|
1
|
Zhang Y, Tapa J, Johnson CC, Phillips TR, Fairley CK, Ameyan W, Mello MB, Chow EPF, Chidarikire T, Ong JJ. HIV, hepatitis, and syphilis self-testing among adolescents and young adults: A systematic review and meta-analysis. J Infect Public Health 2025; 18:102764. [PMID: 40157332 DOI: 10.1016/j.jiph.2025.102764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Revised: 03/13/2025] [Accepted: 03/16/2025] [Indexed: 04/01/2025] Open
Abstract
BACKGROUND Adolescents and young adults (AYA) make up a significant share of the world's burden of HIV and other sexually transmitted infections (STI). Self-testing can increase testing coverage and strengthen the uptake of prevention and treatment services. We critically appraised the literature regarding HIV, hepatitis, and syphilis self-testing among AYA (age 10-24 years) and assessed its usability, feasibility, and acceptability. METHODS We conducted a systematic review, searching six databases between January 2010 and October 2023. We included all studies on HIV, hepatitis and syphilis self-testing in AYA. We used a random-effects meta-analysis to pool evidence across the three infections as evidence was deemed sufficiently similar. We summarised the uptake, proportion of first-time testers and linkage to care. Qualitative data were narratively synthesised. FINDINGS We identified 89 relevant studies. Most were conducted in Africa (57/89, 64 %) and lower-middle-income countries (34/89, 38 %). Our meta-analysis of 27 studies (n = 28,787 individuals) demonstrated that 79 % (95 % CI: 69-87 %, I2 = 99 %) of AYA who were offered HIV or syphilis self-test completed the test. Five studies (n = 4117) demonstrated 62 % (95 % CI: 53-71 %, I2 = 83 %) were first-time testers. No studies reported completion rates for hepatitis self-testing. In general, AYA were highly accepting of self-testing and found it easy to use. INTERPRETATION Self-testing is a safe, acceptable and effective way to increase access to HIV, hepatitis and syphilis testing in AYA. Given these features of self-testing, policies to increase its use should significantly improve testing and maximise their public health impact.
Collapse
Affiliation(s)
- Ying Zhang
- School of Translational Medicine, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - James Tapa
- School of Translational Medicine, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Cheryl C Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Tiffany R Phillips
- School of Translational Medicine, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Christopher K Fairley
- School of Translational Medicine, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Wole Ameyan
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Maeve B Mello
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Eric P F Chow
- School of Translational Medicine, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Thato Chidarikire
- South Africa Country Office, World Health Organization, Pretoria, South Africa
| | - Jason J Ong
- School of Translational Medicine, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| |
Collapse
|
|
2
|
Hassan R, Thornton N, King H, Aufderheide G, Silberzahn B, Huettner S, Jennings JM, Evans KN, Fields EL. Perceptions of a community-based HIV/STI testing program among Black gay, bisexual, and other MSM in Baltimore: a qualitative analysis. AIDS Care 2024; 36:1570-1579. [PMID: 38976576 PMCID: PMC11511628 DOI: 10.1080/09540121.2024.2372722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 06/21/2024] [Indexed: 07/10/2024]
Abstract
Black gay, bisexual, and other men who have sex with men (GBM) are disproportionately affected by HIV and STIs. Safe Spaces 4 Sexual Health (SS4SH), a community-informed, status-neutral HIV/STI testing intervention combines online outreach via geo-social networking apps and social media with mobile van testing. During 2018-2019, we recruited 25 participants for interviews about their perceptions of SS4SH compared to clinic-based testing. Participants were aged 21-65 years (mean 35); 22 (88%) identified as Black/African American; 20 (80%) identified as gay; and 10 (40%) were living with HIV. Interviews were transcribed, coded, and analyzed using a modified thematic constant comparative approach. Five themes emerged; two related to perceptions of online outreach materials (participants were drawn to eye-catching and to-the-point messages and desired more diversity and representation in messages), and three related to preference for the mobile van (participants found SS4SH provided more comfort, more privacy/confidentiality, and increased accessibility and efficiency). GBM is increasingly using geo-social networking apps to meet sexual partners, and tailored online outreach has the potential to reach historically underserved populations. SS4SH is a barrier-reducing strategy that may serve as an entry to a status-neutral approach to services and help reduce stigma and normalize accessing HIV services.
Collapse
Affiliation(s)
- Rashida Hassan
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Hope King
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | - Kimberly N. Evans
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | |
Collapse
|
|
3
|
Eaton LA, Huedo-Medina T, Earnshaw VA, Kalichman M, Watson RJ, Driver R, Chandler CJ, Kalinowski J, Kalichman SC. Randomized Clinical Trial of Stigma Counseling and HIV Testing Access Interventions to Increase HIV Testing Among Black Sexual Minority Men and Transwomen. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:650-660. [PMID: 37898978 DOI: 10.1007/s11121-023-01603-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 10/31/2023]
Abstract
Advances in HIV prevention tools have outpaced our ability to ensure equitable access to these tools. Novel approaches to reducing known barriers to accessing HIV prevention, such as stigma and logistical-related factors, are urgently needed. To evaluate the efficacy of a randomized controlled trial with four intervention arms to address barriers to HIV/STI testing uptake (primary outcome) and PrEP use, depression, and HIV test results (secondary outcomes). We tested a 2 × 2 research design: main effect 1-stigma-focused vs. health information evaluation-focused counseling, main effect 2-offering HIV/STI testing appointments in person vs. at home with a counselor via video chat, and the interaction of the main effects. Participants (N = 474) residing in the southeastern USA were screened and enrolled in a longitudinal trial. Intervention efficacy was established using generalized linear modeling with binomial or Poisson distributions. Intervention efficacy demonstrated an increase in HIV/STI testing uptake when testing was made available at home with a counselor via video chat vs. in person (83% vs. 75% uptake, p < .05), and participants were also more likely to test positive for HIV over the course of the study in the at-home condition (14.5% vs. 9.4%, p < .05). Stigma-focused counseling resulted in lower depression scores and greater uptake of PrEP among participants < 30 years of age when compared with health information counseling (15.4% vs. 9.6%, p < .05). In order to prevent further disparities between HIV prevention advances and access to HIV prevention tools, we must prioritize improvements in linking people to care. Novel interventions, such as those proposed here, offer a practical, evidence-based path to addressing long-standing barriers to HIV prevention strategies. Trial registration: NCT03107910.
Collapse
Affiliation(s)
- Lisa A Eaton
- Human Development and Family Sciences, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06279-1248, USA.
| | | | - Valerie A Earnshaw
- Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | | | - Ryan J Watson
- Human Development and Family Sciences, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06279-1248, USA
| | - Redd Driver
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cristian J Chandler
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jolaade Kalinowski
- Human Development and Family Sciences, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06279-1248, USA
| | - Seth C Kalichman
- Psychological Sciences, University of Connecticut, Storrs, CT, USA
| |
Collapse
|
|
4
|
Chang K, D'Anna LH, Owens J, Wood J. The Effects of Previous Experiences of Healthcare Discrimination on HIV Intervention Outcomes. AIDS Behav 2024; 28:1741-1751. [PMID: 38367163 DOI: 10.1007/s10461-024-04267-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 02/19/2024]
Abstract
Although several healthcare interventions have been developed to address HIV among young Black/African American men who have sex with men (YBMSM), the HIV epidemic in the United States continues to disproportionately burden this population. The current study examines previous healthcare discrimination and how it affects HIV intervention delivery. One hundred seventy-two YBMSM participated in the Peer Promotion of Wellness and Enhanced Linkage to Resources (PPOWER) project, which used a short, multi-faceted, community-level intervention based on Community Peers Reaching Out and Modeling Intervention Strategies (Community PROMISE). Data were collected at baseline, a 45-day follow up, and a 90-day follow up. Generalized Estimating Equations (GEE) were used to examine the effects of previous healthcare discrimination on outcomes related to HIV testing, alcohol and drug use, and sexual behaviors. Previous healthcare discrimination was found to moderate the relationship between time and intentions to test for HIV, perceptions of sexual risk, problem marijuana use, and problem other drug use, such that those who had experienced more healthcare discrimination showed greater improvements over time compared to those who had experienced less healthcare discrimination. The results of the current study suggest that a community-level peer intervention, in combination with a component to promote cultural competency and address prior experiences of discrimination in healthcare settings, may be highly effective for people who have experienced a barrier in their continuum of care as a result of racial discrimination.
Collapse
Affiliation(s)
- Kyle Chang
- Center for Health Equity Research, California State University Long Beach, 1250 Bellflower Blvd., FO5 Rm. 120, Long Beach, CA, 90840, USA.
| | - Laura Hoyt D'Anna
- Center for Health Equity Research, California State University Long Beach, 1250 Bellflower Blvd., FO5 Rm. 120, Long Beach, CA, 90840, USA
| | - Jaelen Owens
- Center for Health Equity Research, California State University Long Beach, 1250 Bellflower Blvd., FO5 Rm. 120, Long Beach, CA, 90840, USA
| | - Jefferson Wood
- Center for Health Equity Research, California State University Long Beach, 1250 Bellflower Blvd., FO5 Rm. 120, Long Beach, CA, 90840, USA
| |
Collapse
|
|
5
|
Greene E, Walcott M, Guerra L, Tieu HV, Nandi V, Soler J, Diaz J, Curriero F, Latkin C, Bosompem A, Frye V, NNHIV Study Team. Correlates of concordance between self-reported and lab-confirmed viral load among Black and Latine men who have sex with men (BLMSM) living with HIV in New York City. AIDS Care 2024; 36:661-671. [PMID: 37399515 PMCID: PMC10761596 DOI: 10.1080/09540121.2023.2229816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Abstract
Sustained viral suppression is one of the four strategies in the U.S. Department of Health and Human Services' (HHS) plan to end the HIV epidemic in the United States. Individuals living with HIV must understand their viral load accurately for this strategy to be effective. We conducted cross-sectional analyses using baseline data from the NNHIV longitudinal study among men who have sex with men (MSM) living with HIV in New York City to identify factors associated with concordant knowledge between self-reported and lab-confirmed viral load. Of 164 Black and/or Latine participants, 67% (n = 110) reported that their viral load was undetectable, however lab tests showed only 44% (n = 72) had an undetectable viral load (<20 copies/ml). Overall, 62% of the sample (n = 102) had concordant HIV viral load knowledge (agreement of self-reported and lab viral load). In multivariable regression, those with unstable housing (PR = 0.52, 0.30-0.92) and those who had higher levels of beliefs of racism in medicine scale (PR = 0.76, 0.59-0.97) were less likely to have concordant knowledge. Our study underscores the need for implementing measures to improve viral load knowledge, U = U messaging, and strategies to achieve and maintain undetectable viral load status to reduce the burden of HIV at the population level.
Collapse
Affiliation(s)
| | - Melonie Walcott
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, NY, NY
| | - Lauren Guerra
- Department of Epidemiology, Columbia University Mailman School of Public Health, NY, NY
| | - Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, NY, NY
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, NY, NY
| | - Vijay Nandi
- Laboratory of Data Analytic Services, Lindsley F. Kimball Research Institute, New York Blood Center, NY, NY
| | - Jorge Soler
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, NY, NY
| | - Jose Diaz
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Frank Curriero
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Carl Latkin
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | | | - Victoria Frye
- CUNY School of Medicine, NY, NY
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, NY, NY
| | | |
Collapse
|
|
6
|
Badru OA, Adeagbo OA. The perception of HIV self-testing and willingness to use mHealth for HIV prevention among Black men who have sex with men in Iowa, United States: A qualitative study. Digit Health 2024; 10:20552076241302250. [PMID: 39640965 PMCID: PMC11618894 DOI: 10.1177/20552076241302250] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 11/07/2024] [Indexed: 12/07/2024] Open
Abstract
Objective The World Health Organization approved HIV self-test (HIVST) to break the barriers to HIV testing. Black men who have sex with men (Black MSM) in the United States are less likely to test for HIV or link to care due to several factors, such as stigma and distance. We explored Black MSM's knowledge of HIVST and their willingness to use a mobile application (mHealth) to link to HIV care and engage with health providers. Methods Between March and September 2023, we interviewed 12 Black MSM in small urban areas and explored HIVST awareness and willingness to use mHealth. Participants were recruited through purposive and snowball sampling. The data were analyzed inductively. Results The age range was 20-42 years. Participants had mixed knowledge of HIVST. The barriers to HIVST uptake are poor knowledge of HIVST, lack of adequate medical insurance to access HIVST kits, and concerns about the efficacy of HIVST kits. Black MSM were willing to link to care via mHealth but expressed concerns related to safety, confidentiality, and the risk of HIV stigma. Participants recommended wider awareness via social media and that the proposed mobile application has a simple interface for ease of use. Conclusion To encourage uptake among Black MSM, the Iowa Department of Health and Human Services should make HIVST accessible (low-cost or free). The proposed mHealth should be developed with a simple and interactive interface, including images and videos to guide HIVST and linkage to health professionals for assistance.
Collapse
Affiliation(s)
| | - Oluwafemi Atanda Adeagbo
- Department of Community and Behavioral Health, University of Iowa, USA
- Department of Sociology, University of Johannesburg, Johannesburg, South Africa
| |
Collapse
|
|
7
|
Zapata JP, Hirshfield S, Nelson K, Horvath K, John SA. Preferred Characteristics for mHealth Interventions Among Young Sexual Minoritized Men to Support HIV Testing and PrEP Decision-Making: Focus Group Study. JMIR Form Res 2023; 7:e51103. [PMID: 37713640 PMCID: PMC10616747 DOI: 10.2196/51103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/01/2023] [Accepted: 09/15/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Epidemiological trends in the United States have shown an increase in HIV cases among young sexual minoritized men. Using mobile health (mHealth), which refers to health services and information delivered or enhanced through the internet and related technologies, is a crucial strategy to address HIV disparities. However, despite its potential, the practical implementation of mHealth remains limited. Additionally, it is important to consider that young individuals may become accustomed to, distracted from, or lose interest in these apps, highlighting the need for regular updates and monitoring of relevant content. OBJECTIVE In this study, we sought to highlight the voices of young sexual minoritized men aged 17-24 years and explored preferred mHealth intervention characteristics and willingness to adopt these technologies among a diverse, nationwide sample of young sexual minoritized men. METHODS From April to September 2020, we recruited participants through web-based platforms such as social media and geosocial networking apps for men. These individuals were invited to participate in synchronous web-based focus group discussions centered around topics pertaining to HIV testing and prevention and their preferences for mHealth technologies. RESULTS A total of 41 young sexual minoritized men, aged between 17 and 24 years, participated in 9 focus group discussions spanning April to September 2020, with 3-7 participants in each group. The findings shed light on three key insights regarding young sexual minoritized men's preferences: (1) the need for personalized and representative content, (2) a preference for mobile and web-based simulation of prevention scenarios, and (3) a preference for digital software with individually tailored content. As expected, preference for mHealth apps was high, which supports the potential and need to develop or adapt interventions that use smartphones as a platform for engaging young sexual minoritized men in HIV prevention. This study expands on previous research in multiple meaningful ways, delving into the use and perceptions of mHealth information amid the COVID-19 pandemic. This study also highlighted the importance of streamlined access to health care providers, especially in light of the barriers faced by young people during the COVID-19 pandemic. In terms of presentation and navigation, participants favored a user-friendly design that was easy to use and appropriate for their age, which was effectively addressed through the implementation of web-based simulations. CONCLUSIONS Ultimately, this study provides valuable insight into the preferences of young sexual minoritized men when it comes to mHealth interventions and highlights the need for further research in order to develop effective and tailored HIV prevention tools. A future direction for researchers is to evaluate how best to address participants' desire for personalized content within mHealth apps. Additionally, as technology rapidly evolves, there is a need to re-assess the effectiveness of web-based simulations, particularly those that are used in HIV prevention.
Collapse
Affiliation(s)
- Juan Pablo Zapata
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Sabina Hirshfield
- State University of New York Downstate Health Sciences University, Brooklyn, NY, United States
| | - Kimberly Nelson
- Department of Medicine, School of Public Health, Boston University, Boston, MA, United States
| | - Keith Horvath
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Steven A John
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| |
Collapse
|
|
8
|
Freitas CAM, Rossi TA, Dourado I, Castellanos MEP, Guimarães NS, Magno L. Mapping evidence on health promotion in HIV testing among men who have sex with men and transgender women using the social-ecological model and the vulnerability theoretical framework: a scoping review. BMC Public Health 2023; 23:1946. [PMID: 37805484 PMCID: PMC10559455 DOI: 10.1186/s12889-023-16860-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/29/2023] [Indexed: 10/09/2023] Open
Abstract
This study aimed to map the scientific evidence on health promotion in human immunodeficiency virus) HIV testing among men who have sex with men (MSM) and transgender women (TGW) based on the social-ecological model (i.e., individual, organizational and social levels) and the theoretical framework of vulnerability (i.e., individual, social, and programmatic levels). The reviewed studies indicated several barriers to accessing HIV testing (e.g., economic, structural, and bureaucratic) and demonstrated the potential for community approaches to promote greater access to HIV testing and minimize the stigma and discrimination associated with HIV testing, primarily through community leadership and social support networks. The socio-ecological model of health promotion and the vulnerability approach have the potential to contribute to improving HIV testing services by balancing the technical and political power of health services and providers with community participation while considering the social contexts. Therefore, there is a need for reflection on health promotion policies and programs aimed at expanding access to HIV testing among MSM and TGW through interventions that consider the social contexts and cultural perspectives. Moreover, inter-sectoral strategies aimed at improving living conditions and access to fundamental resources for maintaining health and well-being should be considered.
Collapse
Affiliation(s)
- Camila Amaral Moreno Freitas
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Basílio da Gama Street, Salvador, BA, 40110-040, Brazil.
| | - Thais Aranha Rossi
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), 2555 Silveira Martins Street, Salvador, BA, 41150000, Brazil
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Basílio da Gama Street, Salvador, BA, 40110-040, Brazil
| | | | - Nathalia Sernizon Guimarães
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Basílio da Gama Street, Salvador, BA, 40110-040, Brazil
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), 2555 Silveira Martins Street, Salvador, BA, 41150000, Brazil
| | - Laio Magno
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Basílio da Gama Street, Salvador, BA, 40110-040, Brazil
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), 2555 Silveira Martins Street, Salvador, BA, 41150000, Brazil
| |
Collapse
|
|
9
|
Vitsupakorn S, Pierce N, Ritchwood TD. Cultural interventions addressing disparities in the HIV prevention and treatment cascade among Black/African Americans: a scoping review. BMC Public Health 2023; 23:1748. [PMID: 37679765 PMCID: PMC10485990 DOI: 10.1186/s12889-023-16658-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 08/30/2023] [Indexed: 09/09/2023] Open
Abstract
Culture is an important determinant of HIV risk and protective behaviors; yet, we know little about how it is integrated in HIV interventions. This scoping review characterizes the integration of culture in HIV prevention and treatment interventions focused on Black/African Americans. We searched MEDLINE, PsycINFO, CINAHL, and Google Scholar for peer-reviewed manuscripts published between July 1, 2011, and June 28, 2021. Twenty-five interventions were identified, with 96% focused on prevention. Most (40%) targeted men who have sex with men or transgender women. Only three were grounded in cultural theory. Although all interventions were labeled "culturally based," only two explicitly defined culture. Moreover, there was much diversity regarding the ways in which interventions integrated cultural elements, with some conflating race/ethnicity with culture. To improve uptake and HIV-related outcomes, interventions integrating culture are greatly needed. Additionally, HIV interventions purporting to be "culturally based" must include basic information to support rigor and reproducibility.
Collapse
Affiliation(s)
| | - Nia Pierce
- College of Humanities and Social Sciences, North Carolina State University, Raleigh, NC, USA
| | - Tiarney D Ritchwood
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| |
Collapse
|
|
10
|
Dale SK, Etienne K, Hall S, Lazarus K, Nunnally K, Gibson G, Bolden R, Gardner N, Sanders J, Reid R, Phillips A. Five point initiative: a community-informed bundled implementation strategy to address HIV in Black communities. BMC Public Health 2023; 23:1625. [PMID: 37626315 PMCID: PMC10463742 DOI: 10.1186/s12889-023-16525-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Black individuals in the U.S. remain the most disproportionately impacted by new HIV diagnoses, represent the highest portion of individuals living with HIV, and have the highest morbidity rates. Structural inequities and historical oppression are the primary drivers. Such drivers limit access to HIV prevention tools that need to be delivered with culturally congruent and community-informed approaches. METHODS The Five Point Initiative (FPI) is a community-informed bundled implementation strategy developed and piloted between September 2019 and March 2020 in Miami, Florida in communities heavily impacted by HIV. Key components of the strategy included community consultants/experts, five categories (hence the "Five Point") of community businesses (e.g., corner stores, beauty supply stores, laundromats, mechanics, barbershops), local health organizations, an academic research program engrossed in community engaged research, and community residents who provided ongoing feedback throughout. Outcomes of FPI included (a) survey information (e.g., knowledge of and access to PrEP, barriers to care) and pilot data (acceptability and feasibility), (b) expansion of reach to Black individuals in HIV high impact zip codes in Miami, (c) insights on our bundled implementation strategy, (d) condom distribution, and (e) HIV testing. RESULTS Over the course of six months FPI carried out 10 outreach events, partnered with 13 community businesses and 5 health organizations, engaged 677 community residents, collected health information via a survey, distributed 12,434 condoms, provided information on PrEP, and offered voluntary HIV testing (131 completed). FPI's ability to reach residents who are not being reached (e.g., 68.8% never heard of PrEP, 8% no HIV testing ever, 65.9% no primary care provider), positive feedback from residents (e.g., 70% very satisfied, 21% satisfied; 62% strongly agree and 25% agree they would participate again) and qualitative interviews with businesses provide evidence of acceptability and feasibility. Further, survey data provided insights on factors such as socio-demographics, discrimination experiences, barriers to care, social-structural factors, physical and sexual health, and mental health and substance use. CONCLUSIONS The FPI bundled implementation strategy shows promise to deliver health prevention/intervention for HIV and other health conditions to communities facing health inequities and for whom the current system for delivering care is insufficient.
Collapse
Affiliation(s)
- Sannisha K Dale
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA.
| | - Kayla Etienne
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Sidny Hall
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
- New College of Florida, Sarasota, FL, USA
| | - Kimberly Lazarus
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | | | | | - Roxana Bolden
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
- A Sister with A Testimony, Miami, FL, USA
| | - Nadine Gardner
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Jasmyn Sanders
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Rachelle Reid
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Arnetta Phillips
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| |
Collapse
|
|
11
|
Adepoju VA, Imoyera W, Onoja AJ. Preferences for oral- vs blood-based human immunodeficiency virus self-testing: A scoping review of the literature. World J Methodol 2023; 13:142-152. [PMID: 37456972 PMCID: PMC10348079 DOI: 10.5662/wjm.v13.i3.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/22/2023] [Accepted: 05/24/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND The evidence on preferences for oral- vs blood-based human immunodeficiency virus self-testing (HIVST) has been heterogenous and inconclusive. In addition, most evaluations have relied on hypothetical or stated use cases using discreet choice experiments rather than actual preferences among experienced users, which are more objective and critical for the understanding of product uptake. Direct head-to-head comparison of consumer preferences for oral- versus blood-based HIVST is lacking. AIM To examine the existing literature on preferences for oral- vs blood-based HIVST, determine the factors that impact these preferences, and assess the potential implications for HIVST programs. METHODS Databases such as PubMed, Medline, Google Scholar, and Web of Science were searched for articles published between January 2011 to October 2022. Articles must address preferences for oral- vs blood-based HIVST. The study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist to ensure the quality of the study. RESULTS The initial search revealed 2424 records, of which 8 studies were finally included in the scoping review. Pooled preference for blood-based HIVST was 48.8% (9%-78.6%), whereas pooled preference for oral HIVST was 59.8% (34.2%-91%) across all studies. However, for male-specific studies, the preference for blood-based HIVST (58%-65.6%) was higher than that for oral (34.2%-41%). The four studies that reported a higher preference for blood-based HIVST were in men. Participants considered blood-based HIVST to be more accurate and rapid, while those with a higher preference for oral HIVST did so because these were considered non-invasive and easy to use. CONCLUSION Consistently in the literature, men preferred blood-based HIVST over oral HIVST due to higher risk perception and desire for a test that provides higher accuracy coupled with rapidity, autonomy, privacy, and confidentiality, whereas those with a higher preference for oral HIVST did so because these were considered non-invasive and easy to use. Misinformation and distrust need to be addressed through promotional messaging to maximize the diversity of this new biomedical technology.
Collapse
Affiliation(s)
- Victor Abiola Adepoju
- Department of HIV and Infectious Diseases, Jhpiego Nigeria, an affiliate of John Hopkins University, Abuja 900901, Federal Capital Territory, Nigeria
| | - Winifred Imoyera
- Department of HIV and Infectious Diseases, Jhpiego Nigeria, an affiliate of John Hopkins University, Abuja 900901, Federal Capital Territory, Nigeria
| | - Ali Johnson Onoja
- Research, African Health Project, Abuja 900901, Federal Capital Territory, Nigeria
| |
Collapse
|
|
12
|
Guigayoma J, Becker SJ, Ong JJ, Kanamori M, Hickson D, Ward LM, Biello KB, Wray T. Addressing key issues in HIV self-test program implementation for Black and Latino sexual minority men in the Southern United States: a multiphase study protocol. Implement Sci Commun 2023; 4:14. [PMID: 36782303 PMCID: PMC9926573 DOI: 10.1186/s43058-023-00395-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 01/30/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Black and Latino sexual minority men in the Southern United States have the highest HIV infection rates in the country. Increased HIV testing can help decrease onward HIV transmission through detecting previously undiagnosed infections. HIV self-testing is an evidence-based strategy to increase HIV testing among sexual minority men, but the implementation of this intervention in the Southern United States is limited. One implementation barrier is the lack of knowledge of Black and Latino sexual minority men's preferences for various HIV self-testing program characteristics and their willingness to pay for these preferences. In addition, little is known about facilitators and barriers to initiating HIV self-testing programs from the perspectives of HIV prevention implementation decision-makers in this region. METHODS We will conduct an online discrete choice experiment among Black and Latino sexual minority men in the Southern United States (n = 300) to estimate this population's preferences for the following HIV self-testing program characteristics: delivery strategy (home delivery, peer delivery, clinic pickup); delivery speed (same day, next day, 3 days, and 5 days); support (instructions only, during test, and 1 week after delivery); and price ($0, $20, $40, $50, $60). We will also use this choice data to generate willingness-to-pay estimates for each program characteristic. Guided by the Consolidated Framework for Implementation Research, we will then conduct semi-structured interviews (n = 30) with HIV prevention program decision-makers at various health organizations serving Black and Latino sexual minority men in the region to further understand facilitators and barriers to implementation of the most preferred HIV self-testing program design. DISCUSSION By gaining perspectives on HIV self-testing implementation from patients and providers, this project will build a roadmap for the initiation of HIV self-testing programs to decrease HIV incidence among one of the most disproportionately impacted populations in the USA.
Collapse
Affiliation(s)
- John Guigayoma
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main St., Providence, RI, 02912, USA.
| | - Sara J Becker
- Center for Dissemination and Implementation Science, Institute for Public Health and Medicine, Northwestern University, 633 N. Saint Clair St., Chicago, IL, 60611, USA
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
- Central Clinical School, Monash University, 99 Commercial Rd., Melbourne, VIC, 3004, Australia
| | - Mariano Kanamori
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 10th St., FL, 33136, Miami, USA
| | - DeMarc Hickson
- Us Helping Us, People Into Living Inc., 3636 Georgia Ave. NW, Washington, DC, 20010, USA
| | - Lori M Ward
- University of Mississippi Medical Center, 2500 North State St., Jackson, MS, 39216, USA
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main St., Providence, RI, 02912, USA
- Department of Epidemiology, Brown University School of Public Health, 121 S. Main St., Providence, RI, 02912, USA
- The Fenway Institute, Fenway Health, 1340 Boylston St., Boston, MA, 02215, USA
- Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 S. Main St., Providence, RI, 02912, USA
| | - Tyler Wray
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main St., Providence, RI, 02912, USA
| |
Collapse
|
|
13
|
Mantell JE, Khalifa A, Christian SN, Romo ML, Mwai E, George G, Strauss M, Govender K, Kelvin EA. Preferences, beliefs, and attitudes about oral fluid and blood-based HIV self-testing among truck drivers in Kenya choosing not to test for HIV. Front Public Health 2022; 10:911932. [PMID: 36438254 PMCID: PMC9682285 DOI: 10.3389/fpubh.2022.911932] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 10/03/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Clinical trials in sub-Saharan Africa support that HIV self-testing (HIVST) can increase testing rates in difficult-to-reach populations. However, trials mostly evaluate oral fluid HIVST only. We describe preferences for oral fluid vs. blood-based HIVST to elucidate prior trial results and inform testing programs. Methods Participants were recruited from a HIVST randomized controlled trial in Nakuru County, Kenya, which aimed to test the effect of choice between oral HIVST and facility-based testing compared to standard-of-care on HIV testing among truck drivers. We conducted in-depth interviews (IDIs) with purposively sampled trial participants who declined HIV testing at baseline or who were offered access to oral fluid HIVST and chose not to pick up the kit during follow-up. IDIs were conducted with all consenting participants. We first describe IDI participants compared to the other study participants, assessing the statistical significance of differences in characteristics between the two samples and then describe preferences, beliefs, and attitudes about HIVST biospecimen type expressed in the IDIs. Results The final sample consisted of 16 men who refused HIV testing at baseline and 8 men who did not test during follow-up. All IDI participants had tested prior to study participation; mean number of years since last HIV test was 1.55, vs. 0.98 among non-IDI participants (p = 0.093). Of the 14 participants who answered the question about preferred type of HIVST, nine preferred blood-based HIVST, and five, oral HIVST. Preference varied by study arm with four of five participants who answered this question in the Choice arm and five of nine in the SOC arm preferring blood-based HIVST. Six key themes characterized truckers' views about test type: (1) Rapidity of return of test results. (2) Pain and fear associated with finger prick. (3) Ease of use. (4) Trust in test results; (5) fear of infection by contamination; and (6) Concerns about HIVST kit storage and disposal. Conclusion We found no general pattern in the themes for preference for oral or blood-based HIVST, but if blood-based HIVST had been offered, some participants in the Choice arm might have chosen to self-test. Offering choices for HIVST could increase testing uptake.
Collapse
Affiliation(s)
- Joanne E. Mantell
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States,*Correspondence: Joanne E. Mantell
| | - Aleya Khalifa
- ICAP at Columbia University, New York, NY, United States,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Stephanie N. Christian
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, PA, United States
| | - Matthew L. Romo
- Department of Epidemiology and Biostatistics and Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Eva Mwai
- The North Star Alliance, Nairobi, Kenya
| | - Gavin George
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa,Division of Social Medicine and Global Health, Lund University, Lund, Sweden
| | - Michael Strauss
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Kaymarlin Govender
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Elizabeth A. Kelvin
- Department of Epidemiology and Biostatistics and Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| |
Collapse
|
|
14
|
Sullivan PS, Galli R, Malhomme N, York J. Laboratory Industry Perspectives on the Role of Self-Collection and Self-Testing in Remote Care for Sexually Transmitted Infections: How Do We Bring These Services to Scale? Sex Transm Dis 2022; 49:S31-S35. [PMID: 35839281 PMCID: PMC10405362 DOI: 10.1097/olq.0000000000001676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Patrick S Sullivan
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Rick Galli
- MAP Centre for Urban Health Solutions, REACH Nexus, St. Michael's Hospital, Unity Health, Toronto, Canada
| | | | - James York
- Business Development, Molecular Testing Labs, Vancouver, WA
| |
Collapse
|
|
15
|
Liu Y, Hawkins M, Osman A, Zhang C. Assessing the Prevalence and Determinants of Exposure-Influenced HIV Testing among a Sample of Pre- and Post-Exposure Prophylaxis-Naïve Young Men Who Have Sex with Men in the United States. Trop Med Infect Dis 2022; 7:tropicalmed7080146. [PMID: 35893655 PMCID: PMC9331231 DOI: 10.3390/tropicalmed7080146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/19/2022] [Accepted: 07/23/2022] [Indexed: 02/01/2023] Open
Abstract
Self-initiated Human Immunodeficiency Virus (HIV) testing after potential sexual exposure to HIV (i.e., exposure-influenced HIV testing) has high utility in detecting individuals with the highest probabilities of HIV seroconversion. We conducted a cross-sectional study among a sample of sexually active, pre/post-exposure prophylaxis (PrEP/PEP)-naïve young men who have sex with men (YMSM) in two US cities to assess the determinants (e.g., demographic, psychosocial, sexual, substance use, and HIV prevention characteristics) of exposure-influenced HIV testing (never/rarely vs. mostly/always) in their lifetime. Of 261 YMSM, only 26.5% reported mostly/always seeking exposure-influenced prior to the study. Multivariable analyses showed that younger age, sexual orientation non-disclosure, perceived HIV stigma, internalized homophobia, lower general resilience, and lower social support were associated with a lower likelihood of mostly/always seeking exposure-influenced HIV testing. YMSM who never/rarely sought exposure-influenced HIV testing were more likely to use recreational drugs before sex, binge alcohol, and have group sex; while less likely to be aware of PrEP, test for sexually transmitted infections, or use condoms compared to those mostly/always seeking exposure-influenced HIV testing. Exposure-influenced HIV testing is suboptimal among YMSM with elevated risk for HIV. Our findings provide important implications for designing targeted interventions to promote exposure-influenced HIV testing among high-risk YMSM.
Collapse
Affiliation(s)
- Yu Liu
- Division of Epidemiology, Department of Public Health Sciences, University of Rochester Medical Center, 256 Crittenden Blvd., Ste. 3305, Rochester, NY 14642, USA
- Correspondence: ; Tel.: +1-585-276-3562
| | - Mary Hawkins
- Nashville Council on AIDS, Resources, Education and Support (CARES), Nashville, TN 37204, USA; (M.H.); (A.O.)
| | - Amna Osman
- Nashville Council on AIDS, Resources, Education and Support (CARES), Nashville, TN 37204, USA; (M.H.); (A.O.)
| | - Chen Zhang
- School of Nursing, University of Rochester, Rochester, NY 14642, USA;
| |
Collapse
|
|
16
|
Zhou J, Yang L, Ma J, Jiang S, Liu Y, Sun Z. Factors Associated With HIV Testing Among MSM in Guilin, China: Results From a Cross-Sectional Study. Int J Public Health 2022; 67:1604612. [PMID: 35936995 PMCID: PMC9346121 DOI: 10.3389/ijph.2022.1604612] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: The objective of this study is to explore factors affecting the HIV testing behaviors among men who have sex with men (MSM) in China. Methods: A cross-sectional study was conducted in Guilin, China from April to June of 2021. Questionnaire data of 300 MSM were analyzed, and binary logistic regression models were used to examine the socio-demographic and sexual behavior characteristics associated with three HIV testing behaviors (self-testing, institutional testing, and regular testing). Results: The results showed that half of the respondents had the habit of regular HIV testing. Only 30.0% of MSM chose to do HIV testing after high-risk sexual behavior, and self-perceived luck was the main reason for not having HIV testing. Moreover, the influencing factors of three HIV testing behaviors after high-risk sexual behavior differ. Interestingly, income was not related to any of the three HIV testing behaviors among those MSM who participated. Conclusion: This research indicates insufficient health education on HIV testing behaviors among MSM in China. Health promotion practices targeting the MSM population to improve HIV-related knowledge, thus contributing to the HIV epidemic, are required.
Collapse
Affiliation(s)
- Jianfang Zhou
- Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Lu Yang
- Nanjing University of Posts and Telecommunications, Nanjing, China
- *Correspondence: Lu Yang,
| | - Jingyi Ma
- Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Shenyue Jiang
- Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Yuelong Liu
- Guilin Center for Disease Control and Prevention, Guilin, China
| | - Zhiming Sun
- Jiangsu Health Development Research Center, Nanjing, China
| |
Collapse
|
|
17
|
Kularadhan V, Gan J, Chow EPF, Fairley CK, Ong JJ. HIV and STI Testing Preferences for Men Who Have Sex with Men in High-Income Countries: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3002. [PMID: 35270694 PMCID: PMC8910668 DOI: 10.3390/ijerph19053002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/20/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023]
Abstract
Background: Regular testing for HIV and other sexually transmitted infections (STI) is recommended at least annually for sexually active men who have sex with men (MSM) in most high-income countries. To encourage regular use of HIV and STI testing and treatment services for MSM, we reviewed the literature to summarise the attributes of an HIV/STI testing service that MSM prefer. Method: We conducted a scoping review, searching PubMed, EMBASE, PsycINFO and CINAHL in January 2020 for articles reporting primary data on the preferences of MSM (living in high-income countries) for HIV/STI testing services. Two reviewers independently screened titles and abstracts and any discrepancies were resolved by a third reviewer. We extracted data on the service attributes that MSM preferred and summarised these thematically using a socioecological framework. Results: In total, 1464 publications were identified, 220 full texts were read and 57 were included in the final analysis. We found 21 articles addressing 'individual' attributes, 50 articles addressing 'service' attributes and 17 articles addressing 'societal' attributes. The key themes of preferences for HIV/STI testing services were: (1) the appeal of self-testing due to convenience and privacy; (2) the need to provide a variety of testing options; and (3) the influence of the testing experience, including confidentiality and privacy, tester characteristics and stigma. There were distinct patterns of preferences for subpopulations of MSM across studies, such as the preference of self-testing for young MSM, and of in-clinic testing for those who perceived themselves as high risk (i.e., with symptoms of STIs or exposed to a partner living with HIV). Conclusion: To make HIV/STI testing more accessible for MSM and encourage regular screening, it is important to address 'individual', 'service' and 'societal' attributes, such as enhancing the convenience of testing through self-testing, and providing a service that men feel comfortable and safe accessing. Furthermore, services should accommodate the preferences of diverse sub-populations within the MSM community.
Collapse
Affiliation(s)
| | - Joscelyn Gan
- Melbourne Medical School, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Eric P. F. Chow
- Central Clinical School, Monash University, Melbourne, VIC 3800, Australia; (E.P.F.C.); (C.K.F.); (J.J.O.)
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC 3053, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Christopher K. Fairley
- Central Clinical School, Monash University, Melbourne, VIC 3800, Australia; (E.P.F.C.); (C.K.F.); (J.J.O.)
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC 3053, Australia
| | - Jason J. Ong
- Central Clinical School, Monash University, Melbourne, VIC 3800, Australia; (E.P.F.C.); (C.K.F.); (J.J.O.)
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC 3053, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| |
Collapse
|
|
18
|
Johnson MC, Chung R, Leung SYJ, Edelstein Z, Yuan Y, Flavin SM. Combating Stigma Through HIV Self-Testing: New York State's HIV Home Test Giveaway Program for Sexual Minorities. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:174-183. [PMID: 32015253 PMCID: PMC8781215 DOI: 10.1097/phh.0000000000001138] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Gay, bisexual, and men who have sex with men (MSM) are disproportionately affected by the HIV/AIDS epidemic more than any other group. In New York State (NYS) outside of New York City (NYC), MSM accounted for 57% of new HIV/AIDS diagnoses in 2017. HIV/AIDS home testing initiatives have been effective at getting priority populations tested for HIV. OBJECTIVES The NYS Department of Health (NYSDOH) administered the HIV Home Test Giveaway (HHTG) program through social media and mobile applications popular among the priority populations to (1) promote HIV screening among gay and bisexual men, MSM, transgender (TG), and gender queer/gender nonconforming (GNC) individuals who have sex with men, and (2) identify individuals with undiagnosed HIV infection. DESIGN/SETTING The NYSDOH recruited participants from NYS (excluding NYC) through social media campaigns between November 2016 and January 2018. Interested individuals were directed to an online eligibility survey. Eligible participants received a coupon via e-mail for a free HIV self-test (HIVST) kit through the manufacturer's Web site. Eligible participants received a $20 to $25 Amazon online gift card if they completed a voluntary online follow-up survey regarding their test results, experiences with the HHTG, and HIV/AIDS risk behaviors. Participants were also able to request assistance from the NYSDOH with further testing and various prevention and supportive services. PARTICIPANTS In total, 6190 individuals participated and 3197 (52%) were eligible and received a coupon. Of the eligible, 2022 (63%) redeemed coupons for HIVST. RESULTS Among eligible participants, 976 (31%) reported having never been tested for HIV. On the follow-up survey, 922 (29%) participants reported having used the HIVST kit for themselves; 203 (22%) were first-time testers; and 7 (0.8%) tested HIV reactive. Of the follow-up survey participants, 761 (59%) requested assistance with various services. CONCLUSIONS Media campaigns were effective in promoting HIV testing among priority populations and reaching individuals who have never been tested for HIV.
Collapse
Affiliation(s)
- Megan C. Johnson
- New York State Department of Health—AIDS Institute, Albany, New York (Mss Johnson and Flavin, Dr Chung, and Messrs Leung and Yuan); and New York City Department of Health and Mental Hygiene, New York, New York (Dr Edelstein)
| | - Rakkoo Chung
- New York State Department of Health—AIDS Institute, Albany, New York (Mss Johnson and Flavin, Dr Chung, and Messrs Leung and Yuan); and New York City Department of Health and Mental Hygiene, New York, New York (Dr Edelstein)
| | - Shu-Yin J. Leung
- New York State Department of Health—AIDS Institute, Albany, New York (Mss Johnson and Flavin, Dr Chung, and Messrs Leung and Yuan); and New York City Department of Health and Mental Hygiene, New York, New York (Dr Edelstein)
| | - Zoe Edelstein
- New York State Department of Health—AIDS Institute, Albany, New York (Mss Johnson and Flavin, Dr Chung, and Messrs Leung and Yuan); and New York City Department of Health and Mental Hygiene, New York, New York (Dr Edelstein)
| | - Yingchao Yuan
- New York State Department of Health—AIDS Institute, Albany, New York (Mss Johnson and Flavin, Dr Chung, and Messrs Leung and Yuan); and New York City Department of Health and Mental Hygiene, New York, New York (Dr Edelstein)
| | - Susan M. Flavin
- New York State Department of Health—AIDS Institute, Albany, New York (Mss Johnson and Flavin, Dr Chung, and Messrs Leung and Yuan); and New York City Department of Health and Mental Hygiene, New York, New York (Dr Edelstein)
| |
Collapse
|
|
19
|
Zhan J, Fu G, Wu L, Pan M, Yang Y, Chen Z, Cao Y, Li Y, Wang H, Wang B, Du R, Xiong Y, Liu W, Xu N, Xia X, Li Q, Ruan F, Wang J. Inequities in the utilization of HIV counseling and testing services among undergraduates in mainland China. BMC Public Health 2021; 21:2216. [PMID: 34863130 PMCID: PMC8645148 DOI: 10.1186/s12889-021-12252-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/17/2021] [Indexed: 11/22/2022] Open
Abstract
Background HIV counseling and testing (HCT) is provided free of charge on college campuses, but very few studies have examined whether HCT uptake is equitably distributed. This cross-sectional study aimed to compare the relative importance of various determinants of HCT uptake among undergraduates in mainland China so as to assess and subsequently to suggest ways to eliminate inequities in its use, guided by the Andersen’s behavioral model. Methods A total of 10,665 eligible undergraduates were conveniently selected to complete an online survey. Hierarchical logistic regression analyses were performed to identify the factors associated with HCT utilization. Results Only 7.7% of undergraduates had utilized HCT services. HCT uptake was inequitably distributed, since it was mainly determined by predisposing and enabling factors rather than by need factors. Further analysis indicated that HCT uptake was significantly related to two need factors, one enabling factor and six predisposing factors. Those with a higher need [i.e., perceiving themselves to be at higher risk of acquiring HIV infection (AOR = 2.76, 95% CI:2.02–3.78) and engaging in condomless sex (AOR = 1.29, 95% CI:1.00–1.67)] and those with more resources [i.e., being knowledgeable of local AIDS service organization (AOR = 1.59, 95% CI:1.37–1.85)] were more likely to utilize HCT services. Compared to non-heterosexual men, non-heterosexual women (AOR = 0.51, 95% CI:0.37–0.72), heterosexual men (AOR = 0.44, 95% CI:0.33–0.57) and women (AOR = 0.31, 95%CI: 0.24–0.41) were less likely to utilize HCT service. Furthermore, those with more knowledge (AOR = 0.80, 95% CI:0.69–0.94) and taking a positive attitude towards HCT services [i.e, expressing their willingness to utilize HCT services (AOR = 0.68, 95% CI:0.56–0.81) and having recognized the necessity to provide HTC services in the local university (AOR = 0.46, 95% CI:0.36–0.57)] were less likely to utilize HCT services. However, medical students (AOR = 1.34, 95% CI: 1.15–1.56) and non-freshmen (AOR = 1.22, 95% CI:1.03–1.45) were more likely to utilize HCT services. Conclusions To increase HCT uptake and simultaneously reduce the remaining inequities, a comprehensive intervention should be continued to target non-heterosexual men and non- freshmen and those with a higher need for HCT services, conduct health education, improve the availability and accessibility of HIV testing services. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12252-z.
Collapse
Affiliation(s)
- Jihong Zhan
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, Address: No.88 Xianning Avenue, Xianning City, 437100, Hubei Province, China
| | - Guochen Fu
- National Demonstration Center for Experimental General Medicine Education of Hubei University of Science and Technology, Xianning, China
| | - Lei Wu
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, Address: No.88 Xianning Avenue, Xianning City, 437100, Hubei Province, China
| | - Mingliang Pan
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, Address: No.88 Xianning Avenue, Xianning City, 437100, Hubei Province, China
| | - Yuli Yang
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, Address: No.88 Xianning Avenue, Xianning City, 437100, Hubei Province, China
| | - Zhuo Chen
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, Address: No.88 Xianning Avenue, Xianning City, 437100, Hubei Province, China
| | - Yu Cao
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, Address: No.88 Xianning Avenue, Xianning City, 437100, Hubei Province, China
| | - Yong Li
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, Address: No.88 Xianning Avenue, Xianning City, 437100, Hubei Province, China
| | - Hao Wang
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, Address: No.88 Xianning Avenue, Xianning City, 437100, Hubei Province, China
| | - Bixiang Wang
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, Address: No.88 Xianning Avenue, Xianning City, 437100, Hubei Province, China
| | - Ruyi Du
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, Address: No.88 Xianning Avenue, Xianning City, 437100, Hubei Province, China
| | - Yanting Xiong
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, Address: No.88 Xianning Avenue, Xianning City, 437100, Hubei Province, China
| | - Wei Liu
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, Address: No.88 Xianning Avenue, Xianning City, 437100, Hubei Province, China
| | - Nuo Xu
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, Address: No.88 Xianning Avenue, Xianning City, 437100, Hubei Province, China
| | - Xiaobao Xia
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, Address: No.88 Xianning Avenue, Xianning City, 437100, Hubei Province, China
| | - Qianqian Li
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, Address: No.88 Xianning Avenue, Xianning City, 437100, Hubei Province, China
| | - Fang Ruan
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, Address: No.88 Xianning Avenue, Xianning City, 437100, Hubei Province, China.
| | - Junfang Wang
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, Address: No.88 Xianning Avenue, Xianning City, 437100, Hubei Province, China.
| |
Collapse
|
|
20
|
Chong LSH, Kerklaan J, Clarke S, Kohn M, Baumgart A, Guha C, Tunnicliffe DJ, Hanson CS, Craig JC, Tong A. Experiences and Perspectives of Transgender Youths in Accessing Health Care: A Systematic Review. JAMA Pediatr 2021; 175:1159-1173. [PMID: 34279538 DOI: 10.1001/jamapediatrics.2021.2061] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Transgender and nonbinary youths have a higher incidence of a range of health conditions and may paradoxically face limited access to health care. Objective To describe the perspectives and needs of transgender youths in accessing health care. Evidence Review MEDLINE, Embase, PsycInfo, and the Cumulative Index to Nursing and Allied Health Literature were searched from inception to January 2021. Qualitative studies of transgender youths' perspectives on accessing health care were selected. Results from primary studies were extracted. Data were analyzed using thematic synthesis. Findings Ninety-one studies involving 884 participants aged 9 to 24 years across 17 countries were included. We identified 6 themes: experiencing pervasive stigma and discrimination in health care, feeling vulnerable and uncertain in decision-making, traversing risks to overcome systemic barriers to transitioning, internalizing intense fear of consequences, experiencing prejudice undermining help-seeking efforts, and experiencing strengthened gender identity and finding allies. Each theme encapsulated multiple subthemes. Conclusions and Relevance This review found that transgender youths contend with feelings of gender incongruence, fear, and vulnerability in accessing health care, which are compounded by legal, economic, and social barriers. This can lead to disengagement from care and resorting to high-risk and unsafe interventions. Improving access to gender-affirming care services with a cultural humility lens and addressing sociolegal stressors may improve outcomes in transgender and nonbinary youths.
Collapse
Affiliation(s)
- Lauren S H Chong
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- Kids Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Jasmijn Kerklaan
- Kids Research, The Children's Hospital at Westmead, Westmead, Australia
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
| | - Simon Clarke
- Centre for Research into Adolescent's Health, Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Michael Kohn
- Centre for Research into Adolescent's Health, Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Amanda Baumgart
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- Kids Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Chandana Guha
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- Kids Research, The Children's Hospital at Westmead, Westmead, Australia
| | - David J Tunnicliffe
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- Kids Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Camilla S Hanson
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- Kids Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- Kids Research, The Children's Hospital at Westmead, Westmead, Australia
| |
Collapse
|
|
21
|
Parchem B, Molock SD. HIV testing preferences, barriers and facilitators to receiving HIV services among young Black sexual minority men. AIDS Care 2021; 34:839-846. [PMID: 34496705 DOI: 10.1080/09540121.2021.1975627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Young Black sexual minority men (YBSMM) represent a high-priority population for HIV prevention research. HIV testing is a critical public health tool to prevent HIV transmission and is an integral component of health care for high-priority populations. The present study uses Andersen's model of health care utilization as a framework to explore the HIV testing preferences of YBSMM and the barriers and facilitators to receiving HIV services as a means to increase regular HIV testing. A sample of 57 YBSMM (M =19 years) in Washington, DC responded to closed and open-ended questions regarding preferences for HIV testing across various venues. Approximately 61% of the sample reported a previous HIV test and 12% reported a positive result. Participants were most willing to receive free HIV testing at medical establishments and schools. Concerns for privacy were most notable for testing at churches, malls, and schools. Identified barriers to receiving HIV services included cost, stigma, privacy, and access whereas identified facilitators included low cost and support. The findings encourage integrating regular HIV testing into the health care regiment of YBSMM and increasing youth's autonomy over their sexual health.
Collapse
Affiliation(s)
- Benjamin Parchem
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Sherry D Molock
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| |
Collapse
|
|
22
|
Threats M, Boyd DT, Diaz JE, Adebayo OW. Deterrents and motivators of HIV testing among young Black men who have sex with men in North Carolina. AIDS Care 2021; 33:943-951. [PMID: 33244990 PMCID: PMC8155091 DOI: 10.1080/09540121.2020.1852161] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/10/2020] [Indexed: 01/09/2023]
Abstract
In the United States (US), young, Black men who have sex with men (YBMSM) are disproportionately affected by HIV. Delayed and infrequent HIV testing has been associated with the increased likelihood of YBMSM to be infected, yet unaware. Despite increased efforts to provide HIV testing to YBMSM in the US, HIV testing remains underutilized by YBMSM in the South. To develop strategies to increase HIV testing, this study sought to understand the factors that affect HIV testing utilization among YBMSM. Twenty-two HIV-positive and HIV-negative YBMSM aged 22-33 in North Carolina participated in semistructured interviews. Qualitative thematic analysis revealed that deterrents and motivators to HIV testing spanned individual, social, and structural levels. Deterrents included a low perceived risk of HIV, fear of receiving an HIV-positive test result, lack of HIV testing locations, healthcare provider mistreatment and privacy concerns due to intersectional stigma. Motivators of HIV testing included health maintenance, social support, and increased access to HIV testing. The findings from this study contribute to ongoing research that aims to address inconsistent HIV testing and late HIV diagnosis among YBMSM. Interventions to address intersectional stigma in community and healthcare settings can enhance utilization of HIV prevention services .
Collapse
Affiliation(s)
- Megan Threats
- School of Communication and Information, Rutgers University, New Brunswick, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, USA
| | - Donte T. Boyd
- Graduate College of Social Work, University of Houston, Houston, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, USA
| | - José E. Diaz
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, USA
| | - Oluwamuyiwa Winifred Adebayo
- College of Nursing, The Pennsylvania State University, University Park, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, USA
| |
Collapse
|
|
23
|
Gan J, Kularadhan V, Chow EPF, Fairley CK, Hocking JS, Kong FYS, Ong JJ. What do young people in high-income countries want from STI testing services? A systematic review. Sex Transm Infect 2021; 97:574-583. [PMID: 34193529 DOI: 10.1136/sextrans-2021-055044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/09/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There are upward trends of STI rates among young people in most high-income countries. We reviewed the literature to provide a summary of information to support health services with the aim of increasing testing of STIs among young people living in high-income countries. METHODS We conducted a systematic review (Prospero: CRD42020179720) using PubMed, Embase, PsychINFO and CINAHL. The search was performed on 10 January 2020 for studies between January 2000 and 10 January 2020. Two reviewers independently screened articles, and any discrepancies were resolved by a third reviewer. Studies were included if they were performed in high-income countries and contained data on both young people (<26 years) and STI testing preferences. Data regarding the characteristics of STI testing services that young people preferred was extracted. We categorised these characteristics using the framework of a social-ecological model. RESULTS We identified 1440 studies, and 63 studies were included in the final review. We found 32 studies that addressed individual factors, 62 studies that addressed service factors and 17 studies that addressed societal factors. At an individual level, we identified eight attributes including the need for improved sexual health education. At a service level, 14 attributes were identified including preferences from different subgroups of young people (such as sexual and ethnic minorities) for the types of services. At a societal level, we identified two attributes including the need to address stigma associated with STIs. CONCLUSION We provide an overview of the growing body of literature capturing the preferences of young people for STI testing services. To optimise the uptake of STI testing among young people, factors from all socioecological levels should be considered. In addition, understanding and accounting for distinct preferences from subgroups of young people could increase demand for STI testing services for those at greatest need.
Collapse
Affiliation(s)
- Joscelyn Gan
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Eric P F Chow
- Central Clinical School, Monash University, Carlton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University, Carlton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Fabian Y S Kong
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jason J Ong
- Central Clinical School, Monash University, Carlton, Victoria, Australia.,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
|
24
|
Frye V, Nandi V, Paige MQ, McCrossin J, Lucy D, Gwadz M, Sullivan PS, Hoover DR, Wilton L. TRUST: Assessing the Efficacy of an Intervention to Increase HIV Self-Testing Among Young Black Men Who have Sex with Men (MSM) and Transwomen. AIDS Behav 2021; 25:1219-1235. [PMID: 33190178 PMCID: PMC7666714 DOI: 10.1007/s10461-020-03091-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 12/31/2022]
Abstract
HIV testing among young Black MSM and transwomen (YBMSM/TW) is the gateway to biomedical HIV prevention or treatment. HIV self-testing (HST) is a method that may increase consistent HIV testing. TRUST, a brief, peer-based behavioral intervention, was designed to increase uptake of consistent (every three months) HST among YBMSM/TW in New York City. To test the efficacy of the intervention, we randomized 200 friend pairs into either the intervention condition (TRUST) or a time and attention control condition. A modified intent-to-treat analysis found that self-reported HST at 3-month follow-up was statistically significantly higher (uOR 2.29; 95% CI 1.15, 4.58) and at 6-month follow-up was marginally statistically significantly higher (uOR 1.94; 95% CI 1.00, 3.75) in the intervention arm as compared with the control arm. There were no statistically significant differences by arm at 9- or 12-month follow-up. TRUST, a culturally-congruent intervention to increase HST among YBMSM/TW, had short-term impact on past-three month HST. Clinical Trials Registration ClinicalTrial.gov NCT04210271.
Collapse
Affiliation(s)
- Victoria Frye
- Community Health and Social Medicine, Sophie Davis School of Biomedical Education/CUNY School of Medicine, City College of New York, City University of New York, New York, NY, USA
| | - Vijay Nandi
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Mark Q Paige
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Jermaine McCrossin
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Debbie Lucy
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Marya Gwadz
- Silver School of Social Work, New York University, New York, NY, USA
| | | | - Donald R Hoover
- Department of Statistics and Biostatistics, Rutgers University, The State University of New Jersey, Piscataway, NJ, USA
| | - Leo Wilton
- Department of Human Development, College of Community and Public Affairs (CCPA), State University of New York At Binghamton, 4400 Vestal Parkway East, Binghamton, NY, 13902, USA.
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa.
| |
Collapse
|
|
25
|
Khan MNM, Sarwar G, Irfan SD, Gourab G, Rana AKMM, Khan SI. Understanding the Barriers of HIV Testing Services for Men Who Have Sex With Men and Transgender Women in Bangladesh: A Qualitative Study. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2021; 42:272684X21995672. [PMID: 33657941 DOI: 10.1177/0272684x21995672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Coverage of HIV testing services (HTS) is generally low among men who have sex with men (MSM) and transgender women (hijra) in Bangladesh, thus impeding the national goal of attaining the 90-90-90 target. In this context, this article delineates HTS uptake barriers among these populations. This qualitative study entailed 30 in-depth interviews, six focus groups and seven key-informant interviews with purposively selected MSM and hijra, alongside service providers. Participants cited individual and interpersonal barriers such as low risk perception and misconceptions about HIV testing, programmatic barriers such as knowledge gaps among peer service providers, as well as community and structural barriers such as the criminalization and stigmatization of male-to-male sex. Considering these contexts, it is essential for stakeholders to improve the HTS modality using multipronged approaches to address the multifaceted barriers of HTS uptake.
Collapse
Affiliation(s)
| | - Golam Sarwar
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Samira Dishti Irfan
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Gorkey Gourab
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - A K M Masud Rana
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Sharful Islam Khan
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| |
Collapse
|
|
26
|
Fields EL, Hussen SA, Malebranche DJ. Mind the Gap: HIV Prevention Among Young Black Men Who Have Sex with Men. Curr HIV/AIDS Rep 2021; 17:632-642. [PMID: 32914329 PMCID: PMC7483045 DOI: 10.1007/s11904-020-00532-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Young Black men who have sex with men (YBMSM) suffer profound health inequities in new HIV diagnoses and clinical outcomes. While the evolution of HIV prevention options has become increasingly biomedical, inequities in access and uptake of these modalities persist. RECENT FINDINGS Studies suggest that while YBMSM display interest and acceptability of varied HIV prevention options, uptake lags due to the lingering effects of intersectional oppression from racism and sexual prejudice, HIV stigma, institutional and provider bias, and unresolved health policy barriers. Promising avenues to address these barriers have yet to be fully explored. We have the tools to effectively prevent HIV transmission and acquisition among YBMSM, but we have not yet effectively implemented these tools for this priority population. To end the epidemic, we must tailor and adapt HIV prevention strategies to meet the unique intersecting needs, identities, and social contexts of YBMSM.
Collapse
Affiliation(s)
- Errol L Fields
- Division of Adolescent/Young Adult Medicine, Johns Hopkins School of Medicine, 200 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Sophia A Hussen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - David J Malebranche
- Department of General Medicine, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA.
| |
Collapse
|
|
27
|
Akinola M, Wirtz AL, Chaudhry A, Cooney E, Reisner SL. Perceived acceptability and feasibility of HIV self-testing and app-based data collection for HIV prevention research with transgender women in the United States. AIDS Care 2021; 33:1079-1087. [PMID: 33487032 DOI: 10.1080/09540121.2021.1874269] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In the United States, transgender women are disproportionately burdened by HIV infection. Research aimed at curbing the HIV epidemic for this population may benefit from innovative technology to engage participants in research. Adult transgender women (n = 41) from six cities in the southern and eastern United States participated in seven online focus groups between August 2017 and January 2018. Analyses focused on perceived acceptability of novel technologies for research purposes, particularly HIV self-testing (HIVST) and remote data collection through a mobile app. While participants noted a number of benefits to HIVST and remote study participation, including increased participant engagement and sentiments of agency, they also expressed concerns that may impact HIVST and remote participation including housing instability, inconsistent access to technology, and confidentiality. Study findings provide insight into gaps that must be addressed when using technology-enhanced methods to support HIV testing and research participation among transgender women in the US. Substantial effort is required on the part of investigators to ensure equitable access across subgroups and, thus, minimize bias to avoid reproducing health disparities in research.
Collapse
Affiliation(s)
| | - Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aeysha Chaudhry
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Erin Cooney
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | -
- The Fenway Institute, Fenway Health, Boston, MA, USA
| |
Collapse
|
|
28
|
Obiezu-Umeh C, Gbajabiamila T, Ezechi O, Nwaozuru U, Ong JJ, Idigbe I, Oladele D, Musa AZ, Uzoaru F, Airhihenbuwa C, Tucker JD, Iwelunmor J. Young people's preferences for HIV self-testing services in Nigeria: a qualitative analysis. BMC Public Health 2021; 21:67. [PMID: 33413246 PMCID: PMC7792110 DOI: 10.1186/s12889-020-10072-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 12/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV self-testing (HIVST) provides young people with a convenient, discreet, and empowering way to know their HIV status. However, there is limited knowledge of young people's preferences for HIVST services and potential factors that may influence the uptake of HIVST among this population. The purpose of this research was to use qualitative methods to examine HIVST preferences among Nigerian youth. METHODS Semi-structured in-depth interviews with a purposive sample of young people 14-24 years old were conducted in Lagos, Nigeria. Data were analyzed thematically to identify themes and domains related to preferences and factors influencing the use of HIV self-testing. RESULTS A total of 65 youth with mean age of 21 years, were interviewed, and the majority were females (56%). Four themes emerged as the most important characteristics that may influence young people's preferences for HIV self-testing: 1) Cost (i.e. majority of participants noted that they would pay between NGN500 to NGN1,500 naira (USD1.38-USD4.16) for oral HIV self-testing kits); 2) Testing method (i.e. although blood-based sample kits were more popular than oral-based self-testing kits, most preferred the oral-based option due to its perceived benefits and for some, phobia of needles); 3) Access location (i.e. participants suggested they preferred to obtain the HIVST kits from youth-friendly centers, pharmacies, private health facilities, and online stores); and 4) Continuing care and support (i.e. participants highlighted the importance of linkage to care with trained youth health workers for positive or negative test results or toll-free helpline). CONCLUSION HIV self-testing preferences among Nigerian youth appear to be influenced by several factors including lower cost, less invasive testing method, location of testing, and linkage to care and support post testing. Findings underscore the need to address young people's HIV self-testing preferences as a foundation for implementing programs and research to increase the uptake of HIVST.
Collapse
Affiliation(s)
- Chisom Obiezu-Umeh
- College for public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA.
| | - Titilola Gbajabiamila
- Department of Clinical Sciences National Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Oliver Ezechi
- Department of Clinical Sciences National Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Ucheoma Nwaozuru
- College for public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - Jason J Ong
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Central Clinical School, Monash University, Clayton, Australia
| | - Ifeoma Idigbe
- Department of Clinical Sciences National Institute of Medical Research, Yaba, Lagos, Nigeria
| | - David Oladele
- Department of Clinical Sciences National Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Adesola Z Musa
- Department of Clinical Sciences National Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Florida Uzoaru
- College for public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
| | | | - Joseph D Tucker
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Juliet Iwelunmor
- College for public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
| |
Collapse
|
|
29
|
Hawk ME, Chung A, Creasy SL, Egan JE. A Scoping Review of Patient Preferences for HIV Self-Testing Services in the United States: Implications for Harm Reduction. Patient Prefer Adherence 2020; 14:2365-2375. [PMID: 33293799 PMCID: PMC7719302 DOI: 10.2147/ppa.s251677] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/20/2020] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Despite marked progress in the ability to test for, treat, and prevent HIV, the epidemic remains a significant public health concern, especially among key populations including prisoners; sex workers; transgender individuals; gay, bisexual, and other men who have sex with men (MSM); and Black and Latinx MSM. This scoping review was conducted to provide an overview of the current research describing patient preferences for HIVST in the United States to understand what key populations value about HIVST and why they are willing to use it. A targeted search for published literature on patient preferences for HIVST was conducted using Ovid Medline, PsychINFO, and an HIVST research database. RESULTS We reviewed 700 abstracts and 139 full texts. We found 19 articles published between January 2014 and April 2020 that included findings related to HIVST preferences. Overall, HIVST was preferred to more traditional testing. Six primary factors emerged as important HIVST values including: 1) convenience, 2) type of test; 3) cost, 4) stigma reduction, 5) risk reduction, and 6) self-control. Linkage to care was also identified as a key factor when considering HIVST as an option. Much of what makes HIVST attractive to individuals is their ability to self-determine how HIVST can be best integrated into their lives as a harm reduction tool for stigma and sexual risk mitigation. CONCLUSION While there is substantial evidence suggesting HIVST is feasible for use and there are aspects of HIVST that are beneficial and preferred over traditional testing approaches, there is a lack of rigorous implementation studies exploring how best to scale up HIVST in community settings. HIVST has the potential to be a powerful biobehavioral HIV prevention and harm reduction tool to empower individuals to engage with testing on their own terms while providing pathways to prevention and care support.
Collapse
Affiliation(s)
- Mary E Hawk
- Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Evaluation Institute, Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ashley Chung
- Jewish Healthcare Foundation, Pittsburgh, PA, USA
| | - Stephanie L Creasy
- Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Evaluation Institute, Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - James E Egan
- Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Evaluation Institute, Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
|
30
|
Shrestha R, Alias H, Wong LP, Altice FL, Lim SH. Using individual stated-preferences to optimize HIV self-testing service delivery among men who have sex with men (MSM) in Malaysia: results from a conjoint-based analysis. BMC Public Health 2020; 20:1777. [PMID: 33238941 PMCID: PMC7687720 DOI: 10.1186/s12889-020-09832-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/04/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND HIV self-testing (HIVST) has the potential to improve HIV testing uptake and frequency for key populations like MSM who experience multiple barriers accessing clinic-based HIV testing. In the absence of HIVST in Malaysia, there is no guidance to inform HIVST delivery. This study investigated the acceptability of HIVST and preferences about the HIVST service delivery approaches using a standardized stated preference method. METHODS A cross-sectional online survey conducted between January and April 2019 assessed the interest in HIVST in 544 MSM in Malaysia. Participants ranked eight hypothetical HIVST service delivery program elements with varied combinations of six, two-level HIVST service delivery program attributes (cost, privacy, accuracy, kit collection site, kit type, and testing support). SPSS conjoint procedure was used to estimate the relative importance of each attribute and preference across eight possible HIVST service delivery programs. RESULTS Overall, 70.4% had previously tested for HIV, and of those, 64.0% had done so in the past 6 months (45.0% of all participants). Of all the participants, 25.2% reported having used HIVST previously. The acceptability for HIVST service delivery models ranged from 44.9 to 77.1%, with mean acceptability of 56.2% across the eight hypothetical HIVST distribution scenarios. The HIVST service delivery scenario with the highest acceptability had the following attributes: no cost (free), anonymity (name not required), 99-100% accuracy, home-delivered, fingerstick, and testing support using telephone hotline or texting. HIVST cost was the most important attribute (relative importance score: RIS = 19.30) associated with acceptability, followed by anonymity (RIS = 18.41), accuracy (RIS = 17.33), kit delivery (RIS = 16.99), fingerstick kit (RIS = 15.86), and support (RIS = 12.08). CONCLUSIONS Acceptability for HIVST in Malaysian MSM was high but differed markedly by a number of HIVST delivery scenarios and attributes. These findings could be relevant as the Malaysian Ministry of Health is in the process of developing a regulatory framework for ensuring the quality of kits, as well as policies supporting safe use while broader implementation under national AIDS programs.
Collapse
Affiliation(s)
- Roman Shrestha
- Section of Infectious Disease, Department of Internal Medicine, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06510, USA.
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Haridah Alias
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Li P Wong
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Frederick L Altice
- Section of Infectious Disease, Department of Internal Medicine, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06510, USA
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sin H Lim
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
|
31
|
Neilan AM, Bulteel AJB, Hosek SG, Foote JHA, Freedberg KA, Landovitz RJ, Walensky RP, Resch SC, Kazemian P, Paltiel AD, Weinstein MC, Wilson CM, Ciaranello AL. Cost-effectiveness of frequent HIV screening among high-risk young men who have sex with men in the United States. Clin Infect Dis 2020; 73:e1927-e1935. [PMID: 32730625 DOI: 10.1093/cid/ciaa1061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Of new HIV infections in the US, 20% occur among young men who have sex with men (YMSM, ages 13-24), but >50% of YMSM with HIV are unaware of their status. Using Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) data, we projected the clinical benefit and cost-effectiveness of frequent HIV screening among high-risk YMSM from age 15. METHODS Using a mathematical simulation, we examined 3 screening strategies: Yearly, 6-monthly, and 3-monthly, each in addition to the Status quo (SQ, 0.7-10.3% screened/year, stratified by age). We used published data (YMSM-specific when available) including: HIV incidences (0.91-6.41/100PY); screen acceptance (80%), linkage-to-care/antiretroviral therapy (ART) initiation (76%), HIV transmission (0.3-86.1/100PY, by HIV RNA), monthly ART costs ($2,290-$3,780), and HIV per-screen costs ($38). Projected outcomes included CD4 count at diagnosis, primary HIV transmissions from ages 15-30, quality-adjusted life expectancy, costs, and incremental cost-effectiveness ratios (ICERs, $/quality-adjusted life-year saved [QALY]; threshold ≤$100,000/QALY). RESULTS Compared to SQ, all strategies increased projected CD4 at diagnosis (296 to 477-515 cells/µL) and quality-adjusted life expectancy from age 15 (44.4 to 48.3-48.7 years) among YMSM acquiring HIV. Compared to SQ, all strategies increased discounted lifetime cost for the entire population ($170,800 to $178,100-$185,000/person). Screening 3-monthly was cost-effective (ICER: $4,500/QALY) compared to SQ and reduced primary transmissions through age 30 by 40%. Results were most sensitive to transmission rates; excluding the impact of transmissions, screening Yearly was ≤$100,000/QALY (ICER: $70,900/QALY). CONCLUSIONS For high-risk YMSM in the US, HIV screening 3-monthly compared to less frequent screening will improve clinical outcomes and be cost-effective.
Collapse
Affiliation(s)
- Anne M Neilan
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, MA.,Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA.,Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | | | | | - Julia H A Foote
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA
| | - Kenneth A Freedberg
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA.,Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA.,Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA
| | | | - Rochelle P Walensky
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA.,Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Stephen C Resch
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Pooyan Kazemian
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA.,Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | | | - Milton C Weinstein
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Craig M Wilson
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL
| | - Andrea L Ciaranello
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA.,Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| |
Collapse
|
|
32
|
Who is Using the HIV Self-Test among Young Black Men Who Have Sex With Men (MSM) and Transwomen in New York City? J Natl Med Assoc 2020; 112:284-288. [PMID: 32279883 DOI: 10.1016/j.jnma.2020.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/02/2020] [Accepted: 03/13/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND HIV self-testing (HST) is an important complement to existing testing approaches for young Black men who have sex with men (MSM) and transwomen. METHODS In this formative research, we describe prevalence and perceptions of HST using qualitative in-depth interviews (n = 29) and baseline quantitative data (n = 302) from an HST intervention trial for young Black MSM and transwomen. RESULTS In the qualitative analysis, participants preferred the privacy and flexibility of the HST but had concerns about its accuracy and being alone while testing. Quantitative results showed that 14% (44/302) had used an HST in their lifetime; of these, 64% (28/44) used it once and 23% (10/44) in the last 3 months. CONCLUSION To increase consistent testing, HST may provide a new avenue for at-risk individuals that value privacy and control and could benefit from social support during testing.
Collapse
|
|
33
|
Adebayo OW, Williams JR, Garcia A. "The right place and the right time": A qualitative study of the decision-making process of self-initiated HIV testing among young adults. Res Nurs Health 2020; 43:186-194. [PMID: 32048749 DOI: 10.1002/nur.22015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 01/25/2020] [Indexed: 11/08/2022]
Abstract
Young adults continue to have very low rates of human immunodeficiency virus (HIV) testing, which contribute to transmission, late diagnoses, and poor health outcomes. The access and uptake of HIV testing among young adults can be improved by promoting self-initiated testing (i.e., testing without the immediate recommendation of a clinician). Little is known, however, about how young adults self-initiate HIV testing. The purpose of this study was to explore the decision-making process of young adults who self-initiated HIV testing. A qualitative descriptive study was conducted with 30 young adults aged 18-24 years. The findings from this study describe how young adults acknowledge their vulnerability to HIV infection and navigate the process of deciding to self-initiate testing. Some subcategories include Self-Convincing, Conversation Prompts, and The Right Place and Right Time. Findings from this study are pivotal for subsequent studies to further understand self-initiated HIV testing among young adults and design targeted interventions that will improve testing uptake.
Collapse
Affiliation(s)
| | - Jessica R Williams
- The University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina
| | - Ana Garcia
- University of Miami, Miller School of Medicine, Miami, Florida
| |
Collapse
|
|
34
|
Rosengren AL, Davy-Mendez T, Hightow-Weidman LB. Online sex partner seeking and HIV testing frequency among young Black sexual minority men. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2020; 19:42-54. [PMID: 32372886 PMCID: PMC7199779 DOI: 10.1080/15381501.2019.1692749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/24/2019] [Accepted: 11/07/2019] [Indexed: 06/11/2023]
Abstract
Dating apps are a novel means of delivering HIV prevention messages. Young black sexual minority men (YBSMM) app users are at high risk for HIV and could benefit from frequent testing. Understanding testing behaviors among YBSMM is critical to inform tailored prevention interventions. We analyzed testing behaviors of 273 YBSMM, comparing typical testing frequency between app users and non-users using odds ratios. Overall, testing rates were high. App users were more likely than non-users to test at least every 12 months. App-using YBSMM exhibit high compliance with testing guidelines, which may indicate future successful uptake of biomedical preventions, such as Pre-Exposure Prophylaxis.
Collapse
Affiliation(s)
- A Lina Rosengren
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Thibaut Davy-Mendez
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lisa B Hightow-Weidman
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
|
35
|
Taylor TN, DeHovitz J, Hirshfield S. Intersectional Stigma and Multi-Level Barriers to HIV Testing Among Foreign-Born Black Men From the Caribbean. Front Public Health 2020; 7:373. [PMID: 31998675 PMCID: PMC6965168 DOI: 10.3389/fpubh.2019.00373] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 11/21/2019] [Indexed: 01/08/2023] Open
Abstract
Testing is the entry point into the HIV care continuum that includes linkage to and retention in prevention services, and adherence to prevention strategies, including repeat HIV testing. Despite US policy approaches to expand HIV testing to diverse clinical care and community settings, disparities in HIV testing among Black populations persist. Foreign-born (FB) Black persons from the Caribbean have higher annual rates of HIV diagnosis and a higher percentage of late-stage HIV diagnosis, compared with US-born Black persons; and most HIV infections among FB Blacks are among men. In this article, we provide an overview of HIV testing barriers among FB Black men who engage in HIV risk-taking behaviors (e.g., condomless sex with male and/or female partners of unknown HIV serostatus). Barriers to HIV testing for both FB and US-born Black men, include HIV stigma (anticipated, perceived, internalized), low perceived HIV risk, medical or government mistrust, and perceived low access to testing resources. We examine beliefs about masculinity and gender roles that may perpetuate heteronormative stereotypes associated with perceptions of low HIV risk and barriers to HIV testing. We also discuss the impact of recent immigration policies on accessing HIV testing and treatment services and how intersectional stigmas and structural forms of oppression, such as racism, prejudice against select immigrant groups, and homophobia that may further amplify barriers to HIV testing among FB Black men. Finally, we review comprehensive prevention approaches, and suggest innovative approaches, that may improve the uptake of HIV testing among FB Black men.
Collapse
Affiliation(s)
- Tonya N. Taylor
- SUNY Downstate Health Sciences University, Brooklyn, NY, United States
| | | | | |
Collapse
|
|
36
|
Liu Y, Silenzio VMB, Nash R, Luther P, Bauermeister J, Vermund SH, Zhang C. Suboptimal Recent and Regular HIV Testing Among Black Men Who Have Sex With Men in the United States: Implications From a Meta-Analysis. J Acquir Immune Defic Syndr 2019; 81:125-133. [PMID: 30844996 PMCID: PMC6956840 DOI: 10.1097/qai.0000000000002013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The continuum of HIV care among black men who have sex with men (BMSM) continues to be the least favorable in the United States. BMSM are disproportionally HIV-infected-but-unaware, despite expanded HIV testing efforts among this subgroup. METHODS We meta-analytically analyzed various HIV testing patterns [lifetime, after 24 months, after 12 months, after 6 months, and frequent (every 3-6 months) testing] among BMSM using the PRISMA guideline. PubMed, MEDLINE, Web of Science, and PsycINFO were searched for relevant articles, reports, conference proceedings, and dissertations published between January 1, 1996, and April 25, 2018. Two independent investigators reviewed and abstracted data into a standardized form. We used the DerSimonian-Laird random-effect model to pool the HIV testing prevalence and I-square statistics to measure heterogeneity. Funnel plots and Egger tests were used to assess for publication bias. We also performed subgroup and meta-regression analyses to explore aggregate-level characteristics that explain the heterogeneity across studies. RESULTS Our meta-analysis includes a total of 42,074 BMSM pooled from 67 studies. Lifetime HIV testing prevalence was high, 88.2% [95% confidence interval (CI): 86.2% to 90.1%], but recent (after 6 months = 63.4%; 95% CI: 59.3% to 67.4%) and frequent (42.2%, 95% CI: 34.1% to 50.3%) HIV testing prevalence was low. Meta-regression suggests that younger age (borderline significant), lower annual income, and homelessness were correlated with lower lifetime/recent HIV testing prevalence; while ever having condomless insertive/receptive sex, alcohol consumption, and illicit drug use were associated with higher lifetime/recent HIV testing prevalence. CONCLUSIONS Recent and frequent HIV testing remains suboptimal among BMSM. Future testing programs should prioritize strategies to enhance self-initiated, regular HIV testing among BMSM.
Collapse
Affiliation(s)
- Yu Liu
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | | | - Robertson Nash
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Patrick Luther
- Nashville Council on AIDS, Resources, Education and Support (CARES), Nashville, TN
| | | | - Sten H. Vermund
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, CT
| | - Chen Zhang
- School of Nursing, University of Rochester Medical Center, Rochester, NY
| |
Collapse
|
|
37
|
Wray TB, Chan PA, Simpanen EM. Longitudinal effects of home-based HIV self-testing on well-being and health empowerment among men who have sex with men (MSM) in the United States. AIDS Care 2019; 32:148-154. [PMID: 31146548 DOI: 10.1080/09540121.2019.1622636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
HIV self-test (HST) kits have been available for purchase directly by consumers since 2012. However, public health and prevention programs have been slow to adopt self-testing as a strategy for improving testing rates and regularity, in part due to concerns about its effects on the well-being of users and lack of follow-up. This study explored whether there were differences in several constructs related to well-being, including health-related quality of life, social support, health empowerment, and emotional distress, across those who used HSTs versus tested at a clinic over time. Data were drawn from a longitudinal randomized controlled trial exploring methods of encouraging HIV testing (clinic-based, regular home delivery of HSTs) and providing follow-up afterward. Results showed that using HST in a given month was not associated with changes in either distress or well-being that same month. Although social support was lower in months when HST was used (versus clinic-based testing), participants reported that engaging in other health behaviors (e.g., Healthy diet, exercise) were more important in months they used HST compared to testing in a clinic, suggesting that HST may empower MSM to begin making other lifestyle changes that could improve their health.
Collapse
Affiliation(s)
- Tyler B Wray
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Philip A Chan
- Department of Medicine, Brown University, Providence, Rhode Island, USA
| | - Erik M Simpanen
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| |
Collapse
|
|
38
|
Koester KA, Erguera XA, Kang Dufour MS, Udoh I, Burack JH, Grant RM, Myers JJ. "Losing the Phobia:" Understanding How HIV Pre-exposure Prophylaxis Facilitates Bridging the Serodivide Among Men Who Have Sex With Men. Front Public Health 2018; 6:250. [PMID: 30238001 PMCID: PMC6135985 DOI: 10.3389/fpubh.2018.00250] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 08/15/2018] [Indexed: 01/27/2023] Open
Abstract
The use of HIV serostatus information has played a pivotal role in partner selection norms. A phenomenon known as serosorting is the practice of selecting a partner based on a perception that they are of the same HIV status in order to avoid transmission from one partner to the other. An understudied aspect of serosorting is that it has a divisive effect-one accepts or rejects a potential partner based on a singular characteristic, the partner's HIV status, and thus excludes all others. This division has been formally referred to as the HIV serodivide. In this study, we explored partner selection strategies among a group of HIV-negative, young men who have sex with men (n = 29) enrolled in a PrEP demonstration project in Northern California. We found that trends in serosorting were in fact shifting, and that a new and opposite phenomenon was emerging, something we labeled "seromixing" and that PrEP use played a part in why norms were changing. We present three orientations in this regard: (1) maintaining the phobia: in which men justified the continued vigilance and exclusion of people living with HIV as viable sex or romantic partners, (2) loosening/relaxation of phobia: among men who were reflecting on their stance on serosorting and its implications for future sexual and/or romantic partnerships, and (3) losing the phobia: among men letting go of serosorting practices and reducing sentiments of HIV-related stigma. The majority of participants spoke of changing or changed attitudes about intentionally accepting rather than rejecting a person living with HIV as a sex partner. For those who maintained strict serosorting practices, their understandings of HIV risk were not erased as a result of PrEP use. These overarching themes help explain how PrEP use is contributing to a closing of the HIV serodivide.
Collapse
Affiliation(s)
- Kimberly A Koester
- Division of Prevention Science, Center for AIDS Prevention Research, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Xavier A Erguera
- Division of Prevention Science, Center for AIDS Prevention Research, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Mi-Suk Kang Dufour
- Division of Prevention Science, Center for AIDS Prevention Research, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Ifeoma Udoh
- East Bay AIDS Center, Sutter Health, Oakland, CA, United States
| | | | - Robert M Grant
- Virology and Immunology, Gladstone Institutes, University of California, San Francisco, San Francisco, CA, United States
| | - Janet J Myers
- Division of Prevention Science, Center for AIDS Prevention Research, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|