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Luz PM, Apelian H, Lambert G, Fourmigue A, Dvorakova M, Grace D, Lachowsky N, Hart TA, Moore DM, Skakoon-Sparling S, Cox J. HIV Treatment Optimism Moderates the Relationship between Sexual Risk Behavior and HIV Risk Perception among Urban HIV-negative Gay, Bisexual, and Other Men who have Sex With Men. AIDS Behav 2024; 28:2683-2694. [PMID: 38869761 DOI: 10.1007/s10461-024-04380-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/14/2024]
Abstract
Using baseline data of the Engage Cohort Study, a Canadian study of sexually active gay, bisexual and other men who have sex with men (GBM), we evaluated the association between sexual behavior and risk perception among HIV-negative participants and whether HIV treatment optimism moderated this relationship. Participants were recruited by respondent-driven-sampling (RDS). We defined high-risk sexual behavior in the past six months as any condomless anal sex with a casual partner (i.e. not the participant's main partner) with either unknown HIV-status where neither used pre-exposure prophylaxis or with a partner living with HIV having detectable/unknown viral load. We assessed HIV treatment optimism-skepticism using a 12-item scale. RDS-II-weighted adjusted logistic regression models examined associations with risk perception measured by the question "How would you assess your current risk of getting HIV?" (response options were on a 6-point Likert-scale ranging from "very unlikely" to "very likely", dichotomized into "No Perceived Risk" (very unlikely/unlikely) and "Perceived Risk" (somewhat likely/likely/very likely/I think I already have HIV). Of 1961 participants, engagement in high-risk sexual behavior was reported by 155 (17.0%), 62 (12.4%), 128 (17.2%) of participants in Montréal, Toronto, and Vancouver, respectively. High-risk sexual behavior increased the odds of perceived HIV risk (pooled adjusted odds ratio = 2.9, 95%CI = 2.2-3.8). HIV treatment optimism-skepticism scores moderated the relationship: for GBM engaging in high-risk sexual behavior, higher HIV treatment optimism-skepticism scores increased perceived HIV risk. Promoting awareness around advances related to HIV prevention and treatment is important for appropriate risk assessment and for increased engagement in prevention interventions.
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Affiliation(s)
- Paula M Luz
- National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil.
| | - Herak Apelian
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Gilles Lambert
- Direction régionale de santé publique de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montréal, QC, Canada
- Institut national de santé publique du Québec, Montréal, QC, Canada
| | - Alain Fourmigue
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Milada Dvorakova
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Nathan Lachowsky
- School of Public, Health & Social Policy, University of Victoria, Victoria, BC, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - David M Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Shayna Skakoon-Sparling
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
- Psychology Department, University of Guelph, Guelph, ON, Canada
| | - Joseph Cox
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
- Direction régionale de santé publique de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montréal, QC, Canada
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Konda KA, Qquellon J, Torres TS, Vega-Ramirez EH, Elorreaga O, Guillén-Díaz-Barriga C, Diaz-Sosa D, Hoagland B, Guanira JV, Benedetti M, Pimenta C, Vermandere H, Bautista-Arredondo S, Veloso VG, Grinsztejn B, Caceres CF. Awareness of U = U among Sexual and Gender Minorities in Brazil, Mexico, and Peru: Differences According to Self-reported HIV Status. AIDS Behav 2024; 28:2391-2402. [PMID: 38662277 PMCID: PMC11199300 DOI: 10.1007/s10461-024-04336-9] [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] [Accepted: 03/29/2024] [Indexed: 04/26/2024]
Abstract
The slogan Undetectable equals Untransmittable (U = U) communicates that people living with HIV (PLHIV) who are on antiretroviral therapy (ART) will not transmit HIV to their sexual partners. We describe awareness of U = U among sexual and gender minorities (SGM) living in Brazil, Mexico, and Peru by self-reported HIV status (PLHIV, negative, unknown) during 2021 using an online survey. We estimated two models using Poisson regression for each population group: Model A including socio-demographic factors (country, gender, age, race, education, and income), and then Model B including taking ART (for PLHIV) or risk behavior, ever-taking PrEP, and HIV risk perception (for HIV-negative or of unknown HIV status). A total of 21,590 respondents were included (Brazil: 61%, Mexico: 30%, Peru: 9%). Among HIV-negative (74%) and unknown status (12%), 13% ever used PrEP. Among PLHIV (13%), 93% reported current use of ART. Awareness of U = U was 89% in both Brazil and Mexico, which was higher than in Peru 64%. Awareness of U = U was higher among PLHIV (96%) than HIV-negative (88%) and HIV-unknown (70%). In multivariate models, PLHIV with lower education were less aware of U = U, while those taking ART were more aware. Among HIV-negative, non-cisgender, lower income, and those with lower education had lower awareness of U = U, while individuals ever using PrEP had higher awareness. In conclusion, awareness of U = U varied by HIV status, socio-demographic characteristics, and HIV risk behavior. The concept of U = U should be disseminated through educational strategies and include a focus on SGM to combat HIV stigma.
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Affiliation(s)
- K A Konda
- Keck School of Medicine, University of Southern California, 1845 N Soto St, Los Angeles, CA, 90032, USA.
- Centro de Investigación Interdisciplinaria en Sexualidad, Universidad Peruana Cayetano Heredia, SIDA y Sociedad, Lima, Peru.
| | - J Qquellon
- Centro de Investigación Interdisciplinaria en Sexualidad, Universidad Peruana Cayetano Heredia, SIDA y Sociedad, Lima, Peru
| | - T S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - E H Vega-Ramirez
- Instituto Nacional de Psiquiatria Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - O Elorreaga
- Centro de Investigación Interdisciplinaria en Sexualidad, Universidad Peruana Cayetano Heredia, SIDA y Sociedad, Lima, Peru
| | - C Guillén-Díaz-Barriga
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - D Diaz-Sosa
- Instituto Nacional de Psiquiatria Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - B Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - J V Guanira
- Centro de Investigación Interdisciplinaria en Sexualidad, Universidad Peruana Cayetano Heredia, SIDA y Sociedad, Lima, Peru
| | - M Benedetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - C Pimenta
- Departmento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissiveis, Brazilian Ministry of Health, Rio de Janeiro, Brazil
| | - H Vermandere
- Instituto Nacional de Salud Pública (INSP), Mexico City, Mexico
| | | | - V G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - B Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - C F Caceres
- Centro de Investigación Interdisciplinaria en Sexualidad, Universidad Peruana Cayetano Heredia, SIDA y Sociedad, Lima, Peru
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Vega-Ramirez H, Guillen-Diaz-Barriga C, Luz PM, Torres TS. Perceived risk for HIV acquisition and sexual HIV exposure among sexual and gender minorities: a systematic review. BMC Infect Dis 2024; 24:574. [PMID: 38858666 PMCID: PMC11163805 DOI: 10.1186/s12879-024-09456-0] [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: 12/09/2023] [Accepted: 05/30/2024] [Indexed: 06/12/2024] Open
Abstract
We conducted a systematic review to explore the relationship between perceived risk for HIV acquisition and sexual HIV exposure among sexual and gender minorities. We included 39 studies divided into (i) correlations or associations, (ii) models using sexual HIV exposure as the outcome, and (iii) models using perceived risk for HIV acquisition as the outcome. The sample size range was from 55 to 16,667 participants, primarily cisgender men who have sex with men (73.3%) and White (51.3%). Sexual HIV exposure and perceived risk for HIV acquisition assessments and recall time frames across studies differed markedly. Most of studies (84.6%) found significant correlations, comparisons, or associations between different levels of perceived risk for HIV acquisition and high sexual HIV exposure. In addition, 51.3% of studies reported other variables associated with high sexual HIV exposure (i.e., misuse of substances or alcohol) or with high perceived risk for HIV acquisition (i.e., younger age). In conclusion, the association between perceived risk for HIV acquisition and sexual HIV exposure has shown to be consistent. However, the assessment for perceived risk for HIV acquisition should include more components of perception (i.e., an affective component), or for sexual HIV exposure should consider the different estimated sexual per-acts probability of acquiring HIV.
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Affiliation(s)
- Hamid Vega-Ramirez
- Division of Epidemiology and Psychosocial Research, National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico.
| | - Centli Guillen-Diaz-Barriga
- Division of Graduate Studies and Research, Faculty of Psychology, National Autonomous University of Mexico, Mexico City, Mexico
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI- Fiocruz), Rio de Janeiro, Brazil
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI- Fiocruz), Rio de Janeiro, Brazil
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Kelly NK, Rosso MT, Rainer C, Claude K, Muessig KE, Hightow-Weidman L. Discordance Between HIV Risk Perception, Sexual Behavior, and Pre-exposure Prophylaxis Adherence Among Young Sexual and Gender Minorities in the United States. J Adolesc Health 2024; 74:1112-1117. [PMID: 38583158 PMCID: PMC11102322 DOI: 10.1016/j.jadohealth.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE In the United States, youth experience suboptimal HIV pre-exposure prophylaxis (PrEP) adherence. One common idea posits that this is due to their developing decision-making skills. However, quantitative evidence of this assumption is limited. We therefore examined whether individual decision-making factors, such as HIV risk perception and sexual behavior, predicted PrEP adherence in a national trial of young sexual and gender minorities (YSGMs). METHODS In 2019-2021, the Adolescent Medicine Trials Network for HIV Interventions 142 study enrolled 225 PrEP users (ages 16-24) throughout the country. Regression models estimated the associations between HIV risk perception (using a modified Perceived HIV Risk Scale), sexual behavior (condomless anal sex in ≤ 3 months), and self-reported oral PrEP adherence (≥4 pills in the past week) at the same time point (baseline) and longitudinally (3 months). RESULTS Baseline risk perception (risk ratio [RR]: 0.92, 95% confidence interval [CI]: 0.82, 1.04) and condomless anal sex (RR: 1.10, 95% CI: 0.97, 1.25) were not associated with PrEP adherence at the same time point and did not predict 3-month adherence (RR: 0.97, 95% CI: 0.85, 1.11; RR: 1.05, 95% CI: 0.93, 1.19, respectively). Baseline risk perception was not associated with condomless anal sex at either time point (baseline RR: 1.16, 95% CI: 0.94, 1.43; 3-month RR: 1.07, 95% CI: 0.90, 1.28). DISCUSSION In this national trial of YSGM, HIV risk perception and condomless anal sex did not predict PrEP adherence. Targeting individual-level perceptions and behaviors will likely insufficiently address youth's suboptimal PrEP use. Future research should identify YSGM-specific adherence drivers and train providers to recognize such motivations.
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Affiliation(s)
- Nicole K Kelly
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Matthew T Rosso
- Institute on Digital Health and Innovation, Florida State University, College of Nursing, Tallahassee, Florida
| | - Crissi Rainer
- Institute on Digital Health and Innovation, Florida State University, College of Nursing, Tallahassee, Florida
| | - Kristina Claude
- Institute on Digital Health and Innovation, Florida State University, College of Nursing, Tallahassee, Florida
| | - Kathryn E Muessig
- Institute on Digital Health and Innovation, Florida State University, College of Nursing, Tallahassee, Florida
| | - Lisa Hightow-Weidman
- Institute on Digital Health and Innovation, Florida State University, College of Nursing, Tallahassee, Florida
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Abreu Martins C, Leal Seabra I, Rocha Vila Nova PV, Barbosa Rodrigues T, Oeiras Pedroso A, Gir E, Karina Reis R, Tavares Parente A, Oliveira Naiff Ferreira GR, Botelho EP. Spatial analysis of HIV detection rates among Brazilian young men, 2007-2021. AIDS Care 2024; 36:771-780. [PMID: 38227972 DOI: 10.1080/09540121.2024.2301730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/31/2023] [Indexed: 01/18/2024]
Abstract
The main goal of this study was to spatially analyze the HIV epidemic scenario in young men in Brazil, 2007-2021. We used secondary data obtained from the Brazilian Information System for Notifiable Diseases. Individuals aged 15-29 years with permanent residence in Brazil who were diagnosed with HIV during the study period were included in the analysis. Municipality HIV age-adjusted detection rates were analyzed through spatial distribution, autocorrelation, and spatiotemporal risk analyses. During the study period, 108,392 HIV cases were reported in young Brazilian men. The HIV epidemic increased territorially in the northern, northeastern, midwestern, and southeastern regions but decreased in the southern region. Although the number of clusters comprising municipalities with high HIV detection rates (hotspots) decreased, new ones appeared, expanded, or stopped changing size. Hotspots and spatio-temporal risk zones (spatial areas with increased HIV detection in a specific period) comprised economically developed municipalities with high demographic density surrounded by less developed municipalities. The period of the spatiotemporal risk zones was between 2008 and 2021. Our study showed that HIV detection rates continue to increase among young Brazilian men, and health authorities should reinforce efforts mainly in capitals and surrounded municipalities in the north, northeast, southeast, and midwest regions.
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Affiliation(s)
| | | | | | | | | | - Elucir Gir
- Nursing School of RibeirãoPreto, University of São Paulo, Ribeirão Preto, Brazil
| | - Renata Karina Reis
- Nursing School of RibeirãoPreto, University of São Paulo, Ribeirão Preto, Brazil
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Silva KRO, Ferreira RC, Coelho LE, Veloso VG, Grinsztejn B, Torres TS, Luz PM. Knowledge of HIV transmission, prevention strategies and U = U among adult sexual and gender minorities in Brazil. J Int AIDS Soc 2024; 27:e26220. [PMID: 38379186 PMCID: PMC10879640 DOI: 10.1002/jia2.26220] [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: 10/04/2023] [Accepted: 01/30/2024] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Although strong scientific evidence of the efficacy and effectiveness of treatment-as-prevention (TasP) is available, full endorsement of the "Undetectable = Untransmittable" (U = U) and "zero-risk" messages could be improved. Increasing knowledge about HIV transmission, prevention and treatment is a critical component of care efforts. The study assessed knowledge of HIV transmission and prevention strategies, and the perceived accuracy of the slogan U = U among sexual and gender minorities (SGM) in Brazil. METHODS Cross-sectional web-based survey targeting adult SGM living in Brazil (2021-2022) recruited on social media and dating apps. We used the 12-item HIV Knowledge Assessment (HIV-KA) questionnaire to assess HIV knowledge, three items of which address pre-exposure prophylaxis (PrEP), post-exposure prophylaxis and TasP. Perceived accuracy of the U = U slogan was assessed with the question: "With regards to HIV-positive individuals transmitting HIV through sexual contact, how accurate do you believe the slogan U = U is?". We a priori grouped the study population into three mutually exclusive groups: people living with HIV (PLHIV), HIV negative and HIV unknown. We used logistic regression models to assess factors associated with high HIV knowledge and perception of the U = U as completely accurate. RESULTS Of 50,222 individuals accessing the questionnaire, 23,981 were included: 5071 (21.0%) PLHIV, 17,257 (71.5%) HIV negative and 1653 (6.9%) HIV unknown. The proportion of participants with high knowledge was significantly higher for PLHIV and HIV negative (48.1% and 45.5%, respectively) compared to 26.1% of HIV unknown. More PLHIV perceived U = U as completely accurate (80.4%), compared to 60.0% of HIV negative and 42.9% of HIV unknown. HIV knowledge correlates with perceived accuracy of the U = U slogan across all groups. Higher HIV knowledge was associated with higher income and education regardless of HIV status. Among HIV-negative participants, PrEP awareness and use were associated with higher knowledge and accurate perception of the U = U slogan. CONCLUSIONS Our findings show that HIV knowledge and perceived accuracy of U = U are strongly correlated, that knowledge differs according to HIV status, and that poor socio-economic is linked to poor knowledge among SGM from Brazil. Educational strategies regarding TasP, U = U and zero risk targeting socio-economically vulnerable populations are urgent in Brazil.
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Affiliation(s)
| | | | - Lara E. Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo CruzRio de JaneiroBrazil
| | - Valdilea G. Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo CruzRio de JaneiroBrazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo CruzRio de JaneiroBrazil
| | - Thiago S. Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo CruzRio de JaneiroBrazil
| | - Paula M. Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo CruzRio de JaneiroBrazil
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Luz PM, Spaeth H, Scott JA, Grinsztejn B, Veloso VG, Freedberg KA, Losina E. Variability in life expectancy among people with HIV in Brazil by gender and sexual orientation. Braz J Infect Dis 2024; 28:103722. [PMID: 38369294 PMCID: PMC10897846 DOI: 10.1016/j.bjid.2024.103722] [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: 10/23/2023] [Revised: 12/24/2023] [Accepted: 01/24/2024] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION In Brazil, though Antiretroviral Therapy (ART) is available to all, the benefits may not be experienced uniformly. We projected Life Expectancy (LE) for People Living with HIV (PLHIV) in care as currently observed and estimated the impact of guideline-concordant care. METHODS Using a microsimulation model, we projected LE for a cohort of PLHIV and for four population groups: cisgender Men who have Sex with Men (MSM), cisgender Men who have Sex with Women (MSW), Cisgender Women (CGW), and Transgender Women (TGW). Cohort data from Evandro Chagas National Institute of Infectious Diseases/Oswaldo Cruz Foundation (INI/Fiocruz) informed model parameters. We modeled five scenarios: 1) Current care: ART initiation, adherence, and retention in care as currently observed, 2) Guideline-concordant care: immediate ART initiation, full adherence to treatment, and consistent retention in care, 3) Immediate ART initiation with observed adherence to treatment and retention in care, 4) Full adherence to treatment with observed timing of ART initiation and retention in care, and 5) Consistent retention in care with observed timing of ART initiation and adherence. RESULTS With current care, LE from age 15 would be 45.9, 44.4, 54.2, and 42.3 years, for MSM, MSW, CGW, and TGW. With guideline-concordant care, LE would be 54.2, 54.4, 63.1, and 53.2 years, for MSM, MSW, CGW and TGW, with TGW experiencing the greatest potential increase in LE (10.9 years). When investigating the components of care separately, MSW and CGW would gain most LE with immediate ART initiation, whereas for MSM and TGW consistent retention in care would be most impactful. CONCLUSIONS In settings like INI/Fiocruz, MSW and CGW would benefit most from interventions focused on earlier diagnosis and linkage to care, whereas TGW and MSM would benefit from interventions to sustain engagement in care. Assessment of the HIV care continuum for specific populations should inform care priorities.
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Affiliation(s)
- Paula M Luz
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil.
| | - Hailey Spaeth
- Massachusetts General Hospital, Medical Practice Evaluation Center, Department of Medicine, Boston, MA, United States
| | - Justine A Scott
- Massachusetts General Hospital, Medical Practice Evaluation Center, Department of Medicine, Boston, MA, United States
| | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Valdilea G Veloso
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Kenneth A Freedberg
- Massachusetts General Hospital, Division of Infectious Diseases, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Massachusetts General Hospital, Division of General Internal Medicine, Boston, MA, United States; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Elena Losina
- Harvard Medical School, Boston, MA, United States; Harvard University Center for AIDS Research, Harvard Medical School, Boston, MA, United States; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, United States; Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States; Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
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Soares F, Magno L, Pinto JA, Grangeiro A, Bruxvoort K, Greco D, Dourado I. Same-Day Initiation of Oral Pre-Exposure Prophylaxis is High Among Adolescent Men Who Have Sex With Men and Transgender Women in Brazil. J Adolesc Health 2023; 73:S26-S32. [PMID: 37953005 DOI: 10.1016/j.jadohealth.2023.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE This study analyzed the sociodemographic and behavioral characteristics of adolescent men who have sex with men (aMSM) and transgender women (aTGW) initiating oral pre-exposure prophylaxis (PrEP) in human immunodeficiency virus (HIV) prevention clinics. METHODS PrEP1519 is a prospective, multicenter, open-label PrEP demonstration cohort study of aMSM and aTGW aged 15-19 years living in three large Brazilian capital cities. For this analysis, we included adolescents who enrolled in PrEP1519 from February 2019 to August 2021. Adolescents who visited PrEP clinics were classified into four groups based on PrEP eligibility and on their decision to use PrEP: (1) ineligible for same-day PrEP initiation; (2) eligible for same-day PrEP initiation, initiated PrEP at first visit; (3) eligible for PrEP initiation, initiated PrEP after the first visit; and (4) eligible for same-day PrEP initiation but declined. The groups that were eligible for same-day PrEP initiation were compared using the Chi-square and Fisher's exact tests. RESULTS Of the 1,254 adolescents enrolled in the PrEP1519 study, 61 (4.9%) were considered ineligible for same-day PrEP initiation. Of the 1,193 eligible for same-day PrEP initiation, 1,113 (93.3%) initiated PrEP [1,054 initiated PrEP in the first visit (88.3%) and 59 in subsequent visits (4.9%)] and 80 (6.7%) did not. Despite 90% of the PrEP decliners reporting a low risk of HIV infection, most reported condomless anal sex in the past six months (70%). DISCUSSION Same-day PrEP initiation among aMSM and aTGW was high, highlighting that this strategy was important to promote PrEP initiation among adolescents with increased vulnerability to HIV in Brazil.
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Affiliation(s)
- Fabiane Soares
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
| | - Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Bahia, Brazil
| | - Jony Arrais Pinto
- Instituto de Matemática e Estatística, Universidade Federal Fluminense, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alexandre Grangeiro
- Departamento de Medicina Preventiva, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Katia Bruxvoort
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Dirceu Greco
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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Blair KJ, Torres TS, Hoagland B, Bezerra DRB, Veloso VG, Grinsztejn B, Clark J, Luz PM. Moderating Effect of Pre-Exposure Prophylaxis Use on the Association Between Sexual Risk Behavior and Perceived Risk of HIV Among Brazilian Gay, Bisexual, and Other Men Who Have Sex With Men: Cross-Sectional Study. JMIR Public Health Surveill 2023; 9:e45134. [PMID: 37796573 PMCID: PMC10587815 DOI: 10.2196/45134] [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: 12/16/2022] [Revised: 07/14/2023] [Accepted: 07/31/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (MSM) with a higher perceived risk of HIV are more aware of and willing to use pre-exposure prophylaxis (PrEP). PrEP is an effective HIV prevention strategy, but there is a lack of data on how PrEP use might moderate the relationship between sexual risk behavior and perceived risk of HIV. Moreover, most studies measure perceived risk of HIV via a single question. OBJECTIVE We estimated the moderating effect of PrEP use on the association between sexual risk behavior and perceived risk of HIV, measured with the 8-item Perceived Risk of HIV Scale (PRHS), among Brazilian MSM. METHODS A cross-sectional, web-based survey was completed by Brazilian Hornet app users aged ≥18 years between February and March 2020. We included data from cisgender men who reported sex with men in the previous 6 months. We evaluated the moderating effect of current PrEP use on the association between sexual risk behavior, measured via the HIV Incidence Risk Index for MSM (HIRI-MSM), and perceived risk of HIV, measured by the PRHS. Higher HIRI-MSM (range 0-45) and PRHS (range 10-40) scores indicate greater sexual behavioral risk and perceived risk of HIV, respectively. Both were standardized to z scores for use in multivariable linear regression models. RESULTS Among 4344 cisgender MSM, 448 (10.3%) were currently taking PrEP. Current PrEP users had a higher mean HIRI-MSM score (mean 21.0, SD 9.4 vs mean 13.2, SD 8.1; P<.001) and a lower mean PRHS score (mean 24.6, SD 5.1 vs mean 25.9, SD 4.9; P<.001) compared to those not currently taking PrEP. In the multivariable model, greater HIRI-MSM scores significantly predicted increased PRHS scores (β=.26, 95% CI 0.22-0.29; P<.001). PrEP use moderated the association between HIRI-MSM and PRHS score (interaction term β=-.30, 95% CI -0.39 to -0.21; P<.001), such that higher HIRI-MSM score did not predict higher PRHS score among current PrEP users. CONCLUSIONS Our results suggest current PrEP users have confidence in PrEP's effectiveness as an HIV prevention strategy. PrEP's effectiveness, positive psychological impact, and the frequent HIV testing and interaction with health services required of PrEP users may jointly influence the relationship between sexual risk behavior and perceived risk of HIV among PrEP users.
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Affiliation(s)
- Kevin James Blair
- South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, CA, United States
- Department of Surgery, University of California Los Angeles, Los Angeles, CA, United States
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Daniel R B Bezerra
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jesse Clark
- South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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10
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Brown CA, Siegler AJ, Zahn RJ, Valencia RK, Sanchez T, Kramer MR, Phaswana-Mafuya NR, Stephenson R, Bekker LG, Baral SD, Sullivan PS. Assessing the association of stigma and HIV service and prevention uptake among men who have sex with men and transgender women in South Africa. AIDS Care 2023; 35:1497-1507. [PMID: 36755403 PMCID: PMC10406969 DOI: 10.1080/09540121.2023.2175770] [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: 03/01/2022] [Accepted: 01/22/2023] [Indexed: 02/10/2023]
Abstract
HIV prevention for gay, bisexual, and other men who have sex with men (GBMSM) and transgender women (TGW) is critical to reducing health disparities and population HIV prevalence. To understand if different types of stigma impact engagement with HIV prevention services, we assessed associations between stigmas and use of HIV prevention services offered through an HIV prevention intervention. This analysis included 201 GBMSM and TGW enrolled in a prospective cohort offering a package of HIV prevention interventions. Participants completed a baseline survey that included four domains of sexual identity/behavior stigma, HIV-related stigma, and healthcare stigma. Impact of stigma on PrEP uptake and the number of drop-in visits was assessed. No domain of stigma was associated with PrEP uptake. In bivariate analysis, increased enacted sexual identity stigma increased number of drop-in visits. In a logistic regression analysis constrained to sexual identity stigma, enacted stigma was associated with increased drop-in visits (aIRR = 1.30, [95% CI: 1.02, 1.65]). Participants reporting higher enacted stigma were modestly more likely to attend additional services and have contact with the study clinics and staff. GBMSM and TGW with higher levels of enacted stigma may seek out sensitized care after negative experiences in their communities or other healthcare settings.
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Affiliation(s)
- Carolyn A Brown
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA
- ViiV Healthcare, Durham, NC, USA
| | - Aaron J Siegler
- Department of Behavioral Sciences and Health Education, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Ryan J Zahn
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Rachel K Valencia
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Travis Sanchez
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Michael R Kramer
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Nancy Refilwe Phaswana-Mafuya
- SAMRC/JJ Pan African Centre for Epidemics Research (PACER) Extramural Unit; Department of Environmental Health, University of Johannesburg, Johannesburg, South Africa
| | - Rob Stephenson
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | | | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA
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11
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da Costa AR, Barros JF, Lima VP, Magalhães C, Silva HKR, Deusdará R, de Souza Lapa J. Substance Use and Risky Sexual Behavior in the PrEP Outpatient Clinic at the University Hospital of Brasília. Trop Med Infect Dis 2023; 8:323. [PMID: 37368741 DOI: 10.3390/tropicalmed8060323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: To evaluate the epidemiological profile of people who use drugs at the PrEP outpatient clinic of the University Hospital of Brasília; (2) Methods: Cross-sectional study with a review of data from medical records referring to the first medical consultation. The prevalence ratio was calculated using a Poisson regression model with robust variance; (3) Results: A total of 53% of subjects reported drug use in the last 3 months. The unadjusted prevalence ratio of drug use in trans women was PR: 9.0 (95%CI: 1.4-57.5). people who use drugs have a 1.9 times higher prevalence of STI diagnosis, and a 2.4 times higher prevalence of partners compared to non-users; (4) Conclusions: Substance use was associated with a higher STI prevalence ratio and number of sexual partners.
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Affiliation(s)
- Alan Rodrigues da Costa
- Núcleo de Medicina Tropical, Faculdade de Medicina, Campus Universitário Darcy Ribeiro, Universidade de Brasília, Asa Norte, Brasília 70910-900, Brazil
| | - Jônatas Ferreira Barros
- Núcleo de Medicina Tropical, Faculdade de Medicina, Campus Universitário Darcy Ribeiro, Universidade de Brasília, Asa Norte, Brasília 70910-900, Brazil
| | - Valéria Paes Lima
- Núcleo de Medicina Tropical, Faculdade de Medicina, Campus Universitário Darcy Ribeiro, Universidade de Brasília, Asa Norte, Brasília 70910-900, Brazil
| | - Camila Magalhães
- Núcleo de Medicina Tropical, Faculdade de Medicina, Campus Universitário Darcy Ribeiro, Universidade de Brasília, Asa Norte, Brasília 70910-900, Brazil
| | - Hellen Kássia Rezende Silva
- Núcleo de Medicina Tropical, Faculdade de Medicina, Campus Universitário Darcy Ribeiro, Universidade de Brasília, Asa Norte, Brasília 70910-900, Brazil
| | - Rodolfo Deusdará
- Núcleo de Medicina Tropical, Faculdade de Medicina, Campus Universitário Darcy Ribeiro, Universidade de Brasília, Asa Norte, Brasília 70910-900, Brazil
| | - Juliana de Souza Lapa
- Núcleo de Medicina Tropical, Faculdade de Medicina, Campus Universitário Darcy Ribeiro, Universidade de Brasília, Asa Norte, Brasília 70910-900, Brazil
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12
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Luz PM, Deshpande V, Kazemian P, Scott JA, Shebl FM, Spaeth H, Pimenta C, Stern M, Pereira G, Struchiner CJ, Grinsztejn B, Veloso VG, Freedberg KA. Impact of pre-exposure prophylaxis uptake among gay, bisexual, and other men who have sex with men in urban centers in Brazil: a modeling study. BMC Public Health 2023; 23:1128. [PMID: 37308858 PMCID: PMC10262537 DOI: 10.1186/s12889-023-15994-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/23/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) in Brazil remain disproportionately affected by HIV. We estimated the potential incidence reduction by five years with increased uptake of publicly-funded, daily, oral tenofovir/emtricitabine (TDF/FTC) for HIV pre-exposure prophylaxis (PrEP) among MSM using the Cost Effectiveness of Preventing AIDS Complications microsimulation model. We used national data, local studies, and literature to inform model parameters for three cities: Rio de Janeiro, Salvador, and Manaus. RESULTS In Rio de Janero, a PrEP intervention achieving 10% uptake within 60 months would decrease incidence by 2.3% whereas achieving 60% uptake within 24 months would decrease incidence by 29.7%; results were similar for Salvador and Manaus. In sensitivity analyses, decreasing mean age at PrEP initiation from 33 to 21 years increased incidence reduction by 34%; a discontinuation rate of 25% per year decreased it by 12%. CONCLUSION Targeting PrEP to young MSM and minimizing discontinuation could substantially increase PrEP's impact.
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Affiliation(s)
- Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Rio de Janeiro, 21040-360, Brazil.
| | - Vijeta Deshpande
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge Street, Suite 1684, Boston, MA, 02114, USA
| | - Pooyan Kazemian
- Department of Operations, Weatherhead School of Management, Case Western Reserve University, 11119 Bellflower Road, Cleveland, OH, 44106, USA
| | - Justine A Scott
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge Street, Suite 1684, Boston, MA, 02114, USA
| | - Fatma M Shebl
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge Street, Suite 1684, Boston, MA, 02114, USA
| | - Hailey Spaeth
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge Street, Suite 1684, Boston, MA, 02114, USA
| | - Cristina Pimenta
- Ministry of Health of Brazil, SRTVN Quadra 701, Lote D, Edifício PO700, 5º Andar, Brasília/DFBrasilia, 70719-040, Brazil
| | - Madeline Stern
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge Street, Suite 1684, Boston, MA, 02114, USA
| | - Gerson Pereira
- Ministry of Health of Brazil, SRTVN Quadra 701, Lote D, Edifício PO700, 5º Andar, Brasília/DFBrasilia, 70719-040, Brazil
| | | | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Rio de Janeiro, 21040-360, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Rio de Janeiro, 21040-360, Brazil
| | - Kenneth A Freedberg
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge Street, Suite 1684, Boston, MA, 02114, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Harvard University Center for AIDS Research, Harvard Medical School, 42 Church Street, Cambridge, MA, 02138, USA
- Division of General Internal Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
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13
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Reyniers T, Babo SAY, Ouedraogo M, Kanta I, Ekon Agbégnigan L, Rojas D, Eubanks A, Anoma C, Dah TTE, Mensah E, Dembélé Keita B, Spire B, Vuylsteke B, Laurent C. Strategies to improve PrEP uptake among West African men who have sex with men: a multi-country qualitative study. Front Public Health 2023; 11:1165327. [PMID: 37181706 PMCID: PMC10167043 DOI: 10.3389/fpubh.2023.1165327] [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: 02/13/2023] [Accepted: 03/27/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction West African men who have sex with men (MSM) remain at substantial risk of contracting HIV. Pre-exposure prophylaxis (PrEP) can be an effective game-changer in reducing the number of HIV infections in MSM communities. To optimize the roll-out of PrEP, we need to better understand how we can increase its uptake. The objective of this study was to explore the perceptions of West African MSM toward PrEP and their proposed strategies to overcome barriers to PrEP uptake within their communities. Methods Between April 2019 and November 2021, we conducted 12 focus group discussions with 97 MSM not taking PrEP, and 64 semi-structured interviews with MSM taking PrEP, in Burkina Faso, Côte d'Ivoire, Mali, and Togo. Data collection and analysis were guided and conducted by local research teams, enabling a community-based participatory approach. A coordinating researcher collaborated with these local teams to analyze the data guided by a grounded theory approach. Results The results show that participants were generally positive toward PrEP and that MSM communities have become more aware of PrEP for the study. We identified three main strategies for increasing PrEP uptake. First, participants proposed to raise awareness and improve knowledge of HIV as they considered the self-perceived risk of MSM in their communities to be low. Second, because of existing misconceptions and false information, participants proposed to improve the dissemination of PrEP to allow for informed choices, e.g., via peers or PrEP users themselves. Third, as oral PrEP also entails a risk of being associated with HIV or homosexuality, strategies to avoid stigmatization (e.g., hiding pills) were deemed important. Discussion These findings indicate that the roll-out of oral PrEP and other future PrEP modalities should be accompanied by raising awareness and improving knowledge on HIV, and wide dissemination of information that focuses on the health-promoting aspect of these tools. Tailored delivery and long-acting PrEP modalities will be important to avoid potential stigmatization. Sustained efforts to prevent discrimination and stigmatization based on HIV status or sexual orientation continue to be highly important strategies to address the HIV epidemic in West Africa.
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Affiliation(s)
- Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | | | | | - Daniela Rojas
- Aix Marseille Univ, INSERM, IRD, SESSTIM Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
- Coalition Plus, Community-based Research Laboratory, Pantin, France
| | - August Eubanks
- Aix Marseille Univ, INSERM, IRD, SESSTIM Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | | | - Ter Tiero Elias Dah
- Association African Solidarité, Ouagadougou, Burkina Faso
- UFR Sciences de la Santé, Université de Ouahigouya, Ouahigouya, Burkina Faso
| | | | | | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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14
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Pereira CCDA, Torres TS, Luz PM, Hoagland B, Farias A, Brito JDU, Lacerda MVG, Silva DAR, Benedetti M, Pimenta MC, Grinsztejn B, Veloso VG. Preferences for pre-exposure prophylaxis (PrEP) among sexual and gender minorities: a discrete choice experiment in Brazil. LANCET REGIONAL HEALTH. AMERICAS 2023; 19:100432. [PMID: 36950036 PMCID: PMC10025414 DOI: 10.1016/j.lana.2023.100432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 10/27/2022] [Accepted: 01/10/2023] [Indexed: 02/09/2023]
Abstract
Background Men who have sex with men (MSM) and transgender women (TGW) are disproportionally affected by HIV infection in Latin America. This study aims to assess pre-exposure prophylaxis (PrEP) preferences among sexual and gender minorities (SGM) and identify attributes and levels that are related to PrEP uptake and adherence, both crucial for PrEP success. Methods We conducted a discrete choice experiment (DCE) among SGM from all Brazilian regions (September-December/2020). The survey was administered face-to-face (five Brazilian capitals) and online (entire country). We used a D-efficient zero-prior blocked experimental design to select 60 paired-profile DCE choice tasks. Findings The total sample size was 3924 (90.5% MSM; 7.2% TGW and 2.3% non-binary or gender diverse persons). In random-effects logit models, highest levels of protection and "no side effects" were the most important attribute levels. For "presentation", injectable and implant were preferred over oral. Participants were willing to accept a 4.1% protection reduction to receive injectable PrEP or a 4.2% reduction if PrEP were taken monthly. The largest class in the latent class models was defined predominantly by the preference for the highest HIV protection level (p < 0.005). Respondents in this class also preferred no side effects, injectable and implant presentations. Interpretation Higher HIV protection, no side effects, and presentation, whether injectable or implant, were the most important attributes in PrEP preferences. Protection against HIV was the most important attribute. PrEP programs should make available technologies such as long-acting presentations that could reunite the most desired attributes, thus maximizing acceptability and user-appropriateness. Funding Unitaid.
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Affiliation(s)
| | - Thiago Silva Torres
- Laboratório de Pesquisa Clínica em HIV/AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas – INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Paula Mendes Luz
- Laboratório de Pesquisa Clínica em HIV/AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas – INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Brenda Hoagland
- Laboratório de Pesquisa Clínica em HIV/AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas – INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Alessandro Farias
- Centro Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Salvador, BA, Brazil
| | | | | | - Daila Alena Raenck Silva
- Centro de Testagem e Aconselhamento (CTA) Santa Marta, Secretaria Municipal de Saúde de Porto Alegre, RS, Brazil
| | - Marcos Benedetti
- Laboratório de Pesquisa Clínica em HIV/AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas – INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | | | - Beatriz Grinsztejn
- Laboratório de Pesquisa Clínica em HIV/AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas – INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Valdilea Gonçalves Veloso
- Laboratório de Pesquisa Clínica em HIV/AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas – INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
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15
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Algarin AB, Lara MV, Chapin-Bardales J, Baruch-Dominguez R, Sanchez TH, Hernandez-Avila M, Smith LR. Examining Geographical Differences in the HIV Care Continuum Among Men Who Have Sex with Men in Mexico. AIDS Behav 2023; 27:772-782. [PMID: 36156172 PMCID: PMC9511456 DOI: 10.1007/s10461-022-03809-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 11/30/2022]
Abstract
We analyzed data collected by the Encuesta de Sexo Entre Hombres study from 15,233 Mexican men who have sex with men (MSM) between May-July 2017 to examine differences in the HIV care continuum. Data were stratified into 6 geographical regions. Prevalence ratios assessed associations between region and care outcomes. Among participants never testing HIV positive (n = 13,583), 66.1% had ever been tested and 43.0% in the past year. Among HIV-positive persons (n = 1,650), 83.9% reported counseling post-diagnosis, 61.9% timely linkage to care, 42.4% timely CD4/viral load results, 38.2% timely access to antiretroviral therapy (ART), and 87.7% were currently on ART. The Ciudad de México /Estado de México region had significantly superior care continuum outcomes in ever and recent HIV testing, linkage to care, CD4/viral load results, and current ART use. Understanding geographical variations in HIV care for MSM in Mexico is one important step to inform efforts for ending HIV/AIDS by 2030 in Latin America.
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Affiliation(s)
- Angel B Algarin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive, 92093-0507, La Jolla, CA, USA
| | | | | | | | - Travis H Sanchez
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | | | - Laramie R Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive, 92093-0507, La Jolla, CA, USA.
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16
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Veloso VG, Cáceres CF, Hoagland B, Moreira RI, Vega-Ramírez H, Konda KA, Leite IC, Bautista-Arredondo S, Vinícius de Lacerda M, Valdez Madruga J, Farias A, Lima JN, Zonta R, Lauria L, Tamayo CVO, Flores HJS, Santa Cruz YMC, Aguayo RMM, Cunha M, Moreira J, Makkeda AR, Díaz S, Guanira JV, Vermandere H, Benedetti M, Ingold HL, Pimenta MC, Torres TS, Grinsztejn B, d'Albuquerque P, Palombo C, Alencastro PR, Ito RKDL, Benedetti JL, Maria FV, Luz PM, Freitas L, Geraldo K, Derrico M, Nazer S, Kristic T, Girade R, Lima R, Carvalho AR, Rocha C, Leite P, Lessa M, Santini-Oliveira M, Bezerra DR, Souza CDO, Corrêa J, Alves M, Souza C, Portugal C, Valões MDS, Mota GL, Gomes JA, Falcão CFL, Riberson FF, Melo L, Oliveira TA, Oliveira Júnior AM, Fonseca B, Lannoy LH, Carlos LAS, Cunha JP, Coracini SMDA, Rodrigues TO, Mettrau ERS, Meira KV, Tavares H, Valeiras APNV, Rocha TMADC, Amorim A, Sabadini P, Córdoba LG, Gusmão C, Faustino E, Hansen JSDS, Cunha AM, Nishimura NU, Santos JEFRP, Cano AB, Dias WMT, Tonhon M, Rezende TR, Gomes A, Rodrigues EDS, Carneiro MDDA, Castilho A, Carvalho M, Diaz-Sosa D, Guillen-Diaz-Barriga C, Hernández L, Robles R, Medina-Mora ME, González M, Icelo IH, Davalos AM, Castro JG, Valdez LOO, Barajas FR, González VR, Guadarrama GV, Macías I, Sánchez JT, Noriega JPO, Moheno M HR, Ramírez JMB, Juarez VDG, Vizcaíno G, Arjona FJ, Calvo G, Vargas S, Elorreaga O, Gutierrez X, Olivos F, Caviedes D, Adriazola D, Juárez E, Mariño G, Qquellon J, Vasquez F, Jiron JP, Flores S, Campos K. Same-day initiation of oral pre-exposure prophylaxis among gay, bisexual, and other cisgender men who have sex with men and transgender women in Brazil, Mexico, and Peru (ImPrEP): a prospective, single-arm, open-label, multicentre implementation study. Lancet HIV 2023; 10:e84-e96. [PMID: 36565708 PMCID: PMC9889521 DOI: 10.1016/s2352-3018(22)00331-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/29/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although gay, bisexual, and other cisgender men who have sex with men (MSM) and transgender women have the highest HIV burden in Latin America, pre-exposure prophylaxis (PrEP) implementation is poor. We aimed to assess the feasibility of same-day oral PrEP delivery in Brazil, Mexico, and Peru. METHODS Implementation PrEP (ImPrEP) was a prospective, single-arm, open-label, multicentre PrEP implementation study conducted in Brazil (14 sites), Mexico (four sites), and Peru (ten sites). MSM and transgender women were eligible to participate if they were aged 18 years or older, HIV-negative, and reported one or more prespecified criteria. Enrolled participants received same-day initiation of daily oral PrEP (tenofovir disoproxil fumarate [300 mg] coformulated with emtricitabine [200 mg]). Follow-up visits were scheduled at week 4 and quarterly thereafter. We used logistic regression models to identify factors associated with early loss to follow-up (not returning after enrolment), PrEP adherence (medication possession ratio ≥0·6), and long-term PrEP engagement (attending three or more visits within 52 weeks). This study is registered at the Brazilian Registry of Clinical Trials, U1111-1217-6021. FINDINGS From Feb 6, 2018, to June 30, 2021, 9979 participants were screened and 9509 were enrolled (Brazil n=3928, Mexico n=3288, and Peru n=2293). 543 (5·7%) participants were transgender women, 8966 (94·3%) were cisgender men, and 2481 (26·1%) were aged 18-24 years. There were 12 185·25 person-years of follow-up. 795 (8·4%) of 9509 participants had early loss to follow-up, 6477 (68·1%) of 9509 were adherent to PrEP, and 5783 (70·3%) of 8225 had long-term PrEP engagement. Transgender women (adjusted odds ratio 1·60, 95% CI 1·20-2·14), participants aged 18-24 years (1·80, 1·49-2·18), and participants with primary education (2·18, 1·29-3·68) had increased odds of early loss to follow-up. Transgender women (0·56, 0·46-0·70), participants aged 18-24 years (0·52, 0·46-0·58), and those with primary education (0·60, 0·40-0·91) had lower odds of PrEP adherence. Transgender women (0·56, 0·45-0·71), participants aged 18-24 years (0·56, 0·49-0·64), and those with secondary education (0·74, 0·68-0·86) had lower odds of long-term PrEP engagement. HIV incidence was 0·85 per 100 person-years (95% CI 0·70-1·03) and was higher for transgender women, participants from Peru, those aged 18-24 years, Black and mixed-race participants, and participants who were non-adherent to PrEP. INTERPRETATION Same-day oral PrEP is feasible for MSM and transgender women in Latin America. Social and structural determinants of HIV vulnerability need to be addressed to fully achieve the benefits of PrEP. FUNDING Unitaid, WHO, and Ministries of Health in Brazil, Mexico, and Peru. TRANSLATIONS For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Valdiléa G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil.
| | - Carlos F Cáceres
- Universidad Peruana Cayetano Heredia, Centro de Investigaciones Interdisciplinarias em Salud, Sexualidad, y SIDA, Lima, Peru
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Ronaldo I Moreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Hamid Vega-Ramírez
- Instituto Nacional de Psiquiatria Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Kelika A Konda
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Iuri C Leite
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP-Fiocruz), Rio de Janeiro, Brazil
| | | | | | | | - Alessandro Farias
- CEDAP-Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa, Salvador, Brazil
| | - Josué N Lima
- Centro de Referência em DST/AIDS-AMDA, Campinas, Brazil
| | | | - Lilian Lauria
- Hospital Municipal Rocha Maia, Rio de Janeiro, Brazil
| | - Cesar Vidal Osco Tamayo
- Centro de Referencia de Infecciones de Transmisión Sexual del Centro Materno Infantil Tahuantinsuyo Bajo, Lima, Peru
| | | | | | | | - Marcelo Cunha
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP-Fiocruz), Rio de Janeiro, Brazil
| | - Júlio Moreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Alessandra Ramos Makkeda
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Steven Díaz
- United Nations Population Fund, Mexico City, Mexico
| | - Juan V Guanira
- Universidad Peruana Cayetano Heredia, Centro de Investigaciones Interdisciplinarias em Salud, Sexualidad, y SIDA, Lima, Peru
| | | | - Marcos Benedetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | | | | | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
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Torres TS, Nascimento AR, Coelho LE, Konda KA, Vega-Ramirez EH, Elorreaga OA, Diaz-Sosa D, Hoagland B, Guanira JV, Pimenta C, Benedetti M, Caceres CF, Veloso VG, Grinsztejn B. Preferences for PrEP modalities among gay, bisexual, and other men who have sex with men from Brazil, Mexico, and Peru: a cross-sectional study. Ther Adv Infect Dis 2023; 10:20499361231153548. [PMID: 36814515 PMCID: PMC9940158 DOI: 10.1177/20499361231153548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/11/2023] [Indexed: 02/20/2023] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) scale-up is urgent to reduce new HIV cases among gay, bisexual, and other men who have sex with men (MSM) in Latin America. Different PrEP modalities may increase PrEP uptake and adherence, especially among young MSM. Objectives To assess preferences for PrEP modalities among MSM from Brazil, Mexico, and Peru. Design Cross-sectional web-based study (March-May 2018) targeting MSM through advertisements on Grindr, Hornet, and Facebook. We included MSM aged ⩾ 18 years and who reported HIV-negative status. Methods We assessed preferences for PrEP modalities with the following question: 'Considering that all following PrEP modalities were available, which one would you prefer considering a scale from 1 to 3 (1 = most preferred): daily oral PrEP, event-driven PrEP (ED-PrEP), and long-acting injectable PrEP'. We assessed factors associated with each most preferred PrEP modality per country using multivariable logistic regression models. Results A total of 19,457 MSM completed the questionnaire (Brazil: 58%; Mexico: 31%; Peru: 11%); median age was 28 years [interquartile range (IQR): 24-34]. Overall, injectable PrEP was the most preferred modality [42%; 95% confidence interval (CI): 41-43], followed by daily PrEP (35%; 95% CI: 34-35), and ED-PrEP (23%; 95% CI: 23-24). In multivariable models, preferring injectable PrEP was associated with PrEP awareness in all three countries, while PrEP eligibility only in Brazil. Preferring daily PrEP was associated with younger age and lower income in Brazil and Mexico, and lower education only in Brazil. The odds of preferring ED-PrEP were lower among MSM aware and eligible for PrEP in Brazil and Mexico. Conclusions Long-acting injectable PrEP was the preferred PrEP modality among MSM in Brazil, Mexico, and Peru, especially those aware and eligible for PrEP. Public health interventions to increase PrEP modalities literacy and availability in Latin America are urgent especially among MSM of young age, lower income, and lower education.
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Affiliation(s)
- Thiago S. Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Avenida Brasil, 4365 Manguinhos, Rio de Janeiro 21040-360, Brazil
| | - Alessandro R. Nascimento
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Lara E. Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | | | | | | | - Dulce Diaz-Sosa
- National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | | | | | - Marcos Benedetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | | | - Valdilea G. Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
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Bezerra DRB, Jalil CM, Jalil EM, Coelho LE, Netto EC, Freitas J, Monteiro L, Santos T, Souza C, Hoagland B, Veloso VG, Grinsztejn B, Cardoso SW, Torres TS. Comparing Web-Based Venues to Recruit Gay, Bisexual, and Other Cisgender Men Who Have Sex With Men to a Large HIV Prevention Service in Brazil: Evaluation Study. JMIR Form Res 2022; 6:e33309. [PMID: 35925658 PMCID: PMC9389387 DOI: 10.2196/33309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Internet and mobile phones, widely available in Brazil, could be used to disseminate information about HIV prevention and to recruit gay, bisexual, and other cisgender men who have sex with men (MSM) to HIV prevention services. Data evaluating the characteristics of MSM recruited through different web-based strategies and estimating their cost and yield in the country are not available.
Objective
We aimed to describe a web-based recruitment cascade, compare the characteristics of MSM recruited to a large HIV prevention service in Rio de Janeiro according to web-based venues, and estimate the cost per participant for each strategy.
Methods
We promoted advertisements on geosocial networking (GSN) apps (Hornet and Grindr) and social media (Facebook and Instagram) from March 2018 to October 2019. The advertisements invited viewers to contact a peer educator to schedule a visit at the HIV prevention service. Performance of web-based recruitment cascade was based on how many MSM (1) were reached by the advertisement, (2) contacted the peer educator, and (3) attended the service. We used chi-square tests to compare MSM recruited through GSN apps and social media. The estimated advertisement cost to recruit a participant was calculated by dividing total advertisement costs by number of participants who attended the service or initiated preexposure prophylaxis (PrEP).
Results
Advertisement reached 1,477,344 individuals; 1270 MSM contacted the peer educator (86 contacts per 100,000 views)—564 (44.4%), 401 (31.6%) and 305 (24.0%)—through social media, Grindr, and Hornet. Among the 1270 individuals who contacted the peer educator, 36.3% (n=461) attended the service with similar proportion for each web-based strategy (social media: 203/564, 36.0%; Grindr: 152/401, 37.9%; and Hornet: 107/305, 35.1%). MSM recruited through GSN apps were older (mean age 30 years vs 26 years; P<.001), more frequently self-reported as White (111/247, 44.9% vs 62/191, 32.5%; P=.03), and had higher schooling level (postsecondary: 157/254, 61.8% vs 94/194, 48.5%; P=.007) than MSM recruited through social media. GSN apps recruited MSM with higher HIV risk as measured by PrEP eligibility (207/239, 86.6% vs 133/185, 71.9%; P<.001) compared with social media, but there was no difference in PrEP uptake between the two strategies (P=.22). The estimated advertisement costs per participant attending the HIV prevention service were US $28.36 for GSN apps and US $12.17 for social media. The estimated advertisement costs per participant engaging on PrEP were US $58.77 for GSN apps and US $27.75 for social media.
Conclusions
Social media and GSN app advertisements were useful to disseminate information on HIV prevention strategies and to recruit MSM to a large HIV prevention service in Brazil. Compared to GSN apps, social media advertisements were less expensive and reached more vulnerable and younger MSM. Digital marketing campaigns should use different and complementary web-based venues to reach a plurality of MSM.
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Affiliation(s)
| | - Cristina Moreira Jalil
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Emilia Moreira Jalil
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Lara Esteves Coelho
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | | | - Josias Freitas
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Laylla Monteiro
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Toni Santos
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Cleo Souza
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Brenda Hoagland
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | | | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Sandra Wagner Cardoso
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Thiago Silva Torres
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
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Martins TLS, Silva GRDCE, Silva CDA, Gomes DO, Diniz e Silva BV, Carneiro MADS, Pacheco LR, de Araujo NM, Zanchetta MS, Teles SA, Caetano KAA. Hepatitis B and C in Immigrants and Refugees in Central Brazil: Prevalence, Associated Factors, and Immunization. Viruses 2022; 14:1534. [PMID: 35891514 PMCID: PMC9321471 DOI: 10.3390/v14071534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/15/2022] [Accepted: 07/11/2022] [Indexed: 01/27/2023] Open
Abstract
Introduction: Eliminating hepatitis B and C in immigrant and refugee populations is a significant challenge worldwide. Given the lack of information in Brazil, this study aimed to estimate the prevalence of infections caused by hepatitis B and C viruses and factors associated with hepatitis B in immigrants and refugees residing in central Brazil. Methods: An observational, cross-sectional, and analytical study was conducted from July 2019 to January 2020 with 365 immigrants and refugees. Hepatitis B was detected by a rapid immunochromatographic test, enzyme immunoassay, and chemiluminescence, and hepatitis C by rapid immunochromatographic test. Multiple analysis was used to assess factors associated with hepatitis B infection. Results: Of the participants, 57.8% were from Haiti and 35.6% were from Venezuela. Most had been in Brazil for less than 2 years (71.2%). The prevalence of HBV infection and exposure was 6.6% (95% CI: 4.5-9.6%) and 27.9% (95% CI: 23.6-2.8%), respectively, and 34% had isolated anti-HBs positivity. Reporting a sexually transmitted infection was statistically associated with HBV infection (OR: 7.8; 95% CI: 2.3-26.4). No participant with positive anti-HCV serology was found. Conclusions: The study showed that participants were outside the reach of prevention and control actions for hepatitis B. Therefore, public health strategies must be designed to reach, inform, and vaccinate this group.
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Affiliation(s)
- Thaynara Lorrane Silva Martins
- Faculty of Nursing, Federal University of Goias, Goiania 74605-080, Brazil; (T.L.S.M.); (G.R.d.C.e.S.); (C.d.A.S.); (D.O.G.); (L.R.P.); (S.A.T.)
| | - Grazielle Rosa da Costa e Silva
- Faculty of Nursing, Federal University of Goias, Goiania 74605-080, Brazil; (T.L.S.M.); (G.R.d.C.e.S.); (C.d.A.S.); (D.O.G.); (L.R.P.); (S.A.T.)
| | - Carla de Almeida Silva
- Faculty of Nursing, Federal University of Goias, Goiania 74605-080, Brazil; (T.L.S.M.); (G.R.d.C.e.S.); (C.d.A.S.); (D.O.G.); (L.R.P.); (S.A.T.)
| | - Davi Oliveira Gomes
- Faculty of Nursing, Federal University of Goias, Goiania 74605-080, Brazil; (T.L.S.M.); (G.R.d.C.e.S.); (C.d.A.S.); (D.O.G.); (L.R.P.); (S.A.T.)
| | - Bruno Vinícius Diniz e Silva
- Institute of Tropical Medicine and Public Health, Federal University of Goias, Goiania 74605-050, Brazil; (B.V.D.e.S.); (M.A.d.S.C.)
| | | | - Leonora Rezende Pacheco
- Faculty of Nursing, Federal University of Goias, Goiania 74605-080, Brazil; (T.L.S.M.); (G.R.d.C.e.S.); (C.d.A.S.); (D.O.G.); (L.R.P.); (S.A.T.)
| | | | | | - Sheila Araujo Teles
- Faculty of Nursing, Federal University of Goias, Goiania 74605-080, Brazil; (T.L.S.M.); (G.R.d.C.e.S.); (C.d.A.S.); (D.O.G.); (L.R.P.); (S.A.T.)
| | - Karlla Antonieta Amorim Caetano
- Faculty of Nursing, Federal University of Goias, Goiania 74605-080, Brazil; (T.L.S.M.); (G.R.d.C.e.S.); (C.d.A.S.); (D.O.G.); (L.R.P.); (S.A.T.)
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Barbosa AKP, Monteiro P, Montenegro D, Batista JDL, Montarroyos UR. HIV Pre-Exposure Prophylaxis (PrEP) in a Brazilian Clinical Setting: Adherence, Adverse Events, Sexual Behavior, and Sexually Transmitted Infections. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2603-2611. [PMID: 35039983 DOI: 10.1007/s10508-021-02112-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 06/14/2023]
Abstract
Tenofovir/emtricitabine (TDF/FTC) has been used as pre-exposure prophylaxis (PrEP) in preventing HIV infection. PrEP is an effective prevention tool as demonstrated in clinical trials and studies in clinical practice and was incorporated into the Brazilian public health system in December 2017. The present study was a prospective cohort that included 219 PrEP users monitored over a 10 month follow-up period in a capital city in Northeastern Brazil. Data were collected from the PrEP users' electronic medical records platform made available by the Brazilian Health Ministry. During the observation period, there was good user retention to the prevention program (84%) and there was high adherence to medication (90%). Almost half the users (49%) presented an adverse event, although these were mild and transient, 30 days after starting prophylaxis. There was a significant reduction in creatinine clearance (p < .001), from 104.9 to 83.5 mL/min; however, there was no need for drug discontinuation. Throughout the cohort, there was no significant change in the number of sexual partners, but the use of condoms during sexual intercourse decreased (p < .001). There was a non-significant increase in the incidence of syphilis (p = .08), and there was a 50% decrease in reporting signs and symptoms of sexually transmitted infections. No cases of HIV infection were observed. PrEP proved to be an effective tool in HIV prevention, presenting few complications of adverse events.
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Affiliation(s)
- Ana Karina Pinto Barbosa
- Infectious Diseases Service, Faculty of Medical Sciences, University of Pernambuco, Rua Ceará 121, Apto 2503, Encruzilhada, Recife, PE, 52041-130, Brazil.
| | - Polyana Monteiro
- Infectious Diseases Service, Faculty of Medical Sciences, University of Pernambuco, Rua Ceará 121, Apto 2503, Encruzilhada, Recife, PE, 52041-130, Brazil
| | - Demétrius Montenegro
- Infectious Diseases Service, Faculty of Medical Sciences, University of Pernambuco, Rua Ceará 121, Apto 2503, Encruzilhada, Recife, PE, 52041-130, Brazil
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Seabra IL, Pedroso AO, Rodrigues TB, Ferreira GRON, da Silva Ferreira AL, Arcêncio RA, Gomes D, da Silva RAR, Botelho EP. Temporal trend and spatial analysis of the HIV epidemic in young men who have sex with men in the second largest Brazilian Amazonian province. BMC Infect Dis 2022; 22:190. [PMID: 35209850 PMCID: PMC8867691 DOI: 10.1186/s12879-022-07177-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background After 40 years of its starting, the HIV epidemic in Brazilian Amazon region remains on an increasing trend. The young men who have sex with men (MSM) have been the most impacted by the HIV in the last decade. However, much more than attributing the risk behavior to HIV uniquely to the individual, behaviors are shaped by social determinants of health (SDH). Despite the problem, there is a scarcity of studies evaluating the impact of SDH on HIV among young MSM and none of them were done in the Northern of Brazil. Therefore, the main goal of this study was to analyse the HIV epidemic among Brazilian Amazonian young MSM using temporal trends and spatial analysis. Methods We conducted an ecological study using reported cases of HIV/AIDS in young MSM living in Pará, the second larger Brazilian Amazonian province, between 2007 and 2018. Data were obtained from the Information System for Notifiable Diseases. For the temporal analysis, we employed a Seasonal and Trend decomposition using Loess Forecasting model (STLF), which is a hybrid time-series forecast model, that combines the Autoregressive-Integrated Moving Average (ARIMA) forecasting model with the Seasonal-Trend by Loess (STL) decomposition method. For the spatial analysis, Moran’s spatial autocorrelation, spatial scan, and spatial regression techniques were used. Results A total of 2192 notifications were included in the study. Greater variabilities in HIV/AIDS population-level diagnosis rates were found in the festive months. The HIV/AIDS population-level diagnosis rates exhibited an upward trend from 2013 and this trend is forecasted to continue until 2022. Belém, the capital of Pará, presented the highest spatial risk for HIV/AIDS and was the only city to present spatiotemporal risk from 2014 to 2018. The geographic variation of the HIV epidemic was associated with the number of men with formal jobs, the average salary of men, and the percentage of people over 18 years old with elementary education. Conclusion The upward trend of HIV/AIDS population-level diagnosis rate forecasted until 2022 and the variability of the epidemic promoted by the SDH brings an alert and subsidies to health authorities to implement more efficient and focalized public policies against HIV among young MSM in Pará.
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Affiliation(s)
- Iaron Leal Seabra
- Universidade Federal do Pará, Programa de Pós-Graduação em Enfermagem, Rua Augusto Correia, 01 - Setor saúde, GuamáBelém, 66075-110, Pará, Brasil
| | - Andrey Oeiras Pedroso
- Universidade Federal do Pará, Programa de Pós-Graduação em Enfermagem, Rua Augusto Correia, 01 - Setor saúde, GuamáBelém, 66075-110, Pará, Brasil
| | - Taymara Barbosa Rodrigues
- Universidade Federal do Pará, Programa de Pós-Graduação em Enfermagem, Rua Augusto Correia, 01 - Setor saúde, GuamáBelém, 66075-110, Pará, Brasil
| | | | - Ana Lucia da Silva Ferreira
- Departamento de Vigilância Epidemiológica, Secretaria de Saúde Pública do Pará, Av. Doutor Freitas, 235 Sacramenta, 66123-050, Belém, Pará, Brasil
| | - Ricardo Alexandre Arcêncio
- Maternal-Infant and Public Health Nursing Departament, University of São Paulo, College of Nursing at Ribeirão Preto, Avenida Dos Bandeirantes, 3900 - Campus Universitário, Monte Alegre, 14040-902, Ribeirão Preto, São Paulo, Brasil
| | - Dulce Gomes
- Departamento de Matemática, Colégio Luís António Verney, Universidade de Évora, Rua Romão Ramalho,, 597000-671, Évora, Portugal
| | - Richardson Augusto Rosendo da Silva
- Departamento de Enfermagem, Centro de Ciências da Saúde,, Universidade Federal do Rio Grande do Norte, Rua General Cordeiro de Faria, S/N. Petrópolis, 59012-570, Natal, Rio Grande do Norte, Brasil
| | - Eliã Pinheiro Botelho
- Universidade Federal do Pará, Programa de Pós-Graduação em Enfermagem, Rua Augusto Correia, 01 - Setor saúde, GuamáBelém, 66075-110, Pará, Brasil.
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22
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Bezerra DRB, Jalil CM, Jalil EM, Coelho LE, Carvalheira E, Freitas J, Monteiro L, Santos T, Souza C, Hoagland B, Veloso VG, Grinsztejn B, Cardoso SW, Torres TS. Complementary Recruitment Strategies to Reach Men Who Have Sex with Men and Transgender Women: The Experience of a Large Brazilian HIV Prevention Service. AIDS Behav 2022; 26:2643-2652. [PMID: 35122578 DOI: 10.1007/s10461-022-03609-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/29/2022]
Abstract
Different strategies have been used to reach men who have sex with men (MSM) and transgender women (TGW) for HIV prevention services. We described the characteristics of MSM and TGW attending a large HIV prevention service in Brazil according to different recruitment strategies or referrals. A total of 2713 individuals (2246[82.8%] MSM and 467[17.2%] TGW) attended the service. Among HIV-negative MSM and TGW, 74.6% and 82.8% were eligible for pre-exposure prophylaxis (PrEP), respectively. PrEP uptake among MSM and TGW was 56.4% and 39.1%, respectively. Participants were mostly referred by peers (43.6%), followed by web-based (24.1%) and venue-based recruitment (16.2%). More young and Black MSM were referred from venue-based recruitment, and web-based strategies more frequently referred MSM with higher education. TGW who were younger and had higher education were more frequently referred from venue-based recruitment. Web-based recruitment failed to reach TGW. Multiple strategies were complementary to reach diverse MSM and TGW populations.
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Affiliation(s)
- Daniel R B Bezerra
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Cristina M Jalil
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Emilia M Jalil
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Lara E Coelho
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Eduardo Carvalheira
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Josias Freitas
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Laylla Monteiro
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Toni Santos
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Cleo Souza
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Brenda Hoagland
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Valdilea G Veloso
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Beatriz Grinsztejn
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Sandra W Cardoso
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Thiago S Torres
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil.
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23
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High Rates of Sexualized Drug Use or Chemsex among Brazilian Transgender Women and Young Sexual and Gender Minorities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031704. [PMID: 35162728 PMCID: PMC8835457 DOI: 10.3390/ijerph19031704] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/17/2022]
Abstract
(1) Background: We aimed to estimate sexualized drug use (SDU) prevalence and its predictors among sexual and gender minorities. (2) Methods: We used an online and on-site survey to enroll sexual/gender minorities people between October-December/2020, and multivariate logistic regression to obtain SDU correlates. (3) Results: We enrolled 3924 individuals (280 transgender women [TGW], 3553 men who have sex with men [MSM], and 91 non-binary), 29.0% currently on pre-exposure prophylaxis (PrEP). SDU prevalence was 28.8% (95% confidence interval [CI] 27.4-30.2). TGW had 2.44-times increased odds (95%CI 1.75-3.39) of engaging in SDU compared to MSM, regardless of PrEP use. PrEP use (aOR 1.19, 95%CI 1.00-1.41), South/Southeast region (aOR 1.26, 95%CI 1.04-1.53), younger age (18-24 years: aOR 1.41, 95%CI 1.10-1.81; 25-35 years: aOR 1.24, 95%CI 1.04-1.53), white race/color (aOR 1.21, 95%CI 1.02-1.42), high income (aOR 1.32, 95%CI 1.05-1.67), binge drinking (aOR 2.66, 95%CI 2.25-3.14), >5 sexual partners (aOR 1.88, 95%CI 1.61-2.21), condomless anal sex (aOR 1.49, 95%CI 1.25-1.79), self-reported sexually transmitted infection (aOR 1.40, 95%CI 1.14-1.71), and higher perceived HIV-risk (aOR 1.37, 95%CI 1.14-1.64) were associated with SDU. (4) Conclusions: TGW had the highest SDU odds. SDU may impact HIV vulnerability among key populations and should be addressed in HIV prevention approaches.
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Blair KJ, Torres TS, Hoagland B, Bezerra DR, Veloso VG, Grinsztejn B, Clark J, Luz PM. Pre-exposure prophylaxis use, HIV knowledge, and internalized homonegativity among men who have sex with men in Brazil: A cross-sectional study. LANCET REGIONAL HEALTH. AMERICAS 2022; 6:100152. [PMID: 35291206 PMCID: PMC8920052 DOI: 10.1016/j.lana.2021.100152] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Pre-exposure prophylaxis (PrEP) use in Brazil remains low despite free national access. We explored associations of HIV knowledge and internalized homonegativity with PrEP use among PrEP-eligible men who have sex with men (MSM). Methods Brazilian Hornet users completed an online, cross-sectional survey in February-March 2020. We included cis-men ≥18 years old who reported recent sex with men and were PrEP-eligible per the following: condomless anal intercourse, partner(s) living with HIV, transactional sex, and/or sexually transmitted infection. Our outcome was current PrEP use, defined by the response, "I am currently taking PrEP." Key predictors included the HIV/AIDS Knowledge Assessment (HIV-KA) and Reactions to Homosexuality Scale (RHS); higher scores indicate greater knowledge and greater internalized homonegativity, respectively. Scales were standardized for analysis. Associations with current PrEP use were estimated using adjusted odds ratios (aOR) with 95% confidence intervals (95%CI). Findings Among 2398 PrEP-eligible MSM, n = 370 (15·4%) reported current PrEP use. Increasing HIV-KA scores were associated with greater odds of PrEP use (aOR 1·70 [95%CI 1·41-2·04], p < 0·001), and increasing RHS scores with lower odds of PrEP use (aOR 0·83 [95%CI 0·73-0·96], p = 0·010). PrEP use was lower among 18-24 versus 40+-years-old MSM (aOR 0·43 [95%CI 0·27-0·69], p = 0·005), and in Black versus White/Asian respondents (aOR 0·51 [95%CI 0·31-0·85], p = 0·040). Interpretation Among PrEP-eligible Brazilian MSM, HIV knowledge was associated with increased PrEP use and internalized homonegativity with decreased use. Wider dissemination of HIV prevention knowledge and addressing stigma experienced by MSM could promote increased PrEP use. Funding National Institute of Mental Health, Fiocruz, Conselho Nacional de Desenvolvimento Científico e Tecnológico.
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Affiliation(s)
- Kevin J. Blair
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
- Department of Surgery, UCLA, 10833 Le Conte Ave, 72-227 CHS, Los Angeles, CA 90095, USA
| | - Thiago S. Torres
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Brenda Hoagland
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Daniel R.B. Bezerra
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Valdilea G. Veloso
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Jesse Clark
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Paula M. Luz
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
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25
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Trang K, Le LX, Brown CA, To MQ, Sullivan PS, Jovanovic T, Worthman CM, Giang LM. Feasibility, Acceptability, and Design of a Mobile Ecological Momentary Assessment for High-Risk Men Who Have Sex With Men in Hanoi, Vietnam: Qualitative Study. JMIR Form Res 2022; 6:e30360. [PMID: 35084340 PMCID: PMC8950985 DOI: 10.2196/30360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/28/2021] [Accepted: 11/21/2021] [Indexed: 12/26/2022] Open
Abstract
Background Men who have sex with men (MSM) are at a disproportionate risk for HIV infection and common mental disorders worldwide. In the context of HIV, common mental disorders are important and are frequent drivers of suboptimal prevention and treatment outcomes. Mobile ecological momentary assessments (EMAs), or the repeated sampling of people’s behaviors and psychological states in their daily lives using mobile phones, can clarify the triggers and HIV-related sequelae of depressive-anxious symptoms and contribute toward the design of ecological momentary interventions (EMIs) that cater to the contextually varying needs of individuals to optimize prevention and treatment outcomes. Objective This study aims to characterize the feasibility and acceptability of mobile EMA among high-risk MSM in Hanoi, Vietnam. It aims to evaluate the perceived relevance, usability, and concerns of this group with regard to the content and delivery of mobile EMA and the potential of leveraging such platforms in the future to deliver EMIs. Methods Between January and April 2018, a total of 46 participants were recruited. The participants completed 6 to 8 mobile EMA surveys daily for 7 days. Surveys occurred once upon waking, 4 to 6 times throughout the day, and once before sleeping. All surveys queried participants’ perceived safety, social interactions, psychological state, and mental health symptoms. The morning survey further queried on sleep and medication use within the past 24 hours, whereas the night survey queried on sexual activity and substance use and allowed participants to share an audio recording of a stressful experience they had that day. At the end of the week, participants were interviewed about their experiences with using the app. Results Participants completed an average of 21.7 (SD 12.7) prompts over the 7-day period. Excluding nonresponders, the average compliance rate was 61.8% (SD 26.6%). A thematic analysis of qualitative interviews suggested an overall positive reception of the app and 5 recurring themes, which were centered on the relevance of psychological and behavioral items to daily experiences (eg, mental health symptoms and audio recording), benefits of using the app (eg, increased self-understanding), worries and concerns (eg, privacy), usability (eg, confusion about the interface), and recommendations for future design (eg, integrating more open-ended questions). Conclusions Mobile EMA is feasible and acceptable among young MSM in Vietnam; however, more research is needed to adapt EMA protocols to this context and enhance compliance. Most participants eagerly provided information about their mental health status and daily activities. As several participants looked toward the app for further mental health and psychosocial support, EMIs have the potential to reduce HIV and mental health comorbidity among MSM.
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Affiliation(s)
- Kathy Trang
- Global TIES for Children, New York University, New York City, NY, United States
| | - Lam X Le
- Vietnam National University, Hanoi, Vietnam
| | | | - Margaret Q To
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA, United States
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neuroscience, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Carol M Worthman
- Department of Anthropology, Emory University, Atlanta, GA, United States
| | - Le Minh Giang
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
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26
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Torres TS, Jalil EM, Coelho LE, Bezerra DRB, Jalil CM, Hoagland B, Cardoso SW, Arayasirikul S, Veloso VG, Wilson EC, McFarland W, Grinsztejn B. A Technology-Based Intervention Among Young Men Who Have Sex With Men and Nonbinary People (The Conectad@s Project): Protocol for A Vanguard Mixed Methods Study. JMIR Res Protoc 2022; 11:e34885. [PMID: 35023848 PMCID: PMC8796043 DOI: 10.2196/34885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND In many parts of the world, including Brazil, uptake for biomedical interventions has been insufficient to reverse the HIV epidemic among key populations at high risk for HIV, including men who have sex with men. Young MSM (YMSM), particularly Black YMSM, have high HIV incidence, low viral suppression, and low preexposure prophylaxis (PrEP) uptake and adherence. Therefore, novel approaches to increase the HIV biomedical interventions uptake by YMSM are urgently needed. OBJECTIVE We describe the Conectad@s Project, which aims to: (1) estimate the prevalence and incidence of HIV and other sexually transmitted infections, the onset of sexual risk behavior, and barriers to biomedical interventions among YMSM aged 18 to 24 years in Rio de Janeiro, Brazil; and (2) conduct a technology-based adherence intervention study to promote a rapid linkage of YMSM to HIV care or prevention, and support and sustain adherence. METHODS A cross-sectional survey will be conducted with 400 YMSM recruited using respondent-driven sampling (RDS) adapted for social media-based sampling, preceded by a formative phase. HIV and sexually transmitted infections testing will be conducted, including early HIV infection biomarker detection. Behavioral, partnership, network, and structural measures will be collected through structured questionnaires. All individuals recruited for the survey will have access to HIV risk assessment, antiretroviral therapy (ART), PrEP, prevention counseling, and a technology-based adherence intervention. Those who accept the adherence intervention will receive weekly text messages via a social networking app (WhatsApp) for 24 weeks, with follow-up data collected over 48 weeks. RESULTS The Conectad@s project has been approved by our local institutional review board (#CAAE 26086719.0.0000.4262) in accordance with all applicable regulations. Questionnaires for the RDS survey and intervention were developed and tested in 2020, formative interviews were conducted in January and February 2021 to guide the development of the RDS, and enrollment is planned to begin in early 2022. CONCLUSIONS The Conectad@s Project is a vanguard study that, for the first time, will apply digital RDS to sample and recruit YMSM in Brazil and rapidly connect them to ART, PrEP, or prevention counseling through a technology-based adherence intervention. RDS will allow us to estimate HIV prevalence among YMSM and measure HIV infection biomarkers in the context of the onset of risky behavior. The data will lay the groundwork to adapt and implement HIV prevention strategies, identify barriers to the earliest HIV infection diagnosis, immediate ART or PrEP initiation, and detect new clusters of HIV transmission. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/34885.
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Affiliation(s)
- Thiago Silva Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Emilia Moreira Jalil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Lara Esteves Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Cristina Moreira Jalil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Sandra Wagner Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Sean Arayasirikul
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | | | - Erin C Wilson
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Willi McFarland
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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27
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Elorreaga OA, Torres TS, Vega-Ramirez EH, Konda KA, Hoagland B, Benedetti M, Pimenta C, Diaz-Sosa D, Robles-Garcia R, Grinsztejn B, Caceres CF, Veloso VG. Awareness, willingness and barriers to HIV Self-testing (HIVST) among Men who Have Sex with Men (MSM) in Brazil, Mexico, and Peru: A web-based cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000678. [PMID: 36962436 PMCID: PMC10021908 DOI: 10.1371/journal.pgph.0000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/30/2022] [Indexed: 11/18/2022]
Abstract
HIV self-testing (HIVST) is an essential tool within the combined HIV prevention package and has been available in Latin America since 2015. However, HIVST use among key populations remains low. This study describes awareness, willingness, and barriers to HIVST among MSM in Brazil, Mexico, and Peru. A cross-sectional web-based survey was advertised in two geosocial networking apps (Grindr and Hornet) and Facebook in 2018. We included cisgender men ≥18 years old who self-reported HIV-negative status. We used multivariable Poisson regression models to calculate adjusted prevalence ratios (aPR) to assess the factors associated with willingness to use HIVST for each country. A total of 18,916 completed the survey, 59% from Brazil, 30% from Mexico, and 11% from Peru. Overall, 20% of MSM had never tested for HIV. Awareness and willingness to use HIVST were higher in Brazil than in Peru and Mexico (p < .001). Across the countries, the patterns of association of willingness with HIVST barriers were similar. Most participants think post-test counseling is essential and that dealing with a positive result would be difficult (aPR 1.13 to 1.37, range of aPRs across the three countries). Having the knowledge to deal with a positive HIVST resulted in increased willingness to use HIVST (aPR range: 1.11 to 1.22), while a lack of trust in HIVST compared to HIV testing in clinics was inversely associated (aPR range: 0.80 to 0.90). In general, willingness to use HIVST was associated with higher income (aPR range: 1.49 to 1.97), higher education (aPR range: 1.13 to 1.42), and willingness to use PrEP (aPR range: 1.19 to 1.72). Efforts to increase HIVST knowledge and resolve perceived barriers are warranted, especially among MSM with lower income and education from Brazil, Mexico, and Peru. Personalized virtual counseling could be crucial among this population. In addition, those willing to use HIVST are also willing to use PrEP. It indicates that HIVST delivery could be incorporated into PrEP programs within the Brazilian Public Health System and eventually in Mexico and Peru.
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Affiliation(s)
- Oliver A Elorreaga
- Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | | | - Kelika A Konda
- Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Marcos Benedetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Cristina Pimenta
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Dulce Diaz-Sosa
- National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico DF, Mexico
| | | | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Carlos F Caceres
- Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
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28
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Ito H, Yamamoto T, Morita S. The effect of men who have sex with men (MSM) on the spread of sexually transmitted infections. Theor Biol Med Model 2021; 18:18. [PMID: 34635123 PMCID: PMC8504019 DOI: 10.1186/s12976-021-00148-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022] Open
Abstract
Sexually transmitted infections (STIs) have remained a worldwide public health threat. It is difficult to control the spread of STIs, not only because of heterogeneous sexual transmission between men and women but also because of the complicated effects of sexual transmission among men who have sex with men (MSM) and mother-to-child transmission. Many studies point to the existence of a ‘bisexual bridge’, where STIs spread from the MSM network via bisexual connections. However, it is unclear how the MSM network affects heterosexual networks as well as mother-to-child transmission. To analyse the effect of MSM on the spread of STIs, we divided the population into four subpopulations: (i) women, (ii) men who have sex with women only (MSW), (iii) men who have sex with both men and women (MSMW), (iv) men who have sex with men exclusively (MSME). We calculated the type-reproduction numbers of these four subpopulations, and our analysis determined what preventive measures may be effective. Our analysis shows the impact of bisexual bridge on the spread of STIs does not outweigh their population size. Since MSM and mother-to-child transmission rates do not have a strong synergistic effect when combined, complementary prevention measures are needed. The methodologies and findings we have provided here will contribute greatly to the future development of public health.
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Affiliation(s)
- Hiromu Ito
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Nagasaki, 852-8523, Japan
| | - Taro Yamamoto
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Nagasaki, 852-8523, Japan
| | - Satoru Morita
- Department of Mathematical and Systems Engineering, Shizuoka University, Hamamatsu, Shizuoka, 432-8561, Japan. .,Department of Environment and Energy Systems, Graduate School of Science and Technology, Shizuoka University, Hamamatsu, Shizuoka, 432-8561, Japan.
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29
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The Prevalence of HIV Among Men Who Have Sex With Men (MSM) and Young MSM in Latin America and the Caribbean: A Systematic Review. AIDS Behav 2021; 25:3223-3237. [PMID: 33587242 DOI: 10.1007/s10461-021-03180-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2021] [Indexed: 12/11/2022]
Abstract
Young men who have sex with men (YMSM) under 25 years old are among the few populations with increasing numbers of new HIV infections in parts of the world where HIV incidence is declining overall. In this systematic review, we synthesize the literature on HIV prevalence among MSM in Latin America and the Caribbean focusing on YMSM. Results were stratified according to study population sampling method used (probability and non-probability based). Forty-seven studies from 17 countries were published in the last 10 years. Among studies using probability-based sampling method (N = 21), HIV prevalence among MSM ranged from 1.2 to 32.6%. HIV prevalence tended to increase over time in studies sampling at different time points. HIV prevalence among YMSM exceeded 5.0% in more than a half of studies (51%; N = 22/43). Our review corroborates the high and potentially rising incidence of HIV among YMSM and characterizes the region's greatest challenge to ending the epidemic.
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Pre-Exposure Prophylaxis (PrEP) Uptake among Black Men Who Have Sex with Men (BMSM) in the Southern U.S. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189715. [PMID: 34574652 PMCID: PMC8470377 DOI: 10.3390/ijerph18189715] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/18/2021] [Accepted: 09/13/2021] [Indexed: 12/03/2022]
Abstract
Black men who have sex with men (BMSM) living in the United States (U.S.) South are disproportionately affected by HIV and experience significant disparities in HIV incidence, access to HIV care, and prevention across ages and socio-economic statuses. The aim of this commentary is to critically review current literature on the state of PrEP use among BMSM in the U.S. South, including identifying barriers and facilitators to PrEP use in order to inform intervention development. Extant literature shows that despite the documented benefits of PrEP as an effective HIV-prevention method, its uptake among BMSM is limited across the U.S. South. Common barriers to PrEP uptake included stigma, homophobia, mistrust of healthcare systems, negative attitudes from healthcare providers, access and transportation issues, poverty, and misinformation about PrEP. These barriers are likely to have been further exacerbated by the COVID-19 pandemic. Limited access to PrEP and other HIV-prevention programs, such as HIV testing, post-exposure prophylaxis (PEP), and condoms for BMSM are likely increase HIV incidence in this community. Moreover, the rapid expansion of telehealth services during the COVID-19 period may offer increased opportunity to scale-up PrEP through telehealth interventions, especially if in-person services remain limited due to pandemic precautions. Given the intersectional barriers that limit the access and uptake of PrEP among BMSM, we suggest that tailored programs or interventions that seek to address PrEP disparities among Southern BMSM should adopt intersectional and interdisciplinary approaches to better understand the complex challenges of scaling up PrEP. More studies are needed to investigate the impact of COVID-19 on HIV-prevention services among BMSM and to understand how to co-develop—with the BMSM community and healthcare providers—culturally acceptable interventions to reduce the identified challenges using intersectional and interdisciplinary approaches.
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Sexual Exposure to HIV Infection during the COVID-19 Pandemic in Men Who Have Sex with Men (MSM): A Multicentric Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189584. [PMID: 34574508 PMCID: PMC8470798 DOI: 10.3390/ijerph18189584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 12/29/2022]
Abstract
The practice of sex with casual partners without the use of adequate prevention in the period of social distancing due to the COVID-19 pandemic among men who have sex with men (MSM) can expose them to the risk of infection by the HIV virus. To assess this, we conducted an online survey in April and May 2020 in the entire national territory of Brazil and Portugal. We used the snowball technique for sampling, associated with circulation in social networks, totaling 2934 participants. Bivariate and multivariate logistic regression was used to produce the adjusted Odds Ratio (aOR). Eight-hundred-and-forty-two (28.7%) MSM presented at-risk sexual exposure in this period. In general, the types of sexual practices that most increased the chances of sexual exposure were having multiple partners (aOR:14.045); having practiced chemsex (aOR:2.246) and group sex (aOR:2.431), as well as presenting a history of at-risk sexual exposure (aOR:5.136). When we consider each country separately, the chances are increased in Brazil since the probability of the outcome was increased in those who practiced group sex (aOR:5.928), had multiple partners (aOR:19.132), and reported a sexual history of at-risk exposure (aOR:8.861). Our findings indicate that practices that are classically associated with greater chances of engaging in risky sexual exposure to HIV infection were the factors that most increased the chances of acquiring the virus in the pandemic context.
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Blair KJ, Segura ER, Garner A, Lai J, Ritterbusch A, Leon-Giraldo S, Guilamo-Ramos V, Lake JE, Clark JL, Holloway IW. Pre-exposure prophylaxis awareness, use, and intention to use in a regional sample of Latin American geosocial networking application users in 2018-2019. Int J STD AIDS 2021; 32:1261-1267. [PMID: 34340629 DOI: 10.1177/09564624211034618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pre-exposure prophylaxis (PrEP) access is increasing in Latin America. We explored PrEP use among Spanish-speaking, Hornet geosocial networking application users from Latin American countries with limited PrEP data via an online survey completed between December 2018 and February 2019. A total of 718 Hornet users from 10 countries were included, of whom 72.1% reported PrEP awareness. Few (5.6%) were currently taking PrEP, though 32.1% intended to take PrEP in the subsequent 6 months. PrEP awareness was lower in 18-25 year olds compared to 26+ (62.4% vs. 75.6%, aOR 0.67, [95% CI 0.46-0.97]), and higher among those living in larger versus smaller cities (74.4% vs. 58.8%, aOR 1.96, [95% CI 1.25-3.07]) or countries with at least partial versus no PrEP policy adoption (79.1% vs. 60.8%, aOR 2.20, [95% CI 1.56-3.12]). Intention to use PrEP was higher among PrEP-eligible respondents (51.8% vs. 29.6%, aOR 2.26, [95% CI 1.26-4.07]) and those recently tested for a sexually transmitted infection (35.4% vs. 25.5%, aOR 1.58, [95% CI 1.01-2.48]). Efforts to expand PrEP use in Latin America should focus on national PrEP policy adoption, and research should explore barriers to awareness and use among young men who have sex with men.
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Affiliation(s)
- Kevin J Blair
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, 8783University of California Los Angeles, Los Angeles, CA, USA.,Department of Surgery, 8783University of California Los Angeles, Los Angeles, CA, USA
| | - Eddy R Segura
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, 8783University of California Los Angeles, Los Angeles, CA, USA.,Escuela de Medicina, 33217Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Alex Garner
- Hornet Gay Social Network, Los Angeles, CA, USA.,Gay Sexuality and Social Policy Initiative, Luskin School of Public Affairs, 8783University of California Los Angeles, Los Angeles, CA, USA
| | - Jianchao Lai
- Gay Sexuality and Social Policy Initiative, Luskin School of Public Affairs, 8783University of California Los Angeles, Los Angeles, CA, USA
| | - Amy Ritterbusch
- Gay Sexuality and Social Policy Initiative, Luskin School of Public Affairs, 8783University of California Los Angeles, Los Angeles, CA, USA
| | - Sebastian Leon-Giraldo
- Escuela de Gobierno Alberto Lleras Camargo, 27991Universidad de Los Andes, Bogotá, Colombia
| | | | - Jordan E Lake
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, 8783University of California Los Angeles, Los Angeles, CA, USA.,McGovern Medical School, 12339The University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Jesse L Clark
- South American Program in HIV Prevention Research (SAPHIR), Division of Infectious Diseases, Department of Medicine, 8783University of California Los Angeles, Los Angeles, CA, USA
| | - Ian W Holloway
- Gay Sexuality and Social Policy Initiative, Luskin School of Public Affairs, 8783University of California Los Angeles, Los Angeles, CA, USA
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Torres TS, Coelho LE, Konda KA, Vega-Ramirez EH, Elorreaga OA, Diaz-Sosa D, Hoagland B, Pimenta C, Benedetti M, Grinsztejn B, Caceres CF, Veloso VG. Low socioeconomic status is associated with self-reported HIV positive status among young MSM in Brazil and Peru. BMC Infect Dis 2021; 21:726. [PMID: 34332552 PMCID: PMC8325787 DOI: 10.1186/s12879-021-06455-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 07/23/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Despite efforts to stop HIV epidemic in Latin America, new HIV cases continue to increase in the region especially among young MSM (YMSM). This study aims to assess if sociodemographic characteristics are associated with self-reported HIV positive status among YMSM from three Latin American countries. METHODS Cross-sectional web-based survey advertised on dating apps (Grindr and Hornet) and Facebook in Brazil, Mexico and Peru. For this analysis, we included YMSM aged 18-24 years who self-reported their HIV status. We used multivariable logistic regression models for each country separately to verify if sociodemographic characteristics (race, education and income) were associated with HIV self-reported status after adjusting for behavior characteristics (sexual attraction and steady partner). RESULTS Among 43,687 MSM who initiated the questionnaire, 27,318 (62.5%) reported their HIV status; 7001 (25.6%) of whom were YMSM. Most YMSM (83.4%) reported an HIV test in the past year, and 15.7% reported an HIV positive status in Peru, 8.4% in Mexico and 7.7% in Brazil. In adjusted models, low-income was associated with higher odds of self-reported HIV positive status in Brazil (aOR = 1.33, 95%CI: 1.01-1.75) and Peru (aOR = 1.56, 95%CI: 1.02-2.40), but not in Mexico. Lower education was associated with higher odds of self-reported HIV positive status only in Brazil (aOR = 1.35, 95%CI: 1.05-1.75). CONCLUSIONS In this large, cross-country study, self-reported HIV positive status among YMSM was high. Lower socioeconomic status was associated with higher odds of self-reported HIV positive status in Brazil and Peru. There is an urgent need for HIV prevention interventions targeting YMSM, and efforts to address low-income YMSM are especially needed in Peru and Brazil.
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Affiliation(s)
- Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av Brasil, 4365 Manguinhos, Rio de Janeiro, 21040-360, Brazil.
| | - Lara E Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av Brasil, 4365 Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | | | | | | | - Dulce Diaz-Sosa
- National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av Brasil, 4365 Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | | | - Marcos Benedetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av Brasil, 4365 Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av Brasil, 4365 Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | | | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av Brasil, 4365 Manguinhos, Rio de Janeiro, 21040-360, Brazil
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Torres TS, Luz PM, Bezerra DRB, Almeida-Brasil CC, Marins LMS, Veloso VG, Grinsztejn B, Harel D, Thombs BD. Translation and validation in Brazilian Portuguese of the reactions to homosexuality scale. PSYCHOL HEALTH MED 2021; 26:20-36. [PMID: 34219572 DOI: 10.1080/13548506.2021.1936580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Internalized homonegativity results from the acceptance of negative attitudes about one's same-sex orientation, which has negative consequences for the health of gay, bisexual and other men who have sex with men (GBM). We translated the 7-item Reactions to Homosexuality Scale (RHS) to Brazilian Portuguese and assessed its factor structure, validity and reliability. The first step included the translation, back-translation, evaluation, peer review, and pre-testing of the scale. Then, we piloted the scale in two convenience samples of adult Brazilians recruited online during October 2019 and February to March 2020 through advertisements on Grindr and Hornet, respectively. The largest sample was randomly split into two groups for exploratory factor analysis (EFA) then confirmatory factor analysis (CFA). Criterion and construct validity were assessed via correlations between scale scores and study variables. A total of 5573 GBM (sample 1: 218; sample 2: 5355) completed the RHS. EFA (N = 2652) yielded two eigenvalues greater than one (Factor 1: 3.5 and Factor 2: 1.1). A one-factor solution provided the most interpretable model based on examination of scree plot and item factor loadings (χ2(14) = 1373.1, p < 0.001; CFI = 0.89; TLI = 0.84; RMSEA = 0.19; SRMS = 0.09). Though one-factor CFA showed moderate fit, freeing errors terms to covary, based on item content and interpretation, significantly improved model fit (χ2(12) = 309.1, p < .001; CFI = 0.97; TLI = 0.96; RMSEA = 0.09; SRMR = 0.02). As hypothesized, men who did not self-identify as gay (mean score 17.9 compared to those self-identifying as gay: 11.8) and men who reported no sex with men in the past 6 months (mean score 12.6 compared to those who reported sex with men: 10.6) scored higher reflecting higher internalized homonegativity. The RHS was effectively translated and validated in Brazilian Portuguese and can be used to evaluate the role of internalized homonegativity on GBM's health, as well as its impact on the uptake of HIV prevention technologies.
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Affiliation(s)
- Thiago S Torres
- Laboratório de Pesquisa Clínica em DST e AIDS (LAPCLIN-AIDS), Instituto Nacional De Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Paula M Luz
- Laboratório de Pesquisa Clínica em DST e AIDS (LAPCLIN-AIDS), Instituto Nacional De Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Daniel R B Bezerra
- Laboratório de Pesquisa Clínica em DST e AIDS (LAPCLIN-AIDS), Instituto Nacional De Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Celline C Almeida-Brasil
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Luana M S Marins
- Laboratório de Pesquisa Clínica em DST e AIDS (LAPCLIN-AIDS), Instituto Nacional De Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Valdilea G Veloso
- Laboratório de Pesquisa Clínica em DST e AIDS (LAPCLIN-AIDS), Instituto Nacional De Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Beatriz Grinsztejn
- Laboratório de Pesquisa Clínica em DST e AIDS (LAPCLIN-AIDS), Instituto Nacional De Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Daphna Harel
- Department of Applied Statistics, Social Science, and Humanities, New York University, New York, NY, USA.,Center for Practice and Research and the Intersection of Information, Society, and Methodology, New York University, New York, NY, USA
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Departments of Psychiatry; Epidemiology, Biostatistics and Occupational Health; Medicine; Psychology; Educational and Counselling Psychology, and Biomedical Ethics Unit, McGill University, Montréal, Québec, Canada
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35
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Torres TS, Luz PM, Marins LMS, Bezerra DRB, Almeida-Brasil CC, Veloso VG, Grinsztejn B, Harel D, Thombs BD. Cross-cultural adaptation of the Perceived Risk of HIV Scale in Brazilian Portuguese. Health Qual Life Outcomes 2021; 19:117. [PMID: 33836775 PMCID: PMC8033701 DOI: 10.1186/s12955-021-01760-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Valid and reliable instruments are needed to measure the multiple dimensions of perceived risk. The Perceived Risk of HIV Scale is an 8-item measure that assesses how people think and feel about their risk of infection. We set out to perform a cross-cultural adaptation of the scale to Brazilian Portuguese among key populations (gay, bisexual and other men who have sex with men and transgender/non-binary) and other populations (cisgender heterosexual men and cisgender women). METHODS Methodological study with cross-sectional design conducted online during October/2019 (key populations [sample 1] and other populations) and February-March/2020 (key populations not on pre-exposure prophylaxis [sample 2]). Cross-cultural adaptation of the Perceived Risk of HIV Scale followed Beaton et al. 2000 guidelines and included confirmatory factor analysis, differential item functioning (DIF) using the Multiple-Indicator Multiple-Cause model, and concurrent validity to verify if younger individuals, those ever testing for HIV, and engaging in high-risk behaviors had higher scores on the scale. RESULTS 4342 participants from key populations (sample 1 = 235; sample 2 = 4107) and 155 participants from other populations completed the measure. We confirmed the single-factor structure of the original measure (fit indices for sample 1 plus other populations: CFI = 0.98, TLI = 0.98, RMSEA = 0.07; sample 2 plus other populations: CFI = 0.97, TLI = 0.95, RMSEA = 0.09). For the comparisons between key populations and other populations, three items (item 2: "I worry about getting infected with HIV", item 4: "I am sure I will not get infected with HIV", and item 8: "Getting HIV is something I have") exhibited statistically significant DIF. Items 2 and 8 were endorsed at higher levels by key populations and item 4 by other populations. However, the effect of DIF on overall scores was negligible (0.10 and 0.02 standard deviations for the models with other populations plus sample 1 and 2, respectively). Those ever testing for HIV scored higher than those who never tested (p < .001); among key populations, those engaging in high-risk behaviors scored higher than those reporting low-risk. CONCLUSION The Perceived Risk of HIV Scale can be used among key populations and other populations from Brazil.
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Affiliation(s)
- Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil.
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Luana M S Marins
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Daniel R B Bezerra
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | | | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Daphna Harel
- Department of Applied Statistics, Social Science, and Humanities, New York University, New York, NY, USA
- Center for Practice and Research and the Intersection of Information, Society, and Methodology, New York University, New York, NY, USA
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Departments of Psychiatry; Epidemiology, Biostatistics and Occupational Health; Medicine; Psychology; Educational and Counselling Psychology, and Biomedical Ethics Unit, McGill University, Montréal, Québec, Canada
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36
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Luz PM, Torres TS, Almeida-Brasil CC, Marins LMS, Veloso VG, Grinsztejn B, Cox J, Moodie EEM. High-Risk Sexual Behavior, Binge Drinking and Use of Stimulants are Key Experiences on the Pathway to High Perceived HIV Risk Among Men Who Have Sex with Men in Brazil. AIDS Behav 2021; 25:748-757. [PMID: 32940826 DOI: 10.1007/s10461-020-03035-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In Brazil, pre-exposure prophylaxis (PrEP) is currently available for gay, bisexual, and other men who have sex with men. As PrEP use depends on an individual's perceived risk, we explored pathways by which potentially modifiable behaviors lead to high perceived HIV risk. Using online surveys (N = 16,667), we conducted a path analysis on the basis of ordered sequences of multivariate logistic regressions. High perceived HIV risk was low (26.3%) compared to condomless receptive anal sex (41.4%). While younger age increased the odds of binge drinking and of condomless receptive anal sex, it was associated with decreased odds of high perceived HIV risk. In contrast, use of stimulants increased the odds of condomless receptive anal sex and of high perceived HIV risk. Our results suggest that binge drinking and use of stimulants are key points in different pathways to high-risk sexual behavior and may lead to different perceptions of HIV risk.
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Affiliation(s)
- Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil.
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | | | - Luana M S Marins
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Joseph Cox
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Canada
| | - Erica E M Moodie
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Canada
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37
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Queiroz AAFLN, Sousa ÁFLD, Araújo TMED, Brignol S, Reis RK, Fronteira I, Moura MEB. High rates of unprotected receptive anal sex and vulnerabilities to HIV infection among Brazilian men who have sex with men. Int J STD AIDS 2021; 32:368-377. [PMID: 33533301 DOI: 10.1177/0956462420968994] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This study aimed to evaluate unprotected receptive anal sex intercourse (URAI) rates and vulnerabilities to HIV infection among men who have sex with men (MSM) that use geosocial networking dating apps in Brazil. An online, analytical, cross-sectional study was carried out with 2,250 MSM. The analyzed variables were grouped according to domains of vulnerability and analyzed by bi and multivariate statistics to calculate the Adjusted Odds Ratios (aOR). The prevalence of self-reported HIV was 7.1%; and of URAI, 23.4%. The studied variables that increased the chances of engaging in URAI were: identifying as homosexual (aOR = 8.30; 95%CI = 5.68:12.04), pansexual (aOR = 5.01; 95%CI = 2.04:12.38), or bisexual (aOR = 3.14; 95%CI = 2.03:4.80), using apps for obtaining sex (aOR = 1.3; 95%CI = 1.0:1.5), engaging in group sex (aOR = 1.6; 95%CI = 1.3:2.0), and reporting chemsex (aOR = 1.5; 95%CI = 1.1:2.0). Self-reported positive HIV status was associated with: less than a minimum wage income (aOR = 1.78; 95%CI = 1.22:2.58), lower education (aOR = 1.86; 95%CI = 1.31 CI; 2,64), not knowing the partner's HIV status (aOR = 1.84; 95%CI = 1.06:3.19), practicing group sex (aOR = 1.67; 95%CI = 1.04; 2.68), and chemsex (aOR = 2.03; 95%CI =1.06:3.19). The applications interaction is shaped by their own users to better meet their desires and needs. However, this behavior exposes individuals to HIV vulnerabilities.
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Affiliation(s)
| | - Álvaro Francisco Lopes de Sousa
- School of Nursing of Ribeirão Preto, 28133Universidade de São Paulo, São Paulo, Brazil.,Global Health and Tropical Medicine, GHTM, 70907Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisbon, Portugal
| | | | - Sandra Brignol
- Institute of Collective Health, Universidade Federal Fluminense, Niterói, Brazil
| | - Renata Karina Reis
- School of Nursing of Ribeirão Preto, 28133Universidade de São Paulo, São Paulo, Brazil
| | - Inês Fronteira
- Global Health and Tropical Medicine, GHTM, 70907Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisbon, Portugal
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Impact of COVID-19 Pandemic on Sexual Minority Populations in Brazil: An Analysis of Social/Racial Disparities in Maintaining Social Distancing and a Description of Sexual Behavior. AIDS Behav 2021; 25:73-84. [PMID: 32737817 PMCID: PMC7394046 DOI: 10.1007/s10461-020-02984-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We conducted a web-based survey to understand the impact of social distancing measures on Brazilian MSM and transgender/non-binary lives. A total of 3486 respondents were included in this analysis and the great majority were cismen (98%). The median age was 32 years (IQR: 27-40), 44% non-white, 36% low schooling and 38% low income. Most of participants reported HIV negative/unknown status (77%). Participants on-PrEP reported more condomless anal sex than those off-PrEP. Conversely, 24% off-PrEP were at substantial HIV-risk. PrEP/ART continuation were reported by the majority, despite reports of impediments to medication refill. Transgender/non-binary reported more mental health problems and challenges to access health care. Social and racial disparities were associated with unattainability of maintaining social distancing. Tailored social and economic support policies during COVID-19 pandemic should be made available to these populations. Challenges for PrEP/ART access will demand the implementation of innovative solutions to avoid the expansion of the HIV epidemic.
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39
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Colledani D, Camperio Ciani A. A Worldwide Internet Study Based on Implicit Association Test Revealed a Higher Prevalence of Adult Males' Androphilia than Ever Reported Before. J Sex Med 2020; 18:4-16. [PMID: 33250358 DOI: 10.1016/j.jsxm.2020.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 07/18/2020] [Accepted: 09/28/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Social constrictions or the lack of a clear awareness about one's sexual orientation may influence the ability of individuals to explicitly declare their sexual preferences. Thus, the actual prevalence of males' sexual attraction toward adult males, which is estimated by studies relying only on explicit questionnaires, may be biased. Conversely, the implicit measurement of androphilia may be a promising method to obtain more reliable data. AIM In the present work, explicit and implicit methods have been used to investigate the rates of explicit nonheterosexuality and implicit androphilia in a large sample of adult males from all around the world. For implicit androphilia, a rate consistent across the continents and close to that predicted by recent genetic models (about 15%) was expected. In contrast, for self-declared homosexuality, a lower and more variable rate was expected. METHODS A sample of 1,050 participants was recruited through an online platform. All participants completed a short biographical questionnaire, an Autobiographical-Implicit Association Test, the Sexual Preference-Implicit Association Test, and an explicit measure of sexual orientation. The answers to these measures were used to explore explicit sexual orientation and implicit androphilia across six main geographical areas (Middle East and Africa, South America, North America, Asia, Europe, and Oceania). OUTCOMES The main outcome measures were the D score at the Sexual Preference-Implicit Association Test and the scores at the explicit measure of sexual orientation. RESULTS The rate of nonheterosexuality, which can be found using explicit measures, is rather low, variable (from 6.3% to 11.4%), and influenced by cultural factors. In contrast, the prevalence of androphilia resulting from implicit methods is higher and consistent across geographical areas (from 14.4% to 17.6%). CLINICAL IMPLICATIONS Studying the diffusion of adult males' androphilia may be useful to better understand sexual behaviors and preferences and to develop effective health promotion programs among males who have sex with males. STRENGTHS & LIMITATIONS The large and cross-cultural sample and the use of both implicit and explicit measures allowed for obtaining a detailed picture of adult males' sexual orientation and androphilia. The main limitations were the Web-based characteristics of the protocol and the lack of an investigation of actual sexual behaviors. CONCLUSION Compared with the explicit measurement of nonheterosexuality, the implicit measurement of sexual preferences showed a prevalence of androphilia among adult males that is higher, more stable across continents, and more consistent with the predictions of recent genetic models. Colledani D,A. Camperio Ciani Worldwide Internet Study Based on Implicit Association Test Revealed a Higher Prevalence of Adult Males' Androphilia than Ever Reported Before. J Sex Med 2021;18:4-16.
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Affiliation(s)
- Daiana Colledani
- Department of Philosophy, Sociology, Education and Applied Psychology - School of Psychology, University of Padua, Padua, Italy
| | - Andrea Camperio Ciani
- Department of Philosophy, Sociology, Education and Applied Psychology - School of Psychology, University of Padua, Padua, Italy.
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Torres TS, Bastos LS, Kamel L, Bezerra DRB, Fernandes NM, Moreira RI, Garner A, Veloso VG, Grinsztejn B, De Boni RB. Do men who have sex with men who report alcohol and illicit drug use before/during sex (chemsex) present moderate/high risk for substance use disorders? Drug Alcohol Depend 2020; 209:107908. [PMID: 32078972 DOI: 10.1016/j.drugalcdep.2020.107908] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 02/08/2020] [Accepted: 02/10/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND We evaluated the prevalence of sexualized drug use (Chemsex) and its association with moderate/high risk for substance use disorders and HIV sexual risk behavior among men who have sex with men (MSM). METHODS We conducted a cross-sectional web-based survey among MSM from Rio de Janeiro (Brazil). The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was used to screen people at moderate/high-risk for substance use disorders. Individuals found to be using substances in the prior three months were asked if they used before/during sex. Sexualized drug use was classified into: no sexualized drug use, sex using only alcohol (alcohol-sex), sex using only illicit drugs (drug-sex) and sex using alcohol and illicit drugs (alcohol-drug-sex). The questionnaire included questions about sociodemographic, HIV status/prevention and risk behavior. A multinomial regression model was performed to assess the factors associated with sexualized drug use. RESULTS Overall, 1048 MSM completed the questionnaire; median age was 29 years. Prevalence of alcohol and illicit drug use in previous 3 months was 89 % and 49 %, respectively. Most MSM (64 %) reported sexualized drug use: 28 % alcohol-sex, 9 % drug-sex and 27 % alcohol-drug-sex. Median ASSIST scores were higher among those reporting sexualized drug use compared to no use. All HIV sexual risk behavior variables presented increasing prevalence across the outcome categories. In the adjusted multivariate model, having moderate/high-risk for substance use disorders were associated with sexualized drug use. CONCLUSIONS MSM reporting sexualized drug use should receive brief intervention for substance use disorders and be evaluated for combination HIV prevention strategies including PrEP.
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Affiliation(s)
- Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil.
| | - Leonardo S Bastos
- Programa de Computação Cientifica, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Luciana Kamel
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil
| | - Daniel R B Bezerra
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil
| | - Nilo M Fernandes
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil
| | - Ronaldo I Moreira
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil
| | - Alex Garner
- Hornet INC, 3962 Ince Blvd, Culver City, CA 90232, United States
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil
| | - Raquel B De Boni
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Av. Brasil 4365, 21040-360, Rio de Janeiro, Brazil
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