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Shah RV, Wurcel AG. Operationalization of Status Neutral Human Immunodeficiency Virus Care for Criminal-Legal Involved Populations. Infect Dis Clin North Am 2024; 38:613-625. [PMID: 38876904 DOI: 10.1016/j.idc.2024.04.008] [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] [Indexed: 06/16/2024]
Abstract
The United States has the highest number of people incarcerated in the world. Criminal-legal involved populations, including people who are incarcerated in jails and prisons and people who are under community carceral control through probation or parole are at an increased risk for human immunodeficiency virus (HIV). Increasing access to HIV testing, treatment and prevention is necessary to curb the HIV epidemic. This chapter outlines the history of HIV testing in jails and prisons and suggests a Status Neutral HIV Care Framework for improving access to HIV prevention services.
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Affiliation(s)
| | - Alysse G Wurcel
- Division of Infectious Diseases and Geographic Medicine, Tufts Medicine, 800 Washington Street, Boston, MA 02111, USA.
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2
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Murphy M, Rogers BG, Ames E, Galipeau D, Uber J, Napoleon S, Brinkley-Rubinstein L, Toma E, Byrne S, Teitelman AM, Berk J, Chan PA, Ramsey S. Implementing Preexposure Prophylaxis for HIV Prevention in a Statewide Correctional System in the United States. Public Health Rep 2024; 139:174-179. [PMID: 37476929 PMCID: PMC10851896 DOI: 10.1177/00333549231186576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
HIV disproportionately affects populations experiencing incarceration. Preexposure prophylaxis (PrEP) is an effective approach to preventing HIV acquisition among populations at increased risk of acquiring HIV. Yet few, if any, efforts have been made to offer PrEP in correctional settings. Beginning in November 2019, the Rhode Island Department of Corrections (RIDOC) implemented a systemwide PrEP initiation program with linkage to PrEP care in the community upon reentry. Incarcerated individuals identified as being potentially at increased risk of HIV acquisition during standard clinical screenings and medical care were referred to a PrEP care provider for potential PrEP initiation. Of the 309 people who met with a PrEP care provider, 35% (n = 109; 88 men, 21 women) agreed to initiate PrEP while incarcerated. Clinical testing and evaluation were completed for 82% (n = 89; 69 men, 20 women) of those who agreed to initiate PrEP. Of those, 54% (n = 48; 29 men, 19 women) completed the necessary clinical evaluation to initiate PrEP, were determined to be appropriate candidates for PrEP use, and had the medication delivered to a RIDOC facility for initiation. Only 8 people (4 men, 4 women) were successfully linked to a PrEP care provider in the community after release. The RIDOC experience demonstrates notable levels of PrEP interest and moderate levels of PrEP uptake among this population. However, PrEP engagement in care after release and persistence in taking PrEP when in the community were relatively poor, indicating a need to better understand approaches to overcoming barriers to PrEP care in this unique setting.
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Affiliation(s)
- Matthew Murphy
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA
- Brown University School of Public Health, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
- The Rhode Island Department of Corrections, Cranston, RI, USA
| | - Brooke G. Rogers
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA
- Brown University School of Public Health, Providence, RI, USA
- The Miriam Hospital, Providence, RI, USA
| | - Evan Ames
- Rhode Island Hospital, Providence, RI, USA
| | | | - Julia Uber
- Rhode Island Hospital, Providence, RI, USA
| | - Siena Napoleon
- Brown University School of Public Health, Providence, RI, USA
| | | | - Emily Toma
- Brown University School of Public Health, Providence, RI, USA
- The Miriam Hospital, Providence, RI, USA
| | | | | | - Justin Berk
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
- The Rhode Island Department of Corrections, Cranston, RI, USA
| | - Philip A. Chan
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA
- Brown University School of Public Health, Providence, RI, USA
- The Miriam Hospital, Providence, RI, USA
| | - Susan Ramsey
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
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3
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Butts SA, Young B, Blackmon J, Doblecki-Lewis S. Addressing disparities in Pre-exposure Prophylaxis (PrEP) access: implementing a community-centered mobile PrEP program in South Florida. BMC Health Serv Res 2023; 23:1311. [PMID: 38012701 PMCID: PMC10683210 DOI: 10.1186/s12913-023-10277-1] [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: 04/10/2023] [Accepted: 11/04/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) for HIV prevention is highly effective, but disparities in PrEP access remain considerable, particularly among Black and Latino men who have sex with men (MSM). To address this, the University of Miami Mobile PrEP Program was created, offering mobile HIV prevention/PrEP services in areas throughout South Florida where HIV incidence is high and PrEP access is geographically limited. Using a community-centered participatory approach, the program strategized and executed expansion into the Liberty City neighborhood of Miami. This study qualitatively assessed factors affecting Mobile PrEP implementation as perceived by community stakeholders, clients, and program staff. METHODS Forty-one in-depth interviews were conducted with 21 Mobile PrEP clients, 10 key informants from local health organizations, and 10 program staff. Interview questions queried perceived organizational and positional barriers and facilitators to mobile clinic implementation. Service satisfaction, setting preferences, social factors, and likelihood of recommending Mobile PrEP were also assessed. A thematic content analysis was performed using the Consolidated Framework for Implementation Research (CFIR) taxonomy as the guiding constructs for the analysis. RESULTS Participant statements indicated that providing no-cost services, convenient location, program-covered rideshares, individualized patient navigation, and a community-centric approach to patient care, which included staff members with shared lived experiences to increase positive interactions and renewed trust among poorly served communities, were facilitators of PrEP access and intervention uptake. The importance of program familiarization with the community before implementation, particularly for Black and African American communities, who may experience unique barriers to accessing sexual healthcare was strongly emphasized by participants. CONCLUSIONS The Mobile PrEP intervention was found to be an acceptable and accessible mode of HIV/STI preventive care. The importance of pre-implementation community engagement and preparation is emphasized. Future research is needed to refine understanding of the intervention's components and evaluate implementation determinants in other highly impacted neighborhoods.
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Affiliation(s)
- Stefani A Butts
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, USA
| | - BreAnne Young
- Department of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Jakisha Blackmon
- Department of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Susanne Doblecki-Lewis
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, USA.
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4
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Biello KB, Chan PA, Holcomb R, Ndoye CD, Valente PK, Maynard M, Gandhi M, Mayer KH, Mimiaga MJ. PrEPare for Work: A Pilot Randomized Controlled Trial of an Intervention to Optimize HIV PrEP Outcomes Among Male Sex Workers. AIDS Behav 2023; 27:3294-3305. [PMID: 36976389 PMCID: PMC10753039 DOI: 10.1007/s10461-023-04050-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/29/2023]
Abstract
HIV pre-exposure prophylaxis (PrEP) use is limited among male sex workers, who are at exceptionally high-risk for HIV infection. We developed a theory-informed, two-pronged intervention ("PrEPare-for-Work") to optimize PrEP initiation and adherence among male sex workers, which was preliminarily evaluated in a two-stage pilot randomized controlled trial of 110 male sex workers in the US Northeast. Individuals randomized to the Stage 1 PrEPare-for-Work Case Management arm were three times as likely as those in the standard of care (SOC) arm to initiate PrEP (RR = 2.95, 95% CI = 1.57-5.57). Participants who initiated PrEP and were randomized to the Stage 2 PrEPare-for-Work Adherence Counseling arm had higher rates of prevention-effective adherence (measured via tenofovir in hair) compared to those in the SOC arm (RR = 1.7, 95% CI 0.64-4.77; 55.6% vs. 28.6%, respectively); though not statistically significant. Given the need and the promise of this pilot RCT, further efficacy testing is warranted and should be prioritized.
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Affiliation(s)
- Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
- , 121 South Main Street, Providence, RI, 02912, USA.
| | - Philip A Chan
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Medicine, Brown University, Providence, RI, USA
- Open Door Health, Rhode Island Public Health Institute, Providence, RI, USA
- Rhode Island Department of Health, Providence, RI, USA
| | | | | | - Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Allied Health Sciences, University of Connecticut, Waterbury, CT, USA
| | - Michaela Maynard
- Department of Medicine, Brown University, Providence, RI, USA
- Open Door Health, Rhode Island Public Health Institute, Providence, RI, USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), CA, USA
| | | | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- UCLA Center for LGBTQ Advocacy, Research, and Health (C-LARAH), Los Angeles, CA, USA
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5
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Rogers BG, Chan PA, Sutten-Coats C, Zanowick-Marr A, Patel RR, Mena L, Goedel WC, Chu C, Silva E, Galipeau D, Arnold T, Gomillia C, Curoe K, Villalobos J, Underwood A, Sosnowy C, Nunn AS. Perspectives on long-acting formulations of pre-exposure prophylaxis (PrEP) among men who have sex with men who are non-adherent to daily oral PrEP in the United States. BMC Public Health 2023; 23:1643. [PMID: 37641018 PMCID: PMC10463714 DOI: 10.1186/s12889-023-16382-4] [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: 07/02/2022] [Accepted: 07/25/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) persistence among men who have sex with men (MSM) in real world clinical settings for HIV prevention is suboptimal. New longer-acting formulations of PrEP are becoming available, including injectables, subdermal implants, and other oral medications. These longer-acting formulations have the potential to improve retention among those who have challenges remaining adherent to daily oral PrEP. METHODS We interviewed 49 MSM who had initiated but discontinued oral PrEP at three diverse clinics across the United States. We examined participants' perspectives about long-acting PrEP formulations and how long-acting options could affect PrEP use using thematic analysis. RESULTS Participants were not very knowledgeable about long-acting formulations of PrEP but were open to learning about them and considering use. Participants were concerned about safety and efficacy of products given that they were still newer and/or in development. Finally, participants had clear preferences for oral pills, injectables, and then subdermal implants and were most interested in options that reduced the number of visits to the clinic. CONCLUSION Long-acting formulations of PrEP are acceptable to MSM with suboptimal PrEP persistence and have the potential to improve PrEP persistence. However, many felt they needed more information on safety, efficacy, and use to consider these options. As these long-acting formulations are implemented, public health campaigns and clinical interventions to encourage may maximize uptake particularly among those who are not currently adherent to daily oral PrEP.
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Affiliation(s)
- Brooke G Rogers
- Department of Medicine, Division of Infectious Diseases,, Warren Alpert Medical School of Brown University, Providence, 02903, USA.
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, 02903, USA.
| | - P A Chan
- Department of Medicine, Division of Infectious Diseases,, Warren Alpert Medical School of Brown University, Providence, 02903, USA
- Department of Social and Behavioral Sciences, Brown University School of Public Health, Rhode Island, Providence, 02903, USA
| | - C Sutten-Coats
- Department of Social and Behavioral Sciences, Brown University School of Public Health, Rhode Island, Providence, 02903, USA
| | - A Zanowick-Marr
- Department of Medicine, Division of Infectious Diseases,, Warren Alpert Medical School of Brown University, Providence, 02903, USA
| | - R R Patel
- Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - L Mena
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, 39216, USA
- Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - W C Goedel
- Department of Epidemiology, Brown University School of Public Health, Rhode Island, Providence, 02903, USA
| | - C Chu
- Department of Medicine, Division of Infectious Diseases,, Warren Alpert Medical School of Brown University, Providence, 02903, USA
| | - E Silva
- Department of Medicine, Division of Infectious Diseases,, Warren Alpert Medical School of Brown University, Providence, 02903, USA
| | - D Galipeau
- Department of Medicine, Division of Infectious Diseases,, Warren Alpert Medical School of Brown University, Providence, 02903, USA
| | - T Arnold
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, 02903, USA
| | - C Gomillia
- Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - K Curoe
- Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - J Villalobos
- Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - A Underwood
- Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - C Sosnowy
- Department of Medicine, Division of Infectious Diseases,, Warren Alpert Medical School of Brown University, Providence, 02903, USA
| | - Amy S Nunn
- Department of Medicine, Division of Infectious Diseases,, Warren Alpert Medical School of Brown University, Providence, 02903, USA.
- Department of Social and Behavioral Sciences, Brown University School of Public Health, Rhode Island, Providence, 02903, USA.
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Remch M, Scheidell JD, Cleland CM, Turpin R, Duncan DT, Dyer TT, Kaufman JS, Mazumdar M, Brewer R, Feelemyer J, Mayer KH, Khan MR. Mediation of the Effect of Incarceration on Selling Sex Among Black Sexual Minority Men and Black Transgender Women in the HPTN 061 Study. AIDS Behav 2023; 27:2791-2802. [PMID: 36746876 DOI: 10.1007/s10461-023-04003-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 02/08/2023]
Abstract
Incarceration among Black sexual minority men and Black transgender women (BSMM/BTW) is disproportionately high in the United States. Limited research has documented the disruptive effect of incarceration on sexual networks and sexual partnership exchange among BSMM/BTW. We estimate the influence of incarceration on selling sex and mediating pathways among 1169 BSMM/BTW enrolled in the HIV Prevention Trials Network (HPTN) 061 cohort to assess this relationship. Mediators investigated were social support, violence, illicit drug use, and distress due to experienced racism and homophobia. During the 6 months following baseline, 14% of the cohort was incarcerated, including 24% of BTW. After adjustment, recent incarceration was associated with 1.57 (95% CI 1.02, 2.42) times the risk of subsequently selling sex. The hypothesized mediators together explained 25% of the relationship, with an indirect effect risk ratio of 1.09 (95% CI 0.97, 1.24). Our results document an association and call for more research investigating mechanisms.
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Affiliation(s)
- Molly Remch
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, CB 7435, McGavran-Greenberg Hall, Chapel Hill, NC, 27599, USA.
| | - Joy D Scheidell
- Department of Health Sciences, University of Central Florida, Orlando, FL, USA
| | - Charles M Cleland
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Rodman Turpin
- Department of Global and Community Health, George Mason University College of Public Health, Fairfax, VA, USA
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Typhanye T Dyer
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics, & Occupational Health, McGill University, Montreal, QC, Canada
| | - Medha Mazumdar
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Russell Brewer
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Jonathan Feelemyer
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Kenneth H Mayer
- Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Maria R Khan
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Gómez W. Assessing PrEP messaging and communication: A review of the qualitative literature. Curr Opin Psychol 2023; 51:101586. [PMID: 37247445 DOI: 10.1016/j.copsyc.2023.101586] [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: 02/27/2023] [Revised: 04/04/2023] [Accepted: 04/27/2023] [Indexed: 05/31/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is a biomedical HIV prevention intervention approved by the FDA in 2012. Nevertheless, most sexual minority men (SMM) who could benefit from its use are not currently prescribed PrEP. The literature during the first decade of PrEP availability has suggested a diverse set of multi-level barriers and facilitators to PrEP uptake and adherence. Through a scoping review, 16 qualitative studies were surveyed to assess these barriers and facilitators, specifically regarding messaging and communication. Seven main themes were identified: information & misinformation, peer messaging, expansion of sexual experiences, relationships with providers, expectations & stigma, navigation support, and barriers to uptake & adherence. Data suggest that peer support, messaging around empowerment and agency, and PrEP's role in shifting sociosexual norms contributed to uptake and adherence. On the other hand, stigma, provider disconnection, and access issues hindered PrEP uptake and adherence. Findings could inform multi-level, strengths-based, and holistic approaches to designing effective interventions for PrEP engagement among SMM.
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Affiliation(s)
- Walter Gómez
- Jane Addams College of Social Work, University of Illinois Chicago, Chicago IL 1040 W Harrison St, #4220 Chicago, IL 60607-7134, USA.
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8
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Butts S, Young B, Blackmon J, Doblecki-Lewis S. Addressing Disparities in Pre-Exposure Prophylaxis (PrEP) Access: Implementing a Community-Centered Mobile PrEP Program in South Florida. RESEARCH SQUARE 2023:rs.3.rs-2799359. [PMID: 37162949 PMCID: PMC10168452 DOI: 10.21203/rs.3.rs-2799359/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background Pre-exposure prophylaxis (PrEP) for HIV prevention is highly effective, but disparities in PrEP access remain considerable, particularly among Black and Latino men who have sex with men (MSM). To address this, the University of Miami Mobile PrEP Program was created, offering mobile HIV prevention/PrEP services in areas throughout South Florida where HIV incidence is high and PrEP access is geographically limited. Using a community-centered participatory approach, the program strategized and executed expansion into the Liberty City neighborhood of Miami. This study qualitatively assessed factors affecting Mobile PrEP implementation as perceived by community stakeholders, clients, and program staff. Methods Forty-one in-depth interviews were conducted with 21 Mobile PrEP clients, 10 key informants from local health organizations, and 10 program staff. Interview questions queried perceived organizational and positional barriers and facilitators to mobile clinic implementation. Service satisfaction, setting preferences, social factors, and likelihood of recommending Mobile PrEP were also assessed. A thematic content analysis was performed using the Consolidated Framework for Implementation Research (CFIR) taxonomy as the guiding constructs for the analysis. Results Participant statements indicated that providing no-cost services, convenient location, program-covered rideshares, individualized patient navigation, and a community-centric approach to patient care, which included staff members with shared lived experiences to increase positive interactions and renewed trust among poorly served communities, were facilitators of PrEP access and intervention uptake. The importance of program familiarization with the community before implementation, particularly for Black and African American communities, who may experience unique barriers to accessing sexual healthcare was strongly emphasized by participants. Conclusions The Mobile PrEP intervention was found to be an acceptable and accessible mode of HIV/STI preventive care. The importance of pre-implementation community engagement and preparation is emphasized. Future research is needed to refine understanding of the intervention's components and evaluate implementation determinants in other highly impacted neighborhoods.
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9
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Jones MD, Jones K, Almirol E, Payne G, Graves B, Schneider JA, Rijos D, Zawitz C, Zimmerman R, Seal DW, Brewer R, DrPH RB. Examining the Awareness, Acceptability, and Adoption of Conventional and non-conventional Forms of Pre-Exposure Prophylaxis (PrEP) for HIV Prevention Among jail-involved Black Sexual Minority men (BSMM) and Black Transgender Women (BTW) in Two Diverse US Cities. AIDS Behav 2023; 27:1304-1313. [PMID: 36264406 PMCID: PMC10038813 DOI: 10.1007/s10461-022-03866-4] [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: 09/14/2022] [Indexed: 11/01/2022]
Abstract
Black sexual minority men (BSMM) and Black transgender women (BTW) are disproportionately impacted by HIV and incarceration in the United States. In-depth interviews (N=34) and ongoing thematic analysis guided by the Exploration Phase of the Exploration, Preparation, Implementation, Sustainment framework were conducted to uncover key themes focused on the awareness, acceptability, and early adoption of conventional (i.e., daily oral pill) and non-conventional forms of PrEP (i.e., long-acting injectable, e-prescription for pick up post release) among jail-involved BSMM and BTW in Chicago, Illinois and Baton Rouge, Louisiana. The majority of participants were cisgender BSMM (88%) and were enrolled in Chicago (65%). There was greater awareness, availability, and adoption of conventional PrEP and non-conventional PrEP e-prescription for pick up post release among Chicago participants compared with Baton Rouge participants. Participants were largely receptive to all three forms of PrEP and stated a high need for HIV prevention in jails and immediately following release. PrEP stigma emerged as a major barrier to conventional daily PrEP adoption while incarcerated; potential misuse (e.g., pill selling) as a potential barrier to PrEP eprescription; and needle aversion and added clinic time as potential barriers to longacting injectable (LAI)-PrEP. Participants indicated that PrEP e-prescription could help support continuity of care post release and highlighted reduced stigma, convenience, and longer-term HIV protection as benefits for LAI-PrEP. Study findings provided context-specific information to inform the implementation of future PrEP interventions for jail-involved BSMM and BTW in two highly HIV-impacted jurisdictions.
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Affiliation(s)
| | - Keyira Jones
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Ellen Almirol
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Gjvar Payne
- Capitol Area Reentry Program, Baton Rouge, LA, USA
| | - Bobby Graves
- Capitol Area Reentry Program, Baton Rouge, LA, USA
| | | | | | | | - Rick Zimmerman
- College of Nursing, Wayne State University, Detroit, MI, USA
| | - David W Seal
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Russell Brewer
- Department of Medicine, University of Chicago, Chicago, IL, USA.
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10
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Dauria E, Skipalska H, Gopalakrishnan L, Savenko O, Sabadash L, Tolou-Shams M, Flanigan T, Navario P, Castillo TP. Exploratory qualitative study examining acceptability of strategies to improve access to substance use treatment and HIV prevention services for young adults on probation in Ukraine. BMJ Open 2022; 12:e061909. [PMID: 36418138 PMCID: PMC9685251 DOI: 10.1136/bmjopen-2022-061909] [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: 02/12/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Adults <30 years' of age experience elevated HIV-rates in Ukraine. Young adults (YA) involved in the criminal justice system (CJS) are at an increased HIV-risk given elevated rates of substance use, engagement in high-risk sexual behaviour and insufficient healthcare access. The objective of this exploratory study was to investigate the acceptability of strategies to refer and link CJS-involved YA to HIV-prevention and substance use treatment services from CJS settings. DESIGN We conducted qualitative individual interviews with CJS-involved YA (18-24 years), and CJS stakeholders. Interviews were guided by the Social Ecological Model. Interviews with YA explored substance use and sexual behaviour, and acceptability of strategies to link YA to HIV-prevention and substance use treatment services from CJS. Stakeholder interviews explored system practices addressing HIV-prevention and substance use and addiction. Data were analysed using Inductive Thematic Analysis. SETTING Data were collected in three locales, prior to the 2022 Russian-Ukrainian conflict. PARTICIPANTS Thirty YA and 20 stakeholders. RESULTS Most YA were men, reported recent injection drug use and were M age=23 years. YA were receptive to linkage to HIV-prevention services from CJS; this was shaped by self-perceived HIV-risk and lack of access to HIV-prevention services. YA were less receptive to being referred to substance use treatment services, citing a lack of self-perceived need and mistrust in treatment efficacy. Stakeholders identified multilevel contextual factors shaping acceptability of HIV-prevention and substance use treatment from CJS (eg, stigma). CONCLUSIONS Findings should be reviewed as a historical record of the pre-conflict context. In that context, we identified strategies that may have been used to help curtail the transmission of HIV in a population most-at-risk, including CJS-involved YA. This study demonstrates that improving access to substance use treatment and HIV-prevention services via CJS linkage were acceptable if provided in the right conditions (eg, low or no-cost, confidential).
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Affiliation(s)
- Emily Dauria
- Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Lakshmi Gopalakrishnan
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | | | | | - Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | | | - Peter Navario
- School of Public Health, New York University, New York, New York, USA
- HealthRight International, New York, New York, USA
| | - Theresa P Castillo
- School of Public Health, New York University, New York, New York, USA
- HealthRight International, New York, New York, USA
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11
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Murphy MJ, Rogers BG, Chambers LC, Zanowick-Marr A, Galipeau D, Noh M, Scott T, Napoleon SC, Rose J, Chan PA. Characterization of Risk Factors Among Individuals with a History of Incarceration Presenting to a Sexually Transmitted Infections Clinic: Implications for HIV and STI Prevention and Care. AIDS Patient Care STDS 2022; 36:291-299. [PMID: 35951448 PMCID: PMC9419926 DOI: 10.1089/apc.2022.0083] [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: 11/12/2022] Open
Abstract
More than 2 million people are incarcerated in the United States with many millions more processed through correctional facilities annually. Communities impacted by incarceration are also disproportionately impacted by the HIV and sexually transmitted infection (STI) epidemics. However, relatively little is known about the behaviors that place individuals with a history of incarceration at risk for HIV/STI acquisition. We utilized clinical data from patients presenting to an STI clinic located in Providence, Rhode Island. A latent class analysis was conducted on reported HIV acquisition risk behavior and STI testing results on a total of 1129 encounters where a history of incarceration was reported. A total of three classes were identified. Class 1 (N = 187, 11%), more frequently reported 10+ sexual partners (45%), an STI diagnosis (48%) and sex while intoxicated (86%) in the past year as well as identifying as a man who has sex with other men (60%). Class 2 (N = 57, 5%) was more likely to report giving (53%) and receiving (44%) money/drugs for sex in the past year as well as a history of injecting drugs (61%) and using methamphetamine (60%). Class 3 (N = 885, 78%) most frequently reported 0-2 sexual partners (48%), identified as Black (27%), Hispanic/Latino (69%) and a man who only has sex with women (80%). Class 1 had significantly higher odds ratio (1.8, 95% confidence interval = 1.3-2.5) of testing HIV/STI positive. The results provide important insights into risk subgroups for those with a history of incarceration at risk of HIV/STI acquisition.
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Affiliation(s)
- Matthew J Murphy
- School of Public Health, Brown University, Providence, Rhode Island, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Rhode Island Department of Corrections, Brown University, Providence, Rhode Island, USA
| | - Brooke G Rogers
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,The Miriam Hospital Department of Medicine, Division of Infectious Diseases, Providence, Rhode Island, USA
| | - Laura C Chambers
- School of Public Health, Brown University, Providence, Rhode Island, USA.,The Miriam Hospital Department of Medicine, Division of Infectious Diseases, Providence, Rhode Island, USA
| | - Alexandra Zanowick-Marr
- The Miriam Hospital Department of Medicine, Division of Infectious Diseases, Providence, Rhode Island, USA
| | - Drew Galipeau
- The Miriam Hospital Department of Medicine, Division of Infectious Diseases, Providence, Rhode Island, USA
| | - Madeline Noh
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Ty Scott
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Siena C Napoleon
- School of Public Health, Brown University, Providence, Rhode Island, USA.,The Miriam Hospital Department of Medicine, Division of Infectious Diseases, Providence, Rhode Island, USA
| | - Jennifer Rose
- Wesleyan University Quantitative Analysis Center, Brown University, Providence, Rhode Island, USA
| | - Philip A Chan
- School of Public Health, Brown University, Providence, Rhode Island, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,The Miriam Hospital Department of Medicine, Division of Infectious Diseases, Providence, Rhode Island, USA
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12
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Valera P, Ali ZS, Cunningham D, McLaughlin C, Acevedo S. Exploring Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) Knowledge in Incarcerated Men. Am J Mens Health 2022; 16:15579883221107192. [PMID: 35796098 PMCID: PMC9274424 DOI: 10.1177/15579883221107192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
People who are incarcerated have a disproportionately high risk of contracting
human immunodeficiency virus (HIV). While there is no known cure for HIV, there
are biomedical approaches that can successfully manage the virus and prevent its
transmission. A total of 267 men who are incarcerated completed a
cross-sectional survey focused on cancer health, HIV prevention, and mental
health in three state prisons. The mean age was 39 years. The majority had an
annual income of US$10,000 or less, self-identified as heterosexual, not
married, had children, did not have any military status, and identified as
African American/Black. Less than 4% indicated that they had heard about
Pre-Exposure Prophylaxis (PrEP), and only 3% had heard of Post-Exposure
Prophylaxis (PEP). PrEP and PEP effectively prevent HIV infection, but little
attention has focused on increasing the knowledge and awareness of these HIV
prevention interventions in the incarcerated population.
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Affiliation(s)
- Pamela Valera
- Rutgers School of Public Health, Department of Urban-Global Public Health, Newark, NJ, USA.,The Community Health Justice Lab, Newark, NJ, USA
| | - Zaire S Ali
- Rutgers School of Public Health, Department of Urban-Global Public Health, Newark, NJ, USA
| | - Diamond Cunningham
- Rutgers School of Public Health, Department of Urban-Global Public Health, Newark, NJ, USA
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13
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Andriano TM, Arnsten J, Patel VV. Social determinants of health and HIV Pre-Exposure Prophylaxis (PrEP) interest and use among young Black and Latinx sexual minority men. PLoS One 2022; 17:e0267031. [PMID: 35427397 PMCID: PMC9012374 DOI: 10.1371/journal.pone.0267031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/01/2022] [Indexed: 12/01/2022] Open
Abstract
Young Black and Latinx sexual minority men (YBLSMM) have low use of HIV pre-exposure prophylaxis (PrEP), despite high rates of new HIV diagnosis. While unmet social determinants of health (SDOH) have been associated with low uptake of preventive health services, this association is unknown for PrEP. To understand the relationship between SDOH and PrEP adoption in this population, we analyzed data from an online survey of HIV-negative YBLSMM aged 18-29 in New York City (n = 143). Participants completed a 17-item SDOH needs scale measuring basic, health/social-services, and economic needs. We used regression models to examine associations of unmet SDOH with outcomes of intention to use PrEP and current PrEP use. Of those not on PrEP (n = 114), 69 (61%) intended to use PrEP. More unmet SDOH needs overall were associated with intention to use PrEP (OR 1.4; 95% CI 1.1, 2.0), as were more unmet basic needs (OR 1.7; 95% CI 1.1, 2.5) and more unmet economic needs (OR 1.3; 95% CI 1.0, 1.7). Unmet SDOH needs were not associated with current PrEP use. Findings suggest that intention to use PrEP among YBLSMM is a likely marker of unmet SDOH needs, as YBLSMM with unmet needs may have limited resources to support moving from intention to actual use. Future research should evaluate programs engaging YBLSMM intending to use PrEP with interventions to screen for and address SDOH.
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Affiliation(s)
- Tyler M Andriano
- Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Julia Arnsten
- Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, United States of America
| | - Viraj V. Patel
- Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, United States of America
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14
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Goodman A, Patten L, Castillo-Mancilla J, Zimmer S, Madinger N, Frasca K. Factors Associated with Retention and Adherence in a Comprehensive, Diverse HIV Pre-Exposure Prophylaxis Clinic. AIDS Res Hum Retroviruses 2022; 38:327-335. [PMID: 34861765 DOI: 10.1089/aid.2021.0130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Retention in HIV pre-exposure prophylaxis (PrEP) care and adherence to PrEP have been suboptimal in some populations, despite evidence that high adherence dramatically enhances PrEP efficacy. A comprehensive PrEP Clinic with a retention specialist and clinical pharmacist could impact patient's retention and adherence in PrEP care. A retrospective electronic medical record review of patients attending an academic PrEP Clinic was conducted between June 2018 and June 2019 (at least one visit attended for PrEP was required). Retention was defined as a medical or laboratory visit every 3 months ±30 days, as recommended by CDC guidelines, but was analyzed using the number of visits and time between visits via multivariate regression analyses. PrEP adherence was calculated using a Medication-Possession Ratio (MPR) and compared between patient characteristics using Kruskal-Wallis tests. One hundred twenty-two patients were identified by chart review, 96 had sufficient data for follow-up and were included in at least one analysis. The population was primarily cisgender men who have sex with men and over half were African American or Hispanic. Overall, patient retention was 43%. The retention analysis demonstrated that individuals who self-identified as gay were more likely to be retained than those who identified as heterosexual (53% vs. 18%, hazard ratio = 1.75, 95% confidence interval = [1.01-3.03], p = .045). Although not statistically significant, African Americans and cisgender women were less likely to be retained in care. The adherence analysis identified higher median MPRs among patients not reporting previous incarceration (80% vs. 35%, p < .01). Although not statistically significant, there was lower adherence among youth 18-24 (11% vs. 54% MPR >80, p = .058). Despite comprehensive PrEP clinical care, heterosexual individuals were less likely to be retained in PrEP care than those who self-identified as gay and previously incarcerated individuals were less likely to be adherent to PrEP.
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Affiliation(s)
- Andrew Goodman
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Luke Patten
- Department of Biostatistics and Informatics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jose Castillo-Mancilla
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Shanta Zimmer
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nancy Madinger
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Katherine Frasca
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
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15
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Murphy M, Sosnowy C, Rogers B, Napoleon S, Galipeau D, Scott T, Tao J, Berk J, Clarke J, Nunn A, Chan PA. Defining the Pre-exposure Prophylaxis Care Continuum Among Recently Incarcerated Men at High Risk for HIV Infection: Protocol for a Prospective Cohort Study. JMIR Res Protoc 2022; 11:e31928. [PMID: 35142633 PMCID: PMC8874820 DOI: 10.2196/31928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background HIV disproportionately impacts criminal justice–involved individuals, including men who experience incarceration. Men make up the vast majority of those experiencing incarceration as well as those newly diagnosed with HIV infection. Pre-exposure prophylaxis (PrEP) is a highly effective biomedical intervention that significantly reduces the risk of HIV acquisition. However, implementation in criminal justice systems is limited. Little is known about effective PrEP implementation and use in this unique public health context. Objective The aim of this study is to characterize the experience of implementing PrEP clinical care in a criminal justice setting for men vulnerable to HIV acquisition. Methods This article describes a PrEP care continuum for men experiencing incarceration who are at increased risk of HIV acquisition, which can help conceptualize approaches to evaluating PrEP implementation. Results The outlined study will enroll 100 men experiencing incarceration at high risk for HIV acquisition prior to release into the community. The goal is to initiate PrEP prior to release and link individuals to PrEP providers in the community, capturing barriers and facilitators to PrEP use during this uniquely vulnerable time period for HIV acquisition. Conclusions Based on the proposed care continuum and what is known about HIV risk and prevention efforts in the criminal justice context, we outline key future research efforts to better understand effective approaches to preventing HIV infection among this vulnerable population. The described approach presents a powerful public health opportunity to help end the HIV epidemic. International Registered Report Identifier (IRRID) DERR1-10.2196/31928
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Affiliation(s)
| | | | | | | | | | - Ty Scott
- Brown University, Providence, RI, United States
| | - Jun Tao
- Brown University, Providence, RI, United States
| | - Justin Berk
- Brown University, Providence, RI, United States
| | | | - Amy Nunn
- Brown University, Providence, RI, United States
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16
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Parrish KC, Johnson HZ, Williams SL. PrEP navigation continuum among men who have sex with men, trans women, and people with alternative gender identities in three California counties. EVALUATION AND PROGRAM PLANNING 2022; 90:101998. [PMID: 34544606 DOI: 10.1016/j.evalprogplan.2021.101998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
Abstract
Strategies to reduce new HIV infections include pre-exposure prophylaxis (PrEP). Of the estimated over 221,000 Californians with an indication for PrEP, only 31,280 (14 %) were currently taking the medication as of 2019. Centers for Disease Control and Prevention Project PrIDE funds were used to support and develop California PrEP navigation programs designed to increase PrEP uptake among trans persons and men who have sex with men (MSM). An analysis of PrIDE-funded PrEP navigation service outcomes was conducted to highlight where continuum drop-off occurred and how it varied among priority populations. Quantitative service delivery data for PrEP navigation program activities conducted from October 1, 2015 to September 30, 2018 were collected across three county-level local health jurisdictions (LHJs) via standardized, agency-completed service delivery data collection tools. Analyses included frequencies and crosstabs. These variations were not tested statistically but highlight group-specific needs to be addressed before implementing PrEP navigation within California. Continued systematic collection and analyses of PrEP continuum outcomes will allow programs to dynamically identify and address barriers to PrEP uptake in priority populations.
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Affiliation(s)
- Kolbi C Parrish
- Office of AIDS, Center for Infectious Diseases, California Department of Public Health, United States
| | - Hannah Z Johnson
- Office of AIDS, Center for Infectious Diseases, California Department of Public Health, United States
| | - Sheryl L Williams
- Office of AIDS, Center for Infectious Diseases, California Department of Public Health, United States.
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17
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Rouhani S, Allen ST, Whaley S, White RH, O'Rourke A, Schneider KE, Kilkenny ME, Weir BW, Sherman SG. Food access among people who inject drugs in West Virginia. Harm Reduct J 2021; 18:90. [PMID: 34419045 PMCID: PMC8379557 DOI: 10.1186/s12954-021-00536-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 08/13/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The substance use epidemic in the United States continues to drive high levels of morbidity and mortality, particularly among people who inject drugs (PWID). Poor access to food often co-occurs with drug use and contributes to associated sequelae, such as risks for HIV and diabetes. The objective of this study was to examine factors associated with adequate food access among PWID in a rural Appalachian community. METHODS Cross-sectional surveys were used to collect data among PWID aged 18 and older in Cabell County, West Virginia. Frequency of hunger and sociodemographic, structural and drug use characteristics were measured. Adequate food access was defined as reporting 'never' going to bed hungry at night in the past six months. Pearson's χ2 and t-tests and multivariable logistic regression were used to identify factors associated with food access. RESULTS Only 71 individuals (17%) reported never going to bed hungry at night in the past six months. Adjusted odds of having adequate food access were higher among PWID who completed high school (aOR 2.94; P = 0.010) and usually used drugs alone (aOR 1.97; P = 0.025), and lower among PWID who were female (aOR 0.51; P = 0.037), experienced homelessness (aOR 0.23, P < 0.001), were recently arrested (aOR 0.50 P = 0.047), and engaged in receptive sharing of injection equipment (aOR 0.52, P = 0.035). CONCLUSIONS We found extremely low food access in a population of PWID in Appalachia who are vulnerable to overdose and infectious disease transmission. Integrated interventions promoting food access are needed to improve the public health and wellbeing of people who inject drugs in Appalachia.
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Affiliation(s)
- Saba Rouhani
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Baltimore, MD, 21205, USA. .,Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Sean T Allen
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Sara Whaley
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rebecca Hamilton White
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Allison O'Rourke
- DC Center for AIDS Research, Department of Psychology, George Washington University, Washington, DC, USA
| | - Kristin E Schneider
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Brian W Weir
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Baltimore, MD, 21205, USA
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18
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Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1-187. [PMID: 34292926 PMCID: PMC8344968 DOI: 10.15585/mmwr.rr7004a1] [Citation(s) in RCA: 767] [Impact Index Per Article: 255.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for
sexually transmitted infections (STIs) were updated by CDC after consultation
with professionals knowledgeable in the field of STIs who met in Atlanta,
Georgia, June 11–14, 2019. The information in this report updates the
2015 guidelines. These guidelines discuss 1) updated recommendations for
treatment of Neisseria gonorrhoeae, Chlamydia trachomatis,
and Trichomonas vaginalis; 2) addition of
metronidazole to the recommended treatment regimen for pelvic inflammatory
disease; 3) alternative treatment options for bacterial vaginosis; 4) management
of Mycoplasma genitalium; 5) human papillomavirus vaccine
recommendations and counseling messages; 6) expanded risk factors for syphilis
testing among pregnant women; 7) one-time testing for hepatitis C infection; 8)
evaluation of men who have sex with men after sexual assault; and 9) two-step
testing for serologic diagnosis of genital herpes simplex virus. Physicians and
other health care providers can use these guidelines to assist in prevention and
treatment of STIs.
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19
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Chan PA, Nunn A, van den Berg JJ, Cormier K, Sowemimo-Coker G, Napoleon SC, Arnold T, Moitra E. A Randomized Trial of a Brief Behavioral Intervention for PrEP Uptake Among Men Who Have Sex With Men at Increased Risk for HIV Infection. J Acquir Immune Defic Syndr 2021; 87:937-943. [PMID: 33734099 PMCID: PMC8192434 DOI: 10.1097/qai.0000000000002671] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/01/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the efficacy of a novel, brief 2-session behavioral intervention to promote HIV pre-exposure prophylaxis (PrEP) uptake among men who have sex with men (MSM) who are behaviorally at risk for HIV. SETTING A pilot randomized controlled trial was conducted at a sexually transmitted infection (STI) clinic to compare a brief motivational interviewing intervention with passive referral only for PrEP uptake. METHODS MSM who scored as "high risk" on the HIV Incidence Risk index for MSM was offered a brief (15-20 minutes) motivational interviewing-based intervention at the time of STI testing to address barriers to PrEP uptake, including low risk perception, stigma, side effects, and cost. The initial session was followed by a brief, telephone booster session that lasted <10 minutes. The primary outcome was attending a clinical PrEP appointment and accepting a prescription for PrEP. RESULTS Participants were recruited from an urban STI clinic in the United States. A total of 86 MSM who were behaviorally at risk for HIV were enrolled in the study (N = 43 intervention; N = 43 treatment-as-usual, "TAU"). Participants randomized to the intervention were significantly more likely to attend a clinical appointment and accept a prescription for PrEP, compared with treatment-as-usual (52.3% versus 27.9%, respectively; odds ratio = 3.6; 95% confidence interval: 1.5 to 8.9; P = 0.005). CONCLUSIONS A brief behavioral intervention focused on the initial steps in the PrEP care cascade demonstrated preliminary efficacy in promoting uptake among MSM who are behaviorally at risk for HIV.
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Affiliation(s)
- Philip A Chan
- Departments of Medicine; and
- Behavioral and Social Sciences, Brown University, Providence, RI
| | - Amy Nunn
- Behavioral and Social Sciences, Brown University, Providence, RI
| | - Jacob J van den Berg
- Departments of Medicine; and
- Behavioral and Social Sciences, Brown University, Providence, RI
- Department of Epidemiology, Harvard University, Boston, MA; and
| | | | | | | | - Trisha Arnold
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI
| | - Ethan Moitra
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI
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20
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Dauria EF, Levine A, Hill SV, Tolou-Shams M, Christopoulos K. Multilevel Factors Shaping Awareness of and Attitudes Toward Pre-exposure Prophylaxis for HIV Prevention among Criminal Justice-Involved Women. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1743-1754. [PMID: 33236275 PMCID: PMC8276158 DOI: 10.1007/s10508-020-01834-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 05/14/2023]
Abstract
Although pre-exposure prophylaxis (PrEP) is a key tool in HIV prevention efforts, little is known about PrEP as a prevention strategy for criminal justice-involved (CJI) women. The purpose of this study was to examine multilevel factors shaping PrEP awareness and acceptability among CJI women. Between January 2017 and December 2017, we conducted 52 interviews with CJI women at high risk for HIV and stakeholders from the criminal justice (CJ) and public health (PH) systems. Interviews explored awareness of PrEP and the multilevel factors shaping PrEP acceptability. Data were analyzed using inductive thematic analysis and executive summaries. Atlas.ti facilitated analyses. The majority of CJI women (n = 27) were, on average, 41.3 years, from racial and ethnic minority groups (56% Black/African-American; 19% Latinx) and reported engaging in recent high-risk behavior (nearly 60% engaged in transactional sex, 22% reported ≥ 4 sexual partners, and 37% reported injection drug use). Of system stakeholders (n = 25), 52% represented the CJ sector. Although CJI women were generally unaware of PrEP, attitudes toward PrEP were enthusiastic. Barriers to PrEP acceptability included medication side effects (individual level); distrust in HIV prevention mechanisms (community level); lack of local HIV prevention efforts among high-risk women (public policy/HIV epidemic stage level). Factors promoting PrEP included perceived HIV risk (individual level); PrEP being an HIV prevention method that women can control without partner negotiation (social and sexual network level); and availability of public health insurance (community level). Despite low awareness of PrEP, CJI women expressed positive attitudes toward PrEP. To improve PrEP access for CJI women, implementation efforts should address barriers and leverage facilitators across multiple levels to be maximally effective.
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Affiliation(s)
- Emily F Dauria
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 1001 Potrero Ave., Bldg. 5, San Francisco, CA, 94110, USA.
| | - Andrew Levine
- Department of Sociology, New York University, New York, NY, USA
| | - Samantha V Hill
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 1001 Potrero Ave., Bldg. 5, San Francisco, CA, 94110, USA
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21
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Lins-Filho PC, Carvalho FMTD, Freitas JLDM, Ferreira AKA, Melo MCFD, Godoy GP, Caldas Jr ADF. Drug use pattern among non-heterosexual and transgender people detained in a female prison complex. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1916850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | | | | | | | - Gustavo Pina Godoy
- Post Graduation Programme in Dentistry, Federal University of Pernambuco, Recife, Brazil
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22
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Fitch C, Foley J, Klevens M, Cermeño JN, Batchelder A, Mayer K, O'Cleirigh C. Structural Issues Associated with Pre-exposure Prophylaxis Use in Men Who Have Sex with Men. Int J Behav Med 2021; 28:759-767. [PMID: 33834369 DOI: 10.1007/s12529-021-09986-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Limited access to healthcare has been associated with limited uptake of pre-exposure prophylaxis (PrEP) for HIV among men who have sex with men (MSM). This descriptive analysis examined, in a near universal healthcare setting, differences between MSM reporting using versus not using PrEP in the past 12 months. METHOD Data come from the 2017 Boston sample of the National HIV Behavioral Surveillance (NHBS) system, containing a venue-based and time-spaced sample of 530 MSM. The analysis used descriptive frequencies and tests of bivariate associations by PrEP use using Fisher's exact test. RESULTS Five hundred four respondents had data necessary to determine if PrEP was indicated, and 233 (43.9%) had an indication for PrEP. Of these 233 participants, 117 (50.2%) reported using PrEP in the past 12 months. Not being out, in terms of disclosing one's sexual orientation to a healthcare provider, lack of health insurance, limited access to healthcare, and history of incarceration were all significantly associated with not using PrEP in the past 12 months. Race/ethnicity was not significantly associated with PrEP use in the past 12 months. CONCLUSIONS In the setting of Massachusetts healthcare expansion and reform, and in a sample somewhat uncharacteristic of the population of individuals experiencing difficulties accessing PrEP, structural and demographic factors remain potent barriers to PrEP uptake. Targeted PrEP expansion efforts in Massachusetts may focus on identifying vulnerable subgroups of MSM (e.g., underinsured or criminal justice system-involved MSM) and delivering evidence-based interventions to reduce stigma and promote disclosure of same-sex behavior in healthcare settings.
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Affiliation(s)
- Calvin Fitch
- Behavioral Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Harvard University, Boston, MA, USA. .,The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Jacklyn Foley
- Behavioral Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA
| | - Monina Klevens
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA
| | | | - Abigail Batchelder
- Behavioral Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA.,The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Kenneth Mayer
- Harvard Medical School, Harvard University, Boston, MA, USA.,The Fenway Institute, Fenway Health, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.,Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Conall O'Cleirigh
- Behavioral Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA.,The Fenway Institute, Fenway Health, Boston, MA, USA
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Yang C, Zaller N, Clyde C, Tobin K, Latkin C. Association between Recent Criminal Justice Involvement and Transactional Sex among African American Men Who Have Sex with Men in Baltimore. J Urban Health 2020; 97:635-641. [PMID: 30815776 PMCID: PMC7560689 DOI: 10.1007/s11524-019-00350-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Non-Hispanic Black/African American men who have sex with men (AAMSM) have been disproportionately affected by criminal justice (CJ) involvement and HIV. One potential pathway between CJ involvement and high HIV prevalence and incidence among AAMSM is through risky sexual behavior. The goal of this study was to explore the association between recent CJ involvement, i.e., having been arrested and/or in prison/jail in the past 6 months, and transactional sex in a sample of AAMSM in Baltimore. We analyzed the baseline data of 396 AAMSM from a pilot behavioral HIV intervention conducted in Baltimore, MD, between October 2012 and November 2015. A multivariate logistic regression model was conducted to explore the association between recent CJ involvement and transactional sex. A total of 65 (16%) participants reported recent CJ involvement, and 116 (29%) reported transactional sex in the past 90 days. After adjusting for age, education, employment, sexual identity, HIV status, and drug use, recent CJ involvement was significantly associated with transactional sex (AOR 3.31; 95% CI 1.72; 5.70). Being 24-40 years (AOR 2.73; 95% CI 1.17, 6.33) or over 40 years older (AOR 3.80; 95% CI 1.61, 8.98) vs. younger and using drugs (AOR 4.47; 95% CI 2.43, 8.23) also remained independently associated with recent transactional sex. Findings of the current study contribute to the literature on the association between recent history of CJ involvement and transactional sex among AAMSM. More evidence-based HIV prevention interventions for people involved in the CJ system who are at high risk for contracting HIV, particularly racial and sexual minorities such as AAMSM, are urgently needed.
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Affiliation(s)
- Cui Yang
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Nick Zaller
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Catie Clyde
- Clinical and Translational Science Center, University of California-Davis, Davis, CA, USA
| | - Karin Tobin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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24
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Edwards GG, Reback CJ, Cunningham WE, Hilliard CL, McWells C, Mukherjee S, Weiss RE, Harawa NT. Mobile-Enhanced Prevention Support Study for Men Who Have Sex With Men and Transgender Women Leaving Jail: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e18106. [PMID: 32959786 PMCID: PMC7539160 DOI: 10.2196/18106] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/26/2020] [Accepted: 07/14/2020] [Indexed: 01/08/2023] Open
Abstract
Background Men who have sex with men (MSM) and transgender women, particularly those who have experienced criminal justice involvement, have particularly high HIV burdens, and a majority of those in jail have substance use disorders (SUDs). MSM and transgender women also experience elevated rates of incarceration. Once community re-entry occurs, individuals are in a critical period for addressing potential risks of HIV and sexually transmitted infection (STI) acquisition and negative sequelae of substance use. Further, the impact experienced by one’s social and sexual networks experienced at the time of detention and release have important health implications for MSM and transgender women. Objective The purpose of this study is to test a new intervention—Mobile-Enhanced Prevention Support (MEPS)—that involves a GPS-based mobile app called GeoPassport (referred to as GeoPass in practice), incentives, and peer support for promoting HIV prevention, substance use treatment, and use of related services. Methods A two-arm, unblinded, randomized controlled trial will seek to enroll 300 HIV-negative MSM and transgender women, aged 18-49 years, with SUDs, who are either in jail or have recently left jail. Participants will be enrolled by study staff and randomized to the MEPS intervention group or usual care group. The intervention group will receive customized wellness goals in addition to GeoPass, cash incentives, and the support of a trained peer mentor for 6 months. Data collection will consist of a baseline survey and three follow-up surveys at 3, 6, and 9 months postenrollment, either in person or by phone or videoconference when necessary. The primary outcomes include establishing a primary care provider; being prescribed and adhering to pre-exposure prophylaxis (PrEP) for HIV; screening for HIV, STIs, and hepatitis C virus; and engagement in recommended treatment for SUDs. Secondary outcomes include obtaining treatment for any identified infections and avoiding recidivism. Results Enrollment began in November 2019 and study completion is expected in 2023. Conclusions This study will advance our knowledge base on patient navigation and peer mentor interventions. Peer navigation services have been studied for the treatment of HIV, but less often in the context of HIV and STI prevention among sexual and gender minority populations at the time of re-entry into the community from jail. The MEPS study will examine the acceptability and feasibility of combining peer mentor services with a mobile app to facilitate service utilization and participant–peer mentor communication. MEPS will assess patterns of PrEP uptake and utilization in MSM and transgender women leaving jail. The study will provide heretofore unavailable data from persons leaving jail regarding HIV PrEP, STI screening, substance abuse treatment, and service utilization patterns and experiences, including geocoded data for those in the intervention arm. Trial Registration ClinicalTrials.gov (NCT04036396); https://www.clinicaltrials.gov/ct2/show/NCT04036396 International Registered Report Identifier (IRRID) PRR1-10.2196/18106
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Affiliation(s)
- Gabriel G Edwards
- Department of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles, Los Angeles, CA, United States
| | - Cathy J Reback
- Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles, Los Angeles, CA, United States.,Friends Research Institute, Los Angeles, CA, United States
| | - William E Cunningham
- Department of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles, Los Angeles, CA, United States
| | - Charles L Hilliard
- Los Angeles Centers for Alcohol and Drug Abuse, Los Angeles, CA, United States
| | - Charles McWells
- Los Angeles Centers for Alcohol and Drug Abuse, Los Angeles, CA, United States
| | - Sukrit Mukherjee
- Department of Preventative and Social Medicine, Charles R Drew University, Los Angeles, CA, United States.,Center for Biomedical Informatics, Charles R Drew University, Los Angeles, CA, United States
| | - Robert E Weiss
- Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Nina T Harawa
- Department of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Psychiatry, Charles R Drew University, Los Angeles, CA, United States
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25
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Sosnowy C, Tao J, Nunez H, Montgomery MC, Ndoye CD, Biello K, Mimiaga MJ, Raifman J, Murphy M, Nunn A, Maynard M, Chan PA. Awareness and use of HIV pre-exposure prophylaxis among people who engage in sex work presenting to a sexually transmitted infection clinic. Int J STD AIDS 2020; 31:1055-1062. [PMID: 32753003 DOI: 10.1177/0956462420943702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Collette Sosnowy
- Department of Medicine, Brown University Alpert Medical School, Providence, RI, USA
| | - Jun Tao
- Department of Medicine, Brown University Alpert Medical School, Providence, RI, USA
| | - Hector Nunez
- Department of Medicine, Brown University Alpert Medical School, Providence, RI, USA
| | | | | | - Katie Biello
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA.,Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA.,The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Matthew J Mimiaga
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA.,Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA.,The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - Julia Raifman
- Department of Health Law, Policy and Management, Boston University, Boston, MA, USA
| | - Matthew Murphy
- Department of Medicine, Brown University Alpert Medical School, Providence, RI, USA
| | - Amy Nunn
- Department of Medicine, Brown University Alpert Medical School, Providence, RI, USA.,Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Michaela Maynard
- Department of Medicine, Brown University Alpert Medical School, Providence, RI, USA
| | - Philip A Chan
- Department of Medicine, Brown University Alpert Medical School, Providence, RI, USA.,Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA
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26
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English D, Carter JA, Bowleg L, Malebranche DJ, Talan AJ, Rendina HJ. Intersectional social control: The roles of incarceration and police discrimination in psychological and HIV-related outcomes for Black sexual minority men. Soc Sci Med 2020; 258:113121. [PMID: 32590189 PMCID: PMC7506501 DOI: 10.1016/j.socscimed.2020.113121] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/14/2020] [Accepted: 06/06/2020] [Indexed: 12/17/2022]
Abstract
RATIONALE Although Black gay, bisexual, and other sexual minority men face disproportionately high levels of incarceration and police discrimination, little research examines how these stressors may drive HIV and psychological health inequities among these men. OBJECTIVE In this study we examined associations between incarceration history, police and law enforcement discrimination, and recent arrest with sexual HIV risk, Pre-Exposure Prophylaxis (PrEP) willingness, and psychological distress among Black sexual minority men. METHOD Participants were a U.S. national sample of 1172 Black sexual minority men who responded in 2017-2018 to self-report measures of incarceration history, past year police and law enforcement discrimination, recent arrests, sexual HIV risk, PrEP willingness, and psychological distress. We used structural equation modeling to examine direct and indirect pathways from incarceration, police and law enforcement discrimination, and arrests to sexual HIV risk, PrEP willingness, and psychological distress. RESULTS Past-year police and law enforcement discrimination prevalence was 43%. Incarceration history was positively associated with later police and law enforcement discrimination, which, in turn, was positively associated with recent arrest. Incarceration and recent arrest and were associated with greater sexual HIV risk; incarceration and police and law enforcement discrimination were associated with lower PrEP willingness; and police and law enforcement discrimination was associated with higher psychological distress. Mediation analyses showed that the effects of incarceration were partially mediated by police and law enforcement discrimination. CONCLUSION Findings suggest police discrimination may be a mechanism of mass incarceration and fundamental driver of health inequities among Black sexual minority men.
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Affiliation(s)
- Devin English
- Rutgers School of Public Health, Piscataway, NJ, USA
| | - Joseph A Carter
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA; Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA
| | | | | | - Ali J Talan
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
| | - H Jonathon Rendina
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA; Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA.
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27
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Mayer KH, Agwu A, Malebranche D. Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review. Adv Ther 2020; 37:1778-1811. [PMID: 32232664 PMCID: PMC7467490 DOI: 10.1007/s12325-020-01295-0] [Citation(s) in RCA: 187] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Indexed: 01/01/2023]
Abstract
Antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV transmission was first approved by the US Food and Drug Administration in 2012. Despite correlations of decreases in new HIV infections being greatest where PrEP has been deployed, the uptake of PrEP is lagging, particularly among populations with disproportionate HIV burden. This narrative review seeks to identify individual and systemic barriers to PrEP usage in the USA. A comprehensive search of recent literature uncovered a complex array of structural, social, clinical, and behavioral barriers, including knowledge/awareness of PrEP, perception of HIV risk, stigma from healthcare providers or family/partners/friends, distrust of healthcare providers/systems, access to PrEP, costs of PrEP, and concerns around PrEP side effects/medication interactions. Importantly, these barriers may have different effects on specific populations at risk. The full potential of PrEP for HIV prevention will not be realized until these issues are addressed. Strategies to achieve this goal should include educational interventions, innovative approaches to delivery of HIV care, financial support, and destigmatization of PrEP and PrEP users. Until then, PrEP uptake will continue to be suboptimal, particularly among those who need it most.
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Affiliation(s)
- Kenneth H Mayer
- The Fenway Institute and Harvard Medical School, Boston, MA, USA.
| | - Allison Agwu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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28
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Zaller ND, Neher TL, Presley M, Horton H, Marshall SA, Zielinski MJ, Brinkley-Rubinstein L. Barriers to linking high-risk jail detainees to HIV pre-exposure prophylaxis. PLoS One 2020; 15:e0231951. [PMID: 32302371 PMCID: PMC7164641 DOI: 10.1371/journal.pone.0231951] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 04/03/2020] [Indexed: 12/04/2022] Open
Abstract
Individuals involved in the criminal justice (CJ) system continue to be at disproportionate risk for HIV infection, and often have a greater prevalence of substance use and sexual related risk behaviors relative to their non-CJ involved peers. Pre-exposure prophylaxis (PrEP), a once daily antiretroviral medicine, is an evidence-based approach for reducing the risk of contracting HIV but limited data exist regarding the use of PrEP among CJ populations, especially in the U.S. South. This study was conducted at the Pulaski County Regional Detention Facility (PCRDF) in Little Rock, Arkansas (AR), the largest county jail in the state. We explored knowledge about PrEP and HIV, perceptions about PrEP feasibility in both the jail and community settings and barriers to PrEP program implementation, through in-depth qualitative interviews with 21 jail detainees. We purposively sampled individuals based on specific self-reported risk behavior, including sexual risk (both heterosexual and same-sex) and drug related risk (e.g. IDU), among all eligible individuals. We identified five primary themes from the interviews: 1) accessing healthcare during community reentry was a low priority; 2) perception of risk and interaction with people with HIV was low; 3) there are many barriers to disclosing HIV risk behaviors in jail settings; 4) knowledge of PrEP is low but willingness to use is high; and 5) multiple barriers exist to PrEP uptake post-release. Our findings are contextually unique and therefore have important implications for future implementation of PrEP access either within jail settings or linkage to PrEP post release.
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Affiliation(s)
- Nickolas D. Zaller
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
- * E-mail:
| | - Taylor L. Neher
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Makenzie Presley
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Heather Horton
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - S. Alexandra Marshall
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Melissa J. Zielinski
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Lauren Brinkley-Rubinstein
- Department of Social Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Center for Health Equity Research, University of North Carolina, Chapel Hill, North Carolina, United States of America
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29
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Brinkley-Rubinstein L, Crowley C, Montgomery MC, Peterson M, Zaller N, Martin R, Clarke J, Dubey M, Chan PA. Interest and Knowledge of HIV Pre-Exposure Prophylaxis in a Unified Jail and Prison Setting. JOURNAL OF CORRECTIONAL HEALTH CARE 2020; 26:36-41. [PMID: 32105164 DOI: 10.1177/1078345819897405] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pre-exposure prophylaxis (PrEP) may be an effective approach to prevent HIV among people who are currently incarcerated or who have been recently released from incarceration. However, awareness and interest in PrEP are largely unknown in this population. This study assessed 417 incarcerated men's lifetime HIV risk engagement and gauged their interest and willingness to take PrEP. Twenty percent reported ever injecting drugs and 4% ever having sex with a man without a condom; 88% had never heard of PrEP. More White men had heard of PrEP, but higher percentages of men of color were interested in learning more about PrEP and willing to take PrEP to prevent HIV. Future interventions should focus on PrEP education and uptake among individuals who are incarcerated.
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Affiliation(s)
| | | | | | - Meghan Peterson
- Brown University School of Public Health, Providence, RI, USA
| | - Nickolas Zaller
- Office of Global Health, Fay W. Boozman College of Public Health, Little Rock, AR, USA
| | | | - Jennifer Clarke
- Department of Medicine, Brown University, Providence, RI, USA
- Rhode Island Department of Corrections, Cranston, RI, USA
| | - Manisha Dubey
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Philip A Chan
- Department of Medicine, Brown University, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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30
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Peterson M, Macmadu A, Truong AQ, Rich J, Pognon K, Lurie M, Clarke JG, Brinkley-Rubinstein L. Pre-exposure prophylaxis awareness and interest among participants in a medications for addiction treatment program in a unified jail and prison setting in Rhode Island. J Subst Abuse Treat 2019; 106:73-78. [PMID: 31540614 DOI: 10.1016/j.jsat.2019.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 08/23/2019] [Accepted: 08/27/2019] [Indexed: 01/12/2023]
Abstract
People who are incarcerated are at increased risk for HIV (human immunodeficiency virus) acquisition upon release, and one possible intervention for prevention is the use of pre-exposure prophylaxis (PrEP) upon release. The present study assessed HIV risk perceptions as well as PrEP awareness and interest among 39 people who were incarcerated and enrolled in a structured Medication for Addiction Treatment (MAT) program at the Rhode Island Department of Corrections using semi-structured, qualitative interviews. Analysis was conducted using a generalized, inductive method in NVivo 12. While PrEP awareness was low across the study sample, some participants were interested in PrEP uptake or learning more about PrEP after they were provided with an overview of it. PrEP interest strongly related to current perceived HIV risk. Potential barriers included side effects, adherence, and reluctance to take medications in general. MAT programs for people who are criminal justice (CJ) involved may serve as useful linkage spaces to PrEP information, access, and retention.
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Affiliation(s)
- Meghan Peterson
- School of Public Health, Brown University, 121 S Main Street, Providence, RI 02903, United States of America; Center for Prisoner Health and Human Rights, 8 3rd Street, Providence, RI 02906, United States of America.
| | - Alexandria Macmadu
- Center for Prisoner Health and Human Rights, 8 3rd Street, Providence, RI 02906, United States of America; Department of Epidemiology, School of Public Health, Brown University, 121 S Main Street, Providence, RI 02903, United States of America.
| | - Ashley Q Truong
- Center for Prisoner Health and Human Rights, 8 3rd Street, Providence, RI 02906, United States of America.
| | - Josiah Rich
- Center for Prisoner Health and Human Rights, 8 3rd Street, Providence, RI 02906, United States of America; Department of Epidemiology, School of Public Health, Brown University, 121 S Main Street, Providence, RI 02903, United States of America; Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI 02903, United States of America.
| | - Kimberly Pognon
- Center for Prisoner Health and Human Rights, 8 3rd Street, Providence, RI 02906, United States of America.
| | - Mark Lurie
- Department of Epidemiology, School of Public Health, Brown University, 121 S Main Street, Providence, RI 02903, United States of America.
| | - Jennifer G Clarke
- Rhode Island Department of Corrections, 40 Howard Ave, Cranston, RI 02920, United States of America; Departments of Medicine and Obstetrics and Gynecology, Alpert Medical School of Brown University, 222 Richmond St, Providence, RI 02903, United States of America.
| | - Lauren Brinkley-Rubinstein
- Department of Social Medicine, University of North Carolina, 333 S Columbia St, Chapel Hill, NC 27516, United States of America; Center for Health Equity Research, University of North Carolina, 335 S Columbia St, Chapel Hill, NC 27516, United States of America.
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31
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Brinkley-Rubinstein L, Peterson M, Zaller ND, Wohl DA. Best practices for identifying men who have sex with men for corrections-based pre-exposure prophylaxis provision. HEALTH & JUSTICE 2019; 7:7. [PMID: 30982117 PMCID: PMC6717965 DOI: 10.1186/s40352-019-0088-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 04/04/2019] [Indexed: 05/27/2023]
Abstract
PURPOSE Men who have sex with men (MSM) who are incarcerated are at increased risk for HIV acquisition, yet there are challenges associated with disclosing sexual identity/orientation among people who are incarcerated. METHODS The current study used semi-structured, qualitative interviews to explore attitudes and awareness of pre-exposure prophylaxis (PrEP) among 26 MSM who were incarcerated at the Rhode Island Department of Corrections. RESULTS Participants noted variable levels of willingness to disclose sexual identity/orientation. CONCLUSIONS CJ institutions should consider involving medical staff and outside agencies when using the CDC PrEP guidelines or consider a WHO-based, rather than behavior-based, approach to determining candidacy for PrEP.
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Affiliation(s)
- Lauren Brinkley-Rubinstein
- Department of Social Medicine, Center for Health Equity, University of North Carolina at Chapel Hill, 333 S. Columbia St., 341B MacNider Hall, Chapel Hill, NC 27599 USA
- Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | | | - Nickolas D. Zaller
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - David A. Wohl
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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