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Mwaniki SW, Kaberia PM, Mugo PM, Palanee-Phillips T. "What if I get sick, where shall I go?": a qualitative investigation of healthcare engagement among young gay and bisexual men in Nairobi, Kenya. BMC Public Health 2024; 24:52. [PMID: 38166989 PMCID: PMC10763282 DOI: 10.1186/s12889-023-17555-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Globally, young gay, bisexual and other men who have sex with men (YMSM) experience a disproportionate burden of disease compared to young heterosexual men and older MSM. However, YMSM experience major inequities in access and use of health services. We sought to gain a detailed understanding of YMSM's healthcare engagement experiences across public, private, tertiary institution-based and MSM-friendly health facilities in Nairobi, Kenya, to inform development of interventions to improve access and use of health services by YMSM. METHODS In September 2021, in-person qualitative in-depths interviews were conducted among 22 YMSM purposively sampled from 248 YMSM who had previously participated in a respondent-driven sampling integrated bio-behavioral survey. Interviews were done in English, transcribed verbatim and analyzed descriptively using NVivo version 12. RESULTS Participants were 18-24 years old, all identified as cisgender male, three-quarters as gay and a quarter as bisexual. Themes that were defined from the analysis included: YMSM's experiences during healthcare seeking in various clinical settings, priority health needs, desired healthcare provider (HCP) characteristics, and the potential role of digital health interventions in improving access and use of health services. Participants relayed experiences of prejudice, stigma and discrimination when seeking services in public and institution-based health facilities, unlike in community pharmacies, private and MSM-friendly health facilities where they felt they were handled with dignity. Health needs prioritized by YMSM centered on prevention and control of HIV, sexually transmitted infections (STIs), depression and substance abuse. Participants desired HCPs who were empathetic, non-judgmental and knowledgeable about their unique health needs such as management of anorectal STIs. Participants highlighted the usefulness of digital media in offering telehealth consultations and health education on subjects such as HIV/STIs prevention. CONCLUSION During engagement with healthcare, YMSM experience various barriers that may cause them to postpone or avoid seeking care hence resulting in poor health outcomes. There is need to equip HCPs with knowledge, skills and cultural competencies to enable them offer equitable services to YMSM. Considerations should also be made for use of digital health interventions that may help YMSM circumvent some of the aforementioned barriers to service access and use.
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Affiliation(s)
- Samuel Waweru Mwaniki
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Department of Health Services, Administration and Campus Support Services, University of Nairobi, Nairobi, Kenya.
| | - Peter Mwenda Kaberia
- Department of Mathematics, Faculty of Science and Technology, University of Nairobi, Nairobi, Kenya
| | - Peter Mwangi Mugo
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Nairobi, Kenya
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
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2
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Spensley CB, Plegue M, Seda R, Harper DM. Annual HIV screening rates for HIV-negative men who have sex with men in primary care. PLoS One 2022; 17:e0266747. [PMID: 35834582 PMCID: PMC9282649 DOI: 10.1371/journal.pone.0266747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 03/27/2022] [Indexed: 11/27/2022] Open
Abstract
Background Men who have sex with men (MSM) account for most new HIV diagnoses in the US. Annual HIV testing is recommended for sexually active MSM if HIV status is negative or unknown. Our primary study aim was to determine annual HIV screening rates in primary care across multiple years for HIV-negative MSM to estimate compliance with guidelines. A secondary exploratory endpoint was to document rates for non-MSM in primary care. Methods We conducted a three-year retrospective cohort study, analyzing data from electronic medical records of HIV-negative men aged 18 to 45 years in primary care at a large academic health system using inferential and logistic regression modeling. Results Of 17,841 men, 730 (4.1%) indicated that they had a male partner during the study period. MSM were screened at higher rates annually than non-MSM (about 38% vs. 9%, p<0.001). Younger patients (p-value<0.001) and patients with an internal medicine primary care provider (p-value<0.001) were more likely to have an HIV test ordered in both groups. For all categories of race and self-reported illegal drug use, MSM patients had higher odds of HIV test orders than non-MSM patients. Race and drug use did not have a significant effect on HIV orders in the MSM group. Among non-MSM, Black patients had higher odds of being tested than both White and Asian patients regardless of drug use. Conclusions While MSM are screened for HIV at higher rates than non-MSM, overall screening rates remain lower than desired, particularly for older patients and patients with a family medicine or pediatric PCP. Targeted interventions to improve HIV screening rates for MSM in primary care are discussed.
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Affiliation(s)
- Courtney B. Spensley
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Melissa Plegue
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States of America
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Robinson Seda
- Michigan Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Diane M. Harper
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States of America
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America
- Department of Women’s and Gender Studies, University of Michigan, Ann Arbor, MI, United States of America
- * E-mail:
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Xavier Hall CD, Feinstein BA, Rusie L, Phillips Ii G, Beach LB. Race and Sexual Identity Differences in PrEP Continuum Outcomes Among Latino Men in a Large Chicago Area Healthcare Network. AIDS Behav 2022; 26:1943-1955. [PMID: 34993667 PMCID: PMC8736294 DOI: 10.1007/s10461-021-03544-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 01/08/2023]
Abstract
U.S. HIV incidence is threefold higher among Latino individuals than non-Latino Whites. Pre-exposure prophylaxis (PrEP) uptake remains low among Latino men. Most HIV studies view Latino communities as a monolithic group, ignoring racial and sexual diversity. This analysis examines PrEP-related outcomes including eligibility, first prescription, and second prescription across race and sexual identity in a sample of Latino cisgender men (n = 8271) who sought services from a healthcare network in Chicago in 2012-2019. Logistic regression was used to calculate adjusted odds ratios. Latino-only participants had lower odds of PrEP eligibility and first prescription compared to White-Latino participants. No other significant differences by race were detected. While bisexual participants had equivalent odds of PrEP eligibility, they had lower odds of first PrEP prescription compared to gay participants. Heterosexual participants also had lower odds of PrEP eligibility and initiation. Future research should address unique factors shaping PrEP-related outcomes among diverse Latino populations.
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Affiliation(s)
- Casey D Xavier Hall
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Suite 1400, Chicago, IL, 60611, USA.
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL, USA.
| | - Brian A Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | | | - Gregory Phillips Ii
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Suite 1400, Chicago, IL, 60611, USA
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL, USA
| | - Lauren B Beach
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Suite 1400, Chicago, IL, 60611, USA
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL, USA
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Trauma-informed Human Immunodeficiency Virus Prevention for Black Men Who Have Sex With Men: A Critical Need. Sex Transm Dis 2021; 47:447-449. [PMID: 32541303 DOI: 10.1097/olq.0000000000001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Handlovsky I, Bungay V, Johnson J, Oliffe J. Overcoming adversity: a grounded theory of health management among middle-aged and older gay men. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:1566-1580. [PMID: 32579289 DOI: 10.1111/1467-9566.13145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This article presents findings from a grounded theory study in which we explored how self-identifying gay men between 40 and 76 years of age manage their health in the context of homophobia, heteronormativity and discrimination. Data were collected with 25 men over a 6-month period in a large urban setting in Western Canada. A preliminary theory of health management is discussed, consisting of the central phenomenon of overcoming adversity. Three thematic processes are considered that illustrate how adversity and health management are situated within the interrelationships of historical and ongoing discrimination inclusive of and external to the healthcare encounter, the complexity of men's illnesses, and the temporal aspects of HIV epidemics and treatments that occurred throughout their lives. These themes include: advocating for health needs, knowing about health issues and treatments, and engaging in health promoting practices. These findings help to address a gap in knowledge concerning health management among older gay men and support that initiatives aimed at health care with gay men must appreciate the systemic role of discrimination, while supporting men's individual efforts in actively managing their health.
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Affiliation(s)
| | | | - Joy Johnson
- Simon Fraser Faculty of Health Sciences, Burnaby, BC, Canada
| | - John Oliffe
- UBC School of Nursing, Vancouver, BC, Canada
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Kutner BA, Wu Y, Balán IC, Meyers K. "Talking About it Publicly Made Me Feel Both Curious and Embarrassed": Acceptability, Feasibility, and Appropriateness of a Stigma-Mitigation Training to Increase Health Worker Comfort Discussing Anal Sexuality in HIV Services. AIDS Behav 2020; 24:1951-1965. [PMID: 31858301 DOI: 10.1007/s10461-019-02758-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Health workers report challenges to broaching sexual behavior with gay and bisexual men (MSM). We conducted a stigma-mitigation training to increase provider-initiated conversation about anal sexuality among Chinese health workers. The two-day workshop, titled Smarter Sex is the New Safer Sex: Anal Pleasure and Health, coupled information about anal physiology and sexual response with gradual exposure to trainees' emotional and cognitive responses. We analyzed surveys and one-time interviews. Acceptability (satisfaction with training activities and recommended practices), feasibility (compatibility with participants' current practices), and appropriateness (perceived fit with participants' work mission and goals) were high, reaching 84-95% of the scale range, though with variable ratings for trainee comfort during participation. Qualitative data confirm health workers' motivation to discuss anal sexuality and the value of learning about anal physiology and sexual response, but revealed continued uncertainty about how to broach and navigate discussion with clients. Refinement of the training to align with health worker recommendations and to augment communication options and skills is warranted, as is involvement of MSM clientele themselves.
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Affiliation(s)
- Bryan A Kutner
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, USA
| | - Yumeng Wu
- Aaron Diamond AIDS Research Center, The Rockefeller University, New York, USA
| | - Ivan C Balán
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, USA
| | - Kathrine Meyers
- Aaron Diamond AIDS Research Center, The Rockefeller University, New York, USA.
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Bjørnshagen V, Moseng BU, Ugreninov E. Who Do You Reach? A Norwegian Pilot Project on HIV Self-Testing that Targeted Men Who Have Sex with Men. AIDS Behav 2020; 24:568-579. [PMID: 30929148 DOI: 10.1007/s10461-019-02484-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
HIV self-testing reduces barriers associated with other HIV testing services, such as concerns about confidentiality and inconvenience. This article demonstrates who might benefit from this approach to HIV testing by describing the characteristics of men who have sex with men (MSM) who took interest in a Norwegian pilot project on HIV self-testing. Of the MSM users, 27% reported that they had never been tested for HIV. Not disclosing one's same-sex sexuality, particularly among non-gay-identified MSM, was associated with a higher probability of never having been tested for HIV and choosing to test with an HIV self-test because of its anonymity. Never having been tested for HIV was also associated with a higher probability of choosing to test with an HIV self-test due to anonymity. The results suggest that the HIV self-tests' ability to reach MSM who otherwise would not be tested is partly because it is an anonymous HIV testing alternative.
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8
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Newcomb ME, Moran K, Li DH, Mustanski B. Demographic, Regional, and Political Influences on the Sexual Health Care Experiences of Adolescent Sexual Minority Men. LGBT Health 2019; 7:28-36. [PMID: 31750760 DOI: 10.1089/lgbt.2019.0122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Adolescent sexual minority men (ASMM) are affected disproportionately by HIV, and little is known about their utilization of sexual health care services. We aimed to examine demographic, regional, and political influences on the sexual health care experiences of a unique sample of racially diverse ASMM from across the United States. Methods: Data were collected between April 2018 and February 2019 as part of the baseline survey of an ongoing pragmatic trial of a suite of HIV prevention interventions for ASMM. At the time of analysis, 699 participants had completed baseline and were included in multivariable analyses examining demographic, regional, and political differences in perceived access to and experiences of sexual health care. Results: The majority of ASMM reported not having had various sexual health care experiences in the past 12 months (70.8%-85.7%, respectively), and a large proportion reported low-to-moderate perceived access to such services where they live (37.8%-64.1%, respectively). Some groups were significantly less likely to report perceived access to, or having had, certain sexual health care experiences, including ASMM in their early- to mid-teens and those who lived in rural areas, the South, and Republican state-level political climates. Conclusion: These analyses indicate that ASMM underutilize sexual health care and point to specific groups with the lowest rates of engagement. To address the sexual health needs of ASMM, structural changes need to be made in the sociopolitical arena (e.g., federal nondiscrimination legislation) and medical system (e.g., mandated training in LGBTQ care) that will reduce LGBTQ-related stigma and increase access to needed care.
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Affiliation(s)
- Michael E Newcomb
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kevin Moran
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dennis H Li
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Brian Mustanski
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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9
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Sex Education and HIV Testing Among Young Men Who Have Sex With Men: Findings From the 2006-2010 and 2011-2015 National Survey of Family Growth. J Acquir Immune Defic Syndr 2019; 79:179-185. [PMID: 29905592 DOI: 10.1097/qai.0000000000001773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Young men who have sex with men (YMSM) are disproportionally affected by HIV and exhibit low levels of HIV testing. The purpose of this study was to examine the relationship between sex education and subsequent HIV testing among YMSM. METHODS Data from sexually active men aged 15-24 years at interview in the 2006-2010 or 2011-2015 National Survey of Family Growth. Sex education included 3 contexts [formal institutions (eg, schools), parents, and health care providers] and specific topics. Outcome variables were ever- and recent-HIV testing. Multivariate models were adjusted for sociodemographics, and data were weighted to account for the complex survey sampling design. RESULTS A total of 323 sexually active YMSM met inclusion criteria. Overall, 42.4% had ever-tested for HIV and 16.9% tested in the previous 12 months. YMSM were more likely to have ever-tested for HIV if they talked with a parent/guardian about how to prevent HIV/AIDS [adjusted prevalence ratio (aPR) = 1.48; 95% confidence interval (CI): 1.07 to 2.06], talked with a health care provider about how HIV/AIDs is transmitted (aPR = 1.64; 95% CI: 1.13 to 2.38), sexually transmitted diseases (aPR = 1.49; 95% CI: 1.02 to 2.19), condom use (aPR = 1.61; 95% CI: 1.13 to 2.30), and the importance of HIV testing (aPR = 1.83; 95% CI: 1.22 to 2.73). CONCLUSIONS Tailored sex education by parent(s) and health care providers related to HIV/AIDS seems to significantly increase the likelihood of HIV testing among YMSM.
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10
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Rojas Castro D, Delabre RM, Molina J. Give PrEP a chance: moving on from the "risk compensation" concept. J Int AIDS Soc 2019; 22 Suppl 6:e25351. [PMID: 31468693 PMCID: PMC6715948 DOI: 10.1002/jia2.25351] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/24/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION While bio-behavioural interventions (BIs) for sexually transmitted infections (STIs) and HIV prevention have shown their effectiveness (e.g. treatment for syphilis, HPV vaccination or pre-exposure prophylaxis [PrEP]), they have also aroused major concerns regarding behavioural changes that could counteract their benefit. Risk compensation (RC) fears concerning BIs in the HIV/STIs prevention field are intimately linked to representations, judgements and social control on sexual behaviour. With an increasing number of PrEP studies describing a rise in STIs due to RC, this paper argues for a shift away from the focus on RC and proposes a more constructive approach to respond to the needs of people living with HIV and populations most at risk. DISCUSSION The concept of RC, stemming from road safety and derived from economic theory, relies on rational theoretical models of human behaviour. Although widely applied in several contexts its use has been reasonably questioned. Major methodological issues regarding RC have been raised within HIV/AIDS literature. Although behavioural changes (e.g. condomless sex and number of sexual partners) are often erroneously assimilated with RC, there is no evidence that behavioural changes have undermined the effectiveness of previous and current BIs. Still, PrEP has not escaped RC concerns. Increases in condomless sex within the context of growing uptake of PrEP signals a continued need for integrated and innovative HIV and STI prevention strategies and a comprehensive sexual health approach. Routine HIV/STI testing, peer-led counselling, and identification of sexual health needs within the PrEP model of care could become a gold standard in the sexual health field for all populations. CONCLUSIONS RC remains a frequent argument against the availability and provision of prevention methods for vulnerable populations. Individuals should be able to benefit from the full panel of BIs options available, to find and adapt methods according to their needs. Current, past and future PrEP users, with other stakeholders, may provide valuable insight into innovative solutions and programmes to control HIV and other STIs.
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Affiliation(s)
- Daniela Rojas Castro
- Coalition PLUSCommunity‐based Research LaboratoryPantinFrance
- Aix Marseille UnivINSERM, IRD, SESSTIMSciences Economiques & Sociales de la Santé & Traitement de l'Information MédicaleMarseilleFrance
| | | | - Jean‐Michel Molina
- Department of Infectious DiseasesHôpital Saint‐LouisAssistance Publique Hôpitaux de ParisParisFrance
- INSERM, UMR 941Université de Paris Diderot Paris 7Sorbonne Paris CitéParisFrance
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11
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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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12
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Agénor M, Pérez AE, Koma JW, Abrams JA, McGregor AJ, Ojikutu BO. Sexual Orientation Identity, Race/Ethnicity, and Lifetime HIV Testing in a National Probability Sample of U.S. Women and Men: An Intersectional Approach. LGBT Health 2019; 6:306-318. [PMID: 31314667 PMCID: PMC6740155 DOI: 10.1089/lgbt.2019.0001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: We examined differences in lifetime human immunodeficiency virus (HIV) testing in relation to both sexual orientation identity and race/ethnicity among U.S. women and men. Methods: We used 2013-2017 National Health Interview Survey data and multivariable logistic regression to assess the distribution of lifetime HIV testing across and within sexual orientation identity and racial/ethnic groups of U.S. women (n = 60,867) and men (n = 52,201) aged 18-64 years. Results: Among women, Black lesbian (74.1%) and bisexual (74.0%) women had the highest prevalence whereas Asian lesbian women (32.5%) had the lowest prevalence of lifetime HIV testing. Among men, the prevalence of lifetime HIV testing was the highest among Latino gay men (92.6%) and the lowest among Asian heterosexual men (32.0%). In most cases, Black women and Black and Latino men had significantly higher adjusted odds whereas Asian women and men had lower adjusted odds of lifetime HIV testing compared with their White counterparts within sexual orientation identity groups. In many instances, bisexual women and gay men had significantly higher adjusted odds of lifetime HIV testing relative to their heterosexual counterparts within racial/ethnic groups. Compared with White heterosexual individuals, most sexual orientation identity and racial/ethnic subgroups had significantly higher adjusted odds whereas Asian heterosexual, bisexual, and lesbian women and Asian heterosexual and bisexual men may have lower adjusted odds of lifetime HIV testing. Conclusion: Culturally relevant, linguistically appropriate, and structurally competent programs and practices are needed to facilitate lifetime HIV testing among diverse sexual orientation identity and racial/ethnic subgroups of women and men, including multiply marginalized subgroups that are undertested or disproportionately affected by HIV/AIDS.
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Affiliation(s)
- Madina Agénor
- Department of Community Health, Tufts University, Medford, Massachusetts
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
| | - Ashley E. Pérez
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California
| | - Jonathan Wyatt Koma
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jasmine A. Abrams
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland
| | - Alecia J. McGregor
- Department of Community Health, Tufts University, Medford, Massachusetts
| | - Bisola O. Ojikutu
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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13
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Yang C, Krishnan N, Painter JE, Latkin C. The Association Between Disclosure of Same Sex Behavior to Healthcare Providers and PrEP Awareness Among BMSM in Baltimore. AIDS Behav 2019; 23:1888-1892. [PMID: 30666521 DOI: 10.1007/s10461-019-02401-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The goal of this study was to explore the association between disclosure of same sex behavior to a healthcare provider and PrEP awareness in a sample of 192 Black MSM in Baltimore. After adjusting for age, education, sexual identity and employment status, we observed a trend of greater PrEP awareness among Black MSM who disclosed same sex behaviors to healthcare providers (adjusted odds ratio = 2.24, p = 0.08). This study provides new evidence of potential benefit of disclosure of same sex behavior to healthcare providers for awareness of new HIV biomedical interventions. Findings highlight the need to support patient-provider communication on sexual behaviors and PrEP with key populations at risk of HIV.
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Affiliation(s)
- Cui Yang
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St., 2nd FL, Baltimore, MD, 21205, USA.
| | - Nandita Krishnan
- Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, DC, USA
| | | | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St., 2nd FL, Baltimore, MD, 21205, USA
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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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Phillips G, Neray B, Janulis P, Felt D, Mustanski B, Birkett M. Utilization and avoidance of sexual health services and providers by YMSM and transgender youth assigned male at birth in Chicago. AIDS Care 2019; 31:1282-1289. [PMID: 30821480 DOI: 10.1080/09540121.2019.1587370] [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: 10/27/2022]
Abstract
Young men who have sex with men (YMSM) and transgender youth assigned male at birth (AMAB) bear a disproportionate burden of the HIV epidemic, yet are sub optimally engaged by sexual health service providers and HIV prevention services. To increase sexual health and HIV prevention behaviors and address disparities in HIV incidence and outcomes among YMSM and AMAB transgender youth, it is critical to understand patterns of service utilization and avoidance. This study examined how and why YMSM and AMAB transgender youth use or avoid sexual health services and service providers in a large Midwestern city within a survey administered to 890 participants from a longitudinal cohort study (RADAR). Results demonstrate low overall use of sexual health services and minimal interest in seeking pre-exposure prophylaxis (PrEP), consistent with prior research. Low awareness of available services was associated with how and where YMSM and trans youth AMAB seek care, with 76% of our sample reporting this as their primary reason for not seeking specific sexual health services. Additional associations are discussed, and recommendations are made for how to improve available services and access.
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Affiliation(s)
- Gregory Phillips
- a Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Balint Neray
- a Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Patrick Janulis
- a Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Dylan Felt
- a Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Brian Mustanski
- a Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Michelle Birkett
- a Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine , Chicago , IL , USA
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Fisher CB, Fried AL, Macapagal K, Mustanski B. Patient-Provider Communication Barriers and Facilitators to HIV and STI Preventive Services for Adolescent MSM. AIDS Behav 2018; 22:3417-3428. [PMID: 29546468 DOI: 10.1007/s10461-018-2081-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Adolescent males who have sex with males (AMSM) are at increased risk of contracting HIV/AIDS and other sexually transmitted infections (STIs). Healthcare providers are a critical source of HIV/STI prevention, yet little is known about AMSM patient-provider sexual health communications and services. To explore this issue, we surveyed a national sample of 198 AMSM 14-17 years. Four online psychometrically validated scales indicated over half the youth avoided communicating their sexual orientation and sexual health concerns to providers due to fear of heterosexist bias, concern their sexual health information would be disclosed to parents, and a general belief that sexual minority youth do not receive equitable treatment in health care settings. Youth who reported their physicians had initiated discussion about their sexual orientation were significantly more likely to have received HIV/STI preventive services and testing. Discussion includes the importance of medical training that meets the unique sexual health needs of AMSM.
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Affiliation(s)
- Celia B Fisher
- Center for Ethics Education and Department of Psychology, Fordham University, Bronx, NY, 10458, USA.
| | - Adam L Fried
- Clinical Psychology Program, Midwestern University, Glendale, AZ, USA
| | - Kathryn Macapagal
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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17
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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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18
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Chávez PRG, Wesolowski LG, Peters PJ, Johnson CH, Nasrullah M, Oraka E, August EM, DiNenno E. How well are U.S. primary care providers assessing whether their male patients have male sex partners? Prev Med 2018; 107:75-80. [PMID: 29126916 PMCID: PMC5807188 DOI: 10.1016/j.ypmed.2017.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 10/31/2017] [Accepted: 11/02/2017] [Indexed: 11/17/2022]
Abstract
Identifying patients at-risk for HIV infection, such as men who have sex with men (MSM), is an important step in providing HIV testing and prevention interventions. It is unknown how primary care providers (PCPs) assess MSM status and related HIV-risk factors. We analyzed data from a panel-derived web-based survey for healthcare providers conducted in 2014 to describe how PCPs in the U.S. determined their patients' MSM status. We calculated adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) to describe PCP characteristics associated with systematically determining MSM status (i.e., PCP used "a patient-completed questionnaire" or "routine verbal review of sex history"). Among the 1008 PCPs, 56% determined MSM status by routine verbal review of sexual history; 41% by patient disclosure; 39% by questions driven by symptoms/history; 23% by using a patient-completed questionnaire, and 9% didn't determine MSM status. PCPs who systematically determined MSM status (n=665; 66%) were more likely to be female (aPR=1.16, CI=1.06-1.26), to be affiliated with a teaching hospital (aPR=1.15, CI=1.06-1.25), to routinely screen all patients aged 13-64 for HIV (aPR=1.29, CI=1.18-1.41), and to estimate that 6% or more of their male patients are MSM (aPR=1.14, CI=1.01-1.30). The majority of PCPs assessed MSM status and HIV risk factors through routine verbal reviews of sexual history. Implementing a systematic approach to identify MSM status and assess risk may allow PCPs to identify more patients needing frequent HIV testing and other preventive services, while mitigating socio-cultural barriers to obtaining such information.
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Affiliation(s)
- Pollyanna R G Chávez
- Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
| | - Laura G Wesolowski
- Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
| | - Philip J Peters
- Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
| | - Christopher H Johnson
- Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
| | - Muazzam Nasrullah
- Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
| | - Emeka Oraka
- ICF International at Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
| | - Euna M August
- Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
| | - Elizabeth DiNenno
- Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
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Factors Associated With Recent Human Immunodeficiency Virus Testing Among Men Who Have Sex With Men in Puerto Rico, National Human Immunodeficiency Virus Behavioral Surveillance System, 2011. Sex Transm Dis 2017; 43:346-52. [PMID: 27200518 DOI: 10.1097/olq.0000000000000451] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Annual human immunodeficiency virus (HIV) testing is considered a key strategy for HIV prevention for men who have sex with men (MSM). In Puerto Rico, HIV research has primarily focused on injection drug use, yet male-to-male sexual transmission has been increasing in recent years. METHODS Cross-sectional data from the National HIV Behavioral Surveillance system collected in 2011 in San Juan, Puerto Rico, were analyzed to identify factors associated with HIV testing in the past 12 months (recent testing). RESULTS Overall, 50% of participants were tested recently. In the multivariate analysis, testing recently was associated with having multiple partners in the past 12 months (adjusted prevalence ratio [aPR] [≥4 vs 1 partner] = 1.5; 95% confidence interval [95% CI], 1.2-2.0), visiting a health care provider in the past 12 months (aPR, 1.4; 95% CI, 1.04-1.8), and disclosing male-male attraction/sex to a health care provider (aPR< 1.4; 95% CI, 1.1-1.7). CONCLUSIONS Human immunodeficiency virus testing was suboptimal among MSM in San Juan. Strategies to increase HIV testing among MSM may include promoting HIV testing for all sexually active MSM including those with fewer partners, increasing utilization of the healthcare system, and improving patient-provider communication.
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Stupiansky NW, Liau A, Rosenberger J, Rosenthal SL, Tu W, Xiao S, Fontenot H, Zimet GD. Young Men's Disclosure of Same Sex Behaviors to Healthcare Providers and the Impact on Health: Results from a US National Sample of Young Men Who Have Sex with Men. AIDS Patient Care STDS 2017; 31:342-347. [PMID: 28753396 DOI: 10.1089/apc.2017.0011] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Many men who have sex with men (MSM) do not disclose their same sex behaviors to healthcare providers (HCPs). We used a series of logistic regression models to explore a conceptual framework that first identified predictors of disclosure to HCPs among young MSM (YMSM), and subsequently examined young men's disclosure of male-male sexual behaviors to HCPs as a mediator between sociodemographic and behavioral factors and three distinct health outcomes [HIV testing, sexually transmitted infection (STI) testing, and human papillomavirus (HPV) vaccination]. We determined the predictors of disclosure to HCPs among YMSM and examined the relationship between disclosure and the receipt of appropriate healthcare services. Data were collected online through a US national sample of 1750 YMSM (ages 18-29 years) using a social and sexual networking website for MSM. Sexual history, STI/HIV screening history, sexual health, and patient-provider communication were analyzed in the logistic regression models. Participants were predominantly white (75.2%) and gay/homosexual (76.7%) with at least some college education (82.7%). Young men's disclosure of male-male sexual behaviors to HCPs was associated with the receipt of all healthcare outcomes in our model. Disclosure was a stronger mediator in HPV vaccination than in HIV and STI testing. Disclosure to non-HCP friends and family, HCP visit in the past year, and previous STI diagnosis were the strongest predictors of disclosure. Young men's disclosure of male-male sexual behaviors to HCPs is integral to the receipt of appropriate healthcare services among YMSM. HPV vaccination is more dependent on provider-level interaction with patients than HIV/STI testing.
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Affiliation(s)
- Nathan W. Stupiansky
- Department of Health Promotion Sciences, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona
| | - Adrian Liau
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Joshua Rosenberger
- Pennsylvania State University College of Health and Human Development, State College, Pennsylvania
| | | | - Wanzhu Tu
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Shan Xiao
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Holly Fontenot
- Boston College William F. Connell School of Nursing, Boston, Massachusetts
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Noble M, Jones AM, Bowles K, DiNenno EA, Tregear SJ. HIV Testing Among Internet-Using MSM in the United States: Systematic Review. AIDS Behav 2017; 21:561-575. [PMID: 27498198 DOI: 10.1007/s10461-016-1506-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Regular HIV testing enables early identification and treatment of HIV among at-risk men who have sex with men (MSM). Characterizing HIV testing needs for Internet-using MSM informs development of Internet-facilitated testing interventions. In this systematic review we analyze HIV testing patterns among Internet-using MSM in the United States who report, through participation in an online study or survey, their HIV status as negative or unknown and identify demographic or behavioral risk factors associated with testing. We systematically searched multiple electronic databases for relevant English-language articles published between January 1, 2005 and December 16, 2014. Using meta-analysis, we summarized the proportion of Internet-using MSM who had ever tested for HIV and the proportion who tested in the 12 months preceding participation in the online study or survey. We also identified factors predictive of these outcomes using meta-regression and narrative synthesis. Thirty-two studies that enrolled 83,186 MSM met our inclusion criteria. Among the studies reporting data for each outcome, 85 % (95 % CI 82-87 %) of participants had ever tested, and 58 % (95 % CI 53-63 %) had tested in the year preceding enrollment in the study, among those for whom those data were reported. Age over 30 years, at least a college education, use of drugs, and self-identification as being homosexual or gay were associated with ever having tested for HIV. A large majority of Internet-using MSM indicated they had been tested for HIV at some point in the past. A smaller proportion-but still a majority-reported they had been tested within the year preceding study or survey participation. MSM who self-identify as heterosexual or bisexual, are younger, or who use drugs (including non-injection drugs) may be less likely to have ever tested for HIV. The overall findings of our systematic review are encouraging; however, a subpopulation of MSM may benefit from targeted outreach. These findings indicate unmet needs for HIV testing among Internet-using MSM and identify subpopulations that might benefit from targeted outreach, such as provision of HIV self-testing kits.
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Affiliation(s)
- Meredith Noble
- Hayes, Inc., 157 S. Broad Street, Lansdale, PA, 19446, USA.
| | | | - Kristina Bowles
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth A DiNenno
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Kelley CF, Kahle E, Siegler A, Sanchez T, Del Rio C, Sullivan PS, Rosenberg ES. Applying a PrEP Continuum of Care for Men Who Have Sex With Men in Atlanta, Georgia. Clin Infect Dis 2015; 61:1590-7. [PMID: 26270691 DOI: 10.1093/cid/civ664] [Citation(s) in RCA: 227] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 06/25/2015] [Indexed: 01/03/2023] Open
Abstract
Reductions in human immunodeficiency virus (HIV) incidence with pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM) will require significant coverage of those at risk. We propose a simplified framework, similar to the HIV care continuum, to achieve protection with PrEP as follows: 1. At-risk MSM; 2. Awareness of and willingness to take PrEP; 3. Access to healthcare; 4. Receiving a prescription; and 5. Adhering to effective PrEP. We evaluated the PrEP care continuum on an Atlanta cohort of MSM and projected how many MSM might achieve protection from HIV. Even with optimistic estimates, few Atlanta MSM (15%) are projected to achieve protection from HIV with PrEP given the significant barriers described. Each continuum step represents an important point for intervention that could substantially increase the overall effectiveness of PrEP. In addition, novel strategies for PrEP delivery are needed to achieve the necessary effectiveness for Atlanta MSM at risk of HIV.
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Affiliation(s)
- Colleen F Kelley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine Department of Epidemiology
| | | | | | | | - Carlos Del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Hidden from health: structural stigma, sexual orientation concealment, and HIV across 38 countries in the European MSM Internet Survey. AIDS 2015; 29:1239-46. [PMID: 26035323 PMCID: PMC4820755 DOI: 10.1097/qad.0000000000000724] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective Substantial country-level variation exists in prejudiced attitudes towards male homosexuality and in the extent to which countries promote the unequal treatment of MSM through discriminatory laws. The impact and underlying mechanisms of country-level stigma on odds of diagnosed HIV, sexual opportunities, and experience of HIV-prevention services, needs and behaviours have rarely been examined, however. Design Data come from the European MSM Internet Survey (EMIS), which was administered between June and August 2010 across 38 European countries (N =174 209). Methods Country-level stigma was assessed using a combination of national laws and policies affecting sexual minorities and a measure of attitudes held by the citizens of each country. We also assessed concealment, HIV status, number of past 12-month male sex partners, and eight HIV-preventive services, knowledge, and behavioural outcomes. Results MSM living in countries with higher levels of stigma had reduced odds of diagnosed HIV and fewer partners but higher odds of sexual risk behaviour, unmet prevention needs, not using testing services, and not discussing their sexuality in testing services. Sexual orientation concealment mediated associations between country-level stigma and these outcomes. Conclusion Country-level stigma may have historically limited HIV transmission opportunities among MSM, but by restricting MSM’s public visibility, it also reduces MSM’s ability to access HIV-preventive services, knowledge and precautionary behaviours. These findings suggest that MSM in European countries with high levels of stigma are vulnerable to HIV infection. Although they have less opportunity to identify and contact other MSM, this might change with emerging technologies.
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Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1-137. [PMID: 26042815 PMCID: PMC5885289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 30-May 2, 2013. The information in this report updates the Sexually Transmitted Diseases Treatment Guidelines, 2010 (MMWR Recomm Rep 2010;59 [No. RR-12]). These updated guidelines discuss 1) alternative treatment regimens for Neisseria gonorrhoeae; 2) the use of nucleic acid amplification tests for the diagnosis of trichomoniasis; 3) alternative treatment options for genital warts; 4) the role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications; 5) updated HPV vaccine recommendations and counseling messages; 6) the management of persons who are transgender; 7) annual testing for hepatitis C in persons with HIV infection; 8) updated recommendations for diagnostic evaluation of urethritis; and 9) retesting to detect repeat infection. Physicians and other health-care providers can use these guidelines to assist in the prevention and treatment of STDs.
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Affiliation(s)
- Kimberly A. Workowski
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
- Emory University, Atlanta, Georgia
| | - Gail A. Bolan
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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25
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Mayer KH, Krakower DS. Editorial Commentary:Uncoupling Epidemiological Synergy: New Opportunities for HIV Prevention for Men Who Have Sex With Men. Clin Infect Dis 2015; 61:288-90. [DOI: 10.1093/cid/civ291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/01/2015] [Indexed: 01/30/2023] Open
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Meanley S, Gale A, Harmell C, Jadwin-Cakmak L, Pingel E, Bauermeister JA. The role of provider interactions on comprehensive sexual healthcare among young men who have sex with men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2015; 27:15-26. [PMID: 25646727 DOI: 10.1521/aeap.2015.27.1.15] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Testing for both HIV and STIs is an essential component of comprehensive sexual healthcare for young men who have sex with men (YMSM). Using data collected from YMSM living in the Detroit metropolitan area (N = 304, ages 18-29; 51% Black, 25% White, 14% Latino), we examined YMSM's access to a medical provider in the prior year and tested whether a provider's conversation regarding HIV/STI prevention was associated with their type of testing behavior: Non-Testers, HIV-Only Testing, and HIV and STI Testing. Over half (56.7%) reported a routine provider visit in the previous year. Visits were associated with having insurance, provider comfort, and prior HIV and/or STI testing. Among YMSM who visited a doctor, our multinomial regression exhibited that those whose provider discussed HIV/STI prevention were most likely to have tested for both HIV and STIs, as compared to the HIV Only and Never Tester categories. Patient-provider communication regarding HIV/STI prevention is critical to motivate comprehensive sexual healthcare access among YMSM. Strategies that enable providers to discuss HIV/STI prevention with YMSM in a sex-positive manner may help maximize comprehensive testing.
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27
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Joseph HA, Belcher L, O'Donnell L, Fernandez MI, Spikes PS, Flores SA. HIV testing among sexually active Hispanic/Latino MSM in Miami-Dade County and New York City: opportunities for increasing acceptance and frequency of testing. Health Promot Pract 2014; 15:867-80. [PMID: 24920606 DOI: 10.1177/1524839914537493] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
HIV testing behavior is important in understanding the high rates of undiagnosed infection among Hispanic/Latino men who have sex with men (MSM). Correlates of repeat/recent testing (within the past year and ≥5 tests during lifetime) and test avoidance (never or >5 years earlier) were examined among 608 sexually active Hispanic/Latino MSM (Miami-Dade County and New York City). Those who reported repeat/recent testing were more likely to have incomes over $30,000, speak English predominately, and have visited and disclosed same-sex behavior to a health care provider (HCP) in the past year. Those who were classified as test avoiders were less likely to have incomes over $10,000 and to have seen an HCP in the past year. The main reason for not testing (in both groups) was fear of HIV positivity; however, twice as many test avoiders considered this their main reason, and more test avoiders had confidentiality concerns. Results suggest that messages to encourage testing among Hispanic/Latino MSM may be most effective if past testing patterns and reasons for not testing are considered. HCPs can play an important role by consistently offering HIV tests to MSM and tailoring messages based on prior testing histories.
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Affiliation(s)
| | - Lisa Belcher
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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28
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Wilkerson JM, Fuchs EL, Brady SS, Jones-Webb R, Simon Rosser BR. Correlates of human immunodeficiency virus/sexually transmitted infection (HIV/STI) testing and disclosure among HIV-negative collegiate men who have sex with men. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2014; 62:450-60. [PMID: 24794417 PMCID: PMC4167191 DOI: 10.1080/07448481.2014.917654] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To determine the extent to which personal, behavioral, and environmental factors are associated with human immunodeficiency virus/sexually transmitted infection (HIV/STI) testing and disclosure. PARTICIPANTS Nine hundred thirty HIV-negative collegiate men who have sex with men (MSM) who completed an online survey about alcohol use and sexual behavior. METHODS Correlates of testing and disclosure significant in bivariate analyses (p < .05) were grouped into personal, behavioral, or environmental factors and entered into multivariable logistic regression models. RESULTS About half of participants tested for HIV (51.9%) and for STIs (45.8%) at least annually. Over half (57.8%) of participants always/almost always discussed HIV status with new sex partners; 61.1% with new unprotected sex partners. Personal and behavioral factors (age and outness) explained differences in testing, and the behavioral factor (routine testing) explained differences in disclosure. CONCLUSIONS Collegiate MSM should be supported in coming out, encouraged to engage in routine testing, and counseled on discussing HIV/STI status with potential sex partners.
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Affiliation(s)
- J. Michael Wilkerson
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston Texas
| | - Erika L. Fuchs
- University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Sonya S. Brady
- University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Rhonda Jones-Webb
- University of Minnesota School of Public Health, Minneapolis, Minnesota
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Gilbert M, Hottes TS, Kerr T, Taylor D, Fairley CK, Lester R, Wong T, Trussler T, Marchand R, Shoveller J, Ogilvie G. Factors associated with intention to use internet-based testing for sexually transmitted infections among men who have sex with men. J Med Internet Res 2013; 15:e254. [PMID: 24240644 PMCID: PMC3841365 DOI: 10.2196/jmir.2888] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 09/26/2013] [Accepted: 10/02/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Internet-based testing programs are being increasingly used to reduce testing barriers for individuals at higher risk of infection, yet the population impact and potential for exacerbation of existing health inequities of these programs are not well understood. OBJECTIVE We used a large online sample of men who have sex with men (MSM) in Canada to measure acceptability of Internet-based testing and perceived advantages and disadvantages of this testing approach. METHODS We asked participants of the 2011/2012 Sex Now Survey (a serial online survey of gay and bisexual men in Canada) whether they intended to use Internet-based testing and their perceived benefits and disadvantages of use. We examined whether intention to use was associated with explanatory variables spanning (A) sociodemographics, (B) Internet and technology usage, (C) sexually transmitted infections (STI)/ human immunodeficiency virus (HIV) and risk, and (D) health care access and testing, using multivariable logistic regression (variable selection using Bayesian information criterion). RESULTS Overall, intention to use was high (5678/7938, 71.53%) among participants with little variation by participant characteristics. In our final model, we retained the variables related to (B) Internet and technology usage: use of Internet to cruise for sex partners (adjusted odds ratio [AOR] 1.46, 95% CI 1.25-1.70), use of Internet to search for sexual health information (AOR 1.36, 95% CI 1.23-1.51), and mobile phone usage (AOR 1.19, 95% 1.13-1.24). We also retained the variables for (D) health care access and testing: not "out" to primary care provider (AOR 1.24, 95% CI 1.10-1.41), delayed/avoided testing due to privacy concerns (AOR 1.77, 95% CI 1.49-2.11), and delayed/avoided testing due to access issues (AOR 1.65, 95% CI 1.40-1.95). Finally, we retained the variable being HIV positive (AOR 0.56, 95% CI 0.46-0.68) or HIV status unknown (AOR 0.89, 95% CI 0.77-1.01), age <30 years (AOR 1.41, 95% CI 1.22-1.62), and identifying as bisexual (AOR 1.18, 95% CI 1.04-1.34) or straight/other (AOR 0.67, 95% CI 0.50-0.90). The greatest perceived benefits of Internet-based testing were privacy (2249/8388, 26.81%), general convenience (1701/8388, 20.28%), and being able to test at any time (1048/8388, 12.49%). The greatest perceived drawbacks were the inability to see a doctor or nurse (1507/8388, 17.97%), wanting to talk to someone about results (1430/8388, 17.97%), not wanting online results (1084/8388, 12.92%), and low trust (973/8388, 11.60%). CONCLUSIONS The high and wide-ranging intention to use that we observed suggests Internet-based testing has the potential to reach into all subgroups of MSM and may be particularly appealing to those facing current barriers to accessing STI/HIV testing and who are more comfortable with technology. These findings will be used to inform the promotion and further evaluation of an Internet-based testing program currently under development in British Columbia, Canada.
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Affiliation(s)
- Mark Gilbert
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, BC, Canada.
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Hussen SA, Stephenson R, del Rio C, Wilton L, Wallace J, Wheeler D. HIV testing patterns among black men who have sex with men: a qualitative typology. PLoS One 2013; 8:e75382. [PMID: 24069408 PMCID: PMC3777907 DOI: 10.1371/journal.pone.0075382] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 08/14/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Black men who have sex with men (MSM) in the Southeastern United States are disproportionately affected by HIV. Black MSM are more likely to have unrecognized HIV infection, suggesting that testing may occur later and/or infrequently relative to current recommendations. The objective of this qualitative study was to explore the HIV testing behaviors of Black MSM in Atlanta, Georgia, who were participants in the HIV Prevention Trials Network Brothers Study (HPTN 061). METHODS AND FINDINGS We conducted 29 in-depth interviews and four focus groups with a community-recruited sample. Modified grounded theory methodologies were used to guide our inductive analysis, which yielded a typology comprised of four distinct HIV testing patterns. Participants could be categorized as: (1) Maintenance Testers, who tested regularly as part of routine self-care; (2) Risk-Based Testers, whose testing depended on relationship status or sexual behavior; (3) Convenience Testers, who tested irregularly depending on what testing opportunities arose; or (4) Test Avoiders, who tested infrequently and/or failed to follow up on results. We further characterized these groups with respect to age, socioeconomic factors, identity, stigma and healthcare access. CONCLUSIONS Our findings highlight the heterogeneity of HIV testing patterns among Black MSM, and offer a framework for conceptualizing HIV testing in this group. Public health messaging must account for the diversity of Black MSM's experiences, and multiple testing approaches should be developed and utilized to maximize outreach to different types of testers.
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Affiliation(s)
- Sophia A. Hussen
- Hubert Department of Global Health, Rollins School of Public Health of Emory University, Atlanta, Georgia, United States of America
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Robert Stephenson
- Hubert Department of Global Health, Rollins School of Public Health of Emory University, Atlanta, Georgia, United States of America
| | - Carlos del Rio
- Hubert Department of Global Health, Rollins School of Public Health of Emory University, Atlanta, Georgia, United States of America
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Leo Wilton
- Department of Human Development, Binghamton University, Binghamton, New York, United States of America
| | - Jermel Wallace
- Hubert Department of Global Health, Rollins School of Public Health of Emory University, Atlanta, Georgia, United States of America
| | - Darrell Wheeler
- Graduate School of Social Work, Loyola University, Chicago, Illinois, United States of America
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Sexual healthcare preferences among gay and bisexual men: a qualitative study in San Francisco, California. PLoS One 2013; 8:e71546. [PMID: 23977073 PMCID: PMC3747218 DOI: 10.1371/journal.pone.0071546] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 06/29/2013] [Indexed: 01/22/2023] Open
Abstract
Background Research on gay and other men who have sex with men's (G/MSM) preferences for sexual healthcare services focuses largely on HIV testing and to some extent on sexually transmitted infections (STI). This research illustrates the frequency and location of where G/MSM interface with the healthcare system, but it does not speak to why men seek care in those locations. As HIV and STI prevention strategies evolve, evidence about G/MSM's motivations and decision-making can inform future plans to optimize models of HIV/STI prevention and primary care. Methods We conducted a phenomenological study of gay men's sexual health seeking experiences, which included 32 in-depth interviews with gay and bisexual men. Interviews were transcribed verbatim and entered into Atlas.ti. We conducted a Framework Analysis. Findings We identified a continuum of sexual healthcare seeking practices and their associated drivers. Men differed in their preferences for separating sexual healthcare from other forms of healthcare (“fragmentation”) versus combining all care into one location (“consolidation”). Fragmentation drivers included: fear of being monitored by insurance companies, a desire to seek non-judgmental providers with expertise in sexual health, a desire for rapid HIV testing, perceiving sexual health services as more convenient than primary care services, and a lack of healthcare coverage. Consolidation drivers included: a comfortable and trusting relationship with a provider, a desire for one provider to oversee overall health and those with access to public or private health insurance. Conclusions Men in this study were likely to separate sexual healthcare from primary care. Based on this finding, we recommend placing new combination HIV/STI prevention interventions within sexual health clinics. Furthermore, given the evolution of the financing and delivery of healthcare services and in HIV prevention, policymakers and clinicians should consider including more primary care services within sexual healthcare settings.
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Patterns of HIV and sexually transmitted infection testing among men who have sex with men couples in the United States. Sex Transm Dis 2013; 39:871-6. [PMID: 23060078 DOI: 10.1097/olq.0b013e3182649135] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Most men who have sex with men (MSM) within the United States acquire human immunodeficiency virus (HIV) while in a same-sex relationship. Few studies have examined HIV and sexually transmitted infection (STI) testing rates among MSM couples. Interestingly, the patterns that MSM test for HIV while in their relationships remain largely unknown. The current study helps fill this gap in knowledge by assessing HIV testing patterns and HIV and STI testing rates from a large convenience sample of Internet-using MSM couples. METHODS The current study used a cross-sectional study design to collect dyadic data from 361 MSM couples who lived throughout the United States. A novel recruitment strategy that included placing paid targeted advertisements on Facebook enrolled both men in the couple to independently complete the confidential electronic survey. RESULTS Nearly half of the HIV-negative men indicated either not having been tested for HIV since their relationship started or only testing if they believed they were at risk. Few men reported testing every 3 to 4 months. HIV/STI testing rates varied among the sample of couples. Few men reported having been diagnosed with a recent STI. Testing patterns and rates were mostly similar, irrespective of whether unprotected anal intercourse was practiced within and/or outside the relationship. CONCLUSIONS HIV testing and prevention services must target men who are at risk for acquiring HIV within MSM couples. To help accomplish this goal, additional research is needed to examine the specific barriers and facilitators to HIV and STI testing among MSM in couples.
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McNaghten AD, Valverde EE, Blair JM, Johnson CH, Freedman MS, Sullivan PS. Routine HIV testing among providers of HIV care in the United States, 2009. PLoS One 2013; 8:e51231. [PMID: 23341880 PMCID: PMC3544875 DOI: 10.1371/journal.pone.0051231] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 10/31/2012] [Indexed: 12/05/2022] Open
Abstract
In 2006, CDC recommended HIV screening as part of routine medical care for all persons aged 13-64 years. We examined adherence to the recommendations among a sample of HIV care providers in the US to determine if known providers of HIV care are offering routine HIV testing in outpatient settings. Data were from the CDC's Medical Monitoring Project Provider Survey, administered to physicians, nurse practitioners and physician assistants from June-September 2009. We assessed bivariate associations between testing behaviors and provider and practice characteristics and used multivariate regression to determine factors associated with offering HIV screening to all patients aged 13-64 years. Sixty percent of providers reported offering HIV screening to all patients 13 to 64 years of age. Being a nurse practitioner (aOR = 5.6, 95% CI = 2.6-11.9) compared to physician, age<39 (aOR = 1.9, 95% CI = 1.0-3.5) or 39-49 (aOR = 2.1, 95% CI = 1.4-3.3) compared with ≥50 years, and black race (aOR = 2.6, 95% CI = 1.2-6.0) compared with white race was associated with offering testing to all patients. Providers with low (aOR = 0.2, 95% CI = 0.1-0.3) or medium (aOR = 0.4, 95% CI = 0.2-0.6) HIV-infected patient loads were less likely to offer HIV testing to all patients compared with providers with high patient loads. Many providers of HIV care are still conducting risk-based rather than routine testing. We found that provider profession, age, race, and HIV-infected patient load were associated with offering HIV testing. Health care providers should use patient encounters as an opportunity to offer routine HIV testing to patients as outlined in CDC's revised recommendations for HIV testing in health care settings.
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Affiliation(s)
- A D McNaghten
- Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Sullivan PS, Carballo-Diéguez A, Coates T, Goodreau SM, McGowan I, Sanders EJ, Smith A, Goswami P, Sanchez J. Successes and challenges of HIV prevention in men who have sex with men. Lancet 2012; 380:388-99. [PMID: 22819659 PMCID: PMC3670988 DOI: 10.1016/s0140-6736(12)60955-6] [Citation(s) in RCA: 289] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Men who have sex with men (MSM) have been substantially affected by HIV epidemics worldwide. Epidemics in MSM are re-emerging in many high-income countries and gaining greater recognition in many low-income and middle-income countries. Better HIV prevention strategies are urgently needed. Our review of HIV prevention strategies for MSM identified several important themes. At the beginning of the epidemic, stand-alone behavioural interventions mostly aimed to reduce unprotected anal intercourse, which, although somewhat efficacious, did not reduce HIV transmission. Biomedical prevention strategies reduce the incidence of HIV infection. Delivery of barrier and biomedical interventions with coordinated behavioural and structural strategies could optimise the effectiveness of prevention. Modelling suggests that, with sufficient coverage, available interventions are sufficient to avert at least a quarter of new HIV infections in MSM in diverse countries. Scale-up of HIV prevention programmes for MSM is difficult because of homophobia and bias, suboptimum access to HIV testing and care, and financial constraints.
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Affiliation(s)
- Patrick S Sullivan
- Rollins School of Public Health, Emory University, Atlanta 30322, GA, USA.
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Prevalence and determinants of recent HIV testing among sexually active men who have sex with men in the St. Louis metropolitan area, Missouri, 2008. Sex Transm Dis 2012; 39:306-11. [PMID: 22421699 DOI: 10.1097/olq.0b013e31824018d4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND New human immunodeficiency virus (HIV) diagnoses in the St. Louis metropolitan area, MO, occur predominantly among men who have sex with men (MSM). The Centers for Disease Control and Prevention recommends HIV testing at least annually for sexually active MSM. We examined prevalence and factors associated with recent HIV testing among MSM in the St. Louis area. METHODS The 2008 National HIV Behavioral Surveillance system recruited men in 21 US metropolitan areas through venue-based, time-space sampling. Men were interviewed for behavioral risks and testing history. The analysis included men in St. Louis who had engaged in male-male sex during the previous year and excluded men who had tested HIV-positive >12 months before the interviews. Factors associated with testing during the previous 12 months were identified using log-binomial regression. RESULTS Among 339 MSM, 198 (58%) had been tested during the previous 12 months. MSM were more likely to have been tested if they were black (adjusted prevalence ratio [APR]: 1.6; 95% confidence interval [CI]: 1.0-2.5); had visited a health care provider during the previous 12 months (APR: 1.6; 95% CI: 1.3-2.1); or had ever disclosed same-sex attractions or male-male sex to health care providers (APR: 1.6; 95% CI: 1.2-2.0). Of the 141 men who were untested within 12 months, 89 (63%) attributed not testing to perceived low risk. CONCLUSIONS Nearly half of sexually active MSM in this analysis had not been tested for HIV during the previous year. Annual visits to health care providers during which sexual risk is discussed are likely to promote testing among MSM.
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Gass K, Hoff CC, Stephenson R, Sullivan PS. Sexual agreements in the partnerships of internet-using men who have sex with men. AIDS Care 2012; 24:1255-63. [PMID: 22375729 DOI: 10.1080/09540121.2012.656571] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Recent studies among men who have sex with men (MSM) have found that the majority of HIV transmission results from sex with a main partner. One factor likely to affect the risk of transmission is the type of agreements the couple has regarding sexual behaviour within and outside the relationship. This study recruited 732 Internet-using MSM through Facebook banner ads. Participants completed an online questionnaire regarding demographic characteristics of the respondent and their main partner, the sexual behaviour of the couple, the existence of a sexual agreement, and the strength of investment in that agreement. The Pearson chi-square test was used to assess the association between sexual agreements (categorized as open, closed, or none) and the predictive variables. Respondents' investment in their sexual agreement was measured using the sexual agreement investment scale (a composite score ranging from 0 to 52). Ninety-one percent of respondents had some form of sexual agreement in place with their main partner. The presence and type of sexual agreement was found to be strongly associated with many characteristics of the individual and couple, including the respondent's HIV status, length of time with the main partner, having unprotected anal intercourse with a man other than their main partner, and happiness in the relationship. Increases in the strength of respondents' investment in their sexual agreement were found to be associated with newness of the relationship, relationship happiness, having a closed relationship, and decreases in risky sexual behaviour. This study offers further evidence of the important role that sexual agreements play in male couples. The overwhelming prevalence of sexual agreements and their association with relationship happiness and risky sexual behaviours has important implications for future HIV prevention and control strategies, including the implementation of couples voluntary counseling and testing.
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Affiliation(s)
- Katherine Gass
- Department of Epidemiology, Emory University, Atlanta, GA, USA.
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Matthews JE, Stephenson R, Sullivan PS. Factors associated with self-reported HBV vaccination among HIV-negative MSM participating in an online sexual health survey: a cross-sectional study. PLoS One 2012; 7:e30609. [PMID: 22363453 PMCID: PMC3281854 DOI: 10.1371/journal.pone.0030609] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 12/25/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A substantial proportion of men who have sex with men (MSM) in the United States remain unvaccinated against hepatitis B. We sought to understand which factors are associated with vaccination among HIV-negative MSM. METHODOLOGY/PRINCIPAL FINDINGS Data were from a 2010 web-based survey of adult MSM. We calculated the prevalence of self-reported hepatitis B vaccination among 1,052 HIV-negative or HIV-untested men who knew their hepatitis B vaccination status, and used multivariate logistic regression to determine associated factors. 679 (64.5%) MSM reported being vaccinated. Younger men were more likely to report being vaccinated than older men, and there was a significant interaction between age and history of hepatitis B testing. Men with at least some college education were at least 2.1 times as likely to be vaccinated as men with a high school education or less (95% CI = 1.4-3.1). Provider recommendation for vaccination (aOR = 4.2, 95% CI = 2.4-7.4) was also significantly associated with receipt of vaccination. CONCLUSIONS/SIGNIFICANCE Providers should assess sexual histories of male patients and offer those patients with male sex partners testing for hepatitis infection and vaccinate susceptible patients. There may be particular opportunities for screening and vaccination among older and more socioeconomically disadvantaged MSM.
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Affiliation(s)
- Jonathan E. Matthews
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
| | - Rob Stephenson
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
| | - Patrick S. Sullivan
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
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Mistaken Assumptions and Missed Opportunities: Correlates of Undiagnosed HIV Infection Among Black and Latino Men Who Have Sex With Men. J Acquir Immune Defic Syndr 2011; 58:64-71. [DOI: 10.1097/qai.0b013e31822542ad] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wolitski RJ, Fenton KA. Sexual health, HIV, and sexually transmitted infections among gay, bisexual, and other men who have sex with men in the United States. AIDS Behav 2011; 15 Suppl 1:S9-17. [PMID: 21331797 DOI: 10.1007/s10461-011-9901-6] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The sexual health of gay, bisexual, and other men who have sex with men (MSM) in the United States is not getting better despite considerable social, political and human rights advances. Instead of improving, HIV and sexually transmitted infections (STIs) remain disproportionately high among MSM and have been increasing for almost two decades. The disproportionate and worsening burden of HIV and other STIs among MSM requires an urgent re-assessment of what we have been doing as a nation to reduce these infections, how we have been doing it, and the scale of our efforts. A sexual health approach has the potential to improve our understanding of MSM's sexual behavior and relationships, reduce HIV and STI incidence, and improve the health and well-being of MSM.
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Affiliation(s)
- Richard J Wolitski
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton RD NE (E-35), Atlanta, GA 30333, USA.
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