AIDS Educ Prev
· 2022 Aug · PMID 35994576
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The dapivirine monthly vaginal ring-a discreet, anti-HIV microbicide created specifically for women-has received a positive scientific opinion by the European Medicines Agency and is included in the WHO HIV prevention gu...The dapivirine monthly vaginal ring-a discreet, anti-HIV microbicide created specifically for women-has received a positive scientific opinion by the European Medicines Agency and is included in the WHO HIV prevention guidelines. It has received regulatory approvals in several countries in southern and eastern Africa. During the review of the New Drug Application that was submitted in December 2020, FDA advised the developer, International Partnership for Microbicides, that it was unlikely to be approved in the United States; the application has since been withdrawn. This commentary will present the case for FDA approval for the dapivirine ring. Advocacy is urgently needed to protect U.S. women's access to user-controlled HIV prevention technologies, consistent with both global regulatory decisions to date and with a reproductive justice framework. Women continue to need the fullest range of HIV prevention methods to integrate into their lives in the most practical and effective way possible.
AIDS Educ Prev
· 2022 Aug · PMID 35994575
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The COVID-19 pandemic has exacerbated HIV-related disparities and has likely disrupted service provision by organizations providing critical HIV-related services, especially in the U.S. Deep South, an area disproportiona...The COVID-19 pandemic has exacerbated HIV-related disparities and has likely disrupted service provision by organizations providing critical HIV-related services, especially in the U.S. Deep South, an area disproportionately affected by HIV. To assess the impact of COVID-19 on organizations providing services for people living with HIV and/or sexual and gender minorities throughout the Deep South, an online survey was developed and disseminated from January to June 2021 regarding service disruption, organizational changes and needs, and staff and client impact and needs. Organizations reported ongoing organization-level financial and structural complications, staff difficulties including mental health challenges and lack of technology proficiency, and exacerbated challenges for clients including increased mental health concerns, substance use, and housing instability, among others. Organizations will need to be supported as they navigate the exacerbated mental health challenges of clients and staff as well as financially supported as they address economic disparities related to the pandemic.
Truong HM, Fatch R, McFarland W
… +4 more, Grasso M, Raymond HF, Holt M, Steward WT
AIDS Educ Prev
· 2022 Jun · PMID 35647868
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Travelers may adapt HIV risk-reduction practices based on perceived destination-specific norms. We examined the association between perceived condom norms and condomless anal sex (CAS) during international and domestic t...Travelers may adapt HIV risk-reduction practices based on perceived destination-specific norms. We examined the association between perceived condom norms and condomless anal sex (CAS) during international and domestic travel and in the home environment among men who have sex with men. Men who traveled internationally in the past 12 months were recruited by respondent-driven sampling ( = 501). Not knowing destination-specific condom norms was significantly associated with less CAS during international travel and in the home environment but not during domestic travel. Perceiving home environment condom norms to expect use of condoms was significantly associated with less CAS during domestic but not international travel. Men were less likely to engage in CAS during international travel when destination-specific condom norms were unknown. Unfamiliarity with the environment and culture may influence some men to refrain from higher-risk behaviors. During domestic travel, some men appeared to apply home environment condom norms, which may be erroneous in some situations and pose an HIV risk.
Carneiro PB, Frye V, Mirzayi C
… +5 more, Patel V, Lounsbury D, Huang TT, Sabounchi N, Grov C
AIDS Educ Prev
· 2022 Jun · PMID 35647867
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HIV-outcome inequities remain prevalent in the U.S. Medical providers (MPs) are gatekeepers of PrEP, and understanding the dynamics of PrEP assessments is of major interest for public health. We analyzed data from Togeth...HIV-outcome inequities remain prevalent in the U.S. Medical providers (MPs) are gatekeepers of PrEP, and understanding the dynamics of PrEP assessments is of major interest for public health. We analyzed data from Together 5000, an internet-based U.S. national cohort of sexual and gender minority (SGM) individuals aged 16-49 years and at risk for HIV. Among those eligible for PrEP uptake (n = 6264), we modeled predictors of discussing PrEP with an MP. A third (31%) of participants had spoken to a MP about PrEP. Among those who spoke to a MP, 45% suggested they would initiate PrEP; this outcome was more common among participants older than 24. With a persistent stagnant uptake nationwide, new opportunities to influence PrEP uptake must be explored. An attractive less targeted space is the medical office, specifically ways to support an initial and continued discussion about PrEP between MPs and their patients.
AIDS Educ Prev
· 2022 Jun · PMID 35647866
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Research is limited on the effect of racism and social determinants of health on HIV pre-exposure prophylaxis (PrEP) use. This study used the PrEP-to-Need Ratio (PNR), which measures PrEP prescriptions divided by HIV dia...Research is limited on the effect of racism and social determinants of health on HIV pre-exposure prophylaxis (PrEP) use. This study used the PrEP-to-Need Ratio (PNR), which measures PrEP prescriptions divided by HIV diagnoses in the county, to evaluate sufficient PrEP use. AIDSVu datasets were compared to county-level social determinants of health. Standardized regression coefficients (β) were compared to identify strongest associations with PNR. Overall, factors including percent African American and percent uninsured had negative correlations with PNR, whereas median household income and severe housing cost burden had positive associations. Stratifying for population size, percent African American, percent uninsured, and severe housing cost burden were significant for low population areas, whereas median household income, percent in poverty, percent uninsured, and percent African American were significant for large populations. To reduce PrEP disparities, public health must develop strategies to reach those most in need, especially historically disadvantaged communities.
Aidoo-Frimpong G, Collins RL, Agbemenu K
… +3 more, Orom H, Morse GD, Nelson LE
AIDS Educ Prev
· 2022 Jun · PMID 35647865
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African immigrants in the United States experience disparities in HIV incidence. Pre-exposure prophylaxis (PrEP) effectively prevents HIV infection, yet uptake is low among racial and ethnic minorities. To better underst...African immigrants in the United States experience disparities in HIV incidence. Pre-exposure prophylaxis (PrEP) effectively prevents HIV infection, yet uptake is low among racial and ethnic minorities. To better understand PrEP adoption among African immigrants, in March 2020, we conducted interviews with Ghanaian immigrants ( = 40) to explore the barriers and ways to overcome these barriers to PrEP adoption. Participants described several barriers (e.g., low HIV knowledge and risk perception, fear of social judgment, cultural values, and norms), which may impede PrEP adoption. We categorized these barriers according to the levels of the socioecological model (individual, interpersonal, community, and organizational/structural factors). Participants also identified strategies to overcome the barriers, such as providing comprehensive education on HIV and PrEP. Our research provides foundational knowledge that can inform future PrEP research with Ghanaian and other African immigrants and offers important insights into factors that may impact PrEP adoption in this population.
Amirkhanian YA, Kelly JA, DiFranceisco WJ
… +3 more, Tarima SS, McAuliffe TL, Kuznetsova AV
AIDS Educ Prev
· 2022 Jun · PMID 35647864
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This study examined psychosocial and health needs of persons living with HIV (PLWH) in Russia. The study combined baseline datasets from two social network samples of PLWH in St. Petersburg ( = 872). Samples were recruit...This study examined psychosocial and health needs of persons living with HIV (PLWH) in Russia. The study combined baseline datasets from two social network samples of PLWH in St. Petersburg ( = 872). Samples were recruited between 2014 and 2018 by enrolling a PLWH seed who was either out-of-care or treatment nonadherent as well as network members surrounding each seed, assessing each participant's HIV care, transmission risk, substance use, and mental health characteristics. Almost one-quarter of participants said they were never offered antiretroviral therapy (ART), and-among those offered ART-one-quarter refused or discontinued therapy and 45% were <95% ART-adherent. Almost half of participants had detectable viral load, and many reported continued condomless intercourse with potentially nonconcordant serostatus partners or needle sharing. Over 46% of participants had elevated scores on measures of depression, hopelessness, state anxiety, or poor social support. Study findings illustrate unmet needs of PLWH in Russia.
Adherence to antiretroviral therapy (ART) is vital for reducing racial and gender disparities in morbidity and mortality among people living with HIV/AIDS (PLWH). Little research attention has been given to aspects of fa...Adherence to antiretroviral therapy (ART) is vital for reducing racial and gender disparities in morbidity and mortality among people living with HIV/AIDS (PLWH). Little research attention has been given to aspects of family functioning affecting ART adherence among PLWH vulnerable to disparities. Data were from n = 313 participants (93% African American) in the BEACON study, which recruited injection-drug-using PLWH on ART. Using factor analysis and longitudinal structural equation modeling, we found that current substance use and negative family conflict tactics (i.e., non-negotiation) predicted PLWH's lower probability of ART adherence at 12-month follow-up; and greater HIV disclosure to support network members predicted a higher probability of adherence. These findings suggest the importance of family and other support network members in this vulnerable population's ART adherence. Social network-focused interventions promoting prosocial response to conflict and negotiation skills are important for improving vulnerable PLWH's HIV outcomes and reducing health disparities.
Black sexual minority men (BSMM) are substantially less likely than White SMM to accept a clinician's recommendation to initiate HIV pre-exposure prophylaxis (PrEP). The purpose of this study is to identify PrEP messagin...Black sexual minority men (BSMM) are substantially less likely than White SMM to accept a clinician's recommendation to initiate HIV pre-exposure prophylaxis (PrEP). The purpose of this study is to identify PrEP messaging preferences among BSMM. Data were obtained from 12 focus groups and one in-depth interview among BSMM in Baltimore, MD (N = 39). Focus groups were stratified (18-24, 25-34, and 35 and older), and facilitators probed on ways clinicians could discuss PrEP with BSMM. An adapted pile sorting approach was used to identify themes. Most identified as homosexual, gay, or same-gender-loving (68%), were employed (69%), and single (66%). Thematic analysis revealed that BSMM wanted clinicians to explain PrEP efficacy and side effects, tailor messaging, provide prevention messaging with care, and disclose PrEP use. Clinicians could increase uptake and adherence among BSMM by implementing PrEP communication preferences. Discussing PrEP efficacy and safety is also necessary. When possible, clinicians should disclose PrEP use history to build trust.
Restar AJ, Quilantang MIN, Surace A
… +5 more, Ogunbajo A, Chan R, Adia A, Cu-Uvin S, Operario D
AIDS Educ Prev
· 2022 Apr · PMID 35438540
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Drug use and HIV are key issues for public health interventions in the Philippines. We examined associations of problematic drug use among 320 Filipinx transgender women (trans-WSM) and cisgender men who have sex with me...Drug use and HIV are key issues for public health interventions in the Philippines. We examined associations of problematic drug use among 320 Filipinx transgender women (trans-WSM) and cisgender men who have sex with men (cis-MSM). The prevalence of exhibited problematic drug use in this sample was 29.38%. Greater odds of problematic drug use were observed among Filipinx participants who recently engaged in sex work (adjusted OR [aOR] = 2.79, 95% CI [1.08, 7.18]), reported having HIV positive and unknown status vs. negative status (aOR = 3.61, 95% CI [1.39, 9.39], and aOR = 13.99, 95% CI [2.04, 29.69], respectively), exhibited low HIV knowledge (aOR = 4.15, 95% CI [1.82, 9.44]), and displayed hazardous drinking (aOR = 2.77, 95% CI [1.21, 6.33]). Given its correlates of HIV-related indicators, integration of HIV and harm reduction services as a public health intervention could potentially decrease problematic drug use.
We conducted a mixed-method longitudinal evaluation of an HIV primary care practice transformation project in Washington, D.C. The project aimed to enhance organizational capacity to deliver culturally appropriate and pa...We conducted a mixed-method longitudinal evaluation of an HIV primary care practice transformation project in Washington, D.C. The project aimed to enhance organizational capacity to deliver culturally appropriate and patient-centered care for Latinxs living with HIV. Quantitative and qualitative data were simultaneously collected to capture the complex interactions among care providers, staff, and patients as well as to monitor practice changes that occurred as a result of the project implementation. The practice transformation intervention consisted of core competency workforce training, workflow redesign, and data-driven quality improvement strategies utilized to guide the intervention and to gather data from providers and patients. The mixed-methods approach facilitated meaningful change within the clinic that resulted in improved patient outcomes, patient experiences of care, and increases in staff's perceived level of knowledge of patient-centered care and improved efficiencies in HIV health care service delivery.
Corneli A, Perry B, Taylor J
… +9 more, Beckford J, Molokwu N, Reif S, Wilson J, Gulden C, Bickham J, Siren J, Thompson W, Clement ME
AIDS Educ Prev
· 2022 Apr · PMID 35438538
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Black populations in the U.S. South are disproportionally affected by HIV and COVID-19 due to longstanding inequalities. We conducted 20 in-depth interviews-12 with Black same-gender-loving men and 8 with Black cisgender...Black populations in the U.S. South are disproportionally affected by HIV and COVID-19 due to longstanding inequalities. We conducted 20 in-depth interviews-12 with Black same-gender-loving men and 8 with Black cisgender women-to explore the impact of the initial phase of the COVID-19 pandemic on sexual activities and PrEP use. Almost all participants reduced the frequency of sex and number of partners. Women described little interest in sex, whereas men began to connect with some sexual partners after stay-at-home orders were lifted. Both populations were concerned about contracting COVID-19 through sexual partners, and men described selecting partners based on perceived COVID-19 risk. Participants valued PrEP and could access it, although several men who were not having sex stopped taking it. Risk of acquiring HIV during this time was likely limited. Future qualitative research is needed to understand how sexual behaviors and PrEP use changed as the pandemic continued.
AIDS Educ Prev
· 2022 Apr · PMID 35438537
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The national "Ending the HIV Epidemic: A Plan for America" supports expanded testing in jurisdictions and groups with disproportionate HIV burden. Public health planners benefit from learning HIV testing service (HTS) st...The national "Ending the HIV Epidemic: A Plan for America" supports expanded testing in jurisdictions and groups with disproportionate HIV burden. Public health planners benefit from learning HIV testing service (HTS) strengths, challenges, and innovations. We conducted semistructured interviews with 120 HTS staff from local health departments, community-based organizations, and community members in Houston, Texas; Miami, Florida; New Orleans, Louisiana; and Washington, DC. We coded interview transcripts using qualitative methods to identify themes. Program strengths include HIV testing integration with other client services; prioritized testing and tailored incentives; multiple advertising methods; and partnerships among HTS providers. Challenges include stigma, fear, and disparities; funding requirements that create competition between providers; and service accessibility, unnecessary repeat testing, and insufficient innovation. The four jurisdictions addressed some, but not all, of these challenges. Cross-jurisdictional collaboration, together with state and federal partners plus program data may help identify additional strategies for strengthening HTS.
AIDS Educ Prev
· 2022 Feb · PMID 35192396
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South Africa recorded and estimated 230,000 new infections in 2020, and low levels of AIDS risk awareness remain prevalent among the nation's youth. While public health awareness initiatives continue to be necessary, the...South Africa recorded and estimated 230,000 new infections in 2020, and low levels of AIDS risk awareness remain prevalent among the nation's youth. While public health awareness initiatives continue to be necessary, the large quantity of AIDS-related content that has permeated the media landscape since the start of the epidemic has resulted in increasing indifference to health messaging. Drawing from the concept of referent emotional responses, this article analyzes the reception of "Sing," an HIV/AIDS awareness music video characterized by emotive visual representations of AIDS. The data highlight ongoing fatigue towards HIV/AIDS messaging and the potential of highly emotive media to engage target audiences in a climate of indifference to AIDS awareness. The article recommends that future awareness and prevention campaigns consider the role of emotive content in effective AIDS-related health promotion in South Africa.
Eschliman EL, Uzzi M, White JJ
… +7 more, Mathews A, Henry M, Moran MB, Page K, Latkin CA, Tucker JD, Yang C
AIDS Educ Prev
· 2022 Feb · PMID 35192395
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Pre-exposure prophylaxis (PrEP) is an important and highly effective HIV prevention strategy, but its uptake remains low, particularly among marginalized populations at high risk of HIV. Innovative and community-driven p...Pre-exposure prophylaxis (PrEP) is an important and highly effective HIV prevention strategy, but its uptake remains low, particularly among marginalized populations at high risk of HIV. Innovative and community-driven promotion strategies, such as open contests, are needed to address disparities. This directed content analysis uses a PrEP-specific adaptation of the Information-Motivation-Behavioral Skills (IMB) model to identify themes related to PrEP use reflected in community-generated submissions (n = 73) from an open contest conducted to elicit crowdsourced health promotion messages on PrEP in Baltimore, Maryland. In addition to identifying eight of the themes from the adapted IMB model, this analysis also identified two novel salient themes in the motivation category: self-worth/self-love and self-care practice. Findings from this analysis can inform PrEP promotion efforts by pointing to salient themes identified from a community-driven approach that are less well represented in existing research.
Stutterheim SE, Kuijpers KJR, Waldén MI
… +3 more, Finkenflügel RNN, Brokx PAR, Bos AER
AIDS Educ Prev
· 2022 Feb · PMID 35192394
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We investigated whether HIV stigma has changed in recent years. We compared data on stigma settings and manifestations from 2007 ( = 667) and, specifically for health care, 2009 ( = 262), to data acquired in 2019/2020 (...We investigated whether HIV stigma has changed in recent years. We compared data on stigma settings and manifestations from 2007 ( = 667) and, specifically for health care, 2009 ( = 262), to data acquired in 2019/2020 ( = 258). Results showed reductions in stigma from friends, family, acquaintances, at work, in the financial services sector, and in media, but stigmatizing messages in media remained highly prevalent. Stigma in the LGBTQI+ community, with sexual partners, and while partying also remained prevalent and, disconcertingly, relatively unchanged. Stigma in health care increased. HIV stigma was positively related to psychological distress, and negatively related to social support and medication adherence. Further, most participants were familiar with U=U and PrEP, but 13.3% questioned the accuracy of U=U. Stigma reduction efforts should focus on reducing stigma in media, in the LGBTQI+ community and while dating, and in health care, with U=U as a key message.
Bartels SM, Guzmán Guevara K, Pajarito Rompich Y
… +1 more, Barrington C
AIDS Educ Prev
· 2022 Feb · PMID 35192393
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The emotional burden of an HIV diagnosis can impact HIV outcomes and overall well-being. We piloted a four-session individual-level emotional well-being intervention, offered during HIV care visits, for gay and bisexual...The emotional burden of an HIV diagnosis can impact HIV outcomes and overall well-being. We piloted a four-session individual-level emotional well-being intervention, offered during HIV care visits, for gay and bisexual men living with HIV in Guatemala City who were recently diagnosed or reengaged in care. To assess intervention impact in a contextualized manner, we conducted longitudinal qualitative interviews ( = 3) with study participants (n = 10) over 12 months. Data analysis included thematic coding using NVivo and longitudinal narrative summaries and matrices to identify narratives of change and assess intervention impact. Participants experienced changes in their view of self and diagnosis perceptions, improved physical and mental health, increased interest in sex and relationships, and a clarification of their life goals. The intervention helped participants reach diagnosis acceptance, improve self-esteem, and gain self-efficacy for managing life with HIV. Findings support the importance of integrating emotional well-being into HIV care.
AIDS Educ Prev
· 2022 Feb · PMID 35192392
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Familism may play an important role in HIV risk behaviors among men who have sex with men (MSM) living in a collectivist culture. This study examined a hypothesized path from familism, stressful life events (i.e., advers...Familism may play an important role in HIV risk behaviors among men who have sex with men (MSM) living in a collectivist culture. This study examined a hypothesized path from familism, stressful life events (i.e., adverse childhood experiences, intimate partner violence, and sexuality-related discriminatory experiences), and coping strategies to condomless anal sex (CAS) among Taiwanese MSM. Participants were 1,000 MSM (mean age = 28.5 years) recruited through five community-based organizations. Structural equation modeling using bootstrapping with 3,000 iterations evaluated the mediating effects of 14 coping strategies. We found a pathway from familism to CAS through stressful life events and substance use coping. The protective effects of familism on stressful life events and CAS suggest that integrating components of family support and family connection into HIV prevention and education programs may increase the effectiveness of these programs in reducing HIV risk behaviors and dysfunctional coping strategies among MSM in Taiwan.
Resnick D, Schapira MM, Andrews ME
… +4 more, Essoka-Lasenberry A, Davis-Vogel A, Bauermeister JA, Wood SM
AIDS Educ Prev
· 2022 Feb · PMID 35192391
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This qualitative study aimed to determine how men and gender diverse individuals who have sex with men describe their perceived risk of HIV and what factors influence this risk assessment. We conducted in-depth, virtual...This qualitative study aimed to determine how men and gender diverse individuals who have sex with men describe their perceived risk of HIV and what factors influence this risk assessment. We conducted in-depth, virtual interviews with 18 HIV-negative individuals from Philadelphia, eligible for or taking PrEP. The interviews assessed the participants' understanding of their HIV risk, using thematic analysis to deductively code and extract themes. Three themes emerged: (1) participants expressed both deliberative and affective risk perception before and after sexual encounters; (2) participants linked HIV knowledge to risk perception and stigma; (3) participants connected intrinsic and extrinsic factors to risk perception differently. Participants endorsed low overall risk perception, while also describing moments of high affective risk perception after sexual encounters in which they were not able to implement their preferred prevention strategies. Future research should explore helping individuals transform affective risk perception into empowerment around sexual health.
AIDS Educ Prev
· 2021 Dec · PMID 34874761
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We collected 216 responses from sexually active MSM, transgender women, and gender-nonconforming (GNC) people of color through a web-based survey to understand the facilitators and barriers to research participation in a...We collected 216 responses from sexually active MSM, transgender women, and gender-nonconforming (GNC) people of color through a web-based survey to understand the facilitators and barriers to research participation in a hypothetical LAI PrEP trial. In adjusted models, these items were found to be significantly associated with research participation likelihood: ever participated in HIV research study; comfort with taking daily pill; comfort with providing urine sample; and concerns over potential side effects of shot. Asian participants were more concerned about others knowing they were being recruited than were Black and Latinx respondents F(2, 216) = 3.98; < .05. Asian respondents were also less comfortable with being recruited at organizations serving communities of color than Black and Latinx respondents, F(2, 216) = 5.10; < .05. Cisgender respondents were more comfortable with being recruited by a friend or colleague than were transgender/GNC respondents, F(1, 215) = 4.8; < .05.