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Hassan A, Dulai J, Stewart M, Ryu H, Anand P, Worthington C, Gilbert M, Grace D. 'Sometimes white doctors are not very friendly or inclusive': a Critical Race Theory analysis of racism within and beyond sexual health settings. CULTURE, HEALTH & SEXUALITY 2024:1-17. [PMID: 38909285 DOI: 10.1080/13691058.2024.2367683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 06/10/2024] [Indexed: 06/24/2024]
Abstract
Many Two-Spirit, gay, bisexual, transgender, and other queer Black, Indigenous, people of colour in Canada encounter racism when testing for sexually transmitted and blood-borne infections. Our objective in this study was to understand how racism shapes testing experiences for these communities in Ontario, Canada. Four peer researchers conducted recruitment and data collection in consultation with a community advisory board. Focus groups and interviews took place with 21 participants and their narrative accounts were analysed using reflexive thematic analysis. Participants identified three interrelated issues when testing: (1) experiencing judgement and discomfort due to racism; (2) lack of community and cultural indicators in testing spaces; and (3) barriers to accessing testing centres and services. Systemic racism was linked to each of these barriers, including increased distance to testing centres due to racial segregation. Participant accounts signal the need for antiracist testing spaces and practices. Key implications include the need for antiracism training for health service providers and others working with Two-Spirit, gay, bisexual, transgender, and other queer Black, Indigenous, people of colour, and the organisations that serve them, in order to make testing spaces safer. Dismantling systemic racism is imperative to achieve health equity for members of these communities.
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Affiliation(s)
- Abdi Hassan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Joshun Dulai
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - MacKenzie Stewart
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Heeho Ryu
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Praney Anand
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Alliance for South Asian AIDS Prevention, Toronto, ON, Canada
| | - Catherine Worthington
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Mark Gilbert
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Takenaka BP, Kirklewski SJ, Griffith FJ, Gibbs JJ, Lauckner CK, Nicholson E, Tengatenga C, Hansen NB, Kershaw T. "It's another gay disease": an intersectional qualitative approach contextualizing the lived experiences of young gay, bisexual, and other sexual minoritized men in the United States during the mpox outbreak. BMC Public Health 2024; 24:1574. [PMID: 38862933 PMCID: PMC11167942 DOI: 10.1186/s12889-024-19062-z] [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: 04/07/2024] [Accepted: 06/05/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND The U.S. mpox outbreak in 2022 introduced new and exacerbated existing challenges that disproportionately stigmatize gay, bisexual, and other sexual minoritized men (GBSMM). This study contextualizes the perceptions, susceptibility, and lived experiences of the mpox outbreak among GBSMM in the U.S. using an intersectional framework. METHODS Between September 2022 to February 2023, we conducted 33 semi-structured qualitative interviews with purposively sampled GBSMM in the Northeast and the South region of the United States on various aspects related to their experience during the mpox outbreak. RESULTS We identified four themes: (1) understanding and conceptualizations of mpox, (2) mpox vaccine availability and accessibility, (3) mpox vaccine hesitancy and mistrust, and (4) call to action and recommendations. GBSMM collectively discussed the elevated mpox stigmatization and homophobic discourse from mainstream social media and news outlets. GBSMM also discussed the lack of availability of mpox vaccines, unclear procedures to receive the vaccine, and continued mistrust in government, non-government, and other institutions of health that were complicit in anti-LGBTQ + narratives related to mpox. However, they expressed that these challenges may be addressed through more LGTBQ + representation and leveraging ways to empower these communities. CONCLUSION GBSMM have mpox experiences that are distinct and multifaceted. Effectively addressing mpox and mitigating public health emergencies for GBSMM requires prioritizing destigmatizing communication channels and vaccine distribution strategies by centering their stories and lived experiences to advance health equity.
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Affiliation(s)
- Bryce Puesta Takenaka
- Yale School of Public Health, Department of Social and Behavioral Sciences, 60 College Street, New Haven, CT, 06510, USA.
| | - Sally J Kirklewski
- Yale School of Public Health, Department of Social and Behavioral Sciences, 60 College Street, New Haven, CT, 06510, USA
| | - Frances J Griffith
- Yale School of Medicine, Division of Prevention and Community Research, 389 Whitney Avenue, New Haven, CT, 06516, USA
| | - Jeremy J Gibbs
- School of Social Work, University of Georgia, 279 Williams St, Athens, GA, 30602, USA
| | - Carolyn K Lauckner
- College of Medicine, Department of Behavioral Sciences, University of Kentucky, 800 Rose Street MN 150, Lexington, KY, 40506, USA
| | - Erin Nicholson
- Yale School of Public Health, Department of Social and Behavioral Sciences, 60 College Street, New Haven, CT, 06510, USA
| | - Cecil Tengatenga
- School of Medicine, University of Connecticut, 200 Academic Wy, Farmington, CT, 06032, USA
| | - Nathan B Hansen
- Department of Health Promotion & Behavior, University of Georgia College of Public Health, 100 Foster Road, Athens, GA, 30606, USA
| | - Trace Kershaw
- Yale School of Public Health, Department of Social and Behavioral Sciences, 60 College Street, New Haven, CT, 06510, USA
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Bear Don't Walk OJ, Paullada A, Everhart A, Casanova-Perez R, Cohen T, Veinot T. Opportunities for incorporating intersectionality into biomedical informatics. J Biomed Inform 2024; 154:104653. [PMID: 38734158 PMCID: PMC11146624 DOI: 10.1016/j.jbi.2024.104653] [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: 11/18/2023] [Revised: 04/06/2024] [Accepted: 05/08/2024] [Indexed: 05/13/2024]
Abstract
Many approaches in biomedical informatics (BMI) rely on the ability to define, gather, and manipulate biomedical data to support health through a cyclical research-practice lifecycle. Researchers within this field are often fortunate to work closely with healthcare and public health systems to influence data generation and capture and have access to a vast amount of biomedical data. Many informaticists also have the expertise to engage with stakeholders, develop new methods and applications, and influence policy. However, research and policy that explicitly seeks to address the systemic drivers of health would more effectively support health. Intersectionality is a theoretical framework that can facilitate such research. It holds that individual human experiences reflect larger socio-structural level systems of privilege and oppression, and cannot be truly understood if these systems are examined in isolation. Intersectionality explicitly accounts for the interrelated nature of systems of privilege and oppression, providing a lens through which to examine and challenge inequities. In this paper, we propose intersectionality as an intervention into how we conduct BMI research. We begin by discussing intersectionality's history and core principles as they apply to BMI. We then elaborate on the potential for intersectionality to stimulate BMI research. Specifically, we posit that our efforts in BMI to improve health should address intersectionality's five key considerations: (1) systems of privilege and oppression that shape health; (2) the interrelated nature of upstream health drivers; (3) the nuances of health outcomes within groups; (4) the problematic and power-laden nature of categories that we assign to people in research and in society; and (5) research to inform and support social change.
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Affiliation(s)
- Oliver J Bear Don't Walk
- Department of Biomedical Informatics and Medical Education, University of Washington, United States.
| | - Amandalynne Paullada
- Department of Biomedical Informatics and Medical Education, University of Washington, United States
| | - Avery Everhart
- Department of Geography, Faculty of Arts, University of British Columbia, Canada
| | - Reggie Casanova-Perez
- Department of Biomedical Informatics and Medical Education, University of Washington, United States
| | - Trevor Cohen
- Department of Biomedical Informatics and Medical Education, University of Washington, United States
| | - Tiffany Veinot
- School of Information and School of Public Health, University of Michigan, United States
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Yu YJ, Schieber E, Janamnuaysook R, Wang B, Gunasekar A, MacDonell K, Getwongsa P, Kim D, Wongharn P, Phanuphak N. Barriers and facilitators to pre-exposure prophylaxis (PrEP) uptake and adherence among men who have sex with men (MSM) in Thailand: a qualitative study. AIDS Care 2024:1-9. [PMID: 38574278 DOI: 10.1080/09540121.2024.2332443] [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: 08/23/2023] [Accepted: 03/12/2024] [Indexed: 04/06/2024]
Abstract
Young MSM (YMSM), aged 15-24, account for nearly half of new HIV infections in Thailand. Pre-exposure prophylaxis (PrEP) is an effective prevention medicine for populations at substantial HIV risk, yet YMSM frequently have suboptimal uptake of and adherence to PrEP. We conducted 35 in-depth interviews with YMSM to explore barriers and facilitators of both PrEP initiation and adherence. Interviews also elicited the perceptions and experiences of healthcare providers (HCPs) working with YMSM at three clinics in Bangkok. Primary barriers to PrEP initiation were limited accessibility, insufficient knowledge, and efficacy concerns; HCPs identified no-to-low self-perception of HIV risk, pre-existing health problems, fears of side effects, and living in distant provinces as barriers to PrEP initiation. YMSM primarily reported PrEP information and self-perceptions of elevated HIV risk as facilitators to PrEP initiation. Additionally, forgetfulness and low HIV risk awareness were common barriers to PrEP adherence. Reminders were a prominent facilitator of PrEP adherence alongside disclosure to close relationships, the routinization of regimens, and convenient facilities. HCPs regarded counseling as the leading facilitator of PrEP adherence. By understanding the barriers/facilitators of PrEP use, the current study seeks to help develop evidence-informed PrEP intervention programs among YMSM while considering cultural sensitivity.
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Affiliation(s)
- Yeon Jung Yu
- Department of Anthropology, Western Washington University, Bellingham, WA, USA
| | - Elizabeth Schieber
- Department of Population and Quantitative Health Sciences, The University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Rena Janamnuaysook
- Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand
- Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
- Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, The University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Abhinaya Gunasekar
- Department of Population and Quantitative Health Sciences, The University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Karen MacDonell
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
| | | | - Deogwoon Kim
- Department of Population and Quantitative Health Sciences, The University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Prissana Wongharn
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | - Nittaya Phanuphak
- Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand
- Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
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Kadye T, Jamil MS, Johnson C, Baggaley R, Barr-DiChiara M, Cambiano V. Country uptake of WHO recommendations on differentiated HIV testing services approaches: a global policy review. BMJ Open 2024; 14:e058098. [PMID: 38485173 PMCID: PMC10941124 DOI: 10.1136/bmjopen-2021-058098] [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: 10/19/2021] [Accepted: 03/03/2023] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES In 2015 and 2016, WHO issued guidelines on HIV testing services (HTS) highlighting recommendations for a strategic mix of differentiated HTS approaches. The policy review examines the uptake of differentiated HTS approaches recommendations in national policies. METHODS Data were extracted from national policies published between January 2015 and June 2019. The WHO-recommended HTS approaches included facility-based testing, community-based testing, HIV self-testing and provider-assisted referral (or assisted partner notification). Other supportive recommendations include pre-test information, post-test counselling, lay provider testing and rapid testing. Descriptive analyses were conducted to examine inclusion of recommendations in national policies. RESULTS Of 194 countries worldwide, 65 published policies were identified; 24 WHO Africa region (AFR) countries (51%, 24/47), 21 WHO European region (EUR) (40%, 21/53), 6 WHO Eastern Mediterranean region (EMR) (29%, 6/21), 5 Pan-American region (AMR) (14%, 5/35), 5 Western Pacific Region (WPR) (19%, 5/27) and 4 WHO South East Asia Region (SEAR) (36%, 4/11). Only five countries included all recommendations. 63 included a minimum of one. 85% (n=55) included facility-based testing for pregnant women, 75% (n=49) facility-based testing for key populations, 74% (n=48) community-based testing for key populations, 69% (n=45) rapid testing, 57% (n=37) post-test counselling, 45% (n=29) lay provider testing, 38% (n=25) HIV self-testing, 29% (n=19) pre-test information and 25% (n=16) provider-assisted referral. The proportion in each region that included at least one recommendation were: 100% AFR (24/47), 100% EMR (6/6), 100% AMR (5/5), 100% WPR (5/5), 100% SEAR (4/4) and 95% EUR (20/21). AFR followed by EMR included the highest number of reccomendations. CONCLUSION There was substantial variability in the uptake of the WHO-differentiated HTS recommendations. Those in EMR included the most WHO-differentiated HTS recommendation followed by AFR. Countries within AMR included the least number of recommendations. Ongoing advocacy and efforts are needed to support the uptake of the WHO-differentiated HTS recommendations in country policies as well as their implementation.
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Affiliation(s)
| | | | - Cheryl Johnson
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | | | - Magdalena Barr-DiChiara
- Department of Global Programmes of HIV, Hepatitis and HIV, World Health Organization, Geneva, Switzerland
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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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Watson DL, Listerud L, Drab RA, Lin WY, Momplaisir FM, Bauermeister JA. HIV pre-exposure prophylaxis programme preferences among sexually active HIV-negative transgender and gender diverse adults in the United States: a conjoint analysis. J Int AIDS Soc 2024; 27:e26211. [PMID: 38332521 PMCID: PMC10853582 DOI: 10.1002/jia2.26211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Current implementation efforts have failed to achieve equitable HIV pre-exposure prophylaxis (PrEP) provision for transgender and gender-diverse (trans) populations. We conducted a choice-based conjoint analysis to measure preferences for key attributes of hypothetical PrEP delivery programmes among a diverse online sample predominantly comprised of transmasculine and nonbinary individuals in the United States. METHODS Between April 2022 and June 2022, a national online survey with an embedded conjoint analysis experiment was conducted among 304 trans individuals aged ≥18 years in the United States to assess five PrEP programme attributes: out-of-pocket cost; dispensing venue; frequency of visits for PrEP-related care; travel time to PrEP provider; and ability to bundle PrEP-related care with gender-affirming hormone therapy services. Participants responded to five questions, each of which presented two PrEP programme scenarios and one opt-out option per question and selected their preferred programme in each question. We used hierarchical Bayes estimation and multinomial logistic regression to measure part-worth utility scores for the total sample and by respondents' PrEP status. RESULTS The median age was 24 years (range 18-56); 75% were assigned female sex at birth; 54% identified as transmasculine; 32% as nonbinary; 14% as transfeminine. Out-of-pocket cost had the highest attribute importance score (44.3%), followed by the ability to bundle with gender-affirming hormone therapy services (18.7%). Minimal cost-sharing ($0 out-of-pocket cost) most positively influenced the attribute importance of cost (average conjoint part-worth utility coefficient of 2.5 [95% CI 2.4-2.6]). PrEP-experienced respondents preferred PrEP delivery in primary care settings (relative utility score 4.7); however, PrEP-naïve respondents preferred pharmacies (relative utility score 5.1). CONCLUSIONS Participants preferred programmes that offered PrEP services without cost-sharing and bundled with gender-affirming hormone therapy services. Bolstering federal regulations to cover PrEP services and prioritizing programmes to expand low-barrier PrEP provision are critical to achieving equitable PrEP provision. Community-engaged implementation research conducted by and in close collaboration with trans community stakeholders and researchers are needed to streamline the design of patient-centred PrEP programmes and develop implementation strategies that are salient to the diverse sexual health needs of trans patients.
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Affiliation(s)
- Dovie L. Watson
- Department of Medicine (Infectious Diseases)University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Louis Listerud
- Department of Family and Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ryan A. Drab
- Department of Family and Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Willey Y. Lin
- Department of Family and Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Florence Marie Momplaisir
- Department of Medicine (Infectious Diseases)University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - José A. Bauermeister
- Department of Family and Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Gaumer G, Senthil Kumar VS, Crown W, Jordan M, Hurley C, Subramanian M, Nandakumar AK. Equity of the HIV epidemic response in 13 African countries. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2023; 22:276-289. [PMID: 38117740 DOI: 10.2989/16085906.2023.2277887] [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: 08/01/2023] [Accepted: 10/01/2023] [Indexed: 12/22/2023]
Abstract
For over 25 years, new programs to attempt to stem the HIV epidemic have been developed in Africa by country governments as well as external donors. These programs and activities have built and operated facilities, trained clinicians, financed drugs and commodities, supported and helped finance government health planning and operations, and contributed in other ways. Who has benefited from this massive mobilization? While some single country and narrowly focused studies have been done, the issue of equity of HIV programs for vulnerable populations has not been examined in a large set of countries. Using Population-based HIV Impact Assessment (PHIA) data, we examine equity of the HIV programs in 13 African countries to determine if vulnerable groups (such as those with low wealth, rural populations, young adults, and females) have achieved comparable levels of access to HIV program services. In contrast, we also compare the equity of the HIV response to rural and low-wealth populations with the equity of corresponding domestic health systems using Demographic and Health Survey data.This study found that in over half of the countries, the HIV response indicators were equitable for vulnerable population segments including the low-wealth population (in seven countries) and rural population segment (in nine countries). In no country was the domestic health system equitable for these two groups. However, HIV programming does show some clear patterns of inequity for low-wealth and rural populations in some countries. For gender and young adults, the HIV response indicators show that in all 13 countries men and young adults are consistently underserved relative to their counterparts.
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Affiliation(s)
- Gary Gaumer
- Institute for Global Health and Development, The Heller School for Social Policy and Management, Brandeis University, Waltham MA, USA
| | - V S Senthil Kumar
- Institute for Global Health and Development, The Heller School for Social Policy and Management, Brandeis University, Waltham MA, USA
| | - William Crown
- Institute for Global Health and Development, The Heller School for Social Policy and Management, Brandeis University, Waltham MA, USA
| | - Monica Jordan
- Institute for Global Health and Development, The Heller School for Social Policy and Management, Brandeis University, Waltham MA, USA
| | - Clare Hurley
- Institute for Global Health and Development, The Heller School for Social Policy and Management, Brandeis University, Waltham MA, USA
| | - Maya Subramanian
- Institute for Global Health and Development, The Heller School for Social Policy and Management, Brandeis University, Waltham MA, USA
| | - A K Nandakumar
- Institute for Global Health and Development, The Heller School for Social Policy and Management, Brandeis University, Waltham MA, USA
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McIntyre AC, Cody SL, Ezemenaka CJ, Johnson K, Mugoya G, Foster P. HIV Knowledge, Risk Factors, and Utilization of Services in the US Rural Deep South. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01868-z. [PMID: 37985647 DOI: 10.1007/s40615-023-01868-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND HIV prevalence in the rural South remains high among Black Americans due to limited access to prevention and treatment services and poverty. HIV care inequities for Black Americans living in the rural South are further intensified by high mortality rates, low HIV health literacy, stigma, and discrimination. Few studies have focused on HIV knowledge and risk factors within Black Americans in the rural South. METHODS This cross-sectional study examined the association between HIV risk factors, HIV knowledge, and utilization of HIV and/or sexually transmitted infection (STI) testing services among Black Americans (N = 200) living in the rural South. HIV knowledge, risk factors, and utilization of testing services were assessed via The HIV Knowledge Questionnaire, The HIV Risk Factor Questionnaire, and three investigator-generated questions, respectively. Linear regression was used to examine the relationship between demographic characteristics, HIV knowledge, utilization of testing services, and HIV risk factors. RESULTS Among 200 participants, a smaller percentage (37.7%, n = 75) reported using HIV/STI testing services compared to non-users. Controlling for demographic covariates in the model, HIV knowledge (p < .0001) and marital status (p = .010) were significantly associated with HIV risk factors. HIV risk factors decreased as HIV knowledge increased. Individuals who reported being single also reported having fewer risk factors. CONCLUSION Future research should examine the impact of HIV education tailored for individuals with greater HIV risk factors within rural Black Americans. Studies exploring barriers to the utilization of HIV/STI testing services within Black American rural communities are warranted.
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Affiliation(s)
- Alissa C McIntyre
- Department of Psychology, The University of Alabama, 348 Gordon Palmer Hall, Tuscaloosa, AL, 35487-0348, USA.
| | - Shameka L Cody
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL, USA
| | | | - Karen Johnson
- Department of Social Work, The University of Alabama, Tuscaloosa, AL, USA
| | - George Mugoya
- Department of Educational Studies, The University of Alabama, Tuscaloosa, AL, USA
| | - Pamela Foster
- Department of Community Medicine/Population Health, School of Medicine, The University of Alabama, Tuscaloosa Regional Campus, Tuscaloosa, AL, USA
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Kurniawan K, Fitri SUR, Khoirunnisa K, Yosep I. The Needs of Nurses to Improve Nursing Care for HIV-Positive MSM in Indonesia: A Qualitative Descriptive Study. J Multidiscip Healthc 2023; 16:3007-3015. [PMID: 37849960 PMCID: PMC10578156 DOI: 10.2147/jmdh.s426818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/05/2023] [Indexed: 10/19/2023] Open
Abstract
Purpose The existence of HIV-positive men who have sex with men (HIV-positive MSM) in Indonesia is controversial because it goes against current norms. As a result, they are unable to confide in themselves about their identities. Therefore, it is often difficult for nurses to identify those who need treatment. This study aimed to explore the needs of nurses to improve nursing care for HIV-positive MSM. Materials and Methods The qualitative study with a purposive sample of 15 nurses participated in semi-structured and in-depth interviews. The data is analyzed by thematic analysis. Results Three key themes emerged:(1) effective therapeutic communication techniques for HIV-positive MSM, (2) increasing the skills and knowledge of nurses; (3) continuity of care. Conclusion The need to improve the knowledge and skills of nurses in caring for HIV-positive MSM will impact the quality of nursing care and lead to better patient's center care. Furthermore, it will increase satisfaction with the nursing care provided.
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Affiliation(s)
- Kurniawan Kurniawan
- Department of Mental Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, 45363, Indonesia
- Faculty of Nursing, Universitas Indonesia, Depok, 16424, Indonesia
| | - Siti Ulfah Rifa’atul Fitri
- Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, 45363, Indonesia
| | - Khoirunnisa Khoirunnisa
- Department of Pediatric, Faculty of Nursing, Universitas Padjadjaran, Sumedang, 45363, Indonesia
| | - Iyus Yosep
- Department of Mental Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, 45363, Indonesia
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Zigah EY, Abu-Ba'are GR, Shamrock OW, Dakpui HD, Apreku A, Boyd DT, Nelson LE, Torpey K. "For my safety and wellbeing, I always travel to seek health care in a distant facility"-the role of place and stigma in HIV testing decisions among GBMSM - BSGH 002. Health Place 2023; 83:103076. [PMID: 37423093 DOI: 10.1016/j.healthplace.2023.103076] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/11/2023]
Abstract
Gays, bisexuals, and all other men who have sex with men (GBMSM) are heavily impacted by HIV in Ghana compared to the general population. In addition to HIV and same-sex intercourse stigma, barriers such as reduced privacy, lower-income status and limited health care facilities (HCF) affect HIV testing decisions among GBMSM. We employed a phenomenological research design to understand the role of place and stigma in HIV testing among GBMSM in slums. GBMSM (n = 12) from slums in Accra and Kumasi, Ghana, were recruited and engaged in face-to-face interviews. We used a multiple reviewer summative content analysis to analyze and organize our key findings. The HIV testing options we identified include 1. Government HCF, 2. NGO and community outreach 3. Peer-educated services. Factors influencing GBMSM to test for HIV at HCF outside their areas included 1. The location of HCF 2. HIV and sexual stigma from slum areas 3. Positive HCW attitudes at distant HCF. 4. Negative Healthcare worker (HCW) attitudes towards GBMSM. These findings highlighted how stigma from slums and HCW influence HIV testing decisions and the need for place-based interventions to address stigma among HCW in slums to improve testing among GBMSM.
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Affiliation(s)
- Edem Yaw Zigah
- Behavioral, Sexual, and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana.
| | - Gamji Rabiu Abu-Ba'are
- Behavioral, Sexual, and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana; Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester, Rochester, NY, USA; School of Nursing, University of Rochester, Rochester, NY, USA; Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, USA
| | - Osman Wumpini Shamrock
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester, Rochester, NY, USA; School of Nursing, University of Rochester, Rochester, NY, USA
| | - Henry Delali Dakpui
- Behavioral, Sexual, and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana
| | - Amos Apreku
- School of Public Health, University of Ghana, Accra, Ghana
| | - Donte T Boyd
- College of Social Work, Ohio State University, Columbus, OH, USA
| | - LaRon E Nelson
- School of Nursing, Yale University, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, USA
| | - Kwasi Torpey
- School of Public Health, University of Ghana, Accra, Ghana
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Lucas NA, Bates GW, Buzwell S. I Am More than HIV: A Qualitative Exploration of Factors That Can Strengthen Resilience Among HIV-Positive Gay Men in Australia. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2023:1-16. [PMID: 37363353 PMCID: PMC10257188 DOI: 10.1007/s13178-023-00829-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/28/2023]
Abstract
Introduction HIV-positive gay men continue to experience stigma related to sexual orientation and HIV status. Although resilience toward such stressors can be achieved, limited Australian research exists that examines how resilience is strengthened toward these dual stigmas. Methods A total of 20 men from Melbourne, Australia, participated in semi-structured interviews between March and October 2019 to explore ways in which they manage such stigmas. Results Reflexive thematic analysis identified two primary themes: (1) "intrapersonal control," which relates to individual mind set and lifestyle changes that participants utilized to strengthen resilience; (2) "systemic change," which includes participants' needs for better public health messaging. Findings show resilience was enhanced when proactive approaches to sexual orientation, HIV health appraisal, lifestyle changes, and social support were made. Further, outdated HIV awareness campaigns and a lack of current messaging regarding HIV transmission in the wider community were identified as inhibiting resilience development and promoting stigma among gay men. Conclusion The results from this study show ways that Australian gay men strengthen their resilience through both intrapersonal (e.g., self-awareness, reappraisal, and self-efficacy) and external resources (e.g., education and public awareness) and how health care providers and social policy makers could better support the men to achieve this. Social-Policy Implications Findings suggest that targeted public health responses are required to compliment the advances made in biomedicine and viral suppression.
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Affiliation(s)
- Neil A. Lucas
- Department of Psychology, School of Health Sciences, Swinburne University of Technology, John Street, Hawthorn, 3122 Melbourne, Australia
| | - Glen W. Bates
- Department of Psychology, School of Health Sciences, Swinburne University of Technology, John Street, Hawthorn, 3122 Melbourne, Australia
| | - Simone Buzwell
- Department of Psychology, School of Health Sciences, Swinburne University of Technology, John Street, Hawthorn, 3122 Melbourne, Australia
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13
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Sharafi M, Mirahmadizadeh A, Hassanzadeh J, Seif M, Heiran A. Duration of delayed diagnosis in HIV/AIDS patients in Iran: a CD4 depletion model analysis. Front Public Health 2023; 11:1029608. [PMID: 37139388 PMCID: PMC10149797 DOI: 10.3389/fpubh.2023.1029608] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 03/21/2023] [Indexed: 05/05/2023] Open
Abstract
Objective Delayed diagnosis of HIV can lead to an inappropriate response to antiretroviral therapy (ART), rapid progression of the disease, and death. It can also carry harmful effects on public health due to the increment of transmission. This study aimed to estimate the duration of delayed diagnosis (DDD) in HIV patients in Iran. Methods This hybrid cross-sectional cohort study was conducted on the national HIV surveillance system database (HSSD). Linear mixed effect models with random intercept, random slope, and both were used to estimate the parameters required for the CD4 depletion model to determine the best-fitted model for DDD, stratified by the route of transmission, gender, and age group. Results The DDD was estimated in 11,373 patients including 4,762 (41.87%) injection drug users (IDUs), 512 (4.5%) men who had sexual contact with men (MSM), 3,762 (33.08%) patients with heterosexual contacts, and 2,337 (20.55%) patients who were infected through other routes of HIV transmission. The total mean DDD was 8.41 ± 5.97 years. The mean DDD was 7.24 ± 0.08 and 9.43 ± 6.83 years in male and female IDUs, respectively. In the heterosexual contact group, DDD was obtained as 8.60 ± 6.43 years in male patients and 9.49 ± 7.17 years in female patients. It was also estimated as 9.37 ± 7.30 years in the MSM group. Furthermore, patients infected through other transmission routes were found with a DDD of 7.90 ± 6.74 years for male patients and a DDD of 7.87 ± 5.87 years for female patients. Conclusion A simple CD4 depletion model analysis is represented, which incorporates a pre-estimation step to determine the best-fitted linear mixed model for calculating the parameters required for the CD4 depletion model. Considering such a noticeably high HIV diagnostic delay, especially in older adults, MSM, and heterosexual contact groups, regular periodic screening is required to reduce the DDD.
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Affiliation(s)
- Mehdi Sharafi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Mirahmadizadeh
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- *Correspondence: Alireza Mirahmadizadeh
| | - Jafar Hassanzadeh
- Department of Epidemiology, School of Health, Research Center for Health Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhgan Seif
- Non-communicable Diseases Research Center, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Heiran
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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14
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Panag DS, Jain N, Katagi D, De Jesus Cipriano Flores G, Silva Dutra Macedo GD, Rodrigo Díaz Villa G, Yèche M, Velázquez Mérida SY, Kapparath S, Sert Z, Reinis A. Variations in national surveillance reporting for Mpox virus: A comparative analysis in 32 countries. Front Public Health 2023; 11:1178654. [PMID: 37143972 PMCID: PMC10151817 DOI: 10.3389/fpubh.2023.1178654] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/17/2023] [Indexed: 05/06/2023] Open
Abstract
Objectives Case Reporting and Surveillance (CRS) are crucial to combat the global spread of the Monkeypox virus (Mpox). To support CRS, the World Health Organization (WHO) has released standardized case definitions for suspected, probable, confirmed, and discarded cases. However, these definitions are often subject to localized adaptations by countries leading to heterogeneity in the collected data. Herein, we compared the differences in Mpox case definitions in 32 countries that collectively reported 96% of the global Mpox caseload. Methods We extracted information regarding Mpox case definitions issued by the competent authorities in 32 included countries for suspected, probable, confirmed, and discarded cases. All data were gathered from online public sources. Results For confirmed cases, 18 countries (56%) followed WHO guidelines and tested for Mpox using species specific PCR and/or sequencing. For probable and suspected cases, seven and eight countries, respectively were found to have not released definitions in their national documentations. Furthermore, none of the countries completely matched WHO's criteria for probable and suspected cases. Overlapping amalgamations of the criteria were frequently noticed. Regarding discarded cases, only 13 countries (41%) reported definitions, with only two countries (6%) having definition consistent with WHO guidelines. For case reporting, 12 countries (38%) were found to report both probable and confirmed cases, in line with WHO requirements. Conclusion The heterogeneity in case definitions and reporting highlights the pressing need for homogenization in implementation of these guidelines. Homogenization would drastically improve data quality and aid data-scientists, epidemiologists, and clinicians to better understand and model the true disease burden in the society, followed by formulation and implementation of targeted interventions to curb the virus spread.
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Affiliation(s)
| | - Nityanand Jain
- Faculty of Medicine, Riga Stradinš University, Riga, LV, Latvia
- *Correspondence: Nityanand Jain,
| | - Dimitra Katagi
- Faculty of Medicine, School of Medicine, University of Patras, Rio, Greece
| | | | - Gabriela Dias Silva Dutra Macedo
- Faculty of Medicine, Universidade da Região de Joinville (UNIVILLE), Joinville, Brazil
- Pontifícia Universidade Católica do Paraná (PUCPR), Rua Imaculada Conceição, Prado Velho, Curitiba - PR, Brazil
| | | | - Mathieu Yèche
- ICM, Paris Brain Institute, Hopital de la Pitie-Salpetriere, Sorbonne Universite, INSERM U1127, CNRS UMR7225, Paris, France
- Département de Biologie de l’École Normale Supérieure (ENS), PSL Research University, Paris, France
| | | | - Sreerag Kapparath
- Faculty of Medicine, Tbilisi State Medical University, Tbilisi, Georgia
| | - Zilfi Sert
- Faculteit der Bètawetenschappen, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Aigars Reinis
- Faculty of Medicine, Riga Stradinš University, Riga, LV, Latvia
- Joint Laboratory, Pauls Stradinš Clinical University Hospital, Riga, Latvia
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Rodriguez-Diaz CE, Crowley JS, Santiago-Rivera Y, Millett GA. From COVID-19 to Monkeypox: Unlearned Lessons for Black, Latino, and Other Men With HIV Who Have Sex With Men. Am J Public Health 2022; 112:1567-1571. [PMID: 36108251 PMCID: PMC9558207 DOI: 10.2105/ajph.2022.307093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 09/03/2023]
Affiliation(s)
- Carlos E Rodriguez-Diaz
- Carlos E. Rodriguez-Diaz is with the Department of Prevention and Community Health and the Gill-Lebovic Center for Community Health in the Caribbean and Latin America, Milken Institute School of Public Health, George Washington University, Washington, DC. Jeffrey S. Crowley is with the Infectious Diseases Initiative, O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC. Yaiomy Santiago-Rivera is with the Department of Epidemiology, Milken Institute School of Public Health. Gregorio A. Millett is with amfAR, The Foundation for AIDS Research, Washington, DC
| | - Jeffrey S Crowley
- Carlos E. Rodriguez-Diaz is with the Department of Prevention and Community Health and the Gill-Lebovic Center for Community Health in the Caribbean and Latin America, Milken Institute School of Public Health, George Washington University, Washington, DC. Jeffrey S. Crowley is with the Infectious Diseases Initiative, O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC. Yaiomy Santiago-Rivera is with the Department of Epidemiology, Milken Institute School of Public Health. Gregorio A. Millett is with amfAR, The Foundation for AIDS Research, Washington, DC
| | - Yaiomy Santiago-Rivera
- Carlos E. Rodriguez-Diaz is with the Department of Prevention and Community Health and the Gill-Lebovic Center for Community Health in the Caribbean and Latin America, Milken Institute School of Public Health, George Washington University, Washington, DC. Jeffrey S. Crowley is with the Infectious Diseases Initiative, O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC. Yaiomy Santiago-Rivera is with the Department of Epidemiology, Milken Institute School of Public Health. Gregorio A. Millett is with amfAR, The Foundation for AIDS Research, Washington, DC
| | - Gregorio A Millett
- Carlos E. Rodriguez-Diaz is with the Department of Prevention and Community Health and the Gill-Lebovic Center for Community Health in the Caribbean and Latin America, Milken Institute School of Public Health, George Washington University, Washington, DC. Jeffrey S. Crowley is with the Infectious Diseases Initiative, O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC. Yaiomy Santiago-Rivera is with the Department of Epidemiology, Milken Institute School of Public Health. Gregorio A. Millett is with amfAR, The Foundation for AIDS Research, Washington, DC
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