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Palich R, Rodger AJ, Nicholls EJ, Wright T, Samba P, Chu IYH, Burns FM, Weatherburn P, Trevelion R, McCabe L, Witzel TC. Experiences with health care services and HIV testing after sexual assault in cisgender gay, bisexual and other men who have sex with men and transgender people. HIV Med 2024. [PMID: 38433523 DOI: 10.1111/hiv.13629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES This qualitative sub-study aimed to explore how cisgender gay, bisexual, and other men who have sex with men (cis-GBMSM) and transgender people who reported non-consensual sex (NCS) accessed health care services, what barriers they faced, and how this experience influenced subsequent HIV testing. METHODS SELPHI is an online randomized controlled trial evaluating both acceptability and efficiency of HIV-self testing among cis-GBMSM and transgender people. Semi-structured interviews were conducted, audio-recorded, transcribed, and analysed through a framework analysis, as a qualitative sub-study. We identified narratives of NCS from interviews and investigated experiences of cis-GBMSM and transgender people accessing health care services following sexual assault. RESULTS Of 95 participants, 15 (16%) spontaneously reported NCS. Participants reported a broad range of NCS, including partner's coercive behaviours, non-consensual removal of condoms, and rapes. All feared HIV transmission, leading them to test for HIV, underlining a marked lack of awareness of post-exposure prophylaxis (PEP). Most had negative experiences in communicating with reception staff in sexual health clinics following these incidents. A lack of confidentiality and empathy was described in these situations of psychological distress. Clinic visits were primarily focused on testing for HIV and sexually transmitted infection, and generally no specific psychological support was offered. Getting a negative HIV result was a key step in regaining control for people who experienced NCS. CONCLUSIONS Sexual health care providers should take care to more fully address the issue of NCS with cis-GBMSM and transgender people when it arises. Recognizing and managing the emotional impact of NCS on affected patients would prevent negative experiences and increase confidence in care.
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Affiliation(s)
- Romain Palich
- University College London, Institute for Global Health, Royal Free Hospital, NHS, London, UK
| | - Alison J Rodger
- University College London, Institute for Global Health, Royal Free Hospital, NHS, London, UK
| | - Emily Jay Nicholls
- University College London, Institute for Global Health, Royal Free Hospital, NHS, London, UK
| | - Talen Wright
- University College London, Division of Psychiatry, London, UK
| | | | - Isaac Yen-Hao Chu
- University College London, Institute for Global Health, Royal Free Hospital, NHS, London, UK
- London School of Hygiene and Tropical Medicine, Department of Public Health, Environments and Society, London, UK
| | - Fiona M Burns
- University College London, Institute for Global Health, Royal Free Hospital, NHS, London, UK
| | - Peter Weatherburn
- London School of Hygiene and Tropical Medicine, Department of Public Health, Environments and Society, London, UK
| | | | - Leanne McCabe
- University College London, MRC Clinical Trials Unit, London, UK
| | - T Charles Witzel
- University College London, Institute for Global Health, Royal Free Hospital, NHS, London, UK
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Witzel TC, Nicholls EJ, McCabe L, Weatherburn P, McCormack S, Bonell C, Gafos M, Lampe FC, Speakman A, Dunn D, Ward D, Phillips AN, Pebody R, Gabriel MM, Collaco-Moraes Y, Rodger AJ, Burns FM. Understanding experiences of potential harm among MSM (cis and trans) using HIV self-testing in the SELPHI randomised controlled trial in England and Wales: a mixed-methods study. Sex Transm Infect 2023; 99:534-540. [PMID: 37607814 PMCID: PMC10715485 DOI: 10.1136/sextrans-2023-055840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/15/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND The potential of HIV self-testing (HIVST) to cause harm is a concern hindering widespread implementation. The aim of this paper is to understand the relationship between HIVST and harm in SELPHI (An HIV Self-testing Public Health Intervention), the largest randomised trial of HIVST in a high-income country to date. METHODS 10 111 cis and trans men who have sex with men (MSM) recruited online (geolocation social/sexual networking apps, social media), aged 16+, reporting previous anal intercourse and resident in England or Wales were first randomised 60/40 to baseline HIVST (baseline testing, BT) or not (no baseline testing, nBT) (randomisation A). BT participants reporting negative baseline test, sexual risk at 3 months and interest in further HIVST were randomised to three-monthly HIVST (repeat testing, RT) or not (no repeat testing, nRT) (randomisation B). All received an exit survey collecting data on harms (to relationships, well-being, false results or being pressured/persuaded to test). Nine participants reporting harm were interviewed in-depth about their experiences in an exploratory substudy; qualitative data were analysed narratively. RESULTS Baseline: predominantly cis MSM, 90% white, 88% gay, 47% university educated and 7% current/former pre-exposure prophylaxis (PrEP) users. Final survey response rate was: nBT=26% (1056/4062), BT=45% (1674/3741), nRT=41% (471/1147), RT=50% (581/1161).Harms were rare and reported by 4% (n=138/3691) in exit surveys, with an additional two false positive results captured in other study surveys. 1% reported harm to relationships and to well-being in BT, nRT and RT combined. In all arms combined, being pressured or persuaded to test was reported by 1% (n=54/3678) and false positive results in 0.7% (n=34/4665).Qualitative analysis revealed harms arose from the kit itself (technological harms), the intervention (intervention harms) or from the social context of the participant (socially emergent harms). Intervention and socially emergent harms did not reduce HIVST acceptability, whereas technological harms did. DISCUSSION HIVST harms were rare but strategies to link individuals experiencing harms with psychosocial support should be considered for HIVST scale-up. TRIAL REGISTRATION NUMBER ISRCTN20312003.
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Affiliation(s)
- T Charles Witzel
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Institute for Global Health, University College London, London, UK
| | | | - Leanne McCabe
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Peter Weatherburn
- Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Christopher Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Mitzy Gafos
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Fiona C Lampe
- Institute for Global Health, University College London, London, UK
| | - Andrew Speakman
- Institute for Global Health, University College London, London, UK
| | - David Dunn
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Denise Ward
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | | | - Michelle M Gabriel
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | - Alison J Rodger
- Institute for Global Health, University College London, London, UK
| | - Fiona M Burns
- Institute for Global Health, University College London, London, UK
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Nicholls EJ, Policek N, Volny-Anne A, Spire B, Burns F, Ruiz-Burga E, Tariq S. A systematic review of qualitative research on recently acquired HIV. AIDS 2023; 37:2199-2212. [PMID: 37650757 PMCID: PMC10621639 DOI: 10.1097/qad.0000000000003697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES Recently acquired HIV is a critical time when people may experience debilitating symptoms and is when they are most likely to pass HIV on. Qualitative research offers insights into lived experiences and a deeper understanding of the contextual factors underlying HIV acquisition. We aimed to synthesize qualitative literature on recently acquired HIV. DESIGN Systematic review and textual narrative synthesis. METHODS We searched MEDLINE, CINAHL Plus, PsycINFO and Sociology Database. Articles were screened, and two authors completed full text review and data extraction. Quality appraisal was conducted (Critical Appraisal Skills Programme Qualitative Studies Checklist) and certainty of findings graded (GRADE-CERQual). RESULTS We reviewed 1890 articles (1554 following de-duplication), excluding 1539. Fifteen articles were included and an additional article was included after updating the search. We identified 15 themes, three of which we have high confidence in: recent acquisition of HIV facilitates understanding of circumstances of HIV acquisition; indeterminate HIV tests generate uncertainty and anxiety; and people with recently acquired HIV are motivated to reduce risk of onward transmission. CONCLUSIONS Our findings highlight the importance of continued research into recently acquired HIV, as well as the need for support to manage the emotional impact of indeterminate test results and negotiate risk reduction. We found no studies exploring sexual risk in the context of recently acquired HIV, or use of pre-exposure prophylaxis or treatment as prevention. The literature is primarily focused on HIV acquisition from an individual and behavioural perspective, neglecting important aspects of lived experience such as immediate ART, stigma, and health and wellbeing.
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Affiliation(s)
| | | | | | - Bruno Spire
- Aix Marseille Univ., Inserm, IRD, SESSTIM, ISSPAM, Marseille, France
| | - Fiona Burns
- Institute for Global Health, University College London, London
- Royal Free London NHS Foundation Trust, London
| | | | - Shema Tariq
- Institute for Global Health, University College London, London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
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Ruiz-Burga E, Tariq S, Touloumi G, Gill J, Nicholls EJ, Sabin C, Mussini C, Meyer L, Volny Anne A, Carlander C, Grabar S, Jarrin I, Van der Valk M, Wittkop L, Spire B, Pantazis N, Burns FM, Porter K. CASCADE protocol: exploring current viral and host characteristics, measuring clinical and patient-reported outcomes, and understanding the lived experiences and needs of individuals with recently acquired HIV infection through a multicentre mixed-methods observational study in Europe and Canada. BMJ Open 2023; 13:e070837. [PMID: 37169505 DOI: 10.1136/bmjopen-2022-070837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION Despite the availability of pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART), 21 793 people were newly diagnosed with HIV in Europe in 2019. The Concerted action on seroconversion to AIDS and death in Europe study aims to understand current drivers of the HIV epidemic; factors associated with access to, and uptake of prevention methods and ART initiation; and the experiences, needs and outcomes of people with recently acquired HIV. METHODS AND ANALYSIS This longitudinal observational study is recruiting participants aged ≥16 years with documented laboratory evidence of HIV seroconversion from clinics in Canada and six European countries. We will analyse data from medical records, self-administered questionnaires, semistructured interviews and participatory photography. We will assess temporal trends in transmitted drug resistance and viral subtype and examine outcomes following early ART initiation. We will investigate patient-reported outcomes, well-being, and experiences of, knowledge of, and attitudes to HIV preventions, including PrEP. We will analyse qualitative data thematically and triangulate quantitative and qualitative findings. As patient public involvement is central to this work, we have convened a community advisory board (CAB) comprising people living with HIV. ETHICS AND DISSEMINATION All respective research ethics committees have approval for data to contribute to international collaborations. Written informed consent is required to take part. A dissemination strategy will be developed in collaboration with CAB and the scientific committee. It will include peer-reviewed publications, conference presentations and accessible summaries of findings on the study's website, social media and via community organisations.
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Affiliation(s)
- Elisa Ruiz-Burga
- Institute for Global Health, University College London, London, UK
| | - Shema Tariq
- Institute for Global Health, University College London, London, UK
- Central and Northwest London NHS Foundation Trust, Mortimer Market Centre, London, UK
| | - Giota Touloumi
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | - John Gill
- Southern Alberta HIV Clinic, Calgary, Alberta, Canada
| | | | - Caroline Sabin
- Institute for Global Health, University College London, London, UK
| | - Cristina Mussini
- Department of Surgical, Medical, Dental and Morphological Sciences with Interest Transplant, University of Modena and Reggio Emilia, Modena, Italy
| | - Laurence Meyer
- INSERM CESP U1018, APHP Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris-Saclay University, Gif-sur-Yvette, France
| | | | - Christina Carlander
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Sophie Grabar
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, AP-HP, Hôpital St Antoine, Paris, France
| | - Inma Jarrin
- National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Infecciosas, Madrid, Spain
| | - Marc Van der Valk
- Department of Infectious Diseases, Amsterdam Infection & Immunity Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- HIV Monitoring Foundation, Amsterdam, Netherlands
| | - Linda Wittkop
- INSERM, BPH, U1219, CIC-EC 1401, Universite Bordeaux, Bordeaux, France
- INRIA SISTM Team, Talence, France
| | - Bruno Spire
- Inserm, IRD, SESSTIM, ISSPAM, Aix-Marseille Université, Marseille, France
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | - Fiona M Burns
- Institute for Global Health, University College London, London, UK
| | - Kholoud Porter
- Institute for Global Health, University College London, London, UK
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Nicholls EJ, McGowan CR, Miles S, Baxter L, Dix L, Rowlands S, McCartney D, Marston C. Provision of cervical screening for transmasculine patients: a review of clinical and programmatic guidelines. BMJ Sex Reprod Health 2023; 49:118-128. [PMID: 36344235 DOI: 10.1136/bmjsrh-2022-201526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Most cervical cancer can be prevented through routine screening. Disparities in uptake of routine screening therefore translate into disparities in cervical cancer incidence and outcomes. Transmasculine people including transgender men experience multiple barriers to cervical screening and their uptake of screening is low compared with cisgender women. Comprehensive evidence-based guidelines are needed to improve cervical screening for this group. METHODS We searched for and synthesised clinical and programmatic guidelines for the provision of cervical screening for transmasculine patients. FINDINGS The guidelines offer recommendations addressing: (1) reception, check-in and clinic facilities; (2) patient data and invitation to screening; (3) improving inclusion in screening programmes; and (4) sexual history taking, language and identity. Guidelines offer strategies for alleviating physical and psychological discomfort during cervical screening and recommendations on what to do if the screening procedure cannot be completed. Most of the guidelines were from and for high-income countries. DISCUSSION The evidence base is limited, but existing guidelines provide recommendations to ensure life-saving screening services are available to all who need them. We were only able to identify one set of guidelines for a middle-income country, and none for low-income countries. We encourage the involvement of transmasculine people in the development of future guidelines.
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Affiliation(s)
- Emily Jay Nicholls
- Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
- Institute for Global Health, University College London, London, UK
| | - Catherine R McGowan
- Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Sam Miles
- Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Louisa Baxter
- Medical Specialties Unit, Médecins Sans Frontières, Barcelona, Spain
| | - Laura Dix
- Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Daniel McCartney
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, London, UK
| | - Cicely Marston
- Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
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Nicholls EJ, Samba P, McCabe L, Gafos M, Philips AN, Trevelion R, Rodger AJ, Burns FM, Weatherburn P, Witzel TC. Experiences of and attitudes towards HIV testing for Asian, Black and Latin American men who have sex with men (MSM) in the SELPHI (HIV Self-Testing Public Health Intervention) randomized controlled trial in England and Wales: implications for HIV self-testing. BMC Public Health 2022; 22:809. [PMID: 35459233 PMCID: PMC9034480 DOI: 10.1186/s12889-022-13189-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 04/01/2022] [Indexed: 11/11/2022] Open
Abstract
Background HIV self-testing (HIVST) could play an important role in improving access to testing and therefore reducing inequalities related to late diagnosis of HIV, while also improving access to HIV prevention interventions such as HIV pre-exposure prophylaxis. This study sought to understand the potential role of HIVST by exploring the experiences of Asian, Black and Latin American men who have sex with men (MSM) accessing the gay scene and the circulation of HIV testing norms; experiences of accessing HIV testing services; HIVST acceptability and preferences for intervention adaptations. Methods Twenty-nine qualitative interviews were conducted with Asian, Black and Latin American MSM who had participated in SELPHI, an HIVST randomised controlled trial. Topics included HIV testing history, HIV testing patterns, experiences of accessing sexual health services, mental health, engagement with HIVST and SELPHI, and experiences of the gay scene. Interviews were audio recorded, transcribed and then analysed using a thematic framework. Results The gay scene was identified as an important site for learning about HIV and being exposed to norms reinforcing the importance of protective behaviours. However, experiences of discomfort due to perceptions of ‘whiteness’ on the scene or experiences of racism may hinder the protective function the scene could play in developing norms influencing HIV testing behaviour. Discomfort in clinic waiting rooms was identified as a substantial barrier to accessing clinical services and many interviewees expressed preferences regarding the personal characteristics of healthcare providers. HIVST was found to be acceptable and some interviewees suggested potential adaptations of the HIVST offer, such as packaging HIVST with at home sexually transmitted infections testing options. Conclusions HIVST responds to some service access barriers experienced by Asian, Black and Latin American MSM. The decoupling of HIV testing and clinic attendance may be particularly valuable for MSM of minority ethnic backgrounds who are likely to experience anxiety and discomfort in clinic waiting rooms more acutely than White MSM due to concerns around implied disclosure. This suggests that HIVST may have the potential to increase testing uptake and frequency, particularly for those with complex relationships with clinical services. Trial Registration SELPHI was prospectively registered with the ISRCTN (ref: ISRCTN 20312003).
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Affiliation(s)
- Emily Jay Nicholls
- Department of Public Health, Environment and Society, London School of Hygiene and Tropical Medicine, 5-17 Tavistock Place, London, WC1H 9SH, UK. .,Institute for Global Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK.
| | - Phil Samba
- Department of Public Health, Environment and Society, London School of Hygiene and Tropical Medicine, 5-17 Tavistock Place, London, WC1H 9SH, UK
| | - Leanne McCabe
- Medical Research Council Clinical Trials Unit at University College London, 90 High Holborn, London, WC1V 6LJ, UK
| | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 5-17 Tavistock Place, London, WC1H 9SH, UK
| | - Andrew N Philips
- Institute for Global Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Roy Trevelion
- HIV I-Base, 107 The Maltings, 169 Tower Bridge Road, London, SE1 3LJ, UK
| | - Alison J Rodger
- Institute for Global Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Fiona M Burns
- Institute for Global Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Peter Weatherburn
- Department of Public Health, Environment and Society, London School of Hygiene and Tropical Medicine, 5-17 Tavistock Place, London, WC1H 9SH, UK
| | - T Charles Witzel
- Department of Public Health, Environment and Society, London School of Hygiene and Tropical Medicine, 5-17 Tavistock Place, London, WC1H 9SH, UK.,Institute for Global Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
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Wright T, Nicholls EJ, Rodger AJ, Burns FM, Weatherburn P, Pebody R, McCabe L, Wolton A, Gafos M, Witzel TC. Accessing and utilising gender-affirming healthcare in England and Wales: trans and non-binary people's accounts of navigating gender identity clinics. BMC Health Serv Res 2021; 21:609. [PMID: 34182985 PMCID: PMC8240290 DOI: 10.1186/s12913-021-06661-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/18/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Transgender, or trans, people experience a number of barriers to accessing gender-affirming healthcare and have a range of barriers and facilitators to primary care and specialist services, commonly citing discrimination and cisgenderism playing a central role in shaping accessibility. The pathway through primary care to specialist services is a particularly precarious time for trans people, and misinformation and poorly applied protocols can have a detrimental impact on wellbeing. METHOD We recruited trans participants from an HIV Self-Testing Public Health Intervention (SELPHI) trial to interviews which explored contemporary gender-affirming service experiences, with an aim to examine the path from primary care services through to specialist gender services, in the UK. RESULTS A narrative synthesis of vignettes and thematic analysis of in-depth qualitative interviews were conducted with twenty trans individuals. We summarise positive and negative accounts of care under three broad categories: Experiences with primary care physicians, referrals to gender identity clinics (GICs), and experiences at GICs. CONCLUSIONS We discuss implications of this research in terms of how to improve best practice for trans people attempting to access gender-affirming healthcare in the UK. Here we highlight the importance of GP's access to knowledge around pathways and protocols and clinical practice which treats trans patients holistically.
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Affiliation(s)
- Talen Wright
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK.
| | - Emily Jay Nicholls
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London , UK
| | - Alison J Rodger
- Institute for Global Health, University College London, London, UK
| | - Fiona M Burns
- Institute for Global Health, University College London, London, UK
| | - Peter Weatherburn
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London , UK
| | | | - Leanne McCabe
- MRC Clinical Trials Unit, University College London, London, UK
| | | | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - T Charles Witzel
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London , UK
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Nicholls EJ, Rhodes T, Egede SJ. Situating adherence to medicines: The embodied practices and hinterlands of HIV antiretrovirals. Sociol Health Illn 2021; 43:1085-1099. [PMID: 33774846 DOI: 10.1111/1467-9566.13270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 06/12/2023]
Abstract
Adherence to medicines tends to be envisaged as a matter of actors' reasoned actions, though there is increasing emphasis on situating adherence as a practice materialised in everyday routines. Drawing on the qualitative interview accounts of Black African women living with HIV in London, UK, we treat adherence to HIV medicines as not only situated in the practices of the immediate and everyday but also relating to a hinterland of historical and social relations. We move from accounts which situate adherence as an embodied matter of affect in the present, to accounts which locate adherence as a condition of precarity, which also trace to enactments of time and place in the past. Adherence is therefore envisaged as a multiple and fluid effect which is made-up in-the-now and in relation to a hinterland of practices which locate elsewhere.
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Affiliation(s)
- Emily Jay Nicholls
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
| | - Tim Rhodes
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Siri Jonina Egede
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
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Abstract
In this paper, we draw on our collaborative work running a salon for thinking about care in STS research, which quickly became more about fostering an ethico-politics for thinking with care as a mode of academic intervention. Not dissimilar to the origins of the salon in nineteenth-century France, the salon provided a provocative and disruptive space for early career researchers (ECRs) to think together.
As attention and critique increasingly point towards the unequal distribution of harms arising from marketization and the vulnerability of ECRs in the ‘neoliberal university,’ we have witnessed a surge in activities that promise a supportive space, such as pre-conference conferences, seminar series, discussion forums and self-care workshops. In this paper, we ask not only what these modes of care might make possible, but also what exclusionary practices and patterns they mask or render more palatable (Ahmed, 2004; Duclos & Criado, 2020; Martin et al., 2015; Murphy, 2015).
Reflecting on our experiences of organizing and participating in the salon, with the stated purpose to explore ‘ecologies of care’ as an embodied socio-material practice (Puig de la Bellacasa, 2017), we move from care ‘out there’ in STS research to care ‘in here’. We follow threads spun by and out from the group to rethink our own academic care practices and how to do the academy otherwise.
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Huddart RA, Thompson C, Houlston R, Huddart RA, Nicholls EJ, Horwich A. Familial predisposition to both male and female germ cell tumours? J Med Genet 1996; 33:86. [PMID: 8825060 PMCID: PMC1051823 DOI: 10.1136/jmg.33.1.86] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Childs WJ, Nicholls EJ, Horwich A. The optimisation of carboplatin dose in carboplatin, etoposide and bleomycin combination chemotherapy for good prognosis metastatic nonseminomatous germ cell tumours of the testis. Ann Oncol 1992; 3:291-6. [PMID: 1382552 DOI: 10.1093/oxfordjournals.annonc.a058182] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
An analysis of carboplatin dose response was performed in 121 patients with good prognosis metastatic nonseminomatous germ cell tumours (NSGCT) of the testis, referred to the Royal Marsden Hospital since 1984, who had been given combination carboplatin, etoposide and bleomycin (CEB) chemotherapy. With a median follow-up of 40 months (range: 7 to 85 months) nine patients (7%) have failed CEB. Carboplatin dose was analysed in all patients using body surface area (BSA) to derive a carboplatin dose per metre squared (mg/m2) and by calculation of a predicted serum concentration chi time (AUC: area under the curve) derived from the glomerular filtration rate (GFR), using the formula; Dose = AUC(GFR + 25). At a carboplatin dose of 400 mg/m2 or greater 2 out of 58 patients (3.4%) failed treatment while 7 out of 63 patients (11%) who received a dose less than this failed (p greater than 0.1). At an AUC of 5.0 mg.min/ml or greater, 2 out of 74 patients (2.7%) failed while 7 out of 47 patients (14.9%) who had an AUC less than this failed (p less than 0.05). There was evidence for a dose/response relationship at relatively low doses and the failure rate rose to 26% for doses less than 4.5 mg.min/ml (p less than 0.001) or 15.6% for doses less than 350 mg/m2 (p greater than 0.1). In view of the more precise determination of toxicity and efficacy it is recommended that carboplatin dose be based on the GFR.
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Abstract
Seminal analysis was performed within 2 months of orchiectomy on 97 patients with clinical Stage I malignant testicular teratoma managed by surveillance following orchiectomy. Relapse of malignant disease occurred in 28% of 47 patients with a sperm count less than 10 X 10(6)/ml and in 32% of 50 patients with a sperm count greater than or equal to 10 X 10(6)/ml. Of 11 patients with azoospermia, 4 relapsed and 1 developed contralateral testicular germ cell tumour. Of 35 patients with malignant teratoma undifferentiated the relapse rate was 68% in 16 patients with a sperm count less than 10 X 10(6)/ml and 42% in 19 patients with a sperm count greater than or equal to 10 X 10(6)/ml. It was concluded that sperm count analysis is non-contributory in estimating the risk of relapse in clinical Stage I teratoma.
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Affiliation(s)
- A Horwich
- Testicular Tumour Unit, Royal Marsden Hospital, Sutton
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