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Chadwick SB, Antebi-Gruszka N, Siegel K, Schrimshaw EW. "I Assumed that He Knows Because He's Seen My Profile": HIV Status Disclosure and Condom Use Decisions Among Men who have Sex with Men (MSM) Using Hookup Apps and Websites. AIDS Behav 2023; 27:3992-4009. [PMID: 37392269 DOI: 10.1007/s10461-023-04114-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 07/03/2023]
Abstract
In the present study, we sought to better understand how MSM make decisions about HIV disclosure when using hook-up apps/websites and how these decisions relate to condom use during app/website-facilitated sexual encounters. Semi-structured interviews were conducted with 60 MSM (30% living with HIV) who had used hook-up apps and websites to meet sexual partners within the past three months. Results demonstrated a variety of approaches to HIV status disclosure. Some men reported usually discussing HIV status, but others discussed HIV status selectively (e.g., only when asked, when a relationship became more serious). Some men reported that listing one's status in a profile precluded the need to discuss it further. Others noted that leaving an HIV status blank "hinted" at their own or others' HIV positive or negative status. These approaches were closely linked to decisions about condom use. Many men reported serosorting based on inferences or assumptions about partners' HIV status. Together, results highlighted potential gaps in communication that can lead to faulty assumptions about HIV status and subsequent serodiscordant condomless sex and suggest that interventions that promote HIV status disclosure address these potential faulty assumptions.
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Affiliation(s)
- Sara B Chadwick
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL, USA.
- Departments of Psychology & Gender and Women's Studies, University of Wisconsin- Madison, Madison, WI, USA.
- Department of Gender & Women's Studies, University of Wisconsin-Madison, 3381 Sterling Hall, 475 N. Charter Street, Madison, WI, 53706, USA.
| | | | - Karolynn Siegel
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Eric W Schrimshaw
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL, USA
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Mandlate F, Greene MC, Pereira LF, Sweetland AC, Kokonya D, Duarte CS, Cournos F, Oquendo MA, Wainberg ML, Sidat M, Sevene E, Mello MF. Lay HIV counselors' knowledge and attitudes toward depression: A mixed-methods cross-sectional study at primary healthcare centers in Mozambique. Front Public Health 2022; 10:919827. [PMID: 36249253 PMCID: PMC9554257 DOI: 10.3389/fpubh.2022.919827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/31/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction Depression is the most common mental disorder among people living with HIV/AIDS and has a negative impact on HIV treatment outcomes. Training lay HIV counselors to identify and manage depression may contribute to improved patient access and adherence to treatment, and reduce stigma and discrimination among lay health workers toward both HIV and depression. The purpose of this study was to assess the current knowledge and attitudes of lay HIV counselors toward managing depression in primary care in Mozambique. Methods We conducted a mixed-methods cross-sectional study to assess depression-related knowledge and attitudes among lay HIV counselors in 13 primary healthcare facilities in Mozambique. We used the quantitative Depression Attitude Questionnaire (DAQ) scale, followed by open-ended questions to further explore three key DAQ domains: the nature of depression, treatment preferences, and professional attitudes or reactions. Results The sample included 107 participants (77.6% female, mean age: 32.3 years, sd = 7.4). Most (82.2%) had less than a high/technical school education. Findings suggested that some HIV counselors had knowledge of depression and described it as a cluster of psychological symptoms (e.g., deep sadness, anguish, apathy, isolation, and low self-esteem) sometimes leading to suicidal thoughts, or as a consequence of life stressors such as loss of a loved one, abuse, unemployment or physical illness, including being diagnosed with HIV infection. HIV counselors identified talking to trusted people about their problems, including family and/or counseling with a psychotherapist, as the best way for patients to deal with depression. While acknowledging challenges, counselors found working with patients with depression to be rewarding. Conclusion Lay health counselors identified HIV and psychosocial issues as key risk factors for depression. They believed that the treatment approach should focus on social support and psychotherapy.
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Affiliation(s)
- Flavio Mandlate
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - M. Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Luis F. Pereira
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Annika C. Sweetland
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Donald Kokonya
- School of Medicine, Masinde Muliro University of Science and Technology, Kakamega, Kenya
| | - Cristiane S. Duarte
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Francine Cournos
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Maria A. Oquendo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Milton L. Wainberg
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Mohsin Sidat
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Esperança Sevene
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Marcelo F. Mello
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
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Hightow-Weidman LB, Muessig K, Soberano Z, Rosso MT, Currie A, Adams Larsen M, Knudtson K, Vecchio A. Tough Talks Virtual Simulation HIV Disclosure Intervention for Young Men Who Have Sex With Men: Development and Usability Testing. JMIR Form Res 2022; 6:e38354. [PMID: 36074551 PMCID: PMC9501675 DOI: 10.2196/38354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background
HIV status disclosure is an important decision with barriers specific to young men who have sex with men (YMSM), who have the highest rates of new HIV infections in the United States. Behavioral and social determinants of the difficulty to disclose can include fear of rejection, stigma, loss of financial stability, and lack of communication skills. Once able to disclose, a person may have increased access to social support and improved informed risk reduction conversations and medication adherence. Despite the known challenges and advantages of disclosure, there are few effective tools supporting this behavior.
Objective
To address this gap in disclosure interventions, the Tough Talks (TT) app, an mHealth intervention using artificial intelligence (AI)–facilitated role-playing scenarios, was developed for YMSM. This paper reports stages of development of the integrated app and results of the usability testing.
Methods
Building on the successful development and testing of a stand-alone interactive dialogue feature in phases 1-3, we conducted additional formative research to further refine and enhance the disclosure scenarios and develop and situate them within the context of a comprehensive intervention app to support disclosure. We assessed the new iteration for acceptability and relevance in a usability study with 8 YMSM with HIV. Participants completed a presurvey, app modules, and a semistructured qualitative interview.
Results
TT content and activities were based on social cognitive theory and disclosure process model framework and expanded to a 4-module curriculum. The AI-facilitated scenarios used dialogue from an utterance database developed using language crowdsourced through a comic book contest. In usability testing, YMSM reported high satisfaction with TT, with 98% (31/33) of activities receiving positive ratings. Participants found the AI-facilitated scenarios and activities to be representative and relevant to their lived experiences, although they noted difficulty having nuanced disclosure conversations with the AI.
Conclusions
TT was an engaging and practical intervention for self-disclosure among YMSM with HIV. Facilitating informed disclosure decisions has the potential to impact engagement in sexual risk behaviors and HIV care. More information is needed about the ideal environment, technical assistance, and clinical support for an mHealth disclosure intervention. TT is being tested as a scalable intervention in a multisite randomized controlled trial to address outstanding questions on accessibility and effect on viral suppression.
Trial Registration
ClinicalTrials.gov NCT03414372; https://clinicaltrials.gov/ct2/show/NCT03414372
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Affiliation(s)
- Lisa B Hightow-Weidman
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kathryn Muessig
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Zach Soberano
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Matthew T Rosso
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | | | - Kelly Knudtson
- School of Medicine, University of Washington, Seattle, WA, United States
| | - Alyssa Vecchio
- Department of Family & Community Medicine, University of New Mexico, Albuquerque, NM, United States
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Correlates of prevalent syphilis infection among men who have sex with men (MSM) living with HIV attending the HIV clinic in Trinidad. PLoS One 2022; 17:e0265909. [PMID: 35358217 PMCID: PMC8970382 DOI: 10.1371/journal.pone.0265909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 03/09/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Syphilis among men who have sex with men (MSM) living with HIV is of public health concern, thus the objective of the study is to determine the correlates of prevalent syphilis infection in this population so that urgent interventions could be instituted.
Methods
A cross-sectional study was conducted during the period September 2020-June 2021 among MSM who attended a large HIV Clinic in Trinidad. A questionnaire was administered to obtain socio-demographic data and correlates of prevalent syphilis and patients were screened for syphilis using the traditional algorithm. Descriptive and bivariate analyses were conducted and multivariable logistic regression factors was used to assess factors significantly associated with a syphilis diagnosis.
Results
Two hundred and sixty four MSM were enrolled; age range 18–64 years, median age 33 years and 89 (34.4%) were actively bisexual. The prevalence of syphilis was 28% (74/264) and 89.2% (66/74) of these infections were asymptomatic. Multivariable logistic regression analysis showed that those patients who participated in sex with anonymous partners (OR 2.09; 95% CI, 1.03–4.26), those with a previous diagnosis of syphilis (OR 5.16; 95% CI, 1.03–25.83) and those who used marijuana in the last 12 months (OR 2.13; 95% CI, 1.14–3.96) were more likely to be diagnosed with syphilis.
Conclusion
There is a high prevalence of asymptomatic syphilis among MSM living with HIV in Trinidad. Repeat episodes of syphilis and anonymous sex may play a role in the transmission dynamics of T pallidum infection in this population, thus urgent public health prevention interventions are warranted.
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Okafor CN, Li MJ, Hucks-Ortiz C, Mayer KH, Shoptaw S. Disclosure of HIV Status and HIV Sexual Transmission Behaviors among HIV-Positive Black Men Who Have Sex with Men in the BROTHERS (HPTN 061) Study. J Urban Health 2020; 97:692-703. [PMID: 32020466 PMCID: PMC7560677 DOI: 10.1007/s11524-020-00419-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We assessed whether disclosure of HIV status is significantly associated with reported HIV sexual risk behaviors among HIV positive Black/African American men who have sex with men (MSM) (Black MSM) in six cities in the USA. Participants from the BROTHERS (HIV Prevention Trials Network [HPTN 061]) study focused on assessing the feasibility and acceptability of a multifaceted HIV prevention intervention to reduce HIV infections among Black MSM enrolled between July 2009 and October 2010. All participants completed a behavioral assessment using an audio computer-assisted self-interview that included questions about HIV status disclosure, HIV sexual risk behaviors, and other behaviors. Biological samples were also collected. This analysis focused on baseline data of HIV-positive Black MSM in the HPTN 061 study. Of the 143 HIV-positive Black MSM (majority ≥ 35 years of age) included in this analysis, 58% reported disclosing their HIV status to their last male anal sex partner. Forty-three percent and 42% reported condomless insertive and receptive anal intercourse respectively with their last male partner; whereas, 17% and 18% of the sample engaged in condomless insertive and receptive anal intercourse with a serodiscordant/unknown status partner, respectively. In multivariable logistic regression models, there was no statistically significant association between HIV status disclosure and condomless insertive anal intercourse (aOR = 0.35, 95% CI 0.11, 1.08; p = 0.30), condomless receptive anal intercourse (aOR = 2.48, 95% CI 0.94, 6.52; p = 0.20), or condomless receptive anal intercourse with a serodiscordant/unknown status partner (aOR = 0.55, 95% CI 0.20, 1.49; p = 0.45). However, HIV status disclosure was significantly associated with lower odds of reporting condomless insertive anal intercourse with a serodiscordant/unknown status partner (aOR = 0.19, 95% CI 0.06, 0.68; p ≤ 0.01). Among this multi-city sample of HIV-positive Black MSM, disclosure of HIV status was common and associated with lower HIV sexual risk behaviors. These findings should motivate and guide research to develop prevention messages to increase HIV status disclosures.
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Affiliation(s)
- Chukwuemeka N Okafor
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, USA.
- Center for Behavioral and Addiction Medicine, Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, USA.
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, USA.
| | - Michael J Li
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, USA
- Center for Behavioral and Addiction Medicine, Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, USA
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Christopher Hucks-Ortiz
- CommonSpirit Health, Dignity Health, CARE Clinic, St. Mary Medical Center, Long Beach, CA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Division of Infectious Disease, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Steve Shoptaw
- Center for Behavioral and Addiction Medicine, Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, USA
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, USA
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Social-Environmental Resilience, PrEP Uptake, and Viral Suppression among Young Black Men Who Have Sex with Men and Young Black Transgender Women: the Neighborhoods and Networks (N2) Study in Chicago. J Urban Health 2020; 97:728-738. [PMID: 32468507 PMCID: PMC7560645 DOI: 10.1007/s11524-020-00425-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Young black men who have sex with men (YBMSM) and young black transgender women (TGW) have experienced a stark disparity in HIV prevention and care. Resilience, collective resources to adapt stressors or adversities, may improve HIV prevention and care outcomes. The present study investigated the association of resilience-based factors with PrEP uptake and viral suppression from a socioecological perspective among YBMSM and young black TGW. Data were from the baseline cycle of the Neighborhoods and Networks (N2) Study, an ongoing cohort study of 16-34-year-old YBMSM and young black TGW in Chicago (n = 324). Confidant network-level and neighborhood affiliation variables were created to measure the social-environmental context of resilience. All analyses were stratified by participants' HIV status (184 HIV-negative participants and 140 HIV-positive participants). Among HIV-negative participants, having a parental figure within an individual's confidant network was significantly associated with a greater likelihood of PrEP use. Among HIV-positive participants, confidant network members' awareness of an individual's HIV status was associated with viral suppression. Social support resources from confidant networks could improve HIV prevention and care engagement among YBMSM and young black TGW. Understanding the social and environmental contexts of resilience resource is critical for HIV prevention and care engagement.
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HIV status disclosure by Nigerian men who have sex with men and transgender women living with HIV: a cross-sectional analysis at enrollment into an observational cohort. BMC Public Health 2020; 20:1282. [PMID: 32842997 PMCID: PMC7448976 DOI: 10.1186/s12889-020-09315-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background Men who have sex with men (MSM) and transgender women (TGW) are disproportionately impacted by HIV and may face barriers to HIV status disclosure with negative ramifications for HIV prevention and care. We evaluated HIV status disclosure to sexual partners, HIV treatment outcomes, and stigma patterns of MSM and TGW in Abuja and Lagos, Nigeria. Methods Previously-diagnosed MSM and TGW living with HIV who enrolled in the TRUST/RV368 cohort from March 2013 to August 2018 were asked, “Have you told your (male/female) sexual partners (MSP/FSP) that you are living with HIV?” In separate analyses, robust Poisson regression models were used to estimate risk ratios (RRs) and 95% confidence intervals (95% CIs) for characteristics associated with HIV status disclosure to MSP and FSP. Self-reported stigma indicators were compared between groups. Results Of 493 participants living with HIV, 153 (31.0%) had disclosed their HIV status to some or all MSP since being diagnosed. Among 222 with FSP, 34 (15.3%) had disclosed to some or all FSP. Factors independently associated with disclosure to MSP included living in Lagos (RR 1.58 [95% CI 1.14–2.20]) and having viral load < 50 copies/mL (RR 1.67 [95% CI 1.24–2.25]). Disclosure to FSP was more common among participants who were working in entertainment industries (RR 6.25 [95% CI 1.06–36.84]) or as drivers/laborers (RR 6.66 [95% CI 1.10–40.36], as compared to unemployed) and also among those married/cohabiting (RR 3.95 [95% CI 1.97–7.91], as compared to single) and prescribed ART (RR 2.27 [95% CI 1.07–4.83]). No differences in self-reported stigma indicators were observed by disclosure status to MSP but disclosure to FSP was associated with a lower likelihood of ever having been assaulted (26.5% versus 45.2%, p = 0.042). Conclusions HIV status disclosure to sexual partners was uncommon among Nigerian MSM and TGW living with HIV but was associated with improved HIV care outcomes. Disclosure was not associated with substantially increased experiences of stigma. Strategies to encourage HIV status disclosure may improve HIV management outcomes in these highly-marginalized populations with a high burden of HIV infection.
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Hood KB, Hall CJ, Owens BD, Patev AJ, Belgrave FZ. HIV Testing Behaviors among Black Rural Women: The Moderating Role of Conspiracy Beliefs and Partner Status Disclosure. Ethn Dis 2020; 30:251-260. [PMID: 32346270 DOI: 10.18865/ed.30.2.251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective This study investigated whether HIV testing attitudes, HIV conspiracy beliefs, and reported sexual partner disclosure of HIV/STI status related to one-month self-report HIV testing outcomes following a brief intervention among Black women aged 18-25 years residing in rural Mississippi. Participants Black women (N=119; M age=19.90, SD=1.81) recruited in rural Mississippi completed an online assessment before a brief HIV prevention intervention and a one month follow-up assessment during January to November 2016. Main Outcome Measures Self-reported HIV testing 30-days following the intervention, partner HIV/STI status disclosure, beliefs in HIV conspiracy theory, and HIV testing attitudes in pre- and post-intervention assessments. Bivariate and multivariate analyses tested associations with HIV testing behaviors following the intervention. Results Moderated moderation was used to examine whether HIV conspiracy beliefs and partner disclosure status both moderated the relationship between pre-intervention attitudes toward HIV testing and HIV testing at 1-month follow-up. It was found that both HIV conspiracy beliefs and partner disclosure moderated the relationship between attitudes and HIV testing at one-month follow-up. When partner disclosure was low, women with more negative attitudes toward testing and higher conspiracy beliefs were less likely to get tested than those with negative attitudes and lower conspiracy beliefs; conspiracy beliefs did not relate to testing outcomes when testing attitudes were positive. Conclusion Findings suggest that interventions may benefit from accounting for conspiracy beliefs and the dyadic status disclosure when encouraging young rural women to test for HIV.
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Affiliation(s)
- Kristina B Hood
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Calvin J Hall
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Bianca D Owens
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Alison J Patev
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Faye Z Belgrave
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
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