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Irie WC, Calabrese SK, Mayer KH, Geng EH, Blackstock O, Marcus JL. Social and structural factors associated with interest in HIV preexposure prophylaxis among Black women in the United States. AIDS Care 2024; 36:672-681. [PMID: 38176016 PMCID: PMC10994725 DOI: 10.1080/09540121.2023.2299338] [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: 03/08/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
In a nationwide sample of cisgender Black women in the US, we assessed the associations between social and structural factors and interest in using HIV preexposure prophylaxis (PrEP). Among 315 respondents, 62.2% were interested in PrEP if it were provided for free. Positive social norms surrounding PrEP, including injunctive norms (perceived social acceptability of PrEP use) and descriptive norms (perceived commonality of PrEP use), were positively associated with interest in using PrEP. Concerns about HIV infection, recently visiting a health care provider, and comfort discussing PrEP with a provider were also positively associated with interest in using PrEP. Anticipating PrEP disapproval from others was negatively associated with interest in PrEP. Although PrEP can promote autonomy and personal discretion, Black women's PrEP-related decisions occur in a complex social environment. Black women may benefit from interventions to promote positive norms and attitudes surrounding PrEP at the community level and empower them in discussions with their providers about PrEP.
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Affiliation(s)
- Whitney C. Irie
- Boston College School of Social Work, Chestnut Hill, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Sarah K. Calabrese
- Department of Psychological and Brain Sciences, George Washington University, Washington, D.C., USA
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, D.C., USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
| | - Elvin H. Geng
- Division of Infectious Diseases, Washington University in St Louis, St. Louis, MO, USA
| | | | - Julia L. Marcus
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Irie W, Mahone A, Nakka R, Ghebremichael M. Confidence in Ability to Communicate With Sexual Partners About PrEP Among Black Cisgender Women. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:333-346. [PMID: 37843905 DOI: 10.1521/aeap.2023.35.5.333] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
This study explored the factors associated with Black women's confidence in their ability to engage male sexual partners in discussions about PrEP. Communication about PrEP with male partners is an important, yet minimally explored, outcome in PrEP research among Black women in heterosexual partnerships. Among 315 respondents, results show significant differences in anticipated stigma and interest in PrEP between a binary outcome variable being confident and not-confident discussing PrEP with sexual partners. Further, factors such as employment, worrying about HIV infection, interest in taking oral PrEP, subjective norms, injunctive norms, and descriptive norms were associated with Black women's higher odds of confidence in their ability to engage sexual partners about PrEP. Conversely, PrEP disapproval and stigma resulted in lower odds of Black women's confidence in their ability to engage sexual partners about PrEP. Results indicate the need for continued investigation of confidence and, relatedly, communication about PrEP among heterosexual couples and communitylevel interventions normalizing PrEP discussions and uptake.
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Affiliation(s)
- Whitney Irie
- Boston College School of Social Work, Chestnut Hill, Massachusetts, and The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Anais Mahone
- School of Social Work, Rutgers University, New Brunswick, New Jersey
| | - Raja Nakka
- The Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts
| | - Musie Ghebremichael
- The Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts
- Department of Medicine, Harvard Medical School, Cambridge, Massachusetts
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Irie WC, Mahone A, Nakka R, Ghebremichael M. Factors Associated with Comfort Discussing PrEP with Healthcare Providers among Black Cisgender Women. Trop Med Infect Dis 2023; 8:436. [PMID: 37755897 PMCID: PMC10534734 DOI: 10.3390/tropicalmed8090436] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/17/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023] Open
Abstract
Preexposure prophylaxis (PrEP) for HIV prevention uptake remains low among Black cisgender women in the United States, despite their disproportionate HIV burden. This study aimed to examine factors associated with Black women's comfort discussing PrEP with healthcare providers and its link to their interest in PrEP use. A cross-sectional survey was conducted with a national sample of 315 Black cisgender women. Descriptive statistics and logistic regression models were utilized for data analysis. The results showed that 79% of Black women felt comfortable discussing PrEP with their healthcare provider. Age, recent healthcare provider visit, interest in PrEP, and positive social norms were associated with increased odds of comfort in discussing PrEP, while anticipated PrEP disapproval and stigma were associated with decreased odds. Older age was related to greater comfort, potentially due to increased familiarity and self-efficacy in discussing sexual health. Recent healthcare utilization indicated positive provider relationships, facilitating discussions about sexual health. Anticipating support from social networks positively influenced comfort levels. Conversely, PrEP-related stigma and anticipated disapproval were barriers to comfort. These findings highlight the importance of provider-patient communication and social support in facilitating PrEP engagement among Black cisgender women. Interventions should consider age-appropriate strategies and address structural and provider biases to improve PrEP discussions and promote HIV prevention.
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Affiliation(s)
- Whitney C. Irie
- Boston College School of Social Work, Chestnut Hill, MA 02467, USA
- The Fenway Institute, Fenway Health, Boston, MA 02215, USA
| | - Anais Mahone
- School of Social Work, Rutgers University, New Brunswick, NJ 08901, USA
| | - Raja Nakka
- The Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA (M.G.)
| | - Musie Ghebremichael
- The Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA (M.G.)
- Department of Medicine, Harvard Medical School, Cambridge, MA 02215, USA
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Goymann H, Mavuso M, McMahon SA, Hettema A, Hughey AB, Matse S, Dlamini P, Kahn K, Bärnighausen T, Jahn A, Bärnighausen K. 'We Should Not Be Quiet but We Should Talk': Qualitative Accounts of Community-Based Communication of HIV Pre-Exposure Prophylaxis. QUALITATIVE HEALTH RESEARCH 2023; 33:842-856. [PMID: 37403738 PMCID: PMC10426252 DOI: 10.1177/10497323231181207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Community leaders play an important role in the acceptance of public health services, but little is known about their willingness to facilitate HIV pre-exposure prophylaxis (PrEP) roll-out in Eswatini. We conducted in-depth interviews (n = 25) with purposefully selected male and female community leaders in Eswatini. We analysed our data inductively using a thematic analysis approach. Community leaders feel they are important communicators of culturally appropriate PrEP messaging. Our participants described a complex social space within their communities influenced by religion, tradition, values, and HIV stigma. Community leaders use their position to provide leverage for unique, effective, and easily accessible messages and platforms to reach the community in a manner that ensures trust, relatability, familiarity, and shared faith. Community leaders feel that they are trusted and see trust manifesting in the conversations they are able to engage in, and have a reach that extends beyond formal health services. Existing PrEP programming should embed community leader participation in PrEP programming and engage the trust, knowledge, and potential of community leaders to support PrEP uptake and acceptance.
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Affiliation(s)
- Hannah Goymann
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | | | | | | | | | | | | | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Till Bärnighausen
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Africa Health Research Institute, Kwazulu-Natal, South Africa
| | - Albrecht Jahn
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Kate Bärnighausen
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Kiridaran V, Chawla M, Bailey JV. Views, attitudes and experiences of South Asian women concerning sexual health services in the UK: a qualitative study. EUR J CONTRACEP REPR 2022; 27:418-423. [PMID: 35899823 DOI: 10.1080/13625187.2022.2096216] [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: 11/03/2022]
Abstract
OBJECTIVE To explore the views, attitudes, and experiences of South Asian women in the UK regarding sexual health services. METHODS We performed virtual semi-structured interviews with South Asian women 18 and over living in the UK. We explored participants' experiences of accessing sexual health services, including contraception, smear tests and sexually transmitted infection (STI) tests. We coded interview transcripts and analysed them thematically. RESULTS From February to April 2021, we conducted 14 interviews with South Asian women between the ages of 18 and 40 living in England and Wales, from February to April 2021. We identified four overarching themes: Access to sexual health services, entry to sexual health services, quality of sexual health services and stigma associated with sexual health services. Important barriers to sexual health services include limited knowledge of local provision, stigma and shame, and concerns about confidentiality. Participants found it difficult to discuss their sexual health (with anyone) and were often being met with judgement and a lack of partnership from clinicians. CONCLUSION Our results suggest that South Asian women are uncomfortable accessing sexual health services and communicating their sexual health concerns with health care professionals. Service providers should collaborate with community-based organisations to ensure that services are discrete, confidential, and culturally appropriate.
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Affiliation(s)
| | - Mehar Chawla
- Obstetrics & Gynaecology Department, West Middlesex University Hospital, Chelsea and Westminster NHS Trust, London, UK.,eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Julia V Bailey
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, UK
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Irie WC, Calabrese SK, Patel RR, Mayer KH, Geng EH, Marcus JL. Preferences for HIV Preexposure Prophylaxis Products Among Black Women in the U.S. AIDS Behav 2022; 26:2212-2223. [PMID: 34985607 PMCID: PMC9167149 DOI: 10.1007/s10461-021-03571-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 01/27/2023]
Abstract
In a nationwide sample of Black women in the U.S., we assessed preferences for HIV preexposure prophylaxis (PrEP) products, including long-acting injectable (LAI) PrEP and once-daily oral PrEP. Among 315 respondents, 32.1% were aware of PrEP and 40.6% were interested in using it; interest increased to 62.2% if PrEP were provided for free. Oral PrEP was the preferred option (51.1%), followed by LAI PrEP (25.7%), vaginal gel (16.5%), and vaginal ring (6.7%). When examining oral and LAI PrEP alone, most (62.7%) preferred oral PrEP. LAI PrEP was more likely to be preferred among respondents with concerns about healthcare costs or PrEP-related stigma, and among those who reported inconsistent condom use and multiple sexual partners. Although most Black women preferred oral PrEP, LAI PrEP may be appealing to a subset with social and structural barriers to PrEP use, such as cost and stigma, and those at increased risk of HIV infection.
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Affiliation(s)
- Whitney C Irie
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Dr, Ste 401, Boston, MA, 02215, USA.
| | - Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Rupa R Patel
- Division of Infectious Diseases, Washington University in St Louis, St. Louis, MO, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Elvin H Geng
- Division of Infectious Diseases, Washington University in St Louis, St. Louis, MO, USA
| | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
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Williams RS, Stetten NE, Cook C, Cook R, Ezenwa MO, Lucero R. The Meaning and Perceptions of HIV-Related Stigma in African American Women Living With HIV in Rural Florida: A Qualitative Study. J Assoc Nurses AIDS Care 2022; 33:118-131. [PMID: 33782240 PMCID: PMC9744244 DOI: 10.1097/jnc.0000000000000252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT African Americans are disproportionally affected by HIV/AIDS compared with other races/ethnicities, yet few studies have examined the cultural and/or attitudinal precursors that can make African American women vulnerable to HIV-related stigma in the rural South. This study qualitatively explored the meaning and perceptions of HIV-related stigma among African American women in Florida. Thirteen semi-structured interviews were conducted using an empirical phenomenological approach. Five observer perspectives and 26 participant perspectives emerged. Participants described stigma through self-conceptualizations (e.g., ignorance), experiences (e.g., judgments), psychological dysfunction (e.g., mental health), intersectionality (e.g., race, disability), and overcoming stigma (e.g., advocacy). Our findings reveal that HIV-related stigma is unpleasant for African American women. However, over time, women in this study developed strategies to combat stigma. Elements of stigma reduction described in this study may be an important starting point for designing a culturally targeted intervention for African American women living with HIV.
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Affiliation(s)
- Renessa S. Williams
- Renessa S. Williams, PhD, RN, is a Postdoctoral Associate, Miller School of Medicine, Department of Surgery, University of Miami, Coral Gables, Florida, USA. Nichole E. Stetten, PhD, MPH, CPH, is a Research Assistant Professor, College of Public Health and Health Professions, Department of Occupational Therapy, University of Florida, Gainesville, Florida, USA. Christa Cook, PhD, RN, FAAN, is an Associate Professor, College of Nursing, University of Central Florida, Orlando, Florida, USA. Robert Cook, MD, MPH, is a Professor, College of Public Health and Health Professions & College of Medicine, Department of Epidemiology, University of Florida, Gainesville, Florida, USA. Miriam O. Ezenwa, PhD, RN, FAAN, is an Associate Professor, College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, USA. Robert Lucero, PhD, MPH, RN, FAAN, is an Associate Professor, College of Nursing, Department of Family, Community and Health Systems Science, University of Florida, Gainesville, Florida, USA
| | - Nichole E. Stetten
- Renessa S. Williams, PhD, RN, is a Postdoctoral Associate, Miller School of Medicine, Department of Surgery, University of Miami, Coral Gables, Florida, USA. Nichole E. Stetten, PhD, MPH, CPH, is a Research Assistant Professor, College of Public Health and Health Professions, Department of Occupational Therapy, University of Florida, Gainesville, Florida, USA. Christa Cook, PhD, RN, FAAN, is an Associate Professor, College of Nursing, University of Central Florida, Orlando, Florida, USA. Robert Cook, MD, MPH, is a Professor, College of Public Health and Health Professions & College of Medicine, Department of Epidemiology, University of Florida, Gainesville, Florida, USA. Miriam O. Ezenwa, PhD, RN, FAAN, is an Associate Professor, College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, USA. Robert Lucero, PhD, MPH, RN, FAAN, is an Associate Professor, College of Nursing, Department of Family, Community and Health Systems Science, University of Florida, Gainesville, Florida, USA
| | - Christa Cook
- Renessa S. Williams, PhD, RN, is a Postdoctoral Associate, Miller School of Medicine, Department of Surgery, University of Miami, Coral Gables, Florida, USA. Nichole E. Stetten, PhD, MPH, CPH, is a Research Assistant Professor, College of Public Health and Health Professions, Department of Occupational Therapy, University of Florida, Gainesville, Florida, USA. Christa Cook, PhD, RN, FAAN, is an Associate Professor, College of Nursing, University of Central Florida, Orlando, Florida, USA. Robert Cook, MD, MPH, is a Professor, College of Public Health and Health Professions & College of Medicine, Department of Epidemiology, University of Florida, Gainesville, Florida, USA. Miriam O. Ezenwa, PhD, RN, FAAN, is an Associate Professor, College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, USA. Robert Lucero, PhD, MPH, RN, FAAN, is an Associate Professor, College of Nursing, Department of Family, Community and Health Systems Science, University of Florida, Gainesville, Florida, USA
| | - Robert Cook
- Renessa S. Williams, PhD, RN, is a Postdoctoral Associate, Miller School of Medicine, Department of Surgery, University of Miami, Coral Gables, Florida, USA. Nichole E. Stetten, PhD, MPH, CPH, is a Research Assistant Professor, College of Public Health and Health Professions, Department of Occupational Therapy, University of Florida, Gainesville, Florida, USA. Christa Cook, PhD, RN, FAAN, is an Associate Professor, College of Nursing, University of Central Florida, Orlando, Florida, USA. Robert Cook, MD, MPH, is a Professor, College of Public Health and Health Professions & College of Medicine, Department of Epidemiology, University of Florida, Gainesville, Florida, USA. Miriam O. Ezenwa, PhD, RN, FAAN, is an Associate Professor, College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, USA. Robert Lucero, PhD, MPH, RN, FAAN, is an Associate Professor, College of Nursing, Department of Family, Community and Health Systems Science, University of Florida, Gainesville, Florida, USA
| | - Miriam O. Ezenwa
- Renessa S. Williams, PhD, RN, is a Postdoctoral Associate, Miller School of Medicine, Department of Surgery, University of Miami, Coral Gables, Florida, USA. Nichole E. Stetten, PhD, MPH, CPH, is a Research Assistant Professor, College of Public Health and Health Professions, Department of Occupational Therapy, University of Florida, Gainesville, Florida, USA. Christa Cook, PhD, RN, FAAN, is an Associate Professor, College of Nursing, University of Central Florida, Orlando, Florida, USA. Robert Cook, MD, MPH, is a Professor, College of Public Health and Health Professions & College of Medicine, Department of Epidemiology, University of Florida, Gainesville, Florida, USA. Miriam O. Ezenwa, PhD, RN, FAAN, is an Associate Professor, College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, USA. Robert Lucero, PhD, MPH, RN, FAAN, is an Associate Professor, College of Nursing, Department of Family, Community and Health Systems Science, University of Florida, Gainesville, Florida, USA
| | - Robert Lucero
- Renessa S. Williams, PhD, RN, is a Postdoctoral Associate, Miller School of Medicine, Department of Surgery, University of Miami, Coral Gables, Florida, USA. Nichole E. Stetten, PhD, MPH, CPH, is a Research Assistant Professor, College of Public Health and Health Professions, Department of Occupational Therapy, University of Florida, Gainesville, Florida, USA. Christa Cook, PhD, RN, FAAN, is an Associate Professor, College of Nursing, University of Central Florida, Orlando, Florida, USA. Robert Cook, MD, MPH, is a Professor, College of Public Health and Health Professions & College of Medicine, Department of Epidemiology, University of Florida, Gainesville, Florida, USA. Miriam O. Ezenwa, PhD, RN, FAAN, is an Associate Professor, College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, USA. Robert Lucero, PhD, MPH, RN, FAAN, is an Associate Professor, College of Nursing, Department of Family, Community and Health Systems Science, University of Florida, Gainesville, Florida, USA
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Threats M, Boyd DT, Diaz JE, Adebayo OW. Deterrents and motivators of HIV testing among young Black men who have sex with men in North Carolina. AIDS Care 2021; 33:943-951. [PMID: 33244990 PMCID: PMC8155091 DOI: 10.1080/09540121.2020.1852161] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/10/2020] [Indexed: 01/09/2023]
Abstract
In the United States (US), young, Black men who have sex with men (YBMSM) are disproportionately affected by HIV. Delayed and infrequent HIV testing has been associated with the increased likelihood of YBMSM to be infected, yet unaware. Despite increased efforts to provide HIV testing to YBMSM in the US, HIV testing remains underutilized by YBMSM in the South. To develop strategies to increase HIV testing, this study sought to understand the factors that affect HIV testing utilization among YBMSM. Twenty-two HIV-positive and HIV-negative YBMSM aged 22-33 in North Carolina participated in semistructured interviews. Qualitative thematic analysis revealed that deterrents and motivators to HIV testing spanned individual, social, and structural levels. Deterrents included a low perceived risk of HIV, fear of receiving an HIV-positive test result, lack of HIV testing locations, healthcare provider mistreatment and privacy concerns due to intersectional stigma. Motivators of HIV testing included health maintenance, social support, and increased access to HIV testing. The findings from this study contribute to ongoing research that aims to address inconsistent HIV testing and late HIV diagnosis among YBMSM. Interventions to address intersectional stigma in community and healthcare settings can enhance utilization of HIV prevention services .
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Affiliation(s)
- Megan Threats
- School of Communication and Information, Rutgers University, New Brunswick, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, USA
| | - Donte T. Boyd
- Graduate College of Social Work, University of Houston, Houston, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, USA
| | - José E. Diaz
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, USA
| | - Oluwamuyiwa Winifred Adebayo
- College of Nursing, The Pennsylvania State University, University Park, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, USA
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Taggart T, Mayer KH, Vermund SH, Huang S, Hayashi K, Ransome Y. Interaction of Religion/Spirituality With Internalized HIV Stigma, Depression, Alcohol Use, and Sexual Risk Among Black Men Who Have Sex With Men: The 6 City HPTN 061 Study. J Acquir Immune Defic Syndr 2021; 87:e188-e197. [PMID: 33633033 PMCID: PMC8131231 DOI: 10.1097/qai.0000000000002667] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/16/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Black men who have sex with men (BMSM) remain at highest risk for HIV in the United States. Internalized HIV stigma and depression contribute to substance use and condomless anal intercourse (CAI). Religion and spirituality (R/S) are associated with decreased HIV-related risk behaviors for some groups, but their impact among BMSM is uncertain. We investigated the main and moderating roles of R/S on pathways from internalized HIV stigma to CAI while under the influence of drugs. METHODS We used baseline data from 1511 BMSM from the HIV Prevention Trials Network (HPTN) 061 study to examine the associations between internalized HIV stigma, depressive symptoms, alcohol use, and CAI while under the influence of drugs, adjusting for covariates in generalized structural equation models. We then tested whether R/S moderated the association between (1) internalized HIV stigma and depressive symptoms, (2) depressive symptoms and alcohol use, and (3) alcohol use and CAI while under the influence of drugs. RESULTS Spiritual beliefs [F(1,2) = 9.99, P < 0.001], spiritual activities [F(1,2) = 9.99, P < 0.001], and religious attendance [F(1,2) = 9.99, P < 0.001] moderated the pathway between internalized HIV stigma and depressive symptoms. As internalized HIV stigma increased, those with lower spiritual activity scores experienced significantly higher increases in depressive symptoms compared with those with higher spiritual activity scores whose depressive symptom scores remained unchanged [stigma × spiritual activities B = -0.18 (SE = 0.07), P < 0.001]. CONCLUSIONS Religion and spirituality were protective against CAI among BMSM. Future intervention research should explore ways to incorporate religious and/or spiritual activities to reduce internalized HIV stigma as one way to reduce depressive symptoms among BMSM.
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Affiliation(s)
- Tamara Taggart
- Department of Prevention and Community Health, George Washington University, Milken Institute School of Public Health
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Shu Huang
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Kamden Hayashi
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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10
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Maragh-Bass AC, Sloan DH, Alghanim F, Knowlton AR. A mixed-methods exploration of faith, spirituality, and health program interest among older African Americans with HIV. Qual Life Res 2020; 30:507-519. [PMID: 33052513 DOI: 10.1007/s11136-020-02656-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Persons living with HIV (PLWH) are living into old age with more complex care needs that non-PLWH. Promoting quality of life should include advance care planning (ACP) education, particularly among African Americans. We explored faith/spirituality-related correlates of interest in a future quality of life program among African American PLWH. METHODS Data were from the AFFIRM study. Participants were recruited from an HIV clinic and completed surveys, interviews, and focus groups. Quantitative analyses included Logistic regression. Qualitative data were coded using grounded theory. RESULTS Nearly half of participants had less than a high school education (47.9%), and roughly 90% had heard of at least one ACP-related topic (86.6%; N = 315). Qualitative themes related to quality of life and faith/spirituality were: (1) Coping with life challenges; (2) Motivation to improve health for loved ones; and (3) Support programs for people with HIV (N = 39). Satisfaction with religion/spirituality was associated with greater interest in a future program (p < .05); discussing ACP before getting sick was associated with less interest (p < .05). CONCLUSIONS/PRACTICE IMPLICATIONS Prioritizing skill-building and grounding in spirituality with input from faith leaders can reduce ACP inequities and improve health outcomes among African Americans.
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Affiliation(s)
- Allysha C Maragh-Bass
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd floor, Baltimore, MD, 21205, USA. .,FHI 360, Behavioral, Epidemiological, and Clinical Sciences Division, Durham, NC, USA.
| | - Danetta Hendricks Sloan
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd floor, Baltimore, MD, 21205, USA
| | - Fahid Alghanim
- Internal Medicine Residency Program, Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy R Knowlton
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd floor, Baltimore, MD, 21205, USA
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11
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Vigliotti V, Taggart T, Walker M, Kusmastuti S, Ransome Y. Religion, faith, and spirituality influences on HIV prevention activities: A scoping review. PLoS One 2020; 15:e0234720. [PMID: 32544212 PMCID: PMC7297313 DOI: 10.1371/journal.pone.0234720] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 06/02/2020] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Strategies to increase uptake of next-generation biomedical prevention technologies (e.g., long-acting injectable pre-exposure prophylaxis (PrEP)) can benefit from understanding associations between religion, faith, and spirituality (RFS) and current primary HIV prevention activities (e.g., condoms and oral PrEP) along with the mechanisms which underlie these associations. METHODS We searched PubMed, Embase, Academic Search Premier, Web of Science, and Sociological Abstracts for empirical articles that investigated and quantified relationships between RFS and primary HIV prevention activities outlined by the United States (U.S.) Department of Health and Human Services: condom use, HIV and STI testing, number of sexual partners, injection drug use treatment, medical male circumcision, and PrEP. We included articles in English language published between 2000 and 2020. We coded and analyzed studies based on a conceptual model. We then developed summary tables to describe the relation between RFS variables and the HIV prevention activities and any underlying mechanisms. We used CiteNetExplorer to analyze citation patterns. RESULTS We identified 2881 unique manuscripts and reviewed 29. The earliest eligible study was published in 2001, 41% were from Africa and 48% were from the U.S. RFS measures included attendance at religious services or interventions in religious settings; religious and/or spirituality scales, and measures that represent the influence of religion on behaviors. Twelve studies included multiple RFS measures. Twenty-one studies examined RFS in association with condom use, ten with HIV testing, nine with number of sexual partners, and one with PrEP. Fourteen (48%) documented a positive or protective association between all RFS factors examined and one or more HIV prevention activities. Among studies reporting a positive association, beliefs and values related to sexuality was the most frequently observed mechanism. Among studies reporting negative associations, behavioral norms, social influence, and beliefs and values related to sexuality were observed equally. Studies infrequently cited each other. CONCLUSION More than half of the studies in this review reported a positive/protective association between RFS and HIV prevention activities, with condom use being the most frequently studied, and all having some protective association with HIV testing behaviors. Beliefs and values related to sexuality are possible mechanisms that could underpin RFS-related HIV prevention interventions. More studies are needed on PrEP and spirituality/subjective religiosity.
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Affiliation(s)
- Vivian Vigliotti
- Robbins Institute for Health Policy & Leadership, Baylor University, Waco, Texas, United States of America
| | - Tamara Taggart
- Department Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
- Prevention and Community Health, George Washington University School of Public Health, Washington, DC, United States of America
| | - Mahaya Walker
- Department Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Sasmita Kusmastuti
- Department of Public Health, University of Copenhagen, Copenhagen, Kobenhavns, Denmark
| | - Yusuf Ransome
- Department Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
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12
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Ghayda RA, Hong SH, Yang JW, Jeong GH, Lee KH, Kronbichler A, Solmi M, Stubbs B, Koyanagi A, Jacob L, Oh H, Kim JY, Shin JI, Smith L. A Review of Pre-Exposure Prophylaxis Adherence among Female Sex Workers. Yonsei Med J 2020; 61:349-358. [PMID: 32390358 PMCID: PMC7214109 DOI: 10.3349/ymj.2020.61.5.349] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 12/27/2022] Open
Abstract
Globally and in Africa specifically, female sex workers (FSWs) are at an extraordinarily high risk of contracting human immunodeficiency virus (HIV). Pre-exposure prophylaxis (PrEP) has emerged as an effective and ethical method with which to prevent HIV infection among FSWs. PrEP efficacy is, however, closely linked to adherence, and adherence to PrEP among FSWs is a complex and interrelated process that has been shown to be of importance to public health policies and HIV control and intervention programs. This comprehensive review categorizes barriers to and facilitators of adherence to HIV PrEP for FSWs, and describes five strategies for promoting PrEP adherence among FSWs. These strategies encompass 1) a long-term educational effort to decrease the stigma associated with sex work and PrEP use, 2) education on how PrEP works, 3) lifestyle modification, 4) research on next-generation PrEP products to address the inconvenience of taking daily pills, and 5) integration of PrEP into existing services, such as social services and routine primary care visits, to reduce the economic burden of seeking the medication. Our review is expected to be useful for the design of future PrEP intervention programs. Multidisciplinary intervention should be considered to promote PrEP adherence among FSWs in order to help control the HIV epidemic.
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Affiliation(s)
- Ramy Abou Ghayda
- Division of Urology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sung Hwi Hong
- Division of Urology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Urology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jae Won Yang
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Gwang Hun Jeong
- College of Medicine, Gyeongsang National University, Jinju, Korea
| | - Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Andreas Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Marco Solmi
- Department of Neuroscience, Padova Neuroscience Center (PNC), University of Padua, Padua, Italy
| | - Brendon Stubbs
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- ICREA, Pg. Lluis Companys 23, Barcelona, Spain
| | - Louis Jacob
- Parc Sanitari Sant Joan de Déu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Hans Oh
- School of Social Work, University of Southern California, Los Angeles, CA, USA
| | | | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
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13
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Ransome Y, Bogart LM, Kawachi I, Kaplan A, Mayer KH, Ojikutu B. Area-level HIV risk and socioeconomic factors associated with willingness to use PrEP among Black people in the U.S. South. Ann Epidemiol 2019; 42:33-41. [PMID: 31899083 PMCID: PMC7056502 DOI: 10.1016/j.annepidem.2019.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/25/2019] [Accepted: 11/28/2019] [Indexed: 02/02/2023]
Abstract
Purpose: In the United States (U.S.), southern states have the highest HIV incidence. Uptake of pre-exposure prophylaxis (PrEP) has been slow among Black people, particularly in the South. We know little about how area-level HIV risk influences one's willingness to use PrEP. Methods: 169 Black participants across 142 ZIP codes in the South completed the 2016 National Survey on HIV in the Black Community. We performed log-binomial regression to estimate the prevalence risk associated with residing in the upper 25th percentile of increases in new HIV diagnosis (2014–2015) within ZIP code and an individual's willingness to use PrEP, adjusting for individual and area-level covariates. Results: Participants were 68% female, mean age of 36 years, and 24% willing to use PrEP. Among the ZIP codes, 23% were within Atlanta, GA. The median increase in new HIV diagnoses was 25 per 100,000 population from 2014 to 2015 (IQR, 14–49). Participants living in ZIP codes within the upper 25th (compared-to-lower 75th) percentile of new HIV diagnoses were more willing to use PrEP (adjusted prevalence ratio (aPR) = 2.02, 95% CI = 1.06–3.86, P = .03). Area-level socioeconomic factors attenuated that association (aPR = 1.63, 95% CI = 0.78–3.39, P = .19). Conclusions: Area-level factors may influence PrEP uptake among Black people in the South.
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Affiliation(s)
- Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT.
| | - Laura M Bogart
- Pardee RAND Graduate School, RAND Corporation, Santa Monica, CA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Anna Kaplan
- Cambridge Public Health Department, Cambridge, MA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA
| | - Bisola Ojikutu
- Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA
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14
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Nunn A, Jeffries WL, Foster P, McCoy K, Sutten-Coats C, Willie TC, Ransome Y, Lanzi RG, Jackson E, Berkley-Patton J, Keefer M, Coleman JD. Reducing the African American HIV Disease Burden in the Deep South: Addressing the Role of Faith and Spirituality. AIDS Behav 2019; 23:319-330. [PMID: 31444712 DOI: 10.1007/s10461-019-02631-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Nearly half of HIV infections in the United States are concentrated among African Americans, and over half of new HIV infections occur in the South. African Americans have poorer outcomes in the entire continua of HIV and PrEP care. Complex social, structural, and behavioral factors contribute to our nation's alarming racial disparities in HIV infection, particularly in the Deep South. Despite the importance of faith, spirituality and religious practice in the lives of many African Americans, there has been little scientific investment exploring how African Americans' religious participation, faith and spirituality may impact our nation's HIV epidemic. This article summarizes the state of the science on this critical issue. We also identify opportunities for new scholarship on how faith, spirituality and religious participation may impact HIV care continuum outcomes in the South and call for greater federal research investment on these issues.
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Affiliation(s)
- Amy Nunn
- Center for Health Equity Research, Brown University, 121 S. Main St, G-810, Providence, RI, 02903, USA.
- Rhode Island Public Health Institute, Providence, USA.
| | - William L Jeffries
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Antlanta, USA
| | - Pamela Foster
- Department of Community Medicine/Population Health, University of Alabama School of Medicine, Tuscaloosa Regional Campus, Tuscaloosa, USA
| | - Katryna McCoy
- School of Nursing & Health Studies, University of Washington - Bothell, Bothell, USA
| | - Cassandra Sutten-Coats
- Center for Health Equity Research, Brown University, 121 S. Main St, G-810, Providence, RI, 02903, USA
- Rhode Island Public Health Institute, Providence, USA
| | - Tiara C Willie
- Rhode Island Public Health Institute, Providence, USA
- Warren Alpert School of Medicine, Brown University, Providence, USA
| | - Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, USA
| | - Robin Gaines Lanzi
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, USA
- Center for AIDS Research, University of Alabama at Birmingham, Birmingham, USA
| | - Edward Jackson
- Center for AIDS Research, University of Alabama at Birmingham, Birmingham, USA
| | | | - Michael Keefer
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, USA
| | - Jason D Coleman
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, USA
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