scholarly journals Understanding and managing HIV infection risk among men who have sex with men in rural Uganda: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lydia Jacenta Nakiganda ◽  
Stephen Bell ◽  
Andrew E. Grulich ◽  
David Serwadda ◽  
Rosette Nakubulwa ◽  
...  
Keyword(s):  
Health Promotion ◽  
Hiv Prevention ◽  
Hiv Infection ◽  
Hiv Risk ◽  
Community Outreach ◽  
Sexual Relationships ◽  
Local Health ◽  
Same Sex ◽  
Rural Settings ◽  
Sex With Men

Abstract Background Same-sex sexual relations are criminalised in Uganda, and men who have sex with men (MSM) experience a high burden of HIV infection. In Uganda, health promotion policies focus on equity in healthcare and creating enabling environments. At present there is limited evidence upon which to enhance engagement of MSM in rural settings into effective HIV prevention. To fill this gap, our study explored MSM’s understandings of HIV risk and strategies used to reduce HIV risk in their sexual lives. Methods In-depth interviews were conducted with sixteen MSM in rural communities in Southwestern Uganda. Inductive thematic analysis examined men’s perceptions of HIV risk and strategies of reducing their own HIV risks. Results Understandings of HIV risk and risk practices were framed by lack of access to condoms, challenges negotiating condom and pre-exposure prophylaxis (PrEP) use, and condomless sex being reported as more pleasurable than sex with condoms. Strategies men perceived as enabling them to manage HIV risk included: PrEP use; condom use; knowing partners’ HIV status; avoiding partners associated with HIV risk; oral sex; withdrawal before ejaculation and washing one’s penis after sex. There were several misconceptions arising from poor HIV prevention knowledge. Strategies reliant on communication and negotiation with sexual partners were inhibited by gendered powered imbalances. Conclusions Our findings illustrate that MSM in rural settings in Uganda are making concerted efforts to implement strategies that might reduce risk of HIV transmission and infection within their sexual relationships. Key HIV health promotion and service-related strategies to support MSM with these efforts include an effective condom and lubricant supply chain; a PrEP program in trusted local health units, implemented via discreet community-outreach mechanisms; and same-sex specific HIV-related health promotion.

scholarly journals Southern African guidelines for the safe use of pre-exposure prophylaxis in men who have sex with men who are at risk for HIV infection

2012 ◽  
Vol 13 (2) ◽  
Author(s):  
Southern African HIV Clinicians Society Consensus Committee
Keyword(s):  
At Risk ◽  
Renal Function ◽  
Hiv Prevention ◽  
Hepatitis B ◽  
Hiv Infection ◽  
Creatinine Clearance ◽  
Fixed Dose ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
Hiv Negative

Background. The use of oral antiretrovirals to prevent HIV infection among HIV-negative men who have sex with men (MSM) has been shown to be safe and efficacious. A large, randomised, placebo-controlled trial showed a 44% reduction in the incidence of HIV infection among MSM receiving a daily oral fixed-dose combination of tenofovir disoproxil fumarate and emtricitabine (Truvada) in combination with an HIV prevention package. Improved protection was seen with higher levels of adherence. Aim. The purpose of this guideline is to: (i) explain what pre-exposure prophylaxis (PrEP) is; (ii) outline current indications for its use; (iii) outline steps for appropriate client selection; and (iv) provide guidance for monitoring and maintaining clients on PrEP. Method. PrEP is indicated for HIV-negative MSM who are assessed to be at high risk for HIV acquisition and who are willing and motivated to use PrEP as part of a package of HIV prevention services (including condoms, lubrication, sexually transmitted infection (STI) management and risk reduction counselling). Recommendations. HIV testing, estimation of creatinine clearance and STI and hepatitis B screening are recommended as baseline investigations. Daily oral Truvada, along with adherence support, can then be prescribed for eligible MSM. PrEP should not be given to MSM with abnormal renal function, nor to clients who are unmotivated to use PrEP as part of an HIV prevention package; nor should it be commenced during an acute viral illness. Three-monthly follow-up visits to assess tolerance, renal function, adherence and ongoing eligibility is recommended. Six-monthly STI screens and annual creatinine levels to estimate creatinine clearance are recommended. Hepatitis B vaccination should be provided to susceptible clients. Gastro-intestinal symptoms and weight loss are common side-effects, mostly experienced for the first 4 - 8 weeks after initiating PrEP. There is a risk of the development of antiretroviral resistance among those with undiagnosed acute HIV infection during PrEP initiation and among those with sub-optimal adherence who become HIV infected while on PrEP. Risk compensation (increasing sexual behaviours that can result in exposure to HIV) while on PrEP may become a concern, and clinicians should continue to support MSM clients to continue to use condoms, condom-compatible lubrication and practice safer sex. Research is ongoing to assess optimum dosing regimens, potential long-term effects and alternative PrEP medications. Recommendations for the use of PrEP among other at-risk individuals, and the components of these recommendations, will be informed by future evidence. S Afr J HIV Med 2012;13(2):40-55.

scholarly journals 1630. Voluntary HIV Testing and Self-Realization of Risk of HIV Infection Among Young Men-Who-Have-Sex-with-Men in the Miami-Dade Area

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S595-S595
Author(s):  
Hampton Ocon ◽  
Samir Sabbag
Keyword(s):  
Public Health ◽  
High Risk ◽  
Hiv Infection ◽  
Hiv Testing ◽  
Hiv Risk ◽  
Perceived Risk ◽  
Health Initiatives ◽  
History Of ◽  
Sex With Men ◽  
Public Health Initiatives

Abstract Background According to the Centers for Disease Control and Prevention, Miami-Dade County has the highest rate of new HIV diagnoses in the Nation. So far, a large focus of public health initiatives has been spreading awareness of HIV testing locations, but this form of voluntary testing relies on individuals realizing that they are at risk of HIV infection in the first place. Consequently, a major obstacle to encouraging young men-who-have-sex-with-men (YMSM) to test themselves for HIV is their own self-perceived risk of having an undetected infection. Methods In an effort to better understand the discordance between high-risk sexual behavior and HIV testing among this high-risk population, YMSM (18–24) were surveyed through smartphone applications that facilitate sexual encounters in the Miami-Dade area (eg Grindr, Scruff). Users were asked about their history of condomless anal intercourse (CAI), their HIV testing habits, and whether or not they believe it possible that they are currently infected with HIV. An analysis of the relationship between CAI and self-perception of possible HIV infection was performed using Cochran-Mantel–Haenszel testing. Results Of the 843 eligible responses, 667 reported a history of voluntary HIV testing while 176 had never voluntarily tested. 726 respondents reported a history of CAI and 131 of these have never voluntarily tested. Of the 843 total participants, 1.6% were in the highest HIV risk group, which is those who have engaged in CAI with an exchange/casual partner, have never voluntarily tested for HIV, and have no self-perceived risk of being currently infected. According to data analysis, YMSM who have engaged in CAI but have never been tested for HIV were not more likely to have a self-perceived possibility of infection when compared with those who have voluntarily tested (P < 0.595). Conclusion This suggests that many high-risk YMSM are not voluntarily testing themselves for HIV not because they do not have access to testing, but rather because they do not perceive themselves as being possibly infected in the first place. Therefore, in addition to increasing access to HIV testing, new public health initiatives must be designed to facilitate YMSM understanding their own personal HIV risk. Disclosures All authors: No reported disclosures.

scholarly journals Are HIV-Negative Men Who Have Sex with Men and Who Bareback Concerned About HIV Infection? Implications for HIV Risk Reduction Interventions

2012 ◽  
Vol 42 (2) ◽  
pp. 279-289 ◽  
Author(s):  
Iván C. Balán ◽  
Alex Carballo-Diéguez ◽  
Ana Ventuneac ◽  
Robert H. Remien ◽  
Curtis Dolezal ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Risk Reduction ◽  
Hiv Risk ◽  
Hiv Risk Reduction ◽  
Sex With Men ◽  
Hiv Risk Reduction Interventions ◽  
Hiv Negative

scholarly journals Quality of HIV Websites With Information About Pre-Exposure Prophylaxis or Treatment as Prevention for Men Who Have Sex With Men: Systematic Evaluation (Preprint)

2018 ◽  
Author(s):  
Taylor Silverman ◽  
Nicole Asante ◽  
Jacob J van den Berg
Keyword(s):  
Hiv Prevention ◽  
Hiv Infection ◽  
Rating Scale ◽  
The United States ◽  
Treatment As Prevention ◽  
Key Words And Phrases ◽  
Prevention Strategies ◽  
Hiv Prevention Strategies ◽  
Sex With Men ◽  
Exposure Prophylaxis

BACKGROUND Knowledge and uptake of high-efficacy HIV prevention strategies such as pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) remain low among men who have sex with men (MSM) who are at the highest risk for HIV infection in the United States. Electronic health (eHealth) interventions are promising tools for disseminating information about these critical yet underutilized strategies and addressing key barriers to uptake among target populations. However, existing HIV prevention websites are understudied and unevaluated. OBJECTIVE This study aimed to systematically review and evaluate existing HIV websites that include information about PrEP or TasP for MSM. METHODS From March 2018 to May 2018, 2 trained research assistants (RAs) entered relevant key words and phrases into 3 commonly used search engines and applied exclusion criteria to all returned results to identify 31 websites included in this review. RAs independently scored each website for authority, usability, interactivity, and PrEP/TasP-related content based on a standardized rating scale and then averaged the results. RESULTS No website received a perfect score in any of the 4 categories, and the average website score was 62% (37/60). Less than a quarter of the websites (23%, 7/31) received a score of more than 75% (7.5/10) for content. Approximately two-thirds of the websites (65%, 20/31) received a score of 50% (5/10) or lower for interactivity. The average score in usability was 68% (6.8/10) and in authority was 69% (6.9/10). Other deficiencies observed included difficulty locating relevant content and lack of information targeting audiences with the highest likelihood of HIV infection. CONCLUSIONS Existing HIV prevention websites with information about PrEP or TasP for MSM fail to provide adequate content as well as present that content to users in an interactive and audience-conscious way. Future eHealth interventions should attempt to rectify these deficiencies to successfully engage and educate MSM at high risk for HIV regarding prevention strategies.

scholarly journals Population Size Estimation of Gay and Bisexual Men and Other Men Who Have Sex With Men Using Social Media-Based Platforms (Preprint)

2017 ◽  
Author(s):  
Stefan Baral ◽  
Rachael M Turner ◽  
Carrie E Lyons ◽  
Sean Howell ◽  
Brian Honermann ◽  
...  
Keyword(s):  
Social Media ◽  
Hiv Prevention ◽  
Population Size ◽  
The United States ◽  
Size Estimation ◽  
Same Sex ◽  
Care Needs ◽  
Population Size Estimates ◽  
Sex With Men ◽  
Size Estimates

BACKGROUND Gay, bisexual, and other cisgender men who have sex with men (GBMSM) are disproportionately affected by the HIV pandemic. Traditionally, GBMSM have been deemed less relevant in HIV epidemics in low- and middle-income settings where HIV epidemics are more generalized. This is due (in part) to how important population size estimates regarding the number of individuals who identify as GBMSM are to informing the development and monitoring of HIV prevention, treatment, and care programs and coverage. However, pervasive stigma and criminalization of same-sex practices and relationships provide a challenging environment for population enumeration, and these factors have been associated with implausibly low or absent size estimates of GBMSM, thereby limiting knowledge about the dynamics of HIV transmission and the implementation of programs addressing GBMSM. OBJECTIVE This study leverages estimates of the number of members of a social app geared towards gay men (Hornet) and members of Facebook using self-reported relationship interests in men, men and women, and those with at least one reported same-sex interest. Results were categorized by country of residence to validate official size estimates of GBMSM in 13 countries across five continents. METHODS Data were collected through the Hornet Gay Social Network and by using an a priori determined framework to estimate the numbers of Facebook members with interests associated with GBMSM in South Africa, Ghana, Nigeria, Senegal, Côte d'Ivoire, Mauritania, The Gambia, Lebanon, Thailand, Malaysia, Brazil, Ukraine, and the United States. These estimates were compared with the most recent Joint United Nations Programme on HIV/AIDS (UNAIDS) and national estimates across 143 countries. RESULTS The estimates that leveraged social media apps for the number of GBMSM across countries are consistently far higher than official UNAIDS estimates. Using Facebook, it is also feasible to assess the numbers of GBMSM aged 13-17 years, which demonstrate similar proportions to those of older men. There is greater consistency in Facebook estimates of GBMSM compared to UNAIDS-reported estimates across countries. CONCLUSIONS The ability to use social media for epidemiologic and HIV prevention, treatment, and care needs continues to improve. Here, a method leveraging different categories of same-sex interests on Facebook, combined with a specific gay-oriented app (Hornet), demonstrated significantly higher estimates than those officially reported. While there are biases in this approach, these data reinforce the need for multiple methods to be used to count the number of GBMSM (especially in more stigmatizing settings) to better inform mathematical models and the scale of HIV program coverage. Moreover, these estimates can inform programs for those aged 13-17 years; a group for which HIV incidence is the highest and HIV prevention program coverage, including the availability of pre-exposure prophylaxis (PrEP), is lowest. Taken together, these results highlight the potential for social media to provide comparable estimates of the number of GBMSM across a large range of countries, including some with no reported estimates.

Sociocultural and Behavioral Contexts of Condom Use in Heterosexual Married Couples in India: Challenges to the HIV Prevention Program

2004 ◽  
Vol 31 (1) ◽  
pp. 101-117 ◽  
Author(s):  
Gauri Bhattacharya
Keyword(s):  
Hiv Prevention ◽  
Hiv Infection ◽  
Condom Use ◽  
Health Beliefs ◽  
Cultural Beliefs ◽  
Married Couples ◽  
Holistic Health ◽  
High Risk Group ◽  
Sexual Relationships ◽  
Heterosexual Couples

This article examines sociocultural expectations of sexual behavior and the reasons why not using condoms may be logical to married heterosexual couples in India. Married women who report monogamous sexual relationships with their husbands are a high-risk group for HIV infection in India. Based on the public health model and a population-based perspective on HIV infection prevention, this article illustrates the underlying mechanisms that link the role of women in society, holistic health beliefs, and cultural beliefs about the transmission of HIV with the precursors to nonuse of condoms. The author concludes that promoting condom use requires an emphasis on family health, not only as contraceptives. Challenges for reducing the social stigma and developing a comprehensive policy on HIV prevention and AIDS treatment and care are discussed.

scholarly journals 863. Increasing PrEP Uptake: A Diffusion-Based Network Intervention for HIV Prevention Among Young Black Men Who Have Sex With Men

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S21-S22
Author(s):  
Matthew Ferreira ◽  
Lindsay Young ◽  
John Schneider
Keyword(s):  
Hiv Prevention ◽  
Hiv Infection ◽  
Black Men ◽  
Controlled Trial ◽  
Biomedical Intervention ◽  
Network Intervention ◽  
Sex With Men ◽  
Hiv Negative ◽  
Peer Leader

Abstract Background Advances in biomedical prevention strategies provide new opportunities for reducing HIV incidence among young black men who have sex with men (YBMSM). Pre-exposure prophylaxis (PrEP) is for HIV-negative individuals and has been shown to be up to 99% effective in preventing HIV infection when taken as prescribed by CDC clinical practice guidelines. Several studies, however, have documented low rates of PrEP uptake among YBMSM. Methods PrEP Chicago is a randomized controlled trial peer leader intervention designed to promote uptake of PrEP for HIV prevention among YBMSM. Participants (n = 423) were recruited using respondent-driven sampling (RDS) and randomized to either an intervention (n = 209) or control (n = 214) condition. Eligibility criteria included: aged 18–35, identifies as a person of color, assigned male sex at birth, had sex with a man in the past 12 months, had an active Facebook profile, and resided in Chicago. The intervention includes a half-day, small group PrEP, and peer leader training workshop followed by monthly check-in booster calls. Approximately 12 months after their initial baseline visit, participants return to complete follow-up data collection and switch conditions, giving year 1 control participants the opportunity to learn about PrEP. Results The number of HIV-negative intervention participants on PrEP at baseline vs. 12-month follow-up (PrEP Chicago Study, Chicago, 2016–2018). A total of 341 participants (80.6%) returned at 12 months. Of 209 intervention participants at baseline, 176 (84.2%) completed a follow-up survey at 12 months. At baseline, 13 (13.3%) of 98 HIV-negative intervention participants indicated that they were currently taking PrEP. At 12 months, this number grew to 25 (32.5%) of 77 HIV-negative intervention participants, indicating that they were currently taking PrEP. A total of 21 participants reported initiating PrEP during their time in the intervention. Conclusion PrEP is a valuable biomedical intervention for preventing HIV infection in those at risk. PrEP Chicago, a network intervention designed to promote uptake of PrEP among YBMSM, shows promising results for PrEP adoption among this community. Disclosures All authors: No reported disclosures.

A New Era of HIV Risk: It's Not What You Know, It's Who You Know (and How Infectious)

2019 ◽  
Vol 70 (1) ◽  
pp. 673-701 ◽  
Author(s):  
Andrew C. Cortopassi ◽  
Redd Driver ◽  
Lisa A. Eaton ◽  
Seth C. Kalichman
Keyword(s):  
Hiv Prevention ◽  
Hiv Risk ◽  
Hiv Transmission ◽  
Belief Systems ◽  
Hiv Treatment ◽  
Sexual Relationships ◽  
Treatment As Prevention ◽  
New Era ◽  
Sexually Transmitted ◽  
Hiv Treatment As Prevention

HIV is transmitted in social and sexual relationships, and HIV transmission risks, as well as protective actions, are evolving as HIV epidemics unfold. The current focus of HIV prevention is centered on antiretroviral medications used to reduce HIV infectiousness in persons already infected with HIV [treatment as prevention (TasP)]. The same medications used to treat infected persons can also be used by uninfected persons as pre-exposure prophylaxis (PrEP) to reduce the infectivity of HIV. Both PrEP and TasP are effective when adherence is high and individuals do not have co-occurring sexually transmitted infections. HIV prevention is most effective and efficient when delivered within sexual networks with high HIV prevalence. Specific network characteristics are recognized as important facilitators of HIV transmission; these characteristics include the degree of similarity among network members (homophily), gender role norms, and belief systems. Since 2011, HIV risk has been redefined based on infectiousness and infectivity, ushering in a new era of HIV prevention with the potential to end HIV epidemics.

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