Improving HIV medical care engagement by attending to status disclosure and social support

ABSTRACT

Expeditious linkage and consistent engagement in medical care is important for people with HIV’s (PWH) health. One theory on fostering linkage and engagement involves HIV status disclosure to mobilize social support. To assess disclosure and social support’s association with linkage and engagement, we conducted a qualitative study sampling black and Latino men who have sex with men (MSM of color) in the U.S. Participants' narratives presented mixed results. For instance, several participants who reported delaying, inconsistent access, or detachment from care also reported disclosing for support purposes, yet sporadic engagement suggests that their disclosure or any subsequent social support have not assisted. The findings contribute to the literature that questions disclosure and social support’s influence on care engagement, especially when decontextualized from circumstances and intentions. Our findings suggest the mechanics of disclosure and social support require planned implementation if intending to affect outcomes, especially among MSM of color. From the findings, we explore steps that may bolster interventions seeking to anchor medical care engagement.     

Engagement in HIV care and sexual transmission risk behavior among men who have sex with men using online social/sexual networking in Latin America

HIV/AIDS in Latin America is concentrated among men who have sex with men (MSM). However, accurate estimates of engagement in HIV care in this population can be difficult to ascertain because many do not self-identify as MSM. Given evidence of decreased HIV transmissibility in the context of antiretroviral therapy (ART) adherence, identifying individuals not in care who are engaging in HIV transmission risk behavior is crucial for secondary prevention. Primary aims of this study were to examine engagement in care from testing to ART adherence among MSM using online social/sexual networking across Latin America, and whether individuals not in care at each step reported greater sexual transmission risk behavior than those in care. In the overall sample (n = 28,779), approximately 75% reported ever being tested for HIV, and 9% reported having received an HIV diagnosis. Among known HIV-infected individuals, 20% reported not being in care, 30% reported not taking ART, and 55% reported less than 100% ART adherence. Over one-third of HIV-infected individuals reported sexual HIV transmission risk behavior, defined as unprotected anal intercourse (UAI) with a male partner of different/unknown HIV serostatus in the past three months. HIV-infected individuals not engaged in care more often reported UAI compared to those in care (OR = 1.29; 95% CI = 1.01–1.66). Although not statistically significant, HIV-infected individuals not on ART more often reported UAI compared to those on ART (OR = 1.18; 95% CI = 0.94–1.47). Individuals who reported less than 100% ART adherence more often reported UAI compared to individuals with 100% adherence (OR = 1.55; 95% CI = 1.26–1.90). Findings demonstrate that a substantial portion of HIV-infected MSM in Latin America who are likely not virologically suppressed from lack of ART use or adherence report sexual HIV transmission risk. Tailoring secondary HIV prevention for MSM in Latin America who are not in HIV care or adherent to ART may be warranted.     

Alcohol use disorders negatively influence antiretroviral medication adherence among men who have sex with men in Peru

As international guidelines increase access to antiretroviral therapy (ART) globally, ART adherence becomes increasingly important to achieve HIV treatment as prevention (TasP) goals. In the concentrated HIV epidemic among men who have sex with men (MSM) and transgendered women (TGW) in Lima, Peru, the independent correlates of ART nonadherence were examined to inform treatment intervention priorities. Cross sectional survey of HIV-infected MSM and TGW who are engaged in clinical care in Lima, Peru. From June to August 2012, 302 HIV-infected Peruvian MSM/TGW from three clinical care sites were recruited using convenience sampling to participate in a cross-sectional computer-assisted adherence survey. Several standardized screening measures associated with ART nonadherence were examined in order to determine the independent correlates of optimal (≥90%) and perfect (100%) adherence, which were assessed using logistic regression. Of the 302 participants recruited, 263 (87.1%) were prescribed ART. Among those prescribed ART, 229 (87.1%) reported optimal and 146 (55.5%) reported perfect adherence. The prevalence of alcohol use disorders (AUD; 43.2%), alcohol dependence (5.3%), recent drug use (6.0%), and depression (44.5%) was high, and most participants had some evidence of neurocognitive impairment. Meeting criteria for having an AUD and depression were collinear (p < 0.001). On multivariate analysis, having an AUD was inversely related and the only independent correlate of optimal (AOR = 0.427; 95% CI = 0.187–0.976) and perfect (AOR = 0.552; 95% CI = 0.327–0.930) ART adherence. AUDs are highly prevalent among Peruvian HIV-infected MSM and contribute significantly to ART nonadherence. These findings support the need for screening and treating underlying AUDs. In order to meet HIV TasP goals, evidence-based strategies targeting AUDs are likely to directly improve ART adherence and indirectly improve overall individual health, HIV treatment engagement, and reduce transmission to sexual partners among this vulnerable and disproportionally affected population.     

Community engagement among men who have sex with men living with HIV/AIDS in Taiwan

Community engagement was developed as a global principle in the provision of HIV/AIDS services, yet evidence-based research of implementation of the principle is lacking in Taiwan. This short report aims to understand factors associated with engagement in two types of activities with varying levels of visibility: HIV-related community events and HIV-related community action, in Taiwanese men who have sex with men (MSM) living with HIV. A cross-sectional survey was distributed to a purposive sample of participants recruited from AIDS service organizations (ASOs). Among participants (n?=?178), 63.6% were involved in HIV-related community events, while less than half (47.7%) were involved in HIV-related community action. In multivariable analysis, age, involvement in ASOs, and AIDS knowledge were positively associated with engagement in community events, and living in the north of Taiwan, years of infection, and self-stigma were negatively associated with this type of engagement. Few factors, with the exception of involvement in ASOs, were positively associated with engagement in HIV-related community action. To this end, ASOs appear to play a strong role in improving and organizing both types of community engagement in Taiwan. Future studies should evaluate tailored programs delivered through ASOs for strengthening community connectedness among younger, stigmatized, and longer diagnosed MSM living with HIV.     

Age matters: differences in correlates of self-reported HIV antiretroviral treatment adherence between older and younger Black men who have sex with men living with HIV

Black men who have sex with men (BMSM) show lower levels of adherence to antiretroviral therapy (ART) for HIV medications than other racial/ethnic groups in the U.S. Yet, little is known about age differences in factors that predict ART adherence among BMSM. We combined data from two surveys of HIV-positive BMSM, resulting in 209 participants (130 aged 18–50 years; 79 aged 50 years or older). Multivariate linear regressions examined associations between baseline characteristics and adherence to HIV medications as well as interactions of baseline characteristics with age. The associations between trust in healthcare and doctor satisfaction ratings with higher adherence were stronger for older vs younger men (p?<?.05); the association between problem drinking and lower adherence was stronger among younger men (p?<?.05). Future research should examine how interventions may address these age-specific factors to improve ART adherence among BMSM living with HIV.     

Online sex partner seeking and HIV testing frequency among young black sexual minority men

Abstract

Dating apps are a novel means of delivering HIV prevention messages. Young black sexual minority men (YBSMM) app users are at high risk for HIV and could benefit from frequent testing. Understanding testing behaviors among YBSMM is critical to inform tailored prevention interventions. We analyzed testing behaviors of 273 YBSMM, comparing typical testing frequency between app users and non-users using odds ratios. Overall, testing rates were high. App users were more likely than non-users to test at least every 12?months. App-using YBSMM exhibit high compliance with testing guidelines, which may indicate future successful uptake of biomedical preventions, such as Pre-Exposure Prophylaxis.     

HIV/AIDS stigma among a sample of primarily African-American and Latino men who have sex with men social media users

The recent increase in social media use allows these technologies to rapidly reach communities with higher HIV prevalence, such as African-American and Latino men who have sex with men (MSM). However, no studies have looked at HIV/AIDS stigma among social media users from African-American and Latino MSM communities, or the association between stigma and social media use among these groups. This study sought to assess the level of HIV/AIDS stigma among a sample of social media-using African-American and Latino MSM from Los Angeles. A total of 112 (primarily African-American and Latino, n?=?98, 88%) MSM Facebook users completed a survey on demographics, online social network use, and HIV/AIDS stigma. A composite stigma score was created by taking the cumulative score from a 15-item stigma questionnaire. Cumulative logistic models were used to assess the association between HIV/AIDS stigma and online social network use. In general, participants reported a low level of HIV/AIDS stigma (mean?=?22.2/75, SD?=?5.74). HIV/AIDS stigma composite score was significantly associated with increased time spent on online social networks each day (Adjusted odds ratios (AOR): 1.07, 95% CI: 1.00, 1.15). Among this diverse sample of MSM online social network users, findings suggest that HIV/AIDS stigma is associated with usage of social media. We discuss the implications of this work for future HIV prevention.     

多部门参与的MSM人群艾滋病预防控制模式的研究

目的 通过对中国既往在MSM人群中开展的艾滋病干预工作进行系统调查研究,总结多部门参与的MSM人群艾滋病预防控制的经验,为中国在MSM人群中控制艾滋病流行提供科学依据.方法 通过文献检索和信息查询方法,确定广州、成都、乌鲁木齐、北京、青岛、合肥和沈阳7个城市为调研现场,分别对项目负责人、项目工作人员和参与干预活动的MSM进行个人访谈,同时收集现场的相关资料,运用定性资料分析软件ATLAS.ti5.0进行资料分析.结果 中国既往多部门参与的MSM人群艾滋病预防控制模式有,以疾病预防控制中心为主导的、以MSM志愿者组织为主导的和以科研部门为主导的三类多部门参与模式,每类模式都有自身优势和不足.结论 针对不同地区MSM人群特点,建立适合本地区的多部门参与的MSM人群艾滋病预防控制模式,以适应遏制艾滋病流行的需要.     

Dynamic social support networks of younger black men who have sex with men with new HIV infection

Rising rates of HIV infection among younger black men who have sex with men (YBMSM) in the USA have generated a public health emergency. Living with HIV requires deep and persistent social support often available only from close confidants. Enlisting endogenous support network members into the care of HIV-infected YBMSM may help shape sustainable supportive environments, leading to long-term improvements in mental and HIV-specific health outcomes. The present study examined trends in support network change over time after new HIV diagnoses among 14 YBMSM. Participants completed a social network survey that utilized sociograms to record support confidants (SCs) preceding HIV diagnosis and at one and nine months postdiagnosis. Reported SCs included family of origin, friends, sex partners, and other associates. Analysis revealed three distinct patterns of change: high gain, high turnover, and stable networks. These patterns offer valuable insights into the social support of YBMSM during the period following diagnosis. This research underscores a growing movement to embrace key support figures in the lives of YBMSM, who may be critical to promoting overall health and adherence to HIV-care.     

Depression and social support mediate the effect of HIV self-stigma on condom use intentions among Chinese HIV-infected men who have sex with men

HIV self-stigma in HIV positive men who have sex with men (HIVMSM) has been identified as one of the largest challenges of HIV prevention, and associates with numerous negative outcomes, including depression, decreased social support, and less condom use intentions. In the present study, 321 HIVMSM in Chengdu, China were recruited to examine the prevalence of condom use in the past months and intentions to use condoms in next six months; we also identify pathways between HIV self-stigma and intentions to use condoms by the structural equation modeling approach. Results showed that Chinese HIVMSM had the suboptimal prevalence of consistent condom use and low intentions to use condoms consistently. Additionally, depression and decreased social support were significant mediators between HIV self-stigma and condom use intentions. The complex pathways between HIV self-stigma and intentions to use condoms should be taken into account in the HIV prevention and intervention programs.     

Correlates of same-sex behavior disclosure to health care providers among Black MSM in the United States: implications for HIV prevention

Disclosure of same-sex behavior to health care providers (HCPs) by men who have sex with men (MSM) has been argued to be an important aspect of HIV prevention. However, Black MSM are less likely to disclose compared to white MSM. This analysis of data collected in the United States from 2006–2009 identified individual and social network characteristics of Black MSM (n?=?226) that are associated with disclosure that may be leveraged to increase disclosure. Over two-thirds (68.1%) of the sample had ever disclosed to HCPs. Part-time employment (AOR?=?0.32, 95% CI?=?0.11–0.95), bisexual identity (AOR?=?0.29, 95% CI?=?0.12–0.70), and meeting criteria for alcohol use disorders (AOR?=?0.32, 95% CI?=?0.14–0.75) were negatively associated with disclosure. Disclosers were more likely to self-report being HIV-positive (AOR?=?4.47, 95% CI?=?1.54–12.98), having more frequent network socialization (AOR?=?2.15, 95% CI?=?1.24–3.73), and having a social network where all members knew the participant had sex with men (AOR?=?4.94, 95% CI?=?2.06–11.86). These associations were not moderated by self-reported HIV status. Future interventions to help MSM identify social network members to safely disclose their same-sex behavior may also help disclosure of same-sex behavior to HCPs among Black MSM.     

HIV risk and prevention among men who have sex with men in rural South Africa

Rural South African men who have sex with men (MSM) are likely to be underserved in terms of access to relevant healthcare and HIV prevention services. While research in urban and peri-urban MSM populations has identified a range of factors affecting HIV risk in South African MSM, very little research is available that examines HIV risk and prevention in rural MSM populations. This exploratory study begins to address this lack by assessing perceptions of HIV risk among MSM in rural Limpopo province. Using thematic analysis of interview and discussion data, two overarching global themes that encapsulated participants’ understandings of HIV risk and the HIV risk environment in their communities were developed. In the first theme, “community experience and the rural social environment”, factors affecting HIV risk within the broad risk environment were discussed. These included perceptions of traditional value systems and communities as homophobic; jealousy and competition between MSM; and the role of social media as a means of meeting other MSM. The second global theme, “HIV/AIDS knowledge, risk and experience”, focused on factors more immediately affecting HIV transmission risk. These included: high levels of knowledge of heterosexual HIV risk, but limited knowledge of MSM-specific risk; inconsistent condom and lubricant use; difficulties in negotiating condom and lubricant use due to uneven power dynamics in relationships; competition for sexual partners; multiple concurrent sexual partnerships; and transactional sex. These exploratory results suggest that rural South African MSM, like their urban and peri-urban counterparts, are at high risk of contracting HIV, and that there is a need for more in-depth research into the interactions between the rural context and the specific HIV risk knowledge and behaviours that affect HIV risk in this population.     

Someone to count on: social support as an effect modifier of viral load suppression in a prospective cohort study

Though functional social support has been shown to serve as a protective factor for HIV viral load suppression in other populations, scant research has examined this relationship among men who have sex with men (MSM) in the United States. We assessed characteristics of social support, effects of social support on HIV viral load, and moderation by social support of the relationship between psychosocial indicators of a synergistic epidemic (syndemic) and HIV viral load. We analyzed longitudinal data from HIV-positive MSM using antiretroviral therapy who were enrolled in the Multicenter AIDS Cohort Study between 2002 and 2009 (n?=?712). First, we conducted reliability assessments of a one-item social support measure. Then, we conducted a series of generalized longitudinal mixed models to assess our research questions. Moderation was assessed using an interaction term. A three-level (low/medium/high) social support variable demonstrated high reliability (intraclass correlation coefficients =?0.72; 95% CI: 0.70, 0.75). Black and Hispanic MSM reported lower social support than their White counterparts (p?p?p?p?p?相似文献   

中国9城市2250例男男性接触者HIV/AIDS相关状况调查概况

目的 对男同性爱者/男男性接触者(gay/MSM)的艾滋病病毒(HIV)/艾滋病(AIDS)相关状况进行调查研究,为制定对该人群有效的HIV/AIDS防控措施提供依据.方法 采用定向抽样("滚雪球")法,对我国9个城市2 250名MSM同步开展横断面匿名问卷调查和血清HIV抗体检测,使用SPSS 11.0进行资料统计分析.结果 本组样本平均年龄(29.1±9.2)岁.75.3%非在婚,24.7%在婚.34.8%的非在婚者和74.0%的在婚者近6个月有女性性伴.94.8%近6个月有男性性伴,其平均伴数为(8.0±17.8)人.82.7%近6个月有肛交性伴,其平均性伴数为(6.6±15.6)人.近一年内寻找同性性伴的主要途径为:网站52.0%、酒吧25.5%、浴池21.1%等,49.5%近6个月在gay活动场所寻找陌生男性并性交.最偏好的性行为方式分别为插入对方肛门43.8%,插入对方口腔20.4%.27.7%近一年性交时自己或对方曾出血.72.3%登陆过gay网站及聊天室,58.8%曾通过网站寻找性伴,55.5%与gay网友见面并性交过.18.6%近一年参与过群交.13.2%曾买性,其近一年买性平均人数为(4.7±7.4)人,平均买性次数为(5.7±8.7)次.总样本中,75.1%最近一次肛交用过安全套,6.1%最近一次用套时遇到过安全套破裂或滑脱.24.6%曾检测过HIV.本次调查中HIV抗体确证阳性率为2.2%.22.4%近6个月有过性传播感染(STI)临床症状,11.0%MSM曾被确诊患STI,近一年STI发病率为6.6%.结论 MSM人群存在多种HIV/AIDS相关行为,是HIV由高危行为人群向一般人群传播的重要桥梁.应根据该人群的高危行为特点,制定HIV/AIDS防控措施.     

对男男性接触者AIDS高危性行为健康干预研究

目的　评价健康干预措施对男男性接触者 (MSM)艾滋病 (AIDS)高危性行为的影响效果。方法　采用不记名问卷调查方式 ,并用Spss软件进行统计。结果　干预时间超过 1年的MSM ,近 1年肛交性伴侣数和无保护性被动肛交的发生率显著低于 <1年者 (P <0 0 5 ) ;但近 1年性伴侣数、偶遇性伴侣数、外地性伴侣数、外地偶遇性伴侣数、无保护性肛交的偶然性伴侣数、近 1年用过安全套、最近 1次保护性肛交及近 1年无保护性主动肛交的比例 ,近 1年在公共场所寻找偶遇性伴侣、参与性交易及参加群交的比例 ,随着干预时间的延长有不同程度的改变 ,但改变无显著的统计学意义 (P >0 0 5 )。结论　健康干预可减少MSM的AIDS高危性行为 ,但它是一个长期而复杂的工程 ,需要深入持久地开展     

Intersectional stigma and psychosocial well-being among MSM living with HIV in Guangxi,China

ABSTRACT

The existing literature suggests a negative impact of intersectional stigma on multiple aspects of psychosocial well-being among individuals with multiple stigmatized identities. However, such impact remains poorly understood. This study aims to investigate the association between intersectional stigma and psychosocial well-being among 193 men who have sex with men (MSM) living with HIV. Based on their responses to measures of HIV-related stigma and sexual and gender minority (SGM) stigma, the participants were grouped into “high” vs “low” on each type of stigma. The General Linear Model (GLM) was used to analyze the main and interaction effect of two types of stigma on multiple psychosocial measures. Our results indicated a significant interaction effect of two types of stigma on depression, anxiety, quality of life, and psychological resilience after controlling for key socio-demographic covariates. The findings suggest that experiencing both HIV-related stigma and SGM stigma may synergistically lead to poor psychosocial well-being among MSM in a more profound manner than experiencing only one type of stigma. It is critical for researchers and clinicians to consider the patients’ multiple stigmatized identities, develop effective intervention strategies, and improve the psychosocial well-being of MSM living with HIV in China and other cultural settings.     

2009-2011年南京市MSM人群艾滋病哨点监测结果分析

目的了解南京市男男性行为人群(MSM)哨点监测中,其艾滋病病毒(HIV)抗体阳性率和相关性行为的变化情况,为在该人群中制定有针对性的艾滋病干预策略提供依据。方法利用2009-2011年南京市MSM哨点监测数据,对HIV感染状况及相关性行为进行分析。结果 2009-2011年,分别调查了符合条件的MSM1 086人、823人和712人,分别检测出HIV抗体阳性者59人、85人和53人,HIV抗体阳性率分别为5.4%、10.3%和7.4%。结论南京市MSM人群中HIV感染情况已经相当严重,应当及时采取有效措施,控制艾滋病疫情在该人群中的进一步蔓延。     

MSM中HIV感染者无保护肛交行为及其影响因素分析

目的了解男男性行为人群（MSM）中艾滋病病毒（HIV）感染者的无保护肛交性行为的状况,分析其影响因素,为开展针对性干预活动防止＂二代传播＂提供信息。方法对＂全国男男性行为人群艾滋病综合防治试点＂工作数据库中,HIV感染者的信息进行分析,描述研究对象的社会人口学和高危性行为特点,并分析无保护肛交性行为的影响因素。结果共获得MSM中HIV感染者的有效样本754人,梅毒检出率为28.9%。最近6个月内无保护肛交发生率为67.4%。与无保护肛交发生有关的危险因素是在当地居住时间超过6个月,经常到浴池、公园等场所寻找性伴,以及最近1年内未接受过艾滋病相关服务。结论 MSM中HIV感染者的无保护肛交行为发生率、梅毒感染率高,构成艾滋病进一步传播流行的风险,亟待在该人群中开展针对性行为干预。