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Kalu N, Ross MW, Taegtmeyer M, Lamontagne E, Howell S, Neuman M. Association of same-sex criminalisation laws and national HIV policies with HIV testing in African MSM: an ecological single-level and multilevel cross-sectional study of sub-Saharan African countries. Sex Transm Infect 2024; 100:sextrans-2023-055964. [PMID: 38331571 DOI: 10.1136/sextrans-2023-055964] [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: 08/15/2023] [Accepted: 01/13/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND HIV incidence among men who have sex with men (MSM) in sub-Saharan Africa (SSA) remains high compared with the general population. Many countries in the region still criminalise consensual homosexual relationships, and some are yet to adopt WHO-recommended interventions for MSM into national HIV policies. This study examines how HIV testing of adult MSM in SSA varies according to the legal climate and presence of targeted HIV policy using data from the cross-sectional 2019 Global LGBTI Internet Survey study. METHODS Using data from 3191 MSM in 44 SSA countries, we assessed associations of legal climate and HIV policy with ever and recent HIV testing using linear ecological and logistic multilevel analyses. From the single-level analysis, we can compare our findings to previously reported data, then, extending to a two-level multilevel analysis, we account for the hierarchical structure of the population and simultaneously adjust for differences in context and composition in each country. We then test the sensitivity of our analyses to excluding countries from the model. RESULTS We find evidence that legalised same-sex relationships were associated with increased odds of ever testing (OR=2.00, 95% CI 1.04, 3.82) in multilevel analyses. We also find evidence of an association of targeted HIV policies with increased odds of ever testing (OR=2.49, 95% CI 1.12, 5.52). We did not find evidence of an association of the legal climate (OR=1.01, 95% CI 0.69, 1.46) and targeted HIV policies (OR=1.26, 95% CI 0.78, 2.04) with recent testing. CONCLUSIONS This study suggests elimination of discriminatory laws and policies might be important for increasing HIV status awareness of MSM, an important first step in epidemic control. Additionally, we highlight heterogeneity between South Africa and other SSA countries, which has implications for studying SSA countries as a homogeneous group.
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Affiliation(s)
- Ngozi Kalu
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Michael W Ross
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Sean Howell
- LGBT+ Foundation, San Francisco, California, USA
| | - Melissa Neuman
- MRC International Statistics and Epidemiology Group and Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Matlapeng KM, Babatunde GB, Gwelo NB, Akintola O. Accessing HIV services in Botswana: perspectives of men who have sex with men and other stakeholders. Glob Health Action 2023; 16:2262197. [PMID: 37830348 PMCID: PMC10578085 DOI: 10.1080/16549716.2023.2262197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/19/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) represent an increasing number of new HIV infections in Botswana. Many in Botswana still hold discriminatory views against people who engage in same-sex practices. While it is well documented that stigma and discrimination undermine efforts to prevent HIV, the literature about the perception and experiences of discrimination against MSM in accessing HIV services in Botswana is scant. OBJECTIVE(S) In this study, we sought to explore the perception and experiences of discrimination against MSM to improve access to HIV services and reduce discrimination against this marginalised population. METHODS We employed a descriptive qualitative design using purposive sampling to recruit 20 MSM and 12 stakeholders (six policy-makers and six service providers) involved in implementing HIV/AIDS interventions in Botswana. We conducted semi-structured interviews with participants. All data were audio-recorded, transcribed, translated into English and analysed using thematic analysis. RESULTS The findings of this study show that MSM experience discrimination at the policy, healthcare system and community levels, which undermines their ability to seek HIV services. The participants reported that MSM are excluded from HIV policies and targeted HIV services. They reported a scarcity of trained personnel, poor access to HIV information, condoms, lack of treatment services targeted at MSM and negative attitudes directed towards MSM by service providers and other users. The participants also reported that they are excluded from community interventions and experience negative attitudes from community and family members. CONCLUSION Discrimination against MSM undermines the ability of HIV interventions to address MSM sexual health needs. The findings indicate the importance of enabling MSM to overcome discrimination to seek HIV services. Also, there is a need to further explore discrimination against MSM by service providers within the healthcare settings and ways to improve their understanding of male same-sex practices.
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Affiliation(s)
- Kgosiekae Maxwell Matlapeng
- School of Public Health, University of Western Cape, Cape Town, South Africa
- Public Health Science Department, Institute of Health Sciences, Serowe, Botswana
| | - Gbotemi Bukola Babatunde
- School of Public Health, University of Western Cape, Cape Town, South Africa
- Graduate School of Professional Psychology, University of Denver, Denver, CO, USA
| | - Netsai Bianca Gwelo
- School of Public Health, University of Western Cape, Cape Town, South Africa
| | - Olagoke Akintola
- School of Public Health, University of Western Cape, Cape Town, South Africa
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Abstract
PURPOSE OF REVIEW HIV prevention and treatment interventions for MSM are not well studied or reported from low-income and middle-income countries (LMIC) in comparison to those targeting gender-conforming populations. Some evidence-based strategies to engage MSM in appropriate healthcare have recently reported on their experiences and impact. Novel recruitment strategies have been developed for treatment and preexposure prophylaxis (PrEP) for MSM, leveraging new community engagement strategies and social media technologies. RECENT FINDINGS Despite publication of several new guidelines, there is little recent evidence available to guide MSM health programs in LMIC, highlighting the need for ongoing research and publication. Some important PrEP pilot study results have recently been published, such as the PrEP Brazil and Princess PrEP programmes, which could guide the scale-up of MSM PrEP. The novel use of technology and online platforms to strengthen MSM health delivery and support is particularly important. SUMMARY Providing healthcare to MSM requires consideration of context, broad stakeholder engagement, implementation of best practice guidelines and ongoing situational assessment and integration of novel community engagement methods that are evidence-based. Implementation of improved antiretroviral programmes and the access to PrEP for MSM are vital.
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Fearon E, Tenza S, Mokoena C, Moodley K, Smith AD, Bourne A, Weatherburn P, Palanee-Phillips T. HIV testing, care and viral suppression among men who have sex with men and transgender individuals in Johannesburg, South Africa. PLoS One 2020; 15:e0234384. [PMID: 32555703 PMCID: PMC7299351 DOI: 10.1371/journal.pone.0234384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 05/26/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Men who have sex with men and transgender individuals (MSM/TG) carry a disproportionately high burden of HIV, including in South Africa. However, there are few empirical population-representative estimates of viral suppression and the HIV care cascade including HIV testing among this population, nor of factors associated with these outcomes. METHODS We conducted a respondent driven sampling (RDS) survey among 301 MSM/TG in Johannesburg in 2017. Participants gave blood samples for HIV testing and viral load. Participants self-completed a survey including sociodemographics, HIV testing history, and engagement in care. We calculated RDS-II weighted estimates of the percentage of HIV-negative MSM/TG reporting HIV testing in the previous 6 months, their testing experience and preferences. Among those HIV-positive, we estimated the percentage status-aware, on ART, and virally suppressed (<50 viral copies/ml plasma). We conducted RDS-weighted robust Poisson regression to obtain weighted prevalence ratios of factors associated with 1) HIV testing among those HIV-negative; and 2) viral suppression among those HIV-positive. RESULTS There were 118/300 HIV-positive MSM/TG, (37.5%). Of the HIV-negative MSM/TG, 61.5% reported that they had tested for HIV in the previous 6 months, which was associated with selling sex to men (Prevalence Ratio = 1.67, 95% CI 1.36-2.05). There were 76/118 HIV-positive MSM/TG (56.5%) who reported having previously tested positive for HIV and 39/118 (30.0%) who reported current ART. There were 58/118 HIV-positive MSM/TG with viral loads <50 copies/ml plasma (46.9%). Viral suppression was associated with older age (adjusted PR = 1.03, 95% CI 1.00-1.06 for each year), neighbourhood, and having bought sex from men (adjusted PR = 1.53, 95% CI 1.12-2.08). CONCLUSIONS HIV prevalence was very high. Viral suppression among those HIV-positive was similar to the general male population in South Africa, but remains far short of national and international targets. A majority of HIV-negative MSM/TG had HIV tested in the previous 6 months, though there is room for improvement.
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Affiliation(s)
- Elizabeth Fearon
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Siyanda Tenza
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Cecilia Mokoena
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Kerushini Moodley
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Adrian D. Smith
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, LaTrobe University, Melbourne, Australia
| | - Peter Weatherburn
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Sheppard DM, Frost D, Jefford M, O'Connor M, Halkett G. 'Beyond Cancer': a study protocol of a multimodal occupational rehabilitation programme to support breast cancer survivors to return work. BMJ Open 2019; 9:e032505. [PMID: 31843840 PMCID: PMC6924857 DOI: 10.1136/bmjopen-2019-032505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION With more women working and surviving breast cancer, issues concerning sustainable employment must be addressed. Support to transition back to work is a gap in survivorship care. This paper describes the feasibility trial protocol for 'Beyond Cancer', a multimodal occupational rehabilitation programme to support breast cancer survivors' return to work. Breast cancer survivors are hypothesised to show improved work status, work capacity and perceived support at work at 6 months postintervention relative to baseline and a historical usual care group. METHODS AND ANALYSIS The prospective feasibility design allows determination of change in primary (work status) as well as secondary outcome measures work capacity and perceived support at work. PARTICIPANTS breast cancer survivors of working age, unable to work in their prediagnosis capacity for >3 months, their employers and a historical usual care group. Key intervention elements: an evidence-based biopsychosocial assessment and health coaching programme, employer education and support, and return to work (RTW) planning and monitoring. Health coaching empowers survivors to return to social function, including work. Employer education and support facilitates communication and improves workplace support. For employers, we predict change in confidence in effectively supporting employees' RTW. Multilevel regression modelling will provide indications of efficacy for primary and secondary outcomes, and thematic analysis will examine perceived efficacy and acceptability. ETHICS AND DISSEMINATION Ethics approval has been granted by Monash and Curtin University Human Research Ethics Committees (HREC: 13300, HRE2019-0280, respectively). The evaluation of this innovative programme will provide the foundation for an Randomised Controlled Trial (RCT) and national roll-out, thus improving the quality of life of those who have been directly affected by breast cancer across Australia. Results will be published in peer-reviewed journals, presented at relevant conferences and disseminated to survivorship-focused organisations. TRIAL REGISTRATION NUMBER Registered trial with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12618001985279); Pre-results.
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Affiliation(s)
| | - Dorothy Frost
- Research and Innovation, MedHealth Group, Melbourne, Victoria, Australia
| | - Michael Jefford
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Melbourne, Victoria, Australia
- Australian Cancer Survivorship Centre, a Richard Pratt legacy, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Moira O'Connor
- School of Psychology, Curtin University Bentley Campus, Perth, Western Australia, Australia
| | - Georgia Halkett
- School of Nursing, Midwifery and Paramedicine, Curtin University Bentley Campus, Perth, Western Australia, Australia
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Schwartz SR, Kavanagh MM, Sugarman J, Solomon SS, Njindam IM, Rebe K, Quinn TC, Toure-Kane C, Beyrer C, Baral S. HIV viral load monitoring among key populations in low- and middle-income countries: challenges and opportunities. J Int AIDS Soc 2018; 20 Suppl 7. [PMID: 29171178 PMCID: PMC5978693 DOI: 10.1002/jia2.25003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 08/21/2017] [Accepted: 08/21/2017] [Indexed: 11/08/2022] Open
Abstract
Introduction Key populations bear a disproportionate HIV burden and have substantial unmet treatment needs. Routine viral load monitoring represents the gold standard for assessing treatment response at the individual and programme levels; at the population‐level, community viral load is a metric of HIV programme effectiveness and can identify “hotspots” of HIV transmission. Nevertheless, there are specific implementation and ethical challenges to effectively operationalize and meaningfully interpret viral load data at the community level among these often marginalized populations. Discussion Viral load monitoring enhances HIV treatment, and programme evaluation, and offers a better understanding of HIV surveillance and epidemic trends. Programmatically, viral load monitoring can provide data related to HIV service delivery coverage and quality, as well as inequities in treatment access and uptake. From a population perspective, community viral load data provides information on HIV transmission risk. Furthermore, viral load data can be used as an advocacy tool to demonstrate differences in service delivery and to promote allocation of resources to disproportionately affected key populations and communities with suboptimal health outcomes. However, in order to perform viral load monitoring for individual and programme benefit, health surveillance and advocacy purposes, careful consideration must be given to how such key population programmes are designed and implemented. For example, HIV risk factors, such as particular sex practices, sex work and drug use, are stigmatized or even criminalized in many contexts. Consequently, efforts must be taken so that routine viral load monitoring among marginalized populations does not cause inadvertent harm. Furthermore, given the challenges of reaching representative samples of key populations, significant attention to meaningful recruitment, decentralization of care and interpretation of results is needed. Finally, improving the interoperability of health systems through judicious use of biometrics or identifiers when confidentiality can be maintained is important to generate more valuable data to inform monitoring programmes. Conclusions Opportunities for expanded viral load monitoring could and should benefit all those affected by HIV, including key populations. The promise of the increasing routinization of viral load monitoring as a tool to advance HIV treatment equity is great and should be prioritized and appropriately implemented within key population programmatic and research agendas.
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Affiliation(s)
- Sheree R Schwartz
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Matthew M Kavanagh
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, USA.,O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA
| | - Jeremy Sugarman
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Sunil S Solomon
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Illiassou M Njindam
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Kevin Rebe
- Anova Health Institute, Cape Town, South Africa
| | - Thomas C Quinn
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Division of Intramural Research, National Institutes of Health, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Coumba Toure-Kane
- Department of Bacteriology and Virology, CHU Le Dantec, Dakar, Senegal
| | - Chris Beyrer
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Stefan Baral
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
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