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Lauckner C, Haney K, Sesenu F, Kershaw T. Interventions to Reduce Alcohol Use and HIV Risk among Sexual and Gender Minority Populations: a Systematic Review. Curr HIV/AIDS Rep 2023; 20:231-250. [PMID: 37225923 PMCID: PMC10436179 DOI: 10.1007/s11904-023-00660-2] [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: 05/08/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE OF REVIEW Sexual and gender minority (SGM) individuals are diagnosed with HIV at disproportionate rates, and hazardous alcohol use can increase their HIV risk. This review assessed the state of the literature examining interventions for addressing alcohol use and sexual HIV risk behaviors among SGM individuals. RECENT FINDINGS Fourteen manuscripts from 2012 to 2022 tested interventions that address both alcohol use and HIV risk behaviors among SGM populations, with only 7 randomized controlled trials (RCTs). Virtually all the interventions targeted men who have sex with men, with none focused on transgender populations or cisgender women. While they demonstrated some evidence of effectiveness in reducing alcohol use and/or sexual risk, the outcomes varied widely between studies. More research is needed that tests interventions in this area, particularly for transgender individuals. The use of larger-scale RCTs with diverse populations and standardized outcome measures are needed to strengthen the evidence base.
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Affiliation(s)
- Carolyn Lauckner
- Center for Health Equity Transformation, University of Kentucky, 465 Healthy Kentucky Research Bldg, 760 Press Ave., Lexington, KY, 40536, USA.
| | - Kimberly Haney
- Center for Health Equity Transformation, University of Kentucky, 465 Healthy Kentucky Research Bldg, 760 Press Ave., Lexington, KY, 40536, USA
| | - Fidelis Sesenu
- Center for Health Equity Transformation, University of Kentucky, 465 Healthy Kentucky Research Bldg, 760 Press Ave., Lexington, KY, 40536, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Brousseau NM, Driver R, Simon K, Watson RJ, Earnshaw VA, Chandler CJ, Kalichman S, Eaton LA. PrEP-Related Interactive Toxicity Beliefs: Associations With Stigma, Substance Use, and PrEP Uptake. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:114-125. [PMID: 37129594 DOI: 10.1521/aeap.2023.35.2.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Despite documented efficacy in reducing HIV transmission, pre-exposure prophylaxis (PrEP) uptake among Black sexual minority men (BSMM) is limited. One understudied factor which may impede PrEP uptake is PrEP-related interactive toxicity beliefs (i.e., believing it is hazardous to use alcohol/drugs while taking PrEP). Data from N = 169 HIV negative BSMM over 4 months showed high rates of agreement with at least one alcohol (78%) or drug (84%) interactive toxicity belief. Univariate analyses showed increased alcohol or drug interactive toxicity beliefs predicted lower PrEP uptake. Multivariable regression suggested those with PrEP-related alcohol or drug interactive toxicity beliefs were more likely to report high PrEP stigma, more negative PrEP beliefs (e.g., concern that taking PrEP disrupts life), and were more likely to use alcohol/drugs (respectively) prior to/during sex. Findings warrant intervention work targeting interactive toxicity beliefs with tailored messaging to mitigate PrEP stigma and correct concerns around substance use and PrEP.
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Affiliation(s)
- Natalie M Brousseau
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut
| | - Redd Driver
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, New York
| | - Kay Simon
- Department of Family Social Science, University of Minnesota, St. Paul, Minnesota
| | - Ryan J Watson
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware
| | - Cristian J Chandler
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Seth Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut
| | - Lisa A Eaton
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut
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3
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Watson RJ, Morgan E, Collibee C, Kalinowski J, Cunningham C, Edelman EJ, Chan P, Eaton LA. Substance Use and Healthcare Utilization Across the Pre-Exposure Prophylaxis (PrEP) Care Cascade among Black and Latino Men Who Have Sex with Men. Subst Use Misuse 2022; 57:1698-1707. [PMID: 35938746 PMCID: PMC9554788 DOI: 10.1080/10826084.2022.2108059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Background: Despite the documented efficacy of pre-exposure prophylaxis (PrEP) for HIV prevention, large disparities in uptake and adherence exist among Black and Latino/Hispanic men who have sex with men (BLMSM). Limited data exists among BLMSM on the impact of substance use at different stages of the PrEP Care Cascade. We examined the ways substance (alcohol, cannabis, other drug) use is related to PrEP experiences across the PrEP Care Cascade (PrEP aware/no use; PrEP use/discontinuation; PrEP use/adherent).Methods: We utilized data from a national sample of 908 BLMSM (Mage = 25.17, range: 18-29), collected between February and October 2020.Results: We found that heavier alcohol use, more other drug (e.g., cocaine) use, more participant healthcare utilization, and higher number of partners across all measures of substance use were separately associated with a lower likelihood of being aware of PrEP. These same factors were also associated with a higher likelihood of PrEP adherence. Conversely, only cannabis use was associated with discontinuation of PrEP use.Conclusions: While we confirm some earlier findings (i.e., alcohol use is associated with both PrEP discontinuation and PrEP use), we newly identify cannabis as a barrier to the adherence of PrEP. Our findings highlight the need for improved PrEP interventions to increase awareness among BLMSM with substance use who are among the most at-risk for HIV infection.
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Affiliation(s)
- Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Ethan Morgan
- College of Nursing, Infectious Disease Institute, The Ohio State University, Columbus, Ohio, USA
| | - Charlene Collibee
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jolaade Kalinowski
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Casey Cunningham
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - E Jennifer Edelman
- Program in Addiction Medicine, Yale School of Medicine and Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut, USA
| | - Philip Chan
- Department of Medicine, Brown University, Providence, Rhode Island, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
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Wray TB, Chan PA, Guigayoma JP, Kahler CW. Game Plan-a Brief Web-Based Intervention to Improve Uptake and Use of HIV Pre-exposure Prophylaxis (PrEP) and Reduce Alcohol Use Among Gay and Bisexual Men: Content Analysis. JMIR Form Res 2022; 6:e30408. [PMID: 34989679 PMCID: PMC8771347 DOI: 10.2196/30408] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 10/18/2021] [Accepted: 11/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background HIV pre-exposure prophylaxis (PrEP) has considerable potential for reducing incidence among high-risk groups, such as gay, bisexual, and other men who have sex with men (GBM). However, PrEP’s effectiveness is closely linked with consistent use, and a variety of individual-level barriers, including alcohol use, could impede optimal uptake and use. Web-based interventions can encourage medication adherence, HIV prevention behaviors, and responsible drinking and may help support PrEP care, particularly in resource-limited settings. Objective We previously developed a web application called Game Plan that was designed to encourage heavy drinking GBM to use HIV prevention methods and reduce their alcohol use and was inspired by brief motivational interventions. This paper aims to describe the web-based content we designed for integration into Game Plan to help encourage PrEP uptake and consistent use among GBM. In this paper, we also aim to describe this content and its rationale. Methods Similar to the original site, these components were developed iteratively, guided by a thorough user-centered design process involving consultation with subject-matter experts, usability interviews and surveys, and user experience surveys. Results In addition to Game Plan’s pre-existing content, the additional PrEP components provide specific, personal, and digestible feedback to users about their level of risk for HIV without PrEP and illustrate how much consistent PrEP use could reduce it; personal feedback about their risk for common sexually transmitted infections to address low-risk perceptions; content challenging common beliefs and misconceptions about PrEP to reduce stigma; content confronting familiar PrEP and alcohol beliefs; and a change planning module that allows users to select specific goals for starting and strategies for consistent PrEP use. Users can opt into a weekly 2-way SMS text messaging program that provides similar feedback over a 12-week period after using Game Plan and follows up on the goals they set. Conclusions Research preliminarily testing the efficacy of these components in improving PrEP outcomes, including uptake, adherence, sexually transmitted infection rates, and alcohol use, is currently ongoing. If supported, these components could provide a scalable tool that can be used in resource-limited settings in which face-to-face intervention is difficult.
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Affiliation(s)
- Tyler B Wray
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
| | - Philip A Chan
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - John P Guigayoma
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
| | - Christopher W Kahler
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
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George WH, Blayney JA, Stappenbeck CA, Davis KC. The Role of Alcohol-Related Behavioral Risk in the Design of HIV Prevention Interventions in the Era of Antiretrovirals: Alcohol Challenge Studies and Research Agenda. AIDS Behav 2021; 25:347-364. [PMID: 34244871 DOI: 10.1007/s10461-021-03351-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/29/2022]
Abstract
HIV/AIDS remains a significant health threat and alcohol is a robust contributing factor. After 25 years of alcohol challenge studies investigating alcohol-related behavioral risk (ARBR), much has been learned delineating how drinking influences sexual transmission. We examine this research and consider its relevance for interventions in the era of antiretrovirals. We consider prototypic alcohol challenge methods, illustrative findings, and prevention/intervention implications, noting three perspectives: (a) scale up/extend existing interventions, including identifying under-targeted risk groups and intersecting with PrEP/PEP interventions; (b) modify existing interventions by cultivating psychoeducational content related to alcohol expectancies, alcohol myopia, sexual arousal, risk perception, sexual abdication, and condom use resistance; and (c) innovate new interventions through Science of Behavior Change approaches and repurposing ARBR paradigms. Finally, we suggest research directions concluding that until HIV incidence diminishes significantly, psychosocial interventions addressing the nexus of alcohol use, sexual transmission, and adherence to biomedical protocols will be an important priority.
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Affiliation(s)
- William H George
- Department of Psychology, University of Washington, Box 351525, Seattle, WA, 98195-1525, USA.
| | - Jessica A Blayney
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Cynthia A Stappenbeck
- Department of Psychology, Center for Research on Interpersonal Violence, Georgia State University, Atlanta, GA, USA
| | - Kelly Cue Davis
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
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6
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Wray TB, Chan PA, Kahler CW. Game Plan, a Web-Based Intervention to Improve Adherence and Persistence to HIV Pre-exposure Prophylaxis and Reduce Heavy Drinking in Gay, Bisexual, and Other Men Who Have Sex With Men: Usability and User Experience Testing. JMIR Form Res 2021; 5:e31843. [PMID: 34783662 PMCID: PMC8663613 DOI: 10.2196/31843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/08/2021] [Accepted: 09/26/2021] [Indexed: 12/31/2022] Open
Abstract
Background Encouraging consistent use of pre-exposure prophylaxis (PrEP) is essential for reducing HIV incidence, particularly among gay, bisexual, and other men who have sex with men (GBM), and especially those who engage in heavy drinking. Although practice guidelines recommend providing adherence counseling to PrEP patients, clinics and providers may not have the resources or expertise to provide it. Internet-facilitated interventions have been shown to improve HIV prevention outcomes, including medication and care adherence. Game Plan is a website we created to help users make a tangible plan for reducing their HIV risk. We designed additional components of Game Plan to address key individual level barriers to PrEP use. Objective The aim of this mixed methods research is to test the usability and user experience of these components with intended users: GBM who drink heavily and are on PrEP. Methods In study 1 (usability), we completed a detailed individual interview in which participants (n=10) walked through a prototype of the website, thinking aloud as they did, and completed a follow-up interview and web-based survey afterward. Study 2 (user experience) involved providing participants (n=40) with a link to the prototype website to explore on their own and asking them to complete the same follow-up survey afterward. Qualitative data were analyzed using thematic analysis, and descriptive statistics were used to analyze quantitative data. Results Users in both studies gave the website excellent ratings for usability, overall satisfaction, and quality, and most often described the site as informative, helpful, and supportive. Users also rated the site’s content and feel as respectful of them and their autonomy, empathetic, and they stated that it conveyed confidence in their ability to change. The study 1 interviews highlighted the importance of the website’s esthetics to the participants’ engagement with it and its credibility in prompting genuine reflection. Conclusions GBM who reported heavy drinking and used PrEP generally found a website focused on helping them to create a plan to use PrEP consistently to be helpful. Adopting user-centered design methods and attending to the esthetics of mobile health interventions are important steps toward encouraging engagement and reducing at-risk behaviors.
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Affiliation(s)
- Tyler B Wray
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Philip A Chan
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Christopher W Kahler
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
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Addressing Unhealthy Alcohol Use and the HIV Pre-exposure Prophylaxis Care Continuum in Primary Care: A Scoping Review. AIDS Behav 2021; 25:1777-1789. [PMID: 33219492 DOI: 10.1007/s10461-020-03107-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 12/19/2022]
Abstract
Individuals with unhealthy alcohol use are at increased risk for HIV acquisition and may benefit from receiving HIV pre-exposure prophylaxis (PrEP) in primary care settings. To date, literature synthesizing what is known about the impact of unhealthy alcohol use on the PrEP care continuum with a focus on considerations for primary care is lacking. We searched OVID Medline and Web of Science from inception through March 19, 2020, to examine the extent, range, and nature of research on PrEP delivery among individuals with unhealthy alcohol use in primary care settings. We identified barriers and opportunities at each step along the PrEP care continuum, including for specific populations: adolescents, people who inject drugs, sex workers, and transgender persons. Future research should focus on identification of candidate patients, opportunities for patient engagement in novel settings, PrEP implementation strategies, and stigma reduction.
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Sousa LRM, Elias HC, Fernandes NM, Gir E, Reis RK. Knowledge of PEP and PrEP among people living with HIV/aids in Brazil. BMC Public Health 2021; 21:64. [PMID: 33413241 PMCID: PMC7788867 DOI: 10.1186/s12889-020-10135-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 12/27/2020] [Indexed: 11/18/2022] Open
Abstract
Background Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) are key to preventing sexual transmission of HIV, whose sexual partners are at high risk of acquiring HIV. We aimed to determine the factors associated with PrEP and PEP’s knowledge as secondary prevention among people living with HIV/AIDS. Method Cross-sectional analytical study carried out among people living with HIV/AIDS treated at five specialized services in the city of Ribeirão Preto, São Paulo, Brazil. Data were collected from July 2016 to July 2017. Individual interviews were conducted. We used multivariable logistic regression to determine factors associated with knowing PrEP and PEP. Results Of the 397 participants, 140 (35.26%) were heterosexual women aged 40 to 49 years (36.2%).Participants with less than 11 years of study (adjusted odds: 0.29; 95% CI: 0.13–0.60); who did not have a low viral load or did not know their viral load (adjusted odds: 0.29; 95% CI: 0.09–0.83) and those with casual partners (adjusted odds: 0.29; 95% CI: 0.09–0.83) were less likely to know about the PrEP. MSM (adjusted odds: 2.88; 95% CI: 1.59–5.3) and those who used alcohol during sexual intercourse (adjusted odds: 1.7; 95% CI: 1.0–2.8) were more likely to know about the PEP. Conclusions The knowledge about PEP and PrEP is low in Brazil. This may undermine secondary prevention efforts. Educational interventions to raise awareness of these prevention methods are needed among people living with HIV and who have HIV-negative sexual partners.
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Affiliation(s)
- Laelson Rochelle Milanês Sousa
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, R. Prof. Hélio Lourenço, 3900, Vila Monte Alegre, Ribeirão Preto, SP, CEP: 14040-902, Brazil.
| | - Henrique Ciabotti Elias
- Department of Nursing, Federal University of TriânguloMineiro, Uberaba, Minas Gerais, Brazil
| | - Nilo Martinez Fernandes
- Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Elucir Gir
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, R. Prof. Hélio Lourenço, 3900, Vila Monte Alegre, Ribeirão Preto, SP, CEP: 14040-902, Brazil
| | - Renata Karina Reis
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, R. Prof. Hélio Lourenço, 3900, Vila Monte Alegre, Ribeirão Preto, SP, CEP: 14040-902, Brazil
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Shuper PA, Joharchi N, Bogoch II, Loutfy M, Crouzat F, El-Helou P, Knox DC, Woodward K, Rehm J. Alcohol consumption, substance use, and depression in relation to HIV Pre-Exposure Prophylaxis (PrEP) nonadherence among gay, bisexual, and other men-who-have-sex-with-men. BMC Public Health 2020; 20:1782. [PMID: 33256651 PMCID: PMC7706215 DOI: 10.1186/s12889-020-09883-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/12/2020] [Indexed: 11/29/2022] Open
Abstract
Background Although HIV pre-exposure prophylaxis (PrEP) substantially diminishes the likelihood of HIV acquisition, poor adherence can decrease the HIV-protective benefits of PrEP. The present investigation sought to identify the extent to which alcohol consumption, substance use, and depression were linked to PrEP nonadherence among gay, bisexual, and other men-who-have-sex-with-men (gbMSM). Methods gbMSM (age ≥ 18, prescribed PrEP for ≥3 months) were recruited from two clinics in Toronto, Canada for an e-survey assessing demographics; PrEP nonadherence (4-day PrEP-focused ACTG assessment); hazardous and harmful alcohol use (AUDIT scores of 8–15 and 16+, respectively); moderate/high risk substance use (NIDA M-ASSIST scores > 4); depression (CESD-10 scores ≥10); and other PrEP-relevant factors. The primary outcome, PrEP nonadherence, entailed missing one or more PrEP doses over the past 4 days. A linear-by-linear test of association assessed whether increasing severity of alcohol use (i.e., based on AUDIT categories) was linked to a greater occurrence of PrEP nonadherence. Univariate logistic regression was employed to determine factors associated with PrEP nonadherence, and factors demonstrating univariate associations at the p < .10 significance level were included in a multivariate logistic regression model. Additive and interactive effects involving key significant factors were assessed through logistic regression to evaluate potential syndemic-focused associations. Results A total of 141 gbMSM (Mean age = 37.9, white = 63.1%) completed the e-survey. Hazardous/harmful drinking (31.9%), moderate/high risk substance use (43.3%), and depression (23.7%) were common; and one in five participants (19.9%) reported PrEP nonadherence. Increasing alcohol use level was significantly associated with a greater likelihood of nonadherence (i.e., 15.6, 25.0, and 44.4% of low-risk, hazardous, and harmful drinkers reported nonadherence, respectively (χ2(1) = 4.79, p = .029)). Multivariate logistic regression demonstrated that harmful alcohol use (AOR = 6.72, 95%CI = 1.49–30.33, p = .013) and moderate/high risk cocaine use (AOR = 3.11, 95%CI = 1.01–9.59, p = .049) independently predicted nonadherence. Furthermore, an additive association emerged, wherein the likelihood of PrEP nonadherence was highest among those who were hazardous/harmful drinkers and moderate/high risk cocaine users (OR = 2.25, 95%CI = 1.19–4.25, p = .013). Depression was not associated with nonadherence. Conclusions Findings highlight the need to integrate alcohol- and substance-focused initiatives into PrEP care for gbMSM. Such initiatives, in turn, may help improve PrEP adherence and reduce the potential for HIV acquisition among this group.
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Affiliation(s)
- Paul A Shuper
- Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, ON, M5S 2S1, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada.
| | - Narges Joharchi
- Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, ON, M5S 2S1, Canada
| | - Isaac I Bogoch
- Divisions of General Internal Medicine and Infectious Diseases, University Health Network, 200 Elizabeth St., Toronto, ON, M5G 2C4, Canada.,Department of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Mona Loutfy
- Department of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada.,Maple Leaf Medical Clinic, 14 College St., Toronto, ON, M5G 1K2, Canada
| | - Frederic Crouzat
- Maple Leaf Medical Clinic, 14 College St., Toronto, ON, M5G 1K2, Canada
| | - Philippe El-Helou
- Department of Medicine, Division of Infectious Diseases, McMaster University, 1200 Main St. W., Hamilton, ON, L8N 3Z5, Canada
| | - David C Knox
- Maple Leaf Medical Clinic, 14 College St., Toronto, ON, M5G 1K2, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Ave., Toronto, ON, M5G 1V7, Canada
| | - Kevin Woodward
- Department of Medicine, Division of Infectious Diseases, McMaster University, 1200 Main St. W., Hamilton, ON, L8N 3Z5, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, ON, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada.,Department of Psychiatry, University of Toronto, 250 College St., Toronto, ON, M5T 1R8, Canada.,PAHO/WHO Collaborating Centre for Addiction and Mental Health, 33 Russell St., Toronto, ON, M5S 2S1, Canada.,Epidemiological Research Unit, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.,Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, 01187, Dresden, Germany.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, 8-2 Trubetskaya str., Moscow, Russian Federation, 119991.,Graduate Department of Community Health and Institute of Medical Science, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
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10
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Luehring-Jones P, Palfai TP, Tahaney KD, Maisto SA, Simons J. Pre-Exposure Prophylaxis (PrEP) Use is Associated With Health Risk Behaviors Among Moderate- and Heavy-Drinking MSM. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:452-462. [PMID: 31550196 DOI: 10.1521/aeap.2019.31.5.452] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Among men who have sex with men (MSM), acute alcohol consumption is associated with higher rates of condomless anal intercourse, which is linked with a greater likelihood of exposure to HIV and other sexually transmitted infections. While pre-exposure prophylaxis (PrEP) to prevent HIV infection has become more widespread in this population in recent years, so too have concerns that PrEP uptake may be associated with health risk behaviors. This study investigated differences in sexual behaviors and drug use habits between PrEP users and nonusers in a sample of moderate- and heavy-drinking MSM. Results indicated that PrEP use was associated with riskier sexual practices, weaker self-regulatory cognitions related to condom use, and more frequent illicit drug use. These findings suggest that moderate-and heavy-drinking MSM who use PrEP may comprise a unique risk group that could benefit from targeted counseling or other interventions to reduce their risk of negative health consequences.
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Affiliation(s)
- Peter Luehring-Jones
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Tibor P Palfai
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Kelli D Tahaney
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, New York
| | - Jeffrey Simons
- Department of Psychology, University of South Dakota, Vermillion, South Dakota
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11
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Pinto RM, Lacombe-Duncan A, Kay ES, Berringer KR. Expanding Knowledge About Implementation of Pre-exposure Prophylaxis (PrEP): A Methodological Review. AIDS Behav 2019; 23:2761-2778. [PMID: 31292825 PMCID: PMC6789046 DOI: 10.1007/s10461-019-02577-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Methodological limitations in PrEP implementation studies may explain why PrEP implementation is lagging. This methodological review provides a description and critique of the methods used to identify barriers to PrEP implementation in the United States (2007-18). For each selected article, we provide: (1) research questions; (2) measures; (3) design; (4) sample (size and type); and (5) theoretical orientation. Among 79 articles which identified knowledge, attitudes, and behavioral and social/structural barriers to PrEP implementation, 51 (65%) were quantitative; 25 (32%) qualitative; and 3 (4%) were mixed-methods; overall, just one-half described a conceptual approach. About two-thirds of articles were conducted with patients and one-third with healthcare providers. Our review reveals a paucity of longitudinal, mixed-methods, and ethnographic/observational research and guiding theoretical frameworks; thus, the applicability of results are limited. We recommend that interventions aimed at PrEP implementation address barriers situated at multiple ecological domains, and thus improve PrEP access, uptake, and adherence.
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Affiliation(s)
- Rogério M Pinto
- University of Michigan, School of Social Work, Office 2850, 1080 South University, Ann Arbor, MI, 48109, USA.
| | - Ashley Lacombe-Duncan
- University of Michigan, School of Social Work, Office 2850, 1080 South University, Ann Arbor, MI, 48109, USA
| | - Emma Sophia Kay
- University of Michigan, School of Social Work, Office 2850, 1080 South University, Ann Arbor, MI, 48109, USA
| | - Kathryn R Berringer
- University of Michigan, School of Social Work, Office 2850, 1080 South University, Ann Arbor, MI, 48109, USA
- University of Michigan, Anthropology, Ann Arbor, MI, USA
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Grov C, Rendina HJ, John SA, Parsons JT. Determining the Roles that Club Drugs, Marijuana, and Heavy Drinking Play in PrEP Medication Adherence Among Gay and Bisexual Men: Implications for Treatment and Research. AIDS Behav 2019; 23:1277-1286. [PMID: 30306433 PMCID: PMC6458096 DOI: 10.1007/s10461-018-2309-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Researchers have established that substance use interferes with anti-retroviral medication adherence among gay and bisexual men (GBM) living with HIV. There is limited parallel examination of pre-exposure prophylaxis (PrEP) adherence among HIV-negative GBM. We conducted retrospective 30-day timeline follow-back interviews and prospective semi-weekly diary data for 10 weeks with 104 PrEP-using GBM, half of whom engaged in club drug use (ketamine, ecstasy, GHB, cocaine, or methamphetamine)-generating 9532 days of data. Participants reported their day-by-day PrEP, club drug, marijuana, and heavy alcohol use (5 + drinks in one sitting). On average, club drug users were no more likely to miss a dose of PrEP than non-club drug users (M = 1.6 doses, SD = 3.0, past 30 days). However, we found that club drug use (at the event level) increased the odds of missing a dose on the same day by 55% and the next day (e.g., a "carryover effect") by 60%. Further, missing a dose on one day increased the odds of missing a dose the following day by eightfold. We did not identify an event-level effect of marijuana use or heavy drinking on PrEP adherence. Our data suggest club drug users could have greater protective effects from daily oral or long-acting injectable PrEP compared to a time-driven PrEP regimen because of the concurrence of club drug use and PrEP non-adherence.
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Affiliation(s)
- Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, The CUNY Institute for Implementation Science in Population Health, 55 W 125th Street, New York, NY, 10027, USA.
| | - H Jonathon Rendina
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, USA
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
| | - Steven A John
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jeffrey T Parsons
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, USA
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
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Cortopassi AC, Driver R, Eaton LA, Kalichman SC. A New Era of HIV Risk: It's Not What You Know, It's Who You Know (and How Infectious). Annu Rev Psychol 2018; 70:673-701. [PMID: 30256719 DOI: 10.1146/annurev-psych-010418-102927] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
HIV is transmitted in social and sexual relationships, and HIV transmission risks, as well as protective actions, are evolving as HIV epidemics unfold. The current focus of HIV prevention is centered on antiretroviral medications used to reduce HIV infectiousness in persons already infected with HIV [treatment as prevention (TasP)]. The same medications used to treat infected persons can also be used by uninfected persons as pre-exposure prophylaxis (PrEP) to reduce the infectivity of HIV. Both PrEP and TasP are effective when adherence is high and individuals do not have co-occurring sexually transmitted infections. HIV prevention is most effective and efficient when delivered within sexual networks with high HIV prevalence. Specific network characteristics are recognized as important facilitators of HIV transmission; these characteristics include the degree of similarity among network members (homophily), gender role norms, and belief systems. Since 2011, HIV risk has been redefined based on infectiousness and infectivity, ushering in a new era of HIV prevention with the potential to end HIV epidemics.
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Affiliation(s)
- Andrew C Cortopassi
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut 06269, USA;
| | - Redd Driver
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut 06269, USA;
| | - Lisa A Eaton
- Department of Human Development and Family Studies, University of Connecticut, Storrs, Connecticut 06269, USA
| | - Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut 06269, USA;
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