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Dhairyawan R, Okhai H, Hill T, Sabin CA. Differences in HIV clinical outcomes amongst heterosexuals in the United Kingdom by ethnicity. AIDS 2021; 35:1813-1821. [PMID: 33973878 PMCID: PMC7611528 DOI: 10.1097/qad.0000000000002942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE We investigated differences in clinical outcomes in heterosexual participants, by ethnicity in the UK Collaborative HIV Cohort Study from 2000 to 2017. DESIGN Cohort analysis. METHODS Logistic/proportional hazard regression assessed ethnic group differences in CD4+ cell count at presentation, engagement-in-care, combination antiretroviral therapy (cART) initiation, viral suppression and rebound. RESULTS Of 12 302 participants [median age: 37 (interquartile range: 31-44) years, 52.5% women, total follow-up: 85 846 person-years], 64.4% were black African, 19.1% white, 6.3% black Caribbean, 3.6% black other, 3.3% South Asian/other Asian and 3.4% other/mixed. CD4+ cell count at presentation amongst participants from non-white groups were lower than the white group. Participants were engaged-in-care for 79.6% of follow-up time; however, black and other/mixed groups were less likely to be engaged-in-care than the white group (adjusted odds ratios vs. white: black African: 0.70 (95% confidence interval (CI) 0.63-0.79], black Caribbean: 0.74 (0.63-0.88), other/mixed: 0.78 (0.62-0.98), black other: 0.81 (0.64-1.02)). Of 8867 who started cART, 79.1% achieved viral suppression, with no differences by ethnicity in cART initiation or viral suppression. Viral rebound (22.2%) was more common in the black other [1.95 (1.37-2.77)], black African [1.85 (1.52-2.24)], black Caribbean [1.73 (1.28-2.33)], South Asian/other Asian [1.35 (0.90-2.03)] and other/mixed [1.09 (0.69-1.71)] groups than in white participants. CONCLUSION Heterosexual people from black, Asian and minority ethnic (BAME) groups presented with lower CD4+ cell counts, spent less time engaged-in-care and were more likely to experience viral rebound than white people. Work to understand and address these differences is needed.
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Affiliation(s)
| | - Hajra Okhai
- Institute for Global Health, University College London, UK
| | - Teresa Hill
- Institute for Global Health, University College London, UK
| | - Caroline A Sabin
- Institute for Global Health, University College London, UK
- National Institute for Health Research Health Protection Research Unit in Blood-Borne and Sexually Transmitted Infections, University College London, London, UK
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Jaspal R, Lopes B, Jamal Z, Yap C, Paccoud I, Sekhon P. HIV knowledge, sexual health and sexual behaviour among Black and minority ethnic men who have sex with men in the UK: a cross-sectional study. Sex Health 2020; 16:25-31. [PMID: 30476462 DOI: 10.1071/sh18032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 08/01/2018] [Indexed: 01/13/2023]
Abstract
Background Black and minority ethnic (BME) men who have sex with men (MSM) face a major burden in relation to HIV infection. Using a cross-sectional correlational survey design, the present study explored the relationships between HIV knowledge and reported sexual health and sexual behaviour in this population. METHODS A convenience sample of 538 BME MSM was recruited in London, Leicester and Leeds: 346 (64%) self-identified as South Asian, 88 (16%) self-identified as Latin American, 76 (14%) self-identified as Black, 13 (2%) self-identified as mixed, and 15 (3%) self-identified as other. RESULTS HIV knowledge was low across the board, and South Asian MSM manifested the lowest scores. Respondents who perceived their HIV risk to be low possessed the least HIV knowledge. There were interethnic differences in the frequency of gay sauna visits, sex-seeking on mobile applications, drug use and attendance at sex parties. Respondents reported a high frequency of racism and discrimination, with Black MSM reporting highest frequency. CONCLUSIONS There is an urgent need to raise awareness of HIV in BME MSM, and a culturally competent approach to HIV awareness-raising in BME MSM is required. These findings shed light on the contexts in which HIV prevention efforts should be targeted to reach specific ethnic groups, as well as some of the potential syndemics that can increase HIV risk or undermine HIV outcomes in BME MSM patients.
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Affiliation(s)
- Rusi Jaspal
- Trinity House, De Montfort University, Leicester, LE2 7BY, UK
| | - Barbara Lopes
- Center for Research in Neuropsychology and Cognitive Behavioural Intervention, Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra, Rua do Colégio Novo, P-301-802 Coimbra, Portugal
| | - Zahra Jamal
- NAZ Project London, 30 Black's Road, London, W6 9DT, UK
| | - Carmen Yap
- NAZ Project London, 30 Black's Road, London, W6 9DT, UK
| | - Ivana Paccoud
- NAZ Project London, 30 Black's Road, London, W6 9DT, UK
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Glendinning E, Spiers J, Smith JA, Anderson J, Campbell LJ, Cooper V, Horne R. A Qualitative Study to Identify Perceptual Barriers to Antiretroviral Therapy (ART) Uptake and Adherence in HIV Positive People from UK Black African and Caribbean Communities. AIDS Behav 2019; 23:2514-2521. [PMID: 31520239 PMCID: PMC6766469 DOI: 10.1007/s10461-019-02670-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To inform the development of interventions to increase uptake and adherence to antiretroviral therapy (ART), we explored perceptions of ART in semi-structured interviews with 52 men and women from UK black African and black Caribbean communities. Verbatim transcripts were analyzed using framework analysis. Perceptions of ART could be grouped into two categories: doubts about the personal necessity for ART and concerns about potential adverse effects. Doubts about necessity stemmed from feeling well, doubts about the efficacy of ART, religious beliefs and the belief that treatment was futile because it could not cure HIV. Concerns about adverse effects included the fear that attending HIV services and taking treatment would lead to disclosure of HIV, feeling overwhelmed at the prospect of starting treatment soon after diagnosis, fears about side effects and potential long-term effects, and physical repulsion. The findings will facilitate the development of interventions to increase uptake and adherence to ART.
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Affiliation(s)
- Elizabeth Glendinning
- Centre for Behavioural Medicine, UCL School of Pharmacy, BMA House, Tavistock Square, London, WC1H 9JP UK
| | - Johanna Spiers
- Centre for Behavioural Medicine, UCL School of Pharmacy, BMA House, Tavistock Square, London, WC1H 9JP UK
| | - Jonathan A. Smith
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Jane Anderson
- Centre for the Study of Sexual Health and HIV, Homerton University Hospital, London, UK
| | | | - Vanessa Cooper
- Centre for Behavioural Medicine, UCL School of Pharmacy, BMA House, Tavistock Square, London, WC1H 9JP UK
| | - Rob Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, BMA House, Tavistock Square, London, WC1H 9JP UK
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Gunaratnam P, McManus H, Watchirs-Smith L, McGregor S, Callander D, Brown G, Lobo R, OʼConnor C, Hellard M, Medland N, Lewis D, Palmer C, Law M, Gray R, Donovan B, Guy R. People Born in Non-Main English Speaking Countries Are Less Likely to Start HIV Treatment Early in Australia: A National Cohort Analysis, 2014-15. J Acquir Immune Defic Syndr 2019; 77:e31-e34. [PMID: 29135653 DOI: 10.1097/qai.0000000000001585] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Praveena Gunaratnam
- The Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, Australia
| | - Hamish McManus
- The Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, Australia
| | - Lucy Watchirs-Smith
- The Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, Australia
| | - Skye McGregor
- The Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, Australia
| | - Denton Callander
- The Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, Australia
| | - Graham Brown
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Roanna Lobo
- School of Public Health, Curtin University, Perth, Australia
| | - Catherine OʼConnor
- The Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, Australia.,Sexual Health Service, Sydney Local Health District, Sydney, Australia.,Faculty of Medicine, Central Clinical School, University of Sydney, Sydney, Australia
| | | | - Nick Medland
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - David Lewis
- Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney Medical School-Westmead, University of Sydney, Sydney, Australia.,Western Sydney Sexual Health Centre, Sydney, Australia
| | - Cheryn Palmer
- Princess Alexandria Hospital, Sexual Health Clinic, Brisbane, Australia
| | - Matthew Law
- The Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, Australia
| | - Richard Gray
- The Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, Australia
| | - Basil Donovan
- The Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, Australia
| | - Rebecca Guy
- The Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, Australia
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Equality in sexual health promotion: a systematic review of effective interventions for black and minority ethnic men who have sex with men. BMC Public Health 2016; 16:810. [PMID: 27534390 PMCID: PMC4989329 DOI: 10.1186/s12889-016-3418-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 06/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the past decade, new diagnoses of HIV have increased eightfold among men who have sex with men (MSM) of other or of mixed ethnicity in the UK. Yet there is little intervention research on HIV among black and minority ethnic (BME) MSM. This article aimed to identify effective HIV and sexual health prevention strategies for BME MSM. METHODS We searched three databases PubMed, Scopus and PsychInfo using a combination of search terms: MSM or men who have sex with men and women (MSMW); Black and Minority Ethnic; HIV or sexual health; and evaluation, intervention, program* or implementation. We identified a total of 19 studies to include in the review including those which used randomised control, pre/post-test and cross-sectional design; in addition, we included intervention development studies. RESULTS A total of 12 studies reported statistically significant results in at least one of the behavioural outcomes assessed; one study reported significant increases in HIV knowledge and changes in safer sex practices. In 10 studies, reductions were reported in unprotected anal intercourse (UAI), number of sexual partners, or in both of these measures. Six out of the 13 studies reported reductions in UAI; while seven reported reductions in number of sexual partners. Seven were intervention development studies. CONCLUSIONS Research into the mechanisms and underpinnings of future sexual health interventions is urgently needed in order to reduce HIV and other sexually transmitted infection (STI) among UK BME MSM. The design of interventions should be informed by the members of these groups for whom they are targeted to ensure the cultural and linguistic sensitivity of the tools and approaches generated.
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Van Beckhoven D, Florence E, Ruelle J, Deblonde J, Verhofstede C, Callens S, Vancutsem E, Lacor P, Demeester R, Goffard JC, Sasse A. Good continuum of HIV care in Belgium despite weaknesses in retention and linkage to care among migrants. BMC Infect Dis 2015; 15:496. [PMID: 26530500 PMCID: PMC4631021 DOI: 10.1186/s12879-015-1230-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 10/19/2015] [Indexed: 01/06/2023] Open
Abstract
Background The Belgian HIV epidemic is largely concentrated among men who have sex with men and Sub-Saharan Africans. We studied the continuum of HIV care of those diagnosed with HIV living in Belgium and its associated factors. Methods Data on new HIV diagnoses 2007–2010 and HIV-infected patients in care in 2010–2011 were analysed. Proportions were estimated for each sequential stage of the continuum of HIV care and factors associated with attrition at each stage were studied. Results Of all HIV diagnosed patients living in Belgium in 2011, an estimated 98.2 % were linked to HIV care, 90.8 % were retained in care, 83.3 % received antiretroviral therapy and 69.5 % had an undetectable viral load (<50 copies/ml). After adjustment for sex, age at diagnosis, nationality and mode of transmission, we found lower entry into care in non-Belgians and after preoperative HIV diagnoses; lower retention in non-Belgians and injecting drug users; higher retention in men who have sex with men and among those on ART. Younger patients had lower antiretroviral therapy uptake and less viral suppression; those with longer time from diagnosis had higher ART uptake and more viral suppression; Sub-Saharan Africans on ART had slightly less viral suppression. Conclusions The continuum of HIV care in Belgium presents low attrition rates over all stages. The undiagnosed HIV-infected population, although not precisely estimated, but probably close to 20 % based on available survey and surveillance results, could be the weakest stage of the continuum of HIV care. Its identification is a priority along with improving the HIV care continuum of migrants. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1230-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- D Van Beckhoven
- Epidemiology of Infectious Diseases Unit, Scientific Institute of Public Health, Rue J. Wytsman 14, 1050, Brussels, Belgium.
| | - E Florence
- Department of Clinical Sciences, Instituut Tropische Geneeskunde, Antwerp, Belgium.
| | - J Ruelle
- Institute of Experimental and Clinical Research (IREC), Unit of Medical Microbiology (MBLG), Université Catholique de Louvain, Brussels, Belgium.
| | - J Deblonde
- Epidemiology of Infectious Diseases Unit, Scientific Institute of Public Health, Rue J. Wytsman 14, 1050, Brussels, Belgium.
| | - C Verhofstede
- AIDS Reference Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium.
| | - S Callens
- Department of Internal Medicine, Universitair Ziekenhuis Gent, Ghent, Belgium.
| | - E Vancutsem
- Department of Microbiology and Infection Control, Universitair Ziekenhuis Brussel, Brussels, Belgium.
| | - P Lacor
- Department of Internal Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium.
| | - R Demeester
- Department of Internal Medicine and Infectious Diseases, CHU de Charleroi, Charleroi, Belgium.
| | - J-C Goffard
- Service of Internal Medicine, Hôpital Erasme, Brussels, Belgium.
| | - A Sasse
- Epidemiology of Infectious Diseases Unit, Scientific Institute of Public Health, Rue J. Wytsman 14, 1050, Brussels, Belgium.
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Millett GA, Peterson JL, Flores SA, Hart TA, Jeffries WL, Wilson PA, Rourke SB, Heilig CM, Elford J, Fenton KA, Remis RS. Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis. Lancet 2012; 380:341-8. [PMID: 22819656 DOI: 10.1016/s0140-6736(12)60899-x] [Citation(s) in RCA: 551] [Impact Index Per Article: 45.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND We did a meta-analysis to assess factors associated with disparities in HIV infection in black men who have sex with men (MSM) in Canada, the UK, and the USA. METHODS We searched Embase, Medline, Google Scholar, and online conference proceedings from Jan 1, 1981, to Dec 31, 2011, for racial comparative studies with quantitative outcomes associated with HIV risk or HIV infection. Key words and Medical Subject Headings (US National Library of Medicine) relevant to race were cross-referenced with citations pertinent to homosexuality in Canada, the UK, and the USA. Data were aggregated across studies for every outcome of interest to estimate overall effect sizes, which were converted into summary ORs for 106,148 black MSM relative to 581,577 other MSM. FINDINGS We analysed seven studies from Canada, 13 from the UK, and 174 from the USA. In every country, black MSM were as likely to engage similarly in serodiscordant unprotected sex as other MSM. Black MSM in Canada and the USA were less likely than other MSM to have a history of substance use (odds ratio, OR, 0·53, 95% CI 0·38-0·75, for Canada and 0·67, 0·50-0·92, for the USA). Black MSM in the UK (1·86, 1·58-2·18) and the USA (3·00, 2·06-4·40) were more likely to be HIV positive than were other MSM, but HIV-positive black MSM in each country were less likely (22% in the UK and 60% in the USA) to initiate combination antiretroviral therapy (cART) than other HIV-positive MSM. US HIV-positive black MSM were also less likely to have health insurance, have a high CD4 count, adhere to cART, or be virally suppressed than were other US HIV-positive MSM. Notably, despite a two-fold greater odds of having any structural barrier that increases HIV risk (eg, unemployment, low income, previous incarceration, or less education) compared with other US MSM, US black MSM were more likely to report any preventive behaviour against HIV infection (1·39, 1·23-1·57). For outcomes associated with HIV infection, disparities were greatest for US black MSM versus other MSM for structural barriers, sex partner demographics (eg, age, race), and HIV care outcomes, whereas disparities were least for sexual risk outcomes. INTERPRETATION Similar racial disparities in HIV and sexually transmitted infections and cART initiation are seen in MSM in the UK and the USA. Elimination of disparities in HIV infection in black MSM cannot be accomplished without addressing structural barriers or differences in HIV clinical care access and outcomes. FUNDING None.
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Affiliation(s)
- Gregorio A Millett
- National Center for HIV/AIDS, Viral, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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