1
|
Restar AJ, Quilantang MIN, Surace A, Ogunbajo A, Chan R, Adia A, Cu-Uvin S, Operario D. Characterizing Problematic Drug Use Among Transgender Women and Cisgender Men During the Emerging HIV Crisis in the Philippines: Implications for Policy Research. AIDS Educ Prev 2022; 34:116-130. [PMID: 35438540 PMCID: PMC10442844 DOI: 10.1521/aeap.2022.34.2.116] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Drug use and HIV are key issues for public health interventions in the Philippines. We examined associations of problematic drug use among 320 Filipinx transgender women (trans-WSM) and cisgender men who have sex with men (cis-MSM). The prevalence of exhibited problematic drug use in this sample was 29.38%. Greater odds of problematic drug use were observed among Filipinx participants who recently engaged in sex work (adjusted OR [aOR] = 2.79, 95% CI [1.08, 7.18]), reported having HIV positive and unknown status vs. negative status (aOR = 3.61, 95% CI [1.39, 9.39], and aOR = 13.99, 95% CI [2.04, 29.69], respectively), exhibited low HIV knowledge (aOR = 4.15, 95% CI [1.82, 9.44]), and displayed hazardous drinking (aOR = 2.77, 95% CI [1.21, 6.33]). Given its correlates of HIV-related indicators, integration of HIV and harm reduction services as a public health intervention could potentially decrease problematic drug use.
Collapse
Affiliation(s)
- Arjee J Restar
- University of Washington School of Public Health, Seattle, Washington and Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
- Brown University School of Public Health, Providence, Rhode Island
| | - Ma Irene N Quilantang
- Brown University School of Public Health, Providence, Rhode Island
- The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island
- University of Philippines, Manila, Philippines
| | - Anthony Surace
- Brown University School of Public Health, Providence, Rhode Island
| | | | | | - Alexander Adia
- Brown University School of Public Health, Providence, Rhode Island
- The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island
| | - Susan Cu-Uvin
- Brown University School of Public Health, Providence, Rhode Island
- The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island
- Providence-Boston Center for AIDS Research, Providence, Rhode Island, and the Department of Medicine Miriam Hospital, Providence, Rhode Island
| | - Don Operario
- Brown University School of Public Health, Providence, Rhode Island
- The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island
| |
Collapse
|
2
|
Sabado-Liwag MD, Manalo-Pedro E, Taggueg R, Bacong AM, Adia A, Demanarig D, Sumibcay JR, Valderama-Wallace C, Oronce CIA, Bonus R, Ponce NA. Addressing The Interlocking Impact Of Colonialism And Racism On Filipinx/a/o American Health Inequities. Health Aff (Millwood) 2022; 41:289-295. [PMID: 35130069 DOI: 10.1377/hlthaff.2021.01418] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Within the monolithic racial category of "Asian American," health determinants are often hidden within each subgroup's complex histories of indigeneity, colonialism, migration, culture, and socio-political systems. Although racism is typically framed to underscore the ways in which various institutions (for example, employment and education) disproportionately disadvantage Black/Latinx communities over White people, what does structural racism look like among Filipinx/a/o Americans (FilAms), the third-largest Asian American group in the US? We argue that racism defines who is visible. We discuss pathways through which colonialism and racism preserve inequities for FilAms, a large and overlooked Asian American subgroup. We bring to light historical and modern practices inhibiting progress toward dismantling systemic racial barriers that impinge on FilAm health. We encourage multilevel strategies that focus on and invest in FilAms, such as robust accounting of demographic data in heterogeneous populations, explicitly naming neocolonial forces that devalue and neglect FilAms, and structurally supporting community approaches to promote better self- and community care.
Collapse
Affiliation(s)
- Melanie D Sabado-Liwag
- Melanie D. Sabado-Liwag , California State University, Los Angeles, Los Angeles, California
| | - Erin Manalo-Pedro
- Erin Manalo-Pedro, University of California Los Angeles (UCLA), Los Angeles, California
| | - Roy Taggueg
- Roy Taggueg Jr., University of California Davis, Davis, California
| | | | - Alexander Adia
- Alexander Adia, Filipinx/a/o Community Health Association, Los Angeles, California
| | | | | | | | - Carlos Irwin A Oronce
- Carlos Irwin A. Oronce, Veterans Affairs Greater Los Angeles Healthcare System and UCLA, Los Angeles, California
| | - Rick Bonus
- Rick Bonus, University of Washington, Seattle, Washington
| | | |
Collapse
|
3
|
Restar A, Surace A, Adia A, Goedel W, Ogunbajo A, Jin H, Edeza A, Hernandez L, Cu-Uvin S, Operario D. Characterizing Awareness of Pre-Exposure Prophylaxis for HIV Prevention in Manila and Cebu, Philippines: Web-Based Survey of Filipino Cisgender Men Who Have Sex With Men. J Med Internet Res 2022; 24:e24126. [PMID: 34994705 PMCID: PMC8783281 DOI: 10.2196/24126] [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] [Received: 09/09/2020] [Revised: 10/14/2020] [Accepted: 09/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background The Philippines is experiencing an HIV crisis and is considering implementing pre-exposure prophylaxis (PrEP) as a national public health strategy for HIV prevention for cisgender men who have sex with men (cis-MSM). However, critical information on the awareness of PrEP among cis-MSM is needed to roll out this public health initiative. Objective This study aims to assess PrEP awareness and related correlates (ie, sociodemographic variables, social factors, and health care access and use) among Filipino cis-MSM. Methods We conducted a web-based survey with Filipino cis-MSM (n=179) residing in the cities of Manila and Cebu, Philippines. Multivariable analysis procedures were performed to examine the factors associated with PrEP awareness. Results Our sample demonstrated high awareness (134/179, 74.9%) and interest (159/179, 88.8%) in taking PrEP. The adjusted model showed that greater odds of PrEP awareness were associated with having a college education or higher versus a high school education or lower (adjusted odds ratio [aOR] 7.30, 95% CI 1.01-52.47), earning between PHP 10,000 (US $198.6) and PHP 20,000 (US $397.2) versus <PHP 10,000 (US $198.60; aOR 9.32, 95% CI 1.41-6.22), having had a prior HIV test (aOR 6.06, 95% CI 1.20-13.55), having high HIV knowledge (aOR 3.50, 95% CI 1.11-10.98), and having friends who discussed PrEP (aOR 11.17, 95% CI 2.73-14.5). Conclusions Our findings demonstrate that Filipino cis-MSM are aware of and interested in taking PrEP, but there is currently an unmet need for such biomedical HIV prevention technologies among this population. Incorporating PrEP education into routine HIV screening and leveraging cis-MSM social networks may be useful in optimizing potential PrEP implementation in the Philippines.
Collapse
Affiliation(s)
- Arjee Restar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.,Brown University Global Health Initiative, The Philippine Health Initiative for Research, Service, and Training, Providence, RI, United States.,amFAR, The Foundation of AIDS Research, Washington, DC, United States.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States.,Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | - Anthony Surace
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Alexander Adia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.,Brown University Global Health Initiative, The Philippine Health Initiative for Research, Service, and Training, Providence, RI, United States
| | - William Goedel
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Adedotun Ogunbajo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Harry Jin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Alberto Edeza
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Laufred Hernandez
- Department of Behavioral Sciences, University of Philippines in Manila, Manila, Philippines
| | - Susan Cu-Uvin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.,Brown University Global Health Initiative, The Philippine Health Initiative for Research, Service, and Training, Providence, RI, United States.,Providence-Boston Center for AIDS Research, Providence, RI, United States.,Department of Medicine, Miriam Hospital, Providence, RI, United States
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.,Brown University Global Health Initiative, The Philippine Health Initiative for Research, Service, and Training, Providence, RI, United States
| |
Collapse
|
4
|
Restar AJ, Breslow AS, Jin H, Quilantang MI, Sison O, Bermudez AN, Palatino M, Adia A, Cu-Uvin S, Operario D, Nazareno J. Transgender-specific developmental milestones and associated experiences of violence, discrimination, and stigma among Filipinx transgender women who are sexually active with men. PLoS One 2021; 16:e0248248. [PMID: 33690677 PMCID: PMC7942990 DOI: 10.1371/journal.pone.0248248] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background For transgender people, reaching transgender (trans)-specific developmental milestones, including recognizing and expressing one’s identity, plays an integral role in overall health, wellbeing, and the pursuit of gender affirmation. Yet trans people continue to face minority stressors, including structural violence (i.e., discrimination, violence, and stigma), which may interfere with the achievement of these milestones. Among trans women specifically, however, potential associations between gender developmental milestones and structural violence are not well characterized in the literature. In a sample of Filipinx (i.e., an inclusive term for describing non-binary genders in the Philippines) trans women who are sexually active with men (trans-WSM), we thus sought to: (a) describe the mean ages at which gender developmental milestones occur and (b) examine the associations between structural violence and mean ages at which at which Filipinx trans-WSM experience trans-specific developmental milestones. Methods Using data from Project #ParaSaAtin, an online survey of Filipinx trans-WSM (n = 139), we mapped age-estimates per trans-specific milestones and then tested whether structural violence is associated with the mean age at which trans women experience trans-specific developmental milestones. Results Overall, participants who reported higher levels of discrimination, stigma, and violence also experienced a later age for nearly each milestone (i.e., initial self-awareness of transfeminine identity, transfeminine expression in private, transfeminine expression in public, first consensual oral/vaginal/anal sex with a cisgender male partner, first consensual oral/vaginal/anal sex with a cisgender male partner as a trans women, and hormone integration) (all p-values <0.05). Of note, the single exception to this pattern was the non-significant association between stigma and initial disclosure of transfeminine identification to another person. Conclusion Results are consistent with psychological literature outlining a temporal sequence of developmental milestones among young trans-WSM. For young trans-WSM in the Philippines, data from this study demonstrate significant associations between structural violence and the achievement of developmental milestones. These findings highlight the need for trauma-informed, strengths-based programming and institutional policies that measure and mitigate anti-trans violence.
Collapse
Affiliation(s)
- Arjee J. Restar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, United States of America
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail:
| | - Aaron S. Breslow
- PRIME Center for Health Equity, Albert Einstein College of Medicine, Bronx, New York, United States of America
- Health Equity Research Lab, Harvard Medical School, Cambridge, Massachusetts, United States of America
| | - Harry Jin
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ma Irene Quilantang
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, United States of America
- Department of Behavioral Sciences, University of Philippines, Manila, Philippines
| | - Olivia Sison
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, United States of America
- College of Medicine, University of Philippines, Manila, Philippines
| | - Amiel Nazer Bermudez
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, United States of America
- College of Public Health, University of Philippines, Manila, Philippines
| | - Maylin Palatino
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, United States of America
- Department of Behavioral Sciences, University of Philippines, Manila, Philippines
| | - Alexander Adia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, United States of America
| | - Susan Cu-Uvin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, United States of America
- Providence-Boston Center for AIDS Research, Providence, Rhode Island, United States of America
- Miriam Hospital, Department of Medicine, Providence, Rhode Island, United States of America
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, United States of America
| | - Jennifer Nazareno
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, United States of America
| |
Collapse
|
5
|
Restar AJ, Jin H, Ogunbajo A, Adia A, Surace A, Hernandez L, Cu‐Uvin S, Operario D. Differences in HIV risk and healthcare engagement factors in Filipinx transgender women and cisgender men who have sex with men who reported being HIV negative, HIV positive or HIV unknown. J Int AIDS Soc 2020; 23:e25582. [PMID: 32844564 PMCID: PMC7448155 DOI: 10.1002/jia2.25582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/23/2020] [Revised: 06/12/2020] [Accepted: 06/23/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Understanding HIV risk and healthcare engagement of at-risk individuals by HIV status is vital to informing HIV programmes in settings where the HIV epidemic is rapidly expanding like the Philippines. This study examined differences in HIV risk and healthcare engagement factors among Filipinx transgender women and cisgender men who have sex with men (trans-WSM and cis-MSM respectively) who self-reported being HIV negative, HIV positive or HIV unknown. METHODS Between 2018 and 2019, we conducted Project #ParaSaAtin, an online cross-sectional survey that examined the structural, social and behavioural factors impacting HIV services among Filipinx trans-WSM and cis-MSM (n = 318). We performed multinomial regression procedures to determine factors associated with HIV status (with HIV-negative referent). Co-variates included participant demographics, experiences of social marginalization, HIV risk, healthcare engagement and alcohol and substance problems. RESULTS Self-reported HIV status of the sample was as follows: 38% HIV negative, 34% HIV positive and 28% HIV unknown. Relative to HIV-negative respondents, HIV-positive respondents were more likely to be older (25- to 29-year-old adjusted risk ratio [aRRR]=5.08, 95% Confidence Interval [95% CI] = 1.88 to 13.72; 30- to 34-year-old aRRR = 4.11, 95% CI = 1.34 to 12.58; and 35 + years old aRRR = 8.13, 95% CI = 2.40 to 27.54, vs. 18 to 25 years old respectively), to live in Manila (aRRR = 5.89, 95% CI = 2.20 to 15.72), exhibit hazardous drinking (aRRR = 2.87, 95% CI = 1.37 to 6.00) and problematic drug use (aRRR = 2.90, 95% CI = 1.21 to 7.13). HIV-positive respondents were less likely to identify as straight (aRRR = 0.13, 95% CI = 0.02 to 0.72), and were more likely to avoid HIV services due to lack of anti-lesbian, gay, bisexual and transgender (LGBT) discrimination policies (aRRR = 0.37, 95% CI = 0.14 to 0.90). Relative to HIV-negative respondents, HIV-unknown respondents were less educated (some college aRRR = 0.10, 95% CI = 0.02 to 0.37, beyond college aRRR = 0.31, 95% CI = 0.09 to 0.99, vs. high school or below respectively), had lower HIV knowledge (aRRR = 0.30, 95% CI = 0.20 to 0.71), and were less communicative about safer sex (ARR = 0.29, 95% CI = 0.09 to 0.92). Moreover, HIV-unknown respondents were also more likely to have avoided HIV services due to cost (aRRR = 4.46, 95% CI = 1.73 to 11.52). CONCLUSIONS This study highlights differences in HIV risks and healthcare engagement by HIV status. These findings show different barriers exist per HIV status group, and underscore the need to address Filipinx trans-WSM and cis-MSM's poor engagement in HIV services in the Philippines.
Collapse
Affiliation(s)
- Arjee J Restar
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
- The Philippine Health Initiative for Research, Service, and TrainingBrown University Global Health InitiativeProvidenceRIUSA
- amfARFoundation of AIDS ResearchWashingtonDCUSA
| | - Harry Jin
- Department of EpidemiologyBrown University School of Public HealthProvidenceRIUSA
| | - Adedotun Ogunbajo
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
| | - Alexander Adia
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
- The Philippine Health Initiative for Research, Service, and TrainingBrown University Global Health InitiativeProvidenceRIUSA
| | - Anthony Surace
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
| | - Laufred Hernandez
- Department of Behavioral SciencesUniversity of Philippines ManilaManilaPhilippines
| | - Susan Cu‐Uvin
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
- The Philippine Health Initiative for Research, Service, and TrainingBrown University Global Health InitiativeProvidenceRIUSA
- Providence‐Boston Center for AIDS ResearchProvidenceRIUSA
- Department of MedicineMiriam HospitalProvidenceRIUSA
| | - Don Operario
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
- The Philippine Health Initiative for Research, Service, and TrainingBrown University Global Health InitiativeProvidenceRIUSA
| |
Collapse
|
6
|
Restar A, Ogunbajo A, Adia A, Nazareno J, Hernandez L, Sandfort T, Lurie M, Cu-Uvin S, Operario D. Using structural equation modelling to characterise multilevel socioecological predictors and mediators of condom use among transgender women and cisgender men who have sex with men in the Philippines. BMJ Glob Health 2020; 5:e002463. [PMID: 32699154 PMCID: PMC7380848 DOI: 10.1136/bmjgh-2020-002463] [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: 03/05/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Risks for condomless sex among transgender women and cisgender men who have sex with men (trans-WSM and cis-MSM, respectively) in the Philippines, where HIV recently became a national public health crisis, are shaped and exacerbated by various risk factors across multiple levels. METHODS Between June 2018 and August 2019, we conducted a cross-sectional online study with 318 trans-WSM and cis-MSM respondents from Manila and Cebu cities. Structural equational modelling procedures were performed to determine direct, indirect and overall effects between condom use and latent variables across multiple socioecological levels: personal (ie, condom self-efficacy), social (ie, social capital), environmental (ie, barriers to condom and HIV services) and structural (ie, structural violence, antidiscrimination policies). RESULTS Adjusted for gender, age, location and income, our model showed that: (1) all latent variables at the structural and environmental levels were significantly positively associated with each other (all ps<0.05); (2) barriers to condom and HIV services were significantly negatively associated with social capital (p<0.001) as well as condom self-efficacy (p<0.001); and (3) there were significantly positive associations between social capital and condom self-efficacy (p<0.001), and between condom self-efficacy and condom use (p<0.001). Moreover, social capital and condom self-efficacy fully mediated and buffered the negative effects between environmental and structural barriers and condom use. CONCLUSION This is the first known study pointing to multiple relationships and pathways across multiple socioecological levels that can potentially be leveraged for future interventions aimed at improving condom use among Filipinx trans-WSM and cis-MSM. Such interventions should be multicomponent and build and/or strengthen social capital and condom self-efficacy, as well as intentionally target prominent structural and environmental barriers to condom use.
Collapse
Affiliation(s)
- Arjee Restar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Adedotun Ogunbajo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Alexander Adia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Jennifer Nazareno
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Laufred Hernandez
- Department of Behavioral Sciences, University of the Philippines Manila, Manila, Metro Manila, Philippines
| | - Theo Sandfort
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, New York, USA
| | - Mark Lurie
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Susan Cu-Uvin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, USA
| |
Collapse
|
7
|
Abstract
Pre-exposure prophylaxis (PrEP) can efficaciously avert HIV acquisition for individuals at risk, including transgender individuals (trans) in the Philippines. We conducted multivariate logistic regression procedures in an online sample of Filipina trans women (n = 139) to examine associations of PrEP awareness. In this sample, 53% of Filipina trans women were unaware of PrEP, but almost all (93%) expressed interest in taking PrEP once learning about it. Greater odds of PrEP awareness was associated with discussion of HIV services with their health care providers, higher HIV knowledge, and discussion of PrEP among trans friends. Lower odds of PrEP awareness was associated with reporting being currently unemployed. The findings underscore a subset of trans women who might be early adopters of PrEP, and highlight PrEP inequities among trans women most marginalized, including those who are unemployed and have engaged in sex work.
Collapse
Affiliation(s)
- Arjee J Restar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island
- amfAR, The Foundation of AIDS Research, Washington, DC
| | - Alexander Adia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island
| | - Susan Cu-Uvin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island
- Providence-Boston Center for AIDS Research and Miriam Hospital, Department of Medicine, Providence, Rhode Island
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island
| |
Collapse
|
8
|
Restar AJ, Adia A, Nazareno J, Hernandez L, Sandfort T, Lurie M, Cu-Uvin S, Operario D. Barriers and facilitators to uptake of condoms among Filipinx transgender women and cisgender men who have sex with men: A situated socio-ecological perspective. Glob Public Health 2020; 15:520-531. [PMID: 31630622 PMCID: PMC7093239 DOI: 10.1080/17441692.2019.1679218] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 04/25/2019] [Accepted: 09/12/2019] [Indexed: 10/25/2022]
Abstract
Transgender women (TW) and cisgender men who have sex with men (cis-MSM) are disproportionately impacted by the national HIV crisis in the Philippines, where the HIV incidence has, in large part, been attributed to condomless sex. This study sought to qualitatively examine the socio-ecological factors that contribute to low condom uptake among Filipinx TW and cis-MSM communities in Manila. Between July and August 2017, we conducted semi-structured qualitative interviews with 30 TW and cis-MSM participants (n = 23 and 7, respectively). We identified structural factors described by TW and cis-MSM, and noted that they varied per situation and context of: (a) friends (e.g. as condom promoters and educators), (b) schools (e.g. lack of sex education and HIV curriculum), (c) health care facilities (e.g. availability, educational programmes, and HIV testing requirement), (d) stores (e.g. placement of condoms, distance to store, and cost), and (e) church (e.g. prohibition of condom distribution programmes, and unsupportiveness). Condom-related stigma as a social factor was pervasively present across all situation or context. Our findings support the need for multilevel condom promotion interventions that are tailored per situation or context. Future research is needed to identify factors that can be leveraged for condom promotion strategies within diverse situations.
Collapse
Affiliation(s)
- Arjee J. Restar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island, USA
- amfAR, The Foundation of AIDS Research, Washington, DC, USA
| | - Alexander Adia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island, USA
| | - Jennifer Nazareno
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island, USA
| | - Laufred Hernandez
- Department of Behavioral Sciences, University of Philippines in Manila, Philippines
| | - Theo Sandfort
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division on Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Mark Lurie
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Susan Cu-Uvin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island, USA
- Providence-Boston Center for AIDS Research, Providence, Rhode Island, USA
- Miriam Hospital, Department of Medicine, Providence, RI, USA
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island, USA
| |
Collapse
|
9
|
Restar AJ, Santamaria EK, Adia A, Nazareno J, Chan R, Lurie M, Sandfort T, Hernandez L, Cu-Uvin S, Operario D. Gender affirmative HIV care framework: Decisions on feminizing hormone therapy (FHT) and antiretroviral therapy (ART) among transgender women. PLoS One 2019; 14:e0224133. [PMID: 31634378 PMCID: PMC6802834 DOI: 10.1371/journal.pone.0224133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 05/29/2019] [Accepted: 10/05/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Integration of feminizing hormone therapy (FHT) and antiretroviral therapy (ART) is critical in providing gender-affirming HIV care for transgender (trans) women living with HIV. However, interpersonal communications with HIV providers who are not competent with FHT may complicate this integration. METHODS We conducted semi-structured interviews with trans women (n = 9) who self-reported as HIV-positive and their HIV providers (n = 15) from community-based venues (e.g., clinics) in Manila, Philippines. RESULTS We identified five key themes from our qualitative data: (1) provider's concerns; (2) patient's goals; (3) affirmative vs. non-affirmative provider rhetoric; (4) alignment vs. misalignment of provider rhetoric to patient goals; and (5) FHT and ART-related decisions. Based on these themes, we describe a gender-affirmative HIV care framework to understand FHT-ART decisions among trans women living with HIV. Based on our data, this framework shows that provider-patient communications regarding ART and FHT consists primarily of provider concerns and patient goals regarding FHT. These communications can take on a gender-affirmative or non-affirmative style of rhetoric that either aligns or misaligns with patient goals and may lead to differences in FHT and ART-related decisions among trans women living with HIV. CONCLUSION There exist mixed regimens and beliefs about taking FHT and ART among this sample of trans women. While trans participants' main source of health information is their HIV provider, providers are likely to communicate non-affirmative rhetoric that negatively impacts trans women's decision to take FHT and ART. Research is needed to elucidate co-prescriptions of gender-affirmative services with HIV care among this group in the Philippines.
Collapse
Affiliation(s)
- Arjee J. Restar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, RI, United States of America
- amfAR, The Foundation of AIDS Research, Washington, DC, United States of America
| | - E. Karina Santamaria
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
| | - Alexander Adia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, RI, United States of America
| | - Jennifer Nazareno
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, RI, United States of America
| | - Randolph Chan
- Department of Special Education and Counselling, The Education University of Hong Kong, Tai Po, Hong Kong
| | - Mark Lurie
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
| | - Theo Sandfort
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division on Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, New York, NY, United States of America
| | - Laufred Hernandez
- Department of Behavioral Sciences, University of Philippines in Manila, Manila, Philippines
| | - Susan Cu-Uvin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, RI, United States of America
- Providence-Boston Center for AIDS Research, Providence, RI, United States of America
- Miriam Hospital, Department of Medicine, Providence, RI, United States of America
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, RI, United States of America
| |
Collapse
|
10
|
Restar A, Nguyen M, Nguyen K, Adia A, Nazareno J, Yoshioka E, Hernandez L, Operario D. Trends and emerging directions in HIV risk and prevention research in the Philippines: A systematic review of the literature. PLoS One 2018; 13:e0207663. [PMID: 30517178 PMCID: PMC6281194 DOI: 10.1371/journal.pone.0207663] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 07/16/2018] [Accepted: 11/05/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Philippines is experiencing one of the fastest growing epidemics globally. Evidence-based public health policies are needed. To describe the public health literature on HIV risk groups and prevention approaches in the Philippines, we reviewed published empirical studies with HIV-related outcomes. METHODS Based on an a priori systematic review protocol, we searched PubMed, PsycINFO and CINAHL databases for quantitative studies conducted in the Philippines that reported on HIV risk groups factors and interventions to prevent HIV. The search included studies published as of April 2018. RESULTS We identified 755 records, screened 699 unique titles and abstracts, and conducted full text review of 122 full reports of which 51 articles met inclusion criteria. The majority were cross-sectional studies describing HIV and STI prevalence and risk factors in samples recruited from the Philippines. Four HIV prevention programs conducted in the Philippines were identified, all of which reported improvements on HIV knowledge, attitudes, and behaviors. Overall, female sex workers (FSWs) constituted the primary study population, and few studies reported data from men who have sex with men (MSM), people who inject drugs (PWIDs), and youth. No studies reported on transgender populations. Most studies were focused on examining condom use-related outcomes and STI history, few had biomarkers for HIV, and none addressed biomedical HIV prevention strategies. CONCLUSION This review identifies an agenda for future HIV research that is needed to address the growing and shifting nature of the HIV epidemic in the Philippines.
Collapse
Affiliation(s)
- Arjee Restar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
| | - Mary Nguyen
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
| | - Kimberly Nguyen
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
| | - Alexander Adia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
| | - Jennifer Nazareno
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
| | - Emily Yoshioka
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
| | - Laufred Hernandez
- Department of Behavioral Sciences, University of the Philippines, Manila, Philippines
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
| |
Collapse
|