Using behavioral economics to increase HIV knowledge and testing among Latinx sexual minority men and transgender women

Abstract Background We developed a novel intervention that uses behavioral economics incentives and mobile-health text messages to increase HIV knowledge and testing frequency among Latinx sexual minority men and Latinx transgender women. Here we provide a theoretically-grounded assessment regarding the intervention’s acceptability and feasibility. Methods We conducted 30-min exit interviews with a stratified sample of participants (n = 26 Latinx sexual minority men, 15 Latinx transgender women), supplemented with insights from study staff (n = 6). All interviews were recorded, transcribed, and translated for a content analysis using Dedoose. Cohen’s Kappa was 89.4% across coded excerpts. We evaluated acceptability based on how participants cognitively and emotionally reacted to the intervention and whether they considered it to be appropriate. We measured feasibility based on resource, scientific and process assessments (e.g., functionality of text messaging service, feedback on study recruitment procedures and surveys). Results Regarding acceptability, most participants clearly understood the intervention as a program to receive information about HIV prevention methods through text messages. Participants who did not complete the intervention shared they did not fully understand what it entailed at their initial enrollment, and thought it was a one-time engagement and not an ongoing program. Though some participants with a higher level of education felt the information was simplistic, most appreciated moving beyond a narrow focus on HIV to include general information on sexually transmitted infections; drug use and impaired sexual decision-making; and differential risks associated with sexual positions and practices. Latinx transgender women in particular appreciated receiving information about Pre-Exposure Prophylaxis. While participants didn’t fully understand the exact chances of winning a prize in the quiz component, most enjoyed the quizzes and chance of winning a prize. Participants appreciated that the intervention required a minimal time investment. Participants shared that the intervention was generally culturally appropriate. Regarding feasibility, most participants reported the text message platform worked well though inactive participants consistently said technical difficulties led to their disengagement. Staff shared that clients had varying reactions to being approached while being tested for HIV, with some unwilling to enroll and others being very open and curious about the program. Both staff and participants relayed concerns regarding the length of the recruitment process and study surveys. Conclusions Our theoretically-grounded assessment shows the intervention is both acceptable and feasible. Trial registration The trial was registered on May 5, 2017 with the ClinicalTrials.gov registry [NCT03144336].

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Rapid mixed-methods assessment of COVID-19 impact on Latinx sexual minority men and Latinx transgender women

PLoS ONE ◽

10.1371/journal.pone.0244421 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0244421

Author(s):

Sarah MacCarthy ◽

Max Izenberg ◽

Joanna L. Barreras ◽

Ron A. Brooks ◽

Ana Gonzalez ◽

...

Keyword(s):

Mixed Methods ◽

Sexual Minority ◽

Healthcare Access ◽

Transgender Women ◽

Medical Attention ◽

Computer Assisted ◽

Hiv Knowledge ◽

Sexual Minority Men ◽

Minority Men ◽

The Impact

We conducted a rapid, mixed-methods assessment to understand how COVID-19 affected Latinx sexual minority men (LSMM) and transgender women (LTGW). Using a computer-assisted telephone interviewing software, one interviewer called 52 participants (randomly sampled from a larger HIV prevention pilot study aiming to increase HIV knowledge and testing frequency; n = 36 LSMM and n = 16 LTGW) between 04/27/20-05/18/20. We quantified core domains using the Epidemic-Pandemic Impacts Inventory scale and provided important context through open-ended qualitative questions assessing: 1) COVID-19 infection history and experiences with quarantine; 2) Health and healthcare access; 3) Employment and economic impact of COVID-19. Participants reported increases in physical conflict or verbal arguments with a partner (13.5%) or other adult(s) (19.2%) due to stressors associated with the safer-at-home order. Participants also reported increased alcohol consumption (23.1%), problems with sleep (67.3%) and mental health (78.4%). Further, disruptions in access to Pre-Exposure Prophylaxis or PrEP–a daily pill to prevent HIV–occurred (33.3% of 18 participants who reported being on PrEP). Many said they received less medical attention than usual (34.6%), and LTGW reported delays in critical gender-affirming hormones/procedures. Half of the participants lost their jobs (50.0%); many undocumented participants relayed additional financial concerns because they did not qualify for financial assistance. Though no COVID-19 infections were noted, COVID-19 dramatically impacted other aspects of health and overall wellbeing of LSMM and LTGW. Public health responses should address the stressors faced by LSMM and LTGW during the COVID-19 pandemic and the impact on wellbeing.

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Understanding Social and Sexual Networks of Sexual Minority Men and Transgender Women in Guatemala City to Improve HIV Prevention Efforts

Journal of Health Care for the Poor and Underserved ◽

10.1353/hpu.2014.0163 ◽

2014 ◽

Vol 25 (4) ◽

pp. 1698-1717 ◽

Cited By ~ 11

Author(s):

C. Tucker ◽

C. Galindo Arandi ◽

J. Herbert Bolaños ◽

G. Paz-Bailey ◽

C. Barrington

Keyword(s):

Hiv Prevention ◽

Sexual Minority ◽

Transgender Women ◽

Sexual Networks ◽

Guatemala City ◽

Sexual Minority Men ◽

Minority Men ◽

Social And Sexual Networks

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Correlates of PrEP Uptake Among Young Sexual Minority Men and Transgender Women in New York City: The Need to Reframe “Risk” Messaging and Normalize Preventative Health

AIDS and Behavior ◽

10.1007/s10461-021-03254-4 ◽

2021 ◽

Author(s):

J. Jaiswal ◽

C. LoSchiavo ◽

S. Meanley ◽

K. Hascher ◽

A. B. Cox ◽

...

Keyword(s):

New York ◽

New York City ◽

Sexual Minority ◽

York City ◽

Transgender Women ◽

Sexual Minority Men ◽

Preventative Health ◽

Minority Men

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Characterisation of social support following incarceration among black sexual minority men and transgender women in the HPTN 061 cohort study

BMJ Open ◽

10.1136/bmjopen-2021-053334 ◽

2021 ◽

Vol 11 (9) ◽

pp. e053334

Author(s):

Joy D Scheidell ◽

Typhanye V Dyer ◽

Christopher Hucks-Ortiz ◽

Jasmyn Abrams ◽

Medha Mazumdar ◽

...

Keyword(s):

Social Support ◽

Cohort Study ◽

Sexual Minority ◽

Transgender Women ◽

Sexual Minority Men ◽

The Past ◽

Increased Risk ◽

Tangible Support ◽

Minority Men

ObjectiveTo examine longitudinal associations between recent incarceration and subsequent social support among black sexual minority men and transgender women, and whether associations differed between those who did and did not have support prior to incarceration.DesignA secondary analysis in 2020 of data from the HIV Prevention Trials Network 061, a cohort study of black sexual minority men and transgender women recruited in 2009–2010 and followed for 12 months.SettingSix US cities (Atlanta, Boston, Los Angeles, New York City, San Francisco and Washington DC).ParticipantsIndividuals ≥18 years of age who identified as black, reported being male or assigned male at birth, reported ≥1 unprotected anal intercourse event with a male partner in the past 6 months, and reported on incarceration at the 6-month follow-up visit.ExposureHaving spent ≥1 night in jail/prison in the past 6 months reported at the 6-month follow-up visit.OutcomeSocial support measured using a six-item scale assessing frequency of emotional/informational, affectionate and tangible support (range 6–30); and dichotomous indicators of low support for each item (ie, receiving that form of support none/little of the time).ResultsAmong participants who returned for the 6-month visit (N=1169), 14% had experienced incarceration in the past 6 months. Mean support score was 20.9; 18.9 among those with recent incarceration versus 21.2 among those without. Recent incarceration predicted lower support (adjusted β −2.40, 95% CI −3.94 to –0.85). Those recently incarcerated had increased risk of lacking emotional/informational (eg, no one to talk to adjusted risk ratio (aRR) 1.55, 95% CI 1.13 to 2.13) and affectionate (aRR 1.51, 95% CI 1.11 to 2.04) but not tangible support. Effects appeared somewhat stronger among those who had support at baseline.ConclusionsIncarceration may reduce support on re-entry among black sexual minority men and transgender women, populations unequally targeted for incarceration and at risk for low support.

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Estimating the Roles of Racism and Homophobia in HIV Testing Among Black Sexual Minority Men and Transgender Women With a History of Incarceration in the HPTN 061 Cohort

AIDS Education and Prevention ◽

10.1521/aeap.2021.33.2.143 ◽

2021 ◽

Vol 33 (2) ◽

pp. 143-157

Author(s):

Rodman Turpin ◽

Maria Khan ◽

Joy Scheidell ◽

Jonathan Feelemyer ◽

Christopher Hucks-Ortiz ◽

...

Keyword(s):

Hiv Testing ◽

Sexual Minority ◽

Transgender Women ◽

Positive Interactions ◽

Sexual Minority Men ◽

Interaction Terms ◽

Treatment And Prevention ◽

History Of ◽

Minority Men ◽

Prevalence Ratios

Black sexual minority men (BSMM) and Black transgender women (BTW) have disproportionately high HIV prevalence, making HIV testing critical for treatment and prevention. Racism and homophobia may be barriers to testing among BSMM/BTW, particularly in the context of previous incarceration. We analyzed a subsample (n = 655) of HIV-negative, previously incarcerated BSMM/BTW in the HIV Prevention Trials Network 061 study, generating prevalence ratios and interaction terms testing associations between experienced racism and homophobia with past-year HIV testing. Both racism (aPR = 0.83, 95% CI [0.70, 0.98]) and homophobia (aPR: 0.68, 95% CI [0.48, 0.98]) were associated with lower testing, although their interaction was associated with unexpectedly higher testing (Interaction aPR = 1.77, 95% CI [1.25, 2.49]). Among BSMM/BTW with a history of incarceration, racism and homophobia are barriers to HIV testing. Positive interactions between racism and homophobia could be explained by numerous factors (e.g., resilience, coping) and warrants further study.

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Depressive Symptoms among Latino Sexual Minority Men and Latina Transgender Women in a New Settlement State: The Role of Perceived Discrimination

Depression Research and Treatment ◽

10.1155/2016/4972854 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 9

Author(s):

Christina J. Sun ◽

Alice Ma ◽

Amanda E. Tanner ◽

Lilli Mann ◽

Beth A. Reboussin ◽

...

Keyword(s):

Depressive Symptoms ◽

Racial Discrimination ◽

Sexual Minority ◽

Perceived Discrimination ◽

Transgender Women ◽

Sexual Minority Men ◽

Sexual Discrimination ◽

Minority Men ◽

Clinically Significant

Background.Little is known about the role of discrimination on depression among Latino sexual and gender identity minorities. This manuscript examined the relationship between ethnic/racial discrimination and sexual discrimination on clinically significant depressive symptoms among Latino sexual minority men (i.e., gay and bisexual men and other men who have sex with men) and Latina transgender women.Methods.A community-based participatory research partnership recruited participants (N= 186; 80.6% cisgender men) in North Carolina to a social network-based HIV intervention. Using baseline data, we quantified the amount of perceived discrimination and conducted mixed-effects logistic regression analyses to examine correlates of clinically significant depressive symptoms.Results.A high percentage of participants reported ethnic/racial discrimination (73.7%) and sexual discrimination (53.8%). In the multivariable models, ethnic/racial discrimination, sexual discrimination, masculinity, fatalism, and social support were significantly associated with clinically significant depressive symptoms.Discussion.Improving mental health requires multilevel interventions that address pertinent individual, interpersonal, and system level factors.

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