scholarly journals Lessons Learned from Longer Acting Reversible Contraception Applied to Longer Acting HIV Prevention Technologies

2021 ◽  
Author(s):  
Rachel Logan ◽  
Dominika Seidman
Keyword(s):  
Hiv Prevention ◽  
Reproductive Health ◽  
Sexual Health ◽  
Lessons Learned ◽  
Reproductive Justice ◽  
Holistic View ◽  
Marginalized Communities ◽  
Exposure Prophylaxis

Abstract Purpose of Review This review describes lessons learned from longer acting contraception and employs a reproductive justice lens to inform expansion of emerging HIV prevention technologies. Recent Findings Reproductive justice is a framework that advocates for the promotion of universal sexual and reproductive freedoms, particularly among historically marginalized communities. This framework takes a holistic view of individuals and sees the interconnections between sexual health, reproductive health, and overall health. Employing a sexual and reproductive justice perspective is essential to understanding and helping to mitigate the role intersecting structural, sexual, and reproductive oppressions, including those demonstrated through promotion of longer acting contraception, and can critically inform rollout of future prevention technologies, such as longer acting HIV pre-exposure prophylaxis. Summary This review highlights the need for researchers, clinicians, and policymakers to apply lessons learned from contraception and specifically focuses on principles of reproductive justice to offer expanding HIV prevention options.

scholarly journals 1273. Reasons for Disengagement in Care among Individuals Receiving Pre-Exposure Prophylaxis (PrEP) from a Sexual Health Clinic

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S458-S458
Author(s):  
Jason Zucker ◽  
Deborah Theodore ◽  
Caroline Carnevale ◽  
Elijah LaSota ◽  
Paul Richards ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Sexual Health ◽  
Hiv Risk ◽  
Perceived Risk ◽  
Medical Center ◽  
Academic Medical Center ◽  
Health Clinic ◽  
Receptive Anal Intercourse ◽  
Online Questionnaire ◽  
Exposure Prophylaxis

Abstract Background Pre-exposure prophylaxis (PrEP) effectively reduces HIV acquisition, but its efficacy depends on continued engagement through periods of high and low risk. Persistence in HIV prevention care has been low in real-world settings. In our program, 32% of patients are lost to care after their first visit and only 35% of patients are retained at their planned third visit. Reasons for low persistence in care are poorly described. Methods We identified all MSM who started PrEP between July 2015 and June 2018 at a sexual health clinic in an urban academic medical center in New York and had not had a visit in ≥6 months. We called patients between July 2018 and January 2019; those who were English speaking were given the option to complete an online questionnaire about current PrEP status, reasons for disengagement, and social and behavioral determinants of health (SBDH). Results Up to 710 patients were eligible for the study; over 700 calls were made. 125 participants agreed to participate and 57 (46%) completed the questionnaire. 24 patients (42%) were still actively taking PrEP. The most common reasons for starting PrEP were fear of getting HIV (58%), high self-perceived HIV risk (28%), and recommendations from friends (26%). Among those no longer taking PrEP, the most common reasons for discontinuation were cost/insurance issues (32%), lower perceived HIV risk (18%), concern about long-term side effects (12%), and trouble attending every-3-month appointments (12%). For those stopping due to lower perceived risk, 40% were in a monogamous relationship, 60% were less sexually active, and 20% always used a condom or did not engage in receptive anal intercourse. 56% of patients had at least 1 major life event in the preceding 3 months, including loss of a job (25%), breakup with a partner (12%), illness or death of a family member (11%), or unstable housing (8%). 47% used drugs or alcohol before sex in the past month including 39% not on PrEP. Conclusion Reasons for engagement, disengagement, and re-engagement are highly variable at the individual level. Cost and insurance issues were common in spite if clinic resources available to cover the cost of visits and medications. Life trauma was common. Individualized interventions to address SBDH may be required to engage and retain individuals in HIV prevention care. Disclosures All authors: No reported disclosures.

scholarly journals Acceptability and Feasibility of the CHARISMA Counseling Intervention to Support Women’s Use of Pre-Exposure Prophylaxis

2020 ◽  
Author(s):  
Ellen Wilson ◽  
L. Danielle Wagner ◽  
Thesla Palanee-Phillips ◽  
Sarah T. Roberts ◽  
Elizabeth E. Tolley ◽  
...  
Keyword(s):  
Pilot Study ◽  
Hiv Prevention ◽  
Positive Impact ◽  
Male Partner ◽  
Study Participant ◽  
Lessons Learned ◽  
Vaginal Microbicides ◽  
Clinic Staff ◽  
Counseling Intervention ◽  
Exposure Prophylaxis

Abstract Background: Women may need or seek male partner approval to {Malow, 2000 #18}{Malow, 2000 #18}{Malow, 2000 #18}{Malow, 2000 #18}safely and consistently use oral antiretroviral pre-exposure prophylaxis (PrEP) or vaginal microbicides. We developed CHARISMA, a counseling intervention to support women’s relationships and their ability to consistently use HIV prevention products.Methods: In a pilot study with 95 female participants in Johannesburg, South Africa, lay counselors assessed participants’ relationship(s) with their male partner(s) and barriers or facilitators to HIV prevention method use, and then provided tailored, interactive counseling. We conducted study participant surveys and clinic staff interviews to evaluate CHARISMA’s feasibility and acceptability.Results: The CHARISMA pilot study indicates that a two-session relationship counseling intervention with 6-month follow-up to support women’s ability to safely and effectively use vaginal microbicides was generally acceptable and feasible. Most participants thought CHARISMA was relevant, helpful, and about the right length, and that it had a positive impact on their relationships with their partners and their product use. Staff stated that it was generally feasible to implement. Based on these promising preliminary findings, the project team is currently conducting a randomized controlled trial in which participants are receive either the standard of care for IPV screening and referral (control arm) or the CHARISMA intervention.Conclusions: Clinic staff felt strongly that the length and intensity of CHARISMA were necessary for participants to begin to trust the counselors enough to be open and honest about problems in their relationships, and to begin to overcome the normalization of intimate partner violence. The length and intensity of CHARISMA may not be feasible in some settings, but a shorter version of the intervention may not offer as much support as women and staff need. One possible approach to reduce the burden on clinic staff would be to self-administer the intervention through a computer rather than requiring a counselor. Lessons learned from the pilot study may be relevant to others developing interventions supporting women’s use of oral PrEP or vaginal microbicides.

scholarly journals Queering reproductive access: reproductive justice in assisted reproductive technologies

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Michelle W. Tam
Keyword(s):  
Reproductive Health ◽  
Policy Development ◽  
White Supremacy ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Low Fertility ◽  
Reproductive Capacity ◽  
Reproductive Justice ◽  
Heterosexual Couples ◽  
Marginalized Communities

Abstract Background Advancements in assisted reproductive technologies (ART) and policy development have enabled more people to have biologically related children in Canada. However, as ART continues to focus on infertility and low fertility of heterosexual couples, ART access and research has been uneven towards meeting the reproductive needs of lesbian, gay, bisexual, transgender, queer, two-spirit, intersex, and asexual (LGBTQ2SIA +) people. Furthermore, experiences of reproduction are impacted by intersectional lived realities of race, gender, sexuality, and class. This commentary utilizes a reproductive justice (RJ) framework to consider reproductive access for LGBTQ2SIA + Black, Indigenous, and people of colour (BIPOC), while simultaneously engaging through a critical lens RJ has on ART. An RJ framework considers the constitutive elements of reproductive capacity and decision making that are not often at the forefront of reproductive health discussions. Additionally, this commentary discusses reproductive rights violations and reproductive violence such as coerced and forced sterilizations that have and are currently occurring in Canada. This article considers systems of access and structures of regulation that seek to control the reproductive capacities of marginalized communities, while empowering accessibility and upholding white supremacy and heteronormativity. In thinking through research and access in ART, who are ART users and whose reproduction is centered in research and access in Canada? Conclusion A reproductive justice framework is urgently needed to address inequities of sexual and reproductive health access in Canada.

scholarly journals Overlapping needs for sexual and reproductive health and HIV prevention in women with substance use disorders

2022 ◽  
Vol 18 ◽  
pp. 174550652110705
Author(s):  
Britton Gibson ◽  
Emily Hoff ◽  
Alissa Haas ◽  
Zoe M Adams ◽  
Carolina R Price ◽  
...  
Keyword(s):  
Substance Use ◽  
Hiv Prevention ◽  
Reproductive Health ◽  
Health Services ◽  
Confidence Interval ◽  
Substance Use Disorders ◽  
Sexual And Reproductive Health ◽  
Individual Characteristics ◽  
Contraception Use ◽  
Exposure Prophylaxis

Objectives: Women with substance use disorders have high unmet needs for HIV prevention and drug treatment and face challenges accessing care for other unique health issues, including their sexual and reproductive health. Methods: We did a cross-sectional evaluation of sexual and reproductive health behaviors and outcomes among women with substance use disorders, who were enrolled in one of two concurrent clinical trials of pre-exposure prophylaxis for HIV prevention. Descriptive analyses and bivariate logistic regression were used to assess factors driving contraceptive use, and other essential sexual and reproductive health services utilization and outcomes. Results: Among 226 women, 173 (76.5%) were of reproductive age. Most women had histories of unintended pregnancy (79.2%) or miscarriage (45.1%) and high HIV risk behaviors (53.5%). Most (61%) participants did not use any form of contraception at the time of assessment, although few (15%) reported pregnancy intentions. In bivariate models, ongoing criminal justice involvement was associated with 2.22 higher odds of not using contraception (95% confidence interval = 1.09–4.53; p = 0.03) and hazardous drinking was protective against not using contraception (odds ratio = 0.33, 95% confidence interval = 0.13–0.81; p = 0.02). Contraception use was not significantly associated with any other individual characteristics or need factors. Conclusions: This is the first study that identifies the unmet sexual and reproductive health needs of women with substance use disorders who are engaging with pre-exposure prophylaxis. We found that women accessed some health services but not in a way that holistically addresses the full scope of their needs. Integrated sexual and reproductive care should align women’s expressed sexual and reproductive health intentions with their behaviors and outcomes, by addressing social determinants of health.

scholarly journals Integrating Pre-Exposure Prophylaxis Delivery in Public Health Family Planning Clinics: Lessons Learned From a Programmatic Implementation Project in Kenya

2021 ◽  
Vol 3 ◽  
Author(s):  
Kenneth K. Mugwanya ◽  
John Kinuthia
Keyword(s):  
Family Planning ◽  
Hiv Prevention ◽  
Implementation Strategies ◽  
Hiv Infections ◽  
Lessons Learned ◽  
African Women ◽  
Data Systems ◽  
Prep Implementation ◽  
Exposure Prophylaxis ◽  
Delivery Models

Sexually active African women are a priority population for HIV prevention due to the disproportionately high frequency of new HIV infections. Family planning (FP) clinics offer an already trusted platform that can be used to reach women for HIV prevention services, including pre-exposure prophylaxis (PrEP). In the recent PrEP Implementation in Young Women and Adolescent (PrIYA program), we piloted PrEP implementation in FP clinics in Kisumu, Kenya, and demonstrated that it was possible to integrate PrEP provision in FP systems with a program-dedicated staff. In this perspective, we describe experiences and strategies employed to introduce PrEP implementation in FP clinics and lessons learned. We identified the following lessons for PrEP introduction in FP clinics in Kenya: (1) possible to integrate and generate high enthusiasm for PrEP delivery in FP clinics but persistence on PrEP is a challenge, (2) involvement of national and regional stakeholders is critical for buy-in, contextualization, and sustainability, (3) delivery models that do not integrate fully with existing staff and systems are less sustainable, (4) creatinine testing at PrEP initiation may not be necessary, (5) fully integrated HIV and FP data systems need to be developed, and (6) incorporating implementation science evaluation is important to understand and document effective implementation strategies. In summary, integration of HIV prevention and FP services provides an opportunity to promote one-stop women-centered care efficiently. However, a broader focus on delivery models that utilize existing staff and novel strategies to help women identify their own risk for HIV are needed to ensure greater success and sustainability.

Australian interdisciplinary healthcare providers' perspectives on the effects of broader pre-exposure prophylaxis (PrEP) access on uptake and service delivery: a qualitative study

Sexual Health ◽  
2020 ◽  
Vol 17 (6) ◽  
pp. 485
Author(s):  
Mattea Lazarou ◽  
Lisa Fitzgerald ◽  
Melissa Warner ◽  
Sandra Downing ◽  
Owain D. Williams ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Sexual Health ◽  
Professional Training ◽  
Healthcare Providers ◽  
Prevention Measures ◽  
Barriers To Access ◽  
Study Results ◽  
Rural Access ◽  
Exposure Prophylaxis ◽  
Interdisciplinary Healthcare

Background The addition of pre-exposure prophylaxis (PrEP) for HIV prevention to the Australian Government-subsidised Pharmaceutical Benefits Scheme (PBS) enables any doctor or nurse practitioner to prescribe it and has increased accessibility options. However, understanding of Australian healthcare providers’ (HCP) knowledge and preparedness to prescribe PrEP remains limited. Methods: Semistructured interviews, conducted before PBS listing (October 2016–April 2017), explored PrEP knowledge and prescription experiences of 51 multidisciplinary HCPs involved with the Queensland Pre-Exposure Prophylaxis Demonstration study. Results: Thematic analysis revealed that participants viewed PrEP as a necessary HIV prevention option, but there was concern about confusing prevention messages and potential risk compensation. Clinical capacity, stigma, cultural norms, rural access and PrEP-associated costs were identified as barriers to access and uptake. Some of these barriers may be addressed by the PBS listing; nonetheless, there was strong specialist concern about the preparedness of general practitioners without sexual health experience to prescribe PrEP. Participants identified a need to educate all HCPs, implement multidisciplinary supply models and provide timely access to PrEP for vulnerable populations and those ineligible for Medicare (Australia’s universal healthcare insurance system). Conclusions: Although PrEP listing on the PBS addressed structural barriers to access, this study highlights the role of nurses and other interdisciplinary healthcare workers in the provision of PrEP in addressing the sociocultural barriers that still affect the access of certain populations to HIV prevention measures. These findings will inform further professional training as PrEP is more widely accessed and requested outside specialist sexual health services. Future work is needed to ensure that the primary healthcare workforce is prepared to provide competent and safe access to PrEP across diverse locations and population groups.

scholarly journals Risk perception, safer sex practices and PrEP enthusiasm: barriers and facilitators to oral HIV pre-exposure prophylaxis in Black African and Black Caribbean women in the UK

2020 ◽  
Vol 96 (5) ◽  
pp. 349-354 ◽  
Author(s):  
Sarah E Nakasone ◽  
Ingrid Young ◽  
Claudia S Estcourt ◽  
Josina Calliste ◽  
Paul Flowers ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Sexual Health ◽  
Health Knowledge ◽  
Safer Sex ◽  
Black African ◽  
Caribbean Women ◽  
Black Caribbean ◽  
African Black ◽  
Exposure Prophylaxis ◽  
Sexual Health Knowledge

ObjectivesUK Black African/Black Caribbean women remain disproportionately affected by HIV. Although oral pre-exposure prophylaxis (PrEP) could offer them an effective HIV prevention method, uptake remains limited. This study examined barriers and facilitators to PrEP awareness and candidacy perceptions for Black African/Black Caribbean women to help inform PrEP programmes and service development.MethodsUsing purposive sampling through community organisations, 32 in-depth, semi-structured interviews were conducted with Black African/Black Caribbean women living in London and Glasgow between June and August 2018. Participants (aged 19–63) included women of varied HIV statuses to explore perceptions of sexual risk and safer sex, sexual health knowledge and PrEP attitudes. A thematic analysis guided by the Social Ecological Model was used to explore how PrEP perceptions intersected with wider safer sex understandings and practices.ResultsFour key levels of influence shaping safer sex notions and PrEP candidacy perceptions emerged: personal, interpersonal, perceived environment and policy. PrEP-specific knowledge was low and some expressed distrust in PrEP. Many women were enthusiastic about PrEP for others but did not situate PrEP within their own safer sex understandings, sometimes due to difficulty assessing their own HIV risk. Many felt that PrEP could undermine intimacy in their relationships by disrupting the shared responsibility implicit within other HIV prevention methods. Women described extensive interpersonal networks that supported their sexual health knowledge and shaped their interactions with health services, though these networks were influenced by prevailing community stigmas.ConclusionsDifficulty situating PrEP within existing safer sex beliefs contributes to limited perceptions of personal PrEP candidacy. To increase PrEP uptake in UK Black African/Black Caribbean women, interventions will need to enable women to advance their knowledge of PrEP within the broader context of their sexual health and relationships. PrEP service models will need to include trusted ‘non-sexual health-specific’ community services such as general practice.

scholarly journals New findings from intervention research: Youth reproductive health and HIV prevention

2004 ◽  
Author(s):  
Keyword(s):  
Hiv Prevention ◽  
Reproductive Health ◽  
Youth Development ◽  
Family Health ◽  
Intervention Research ◽  
Lessons Learned ◽  
Meeting Report ◽  
Population Council ◽  
Hiv Knowledge ◽  
New Findings

On September 9, 2003, FRONTIERS/Population Council, Horizons/Population Council, and YouthNet/Family Health International co-sponsored a technical meeting in Washington, DC, “New Findings from Intervention Research: Youth Reproductive Health and HIV Prevention.” Approximately 150 HIV/AIDS, reproductive health, and youth development experts from a diversity of organizations and backgrounds participated. The purpose of the meeting was to disseminate newly available research findings on how to change youth reproductive health/HIV knowledge, attitudes, and behaviors in developing countries. The meeting also sought to stimulate discussion on lessons learned, best practices, and recommendations for future youth programs and research. This meeting report summarizes the presentations and discussions at the meeting, following the meeting agenda.

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