Stigma, gay men and biomedical prevention: the challenges and opportunities of a rapidly changing HIV prevention landscape

Improvements in biomedical technologies, combined with changing social attitudes to sexual minorities, provide new opportunities for HIV prevention among gay and other men who have sex with men (GMSM). The potential of these new biomedical technologies (biotechnologies) to reduce HIV transmission and the impact of HIV among GMSM will depend, in part, on the degree to which they challenge prejudicial attitudes, practices and stigma directed against gay men and people living with HIV (PLHIV). At the structural level, stigma regarding gay men and HIV can influence the scale-up of new biotechnologies and negatively affect GMSM’s access to and use of these technologies. At the personal level, stigma can affect individual gay men’s sense of value and confidence as they negotiate serodiscordant relationships or access services. This paper argues that maximising the benefits of new biomedical technologies depends on reducing stigma directed at sexual minorities and people living with HIV and promoting positive social changes towards and within GMSM communities. HIV research, policy and programs will need to invest in: (1) responding to structural and institutional stigma; (2) health promotion and health services that recognise and work to address the impact of stigma on GMSM’s incorporation of new HIV prevention biotechnologies; (3) enhanced mobilisation and participation of GMSM and PLHIV in new approaches to HIV prevention; and (4) expanded approaches to research and evaluation in stigma reduction and its relationship with HIV prevention. The HIV response must become bolder in resourcing, designing and evaluating programs that interact with and influence stigma at multiple levels, including structural-level stigma.

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Catholic Family Ties: Sustaining and Supporting HIV-Positive Canadian Gay Men’s Faith, Mental Health, and Wellbeing

Religions ◽

10.3390/rel11080391 ◽

2020 ◽

Vol 11 (8) ◽

pp. 391

Author(s):

Renato M. Liboro

Keyword(s):

Family Support ◽

Religious Coping ◽

Gay Men ◽

Sexual Minorities ◽

Hiv Positive ◽

People Living With Hiv ◽

Family Ties ◽

Life Challenges ◽

Living With Hiv ◽

Hiv Aids

Research has documented that sexual minorities and people living with HIV/AIDS have successfully used religious coping to help them overcome life challenges related to their sexual orientation and HIV status, including religious struggles surrounding their faith brought about by stigma and discrimination that have historically been promoted by organized religion. Research has also documented how sexual minorities and people living with HIV/AIDS have utilized family support as a vital resource for effectively coping with life challenges associated with homophobia, heterosexism, and HIV stigma, which have historically been perpetuated in certain family and faith dynamics. The aim of the community-engaged, qualitative study described in this article was to examine the synergistic effects of religious coping and family support, particularly in the context of Catholic family ties, as a unified mechanism for supporting HIV-positive gay men in the face of religious struggles and other life challenges. Confidential, semi-structured interviews were conducted with nine HIV-positive, gay men from the Greater Toronto Area of Ontario, Canada, to obtain their perspectives on how and why their Catholic family ties have helped support them through their religious struggles and other life challenges. Utilizing a modified Grounded Theory approach, interview data were collected and analyzed until data saturation was achieved. The findings and lessons learned from the study’s analysis are discussed in this article, which elaborates on the unique synergy of religious coping and family support as interconnected mechanisms that could be of significant value for supporting HIV-positive gay men experiencing religious struggles and other life challenges.

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A question of scale? The challenge of expanding the impact of non-governmental organisations' HIV/AIDS efforts in developing countries

10.31899/hiv2001.1003 ◽

2001 ◽

Author(s):

Jocelyn DeJong

Keyword(s):

Developing Countries ◽

Scale Up ◽

Support Programs ◽

People Living With Hiv ◽

Care And Support ◽

The Face ◽

Living With Hiv ◽

The Impact ◽

Specific Challenge ◽

Hiv Aids

There are currently more than 36 million people living with HIV/AIDS globally, and in 1999 5.3 million individuals were newly infected with the virus. AIDS activities initiated by nongovernmental organizations (NGOs) have been highly influential on thinking and strategies found within the HIV/AIDS sector. Yet NGOs often experience particular difficulties in increasing the scale of their activities to reach larger numbers of people, to have an impact at levels higher than the community, and to address the broader social determinants of HIV/AIDS. Perceiving the urgent need for NGOs to expand the scale of their activities in the face of an escalating epidemic, Horizons and the International HIV/AIDS Alliance launched an initiative to examine the nature of the challenge to scale up in the context of HIV/AIDS internationally. This publication was prepared as part of this initiative and addresses the specific challenge of deliberately increasing the scale of HIV/AIDS prevention, care, and support programs in developing countries.

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“[It] is now my responsibility to fulfill that wish:” Clinical and rapid autopsy staff members’ experiences and perceptions of HIV reservoir research at the end of life

PLoS ONE ◽

10.1371/journal.pone.0242420 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242420

Author(s):

Kelly E. Perry ◽

Jeff Taylor ◽

Hursch Patel ◽

Sogol Stephanie Javadi ◽

Kushagra Mathur ◽

...

Keyword(s):

Focus Group ◽

End Of Life ◽

Scale Up ◽

People Living With Hiv ◽

Autopsy Study ◽

Hiv Reservoir ◽

Staff Members ◽

Rapid Autopsy ◽

Living With Hiv ◽

The Impact

Introduction Little is known about the effects of HIV reservoir research at the end of life on staff members involved. Staff members’ perceptions and experiences were assessed related to their involvement in the Last Gift, a rapid autopsy study at the University of California San Diego enrolling people living with HIV who are terminally ill and have a desire to contribute to HIV cure-related research. Methods Two focus group discussions consisting of clinical (n = 7) and rapid research autopsy (n = 8) staff members were conducted to understand the perspectives of staff members and the impact the Last Gift rapid autopsy study had on them. The total sample consisted of 66.7% females and 33.3% males and was ethnically diverse (66.7% Caucasian, 6.7% African American, 20.0% Asian descent, 6.7% Hispanic descent and American Indian) with a range of experience in the HIV field from 1 year to 30 years. Results Qualitative focus group data revealed five major themes underlying study staff members’ multilayered mental and practical involvement: 1) positive perceptions of the Last Gift study, with sub-themes including Last Gift study participants’ altruism, fulfillment, and control at the end of life, 2) perceptions of staff members’ close involvement in the Last Gift study, with sub-themes related to staff members’ cognitive processing, self-actualization and fulfillment, stress management and resilience, coping mechanisms, and gratitude toward Last Gift participants and toward the study itself, 3) considerations for successful and sustainable study implementation, such as ethical awareness and sustained community and patient engagement, 4) collaborative learning and organizational processes and the value of interdependence between staff members, and 5) considerations for potential study scale-up at other clinical research sites. Discussion Understanding staff members’ nuanced emotional and procedural experiences is crucial to the Last Gift study’s sustainability and will inform similar cure research studies conducted with people living with HIV at the end of life. The study’s potential reproducibility depends on a robust research infrastructure with established, interdependent clinical and rapid autopsy teams, continuous community engagement, and an ethical and well-informed engagement process with people living with HIV.

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TB preventive treatment in high- and intermediate-incidence countries: research needs for scale-up

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.21.0293 ◽

2021 ◽

Vol 25 (10) ◽

pp. 823-831

Author(s):

O. Oxlade ◽

S. den Boon ◽

D. Menzies ◽

D. Falzon ◽

M. Y. Lane ◽

...

Keyword(s):

Scale Up ◽

Preventive Treatment ◽

System Level ◽

People Living With Hiv ◽

Research Needs ◽

Household Contacts ◽

Incidence And Mortality ◽

High Risk Populations ◽

Living With Hiv ◽

The Impact

BACKGROUND: In 2018, the WHO Member States committed to providing TB preventive treatment (TPT) to at least 30 million people by 2022. However, only 6.3 million people had initiated TPT by the end of 2019. Major knowledge gaps and research needs in diagnosis, treatment and the programmatic management of TPT (PMTPT) require to be addressed urgently.METHODS: In September 2019, a group of stakeholders involved in PMTPT in high TB burden countries met to develop an action agenda to support the global expansion of PMTPT.RESULTS: Barriers at the health system level, and priorities for research to overcome these, were identified for each step of the PMTPT cascade. The need for data on TPT financing, gaps and coverage under national health insurance schemes, as well as the need for mathematical and cost-effectiveness modelling of the impact of TPT on TB incidence and mortality were highlighted. Specific research needs were identified for high-risk populations such as household contacts of any age and people living with HIV, as well as other people at risk.CONCLUSIONS: The meeting facilitated agreement on a set of actions needed to ensure that PMTPT continues to expand to achieve the End TB Strategy targets.

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‘Management of a spoiled identity’: systematic review of interventions to address self-stigma among people living with and affected by HIV

BMJ Global Health ◽

10.1136/bmjgh-2018-001285 ◽

2019 ◽

Vol 4 (2) ◽

pp. e001285 ◽

Cited By ~ 10

Author(s):

Marija Pantelic ◽

Janina I Steinert ◽

Jay Park ◽

Shaun Mellors ◽

Fungai Murau

Keyword(s):

Low Income ◽

Sex Workers ◽

Grey Literature ◽

Scale Up ◽

Bibliographic Databases ◽

People Living With Hiv ◽

Structural Level ◽

Key Populations ◽

Global Public Health ◽

Living With Hiv

BackgroundSelf-stigma, also known as internalised stigma, is a global public health threat because it keeps people from accessing HIV and other health services. By hampering HIV testing, treatment and prevention, self-stigma can compromise the sustainability of health interventions and have serious epidemiological consequences. This review synthesised existing evidence of interventions aiming to reduce self-stigma experienced by people living with HIV and key populations affected by HIV in low-income and middle-income countries.MethodsStudies were identified through bibliographic databases, grey literature sites, study registries, back referencing and contacts with researchers, and synthesised following Cochrane guidelines.ResultsOf 5880 potentially relevant titles, 20 studies were included in the review. Represented in these studies were 9536 people (65% women) from Ethiopia, India, Kenya, Lesotho, Malawi, Nepal, South Africa, Swaziland, Tanzania, Thailand, Uganda and Vietnam. Seventeen of the studies recruited people living with HIV (of which five focused specifically on pregnant women). The remaining three studies focused on young men who have sex with men, female sex workers and men who inject drugs. Studies were clustered into four categories based on the socioecological level of risk or resilience that they targeted: (1) individual level only, (2) individual and relational levels, (3) individual and structural levels and (4) structural level only. Thirteen studies targeting structural risks (with or without individual components) consistently produced significant reductions in self-stigma. The remaining seven studies that did not include a component to address structural risks produced mixed effects.ConclusionStructural interventions such as scale-up of antiretroviral treatment, prevention of medication stockouts, social empowerment and economic strengthening may help substantially reduce self-stigma among individuals. More research is urgently needed to understand how to reduce self-stigma among young people and key populations, as well as how to tackle intersectional self-stigma.

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Community-based model for the delivery of antiretroviral therapy in Cambodia: a quasi-experimental study protocol

BMC Infectious Diseases ◽

10.1186/s12879-021-06414-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sovannary Tuot ◽

Alvin Kuo Jing Teo ◽

Kiesha Prem ◽

Pheak Chhoun ◽

Chamroen Pall ◽

...

Keyword(s):

Experimental Study ◽

Antiretroviral Therapy ◽

Scale Up ◽

Economic Evaluations ◽

People Living With Hiv ◽

Cad Model ◽

Community Based ◽

Quasi Experimental ◽

Living With Hiv ◽

Art Delivery

Abstract Background Multi-month dispensing (MMD) is the mainstay mechanism for clinically stable people living with HIV in Cambodia to refill antiretroviral therapy (ART) every 3-6 months. However, less frequent ART dispensing through the community-based ART delivery (CAD) model could further reduce the clients’ and health facilities’ burden. While community-based services have been recognized as an integral component of HIV response in Cambodia, their role and effectiveness in ART delivery have yet to be systematically assessed. This study aims to evaluate the CAD model’s effectiveness on the continuum of care and treatment outcomes for stable people living with HIV in Cambodia. Methods We will conduct this quasi-experimental study in 20 ART clinics across the capital city and nine provinces between May 2021 and April 2023. Study sites were purposively selected based on the availability of implementing partners, the number of people living with HIV each clinic serves, and the accessibility of the clinics. In the intervention arm, approximately 2000 stable people living with HIV will receive ART and services from the CAD model. Another 2000 stable people living with HIV in the control arm will receive MMD—a standard care model for stable people living with HIV. The primary outcomes will be retention in care, viral load suppression, and adherence to ART. The secondary endpoints will include health providers’ work burden, the model’s cost-effectiveness, quality of life, mental health, social support, stigma, and discrimination. We will compare the outcome indicators within each arm at baseline, midline, and endline using descriptive and inferential statistics. We will evaluate the differences between the intervention and control arms using the difference-in-differences method. We will perform economic evaluations to determine if the intervention is cost-effective. Discussion This study will build the evidence base for future implementation and scale-up of CAD model in Cambodia and other similar settings. Furthermore, it will strengthen engagements with community stakeholders and further improve community mobilization, a vital pillar of the Cambodian HIV response. Trial registration ClinicalTrials.gov, NCT04766710. Registered 23 February 2021, Version 1.

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Consequences of COVID-19 crisis for persons with HIV: the impact of social determinants of health

BMC Public Health ◽

10.1186/s12889-021-10296-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kristie C. Waterfield ◽

Gulzar H. Shah ◽

Gina D. Etheredge ◽

Osaremhen Ikhile

Keyword(s):

Public Health ◽

Health Care ◽

Clinical Care ◽

Hiv Infections ◽

People Living With Hiv ◽

Negative Consequences ◽

Persons Who Inject Drugs ◽

Persons Living With Hiv ◽

Living With Hiv ◽

The Impact

Abstract Background With the indiscriminate spread of COVID-19 globally, many populations are experiencing negative consequences such as job loss, food insecurity, and inability to manage existing medical conditions and maintain preventive measures such as social distancing and personal preventative equipment. Some of the most disadvantaged in the COVID-19 era are people living with HIV/AIDS and other autoimmune diseases. Discussion As the number of new HIV infections decrease globally, many subpopulations remain at high risk of infection due to lack of or limited access to prevention services, as well as clinical care and treatment. For persons living with HIV or at higher risk of contracting HIV, including persons who inject drugs or men that have sex with men, the risk of COVID-19 infection increases if they have certain comorbidities, are older than 60 years of age, and are homeless, orphaned, or vulnerable children. The risk of COVID-19 is also more significant for those that live in Low- and Middle-Income Countries, rural, and/or poverty-stricken areas. An additional concern for those living the HIV is the double stigma that may arise if they also test positive for COVID-19. As public health and health care workers try to tackle the needs of the populations that they serve, they are beginning to realize the need for a change in the infrastructure that will include more efficient partnerships between public health, health care, and HIV programs. Conclusion Persons living with HIV that also have other underlying comorbidities are a great disadvantage from the negative consequences of COVID-19. For those that may test positive for both HIV and COVID-19, the increased psychosocial burdens stemming from stress and isolation, as well as, experiencing additional barriers that inhibit access to care, may cause them to become more disenfranchised. Thus, it becomes very important during the current pandemic for these challenges and barriers to be addressed so that these persons living with HIV can maintain continuity of care, as well as, their social and mental support systems.

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Free access to antiretroviral treatment and protection against the risk of catastrophic health expenditure in people living with HIV: evidence from Cameroon

BMC Health Services Research ◽

10.1186/s12913-021-06331-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Marwân-al-Qays Bousmah ◽

Marie Libérée Nishimwe ◽

Christopher Kuaban ◽

Sylvie Boyer

Keyword(s):

Socioeconomic Status ◽

Health Expenditure ◽

Antiretroviral Treatment ◽

Catastrophic Health Expenditure ◽

Hiv Care ◽

Free Access ◽

People Living With Hiv ◽

Art Policy ◽

Living With Hiv ◽

The Impact

Abstract Background To foster access to care and reduce the burden of health expenditures on people living with HIV (PLHIV), several sub-Saharan African countries, including Cameroon, have adopted a policy of removing HIV-related fees, especially for antiretroviral treatment (ART). We investigate the impact of Cameroon’s free antiretroviral treatment (ART) policy, enacted in May 2007, on catastrophic health expenditure (CHE) risk according to socioeconomic status, in PLHIV enrolled in the country’s treatment access program. Methods Based on primary data from two cross-sectional surveys of PLHIV outpatients in 2006–2007 and 2014 (i.e., before and after the policy’s implementation, respectively), we used inverse propensity score weighting to reduce covariate imbalances between participants in both surveys, combined with probit regressions of CHE incidence. The analysis included participants treated with ART in one of the 11 HIV services common to both surveys (n = 1275). Results The free ART policy was associated with a significantly lower risk of CHE only in the poorest PLHIV while no significant effect was found in lower-middle or upper socioeconomic status PLHIV. Unexpectedly, the risk of CHE was higher in those with middle socioeconomic status after the policy’s implementation. Conclusions Our findings suggest that Cameroon’s free ART policy is pro-poor. As it only benefitted PLHIV with the lowest socioeconomic status, increased comprehensive HIV care coverage is needed to substantially reduce the risk of CHE and the associated risk of impoverishment for all PLHIV.

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Vaccine responses in ageing and chronic viral infection

Oxford Open Immunology ◽

10.1093/oxfimm/iqab007 ◽

2021 ◽

Author(s):

Chloe Rees-Spear ◽

Laura E McCoy

Keyword(s):

Viral Infections ◽

The Elderly ◽

People Living With Hiv ◽

Chronic Infections ◽

Vaccine Responses ◽

Inflammatory Conditions ◽

Immunological Changes ◽

Cellular Responsiveness ◽

Living With Hiv ◽

The Impact

Abstract Lay Summary Improved life expectancy in recent years has led to a growing population of adults over the age of 60. Age is commonly associated with increased inflammatory conditions and infections. Similar immunological changes have been observed during chronic infections, in particular HIV, where this is compounded by the success of antiretroviral therapy that has increased the number of people living with HIV into their sixties and beyond. The increased susceptibility of these groups to infection makes vaccination all the more important. However, the alterations to their immune systems call into question how effective those vaccinations may be. Here we discuss vaccine efficacy within elderly and chronically infected populations and investigate the immunological changes that may impact vaccine responsiveness. Over the last few decades, changing population demographics have shown that there is a growing number of individuals living past the age of 60. With this expanding older population comes an increase in individuals that are more susceptible to chronic illness and disease. An important part of maintaining health in this population is through prophylactic vaccination, however, there is growing evidence that vaccines may be less effective in the elderly. Furthermore, with the success of anti-viral therapies, chronic infections such as HIV are becoming increasingly prevalent in older populations and present a relatively unstudied population with respect to the efficacy of vaccination. Here we will examine the evidence for age-associated reduction in antibody and cellular responsiveness to a variety of common vaccines, and investigate the underlying causes attributed to this phenomenon, such as inflammation and senescence. We will also discuss the impact of chronic viral infections on immune responses in both young and elderly patients, particularly those living with HIV, and how this affects vaccinations in these populations.

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