Masculine ideology and Black men who have sex with men's interest in HIV pre-exposure prophylaxis (PrEP)

We examined how traditional masculinity and stigma surrounding HIV pre-exposure prophylaxis (PrEP) affect PrEP interest among Black men who have sex with men (BMSM). One hundred twenty-three men attending a Black Gay Pride event completed measures assessing traditional masculinity, PrEP stigma, and PrEP interest along with two behavioral measures of interest in PrEP. Results demonstrated that avoidance of femininity directly related to interest in PrEP and indirectly through conformity to heterosexual self-presentation. Further, PrEP stigma differentially moderated both of these relationships. Interventions designed to improve engagement of PrEP for BMSM should be attentive to traditional masculinity as a barrier.

Transgender women and HIV-related health disparities: falling off the HIV treatment cascade

Background Transgender women living with HIV infection experience poorer health outcomes across the HIV continuum of care. While disparities are well established, their underlying mechanisms are not well understood. This study examined the HIV continuum of care (also known as the HIV treatment cascade), including linkage and engagement in care and health status among transgender women and cisgender women and cisgender men living with HIV.

METHOD

Case-control matching was applied to a cohort of 1101 people living with HIV; 70 transgender women living with HIV were matched on years since testing HIV positive with cisgender women and cisgender men. Participants provided measures indicative of the HIV treatment cascade that included linkage and engagement in care, receiving and adhering to antiretroviral therapy (ART), and HIV viral suppression. Common correlates of HIV-related health status: depression symptoms, HIV-related stress, alcohol and drug use, healthcare conspiracy beliefs, medical mistrust, emotional social support and tangible social support, were also assessed.

RESULTS

Transgender women were significantly less likely to receive ART, were less adherent to ART and had poorer HIV viral suppression than cisgender persons. Multivariable models demonstrated that health disparities were predicted by transgender women having poorer tangible social support over and above the other correlates of health outcomes.

CONCLUSION

Tangible support is amenable by interventions such as building and strengthening supportive networks and paraprofessional services. Socially supportive interventions should be considered critical in efforts to decrease HIV health disparities among transgender women.

Diminishing Perceived Threat of AIDS and Increasing Sexual Risks of HIV Among Men Who Have Sex with Men, 1997-2015

Community-wide awareness that antiretroviral therapies (ART) provides protection against HIV has the potential to increase perceived safety and thereby increase condomless anal sex among men who have sex with men (MSM). Furthermore, reductions in condom use can increase exposure to sexually transmitted infections, which in turn can reduce the protective effects of ART on HIV transmission. The current study extends previous community-based behavioral surveillance research on beliefs regarding use of ART for HIV prevention and sexual practices among MSM. Anonymous cross-sectional community surveys were collected from 1831 men at the same gay pride event in Atlanta, GA four times over nearly two decades; 1997, 2005-2006 (the 2006 survey over-sampled African-Americans to diversify the study), and 2015. Results indicate clear and consistent trends of increasing beliefs that HIV treatments reduce HIV transmission risks, reflecting the dissemination of HIV prevention research findings. Changes in treatment beliefs coincide with increased rates of condomless anal intercourse. Increased beliefs that treatments prevent HIV and increased condomless anal sex were observed for both HIV positive men and men who had not tested HIV positive. Results illustrate the emergence of an era where ART is the focus of HIV prevention and community-held beliefs and behaviors regarding definitions of risk create a new and potentially problematic environment for HIV transmission.

Stigma and Conspiracy Beliefs Related to Pre-exposure Prophylaxis (PrEP) and Interest in Using PrEP Among Black and White Men and Transgender Women Who Have Sex with Men

The HIV/AIDS epidemic in the US continues to persist, in particular, among race, sexual orientation, and gender minority populations. Pre-exposure prophylaxis (PrEP), or using antiretroviral medications for HIV prevention, is an effective option, but uptake of PrEP has been slow. Sociocultural barriers to using PrEP have been largely underemphasized, yet have the potential to stall uptake and, therefore, warrant further understanding. In order to assess the relationships between potential barriers to PrEP (i.e., PrEP stigma and conspiracy beliefs), and interest in PrEP, Black men and transgender women who have sex with men (BMTW, N = 85) and White MTW (WMTW, N = 179) were surveyed at a gay pride event in 2015 in a large southeastern US city. Bivariate and multivariate logistic regression analyses were completed to examine factors associated with PrEP interest. Among the full sample, moderate levels of PrEP awareness (63%) and low levels of use (9%) were observed. Believing that PrEP is for people who are promiscuous (stigma belief) was strongly associated with lack of interest in using PrEP, and individuals who endorsed this belief were more likely to report sexual risk taking behavior. Conspiracy beliefs related to PrEP were reported among a large minority of the sample (42%) and were more frequently reported among BMTW than WMTW. Given the strong emphasis on the use of biomedical strategies for HIV prevention, addressing sociocultural barriers to PrEP access is urgently needed and failure to do so will weaken the potential benefits of biomedical prevention.

Calcium absorption on high and low calcium intakes in relation to vitamin D receptor genotype

The finding that the link between polymorphism at the vitamin D receptor (VDR) gene and rates of bone loss from the femoral neck in postmenopausal women is enhanced at low calcium intakes suggests that intestinal calcium absorption is a site of differential action of the VDR alleles. 1,25-Dihydroxyvitamin D [1,25-(OH)2D] and its receptor mediate active calcium transport, the major mechanism of calcium absorption at low calcium intakes. We compared fractional calcium absorption in healthy late postmenopausal women with (bb) and without (BB) the BSM-1 restriction site. In 60 women (26 BB and 34 bb), we measured calcium absorption and plasma 1,25-(OH)2D after 2 weeks on a high (1500 mg/day) and 2 weeks on a low (< 300 mg/day) calcium intake. The mean 45Ca absorption indexes were similar in the two groups on the high calcium intake [19.01 +/- 1.12% (+/- SEM)/L in BB and 20.45 +/- 0.97%/L in bb; P = 0.346] and differed significantly on the low calcium intake (20.57 +/- 1.10%/L vs. 23.66 +/- 0.95%/L; P = 0.044). Calcium restriction induced similar percent increases in plasma 1,25-(OH)2D, but the BB group had a smaller increase in the fractional 45Ca absorption index [7.8 +/- 3.8% (+/- SEM) vs. 20.7 +/- 3.3% in bb; P = 0.016; increments adjusted for initial absorption value]. In conclusion, compared to women with the bb variants, women with BB allelic variants of the VDR have reduced calcium absorption efficiency on low calcium intake, consistent with a functional defect in the intestinal VDR. The impact of this heritable difference is reduced at higher calcium intakes.

Calcium absorption responses to calcitriol in black and white premenopausal women

On the basis of recent findings that adult black women had similar calcium absorption but higher levels of 1,25-dihydroxyvitamin D [1,25-(OH)2D] than white women, we hypothesized that blacks have a gut resistance to the action of calcitriol. To test this, we studied 11 black [age, 32.4 +/- 5.7 (+/- SD) yr] and 12 white women (28.4 +/- 5.5 yr). The women were maintained on a constant 500-mg calcium diet for 4 weeks, and each received calcitriol (0.25 microgram) four times daily for the last 2 weeks. After 2 and 4 weeks, each subject had measurements of fractional 45Ca absorption index and blood and urine tests. At 2 weeks, the black women had similar calcium absorption indexes [18.7 +/- 1.9% (+/- SEM)/L vs. 20.0 +/- 1.8%/L; age adjusted], borderline higher 1,25-(OH)2D levels [95.7 +/- 6.4 (+/- SEM) vs. 78.2 +/- 6.2 pmol/L; P = 0.071; age adjusted], higher serum PTH levels, and lower urinary calcium excretion. Calcitriol therapy induced similar increments in plasma 1,25-(OH)2D levels in the two groups, but a smaller increment in calcium absorption in the black women (18.4 +/- 8.6% vs. 44.6 +/- 7.8%; P = 0.043; means adjusted for age and initial absorption index). These findings support the hypothesis that, compared with whites, healthy premenopausal black women have gut resistance to the action of calcitriol.