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Atujuna M, Newman PA, Wallace M, Eluhu M, Rubincam C, Brown B, Bekker LG. Contexts of vulnerability and the acceptability of new biomedical HIV prevention technologies among key populations in South Africa: A qualitative study. PLoS One 2018; 13:e0191251. [PMID: 29420549 PMCID: PMC5805172 DOI: 10.1371/journal.pone.0191251] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/02/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND New biomedical prevention technologies (NPTs) may contribute to substantially reducing incident HIV infections globally. We explored acceptability and preferences for NPTs among key and other vulnerable populations in two South African townships. METHODS We conducted six focus groups and 12 in-depth interviews with adolescents, and adult heterosexual men, women, and men who have sex with men (MSM) (n = 48), and eight in-depth interviews with key informant healthcare workers. The interview guide described pre-exposure prophylaxis (PrEP), vaginal rings, rectal microbicides and HIV vaccines, and explored acceptability and product preferences. Focus groups and in-depth interviews (45-80 minutes) were conducted in Xhosa, audiotaped, and transcribed and translated into English. Data were coded and reviewed using framework analysis with NVivo software. RESULTS Overall, initial enthusiasm and willingness to use NPTs evolved into concerns about how particular NPTs might affect or require alterations in one's everyday lifestyle and practices. Different product preferences and motivations emerged by population based on similarity to existing practices and contexts of vulnerability. Adult women and female adolescents preferred a vaginal ring and HIV vaccine, motivated by longer duration of protection to mitigate feared repercussions from male partners, including threats to their marriage and safety, and a context of ubiquitous rape. Male adolescents preferred an HIV vaccine, seen as protection in serodiscordant relationships and convenient in obviating the HIV stigma and cost involved in buying condoms. Adult men preferred PrEP, given familiarity with oral medications and mistrust of injections, seen as enabling serodiscordant couples to have a child. MSM preferred a rectal microbicide given familiarity with gel-based lubricants, with concerns about duration of protection in the context of unplanned consensual sex and rape. CONCLUSIONS Biomedical interventions to prevent HIV transmission, rather than obviating social-structural factors that produce vulnerability, may be limited by these same factors. Implementation of NPTs should engage local communities to understand real-world constraints and strategise to deliver effective, multi-level combination prevention.
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Affiliation(s)
- Millicent Atujuna
- Desmond Tutu HIV Foundation, Health Sciences Faculty, Institute of Infectious Disease, University of Cape Town, Cape Town, South Africa
| | - Peter A. Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Melissa Wallace
- Desmond Tutu HIV Foundation, Health Sciences Faculty, Institute of Infectious Disease, University of Cape Town, Cape Town, South Africa
| | - Megan Eluhu
- Desmond Tutu HIV Foundation, Health Sciences Faculty, Institute of Infectious Disease, University of Cape Town, Cape Town, South Africa
| | - Clara Rubincam
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Ben Brown
- Desmond Tutu HIV Foundation, Health Sciences Faculty, Institute of Infectious Disease, University of Cape Town, Cape Town, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Foundation, Health Sciences Faculty, Institute of Infectious Disease, University of Cape Town, Cape Town, South Africa
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Preference of Oral Tenofovir Disoproxil Fumarate/Emtricitabine Versus Rectal Tenofovir Reduced-Glycerin 1% Gel Regimens for HIV Prevention Among Cisgender Men and Transgender Women Who Engage in Receptive Anal Intercourse with Men. AIDS Behav 2017; 21:3336-3345. [PMID: 29119473 DOI: 10.1007/s10461-017-1969-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Oral pre-exposure prophylaxis (PrEP) can prevent HIV transmission. Yet, some may prefer not to take systemic daily medication. MTN-017 was a 3-period, phase 2 safety and acceptability study of microbicide gel applied rectally either daily or before and after receptive anal intercourse (RAI), compared to daily oral tablet. At baseline, cisgender men and transgender women who reported RAI (N = 187) rated the daily oral regimen higher in overall liking, ease of use, and likelihood of future use than the gel regimens. After trying all three, 28% liked daily oral the least. Gel did not affect sexual enjoyment (88%) or improved it (7-8%). Most partners had no reaction to gel use. Ease of gel use improved significantly between the first and the last few times of daily use. A rectal gel used before and after RAI may constitute an attractive alternative to daily tablet. Experience with product use may increase acceptability.
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Galea JT, Monsour E, Nureña CR, Blas MM, Brown B. HPV vaccine knowledge and acceptability among Peruvian men who have sex with men and transgender women: A pilot, qualitative study. PLoS One 2017; 12:e0172964. [PMID: 28245234 PMCID: PMC5330512 DOI: 10.1371/journal.pone.0172964] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/13/2017] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Human papillomavirus (HPV) is the most common sexually transmitted infection globally and is responsible for a variety of cancers in men and women. An effective HPV vaccine licensed for use in girls and boys has been indicated for-but is not widely implemented in-men who have sex with men (MSM). Limited data are available for transgender women (TW). We explored the social and behavioral aspects related to HPV vaccine uptake and participation in HPV vaccine studies among Peruvian MSM and TW. METHODS Focus groups and individual in-depth interviews were conducted to obtain the knowledge, thoughts, and opinions from Peruvian MSM and TW regarding HPV vaccination. Data were analyzed using systematic comparative and descriptive content analysis. RESULTS Three focus groups and fifteen individual in-depth interviews were conducted among 36 MSM and TW. Participant mean age was 26 years (range 18-40). Though many participants were unfamiliar with HPV vaccination, most expressed positive attitudes. Participants expressed concerns about the potential for stigma when disclosing HPV vaccination. CONCLUSION Peruvian MSM and TW felt that HPV vaccination would be acceptable to themselves and their peers. Nonetheless, vaccine intake may be impeded by potential stigma. Findings from this study may guide HPV vaccine implementation in similar populations.
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Affiliation(s)
- Jerome T. Galea
- Socios En Salud, Lima, Peru
- Epicentro Salud, Lima, Peru
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Emmi Monsour
- Center for Healthy Communities, School of Medicine, University of California, Riverside, California, United States of America
| | - César R. Nureña
- School of Anthropology, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Magaly M. Blas
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Brandon Brown
- Center for Healthy Communities, School of Medicine, University of California, Riverside, Riverside, California, United States of America
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Rectal Douching Prevalence and Practices Among Peruvian Men Who have Sex with Men and Transwomen: Implications for Rectal Microbicides. AIDS Behav 2016; 20:2555-2564. [PMID: 26459331 DOI: 10.1007/s10461-015-1221-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Peruvian men who have sex with men (MSM) and transwomen (TW) could benefit from a rectal microbicide (RM) formulated as a rectal douche to prevent HIV infection. However, little is known about rectal douching practices among Peruvian MSM and TW, information necessary to inform RM douche development and future uptake. Using a self-administered interview, we examined the prevalence of and factors associated with rectal douching among a convenience sample of 415 Peruvian MSM and 68 TW. In the previous 6 months, 18 % of participants reported rectal douching using pre-filled commercial kits or plastic bottles or enema bags filled with water, water/soap or saltwater. Multivariate logistic analysis found that "equally insertive and receptive" or "exclusively/mainly receptive" sex roles were associated with douche use. Rectal douching among Peruvian MSM and TW is similar to reports from other studies and supports the potential uptake of a douche-formulated RM in these populations.
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Tang EC, Galea JT, Kinsler JJ, Gonzales P, Sobieszczyk ME, Sanchez J, Lama JR. Using conjoint analysis to determine the impact of product and user characteristics on acceptability of rectal microbicides for HIV prevention among Peruvian men who have sex with men. Sex Transm Infect 2015; 92:200-5. [PMID: 26574569 DOI: 10.1136/sextrans-2015-052028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 09/28/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Men who have sex with men (MSM) are in need of novel and acceptable HIV prevention interventions. In Peru, a Phase II clinical trial was recently completed evaluating rectally applied tenofovir gel among Peruvian MSM and transgender women. If deemed safe and acceptable, the product could move into efficacy testing, but acceptability data for similar products are needed now in order to prepare for future implementation. Peru is in need of expanded, national acceptability data among likely users. METHODS Using conjoint analysis of an online cross-sectional survey taken by 1008 Peruvian MSM and transgender women, we tested the acceptability of eight hypothetical rectal microbicide (RM) products comprising six, dual-value attributes. We also assessed the relationship of select product attributes with sample characteristics. RESULTS Highest acceptability was found for a RM that was 90% effective, used before and after sex, without side effects, costing approximately $0.30, had no prescription requirement and had a single-use applicator. Product effectiveness and presence of side effects were the factors most likely to drive RM acceptance and use. Education, sexual orientation, sexual role and concern for HIV infection were also related to aspects of RM acceptability. CONCLUSION RM acceptability was high, confirming the results of earlier, smaller studies and placing confidence in the acceptability of RMs. Analysis of the relationships with product attributes and sample characteristics underscore the need to consider the impact of factors such as sexual orientation, sexual role, level of education and concern for HIV acquisition on RM acceptability.
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Affiliation(s)
- Eric C Tang
- Columbia University College of Physicians & Surgeons, New York, New York, USA
| | | | - Janni J Kinsler
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | | | - Magdalena E Sobieszczyk
- Columbia University College of Physicians & Surgeons, New York, New York, USA Department of Medicine, Division of Infectious Disease, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | - Jorge Sanchez
- Asociación Civil Impacta Salud y Educación, Lima, Peru Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Javier R Lama
- Asociación Civil Impacta Salud y Educación, Lima, Peru Department of Global Health, University of Washington, Seattle, Washington, USA
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Yah CS, Simate GS. Nanoparticles as potential new generation broad spectrum antimicrobial agents. Daru 2015; 23:43. [PMID: 26329777 PMCID: PMC4557602 DOI: 10.1186/s40199-015-0125-6] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/12/2015] [Indexed: 12/20/2022] Open
Abstract
The rapid emergence of antimicrobial resistant strains to conventional antimicrobial agents has complicated and prolonged infection treatment and increased mortality risk globally. Furthermore, some of the conventional antimicrobial agents are unable to cross certain cell membranes thus, restricting treatment of intracellular pathogens. Therefore, the disease-causing-organisms tend to persist in these cells. However, the emergence of nanoparticle (NP) technology has come with the promising broad spectrum NP-antimicrobial agents due to their vast physiochemical and functionalization properties. In fact, NP-antimicrobial agents are able to unlock the restrictions experienced by conventional antimicrobial agents. This review discusses the status quo of NP-antimicrobial agents as potent broad spectrum antimicrobial agents, sterilization and wound healing agents, and sustained inhibitors of intracellular pathogens. Indeed, the perspective of developing potent NP-antimicrobial agents that carry multiple-functionality will revolutionize clinical medicine and play a significant role in alleviating disease burden.
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Affiliation(s)
- Clarence S Yah
- Department of Biochemistry and Microbiology, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa.
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, E7146, 615 N. Wolfe Street, Baltimore, 21205, , MD, USA.
| | - Geoffrey S Simate
- School of Chemical and Metallurgical Engineering, University of the Witwatersrand, P/Bag 3, Wits 2050, Johannesburg, South Africa.
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Murphy DA, Lea T, de Wit JBF, Ellard JM, Kippax SC, Rosengarten M, Holt M. Interest in using rectal microbicides among Australian gay men is associated with perceived HIV vulnerability and engaging in condomless sex with casual partners: results from a national survey. Sex Transm Infect 2014; 91:266-8. [PMID: 25416839 DOI: 10.1136/sextrans-2014-051694] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 10/26/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We assessed interest in using rectal microbicides to prevent HIV transmission among gay men in Australia. METHODS A national online survey was conducted in 2013. Interest in using rectal microbicides was measured on a seven-item scale (α=0.81). Factors independently associated with greater interest in using a microbicide were identified using multivariate logistic regression. RESULTS Data were collected from 1223 HIV-negative and untested men. Mean age was 31.3 years (SD=10.8, range 18-65); 77% were born in Australia and 25% reported any condomless anal sex with a casual partner in the previous 6 months. Overall, there was moderate interest in using rectal microbicides (M=3.33, range 1-5). In multivariate analysis, greater interest in using microbicides was independently associated with being born outside Australia (adjusted OR (AOR)=1.59; p=0.009), greater self-perceived likelihood of becoming HIV positive (AOR=3.40; p<0.001), less uncertainty about the efficacy of microbicides (AOR=0.65; p=0.009), any condomless anal sex with casual partners in the previous 6 months (AOR=1.78; p=0.03) and ever having received postexposure prophylaxis (AOR=1.53; p=0.04). Interest in using microbicides was not associated with age, number of male sex partners or the HIV status of regular male partners. CONCLUSIONS Interest in using rectal microbicides was associated with self-perceived vulnerability to HIV, engaging in sexual practices that increase the risk of HIV acquisition and less uncertainty about the efficacy of microbicides. There appears to be a group of men who would benefit from, and are highly motivated to use, a rectal microbicide product.
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Affiliation(s)
- Dean A Murphy
- Centre for Social Research in Health, UNSW Australia, Sydney, New South Wales, Australia
| | - Toby Lea
- Centre for Social Research in Health, UNSW Australia, Sydney, New South Wales, Australia
| | - John B F de Wit
- Centre for Social Research in Health, UNSW Australia, Sydney, New South Wales, Australia Utrecht University, Social and Organizational Psychology, Utrecht, The Netherlands
| | - Jeanne M Ellard
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Susan C Kippax
- Social Policy Research Centre, UNSW, Sydney, New South Wales, Australia
| | - Marsha Rosengarten
- Centre for Social Research in Health, UNSW Australia, Sydney, New South Wales, Australia Department of Sociology, Goldsmiths, London, UK
| | - Martin Holt
- Centre for Social Research in Health, UNSW Australia, Sydney, New South Wales, Australia
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