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Lee JJ, Li Verdugo J, Xiao AY, Vo K. Digital Interventions to Enhance PrEP Uptake and Adherence Through Stigma Reduction. Curr HIV/AIDS Rep 2023; 20:458-469. [PMID: 38057685 DOI: 10.1007/s11904-023-00685-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE OF REVIEW Although pre-exposure prophylaxis (PrEP) is effective for reducing risk of HIV transmission, stigma persists as a barrier to HIV prevention. Digital technologies present opportunities to access hard-to-reach populations and increase the efficiency of established interventions. This review examines current digital interventions addressing stigma to improve PrEP-related outcomes. RECENT FINDINGS Digital technologies are increasingly used for HIV prevention and include a wide range of formats. Recent interventions focused on stigma and PrEP tend to engage mobile phone-related technology and focus on younger populations with particular attention to men who have sex with men and transgender women. Digital interventions that address stigma are promising for improving PrEP-related outcomes. No single technology currently demonstrates consistent superiority. Limited access to PrEP and heightened stigma in under-resourced countries present challenges for interventions supporting diverse communities. Further research should examine how digital interventions can reduce stigma beyond the individual level to enhance PrEP use and explore opportunities to improve and integrate approaches to stigma measurement.
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Affiliation(s)
- Jane J Lee
- School of Social Work, University of Washington, 4101 15th Avenue NE, Seattle, WA, 98105, USA.
| | - Juliann Li Verdugo
- School of Social Work, University of Washington, 4101 15th Avenue NE, Seattle, WA, 98105, USA
| | | | - Katie Vo
- School of Public Health, University of Washington, Seattle, WA, USA
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Temelkovska T, Moriarty K, Huerta L, Perez-Brumer AG, Segura ER, Passaro RC, Lake JE, Clark JL, Blair CS. Both/And: Mixed methods analysis of network composition, communication patterns, and socio-economic support within social networks of transgender women involved in sex work in Lima, Peru. BMC Public Health 2023; 23:2385. [PMID: 38041045 PMCID: PMC10690964 DOI: 10.1186/s12889-023-17278-z] [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: 07/07/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023] Open
Abstract
INTRODUCTION Social networks contribute to normative reinforcement of HIV prevention strategies, knowledge sharing, and social capital, but little research has characterized the social networks of transgender women (TW) in Latin America. We conducted a mixed methods analysis of three network clusters of TW in Lima, Peru, to evaluate network composition, types of support exchanged, and patterns of communication. METHODS We recruited TW residing in or affiliated with three "casas trans" (houses shared among TW) in Lima between April-May 2018. Eligible participants were 18 or older, self-reported HIV-negative, and reported recent intercourse with a cis-male partner. Participants completed demographic questionnaires, social network interviews, and semi-structured interviews to assess egocentric network structures, support exchanged, and communication patterns. Quantitative and qualitative data were analyzed using Stata v14.1 and Atlas.ti, respectively. RESULTS Of 20 TW, median age was 26 years and 100% reported involvement in commercial sex work. Respondents identified 161 individuals they interacted with in the past month (alters), of whom 33% were TW and 52% family members. 70% of respondents reported receiving emotional support from family, while 30% received financial support and instrumental support from family. Of the 13 (65%) respondents who nominated someone as a source of HIV prevention support (HPS), the majority (69%) nominated other TW. In a GEE regression analysis adjusted for respondent education and region of birth, being a family member was associated with lower likelihood of providing financial support (aOR 0.21, CI 0.08-0.54), instrumental support (aOR 0.16, CI 0.06-0.39), and HPS (aOR 0.18, CI 0.05-0.64). In qualitative interviews, most respondents identified a cis-female family member as their most trusted and closest network member, but other TW were more often considered sources of day-to-day support, including HPS. CONCLUSION TW have diverse social networks where other TW are key sources of knowledge sharing and support, and family members may also represent important and influential components. Within these complex networks, TW may selectively solicit and provide support from different network alters according to specific contexts and needs. HIV prevention messaging could consider incorporating network-based interventions with TW community input and outreach efforts for supportive family members.
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Affiliation(s)
- Tijana Temelkovska
- Department of Obstetrics and Gynecology, University of Colorado, 12631 East 17th Avenue, AO1, 4th Floor, Aurora, CO, 80045, USA.
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, UCLA, 911 Broxton Ave, Suite 301, Los Angeles, CA, 90024, USA.
| | - Kathleen Moriarty
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC, 20007, USA
| | - Leyla Huerta
- Feminas, Jiron Carlos de los Heros 265, Cercado de Lima 15084, Lima, Peru
| | - Amaya G Perez-Brumer
- Division of Social and Behavioral Health Sciences, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 5th Floor, Room 554, Toronto, ON, Canada
| | - Eddy R Segura
- Facultad de Ciencias de la Salud, Universidad de Huánuco, Jirón Hermilio, Valdizan, Huánuco, 859-885, 10001, Peru
| | - Ryan Colby Passaro
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, 1200 N State Street, Los Angeles, CA, 90033, USA
| | - Jordan E Lake
- Department of Internal Medicine, McGovern Medical School at UTHealth, MSB 1.150, Houston, Fannin, Houston, Texas, 6431, 77030, USA
| | - Jesse L Clark
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, UCLA, 911 Broxton Ave, Suite 301, Los Angeles, CA, 90024, USA
| | - Cheríe S Blair
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, UCLA, 911 Broxton Ave, Suite 301, Los Angeles, CA, 90024, USA
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