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Jamison KE, Braunstein SL, Pathela P. Racial inequities in HIV incidence among men who have sex with men prior to and amidst an Ending the HIV Epidemic initiative. AIDS 2024; 38:1047-1055. [PMID: 38265417 DOI: 10.1097/qad.0000000000003845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE The aim of this study was to examine trends in HIV incidence among men who have sex with men (MSM) relative to the scale up of Ending the HIV Epidemic (EHE) initiatives, including biomedical prevention strategies, and to describe racial inequities over time. DESIGN A cross-sectional study, matching annual cohorts of New York City (NYC) Sexual Health Clinic (SHC) patients from 2010 to 2018 to the citywide HIV registry to identify seroconversions during 1 year of follow-up, through 2019. METHODS We examined HIV incidence for each annual cohort of MSM using diagnoses within 1 year after last negative HIV test. We calculated incidence rates and rate ratios (IRR) pooled across 3-year intervals (2010-2012, 2013-2015, 2016-2018) by race/ethnicity, age, neighborhood poverty level, recent STI diagnosis, and condom use during anal sex. RESULTS There were 36 156 study visits among MSM attending NYC SHCs, including 37% among White MSM and 63% among MSM of color. From 2010 to 2018, HIV incidence decreased overall from 2.82 to 0.82/100 person-years, and among all race/ethnicity, age, poverty, STI, and condom use subgroups. For 2010-2012 vs. 2016-2018, adjusted IRRs (95% CI) increased for Black MSM [1.8 (1.3-2.6) vs. 6.0 (3.5-10.2)], Latino MSM [1.4 (1.0-2.0) vs. 4.0 (2.3-6.8)], and MSM of other races [1.0 (0.6-1.7) vs. 2.5 (1.3-4.9)] compared with White MSM. Black and Latino MSM seroconverted at significantly higher rates than White MSM in the same age groups and neighborhood poverty level. CONCLUSION Despite decreases in HIV incidence among MSM, racial inequities were exacerbated over time. Addressing structural factors that impact racial inequities in risk of HIV should undergird EHE initiatives.
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Affiliation(s)
- Kelly E Jamison
- New York City Department of Health & Mental Hygiene, Long Island City, New York, USA
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2
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Greene E, Walcott M, Guerra L, Tieu HV, Nandi V, Soler J, Diaz J, Curriero F, Latkin C, Bosompem A, Frye V. Correlates of concordance between self-reported and lab-confirmed viral load among Black and Latine men who have sex with men (BLMSM) living with HIV in New York City. AIDS Care 2024; 36:661-671. [PMID: 37399515 PMCID: PMC10761596 DOI: 10.1080/09540121.2023.2229816] [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: 03/15/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Abstract
Sustained viral suppression is one of the four strategies in the U.S. Department of Health and Human Services' (HHS) plan to end the HIV epidemic in the United States. Individuals living with HIV must understand their viral load accurately for this strategy to be effective. We conducted cross-sectional analyses using baseline data from the NNHIV longitudinal study among men who have sex with men (MSM) living with HIV in New York City to identify factors associated with concordant knowledge between self-reported and lab-confirmed viral load. Of 164 Black and/or Latine participants, 67% (n = 110) reported that their viral load was undetectable, however lab tests showed only 44% (n = 72) had an undetectable viral load (<20 copies/ml). Overall, 62% of the sample (n = 102) had concordant HIV viral load knowledge (agreement of self-reported and lab viral load). In multivariable regression, those with unstable housing (PR = 0.52, 0.30-0.92) and those who had higher levels of beliefs of racism in medicine scale (PR = 0.76, 0.59-0.97) were less likely to have concordant knowledge. Our study underscores the need for implementing measures to improve viral load knowledge, U = U messaging, and strategies to achieve and maintain undetectable viral load status to reduce the burden of HIV at the population level.
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Affiliation(s)
| | - Melonie Walcott
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, NY, NY
| | - Lauren Guerra
- Department of Epidemiology, Columbia University Mailman School of Public Health, NY, NY
| | - Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, NY, NY
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, NY, NY
| | - Vijay Nandi
- Laboratory of Data Analytic Services, Lindsley F. Kimball Research Institute, New York Blood Center, NY, NY
| | - Jorge Soler
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, NY, NY
| | - Jose Diaz
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Frank Curriero
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Carl Latkin
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | | | - Victoria Frye
- CUNY School of Medicine, NY, NY
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, NY, NY
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3
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Roth GH, Walker ER, Talley CL, Hussen SA. 'It's a very grey, very messy area': a qualitative examination of factors influencing undetectable gay men's HIV status disclosure to sexual partners. CULTURE, HEALTH & SEXUALITY 2023; 25:664-679. [PMID: 35697340 DOI: 10.1080/13691058.2022.2086708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
HIV disclosure to sexual partners remains a multifaceted yet stigmatised process. The 'undetectable equals untransmittable' (U = U) concept has raised ethical and moral concerns about the obligation and need to disclose, and using Internet applications to seek sex partners has modified disclosure practices. While previous qualitative literature has examined the HIV disclosure process, there is a dearth of information on this topic among gay men in the USA who have an undetectable viral load. Using thematic analysis of data collected during a period of expanded U = U knowledge, this study explores the cognitive, contextual, interpersonal and structural factors impacting undetectable gay men's HIV status disclosure decisions to sexual partners. In-depth interviews were conducted in August 2020 over Zoom with 20 gay men with undetectable viral loads. The main themes included 'sense of obligation,' 'situational disclosure' and 'partners' responsibility in the disclosure process.' Participants balanced the aforementioned factors to inform their disclosure decisions, and disclosure patterns varied across participants dependent upon thoughts regarding ethics and morality of (non-)disclosure. The findings provide new insights to how participants navigate disclosure while considering U = U, HIV criminalisation laws, and finding partners through Internet applications while providing direction for future studies and support for decriminalising HIV and expanding HIV education.
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Affiliation(s)
- Grant H Roth
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Elizabeth Reisinger Walker
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Colin L Talley
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sophia A Hussen
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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4
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Wray TB, Guigayoma JP, Emery NN. Emotional Reactions to High-Risk Sex among Sexual Minority Men: Exploring Potential Opportunities for Just-In-Time Intervention. JOURNAL OF SEX RESEARCH 2023; 60:718-727. [PMID: 36098665 PMCID: PMC10008763 DOI: 10.1080/00224499.2022.2113854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Rates of HIV and other sexually transmitted infections (STIs) are high among sexual minority men (SMM). A large body of research has explored determinants of HIV/STI risk behavior, but few studies have explored emotional consequences of these events. Understanding the valence, timing, and strength of emotional reactions to sexual risk could inform use of specific behavior change techniques in interventions (such as anticipated regret) and identify new opportunities for intervention, including just-in-time interventions. We analyzed data from an ecological momentary assessment (EMA) study of 100 HIV-negative/unknown-status SMM to understand patterns of positive affect, negative affect, shame, and stress in the 24 hours after sex. Mixed-effects models showed that the probability of negative affect was higher in the hours following condomless anal sex (CAS) with high-risk partners during which SMM reported being under the influence of alcohol or drugs (A/D involved CAS), versus all other types of sex events (OR = 0.92, SE = 0.03, p = .017). The probability of shame was also higher after A/D-involved CAS, versus other sex events (OR = 1.14, SE = 0.07, p = .035). Findings suggest that the hours following A/D-involved CAS events may be an opportune time to intervene to help SMM avoid similarly aversive experiences in the future.
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Affiliation(s)
- Tyler B. Wray
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, 121. S. Main Street, Box G-S121-5, Providence, RI 02903
| | - John P. Guigayoma
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, 121. S. Main Street, Box G-S121-5, Providence, RI 02903
| | - Noah N. Emery
- Department of Psychology, Colorado State University, 1876 Campus Delivery, Fort Collins, CO 80523
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5
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English D, Smith JC, Scott-Walker L, Lopez FG, Morris M, Reid M, Lashay C, Bridges D, McNeish D. Feasibility, Acceptability, and Preliminary HIV Care and Psychological Health Effects of iTHRIVE 365 for Black Same Gender Loving Men. J Acquir Immune Defic Syndr 2023; 93:55-63. [PMID: 36706362 PMCID: PMC10840385 DOI: 10.1097/qai.0000000000003167] [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: 06/17/2022] [Accepted: 12/29/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVES This uncontrolled pilot study examined the feasibility, acceptability, and preliminary HIV and psychological health effects of iTHRIVE 365, a multicomponent intervention designed by and for Black same gender loving men (SGLM) to promote: health knowledge and motivation, Black SGLM social support, affirming health care, and housing and other economic resources. DESIGN METHODS We conducted a 14-day daily diary study with 32 Black SGLM living with HIV connected to THRIVE SS in Atlanta, GA. Daily surveys assessed intervention engagement, antiretroviral medication (ART) use, depressive symptoms, anxiety symptoms, and emotion regulation difficulties. App paradata (ie, process data detailing app usage) assessed amount of intervention engagement via page access. Participants began receiving access to the intervention on day 7. After the 14-day daily diary period, participants responded to follow-up items on the user-friendliness, usefulness, helpfulness, and whether they would recommend iTHRIVE 365 to others. Chi-square analyses examined associations between intervention engagement and ART use, and dynamic structural equation modelling assessed longitudinal associations from intervention engagement to next-day psychological health. This intervention trial is registered on ClinicalTrials.gov (NCT05376397). RESULTS On average, participants engaged with iTHRIVE 365 over once every other day and accessed intervention pages 4.65 times per day. Among participants who engaged with the intervention, 78% reported it was helpful to extremely helpful, 83% reported it was moderately to extremely useful, and 88% reported it was user-friendly and they would recommend it to others. On intervention engagement days, participants had higher odds of ART use, χ 2 (1) = 4.09, P = 0.04, than intervention nonengagement days. On days after intervention engagement, participants showed non-null decreases in depressive symptoms (τ = -0.14; 95% CI : = [-0.23, -0.05]) and emotion regulation difficulties (τ = -0.16; 95% CI : = [-0.24, -0.02]). CONCLUSIONS Findings suggest iTHRIVE 365 is feasible, acceptable, and positively affects daily ART use, depressive symptoms, and emotion regulation difficulties.
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Affiliation(s)
- Devin English
- Department of Urban-Global Public Health, Rutgers School of Public Health, Newark, NJ, USA
| | | | | | | | - Michael Morris
- THRIVE Social Services (THRIVE SS), Inc., Atlanta, GA, USA
| | - Malcolm Reid
- THRIVE Social Services (THRIVE SS), Inc., Atlanta, GA, USA
| | | | - Dwain Bridges
- THRIVE Social Services (THRIVE SS), Inc., Atlanta, GA, USA
| | - Daniel McNeish
- Department of Psychology, Arizona State University, Tempe, AZ
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O’Shea JG, Fanfair RN, Dasgupta S, Tie Y, Yuan X, Beer L, Weiser J. Cisgender women with HIV in the United States: how have HIV care continuum outcomes changed over time? 2015-2020. AIDS 2023; 37:347-353. [PMID: 36541646 PMCID: PMC10928949 DOI: 10.1097/qad.0000000000003431] [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: 12/24/2022]
Abstract
OBJECTIVE To evaluate HIV care continuum trends over time among women with HIV (WWH). DESIGN The Medical Monitoring Project (MMP) is a complex sample survey of adults with diagnosed HIV in the United States. METHODS We used 2015-2019 MMP data collected from 5139 adults with diagnosed HIV infection who identified as cisgender women. We calculated weighted percentages with 95% confidence intervals (CIs) for all characteristics and estimated annual percentage change (EAPC) and the associated 95% CI to assess trends. EAPCs were considered meaningful from a public health perspective if at least 1% with P values less than 0.05. RESULTS Among cisgender women with diagnosed HIV infection during 2015-2019, 58.8% were Black or African American (95% CI 54.4-63.3), 19% were Hispanic/Latina (95% CI 14.7-23.2), and 16% were Non-Hispanic White (95% CI 14.1-17.9) persons. There was a meaningful increase in the percentage who ever had stage 3 HIV disease from 55.8% (95% CI 51.0-60.5) in 2015 to 61.5% (95% CI 58.1-64.8) in 2019 (EAPC 1.7%; CI 1.5-1.9; P < 0.001). There were no meaningful changes over time among women, overall, in retention in care, antiretroviral therapy (ART) prescription, ART adherence, missed appointments, or recent or sustained viral suppression. CONCLUSION The HIV care continuum outcomes among WWH did not meaningfully improve from 2015 to 2019, raising a concern that Ending the HIV Epidemic in the US (EHE) initiative goals will not be met. To improve health and reduce transmission of HIV among WWH, multifaceted interventions to retain women in care, increase ART adherence, and address social determinants of health are urgently needed.
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Affiliation(s)
- Jesse Garrett O’Shea
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robyn Neblett Fanfair
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sharoda Dasgupta
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yunfeng Tie
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xin Yuan
- DLH Corporation, Atlanta, GA, USA
| | - Linda Beer
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John Weiser
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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7
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Wang G, Song W, Rao S, Heitgerd J, Mulatu MS, Karch D, Belcher L. HIV Positivity, Linkage to Medical Care, Interview for Partner Services, and Pre-Exposure Prophylaxis Awareness and Referral Among Men Who Have Sex With Men Tested in Non-healthcare Settings in the United States, 2019. J Acquir Immune Defic Syndr 2023; 92:34-41. [PMID: 36166309 PMCID: PMC10959101 DOI: 10.1097/qai.0000000000003106] [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: 06/15/2022] [Accepted: 09/23/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV. This study reports data on HIV testing program outcomes among MSM tested for HIV in non-healthcare settings in the United States. METHODS We analyzed Centers for Disease Control and Prevention's National HIV Prevention Program Monitoring and Evaluation data collected in 2019. Descriptive and multivariate robust Poisson regression analyses were conducted to summarize the patterns of HIV testing program outcomes [ie, positivity, linkage to HIV medical care within 30 days of diagnosis, interview for partner services (PS), and pre-exposure prophylaxis (PrEP) awareness and referral] by demographic characteristics, HIV prevalence, and testing site type. RESULTS A total of 123,251 HIV tests were conducted among MSM; of these, 1773 (1.4%) were newly diagnosed with HIV. Among MSM newly diagnosed with HIV, 75% were linked to HIV medical care and 80% were interviewed for PS. Among MSM who tested HIV-negative, 63% were aware of PrEP and 47% of those who were eligible for PrEP were referred to PrEP providers. Referral or linkage to services varied by demographic characteristics or other factors. CONCLUSIONS Linkage to HIV medical care and interview for PS among MSM newly diagnosed with HIV in non-healthcare settings were below national or funding program targets. Most MSM with risk factors for HIV infection were not referred to PrEP providers. Expanded efforts to address barriers to equitable access to services may help improve HIV-related outcomes among MSM and contribute to ending the HIV epidemic in the United States.
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Affiliation(s)
- Guoshen Wang
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wei Song
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shubha Rao
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet Heitgerd
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mesfin S. Mulatu
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Debra Karch
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa Belcher
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Goldbach JT, Kipke MD. What affects timely linkage to HIV Care for Young Men of Color who have sex with Men? Young Men's Experiences Accessing HIV Care after Seroconverting. AIDS Behav 2022; 26:4012-4025. [PMID: 35672551 DOI: 10.1007/s10461-022-03727-0] [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: 05/20/2022] [Indexed: 11/26/2022]
Abstract
The HIV care continuum provides intervention points that should be addressed to optimally identify, engage, and retain populations in HIV care. This study addressed the lack of research into barriers and facilitators of linkage to care for HIV-positive young men who have sex with men (YMSM) of color. Data were collected using a qualitative timeline follow-back interview approach with YMSM who had seroconverted in the last 6 months. Interviews were conducted with 15 YMSM from April 2017 to April 2018. This study provides important information about what can delay linkage to care for YMSM of color. These delays include fractured referrals to care providers via mobile HIV testing vans, adapting to an HIV diagnosis and integrating it into their lives, and finding caring and competent providers that offer wraparound services, specifically mental health services, as soon as possible after an HIV diagnosis. Addressing these issues is imperative to optimize YMSM's engagement in the HIV care continuum and work toward ending the epidemic.
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Affiliation(s)
- Jeremy T Goldbach
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, 63130, St. Louis, MO, United States.
| | - Michele D Kipke
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, United States
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, United States
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9
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Understanding the Association between PrEP Stigma and PrEP Cascade Moderated by the Intensity of HIV Testing. Trop Med Infect Dis 2022; 7:tropicalmed7050074. [PMID: 35622701 PMCID: PMC9147022 DOI: 10.3390/tropicalmed7050074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: In the U.S., men who have sex with men (MSM) account for the majority of new HIV infections. On the other hand, pre-exposure prophylaxis (PrEP) is an effective strategy to curb HIV transmission, but it is widely underutilized. It is unknown how stigma affects PrEP care in the context of other HIV prevention strategies. (2) Methods: We included a total of 318 MSM in the current analysis. We employed bivariate and multivariable analyses to assess the association between PrEP stigma and PrEP cascade while controlling for potential confounders on each specific pathway. We further used a series of moderation analyses based upon the intensity of HIV testing within different timeframes to assess the association between PrEP stigma and PrEP cascade. (3) Results: Compared with MSM who used PrEP, those who never used PrEP reported higher internalized and vicarious PrEP stigma. Internalized PrEP stigma has significantly reduced the likelihood of PrEP willingness and PrEP uptake among this group. The trend analysis showed significant trend patterns across different frequencies of HIV testing. (4) Conclusions: A structural-level reform is urgently needed to turn the HIV service encounters into opportunities to facilitate and optimize the PrEP cascade among this group who may benefit from PrEP use.
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10
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Meyers-Pantele SA, Sullivan P, Mansergh G, Hirshfield S, Stephenson R, Horvath KJ. Race-Based Medical Mistrust, HIV-Related Stigma, and ART Adherence in a Diverse Sample of Men Who Have Sex with Men with HIV. AIDS Behav 2022; 26:1456-1466. [PMID: 34669061 PMCID: PMC9007843 DOI: 10.1007/s10461-021-03500-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 11/28/2022]
Abstract
Disparities in antiretroviral treatment (ART) access by race for men who have sex with men (MSM) with HIV persist. We assessed whether race-based medical mistrust and HIV stigma impact ART adherence among MSM with HIV. Longitudinal data were drawn from a RCT of a messaging intervention to promote sexual health among MSM. Regression models tested associations between baseline race-based medical mistrust, HIV stigma, and ART adherence at follow-up. In multivariable models with the overall sample of MSM with HIV (n = 383), baseline medical mistrust was negatively associated with ART adherence 3-months post-baseline. Among participants of color (i.e., Black/African American, Hispanic/Latino, or another race; n = 301), HIV stigma was negatively associated with optimal ART adherence 6-months post-baseline. Medical mistrust was longitudinally associated with reduced ART adherence among racially and ethnically diverse MSM with HIV. HIV-related services might prioritize patients reporting medical mistrust for additional supports.
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Affiliation(s)
- Stephanie A Meyers-Pantele
- Department of Psychology, San Diego State University, San Diego, CA, USA.
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA.
| | - Patrick Sullivan
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Gordon Mansergh
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Rob Stephenson
- The Center for Sexuality and Health Disparities and the School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
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Dangerfield DT, Ober AJ, Anderson JN, Gorbach P, Bluthenthal RN. Observational "go-alongs" of follow-up HIV care visits of two virally suppressed Black sexual minority men. Public Health Nurs 2022; 39:153-160. [PMID: 34403517 PMCID: PMC8766864 DOI: 10.1111/phn.12960] [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] [Received: 05/04/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE This study explored potentially underreported healthcare contexts, clinical experiences, and motivations for adherence in care among virally suppressed Black sexual minority men (BSMM) living with HIV (LWHIV) in Baltimore, MD. METHODS Go-alongs with two virally suppressed BSMM LWHIV supplemented 27 in-depth interviews of a larger qualitative study guided by Positive Deviance and Life Course Theory. The go-alongs involved accompanying participants' follow-up HIV care visit to obtain a better account of contextual healthcare factors. Observations focused on (1) clinic location and resources, (2) sources of HIV and sexuality stigma or support in the clinic, and (3) patient-provider interactions. RESULTS We found that facilitators and barriers to viral suppression for BSMM LWHIV included structural factors (i.e., healthcare setting, facility, and services), quality of patient-provider interactions, and personal motivations to achieve viral suppression. CONCLUSION Clinic accessibility, co-located clinical services, and rapport with clinicians and healthcare staff could be key contextual conditions that facilitate retention in care among BSMM LWHIV.
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Affiliation(s)
| | - Allison J. Ober
- Policy and Behavioral Science Researcher, RAND Corporation, Los Angeles, CA, USA
| | - Janeane N. Anderson
- Assitant Professor, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Pamina Gorbach
- Professor, University of California Los Angeles, Los Angeles, CA, USA
| | - Ricky N. Bluthenthal
- Professor, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
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12
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Dangerfield DT, Ober AJ, Li MJ, Allen S, Bluthenthal RN. HIV Treatment Adherence Strategies Among Virally Suppressed Black Sexual Minority Men in Baltimore, Maryland, and Los Angeles, California: A Theory-Based Qualitative Study. J Assoc Nurses AIDS Care 2022; 33:54-62. [PMID: 34939988 PMCID: PMC8718261 DOI: 10.1097/jnc.0000000000000304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Indexed: 01/03/2023]
Abstract
ABSTRACT The goals and strategies of Black sexual minority men living with HIV (BSMMLWH) who achieve viral suppression require further investigation. This study explored treatment adherence strategies among BSMMLWH with sustained viral suppression. We conducted 27 in-depth qualitative interviews with BSMMLWH in Baltimore, Maryland, and Los Angeles, California, between December 2018 and May 2019. Interviews included questions guided by Positive Deviance and Life Course theoretical frameworks regarding multilevel factors and explicit strategies for antiretroviral therapy adherence. Themes regarding intentional, age group-specific strategies such as using technology (among younger men) and taking HIV medications with other daily pills (among older men) were identified. Participants also reported symbiotic goals and values that encouraged adherence, such as having a desire to live, strong familial relationships with clinicians, and support networks. Identifying personal goals and having supportive clinical and social relationships could be key to improving treatment adherence and viral suppression among BSMMLWH.
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Affiliation(s)
| | | | - Michael J. Li
- Department of Family Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Sophia Allen
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Ricky N. Bluthenthal
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
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13
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HIV care continuum interventions for Black men who have sex with men in the USA. Lancet HIV 2021; 8:e776-e786. [PMID: 34695375 DOI: 10.1016/s2352-3018(21)00241-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 08/20/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
Disparities persist along the HIV care continuum among Black men who have sex with men (MSM) in the USA. As part of an initiative funded by the Health Resources and Services Administration's HIV/AIDS Bureau (US Department of Health and Human Services), we searched for recently published interventions focused on improving HIV care continuum outcomes among Black MSM with HIV in the USA. Our search identified 14 interventions, all of which were associated with at least one statistically significant outcome. Medication adherence was the most common outcome of interest, and linkage to care was the least common. More than half of the interventions focused on younger populations and took place in the US South. Interventions used a range of strategies to increase cultural relevance and address common barriers to optimal HIV outcomes for Black MSM. Several interventions harnessed social media, text messaging, and smartphone apps to facilitate social support, deliver HIV education, and encourage medication adherence. Interventions were delivered mostly at the individual or interpersonal level, although three made system-level changes to address structural barriers. Notably missing were interventions focused on minimising behavioural health barriers, and interventions directly addressing social determinants of health such as housing. To accelerate the pace of implementation and scale-up of interventions for Black MSM with HIV, public health entities can pilot emerging interventions in real-world settings, and use an implementation science approach to evaluate outcomes and assess the implementation strategies that drive or hinder effectiveness.
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Hanshaw BD. Reimagining Inclusivity in Health Care for Sexual Minorities to End the HIV Epidemic: A Student Perspective. Am J Public Health 2021; 111:1263-1264. [PMID: 34110918 DOI: 10.2105/ajph.2021.306346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Brady D Hanshaw
- Brady D. Hanshaw is with the Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill
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15
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Sherman JP, Dyar C, Morgan E. Substance use treatment partially mitigates association between methamphetamine use and STI risk: findings from the NSDUH cohort. Sex Transm Infect 2021; 98:210-214. [PMID: 33952681 PMCID: PMC8568730 DOI: 10.1136/sextrans-2021-055004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/05/2021] [Accepted: 04/14/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In recent years, both methamphetamine use and STIs have been on the rise in the USA. In this analysis, we sought to ascertain whether the risk of STIs and HIV among methamphetamine users was moderated on the basis of participation in substance use treatment programmes. METHODS Data came from the National Survey on Drug Use and Health, 2015-2019. Among adult participants, survey-weighted logistic regression analyses were used to assess the relationship between past year methamphetamine use and risk of HIV and STIs, stratified by methamphetamine treatment utilisation and adjusted for demographic and other risk factors. RESULTS Among participants in the analytic sample (n=210 392), 1862 (0.9%) reported past year methamphetamine use, 566 (0.3%) reported receiving treatment for its use, 5471 (2.6%) tested positive for any STI in the past year and 395 (0.2%) for HIV ever in their lifetime. Past year methamphetamine use was associated with increased risk of STIs among those who did not receive treatment (adjusted OR=3.628; 95% CI 2.75 to 4.92). Significant moderation was also present between past-year methamphetamine use, risk of STI, and substance use treatment. CONCLUSION In this analysis, we demonstrated a strong relationship between methamphetamine use and risk of STIs that differed based on receipt of substance use treatment. These findings suggested that integrated STI and substance use treatment programmes may yield substantial public health benefits.
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Affiliation(s)
| | - Christina Dyar
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA
| | - Ethan Morgan
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
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16
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17
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Dangerfield Ii DT, Wylie C, Anderson JN. Conducting Virtual, Synchronous Focus Groups Among Black Sexual Minority Men: Qualitative Study. JMIR Public Health Surveill 2021; 7:e22980. [PMID: 33427671 PMCID: PMC7899800 DOI: 10.2196/22980] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/23/2020] [Accepted: 01/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background Focus groups are useful to support HIV prevention research among US subpopulations, such as Black gay, Black bisexual, and other Black sexual minority men (BSMM). Virtual synchronous focus groups provide an electronic means to obtain qualitative data and are convenient to implement; however, the protocols and acceptability for conducting virtual synchronous focus groups in HIV prevention research among BSMM are lacking. Objective This paper describes the protocols and acceptability of conducting virtual synchronous focus groups in HIV prevention research among BSMM Methods Data for this study came from 8 virtual synchronous focus groups examined in 2 studies of HIV-negative BSMM in US cities, stratified by age (N=39): 2 groups of BSMM ages 18-24 years, 5 groups of BSMM ages 25-34 years, and 1 group of BSMM 35 years and older. Virtual synchronous focus groups were conducted via Zoom, and participants were asked to complete an electronic satisfaction survey distributed to their email via Qualtrics. Results The age of participants ranged from 18 to 44 years (mean 28.3, SD 6.0). All participants “strongly agreed” or “agreed” that they were satisfied participating in an online focus group. Only 17% (5/30) preferred providing written informed consent versus oral consent. Regarding privacy, most (30/30,100%) reported “strongly agree” or “agree” that their information was safe to share with other participants in the group. Additionally, 97% (29/30) reported being satisfied with the incentive. Conclusions Conducting virtual synchronous focus groups in HIV prevention research among BSMM is feasible. However, thorough oral informed consent with multiple opportunities for questions, culturally relevant facilitation procedures, and appropriate incentives are needed for optimal focus group participation.
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Affiliation(s)
- Derek T Dangerfield Ii
- Johns Hopkins School of Nursing, Baltimore, MD, United States.,Us Helping Us, People Into Living, Inc, Washington DC, MD, United States
| | - Charleen Wylie
- Johns Hopkins School of Nursing, Baltimore, MD, United States
| | - Janeane N Anderson
- Department of Health Promotion and Disease Prevention, College of Nursing, University of Tennessee Health Science Center, Memphis, TN, United States
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