risk behaviours change. In this Viewpoint we examine the current guidelines and early programmatic outcomes after starting, stopping, and restarting PrEP, and we review the implications of PrEP in relation to HIV testing algorithms. Guidelines suggest to discontinue PrEP when a person is no longer at risk for HIV, but effectively implementing this strategy requires support tools to make the decision of stopping and restarting PrEP that considers the complex relationship between risk perceptions and risk behaviours. Safely discontinuing PrEP also requires greater understanding of the daily dosing duration that is needed to protect the person after their last HIV exposure. Additionally, clear strategies are needed to re-engage a person as their HIV exposure risk changes over time.
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Affiliation(s)
- Sarah E Rutstein
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
| | - Dawn K Smith
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shona Dalal
- Department of Global HIV, Hepatitis, and STI Programmes, WHO, Geneva, Switzerland
| | - Rachel C Baggaley
- Department of Global HIV, Hepatitis, and STI Programmes, WHO, Geneva, Switzerland
| | - Myron S Cohen
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
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25
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Ahouada C, Diabaté S, Mondor M, Hessou S, Guédou FA, Béhanzin L, Batona G, Gning NN, Zannou DM, Alary M. Acceptability of pre-exposure prophylaxis for HIV prevention: facilitators, barriers and impact on sexual risk behaviors among men who have sex with men in Benin. BMC Public Health 2020; 20:1267. [PMID: 32819335 PMCID: PMC7441559 DOI: 10.1186/s12889-020-09363-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 08/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Benin, men who have sex with men (MSM) do not always use condoms during anal sex. Pre-exposure prophylaxis (PrEP) using Truvada® (tenofovir disoproxil fumarate / emtricitabine) may be a complementary HIV prevention measure for MSM. This study aimed at identifying the potential facilitators and barriers to the use of PrEP. METHODS This was a cross-sectional study conducted in 2018 among male-born MSM aged 18 years or older who reported being HIV-negative or unaware of their HIV status. The participants were recruited by the RDS technique (respondent driven sampling) in six cities of Benin. Logistic regression analyses, adapted to RDS statistical requirements, were performed to identify the factors associated with PrEP acceptability. RESULTS Mean age of the 400 MSM recruited was 26.2 ± 5.0 years. PrEP was known by 50.7% of respondents. The intention to use PrEP was expressed by 90% of MSM. If PrEP effectiveness were 90% or more, 87.8% of the respondents thought they would decrease condom use. In multivariate analysis, the facilitators associated with PrEP acceptability were: not having to pay for PrEP (odds ratio (OR) = 2.39, 95% CI: 1.50-4.46) and its accessibility within MSM networks (OR = 9.82, 95% CI: 3.50-27.52). Only one barrier was significant: the concern that taking PrEP be perceived as marker of adopting HIV risky behaviors (OR = 0.11, 95% CI: 0.04-0.30). CONCLUSION In Benin, not all MSM know about PrEP. But once well informed, the majority seems willing to use it if made available. The free availability of the drug and its accessibility in the MSM networks are important facilitators. The possibility of decrease in condom use should not be a barrier to the prescription of PrEP if made available.
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Affiliation(s)
- Carin Ahouada
- Hopital de Zone Allada, Allada, Benin.,Centre de recherche du CHU de Québec, Université Laval, Québec, Québec, Canada.,Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada
| | - Souleymane Diabaté
- Centre de recherche du CHU de Québec, Université Laval, Québec, Québec, Canada.,Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada.,Université Alassane Ouattara, Bouaké, Côte d'Ivoire
| | - Myrto Mondor
- Centre de recherche du CHU de Québec, Université Laval, Québec, Québec, Canada
| | - Septime Hessou
- Centre Interfacultaire de Formation et de Recherche en Environnement pour le Développement Durable (CIFRED/UAC), Abomey-Calavi, Bénin
| | | | - Luc Béhanzin
- Dispensaire des IST, Centre de Santé Cotonou I, Cotonou, Bénin.,École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Épidémiologique, Université de Parakou, Parakou, Bénin
| | - Georges Batona
- Dispensaire des IST, Centre de Santé Cotonou I, Cotonou, Bénin
| | - Ndeye Ndiagna Gning
- Centre de recherche du CHU de Québec, Université Laval, Québec, Québec, Canada.,Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada
| | - D Marcel Zannou
- Centre National Hospitalier et Universitaire Hubert Koutoukou Maga de Cotonou, Cotonou, Benin.,Faculté des Sciences de la Santé, Cotonou, Bénin
| | - Michel Alary
- Centre de recherche du CHU de Québec, Université Laval, Québec, Québec, Canada. .,Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada. .,Institut national de santé publique, Québec, Québec, Canada. .,Hôpital du Saint-Sacrement 1050 chemin Ste-Foy Québec, Québec, QC, G1S 4L8, Canada.
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26
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Furukawa NW, Maksut JL, Zlotorzynska M, Sanchez TH, Smith DK, Baral SD. Sexuality Disclosure in U.S. Gay, Bisexual, and Other Men Who Have Sex With Men: Impact on Healthcare-Related Stigmas and HIV Pre-Exposure Prophylaxis Denial. Am J Prev Med 2020; 59:e79-e87. [PMID: 32376144 PMCID: PMC7375915 DOI: 10.1016/j.amepre.2020.02.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Stigma impairs access to health care by gay, bisexual, and other men who have sex with men. Gay, bisexual, and other men who have sex with men who are open about their sexuality, or out, are more resilient to stigma than those who are not out. Outness may influence healthcare utilization and prescription of HIV pre-exposure prophylaxis to HIV-negative gay, bisexual, and other men who have sex with men. METHODS Analyzing the 2018 American Men's Internet Survey during 2019, the adjusted prevalence ratios of healthcare stigmas and outness to healthcare providers were calculated. The effect of outness on annual healthcare visits and stigma was measured. Pre-exposure prophylaxis seeking and denial by providers was quantified and stratified by outness. RESULTS Of 5,794 respondents, 3,402 (58.7%) were out to their provider. Out gay, bisexual, and other men who have sex with men were less likely to experience anticipated stigma (adjusted prevalence ratio=0.75, 95% CI=0.72, 0.80) but more likely to experience enacted stigma or discrimination (adjusted prevalence ratio=1.23, 95% CI=1.18, 1.28). In a subsample of out gay, bisexual, and other men who have sex with men, recently experienced discrimination was associated with higher healthcare utilization (adjusted prevalence ratio=1.51, 95% CI=1.14, 1.51). Conversely, recent experienced discrimination was associated with lower healthcare utilization in not out gay, bisexual, and other men who have sex with men (adjusted prevalence ratio=0.67, 95% CI=0.54, 0.82). Of 3,104 out gay, bisexual, and other men who have sex with men, 1,417 (45.7%) discussed pre-exposure prophylaxis with their providers, compared with 120 of 1,711 (7.0%) gay, bisexual, and other men who have sex with men who were not out (p<0.001). Pre-exposure prophylaxis denials were less common among out (116/793, 14.6%) than not out (14/55, 25.5%) gay, bisexual, and other men who have sex with men (p=0.044). CONCLUSIONS Healthcare provider-related stigmas impair healthcare engagement among not out gay, bisexual, and other men who have sex with men who were also more commonly denied pre-exposure prophylaxis. Ending the HIV epidemic necessitates creating safe environments for disclosure of sexual preferences and practices to facilitate access to HIV prevention.
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Affiliation(s)
- Nathan W Furukawa
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Jessica L Maksut
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Maria Zlotorzynska
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Travis H Sanchez
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Dawn K Smith
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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27
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Abstract
OBJECTIVE To estimate the proportion of US HIV-positive men who report a male HIV-negative/unknown status (HIV-discordant) sexual partner taking preexposure prophylaxis (PrEP), and the use of multiple HIV prevention strategies within partnerships. DESIGN The Medical Monitoring Project is a complex sample survey of US adults with diagnosed HIV. METHODS We used data collected during June 2016 to May 2018 among sexually active HIV-positive men who had at least one HIV-discordant male partner (N = 1871) to estimate the weighted prevalence of reporting at least one partner taking PrEP. Among HIV-discordant partnerships (N = 4029), we estimated PrEP use, viral suppression among HIV-positive partners, and condomless anal sex. We evaluated significant (P < 0.05) differences between groups using prevalence ratios with predicted marginal means. RESULTS Twenty-eight percent of sexually active HIV-positive MSM reported at least one HIV-discordant male partner taking PrEP. Twenty percent of HIV-discordant partners were reported to be taking PrEP; 73% were taking PrEP or the HIV-positive partner was virally suppressed. PrEP use was lower among black and Hispanic partners compared with white partners (12% and 19% vs. 27%). Fewer black than white MSM were in partnerships in which PrEP was used or the HIV-positive partner had sustained viral suppression (69% vs. 77%). Condomless anal intercourse was more prevalent in partnerships involving PrEP use and in partnerships involving either PrEP use or sustained viral suppression among the HIV-positive partner. CONCLUSION PrEP use was reported among one in five partners, with disparities between black and white partners. Increasing PrEP use and decreasing racial/ethnic disparities could reduce disparities in HIV incidence and help end the US HIV epidemic.
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28
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Quinn KG, Christenson E, Sawkin MT, Hacker E, Walsh JL. The Unanticipated Benefits of PrEP for Young Black Gay, Bisexual, and Other Men Who Have Sex with Men. AIDS Behav 2020; 24:1376-1388. [PMID: 31768688 DOI: 10.1007/s10461-019-02747-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is effective at reducing new HIV infections among adherent users. However, there are potential benefits of PrEP beyond HIV prevention that remain understudied, particularly among young Black gay, bisexual, and other men who have sex with men (MSM). In 2018, we conducted six focus groups (n = 36) in four midwestern cities: Milwaukee, WI; Minneapolis, MN; Detroit, MI; and Kansas City, MO with current and former PrEP users who identified as Black MSM. The focus groups covered medical care and provider experiences, patterns of PrEP use and adherence, relationships while on PrEP, and PrEP stigma. Results revealed four unanticipated benefits of PrEP for young Black MSM: (1) improved engagement in medical care, (2) reduced sexual and HIV anxiety, (3) increased sexual comfort and freedom, and (4) positive sexual relationships with people living with HIV. Findings from this study fill a gap in our understanding of the potential benefits of PrEP beyond HIV prevention. Public health campaigns and messaging around PrEP should incorporate such benefits to reach young Black MSM who may be motivated by benefits beyond HIV prevention.
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29
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Nöstlinger C, Reyniers T, Smekens T, Apers H, Laga M, Wouters K, Vuylsteke B. Drug use, depression and sexual risk behaviour: a syndemic among early pre-exposure prophylaxis (PrEP) adopters in Belgium? AIDS Care 2020; 32:57-64. [PMID: 32160759 DOI: 10.1080/09540121.2020.1739218] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Little is known about how interacting psychosocial problems may influence sexual behaviour among men having sex with men taking Pre-exposure prophylaxis (PrEP). This study assessed (1) the prevalence of depression, recreational drug-use and sexual risk behaviour; (2) changes in these psychosocial conditions over time; and (3) the interaction of drug use and depression with sexual risk behaviour. We analysed data of the Belgian Be-PrEP-ared cohort study (N = 200). We assessed depression using the PHQ-9, recreational drug use and receptive condomless anal intercourse (rCAI) with anonymous partners. Frequencies of psychosocial problems were compared at baseline, 9 and 18 months follow-up (FU). Bivariate associations between depression and drug-use behaviour, and their interaction with rCAI with anonymous sexual partners using was examined using linear regression. Receptive CAI increased from 41% at baseline to 53% at M18 (p = 0.038). At baseline, we found an interaction effect of poly-drug use and depression, potentiating rCAI with anonymous partners. Participants reporting poly-drug use associated with depression were significant more likely to report this type of sexual risk behaviour than those who did not report this association (p = 0.030). The high level of intertwined psychosocial problems call for multi-level interventions for those PrEP users experiencing a syndemic burden.
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Affiliation(s)
| | - Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Tom Smekens
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Hanne Apers
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marie Laga
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kristien Wouters
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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30
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Hibbert MP, Brett CE, Porcellato LA, Hope VD. Sexually transmitted infection diagnoses, sexualised drug use and associations with pre-exposure prophylaxis use among men who have sex with men in the UK. Int J STD AIDS 2020; 31:254-263. [PMID: 32036753 DOI: 10.1177/0956462419897222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Previous research has focused on acceptability of pre-exposure prophylaxis (PrEP) use, but few community-based studies have been conducted regarding actual use, and PrEP use in the context of sexualised drug use remains understudied. A national online cross-sectional study recruited men who have sex with men (MSM) via social media (April–June 2018). Multivariable logistic regression was used to investigate factors associated with PrEP use. Bivariate analyses compared engaging in condomless anal intercourse (CAI) under the influence of specific drugs and recent sexually transmitted infection (STI) diagnoses (past 12 months) between MSM taking PrEP and those not. Overall, 6% (99/1581) MSM reported current PrEP use. Factors associated with PrEP use were increasing age, recent genitourinary medicine (GUM) attendance (95% versus 45%, aOR = 6.25, 95%CI 2.05, 19.03), an HIV test in the past three months (89% versus 23%, aOR = 14.22, 95%CI 6.76, 29.90), and recent engagement in chemsex (21% versus 4%, aOR = 3.56, 95%CI 1.78, 7.11). MSM taking PrEP were more likely to have had an STI diagnosis (42% versus 8%), most commonly chlamydia (26% versus 3%) and gonorrhoea (25% versus 4%). Considering the elevated levels of self-reported STI diagnoses among those on PrEP, there was a high level of engagement with sexual health services, which may help reduce onward STI transmission.
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Affiliation(s)
- Matthew P Hibbert
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Caroline E Brett
- School of Natural Sciences and Psychology, Liverpool John Moores University, Liverpool, UK
| | - Lorna A Porcellato
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Vivian D Hope
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
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31
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Rojas Castro D, Delabre RM, Molina J. Give PrEP a chance: moving on from the "risk compensation" concept. J Int AIDS Soc 2019; 22 Suppl 6:e25351. [PMID: 31468693 PMCID: PMC6715948 DOI: 10.1002/jia2.25351] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/24/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION While bio-behavioural interventions (BIs) for sexually transmitted infections (STIs) and HIV prevention have shown their effectiveness (e.g. treatment for syphilis, HPV vaccination or pre-exposure prophylaxis [PrEP]), they have also aroused major concerns regarding behavioural changes that could counteract their benefit. Risk compensation (RC) fears concerning BIs in the HIV/STIs prevention field are intimately linked to representations, judgements and social control on sexual behaviour. With an increasing number of PrEP studies describing a rise in STIs due to RC, this paper argues for a shift away from the focus on RC and proposes a more constructive approach to respond to the needs of people living with HIV and populations most at risk. DISCUSSION The concept of RC, stemming from road safety and derived from economic theory, relies on rational theoretical models of human behaviour. Although widely applied in several contexts its use has been reasonably questioned. Major methodological issues regarding RC have been raised within HIV/AIDS literature. Although behavioural changes (e.g. condomless sex and number of sexual partners) are often erroneously assimilated with RC, there is no evidence that behavioural changes have undermined the effectiveness of previous and current BIs. Still, PrEP has not escaped RC concerns. Increases in condomless sex within the context of growing uptake of PrEP signals a continued need for integrated and innovative HIV and STI prevention strategies and a comprehensive sexual health approach. Routine HIV/STI testing, peer-led counselling, and identification of sexual health needs within the PrEP model of care could become a gold standard in the sexual health field for all populations. CONCLUSIONS RC remains a frequent argument against the availability and provision of prevention methods for vulnerable populations. Individuals should be able to benefit from the full panel of BIs options available, to find and adapt methods according to their needs. Current, past and future PrEP users, with other stakeholders, may provide valuable insight into innovative solutions and programmes to control HIV and other STIs.
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Affiliation(s)
- Daniela Rojas Castro
- Coalition PLUSCommunity‐based Research LaboratoryPantinFrance
- Aix Marseille UnivINSERM, IRD, SESSTIMSciences Economiques & Sociales de la Santé & Traitement de l'Information MédicaleMarseilleFrance
| | | | - Jean‐Michel Molina
- Department of Infectious DiseasesHôpital Saint‐LouisAssistance Publique Hôpitaux de ParisParisFrance
- INSERM, UMR 941Université de Paris Diderot Paris 7Sorbonne Paris CitéParisFrance
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32
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Mboumba Bouassa RS, Bélec L, Gubavu C, Péré H, Matta M, Maka A, Puech J, Tonen Wolyec S, Veyer D, Gravier A, Hocqueloux L, Prazuck T. High Prevalence of Anal and Oral High-Risk Human Papillomavirus in Human Immunodeficiency Virus-Uninfected French Men Who Have Sex With Men and Use Preexposure Prophylaxis. Open Forum Infect Dis 2019; 6:ofz291. [PMID: 31660393 PMCID: PMC6735951 DOI: 10.1093/ofid/ofz291] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/18/2019] [Indexed: 12/12/2022] Open
Abstract
Background We assessed the prevalence and risk factors of anal and oral high-risk (HR) human papillomavirus (HPV) infection in human immunodeficiency virus–uninfected men who have sex with men (MSM) and take preexposure prophylaxis (PrEP) in France. Methods Anal and oral samples were screened by multiplex real-time polymerase chain reaction (Anyplex II HPV 28; Seegene) for HPV DNA. Results A total of 61 unvaccinated MSM (mean age, 36.1 years) were enrolled. Anal HPV and HR-HPV prevalences were 93.4% and 81.9%, respectively, and oral HPV and HR-HPV prevalences, 33.9% and 19.6%, respectively. HR-HPV type 33 was the most detected genotype, in both anal and oral samples. Among MSM, 68.8% carried ≥1 anal HPV type targeted by the 9-valent Gardasil-9 vaccine; all oral HPV-positive samples carried ≥1 strain included in the vaccine. Condomless receptive anal intercourse and history of anal gonorrhea were the main factors associated with increased risk for anal HPV infection (adjusted odds ratio, 10.4) and anal infection with multiple HR-HPV genotypes (5.77), respectively. Conversely, having had <10 partners in the last 12 months was associated with decreased risk for anal carriage of both multiple HPV (adjusted odds ratio, 0.19) and HR-HPV (0.17) types. Conclusion French MSM using PrEP are at high risk for both anal and oral carriage of HR-HPV that could lead to HPV-related cancers.
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Affiliation(s)
- Ralph-Sydney Mboumba Bouassa
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris and Université Paris Descartes, Paris Sorbonne Cité, France.,Ecole Doctorale Régionale en Infectiologie Tropicale, Franceville, Gabon
| | - Laurent Bélec
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris and Université Paris Descartes, Paris Sorbonne Cité, France
| | - Camelia Gubavu
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Régional d'Orléans, and the Centre Gratuit d'Information, de Dépistage et de Diagnostic d'Orléans, France
| | - Hélène Péré
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris and Université Paris Descartes, Paris Sorbonne Cité, France
| | - Mathieu Matta
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris and Université Paris Descartes, Paris Sorbonne Cité, France
| | - Artur Maka
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Régional d'Orléans, and the Centre Gratuit d'Information, de Dépistage et de Diagnostic d'Orléans, France
| | - Julien Puech
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris and Université Paris Descartes, Paris Sorbonne Cité, France
| | - Serge Tonen Wolyec
- Ecole Doctorale Régionale en Infectiologie Tropicale, Franceville, Gabon.,Faculté de Médecine et de Pharmacie, Université de Kisangani, Kisangani, Democratic Republic of the Congo
| | - David Veyer
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris and Université Paris Descartes, Paris Sorbonne Cité, France
| | - Anne Gravier
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Régional d'Orléans, and the Centre Gratuit d'Information, de Dépistage et de Diagnostic d'Orléans, France
| | - Laurent Hocqueloux
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Régional d'Orléans, and the Centre Gratuit d'Information, de Dépistage et de Diagnostic d'Orléans, France
| | - Thierry Prazuck
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Régional d'Orléans, and the Centre Gratuit d'Information, de Dépistage et de Diagnostic d'Orléans, France
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Abstract
PURPOSE OF REVIEW This study aims to review the epidemiology of sexually transmitted infections (STIs) among men who have sex with men (MSM) and suggest control measures. RECENT FINDINGS Despite declines in new HIV diagnosis, bacterial STIs among MSM have dramatically risen since the late 1990s. This increase occurred concurrent with introduction of effective antiretroviral therapy, the advent of electronic mechanisms for meeting sex partners and population-level changes in sexual behavior, including decreased condom use. HIV pre-exposure prophylaxis (PrEP) is now further diminishing condom use, though its impact on STIs is uncertain. A plan to confront the MSM STI epidemic should include increased HIV/STI testing promoted through expanded public health clinical infrastructure, health care system reform to improve the care of gender and sexual minorities and promote low-barrier care, re-invigorated condom promotion, and scientific innovation. There is an urgent need to implement new STI control measures while continuing to expand PrEP use.
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Affiliation(s)
- Meena S Ramchandani
- Department of Medicine, Harborview Medical Center, University of Washington, Mailstop: 359777, 325 Ninth Avenue, Seattle, WA, 98104, USA.
- Public Health-Seattle and King County HIV/STD Program, Seattle, WA, USA.
| | - Matthew R Golden
- Department of Medicine, Harborview Medical Center, University of Washington, Mailstop: 359777, 325 Ninth Avenue, Seattle, WA, 98104, USA
- Public Health-Seattle and King County HIV/STD Program, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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Hoenigl M, Morgan E, Franklin D, Anderson PL, Pasipanodya E, Dawson M, Hanashiro M, Ellorin EE, Blumenthal J, Heaton R, Moore DJ, Morris SR. Self-initiated continuation of and adherence to HIV pre-exposure prophylaxis (PrEP) after PrEP demonstration project roll-off in men who have sex with men: associations with risky decision making, impulsivity/disinhibition, and sensation seeking. J Neurovirol 2019; 25:324-330. [PMID: 30617849 PMCID: PMC6612450 DOI: 10.1007/s13365-018-0716-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/03/2018] [Accepted: 12/17/2018] [Indexed: 12/19/2022]
Abstract
The objective of this study was to examine differences in the levels of risky decision making and other frontal system behavior constructs in relation to self-initiated continuance of HIV pre-exposure prophylaxis (PrEP) and PrEP adherence outcomes among men who have sex with men (MSM) following completion of a clinical PrEP trial. At the last PrEP trial visit, study provided PrEP was discontinued and participants were navigated to the community for PrEP continuation. In this cross-sectional analysis, 84/187 (45%) MSM who completed a prospective observational post-PrEP trial follow-up visit at the University of California San Diego were included. PrEP adherence was measured using dried blood spot tenofovir diphosphate (TFV-DP) levels. Risky decision making was assessed using the Iowa Gambling Task (IGT) and the Balloon Analogue Risk Task (BART), while impulsivity/disinhibition, sensation seeking, and substance use were assessed via standardized self-report questionnaires. A total of 58/84 (69%) of MSM who completed the 12-month post-study visit continued PrEP. Of those, n = 46 (79%) reached TFV-DP levels associated with adequate adherence. Individuals who elected to continue PrEP 12 months post-trial had riskier decision making on BART, but less impulsivity/disinhibition compared to individuals who did not continue PrEP. Neither risky decision making nor impulsivity/disinhibition/sensation seeking nor substance use correlated with PrEP adherence. Our findings suggest that those with risky decision making may have greater insight into their HIV risks, and therefore be more likely to continue to use PrEP. However, elevated impulsivity/disinhibition, indicative of greater neurobehavioral alterations, was negatively associated with PrEP continuance and is a potential target for future interventions to help people link to PrEP.
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Affiliation(s)
- Martin Hoenigl
- University of California San Diego (UCSD), San Diego, CA, USA.
- Medical University of Graz, Graz, Austria.
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, 200 W Arbor Drive, San Diego, CA, 92103, USA.
| | - Erin Morgan
- University of California San Diego (UCSD), San Diego, CA, USA
| | - Donald Franklin
- University of California San Diego (UCSD), San Diego, CA, USA
| | | | | | - Matthew Dawson
- University of California San Diego (UCSD), San Diego, CA, USA
| | | | - Eric E Ellorin
- University of California San Diego (UCSD), San Diego, CA, USA
| | - Jill Blumenthal
- University of California San Diego (UCSD), San Diego, CA, USA
| | - Robert Heaton
- University of California San Diego (UCSD), San Diego, CA, USA
| | - David J Moore
- University of California San Diego (UCSD), San Diego, CA, USA
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