scholarly journals Is social-ecological risk associated with individual HIV risk beliefs and behaviours?: An analysis of Kenyan adolescents' local communities and activity spaces

2020 ◽  
Author(s):  
Christina Schmidt ◽  
Eve Puffer ◽  
Sherryl Broverman ◽  
Virginia Warren ◽  
Eric Green
Keyword(s):  
Hiv Risk ◽  
Hiv Transmission ◽  
Local Communities ◽  
Individual Behaviour ◽  
Western Kenya ◽  
Activity Spaces ◽  
Risk Beliefs ◽  
Social Ecological ◽  
Community Risk ◽  
Individual Behaviour Change

The places where adolescents live, learn, and play are thought to influence behaviours and health, but we have limited tools for measuring environmental risk on a hyperlocal level. Working with 218 adolescents and their parents/guardians in rural western Kenya, we combined participatory mapping activities with satellite imagery to identify adolescent activity spaces and create a novel measure of social-ecological dangers. We then examined the associations between community risk and individual HIV risk beliefs and behaviours. We found support for the conjecture, derived from social-ecological models of HIV transmission, that community-level risks may be associated with individual beliefs and behaviours. As community risk increased for a sample of Kenyan adolescents, so did their reports of riskier sex beliefs and behaviours, as well as unsupervised outings at night. This study reinforces calls for disease prevention approaches that go beyond emphasizing individual behaviour change.

scholarly journals The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development

2017 ◽  
Vol 21 (5) ◽  
pp. 1-164 ◽  
Author(s):  
Paul Flowers ◽  
Olivia Wu ◽  
Karen Lorimer ◽  
Bipasha Ahmed ◽  
Hannah Hesselgreaves ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Behaviour Change ◽  
Hiv Transmission ◽  
Meta Analysis ◽  
Clinical Effectiveness ◽  
Individual Behaviour ◽  
Behaviour Change Interventions ◽  
Individual Level ◽  
The Uk ◽  
Individual Behaviour Change

AbstractBackgroundMen who have sex with men (MSM) experience significant inequalities in health and well-being. They are the group in the UK at the highest risk of acquiring a human immunodeficiency virus (HIV) infection. Guidance relating to both HIV infection prevention, in general, and individual-level behaviour change interventions, in particular, is very limited.ObjectivesTo conduct an evidence synthesis of the clinical effectiveness of behaviour change interventions to reduce risky sexual behaviour among MSM after a negative HIV infection test. To identify effective components within interventions in reducing HIV risk-related behaviours and develop a candidate intervention. To host expert events addressing the implementation and optimisation of a candidate intervention.Data sourcesAll major electronic databases (British Education Index, BioMed Central, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Educational Resource Index and Abstracts, Health and Medical Complete, MEDLINE, PsycARTICLES, PsycINFO, PubMed and Social Science Citation Index) were searched between January 2000 and December 2014.Review methodsA systematic review of the clinical effectiveness of individual behaviour change interventions was conducted. Interventions were examined using the behaviour change technique (BCT) taxonomy, theory coding assessment, mode of delivery and proximity to HIV infection testing. Data were summarised in narrative review and, when appropriate, meta-analysis was carried out. Supplemental analyses for the development of the candidate intervention focused on post hoc realist review method, the assessment of the sequential delivery and content of intervention components, and the social and historical context of primary studies. Expert panels reviewed the candidate intervention for issues of implementation and optimisation.ResultsOverall, trials included in this review (n = 10) demonstrated that individual-level behaviour change interventions are effective in reducing key HIV infection risk-related behaviours. However, there was considerable clinical and methodological heterogeneity among the trials. Exploratory meta-analysis showed a statistically significant reduction in behaviours associated with high risk of HIV transmission (risk ratio 0.75, 95% confidence interval 0.62 to 0.91). Additional stratified analyses suggested that effectiveness may be enhanced through face-to-face contact immediately after testing, and that theory-based content and BCTs drawn from ‘goals and planning’ and ‘identity’ groups are important. All evidence collated in the review was synthesised to develop a candidate intervention. Experts highlighted overall acceptability of the intervention and outlined key ways that the candidate intervention could be optimised to enhance UK implementation.LimitationsThere was a limited number of primary studies. All were from outside the UK and were subject to considerable clinical, methodological and statistical heterogeneity. The findings of the meta-analysis must therefore be treated with caution. The lack of detailed intervention manuals limited the assessment of intervention content, delivery and fidelity.ConclusionsEvidence regarding the effectiveness of behaviour change interventions suggests that they are effective in changing behaviour associated with HIV transmission. Exploratory stratified meta-analyses suggested that interventions should be delivered face to face and immediately after testing. There are uncertainties around the generalisability of these findings to the UK setting. However, UK experts found the intervention acceptable and provided ways of optimising the candidate intervention.Future workThere is a need for well-designed, UK-based trials of individual behaviour change interventions that clearly articulate intervention content and demonstrate intervention fidelity.Study registrationThe study is registered as PROSPERO CRD42014009500.FundingThe National Institute for Health Research Health Technology Assessment programme.

scholarly journals Psychological Sense of Community and the Use of Condoms and PrEP Among a Sample of Aging Black MSM

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 824-824
Author(s):  
Andre Brown ◽  
Mark Brennan-Ing ◽  
Steven Meanley ◽  
Sabina Haberlen ◽  
Deanna Ware ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Condom Use ◽  
Risk Reduction ◽  
Hiv Risk ◽  
Sense Of Community ◽  
Hiv Transmission ◽  
Future Research ◽  
Psychological Sense Of Community ◽  
Hiv Risk Reduction ◽  
Psychological Sense

Abstract Psychological sense of community (PSOC) in Black men who have sex with men (BMSM) may facilitate condom and pre-exposure prophylaxis (PrEP) use to prevent HIV transmission. Understanding BMSM’s PSOC contribution to HIV risk reduction may inform HIV prevention efforts for this population, that is disproportionately affected by HIV. Adjusted for sociodemographic characteristics and HIV status, we conducted logistic regressions to test the association between PSOC and condom use among aging BMSM (n=176). Multivariate analyses exhibited no association between PSOC and condom use (AOR= 0.994, 95% CI= 0.942, 1.049). HIV+ participants had higher condom use odds compared to HIV- participants (AOR= 4.031, 95% CI= 1.723, 9.426). A sub-analysis of HIV- participants (n=61), showed no associated between PSOC and PrEP use (AOR= 1.002, 95% CI= 0.904, 1.112). These results have implications for secondary HIV prevention and future research on alternative aspects of social support that may increase BMSM’s HIV risk reduction behaviors.

scholarly journals 962. Linkage to Care Outcomes among Known HIV-Positive Patients at a High Prevalence Urban Hospital Emergency Department

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S511-S511
Author(s):  
Alexander W Sudyn ◽  
Jeffrey M Paer ◽  
Swetha Kodali ◽  
Samuel Maldonado ◽  
Amesika Nyaku ◽  
...  
Keyword(s):  
Hiv Risk ◽  
Hiv Transmission ◽  
Univariate Analysis ◽  
Linkage To Care ◽  
Retrospective Chart Review ◽  
Retention In Care ◽  
Patient Navigator ◽  
Urban Hospital ◽  
Opt Out ◽  
The Impact

Abstract Background Retention in care of persons with HIV (PWH) is essential for achieving viral suppression and decreasing community transmission. CDC estimates that the 23% of known PWH not retained in care account for 43% of all new transmissions. This study seeks to describe the impact of an opt-out ED screening with navigator-assisted linkage to care (LTC) protocol for out of care PWH. Methods An IRB-approved retrospective chart review was conducted among PWH (prior positive) inadvertently retested in the ED between 2015 and 2018. Univariate and multivariate logistic regression was used to identify factors associated with LTC with patient navigator (PN) support. Factors with p ≤ 0.1 were included in the multivariate analysis as were age and sex at birth. Patients who died were excluded from statistical analyses. Results Among 464 patients who tested positive, 338 (73%) were known positive with 120 (35%) of those out of care at the time of screening. Mean age for this group was 47 (SD 11.9); 57% male, 81% non-Hispanic black, 10% Hispanic, and 6% non-Hispanic white. Fifty-five (46%) patients were successfully LTC, 54 (45%) referred to the state for linkage, and 11 (9%) died. A total of 109 patients were included in the analysis. Univariate analysis was performed for age (F(1, 107) = 0.98, p = 0.324) and female sex at birth (OR = 1.42 [95% CI 0.66, 3.05], p = 0.373) as well as Hispanic race (OR = 3.33 [95% CI 0.84, 13.04], p = 0.085), heterosexual HIV risk (OR = 2.76 [95% CI 1.27, 5.99], p = 0.011), IDU (OR = 0.49 [95% CI 0.21, 1.11], p = 0.088), and other SUD (OR = 0.42 [95% CI 0.19, 0.94], p = 0.035). Only heterosexual HIV risk (OR = 3.01 [95% CI 1.23, 7.32], p = 0.015) maintained significance in the final multivariate model. Conclusion Opt-out ED screening revealed >30% of known positive PWH were out of care at the time of testing; of whom nearly 50% were LTC with PN support. It is possible that persons reporting heterosexual HIV risk may feel less stigmatized and therefore are more likely to LTC. Similarly, the association with SUD, albeit non-significant, may reflect underrepresentation of individuals with SUD in remission among patient navigators. Future opt-out ED screening protocols should build upon diverse care teams to further engage patients with SUD and those at risk for non-heterosexual HIV transmission. Disclosures All Authors: No reported disclosures

scholarly journals HIV Risk Behavior and Beliefs of HIV-Seropositive Drug Users

1992 ◽  
Vol 22 (4) ◽  
pp. 833-847 ◽  
Author(s):  
Christina Hartgers ◽  
Pieta Krijnen ◽  
Johanna A.R. van den Hoek ◽  
Roel A. Coutinho ◽  
Joop van der Pligt
Keyword(s):  
Risk Behavior ◽  
Hiv Risk ◽  
Drug Users ◽  
Hiv Transmission ◽  
Hiv Risk Behavior ◽  
Unsafe Sex ◽  
Response Efficacy ◽  
Female Prostitute ◽  
Hiv Seropositive ◽  
Hiv Negative

To assess HIV risk behavior, beliefs, attitudes and intentions among HIV-seropositive drug users (DUs), we studied 122 HIV-positive DUs (including ninety-five current injectors) participating in a longitudinal HIV-study among DUs in Amsterdam. All were familiar with their serostatus. Over a period of four months, 20% of the sample put others at risk of HIV infection, mainly through unsafe sex. Forty-nine percent think they might infect someone with HIV in the future, again mainly through unsafe sex. Although the majority intends to use condoms, self-efficacy and response efficacy is low; that is, many do not think they are able to use condoms when necessary and many have limited confidence in the efficacy of condoms in preventing HIV transmission. Correlates of HIV risk behavior were non-Dutch nationality and being a female prostitute. The results suggest that, next to efforts which aim to prevent new infections among HIV-negative injectors or sexual partners of injectors, prevention efforts should focus on HIV-seropositive DUs or former DUs.

Men Who Have Sex With Men and HIV Risk Behavior: Exploring the Influence of Masculinity Within the Social Ecological Model

2021 ◽  
Vol 33 (6) ◽  
pp. 511-533
Author(s):  
Kenneth C. Hergenrather ◽  
Diona Emmanuel ◽  
Robert J. Zeglin ◽  
David J. Ruda ◽  
Scott D. Rhodes
Keyword(s):  
Risk Behavior ◽  
Hiv Risk ◽  
Ecological Model ◽  
The United States ◽  
Social Ecological Model ◽  
Hiv Risk Behavior ◽  
Bisexual Men ◽  
Social Ecological ◽  
The Social ◽  
Sex With Men

In the United States, gay, bisexual men, and men who have sex with men (MSM) represent 86% of new HIV infections among males. Approximately 1 in 7 men with HIV are unaware of their HIV status (CDC, 2017, 2019a, 2020a). To explore influences on MSM HIV risk behavior, the authors performed a systematic review of quantitative studies conducted in the U.S. assessing what is purported as masculinity. From 30 identified studies, significant findings were framed within the Social Ecological Model (SEM) levels (e.g., Individual, Relationship, Community). SEM level themes were applied to create the Masculinity 10, a preliminary 10-item assessment to explore the influence of masculinity on MSM HIV risk behavior. To increase MSM engagement in HIV prevention and treatment, the influences of masculinity (e.g., attitude toward sexual minorities, appearance, emotion, temperament, substance use, sexual activity, social support, intimate relationships, health care) on HIV risk behavior should be further explored.

HIV Risk Perception and Prevalence in a Program for Prevention of Mother-to-Child HIV Transmission

2005 ◽  
Vol 39 (3) ◽  
pp. 354-358 ◽  
Author(s):  
Harriet Mpairwe ◽  
Lawrence Muhangi ◽  
Proscovia B Namujju ◽  
Andrew Kisitu ◽  
Alex Tumusiime ◽  
...  
Keyword(s):  
Risk Perception ◽  
Hiv Risk ◽  
Hiv Transmission ◽  
Hiv Risk Perception ◽  
Mother To Child

Factors influencing uptake of pre-exposure prophylaxis: some qualitative insights from an intervention study of men who have sex with men in China

Sexual Health ◽  
2018 ◽  
Vol 15 (1) ◽  
pp. 39 ◽  
Author(s):  
Chunxing Liu ◽  
Yingying Ding ◽  
Zhen Ning ◽  
Meiyang Gao ◽  
Xing Liu ◽  
...  
Keyword(s):  
Hiv Risk ◽  
Intervention Study ◽  
Implementation Strategies ◽  
Self Assessment ◽  
Risk Beliefs ◽  
Group Data ◽  
Prep Implementation ◽  
Substantial Risk ◽  
Sex With Men ◽  
Exposure Prophylaxis

Background: Pre-exposure prophylaxis (PrEP) is a biomedical approach for preventing the acquisition of HIV in populations at substantial risk for HIV. However, its uptake among men who have sex with men (MSM) is low in China. The study aimed to identify factors that might influence MSM’s uptake and use of PrEP. Methods: In-depth interviews were conducted with 32 self-identified MSM from a PrEP intervention study evaluating daily oral tenofovir disoproxil fumarate (TDF) to prevent HIV infection. Of these men, 11 were presently using the ‘TDF’ group; 8 from the ‘change-over’ group (i.e. initially used PrEP but subsequently quitted); and 13 from the non-user group. Data were analysed using thematic approach. Results: Perception of low HIV risk, mistrust of the national PrEP program, and concerns of side effects were the main reasons for not wanting to use PrEP. Also, lack of main sexual partner’s support, difficulties in adhering to the daily TDF regimen, and the inconvenient schedules in securing the medicine were the major reasons for not wanting to use or quitting the use of PrEP. On the other hand, perceived high HIV risk, beliefs in efficacy of PrEP, and worries of transmitting HIV to families were the major motives for PrEP uptake. Conclusions: Findings suggest that PrEP implementation strategies should first address issues including but not limited to accurate self-assessment of HIV risk, mistrust and limited knowledge about medical trials and PrEP, and ease of accessing PrEP.

Strategies for Primary and Secondary Prevention of HIV Transmission

2010 ◽  
Author(s):  
Mary Ann Cohen ◽  
Harold W. Goforth
Keyword(s):  
Primary Prevention ◽  
Hiv Prevention ◽  
Secondary Prevention ◽  
Risk Reduction ◽  
Hiv Risk ◽  
Hiv Transmission ◽  
Sexual Practices ◽  
Prevention Strategies ◽  
Primary And Secondary Prevention ◽  
Hiv Risk Reduction

Since HIV disease was first recognized three decades ago, numerous efforts have been made to prevent its continued transmission. The Centers for Disease Control and Prevention (CDC) estimates that more than 56,000 Americans become infected each year—one person every 9 1/2 minutes—and that more than one million people in this country are now living with HIV (CDC, 2008, 2009;Hall et al., 2008). The CDC estimates that roughly 1 in 5 people infected with HIV in the United States is unaware of his or her infection and may be unknowingly transmitting the virus to others (CDC, 2008). Over the past 15 years, many behavioral HIV risk reduction interventions have been developed, with prevention efforts targeting mostly HIV-negative individuals and focusing almost exclusively on HIV testing and counseling. More recently, comprehensive HIV prevention has involved both primary and secondary prevention activities to decrease the number of new HIV infections and associated complications, respectively (Marks et al., 2006; O’Leary and Wolitski, 2009). Psychiatric factors both complicate and perpetuate the HIV pandemic as a result of unsafe sexual practices and substance use disorders. In this chapter, we describe some of the psychiatric and psychodynamic factors that lead to HIV transmission and present novel strategies to assist clinicians and health-care policymakers in prevention efforts. Primary prevention is defined as any activity that reduces the burden of morbidity or mortality from disease; it is to be distinguished from secondary prevention, in which activities are designed to prevent the complications of already existing disease. In the case of HIV, primary prevention efforts focus on strategies designed to prevent the transmission of HIV—keeping seronegative people seronegative. In the HIV pandemic, however, many prevention strategies share characteristics of both primary and secondary efforts, so the distinction is somewhat artificial. Multiple prevention strategies have been devised, and these center around HIV counseling, substance abuse programs, and HIV prevention and intervention programs for children. Counseling healthy pregnant women, uninfected children, adolescents, adults, and older persons about HIV risk reduction and providing information about sexual health are important components to primary prevention strategies, but few physicians and other clinicians actually do this unless it is a part of a program specifically designed to prevent HIV transmission.

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