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Hayes R, Nutland W, Rayment M, Wayal S, Apea V, Clarke A, McOwan A, Sullivan A, Desai M, Jajja A, Rice B, Horne R, McCormack S, Gafos M. "Sex without fear": exploring the psychosocial impact of oral HIV pre-exposure prophylaxis on gay men in England. AIDS Res Ther 2023; 20:81. [PMID: 37964322 PMCID: PMC10648634 DOI: 10.1186/s12981-023-00568-2] [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: 10/12/2022] [Accepted: 09/02/2023] [Indexed: 11/16/2023] Open
Abstract
Gay, bisexual, and other men who have sex with men (GBMSM) experience a high prevalence of psychosocial health problems, such as harmful substance use and depression, as well as being disproportionately affected by HIV. HIV Pre-Exposure Prophylaxis (PrEP) may provide psychosocial benefits beyond its intended purpose of reducing HIV infection. We explore the psychosocial impact of oral PrEP use on gay men in England using qualitative data from the PROUD study. From February 2014 to January 2016, semi-structured in-depth interviews were conducted with 40 gay men and one trans woman. Participants were purposively recruited based on trial arm allocation, adherence, and sexual risk behaviours. By removing HIV risk from sex, PrEP improves users' wellbeing by reducing HIV-related anxiety and internalised stigma and increasing HIV prevention self-efficacy, sexual pleasure, and intimacy. In turn, these psychological changes may influence behaviour in the form of greater sexual freedom, reduced harmful drug use, and more protective sexual health behaviours. However, PrEP may create internal conflict for some gay men, due to its disruption of social norms around condom use and its perceived influence on their sexual behaviour leading to reduced condom self-efficacy. These findings provide a baseline of PrEP's psychosocial impact amongst some of the first PrEP users in England and supports calls to consider the psychosocial impact of PrEP in prescribing guidelines.
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Affiliation(s)
- Rosalie Hayes
- Wolfson Institute of Population Health, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
| | | | - Michael Rayment
- Directorate of HIV and GU Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sonali Wayal
- Institute for Global Health, Mortimer Market Centre, University College London, London, UK
| | - Vanesa Apea
- Ambrose King Centre, Barts Health NHS Trust, London, UK
| | - Amanda Clarke
- Department of HIV, Sexual Health and Contraception, Royal Sussex County Hospital, University Hospitals Sussex NHS Trust, Brighton, UK
| | - Alan McOwan
- Directorate of HIV and GU Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Ann Sullivan
- Directorate of HIV and GU Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Monica Desai
- STI & HIV Division, Blood Safety, Health Security Agency, London, UK
| | - Andrew Jajja
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Brian Rice
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rob Horne
- School of Pharmacy, University College London, London, UK
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, University College London, London, UK.
| | - Mitzy Gafos
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Garcia Iglesias J, Nagington M, Pickersgill M, Brady M, Dewsnap C, Highleyman L, Membrillo de Novales FJ, Nutland W, Thrasher S, Umar E, Muchamore I, Webb J. Is mpox an STI? The societal aspects and healthcare implications of a key question. Wellcome Open Res 2023; 7:252. [PMID: 37425485 PMCID: PMC10329192 DOI: 10.12688/wellcomeopenres.18436.2] [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] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 07/11/2023] Open
Abstract
This letter explores the societal aspects and healthcare implications that underlie thinking about mpox (formerly known was monkeypox), in the 2022 outbreak, as a sexually transmitted infection (STI). The authors examine what underlies this question, exploring what is an STI, what is sex, and what is the role of stigma in sexual health promotion. The authors argue that, in this specific outbreak, mpox is an STI among men who have sex with men (MSM). The authors highlight the need of critically thinking about how to communicate effectively, the role of homophobia and other inequalities, and the importance of the social sciences.
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Affiliation(s)
| | | | - Martyn Pickersgill
- Centre for Biomedicine, Self and Society, University of Edinburgh, Edinburgh, UK
| | - Michael Brady
- King's College Hospital NHS Foundation Trust, London, UK
| | - Claire Dewsnap
- Sexual Health, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | | | | | | | - Steven Thrasher
- Medill School of Journalism, Media, Integrated Marketing Communications, Northwestern University, Evanston, USA
| | - Eric Umar
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Ian Muchamore
- Centre for Biomedicine, Self and Society, University of Edinburgh, Edinburgh, UK
| | - Jamie Webb
- Centre for Technomoral Futures, University of Edinburgh, Edinburgh, UK
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Garcia Iglesias J, Nagington M, Pickersgill M, Brady M, Dewsnap C, Highleyman L, Membrillo de Novales FJ, Nutland W, Thrasher S, Umar E, Muchamore I, Webb J. Is mpox an STI? The societal aspects and healthcare implications of a key question. Wellcome Open Res 2023; 7:252. [PMID: 37425485 PMCID: PMC10329192 DOI: 10.12688/wellcomeopenres.18436.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 11/19/2023] Open
Abstract
This letter explores the societal aspects and healthcare implications that underlie thinking about mpox (formerly known was monkeypox), in the 2022 outbreak, as a sexually transmitted infection (STI). The authors examine what underlies this question, exploring what is an STI, what is sex, and what is the role of stigma in sexual health promotion. The authors argue that, in this specific outbreak, mpox is an STI among men who have sex with men (MSM). The authors highlight the need of critically thinking about how to communicate effectively, the role of homophobia and other inequalities, and the importance of the social sciences.
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Affiliation(s)
| | | | - Martyn Pickersgill
- Centre for Biomedicine, Self and Society, University of Edinburgh, Edinburgh, UK
| | - Michael Brady
- King's College Hospital NHS Foundation Trust, London, UK
| | - Claire Dewsnap
- Sexual Health, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | | | | | | | - Steven Thrasher
- Medill School of Journalism, Media, Integrated Marketing Communications, Northwestern University, Evanston, USA
| | - Eric Umar
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Ian Muchamore
- Centre for Biomedicine, Self and Society, University of Edinburgh, Edinburgh, UK
| | - Jamie Webb
- Centre for Technomoral Futures, University of Edinburgh, Edinburgh, UK
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Nadarzynski T, Nutland W, Samba P, Bayley J, Witzel TC. The Impact of First UK-Wide Lockdown (March-June 2020) on Sexual Behaviors in Men and Gender Diverse People Who Have Sex with Men During the COVID-19 Pandemic: A Cross-Sectional Survey. Arch Sex Behav 2023; 52:617-627. [PMID: 36344786 PMCID: PMC9640839 DOI: 10.1007/s10508-022-02458-6] [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: 12/17/2021] [Revised: 06/30/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
The global COVID-19 pandemic resulted in strict social distancing measures restricting close physical contact. Men (cis and trans) and other gender diverse people who have sex with men (MGDSM) are at higher risk of sexually transmitted infections (STIs) and may have experienced changes in sexual behavior during government restrictions on social and sexual contact. We aimed to examine self-reported sexual behavior of MGDSM during the first UK-wide lockdown to identify the characteristics of the individuals who might most require sexual health promotion and clinical support. In April-May 2020, we conducted an online survey of MGDSM, promoted on social media and Grindr. Our exploratory approach used descriptive analysis to identify self-reported changes in sexual behavior and performed regression analyses to identify correlates of casual sex during the lockdown. A total of 1429 respondents completed the survey: mean age 36 years, 84% White, 97% male or trans male, 98% assigned male sex at birth, 2% female or non-binary, 65% degree educated or higher. During the lockdown, 76% reported not having any casual sex partners. While the majority reported reduced casual sex, 3% reported an increase in casual sex with one person and 2% with three or more people (group sex). About 12% of the sample engaged in casual sex with only one person and 5% with four or more sexual partners during the lockdown. Reporting casual sex during lockdown was associated with: lower level of education OR = 2.37 [95% CI 1.40-4.01]; identifying as a member of an ethnic minority OR = 2.27[1.40-3.53]; daily usage of sexual networking apps OR = 2.24[1.54-3.25]; being less anxious about contracting SARS-CoV-2 through sex OR = 1.66[1.12-2.44]; using PrEP before lockdown OR = 1.75[1.20-2.56]; continuing to use PrEP OR = 2.79[1.76-4.57]; and testing for STIs during lockdown OR = 2.65[1.76-3.99]. A quarter of respondents remained sexually active with casual partners, indicating a need to provide STI screening services and health promotion targeted to groups most likely to have need over this period. Future research is required to better understand how to support sexual and gender minorities to manage sexual risk in the context of pandemic public health initiatives.
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Affiliation(s)
- Tom Nadarzynski
- School of Social Sciences, University of Westminster, Room 6.101, 115 New Cavendish Street, London, W1W 6UW, UK.
| | - Will Nutland
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
- The Love Tank CIC, London, UK
| | - Phil Samba
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
- The Love Tank CIC, London, UK
| | - Jake Bayley
- Sexual Health and HIV Department, Barts NHS Trust, 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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Paparini S, Whitacre R, Smuk M, Thornhill J, Mwendera C, Strachan S, Nutland W, Orkin C. Public understanding and awareness of and response to monkeypox virus outbreak: A cross‐sectional survey of the most affected communities in the United Kingdom during the 2022 public health emergency. HIV Med 2022; 24:544-557. [PMID: 36385726 DOI: 10.1111/hiv.13430] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/14/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Our objective was to examine the public response to public health and media messaging during the human monkeypox virus (MPXV) outbreak in the UK, focusing on at-risk communities. METHODS A co-produced, cross-sectional survey was administered in June and July 2022 using community social media channels and the Grindr dating app. Basic descriptive statistics, logistic regression, and odds ratio p values are presented. RESULTS Of 1932 survey respondents, 1750 identified as men, 88 as women, and 64 as gender non-conforming. Sexual identity was described as gay/lesbian/queer (80%), bisexual (12%), heterosexual (4%), and pansexual (2%); 39% were aged <40 years; 71% self-identified as White, 3% as Black, 8% as Asian, 2%as LatinX, and 11% as 'Mixed or Other' heritage groups. In total, 85% were employed and 79% had completed higher education. A total of 7% of respondents identified themselves as living with HIV. Overall, 34% reported limited understanding of public health information, 52% considered themselves at risk, 61% agreed that people with MPXV should isolate for 21 days, 49% reported they would first attend a sexual health clinic if symptomatic, 86% reported they would accept a vaccine, and 59% believed that MPXV originated from animals. The most trusted sources of information were healthcare professionals (37%), official health agencies (29%), and mainstream media (12%). CONCLUSIONS Vaccine acceptability was very high, yet the understanding and acceptance of public health information varied. Social determinants of health inequalities already shaping the UK landscape risk were compounded in this new emergency. Engagement with structurally disadvantaged members of affected communities and better dissemination of public health messaging by trusted healthcare professionals are essential for the public health response.
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Affiliation(s)
- Sara Paparini
- SHARE Collaborative, Wolfson Institute of Population Health, Queen Mary University of London London UK
| | - Ryan Whitacre
- Global Health Centre, Department of Anthropology and Sociology Graduate Institute of International and Development Studies Geneva Switzerland
| | - Melanie Smuk
- Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry Queen Mary University of London London UK
| | - John Thornhill
- SHARE Collaborative, Centre for Immunobiology, Blizard Institute Queen Mary University of London London UK
- Department of Infection and Immunity Barts Health NHS Trust London UK
| | - Chikondi Mwendera
- SHARE Collaborative, Blizard Institute Queen Mary University of London London UK
| | | | | | - Chloe Orkin
- SHARE Collaborative, Centre for Immunobiology, Blizard Institute Queen Mary University of London London UK
- Department of Infection and Immunity Barts Health NHS Trust London UK
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Reyes-Urueña J, D'Ambrosio A, Croci R, Bluemel B, Cenciarelli O, Pharris A, Dukers-Muijrers N, Nutland W, Niaupari S, Badran J, Spiteri G, Noori T. High monkeypox vaccine acceptance among male users of smartphone-based online gay-dating apps in Europe, 30 July to 12 August 2022. Euro Surveill 2022; 27. [PMID: 36268737 DOI: 10.2807/1560-7917.es.2022.27.42.2200757] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We assess monkeypox vaccination acceptance among male adults in the European Region. We conducted an online survey through two dating apps targeting men who have sex with men, from 30 July to 12 August 2022. We developed Bayesian hierarchical logistic regression models to investigate monkeypox vaccination acceptance. Overall crude vaccination acceptance was 82% and higher in north-western compared to south-eastern European regions. Acceptance strongly rose with perception of increased disease severity and transmission risk, and in individuals linked to healthcare.
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Affiliation(s)
| | - Angelo D'Ambrosio
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Roberto Croci
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Benjamin Bluemel
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Orlando Cenciarelli
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Nicole Dukers-Muijrers
- Health Promotion, CAPHRI, Maastricht University, Maastricht, the Netherlands.,Public Health Service South Limburg, the Netherlands
| | - Will Nutland
- The Love Tank CIC/PrEPster, London, United Kingdom
| | - Steph Niaupari
- Grindr/Grindr for Equality, West Hollywood, California, United States of America
| | - Jawad Badran
- Hornet, Los Angeles, California, United States of America
| | - Gianfranco Spiteri
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Teymur Noori
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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Arnold-Forster D, Horne R, Nutland W, Wayal S, Rayment M, Rae C, Desai M, Clarke A, Sullivan A, McCormack S, Gafos M. Perceptions and Practicalities Influencing Pre-exposure Prophylaxis Adherence Among Men Who Have Sex with Men in England. AIDS Behav 2022; 26:2768-2782. [PMID: 35182281 PMCID: PMC9252952 DOI: 10.1007/s10461-022-03624-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 12/27/2022]
Abstract
PrEP is highly effective for HIV prevention but requires adequate adherence. In this paper we use the perceptions and practicalities approach (PAPA) to identify factors that influenced PrEP adherence using qualitative data from the PROUD study. From February 2014 to January 2016, we interviewed 41 gay, bisexual and other men-who-have-sex-with-men and one trans woman who were enrolled in the study. We purposively recruited participants for interview based on trial arm allocation, adherence and sexual risk behaviours. The interviews were conducted in English, audio-recorded, transcribed, coded and analysed using framework analysis. Participants in general were highly motivated to use and adhere to PrEP, and this was linked to strong perceptions of personal necessity for PrEP as they felt at risk of HIV and viewed PrEP as highly effective. On the other hand, concerns about side effects and HIV resistance did inhibit PrEP initiation and adherence although this was uncommon. Practical factors such as daily routine, existing habitual pill-taking and pill storage impacted adherence. Drug and alcohol use rarely caused participants to miss doses. These findings indicate that using the principals of PAPA to unpick influencers of PrEP use, could help tailor adherence support in PrEP programmes.
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Affiliation(s)
- Dora Arnold-Forster
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Kepple Street, London, WC1E 7HT, UK
| | - Robert Horne
- School of Pharmacy, University College London, London, UK
| | | | - Sonali Wayal
- Institute for Global Health, University College London, London, UK
| | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Caroline Rae
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Monica Desai
- National Institute for Health and Care Excellence, London, UK
| | - Amanda Clarke
- Claude Nicol Centre, Royal Sussex County Hospital, Brighton, UK
| | - Ann Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sheena McCormack
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Kepple Street, London, WC1E 7HT, UK.
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
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Grenfell P, Rafael S, Calliste J, Nutland W. ‘We go where we know’: Reflections from Mobilizing for PrEP and Sexual Health (MobPrESH) – A peer-led PrEP education programme across England, for and by women and non-binary people. Womens Health (Lond Engl) 2022; 18:17455057221091727. [PMID: 35404186 PMCID: PMC9006354 DOI: 10.1177/17455057221091727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Pre-exposure prophylaxis is a highly effective method of HIV prevention but few women know about it, have access to it, or see it as relevant to them. In 2019, grassroots organization PrEPster piloted a peer-led intervention, MobPrESH (Mobilizing for Pre-Exposure prophylaxis (PrEP) and Sexual Health), across three sites in England, to mobilize for PrEP and sexual health with communities of women and non-binary people most affected by HIV, including Black women and non-binary people, people of colour, migrants, and transgender (trans) women. Objectives: We aimed to explore the accessibility, feasibility, acceptability, and ‘fidelity’ of MobPrESH, from the perspectives of peer mobilizers and project staff. Methods: We conducted focus group discussions and qualitative interviews with nine peer mobilizers (most identified as Black cisgender (cis) women) and six project staff (including Black and white cis women and non-binary people). We analysed data thematically, iteratively, and inductively, informed by concepts of reproductive and social justice. Results: We present findings in five thematic areas: connecting and relating to situate sexual health discussions, navigating silence and stigma, connecting within and across communities, competing pressures and structural hostilities, and resources and continuity. Community knowledge-building about PrEP is a slow, iterative process that needs investment and creation of trusted spaces that centre communities’ needs and concerns. Peer mobilizers and the communities they engaged with had competing demands in their lives, and knowledge-raising about PrEP was impacted by intersecting stigmas, discrimination, and oppressions around HIV status, racism, misogyny, transphobia, homophobia, and anti-sex worker rhetoric. Conclusions: Peer-led PrEP interventions require funding and foregrounding, particularly for women and non-binary people who are Black, trans, migrants, and people of colour, situated relative to their wider health needs, life pressures, and priorities. This requires concurrent challenge of the racist and patriarchal structures that continue to obscure the sexual and reproductive health needs of racially minoritized and marginalized women and non-binary people.
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Affiliation(s)
- Pippa Grenfell
- London School of Hygiene & Tropical Medicine, London, UK
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Bourne A, Carman M, Kabuti R, Nutland W, Fearon E, Liku J, Tukai A, Weatherburn P, Kimani J, Smith AD. Experiences and challenges in sexual health service access among men who have sex with men in Kenya. Glob Public Health 2021; 17:1626-1637. [PMID: 34632949 DOI: 10.1080/17441692.2021.1987501] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Men who have sex with men (MSM) in Kenya bear a heavy burden of HIV/STIs and are a priority population in the national HIV/AIDS response, yet remain criminalised and stigmatised within society. HIV pre-exposure prophylaxis (PrEP) offers an opportunity to significantly impact the HIV epidemic, as does the concept of U = U, whereby those who are living with HIV and on treatment are uninfectious when their viral load has been suppressed so as to be undetectable. However, the value of such innovations will not be realised without sufficient understanding of, and respect for, the sexual health service provision needs of MSM. This paper describes findings from 30 in-depth interviews with MSM living in Nairobi that explored engagement with sexual health service providers, barriers to access and perceived opportunities to improve service design and delivery. Findings indicate concern relating to the professionalism of some staff working within public hospitals as well as feelings that many sexual health services were not considered safe spaces for the discussion of MSM-specific sexual behaviour. Diverse views were expressed relating to comfort in public, community and private sexual health services as well as how these are and should be organised.
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Affiliation(s)
- Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia.,Kirby Institute, UNSW, Sydney, Australia
| | - Marina Carman
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Rhoda Kabuti
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Will Nutland
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth Fearon
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer Liku
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Anthony Tukai
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Peter Weatherburn
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi, Kenya.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Adrian D Smith
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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10
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Gorna R, MacDermott N, Rayner C, O'Hara M, Evans S, Agyen L, Nutland W, Rogers N, Hastie C. Long COVID guidelines need to reflect lived experience. Lancet 2021; 397:455-457. [PMID: 33357467 PMCID: PMC7755576 DOI: 10.1016/s0140-6736(20)32705-7] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 02/06/2023]
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11
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O'Halloran C, Croxford S, Mohammed H, Gill ON, Hughes G, Fifer H, Allen H, Owen G, Nutland W, Delpech V, Saunders JM. Factors associated with reporting antibiotic use as STI prophylaxis among HIV PrEP users: findings from a cross-sectional online community survey, May–July 2019, UK. Sex Transm Infect 2020; 97:429-433. [DOI: 10.1136/sextrans-2020-054592] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/08/2020] [Accepted: 09/27/2020] [Indexed: 01/31/2023] Open
Abstract
ObjectivesThe use of antibiotics as pre-exposure or postexposure prophylaxis for sexually transmitted infection (STI) prevention (STI prophylaxis) is not currently recommended in the UK, but there is evidence that self-prescribing occurs among those at greatest risk. We present the prevalence and factors associated with STI prophylaxis among a community sample of HIV pre-exposure prophylaxis (PrEP) users.MethodsThe 2019 online PrEP User Survey ran between 17 May and 1 July. Eligible participants included UK residents reporting HIV PrEP use or having tried to obtain HIV PrEP since January 2017. STI prophylaxis use was defined as reporting buying antibiotics to prevent STIs, either privately or through the internet; this question was only asked to HIV PrEP users. Factors associated with STI prophylaxis use were assessed using univariable and multivariable logistic regression.ResultsOverall, 9% (167/1856) of HIV PrEP users reported STI prophylaxis use; 97% were gay or bisexual men, 84% reported white ethnicity, 55% resided in London and 69% were aged ≥35 years. Factors associated with STI prophylaxis included: reporting ≥5 compared with 1–4 condomless sex partners in the past 6 months (12% vs 5.6%, adjusted odds ratio (aOR)=1.80; 95% CI 1.22 to 2.64), reporting chemsex drug use compared with no sexualised drug use in the past 12 months (13% vs 6.0%, aOR=1.88; 95% CI 1.20 to 2.93) and reporting an STI diagnosis in the past 12 months (12% vs 6.6%, aOR=1.54; 95% CI 1.08 to 2.18). Variables not significant in multivariable analyses included: ethnicity, age, residence and HIV PrEP sourcing.ConclusionsApproximately 1 in 10 HIV PrEP users from this community sample reported self-prescribed STI prophylaxis. STI prophylaxis was associated with sexual behaviour known to facilitate STI transmission and with a history of recent STIs acquisition. Given the potential risk of antimicrobial resistance, sexual health clinicians should consider asking attendees, especially HIV PrEP users, about the use of antibiotics as STI prophylaxis, to inform appropriate counselling, testing and management.
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12
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Fearon E, Bourne A, Tenza S, Palanee‐Phillips T, Kabuti R, Weatherburn P, Nutland W, Kimani J, Smith AD. Online socializing among men who have sex with men and transgender people in Nairobi and Johannesburg and implications for public health-related research and health promotion: an analysis of qualitative and respondent-driven sampling survey data. J Int AIDS Soc 2020; 23 Suppl 6:e25603. [PMID: 33000904 PMCID: PMC7527758 DOI: 10.1002/jia2.25603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 07/09/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION There is little published literature about gay, bisexual and other men who have sex with men and transgender individuals (MSM and TG)'s use of social media in sub-Saharan Africa, despite repressive social and/or criminalizing contexts that limit access to physical HIV prevention. We sought to describe MSM and TG's online socializing in Nairobi and Johannesburg, identifying the characteristics of those socializing online and those not, in order to inform the development of research and health promotion in online environments. METHODS Respondent-driven sampling surveys were conducted in 2017 in Nairobi (n = 618) and Johannesburg (n = 301) with those reporting current male gender identity or male sex assigned at birth and sex with a man in the last 12 months. Online socializing patterns, sociodemographic, sexual behaviour and HIV-testing data were collected. We examined associations between social media use and sociodemographic characteristics and sexual behaviours among all, and only those HIV-uninfected, using logistic regression. Analyses were RDS-II weighted. Thirty qualitative interviews were conducted with MSM and TG in each city, which examined the broader context of and motivations for social media use. RESULTS Most MSM and TG had used social media to socialize with MSM in the last month (60% Johannesburg, 71% Nairobi), mostly using generic platforms (e.g. Facebook), but also gay-specific (e.g. Grindr). HIV-uninfected MSM and TG reporting riskier recent sexual behaviours had raised odds of social media use in Nairobi, including receptive anal intercourse (adjusted OR = 2.15, p = 0.006), buying (aOR = 2.24, p = 0.015) and selling sex with men (aOR = 2.17, p = 0.004). Evidence for these associations was weaker in Johannesburg, though socializing online was associated with condomless anal intercourse (aOR = 3.67, p = 0.003) and active syphilis (aOR = 13.50, p = 0.016). Qualitative findings indicated that while online socializing can limit risk of harm inherent in face-to-face interactions, novel challenges were introduced, including context collapse and a fear of blackmail. CONCLUSIONS Most MSM and TG in these cities socialize online regularly. Users reported HIV acquisition risk behaviours, yet this space is not fully utilized for sexual health promotion and research engagement. Effective, safe and acceptable means of using online channels to engage with MSM/TG that account for MSM and TG's strategies and concerns for managing online security should now be explored, as complements or alternatives to existing outreach.
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Affiliation(s)
- Elizabeth Fearon
- Department of Global Health & DevelopmentLondon School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | - Adam Bourne
- Australian Research Centre in Sex, Health & SocietyLa Trobe UniversityMelbourneAustralia
| | - Siyanda Tenza
- Wits Reproductive Health and HIV InstituteSchool of Clinical MedicineUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Thesla Palanee‐Phillips
- Wits Reproductive Health and HIV InstituteSchool of Clinical MedicineUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | - Peter Weatherburn
- Sigma ResearchDepartment of Public Health, Environments and SocietyLondon School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | - Will Nutland
- Sigma ResearchDepartment of Public Health, Environments and SocietyLondon School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | - Joshua Kimani
- Partners for Health and DevelopmentNairobiKenya
- Department of Community Health SciencesUniversity of Manitoba (UoM)WinnipegCanada
| | - Adrian D Smith
- Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
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O'Halloran C, Owen G, Croxford S, Sims LB, Gill ON, Nutland W, Delpech V. Current experiences of accessing and using HIV pre-exposure prophylaxis (PrEP) in the United Kingdom: a cross-sectional online survey, May to July 2019. ACTA ACUST UNITED AC 2020; 24. [PMID: 31796157 PMCID: PMC6891944 DOI: 10.2807/1560-7917.es.2019.24.48.1900693] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The 2019 online pre-exposure prophylaxis (PrEP) user survey in the United Kingdom was conducted to assess HIV PrEP access, and user characteristics. One in five respondents continued experiencing difficulties accessing PrEP; users were almost exclusively gay or bisexual men at high risk of HIV. The majority obtained PrEP through health service clinics and rated PrEP positively. High STI rates were reported among users. Renal and sexual health checks are advised for those sourcing PrEP privately.
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Affiliation(s)
| | - Greg Owen
- iWantPrEPNow, London, United Kingdom
| | - Sara Croxford
- National Infection Service, Public Health England, London, United Kingdom
| | - Lee B Sims
- School of Public Health, Imperial College London, London, United Kingdom
| | - O Noel Gill
- These authors contributed equally.,National Infection Service, Public Health England, London, United Kingdom
| | - Will Nutland
- PrEPster, London, United Kingdom.,These authors contributed equally
| | - Valerie Delpech
- These authors contributed equally.,National Infection Service, Public Health England, London, United Kingdom
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Wang X, Nutland W, Brady M, Green I, Boffito M, McClure M. Quantification of tenofovir disoproxil fumarate and emtricitabine in generic pre-exposure prophylaxis tablets obtained from the internet. Int J STD AIDS 2019; 30:765-768. [PMID: 31072205 DOI: 10.1177/0956462419841144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this study, we addressed the recent concerns over the authenticity of generic pre-exposure prophylaxis (PrEP) purchased online by sampling 14 generic PrEPs from different manufacturers and suppliers and measuring tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) content using high-performance liquid chromatography. We confirmed that all the PrEP tablets contained 94.3% to 104.9% of the 300 mg of TDF claimed on the label and 97.3% to 104.4% of the 200 mg FTC claimed on the label.
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Affiliation(s)
- Xinzhu Wang
- 1 Department of Medicine, Imperial College London, London, UK
| | | | | | - Ian Green
- 3 Terrence Higgins Trust, London, UK
| | - Marta Boffito
- 1 Department of Medicine, Imperial College London, London, UK.,4 HIV/GUM department, Chelsea and Westminster Hospital, London, UK
| | - Myra McClure
- 1 Department of Medicine, Imperial College London, London, UK
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Witzel TC, Nutland W, Bourne A. What are the motivations and barriers to pre-exposure prophylaxis (PrEP) use among black men who have sex with men aged 18-45 in London? Results from a qualitative study. Sex Transm Infect 2019; 95:262-266. [PMID: 30833366 PMCID: PMC6585870 DOI: 10.1136/sextrans-2018-053773] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 07/19/2018] [Revised: 12/11/2018] [Accepted: 01/26/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Black men who have sex with men (BMSM) have higher HIV incidence and prevalence when compared with other men who have sex with men, despite similar risk profiles. New prevention technologies, including pre-exposure prophylaxis (PrEP), may be effective in responding to these inequalities, provided they are appropriately targeted and acceptable to their intended beneficiaries. This study aims to understand the motivations and barriers of BMSM aged 18-45 to PrEP uptake. METHODS Twenty-five BMSM recruited through geolocation social networking apps took part in in-depth interviews between April and August 2016. Intersectionality theory was used as an organising principle. Interviews were transcribed verbatim and analysed using a thematic framework analysis. RESULTS For BMSM with heterogeneous social groups, discussions about sexual health were challenging because of the intersection of ethnic background, family history and religion. This limited conversations about PrEP to gay male friends who often held stigmatising views of condomless anal intercourse. BMSM reported exclusion from gay male spaces (online and offline) which could serve to restrict exposure to PrEP messages. Stereotypes of BMSM intersected with negative conceptions of PrEP users, limiting acknowledgement of PrEP candidacy. For those who had attempted to or successfully accessed it, PrEP was framed as a strategy to mitigate risk and to guard against further stigma associated with HIV infection. DISCUSSION BMSM operate within a complex set of circumstances related to the intersection of their sexual, ethnic, cultural and religious identities, which shape PrEP acceptability. Interventions which seek to facilitate uptake in this group must be attentive to these. Health promotion and clinical services could seek to facilitate nuanced discussions about the merits of PrEP for those at frequent risk, perhaps while also providing publicly visible PrEP role models for BMSM and other marginalised groups.
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Affiliation(s)
- T Charles Witzel
- Sigma Research, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Will Nutland
- Sigma Research, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Adam Bourne
- Australian Research Centre for Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
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Witzel TC, Guise A, Nutland W, Bourne A. It Starts With Me: Privacy concerns and stigma in the evaluation of a Facebook health promotion intervention. Sex Health 2018; 13:228-33. [PMID: 27075940 DOI: 10.1071/sh15231] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 03/08/2016] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background As efforts continue to increase rates of HIV testing and condom use among at-risk communities in England, organisations have sought use social media for health promotion interventions. As part of a wider evaluation of It Starts With Me (ISWM), a sexual health promotion intervention in England targeting gay and bisexual men and African people through Facebook, this study sought to explore how the online environment shapes end user engagement with sexual health interventions. A primary objective was to explore how privacy concerns can act as a barrier to engagement for the audience of ISWM. METHODS A purposive sample of 40 individuals were recruited, who were targeted by the intervention for in-depth interviews. Data collection was in two phases. In the first phase, individuals were sampled based on engagement with online health interventions in general, while in the second phase, all individuals were sampled on the basis of engagement with the intervention. RESULTS Privacy concerns related to the ecology of social networking sites, issues with implied disclosure and discrimination, as well as uncertainty over control of data. These concerns limited the organic reach of the intervention by confining the intervention to those who already held the norms diffused through it, and by discouraging participants from sharing and commenting on content. CONCLUSIONS Care should be taken to address concerns when designing interventions delivered through social media. Gated interventions may be more beneficial for marginalised communities, while large-scale interventions such as ISWM may provide a useful backdrop for face-to-face interventions.
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Affiliation(s)
- T Charles Witzel
- Sigma Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Andy Guise
- Sigma Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Will Nutland
- Sigma Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Adam Bourne
- Sigma Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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Paparini S, Nutland W, Rhodes T, Nguyen VK, Anderson J. DIY HIV prevention: Formative qualitative research with men who have sex with men who source PrEP outside of clinical trials. PLoS One 2018; 13:e0202830. [PMID: 30138482 PMCID: PMC6107262 DOI: 10.1371/journal.pone.0202830] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 08/09/2018] [Indexed: 01/11/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) with antiretroviral medication is an effective, evidence-based option for HIV prevention. In England, issues of cost-effectiveness and of responsibility for commissioning prevention services have so far led National Health Service (NHS) England to decide not to commission PrEP. Given the significant lag between the awareness of PrEP efficacy and the opportunity to obtain PrEP through traditional health care routes, many gay and other men who have sex with men (MSM) have turned to ‘DIY PrEP’, purchasing generic formulations of PrEP for themselves on the internet or via other alternative routes. However, there is very little research on DIY PrEP practices and no qualitative study with DIY PrEP users in the UK. A formative qualitative study was conducted in 2017 to inform the development of an intervention (PrEP Club) to support DIY PrEP users and improve the safety and experience of this prevention strategy. Focus groups were held with 20 MSM who are based in London and are obtaining PrEP through means other than clinical trials, to explore their accounts of sourcing and using PrEP and the experiential meanings of these. In this article, we report findings from this first, formative study and present the different practices involved in finding out about PrEP, buying it and ascertaining legitimacy of sellers and products. We reflect on the uncertainties participants described related to actually using PrEP, including deciding on drug dosing and monitoring their health. Finally, we present the results of the discussions participants had about the kind of support they had received, the help they would have liked, and their views on proposed interventions to support DIY PrEP users, such as PrEP Club.
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Affiliation(s)
- Sara Paparini
- Department of Anthropology and Sociology of Development, Graduate Institute of International and Development Studies, Geneva, Switzerland
- * E-mail:
| | - Will Nutland
- Department of Social and Environmental Health Research, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tim Rhodes
- Department of Social and Environmental Health Research, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Vinh-Kim Nguyen
- Department of Anthropology and Sociology of Development, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Jane Anderson
- Homerton University Hospital NHS Foundation Trust, London, United Kingdom
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18
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Witzel TC, Nutland W, Bourne A. What qualities in a potential HIV pre-exposure prophylaxis service are valued by black men who have sex with men in London? A qualitative acceptability study. Int J STD AIDS 2018; 29:760-765. [PMID: 29466919 PMCID: PMC7614225 DOI: 10.1177/0956462418755224] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Black men who have sex with men (BMSM) have higher HIV incidence and prevalence when compared to other MSM, despite similar levels of condom use and testing. Pre-exposure prophylaxis (PrEP) could be a useful intervention to reduce these inequalities. This research therefore aims to understand the dimensions of acceptability of a potential PrEP service for BMSM aged 18-45 years in London. In-depth semi-structured interviews were conducted with 25 PrEP-eligible BMSM between April and August 2016. Interviews were recorded and transcribed verbatim, then subject to a thematic framework analysis, informed by intersectionality theory. BMSM had distinct preferences for sexual health services, which have implications for PrEP service development. Three primary domains emerged in our analysis: proximity and anonymity; quality, efficiency and reassurance; and understanding, empathy and identity. These relate, respectively, to preferences regarding clinic location and divisions from community, features of service delivery and staff characteristics. Due to concerns about confidentiality, community-based services may not be useful for this group. Careful consideration in regards to components used in service development will facilitate ongoing engagement. Interpersonal skills of staff are central to service acceptability, particularly when staff are perceived to be from similar cultural backgrounds as their patients.
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Affiliation(s)
- T Charles Witzel
- Sigma Research, Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Will Nutland
- Sigma Research, Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Adam Bourne
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia
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Gafos M, Brodnicki E, Desai M, McCormack S, Nutland W, Wayal S, White E, Wood G, Barber T, Bell G, Clarke A, Dolling D, Dunn D, Fox J, Haddow L, Lacey C, Nardone A, Quinn K, Rae C, Reeves I, Rayment M, White D, Apea V, Ayap W, Dewsnap C, Collaco-Moraes Y, Schembri G, Sowunmi Y, Horne R. Acceptability of an open-label wait-listed trial design: Experiences from the PROUD PrEP study. PLoS One 2017; 12:e0175596. [PMID: 28426834 PMCID: PMC5398545 DOI: 10.1371/journal.pone.0175596] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/28/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND PROUD participants were randomly assigned to receive pre-exposure prophylaxis (PrEP) immediately or after a deferred period of one-year. We report on the acceptability of this open-label wait-listed trial design. METHODS Participants completed an acceptability questionnaire, which included categorical study acceptability data and free-text data on most and least liked aspects of the study. We also conducted in-depth interviews (IDI) with a purposely selected sub-sample of participants. RESULTS Acceptability questionnaires were completed by 76% (415/544) of participants. After controlling for age, immediate-group participants were almost twice as likely as deferred-group participants to complete the questionnaire (AOR:1.86;95%CI:1.24,2.81). In quantitative data, the majority of participants in both groups found the wait-listed design acceptable when measured by satisfaction of joining the study, intention to remain in the study, and interest in joining a subsequent study. However, three-quarters thought that the chance of being in the deferred-group might put other volunteers off joining the study. In free-text responses, data collection tools were the most frequently reported least liked aspect of the study. A fifth of deferred participants reported 'being deferred' as the thing they least liked about the study. However, more deferred participants disliked the data collection tools than the fact that they had to wait a year to access PrEP. Participants in the IDIs had a good understanding of the rationale for the open-label wait-listed study design. Most accepted the design but acknowledged they were, or would have been, disappointed to be randomised to the deferred group. Five of the 25 participants interviewed reported some objection to the wait-listed design. CONCLUSION The quantitative and qualitative findings suggest that in an environment where PrEP was not available, the rationale for the wait-listed trial design was well understood and generally acceptable to most participants in this study.
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Affiliation(s)
- Mitzy Gafos
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Elizabeth Brodnicki
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Monica Desai
- HIV/STI Department, Public Health England, London, United Kingdom
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
- Directorate of HIV and GU medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Will Nutland
- Sigma research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sonali Wayal
- Centre for Sexual Health and HIV Research, Mortimer Market Centre, London, United Kingdom
| | - Ellen White
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Gemma Wood
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Tristan Barber
- Directorate of HIV and GU medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Gill Bell
- Sheffield Health, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Amanda Clarke
- Claude Nichol Centre, Royal Sussex County Hospital, Brighton, United Kingdom
| | - David Dolling
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - David Dunn
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Julie Fox
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Lewis Haddow
- Centre for Sexual Health and HIV Research, Mortimer Market Centre, London, United Kingdom
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Charles Lacey
- York Hospitals NHS Foundation Trust, York, United Kingdom
| | - Anthony Nardone
- HIV/STI Department, Public Health England, London, United Kingdom
| | - Killian Quinn
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Caroline Rae
- Directorate of HIV and GU medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Iain Reeves
- Department of Sexual Health, Homerton University Hospital NHS Foundation Trust, London, United Kingdom
| | - Michael Rayment
- Directorate of HIV and GU medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - David White
- Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Vanessa Apea
- Ambrose King Centre, Barts Health NHS Trust, London, United Kingdom
| | - Wilbert Ayap
- St Mary’s Hospital, Imperial College NHS Foundation Trust, London, United Kingdom
| | - Claire Dewsnap
- Sheffield Health, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Yolanda Collaco-Moraes
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Gabriel Schembri
- Manchester Centre for Sexual Health, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Yinka Sowunmi
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Rob Horne
- School of Pharmacy, University College London, London, United Kingdom
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Portman M, Owen G, Quinn K, Craddock A, Thompson M, Nwokolo N, Reeves I, Bayley J, Brady M, Nutland W, McCormack S. P229 Clinician and community collaboration on PrEP in the UK – a narrative. Br J Vener Dis 2016. [DOI: 10.1136/sextrans-2016-052718.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Grenfell P, Nutland W, McManus S, Datta J, Soldan K, Wellings K. Views and experiences of men who have sex with men on the ban on blood donation: a cross sectional survey with qualitative interviews. BMJ 2011; 343:d5604. [PMID: 21903692 PMCID: PMC3168936 DOI: 10.1136/bmj.d5604] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore compliance with the UK blood services' criterion that excludes men who have had penetrative sex with a man from donating blood, and to assess the possible effects of revising this policy. DESIGN A random location, cross sectional survey followed by qualitative interviews. SETTING Britain. PARTICIPANTS 1028 of 32,373 men in the general population reporting any male sexual contact completed the survey. Additional questions were asked of a general population sample (n=3914). Thirty men who had had penetrative sex with a man participated in the qualitative interviews (19 who had complied with the blood services' exclusion criterion and 11 who had not complied). Main outcome measure Compliance with the blood services' lifetime exclusion criterion for men who have had penetrative sex with a man. RESULTS 10.6% of men with experience of penetrative sex with a man reported having donated blood in Britain while ineligible under the exclusion criterion, and 2.5% had donated in the previous 12 months. Ineligible donation was less common among men who had had penetrative sex with a man recently (in previous 12 months) than among men for whom this last occurred longer ago. Reasons for non-compliance with the exclusion included self categorisation as low risk, discounting the sexual experience that barred donation, belief in the infallibility of blood screening, concerns about confidentiality, and misunderstanding or perceived inequity of the rule. Although blood donation was rarely viewed as a "right," potential donors were seen as entitled to a considered assessment of risk. A one year deferral since last male penetrative sex was considered by study participants to be generally feasible, equitable, and acceptable. CONCLUSIONS A minority of men who have sex with men who are ineligible to donate blood under the current donor exclusion in Britain have nevertheless done so in the past 12 months. Many of the reasons identified for non-compliance seem amenable to intervention. A clearly rationalised and communicated one year donor deferral is likely to be welcomed by most men who have sex with men.
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Affiliation(s)
- P Grenfell
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - W Nutland
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - S McManus
- National Centre for Social Research, London EC1V 0AX
| | - J Datta
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - K Soldan
- Health Protection Agency, London NW9 5EQ
| | - K Wellings
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
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Hickson F, Reid D, Weatherburn P, Stephens M, Nutland W, Boakye P. HIV, sexual risk, and ethnicity among men in England who have sex with men. Sex Transm Infect 2004; 80:443-50. [PMID: 15572611 PMCID: PMC1744930 DOI: 10.1136/sti.2004.010520] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [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: 11/04/2022] Open
Abstract
OBJECTIVES To examine ethnic group differences in HIV testing history and sexual HIV risk behaviours that may account for such differences, among men in England who have sex with men (MSM), in order to inform HIV prevention planning priorities. METHODS A self completion survey in the summer of 2001 was carried out in collaboration with community based health promoters. Three recruitment methods were used: "gay pride" festivals, health promoter distributed leaflets, internet version advertised with gay service providers. The leaflet was produced with an alternative cover for targeted recruitment of black men. RESULTS In a sample of 13,369 MSM living in England, 17.0% were from minority ethnic groups and 5.4% had tested HIV positive. Compared to the white British majority, Asian men were 0.32 times as likely to be living with diagnosed HIV infection, while black men were 2.06 times as likely to be doing so. Among men who had not tested HIV positive, Asian men were less likely to have sex with a known HIV positive partner, while black men were more likely to have insertive unprotected anal intercourse both with a partner they knew to be HIV positive and with a partner whose HIV status they did not know. CONCLUSIONS Among MSM in England, HIV prevalence is higher among black men and lower among Asian men compared with the white British majority. Increased sexual HIV risk behaviour, especially exposure during insertive anal intercourse, accounts for some of this difference. HIV prevention programmes for MSM and African people should both prioritise black MSM.
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Affiliation(s)
- F Hickson
- Sigma Research, 64 Eurolink Centre, 49 Effra Road, London SW2 1BZ, UK.
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