1
|
Luz PM, Apelian H, Lambert G, Fourmigue A, Dvorakova M, Grace D, Lachowsky N, Hart TA, Moore DM, Skakoon-Sparling S, Cox J. HIV Treatment Optimism Moderates the Relationship between Sexual Risk Behavior and HIV Risk Perception among Urban HIV-negative Gay, Bisexual, and Other Men who have Sex With Men. AIDS Behav 2024; 28:2683-2694. [PMID: 38869761 DOI: 10.1007/s10461-024-04380-5] [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: 05/15/2024] [Indexed: 06/14/2024]
Abstract
Using baseline data of the Engage Cohort Study, a Canadian study of sexually active gay, bisexual and other men who have sex with men (GBM), we evaluated the association between sexual behavior and risk perception among HIV-negative participants and whether HIV treatment optimism moderated this relationship. Participants were recruited by respondent-driven-sampling (RDS). We defined high-risk sexual behavior in the past six months as any condomless anal sex with a casual partner (i.e. not the participant's main partner) with either unknown HIV-status where neither used pre-exposure prophylaxis or with a partner living with HIV having detectable/unknown viral load. We assessed HIV treatment optimism-skepticism using a 12-item scale. RDS-II-weighted adjusted logistic regression models examined associations with risk perception measured by the question "How would you assess your current risk of getting HIV?" (response options were on a 6-point Likert-scale ranging from "very unlikely" to "very likely", dichotomized into "No Perceived Risk" (very unlikely/unlikely) and "Perceived Risk" (somewhat likely/likely/very likely/I think I already have HIV). Of 1961 participants, engagement in high-risk sexual behavior was reported by 155 (17.0%), 62 (12.4%), 128 (17.2%) of participants in Montréal, Toronto, and Vancouver, respectively. High-risk sexual behavior increased the odds of perceived HIV risk (pooled adjusted odds ratio = 2.9, 95%CI = 2.2-3.8). HIV treatment optimism-skepticism scores moderated the relationship: for GBM engaging in high-risk sexual behavior, higher HIV treatment optimism-skepticism scores increased perceived HIV risk. Promoting awareness around advances related to HIV prevention and treatment is important for appropriate risk assessment and for increased engagement in prevention interventions.
Collapse
Affiliation(s)
- Paula M Luz
- National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil.
| | - Herak Apelian
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Gilles Lambert
- Direction régionale de santé publique de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montréal, QC, Canada
- Institut national de santé publique du Québec, Montréal, QC, Canada
| | - Alain Fourmigue
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Milada Dvorakova
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Nathan Lachowsky
- School of Public, Health & Social Policy, University of Victoria, Victoria, BC, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - David M Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Shayna Skakoon-Sparling
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
- Psychology Department, University of Guelph, Guelph, ON, Canada
| | - Joseph Cox
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
- Direction régionale de santé publique de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montréal, QC, Canada
| |
Collapse
|
2
|
Vega-Ramirez H, Guillen-Diaz-Barriga C, Luz PM, Torres TS. Perceived risk for HIV acquisition and sexual HIV exposure among sexual and gender minorities: a systematic review. BMC Infect Dis 2024; 24:574. [PMID: 38858666 PMCID: PMC11163805 DOI: 10.1186/s12879-024-09456-0] [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] [Received: 12/09/2023] [Accepted: 05/30/2024] [Indexed: 06/12/2024] Open
Abstract
We conducted a systematic review to explore the relationship between perceived risk for HIV acquisition and sexual HIV exposure among sexual and gender minorities. We included 39 studies divided into (i) correlations or associations, (ii) models using sexual HIV exposure as the outcome, and (iii) models using perceived risk for HIV acquisition as the outcome. The sample size range was from 55 to 16,667 participants, primarily cisgender men who have sex with men (73.3%) and White (51.3%). Sexual HIV exposure and perceived risk for HIV acquisition assessments and recall time frames across studies differed markedly. Most of studies (84.6%) found significant correlations, comparisons, or associations between different levels of perceived risk for HIV acquisition and high sexual HIV exposure. In addition, 51.3% of studies reported other variables associated with high sexual HIV exposure (i.e., misuse of substances or alcohol) or with high perceived risk for HIV acquisition (i.e., younger age). In conclusion, the association between perceived risk for HIV acquisition and sexual HIV exposure has shown to be consistent. However, the assessment for perceived risk for HIV acquisition should include more components of perception (i.e., an affective component), or for sexual HIV exposure should consider the different estimated sexual per-acts probability of acquiring HIV.
Collapse
Affiliation(s)
- Hamid Vega-Ramirez
- Division of Epidemiology and Psychosocial Research, National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico.
| | - Centli Guillen-Diaz-Barriga
- Division of Graduate Studies and Research, Faculty of Psychology, National Autonomous University of Mexico, Mexico City, Mexico
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI- Fiocruz), Rio de Janeiro, Brazil
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI- Fiocruz), Rio de Janeiro, Brazil
| |
Collapse
|
3
|
Metheny N, Mkhize SP, Scott D, Hatcher A. Violence Victimization and Depressive Symptoms Among a Sub-Sample of Sexual and Gender Minority Adults in a Population-Based South African Study. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241243348. [PMID: 38654528 DOI: 10.1177/08862605241243348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Sexual and gender minority (SGM) adults in South Africa face high levels of violence and poor mental health outcomes. Interventions to prevent these negative health implications are hampered by a lack of representative data among this population. This study aims to quantify the associations between three forms of violent victimization and depressive symptoms in a sub-sample of SGM drawn from a population-based cross-sectional study in Gauteng, South Africa. Data come from the sixth Quality of Life survey conducted in South Africa's Gauteng province. Brief screeners assessed childhood sexual abuse (CSA), past-year intimate partner violence (IPV), non-partner violence, and depressive symptoms. Three survey-weighted logistic regression analyses were fit to model associations between elevated depressive symptoms and CSA, past-year IPV, and past-year non-partner violence, controlling for socio-demographics (age, race, sex, area of residence, education, socioeconomic status, and recent employment). N = 1,328 SGM respondents were included. Over 40% (n = 537) reported depressive symptoms, while 17% (n = 222) reported CSA, 5% (n = 67) reported IPV, and 16% (n = 208) reported non-partner violence. CSA and non-partner violence were associated with significantly higher odds of reporting depressive symptoms (aOR: 1.51, 95% CI [1.03, 2.23]; aOR: 1.84, [1.24, 2.73], respectively). IPV was not associated with elevated depressive symptoms (aOR: 1.17, [0.64, 2.16]). In all models, employment in the past 7 days was associated with significantly lower odds of reporting depressive symptoms. Recent and childhood violence is a major burden that is associated with elevated symptoms of depression among SGM in urban South Africa. Community-tailored interventions and policy-related advocacy related to employment and violence prevention may alleviate depressive symptoms in SGM adults in Gauteng.
Collapse
Affiliation(s)
| | - Sthembiso Pollen Mkhize
- University of Johannesburg, South Africa
- University of the Witwatersrand, Johannesburg, South Africa
| | | | - Abigail Hatcher
- University of the Witwatersrand, Johannesburg, South Africa
- University of North Carolina, Chapel Hill, USA
| |
Collapse
|
4
|
Blair KJ, Torres TS, Hoagland B, Bezerra DRB, Veloso VG, Grinsztejn B, Clark J, Luz PM. Moderating Effect of Pre-Exposure Prophylaxis Use on the Association Between Sexual Risk Behavior and Perceived Risk of HIV Among Brazilian Gay, Bisexual, and Other Men Who Have Sex With Men: Cross-Sectional Study. JMIR Public Health Surveill 2023; 9:e45134. [PMID: 37796573 PMCID: PMC10587815 DOI: 10.2196/45134] [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: 12/16/2022] [Revised: 07/14/2023] [Accepted: 07/31/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (MSM) with a higher perceived risk of HIV are more aware of and willing to use pre-exposure prophylaxis (PrEP). PrEP is an effective HIV prevention strategy, but there is a lack of data on how PrEP use might moderate the relationship between sexual risk behavior and perceived risk of HIV. Moreover, most studies measure perceived risk of HIV via a single question. OBJECTIVE We estimated the moderating effect of PrEP use on the association between sexual risk behavior and perceived risk of HIV, measured with the 8-item Perceived Risk of HIV Scale (PRHS), among Brazilian MSM. METHODS A cross-sectional, web-based survey was completed by Brazilian Hornet app users aged ≥18 years between February and March 2020. We included data from cisgender men who reported sex with men in the previous 6 months. We evaluated the moderating effect of current PrEP use on the association between sexual risk behavior, measured via the HIV Incidence Risk Index for MSM (HIRI-MSM), and perceived risk of HIV, measured by the PRHS. Higher HIRI-MSM (range 0-45) and PRHS (range 10-40) scores indicate greater sexual behavioral risk and perceived risk of HIV, respectively. Both were standardized to z scores for use in multivariable linear regression models. RESULTS Among 4344 cisgender MSM, 448 (10.3%) were currently taking PrEP. Current PrEP users had a higher mean HIRI-MSM score (mean 21.0, SD 9.4 vs mean 13.2, SD 8.1; P<.001) and a lower mean PRHS score (mean 24.6, SD 5.1 vs mean 25.9, SD 4.9; P<.001) compared to those not currently taking PrEP. In the multivariable model, greater HIRI-MSM scores significantly predicted increased PRHS scores (β=.26, 95% CI 0.22-0.29; P<.001). PrEP use moderated the association between HIRI-MSM and PRHS score (interaction term β=-.30, 95% CI -0.39 to -0.21; P<.001), such that higher HIRI-MSM score did not predict higher PRHS score among current PrEP users. CONCLUSIONS Our results suggest current PrEP users have confidence in PrEP's effectiveness as an HIV prevention strategy. PrEP's effectiveness, positive psychological impact, and the frequent HIV testing and interaction with health services required of PrEP users may jointly influence the relationship between sexual risk behavior and perceived risk of HIV among PrEP users.
Collapse
Affiliation(s)
- Kevin James Blair
- South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, CA, United States
- Department of Surgery, University of California Los Angeles, Los Angeles, CA, United States
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Daniel R B Bezerra
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jesse Clark
- South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| |
Collapse
|
5
|
Jennings Mayo-Wilson L, Coleman Lewis J, MacCarthy S, Linnemayr S. Assessing behavioral economic biases among young adults who have increased likelihood of acquiring HIV: a mixed methods study in Baltimore, Maryland. AIDS Res Ther 2023; 20:25. [PMID: 37150823 PMCID: PMC10165802 DOI: 10.1186/s12981-023-00521-3] [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] [Received: 01/27/2023] [Accepted: 04/18/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Behavioral economic (BE) biases have been studied in the context of numerous health conditions, yet are understudied in the field of HIV prevention. This aim of this study was to quantify the prevalence of four common BE biases-present bias, information salience, overoptimism, and loss aversion-relating to condom use and HIV testing in economically-vulnerable young adults who had increased likelihood of acquiring HIV. We also qualitatively examined participants' perceptions of these biases. METHODS 43 participants were enrolled in the study. Data were collected via interviews using a quantitative survey instrument embedded with qualitative questions to characterize responses. Interviews were transcribed and analyzed using descriptive statistics and deductive-inductive content analyses. RESULTS 56% of participants were present-biased, disproportionately discounting future rewards for smaller immediate rewards. 51% stated they were more likely to spend than save given financial need. Present-bias relating to condom use was lower with 28% reporting they would engage in condomless sex rather than wait one day to access condoms. Most participants (72%) were willing to wait for condom-supported sex given the risk. Only 35% knew someone living with HIV, but 67% knew someone who had taken an HIV test, and 74% said they often think about preventing HIV (e.g., high salience). Yet, 47% reported optimistically planning for condom use, HIV discussions with partners, or testing but failing to stick to their decision. Most (98%) were also averse (b = 9.4, SD ±.9) to losing their HIV-negative status. Qualitative reasons for sub-optimal condom or testing choices were having already waited to find a sex partner, feeling awkward, having fear, or not remembering one's plan in the moment. Optimal decisions were attributed qualitatively to self-protective thoughts, establishing routine care, standing on one's own, and thinking of someone adversely impacted by HIV. 44% of participants preferred delayed monetary awards (e.g., future-biased), attributed qualitatively to fears of spending immediate money unwisely or needing time to plan. CONCLUSION Mixed methods BE assessments may be a valuable tool in understanding factors contributing to optimal and sub-optimal HIV prevention decisions. Future HIV prevention interventions may benefit from integrating savings products, loss framing, commitment contracts, cues, or incentives.
Collapse
Affiliation(s)
- Larissa Jennings Mayo-Wilson
- Department of Health Behavior, Department of Maternal and Child Health, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 310 Rosenau Hall CB #7400, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.
| | - Jessica Coleman Lewis
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Sarah MacCarthy
- Department of Health Behavior, University of Alabama at Birmingham School of Public Health, 1665 University Boulevard, Birmingham, AL, USA
| | | |
Collapse
|
6
|
Ferrand J, Walsh-Buhi E, Dodge B, Svetina D, Herbenick D. Variations in Pre-exposure Prophylaxis (PrEP) Awareness and Healthcare Provider Interactions in a Nationally Representative Sample of American Men Aged 15-49 Years: A Cross-Sectional Study. AIDS Behav 2023:10.1007/s10461-023-04016-0. [PMID: 36786940 DOI: 10.1007/s10461-023-04016-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 02/15/2023]
Abstract
Awareness of and discussions with a healthcare provider (HCP) around pre-exposure prophylaxis (PrEP), an effective HIV prevention method, are associated with PrEP uptake, yet few studies utilize representative samples or report on these outcomes using distinct behavioral risk subgroups. This cross-sectional study utilized responses given by men on the 2017-2019 National Survey of Family Growth, a nationally representative survey of Americans aged 15-49 years. Multiple logistic regression models were used to determine how respondents' sociodemographic characteristics and HIV risk behaviors were related to PrEP awareness and HCP discussions. PrEP awareness was low (29.40%) as was the proportion who reported ever discussing PrEP with an HCP (4.48%). Odds of being PrEP aware and discussing PrEP with an HCP varied significantly within sexual behavior subgroups based on sociodemographic and behavioral characteristics highlighting the differential risks within distinct behavioral subgroupings of men. Sexual behavior subgroupings should be considered when promoting PrEP awareness and discussions as HIV risk behaviors vary considerably and sexual identity alone may not sufficiently capture one's HIV risk.
Collapse
Affiliation(s)
- John Ferrand
- Department of Applied Health Science, Indiana University, School of Public Health-Bloomington, 1025 E. 7th St., Bloomington, IN, 47405, USA.
| | - Eric Walsh-Buhi
- Department of Applied Health Science, Indiana University, School of Public Health-Bloomington, 1025 E. 7th St., Bloomington, IN, 47405, USA
| | - Brian Dodge
- Health Sciences, Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Dubravka Svetina
- Department of Counseling and Educational Psychology, Indiana University, School of Education, Bloomington, IN, USA
| | - Debby Herbenick
- Department of Applied Health Science, Indiana University, School of Public Health-Bloomington, 1025 E. 7th St., Bloomington, IN, 47405, USA
| |
Collapse
|
7
|
Gheibi Z, Joulaei H, Fararouei M, Shokoohi M, Foroozanfar Z, Dianatinasab M. Late diagnosis of HIV infection and its associated factors in Shiraz, Southern Iran: a retrospective study. AIDS Care 2022; 34:1321-1329. [PMID: 34495786 DOI: 10.1080/09540121.2021.1975629] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Late diagnosis (LD) of HIV infection can give rise to suboptimal responses to antiretroviral treatment. The current study aimed to determine the prevalence and associated factors of HIV LD in Shiraz, Southern Iran. This retrospective cohort study was conducted from August 1997 to May 2018. Medical records were examined to extract required data. Individuals with time period less than three months from HIV diagnosis to an advanced phase of AIDS on CD4 < 350 were considered as LD. Multivariable logistic regression used to investigate the associated factors of late HIV diagnosis and adjusted odds ratios were reported. Of 1385 individuals, 1043 (75.3%) were considered as LD. The following factors were identified as the associated factors of LD: age at diagnosis (OR = 1.72, 95% CI: 1.22, 2.41), HCV co-infection (OR = 1.65, 95% CI: 1.23, 2.21), not living in Shiraz (OR = 1.36, 95% CI: 1.02, 1.82), increased likelihood of LD and being housewife (OR = 0.67, 95% CI: 0.47, 0.95) which decreased the likelihood of LD. Our results showed delayed diagnosis of a large proportion of individuals with HIV. It is critical to improve the HIV testing guidelines in Iran to identify individuals with HIV without delays in order to provide them with timely HIV medical care and treatment.
Collapse
Affiliation(s)
- Zahra Gheibi
- Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hassan Joulaei
- Shiraz HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Fararouei
- Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mostafa Shokoohi
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies, Health Kerman University of Medical Sciences, Kerman, Iran
| | - Zohre Foroozanfar
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mostafa Dianatinasab
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
8
|
Liu Y, Fu G, Chen Y, Wu L, Pan M, Yang Y, Chen Z, Cao Y, Li Y, Wang H, Wang B, Lv C, Du R, Xiong Y, Liu W, Xu N, Xia X, Li Q, Ruan F, Wang J. Discordance between perceived risk and actual risky sexual behaviors among undergraduate university students in mainland China: a cross-sectional study. BMC Public Health 2022; 22:729. [PMID: 35413860 PMCID: PMC9006618 DOI: 10.1186/s12889-022-13132-w] [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] [Received: 03/17/2021] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV prevention, diagnosis, treatment and care services might be hampered by inaccurate risk assessment. This study aimed to investigate the extent of and factors associated with the discordance between perceived risk and actual risky sexual behaviors among undergraduates in mainland China, guided by the Anderson's behavioral model. METHODS This study involved a secondary analysis of cross-sectional data collected during the fall semester of 2018-2019 academic year. The present analysis was restricted to 8808 undergraduates with low risk perception. Those who had low perceived risk but actually engaged in risky sexual behaviors were categorized as risk discordance (RD). Univariate and multivariate Logistic regression analyses were conducted to identify factors associated with RD. RESULTS Overall, the discordance rate between perceived and actual risk was 8.5% (95% CI: 7.9%-9.1%). Multivariate Logistic regression analysis indicated that non-heterosexual women (AOR = 0.41, 95% CI:0.27-0.60), heterosexual men (AOR = 0.45, 95% CI:0.33-0.61) and women (AOR = 0.26, 95% CI:0.19-0.35) were less likely to exhibit RD, when compared with non- heterosexual men. Furthermore, non-freshmen (AOR = 1.57, 95% CI:1.30-1.90), early initiators of sexual intercourse (AOR = 5.82, 95% CI:4.10-8.26), and those who had lower levels of HIV knowledge (AOR = 1.28, 95% CI:1.08-1.51), displayed higher levels of stigma against PLHIV (AOR = 1.50, 95% CI:1.26-1.77) and had ever been tested for HIV (AOR = 1.36, 95% CI:1.04-1.77) were more prone to reporting RD. Those with more enabling resources [i.e., displaying high levels of condom use self-efficacy (AOR = 0.70, 95% CI:0.59-0.84) and being knowledge of local testing center (AOR = 0.71, 95% CI:0.60-0.83)] were less likely to report RD. However, spending more than 2000 Yuan a month on basic needs (AOR = 2.55, 95% CI:2.07-3.14), residing in urban areas (AOR = 1.35, 95% CI:1.15-1.59) and being knowledgeable of the national AIDS policy (AOR = 1.40,95% CI:1.18-1.66) increased the chance of exhibiting RD. CONCLUSIONS Comprehensive interventions, including targeting students with high-risk characteristics, improving the acceptability of PrEP and PEP, conducting health education, enhancing self-efficacy for using condoms and making opt-out HIV testing routine in college campus, should be taken to reduce the discordance between perceived and actual HIV risk and finally to reach the goal of Zero AIDS.
Collapse
Affiliation(s)
- Yusi Liu
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Guochen Fu
- National Demonstration Center for Experimental General Medicine Education of Hubei University of Science and Technology, Xianning City, China
| | - Yifan Chen
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Lei Wu
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Mingliang Pan
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Yuli Yang
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Zhuo Chen
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Yu Cao
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Yong Li
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Hao Wang
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Bixiang Wang
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Chengcheng Lv
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Ruyi Du
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Yanting Xiong
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Wei Liu
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Nuo Xu
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Xiaobao Xia
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Qianqian Li
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Fang Ruan
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Junfang Wang
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China.
| |
Collapse
|
9
|
Qanche Q, Wondimu W, Asefa A, Yosef T, Midaksa G, Nigussie T. Factors Contributing to High HIV Prevalence in Majang Zone, Southwest Ethiopia: What Lies Beneath the Tip of the Iceberg? J Multidiscip Healthc 2021; 14:3273-3283. [PMID: 34858030 PMCID: PMC8630364 DOI: 10.2147/jmdh.s331708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/09/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Despite the tremendous efforts made, HIV epidemic has been continuing to be a public health threat and one of the leading causes of death in sub-Saharan African countries. Gambella region is a high prevalence region persistently exhibiting the highest share of HIV cases in Ethiopia. Thus, the objective of this study was to explore factors contributing to high HIV prevalence in the Majang zone of Gambella region, Southwest Ethiopia. METHODS A descriptive qualitative study was conducted in the Majang zone of Gambella region, Southwest Ethiopia from March to May 2019. A heterogeneous purposive sampling technique was employed to recruit key informants and focused group discussion participants. Eighteen key informant interviews and 9 focused group discussions were conducted (N = 90) with health professionals, youth, mothers, and community elders. An interview guide developed through an extensive literature review was used to elicit information from the study participants, and data were collected by the investigators themselves with the help of local guides. Data were audio recorded, transcribed, translated, coded, and analyzed thematically, assisted by Atlas.ti 7.5.16 software. Trustworthiness of the data was ensured through data triangulation, prolonged engagement, member checking, and inquiry audit in which findings were audited and verified by qualitative research experts. Ethical clearance was obtained from the Institutional Review Board of Mizan Tepi University, and written signed informed consent was obtained from all the participants prior to conducting the interviews. RESULTS A total of 90 individuals have participated in this study. Several factors appear to underlie the sustained high prevalence of HIV in the study area and were organized into five major themes: 1) government-related factors, 2) community perception towards HIV, 3) substance use, 4) socio-cultural factors, and 5) movement of people. CONCLUSION Low government attention towards HIV prevention and control activities, low perceived severity of HIV, substance use, socio-cultural factors, and high movement of people appear to inform the understanding of factors contributing to HIV risk in Majang zone. The sociocultural factors include the use of "Tifo Bet" and social support for polygamy. These findings loudly call for the governmental, non-governmental, and private sectors to reconsider and strengthen strategies for the prevention and control of HIV in the study area.
Collapse
Affiliation(s)
- Qaro Qanche
- Department of Public Health, School of Public Health, College of Medicine and Health Science, Mizan-Tepi University, Mizan Aman, Southern Nations, Nationalities and Peoples Regional State, Ethiopia
| | - Wondimagegn Wondimu
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Science, Mizan-Tepi University, Mizan Aman, Southern Nations, Nationalities and Peoples Regional State, Ethiopia
| | - Adane Asefa
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Science, Mizan-Tepi University, Mizan Aman, Southern Nations, Nationalities and Peoples Regional State, Ethiopia
| | - Tewodros Yosef
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Science, Mizan-Tepi University, Mizan Aman, Southern Nations, Nationalities and Peoples Regional State, Ethiopia
| | - Gachana Midaksa
- Department of Public Health, School of Public Health, College of Medicine and Health Science, Mizan-Tepi University, Mizan Aman, Southern Nations, Nationalities and Peoples Regional State, Ethiopia
| | - Tadesse Nigussie
- Department of Public Health, College of Health Science, Salale University, Salale, Oromia Regional State, Ethiopia
| |
Collapse
|
10
|
van Empel E, de Vlieg RA, Montana L, Gómez-Olivé FX, Kahn K, Tollman S, Berkman L, Bärnighausen TW, Manne-Goehler J. Older Adults Vastly Overestimate Both HIV Acquisition Risk and HIV Prevalence in Rural South Africa. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3257-3276. [PMID: 34599468 PMCID: PMC8563552 DOI: 10.1007/s10508-021-01982-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/02/2021] [Accepted: 03/08/2021] [Indexed: 06/13/2023]
Abstract
Perceptions of HIV acquisition risk and prevalence shape sexual behavior in sub-Saharan Africa (SSA). We used data from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa baseline survey. Data were collected through home-based interviews of 5059 people ≥ 40 years old. We elicited information on perceived risk of HIV acquisition and HIV prevalence among adults ≥ 15 and ≥ 50 years old. We first describe these perceptions in key subgroups and then compared them to actual estimates for this cohort. We then evaluated the relationship between sociodemographic characteristics and accurate perceptions of prevalence in regression models. Finally, we explored differences in behavioral characteristics among those who overestimated risk compared to those who underestimated or accurately estimated risk. Compared to the actual HIV acquisition risk of < 1%, respondents vastly overestimated this risk: 35% (95% CI: 32-37) and 34% (95% CI: 32-36) for men and women, respectively. Respondents overestimated HIV prevalence at 53% (95% CI: 52-53) for those ≥ 15 years old and 48% (95% CI: 48-49) for those ≥ 50 years old. True values were less than half of these estimates. There were few significant associations between demographic characteristics and accuracy. Finally, high overestimators of HIV prevalence tested themselves less for HIV compared to mild overestimators and accurate reporters. More than 30 years into the HIV epidemic, older people in a community with hyperendemic HIV in SSA vastly overestimate both HIV acquisition risk and prevalence. These misperceptions may lead to fatalism and reduced motivation for prevention efforts, possibly explaining the continued high HIV incidence in this community.
Collapse
Affiliation(s)
- Eva van Empel
- Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, 02138, USA.
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Rebecca A de Vlieg
- Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, 02138, USA
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Livia Montana
- Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, 02138, USA
| | - F Xavier Gómez-Olivé
- Medical Research Council/Wits Rural, Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, Parktown, South Africa
| | - Kathleen Kahn
- Medical Research Council/Wits Rural, Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, Parktown, South Africa
| | - Stephen Tollman
- Medical Research Council/Wits Rural, Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, Parktown, South Africa
| | - Lisa Berkman
- Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, 02138, USA
- Medical Research Council/Wits Rural, Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, Parktown, South Africa
| | - Till W Bärnighausen
- Medical Research Council/Wits Rural, Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, Parktown, South Africa
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Africa Health Research Institute, Mtubatuba, South Africa
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Jennifer Manne-Goehler
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
11
|
Zimmermann HML, van Bilsen WPH, Boyd A, Prins M, van Harreveld F, Davidovich U. Prevention challenges with current perceptions of HIV burden among HIV-negative and never-tested men who have sex with men in the Netherlands: a mixed-methods study. J Int AIDS Soc 2021; 24:e25715. [PMID: 34449130 PMCID: PMC8395388 DOI: 10.1002/jia2.25715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/16/2021] [Accepted: 03/31/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION As biomedical advances improved HIV treatment, the perceptions of severity and anticipated consequences of HIV could have changed accordingly. This study investigates the current perceptions of severity and anticipated consequences of HIV infection and its association with sexual risk behaviour among HIV-negative and never-tested men who have sex with men (MSM) living in the Netherlands. METHODS In-depth interviews with recently diagnosed HIV-positive MSM were used to develop a questionnaire measuring the perceived severity and anticipated consequences of HIV infection. The questionnaire was distributed online between April and July 2019. A structural equation model was constructed to explore the anticipated consequences contributing to the perceived HIV severity and to assess the association between the perceived severity and sexual risk behaviour. RESULTS In total, 1,072 HIV-negative and never-tested MSM completed the questionnaire, of whom 28% reported recent sexual risk behaviour. Almost one-quarter of participants (23%) had a low perceived HIV severity, which was associated with more prevalent sexual risk taking (β = -0.07, 95% CI = -0.12/-0.01). In this model, the perceived severity of HIV was more strongly associated with anticipated psychological consequences of HIV (β = 0.34, 95% CI = 0.24 to 0.44) and to a lesser extent with anticipated negative consequences of HIV on sex/relationships (β = 0.28, 95% CI = 0.19 to 0.38) and disclosure-related consequences (β = 0.16, 95% CI = 0.07 to 0.26). Health-related consequences of HIV were not significantly associated with the severity perceptions (β = 0.06, 95% CI = -0.03 to 0.14). CONCLUSIONS Anticipated negative social and psychological consequences of HIV mostly contribute to high HIV-severity perceptions in MSM. A smaller subgroup of MSM does not perceive HIV as a serious disease, which is associated with increased sexual risk taking. Efforts to normalize living with HIV are essential but might present a challenge for HIV prevention as it could, for a minority of MSM, decrease the motivation to prevent HIV infection.
Collapse
Affiliation(s)
- Hanne ML Zimmermann
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamThe Netherlands
| | - Ward PH van Bilsen
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamThe Netherlands
| | - Anders Boyd
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamThe Netherlands
- Stichting HIV MonitoringAmsterdamThe Netherlands
| | - Maria Prins
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamThe Netherlands
- Department of Internal MedicineDivision of Infectious DiseasesAmsterdam Infection & Immunity Institute (AIII), Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Frenk van Harreveld
- Department of Social PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
- National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | - Udi Davidovich
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamThe Netherlands
- Department of Social PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
| | | |
Collapse
|
12
|
Mpunga E, Persaud N, Akolo C, Boyee D, Kamanga G, Trapence G, Chilongozi D, Ruberintwari M, Masankha Banda L. Qualitative assessment of readiness for use of HIV pre-exposure prophylaxis among men who have sex with men (MSM) in Malawi: Qualitative study using key informant interviews and focus group discussions. JMIR Public Health Surveill 2021; 7:e26177. [PMID: 34228627 PMCID: PMC8581750 DOI: 10.2196/26177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 06/23/2021] [Accepted: 06/29/2021] [Indexed: 12/11/2022] Open
Abstract
Background Men who have sex with men (MSM) are a key group for HIV interventions in Malawi considering their high HIV prevalence (17.5% compared to 8.4% among men in the general population). The use of oral preexposure prophylaxis (PrEP) presents a new opportunity for MSM to be protected. We present the findings from a qualitative assessment designed to assess awareness of and willingness and barriers to using PrEP among MSM in Malawi. Objective The 3 main objectives of this assessment were to determine: (1) awareness of PrEP, (2) factors that influence willingness to use PrEP, and (3) potential barriers to PrEP use and adherence among MSM in order to guide the design and implementation of a PrEP program in Malawi. Methods Ahead of the introduction of PrEP in Malawi, a qualitative study using in-depth interviews (IDIs) and focus group discussions (FGDs) was conducted in October 2018 in Blantyre, Lilongwe, and rural districts of Mzimba North and Mangochi. With support of members of the population, study participants were purposively recruited from 4 MSM-friendly drop-in centers where MSM receive a range of health services to ensure representativeness across sites and age. Participants were asked what they had heard about PrEP, their willingness to use PrEP, their barriers to PrEP use, and their preferences for service delivery. The data were analyzed using a thematic content analysis framework that was predetermined in line with objectives. Results A total of 109 MSM were interviewed—13 through IDIs and 96 through FGDs. Most participants were aware of PrEP as a new HIV intervention but had limited knowledge related to its use. However, the majority were willing to use it and were looking forward to having access to it. IDI participants indicated that they will be more willing to take PrEP if the dosing frequency were appropriate and MSM were involved in information giving and distribution of the drug. FGD participants emphasized that places of distribution and characteristics of the service provider are the key factors that will affect use. Knowing the benefits of PrEP emerged as a key theme in both the IDIs and FGDs. Participants highlighted barriers that would hinder them from taking PrEP such as side effects which were cited in IDIs and FGDs. Key factors from FGDs include cost, fear of being outed, drug stockouts, fear of being known as MSMs by wives, and lack of relevant information. FGDs cited stigma from health care workers, forgetfulness, and community associated factors. Conclusions Despite having inadequate knowledge about PrEP, study participants were largely willing to use PrEP if available. Programs should include an effective information, education, and communication component around their preferences and provide PrEP in MSM-friendly sites.
Collapse
|
13
|
van Bilsen WP, Zimmermann HM, Boyd A, van Harreveld F, Davidovich U. Factors Associated with Never Testing for HIV: Directions for Targeted Testing Interventions Among Men Who Have Sex with Men. AIDS Patient Care STDS 2021; 35:204-210. [PMID: 34097463 DOI: 10.1089/apc.2021.0024] [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] [Indexed: 11/12/2022] Open
Abstract
Men who have sex with men (MSM) and who are unaware of their HIV infection contribute to onward HIV transmission and are more likely to progress to severe illness. We therefore assessed determinants of never testing for HIV among MSM living in the Netherlands. Between April and July 2019, 950 HIV-negative and 122 never-tested MSM completed a cross-sectional survey on sociodemographics, HIV testing behavior, and sexual risk taking, which was distributed through gay networking sites/apps. In never-tested MSM, median age was 37 (interquartile range = 22-51) years and 37 (30%) reported recent sexual risk behavior. Never testing was associated with younger age [adjusted odds ratio (aOR) per year increase = 0.98, 95% confidence interval (CI) = 0.97-1.00, p = 0.015], having sex with men and women (aOR = 2.85, 95% CI = 1.57-5.62, p = 0.001), and not knowing others living with HIV (aOR = 3.85, 95% CI = 2.35-6.32, p < 0.001) in multi-variable logistic regression analysis. A significant interaction effect between education level and residential area was observed (p = 0.001). Among higher-educated MSM, those living outside a large urban area had higher odds of never testing compared to those living in an urban area (aOR = 6.26, 95% CI = 2.42-16.24, p < 0.001). Lower-educated MSM had higher odds of never testing irrespective of residential area (large urban area: aOR = 12.06, 95% CI = 4.00-36.38; outside large urban area: aOR 9.29, 95% CI = 3.64-23.76; p < 0.001 for both). Among MSM recently exposed to sexual risk, never testing was associated with having sex with men and women (aOR = 2.80, 95% CI = 1.09-7.18, p = 0.032) and not knowing others with HIV (aOR = 4.91, 95% CI = 1.97-12.24, p = 0.001). To conclude, testing interventions for those never tested should be tailored to residential area and education level, and inclusive of bisexuality.
Collapse
Affiliation(s)
- Ward P.H. van Bilsen
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Hanne M.L. Zimmermann
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Anders Boyd
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Stichting HIV Monitoring, Amsterdam, the Netherlands
| | - Frenk van Harreveld
- Department of Social Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Department of Social Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | | |
Collapse
|
14
|
HIV Testing and Risks of Sexual Behavior among HIV-Negative Men Who Have Sex with Men in Ningbo, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041322. [PMID: 32092851 PMCID: PMC7068381 DOI: 10.3390/ijerph17041322] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 12/31/2022]
Abstract
Human immunodeficiency virus (HIV) testing is confirmed as a preventive strategy for HIV control. However, the testing rate and risk behaviors of HIV-negative men who have sex with men (MSM) remain unclear. We aimed to examine factors associated with HIV testing and high-risk behaviors among HIV-negative MSM. From July 2016 to June 2017, participants were recruited by snowball sampling from WeChat groups, bars, and other venues. HIV testing was performed to exclude HIV-positive MSM. Face-to-face questionnaires regarding HIV testing and high-risk behaviors were conducted; 988 MSM were included, and 57.1% of participants underwent HIV testing in the past year. The proportion of high-risk behaviors was 49.9%. Factors associated with HIV testing were bisexual orientation, substance use to adjust psychiatric disorders, and receiving acquired immune deficiency syndrome (AIDS) interventions. Being married, bisexual orientation, and receiving AIDS interventions were risk factors for high-risk sexual behaviors, while college or higher degree was a protective factor. We determined that HIV transmission factors are widespread, and the rate of HIV testing is relatively low. Attention should be given to marital status, using substances to adjust psychiatric disorders, or bisexual HIV-negative MSM, and AIDS interventions should be strengthened to promote HIV testing and reduce high-risk behaviors.
Collapse
|
15
|
Badawi MM, SalahEldin MA, Idris AB, Hasabo EA, Osman ZH, Osman WM. Knowledge gaps of STIs in Africa; Systematic review. PLoS One 2019; 14:e0213224. [PMID: 31513584 PMCID: PMC6742237 DOI: 10.1371/journal.pone.0213224] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 08/20/2019] [Indexed: 12/25/2022] Open
Abstract
Sexually Transmitted Infections (STIs) are ambiguous burden of tremendous health, social and economic consequences. The current systematic review was conducted in order to determine awareness and knowledge of Africans toward sexually transmitted infections, not only concerning HIV/AIDS, but also other STIs such as gonorrhea, syphilis, HBV, HCV and HPV. A systematic review of literature was conducted, studies were retrieved and selected after fulfilling the inclusion criteria as well as passing the assessment procedure. Related data was extracted, quantitative analysis was conducted among participants who responded to questions related to HIV, HBV, HCV, HPV or STIs knowledge, sensitivity analysis as well as subgroup analysis were also conducted. Seventy four articles addressing knowledge among 35 African countries were included and 136 questions were analyzed and synthesized. The question "does using condom reduces HIV transmission?" was answered by 1,316,873 Africans in 35 countries, 66.8% [95% Cl; 62.6, 70.9] answered yes. While the question "is sexual contact a possible route of HBV transmission?" was answered by 7,490 participants in 5 countries; 42.5% [95% Cl; 20.4, 64.7] answered yes. The differences observed among populations are highlighting the possibility for improvement by directing light toward specific populations as well as addressing specific awareness knowledge to ensure that the general as well as the related specific preventive knowledge is improved.
Collapse
Affiliation(s)
- Marwan M. Badawi
- Medical Unit, Higher Academy for Strategic and Security Studies, Alamal Hospital, Khartoum, Sudan
| | - Maryam A. SalahEldin
- Medical Microbiology Department, Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan
| | - Alaa B. Idris
- Faculty of Medicine, University of Bahri, Khartoum, Sudan
| | | | - Zeinab H. Osman
- Faculty of Medical Laboratory Sciences, Sudan International University, Khartoum, Sudan
| | - Widad M. Osman
- Faculty of Medicine, National Ribat University, Khartoum, Sudan
| |
Collapse
|
16
|
Kahle EM, Suarez N, Sharma A, Sullivan S, Stephenson R. Threat and impact of HIV compared to other health conditions among an online sample of gay, bisexual and other men who have sex with men in the U.S. AIDS Care 2019; 32:608-615. [PMID: 31167542 DOI: 10.1080/09540121.2019.1626341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Gay, bisexual and other men who have sex with men (GBMSM) experience greater health disparities, and concern about other health conditions may decrease engagement in HIV prevention. This study assessed perceived threat and impact of HIV relative to other health concerns among GBMSM. Data were from a national online survey of GBMSM conducted between August and September 2015. Participants ranked concern about contracting HIV and impact of HIV on their health compared with other health conditions. The association of HIV threat and impact with recent condomless anal sex (CAS) and HIV testing were assessed using regression models. Among 466 participants, threat and impact of HIV were ranked lower compared to cancer, Alzheimer's and heart disease. Concern about getting HIV was associated with greater odds of recent HIV testing (adjOR 1.1, 95%CI 1.02-1.18) and lower CAS (adjOR 0.86, 95%CI 0.78-0.94). Among GBMSM, other health conditions may be perceived as a greater threat and higher impact on health compared with HIV. Integrating complex health care concerns with HIV prevention strategies may increase engagement in prevention.
Collapse
Affiliation(s)
- Erin M Kahle
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas Suarez
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Akshay Sharma
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Stephen Sullivan
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
17
|
Freeborn K, Portillo C, Boyer CB, Santos GM. Misclassification of sexual health risks in a self-identified low risk cohort of men who have sex with men (MSM) enrolled in a community based PrEP program. AIDS Care 2019; 32:230-237. [PMID: 31129982 DOI: 10.1080/09540121.2019.1620167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The CDC recommends PrEP for MSM at substantial risk of HIV acquisition, leaving clinicians unsure whether to prescribe PrEP to MSM who do not disclose HIV risk factors. A longitudinal cohort of MSM requesting PrEP despite reporting during a clinical visit either 100% condom use or participation in oral sex only and no other risk factors was followed over 13 months at a community clinic in San Francisco to assess the accuracy of their HIV risk perception. Participants completed a sexual and substance use behavior questionnaire at baseline, outside of the clinical visit and were followed by quarterly HIV/STI testing and condom use change questionnaires. Condomless sex increased from 0% at baseline to 12% at month 1, peaked at 34% at month 7, and then decreased again to 8% at month 13. Rates of pharyngeal GC/CT varied from 7% at baseline to 12% at month 13, while rectal GC/CT decreased from 6% at baseline to 0% at month 13. The rate of syphilis was 1% both at baseline and at month 13, however, 11% and 15% of clients tested positive for syphilis at months 1 and 7 respectively.
Collapse
Affiliation(s)
- Kellie Freeborn
- Division of Global Women's Health, Department of Obstetrics and Gynecology, The University of North Carolina, Chapel Hill, NC, USA
| | | | - Cherie B Boyer
- San Francisco Division of Adolescent and Young Adult Medicine, Department of Pediatrics UCSF Benioff Children's Hospital San Francisco, University of California, San Francisco, CA, USA
| | - Glen Milo Santos
- School of Nursing, Department of Community Health Systems, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
18
|
Blumenthal J, Jain S, Mulvihill E, Sun S, Hanashiro M, Ellorin E, Graber S, Haubrich R, Morris S. Perceived Versus Calculated HIV Risk: Implications for Pre-exposure Prophylaxis Uptake in a Randomized Trial of Men Who Have Sex With Men. J Acquir Immune Defic Syndr 2019; 80:e23-e29. [PMID: 30422909 PMCID: PMC6331232 DOI: 10.1097/qai.0000000000001888] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Inaccurate HIV risk perception by men who have sex with men is a barrier to HIV prevention. Providing information about objective HIV risk could improve pre-exposure prophylaxis (PrEP) uptake. METHODS PrEP Accessibility Research & Evaluation 2 (PrEPARE2) was a randomized controlled trial of men who have sex with men to determine whether an objective risk score affects future PrEP uptake. Participants completed a baseline survey to assess demographics, risk behaviors, and HIV self-perceived risk (SPR). The survey generated a calculated HIV risk (CalcR) score, estimating HIV risk based on reported condomless anal intercourse and sexually transmitted infections, and was provided to individuals in the intervention arm. Participants were contacted 8 weeks later to determine whether they initiated PrEP. RESULTS Of 171 participants (median age 32 years; 37% Hispanic or non-Hispanic Black; median 5 sexual partners in the past 6 months), 81% had heard of PrEP, and 57% believed they were good PrEP candidates. SPR had poor agreement with CalcR (kappa = 0.176) with 38% underestimating their HIV risk. At week 8, only 14 of 135 participants had initiated PrEP with no difference between arms (CalcR 11%, control 10%, P > 0.99). The most common reason for not starting PrEP was low HIV risk perception. There was a relative decrease in SPR over time (P = 0.06) but no difference between arms (P = 0.29). CONCLUSION Providing an objective HIV risk score alone did not increase PrEP uptake. HIV testing performed at testing sites may be a crucial time to correct misperceptions about risk and initiate same-day PrEP, given enthusiasm for PrEP on the testing day to facilitate greater uptake.
Collapse
Affiliation(s)
| | - Sonia Jain
- University of California, San Diego, La Jolla, CA
| | | | - Shelly Sun
- University of California, San Diego, La Jolla, CA
| | | | - Eric Ellorin
- University of California, San Diego, La Jolla, CA
| | - Sara Graber
- University of California, San Diego, La Jolla, CA
| | | | | |
Collapse
|
19
|
Scholten M, Suárez I, Platten M, Kümmerle T, Jung N, Wyen C, Ernst A, Horn C, Burst V, Suárez V, Rybniker J, Fätkenheuer G, Lehmann C. To prescribe, or not to prescribe: decision making in HIV-1 post-exposure prophylaxis. HIV Med 2018; 19:645-653. [PMID: 29993176 DOI: 10.1111/hiv.12645] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We investigated the trend in usage of post-exposure prophylaxis (PEP) after HIV-1 risk exposure and evaluated PEP prescription decision making of physicians according to guidelines. METHODS All PEP consultations from January 2014 to December 2016 in patients presenting at the University Hospital of Cologne (Germany) were retrospectively analysed. HIV risk contacts included sexual and occupational exposure. The European AIDS Clinical Society (EACS) Guidelines for HIV PEP (version 9.0, 2017) were used for assessment. RESULTS A total of 649 patients presented at the emergency department (ED) or the clinic for infectious diseases (IDC) for PEP consultations. A continuous increase in the number of PEP requests was recorded: 189 in 2014, 208 in 2015 and 252 in 2016. PEP consultations in men who have sex with men (MSM) showed a remarkable increase in 2016 (2014, n = 96; 2015, n = 101; 2016, n = 152). Decisions taken by physicians with a specialization in infectious diseases (n = 547) included 61 (11%) guideline-discordant prescriptions [2014: 14% (n = 22); 2015: 9% (n = 16); 2016: 11% (n = 23)]. Among these, sexual exposure accounted for 45 (74%) cases, including 15 cases of nonconsensual sex, while occupational exposure accounted for 14 (23%) cases and other exposure two cases (3%). The main reason for guideline-discordant PEP prescriptions was emotional stress of the patient (n = 37/61). CONCLUSIONS PEP prescriptions are increasing and decision making is influenced by patients' emotional stress, but PEP prescriptions should be strictly administered according to risk assessment.
Collapse
Affiliation(s)
- M Scholten
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - I Suárez
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - M Platten
- Department I of Internal Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF) Partner Site Bonn-Cologne, Cologne, Germany
| | - T Kümmerle
- Department I of Internal Medicine, University of Cologne, Cologne, Germany.,Practice Ebertplatz, Cologne, Germany
| | - N Jung
- Department I of Internal Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF) Partner Site Bonn-Cologne, Cologne, Germany
| | - C Wyen
- Department I of Internal Medicine, University of Cologne, Cologne, Germany.,Practice Ebertplatz, Cologne, Germany
| | - A Ernst
- Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - C Horn
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - V Burst
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - V Suárez
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - J Rybniker
- Department I of Internal Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF) Partner Site Bonn-Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - G Fätkenheuer
- Department I of Internal Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF) Partner Site Bonn-Cologne, Cologne, Germany
| | - C Lehmann
- Department I of Internal Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF) Partner Site Bonn-Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| |
Collapse
|
20
|
Affiliation(s)
- Joseph Brennan
- University of Sydney, Media and Communications, Sydney, 2006 Australia
| |
Collapse
|