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Guilamo-Ramos V, Johnson C, Thimm-Kaiser M, Benzekri A. Nurse-led approaches to address social determinants of health and advance health equity: A new framework and its implications. Nurs Outlook 2023; 71:101996. [PMID: 37349232 DOI: 10.1016/j.outlook.2023.101996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND The U.S. health care system is burdened by inefficiencies, longstanding health inequities, and unstainable costs. Within the nursing profession and the broader health care sector, there is growing recognition of the need for a paradigm shift that addresses persistent structural problems and advances health equity. PURPOSE Despite evidence of the importance of the social determinants of health (SDOH) in shaping inequitable health outcomes, practical tools for applying SDOH theory in the development of effective nurse-led programs to mitigate harmful SDOH remain scarce. METHODS We synthesize extant SDOH literature into a heuristic framework for conceptualizing core SDOH mechanisms, constructs, and principles. FINDINGS To illustrate how nurse scientists can use the framework to guide the development of programs for SDOH mitigation, we outline a three-step exemplar application to the U.S. Latino HIV epidemic. DISCUSSION Our framework can inform a paradigm shift toward nurse-led, multi-level SDOH mitigation across practice, education, and research.
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Affiliation(s)
- Vincent Guilamo-Ramos
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC; School of Medicine, Department of Family Medicine and Community Health, Department of Infectious Diseases, Duke University, Durham, NC; Presidential Advisory Council on HIV/AIDS, US Department of Health and Human Services, Washington, DC.
| | - Celia Johnson
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC
| | - Marco Thimm-Kaiser
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC
| | - Adam Benzekri
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC
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Owens C, Carter K, Grant MJ, Hubach RD, Hoffman M. An Exploratory Study of the PrEP Modality Preferences Among a Convenience Sample of Parents of Sexual and Gender Minority Adolescents. J Adolesc Health 2023; 73:625-631. [PMID: 37031089 DOI: 10.1016/j.jadohealth.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 04/10/2023]
Abstract
PURPOSE Parents' attitudes toward contraceptive delivery methods have been shown to impact their adolescents' use of contraceptive methods. However, little is known about the HIV pre-exposure prophylaxis (PrEP) delivery method attitudes of parents of sexual and gender minority (SGM) adolescents assigned male at birth (AMAB). This exploratory, mixed-method formative study examined the PrEP delivery method preferences among a convenience sample of 33 parents of SGM adolescents AMAB who live in Texas. METHODS Participants completed an online survey, where they selected their preferred PrEP method for their SGM adolescent AMAB to use: PrEP as a daily oral pill, a bimonthly injectable, or a yearly implant. Parents answered an open-ended question about their reasons for choosing their preferred method. We analyzed data through descriptive statistics and inductive content analysis. RESULTS Findings from this convenience sample suggest that there is not one PrEP delivery method that parents of SGM adolescents AMAB prefer: one third of parents (33.3%) selected PrEP as a daily oral pill, 45.5% selected PrEP as a bimonthly injectable, and 21.2% selected PrEP as an annual implant. Parents cited multiple reasons for selecting a delivery method over another, with the most prevalent reasons being adherence (57.6%), access or cost (21.2%), and generic convenience or ease (21.2%). DISCUSSION Findings from this formative exploratory study sets the stage for future research and intervention development in increasing parental knowledge, preferences, and preference motivations for PrEP delivery methods.
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Affiliation(s)
- Christopher Owens
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas; Center for Health Equity and Evaluation Research, School of Public Health, Texas A&M University, College Station, Texas.
| | - Kaileigh Carter
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas
| | - Morgan J Grant
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas; Center for Health Equity and Evaluation Research, School of Public Health, Texas A&M University, College Station, Texas
| | - Randolph D Hubach
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana
| | - Matt Hoffman
- School of Nursing, Texas A&M University, Bryan, Texas
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Lee YG, Alessi EJ, Lynn M, Starks TJ, Robles G. Everyday Discrimination and HIV Testing Among Partnered Latino/x Sexual Minority Men in the United States: A Stratified Analysis by Birth Location. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:376-389. [PMID: 37843904 DOI: 10.1521/aeap.2023.35.5.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
We examined the association between everyday discrimination and HIV testing patterns-current (≤ 6 months), recent (7-12 months), and delayed (> 12 months or never tested)-among partnered Latino/x sexual minority men (SMM). Multinomial regression analyses revealed that in the full sample (N = 484) experiencing discrimination based on sexual orientation and race/ethnicity attributions concurrently (vs. no discrimination) was associated with higher odds of delayed (vs. current) HIV testing (AOR = 2.6, 95% CI [1.0, 6.7]). Similarly, in the subset of Latino/x SMM born outside the mainland U.S. (n = 209), experiencing concurrent sexual orientation- and race/ethnicity-based discrimination (vs. no discrimination) was associated with higher odds of recent (AOR = 12.4, 95% CI [1.3, 115.7]) and delayed HIV testing (AOR = 7.3, 95% CI [1.6, 33.0]), compared with current testing. Findings suggest that addressing discrimination may improve HIV testing uptake among partnered Latino/x SMM, particularly those born outside the U.S.
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Affiliation(s)
- Yong Gun Lee
- School of Social Work, Rutgers University, New Brunswick, New Jersey
| | - Edward J Alessi
- School of Social Work, Rutgers University, New Brunswick, New Jersey
| | - Matthew Lynn
- School of Social Work, Rutgers University, New Brunswick, New Jersey
| | - Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York, New York, New York
| | - Gabriel Robles
- School of Social Work, Rutgers University, New Brunswick, New Jersey
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Sousa LRM, de Mesquita RF, Wiklander M, Eriksson LE, Gir E, Reis RK. Cultural Adaptation and Validation of the Barriers to HIV Testing Scale-Karolinska Version for Brazilian Men Who Have Sex With Men. J Assoc Nurses AIDS Care 2023; 34:481-498. [PMID: 37561660 PMCID: PMC10481927 DOI: 10.1097/jnc.0000000000000422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
ABSTRACT The aim of this study was to perform the cultural adaptation and validation of the Barriers to HIV testing scale-Karolinska version for Brazilian men who have sex with men. A methodological study was conducted for cultural adaptation and validation of the scale. Reliability analyses, exploratory factor analysis, confirmatory factor analysis, and convergent and discriminant validity tests were performed. Four factors were extracted: F1, personal consequences; F2, structural barriers; F3, confidentiality; F4, economic consequences and individual concerns. Good fit indexes were obtained: (χ 2 )/GL (2.71); goodness of fit index (0.94); root-mean-square error of approximation (0.052; 90% CI [0.045-0.059]); Tucker-Lewis index (0.94); normed fit index (0.93); IFI (0.95); comparative fit index (0.95). Convergent validity results were greater than 0.7 for the four factors. The adapted version of the scale showed satisfactory reliability and validity for assessing barriers to HIV testing among men who have sex with men.
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Affiliation(s)
- Laelson Rochelle Milanês Sousa
- Laelson Rochelle Milanês Sousa, PhD, is a Postdoctoral Researcher, Ribeirão Preto School of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. Rafael Fernandes de Mesquita, PhD, is a Professor, Federal Institute of Education, Science and Technology of Piauí, Teresina, Brazil. Maria Wiklander, PhD, is a Psychologist, Associate Senior Lecturer, Division of Nursing, Department of Neurobiology, Care Sciences and Society Karolinska Institutet, Huddinge, Sweden. Lars E. Eriksson, RN, is an Associate Professor, Senior Lecturer, Department Director of Doctoral Education, Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden. Elucir Gir, PhD, MNSc.RN, is a Full Professor, General and Specialized Nursing Department, Graduate Program in Fundamental Nursing, Vice Dean of University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil. Renata Karina Reis, PhD, MNSc.RN, is a Professor, General and Specialized Nursing Department, Graduate Program in Fundamental Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Rafael Fernandes de Mesquita
- Laelson Rochelle Milanês Sousa, PhD, is a Postdoctoral Researcher, Ribeirão Preto School of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. Rafael Fernandes de Mesquita, PhD, is a Professor, Federal Institute of Education, Science and Technology of Piauí, Teresina, Brazil. Maria Wiklander, PhD, is a Psychologist, Associate Senior Lecturer, Division of Nursing, Department of Neurobiology, Care Sciences and Society Karolinska Institutet, Huddinge, Sweden. Lars E. Eriksson, RN, is an Associate Professor, Senior Lecturer, Department Director of Doctoral Education, Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden. Elucir Gir, PhD, MNSc.RN, is a Full Professor, General and Specialized Nursing Department, Graduate Program in Fundamental Nursing, Vice Dean of University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil. Renata Karina Reis, PhD, MNSc.RN, is a Professor, General and Specialized Nursing Department, Graduate Program in Fundamental Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Maria Wiklander
- Laelson Rochelle Milanês Sousa, PhD, is a Postdoctoral Researcher, Ribeirão Preto School of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. Rafael Fernandes de Mesquita, PhD, is a Professor, Federal Institute of Education, Science and Technology of Piauí, Teresina, Brazil. Maria Wiklander, PhD, is a Psychologist, Associate Senior Lecturer, Division of Nursing, Department of Neurobiology, Care Sciences and Society Karolinska Institutet, Huddinge, Sweden. Lars E. Eriksson, RN, is an Associate Professor, Senior Lecturer, Department Director of Doctoral Education, Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden. Elucir Gir, PhD, MNSc.RN, is a Full Professor, General and Specialized Nursing Department, Graduate Program in Fundamental Nursing, Vice Dean of University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil. Renata Karina Reis, PhD, MNSc.RN, is a Professor, General and Specialized Nursing Department, Graduate Program in Fundamental Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Lars E. Eriksson
- Laelson Rochelle Milanês Sousa, PhD, is a Postdoctoral Researcher, Ribeirão Preto School of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. Rafael Fernandes de Mesquita, PhD, is a Professor, Federal Institute of Education, Science and Technology of Piauí, Teresina, Brazil. Maria Wiklander, PhD, is a Psychologist, Associate Senior Lecturer, Division of Nursing, Department of Neurobiology, Care Sciences and Society Karolinska Institutet, Huddinge, Sweden. Lars E. Eriksson, RN, is an Associate Professor, Senior Lecturer, Department Director of Doctoral Education, Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden. Elucir Gir, PhD, MNSc.RN, is a Full Professor, General and Specialized Nursing Department, Graduate Program in Fundamental Nursing, Vice Dean of University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil. Renata Karina Reis, PhD, MNSc.RN, is a Professor, General and Specialized Nursing Department, Graduate Program in Fundamental Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Elucir Gir
- Laelson Rochelle Milanês Sousa, PhD, is a Postdoctoral Researcher, Ribeirão Preto School of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. Rafael Fernandes de Mesquita, PhD, is a Professor, Federal Institute of Education, Science and Technology of Piauí, Teresina, Brazil. Maria Wiklander, PhD, is a Psychologist, Associate Senior Lecturer, Division of Nursing, Department of Neurobiology, Care Sciences and Society Karolinska Institutet, Huddinge, Sweden. Lars E. Eriksson, RN, is an Associate Professor, Senior Lecturer, Department Director of Doctoral Education, Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden. Elucir Gir, PhD, MNSc.RN, is a Full Professor, General and Specialized Nursing Department, Graduate Program in Fundamental Nursing, Vice Dean of University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil. Renata Karina Reis, PhD, MNSc.RN, is a Professor, General and Specialized Nursing Department, Graduate Program in Fundamental Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Renata Karina Reis
- Laelson Rochelle Milanês Sousa, PhD, is a Postdoctoral Researcher, Ribeirão Preto School of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. Rafael Fernandes de Mesquita, PhD, is a Professor, Federal Institute of Education, Science and Technology of Piauí, Teresina, Brazil. Maria Wiklander, PhD, is a Psychologist, Associate Senior Lecturer, Division of Nursing, Department of Neurobiology, Care Sciences and Society Karolinska Institutet, Huddinge, Sweden. Lars E. Eriksson, RN, is an Associate Professor, Senior Lecturer, Department Director of Doctoral Education, Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden. Elucir Gir, PhD, MNSc.RN, is a Full Professor, General and Specialized Nursing Department, Graduate Program in Fundamental Nursing, Vice Dean of University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil. Renata Karina Reis, PhD, MNSc.RN, is a Professor, General and Specialized Nursing Department, Graduate Program in Fundamental Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
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Crepaz N, Salabarría-Peña Y, Mullins MM, Gunn JK, Higa DH. Systematic Review of Social Determinants of Health Associated With HIV Testing Among Hispanic/Latino Gay, Bisexual, and Other Men Who Have Sex With Men in the United States. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:36-S6. [PMID: 36735227 PMCID: PMC9915884 DOI: 10.1521/aeap.2023.35.1.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This systematic review synthesized published literature (January 2008-October 2021) about the association between social determinants of health (SDOH) and HIV testing among Hispanic/Latino gay, bisexual, and other men who have sex with men (HLMSM), a group disproportionally affected by HIV. Having higher education than a high school diploma, health insurance and access to health care services, and visiting a health care provider in the past 12 months were some of the determinants associated with HIV testing, while limited English proficiency was associated with reduced odds of HIV-testing among HLMSM. More research is needed to understand the relationship of SDOH (especially neighborhood) and HIV testing, how SDOH may affect HIV testing among different HLMSM groups, and how to increase self-testing and use of e-health in this priority population. Additionally, culturally and linguistically appropriate multilevel interventions and health services for HLMSM are urgently needed to diagnose HIV as early as possible after infection.
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Affiliation(s)
- Nicole Crepaz
- Division of HIV Prevention, the U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yamir Salabarría-Peña
- Division of HIV Prevention, the U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary M. Mullins
- Division of HIV Prevention, the U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jayleen K.L. Gunn
- Division of HIV Prevention, the U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service, Washington, D.C
| | - Darrel H. Higa
- Division of HIV Prevention, the U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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HIV Testing Strategies, Types of Tests, and Uptake by Men Who have Sex with Men and Transgender Women: A Systematic Review and Meta-analysis. AIDS Behav 2023; 27:678-707. [PMID: 35984608 DOI: 10.1007/s10461-022-03803-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 11/01/2022]
Abstract
This systematic review and meta-analysis investigated the effectiveness of strategies and types of tests on HIV testing uptake by men who have sex with men (MSM) and transgender women (TGW), and in reaching PLWH. Articles published up to July 2020 were identified from major electronic databases and grey literature. Data were extracted and assessed for risk of bias. Estimates were pooled using random-effect meta-analysis while heterogeneity was evaluated by Cochran's Q test and I2. This study is registered with PROSPERO (CRD42020192740). Of 6820 titles, 263 studies (n = 67,288 participants) were included. The testing strategies reported in most studies were community- (71.2%) and facility-based (28.8%). Highest uptake, with facility-based testing, occurred and reached more PLWH while with standard laboratory tests, it occurred with the highest HIV prevalence among MSM. However, urine test showed a highest rate of new HIV infection. Multiple test combinations had the highest uptake and reached more PLWH among TGW. Various testing strategies, considering barriers and regional differences, and different test types, need be considered, to increase uptake among MSM and TGW.
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Olakunde BO, Pharr JR, Adeyinka DA, Conserve DF. Nonuptake of HIV Testing Among Transgender Populations in the United States: Results from the 2015 U.S. Transgender Survey. Transgend Health 2022; 7:430-439. [PMID: 36644483 PMCID: PMC9829162 DOI: 10.1089/trgh.2020.0141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose In this study, we examined the nonuptake of HIV testing and the main reasons for never testing among transgender populations. Methods Data on 26,927 respondents from the 2015 U.S. Transgender Survey were analyzed in this study. The main reasons for never testing were categorized as low risk perception; access related; fear or HIV-related stigma; and others. We performed weighted descriptive statistics and multivariable logistic regression analyses, controlling for sociodemographic characteristics and sexual orientation. Results Forty-five percent of the respondents had never tested for HIV. Trans women (adjusted odds ratio [aOR]=1.1, 95% confidence interval [CI]=1.07-1.25) and assigned female at birth genderqueer/nonbinary individuals (AFAB GQ/NB) (aOR=1.3, 95% CI=1.16-1.35) had significantly higher odds of reporting never testing for HIV compared with trans men. The most reported reason for never testing was low risk perception (87%). AFAB GQ/NB (aOR=1.4, 95% CI=1.22-1.66) had significantly higher odds of reporting low risk perception as the main reason for never testing for HIV relative to trans men. AFAB GQ/NB were less likely to report access related as the main reason for never testing (aOR=0.8, 95% CI=0.56-0.95). The odds of trans women and assigned male at birth GQ/NB individuals reporting fear or HIV-related stigma as the main reason for never testing were 1.7 (95% CI=1.13-2.55) and 2.8 (95% CI=1.69-4.70) times that of trans men. Both trans women (aOR=0.8, 95% CI=0.65-0.97) and AFAB GQ/NB (aOR=0.7, 95% CI=0.60-0.88) had lower odds of reporting others. The main reasons for never testing also varied by sociodemographic factors, including age, educational attainment, race/ethnicity, employment status, poverty, and sexual orientation. Conclusions HIV testing is suboptimal among transgender populations. Our findings also suggest that barriers to HIV testing vary by transgender populations, thus interventions for improved uptake should be population specific.
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Affiliation(s)
- Babayemi O. Olakunde
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Jennifer R. Pharr
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Daniel A. Adeyinka
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
| | - Donaldson F. Conserve
- Department of Prevention and Community Health, Milken Institute of Public Health, George Washington University, Washington, District of Columbia, USA
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Dibble KE, Murray SM, Wiginton JM, Maksut JL, Lyons CE, Aggarwal R, Augustinavicius JL, Al-Tayyib A, Sey EK, Ma Y, Flynn C, German D, Higgins E, Anderson BJ, Menza TW, Orellana ER, Flynn AB, Wermuth PP, Kienzle J, Shields G, Baral SD. Associations between HIV testing and multilevel stigmas among gay men and other men who have sex with men in nine urban centers across the United States. BMC Health Serv Res 2022; 22:1179. [PMID: 36127682 PMCID: PMC9490978 DOI: 10.1186/s12913-022-08572-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Complex manifestation of stigma across personal, community, and structural levels and their effect on HIV outcomes are less understood than effects in isolation. Yet, multilevel approaches that jointly assesses HIV criminalization and personal sexual behavior stigma in relation to HIV testing have not been widely employed or have only focused on specific subpopulations. The current study assesses the association of three types of MSM-related sexual behavior-related stigma (family, healthcare, general social stigma) measured at both individual and site levels and the presence/absence of laws criminalizing HIV transmission with HIV testing behaviors to inform HIV surveillance and prevention efforts among HIV-negative MSM in a holistic and integrated way. Methods We included nine National HIV Behavioral Surveillance (NHBS) 2017 sites: Baltimore, MD; Denver, CO; Detroit, MI; Houston, TX; Long Island/Nassau-Suffolk, NY; Los Angeles, CA; Portland, OR; San Diego, CA; and Virginia Beach and Norfolk, VA. Multivariable generalized hierarchical linear modeling was used to examine how sexual behavior stigmas (stigma from family, anticipated healthcare stigma, general social stigma) measured at the individual and site levels and state HIV criminalization legislation (no, HIV-specific, or sentence-enhancement laws) were associated with past-year HIV testing behaviors across sites (n = 3,278). Results The majority of MSM across sites were tested for HIV in the past two years (n = 2,909, 95.4%) with the average number of times tested ranging from 1.79 (SD = 3.11) in Portland, OR to 4.95 (SD = 4.35) in Los Angeles, CA. In unadjusted models, there was a significant positive relationship between stigma from family and being tested for HIV in the past two years. Site-level HIV-specific criminalization laws were associated with an approximate 5% reduction in the prevalence of receiving any HIV test in the past two years after individual level stigma and sociodemographic covariate adjustments (PR = 0.94, 95% CI, 0.90–0.99). Conclusions Structural barriers faced by MSM persist and ending the HIV epidemic in the US requires a supportive legal environment to ensure effective engagement in HIV services among MSM. Home-based solutions, such as self-testing, used to deliver HIV testing may be particularly important in punitive settings while legal change is advocated for on the community and state levels. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08572-4.
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Affiliation(s)
- Kate E Dibble
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - John Mark Wiginton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Jessica L Maksut
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Carrie E Lyons
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Rohin Aggarwal
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Jura L Augustinavicius
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Alia Al-Tayyib
- Denver Public Health & Hospital Authority, Denver, CO, 80204, USA
| | - Ekow Kwa Sey
- Los Angeles County Department of Public Health, Los Angeles, CA, 90012, USA
| | - Yingbo Ma
- Los Angeles County Department of Public Health, Los Angeles, CA, 90012, USA
| | - Colin Flynn
- Center for HIV Surveillance, Epidemiology, & Evaluation, Maryland Department of Health, Baltimore, MD, 21202, USA
| | - Danielle German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Emily Higgins
- Division of HIV and STI Programs, Michigan Department of Health and Human Services (MDHHS), Lansing, MI, 48909, USA
| | - Bridget J Anderson
- Bureau of Communicable Disease Control, New York State Department of Health, Albany, NY, 12237, USA
| | - Timothy W Menza
- HIV Data and Analysis Program, Oregon Health Authority, Portland, OR, 97232, USA
| | - E Roberto Orellana
- Regional Research Institute, Portland State University, Portland, OR, 97201, USA.,School of Social Work, University of Washington, Seattle, WA, 98105, USA
| | - Anna B Flynn
- Surveillance & Federal Reporting Section, Maternal, Child, & Adolescent Health Division, California Department of Health,, San Francisco, CA, 94102, USA
| | - Paige Padgett Wermuth
- Division of Management Policy & Community Health (MPACH), The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, 77030, USA
| | - Jennifer Kienzle
- Division of Disease Prevention, Virginia Department of Health, HIV Surveillance, Richmond, VA, 23219, USA
| | - Garrett Shields
- Division of Disease Prevention, Virginia Department of Health, HIV Surveillance, Richmond, VA, 23219, USA
| | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Yamasaki V, Le TP. Family Matters: The Impact of Traditional and Egalitarian Gender Role Messages on Sexual and Gender Minority Latinx Adults' Alcohol Use and Sexual Risk. JOURNAL OF SEX RESEARCH 2022; 59:652-661. [PMID: 34431722 DOI: 10.1080/00224499.2021.1965948] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Latinx sexual and gender minority individuals are at increased risk for engaging in risky sexual behavior given the intersection of their sexual orientation and ethnic identities. Many studies have found that sexual and gender minority Latinx folks experience nonacceptance and discrimination from within their families due to their identity. However, none have explored how underlying familial beliefs, such as traditional and egalitarian gender roles, influence sexual and gender minority Latinx adults' risky sexual behavior. Within a sample of 168 Latinx sexual and gender minority individuals, the present study examined the indirect effect of receiving traditional and egalitarian parental gender role messages on risky sexual behavior through alcohol use and internalized stigma related to their sexual and gender minority identity. Results showed that traditional gender role messages were indirectly associated with increased risky sexual behavior through increased alcohol use, whereas no such indirect effect was found through internalized stigma. Receiving egalitarian gender role messages was not associated with risky sexual behaviors. Findings from this paper can be used to tailor community outreach programs that aim to reduce sexual risk behaviors and alcohol use in the Latinx sexual and gender minority community as a result of traditional parental gender role messages.
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Affiliation(s)
- Vic Yamasaki
- Department of Psychology, The University of Maryland, College Park, MD, USA
| | - Thomas P Le
- Department of Psychology, The University of Maryland, College Park, MD, USA
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10
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Carey JW, Courtenay-Quirk C, Carnes N, Wilkes AL, Schoua-Glusberg A, Tesfaye C, Betley V, Pedersen S, Randall LA, Frew PM. HIV Testing Program Activities and Challenges in Four U.S. Urban Areas. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:99-115. [PMID: 35438537 PMCID: PMC10953676 DOI: 10.1521/aeap.2022.34.2.99] [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] [Indexed: 06/14/2023]
Abstract
The national "Ending the HIV Epidemic: A Plan for America" supports expanded testing in jurisdictions and groups with disproportionate HIV burden. Public health planners benefit from learning HIV testing service (HTS) strengths, challenges, and innovations. We conducted semistructured interviews with 120 HTS staff from local health departments, community-based organizations, and community members in Houston, Texas; Miami, Florida; New Orleans, Louisiana; and Washington, DC. We coded interview transcripts using qualitative methods to identify themes. Program strengths include HIV testing integration with other client services; prioritized testing and tailored incentives; multiple advertising methods; and partnerships among HTS providers. Challenges include stigma, fear, and disparities; funding requirements that create competition between providers; and service accessibility, unnecessary repeat testing, and insufficient innovation. The four jurisdictions addressed some, but not all, of these challenges. Cross-jurisdictional collaboration, together with state and federal partners plus program data may help identify additional strategies for strengthening HTS.
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Affiliation(s)
- James W Carey
- Division of HIV Prevention, at the Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cari Courtenay-Quirk
- HIV Research Branch within the Division of HIV Prevention, at the Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Neal Carnes
- HIV Prevention Capacity Development Branch within the Division of HIV Prevention, at the Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aisha L Wilkes
- Prevention Research Branch within the Division of HIV Prevention, at the Centers for Disease Control and Prevention, Atlanta, Georgia; currently she is with the National Center for Injury Prevention and Control at CDC
| | | | - Casey Tesfaye
- Research Support Services Inc. in Evanston, Illinois
| | | | | | | | - Paula M Frew
- UNLV Population Health & Health Equity Initiative, Las Vegas, Nevada at the time of the study; currently she is with Merck & Co., Inc., Kenilworth, New Jersey
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11
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Iott BE, Loveluck J, Benton A, Golson L, Kahle E, Lam J, Bauermeister JA, Veinot TC. The impact of stigma on HIV testing decisions for gay, bisexual, queer and other men who have sex with men: a qualitative study. BMC Public Health 2022; 22:471. [PMID: 35264132 PMCID: PMC8908600 DOI: 10.1186/s12889-022-12761-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background Stigmatization may prompt gay, bisexual, queer and other men who have sex with men (GBQMSM) to avoid or delay HIV testing. There has been little attention to GBQMSMs’ perspectives about how stigma may influence their decisions about whether, where, and how often to get tested for HIV. Methods We conducted nine focus groups with 64 adult GBQMSM in Metropolitan Detroit, including HIV-negative men and people living with HIV (PLWH). Data were thematically analyzed deductively and inductively in three rounds. Results Three themes emerged regarding whether to get tested: (1) Perceived promiscuity, risk perceptions and HIV testing; (2) Fearing sexual rejection; and (3) Fearing friend and family member distancing and rejection. Themes concerning where to get tested included: (4) Conflating HIV testing and diagnosis; and (5) Seeking privacy and safety at specialized services. As for how often to get tested, themes included: (6) Reducing contact with healthcare providers due to intersectional stigma; (7) Responsibility and regular testing; and (8) HIV stigma and testing as routine care. Black participants articulated themes (3), (4), and (6) with greater frequency than other participants. Framing HIV testing as a personal responsibility may have created a “new stigma,” with unintended consequences not observed with “routine healthcare” messaging. Conclusions GBQMSMs’ perspectives indicate the potential for new foci for HIV testing promotion interventions based on stigma-related issues that they deem important. There is a need for interventions to challenge the “promiscuity” stereotype, and to reduce the sexual stigmatization of GBQMSM living with HIV/AIDS—especially online. Provider stigma requires both intervention and continued availability of specialized services. Future stigma-reduction interventions for Black GBQMSM could focus on building family support/acceptance, awareness of multiple testing options, and integrating LGBTQ-related issues into initiatives for racial justice in health care. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12761-5.
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Affiliation(s)
- Bradley E Iott
- School of Information, University of Michigan, Ann Arbor, MI, USA.,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Akilah Benton
- Detroit Health Department, City of Detroit, Detroit, MI, USA
| | - Leon Golson
- Unified - HIV Health and Beyond, Ypsilanti, MI, USA
| | - Erin Kahle
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Jason Lam
- School of Information, University of Michigan, Ann Arbor, MI, USA
| | | | - Tiffany C Veinot
- School of Information, University of Michigan, Ann Arbor, MI, USA. .,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
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12
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Harkness A, Bainter SA, Mendez NA, Hernandez Altamirano D, O'Cleirigh C, Mimiaga MJ, Mayer KH, Safren SA. Factors associated with barriers to engagement in HIV-prevention care among sexual minority men. J Behav Med 2021; 44:784-793. [PMID: 33993442 PMCID: PMC8981556 DOI: 10.1007/s10865-021-00230-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/24/2021] [Indexed: 10/21/2022]
Abstract
Engagement with HIV-prevention services varies among sexual minority men (SMM). 183 HIV-negative SMM completed a baseline assessment including sociodemographic, psychosocial, identity and stigma, and sexuality measures, as well as HIV-prevention behaviors: (1) date of most recent HIV test, (2) whether they discussed HIV or (3) sexual behavior with their provider, and (4) disclosure to provider about engaging in condomless anal sex (CAS). Factor analysis of these four items yielded an HIV-prevention engagement factor score. Stochastic search variable selection (SSVS) followed by multiple linear regression identified variables associated with HIV-prevention engagement. SSVS identified three variables for inclusion in a multiple linear regression model. Not disclosing sexual orientation to one's provider (p < 0.001), discomfort discussing sex with provider (p < 0.001) and lower education (p = 0.007) were associated with less HIV-prevention engagement. Findings suggest the importance of training providers in culturally competent care to mitigate observed barriers.
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Affiliation(s)
- Audrey Harkness
- Clinical Research Building, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA.
| | - Sierra A Bainter
- University of Miami, 5665 Ponce de Leon Blvd., Coral Gables, FL, 33146, USA
| | - Noelle A Mendez
- Clinical Research Building, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA
| | | | | | | | - Kenneth H Mayer
- Harvard School of Public Health, Boston, USA
- The Fenway Institute, Boston, MA, USA
| | - Steven A Safren
- Clinical Research Building, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA
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13
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Wood OR, Garofalo R, Kuhns LM, Scherr TF, Zetina APM, Rodriguez RG, Nash N, Cervantes M, Schnall R. A randomized controlled trial of an mHealth intervention for increasing access to HIV testing and care among young cisgender men and transgender women: the mLab App study protocol. BMC Public Health 2021; 21:1959. [PMID: 34715833 PMCID: PMC8554516 DOI: 10.1186/s12889-021-12015-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of youth living with HIV in the United States (US) continues to rise, and racial, ethnic, and sexual minority youth including young men who have sex with men (YMSM) and young transgender women (YTGW) bear a disproportionate burden of the HIV epidemic. Due to social and healthcare system factors, many YMSM and YTGW do not seek HIV testing services and are therefore less likely to be aware that they are infected. Mobile health technology (mHealth) has the ability to increase uptake of HIV testing among these populations. Thus, the mLab App-which combines HIV prevention information with a mobile phone imaging feature for interpreting at-home HIV test results-was developed to improve testing rates and linkage to care among Black, Latino, and other YMSM and YTGW living in New York City and Chicago and their surrounding areas. METHODS This study is a three-arm randomized controlled trial among YMSM and YTGW aged 18-29 years. Participants are randomized to either the mLab App intervention including HIV home test kits and standard of preventive care, standard of preventive care only, or HIV home test kits and standard of preventive care only. DISCUSSION mHealth technology used for HIV prevention is capable of delivering interventions in real-time, which creates an opportunity to remotely reach users across the country to strengthen their HIV care continuum engagement and treatment outcomes. Specifically during the COVID-19 pandemic, mHealth technology combined with at-home testing may prove to be essential in increasing HIV testing rates, especially among populations at high-risk or without regular access to HIV testing. TRIAL REGISTRATION This trial was registered with Clinicaltrials.gov ( NCT03803683 ) on January 14, 2019.
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Affiliation(s)
- Olivia R Wood
- Division of Scholarship and Research, Columbia University School of Nursing, 516 W. 168th Street, New York, NY, 10032, USA
| | - Robert Garofalo
- Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL, 60611, USA
| | - Lisa M Kuhns
- Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL, 60611, USA
| | - Thomas F Scherr
- Vanderbilt University, 2201 West End Avenue, Nashville, TN, 37235, USA
| | - Ana Paola Mata Zetina
- Division of Scholarship and Research, Columbia University School of Nursing, 516 W. 168th Street, New York, NY, 10032, USA
| | - Rafael Garibay Rodriguez
- Division of Scholarship and Research, Columbia University School of Nursing, 516 W. 168th Street, New York, NY, 10032, USA
| | - Nathanael Nash
- Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL, 60611, USA
| | - Marbella Cervantes
- Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL, 60611, USA
| | - Rebecca Schnall
- Division of Scholarship and Research, Columbia University School of Nursing, 516 W. 168th Street, New York, NY, 10032, USA.
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14
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Harkness A, Rogers BG, Balise R, Mayo D, Weinstein ER, Safren SA, Pachankis JE. Who Aren't We Reaching? Young Sexual Minority Men's Non-participation in an HIV-Prevention and Mental Health Clinical Trial. AIDS Behav 2021; 25:2195-2209. [PMID: 33483898 PMCID: PMC8169533 DOI: 10.1007/s10461-020-03148-x] [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] [Accepted: 12/21/2020] [Indexed: 11/29/2022]
Abstract
Despite many successful clinical trials to test HIV-prevention interventions for sexual minority men (SMM), not all SMM are reached by these trials. Identifying factors associated with non-participation in these trials could help to ensure the benefits of research extend to all SMM. Prospective participants in New York City and Miami were screened to determine eligibility for a baseline assessment for a mental health/HIV-prevention trial (N = 633 eligible on screen). Logistic regression and classification and regression tree (CART) analysis identified predictors of non-participation in the baseline, among those who were screened as eligible and invited to participate. Individuals who reported unknown HIV status were more likely to be non-participators than those who reported being HIV-negative (OR = 2.39; 95% CI 1.41, 4.04). In New York City, Latinx SMM were more likely to be non-participators than non-Latinx white SMM (OR = 1.81; 95% CI, 1.09, 2.98). A CART model pruned two predictors of non-participation: knowledge of HIV status and age, such that SMM with unknown HIV status and SMM ages 18-19 were less likely to participate. Young SMM who did not know their HIV status, and thus are more likely to acquire and transmit HIV, were less likely to participate. Additionally, younger SMM (18-19 years) and Latinx SMM in New York City were less likely to participate. The findings suggest the importance of tailored recruitment to ensure HIV-prevention/mental health trials reach all SMM.
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Affiliation(s)
- Audrey Harkness
- Department of Public Health Sciences, University of Miami, Clinical Research Building, 1120 NW 14th Street, Suite 1008, Miami, FL, 33136, USA.
| | - Brooke G Rogers
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Raymond Balise
- Department of Public Health Sciences, University of Miami, Clinical Research Building, 1120 NW 14th Street, Suite 1008, Miami, FL, 33136, USA
| | - Daniel Mayo
- Department of Psychology, University of Miami, Miami, FL, USA
| | | | - Steven A Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | - John E Pachankis
- Department of Chronic Disease Epidemiology, Social and Behavioral Sciences Division, Yale School of Public Health, Yale University, New Haven, CT, USA
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15
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Zhao Y, Bromberg DJ, Khoshnood K, Sheng Y. Factors associated with regular HIV testing behavior of MSM in China: a cross-sectional survey informed by theory of triadic influence. Int J STD AIDS 2020; 31:1340-1351. [PMID: 33081648 DOI: 10.1177/0956462420953012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The prevalence of HIV infection among men who have sex with men (MSM) in China has increased in recent years. Regular HIV testing is a key prevention strategy for identifying HIV infections among MSM. Informed by the theory of triadic influence, we aimed to determine individual, social and environmental factors associated with regular HIV testing behavior. Regular HIV testing is defined as taking an HIV test every 3 to 6 months. Both an online survey and a face-to-face survey was administered to MSM in China. Logistic regression was used to examine associations with testing behavior. 500 MSM were surveyed, the prevalence of regular testing was 56.4%. In the final model, age of first sexual intercourse, self-efficacy, perceived risk, number of partners, orientation disclosure, knowledge of HIV testing, behavioral intention and HIV relevant behaviors (sexually transmitted infection testing history) were associated with regular HIV testing; social stream characteristics had stronger associations with regular testing than individual and environmental factors. Findings implicated that interventions aimed at improving the effective counseling service from healthcare providers and the medical environment and intrapersonal changes should be combined to encourage MSM to have their first HIV test and to keep coming back at regular intervals.
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Affiliation(s)
- Yafang Zhao
- School of Nursing, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Daniel J Bromberg
- Yale School of Public Health, Yale University. New Haven, CT, USA.,Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Kaveh Khoshnood
- Yale School of Public Health, Yale University. New Haven, CT, USA
| | - Yu Sheng
- School of Nursing, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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16
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Painter TM, Song EY, Mullins MM, Mann-Jackson L, Alonzo J, Reboussin BA, Rhodes SD. Social Support and Other Factors Associated with HIV Testing by Hispanic/Latino Gay, Bisexual, and Other Men Who Have Sex with Men in the U.S. South. AIDS Behav 2019; 23:251-265. [PMID: 31102108 PMCID: PMC6800592 DOI: 10.1007/s10461-019-02540-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cognitive-psychosocial and other factors may affect participation in HIV testing, particularly by Hispanic/Latino gay, bisexual, and other men who have sex with men (MSM) in the U.S. South, a region hard-hit by HIV. We used univariate and multivariable logistic regression analyses to examine the association between social support and other cognitive-psychosocial factors; sociodemographic characteristics; risk behaviors; and self-reported HIV testing in a sample of 304 Hispanic/Latino MSM in North Carolina. In the multivariable logistic regression analysis, general and HIV-related social support and HIV-related knowledge were associated with greater odds of testing; speaking only Spanish was associated with reduced odds of testing. Social support and aspects of social connectedness may constitute community-based resources for use in HIV prevention efforts with Hispanic/Latino MSM. However, harnessing these resources for HIV prevention will require a better understanding of how social support relationships and processes shape HIV risks and protective actions by these vulnerable MSM.
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Affiliation(s)
- Thomas M Painter
- Prevention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS E-37, Atlanta, GA, 30329, USA.
| | - Eunyoung Y Song
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mary M Mullins
- Prevention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS E-37, Atlanta, GA, 30329, USA
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jorge Alonzo
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Scott D Rhodes
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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17
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Sun CJ, Tobin K, Spikes P, Latkin C. Correlates of same-sex behavior disclosure to health care providers among Black MSM in the United States: implications for HIV prevention. AIDS Care 2019; 31:1011-1018. [PMID: 30449137 PMCID: PMC6525658 DOI: 10.1080/09540121.2018.1548753] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 10/15/2018] [Indexed: 10/27/2022]
Abstract
Disclosure of same-sex behavior to health care providers (HCPs) by men who have sex with men (MSM) has been argued to be an important aspect of HIV prevention. However, Black MSM are less likely to disclose compared to white MSM. This analysis of data collected in the United States from 2006-2009 identified individual and social network characteristics of Black MSM (n = 226) that are associated with disclosure that may be leveraged to increase disclosure. Over two-thirds (68.1%) of the sample had ever disclosed to HCPs. Part-time employment (AOR = 0.32, 95% CI = 0.11-0.95), bisexual identity (AOR = 0.29, 95% CI = 0.12-0.70), and meeting criteria for alcohol use disorders (AOR = 0.32, 95% CI = 0.14-0.75) were negatively associated with disclosure. Disclosers were more likely to self-report being HIV-positive (AOR = 4.47, 95% CI = 1.54-12.98), having more frequent network socialization (AOR = 2.15, 95% CI = 1.24-3.73), and having a social network where all members knew the participant had sex with men (AOR = 4.94, 95% CI = 2.06-11.86). These associations were not moderated by self-reported HIV status. Future interventions to help MSM identify social network members to safely disclose their same-sex behavior may also help disclosure of same-sex behavior to HCPs among Black MSM.
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Affiliation(s)
- Christina J. Sun
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Karin Tobin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Pilgrim Spikes
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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18
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James AJ, Marable D, Cubbison CV, Tarbox AA, Mejia DL, Oo SA, Freedberg KA, Levison JH. HIV testing in a large community health center serving a multi-cultural patient population: A qualitative study of providers. AIDS Care 2019; 31:1585-1592. [PMID: 31131623 DOI: 10.1080/09540121.2019.1612016] [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: 10/26/2022]
Abstract
In the United States, 15% of HIV-positive individuals do not know their HIV serostatus. While CDC guidelines recommend HIV testing for individuals age 13-64 years, racial and ethnic minorities continue to experience delays in HIV diagnosis. We assessed providers' perspectives on HIV testing at an urban community health center serving racial/ethnic minority populations of low socioeconomic status. We conducted five focus groups from January 2017 to November 2017 with 74 health center staff: 20 adult medicine/primary care providers, 34 community health workers (CHWs) and community health administrators, six urgent care physicians, and fourteen behavioral health providers. Study staff analyzed transcripts using a grounded theory approach and used open coding to develop themes. We identified five themes affecting HIV testing: 1) provider perception of patients' preferences for HIV testing; 2) competing medical and social issues; 3) inter-professional communication; 4) knowledge of clinical indicators for HIV testing; and 5) knowledge of frequency of HIV testing. Primary care physicians desired mechanisms to easily identify patients for HIV testing and assistance with testing for non-English speakers. Training to improve comfort with HIV testing, integrating CHWs into routine practice, and focusing on patients' cultural beliefs may increase HIV testing in diverse community health centers..
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Affiliation(s)
- Anthony J James
- From the Divisions of General Internal Medicine, Massachusetts General Hospital , Boston , MA , USA
| | - Danelle Marable
- Center for Community Health Improvement, Massachusetts General Hospital , Boston , MA , USA
| | - Caroline V Cubbison
- From the Divisions of General Internal Medicine, Massachusetts General Hospital , Boston , MA , USA
| | - Andrew A Tarbox
- From the Divisions of General Internal Medicine, Massachusetts General Hospital , Boston , MA , USA
| | - Dianna L Mejia
- From the Divisions of General Internal Medicine, Massachusetts General Hospital , Boston , MA , USA
| | - Sarah A Oo
- Center for Community Health Improvement, Massachusetts General Hospital , Boston , MA , USA
| | - Kenneth A Freedberg
- From the Divisions of General Internal Medicine, Massachusetts General Hospital , Boston , MA , USA.,Infectious Diseases, Massachusetts General Hospital , Boston , MA , USA.,The Medical Practice Evaluation Center, Massachusetts General Hospital , Boston , MA , USA.,Harvard Medical School , Boston , MA , USA
| | - Julie H Levison
- From the Divisions of General Internal Medicine, Massachusetts General Hospital , Boston , MA , USA.,Harvard Medical School , Boston , MA , USA
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19
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Eklund AC, Dillon FR, Ebersole RC. Individual and structural factors predicting HIV testing among Latinx MSM: substance use as a moderator. AIDS Care 2019; 32:193-201. [PMID: 31104481 DOI: 10.1080/09540121.2019.1619664] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The rate of HIV infection for Latinx men who have sex with men (LMSM) increased by 20% from 2008 to 2014 even as rates stabilized among MSM of other racial and ethnic backgrounds. We hypothesize that this disparity is partially attributable to individual and structural factors associated with HIV testing, including substance use practices, among LMSM. In this retrospective study, we examined data from 502 LMSM to determine whether (a) hypothesized relationships exist between individual factors (perceived HIV susceptibility, experiences with HIV prevention, condom use, sex under the influence, sexual identity development status, heterosexual self-presentation, and traditional Latinx gender norms) and structural factors (access to healthcare resources and social support) and HIV testing for LMSM. We also tested whether (b) substance use practices moderate relations between individual and structural factors and HIV testing. Findings indicate that (a) relationships exist between several individual and structural factors and HIV testing and that (b) substance use moderated these relationships to HIV testing in a number of hypothesized ways. Practice and prevention implications are discussed.
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Affiliation(s)
- Austin C Eklund
- Department of Educational & Counseling Psychology, University at Albany, State University of New York, Albany, NY, USA
| | | | - Ryan C Ebersole
- Department of Educational & Counseling Psychology, University at Albany, State University of New York, Albany, NY, USA
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20
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Dillon FR, Eklund A, Ebersole R, Ertl MM, Martin JL, Verile MG, Gonzalez SR, Johnson S, Florentin D, Wilson L, Roberts S, Fisher N. Heterosexual Self-Presentation and Other Individual- and Community-Based Correlates of HIV testing among Latino Men Who Have Sex With Men. PSYCHOLOGY OF MEN & MASCULINITY 2019; 20:238-251. [PMID: 31592191 PMCID: PMC6779342 DOI: 10.1037/men0000166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
From 2010 to 2014, HIV diagnoses among Latino men who have sex with other men (LMSM) have increased by 14%, while diagnoses declined by 11% among white, non-Latino MSM. This health disparity is in part due to exposure to other LMSM with undiagnosed HIV infections. To effectively engage LMSM who are unaware of their serostatus, profiles of men differing in theorized determinants of HIV testing must be considered. In this retrospective study, we examined data from 546 LMSM to investigate whether hypothesized individual- (traditional masculine gender role conformity; sexual identity development status; alcohol and illicit drug use; sexual risk behaviors; perceived HIV susceptibility; and HIV stigma) and community-based (HIV prevention programming, access to health care, social support, neighborhood collective efficacy) factors were associated with differences in HIV testing. Latent profile analysis was used to identify profiles of men, and subsequent analyses examined whether profiles exhibited differential proportions of HIV testing. Four latent profiles were observed. One profile (50.3% tested) differed markedly from all other profiles (5.1 to 11% tested) in HIV testing. Characteristics of participants in this unique profile included reporting lower levels of heterosexual self-presentation, sexual identity uncertainty (and high levels of sexual identity commitment), condom use, HIV stigma, education, and perceived HIV susceptibility than all other profiles. Findings could improve HIV testing rates among LMSM by specifying ways in which public health advertisements/campaigns and community-based testing outreach efforts could be tailored to men most at-risk for transmitting HIV due to unknown serostatus.
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21
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Pérez A, Santamaria EK, Operario D. A Systematic Review of Behavioral Interventions to Reduce Condomless Sex and Increase HIV Testing for Latino MSM. J Immigr Minor Health 2019; 20:1261-1276. [PMID: 29247266 DOI: 10.1007/s10903-017-0682-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Latino men who have sex with men (MSM) in the United States are disproportionately affected by HIV, and there have been calls to improve availability of culturally sensitive HIV prevention programs for this population. This article provides a systematic review of intervention programs to reduce condomless sex and/or increase HIV testing among Latino MSM. We searched four electronic databases using a systematic review protocol, screened 1777 unique records, and identified ten interventions analyzing data from 2871 Latino MSM. Four studies reported reductions in condomless anal intercourse, and one reported reductions in number of sexual partners. All studies incorporated surface structure cultural features such as bilingual study recruitment, but the incorporation of deep structure cultural features, such as machismo and sexual silence, was lacking. There is a need for rigorously designed interventions that incorporate deep structure cultural features in order to reduce HIV among Latino MSM.
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Affiliation(s)
- Ashley Pérez
- Department of Social and Behavioral Sciences, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, 02912, USA.
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA.
| | - E Karina Santamaria
- Department of Social and Behavioral Sciences, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, 02912, USA
| | - Don Operario
- Department of Social and Behavioral Sciences, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, 02912, USA
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
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22
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Levison JH, Levinson JK, Alegría M. A Critical Review and Commentary on the Challenges in Engaging HIV-Infected Latinos in the Continuum of HIV Care. AIDS Behav 2018; 22:2500-2512. [PMID: 29948334 DOI: 10.1007/s10461-018-2187-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Antiretroviral therapy for treatment of HIV infection has become increasingly effective. Persistent poor HIV outcomes in racial and ethnic minority populations in the US call for a closer examination into why Latinos are at significant risk for acquiring and dying from HIV. To improve clinical outcomes and achieve an AIDS-free generation, HIV research must address disparities in HIV outcomes in Latinos, the largest ethnic/racial minority population in the US. Immigrant status as well as cultural factors influence HIV care utilization and are essential to highlight for effective intervention development in Latinos. A better understanding of these individual and contextual factors is critical to developing tailored approaches to engaging Latinos in HIV care. Based on a comprehensive literature review, we offer a framework for understanding what is needed from clinical practice and research to improve engagement in HIV care for US-based Latinos. These findings may have implications for other minority populations.
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23
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Qiao S, Zhou G, Li X. Disclosure of Same-Sex Behaviors to Health-care Providers and Uptake of HIV Testing for Men Who Have Sex With Men: A Systematic Review. Am J Mens Health 2018; 12:1197-1214. [PMID: 29947563 PMCID: PMC6142161 DOI: 10.1177/1557988318784149] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To promote HIV-testing and offer optimal care for men who have sex with men (MSM), health-care providers (HCPs) must first be aware of their patients’ sexual behaviors. Otherwise, HCPs may overlook MSM’s risks for HIV infection and their special health-care needs. For MSM, reporting their same-sex behaviors to HCPs (disclosure to HCPs) may promote their linkage to HIV prevention and treatment cascade and improve their health outcomes. No literature review has been conducted to examine the relationship between disclosure to HCPs and uptake of HIV-testing among MSM. The current study reviewed and synthesized findings from 29 empirical studies published in English by 2016. We summarized the rates of MSM’s disclosure to HCPs, investigated the association between disclosure and HIV-testing among MSM, identified potential facilitators and barriers for disclosure, and discussed the implications of our findings in research and clinical practices. The disclosure rates varied across subgroups and study settings, ranging from 16% to 90% with a median of 61%. Disclosure to HCPs was positively associated with uptake of HIV-testing. African American MSM were less likely to disclose to HCPs. MSM who lived in urban settings with higher education attainment and higher income were more likely to disclose. MSM tended to perceive younger or gay-friendly doctors as safer targets of disclosure. Clinics with LGBT-friendly signs were viewed as safer contexts for disclosure. Having previous communications about substance use, sex, and HIV with HCPs could also facilitate disclosure. The main reasons for nondisclosure included lack of probing from HCPs, concerns on confidentiality breach and stigma, and perceived irrelevance with services. Providing appropriate trainings for HCPs and creating gay-friendly clinical settings can be effective strategies to facilitate disclosures of same-sex behaviors among MSM and meet their specific medical needs. Interventions to promote disclosure should give priorities to MSM from the most marginalized subgroups (e.g., MSM in rural areas, MSM of ethnic minorities).
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Affiliation(s)
- Shan Qiao
- 1 Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Guangyu Zhou
- 1 Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Columbia, SC, USA.,2 School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Xiaoming Li
- 1 Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Columbia, SC, USA
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24
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Mitchell J, Torres MB, Asmar L, Danh T, Horvath KJ. Developing Sustainable and Impactful Mobile Phone HIV Testing Interventions for Spanish-Speaking Men Who Have Sex With Men in the United States: Lessons Learned From Informative Interviews. JMIR Public Health Surveill 2018; 4:e45. [PMID: 29691205 PMCID: PMC5957266 DOI: 10.2196/publichealth.8992] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/11/2018] [Accepted: 02/18/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although many men who have sex with men (MSM) test for HIV at least once in their lifetime, opportunities to improve regular HIV testing, particularly among Hispanic or Latino MSM, is needed. Many mHealth interventions in development, including the ones on HIV testing, have primarily focused on English-speaking white, black, and MSM of other races. To date, no studies have assessed app use, attitudes, and motivations for downloading and sustaining use of mobile apps and preferences with respect to HIV prevention among Spanish-speaking, Hispanic MSM in the United States. OBJECTIVE The primary aims of this study were to determine what features and functions of smartphone apps do Hispanic, Spanish-speaking MSM believe are associated with downloading apps to their smartphones, (2) what features and functions of smartphone apps are most likely to influence men's sustained use of apps over time, and (3) what features and functions do men prefer in a smartphone app aimed to promote regular testing for HIV. METHODS Interviews (N=15) were conducted with a racially diverse group of sexually active, HIV-negative, Spanish-speaking, Hispanic MSM in Miami, Florida. Interviews were digitally recorded, transcribed verbatim, translated back to English, and de-identified for analysis. A constant-comparison method (ie, grounded theory coding) was employed to examine themes that emerged from the interviews. RESULTS Personal interest was the primary reason associated with whether men downloaded an app. Keeping personal information secure, cost, influence by peers and posted reviews, ease of use, and functionality affected whether they downloaded and used the app over time. Men also reported that entertainment value and frequency of updates influenced whether they kept and continued to use an app over time. There were 4 reasons why participants chose to delete an app-dislike, lack of use, cost, and lack of memory or space. Participants also shared their preferences for an app to encourage regular HIV testing by providing feedback on test reminders, tailored testing interval recommendations, HIV test locator, and monitoring of personal sexual behaviors. CONCLUSIONS The features and functions of mobile apps that Spanish-speaking MSM in this study believed were associated with downloading and/or sustained engagement of an app generally reflected the priorities mentioned in an earlier study with English-speaking MSM. Unlike the earlier study, Spanish-speaking MSM prioritized personal interest in a mobile app and de-emphasized the efficiency of an app to make their lives easier in their decision to download an app to their mobile device. Tailoring mobile apps to the language and needs of Spanish-speaking MSM is critical to help increase their willingness to download a mobile app. Despite the growing number of HIV-prevention apps in development, few are tailored to Spanish-speaking MSM, representing an important gap that should be addressed in future research.
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Affiliation(s)
- Jason Mitchell
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI, United States
| | - Maria Beatriz Torres
- Department of Communication Studies, Gustavus Adolphus College, St Peter, MN, United States
| | - Lucy Asmar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Thu Danh
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Keith J Horvath
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
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25
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Tu Amigo Pepe: Evaluation of a Multi-media Marketing Campaign that Targets Young Latino Immigrant MSM with HIV Testing Messages. AIDS Behav 2016; 20:1973-88. [PMID: 26850101 DOI: 10.1007/s10461-015-1277-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Latino immigrant men who have sex with men (MSM) are at risk for HIV and delayed diagnosis in the United States. This paper describes the evaluation of a pilot of the Tu Amigo Pepe, a multimedia HIV testing campaign aimed at Latino MSM in Seattle, WA particularly targeting immigrants who may not identify as gay, ages 18-30 years old. The 16-week campaign included Spanish-language radio public service announcements (PSAs), a Web site, social media outreach, a reminder system using mobile technology, print materials and a toll-free hotline. In developing the PSAs, the Integrated Behavioral Model was used as a framework to reframe negative attitudes, beliefs and norms towards HIV testing with positive ones as well as to promote self-efficacy towards HIV testing. The campaign had a significant and immediate impact on attitudes, beliefs, norms and self-efficacy towards HIV testing as well as on actual behavior, with HIV testing rates increasing over time.
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26
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Persson KI, Berglund T, Bergström J, Eriksson LE, Tikkanen R, Thorson A, Forsberg BC. Motivators and barriers for HIV testing among men who have sex with men in Sweden. J Clin Nurs 2016; 25:3605-3618. [PMID: 27135281 DOI: 10.1111/jocn.13293] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2016] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To explore motivators and barriers to HIV testing and to assess the factors associated with testing among men who have sex with men. BACKGROUND Previous research has considered fear, worries and structural barriers as hindrances to HIV testing among men who have sex with men. However, few studies have included assessments of actual HIV testing when exploring barriers or motivators for such testing. DESIGN The design of the study was a stratified cross-sectional online survey (n = 2373). METHOD Factor analysis was conducted to analyse the barriers and motivators for HIV testing. Logistic regression analysis was conducted to assess predictors for HIV testing. RESULTS Many men who have sex with men test for HIV regularly, and specific reasons for testing were having unprotected sex or starting/ending a relationship. A lack of awareness and a perception of being at low risk for exposure were common reasons for never being tested. Fear and anxiety as well as barriers related to the use of test services remain important hindrances for testing. Predictors associated with having been tested within the past 12 months were: younger age (15-25 years old compared with 47+); knowledge on where to take an HIV test on short notice as well as having talked with a counsellor, having received condoms for free, or having had unprotected anal intercourse with casual partners within the last 12 months. CONCLUSION Easily accessible test services offering testing and counselling on short notice should be available for all men who have sex with men. Outreach activities, distribution of free condoms and testing at venues where men who have sex with men meet are important prevention add-ons that can contribute to increased awareness about HIV and testing. RELEVANCE TO CLINICAL PRACTICE Test services must ensure confidentiality and health care professionals who meet men who have sex with men for testing need competency with regards to men who have sex with men sexual health needs.
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Affiliation(s)
- Kristina Ingemarsdotter Persson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Department of Knowledge Development, Unit for Health and Sexuality, Public Health Agency of Sweden, Solna, Sweden
| | - Torsten Berglund
- Department of Monitoring and Evaluation, Unit for Epidemiology and Health Economics, Public Health Agency of Sweden, Solna, Sweden
| | - Jakob Bergström
- Department of Monitoring and Evaluation, Unit for Statistics and Surveillance, Public Health Agency of Sweden, Solna, Sweden
| | - Lars E Eriksson
- Department of Learning, Informatics, Management and Ethics, Unit for Medical Management Centre/Innovative Care, Karolinska Institutet, Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Nursing Division, School of Health Sciences, City University London, London, UK
| | - Ronny Tikkanen
- Department Social Work, University of Gothenburg, Göteborg, Sweden
| | - Anna Thorson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Birger C Forsberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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27
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Spadafino JT, Martinez O, Levine EC, Dodge B, Muñoz-Laboy M, Fernandez MI. Correlates of HIV and STI testing among Latino men who have sex with men in New York City. AIDS Care 2016; 28:695-8. [PMID: 26886172 DOI: 10.1080/09540121.2016.1147017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We assessed the extent to which sociodemographic, personal, and behavioral factors are associated with human immunodeficiency virus/sexually transmitted infection (HIV/STI) testing among a diverse group of Latino men who have sex with men (MSM) in New York City. The triangulation approach was used to synthesize data from 176 MSM who completed an in-person or phone questionnaire about substance use, alcohol consumption, sexual behaviors, and HIV/STI testing history and 40 participants who participated in focus groups. Correlates of testing significant in univariable analyses (p < .05) were entered into multivariable logistic regression models. Over half (57.9%) of study subjects tested for HIV in the previous 12 months and 60.2% tested for STIs in the previous 12 months. Age and education were positively correlated with HIV testing in multivariable analysis. No significant correlates of STI testing were identified. Spanish-speaking only subjects were less likely to get tested for HIV and STI; however, this association was not significant. Our study demonstrates the need for further study of predictors of STI testing as well as the potential role of language barriers and education in routine testing for HIV. Social and behavioral factors may intensify these obstacles. Future research and interventions should address the role of language barriers and perceived issues of immigration status in the decision to get tested.
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Affiliation(s)
| | - Omar Martinez
- b College of Public Health, Temple University , Philadelphia , PA , USA
| | - Ethan C Levine
- c College of Liberal Arts, Temple University , Philadelphia , PA , USA
| | - Brian Dodge
- d School of Public Health, Indiana University-Bloomington , Bloomington , IN , USA
| | | | - M Isabel Fernandez
- e Department of Public Health , Nova Southeastern University , Fort Lauderdale , FL , USA
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28
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Neme S, Goldenberg T, Stekler JD, Sullivan PS, Stephenson R. Attitudes towards couples HIV testing and counseling among Latino men who have sex with men in the Seattle area. AIDS Care 2015; 27:1354-9. [PMID: 26272715 DOI: 10.1080/09540121.2015.1058894] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Men who have sex with men (MSM) remain the most severely affected risk group in the US HIV/AIDS epidemic. One-third to two-thirds of HIV transmissions among MSM are estimated to come from primary sex partners. Couples HIV testing and counseling (CHTC), in which two individuals receive pre-test counseling, HIV testing and post-test prevention planning together, has been adapted for male couples in the USA, and is now available in more than 30 cities. Previous studies have demonstrated high levels of willingness to use CHTC among MSM, but to date no studies have explored this among Latino MSM (LMSM). To examine the willingness to use CHTC among and further cultural adaptation needed for LMSM, focus group discussions were held with men who self-identified as Latino, were in a relationship with another man, and resided in Seattle. Willingness to use CHTC was high. Participants reported that CHTC could strengthen and validate their relationships, help mitigate stigma, and provide a forum for support, protection, and information sharing. Barriers to CHTC use included fears of rejection, loneliness, and relationship dissolution, and concerns around deportation and financial burden. The high levels of reported willingness to use CHTC among this sample of LMSM point to the potential for CHTC to be further adapted to provide dyadic HIV testing services for LMSM.
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Affiliation(s)
- Santiago Neme
- a Division of Allergy and Infectious Diseases, Department of Medicine , University of Washington , Seattle , WA , USA
| | - Tamar Goldenberg
- b Department of Epidemiology , Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Joanne D Stekler
- a Division of Allergy and Infectious Diseases, Department of Medicine , University of Washington , Seattle , WA , USA
| | - Patrick S Sullivan
- b Department of Epidemiology , Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Rob Stephenson
- c Hubert Department of Global Health , Rollins School of Public Health, Emory University , Atlanta , GA , USA
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