Download or read book Perceptions of Pre exposure Prophylaxis PrEP and Acceptability of Peer Navigation Among HIV negative Latinx and Black Men who Have Sex with Men MSM in Western Washington written by Jahn Jaramillo and published by . This book was released on 2018 with total page 47 pages. Available in PDF, EPUB and Kindle. Book excerpt: HIV PrEP (pre-exposure prophylaxis) is an effective biomedical approach for HIV prevention. However, PrEP is an underutilized resource among Latinx and Black men who have sex with men (MSM) in the United States. Peer navigation approaches are being widely scaled up to support PrEP uptake and adherence, though it remains unclear what strategies work best to effectively address the diverse social and cultural needs of Latinx and Black MSM. This study is based on qualitative research conducted on a subset of 66 Latinx and Black MSM residing in Western Washington who participated in an online CAPI REDCap survey. We conducted semi-structured in-depth interviews with 21 men selected through purposive sampling methods to evaluate the intersectionality of race, ethnicity, sexual orientation, and other identities men possessed and how this related to their views on PrEP in general, and on peer navigation specifically. Thematic analysis was used to identify and analyze emergent themes. Four major themes emerged as relevant to PrEP interest and uptake: 1) disclosure concerns for bisexual/gay masculine identified men; 2) specific challenges for Latinx MSM, including migration status and need for advocacy; 3) specific challenges for Black MSM, including discrimination and need lack of trust; and 4) special considerations for younger men, including limited knowledge and experience discussing sexual health and an interest in more comprehensive peer intervention content. Interest in peer navigation was high among study participants, particularly for men with limited social support or English proficiency and for men who had moved from out of state or another country. Several potential approaches to improve peer navigation were identified, including developing culturally congruent programming to match peers with men based on various identity considerations and identified needs, employing social media such as chatrooms and informational phone lines as complementary combination strategies, and incorporating trauma-informed care into a peer navigation program for Latinx and Black MSM. Tailored peer navigation approaches may help MSM of color by increasing resilience to societal stigma at the individual level, enhancing social support at the interpersonal level and serving as a bridge to providers at the structural level. These strategies could ultimately reduce racial/ethnic HIV disparities, if implemented.
Download or read book What s PrEP written by Jade Pagkas-Bather and published by . This book was released on 2019 with total page 30 pages. Available in PDF, EPUB and Kindle. Book excerpt: Background: HIV PrEP (pre-exposure prophylaxis) is underutilized among Black and Latinx men who have sex with men (MSM). We aimed to estimate interest in peer navigation for PrEP services among minority MSM in Western Washington. Methods: HIV-negative participants aged >̲16 identifying as Black or Latinx MSM completed a REDCap survey in English or Spanish. Survey questions pertained to: demographics, insurance status, access to care, knowledge and attitudes towards PrEP, sexual stigma, mental health, HIV risk assessment, substance and medication use, attitudes towards peer navigation, and importance of peer attributes. Recruitment took place through community-based organizations, flyers, Facebook campaigns, and word of mouth. Factor analysis was used to derive a score for peer navigator interest, and linear regression was utilized to identify associations of participant attributes with this outcome. Results: Among 95 participants (32 Black, 63 Latinx), median age was 30 (IQR 26-40) years. 73% identified as gay, 20% as bisexual, and 5% as queer. Forty-eight percent were interested in peer navigation for PrEP services. In unadjusted regression, being insured (p=0.02), higher sexual stigma score (p=0.006), higher PHQ-9 score (p=0.01), and having a regular medical provider (p=0.002) were associated with higher interest scores; higher income was associated with lower interest (0.001). In adjusted regression, higher income was negatively associated with peer navigator interest (p=0.04). In limited, multivariable analysis, higher stigma score was associated with peer navigator acceptability. Of proposed peer attributes, the most highly rated was matching on sexual orientation (rated "important" or "very important" by 73% of participants), followed by age (50%) and culture (44%). Conclusion: Having insurance and a regular provider may influence men's interest in peer navigation for PrEP services. Mental health training for peers could increase PrEP access, given greater interest among men with higher sexual stigma and depressive symptoms. Peer interventions for PrEP should match peers to clients on sexual orientation, age, and culture.
Download or read book Pre Exposure Prophylaxis Care Continuum Among Men Who Have Sex with Men in Vietnam written by Quang Loc Pham and published by . This book was released on 2020 with total page 132 pages. Available in PDF, EPUB and Kindle. Book excerpt: BackgroundPre-exposure Prophylaxis (PrEP) is effective in preventing HIV acquisition and therefore is a key priority to ending the HIV/AIDS epidemic. Men who have sex with men (MSM) can largely benefit from the program because they are disproportionately affected by the epidemic. There is a paucity of studies conducted in Vietnam investigating barriers of PrEP uptake as well as the PrEP care continuum. The study aims to identify the challenges of PrEP implementation from the perspective of MSM and from the perspective of service providers working in antiretroviral therapy (ART) clinics, and to inform interventions to improve PrEP implementation. Methods A mixed-method design was used in the study. Sub-study 1 utilized the existing data of a cohort study of MSM and the ongoing PrEP-program data of an MSM-focused clinic in Hanoi, Vietnam to identify factors associated with PrEP initiation. Sub-study 2 was in-depth interviews of 30 discontinued MSM to explore multi-level challenges related to PrEP discontinuation. Sub-study 3 was a cross-sectional survey of service providers working in ART clinics in Hanoi, Ho Chi Minh, and Hai Phong Cities in Vietnam to investigate the association between service providers' acceptability of the PrEP program and concern about PrEP use. Results Study 1 found that 43% of HIV-negative MSM initiating PrEP. Four factors associated with increased PrEP initiation were revealed, that were, reported gender identity, no ATS use in the past three months or never, having more than two sexual partners in the last month, and ever tested for HIV in the last 12 months. Study 2 reported the challenges related to PrEP discontinuation in three levels: 1) Individual-level challenges were risk behaviors and risk perception, pill burden, side effects, and lack of motivation to treatment, 2) Institutional-level challenges were PrEP accessibility and logistical difficulties, 3) Structural-level challenges included cost due to the medication, stigma toward PrEP use, and the impact of the COVID-19 pandemic. Additionally, the study found that long-acting injectable PrEP was highly acceptable among discontinued MSM and that side effects and pain due to intramuscular injection were two major challenges related to injectable PrEP. Study 3 presented the high acceptability of PrEP implementation among ART service providers. The association between PrEP acceptability and concern about PrEP use was not observed, however, higher awareness of PrEP-related information, lower stigma toward MSM, and higher job satisfaction were correlated with increased PrEP acceptability. Conclusion MSM faces multi-level challenges to initiate PrEP and to remain in the PrEP program. Interventions targeting the multi-level challenges should be developed and need to be delivered in a comprehensive package.
Download or read book Exploring the Impact of Pre exposure Prophylaxis Related to Sexual Behavior in College Men written by Dalton Poe and published by . This book was released on 2020 with total page 57 pages. Available in PDF, EPUB and Kindle. Book excerpt: Pre-exposure prophylaxis (PrEP) is an effective tool for preventing human immunodeficiency virus (HIV) acquisition in sexually active at-risk individuals such as men who have sex with men (MSM). The purpose of this study is to examine factors associated with intent to engage in risky sexual behavior among HIV-negative college aged (18-24) MSM who are currently adherent to PrEP or who have expressed interest in the future adoption of PrEP. A multiracial/ethnic sample of 31 men expressing interest in the adoption of PrEP and 6 men currently taking PrEP completed a quantitative survey identifying key themes regarding attitudes towards PrEP and potential behaviors associated with adherence. Themes associated with current adherence to PrEP included protection from HIV infection, the opportunity to engage in sexual activities with a non-condom HIV prevention method, and perceived protection from sexually transmitted infections. Themes associated with potential adoption of PrEP included protection from HIV infection, opportunity to engage in sexual activity with known HIV-positive partners, opportunity to engage in sexual activities with a non-condom HIV prevention method, and perceived protection from sexually transmitted infections. Review found that decreased condom use and increased sexual partners are key themes related to initiation of PrEP, and a decrease in frequency of condom use was indicated among the adherent sample. Other key themes identified include barriers to PrEP implementation and misinformation regarding sexually transmitted infections among the population.
Download or read book Pre exposure Prophylaxis Among AfroLatinx MSM Reasons and Experiences written by Angel Hasan Ramos (Graduate student) and published by . This book was released on 2022 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Abstract: Black and Latinx men who have sex with men (MSM) continue to be disproportionately affected by HIV. Pre-Exposure Prophylaxis (PrEP) is an efficacious strategy to prevent the acquisition of HIV. In Los Angeles County (LAC), PrEP continues to be underutilized, and HIV continues to disproportionately impact Black and Latinx MSM (BLMSM) compared to all other racial/ethnic groups of MSM in LAC. This is of particular concern for AfroLatinx MSM (ALMSM) as their context suggests overlapping experiences yet unique needs related to tailored prevention strategies aimed at increasing PrEP uptake among members of this community.
Download or read book Factors Influencing Use of Pre Exposure Prophylaxis written by Justin Terry-Smith and published by . This book was released on 2020-12-26 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Prevention is key to keeping men who have sex with men (MSM) protected from HIV. Despite new and innovative HIV prevention resources such as pre-exposure prophylaxis (PrEP), factors such as education level, employment status, number of sexual partners, and access to health resources may inhibit certain populations from using it. The purpose of this cross-sectional study was to examine the association between education level, employment status, number of sexual partners, and access to health resources and the use of PrEP among MSM.
Download or read book How Substance Use Health Insurance and Social Determinants of Health Affect the HIV Prevention Continuum in Los Angeles CA Focus on Pre Exposure Prophylaxis PrEP and Treatment as Prevention written by Chelsea Leigh Shover and published by . This book was released on 2018 with total page 91 pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: Recent advances in biomedical HIV prevention - including pre-exposure prophylaxis (PrEP) and treatment as prevention (TAsP) - are key to ending the HIV epidemic. The analysis examined how social factors that are strongly related to HIV incidence and treatment outcomes (e.g., substance use, access to healthcare, age, race/ethnicity, gender, and geographic location) may affect the HIV prevention continuum. METHODS: Chapters 2 and 3 use data collected as part of clinical care at the Los Angeles LGBT Center. In Chapter 2, a cross-sectional study of HIV-negative men who have sex with men (MSM) and transgender people who have sex with men (TGSM) who visited the Center between August 2015 and April 2017 examined how sexual history, substance use, and demographic factors were associated with initiating PrEP. In Chapter 3, records-based longitudinal study of patients prescribed PrEP at the Center evaluated discontinuation, HIV incidence, and loss to follow-up. Chapter 4 uses data from the mStudy to analyze the relationship between methamphetamine use (urine drug screen and self-reported frequency) patterns and viremia among HIV positive MSM of color. RESULTS: Use of sex drugs, but not alcohol use, was associated with PrEP initiation among MSM and TGSM. Key demographic risks were associated with lower odds of PrEP initiation (Black or Latino race/ethnicity, younger age). About half of patients who started PrEP at the Center discontinued or were lost to follow-up. HIV incidence among those who discontinued was 1.4%, compared to 0.3% among those who were actively attending follow-up appointments. Persistence was highest for those receiving PrEP through a low-cost program, and lowest for younger people. Longitudinal patterns of frequent and/or recent methamphetamine use were associated with a detectable pattern of viremia. CONCLUSION: Because younger people had lower PrEP initiation and more discontinuation compared to older people, strategies to support youth are key to PrEP's success for HIV prevention. The findings that methamphetamine was an obstacle to secondary HIV prevention but not necessarily to PrEP use highlight how facilitating PrEP use among people who use methamphetamine and other substances may be key to HIV prevention.
Download or read book HIV AIDS in South Africa 25 Years On written by Poul Rohleder and published by Springer Science & Business Media. This book was released on 2009-09-01 with total page 396 pages. Available in PDF, EPUB and Kindle. Book excerpt: Much has happened since the first appearance of AIDS in 1981: it has been identified, studied, and occasionally denied. The virus has shifted host populations and spread globally. Medicine, the social sciences, and world governments have joined forces to combat and prevent the disease. And South Africa has emerged as ground zero for the pandemic. The editors of HIV/AIDS in South Africa 25 Years On present the South African crisis as a template for addressing the myriad issues surrounding the epidemic worldwide, as the book brings together a widely scattered body of literature, analyzes psychosocial and sexual aspects contributing to HIV transmission and prevention, and delves into complex intersections of race, gender, class, and politics. Including largely overlooked populations and issues (e.g., prisoners, persons with disabilities, stigma), as well as challenges shaping future research and policy, the contributors approach their topics with rare depth, meticulous research, carefully drawn conclusions, and profound compassion. Among the topics covered: The relationship between HIV and poverty, starting from the question, "Which is the determinant and which is the consequence?" Epidemiology of HIV among women and men: concepts of femininity and masculinity, and gender inequities as they affect HIV risk; gender-specific prevention and intervention strategies. The impact of AIDS on infants and young children: risk and protective factors; care of children by HIV-positive mothers; HIV-infected children. Current prevention and treatment projects, including local-level responses, community-based work, and VCT (voluntary counseling and testing) programs. New directions: promoting circumcision, vaccine trials, "positive prevention." South Africa’s history of AIDS denialism. The urgent lessons in this book apply both globally and locally, making HIV/AIDS in South Africa 25 Years On uniquely instructive and useful for professionals working in HIV/AIDS and global public health.
Download or read book HIV Pre exposure Prophylaxis PrEP and Men who Have Sex with Men MSM in the Portland Metropolitan Area 2017 written by and published by . This book was released on 2018 with total page 2 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Awareness of HIV Pre exposure Prophylaxis PrEP and Predictors of Interest in PrEP Among HIV negative Persons who Inject Drugs in Seattle Washington written by Maria A. Corcorran and published by . This book was released on 2020 with total page 22 pages. Available in PDF, EPUB and Kindle. Book excerpt: Background: HIV pre-exposure prophylaxis (PrEP) is safe and effective for use in people who inject drugs (PWID), but studies indicate that PrEP is underutilized in this population. We assessed awareness of PrEP and investigated predictors of interest in PrEP among PWID in Seattle, Washington. Methods: This study analyzed data from a 2019 survey of PWID at 3 Seattle-area syringe service programs (SSPs). PWID who injected drugs in the past three months and were HIV-negative by self-report were included. Descriptive statistics were used to compare PrEP-aware and unaware PWID, and multivariate Poisson regression with robust standard errors was used to estimate adjusted prevalence ratios (APR) for interest in PrEP. Results: Among 348 HIV-negative PWID, including ≤1% who were currently taking PrEP, 51% were knowledgeable of PrEP and 46% were interested in PrEP. Interest in PrEP was inversely associated with prior knowledge of PrEP (APR 0.58, 95% CI 0.45 – 0.74); however, interest in PrEP was high among a subset of PWID meeting pre-specified risk criteria for HIV (APR 1.53, 95% CI 1.09 – 2.15). Conclusion: Despite reasonably high knowledge of PrEP and interest in PrEP, current use of PrEP was strikingly low in this urban cohort of PWID. Increasing knowledge of PrEP among PWID may not be sufficient to improve access to and continued use of PrEP among PWID at highest risk for HIV.
Download or read book Maximizing Effectiveness of HIV Preexposure Prophylaxis Among Men Who Have Sex with Men written by Julia Lenore Marcus and published by . This book was released on 2013 with total page 75 pages. Available in PDF, EPUB and Kindle. Book excerpt: Despite decades of prevention and treatment efforts, human immunodeficiency virus (HIV) infection is a global pandemic, with HIV/acquired immunodeficiency syndrome (AIDS) among the leading causes of death for children and adults in developing countries. HIV/AIDS disproportionately affects men who have sex with men (MSM), including in the United States, where MSM account for over half of all new HIV infections. Existing HIV prevention tools have not been sufficient to curb the pandemic, and biomedical prevention strategies, such as circumcision and microbicides, had not been shown to be effective in preventing HIV infection in MSM until 2010, when the multi-national iPrEx study found that daily oral preexposure prophylaxis (PrEP) using antiretroviral therapy (emtricitabine/tenofovir, or FTC/TDF) prevented HIV infection among MSM and transgender women. Although the success of FTC/TDF PrEP in such trials has given new hope to the HIV prevention field, excitement has been tempered by concerns about low adherence to daily pill use among trial participants. Adherence, as measured by self-reported pill use, was high among participants in the iPrEx trial, but testing for evidence of the drug in blood specimens from a subset of participants indicated that actual pill use was much lower than reported pill use. Adherence is critical for PrEP effectiveness; iPrEx participants in whom antiretroviral drug was detected in blood experienced a substantially greater reduction in HIV risk than was seen overall. The iPrEx results suggest that low adherence may be a barrier to successful implementation of PrEP as an HIV prevention strategy among MSM. Identification of effective strategies for supporting the consistent use of prophylactic medications could provide much needed guidance in the development of interventions to support adherence to PrEP. In addition to concerns about adherence, there is a widespread concern that PrEP could result in an increase in sexual risk behaviors by lowering users' perception of their risk of acquiring HIV infection; such risk compensation could reduce or even negate the benefits of PrEP. Foundational to most models of health behavior is the hypothesis that perceived risk is a primary motivation for self-protective behavior. Based on this theory, when a new prevention strategy, such as PrEP, is introduced, risk compensation could be prevented by sustaining individuals' perceptions of their own HIV risk. While the act of taking PrEP on a daily basis could result in risk compensation, it could also provide a daily opportunity to contemplate and manage HIV risk, thus motivating condom use and other self-protective behaviors. A better understanding of whether, and how, PrEP use affects sexual risk behavior could inform the development of risk-reduction interventions for individuals prescribed PrEP. In addition to preventing HIV infection, there is evidence that FTC/TDF PrEP may also be protective against infection with Herpes simplex virus type 2 (HSV-2). HSV-2 is the primary cause of genital ulcer disease worldwide, and HSV-2 infection is known to increase the risk of sexual transmission and acquisition of HIV infection. In the CAPRISA 004 study, a topical 1% tenofovir gel used as PrEP against HIV infection also reduced the risk of HSV-2 acquisition by 51% in women. In the Partners PrEP study, oral FTC/TDF reduced HSV-2 acquisition by 35% among heterosexual couples. Protection against HSV-2 acquisition or expression could enhance the public health impact of PrEP, but it is unknown whether FTC/TDF has anti-herpetic properties in men who have sex with men. The effectiveness of FTC/TDF PrEP in protecting against HIV infection depends on individual-level behaviors, including adherence and sustained risk reduction, as well as its effect on other sexually transmitted infections (STI) that increase the risk of HIV acquisition. Chapter 1 of this dissertation describes a systematic review that aimed to identify interventions that have been used to support adherence to daily oral medications prescribed to healthy or asymptomatic individuals. This review found evidence of interventions that demonstrated short-term improvements in medication adherence across a variety of prevention settings, thus identifying potential strategies for adherence support among PrEP users. Chapter 2 describes an analysis of data from the randomized phase of the iPrEx study to determine whether sexual risk compensation occurred among trial participants. Consistent with other PrEP studies, this analysis found no evidence of increased sexual risk behavior or STIs among participants who believed they had been assigned to the FTC/TDF arm and that the drug was highly effective. Finally, Chapter 3 describes an analysis that used data from the randomized phase of iPrEx to measure the effect of FTC/TDF on HSV-2 acquisition and expression among men who have sex with men. Although there was no effect of FTC/TDF on HSV-2 acquisition, participants receiving the active drug had a lower prevalence of herpetic ulcers than participants receiving the placebo. Taken together, these papers contribute to the HIV prevention field by providing guidance on behavioral support strategies for daily oral PrEP and identifying anti-herpetic properties of FTC/TDF that could increase its effectiveness as a novel prevention tool.
Download or read book Disparities in HIV Pre Exposure Prophylaxis Implementation for Black and Latinx Adults Receiving Care in Public Health Clinics written by Julie Kay Schexnayder and published by . This book was released on 2021 with total page 176 pages. Available in PDF, EPUB and Kindle. Book excerpt: Pre-exposure prophylaxis (PrEP) effectively reduces the risk of Human Immunodeficiency Virus (HIV) infection. PrEP implementation in public health clinics is suggested for increasing PrEP access; However, it is unclear if these venues can reduce the disparities in PrEP use that are observed for Black and Latinx adults. We analyzed data from health departments completing their first PrEP program year between June 1, 2016 and June 30, 2019. We estimated PrEP coverage and adherence in Black and Latinx clients. Semi-structured interviews were conducted with multidisciplinary public health workers (n=6). The Consolidated Framework for Implementation guided a thematic analysis of interviews. Of the 433 PrEP clients, 52.0% were non-Hispanic Black and 8.9% were Hispanic/Latinx. PrEP to need ratios were greater for White clients than for Black or Latinx clients at five of the nine health departments. The average medication possession ratio for Black and Latinx PrEP clients (.79) approached effective daily adherence levels. However, a single prescription was filled for 25.0% of Black and Latinx clients. Qualitative data indicated compatibility issues between PrEP services delivery and community preferences and needs. Challenges integrating longitudinal follow-up practices, and complex PrEP re-enrollment procedures emerged as additional factors influencing PrEP outcomes. The results of this dissertation indicate that public health clinics vary in their ability to deliver all components of PrEP clinical monitoring and in their ability to increase PrEP coverage in Black and Latinx adults. Tailoring of PrEP services to Black and Latinx adults may be necessary to optimize PrEP coverage and adherence.
Download or read book Acceptability and Correlates of Pre Exposure Prophylaxis Use for HIV Prevention Among High Risk Drug Users in Treatment written by Pramila Karki and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background Although people who use drugs (PWUD) are a key population recommended to receive pre-exposure prophylaxis (PrEP) to prevent HIV, few data are available to guide PrEP delivery in this underserved group. We therefore examined the willingness to initiate PrEP, the anticipation of HIV risk reduction while on PrEP, and the acceptability of PrEP based on a number of known PrEP attributes among high-risk PWUD. Methods In a cross-sectional study of 400 HIV-negative, opioid dependent individuals enrolled in a methadone program and reporting recent risk behaviors, we examined independent correlates of being willing to initiate PrEP. Participants also ranked the eight hypothetical PrEP program scenarios with varied combinations of six attributes related to PrEP (cost, dosing, efficacy, side-effects, treatment setting, and frequency of HIV testing). Results While only 72 (18%) were aware of PrEP, after being given a description of it, 251 (62.7%) were willing to initiate PrEP. Willingness to initiate PrEP was associated with having neurocognitive impairment (aOR=3.184, p=0.004) and higher perceived HIV risk (aOR=8.044, p Conclusions Our findings showed high acceptability of PrEP in response to different PrEP program scenarios with different attribute profiles. While willingness to initiate PrEP was high and correlated with being at elevated risk for HIV and having NCI, anticipated higher risk behaviors in this group even while on PrEP suggests that the next generation of HIV prevention approaches may need to combine biomedical and behavioral components to improve adherence to PrEP and to sustain HIV risk reduction over time.
Download or read book Precarious Manhood Beliefs and an HIV Prevention Behavior Among Black Sexual Minority Men written by Ladectric Driver and published by . This book was released on 2021 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Across two studies, the goal of this dissertation is to examine whether precarious manhood beliefs influence perceptions of males, in terms of their masculinity, for seeking pre-exposure prophylaxis (PrEP) to prevent HIV among Black sexual minority men (SMM). In investigating whether precarious manhood beliefs serve as a barrier to the initiation of PrEP, Study 1 examines whether precarious manhood beliefs predict intention to initiate PrEP. We also examine whether attitudes toward PrEP and social network support concerns account for the relationship between beliefs and intentions. Next, we investigate whether projected perceptions of masculinity predict Black SMM's intentions to initiate PrEP and whether precarious manhood beliefs moderate the influence of perceptions on intentions. Study 2 examines whether the perception of other males, in terms of their masculinity, is influenced by their choice to seek preventive healthcare services and whether precarious manhood beliefs moderate these perceptions. Support was found for the hypotheses that (1) precarious manhood beliefs are associated with lower intentions to initiate PrEP through attitudes toward PrEP and (2) that projected perceptions of masculinity predict Black SMM's intentions to initiate PrEP. However, findings overall suggest that perceptions of masculinity may serve to facilitate uptake of PrEP. In Study 1, precarious manhood beliefs predicted attitudes toward PrEP and social network support concerns and demonstrated a positive direct association with intentions to initiate PrEP. In Study 2, participants also perceived other males seeking diagnostic testing and a prophylactic, specifically HIV testing and PrEP, as more masculine than those avoiding preventive healthcare services. No moderating effects of precarious manhood beliefs were found in the present studies. Limitations and implications of the studies are discussed.
Download or read book The Impact of Sexual Behaviours Risk Perceptions and the Criminalization of HIV Non Disclosure on HIV Transmission Among HIV Negative and HIV Positive Men Who Have Sex With Men in Toronto written by Maya A. Kesler and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background: Men who have sex with men (MSM) continue to have disproportionately high rates of human immunodeficiency virus (HIV), even though risk factors for HIV acquisition are known and antiretroviral treatment has reduced transmission. Objectives: To characterize the sexual behaviours and risk perceptions of HIV transmission among HIV-negative and HIV-positive MSM. Methods: 150 HIV-negative and 292 HIV-positive MSM participated in the STI/HIV Co-Infection Study between September 2010 and June 2012. Participants were recruited from the Maple Leaf Medical Clinic, a primary and HIV-related care centre in Toronto. Multivariable logistic regression (MLR) models quantified the relationships between actualsexual HIV risk, HIV incidence risk index for MSM (HIRI-MSM), perceived HIV risk and willingness to take pre-exposure prophylaxis (PrEP) among HIV-negative MSM. MLR and flow chart models were used to estimate the potential impact of HIV non-disclosure laws on HIV testing rates and transmission among HIV-negative MSM, and on condom use, HIV status disclosure and proportion at risk for criminal prosecutions among HIV-positive MSM. Results: As condom use frequency with HIV-positive regular partners decreased, perceived HIV risk (Odds Ratio (OR):18.33, 95% Confidence Interval (CI):1.65-203.45) and willingness to take PrEP (OR:27.11, 95% CI:1.33-554.43) increased. Condom use frequency with casual or HIV-unknown status regular partners and the HIRI-MSM index were not associated with perceived HIV risk or PrEP willingness. The 7% (9/124) reduction in HIV testing due to fear of prosecution found in this study could increase community HIV transmission by 18.5%; the majority of transmission being driven by the unmet needs of undiagnosed HIV-positive MSM. Almost half of HIV-positive MSM were more likely to use condoms and/or disclose their HIV-positive status due to fear of prosecution and 8.6% (25/292) could be at risk for non-disclosure prosecutions given their condom use, viral load and disclosure rates. Conclusions: HIV-negative MSM using condoms less frequently with HIV-positive partners but not with HIV-unknown status or casual partners accurately gauged their sexual risk behaviour and were willing to take PrEP. HIV non-disclosure laws may incentivize safer sex practices among HIV-positive MSM; however, they may also deter HIV testing which impedes HIV prevention efforts and increases community HIV transmission .
Download or read book Which Patients May be Eligible for Pre exposure Prophylaxis PrEP for HIV u00a0 written by helen bradshaw and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Title:Which patients may be eligible for pre-exposure prophylaxis (PrEP) for HIV? Background/introduction:HIV diagnoses remain high among men who have sex with men (MSM). Recent studies show promising results with reducing MSM HIV transmission. The PROUD and IPERGAY studies, using daily or u2018on demandu2019 Truvada as PrEP respectively, showed an 86% HIV transmission reduction. Clinical guidance and funding arrangements for PrEP are in development. We assessed PrEP eligibility amongst MSM attending our sexual health service. Aim(s)/objectives:To ascertain the proportion of MSM attending our service eligible for PrEP on clinical grounds and estimate the service and cost implications of introducing PrEP.Methods:97 MSM attending from December 2014 to July 2015 were reviewed, including patients who had attended for post-exposure prophylaxis and STI screening. Patients were assessed against the PROUD study inclusion criteria to identify those who would benefit from PrEP. Results:Inclusion criteriatPercentage of patients who fit the criteriaBorn malet100%Completed HIV and STI screent84%HIV negative within previous 4 weekst95%Unprotected anal intercourse (UPAI) on > one occasion in the previous 90 dayst16%All criteria fulfilled (Having attended at least once previously was not considered as this was felt unnecessary)t14%No patients met any of the PROUD exclusion criteria. In a further 21% of notes, the exact number of episodes of UPAI, if any, was unclear although all other criteria were met. This suggests a range of 14-35% eligible for PrEP. We assumed all patients would continue having UPAI, were willing to comply with additional visits and were able to provide consent. The annual cost of Truvada is u00a3356 per year. Further service cost analyses will be described.Discussion/conclusion:At least 14-35% of MSM attending our service may benefit from PrEP provision. Additional costs include STI screening, monitoring and care pathways will need to be introduced. However, the overall impact of PrEP may be to reduce new HIV diagnoses and the resultant care costs.
Download or read book HIV Pre exposure Prophylaxis Additional Insights Through Secondary Analyses of the PROUD Trial written by Ellen White and published by . This book was released on 2020 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This thesis utilises data from PROUD, a randomised controlled trial to evaluate pre-exposure prophylaxis (PrEP) for HIV prevention. PROUD randomised 544 HIV-negative men who have sex with men (MSM) to receive PrEP immediately or deferred for a year. The trial demonstrated that PrEP was highly effective at preventing HIV transmission. In this thesis, I consider four further questions: (1) Who should access PrEP? (2) How appropriate are epidemiological measures that are commonly used for PrEP and other prevention strategies? (3) Is PrEP-use associated with an increased risk of sexually transmitted infections (STIs)? and (4) What is the risk of hepatitis C (HCV) among PrEP-users? The highest risk of HIV acquisition was associated with a rectal STI or syphilis diagnosis in the previous year, or reporting condomless receptive intercourse with two or more partners in the previous three months. MSM meeting these criteria are therefore in most need of PrEP. STI diagnoses were more common among PrEP-users, found in both the randomised and pre-/post-PrEP comparisons. It was unclear whether this was driven by a difference in screening or sexual behaviour. Regardless, PrEP-using MSM are at high risk of STIs, and frequent screening in a PrEP programme would likely help control onward transmission. HCV incidence was high and increased during the four-year period of follow-up, doubling in the final year. Risk varied according to reported risk factors. Thus, the current recommendation of quarterly HCV screening for all PrEP-using MSM may not be appropriate unless there is a localised epidemic. My findings show that MSM seeking PrEP have a high but heterogeneous risk of sexually transmitted diseases, with variation according to individual- and population-level risk factors. PrEP programmes need to allocate sufficient provisions to screen for and treat other clinical outcomes, including STIs and HCV.
