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Rotsaert A, Vanhamel J, Vanbaelen T, Vuylsteke B, van der Loeff MS, Hensen B, Kielmann K, Callens S, Reyniers T. HIV Pre-exposure Prophylaxis (PrEP) Care in Belgium: A mixed-methods Study on PrEP Users' Experiences and Service Delivery Preferences. AIDS Behav 2024; 28:393-407. [PMID: 38038778 DOI: 10.1007/s10461-023-04232-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
In Belgium, HIV pre-exposure prophylaxis (PrEP) services are mainly provided through specialised HIV clinics. To optimise PrEP uptake and retention in care, we require insights into users' perspectives on PrEP care. We aimed to elicit experiences with, and preferences for, PrEP service delivery among PrEP users in Belgium, including willingness to involve their family physician (FP) in PrEP care. We adopted a sequential mixed-methods design. We used a web-based longitudinal study among 326 PrEP users that consisted of two questionnaires at six-month intervals, and complemented this with 21 semi-structured interviews (September 2020-January 2022). We conducted descriptive analyses and logistic regression to examine factors associated with willingness to involve their FP in PrEP care. Interviews were analysed using thematic analysis. Survey respondents reported high satisfaction with care received in HIV clinics [median score 9 (IQR 8-10), 10='very satisfied']. Interviews revealed the importance of regular HIV/STI screening, and the expertise and stigma-free environment of HIV clinics. Yet, they also contextualised service delivery barriers reported in the questionnaire, including the burden of cost and challenges integrating PrEP visits into their private and professional lives. Although 63.8% (n = 208/326) of baseline respondents preferred attending an HIV clinic for PrEP follow-up, 51.9% (n = 108/208) of participants in the follow-up questionnaire reported to be willing to have their FP involved in PrEP care. Participants reporting trust in FPs' PrEP and sexual health expertise, or who didn't feel judged by their FP, were more likely to be willing to involve them in PrEP care. Therefore, we recommend a differentiated PrEP service delivery approach, including involving FPs, to make PrEP care more client-centred.
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Affiliation(s)
- Anke Rotsaert
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, B-2000, Belgium
| | - Jef Vanhamel
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, B-2000, Belgium.
| | - Thibaut Vanbaelen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, B-2000, Belgium
| | - Maarten Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute (APH), Amsterdam, the Netherlands
| | - Bernadette Hensen
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, B-2000, Belgium
| | - Karina Kielmann
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, B-2000, Belgium
| | - Steven Callens
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, B-2000, Belgium
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2
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Wheldon CW, Sykes KJ, Ramaswamy M, Bass SB, Collins BN. Integrating HPV Vaccination Within PrEP care Delivery for Underserved Populations: A Mixed Methods Feasibility Study. J Community Health 2023; 48:640-651. [PMID: 36894796 PMCID: PMC10492896 DOI: 10.1007/s10900-023-01202-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2023] [Indexed: 03/11/2023]
Abstract
Human Papillomavirus (HPV) vaccination is effective at preventing anal cancer, which disproportionally impacts gay/bisexual men (GBM) and transgender women (TGW). Vaccine coverage among GBM/TGW is insufficient to reduce anal cancer disparities. Federally qualified health centers (FQHCs) can increase reach and uptake of HPV vaccination by integrating and promoting HPV vaccination in ongoing HIV preventive care (e.g., Pre-exposure Prophylaxis [PrEP]). The purpose of the current study was to assess the feasibility and potential impact of integrating HPV vaccination with PrEP care. We conducted a mixed methods study of PrEP providers and staff (qualitative interviews, N = 9) and PrEP patients (quantitative survey, N = 88) at an FQHC in Philadelphia, Pennsylvania. Qualitative thematic analysis of PrEP provider/staff interviews was informed by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to identify and describe barriers and facilitators to HPV vaccination implementation. Quantitative analysis of PrEP patient survey was informed by the Information-Motivation-Behavioral Skills Model. Quantitative interviews resulted in 16 themes related to characteristics of the inner and outer clinic context. Barriers among providers included lack of focus on HPV in PrEP management guidelines, in metrics mandated by funding agencies, and in electronic medical record templates. Lack of anal cancer specific knowledge and motivation was identified in both PrEP patients and providers/staff. Providing HPV vaccination during routine PrEP visits was highly acceptable to both patients and providers. Based on these findings, we recommend several multi-level strategies to increase HPV vaccine uptake among PrEP patients.
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Affiliation(s)
- Christopher W Wheldon
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Avenue Ritter Annex, 9th floor, Philadelphia, PA, 19122, USA.
| | - Kevin J Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Megha Ramaswamy
- Department of Population Health, University of Kansas School of Medicine, University of Kansas Cancer Center, Kansas City, KS, USA
| | - Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Avenue Ritter Annex, 9th floor, Philadelphia, PA, 19122, USA
| | - Bradley N Collins
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Avenue Ritter Annex, 9th floor, Philadelphia, PA, 19122, USA
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3
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Meites E, Wilkin TJ, Markowitz LE. Review of human papillomavirus (HPV) burden and HPV vaccination for gay, bisexual, and other men who have sex with men and transgender women in the United States. Hum Vaccin Immunother 2022; 18:2016007. [PMID: 35294325 PMCID: PMC8993076 DOI: 10.1080/21645515.2021.2016007] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Gay, bisexual, and other men who have sex with men (MSM) and transgender women, particularly those who are living with HIV, are disproportionately affected by human papillomavirus (HPV). For this narrative review of HPV health outcomes and vaccination for gay, bisexual, and other MSM and transgender women in the United States, we highlighted 71 publications regarding 1) burden of HPV infections and related diseases; 2) HPV vaccine efficacy; 3) HPV vaccination recommendations; 4) HPV vaccination coverage; 5) real-world vaccine effectiveness and health impacts; and 6) HPV vaccination acceptability. Vaccination is effective at reducing HPV infections among MSM; in the United States, routine HPV vaccination is recommended for all adolescents at age 11-12 years and for all persons through age 26 years. Efforts are ongoing to increase vaccination coverage and monitor health impacts of vaccination. Increasing vaccination coverage before sexual exposure to HPV is expected to reduce the burden of HPV-related disease.
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Affiliation(s)
- Elissa Meites
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Timothy J Wilkin
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Lauri E Markowitz
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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4
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Jaramillo J, Pagkas-Bather J, Waters K, Shackelford LB, Campbell RD, Henry J, Grandberry V, Ramirez LF, Cervantes L, Stekler J, Andrasik MP, Graham SM. Perceptions of Sexual Risk, PrEP Services, and Peer Navigation Support among HIV-Negative Latinx and Black Men who have Sex with Men (MSM) Residing in Western Washington. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:1058-1068. [PMID: 36387840 PMCID: PMC9642978 DOI: 10.1007/s13178-021-00595-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/23/2021] [Indexed: 05/27/2023]
Abstract
Introduction HIV PrEP (pre-exposure prophylaxis) is underutilized among Latinx and Black men who have sex with men (MSM) in the United States. Although peer navigation approaches may increase PrEP uptake and adherence, it remains unclear what strategies work best for MSM of color. Methods From July 2017 to August 2018, we conducted semi-structured in-depth interviews with 25 purposively sampled Latinx and Black cisgender MSM to evaluate how the intersectionality of race/ethnicity, sexual orientation, and other identities influenced men's views on PrEP in general and on peer navigation specifically. Thematic analysis was used to identify and analyze emergent themes. Results Emergent themes included: (1) awareness of vulnerability in intimate relationships; (2) barriers to PrEP initiation including perceived side effects, stigma, and financial concerns; (3) a wish to connect with other Latinx and Black MSM in a health and prevention space; and (4) the desire for peer matching based on identity considerations and lived experience. Younger men and Spanish-speaking Latinx men were most interested in peer navigation to access PrEP, while bisexual men had confidentiality concerns. Conclusions In our study, Latinx and Black MSM viewed peer navigation services favorably, especially if they addressed men's desire to connect with other MSM of color. Policy Implications Developing culturally-congruent peer navigation programming could help improve PrEP uptake and care engagement for Latinx and Black MSM. Programs should recruit peers from the racial/ethnic minority communities most impacted by HIV and prioritize matching peers to clients based on identity concerns, needs, and preferences.
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Affiliation(s)
- Jahn Jaramillo
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Jade Pagkas-Bather
- Department of Medicine, Section of Infectious Diseases & Global Health, The University of Chicago, Chicago, Illinois, USA
| | - Kimiam Waters
- College of Arts & Sciences, University of Washington, Seattle, WA, USA
| | | | | | - Jsani Henry
- Public Health- Seattle & King County HIV/STD Program, Seattle, WA, USA
| | | | | | | | - Joanne Stekler
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Michele P. Andrasik
- Department of Global Health, University of Washington, Seattle, WA, USA
- Fred Hutchinson Vaccine and Infectious Disease Division, Seattle, WA, USA
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Susan M. Graham
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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5
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Diaz JE, Sandh S, Schnall R, Garofalo R, Kuhns LM, Pearson CR, Bruce J, Batey DS, Radix A, Belkind U, Hidalgo MA, Hirshfield S. Predictors of Past-Year Health Care Utilization Among Young Men Who Have Sex with Men Using Andersen's Behavioral Model of Health Service Use. LGBT Health 2022; 9:471-478. [PMID: 35867076 PMCID: PMC9587774 DOI: 10.1089/lgbt.2021.0488] [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: 11/13/2022] Open
Abstract
Purpose: This study examined factors associated with past-year health care utilization among young gay, bisexual, and other men who have sex with men (YMSM) using Andersen's behavioral model of health service use. Methods: From 2018 to 2020, 751 YMSM (aged 13-18) recruited online and offline for the MyPEEPS mHealth HIV prevention study completed an online survey. Hierarchical logistic regression models assessed associations between past-year health care utilization (i.e., routine checkup) and predisposing (parental education, race/ethnicity, age, and internalized homonegativity), enabling (health literacy, health care facility type, U.S. Census Divisions), and need factors (ever testing for HIV). Results: The sample included 31.8% Hispanic, 23.9% White, and 14.6% Black YMSM; median age was 16. Most (75%) reported past-year health care utilization, often from private doctor's offices (29.1%); 6% reported no regular source of care. In the final regression model, higher odds of past-year health care utilization were found for younger participants (age 13-14, adjusted odds ratio [AOR] = 1.91; 95% confidence interval [CI]: 1.07-3.43; age 15-16 AOR = 1.55; 95% CI: 1.04-2.30; reference: 17-18) and those with increasing health literacy (AOR = 1.71; 95% CI: 1.36-2.16). YMSM with lower parental education had lower odds of past-year health care utilization (AOR = 0.56; 95% CI: 0.38-0.84), as did those relying on urgent care facilities (AOR = 0.60; 95% CI: 0.41-0.87; reference: routine care facilities) and those who identified as Mixed/Other race (AOR = 0.50; 95% CI: 0.28-0.91; reference: White). Conclusions: Findings highlight opportunities to intervene in YMSM's health risk trajectory before age 17 to reduce drop-off in routine health care utilization. Interventions to improve routine health care utilization among YMSM may be strengthened by building resilience (e.g., health literacy) while removing barriers maintained through structural disadvantage, including equity in education. Clinical Trial Registration Number: NCT03167606.
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Affiliation(s)
- José E Diaz
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA.,Center for Research on AIDS, Yale School of Public Health, New Haven, Connecticut, USA
| | - Simon Sandh
- Department of Epidemiology, School of Global Public Health, New York University, New York, New York, USA
| | - Rebecca Schnall
- Columbia University School of Nursing, New York, New York, USA.,Department of Population and Family Health, Mailman School of Public Health, New York, New York, USA
| | - Robert Garofalo
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lisa M Kuhns
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cynthia R Pearson
- Indigenous Wellness Research Institute, University of Washington School of Social Work, Seattle, Washington, USA
| | - Josh Bruce
- Birmingham AIDS Outreach, Birmingham, Alabama, USA
| | - D Scott Batey
- Department of Social Work, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, New York, USA
| | - Uri Belkind
- Callen-Lorde Community Health Center, New York, New York, USA
| | - Marco A Hidalgo
- Medicine-Pediatrics Division, General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
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Higher sexually transmissible infection test yield among men who have sex with men attending a community-based testing site compared with a clinical service in Sydney, Australia. Sex Transm Dis 2022; 49:e104-e106. [DOI: 10.1097/olq.0000000000001609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Chan C, Patel P, Johnson K, Vaughan M, Price K, McNulty A, Templeton DJ, Read P, Cunningham P, Grulich AE, Bavinton BR. Community-based peer-led HIV/sexually transmitted infection testing services in Sydney for gay and bisexual men captured an eighth of new HIV diagnoses in New South Wales, Australia. AIDS 2021; 35:1878-1880. [PMID: 34397488 DOI: 10.1097/qad.0000000000002982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | | | | | - Anna McNulty
- Sydney Sexual Health Centre, Sydney Hospital
- School of Population Health, UNSW Sydney
| | - David J Templeton
- Kirby Institute, UNSW Sydney
- Department of Sexual Health Medicine and Sexual Assault Medical Service, Sydney Local Health District
- Discipline of Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney
| | - Phillip Read
- Kirby Institute, UNSW Sydney
- Kirketon Road Centre
| | - Philip Cunningham
- NSW State Reference Laboratory for HIV, St Vincent's Hospital
- St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, Sydney, New South Wales, Australia
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8
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Hswen Y, Zhang A, Sewalk KC, Tuli G, Brownstein JS, Hawkins JB. Investigation of Geographic and Macrolevel Variations in LGBTQ Patient Experiences: Longitudinal Social Media Analysis. J Med Internet Res 2020; 22:e17087. [PMID: 33137713 PMCID: PMC7428906 DOI: 10.2196/17087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 04/25/2020] [Accepted: 04/26/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Discrimination in the health care system contributes to worse health outcomes among lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients. OBJECTIVE The aim of this study is to examine disparities in patient experience among LGBTQ persons using social media data. METHODS We collected patient experience data from Twitter from February 2013 to February 2017 in the United States. We compared the sentiment of patient experience tweets between Twitter users who self-identified as LGBTQ and non-LGBTQ. The effect of state-level partisan identity on patient experience sentiment and differences between LGBTQ users and non-LGBTQ users were analyzed. RESULTS We observed lower (more negative) patient experience sentiment among 13,689 LGBTQ users compared to 1,362,395 non-LGBTQ users. Increasing state-level liberal political identification was associated with higher patient experience sentiment among all users but had stronger effects for LGBTQ users. CONCLUSIONS Our findings highlight that social media data can yield insights about patient experience for LGBTQ persons and suggest that a state-level sociopolitical environment influences patient experience for this group. Efforts are needed to reduce disparities in patient care for LGBTQ persons while taking into context the effect of the political climate on these inequities.
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Affiliation(s)
- Yulin Hswen
- Bakar Computational Health Sciences Institute, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
- Computational Epidemiology Lab, Harvard Medical School, Boston, MA, United States
| | - Amanda Zhang
- Innovation Program, Boston Children's Hospital, Boston, MA, United States
- Pritzker School of Medicine, The University of Chicago, Chicago, IL, United States
| | - Kara C Sewalk
- Innovation Program, Boston Children's Hospital, Boston, MA, United States
| | - Gaurav Tuli
- Innovation Program, Boston Children's Hospital, Boston, MA, United States
| | - John S Brownstein
- Computational Epidemiology Lab, Harvard Medical School, Boston, MA, United States
- Innovation Program, Boston Children's Hospital, Boston, MA, United States
| | - Jared B Hawkins
- Computational Epidemiology Lab, Harvard Medical School, Boston, MA, United States
- Innovation Program, Boston Children's Hospital, Boston, MA, United States
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Green DC, Wheeler EM. A Qualitative Exploration of Facilitators for Health Service Use among Aging Gay Men Living with HIV. J Int Assoc Provid AIDS Care 2020; 18:2325958219880569. [PMID: 31597513 PMCID: PMC6900671 DOI: 10.1177/2325958219880569] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Using Anderson’s Health Behavioral Model of Health Service Use, this study explores
factors facilitating health service use among aging gay men living with HIV. Qualitative
data from 10 participants recruited from a federally qualified health center were analyzed
using theoretical thematic analysis. Results shown to facilitate health service use
include an existing need for services in the form of HIV management; predisposing factors
of age and the development of resilience in the face of stigmatizing experiences related
to their sexual identity and health status; and enabling influences including comfort with
medical providers, providers knowledgeable in lesbian, gay, bisexual, transgender, and
queer issues, and sexual concordant providers. Need for services, predisposing factors,
and enabling factors are discussed in relation, as well as each factor’s unique
implications for this population. Results from this study may be used to improve service
use and provides tangible clinical recommendations.
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Affiliation(s)
- Daniel Colton Green
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
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10
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Sexuality Disclosure, Trust, and Satisfaction With Primary Care Among Urban Young Adult Sexual Minority Men. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2020.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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11
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Halkitis PN, Maiolatesi AJ, Krause KD. The Health Challenges of Emerging Adult Gay Men: Effecting Change in Health Care. Pediatr Clin North Am 2020; 67:293-308. [PMID: 32122561 PMCID: PMC8690571 DOI: 10.1016/j.pcl.2019.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article focuses on the health and health care challenges experienced by young and emerging adult gay men. Evidence is provided on the extent to which young and emerging adult gay men are disproportionally burdened by multidimensional health disparities, barriers to health care access, and inadequate provider-patient interactions. Recommendations are provided for health care providers and public health officials working with populations of emerging adult gay men that might have the greatest overall impact on improving this population's well-being and access to competent health care by increasing providers' awareness of the unique needs of young and emerging adult gay men.
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Affiliation(s)
- Perry N. Halkitis
- Center for Health, Identity, Behavior & Prevention Studies, Rutgers School of Public Health, One Riverfront Plaza, Newark, NJ 07102, USA,Department of Biostatistics, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA,Department of Urban-Global Health, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA,Corresponding author. Departments of Biostatistics, Epidemiology and Urban-Global Health, School of Public Health, Rutgers University, 683 Hoes Lane West, Piscataway, NJ 08854.
| | - Anthony J. Maiolatesi
- Center for Health, Identity, Behavior & Prevention Studies, Rutgers School of Public Health, One Riverfront Plaza, Newark, NJ 07102, USA,Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA,Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, New Haven, CT 06510, USA
| | - Kristen D. Krause
- Center for Health, Identity, Behavior & Prevention Studies, Rutgers School of Public Health, One Riverfront Plaza, Newark, NJ 07102, USA,Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA
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12
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O'Byrne P, Orser L. Express testing for sexually transmitted infections: clinical results. J Res Nurs 2019; 24:541-547. [PMID: 34394574 DOI: 10.1177/1744987119843152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Many sexually transmitted infection (STI) clinics are becoming unable to meet increases in service demand. Aims To address increased service delivery demand at our STI clinic, we implemented express testing, which involved self-assessment and visitation with a nurse who performed specimen collection but no examination. Methods Patient consent was obtained and chart review occurred. Results Of our patients who sought testing, 20% (n = 1427/12,711) were eligible for express testing, with 90.7% (n = 1295/1427) of these patients agreeing to use it. We identified 62 infections (all gonorrhoea and chlamydia) among the 1295 patients who used express. In streamlining care provision, express testing enabled us to see 334 more patients, among whom we identified an additional 27 infections (four patients with infectious syphilis, 23 with gonorrhoea or chlamydia). Conclusion Our results support the expanded use of express testing.
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13
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Griffin-Tomas M, Cahill S, Kapadia F, Halkitis PN. Access to Health Services Among Young Adult Gay Men in New York City. Am J Mens Health 2018; 13:1557988318818683. [PMID: 30569800 PMCID: PMC6775565 DOI: 10.1177/1557988318818683] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This research is a cross-sectional study of young adult gay men (YAGM), ages 18 to 29, that aims to understand their health-care access including: having a primary care provider (PCP), frequency of health-care visits, and instances of foregone health care. Surveys were conducted with a modified time-space sample of 800 YAGM in New York City (NYC). Surveys were conducted between November 2015 and June 2016. This study examined associations between sociodemographic characteristics and health-care access using multivariable logistic regression models. In multivariable logistic regression models, there were higher odds of having a PCP among participants enrolled in school (Adjusted Odds Ratio [AOR] = 1.85, 95% CI [1.18, 2.91], p < .01) and covered by insurance (AOR = 21.29, 95% CI [11.77, 38.53], p < .001). Modeling indicated higher odds of more than one health visit in the past 12 months for non-White participants (AOR = 2.27, 95% CI [1.43, 3.63], p < .001), those covered by insurance (AOR = 3.10, 95% CI [1.06, 9.04], p < .05), and those who disclosed their sexual orientation to their PCP (AOR = 2.99, 95% CI [1.58, 5.69], p < .001). Participants with insurance were less likely to report instances of foregone care (AOR = 0.21, 95% CI [0.21, 0.13], p < .001). Understanding the facilitators and barriers to health-care access among YAGM populations is of critical importance, as many YAGM between the ages of 18 and 29 are establishing their access to health care without parental guidance. Health-care access, including the decision to forego care, can represent a missed opportunity for primary prevention and early diagnosis of health issues, as well as more effective, less invasive, and less costly treatments.
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Affiliation(s)
- Marybec Griffin-Tomas
- 1 New Jersey City University, Health Sciences Department, Jersey City, NJ, USA.,2 Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, NJ, USA
| | - Sean Cahill
- 3 National LGBT Health Education Center, The Fenway Institute, Boston, MA, USA
| | - Farzana Kapadia
- 1 New Jersey City University, Health Sciences Department, Jersey City, NJ, USA.,2 Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, NJ, USA.,4 Department of Population Health, Langone Medical Center, New York University, New York, NY, USA
| | - Perry N Halkitis
- 2 Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, NJ, USA.,5 Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Rutgers University, Piscataway, NJ, USA.,6 Rutgers Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA.,7 Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ, USA.,8 Department of Urban-Global Public Health, Rutgers School of Public Health, Rutgers University, Newark, NJ, USA
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14
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Eliason MJ, Robinson P, Balsam K. Development of an LGB-specific health literacy scale. HEALTH COMMUNICATION 2018; 33:1531-1538. [PMID: 28956629 DOI: 10.1080/10410236.2017.1372052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
No studies to date have examined health literacy among lesbian, gay, and bisexual (LGB) individuals, nor considered whether LGB-specific health literacy might be a contributing factor to well-documented health disparities in LGB populations. This pilot study gathered online survey data from a national convenience sample of 232 LGB adults age 40 and older. A scale developed specifically for this study had 10 items related to general health literacy and 10 items related to LGB-specific health information and skills. Factor analysis revealed that the two subscales were distinct and internally consistent, and accounted for 66% of the variance. Higher LGB health literacy was associated with greater likelihood of coming out to the healthcare provider, reporting better overall health, and having healthcare providers who were knowledgeable about LGBT issues. Greater age was associated with lower general health literacy, but was not associated with LGB literacy. Respondents who had worked in healthcare settings had higher levels of both LGB and general health literacy. Potential differences by gender on sociodemographic and health variables were identified that need to be examined in larger, more diverse samples.
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Affiliation(s)
| | | | - Kimberly Balsam
- b Pacific Graduate School of Psychology , Palo Alto University
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Griffin M, Krause KD, Kapadia F, Halkitis PN. A Qualitative Investigation of Healthcare Engagement Among Young Adult Gay Men in New York City: A P18 Cohort Substudy. LGBT Health 2018; 5:368-374. [PMID: 30048197 PMCID: PMC6916523 DOI: 10.1089/lgbt.2017.0015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We used in-depth interviews with a cohort of young adult gay men (YAGM) to provide a more detailed understanding of their current healthcare engagement, including experiences with the healthcare system, provider knowledge of healthcare needs, and desired provider characteristics. METHODS Qualitative interviews were conducted with a sample of 40 YAGM in New York City. The interview guide examined healthcare engagement across key developmental stages: childhood (birth-12), adolescence (13-18), young adulthood (19-22), and the present (23-26). All transcripts were coded using a consensual qualitative research approach to identify crosscutting topics. The interviews were conducted between September and October 2015. RESULTS The following topics were identified: experiences with the healthcare system, provider knowledge of healthcare needs, and desired provider characteristics. Common barriers to healthcare access were financial concerns, lack of insurance, and dissatisfaction with the care provided. Reasons for dissatisfaction with care were based on perceptions of providers' anti-gay attitudes, judgment of same-sex sexual behavior, and lack of provider knowledge about YAGM's health needs. This often led men in this study to seek sexual healthcare from providers other than their primary care provider. When asked about desired provider characteristics, participants noted that basic demographics were of less importance than skills-based characteristics such as rapport, comfort discussing sexual health issues, and knowledge of YAGM's health. CONCLUSION YAGM have unique challenges to engaging in healthcare, including provider stigma and lack of provider knowledge of YAGM's health needs, which are not faced by other young adult populations. The results from this study highlight the need for more extensive and standardized training in medical school and as part of continuing medical education for healthcare providers.
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Affiliation(s)
- Marybec Griffin
- College of Global Public Health, New York University, New York, New York
- Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
| | - Kristen D. Krause
- College of Global Public Health, New York University, New York, New York
- Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
| | - Farzana Kapadia
- College of Global Public Health, New York University, New York, New York
- Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
- Department of Population Health, Langone Medical Center, New York University, New York, New York
| | - Perry N. Halkitis
- Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
- Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Rutgers University, Piscataway, New Jersey
- Department of Urban-Global Public Health, Rutgers School of Public Health, Rutgers University, Newark, New Jersey
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Martos AJ, Wilson PA, Gordon AR, Lightfoot M, Meyer IH. "Like finding a unicorn": Healthcare preferences among lesbian, gay, and bisexual people in the United States. Soc Sci Med 2018; 208:126-133. [PMID: 29803970 DOI: 10.1016/j.socscimed.2018.05.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 05/01/2018] [Accepted: 05/07/2018] [Indexed: 11/26/2022]
Abstract
Lesbian, gay, and bisexual (LGB) peoples' healthcare preferences are often developed in response to social and institutional factors that can ultimately deter them from care. Prior qualitative explorations of LGB healthcare preferences have been limited in their ability to identify and compare patterns across age cohort, gender, and race/ethnicity. The current study examines qualitative data from 186 modified Life Story Interviews with three age cohorts of LGB people from New York City, NY, San Francisco, CA, Tucson, AZ, and Austin, TX to understand the factors influencing LGB people's healthcare preferences. Data are analyzed using a directed content analysis approach. Five key themes emerged regarding influences on healthcare preferences: Stigma, provider expertise, identity, service type, and access. Findings suggest that healthcare preferences among LGB people are both complex and closely linked to social changes over time. Healthcare preferences among LGB people are both complex and closely linked to social changes over time.
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Affiliation(s)
- Alexander J Martos
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA; The Williams Institute, UCLA School of Law, Los Angeles, CA, USA.
| | - Patrick A Wilson
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Allegra R Gordon
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Marguerita Lightfoot
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Ilan H Meyer
- The Williams Institute, UCLA School of Law, Los Angeles, CA, USA
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General Practitioners' views and experiences on the barriers and facilitators that men who have sex with men have when accessing primary care for HIV testing and sexual health screening. Prim Health Care Res Dev 2017; 19:205-209. [PMID: 29094672 DOI: 10.1017/s1463423617000627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Aim This study's objectives were to collate General Practitioners' (GPs) views and experiences on the barriers and facilitators for providing HIV and sexual health screening in primary care to men who have sex with men. BACKGROUND Men who have sex with men (MSM) are disproportionately effected by sexually transmitted infections and HIV. Some MSM may not attend for testing and primary care may come in contact with this group. There may be varying barriers for MSM accessing services. Primary care can provide an opportunity to offer testing but with limited GPs views on this topic, it is important to understand the potential barriers and facilitators. METHOD A structured online survey was used to gather data and the survey link was emailed to all General Practices in the City of Edinburgh. The total available sample of GPs was 485. The survey used a combination of multiple choice questions and Likert scales rating from 1 to 5. Friedman's two-way analysis of variation rank was used for data analysis. Findings In total, 62 GPs from the City of Edinburgh completed the survey with the majority of the sample having over 10 years' experience in primary care. The most significant barrier was patient preference to access specialist services. The highest rated method to promote HIV and sexual health screening was the use of external promotion.
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Datta J, Reid D, Hughes G, Mercer CH, Wayal S, Weatherburn P. Places and people: the perceptions of men who have sex with men concerning STI testing: a qualitative study. Sex Transm Infect 2017; 94:46-50. [PMID: 28778980 PMCID: PMC5800331 DOI: 10.1136/sextrans-2016-052983] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 06/26/2017] [Accepted: 07/02/2017] [Indexed: 11/04/2022] Open
Abstract
Objectives To explore the experiences and views of men who have sex with men (MSM) on attending clinical sexual health services and their preferences regarding service characteristics in the context of the disproportionate burden of STIs experienced by this group. The wider study aim was to develop a risk assessment tool for use in sexual health clinics. Methods Qualitative study comprising eight focus group discussions with 61 MSM in four English cities. Topics included: experience of attending sexual health services, perceptions of norms of attendance among MSM, knowledge of, and attitudes towards, STIs and views on ‘being researched.’ Discussions were audio-recorded and transcribed and a thematic data analysis conducted. Results Attending sexual health services for STI testing was described as embarrassing by some and some clinic procedures were thought to compromise confidentiality. Young men seeking STI testing were particularly sensitive to feelings of awkwardness and self-consciousness. Black and ethnic minority men were concerned about being exposed in their communities. The personal qualities of staff were seen as key features of sexual health services. Participants wanted staff to be friendly, professional, discreet, knowledgeable and non-judgemental. Conclusions A range of opinion on the type of STI service men preferred was expressed with some favouring generic sexual and reproductive health clinics and others favouring specialist community-based services. There was consensus on the qualities they would like to see in healthcare staff. The knowledge, conduct and demeanour of staff could exacerbate or ameliorate unease associated with attending for STI testing.
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Affiliation(s)
- Jessica Datta
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - David Reid
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Gwenda Hughes
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Catherine H Mercer
- Department of Infection and Population Health, University College London, London, UK
| | - Sonali Wayal
- Department of Infection and Population Health, University College London, London, UK
| | - Peter Weatherburn
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
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Martos AJ, Wilson PA, Meyer IH. Lesbian, gay, bisexual, and transgender (LGBT) health services in the United States: Origins, evolution, and contemporary landscape. PLoS One 2017; 12:e0180544. [PMID: 28692659 PMCID: PMC5503273 DOI: 10.1371/journal.pone.0180544] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 06/17/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND LGBT community organizations in the United States have been providing health services since at least the 1970s. However, available explanations for the origins of LGBT health services do not sufficiently explain why health in particular has been so closely and consistently linked to LGBT activism. Little is also known regarding how LGBT health services may have evolved over time with the growing scientific understanding of LGBT health needs. METHODS This study begins with a review of the early intersections of sexuality and health that led to an LGBT health movement in the United States, as well as the evolution of LGBT health services over time. Informed by this, an asset map displaying the location and types of services provided by "LGBT community health centers" today in relation to the population density of LGBT people was explored. An online search of LGBT community health centers was conducted between September-December, 2015. Organizational details, including physical addresses and the services provided, were confirmed via an online database of federally-registered non-profit organizations and organizational websites. The locations and types of services provided were analyzed and presented alongside county-level census data of same-sex households using geographic information system (GIS) software ArcGIS for Desktop. FINDINGS LGBT community health centers are concentrated within urban hubs and coastal states, and are more likely to be present in areas with a high density of same-sex couples. LGBT community health centers do not operate in 13 states. The most common health services provided are wellness programs, HIV/STI services, and counseling services. CONCLUSIONS LGBT community health centers have adapted over time to meet the needs of LGBT people. However, significant gaps in service remain in the United States, and LGBT community health centers may require significant transformations going forward in order to continue serving LGBT people.
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Affiliation(s)
- Alexander J. Martos
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY United States of America
- The Williams Institute, UCLA School of Law, Los Angeles, CA United States of America
| | - Patrick A. Wilson
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY United States of America
| | - Ilan H. Meyer
- The Williams Institute, UCLA School of Law, Los Angeles, CA United States of America
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Everett S. What is the future for sexual and contraceptive services? JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2017; 43:234-236. [PMID: 28676540 DOI: 10.1136/jfprhc-2017-101764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/16/2017] [Indexed: 11/04/2022]
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Morris M, Roberto K. Information-seeking behaviour and information needs of LGBTQ health professionals: a follow-up study. Health Info Libr J 2016; 33:204-21. [DOI: 10.1111/hir.12139] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 02/09/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Martin Morris
- Schulich Library of Science and Engineering; McGill University; Montréal Canada
| | - K.R. Roberto
- Graduate School of Library and Information Science; University of Illinois at Urbana-Champaign; Champaign IL USA
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Arnold EA, Steward WT. HIV transmission in MSM: considerations for PrEP scale-up. Lancet HIV 2016; 3:e62-3. [PMID: 26847227 DOI: 10.1016/s2352-3018(15)00060-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 04/07/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Emily A Arnold
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA 94158, USA.
| | - Wayne T Steward
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA 94158, USA
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Koester KA, Grant RM. Editorial Commentary: Keeping Our Eyes on the Prize: No New HIV Infections With Increased Use of HIV Pre-exposure Prophylaxis. Clin Infect Dis 2015; 61:1604-5. [PMID: 26334051 PMCID: PMC4614416 DOI: 10.1093/cid/civ783] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/07/2015] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Robert M Grant
- University of California Gladstone Institutes San Francisco AIDS Foundation, California
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A Qualitative Study of Medical Mistrust, Perceived Discrimination, and Risk Behavior Disclosure to Clinicians by U.S. Male Sex Workers and Other Men Who Have Sex with Men: Implications for Biomedical HIV Prevention. J Urban Health 2015; 92:667-86. [PMID: 25930083 PMCID: PMC4524849 DOI: 10.1007/s11524-015-9961-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Access to biomedical HIV prevention technologies such as pre-exposure prophylaxis (PrEP) requires individuals to disclose risk behavior to clinicians, but experiences of discrimination and medical mistrust may limit disclosure among male sex workers and other MSM. We explored experiences of perceived discrimination, medical mistrust, and behavior disclosure among male sex workers compared to other men who have sex with men (MSM). We conducted 56 interviews with MSM and compared findings about medical mistrust, discrimination, and disclosure for 31 men who engaged in sex work vs. 25 men who did not. MSM who engaged in sex work reported more medical mistrust and healthcare discrimination due to issues beyond MSM behavior/identity (e.g., homelessness, substance use, poverty). MSM who did not report sex work described disclosing sex with men to clinicians more often. Both subgroups reported low PrEP awareness, but willingness to disclose behavior to obtain PrEP. Medical mistrust and perceived discrimination create barriers for sexual behavior disclosure to clinicians, potentially impeding access to PrEP and other forms of biomedical HIV prevention. These barriers may be higher among male sex workers compared to other MSM, given overlapping stigmas including sex work, substance use, homelessness, and poverty. An intersectionality framework for understanding multiple stigmas can help to identify how these dynamics may limit access to biomedical HIV prevention among male sex workers, as well as suggesting strategies for addressing stigmas to improve the delivery of PrEP and other HIV prevention approaches in this population.
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O'Byrne P, Phillips JC, Campbell B, Reynolds A, Metz G. "Express testing" in STI clinics: extant literature and preliminary implementation data. Appl Nurs Res 2015; 29:177-87. [PMID: 26856511 DOI: 10.1016/j.apnr.2015.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 05/27/2015] [Accepted: 06/01/2015] [Indexed: 01/20/2023]
Abstract
In an era of stagnant resources for sexually transmitted infection (STI) and HIV testing clinics, and at a time of ongoing-and in some cases increasing-STI and HIV transmission, it is important to trial and evaluate novel STI/HIV testing strategies. Based on the extant literature, one such approach is express testing, which includes full STI/HIV testing (as per clinical indication and client request), altered pretest counseling, and no physical examination for both men and women. In this paper, we overview the available research about express testing, including the literature on less-invasive testing, the effects of risk reduction counseling HIV testin/HIV testing, available research on various HIV testing modalities, and the reasons people undergo such testing. Thereafter, we overview our express testing program, which includes a detailed review of our clinical processes (which are unique within the published literature). Lastly, we provide some preliminary pre-implementation data to support the proposed efficacy of express testing.
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Affiliation(s)
| | | | | | | | - Gila Metz
- Ottawa Public Health, Ottawa, Canada
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26
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Underhill K, Morrow KM, Colleran CM, Holcomb R, Operario D, Calabrese SK, Galárraga O, Mayer KH. Access to healthcare, HIV/STI testing, and preferred pre-exposure prophylaxis providers among men who have sex with men and men who engage in street-based sex work in the US. PLoS One 2014; 9:e112425. [PMID: 25386746 PMCID: PMC4227700 DOI: 10.1371/journal.pone.0112425] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 10/15/2014] [Indexed: 11/18/2022] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) is a promising strategy for HIV prevention among men who have sex with men (MSM) and men who engage in sex work. But access will require routine HIV testing and contacts with healthcare providers. This study investigated men’s healthcare and HIV testing experiences to inform PrEP implementation. Methods We conducted 8 focus groups (n = 38) in 2012 and 56 in-depth qualitative interviews in 2013–14 with male sex workers (MSWs) (n = 31) and other MSM (n = 25) in Providence, RI. MSWs primarily met clients in street-based sex work venues. Facilitators asked participants about access to healthcare and HIV/STI testing, healthcare needs, and preferred PrEP providers. Results MSWs primarily accessed care in emergency rooms (ERs), substance use clinics, correctional institutions, and walk-in clinics. Rates of HIV testing were high, but MSWs reported low access to other STI testing, low insurance coverage, and unmet healthcare needs including primary care, substance use treatment, and mental health services. MSM not engaging in sex work were more likely to report access to primary and specialist care. Rates of HIV testing among these MSM were slightly lower, but they reported more STI testing, more insurance coverage, and fewer unmet needs. Preferred PrEP providers for both groups included primary care physicians, infectious disease specialists, and psychiatrists. MSWs were also willing to access PrEP in substance use treatment and ER settings. Conclusions PrEP outreach efforts for MSWs and other MSM should engage diverse providers in many settings, including mental health and substance use treatment, ERs, needle exchanges, correctional institutions, and HIV testing centers. Access to PrEP will require financial assistance, but can build on existing healthcare contacts for both populations.
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Affiliation(s)
- Kristen Underhill
- Yale Center for Interdisciplinary Research on AIDS/Yale Law School, Yale University, New Haven, Connecticut, United States of America
- * E-mail:
| | - Kathleen M. Morrow
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, United States of America
| | - Christopher M. Colleran
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, United States of America
| | - Richard Holcomb
- Project Weber, Providence, Rhode Island, United States of America
| | - Don Operario
- School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Sarah K. Calabrese
- Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Omar Galárraga
- School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
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O'Byrne P, MacPherson P, Ember A, Grayson MO, Bourgault A. Overview of a gay men's STI/HIV testing clinic in Ottawa: clinical operations and outcomes. Canadian Journal of Public Health 2014; 105:e389-94. [PMID: 25365275 DOI: 10.17269/cjph.105.4471] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 09/02/2014] [Accepted: 08/15/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To 1) create a space where men who have sex with men (MSM) feel comfortable accessing sexually transmitted infection/human immunodeficiency virus (STI/HIV) testing, and 2) reduce STI/HIV incidence. PARTICIPANTS Gay men in Ottawa and its surrounding regions. SETTING A preponderance of diagnoses of sexually transmitted infections and HIV continue to occur among MSM. Meanwhile, other literature identifies that many MSM are reluctant to access STI/HIV testing services or to disclose their sexual practices to primary care practitioners. INTERVENTION In Ottawa, in an effort to surmount these issues and decrease STI/HIV incidence among MSM, the local public health unit in collaboration with community partners created "GayZone", a three-hour-per-week STI/HIV testing and STI treatment clinic for gay men. In this paper, we report on the uptake and STI/HIV diagnosis outcomes for this clinic from January 2010 through December 2013. OUTCOMES GayZone is a well-utilized clinic that yields a number of STI/HIV diagnoses per year. Overall, the positivity rates of the STI/HIV tests at this clinic are above-average, although lower than what might be expected by local epidemiological data. While the results of this clinic validate anonymous HIV testing, they bring into question the utility of pharyngeal swabs to test for gonorrhea and chlamydia. CONCLUSION The results of our study demonstrate the utility of a gay men's STI/HIV testing clinic and highlight some areas for improvement. Public health practitioners, frontline clinicians, and community workers in other regions who wish to implement such an STI/HIV clinic would do well to consider our results beforehand.
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Affiliation(s)
- Patrick O'Byrne
- Faculty of Health Sciences School of Nursing University of Ottawa.
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Yang M, Prestage G, Maycock B, Brown G, de Wit J, McKechnie M, Guy R, Keen P, Fairley CK, Zablotska IB. The acceptability of different HIV testing approaches: cross-sectional study among GMSM in Australia. Sex Transm Infect 2014; 90:592-5. [PMID: 25015651 DOI: 10.1136/sextrans-2013-051495] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND We explored the attitudes of Australian gay and other men who have sex with men (GMSM) about the current standard-of-care (non-rapid tests at healthcare settings) and alternative approaches (rapid tests and testing in non-healthcare settings) to better understand the acceptability of alternative testing approaches. METHODS The Contemporary Norms in Networks and Communities of GMSM study enrolled GMSM in Sydney, Melbourne and Perth in 2011-2012 using peer referrals. We explored the self-reported preferences for testing: rapid versus non-rapid and in non-healthcare settings (community-based or home-based testing) versus in healthcare settings, and examined factors associated with preferences for these approaches. Analyses of associations used standard univariate and age-adjusted logistic regression models. RESULTS Among 827 sexually active non-HIV-positive participants, 89% had been tested for HIV. Most preferred by participants was home rapid testing (46%), followed by standard-of-care (23%) and rapid testing in healthcare (20%) or community settings (7%). About 73% of participants preferred rapid over non-rapid testing, and 56% preferred testing in non-healthcare settings rather than in healthcare settings. Preference for rapid testing was associated with being fully employed (adjusted OR (aOR): 1.81; 95% CI 1.16 to 2.82), managerial/professional occupation (aOR: 2.03; 95% CI 1.19 to 3.46) and engaging in unprotected anal intercourse with casual partners (aOR: 1.89; 95% CI 1.29 to 2.78). The same factors were associated with preference for testing in non-healthcare settings. CONCLUSIONS Australian GMSM prefer alternative testing approaches, possibly due to their convenience. The availability of new testing approaches may provide more options for GMSM at risk for HIV infection, improve access to HIV testing and potentially increase HIV testing rates.
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Affiliation(s)
- M Yang
- The Kirby Institute, The University of New South Wales Australia, Sydney, New South Wales, Australia
| | - G Prestage
- The Kirby Institute, The University of New South Wales Australia, Sydney, New South Wales, Australia The Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - B Maycock
- Curtin University, Perth, Western Australia, Australia
| | - G Brown
- The Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia Curtin University, Perth, Western Australia, Australia
| | - J de Wit
- Centre for Social Research in Health, The University of NSW Australia, Sydney, New South Wales, Australia
| | - M McKechnie
- The Kirby Institute, The University of New South Wales Australia, Sydney, New South Wales, Australia
| | - R Guy
- The Kirby Institute, The University of New South Wales Australia, Sydney, New South Wales, Australia
| | - P Keen
- The Kirby Institute, The University of New South Wales Australia, Sydney, New South Wales, Australia
| | - C K Fairley
- Melbourne School of Population Health, University of Melbourne, Victoria, Australia Melbourne Sexual Health Centre, Melbourne, Victoria, Australia Central Clinical School, Monash University, Alfred Hospital, Melbourne, Victoria, Australia
| | - I B Zablotska
- The Kirby Institute, The University of New South Wales Australia, Sydney, New South Wales, Australia
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